Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group.

BACKGROUND AND PURPOSE To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. METHODS After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. RESULTS Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. CONCLUSIONS Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.

[Smoking and digestive tract: a complex relationship. Part 1: Inflammatory bowel disease and cigarette smoking]

Little is known about the effects of smoking on inflammatory bowel diseases (IBD). However the co-occurrence of smoking and IBD often happens in ambulatory care. Smokers have a doubled risk of developing a Crohn's disease with a more active disease course. After quitting, a decrease in risk can be observed after only one year. An inverse relationship is found between smoking and ulcerative colitis. Smoking seems protective for the development of the disease and its course is less active among smokers. Smoking cessation transitorily increases the risk of developing ulcerative colitis. Nevertheless, continuing smoking cannot be justified among those patients given the risks of long-term extra-digestive effects. It is thus important to counsel all smokers with an IBD to quit smoking.

Provider perceptions of physical activity counseling: A systematic review

Background: Although the health benefits of physical activity are well-established, the evidence regarding the efficacy of physical activity counseling by primary care providers is inconclusive. Healthy People 2020 recommends that physicians provide counseling on physical activity to their patients; however, few providers adhere to these guidelines. The primary objective of this review is to systematically summarize and evaluate primary care providers' perceptions and attitudes about physical activity counseling. ^ Methods: A systematic literature search of relevant articles was conducted between January and May 2011 using four databases: MEDLINE (1948 to the present), PsycInfo (1806 to the present), CINAHL Plus with Full Text (1981 to the present), and the Cochrane Library. Studies were included if 1) the study population consisted of primary care providers and, 2) the study evaluated providers' attitudes and perceptions pertaining to physical activity counseling. Both quantitative and studies were considered. ^ Results: Most primary care providers agree that physical activity counseling is important and that they have a role in promoting physical activity to their patients. Providers are uncertain about the effectiveness of counseling, feel only marginally comfortable providing more than general advice about physical activity, and cite major barriers to counseling such as lack of time, lack of training, and lack of reimbursement for their counseling efforts. The evidence in this review suggests that beyond these barriers, providers are more likely to counsel their patients about physical activity if they are active themselves, or if they feel that their patients' condition, such as cardiovascular disease or obesity, would strongly benefit from a lifestyle change. ^ Conclusion: While major barriers to physical activity counseling, such as lack of time for counseling and lack of counseling knowledge still exist, primary care providers are receptive to the idea of acting as physical activity promoters in their clinical practices. However, the barriers encountered need to be addressed on multiple levels (e.g. individual, organizational), and additional training is needed in order for providers to effectively promote the physical activity of their patients.^

AN ASSESSMENT OF KNOWLEDGE AND ATTITUDES OF GENETIC COUNSELING SERVICES IN U.S. HTCs

Hemophilia is a hereditary bleeding disorder which requires lifelong specialized care. A network of Hemophilia Treatment Centers (HTCs) exists to meet the medical needs of patients affected by hemophilia. Genetic counseling services are an integral part of the HTC model of care; however, many HTCs do not have genetic counselors on staff. As a result, the duty to provide these services must fall to other healthcare providers within the HTC. To assess the knowledge and attitudes of these providers we developed a 49 question survey that was distributed electronically to hematologists and nurses at U.S. HTCs. The survey consisted of a three sections: demographic information, knowledge of hemophilia genetics, and attitudes towards genetic services. A total of 111 complete responses were received and analyzed. The average knowledge score among all participants was 74.8% with a total of 81 participants receiving a passing score of 70% or above. Thirty participants scored below 70% in the knowledge section. In general, attitude scores were high indicating that the majority of hematologists and nurses in HTCs feel confident in their ability to provide genetic counseling services. Over 90% of participants reported that they have some form of access to genetic counseling services at their center. Hematologists and nurses practicing in U.S. HTCs demonstrate sufficient knowledge of the genetics of hemophilia, and they generally feel confident in their ability to provide genetic counseling services to their patients. While their knowledge is sufficient, the average knowledge score was lower than 75%. Certain questions covering new genetic technologies and testing practices were more commonly missed than questions asking about more basic aspects of hemophilia genetics, such as inheritance and carrier testing. Finally, many clinics report having access to a counselor, but it is oftentimes a hematologist or nurse who is providing genetic counseling services to patients. Given the inconsistency in knowledge among providers coupled with the high confidence in one’s ability to counsel patients, it leaves room to question whether information about the genetics of hemophilia is being communicated to patients in the most appropriate and accurate manner.

