Lack Of Necessity Research Articles

A survey of the Polytrauma out-patient population: Technological capabilities and potential for Telerehabilitation

Background: Rapid technological advances in personal communication devices have provided new opportunities for their use to provide care, education and support to patients and families in remote locations via telerehabilitation applications. Studies indicate that individuals with brain injury are interested in utilizing internet telerehabilitation services. However, there is minimal data regarding whether these patients have access to the necessary telecommunication devices. As new communication technologies develop, we need a clear understanding of the acceptance of those technologies by the intended service population. Our unique access to the TBI outpatient population allows this study to fill the knowledge gap by exploring the availability of advanced telecommunication devices within that cohort. Methods: A prospective cohort of 70 polytrauma outpatient clinic patients with a history of traumatic brain injury was surveyed via telephone. Respondents were living in the community at the time the survey was conducted. The survey was administered in a structured telephone interview format and analyzed qualitatively. Results: In this cohort, 94% reported ownership and daily use of cell phones, 41% had a Smartphone, 97% reported at least weekly use of a computer, and 81% indicated at least once daily internet use on either a computer or a Smartphone. Cost and lack of necessity were endorsed as barriers to ownership and use of these devices. Conclusions: These results suggest that a significant proportion of individuals with documented TBI have access to advanced and evolving communication technologies that can potentially be utilized for telerehabilitation.

Efficient One‐pot Synthesis of Alkyl 3‐(alkyl)‐4‐methyl‐2‐thioxo‐2,3‐dihydrothiazole‐5‐carboxylates in a Multi Component Reaction

AbstractA simple and efficient one‐pot synthesis of alkyl 2‐(alkyl)‐4‐methyl‐2‐thioxo‐2,3‐dihydrothiazole‐5‐carboxylates from the reaction of primary alkylamines and carbon disulfide in the presence of 2‐chloro‐1,3‐dicarbonyl compounds is described. This new protocol has several advantages such as lack of necessity of the catalyst, good yields, mild conditions and short times for reaction.

Numerical Representations for Nontransitive Preferences

The authors study the lack of necessity of the transitivity property when representing preference relations. Avoiding transitivity hypothesis, this work offers a vision about the modeling of consumer preference relations which are different from the classic one used in economics pedagogy. The acyclic and the asymmetric nontransitive preference relations, which under certain conditions admit different types of numerical representations, are analyzed. Particularly, the construction of real valued functions which characterize the maximal elements are studied. The authors propose introducing this class of preference relations to intermediate economics students. They justify the acceptation of consumer preference relations without transitivities and they present results ensuring the existence of continuous representations for the preference relation. Proofs and development of examples are carefully made in order to help the student.

Cervical Cancer Screening Among Asian Canadian mmigrant and Nonimmigrant Women

To examine whether Pap smear screening and determinants of screening for Asian immigrants are different from those for nonimmigrants in Canada. Data from the Canadian Community Health Survey Cycle 2.1 (2003) were used. Explanatory and multivariate logistic regression analyses were performed to compare rates and determinants of Pap smear screening between Asian immigrants and nonimmigrants. In this study, 64,604 women were included. Asian immigrants had significantly lower rates of Pap smear screening (52%) compared to nonimmigrants (72%). Lack of necessity and time are important barriers. Pap smear screening should be promoted, particularly in recent Asian immigrants.

An ‘experiment in the wilderness’: Newbattle Abbey College and the idea of residential adult education in Scotland 1931–1955

Newbattle Abbey College, Scotland’s only adult residential college, was founded in the 1930s by Philip Kerr, 11th Marquis of Lothian. This paper traces the debates concerning the college and the rationale for adult residential education until the 1950s, focusing on the difficulties that Newbattle faced in establishing itself as a central part of adult education provision. It explores the ideals that Newbattle was held to represent by its supporters, and the variety of languages (spiritual, humanist, socialist and communitarian) used to defend and advocate the project. It also discusses the arguments posed by those who opposed Newbattle, and relates these to perceptions of the lack of necessity for adult education in the postwar social scene, and to the apparent lack of interest in Scotland in non‐vocational education. It concludes by indicating that the survival of Newbattle demonstrates the existence of persistent if fragile support for the ideals it espoused.

