Goals of workThe goal of this study was to evaluate, at a population level, the association between specialized palliativecare services (SPCS) and short- and long-term caregiver...Full Text Available
Aims:To Study the religious and ideological views and practice of PalliativeCare physician towards Euthanasia.Materials and Methods:An...Full Text Available
This article is a story of networking of palliativecare at the corporate level. This gives an insight that if you have will and dedication then you can imagine and make it true that networking can...Full Text Available
Paediatric palliativecare is a holistic approach aimed at addressing the complex issues related to the care of children and families facing chronic life limiting illnesses. The needs of children are...Full Text Available
The outcome of patients admitted to intensive care units is known to be influenced by such factors as age, previous health status, severity of disease, and diagnosis. To estimate the outcome of such...Full Text Available
BackgroundLung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently,...Full Text Available
Caring for a child with a potentially fatal medical condition is a challenge for parents or caregivers. The ability to measure parental self-efficacy in pediatric palliativecare may be an important component of targeting supportive services that address individual needs of families. Therefore, the goal was to develop a Pediatric PalliativeCare Parental Self-Efficacy Measure (PCPEM). First, a list of questions were generated that asked parents their level of confidence in carrying out tasks involved in caring for a child with a potentially fatal medical condition in 6 palliativecare domains: 1) medical discussion/decisions; 2) symptom management/medication; 3) daily activities; 4) feelings/concerns; 5) spirituality; and 6) end-of-life care. The PCPEM was narrowed to 58 questions after expert ...
AbstractObjective: This study examined the effectiveness of a telephone-based referral-care management (TBR-CM) intervention on psychiatric health...Full Text Available
ObjectiveTo report the outcome of children with life-threatening asthma (LTA) admitted to a university Pediatric Intensive Care Unit (PICU).MethodsRetrospective...Full Text Available
BackgroundThe link between maternal factors and birth outcomes is well established. Substantial changes in society and medical care over time have influenced women's reproductive...Full Text Available
ObjectivesPericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome...Full Text Available
Background The Norwood procedure consists of three palliative operations, performed in neonates with hypoplastic left heart syndrome. Especially the first stage (Norwood I) is associated with the highest mortality rates in paediatric cardiac surgery (up to 25%). During surgery, the aorta is reconstructed and a systemic-to-pulmonary shunt is applied. Originally the modified Blalock-Taussig shunt was used, but recently the right-ventricle-to-pulmonary-artery shunt is increasingly being employed. We reviewed the results of our operative strategy, where an individualised choice of shunt is made. Furthermore, attempts to reduce interstage mortality (between Norwood I and II) were assessed. Methods All neonates who underwent Norwood stage I palliation from August 2004 until November 2010 were in...
The objective of this study was to evaluate the effect of pregabalin in painful cervical or lumbosacral radiculopathy treated in Primary Care settings under routine clinical practice. An observational,...Full Text Available
Electronic personal health records (ePHRs) can potentially maximize access and coordination of health information and improve patient/clinician collaboration, patient self-management, and health outcomes....Full Text Available
The purpose of this study was to evaluate the safety and efficacy of TACE with microspheres preloaded with doxorubicin in unresectable intrahepatic cholangiocarcinoma (UCH). Twenty patients with UCH were observed; 9 refused, preferring other palliativecare or chemotherapy, and 11 agreed to be treated with one or more cycles of DC beads loaded with doxorubicin (100-150 mg) in a TACE procedure between February 2006 and September 2007. A total of 29 individual TACE procedures were performed. Follow-up imaging was performed on all patients before, immediately after, and 4 weeks after each TACE procedure to evaluate the response and need for further treatment. Each patient received i.v hydration, antibiotics, and medications against nausea and pain before TACE. Survival rate was calculated using Kaplan-Meier survival curve. A response rate of 100% followed RECIST criteria was observed. Eight of eleven patients are alive, with a median survival of ...
A 67-year-old man presented with gastrointestinal bleeding resulting from a fistula between the aortic stump and the fourth part of the duodenum 14 months after an axillobifemoral bypass, graft excision, and aortic stump closure for aortic graft infection. The patient initially refused any attempt at definitive surgical treatment so coil embolization of the aortic stump was performed via a brachial approach. Coil embolization may be a useful adjunct in the management of such difficult problems. This approach may buy time and allow careful planning of a definitive treatment or may serve as a palliative procedure in inoperable patients. PMID:15947052
Oral mucositis associated with head and neck radiotherapy can substantially hinder completion of cancer therapy. Alleviation of this often severe stomatitis can provide enhanced patient comfort and facilitate appropriate care. A double-blind format was used in a pilot project to measure, against a control rinse, the effectiveness of an oral rinse consisting of hydrocortisone, nystatin, tetracycline, and diphenhydramine in controlling radiation-related mucositis. A combination of clinical evaluation and patient responses to a questionnaire was used to judge the results of the topical medications. Patients using the experimental medication developed less mucositis than did patients in the control group.
BackgroundPatients’ general tendency to adhere to health care provider-recommended treatments is associated with a number of health outcomes, but whether it influences pain...Full Text Available
BackgroundAdolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes...Full Text Available
AimsTo describe nurse burnout, job dissatisfaction, and quality of care in Japanese hospitals, and to determine how these outcomes are associated with work environment...Full Text Available
BackgroundMany interventions found to be effective in health services research studies fail to translate into meaningful patient careoutcomes across multiple contexts. Health services...Full Text Available
IntroductionTransfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with...Full Text Available
Acute kidney injury (AKI) is a common clinical problem with significant clinical and economic consequences. A number of studies point to a rising incidence of AKI in the hospital and in the intensive...Full Text Available
The health politics and policy communities are still struggling with the question of "what went wrong" in the 1993-94 health care reform effort. Here I identify which Americans were politically active and inactive during the health care reform debate to explore the role political participation may have had in determining the outcome of the debate. Using data from a national and California random-sample telephone surveys, and controlling for other demographic attributes, I found that those who engaged in political activity specifically related to health care reform were disproportionately more likely to be self-identified conservatives, less likely to favor an employer mandate plan, more likely to be fifty to sixty-four years old, more likely to be men, and more likely to have greater interest in and knowledge of the health care issue. Even in California, where a single-payer ...
Background Trauma centers are designated to provide systematized multidisciplinary care to injured patients. Effective trauma systems reduce patient mortality by facilitating the treatment of injured patients at appropriately resourced hospitals. Several U.S. studies report reduced mortality among patients admitted directly to a level I trauma center compared with those admitted to hospitals with less resources. It has yet to be shown whether there is an outcome benefit associated with the ?level of hospital? initially treating severely injured trauma patients in Australia. This study was designed to determine whether the level of trauma center providing treatment impacts mortality and/or hospital length of stay. Methods Outcomes were evaluated for severely injured trauma patients with an ...
Objectives Vietnamese patients? views on healthcare are changing as surgical interventions become more commonplace, but their views on perioperative care have remained largely unstudied during this period of rapid change. This study assesses Vietnamese patients? impression of anesthesia safety and postoperative pain in relation to clinical outcomes with the aim of improving patient-centered perioperative care. Methods The study cohort consisted of 180 hospitalized patients who were followed for 24?h following abdominal surgery. The assessments of these patients on the use of anesthesia and postoperative pain were measured by means of a 5-point Likert scale survey. Perioperative events were recorded on standardized forms by medical staff. The relationship between relevant factors affecting ...
To determine the proportion of rheumatoid arthritis (RA) patients receiving preventive health care according to US Preventive Services Task Force recommendations compared with a community-based population sample, with emphasis on dyslipidemia testing, given the increased risk of cardiovascular disease (CVD) in RA patients. Patients with RA (ICD-9 code 714.0 at ?2 office visits with a rheumatologist) and a primary care physician (PCP) at the Geisinger Health System (GHS) were identified through electronic health records. The records were searched back from 3/31/08 for the length of time required to satisfy each outcome measure. Percentages were compared with population testing rates using the Pearson Chi-square test. Eight hundred and thirty-one RA patients were compared to 169,476 subjects...
AbstractBACKGROUND: Disparities in treatment and mortality for colorectal cancer (CRC) may reflect differences in access to specialized care or other characteristics of the area where an individual lives. METHODS: Surveillance, Epidemiology and End Results Program-Medicare data for seniors diagnosed with CRC were linked to area measures of the sociodemographic characteristics and the capacity of surgeons, medical oncologists, and radiation oncologists. Outcomes included receipt of stage-appropriate CRC care and mortality. RESULTS: After adjustment, blacks and Hispanics were less likely than whites to undergo surgery (odds ratio [OR] 0.57, 95% confidence interval (CI) 0.52-0.63 and OR 0.82, 95% CI 0.70-0.95, respectively). Individuals who lived in areas with the highest tertile of surgeon c...
Inferior vena cava (IVC) obstruction is a well-described clinical entity. Most IVC obstructions from malignant neoplasms are a direct result of tumor compression [Oviedo J, Cerda S. Vascular invasion by hepatocellular carcinoma. Arch Pathol Lab Med 2001;125: 454-5; Furui S, Sawada S, et al. Gianturco stent placement in malignant caval obstruction: analysis of factors for predicting the outcome. Radiology 1995;195:147-52; Fletcher WS, Lakin PC, et al. Results of treatment of inferior vena cava syndrome with expandable metallic stents. Arch Surg 1998;133:935-8]. The symptoms of IVC obstruction include progressive ascites, scrotal edema and lower body edema. These constellations of symptoms are described as IVC syndrome and are devastating to a patient with end-stage cancer. We describe a palliative therapy utilizing Luminexx nitinol self-expanding stents to treat intracaval hepatoma thrombus obstructing the IVC. The procedure is rapidly ...
The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. ...
PURPOSE We wanted to examine how coordinated care is implemented in primary care practices to address patients' health behavior change needs. METHODS Site visit notes, documents, interviews, and online implementation diaries were collected from July 2005 to September 2007 from practice-based research networks (PBRNs) participating in Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks (P4H). An iterative group process was used to conduct a cross-case comparative analysis of 9 interventions. Published patient outcomes reports from P4H interventions were referenced to provide information on intervention effectiveness. RESULTS In-practice health risk assessment (HRA) and brief counseling, coupled with referral and outreach to a valued and known counseling resource, emerged as the best way to consistently coordinate and encourage follow-through for health behavior ...
The aims of this study were to identify risk factors and evaluate the association with clinical outcomes of postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Data from 2488 consecutive adult patients were analyzed. Patients were classified as having CSA-AKI based on the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria using peak postoperative creatinine in the postoperative intensive care unit (ICU). Multiple stepwise logistic regression analysis was used to identify independent risk factors for CSA-AKI. CSA-AKI occurred in 584 patients (23.5%). CSA-AKI patients had significantly longer aortic cross-clamp and cardiopulmonary bypass times. Furthermore, CSA-AKI patients had higher hospital mortality (5.5% vs 1.5%, PCopyright2...
BackgroundAlthough self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. ObjectiveTo identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. DesignRetrospective chart review. SettingA tertiary-care academic medical center in South Korea. PatientsThis study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. InterventionPlacement of colonic SEMSs. Main Outcome MeasurementsTechnical success and immediate and long-term clinical success rates. ResultsTechnical...
Summary This third paper, in a three-part CE series on the preventions of infection in patients with chronic kidney disease, focuses on surveillance and auditing of healthcare-associated infections within the renal care environment. The last decade has seen an increased awareness of the threat to patient safety from healthcare-associated infection (HCAI) and the emergence of multi-drug resistance organisms. Effective HCAI prevention strategies include adequate governance structures, access to expert advice, adherence to standard and transmission-based precautions, minimising the use of invasive medical devices, and surveillance. Surveillance data can be collected using outcome (e.g. infection) and/or process (e.g. hand hygiene compliance audit) measures. Establishing a surveillance program...
Background/Purpose: Peripherally inserted central venous catheters (PICCs) are commonly used for neonatal vascular access. The aim of this study was to look at PICC line complication rates and possible predictors of PICC infection in a neonatal intensive care unit. Method: This was a prospective study of 226 neonates who had PICCs on our neonatal intensive care unit between January 2006 and June 2009. Complete data was available on 218 neonates who had 294 PICC lines. Criteria for catheter-related sepsis was positive blood cultures (peripheral/central) and/or a positive catheter tip culture after removal in the presence of a clinical suspicion of line sepsis. Results: Of 218 neonates, 132 (169 lines) were medical, and 86 (125 lines) were surgical. Our PICC line infection rate was 17 infect...
Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinic...
In the last 40 years, significant advances have been made in the understanding of the neurophysiologic processes involved in the experience of trauma and pain. This knowledge, together with the rapid growth and understanding in the behavioral health sciences, has expanded to include a much better appreciation of how these fields are converging and contribute to a process called neuroplasticity. These basic mechanisms common to all patients have important implications for clinical outcome and for improving clinical practice. This article is written for clinicians who manage patients with sacroiliac joint dysfunction, a specific type of nonspecific low back pain.
Background 2009 pandemic influenza A(H1N1) has led to a global increase in severe respiratory illness. Little is known about kidney outcomes and dialytic requirements in critically ill patients infected with pandemic H1N1. Study Design Prospective observational study. Setting & Participants 50 patients with pandemic H1N1 admitted to any of 7 intensive care units in Manitoba, Canada, were prospectively followed. Outcome & Measurements Outcomes were kidney injury and kidney failure defined using RIFLE (risk, injury, failure, loss, end-stage disease) criteria or need for dialysis therapy. Results The pandemic H1N1 group was composed of 50 critically ill patients with pandemic H1N1 with severe respiratory syndrome (47 confirmed cases, 3 probable). Kidney injury, kidney failure, a...
ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework ...
This paper reports the characteristics and local management of 826 acute wounds identified during an audit across all health care providers serving the population of Bradford, UK. Of the wounds encountered 303 were traumatic wounds and 237 primary closures with smaller numbers of other acute wound types. Of the 303 traumatic wounds 174 occurred in women (57.4%). Men predominated in the under 45s (65M:26F), this being largely accounted for by hand and finger trauma (n=62) particularly in patients of working age (M32:F12). Women predominated in the over 65s (50M:130F), this being largely accounted for by lower limb traumatic wounds (M24:F91), the majority of these being in patients 65 and over (M14:F82). In this sub-group of 96 patients 25 had wounds of 6 weeks or longer duration, only 3 had...
National efforts to improve the quality and safety of health care present challenges for medical education and training. Today's doctors need to be skilled communicators who know how to identify, prevent and manage adverse events and near misses, how to use evidence and information, how to work safely in a team, how to practise ethically, and how to be workplace teachers and learners. These competencies (knowledge, skills and attitudes) are set out in the National Patient Safety Education Framework (NPSF) of the Australian Council for Safety and Quality in Health Care. The NPSF is designed to help medical schools, vocational colleges, health organisations and private practitioners develop curricula to enable health professionals to work safely. The NPSF describes what doctors (depending on their level of knowledge and experience) can do to demonstrate competencies in a range of quality and safety activities. Medical schools, vocational ...
This study examined whether cognitive behavioural therapy (CBT) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease (COPD). 41 patients with COPD, who had undergone pulmonary rehabilitation, were randomised to either a four-session CBT intervention condition (n = 21) or a routine care condition (n = 20). Assessments were at baseline, post-intervention, and at 6-, 12- and 18-month follow-ups. Primary outcomes were the rates of panic attacks, panic disorder and anxiety symptoms. Secondary outcomes were depressive symptoms, catastrophic cognitions about breathing difficulties, disease-specific quality of life and hospital admission rates. There were no significant differences between the groups on outcome measures at baseline. By the 18-month follow-up assessment, 12 (60%) routine care group ...
