RESUMEN
Intrauterine contraception is used by about 100 million women worldwide, making it the most popular form of fertility regulation. In UK community contraception clinics, however, long-acting reversible contraception has increased to 28% of users, and intrauterine contraception accounts for only 8% of methods used by women accessing these services. Potential exists to increase uptake of these more effective methods. In this chapter, we review the clinical advantages, disadvantages and cost-effectiveness of intrauterine contraception. We discuss the management of complications along with advice for trainers, and briefly consider issues in developing countries.
Asunto(s)
Conducta Anticonceptiva , Anticoncepción/instrumentación , Dispositivos Intrauterinos/efectos adversos , Anticoncepción/economía , Anticoncepción/métodos , Países en Desarrollo , Femenino , Humanos , Dispositivos Intrauterinos/economía , Dispositivos Intrauterinos de Cobre/efectos adversos , Dispositivos Intrauterinos Medicados/efectos adversos , Reino UnidoRESUMEN
Recent drug discovery developments in the field of small molecule targeted agents have led to much interest in combining these with radiotherapy. There are good preclinical data to suggest this approach worthy of investigation and in this review we discuss how this has translated into recent clinical trials. The outcome of clinical trials investigating radiotherapy/targeted drug combinations published in the last 5 years is discussed, as are trials in progress. The perceived future opportunities and challenges in the development of this exciting area are considered.
Asunto(s)
Antineoplásicos/uso terapéutico , Quimioradioterapia/métodos , Terapia Molecular Dirigida/métodos , Neoplasias/terapia , Fármacos Sensibilizantes a Radiaciones/uso terapéutico , Celecoxib , Ensayos Clínicos como Asunto , Inhibidores de la Ciclooxigenasa 2/farmacología , Receptores ErbB/efectos de los fármacos , Receptores ErbB/efectos de la radiación , Humanos , Neovascularización Patológica/tratamiento farmacológico , Neovascularización Patológica/radioterapia , Pirazoles/farmacología , Sulfonamidas/farmacología , Factor A de Crecimiento Endotelial Vascular/efectos de los fármacos , Factor A de Crecimiento Endotelial Vascular/efectos de la radiaciónRESUMEN
We describe four cases of a localized, granulomatous reaction to BCG including ipsilateral painful, suppurative lymphadenopathy associated with donor immune reconstitution following allogeneic haematopoietic stem cell transplant performed in infancy and preceded by uneventful, routine BCG immunisation. The management of the inflammatory disease in these cases with surgery, antimycobacterial chemotherapy and steroids, is discussed.
Asunto(s)
Vacuna BCG/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Inflamación/inmunología , Linfadenitis/inmunología , Linfadenitis/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Trasplante HomólogoRESUMEN
Blood products are an essential component of the management of postpartum haemorrhage, although there is lack of evidence to guide optimal use. Prospective intervention studies, including randomized trials, are needed to clarify optimal timing and dosage. The new generation of virally inactivated blood products, such as fibrinogen concentrate, might further enhance our knowledge of the value of individual blood components. It seems likely that antifibrinolytic agents will receive less attention in future. However, rFVIIa promises to be a powerful tool in managing massive obstetric haemorrhage, although many questions concerning its efficacy and safety in differing clinical scenarios remain unanswered.
Asunto(s)
Antifibrinolíticos/uso terapéutico , Factor VIIa/uso terapéutico , Hemostasis/efectos de los fármacos , Hemostáticos/uso terapéutico , Hemorragia Posparto/tratamiento farmacológico , Transfusión Sanguínea/métodos , Protocolos Clínicos , Femenino , Humanos , Guías de Práctica Clínica como Asunto , Embarazo , Proteínas Recombinantes/uso terapéuticoAsunto(s)
Aborto Inducido , Instituciones de Atención Ambulatoria , Anestesia Local , Femenino , Humanos , Embarazo , Legrado por AspiraciónRESUMEN
The purpose of this study was to determine the level of awareness of genital Chlamydia infection and level of knowledge related to this infection in family planning (FP) clinic attenders. Clients attending FP clinics during a 3 month study period were invited to complete an anonymous self-administered questionnaire. Five hundred and sixteen questionnaires from female attenders were analysed. Results showed that 54% of respondents had heard of Chlamydia. Subjective knowledge assessment for Chlamydia was low compared to that for other infections. Mean knowledge scores relating to genital chlamydial infection were low. There was no significant age-related trend in knowledge scores. The implications of these findings are discussed in relation to increased Chlamydia screening activity in FP clinics.