Surgeons’ Perceptions of Spinal Navigation: Analysis of Key Factors Affecting the Lack of Adoption of Spinal Navigation Technology

Background Computer-assisted spinal navigation allows for real time localization of surgical instruments in multiple views. Its use decreases radiation exposure and clears the surgical field of the C-arm fluoroscope. Despite these advantages, spinal navigation has yet to gain general acceptance among spine surgeons. The purpose of this study is to survey spine surgeons about their opinions on the strengths and weaknesses of spinal navigation. Methods Spine surgeons from the membership of the Spine Arthroplasty Society (SAS) and the Society for Minimally Invasive Spine Surgery (SMISS) were surveyed regarding their current use of spinal navigation and their perceptions of the strengths and weaknesses of spinal navigation (N = 147). Responses were analyzed using 2-sided chi-square tests. Results Most spine surgeons (63.4%) have only superficial experience with spinal navigation, and 76.2% of surgeons rarely use spinal navigation in their cases. Spine surgeons have the most experience with virtual fluoroscopy spinal navigation systems (35.9%). Surgeons considered longer operating times (63.5%), increased cost (48.3%), lack of necessity (40.7%), unreliable navigation accuracy (37.9%), and too many intraoperative glitches (35.2%) to be the major weaknesses of spinal navigation. Surgeons considered decreased radiation exposure to the surgeon (76.1%), increased screw placement accuracy (65.7%), decreased radiation exposure to the patient (41.8%), and keeping the C-arm away from the operating field (29.1%) to be the greatest advantages of spinal navigation. Among the types of procedures surgeons believe are most likely to benefit from spinal navigation are minimally invasive instrumentation and fusion (72.5%) and complex open deformity (55.6%). Conclusion Most spine surgeons have only superficial experience in spinal navigation. The most commonly selected weaknesses of spinal navigation are increased operative time, cost, and lack of necessity. Increased fluoroscopy and MIS use in the future may shift focus from weaknesses to the strengths of spinal navigation, including decreased radiation exposure and elimination of the C-arm from the operative field.

ChemInform Abstract: Pentafluorophenyl Carbonyl Compounds in the Reformatsky‐Type Reactions Promoted with Fe(CO)5‐Based Metal Complex Systems.

AbstractChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a “Full Text” option. The original article is trackable via the “References” option.

Introducing caesarean section audit in a regional teaching hospital in The Netherlands

Objective The increase in caesarean section rates is considered a reason for serious public health concern. With the objective to create awareness and initiate local discussion, obstetric audit was introduced in a regional teaching hospital in The Netherlands. Study design Caesarean section audit was introduced during the existing daily reports meetings from August 1, 2005 to June 1, 2006 in The Haga hospital, a large teaching hospital in The Hague, The Netherlands. All caesarean sections were discussed with regard to indication, classification and audited for ‘lack of necessity’. For comparing intervention rates with the period prior to audit, Chi-square test with Yates correction for 2 × 2 tables was used. Results Of 1221 deliveries, 228 were caesarean sections (18.7%) while prior to the audit period there were 1216 deliveries with 284 were caesarean sections (23.4%). The caesarean section rate is significantly lower during the audit period. Assisted vaginal deliveries, neonatal outcome, and induction of labor rates were comparable. Concerning the audit question ‘could caesarean section have been prevented’, there was discussion in 24.4% of cases. In 6.7% of caesarean sections, consensus about lack of necessity was achieved. Conclusion Introducing caesarean section audit during the existing structure of daily report meetings in a regional teaching hospital is both feasible and practical. It creates awareness and encourages discussion among staff members concerning indications for caesarean sections and lack of necessity. Furthermore, there was a significant decrease in caesarean section rate during the audit period.