Perspectives from industry, academe, and the NRC are brought together in this report and used to develop a logical framework that links management and organization factors and safety in nuclear power plant performance. The framework focuses on intermediate outcomes which can be predicted by organizational and management factors, and which are subsequently linked to safety. The intermediate outcomes are efficiency, compliance, quality, and innovation. The organization and management factors can be classified in terms of environment, context, organizational governance, organizational design, and emergent processes. Initial empirical analyses were conducted on a limited set of hypotheses derived from the framework. One set of hypotheses concerned the relationships between one of the intermediate outcome variables, efficiency, as measured by critical hours and outage rate, and safety, as measured by 5 NRC indicators. Results of ...
Abstract The fit of patient coping style and psychotherapy focus has been suggested as improving treatment outcome. This article reviews the definitions, measures, and previous research surrounding this hypothesis. An original meta-analysis of 12 carefully selected studies (N = 1,291 patients) resulted in a weighted, mean effect size (d) of .55 in favor of a fit between externalizing patients and symptom-focused treatment or, alternatively, internalizing patients and insight-focused treatment. This medium-size effect indicates that nondiagnostic patient factors, like coping style, are important considerations in the selection of effective therapies. Clinical examples and clinical recommendations are provided. 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:176-183, 2011.
The interscalenic block technique is widely used for ambulatory shoulder surgery despite a substantial number of failures and adverse effects. We prospectively evaluated satisfaction in 40 consecutive patients who underwent open Bankart repair under a single general anesthesic performed in an ambulatory care unit. The mean age of the patients was 23 years. There were 29 men and 11 women. Patients were evaluated postoperatively with a visual analog scale of pain (in the recovery room, at the time of discharge, and the day after and 1 week after surgery) via a home assessment questionnaire that included the following: effectiveness of oral pain medication, ability to perform activities of daily life, and overall satisfaction. One patient failed to be discharged because of a feeling of faintn...
Background: As the global population ages, support for family caregivers who provide the bulk of care to community-dwelling older people is becoming ever more important. However, in many countries, homecare-service practitioners currently do not follow a systematic approach to assessing and responding to caregiver needs. Objectives: The aim of this study was to explore the experiences of caregivers and practitioners who took part in a field test of the Family Caregivers Support Agreement (FCSA) tool, a modified version of the Carers Outcome Agreement Tool (COAT) initially developed as the result of an Anglo-Swedish study. Both the COAT and the FCSA are designed to facilitate partnerships between caregivers and practitioners so that needs assessment and subsequent support services are negot...
SummaryWe consider the problem of estimating the effect of exposure on multiple continuous outcomes, when the outcomes are measured on different scales and are nested within multiple...Full Text Available
A ten week old girl who had previously undergone a palliative procedure for the hypoplastic left heart syndrome had unrelieved aortic coarctation that did not respond to standard balloon dilatation....Full Text Available
Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy, more than 50% of patients have incurable disease at the time...Full Text Available
AIM: To evaluate the efficacy of self expandable metallic stents (SEMS) in patients with malignant esophageal obstruction and fistulas.METHODS: SEMS were implanted in the presence of fluoroscopic...Full Text Available
The heterogeneity of metastatic breast cancer mandates the need to select therapies taking into account tumor and patient characteristics. Chemotherapy is indicated in the palliative setting especially...Full Text Available
ObjectiveTo evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland.DesignSemi-structured telephone...Full Text Available
PurposeDescription and analysis of the effects and side-effects of integrated mental health care in the Netherlands.Context of caseDue...Full Text Available
Purpose To analyze the clinical profile, management and outcome of non-hematological tumors in head and neck region in children less than 18?years of age. Patients and methods Medical records of patients (0?18?years) presenting with non-hematological tumors of head and neck region from 2000 to 2010 were reviewed. Result Out of the 78 patients identified, 50 were males with median age of 14?years (3?months to 18?years). Histologically, 58 out of the 78 patients had malignant tumors and 20 were metastatic at presentation. Common site of tumor origin was noted as thyroid (23/78), salivary glands (21/78) and nasopharynx (13/78). Out of 78 patients, 44 patients were treated by surgery, 26 patients received radiation and 13 patients received chemotherapy, while 9 patients received radio-iodine (...
Therapeutic hypothermia is a promising method for controlling intracranial pressure (ICP) in severely brain-injured patients. However, clinical data regarding the effect of brain hypothermia on overall outcome of these patients is limited. This may be because there are specific pitfalls associated with the clinical management of induced hypothermia in patients with severe traumatic brain injury (TBI). These pitfalls may be avoided by preventing specific risk factors when cooling is induced and with rewarming. However, these risk factors have not been well systematically discussed in the literature. In this paper, three categories of clinical issues regarding the management of brain hypothermia are discussed: (1) stress-induced secondary brain injury mechanisms; (2) technical aspects of intensive care unit (ICU) cooling management; and (3) rewarming rates and methods. For patients with a Glasgow Coma Scale (GCS) score of less than 8, management ...
In 2000, the Accreditation Council of Graduate Medical Education (ACGME) laid out a definition of competence that included six specific areas of focus: patient care (including clinical reasoning), medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The ACGME's intention was to mandate increasingly reliable and valid assessment measures to be used by all training programs over the next decade, with the goal of providing "more credible, accurate, reliable and useful educational outcome data." In this article, the authors will review definitions of competency according to the new ACGME standards and examine the assessment tools currently available, including global evaluations, 360-degree evaluations, checklists, standardized examinations and direct observations. The authors will provide an overview of critical considerations in different assessment ...
This paper describes how a computerized MIS is used to assist HMO management to conduct utilization and quality of care review activities in a prepaid medical care network. The HMO is a ‘network’...Full Text Available
BackgroundExisting studies concerning the health care use of homeless people describe higher utilisation rates for hospital-based care and emergency care, and lower rates for primary...Full Text Available
BackgroundWe examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.MethodsSecondary analyses...Full Text Available
Objective: To explore the interventional method to treat biliary recurrent jaundice after T tube drainage in patients with malignant obstructive jaundice due to cholangiocarcinoma. Methods: 7 biliary metallic stents were placed in 7 patients with recurrent jaundice after T-tube drainage in cholangiocarcinoma cases. Results: Stent placement was once successful in all 7 cases with successful rate of 100%. For all cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that of preoperation together with subsidence of jaundice satisfactorily for 100% after the treatment. Conclusions: Percutaneous placement of biliary metallic stents was effective economic, minimal invasive and safe for palliation of biliary recurrent jaundice after T tube drainage in cholangiocarcinoma-induced obstructive jaundice
The Northwest Foster Care Alumni Study examined the relation between experiences in foster care and depression among young adults who spent at least a year in foster care as adolescents. Results indicate that preparation for leaving foster care, nurturing supports from the foster family, school stability, access to tutoring, access to therapeutic service and support, and a shorter and more stable placement history were associated with a lower probability of depression in young adulthood. Results provide evidence that suggest ways to improve practice to decrease rates of depression among alumni of care. (Contains 2 tables.)
ObjectiveFamily-centered bedside rounds (FCBR) are recommended to improve trainee education, patient outcomes, and family satisfaction. However, bedside teaching...Full Text Available
SUMMARYIncreasingly multiple outcomes are collected in order to characterize treatment effectiveness or to evaluate the impact of large policy initiatives. Often the multiple...Full Text Available
PurposeTo evaluate the clinical characteristics and outcomes of cataract surgery in highly myopic Korean subjects.MethodsWe retrospectively reviewed...Full Text Available
The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological...Full Text Available
Purpose - The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point-of-view. Design/methodology/approach - The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen. Findings - Analysis suggests that care programmes can be combined with integrated care pa...
Abstract Anesthetics affect outcomes from central nervous system (CNS) injuries differently. This is the first study to show how two commonly used anesthetics affect continuously recorded hemodynamic parameters and locomotor recovery during a 2-week period after two levels of contusion spinal cord injury (SCI) in rats. We hypothesized that the level of cardiovascular depression and recovery of locomotor function would be dependent upon the anesthetic used during SCI. Thirty-two adult female rats were subjected to a sham, 25-mm or 50-mm SCI at T3-4 under pentobarbital or isoflurane anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were telemetrically recorded before, during, and after SCI. Locomotor function recovered best in the 25-mm-injured isoflurane-anesthetized animals. There was no significant difference in locomotor recovery between the 25-mm-injured pentobarbital-anesthetized animals and the 50-mm-injured isoflurane-anesthetized animals. White ...
BackgroundDepression is a common illness, often treated in primary care. Many studies have reported undertreatment with antidepressants in primary care. Recently, some studies also...Full Text Available
BackgroundLittle is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced...Full Text Available
"Correctional Health Care: Implications for Public Health Policy" is the first in a series of articles that examines the special health care needs of persons who are incarcerated in America's correctional...Full Text Available
BackgroundUntil now only limited research has been done on the prevalence of chronic pain in primary care. The aim of this investigation was to study the health care utilisation...Full Text Available
Six patient assessment systems that have explicit decision rules for replicating team judgments on level of care patient placement were selected for analysis. The six were selected because of their...Full Text Available
BackgroundThe Emergency Care Summary (ECS) was introduced in 2006 to allow aspects of the general practitioner (GP; family doctor, equivalent to primary care physician) medical record...Full Text Available
OBJECTIVETo examine psychometric properties of the Confidence in Diabetes Self-Care (CIDS) scale, a newly developed instrument assessing diabetes-specific self-efficacy...Full Text Available
... Harbor Township Vineland Voorhees Pediatric Partner Hospitals AtlantiCare Regional Medical Center- City Campus, Atlantic City AtlantiCare Regional Medical Center - ...
OBJECTIVETo evaluate trends in costs of ambulatory care related to female pelvic floor disorders (PFD) in the United States.STUDY DESIGNFull Text Available
OBJECTIVE AND DESIGNThis study used qualitative and quantitative methods to examine the reasons primary care physicians and nurses offered for their inability to initiate guideline-concordant...Full Text Available
Practitioners who care for pregnant women face dilemmas when their patients use illicit drugs, reject medical recommendations, or cause fetal harm. Many ethics scholars characterize those situations as maternal-fetal conflicts. In conflict-based models, maternal rights are considered to conflict with fetal rights, or moral obligations owed to pregnant women are considered to conflict with those owed to their fetuses. I offer an alternative model of pregnancy ethics by applying relational and equality-based moral theories to situations of fetal harm by pregnant women. In this model, clinicians faced with ethical dilemmas should attempt to understand pregnant women and their decisions within their broad social networks and communities, ask how the clinician's personal standpoint influences outcomes judged to be ethical, and determine whether the clinician's ethical formulations reduce or enhance existing gender, class, or racial inequality. This ...
Objective: To assess the efficacy, prospects and future of conservative management of beta thalassemia major patients in a developing country. Design: Patients registered at IHBTS were studied over a period of three years. They consented to being managed on moderate transfusion regimen, aiming to maintain a pre-transfusion haemoglobin(Hgb) level of 9.0 plus minus 1.0 g per dL. We studied their transfusion requirements, status for transfusion transmitted infections (TTls), serum ferritin levels and complications developing as a result of iron overload. Subjects: Initially all registered patients were included in this study. Sporadic patients as well as dropouts occurring due to any reason, (patients concurrently seeking treatment at other centres as well, or complying poorly to advised chelation therapy) were excluded from the study. The data presented here conforms to a cohort of 60 regular patients who adhered best to our selection criteria. Main Outcome Measures: ...
To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two ...
The incidence of hepatocellular carcinoma (HCC) is increasing in developed countries and the general status of HCC patients is now by far better than a few years ago, allowing physicians to propose some different treatments of these patients. Among these treatments, intra-arterial injection of 131-iodine-labelled Lipiodol could be used in palliative, curative or adjuvant settings. After a brief summary of the modalities of this treatment, requiring the collaboration of Gastro-enterologists, Oncologists, Radiologists and Nuclear Medicine physicians, the different possibilities of therapeutic uses of this new approach are described and an outlook of these developments is proposed. (author)
Carcinoma en cuirasse of the breast, which invades the skin via lymphatics and may encase the entire thorax and abdomen, is poorly controlled by surgery, chemotherapy, or conventional irradiation. Palliation of patients with breast carcinoma en cuirasse is a difficult clinical problem which must be effectively managed over extended periods due to the indolent nature of this disease. The management of three cases is reported, and the new technique of rotational subtotal skin electron-beam therapy (SSEBT) is presented. (author).
Self-expanding metallic stent insertion has been widely applied for the palliative treatment of malignant esophageal strictures. Although it is known as an easy, safe, and effective procedure, complications are well known and include things such as stent migration and esophageal stent occlusion caused by tumor in growth. However, metallic stent fractures have been rarely reported in the esophagus, especially for nitinol stents. We report a case of a stent fracture associated with migration in a patient with a malignant esophageal stricture near the gastroesophageal junction. It is highly probable that the stent fracture was due to chemical erosion of the stent caused by gastric juice
The aim of this retrospective study was to determine the safety and efficacy of chemoembolization (TACE) as palliative treatment for patients with unresectable intrahepatic cholangiocarcinoma (CCA) and to compare the results with those in the literature. Fifteen patients with histology-proven CCA (5 men, 10 women) had received palliative treatment with TACE over a 6-year period. The treatment protocol comprised repeated TACE at a minimum of 8-week intervals. TACE was performed with a mixture of 10 ml Lipiodol and 10 mg mitomycin C injected into the tumor-supplying vessels. Follow-up investigations after 8-10 weeks comprised contrast-enhanced multislice spiral CT and laboratory control. Statistical evaluation included survival analysis using the Kaplan-Meier method. During the investigation period 58 TACEs (3.9 #+-# 3.8; 1-15) were performed in 15 patients. Mean tumor size was 10.8 #+-# 4.6 cm (range, 2.0-18.0 cm). Unifocal tumor disease was ...
To evaluate repeated hepatic intraarterial chemotherapy (HIC) as a palliative treatment option for unresectable cholangiocarcinoma and liver metastases of various origins that were progressive under systemic chemotherapy. Between 2002 and 2006, 55 patients were treated in 4-week intervals (mean five sessions). Combined gemcitabine/mitomycin was administered intraarterially within 1 h. Tumor response was evaluated after the third session according to RECIST. Treated tumor entities were colorectal carcinoma (CRC) (n = 12), breast cancer (BC) (n = 12), cholangiocarcinoma (CCC) (n = 10), pancreatic (n = 4), ovarian (n = 3), gastric, cervical, papillary (each n = 2), prostate, esophageal carcinoma, leiomyosarcoma (each n = 1), cancer of unknown primacy (CUP) (n = 5). All patients tolerated the treatment well without any major side effects or complications. In total, there were 1 complete response (CR), 19 partial responses (PR), 19 stable (SD) and 16 progressive ...
To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ...
