BACKGROUND: We investigated the characteristics and causes of various uveitis subtypes in patients presenting to the Regional Eye Centre at the Royal Alexandra Hospital, University of Alberta, Edmonton, Alta., and estimated the incidence of anterior uveitis in northern Alberta. METHODS: A retrospective study was conducted of all patients presenting with uveitis to a single, full-time ophthalmologist at the Regional Eye Centre from September 2004 to June 2005. Uveitis was classified according to onset, severity, anatomical subtype, etiology, recurrence rate, and response to treatment. Statistical analysis was used to compare patients referred by ophthalmologists with those referred by non-ophthalmologists. RESULTS: Two hundred and nine eyes of 171 patients were included in the study. Ophthalmologist referrals consisted of 67.4% anterior, 14.0% intermediate, and 18.6% panuveitis, and non-ophthalmological referrals were 92.8% anterior, 5.4% intermediate, and 1.8% panuveitis. Referrals from ophthalmologists were significantly more likely to be chronic, recurrent, and (or) less responsive to treatment than referrals from other sources. INTERPRETATION: Referral bias strongly affects the proportions of uveitis subtypes seen. Human leukocyte antigen-B27-associated diseases (especially ankylosing spondylitis), sarcoidosis, and herpes infections should be considered among the most likely causes of uveitis to be diagnosed in this patient population.
Currarino syndrome is a rare hereditary condition with constipation as the main symptom. The typical patient has a combination of sacral, anorectal, intraspinal and presacral anomalies. Familial cases most often have a mutation in the MNX1 gene. The majority of Norwegian Currarino patients are treated at Rikshospitalet. This article gives an account of 50 years of experience with the condition.
The study is based on the medical records of patients with Currarino syndrome, as well as some first-degree relatives, from the period 1961-2012. We recorded the results of mutation analysis, X-ray of the sacrum, and ultrasound, MRI and/or CT scans, as well as the treatments administered.
We treated 29 patients over the period in question, and in addition identified seven healthy relatives with a mutation in MNX1 and one relative with a pathognomonic sacral anomaly. There were 15 familial and 14 sporadic cases. Fourteen familial cases and one of the sporadic cases were shown to have a mutation in the MNX1 gene. Phenotypic variation was pronounced, and we saw no obvious correlation between genotype and phenotype. Twenty-six of the patients had constipation and 15 underwent a colostomy. Fourteen patients required neurosurgical and seven urogenital interventions. No patients had malignant disease.
Patients with Currarino syndrome have a highly variable clinical presentation with constipation as the main problem. In patients with a familial syndrome, a mutation in the MNX1 gene can be expected.
The analysis of reports of the obstetric and pediatric hospitals of Moscow for 1991-1998 revealed that, simultaneously with the deterioration of the quality of life of the population, not only a decrease in the birth rate, but also a rise in different forms of pathology in pregnant women and puerperae could be observed. The deterioration of the health characteristics of mothers was accompanied by the growth of high risk groups among newborns as well. Thus, the number of children, born sick or falling sick while staying in the obstetric clinics of Moscow, rose from 208 to 299 o/oo. Simultaneously with the growth of somatic pathology, a significant rise in infectious morbidity rate among newborns from 15 to 43 o/oo and a rise in death rate among newborns due to infectious pathology were noted. A complex of prophylactic measures is proposed. Their introduction will make it possible to decrease the probability of the appearance of severe forms of pathology in pregnant women and newborns, to ensure the effectiveness of epidemiological surveillance of hospital infections and to prevent their further growth among puerperae and newborns.
The aim of the present study was to evaluate a Management & Leadership Education and Training Programme at the hospital before, during, and after implementation, allowing stakeholders to qualify alteration of the Programme as a process by using for instance formative evaluation.
The Delphi method is used for pre-evaluation of the concept of the Programme. Pre- and post-questionnaires were employed to measure the participants' adaptation of the hospital's "Management Fundamentals" before and after the Programme.
The Expert panel stated that the Programme concept was pertinent and applicable. One hundred per cent recommended the Programme to be interdisciplinary. Eighty-two per cent stated that it would probably be difficult to acquire organisational learning. The results of the pre- and post-questionnaires showed that the participants and their superiors found that they adapted the hospital's "Management Fundamentals" better after having followed the Programme.
With the use of the Delphi method (formative evaluation), the Programme concept could be altered already before implementation. The experts stated that they were not sure that the Programme would support organisational learning. Having this knowledge, it has been possible to work with activities supporting organisational learning already during implementation. In future, the experience with pre- and post-measurements will be used in a concrete way to support the learning environment in the organisation.
The manual Mycobacteria Growth Indicator Tube (MGIT) method was evaluated for performing direct and indirect drug susceptibility testing (DST) of Mycobacterium tuberculosis for isoniazid and rifampin on 101 strongly smear-positive sputum specimens in a Siberian prison hospital. Using the indirect method of proportion (MOP) as the "gold standard," the accuracies of isoniazid and rifampin susceptibility testing by the direct MGIT system were 97.0 and 94.1%, respectively. The accuracy of the indirect MGIT system was 98.0% for both drugs. The turnaround times from specimen processing to reporting of the DST results ranged between 4 and 23 (mean, 9.2) days by the direct MGIT method, 9 and 30 (mean, 15.3) days by the indirect MGIT method, and 26 and 101 (mean, 59.6) days by the indirect MOP. MGIT appears to be a reliable, rapid, and convenient method for performing direct and indirect DSTs in low-resource settings, but further studies are required to refine the direct DST protocol. Cost is the only factor prohibiting widespread implementation of MGIT.
The authors have completed a large descriptive study of the system of psychiatric aftercare in Metropolitan Toronto. This article describes the relevant 6-month and 2-year postdischarge outcome in each of five aftercare components for 505 subjects in a traditional system of service delivery. Provincial hospital, research institute, and general hospital subgroups are compared. For the total group, recidivism and employment rates are similar to those found in previous studies. Symptoms and distress levels are high. Considerable numbers of subjects live in inadequate and unsatisfactory housing. Social isolation, inadequate income, and difficulties with instrumental role functioning are persistent problems with little improvement between 6 months and 2 years postdischarge. Differences among the subgroups vary according to type of outcome and, for the most part, can be explained by differences in the characteristics of the patients served by the three types of inpatient treatment settings. These findings provide additional information about serious deficiencies in discharge planning and aftercare service delivery that is focused primarily upon the treatment of illness. The authors conclude that a more balanced system of aftercare requires a shift in resources to rehabilitation programs in the community.