Surgeons' perceptions of spinal navigation: analysis of key factors affecting the lack of adoption of spinal navigation technology.

BackgroundComputer-assisted spinal navigation allows for real time localization of surgical instruments in multiple views. Its use decreases radiation exposure and clears the surgical field of the C-arm fluoroscope. Despite these advantages, spinal navigation has yet to gain general acceptance among spine surgeons. The purpose of this study is to survey spine surgeons about their opinions on the strengths and weaknesses of spinal navigation.MethodsSpine surgeons from the membership of the Spine Arthroplasty Society (SAS) and the Society for Minimally Invasive Spine Surgery (SMISS) were surveyed regarding their current use of spinal navigation and their perceptions of the strengths and weaknesses of spinal navigation (N = 147). Responses were analyzed using 2-sided chi-square tests.ResultsMost spine surgeons (63.4%) have only superficial experience with spinal navigation, and 76.2% of surgeons rarely use spinal navigation in their cases. Spine surgeons have the most experience with virtual fluoroscopy spinal navigation systems (35.9%). Surgeons considered longer operating times (63.5%), increased cost (48.3%), lack of necessity (40.7%), unreliable navigation accuracy (37.9%), and too many intraoperative glitches (35.2%) to be the major weaknesses of spinal navigation.Surgeons considered decreased radiation exposure to the surgeon (76.1%), increased screw placement accuracy (65.7%), decreased radiation exposure to the patient (41.8%), and keeping the C-arm away from the operating field (29.1%) to be the greatest advantages of spinal navigation. Among the types of procedures surgeons believe are most likely to benefit from spinal navigation are minimally invasive instrumentation and fusion (72.5%) and complex open deformity (55.6%).ConclusionMost spine surgeons have only superficial experience in spinal navigation. The most commonly selected weaknesses of spinal navigation are increased operative time, cost, and lack of necessity. Increased fluoroscopy and MIS use in the future may shift focus from weaknesses to the strengths of spinal navigation, including decreased radiation exposure and elimination of the C-arm from the operative field.

Lack of necessity of granuloctye-colony stimulating factor (GF) in Hodgkin’s disease (HD) treated with ABVD

7515 Background: DI is important in the therapy of HD, and GF has been used to maintain DI. Recent data suggest that toxicity (bleomycin pulmonary toxicity [BPT]) is higher in patients (pts) who receive GF (JCO 2005;23:7614). We reviewed all HD pts treated since Jan 1996 with attention to GF use, DI, blood counts, BPT and survival. Methods: We analyzed biopsy-confirmed HD pts who received all of their therapy at NU from Jan 1996 to Oct 2005. BPT was defined as: pulmonary symptoms, bilateral infiltrates on scans and no infection. Results: We identified 95 pts, of whom 77 (81%) received ABVD, 7 (7.4%) Stanford V, and 11 (11.6%) other. Of the 77 ABVD pts, 51 completed all cycles with no GF, 23 received GF and 3 are unknown. In the “no GF” group, median age was 31 yrs, 31% had stage III/IV disease (33% Hasenclever Index > 3); 18% had bulky disease, 37% B symptoms and 53% received radiation (RT). In the GF group (n = 23), median age was 33, 42% had stage III/IV disease (21% Hasenclever index > 3); 17% had bulky disease, 42% B symptoms and 50% had RT. Among the 51 “no GF” ABVD pts (287 cycles), median treatment-day ANC were 0.9, while % monocytes were consistently elevated (see Table). There were no dose adjustments or treatment delays for ANC on day of treatment. Normalized DI was > 99% for all treatment days and median cycle duration was 28.6 days (planned = 28 days). 1/51 of these pts had BPT and 2 episodes of uncomplicated neutropenic fever were seen (2/287 cycles = 0.6% incidence). If Stanford V pts are included (n = 7, 2 without and 5 with GF), BPT occurred in 1/53 with “no GF” and 2/28 with GF (see Table). CR rate (100%), PFS and OS were similar in all groups (see Table). Conclusion: 1) GF is not necessary in order to administer ABVD at > 99% DI, and its absence is associated with low toxicity. 2) ABVD should be given at 100% dose with no delay despite ANC on day of treatment. 3) GF should not be used routinely in HD pts treated with ABVD. [Table: see text] No significant financial relationships to disclose.