BackgroundWe aimed to compare visual and refractive outcome following phacoemulsification and intraocular lens implant (IOL) and combined one-site phacotrabeculectomy.MethodWe...Full Text Available
ObjectiveTo investigate and to quantify the relationship between hospital costs and health outcomes for patients with acute myocardial infarction (AMI) in Veterans Health Administration...Full Text Available
Objective. Cervical cancer patients who had an abandoned radical hysterectomy were evaluated for preoperative clinical predictors, complication rates, and outcomes. Study...Full Text Available
Cerebral atrophy rate is increasingly used as an outcome measure for Alzheimer's disease (AD) trials. We used the Alzheimer's disease Neuroimaging initiative (ADNI) dataset to assess if adjusting...Full Text Available
BackgroundThe optimal treatment for locally recurrent rectal cancer (LRRC) is still a matter of debate. This study assessed the outcome of LRRC patients treated with multimodality...Full Text Available
BackgroundPercutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms...Full Text Available
Purpose:The goal of this study was to use two separate databases to evaluate the clinical outcomes and the economic impact of adherence to Level I Pathways, an evidence-based oncology...Full Text Available
The mouth is an obvious portal of entry to the body, and oral health reflects and influences general health and well being. Maternal oral health has significant implications for birth outcomes and infant...Full Text Available
Study Objectives:To evaluate the value of mouth opening during sleep for predicting surgical outcomes after uvulopalatopharyngoplasty (UPPP).Methods:Retrospectively,...Full Text Available
BackgroundObtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum...Full Text Available
BackgroundControversy exists about how to effectively measure patient reported outcomes in IBS clinical trials. Pain numeric rating scales (NRS) are widely used in...Full Text Available
OBJECTIVE: The management and outcome of 138 abdominal shotgun wounds were examined over a 5-year period. SUMMARY BACKGROUND DATA: It has been proposed that exploratory laparotomy may be unnecessary...Full Text Available
PurposeTo assess the relationship between low-grade inflammation, measured as basal high sensitivity (hs)-CRP, and IVF outcome.MethodsWe recruited...Full Text Available
Although research demonstrates many negative family outcomes associated with single-parent households, little is known about processes that lead to positive outcomes for these families. Using...Full Text Available
We sought to determine the prevalence of metabolic syndrome (MS) in patients with acute myocardial infarction and its effect on clinical outcomes. Employing data from the Korea Acute Myocardial Infarction...Full Text Available
AbstractSevere pediatric traumatic brain injury (TBI) is associated with unfavorable outcomes secondary to injury from activation of the inflammatory cascade, the release of excitotoxic...Full Text Available
Much public health research has been directed to studies of cancer risks due to chemical agents. Recently, increasing attention has been given to adverse reproductive outcomes as another, shorter-term...Full Text Available
Communication problems have been implicated in many safety and quality issues, but tools to examine communication networks and their impact on patient outcomes are only beginning to become available....Full Text Available
AIMSTo evaluate and compare the risk of specific safety outcomes in patients prescribed ibuprofen and paracetamol concomitantly with those in patients prescribed ibuprofen or paracetamol...Full Text Available
Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were...Full Text Available
The question of whether storage of red blood cells (RBCs) alters their capacity to deliver oxygen and affects patient outcomes remains in a state of clinical equipoise. Studies of the changes...Full Text Available
IntroductionVarious multigene predictors of breast cancer clinical outcome have been commercialized, but proved to be prognostic only for hormone receptor (HR) subsets overexpressing...Full Text Available
Pneumatic dilation (PD) is an effective treatment for achalasia cardia. Outcome of PD, however, varies among different studies. Recently, some groups started considering laparoscopic myotomy to be competitive...Full Text Available
... of the utility of the terminal outcomes, ... Other stochastic topics, such as random walks, branching ... find special uses, particularly in queueing theory ...
... commands may be input from a terminal or they ... up the outcomes of the stochastic parameters corre- ... queue of subproblems to be solved, the first ...
The study examines the question of whether or not civilian marketing practices and principles can be applied in the military care setting. Using the NRMC Great Lakes as a basis, the answer is yes--consumers of military medical care are ready to be the rec...
The paper describes the possibilities of using data warehousing and OLAP technologies in public health care in general and then our own experience with these technologies gained during the implementation...Full Text Available
BackgroundMost studies on children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) have been undertaken in tertiary care and little is known about their management...Full Text Available
By analyzing the data of 459 patients who completed the Supportive Care Needs Survey (SCNS), the prevalence, medical and non-medical predictors of unmet needs were investigated. Breast cancer patients...Full Text Available
BackgroundInternationally, there is increasing use of telephone consultations, particularly for triaging requests for acute care. However, little is known about how this mode of...Full Text Available
BackgroundWith a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing...Full Text Available
Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections.Design...Full Text Available
Fresh blood has many potential advantages over older blood, but there is no evidence that these properties translate into clinical benefit for intensive care patients. The observational multicenter...Full Text Available
Digital information flow within the intensive care unit (ICU) continues to grow, with advances in technology and computational biology. Recent developments in the integration and archiving of these...Full Text Available
BackgroundNew Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments,...Full Text Available
Psychology as both a science and a profession has been closely identified with other disciplines in the broad field of health since the turn of the present century. Recent advances in health care have...Full Text Available
OBJECTIVES:To investigate the prevalence of potential drug interactions at the intensive care unit of a university hospital in Brazil and to analyze their clinical significance.METHODS:This...Full Text Available
ObjectiveTo identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients.Full Text Available
Background Little is known about how migrants adapt to first-world public health systems. In Norway, patients are assigned a registered general practitioner (RGP) to provide basic care...Full Text Available
This article explores the effects of reimbursement and utilization control policies on utilization patterns and spending for physician and hospital outpatient services under state Medicaid programs....Full Text Available
OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary...Full Text Available
OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel....Full Text Available
This paper summarizes the findings for the African Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview...Full Text Available
BackgroundIntegration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in...Full Text Available
IntroductionThe aim of the study was to assess and classify incidents of electromagnetic interference (EMI) by second-generation and third-generation mobile phones on critical care...Full Text Available
BackgroundThe Government has invested £7 million (approx. $11.5 million) to connect all Primary Care Practices in Scotland to the National Health Service...Full Text Available
PURPOSE This study was designed to evaluate the impact of electronic medical record (EMR) implementation on quality of diabetes care.METHODS We conducted a 5-year longitudinal...Full Text Available
Objectives:Despite its impact on health policy, the relationship between geographical proximity and health care seeking has received scant attention in the medical literature. This...Full Text Available
OBJECTIVE--To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN--Systematic review of world reports from 1984 to 1994. SETTING--The computerised...Full Text Available
Emergency Departments (ED) are fast-paced, information-intensive environments where patient care team members must address their information needs quickly and accurately. We conducted a qualitative...Full Text Available
The method of linear analogue self-assessment (LASA) was used to quantify the views concerning day care which were held by patients attending a geriatric day hospital. The results suggest that day hospitals...Full Text Available
ObjectivesTo assess Croatian community pharmacists' patient care competencies using the General Level Framework (GLF).MethodsThe competencies of...Full Text Available
PURPOSE We wanted to assess computer capabilities in a primary care practice-based research network and to understand how receptive the practices were to new ideas for automation of practice...Full Text Available
Quality research, requiring large numbers of participants, in the intensive care unit (ICU) population requires multicentre collaboration. Although logistically challenging, this methodology reduces...Full Text Available
BACKGROUND. Diabetes can be effectively treated and monitored in general practice. Postgraduate medical education at a local level is required to support this strategic shift of medical care from hospital...Full Text Available
Despite an accumulating body of literature addressing racial/ethnic disparities in children’s health and health care, there have been few published studies of interventions that have...Full Text Available
Will the aging of Canada's population bankrupt the health care system? In this issue (see pages 1555 to 1560) Dr. Marie Demers reports that the increase in physician service costs for elderly people...Full Text Available
PURPOSE The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinical decision...Full Text Available
The overarching goal of medical training is to nurture the growth of knowledgeable, caring and insightful clinicians guided by the ideals of medical professionalism. Recent definitions of professional...Full Text Available
BackgroundThe Canadian Emergency Department Triage and Acuity Scale (CTAS) is a well recognized and validated triage system that prioritizes patient care by severity of illness....Full Text Available
Patients do considerable information work. Technologies that help patients manage health information so they can play active roles in their health-care, such as personal health records, provide...Full Text Available
Very few areas of medical science have experienced more rapid development of new and beneficial treatment approaches during the past two decades than the disciplines required for total care of patients...Full Text Available
This article compared conceptual and empirical strengths of alternative methods for estimating racial disparities using non-linear models of health care access. Three methods were presented...Full Text Available
ObjectiveTo estimate the joint effect of a multifaceted access intervention on primary care physician (PCP) productivity in a large, integrated prepaid group practice.Data...Full Text Available
OBJECTIVE: To increase cost-efficiency while maintaining the standard of medical care, an accelerated surgical stay program for patients having breast surgery was instituted. SUMMARY BACKGROUND DATA:...Full Text Available
...dates of the implementation of the standard unique health identifier for health care providers. 162.404 Section 162.404 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA...
... Title : Mental Health and Resilience: Soldiers' Perceptions about Psychotherapy, Medications, and Barriers to Care in the United States Military. ...
Abstract An increase in chronic disease prevalence is contributing to health care cost growth and decreased quality of life in industrialized nations worldwide. Inadequate management of chronic diseases is a leading cause of hospitalizations and, thus, avoidable expenditures. In this study, we evaluated the impact of nurse-delivered care calls, the primary intervention of a proactive chronic care management (CCM) program, in a population aged 65 and older in Germany. In this analysis, hospital admission rates were evaluated among program enrollees who were diagnosed with diabetes, heart failure, coronary heart disease, or chronic obstructive pulmonary disease. The Intervention group comprised those members who participated in care calls (n?=?13,486), whereas the Comparison group included e...
The Sultanate of Oman has a relatively young national health care system that could demonstrate its high performance at an international level. Emergency medicine as a specialty has developed rapidly in the country over the last decade. This has involved the parallel development of local emergency residency training, prehospital emergency care, and emergency nursing programs. This article reviews the progress of emergency care practice in this country from a general primary care system toward becoming an established specialty in hospital, prehospital, and private emergency care settings. It also describes aspects of undergraduate, postgraduate, and continuous emergency medicine education in the country. Further, a glimpse into academic emergency medicine and emergency nursing is provided. ...
The key to the future for electric utilities will not be found in legislation or regulation. Title VII of the Energy Policy Act of 1992 will prove to be just as ineffectual in improving the industry's position as was the Public Utility Regulatory Policies Act of 1978. These legislative palliatives, which produced so much commotion and so many reams of heated commentary, are largely irrelevant to a successful future for electric utilities. The key will be found in economics, not in law, and the future will lie in completing Thomas A. Edison's century-old vision for the industry, half of which the industry has heretofore ignored. The industry must embrace the complete vision and evolve from electric utilities into [open quotes]end-use energy utilities.[close quotes
The incidence of hilar cholangiocarcinoma is very rare worldwide. Radical resection is the only prognostic factor for long survival in patients with hilar cholangiocarcinoma. Postoperative radiation therapy can improve local control and survival rates for patients with palliative resection, but it remains controversial in patients with radical resection. Biliary drainage can effectively release bile duct obstruction for the majority of patients with locally advanced disease, and may even prolong survival when combined with radiation therapy. Radiation therapy includes extrernal beam therapy alone, external beam therapy with intraluminal brachytheapy and new radiation technique, such as three dimentional conformal therapy and intensity modulated radiation therapy. The propective randomized clinical study is needed for further investigation in the role of combined modality therapy especially for hilar cholangiocarcinoma. (authors)
Objective To report the clinical response to image-guided percutaneous cryotherapy (IPC) for the palliative management of localized metastases in patients with gynecologic malignancies. Methods Institutional review board approval and patient consent were obtained. Gynecologic oncology patients were identified from our institution's cryotherapy database from August 2003 to August 2007. Cryotherapy was performed with 2.4?mm diameter probes (Endocare, Irvine, CA) with ultrasound or computerized tomography (CT) guidance under conscious sedation and local anesthesia. Follow-up was conducted by imaging studies and clinical encounters, using Response Evaluation Criteria in Solid Tumors (RECIST criteria). Results Twenty-eight ablation sessions were performed for 41 metastatic foci in 15 patients w...
The paper discusses a number of recent studies investigating into the energy conservation and environmental impacts of electric heating systems (off-peak storage systems). In future, i.e. in and after 1993, off-peak storage systems will be evaluated through comparative analyses of oil-fired heating systems, pollutant emission analyses, the eventual success of pollution abatement measures designed for power plant emissions to keep within the legal limiting values, and the possible abandonment of pollution abatement measures abroad. Opposing the electric heating studies submitted by the electric power industry the author refutes their favourable results referring to the palliative selection of inadequate or vague parameters. Assuming average power plant pollutant emissions of 180 mg/standard/sup 3/ the nitrogen oxide emissions of oil-fired heating systems (134.1 kg/Tj) are found to be below those of off-peak storage systems (242.5 kg/Tj).
A 21-year-old woman developed midesophageal stricture two weeks after ingestion of aluminium phosphide (AlP) tablets. Aluminium phosphide is a lethal protoplasmic toxin and is also the most common cause of suicidal poisoning in northern India. Upper gastrointestinal endoscopy (UGIE) showed a tight esophageal stricture 29?cm from the incisors with a circumferential ulcer. Dilatation up to 17?mm was done using Savary-Gilliard dilators. She had repeated dilatations three times at nearly two-week intervals. In view of the resistant stricture, a silicone Polyflex stent was placed across the stricture and removed after 3?months; there was no recurrence of stricture even after three months of follow-up. Patients with recurrent esophageal stricture and those with fistula may benefit from silicone ...
ObjectiveWe sought to determine the clinical outcomes of patients undergoing surgical aortic valve replacement with hemodynamically confirmed severe pulmonary hypertension and aortic stenosis and compare them with the outcomes of patients not undergoing aortic valve replacement and patients undergoing aortic valve replacement with mild-to-moderate pulmonary hypertension. MethodsA total of 317 patients with severe aortic stenosis (aortic valve area 35 mm Hg) was present in 81 patients, of whom 35 (43.2%) underwent surgical aortic valve replacement. We compared the clinical outcomes of these 35 patients with the 46 patient...
Background:Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize...Full Text Available
Increasing evidence suggests that sex differences exist in the etiology, presentation, treatment, and outcome from stroke. The reasons for these sex disparities are becoming increasingly explored, but...Full Text Available
In the last two decades rectal cancer has changed from a surgically managed disease into a multidisciplinary treatment model resulting in considerable improvements in the survival and outcome. This...Full Text Available
The visual outcome, histopathology, and electrodiagnostic tests of a man with a malignant melanoma of the choroid who received foveal argon laser photocoagulation prior to enucleatiion are described....Full Text Available
The purpose of this article is to review the literature for clinical presentation, treatment, outcome and complications of using radiotherapy for the treatment of orbital lymphoma. For this, MEDLINE,...Full Text Available
OBJECTIVE: This study evaluated, in a large, heterogeneous population, the outcome of open cholecystectomy as it is currently practiced. SUMMARY BACKGROUND AND DATA: Although cholecystectomy has been...Full Text Available
Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible for carrying male genes into the next generation. Evolutionary biologists have focused on their...Full Text Available
Our global impact is finally receiving the scientific attention it deserves. The outcome will largely determine the future course of evolution. Human-modified ecosystems are shaped by our activities...Full Text Available
Outcome from trauma, surgery, and a variety of other medical conditions has been shown to be positively affected by providing treatment at facilities experiencing a high volume of patients with those conditions. An electronic literature search was made to identify English-language articles available through March 2011, addressing the effect of patient treatment volume on outcome for patients with subarachnoid hemorrhage. Limited data were identified, with 16 citations included in the current review. Over 60% of hospitals fall into the lowest case-volume quartile. Outcome is influenced by patient volume, with better outcome occurring in high-volume centers treating >60 cases per year. Patients treated at low-volume hospitals are less likely to experience definitive treatment. Furthermore, t...
