Achievements and problems from the view of a physician

Penicillin made possible the cure of many common, and also the most serious, infections, such as meningococcal meningitis and bacterial endocarditis, often with few or no sequelae. Endocarditis had been invariably fatal. Semisynthetic penicillins added new dimensions of convenience of administration and a broader spectrum in the presence of many beta-lactamases. A quantum step forward was permitted by the derivatives of cephalosporin C. Specific clinical advances were (1) the opportunity to use these in some penicillin-allergic patients, (2) activity against wider range of Gram-negative bacilli, (3) activity against Bacteroides fragilis (cefoxitin), (4) more complete renal excretion after oral cephalosporins than with oral penicillins, and (5) delayed renal excretion. Major remaining problems limiting beta-lactam use are (1) allergy, (2) resistant organisms, (3) relatively poor entry into the cerebrospinal fluid (especially of cephalosporins, (4) some nephrotoxicity, (5) local irritation of veins and tissues during administration, and (6) poor results in patients with agranulocytosis.     

Flexibility, efficiency, and accountability: adapting reserve selection algorithms to more complex conservation problems

Flexibility, efficiency and accountability are considered key attributes of good reserve selection methods. Flexibility, the ability to incorporate all the diversity of considerations, concerns and information that typically impinge on real conservation problems, is fundamental if the particulars of any given situation are to be addressed and land use conflicts are to be effectively resolved. High efficiency, the representation of the maximum diversity of the relevant features (e.g. species) at the minimum cost, is important because reserves will commonly be in direct competition with other forms of land use. Accountability means that the solutions are obtained in a transparent way. allowing others to understand why and how the result was arrived at. Because of the robustness of the general integer linear model, a remarkably rich variety of problems concerning the management and efficient use of scarce resources can be represented as problems of this type. This study starts by analysing a simple representation problem and then develops more general problems that can be applied to a variety of conservation planning exercises. It is illustrated how high flexibility can be attained, while simultaneously addressing efficiency and accountability, by modelling reserve selection questions as integer linear problems.     

Patients' experiences with partial dentures: a qualitative study

Objective: The aim of the study was to gain insight into people's experiences of being given and using partial dentures. Methods: In‐depth semi‐structured interviews were carried out with 23 people of varied age, social background and denture wearing experience in Tayside, Scotland. Participants were encouraged to discuss how they came to have partial dentures, their day‐to‐day denture use and their interactions with dentists. The interview data were systematically coded using key theme headings, and summary charts were constructed to facilitate analysis. Results: The initial decision that a partial denture was needed was generally difficult to accept. People perceived the main benefits of partial dentures to be improved appearance and confidence, but experienced a variety of difficulties with their dentures and often coped with these by only wearing them on social occasions. Participants had not always told their dentists about the difficulties they experienced. Barriers to seeking help with denture problems included financial constraints, previous experience of rushed appointments or poor communication from dentists and a perceived lack of entitlement to help when partial dentures were issued free. Conclusions: Partial dentures can be difficult to cope with. People experience a range of difficulties in wearing them, not all of which have been discussed with dentists. Informative and supportive communication when partial dentures are first needed, and subsequently, can improve the quality of patients’ experiences and may help promote effective use and appropriate help‐seeking by partial denture wearers.     

Patients' satisfaction with prosthetic devices

The purpose of the paper was to ascertain the factors which affect the satisfaction of patients with the prosthetic therapy. The purpose of the paper was also to ascertain if there are common factors characteristic for patients dissatisfied with the prosthetic therapy although the specialist appraises it as objectively successful. 52 patients of the Clinical Institute for Rehabilitation and Orthopedic Devices were participating in the research, to which, after unsuccessful surgical-prosthetic rehabilitation, reamputation and prosthetic provision was carried out, which was appraised successful by the doctor. It was endeavored to appraise to what extent the appraisal by the doctor corresponds to patient's satisfaction. On the basis of the questionnaire elaborated specifically for this research and the statistical processing, it was concluded that where the doctor appraised the prosthetic therapy as successful, the same opinion was shared by the majority of the patients (92.3%). Patients are similarly satisfied with the function and the esthetic quality of the prosthesis (73%). The reason why 7.7% of patients are dissatisfied in cases when the doctor considers that there are no objective reasons for that should be sought in non-medical factors. The age, the education, the marital status, the income state, the size of the residence and the regional affiliation do not have a significant influence on the satisfaction of patients with the prosthesis (p > 0.05). Patients with a minor handicap achieve satisfaction with the prosthetic therapy faster, as well as the right-handed persons if the prosthesis on the right-hand extremity is in question (p < 0.05). This investigation showed that the responsibility of not wearing prosthetic aids, both orthopedic, and dental prostheses, couldn't be only neuroticism by prosthetic patients, because that connection is not statistically significant (p < 0.09).     

Methodological problems of training epidemiologists at institutes for physician advanced training

The system of raising the qualification of epidemiologists at the chair of epidemiology of the Kiev Institute for Advanced Medical training is described.     

Attitudes and access: advancing the rights of people with disabilities

Barriers to movement and communication in the physical environment prevent people with disabilities from enjoying the same rights, privileges and opportunities as other members of society. The guidelines presented by Drs. Karen E. Jones and Itamar E. Tamari in this issue (page 647) remind us that access to physicians'' offices is one area in which improvement is greatly needed. But, as Jones and Tamari acknowledge, accessibility involves more than the removal of physical barriers. The greatest obstacles faced by disabled people are often attitudinal ones. Programs that place responsibility for rehabilitation and integration within the community can foster a better understanding of the issues. Family physicians and other professionals must work with communities to change the attitudes, beliefs and behaviours of policy-makers and the public. Until significant progress is made on this front, problems of access that serve to marginalize people with disabilities will persist.     

Discussion: pre-zygotic rights

Silverman uses Warnock's article "Do human cells have rights?" (Bioethics 1987 Jan; 1(1): 1-14) as the springboard for a brief discussion of decision making in the care of handicapped newborns. He argues that the parents of these children should have a major role in deciding for or against life-prolonging treatment, because they must live with the consequences. Silverman does not find it surprising that, in reaching their decision, parents are inclined to weigh the competing interests of family members, including those of children not yet conceived whose rights are foreclosed by the drain on the family of an existing handicapped child.