Lack of necessity for corrections for pyloric losses and duodenogastric reflux in the performance of gastric secretory studies.

Gastric secretory studies are subject to considerable error owing to incomplete collections and to contamination by reflux of alkaline duodenal contents. Corrections for these sources of error have been defined, and they have been extensively applied in a research setting. In order to assess their utility in the performance of routine gastric secretory studies, the value of such corrections was assessed in 56 studies in patients with duodenal ulceration (10), previous surgical vagotomy (8), reflux oesophagitis (30) and primary oesophageal motility disorders (8). The effect of such corrections was small, and there were close correlations between uncorrected and corrected acid outputs in all four groups. The status of the vagal efferent gastric fibres was assessed by comparing the acid output after insulin hypoglycaemia with the maximal acid output after pentagastrin (insulin: pentagastrin ratio). The application of the corrections did not alter the conclusion regarding the assessment of vagal status in 55 of the 56 studies performed. It is concluded that such corrections are not necessary in the routine performance of gastric secretory studies.

Comparison of transmission and scanning electron fractography

The transmission electron microscope, with suitable replication techniques, was used extensively during the 1950s and 1960s to study the surfaces of metal fractures, both to understand the mechanism of fracture and for practical failure analysis. When the scanning electron microscope was introduced in the 1960s, these studies were greatly simplified by the lack of necessity for replication. The appearance of the fracture surfaces, however, was different in some cases from the appearance the fractographer was accustomed to seeing from his or her negative replica. This work was done to help translate from one technique to another.

Benign transient non-organic ileus of neonates.

There are a substantial number of neonates who present with Hirschsprung's disease-like symptoms, but respond very well to conservative therapy. However, once Hirschsprung's disease is ruled out, little attention is paid to these infants, because of the lack of necessity for surgical treatment and their excellent prognosis. The purpose of this study was to elucidate the clinical features of functional ileus of neonates, which we named benign transient non-organic ileus of neonates (BTNIN). Out of 61 neonates referred to our institution with suspected neonatal Hirschsprung's disease (NH), 10 were diagnosed as having NH and 51 as having BTNIN. All the cases of BTNIN showed marked abdominal distension, and 12 showed explosive defecation on digital examination at the first visit. Plain X-ray demonstrated marked whole intestinal dilatation in 12 cases including cases with niveau formation and segmental dilatation. These findings were indistinguishable from those of NH. However, all had a normal anorectal reflex, and rectal suction biopsy revealed normal acetylcholinesterase activity and submucosal ganglion cells. All the cases of BTNIN were treated with periodic glycerin enemas until daily spontaneous defecation was established, which took 2 to 14 months, with an average of 5.0 +/- 2.9 months. None of them showed residual symptoms during the follow-up period.

Assessment of HIV-related sexual risk behaviors among the general female population in Hong Kong.

This study examined sexual practices among the female population in Hong Kong. A total of 2,076 women between 18 and 50 years were interviewed by using a computerized telephone survey method. Sexually active women (59.3%) were classified into the "Husband Only Group" (HOG, n = 1,005), the "Steady Boyfriend Only Group" (SBG, n = 192), and the "Higher Risk Group" (HRG, n = 35). Over 60% of the HRG members did not perceive condom use as an efficacious means for HIV/AIDS prevention. Within the HOG and SBG, 30.0% and 41.1% reported that they always used condoms (25.7% in the HRG). Condom use was often suggested by both men and women of the SBG, but was often initiated by the women only in the HRG. "Trust" and "lack of necessity" were common reasons for not using condoms. About 85% of the respondents would ask their partners to use condoms if they suspected their partners having engaged in commercial sex; however, only 75% would have the final control. The HRG members seemed to be less able to insist on using condoms (55.6%, OR = 0.41, p < .05) and were more likely than the HOG to perceive some chance of contracting HIV (OR = 10.88, p < .01). The prevalence of high risk behaviors among women in Hong Kong was not high; however, those at risk were often inconsistent condom users and they had weak control over condom use. Women in Hong Kong had low awareness of HIV-related risk.