BackgroundRecent studies have shown associations between size and body proportions at birth and health outcomes throughout the life cycle, but there are few data...Full Text Available
PurposeAlthough the safety and feasibility of partial adrenalectomy in patients with von Hippel-Lindau syndrome have been established, long-term outcomes have not been examined. In this study we evaluate the recurrence and functional outcomes in a von Hippel-Lindau syndrome cohort treated for pheochromocytoma with partial adrenalectomy with a followup of at least 5 years. Materials and MethodsWe reviewed the records of patients with von Hippel-Lindau syndrome treated with partial adrenalectomy for pheochromocytoma at the National Cancer Institute. Demographic, germline mutation status, surgical indication, oncologic and functional outcome data were collected. Local recurrence was defined as radiographic evidence of recurrent tumor on the ipsilateral side of partial adrenalectomy. Patients ...
Background and objectives: Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited....Full Text Available
PURPOSE: To determine the risk factors and clinical signs of Curvularia keratitis and to evaluate the management and outcome of this corneal phaeohyphomycosis. METHODS: We reviewed clinical and laboratory...Full Text Available
Governments are increasingly concerned to compare the quality and effectiveness of healthcare interventions but find this a complex matter. Crude hospital statistics can be dangerously misleading and...Full Text Available
The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent...Full Text Available
Introduction: Generally agreed outcome criteria in psychosis are required to evaluate the effectiveness of new treatment strategies. The aim of this study is to explore clinical recovery...Full Text Available
Background There is some evidence that a patient?s pre-operative condition influences short-term and long-term post-operative outcomes. The aim of the present study is to compare the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and modified Glasgow prognostic score (mGPS) models in the prediction of post-operative outcome, both short term and long term, in patients undergoing resection of oesophago-gastric cancer. Patients and Methods Patients who underwent curative resection for oesophago-gastric cancer from January 2005 to May 2009 and who had data to score the POSSUM, P-POSSUM, O-POSSUM and mGPS models were included in the study. Observed morbidity and mortality rates were compared with predicted outcome in different risk groups. Bot...
The IAEA has requested several member states to present their proposal of the application of the Integrated Safeguards (IS) system in their nuclear facilities. This report contains a IS proposal for Finland prepared under the Task FIN C 1264 of The Finnish Support Programme to IAEA Safeguards. The comprehensive safeguards system of the International Atomic Energy Agency (IAEA) has been one of the main tools in the fight against nuclear proliferation since the entry-into-force of the Nuclear Non-proliferation Treaty three decades ago. In the 1990s some of the inherent weaknesses of this so-called traditional safeguards system were revealed first in Iraq and then in North Korea. Therefore, the member states of the LAEA decided to give the Agency additional legal authority in order to make its control system more effective as well as more efficient than before. This was accomplished by the approval of the so-called Model Additional Protocol (INFCIRC/540) in 1997. Straightforward ...
We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50 80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2 81 weeks). Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of ...
We wanted to determine the technical and clinical efficacy of placing a self-expandable PTFE-covered nitinol stent for the management of inoperable malignant biliary obstruction. Thirty six patients with inoperable malignant biliary obstructions were treated by placement of self-expandable PTFE-covered nitinol stents (S and G Biotech Corporation, Seongnam, Korea). Clinical evaluation was done with assessment of the serum bilirubin and alkaline phosphatase levels, which were measured before and after stent placement within 1 week, at 1 month and at 3 months. The patient survival rate and stent patency rate were calculated with performing Kaplan-Meier survival analysis. Successful stent placement was achieved in all the patients without procedure-related complication. Pancreatitis as an early complication occurred in two cases. The serum bilirubin and alkaline phosphatase levels were significantly decreased after the procedure. During the follow-up, recurrent obstructive jaundice ...
We wanted to evaluate the long-term results of a dual expandable nitinol stent for the palliative treatment of malignant gastroduodenal strictures. The dual stent consists of two stents; an outer partially nylon covered stent and an inner bare nitinol stent. The outer stent was placed into the stricture and this was followed by coaxial placement of the inner bare stent. Using fluoroscopic guidance, dual expandable stents were placed in 86 patients with inoperable malignant gastroduodenal strictures. The technical and clinical success, the complication, survival and the stent patency were evaluated during the follow-up period. Stent placement was technically successful in 83 of the 86 patients. After stent placement, 74 of the 85 patients showed improvement of their symptoms. During the mean follow-up period of 133 days, 24 patients (28%) developed recurrent symptoms due to incomplete expansion (n=1), stent migration (n=4), food impaction (n=2), granulation tissue ...
AbstractOBJECTIVETo provide an overview of the 2009 edition of the Rourke Baby Record (RBR), which incorporates recent research in the literature relating to preventive health care for children aged 0 to 5 years.QUALITY OF EVIDENCERecommendations are identified as supported by good, fair, or consensus evidence, according to the classification of the Canadian Task Force on Preventive Health Care.MAIN MESSAGENew information and recommendations are given for growth monitoring, nutrition, developmental surveillance, physical examination maneuvers, immunization schedules, and advice for parents. Anticipatory guidance updates relate to injury prevention, infant swaddling, literacy facilitation, nonparental child care, parenting skills programs, serum lead levels, over-the-counter cough and cold medications, pacifiers, antipyretics, insect repellents, and dental care and oral health. The 2009 RBR is available ...
The objectives of this paper are to: quickly outline the extent of the care gap in osteoporosis; define T-2 (knowledge) translation and its relationship to quality improvement; discuss the barriers to best practice in osteoporosis care after a fracture; convey the importance of rigor in design and evaluation of translational interventions by drawing upon examples from the broader literature; describe in some detail a series of post-fracture intervention trials conducted in Alberta, Canada; and make some conclusions specifically about osteoporosis interventions and more generally about T-2 translational research.
There is ample historical verification of 46,XX congenital adrenal hyperplasia (CAH) patients being born with essentially male genitaliawhile outcome information is scant. Prior to glucocorticoid...Full Text Available
Objectives: To report six month outcome in patients undergoing their first pulmonary vein ablation procedure for idiopathic atrial fibrillation (AF) at a “non-pioneering”...Full Text Available
Purpose:To study the outcome of in-the-bag implanted square-edge polymethyl methacrylate (PMMA) intraocular lenses (IOL) with and without primary posterior capsulotomy in...Full Text Available
... Ashton WS, Puntel RA, Wiswell TE. A rapid and readily available repair of the peripherally inserted central catheter in the nursery. NEONATAL INTENSIVE CARE 11 ...
Patients rely on their primary care physician to manage multiple, often chronic medical conditions that require prescription medications. Balancing the risk to benefit of treatments can be challenging...Full Text Available
During an outbreak of Flavobacterium meningosepticum septicaemia in a neonatal intensive care unit 9 infants were treated with intravenous trimethoprim sulphamethoxazole. Bacteriological cure was achieved...Full Text Available
A questionnaire on the development of specialist clinics was distributed to the members of the Association of British Neurologists and completed by 104 members (85 consultants). Half of the respondents...Full Text Available
ERDMANN A.L., DE ANDRADE S.R., FERREIRA DE MELLO A.L., KLOCK P., DO NASCIMENTO K.C., SANTOS KOERICH M. & STEIN BACKES D. (2011) Practices for caring in nursing: Brazilian research groups. International Nursing Review58, 379-385 Background:- The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. Aim:- To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. Methods:- The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distri...
ObjectiveTo investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of...Full Text Available
Sepsis has continuously been a leading cause of neonatal morbidity and mortality despite current advances in chemotherapy and patient intensive care facilities. Neonates are at high risk for...Full Text Available
BackgroundAs long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors...Full Text Available
A Health Care Establishment (HCE) is an establishment where medical services are rendered. The above services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. Previously, IT equipment consisted solely of stand-alone systems, whereas in recent years, the trend has been towards computer networks and distributed systems in HCEs. The spread of distributed information technology in HCEs have necessitated the implementation of Security in HCISs, to assure confidentiality, integrity and availability of HCE information. This paper discusses the issues of Security and Network Security in Health Care Information Systems (HCISs). It also suggests a method in establishing Network Security Guidelines and describes Principles for the provision of Network Security in HCEs. PMID:10163736
... 82 Ibid, 200. 83 Ibid, 200. 84 Ibid, 201. 43 Page 49. care to hunt down and execute all that claimed to be from the house of David. They considered ...
A Health Care Establishment (HCE) is an establishment where medical services are rendered. These services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. The spread of distributed information technology in HCEs have necessitated the implementation of Network Security in Health Care Information System (HCISs), to assure confidentiality, integrity and availability of HC information being transmitted across HC networks. This paper presents a road map in implementing Network Security guidelines for the provision of Network Security in HCEs, work carried out within the Secure Environment for Information Systems in Medicine (SEISMED) project under the Advanced Informatics in Medicine (AIM) programme. PMID:8591295
... dressing changes and site care, mid-line placement, placement of peripherally inserted central catheters, heparin locks, and patient education. ...
PurposeHealth information technology (HIT) and physician career satisfaction are associated with higher-quality medical care. However, the link between HIT and physician...Full Text Available
The economics of medical computer networks are presented in context with the patient care and administrative goals of medical networks. Design alternatives and network topologies are discussed with...Full Text Available
Summary Objective To evaluate the cost-effectiveness of an educational outreach intervention to improve primary respiratory care by South African nurses. Methods Cost-effectiveness analysis alongside a pragmatic cluster randomised controlled trial, with individual patient data. The intervention, the Practical Approach to Lung Health in South Africa (PALSA), comprised educational outreach based on syndromic clinical practice guidelines for tuberculosis, asthma, chronic obstructive pulmonary disease, pneumonia and other respiratory diseases. The study included 1999 patients aged 15 or over with cough or difficult breathing, attending 40 primary care clinics staffed by nurses in the Free State province. They were interviewed at first presentation, and 1856 (93%) were interviewed 3 months late...
BackgroundAlthough advances in rehydration therapy have made cholera a treatable disease with low case-fatality in settings with appropriate medical care, cholera continues...Full Text Available
In contrast to the increasing availability of information pertaining to the care of children with chronic kidney disease (CKD) from large-scale observational and interventional studies, epidemiological...Full Text Available
Brief admission of the new diabetic child and of a parent to an enlightened hospital for stabilisation, preliminary education, and familiarisation with hospital and community staff is well worth while....Full Text Available
Background Increasing numbers of cancer patients are using the Internet, but little is known about their attitudes toward online health care.Full Text Available
of injuries, disabilities, and deaths; and 3. Encourage professionals from a wide spectrum of disciplines such as engineering, bioengineering, medicine, health care, public...
This bibliography of nonserial publications consists of 610 annotations. It is intended as a guide to the development of a collection for librarians and for health professionals in research and education....Full Text Available
OBJECTIVE: To evaluate the effectiveness of a program to improve hypertension control practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Three hospital-based family...Full Text Available
Diethyl phthalate (DEP) and di-n-butyl phthalate (DnBP) are used extensively in personal care products, including fragrances (DEP) and nail polish (DnBP). Between May 2003 and...Full Text Available
Implementing a successful local area network for a publications work-group isn't as simple as the scarcity of information on the subject would suggest. Making a network work for your requires careful planning, developing and acquiring network expertise, transforming your group's patterns of working together, and carefully managing the human and technological resources.
Implementing a successful local area network for a publications work-group isn`t as simple as the scarcity of information on the subject would suggest. Making a network work for your requires careful planning, developing and acquiring network expertise, transforming your group`s patterns of working together, and carefully managing the human and technological resources.
BackgroundInformal payments for health care are common in most former communist countries. This paper explores the demand side of these payments in Albania. By using data from the...Full Text Available
Comprehensive geriatric care should receive nation-wide attention in order to realize its objectives. An analysis of patient problems at the Geriatirc Clinic, Tygerberg Hospital and Goodwood Aftercare Hospital is presented. The training of personnel, with full motivation of the community, to render health services to the aged is discussed. PMID:7368010
BackgroundEffectiveness of services for patients diagnosed with severe mental illness (SMI) may improve when treatment plans are needs based. A regional Cumulative Needs for Care...Full Text Available
Material related to routine as well as sensitive aspects of parent/day care center relationships is presented in this training module, one of a series providing staff development information for programs operated for dependents of military personnel. The module offers a brief discussion of ways caregivers can help parents feel at ease about leaving their children in child care and presents a set of multiple-choice skill-building exercises for effectively working with parents. Exercises focus on various topics, including how parents can be approached when their child may have a health problem, when child abuse or neglect is suspected, and when parental cooperation is needed to stop a child's undesirable or disruptive behavior. Exercises are also devoted to the questions of whether or not caregivers should act as advisors to parents or tell parents about their child's behavior at the center. Concluding exercises indicate how caregivers can ...
Background: Recent series describing the clinical presentation, response to therapy, and long-term outcome of Zollinger-Ellison syndrome are limited. Aims: To assess the clinical characteristics and long-term outcome of patients with Zollinger-Ellison syndrome. Methods: Over a 20-year period, patients with Zollinger-Ellison syndrome were enrolled in a prospective trial evaluating the efficacy of lansoprazole. Following dose stabilization, patients were followed on a 6-monthly basis with interval history, physical examination, endoscopy with gastric biopsies, gastric acid analysis and laboratory studies. Results: 72 patients (mean age 54+/-12 years, % male 58%, % Caucasian 69%) were prospectively enrolled. The clinical presentation was stereotypical for Zollinger-Ellison syndrome. Symptoms ...
PurposeTo evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery. DesignSystematic review and meta-analysis of retrospective interventional cases series. MethodsSearches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up ?3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal...
PurposeTo conduct a retrospective analysis within a large university teaching hospital, comparing outcomes between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer.Patients and MethodsBetween March 1996 and December 2000, 169 patients were treated radically for muscle-invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgical outcome data.ResultsThere was no difference in overall, cause-specific, and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31 local bladder recurrences...
Objectives The optimal timing of pyeloplasty for children diagnosed with ureteropelvic junction obstruction (UPJO) after workup for antenatal hydronephrosis is disputed. We sought to examine the potential costs and clinical outcomes of treatment protocols featuring different indications for pediatric pyeloplasty using Markov models. Methods Cost and outcomes analysis using Markov modeling was performed for three treatment algorithms: medical management, immediate pyeloplasty (during the first year of life), and pyeloplasty after no improvement on imaging. The costs were determined from the perspective of the medical institution. The variables tracked during Markov model simulation included age at resolution of UPJO, the proportion of patients with worsened hydronephrosis, the number of pye...
Systematically review risks of an infant being born with low birth weight (LBW), preterm birth (PTB) or small for gestational age (SGA) among married and unmarried women. Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies. Studies reporting birth outcomes of married and unmarried (single and cohabitant) were included. Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder, analytical, outcome assessments, and attrition. Meta-analyses were performed using random effect model for both unadjusted and adjusted data and odds ratio (OR), and 95% confidence interval (CI) were calculated. Twenty-one studies of low to moderate risk of bias were inclu...
Abstract Routinely used prognostic factors fail to predict clinical outcome in a significant proportion of breast cancer patients, implying that they can not detect some important biological characteristics. Chromosomal changes have been described in breast carcinomas for many years but their significance is not clear. We compared chromosomal changes with clinico-pathological characteristics and clinical outcome in 203 breast cancer patients with a follow-up of 9-18 years. Combining data from classical cytogenetics and flow cytometry revealed chromosomal abnormalities in 142 cases (70%). Of these, 51 (35.9%) contained two or more cytogenetically abnormal clones. Polyclonality was significantly associated with poor breast-cancer-specific survival (P = 0.03) within 5 years, independent of tu...