Asunto(s)
Infecciones por Chlamydia/transmisión , Chlamydia trachomatis , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto , Adolescente , Adulto , Infecciones por Chlamydia/diagnóstico , Servicios de Planificación Familiar , Femenino , Humanos , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Readers will be familiar with high profile media items, like the Audit Commission investigating national public institutions, and publicising rigorous critiques of their 'value for money'. Family planning (FP) services may be interested to learn that the Audit Commission also perform 'district audits' (nothing to do with 'clinical audit') and that these can analyse broader concerns to do with quality of patient care and acceptability of services, not just efficiency. 'Out of the blue' our service was the focus of such a district audit conducted over just 3 weeks. We were asked what areas, apart from 'value for money', we would like investigated. We were keen to measure if our efforts of collaboration with Primary Care and other agencies had been effective. We learned that there is a national system (DATIS) to compare each FP service's expenditure per thousand patients. We also learned that being the subject of such an investigation need not be a threatening experience, and can be an opportunity to review quality of care and demonstrate our cost effectiveness. This account is the report of the district audit team of our service and our attempts at collaboration.
Asunto(s)
Servicios de Planificación Familiar/normas , Medicina Familiar y Comunitaria , Auditoría Médica , Atención a la Salud , Costos de la Atención en Salud , Humanos , Atención Primaria de Salud , Calidad de la Atención de Salud , Reino UnidoAsunto(s)
Promoción de la Salud , Nombres , Conducta Sexual , Servicios de Planificación Familiar , Humanos , Reino UnidoRESUMEN
The audit aimed to develop a questionnaire to monitor how a new method od contraception is offered in service by identifying local demand and assessing levels of awareness of and interest in a new product (Mirena(R)) The audit also aimed to establish those suitable for Mirena and the numbers of Mirena fitted and characteristics of recipients.
PIP: The National Coordinating Unit for Clinical Audit in Family Planning relies on pilot sites throughout the UK to develop informational materials about new products. Described in this paper is an audit conducted in Chesterfield Community Services (North Derbyshire Community Health Trust) in 1996 with the aim of developing a questionnaire for identifying local awareness of and demand for the Mirena IUD. Family planning staff completed questionnaires for 57 new patients or women requesting a change in contraceptive method. Of the 49 women who identified their current method of contraception, 29 were using condoms, 14 were on the pill, and 2 were IUD users. 41 consultations (72%) included a discussion of Mirena; in the remaining 16 cases, the women had decided on a method prior to consultation. 21 women had heard of the Mirena IUD before their visit to the clinic and 18 expressed an interest in it. Only 7 women actually obtained a Mirena IUD; in 1 other case, the device was not available at the clinic. Another 7 women opted for a copper IUD. The mean age of Mirena acceptors (32.9 years) was significantly higher than the mean age of the sample (28.2 years). Of concern is the possibility that women who want Mirena will be directed toward less expensive IUDs in greater supply in UK clinics. It is recommended that a protocol be established for cases in which Mirena is preferred and suitable, but no supply is available.
Asunto(s)
Servicios de Planificación Familiar , Dispositivos Intrauterinos Medicados , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Reino UnidoRESUMEN
Smyth line (SL) chickens, which develop a depigmenting disorder similar to human vitiligo, produce circulating anti-melanocyte antibodies (Austin, L.M. et al., (1992) The detection of melanocyte autoantibodies in the Smyth chicken model for vitiligo. Clin. Immunol. Immunopathol., 64:112-120). In order to characterize these autoantibodies, we studied the reactivity of cultured chicken, mouse, and human melanocytes, as well as frozen sections of chicken feather follicles and embryonic eyes, against SL serum, employing indirect immunofluorescence. Light Brown Leghorn (LBL) serum was used as a negative control. Chicken (SL and LBL), mouse, and human melanocytes exhibited greater fluorescence with SL serum than with LBL serum (up to a 1:60,000 dilution). The fluorescent pattern was predominant along the perimeter of the cells, suggesting plasma membrane staining. Fluorescence-activated flow cytometry analysis and immunocytochemical localization at the ultrastructural level using intact chicken cells supported this hypothesis. Melanocytes were readily stained in cryosections of regenerating feather follicles and embryonic eyes incubated with SL, but not LBL, serum. In addition, amelanotic melanocytes in albino chicken feathers reacted with SL serum. SL serum also preferentially stained cells emigrating from cultured avian neural tubes and within the dermis of the proliferative germ of regenerating feather follicles suggesting that melanoblasts express the antigens. We conclude that Smyth line serum contains melanocyte autoantibodies that cross-react with mouse and human melanocytes, are able to bind to pigment cells within tissues, and recognize antigens expressed in the cytoplasm and on the surface of melanocytes and melanoblasts.