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Tracheal extubation of adult surgical patients while deeply anesthetized: a survey of United States anesthesiologists

Study Objective: To examine current practice regarding the performance of tracheal extubation of adult surgical patients while deeply anesthetized (deep extubation). Design and Setting: Survey comprised of an anonymous written questionnaire mailed to 1,000 randomly selected active American Society of Anesthesiologists members. Measurements and Main Results: Questionnaires were mailed between February and April 1998. Five hundred eighty-three completed forms were returned, 538 of which were suitable for data analysis. Responses from anesthesiologists who infrequently or never administer general anesthetics to adult surgical patients were excluded. The overall frequency of deep extubation of adults was “never” for 106 respondents (19.7%), “rarely” for 87 (16.2%), and “more frequently” for 345 (64.1%). The most common reasons for never performing deep extubations were lack of necessity and concern regarding potential laryngospasm and aspiration. The most frequent indications for deep extubations were unclipped intracranial aneurysm, reactive airway disease, and open-globe eye surgery. The most frequent contraindications to deep extubations for those who otherwise perform the technique were difficult airway, aspiration risk, and obesity. After performing a deep extubation, 44.0% of respondents remain with the patient in the operating room until he or she is awake. Deep extubations were perceived to have no consistent effect on operating room turnover time by 61.6% of anesthesiologists who perform them. Conclusions: Most anesthesiologists in this survey perform deep extubations in adult surgical patients. Lack of necessity and potential respiratory complications were the main reasons cited by those who do not use the technique. Future investigations are necessary to examine the risk-to-benefit ratio of the technique in adults. Our results may be used to determine which potential indications should be examined in such studies and to help delineate the standard of care followed in this country.

Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary?

To determine whether clinical features can be used in a decision rule to prospectively identify a subgroup of internal jugular catheter placements that are correctly positioned and free from mechanical complications, thus obviating the need for routine postprocedural chest radiographs in selected patients. Prospective cohort study. Tertiary care teaching hospital. A total of 107 consecutive patients who presented to our catheter service for internal jugular catheter insertion because of clinical indications between November 1995 and April 1996. Exclusion criteria were mechanical ventilation, an altered mental status, an age of <15 years, and a height of <152 cm. Right or left internal jugular vein catheter placement followed by a postprocedural chest radiograph. The operating physician completed a detailed questionnaire for each catheter insertion, designed to detect potential complications and to predict the necessity, or lack of necessity, for a postprocedural chest radiograph. The questionnaire documented patient characteristics, the number of needle passes, difficulty establishing access, operator experience, poor anatomical landmarks, number of previous catheter placements, resistance to wire or catheter advancement, resistance to aspiration of blood or flushing of the catheter ports, sensations in the ear, chest, or arm, and development of signs or symptoms suggestive of pneumothorax. After catheter insertion, chest radiographs were obtained to assess for mechanical complications and malpositioned catheters. In 46 cases, the decision rule predicted either a complication or a malposition and, thus, the need for a chest radiograph. In 61 cases, neither was predicted (no chest radiograph was needed). Radiographs confirmed one complication (pneumothorax) and 15 catheter tip malpositions (nine in the right atrium and six in the right axillary vein). Among the 46 cases predicted to have a potential complication or malposition, there were one actual complication (pneumothorax) and six actual malpositions (three axillary vein malpositions and three right atrial malpositions). The positive predictive value of this decision rule is 15%. Among the 61 cases predicted to be free from complications or malpositions and not to require a postprocedural chest radiograph, there were nine unexpected malpositions (three axillary vein malpositions and six right atrial malpositions). The negative predictive value is 85%. The overall sensitivity of the decision rule for detecting complications and malpositions is 44%, and the specificity is 55%. In experienced hands, internal jugular venous catheterization is a safe procedure. However, the incidence of axillary vein or right atrial catheter malposition is 14%, and clinical factors alone will not reliably identify malpositioned catheters. Chest radiographs are necessary to ensure correct internal jugular catheter position.