Abstract Objective:- This study explored 12-month outcome and its associations to social adjustment-related variables in patients with first-episode non-affective psychosis in Finland and Spain. Methods:- Forty-nine Finnish and 37 Spanish patients were evaluated at admission on various characteristics of social adjustment. Outcome was measured for 68 (79%) patients by the Brief Psychiatric Rating Scale, Global Assessment Scale, and Grip on Life. Results:- One-fourth of the patients experienced psychotic symptoms at follow-up. Sixty per-cent of the patients showed good global functioning and Grip on Life. In both patient groups, poor earlier global functioning, weak social network, poor Grip on Life, and psychological dependence on family of origin were associated with poor outcome. In the ...
Objective: To explore the interventional treatment for biliary re-stenosis after metallic stents placement in patients due to cholangiocarcinoma and evaluate its therapeutic effect. Methods: Percutaneous metallic stents placement or combined with continuously infusion arterial chemotherapeutic and chemotherapeutic embolization were performed in 12 patients with biliary re-stenosis using 12 metallic stents. Results: Once stent placement was 100% successful in all 12 cases, TBIL, ALT, GTP and AKP values 7 days postoperatively were significantly lower than that in preoperation. Jaundice was reduced satisfactorily in 12 patients. 3 patients were undergone continuously arterial chemotherapeutics infusion and chemotherapeutic embolization 4 weeks after stents placement. Conclusions: Percutaneous replacement of biliary metallic stents was effective and safe for palliation of malignant biliary re-stenosis and would be much better when combined with continuously arterial ...
The Zollinger-Ellison syndrome (ZES) is taken as an example of the diagnostic and therapeutic strategy in gastro-entero-pancreatic endocrine tumours, given the standard characteristics of this procedure, whatever the nature of the primitive tumour. Management of ZES includes: anatomical localization of gastrinoma and of possible metastases, in 60 % of cases this step conditioning therapeutic indications and chances of cure; search of a type 1-multiple endocrine neoplasia (MEN A), in 25 % of cases; therapeutic indications: ablative surgery with curative intent in case of gastrinoma and of resectable liver metastases, palliative treatment otherwise: anti-secretory drugs, somatostatin analogues, chemotherapy and interferon {alpha}; long-term follow-up of patients with resected tumour. At each step, somatostatin receptor scintigraphy with indium 111-pentetreotide does play a pivotal role. (author). 110 refs.
MRI provides a non-invasive diagnostic tool complementing echocardiography on one hand, and showing advantages over echocardiography, on the other hand, especially after corrective procedures. The multiple different MRI sequences need to be adapted to examinations of children and patients with congenital heart disease (CHD), and can be used to detect morphologic changes, blood-flow in the heart and thoracic vessels and diastolic or systolic function of myocardium. Several factors determine the success of the examination of a complex congenital heart disease or a postoperative situs. Pediatric radiologists and radiologists experienced in congenital heart diseases have to work in close cooperation. Echocardiography should be performed before MRI. The results of prior examinations and the clinical history of the patients, including possible palliative or reconstructive operations, must be available before MRI to guide the planning of the examination. With a systematic ...
Rapid corrosion of PWR steam generator carbon steel support structures and consequential denting of steam generator tubes led to considerable investigation of the mechanism of corrosion and for palliatives. The basic mechanism is now fairly well understood. Chloride present in the boiler feedwater from condenser leakage is concentrated in the support plate crevice as a result of the superheat present. This leads to the formation of a low pH acid ferrous chloride environment either through the hydrolysis of a weak base chloride such as MgCl_2 or the combined action of a neutral chloride with an oxidizing agent. Rapid attack of the carbon steel ensues with the Fe_3O_4 corrosion product forming at the metal/oxide interface. This oxide has a volume approximately twice that of the steel consumed and thus eventually fills the crevice between the tube and the support plate. Oxide growth continues leading to compression of the Alloy 600 primary tube and to distortion and ...
To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression. Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used. Thirty of 31 attempted ...
BackgroundModern metal-on-metal hip resurfacing implants are being increasingly used for young and active patients, although the long-term outcome and failure mechanisms of these...Full Text Available
ObjectiveWe describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with...Full Text Available
Transcatheter arterial chemoembolization (TACE) has become the standard treatment modality for unresectable hepatocellular carcinoma (HCC). Nonetheless, the clinical outcomes in patients with unresectable...Full Text Available
Background and objectives: The severity of anemia at which to initiate erythropoiesis-stimulating agent (ESA) treatment in nondialysis chronic kidney disease (CKD) patients is unclear. Risk of mortality,...Full Text Available
BackgroundResponse shift theory suggests that improvements in health lead patients to change their internal standards and re-assess former health states as worse than initially rated...Full Text Available
1. We have studied determinants of outcome of 7 day courses of treatment in 77 middle aged and elderly patients, in whom the general practitioner's diagnosis of urinary tract infections had been confirmed...Full Text Available
The functional outcome after stroke is unpredictable; it is not accurately predicted by clinical pictures upon hospital admission. The presence of apoptotic neurons in the ischemic penumbra and perihematoma...Full Text Available
This study describes procedures and outcomes in a functional analysis of problem behavior of 2 public school students. For a 13-year-old honors student, bizarre tacts (labeled as psychotic speech by...Full Text Available
Fetal growth restriction (FGR) is an adverse pregnancy outcome associated with significant perinatal and paediatric morbidity and mortality, and an increased risk of chronic disease later in adult life....Full Text Available
ObjectivesThe objective of this paper is to describe the complex mixed-methods design of a study conducted to assess health-related quality of life (HRQOL) outcomes...Full Text Available
Study DesignThis is a retrospective study that was done according to clinical and radiological evaluation.PurposeWe analyzed the clinical and radiological...Full Text Available
A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier...Full Text Available
Aim:Report of 125 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response...Full Text Available
BACKGROUNDSolid-pseudopapillary neoplasms (SPNs) are rare pancreatic tumors with malignant potential. Clinicopathologic characteristics and outcomes of patients with...Full Text Available
Hip fractures are associated with a high rate of mortality and profound temporary and sometimes permanent impairment of quality of life. Current guidelines indicate that surgeons should perform surgery...Full Text Available
BackgroundThere have been dramatic changes in the approach to screening for aneuploidy over the last 20 years. However, the approach to screening for other complications of pregnancy...Full Text Available
Disorders of mitochondrial fat metabolism lead to sudden death in infants and children. Although survival is possible, the underlying molecular mechanisms which enable this outcome have not yet been...Full Text Available
While research has shown that patients’ beliefs about their pain are related to pain adjustment and treatment outcomes, little is known about the beliefs of their significant others....Full Text Available
Background and objectives: The relationship between serum potassium (SK) and mortality in chronic kidney disease (CKD) has not been systematically investigated.Design, setting, participants,...Full Text Available
BackgroundSymptomatic heterotopic ossification (HO) in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the...Full Text Available
ObjectivesTo examine the strength of the volume–outcome relationship among paramedics, a group of providers that has not been previously studied in this context. By identifying...Full Text Available
Lifetime exposure to physical activity is an important construct for evaluating associations between physical activity and disease outcomes, given the long induction periods in many chronic diseases....Full Text Available
The relationship between malaria transmission intensity and clinical disease is important for predicting the outcome of control measures that reduce transmission. Comparisons of hospital data...Full Text Available
The refractive error in 15 eyes with threshold retinopathy of prematurity treated with diode laser photocoagulation was compared with 25 eyes with the same disease severity treated by cryotherapy. Myopia...Full Text Available
SummaryRadiotherapy is used commonly in the treatment of gynecologic malignancies. Many patients experience emotional distress prior to the initiation of radiotherapy, during...Full Text Available
BackgroundIn cancer research, the association between a gene and clinical outcome suggests the underlying etiology of the disease and consequently can motivate further studies. The...Full Text Available
Thirty chemicals or substances currently undergoing long-term carcinogenicity bioassays in rodents have been used in a project to further evaluate methods and information that may have the capability...Full Text Available
BackgroundDifferent microarray studies have compiled gene lists for predicting outcomes of a range of treatments and diseases. These have produced gene lists that have little overlap,...Full Text Available
OBJECTIVEModerately preterm infants (30–34 6/7 weeks’ gestational age) represent the largest population of NICU residents. Whether their clinical...Full Text Available
Idiopathic pulmonary fibrosis (IPF) is a progressive disease with poor survival. The identification of therapeutic targets is essential to improving outcomes. Previous studies found that expression...Full Text Available
Background and objectives: Blacks are over-represented among dialysis patients, but they have better survival rates than whites. It is unclear if the over-representation of blacks on dialysis is due...Full Text Available
Nineteen of 69 patients undergoing coronary angioplasty required immediate coronary surgery after the procedure. Six of these operations were planned as a result of angioplasty that failed without producing...Full Text Available
Cognitive rehabilitation is an effective intervention for addressing cognitive impairments in patients with schizophrenia. Previous research has shown that the early application of Cognitive...Full Text Available
Theoretically, the outcome of World War II in Europe hung in the balance as the Allies poured onto the Normandy beachhead. Following the June 6, 1944 invasion, the Allies continue to come ashore, massively building up men and material inside the beachhead...
The identification of predictive biomarkers is at the core of modern toxicology. So far, a number of approaches have been proposed. These rely on statistical inference of toxicity response from either...Full Text Available
IntroductionTerror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003...Full Text Available
Currently, the outcome of patients with intermediate-and poor-risk germ cell tumors at diagnosis is optimized by the use of risk-appropriate chemotherapy and post-chemotherapy surgical resection of...Full Text Available
This 3-year longitudinal study investigated whether low-wage employment was associated with improved psychological and parenting outcomes in a sample of 178 single mothers who were employed...Full Text Available
BackgroundHigh serum uric acid concentration (hyperuricemia) has been studied for its relationship with multiple adverse health outcomes, such as metabolic syndrome. Intervention...Full Text Available
ObjectiveThis report describes initial activities of the Cancer Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function domain group (CaPS-SF),...Full Text Available
BackgroundHealth related quality of life (HRQoL) is one of the most important outcomes to measure effectiveness of an intervention, especially for islet transplantation...Full Text Available
ContextResponse Evaluation Criteria in Solid Tumors [RECIST (unidimensional)], World Health Organization [WHO (bi-dimensional)] and European Association for Study...Full Text Available
BackgroundPregnant women are more susceptible to severe Plasmodium falciparum malaria, which can lead to poor maternal and fetal outcomes. Few data exist on the...Full Text Available
ObjectiveTo evaluate the effectiveness of a community pharmacist–based home blood pressure (BP) monitoring program.DesignTrial of a high-intensity...Full Text Available
Between 50 and 70% of patients with a terminal illness indicate a preference to remain at home for as long as possible until their death. Nevertheless, a much smaller percentage actually die at home...Full Text Available
The outcome of various osteoprogenitor-cell transplantation protocols was assessed using Col1a1-GFP reporter transgenic mice. The model requires the recipient mice to undergo lethal total body irradiation...Full Text Available
Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people...Full Text Available
Abstract Aims: This study performed a systematic review and meta-analysis on glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) treated with lispro (LP) versus regular insulin (RI) since before pregnancy. Methods: We performed a MEDLINE and EMBASE search. Abstracts (and full articles when appropriate) were reviewed by two independent researchers. Inclusion criteria were patients with T1DM, data on women treated with RI and LP since before pregnancy until delivery in the same article, at least five pregnancies in each group, and information on at least one pregnancy outcome. Quality assessment was performed using the Newcastle?Ottawa Quality Assessment Scale for cohort studies. Results: Outcome data were summarized with Revman version 5.0 (ims.cochrane.org...
The National Cancer Institute Laboratory of Human Carcinogenesis is seeking statements of capability or interest from parties interested in collaborative research to further develop, evaluate, or commercialize a gene signature for prognosis of hepatocellular carcinoma in patients.
Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes of the split anterior tibialis tendon transfer (SPLATT) for correction of...Full Text Available
Objectives. Ninety-one fetuses with dilated or hypertrophic cardiomyopathy (DCM, HCM) and myocarditis were studied. Results. Group 1 “DCM”...Full Text Available
In this letter we report the outcome for the microscopic approach for the semi-magic nuclei /sup 88/Sr and /sup 90/Zr. For comparison, we have also treated the semi-phenomenological version for the Migdal and SDI force.
An application of the renormalized random phase approximation to nuclear structure is presented for the semi-magic nuclei /sup 88/Sr and /sup 90/Zr. It is reported the outcome for the microscopic approach in comparison with the semiphenomenological version for the particle-hole forces.
Inclusion of family members in the assessment of patients with chronic pain can improve outcomes. Family functioning can be assessed in four basic areas: boundaries, power, communication, and intimacy....Full Text Available
The current study investigated relations among ethnic similarity in caregiver-therapist pairs of youth participating in Multisystemic Therapy, therapist adherence, and youth long-term behavioral and criminal outcomes. Participants were 1,979 youth and families treated by 429 therapists across provider organizations in 45 sites. Relations were found, independently, and in the presence of ethnic similarity, between adherence and reductions in youth externalizing and internalizing behavior problems 1-year posttreatment and youth criminal charges 4 years posttreatment. Relations between ethnic similarity and outcomes were found only for reductions in youth externalizing behavior problems and not when adherence was included in the model. Adherence ratings were higher, however, in ethnically similar caregiver-therapist pairs, and evidence was found that this increased adherence predicted slightly better outcomes for youth. ...
Background:There is a need for simple imaging parameters capable of predicting therapeutic outcome.Methods:This retrospective study analysed 50 patients...Full Text Available
Background:This study evaluated the outcomes of patients with complex or persistent thoracobiliary fistulae following penetrating liver trauma, who underwent endoscopic biliary intervention...Full Text Available
ObjectiveAlthough endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because...Full Text Available
IntroductionRadiotherapy outcomes might be further improved by a greater understanding of the individual variations in normal tissue reactions that determine tolerance. Most published...Full Text Available
BackgroundOne-stage implant placement has clinically acceptable treatment outcomes. Among other advantages, it may allow investigation of early wound healing. The...Full Text Available
IntroductionIn critically ill patients the relationship between the storage age of red blood cells (RBCs) transfused and outcomes are controversial. To determine if duration of RBC...Full Text Available
ObjectivesWe undertook a meta-analysis to assess outcomes for drug-eluting (DES) and bare metal stents (BMS) in percutaneous coronary intervention (PCI) for unprotected...Full Text Available
Detrended fluctuation analysis (DFA) is a recently developed technique suitable for describing scaling behavior of variability in physiological signals. The purpose of this study is to explore...Full Text Available
AIM: To compare 2 different types of covered esophageal nitinol stents (Ultraflex and Choostent) in terms of efficacy, complications, and long-term outcome.METHODS: A retrospective review of...Full Text Available
Background & objectives: Fatigue is a debilitating symptom experienced by patients undergoing dialysis, but there is only limited information on its prevalence and its association with patient...Full Text Available
PurposeWound infection after an ileostomy reversal is a common problem. To reduce wound-related complications, purse-string skin closure was introduced as an alternative to conventional...Full Text Available
ObjectiveThe purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for...Full Text Available
Mechanism-based inhibition of cytochrome P450 (CYP) 3A4 is characterized by NADPH-, time-, and concentration-dependent enzyme inactivation, occurring when some drugs are converted by CYPs to reactive...Full Text Available
ObjectiveDisc herniations at the L1-L2 and L2-L3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgical outcome....Full Text Available
BackgroundInadequate platelet inhibition despite aspirin and clopidogrel therapy during and after a percutaneous coronary intervention is associated with an impaired clinical outcome....Full Text Available
Average human behavior in cue combination tasks is well predicted by Bayesian inference models. As this capability is acquired over developmental timescales, the question arises, how it is learned....Full Text Available
Anxiety may cause adverse outcomes through physiologic pathways in patients with cardiac disease. The purpose of this dissertation was to investigate anxiety and its correlates in persons with acute myocardial infarction (AMI) and heart failure (HF). The ...
