[Different models are used to obtain medication history and medication review in Danish hospitals]

The objective of the article is to characterize the models used by pharmacists to obtain medication history and medication review in Danish hospitals. The models are characterized based on the sources used to create an overview of the patient's medication as well as the time spent per patient. Currently pharmacists perform medication review at 16 departments. The sources frequently used are the patient journal (81%) and clinical data (81%). The patient contributes to the medication review in 25%.

A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia

Object

The authors' aim was to compare the subthalamic nucleus (STN) with the globus pallidus internus (GPi) as a stimulation target for deep brain stimulation (DBS) for medically refractory dystonia.

Methods

In a prospective double-blind crossover study, electrodes were bilaterally implanted in the STN and GPi of 12 patients with focal, multifocal, or generalized dystonia. Each patient was randomly selected to undergo initial bilateral stimulation of either the STN or the GPi for 6 months, followed by bilateral stimulation of the other nucleus for another 6 months. Preoperative and postoperative ratings were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and video recordings. Quality of life was evaluated by using questionnaires (36-item Short Form Health Survey). Supplemental Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed for patients with focal dystonia (torticollis) by examining the video recordings.

Results

On average for all patients, DBS improved the BFMDRS movement scores (p < 0.05) and quality of life physical scores (p < 0.01). After stimulation of the STN, the mean 6-month improvement in BFMDRS movement score was 13.8 points; after stimulation of the GPi, this improvement was 9.1 points (p = 0.08). Quality of life did not differ significantly regardless of which nucleus was stimulated. All 12 patients accepted 6 months of stimulation of the STN, but only 7 accepted 6 months of stimulation of the GPi. Among those who rejected stimulation of the GPi, 3 accepted concomitant stimulation of both the STN and GPi for 6 months, resulting in improved quality of life physical and mental scores and BFMDRS movement scores. Among the 4 patients who were rated according to TWSTRS, after 6 months of stimulation of both the STN and GPi, TWSTRS scores improved by 4.7% after stimulation of the GPi and 50.8% after stimulation of the STN (p = 0.08).

Conclusions

The STN seems to be a well-accepted, safe, and promising stimulation target in the treatment of dystonia, but further studies are necessary before the optimal target can be concluded. Simultaneous stimulation of the STN and GPi should be further investigated. Clinical trial registration no.: KF 01-110/01 (Committees on Biomedical Research Ethics of the Capital Region of Denmark).

[Testicular microlithiasis--are biopsy and follow-up necessary?]

INTRODUCTION

Improvement in the technology of ultrasound has made it possible to visualise small calcifications in the testes, known in the literature as testicular microlithiasis (TM). TM is described in otherwise healthy men, but is also found related to cancer and CIS. Here we will discuss the evaluation and follow up of patients with diagnosed TM.

MATERIAL AND METHODS

The study comprises 14 patients in whom TM was diagnosed sonographically in the period from December 1997 to May 2000.

RESULTS

Ultrasound indicated cancer in two patients. Pathology showed germ cell cancer in both. In 12 patients, ultrasound showed only TM, no suspicion of cancer. Biopsies taken in eight of these patients were all benign.

DISCUSSION

The prevalence of TM is still unknown, as is its aetiology. TM is somehow correlated to testicular cancer, as microliths are found much more often in testes with cancer than in those without malignancy. However, in the vast majority of patients, evidence of cancer or CIS cannot be found. Development of cancer in patients formerly diagnosed with TM is rarely described. In the case of TM and no sonographic signs of cancer, we therefore believe biopsies can be limited to patients at increased risk of testicular cancer, for instance those with retained or small atrophic testes, and also possibly to patients known to have developed TM between repeated ultrasound examinations. If a biopsy shows no signs of malignancy or CIS, we see no need for follow up. If biopsy is not indicated, we recommend a clinical check up, followed by further investigations if these are indicated.