Building party organisations and the relevance of past models: The communist and socialist parties in Spain and Portugal

This article explores the development of the party organisations of the communist and socialist parties in contemporary Spain and Portugal. An attempt is made to answer the question of whether these parties resemble the western European mass party model of organisation, which is characterised by the representation and integration of a particular segment of society within the organisational structure. From the contrasting western and southern European paths towards democracy, a hypothesis is generated contending that the limited opportunities and the lack of necessity diminish the likelihood for southern European working‐class parties to build mass organisations. The empirical findings, analysing the nature and size of individual membership, as well as the nature of the linkages between parties and trade unions, reveal that, with the possible exception of the Portuguese communists, the classic mass party is not reproduced in southern Europe. At the same time, however, the model of the party as a membership organisation apparently has not lost its legitimacy.

1461 Safe handling of toxic drugs

Chemotherapy agents and other drugs have an effect on the biochemical processes of cells and can as a result cause toxic effects. Health care workers in Europe are becoming increasingly more concerned about occupational exposure to toxic agents and cancer nurses in particular are interested in the effects of cytotoxic chemotherapy agents. Many nursing and non-nursing organisations have published guidelines for the management of cytotoxic drugs, such as the Occupational Safety and Health Administration (US government 1993), the European Commission (January 1993) and the study module on safe handling of cytotoxic drugs from the Oncology Nursing Society (U.S.A.). Many institutions in the EEC have developed policies for handling toxic drugs based on research studies, which have been inconsistent and confusing. In addition implications for the practice setting have not been taken into consideration. In a study done in The Netherlands by R. Nieweg, it became clear that nurses do not always follow policies for safe handling. The literature suggests several reasons for non compliance such as inconvenience, "lack of necessity" or "we have always done it this way". This session will address the following issues<ul><li>—What risks do nurses encounter when handling toxic drugs?</li><li>—Does your institute/country have guidelines for handling toxic drugs?</li><li>—Are the guidelines, which are available in your institute/country research-based, workable and being evaluated?</li><li>—What can yours do to reduce your contamination risk?</li><li>—Are there measures which can provide a high degree of protection?</li></ul> Information concerning risks and safety measures should be clear and made available to all who work with toxic agents. Only then can health care workers and nurses specifically gain more insight into the risks involved and the safety measures which are necessary.

Defining unnecessary disinfection procedures for single-dose and multiple-dose vials

Recommendations in the literature conflict on the necessity of disinfecting single-use vials prior to aspiration of fluid. Interventions to disinfect the stopper surface on multiple-dose vials vary considerably. To determine the necessity of alcohol disinfection of the stopper on single-dose vials and to compare povidone-iodine and alcohol versus alcohol-only disinfection of the stopper prior to each needle penetration on multiple-dose vials. The rubber stopper surfaces of 100 single-dose vials were cultured for the presence of bacteria. To determine the efficacy of two procedures for disinfection of multiple-dose vials, 87 stopper surfaces routinely disinfected with both povidone-iodine and alcohol were cultured for bacteria. After a change in practice, 100 multiple-dose vials routinely disinfected with alcohol only were cultured for the presence of bacteria. Of the cultures done on single-dose vial stoppers, 99% were sterile. A comparison of the two disinfection techniques for multiple-dose vials revealed that 83 (95%) of the 87 vials prepped with both povidone-iodine and alcohol were sterile, compared with all stoppers disinfected with alcohol only. This study shows the lack of necessity of any disinfection procedure on the rubber stopper of single-dose vials and the efficacy of alcohol only for disinfecting the stopper of multiple-dose vials.