Planning, implementation, and evaluation of an HIV -screening program for pregnant women

The purpose of this study was to evaluate the effectiveness of an HIV-screening program at a private health-care institution where the providers were trained to counsel pregnant women about the HIV-antibody test according to the latest recommendations made by the U.S. Public Health Service (PHS) and the Texas legislature. A before-and-after study design was selected for the study. The participants were OB/GYN nurses who attended an educational program and the patients they counseled about the HIV test. Training improved the nurses' overall knowledge about the content of the program and nurses were more likely to offer the HIV test to all pregnant women regardless of their risk of infection. Still, contrary to what was predicted, the nurses did not give more information to increase the knowledge pregnant women had about HIV infection, transmission, and available treatments. Consequently, many women were not given the chance to correctly assess their risk during the counseling session and there was no evidence that knowledge would reduce the propensity of many women to deny being at risk for HIV. On the other hand, pregnant women who received prenatal care after the implementation of the HIV-screening program were more likely to be tested than women who received prenatal care before its implementation (96% vs. 48%); in turn, the likelihood that more high-risk women would be tested for HIV also increased (94% vs. 60%). There was no evidence that mandatory testing with right of refusal would deter women from being tested for HIV. When the moment comes for a woman to make her decision, other concerns are more important to her than whether the option to be tested is mandatory or not. The majority of pregnant women indicated that their main reasons for being tested were: (a) the recommendation of their health-care provider; and (b) concern about the risks to their babies. Recommending that all pregnant women be tested regardless of their risk of infection, together with making the HIV test readily available to all women, are probably the two best ways of increasing the patients' participation in an HIV-screening program for pregnant women. ^

La traducción del italiano, catalán y portugués en su combinación con el español. Estudio descriptivo basado en encuestas

The aim of this paper is to study the practice of translation involving Spanish, Italian, Catalan and Portuguese. In particular we conduct a survey on professional translators and describe their practice according to different points of view: studies, ages, experience years, linguistic combinations and translation types. The results may not be representative of all translation practitioners but can be used not only for curricular issues but also to counsel translator trainees regarding career or vocational issues.

Differences between groups of family physicians with different attitudes towards at-risk drinkers : a post hoc study of the ODHIN survey in Portugal

Copyright © 2016 Frederico Rosário et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Quantification of standards of proof thresholds in criminal and civil litigation

Standards of proof in law serve the purpose of instructing juries as to the expected levels of confidence in determinations of fact. In criminal trials, to reach a guilty verdict a jury must be satisfied beyond a reasonable doubt, and in civil trials by a preponderance of the evidence. The purposes of this study are to determine the quantitative thresholds used to make these determinations; to ascertain the levels of juror agreement with basic principles of justice; and to try to predict thresholds and beliefs by juror personality characteristics. Participants read brief case descriptions and indicated thresholds in percentages, their beliefs in various principles, and completed three personality measures. A 92-94% threshold in criminal and an 80% threshold in civil matters was found; but prediction by personality was not supported. Significant percentages of jurors disavowed the presumptions of innocence and right to counsel.

The secret of a long and active life and how to enjoy it ... presenting the condensed views, advices and counsel of qualified biologists, physicians, dieticians and specialists, consulted;

On cover: By Frank Linden.

Nominations of Elaine D. Kaplan and Ruth Y. Goldway : hearing before the Committee on Governmental Affairs, United States Senate, One Hundred Fifth Congress, second session, March 30, 1998, nominations of Elaine D. Kaplan, to be Special Counsel of the Office of Special Counsel, and Ruth Y. Goldway, to be Commissioner of the Postal Rate Commission.

Shipping list no.: 98-0363-P.

Need for an independent counsel to investigate U.S. government assistance to Iraq /

At head of title: 102d Congress, 2d session. Committee print, ser. no. 7.

Nominations of Ginger Ehn Lew to be General Counsel ... Lauri Fitz-Pegado to be Assistant Secretary and Director-General of the U.S. and Foreign Commercial Service of the Department of Commerce : hearing before the Committee on Commerce, Science, and Transportation, United States Senate, One Hundred Third Congress, second session, February 10, 1994.

Shipping list no.: 95-0098-P.

Arguments of the defendants' counsel, and the judgment of the Supreme Court, U.S., in the case of Vidal and another, complainants and appellants, versus the mayor, c., of Philadelphia, the executors of S. Girard, and others, defendants appellees [microform] : January term, 1844. : to which is added the will of Stephen Girard /

Vidal, et al., versus the city of Philadelphia -- Argument of Horace Binney, Esq., for defendants -- Argument of John Sergeant, Esq. -- Opinion, Supreme Court of the United States, January term, 1844 -- The will of the late Stephen Girard.

Communication from the Comptroller of the City of New York to the Assembly Committee on Cities, relative to proposed amendments to the greater New York Charter to remedy certain evils, including the practice of the confession of judgments by the corporation counsel.

Cover title.

Report of investigation of summary contempt citation against George W. Crockett, Jr. of the Michigan Bar (Defense Counsel in the Foley Square trial) : presented to the lawyers and judges of Michigan /

Mode of access: Internet.