Asunto(s)
Autoanticuerpos/inmunología , Enfermedades Autoinmunes/inmunología , Membrana Celular/inmunología , Pollos/inmunología , Modelos Animales de Enfermedad , Melanocitos/inmunología , Vitíligo/inmunología , Animales , Autoantígenos/biosíntesis , Autoantígenos/inmunología , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/genética , Células Cultivadas , Embrión de Pollo , Pollos/genética , Citoplasma/inmunología , Células Dendríticas/inmunología , Ojo/embriología , Ojo/inmunología , Plumas/inmunología , Técnica del Anticuerpo Fluorescente , Humanos , Melanocitos/ultraestructura , Ratones , Ratones Endogámicos C57BL/inmunología , Cresta Neural/inmunología , Especificidad de Órganos , Especificidad de la Especie , Vitíligo/sangre , Vitíligo/genéticaRESUMEN
Pruritus is a significant problem for many patients undergoing long-term hemodialysis. Topical capsaicin depletes and prevents the reaccumulation of substance P in peripheral sensory neurons. Substance P functions in the transmission of pain and probably itch sensations. An open-label, uncontrolled trial and a double-blind, vehicle-controlled trial were conducted to evaluate the efficacy and safety of capsaicin 0.025% cream in the treatment of localized areas of pruritus in patients undergoing long-term hemodialysis. Eight of nine evaluable patients in the open-label trial reported marked relief or complete resolution of itching during the study period, and two of five evaluable patients in the double-blind trial reported complete resolution of itching in the capsaicin-treated arm with no or minimal improvement in the vehicle-treated arm. Twelve patients in the open-label trial and two in the double-blind trial were unevaluable. No serious treatment-related adverse reactions occurred.
Asunto(s)
Capsaicina/administración & dosificación , Prurito/tratamiento farmacológico , Diálisis Renal/efectos adversos , Administración Tópica , Adulto , Anciano , Capsaicina/efectos adversos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prurito/etiologíaRESUMEN
Even if we could prevent more infections with the human immunodeficiency virus (HIV) today, we know from the numbers of "well" seropositive people in the world that a sharp rise in the number of AIDS patients and deaths is inevitable in the coming years. This article describes how one London Health Region (population 3.5 million) intends to prevent the further spread of the disease. It includes guidance to health authorities on where to care for people who need hospital treatment, the role of out-patient services, the need for screening and means of developing better care outside hospital. It examines the implications for haemophiliacs and for intravenous drug users and highlights the importance of sound, effective health education for health service staff and for the population as a whole.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Brotes de Enfermedades/prevención & control , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Instituciones de Atención Ambulatoria , Anticuerpos Antivirales/análisis , Servicios de Salud Comunitaria , Infección Hospitalaria/prevención & control , VIH/inmunología , Anticuerpos Anti-VIH , Seropositividad para VIH , Hemofilia A/complicaciones , Humanos , Masculino , Planificación de Atención al Paciente , Aislamiento de Pacientes , Trastornos Relacionados con SustanciasRESUMEN
KIE: A sample of physicians, nurses, and dentists working within the South East Thames Region of England, chosen because they were at risk of acquiring AIDS from patients or were in decision making positions, was surveyed to ascertain health professional knowledge and attitudes concerning the disease. Questions were asked about HIV antibody tests, patient informed consent before testing, compulsory screening of high-risk groups, refusal of hospital admission under the Public Health (Infectious Diseases) Act, screening of various population groups before hospital admission, and the need for special precautions or referral of HIV-positive patients to special units. The study revealed that clinicians tend to be unduly eager to test patients and that they sometimes test without first informing and counseling the patient. The author recommends staff education at all levels.^ieng