BackgroundSocial isolation affects a significant proportion of older people and is associated with poor health outcomes. The current evidence base regarding the effectiveness of...Full Text Available
IntroductionLaparoscopic distal pancreatectomy has been described for more than a decade now and has been considered technically feasible, safe, and with reproducible outcomes. It...Full Text Available
BackgroundDuring surgery, controlled haemostasis to prevent blood loss is vital for a successful outcome. It can be difficult to ligate vessels located deep in the abdomen. A device...Full Text Available
BackgroundHip surface replacement arthroplasty (SRA) can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly...Full Text Available
BackgroundHealth-Related Quality of Life assessment is widely used in clinical research, but rarely in clinical practice. Barriers including practical difficulties administering...Full Text Available
This document presents the results of a review of publicly available information on energy use in health care facilities. The information contained in this document and in the sources cited herein provides the background and context for efforts to reduce energy use and costs in health care. Recognizing the breadth and diversity of relevant information, the author acknowledges that the report is likely not comprehensive. It is intended only to present a broad picture of what is currently known about health care energy use. This review was conducted as part of a 'High Performance Health Care Buildings' research study funded by the California Energy Commission. The study was motivated by the recognition that health care facilities collectively account for a substantial fraction of total commercial building energy use, due in large part to the very high energy ...
Abstract Background- Vitiligo, characterized by destruction of melanocytes, causes a patchy depigmentation of the skin. It has been hypothesized to have an autoimmune pathogenesis. Autoimmune disorders are more common among women and may be associated with adverse pregnancy outcomes, such as recurrent abortions, intrauterine growth restriction (IUGR), and pre-eclampsia. Objective- The purpose of this study was to investigate whether patients with vitiligo have increased rates of gestational complications. Methods- A retrospective comparative study was undertaken comparing pregnancy complications of patients with and without vitiligo. The population was composed of all singleton deliveries that occurred at the Soroka University Medical Center in Israel during the years 1988-2006. Women lack...
Hung and Quyen's model (analysis of strategic interactions between players in the game theoretic framework) is first recapitulated. Solutions to the embargo game with the seller acting as the Stackelberg leader in both periods. Then the timing coordination issue is discussed and perfect equilibrium outcomes under different structures of leader-follower in the game are compared. Numerical simulations show that the structure corresponding to alternated leadership from one period to the other yields the perfect equilibrium outcome that is Pareto improving with respect to the structure where the buyer is first mover in both periods and Pareto dominant for some specific values of the parameters embedded in the game.
Strategic management of key accounts has become an important component of many companies' sales efforts. This research introduces a strategic framework of key account performance that integrates theory from relationship marketing, key account management, and customer equity. Using the three drivers of customer equity - value equity, brand equity, and relationship equity - the framework captures both the relational outcomes (relationship commitment and trust) and financial performance outcomes (profitability and share of spend) of strategic decisions made in key account programs. Implications and future research are then discussed.
Anesthetic techniques vary widely in the endovascular repair of abdominal aortic aneurysms (EVAR). Previous studies have demonstrated the feasibility of using local anesthesia. However, the ideal anesthetic technique has not been determined. This study examines whether anesthesic technique influences the outcomes of EVAR. Data regarding demographics, risk factors, procedural characteristics, recovery characteristics, treatment complications, acute ( 0.05, ANOVA). From these results we concluded that EVAR with local anesthesia is a safe and efficacious method that may reduce recovery times and postoperative medical morbidity compared to use of genera1 or spinal/epidural anesthesia.
The OASIS Registry started annual collection of longitudinal data on patients on home parenteral nutrition (HPN) in 1984. This report describes outcome profiles on 1594 HPN patients in seven disease categories. Analysis showed clinical outcome was principally a reflection of the underlying diagnosis. Patients with Crohn's disease, ischemic bowel disease, motility disorders, radiation enteritis, and congenital bowel dysfunction all had a fairly long-term clinical outcome, whereas those with active cancer and acquired immunodeficiency syndrome (AIDS) had a short-term outcome. The long-term group had a 3-year survival rate of 65 to 80%, they averaged 2.6 complications requiring hospitalization per year, and 49% experienced complete rehabilitation. The short-term group had a mean survival of 6 months; they averaged 4.6 complications per year and about 15% experienced complete rehabilitation. The registry ...
Objectives This paper examines the determinants of the insureds decision to use their health insurance card when seeking outpatient and inpatient health care in Vietnam. Methods Uses Vietnams latest Household Living Standard Survey data and random-intercept logistic regression to assess the influence of the observed individual, household and commune/ward factors on the insureds decision to access health insurance benefits while controlling for the unobserved commune/ward-specific factors. Results Compared to the compulsory enrollees, the voluntary enrollees and the beneficiaries of the Health Care Fund for the Poor are less likely to use their card when seeking inpatient care. An individuals likelihood of accessing insurance benefits varies inversely with income and the level of education,...
Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of 30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated. Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderat...
Participants in the conference selected to attend two different working group sessions. The working groups discussed different perspectives of system-based approaches to osteoporosis and fracture care. The group on postfracture case management recommended that nurse case managers be used to improve communication among patients, orthopaedic surgeons, and those providing ongoing clinical care. The hospital working group discussed the impact of and barriers to improved postfracture management in the hospital setting. The health systems group emphasized the difference between a closed system in which long-term benefits of interventions were more likely to be appreciated than in fee for service systems. The health information technology group discussed the advantages and challenges of electroni...
Opinion statement Because a minority of patients with D-transposition of the great arteries are diagnosed in utero by ultrasound, most present after delivery with cyanosis. In the absence of apparent lung disease, cyanotic neonates suspected of having a cardiac lesion should be immediately transferred to an intensive care unit at a pediatric tertiary care center for monitoring, resuscitation, and to define the cardiac anatomy and physiology. A prostaglandin E-1 infusion is usually initiated to maintain ductal patency and promote intra-cardiac mixing. In the past, balloon atrial septostomy (BAS) was routinely performed to enlarge the atrial septal defect and improve intra-cardiac mixing while the infants awaited surgery. Recent literature has reported an increase risk of stroke in neonates ...
Objective. Preterm neonates are susceptible to infection due to a combination of sub-optimal immunity and increased exposure to invasive organisms. Invasive fungal infections are associated with significant morbidity and mortality among preterm infants cared for in the neonatal intensive care unit (NICU). Mannose-binding lectin (MBL) is a component of the innate immune system, which may be especially important in the neonatal setting. The objective of this study was to investigate the presence of any association between MBL gene polymorphism and nosocomial invasive fungal infection in preterm neonates. Methods. Codon 54 (B allele) polymorphism in exon 1 of the MBL gene was investigated in 31 patients diagnosed as nosocomial invasive fungal infection and 30 control preterm neonates. Results...
Despite the many advances in scientific research over the last several decades, cutting edge technologies and therapeutics often take many years to find their way into widespread use. The dissemination and uptake of best practices into clinical care is sometimes a neglected component of research that is essential to improve the population?s health. Type 2 translational research, sometimes called ?Proof in Practice Research,? seeks to maximize the yield of what has been learned from the bench and from carefully controlled clinical trials and to extend those benefits to a larger population. One aspect of type 2 translational research, sometimes called evidence implementation or implementation science, applies what has been learned about clinical medicine to achieve best practices across prov...
Reliable exposure information for cosmetic and other personal care products and ingredients is needed in order to conduct safety assessments. Essential information includes both the amount of product applied, and the frequency of use. To obtain current data, studies to assess consumer use practices were undertaken. Six widely used personal care product types were included in the studies. Five of the products were cosmetics (spray perfume, hairspray, liquid foundation, shampoo, body wash) and one product was a cosmetic/over-the-counter drug product (solid antiperspirant). Three hundred and sixty women, ages 19-65 years, who regularly use the products of interest, were recruited at 10 different geographical locations within the US. The number of recruits was chosen to ensure a minimum of thr...
The objective of this study was to evaluate the association between the number of blood cultures collected and the appropriateness of care for suspected bacteremic community-acquired urinary tract infection (UTI) in the elderly. We retrospectively evaluated the medical records of 129 patients with UTI >65?years old admitted to a large community-based training hospital in Japan from 1 January 2006 to 31 December 2009. We assessed the association between the number of blood cultures collected and the appropriateness of care received, as well as other factors. Two-thirds of the patients were women, and patients >85?years old accounted for 45.0% of the cases. Most of the organisms isolated from the urine and blood were Escherichia coli (65.4?67.0%). More than two blood cultures were collected ...
Background ?Guidelines for safe and effective management and use of point of care testing? have been recently launched in Ireland. Aims To survey point of care testing (POCT) services in the Republic of Ireland. Methods A questionnaire covering accreditation status, existence of POCT committees, quality management systems, and staff resources was distributed by the Irish External Quality Assessment Scheme (IEQAS). Results Of those that returned completed questionnaires, 56% had assigned specific POCT responsibilities to designated staff. Most support was for blood gases and glucose analysis. Compared with other published studies, Irish laboratories gave similar support for blood gases, less for glucose and much less for urinalysis. Conclusions This survey demonstrated poor IT support for P...
BackgroundHow socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly...Full Text Available
A public health emergency such as an influenza pandemic will lead to shortages of mechanical ventilators, critical care beds, and other potentially life saving treatments. This will raise difficult...Full Text Available
... be able to watch the many intricate steps Dr. Richard Alexander must accomplish to remove the cancer. ... door to informed medical care. Now let's join Dr. Richard Alexander at the University of Maryland Medical ...
Patient decision support systems have a promising role in the delivery of health care. However, the best approach for further development of these systems is a matter of speculation. To help chart a...Full Text Available
BackgroundStrategies to accurately identify the occurrence of specific health care events in administrative data is central to many quality improvement and research efforts. Many...Full Text Available
Patients who fail to attend initial appointments reduce clinic efficiency. To maximize attendance by newly referred outpatients, we introduced a mandatory group orientation clinic for all new patients...Full Text Available
Objective To establish current practice in the use of Read codes for diabetes.Design Cross sectional study.Setting 17 practices in the Battersea...Full Text Available
Personal Health Records (PHRs) are increasingly recognized as a strategy to improve patient-provider communication, availability of health information, and quality of care, by making the delivery of...Full Text Available
Albeit the considerable progress that has been made both in our understanding of the pathophysiology of acute renal failure (ARF) and in its treatment (continuous renal replacement therapies), the morbidity...Full Text Available
Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular...Full Text Available
Over 30 months 9292 consecutive patients admitted to nine coronary care units with suspected myocardial infarction were considered for admission to a randomised double blind study comparing the effect...Full Text Available
OBJECTIVE: The objective was to define and characterize the costs associated with trauma care at a level I trauma center. Once the costs were identified, attending physician-led teams were designed...Full Text Available
BackgroundThere has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk...Full Text Available
BackgroundDespite having the largest population in Africa, Nigeria has no accurate population based data to plan and evaluate eye care services. A national survey was undertaken...Full Text Available
The Joint Commission on Accreditation of Hospitals (JCAH) has continuously emphasized improvement in the quality of care provided in hospitals as the central purpose of the accreditation process. In...Full Text Available
Patient-centered interdisciplinary health care for children with chronic medical disorders represents an evolution from the traditional “stop and go” treatment for acute illnesses. This...Full Text Available
This Mini-Computer-Assisted Nursing Management System allows nursing to control staffing costs and more effectively relate staffing to patient care requirements. Nursing resources are prospectively...Full Text Available
Although the demand for use of information technology within the healthcare industry is intensifying, relatively little has been written about guidelines to optimize IT investments. A technology architecture...Full Text Available
Abstract The Read Thesaurus (Version 3 of the Read Codes) is a controlled medical vocabulary produced during the Clinical Terms Projects with the involvement of over 2,000 health care...Full Text Available
Skin cancers in skin of color often present atypically or with advanced stage in comparison to Caucasian patients. Health care providers must maintain a high index of suspicion when examining...Full Text Available
Dental caries continues to be a common chronic disease among various population groups. Patient care can be improved with detection at the earliest stage. However, current techniques do not...Full Text Available
BackgroundSeverely disabling chronic pain in the adult population is strongly associated with a range of negative health consequences for individuals and high health care costs,...Full Text Available
ObjectiveTo implement a role-reversal exercise to increase first-year pharmacy students' awareness of communication barriers in the health care setting, especially for deaf and hard-of-hearing...Full Text Available
Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic...Full Text Available
BackgroundInternet education is increasingly provided to health professionals, but little is known about the most effective strategies for delivering the content. The purpose of...Full Text Available
ObjectiveTo test whether a disclosure intervention improves subjective health and reduces medical consumption and sick leave in somatising patients in general practice.DesignNon-blind...Full Text Available
Background In May 2000, AstraZeneca launched a Web service for asthma patients and health-care providers called LinkMedica, which includes an asthma diary for...Full Text Available
Continuing Medical Education (CME) is a requirement among practicing physicians to promote continuous enhancement of clinical knowledge to reflect new developments in medical care. Previous research...Full Text Available
ObjectiveThe authors present an Electronic Healthcare Record (EHR) server, designed and developed as a proof of concept of the revised prEN13606:2005 European standard concerning...Full Text Available
The current obesity pandemic is expected to result in considerable downstream morbidity, mortality and incremental costs to health care systems around the world. The major metabolic complications of...Full Text Available
BackgroundMefloquine has historically been considered safe and well-tolerated for long-term malaria chemoprophylaxis, but its prescribing requires careful attention to rule out contraindications...Full Text Available
ObjectiveComputerized physician order entry with clinical decision support has been shown to improve medication safety in adult inpatients, but few data are available regarding its...Full Text Available
This program focused on practice-level service change as a means of improving patient care and developing leadership skills of 19 general practitioners (GPs) and aimed to: promote and support change...Full Text Available
In terms of managing thrombotic disorders, genotype-based individualized patient care emerged as early as 1994 when the association of factor V Leiden (G1691A), and later, prothrombin (G20210A),...Full Text Available
BACKGROUND:Reports indicate that characteristics of older adults with chronic pain may be different than those of younger persons.OBJECTIVE:To study...Full Text Available
An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands...Full Text Available
BackgroundOral cancer is as prevalent as cervical and testicular cancer in the United Kingdom. Nursing staff provide the oral health care for the patient population in hospital....Full Text Available
BackgroundNorway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric...Full Text Available
...Programme Manager Interests Multilevel Statistical Modelling Geography of Health and Health Care Geographical Data Analysis Census Data Analysis Health Services Research (in particular Research Design, Statistical Analysis and Epidemiology) people/mgould.html Homepage | Contacts | Site Map | Privacy Statement | Webmaster | ...
...research and publications and some who are accredited by the British Association of Sport and Exercise Sciences (BASES), which enables them to work with high performance athletes . We care about your progress and welfare. As our recent QAA review noted \\
Out of nearly 900 women in a research study of human immunodeficiency virus infection in pregnancy, 8 were subsequently found not to be infected. Misdiagnoses could have resulted from (a) laboratory...Full Text Available
Laparoscopic colon surgery for select cancers is slowly evolving as the standard of care but minimally invasive approaches for rectal cancer have been viewed with significant skepticism. This procedure...Full Text Available
We report on the presentation and management of a patient with herniation of the rectum following a coccygectomy. We used an abdominal approach and careful pelvic dissection to define the defect in...Full Text Available
The needs of hospitalized geriatric patients differ from the needs of hospitalized younger adults. In an attempt to improve systems of care for the older adult, the Centers for Medicare and Medicaid...Full Text Available
... the nest with young when the female left (male meadow voles were in the nest with young too infrequently ... prairie voles, whereas the number of checks that male meadow voles were in the nest increased s...
