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Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one's own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time. CONCLUSIONS: Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems. WHAT IS KNOWN: • Conducting an evidence-based practice search is considered indispensable to determine the best management of the patient's problem. • Conducting such a search is still considered challenging in many medical disciplines, including pediatrics. WHAT IS NEW: • There is a need to strengthen skills of community pediatricians to find evidence on psychosocial problems and to present this effectively in multidisciplinary teams. • The pediatricians' broad use of other sources of evidence, like experts and online sources, shows the importance of critical evaluation skills.

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Amyloid beta protein (A beta) deposition in the cerebral arterial and capillary walls is one of the major characteristics of brains from patients with Alzheimer's disease and hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D). Vascular A beta deposition is accompanied by degeneration of smooth muscle cells and pericytes. In this study we found that A beta 1-40 carrying the "Dutch" mutation (HCHWA-D A beta 1-40) as well as wild-type A beta 1-42 induced degeneration of cultured human brain pericytes and human leptomeningeal smooth muscle cells, whereas wild-type A beta 1-40 and HCHWA-D A beta 1-42 were inactive. Cultured brain pericytes appeared to be much more vulnerable to A beta-induced degeneration than leptomeningeal smooth muscle cells, because in brain pericyte cultures cell viability already decreased after 2 days of exposure to HCHWA-D A beta 1-40, whereas in leptomeningeal smooth muscle cell cultures cell death was prominent only after 4-5 days. Moreover, leptomeningeal smooth muscle cell cultures were better able to recover than brain pericyte cultures after short-term treatment with HCHWA-D A beta 1-40. Degeneration of either cell type was preceded by an increased production of cellular amyloid precursor protein. Both cell death and amyloid precursor protein production could be inhibited by the amyloid-binding dye Congo red, suggesting that fibril assembly of A beta is crucial for initiating its destructive effects. These data imply an important role for A beta in inducing perivascular cell pathology as observed in the cerebral vasculature of patients with Alzheimer's disease or HCHWA-D.

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Thirty two patients with proven chronic bacterial prostatitis were treated with ciprofloxacin 500 mg twice daily orally for four weeks. The causative organisms, cultured from prostatic fluid were Enterobacteriaceae (19 patients), enterococci (9), staphylococci (4), streptococci (3), non-fermentative Gram-negative rods (2) and anaerobic bacteria (9). Nineteen patients had pure cultures, 13 mixed cultures. The susceptibility of all organisms to ciprofloxacin, sulfamethoxazole, trimethoprim and doxycyclin was determined by agar dilution. The effect of therapy was measured by clinical parameters and by repeated cultures of prostatic fluid during and after therapy up to six months. Clinical cure (at one month after therapy) was obtained in 22 patients, improvement in seven; two patients did not respond, one patient had to stop during therapy because of severe nausea. No other side effects were noted. Ciprofloxacin may be a useful alternative drug in the treatment of prostatitis.

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The in-vitro activity of ciprofloxacin against 376 urinary pathogens was determined. The minimal inhibitory concentrations for 90% of the Enterobacteriaceae were 0.03-0.23 mg/l, for Pseudomonas aeruginosa 0.37 mg/l, for Streptococcus faecalis 0.75 mg/l and for Staphylococcus aureus 0.92 mg/l. A 100 mg dose of ciprofloxacin was administered intravenously to 25 patients undergoing prostatectomy. The concentrations in prostate and serum were measured at different intervals. Peak levels in prostate were 3.0 micrograms/g attained 20 min after administration. Peak serum levels were 1.2 mg/l attained 20 min after administration. Serum and prostate elimination was slowly. The overall serum: prostate ratio 1:2.1.

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Eight patients with a fracture of the shaft of the femur and a concomitant lesion of the superficial femoral artery are presented. Six patients had a viable leg; one patient, a below knee amputation, and one, an above knee amputation. Early recognition of this relatively rare combination is of paramount importance. In our experience, internal fixation of the fracture followed by grafting of the artery through separate incision works best.

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