PurposeTo assess the prevalence and the dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck (HN) cancer who underwent...Full Text Available
Background and ObjectiveCervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It...Full Text Available
ObjectiveTo investigate possible differences in operative delivery rate among low-risk women, randomised to an alongside midwifery-led unit or to standard obstetric units within...Full Text Available
ObjectivesIn 2003, the Omani Ministry of Health Child Health Care Program initiated a national Birth Defects (BD) Register. This paper reviews the magnitude and risk factors of birth...Full Text Available
BackgroundThe prevalence of tobacco use among individuals with mental illness remains a serious public health concern. Tobacco control has received little attention in community...Full Text Available
The Clinical Summary is a Web-based application for accessing the clinical database at the Massachusetts General Hospital. The application has been developed to give physicians in our health care community...Full Text Available
Policies and regulations in the current health care environment have impacted the manner in which patient data - especially protected health information (PHI) - are handled in the clinical and...Full Text Available
ObjectiveMany hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness...Full Text Available
PURPOSE We wanted to assess the impact of an electronic health record–based diabetes clinical decision support system on control of hemoglobin A1c (glycated hemoglobin),...Full Text Available
We previously demonstrated the ability to create engineered arteries by carefully controlling the mechanical environment of intact arteries perfused ex vivo, yielding engineered arteries...Full Text Available
Giardiasis is recognized as a worldwide public health problem. Seroprevalence data from both the developing and developed world show high rates of carriage in populations at risk for fecal-oral transmission,...Full Text Available
BackgroundSarcoma encompasses an uncommon group of cancer and the data is insufficient from Pakistan. We report our four years experience of Sarcoma of soft tissues and bones.MethodsThis...Full Text Available
ObjectiveWhile essential for patient care, information related to medication is often written as free text in clinical records and, therefore, difficult to use in computerized systems....Full Text Available
ObjectiveThe study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central...Full Text Available
Background:The minimum hemoglobin cutoff for blood donation in India is 12.5 gm% for both male and female donors and the minimum donation interval is 3 months. Donation...Full Text Available
Ever-changing audio technology requires that National Library Service NLS always be aware of developments and prepare carefully for any systematic changes that may be desired or required. Usefulness, cost effectiveness, thoughtful stewardship, and educate...
Total health care expenditure in 2006 was $2.1 trillion. This figure is estimated to double within the next few years as the cost of treating diabetes and other chronic conditions continues to rise....Full Text Available
It is usually very complex to design an Integrated Information System in a hospital that includes both in-patient and out-patient medical care data. The difficulty appears because each department...Full Text Available
PurposeTo develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery.Full Text Available
BackgroundChina has had no effective and systematic information system to provide guidance for strengthening PHC (Primary Health Care) or account to citizens on progress. We report...Full Text Available
BACKGROUND AND AIMS:In view of increasing therapeutic efficacy, the delivery of hepatitis C virus (HCV) antiviral treatment is expected to increase. Yet practical experience reveals...Full Text Available
BackgroundEffective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening...Full Text Available
BackgroundMany health care professionals use spinal palpatory exams as a primary and well-accepted part of the evaluation of spinal pathology. However, few studies have explored...Full Text Available
The purpose of the meeting reported here was to develop a set of national evidence-based standards for assessing and managing patients with potentially resectable rectal cancer. This report represents...Full Text Available
ObjectivesTo see whether there are age variations in the relationships between having a close companion friend at church, health, and outpatient physician visits.Full Text Available
You receive an annuity if eligible -- requires 18 months service for FERS; and 60 ... You may use up to 104 hours of your accrued sick leave to care for sick family ...
Social support is a critical, yet underutilized resource when undergoing cancer care. Underutilization occurs in two conditions: (a) when patients fail to seek out information, material assistance,...Full Text Available
... yourself to call 911 until you have performed CPR for about 2 minutes. 3. Carefully place the ... more breaths. The chest should rise. 9. Continue CPR (30 chest compressions followed by 2 breaths, then ...
... and retrieve an AED until you have performed CPR for about 2 minutes. 3. Carefully place the ... more breaths. The chest should rise. 9. Continue CPR (30 chest compressions followed by 2 breaths, then ...
home when you are sick helps everyone you care about Questions & Answers Flu Vaccine: Q&A Vaccine Dosage & Administration Vaccine Supply for 2011-12 Season Vaccine Supply and...
home when you are sick helps everyone you care about Questions & Answers Flu Vaccine: Q&A Vaccine Dosage & Administration Vaccine Supply for 2011-12 Season Vaccine Supply and...
home when you are sick helps everyone you care about Questions & Answers Flu Vaccine: Q&A Vaccine Dosage & Administration Vaccine Supply for 2011-12 Season Vaccine Supply and...
Drownings in Recreational Water Settings - United States, 2001-2002 While immediate CPR can save someone's life, often medical care in the hospital cannot prevent serious...
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)–infected subjects. Initiation of antiretroviral therapy is associated with a 2%–6% decrease...Full Text Available
The aim of the overview is to give a perspective of global biobank development is given in a view of positioning biobanking as a key resource for healthcare to identify new potential markers that can...Full Text Available
The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic...Full Text Available
Abstract This paper focuses on the basic principles of information technology (IT) organization within health sciences centers. The paper considers the placement of the leader of the...Full Text Available
BACKGROUND:The value of other health care professionals is increasingly being recognized to compensate for the shortage of physicians in Canada. Chronic cough is one of the most...Full Text Available
BackgroundComputer-based health-risk assessments are electronic surveys which can be completed by patients privately, for example during their waiting time...Full Text Available
Validation of body-mass relationships requires a careful statistical analysis of data of normal weight individuals. BMI (ratio between body mass and square of body height) and BSI values (ratio between...Full Text Available
Careful measurements do not confirm an anomalous anisotropy in the angular distribution of fission fragments from the fast neutron fission of Americium 242. The energy range covered was 1.60-3.15 MeV. (AIP)
Information needs that arise when clinicians use clinical information systems often go unresolved, forcing clinicians to defer decisions or make them with incomplete knowledge. My research characterizes...Full Text Available
ContextWhile opioids are increasingly used for chronic non-cancer pain (CNCP), we know little about opioid dosing patterns among individuals with CNCP in usual care...Full Text Available
Alton Ochsner was a giant of American surgery. His career encompassed patient care, teaching, and research as symbolized on the original seal of the Ochsner Clinic. His ideas were innovative and groundbreaking...Full Text Available
This study describes instructions for after-hours care offered by family physicians' offices when patients telephone the practice. Randomly selected (n=1,680) Ontario family physicians and general practitioners...Full Text Available
Platelet reactivity plays a pivotal role in the pathogenesis of ischemic adverse events during and after acute coronary syndromes (ACS), and percutaneous coronary intervention (PCI). Glycoprotein (GP)...Full Text Available
BackgroundErrors have been the concern of providers and consumers of health care services. However, consumers' perception of medical errors in developing countries is rarely explored....Full Text Available
BackgroundIntrapartum fetal hypoxia remains an important cause of death and permanent handicap and in a significant proportion of cases there is evidence of suboptimal care related...Full Text Available
BackgroundParents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL). Insight in the dynamics of factors influencing parental HRQoL is necessary...Full Text Available
BackgroundTraffic injuries can cause physical, psychological, and economical impairment, and affected individuals may also experience shortcomings in their post-accident care and...Full Text Available
Recent health care policies and regulations have impacted the manner in which patient data – especially protected health information (PHI) – are handled in both the clinical...Full Text Available
...2010-10-01 false Special rules relating to group health plans. 146.145 Section 146.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH...
...discrimination against participants and beneficiaries based on a health factor. 146.121 Section 146.121 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH...
...named Chair at Epworth Hospital Professor Nilmini Wickramasinghe has been named Chair, Health Information Management , at Epworth HealthCare. Related links School of Business ...the College of Business at RMIT University has been named Epworth Chair, Health Information Management , by Epworth HealthCare. Professor Wickramasinghe has more than ... Professor Wickramasinghersquo;s appointment as Epworth Chair, Health Information Management , will help to further strengthen this clinical academic alliance, with RMIT now ...
Aim.- To describe the clinical aspects of implantable cardioverter defibrillators care in Sweden with focus on organisation, the role and education of nurses, patient information and education and areas in need of improvement. Background.- Implantable cardioverter defibrillators implantations have developed rapidly in recent years and are now an established arrhythmia treatment. The expanding indication for implantable cardioverter defibrillators implantation demands new competencies and resources in the implantable cardioverter defibrillators team members. Methods.- Participants were recruited among physicians and nurses in all of the hospitals implanting implantable cardioverter defibrillators (n-=-16). Data were collected by a questionnaire. Additionally, all written educational materia...
For the performance assessment of radioactive and hazardous waste disposal sites, risk assessments are usually performed for the long term, i.e., over an interval in space and time for which one can predict movement and behavior of toxic agents in the environment. This approach is based on at least three implicit assumptions: One, that the engineering layout will take care of the immediate endangerment of potential receptors; two, that one has carefully evaluated just how far out in space and time the models can be extrapolated, and three, that one can evaluate potential health effects for very low exposures. A few of these aspects will be discussed here in the framework of the scientific method.
The purpose of this study is to investigate the role of femoral marrow MR imaging as predictor of outcome for hemopoietic stem cell transplantation (HSCT) in beta-thalassemia major. MR imaging of the proximal femur, including T1- and T2-weighted spin echo and short-tau inversion recovery and in-phase and out-of-phase fast field echo images, was prospectively performed in 27 thalassemia major patients being prepared for HSCT. The area of red marrow and its percentage of the proximal femur were measured, and the presence of marrow hemosiderosis was assessed. Age-adjusted multivariate logistic regression was used to determine the relationship between red marrow area percentage and marrow hemosiderosis and HSCT outcome. Red area percentage were less in patients with successful (90.25{+-}4.14%) compared to unsuccessful transplants (94.54% {+-}2.93%; p=0.01). Red marrow area percentage correlated positively with duration of symptoms(r=0.428, p=0.026) ...
The main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing adolescents meeting DSM-IV anxiety disorder criteria participated in a non-randomized trial, together with parents and school staff. Outcome was assessed at post-treatment and 2-month follow-up. Treated adolescents showed significant and maintained improvements across primary outcome variables (school attendance; school-related fear; anxiety), with medium to large effect sizes. Half of the adolescents were free of any anxiety disorder at follow-up. Additional improvements were observed across secondary outcome variables (depression; overall functioning; adolescent and parent self-efficacy). The treatment was rated as acceptable by adolescents, parents, and school staff, which may help explain the very low attrition rate. Social ...
Background: The outcome of acute myocardial infarction (AMI) complicated with cardiogenic shock is poor. The aim of this study was to analyse, whether upfront abciximab administration could improve the outcomes of cardiogenic shock. Methods: This multicentre open trial randomized 80 patients with AMI complicated by cardiogenic shock expected to undergo primary PCI into group A (routine upfront-pre-procedural-abciximab bolus followed by 12-h abciximab infusion) and group B (standard therapy). The study primary objective was 30-day combined outcome (death/reinfarction/stroke/new severe renal failure). Results: PCI was technically successful in 90% (A) versus 87.5% (B) patients. Abciximab was used in 100% (A) versus 35% (B). The primary endpoint occurred in 17 group A patients (42.5%) and 11 ...
In an era of unprecedented technological advancement and economic expansion, construction practice continues to evolve but construction education has not changed appreciably since the 1990s. This schism has prompted industry, government, and other key constituents to question the relevancy and efficacy of current programs. The Accreditation Board for Engineering and Technology (ABET) Engineering Criteria 2000 and the American Council for Construction Education (ACCE) emphasizes outcomes over process, and provides an opportunity for stakeholders to help universities define educational goals and objectives and design a curriculum to meet the desired outcomes. While the need for curriculum modification has been acknowledged, the industry position was amorphous and anecdotal and therefore difficult to address. Qualitative methodologies such as formal surveys and structured interviews can be used to capture and quantify industry expectations of the ...
In multi-organisational contexts, scenario building has been used to engage stakeholders in a critical discussion on issues of mutual importance, and to gain their support with regards to possible future responses. A review of existing literature suggests that much has been written regarding the process of scenario development and the benefits of the process, but the detailed analysis of scenario building outcomes, which encompass a large number of issues and their complex interconnections, has not been made explicit for studying and enhancing understanding of a complex societal problem. This paper presents a systematic method for analysing such complex outcomes in order to facilitate reflective thinking on important issues within the wider context for policy development. The method was em...
Abstract Toll-like receptor 2 (TLR2) is an immune sensor for gram-positive bacterial cell wall components. Single-nucleotide polymorphisms (SNPs) in the TLR2 gene that impair its function may, therefore, influence the risk and outcomes of gram-positive bacterial infections. In a cohort of 694 liver transplant recipients, we assessed the TLR2 SNP that is translated into an amino acid substitution of arginine for glutamine at position 753 (R753Q), and we found that its presence was associated with the clinical characteristics and outcomes of gram-positive bacterial infections. The proportions of patients with the TLR2 R753Q SNP did not significantly differ between those with gram-positive bacterial infections and those without gram-positive bacterial infections (9.6% versus 9.6%, P = 0.999)....
Patients with acute myocardial infarction (AMI) and diabetes mellitus, as well as patients admitted with elevated blood glucose without known diabetes, have impaired outcome. Therefore intensive glucose-lowering therapy with insulin (IGL) has been proposed in diabetic or hyperglycaemic patients and has been shown to improve survival and reduce incidence of adverse events. The current manuscript provides an overview of randomised controlled trials investigating the effect of IGL. Furthermore, systematic glucose?insulin?potassium infusion (GIK) has been studied to improve outcome after AMI. In spite of positive findings in some early studies, GIK did not show any beneficial effects in recent clinical trials and thus this concept has been abandoned. While IGL targeted to achieve normoglycaemi...
Despite advances in polymer and drug technology, the underlying stent platform remains a key determinant of clinical outcome. A clear understanding of stent design and the differences between various stent platforms are of increasing importance for the interventional cardiologist. Reduction in stent strut thickness has been associated with improved stent deliverability, improved procedural outcome, and lower rates of subsequent restenosis. Newer-generation 316L-SS stent designs have enabled reduced strut thickness while retaining radial strength and minimizing recoil, but with significant loss of radiopacity, leading to reduced visibility. Cobalt chromium alloys have enabled a reduction in stent strut thickness to around 80?90 mm while retaining modest radiopacity, but due to higher elasti...
Summary Background Pemphigus vulgaris and pemphigus foliaceus are rare, potentially life-threatening, autoimmune disorders characterized by antibodies to epidermal adhesion molecules. Clinical characteristics are painful chronic erosions of mucous membranes and of the skin. There are only few published studies on the impact of the disease on the health status (HS) of patients with these conditions. Objectives To assess the impact of disease on the HS of patients with pemphigus. Methods Fifty-eight patients enrolled at the Bullous Skin Diseases Unit of IDI-IRCCS in the period January-June 2006 were assessed for their HS using the Medical Outcomes Study 36-item short form health survey (SF-36) questionnaire and for anxiety and depression using the Institute for Personality and Ability Testin...
The article draws on interpretive frameworks from diffusion research and social network analysis to explore one particular "travelling reform"--outcomes-based education--that went global. The argument is made that by virtue of studying late adopters of a travelling reform one is examining globalisation. The cases in point for late adoption are Central Asian education systems (in particular Mongolia and Kyrgyz Republic) that borrowed outcomes-based education reforms at a time when the popularity of similar reforms were already in decline in other countries, notably in New Zealand, Australia and South Africa. The emphasis of this study is on the timing of policy borrowing, and it is suggested that more attention is given to the economics of policy borrowing. (Contains 3 notes.)
While both sperm number and quality are now recognized to be important in determining the outcome of sperm competition, very few studies have experimentally assessed the influence of these two parameters simultaneously. We studied the effect of sperm quality and number on competitive fertilization success in an internal-fertilizing fish, the guppy (Poecilia reticulata), which is characterized by high levels of sperm competition. We artificially inseminated virgin females with varying proportion of sperm from two competing males, while holding constant the total number of sperm transferred to the female. Sperm morphology and sperm swimming velocity were also determined prior to insemination. The paternity outcome of sperm competition trials was assessed through molecular analyses of the res...
Summary Background: Red blood cell (RBC) transfusion in hemorrhagic shock is life saving. However, several clinical trials have shown that blood transfusion in the critically ill patient might be associated with adverse outcomes. Furthermore, an association between prolonged blood storage and adverse effects of RBC transfusion has been postulated. The aim of this study is to examine the effect of blood storage time on resuscitation outcome, in an animal model of hemorrhagic shock. Methods: 20 Wistar rats were phlebotomized in order to induce reversible hemorrhagic shock. Half of them were resuscitated with blood stored for a short period of time (4 days), and the other ones were resuscitated with blood stored for a prolonged time (14 days). Blood samples for hemoglobin, pH, lactate, bicarb...
Purpose We retrospectively analyzed the results of percutaneous nephrolithotomy operations for treatment of staghorn kidney stone disease in elderly patients and compared surgical parameters and outcomes with a control group of young adult patients. Patients and method Between 2002 and 2010, 300 consecutive patients underwent percutaneous nephrolithotomy operation for treatment of staghorn kidney stone disease. Forty-five of the patients were older than 65?years and considered to be in elderly group. Thirty-seven of the patients were between the ages 18 and 36?years and considered to be the control group. Surgical parameters and outcomes were compared between groups. Results There were no significant differences between groups for stone area, operation time, difference in hemoglobin levels...
Abstract Introduction.- Sling erosion/extrusion is a complication after suburethral sling insertion for female stress urinary incontinence that occurs in approximately 6% of patients. Symptoms may include vaginal discharge, infections, postcoital bleeding, and alterations of the sexual function. Little is known about the effect of sling erosion on the sexual function of the male partner. Aim.- The aim of this study was to determine male sexual function in partners of women who had undergone sling insertion for stress urinary incontinence and who developed sling erosion postoperatively. Main Outcome Measures.- Main outcome measures were the Brief Male Sexual Function Inventory (BMSFI) and visual analog scale (VAS) scores. Methods.- Male partners of patients who presented with sling erosion ...
The optimal management of men with very favorable clinicopathological factors who develop biochemical recurrence (BCR) after radical prostatectomy (RP) has not been previously reported. Both local and systemic recurrences are unlikely in this cohort. This study examines their management and outcomes. Between October 2000 to March 2010, 1627 men underwent open RP by a single surgeon. In all, 448 (27.5%) met the following criteria for extremely low risk disease: preoperative PSA level <10?ng?ml?1, clinical stage T1c/T2a, Gleason score ?6, estimated cancer volume in the surgical specimen ?5% and no evidence for positive surgical margin. Undetectable PSA was defined as ?0.04?ng?ml?1. BCR was defined as PSA ?0.2?ng?ml...
Complex numbers are an intrinsic part of the mathematical formalism of quantum theory and are perhaps its most characteristic feature. In this article, we show that the complex nature of the quantum formalism can be derived directly from the assumption that a pair of real numbers is associated with each sequence of measurement outcomes, with the probability of this sequence being a real-valued function of this number pair. By making use of elementary symmetry conditions, and without assuming that these real number pairs have any other algebraic structure, we show that these pairs must be manipulated according to the rules of complex arithmetic. We demonstrate that these complex numbers combine according to Feynman's sum and product rules, with the modulus-squared yielding the probability of a sequence of outcomes.
The aim of this study is to clarify the relation among developmental outcome, nutritional state during the neonatal period, maturational electroencephalographic changes. Thirteen extremely low birth weight infants who completed 6- or 9-year follow-up were a subject of this study. Undernutrition was defined as enteral feeding below 100mL/kg/day at 3weeks of age. Dysmature patterns were defined as the persistence of EEG patterns 2weeks or more immature for post-conceptional age. IQ was examined at 6 and 9years of age. Body height and weight, and head circumference at 6years of age were stratified by the percentile grades. Full and verbal IQ was significantly lower in infants with undernutrition than those with normal nutrition. Among infants with undernutrition, those with persistent dysmatu...
Summary Many important moral decisions, particularly at the policy level, require the evaluation of choices involving outcomes of variable magnitude and probability. Many economic decisions involve the same problem. It is not known whether and to what extent these structurally isomorphic decisions rely on common neural mechanisms. Subjects undergoing fMRI evaluated the moral acceptability of sacrificing a single life to save a larger group of variable size and probability of dying without action. Paralleling research on economic decision making, the ventromedial prefrontal cortex and ventral striatum were specifically sensitive to the "expected moral value" of actions, i.e., the expected number of lives lost/saved. Likewise, the right anterior insula was specifically sensitive to outcome p...
Abstract:- Two motorcycle riders lost control of their vehicle, fell, and hit a guardrail, which acted as a blade and led to a rapid, fatal outcome. In one case, the high velocity of the body at the time of the impact resulted in complete detachment of the trunk. Reconstruction of the accident dynamics enabled the guardrail post to be identified as the means of injury in both cases. The two accidents occurred over a short period of time, highlighting a dangerous phenomenon that in less severe cases is presumably associated with different degrees of survivor disability. The accidents deserve mention, because a different design of the impact surface of the guardrail post might have prevented the lethal outcome. There is an urgent need for legislators to pass regulations that modify crash bar...
There are 2 models of male adjustment of sperm investment in the ejaculate in relation to sperm competition. The "risk model" predicts that as "risk" of sperm competition increases, sperm investment also increases. This prediction has been supported in many species, including mammals. The "intensity model" involves the number of competing males copulating with the same female and predicts that males will allocate the highest sperm investment at low sperm competition intensity (SCI) and then decreasing sperm investments as SCI increases. Two alternative outcomes are that sperm investment is unaffected by SCI and that sperm investment increases as SCI increases. There are studies supporting all 3 possible outcomes in relation to SCI but no data on mammals. The present paper presents the firs...
BACKGROUND: Controversy exists as to whether patients with thick (Breslow depth >4 mm), clinically lymph node-negative melanoma require sentinel lymph node (SLN) biopsy. The authors examined the impact of SLN biopsy on prognosis and outcome in this patient population. METHODS: A review of the authors institutional review board-approved melanoma database identified 293 patients with T4 melanoma who underwent surgical excision between 1998 and 2007. Patient demographics, histologic features, and outcome were recorded and analyzed. RESULTS: Of 227 T4 patients who had an SLN biopsy, 107 (47%) were positive. The strongest predictors of a positive SLN included angiolymphatic invasion, satellitosis, or ulceration of the primary tumor. Patients with a T4 melanoma and a negative SLN had a significa...
Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes of the split anterior tibialis tendon transfer (SPLATT) for correction of equinovarus in 47 patients with hemiplegic traumatic brain injury and specifically studied differences in outcomes with two tendon fixation techniques. Seventeen patients constituting Group I underwent fixation with one technique and 30 constituting Group II had another technique. Patients in both groups had appropriate procedures based on dynamic electromyography and gait analyses. Both groups were demographically comparable. All 47 feet were corrected to plantigrade position. Thirty-six of 47 patients became brace-free at final followup. There was a notable decrease in the use of ambulatory a...
Purpose In literature, few papers compare different hemostatic devices in laparoscopic adrenalectomy. This sequential cohort study analyzes the outcomes of laparoscopic adrenalectomy performed by different hemostatic instruments, to evaluate if any of them has any advantage over the other and as secondary endpoints, the impact of body mass index (BMI) and tumor size on the indication, and the outcome of laparoscopic adrenalectomy. Methods Forty-six patients, aged 54.6???46?years, underwent laparoscopic adrenalectomy over 5?years. Mean BMI was 27???4.8?kg/m2. Twenty-four patients had a left tumor, and 22 had a right one. Patients were divided into two groups according to the hemostatic device: Ultracision was used in 26 patients, and Ligasure was used in 20. Groups were well matched for his...
ObjectiveInjury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample. MethodsData were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome wa...
Background Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach. Methods Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The p...
In the spring of 2009, the Romanian government has proposed a restructuring of the national power generation sector segment that is still owned by the state. As most of the power generation capacity is still state-owned, this restructuring will dramatically alter the competitive landscape of this sector. This paper is analyzing the rationale and principles of the restructuring as stated by government documents and officials, the assessment methodology and criteria proposed by the government, as well as the proposed final outcome of the restructuring initiative. Based on this critical assessment and the early results of the restructuring's implementation, we are able to make recommendations that can be considered for a revised restructuring approach. - Research highlights: #-># Power generation sector restructuring is proposed in 2009 by the Romanian government. #-># We assess the objectives, methodology and proposed outcome of the ...
We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The complications were ...
Total skin electron beam therapy (TSEB) was used in the treatment of 33 patients with lymphoma and 13 patients with leukemia involving extensive segments of the skin surface. Twenty-two of 23 had lesions as a primary manifestation of lymphoma (primary cutaneous lymphoma-PCL) and 11 developed cutaneous lesions following disseminated nodal lymphoma (secondary cutaneous lymphoma-SCL). A once weekly fractionation scheme was employed to irradiate the entire skin surface with 3.5 to 4 MeV electron beam from a 6 MeV linear accelerator. During each weekly session, 400 rad were delivered to the entire skin and a complete course consisted of 4-6 consecutive weekly sessions. The majority of patients have been previously treated elsewhere for various periods and all patients have been at risk for a median of 12 months, range from 12-117 months following TSEB. Striking predominance of the diffuse pattern (76%) was demonstrated in both the PCL and SCL. There was extracutaneous involvement in 63% ...
To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. Among the five patients who ...
We analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. The study spanned a three year period before and after capitation was implemented, and compared episodes of outpatient care for children from 14 capitated Community Mental Health Centers (CMHCs) with those from three CMHCs that remained fee-for-service. Proportional hazards regressions revealed that capitation resulted in an increase in outpatient episode duration, over and above similar effects for the comparison fee-for-service episodes. The hypothesis that there were longer capitated episodes for children who were hospitalized was not supported. Children with behavioral and anxiety disorders had longer capitated episodes. Service intensity decreased over time in the managed care sites. Changes in case mix may have had an impact on changes in episode duration and service ...
The aims of the study were to develop and test the psychometric properties of the Thai Family Health Routines (TFHR) scale, a 70-item self-report questionnaire used to measure the health of Thai families through their routine behaviors in daily life. Development of the TFHR was based on the structural domains of Denham's Family Health Model. The TFHR scale was initially composed of 85 items and tested on 1,040 families living in the central region of Thailand. The confirmatory factor analysis, with an acceptable factor structure model, yielded 70 items aligned with six factors: self-care, safety and prevention, mental health behavior, family care, family caregiving, and illness care routines. The preliminary psychometric properties demonstrated that the TFHR scale had satisfactory internal consistency, criterion validity, and construct validity. The test results suggested that the TFHR scale has potential benefits for ...
Following the February 2011 earthquake in Christchurch, New Zealand (NZ), the authors participated in counselling local residents, and debriefing and supervising support teams. Indications were that risk for mental health disorders, including Post-Traumatic Stress Disorder (PTSD), may be elevated in residents, and that this risk may continue for some time. Patients may be de-prioritising their mental health issues when these become normalised throughout the city's population. The authors recommend that primary care patients are assessed using a brief, comprehensive tool (for example, the Case-finding and Help Assessment Tool) that targets many health and behavioural issues identified as increasing in the city following the earthquake. Anxiety and mood disorder symptoms may indicate assessment is appropriate to reduce harm arising from increased risk for PTSD. Concern also is raised for primary health care providers who may have experienced the ...
DescriptionThis new research programme activity on Urban Atmospheric Science will deliver aspects of the NERC strategy: Next Generation Science for Planet Earth. It has been developed as part of the Environment, Pollution & Human Health theme. Research in the Environment, Pollution & Human Health theme is directed at elucidating key environmental processes that form part of a causal pathway between an environmental hazard and disease outcome, and providing a predictive capability of the risk to human heal [continued...
Ventricular septal defect after acute myocardial infarction (AMI) is a complication associated with poor outcome in the absence of intervention. We report a case of successful TEE guided transcatheter closure of a post myocardial infarction (MI) ventricular septal defect (VSD) with an Amplatzer occluder in a 79 years old male with cardiogenic shock.
Non-alcoholic fatty liver disease is a serious health problem linked to obesity and type 2 diabetes. To investigate the biological outcome and therapeutic potential of hepatic fatty acid uptake inhibition,...Full Text Available
We reported a relevant activity of the combination between sorafenib and octreotide long-acting release (LAR) in advanced hepatocellular carcinoma (HCC) patients. In this work, we have studied if oxidative...Full Text Available
Background: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients.Objective:...Full Text Available
To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false-negative outcome of Proton...Full Text Available
AimsThe prevalence and importance of liver function test (LFT) abnormalities in a large contemporary cohort of heart failure patients have not been systematically evaluated.Full Text Available
Experiences with weight stigma negatively impact both psychological outcomes (e.g., body dissatisfaction, depression) and behavioral outcomes (e.g., dieting, exercise). However, not everyone is equally affected by experiences with weight stigma. This study examined whether internalized societal attitudes about weight moderated the impact of weight stigma. Adult participants (n = 111) completed measures of experiences with weight stigma, as well as two indexes of internalized societal attitudes (the moderators): Internalized anti-fat attitudes and internalization of societal standards of attractiveness. Psychological outcomes included self-esteem, body dissatisfaction, drive for thinness, and bulimic symptoms; behavioral outcomes included avoidance of exercise and self-reported exercise behavior. Weight stigma was positively correlated with body dissatisfaction, drive for thinness, and bulimic symptoms, ...
BackgroundSelf-management of asthma may improve asthma outcomes. The Internet has been suggested as a tool for the monitoring and self-management of asthma....Full Text Available
SummaryThe report describes successful management of 10 women in 2nd and 3rd pregnancy trimesters with EchiTab IgG antivenom after carpet viper (Echis ocellatus) envenoming. All...Full Text Available
Cystic fibrosis (CF) is a monogenic disease characterized by a high variability of disease severity and outcome that points to the role of environmental factors and modulating genes that shape the course...Full Text Available
Divided into diagnostic and treatment sections, this book provides a comprehensive overview of the most common medical procedures performed in modern clinical settings. Each section presents common names for the procedure; an outline of the disease or injury for which the procedure is performed; a brief review of the anatomical structures and physiological processes that are involved; staffing, equipment, and pre-procedure requirements; a detailed description of the procedure itself; and, a discussion of expected outcomes as well as potential complications. Each chapter includes a summary and
Background:Acute Coronary Syndrome (ACS) can occur in patients with prior coronary artery bypass grafting (CABG). In the Gulf Registry of acute coronary events (Gulf RACE), we identified...Full Text Available
Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive...Full Text Available