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Sample records for brazilian cardiology referral

  1. Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

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    André C. Marques

    2014-12-01

    Full Text Available OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62 and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07 were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01; verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81; a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94; and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99. CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.

  2. Provision of Transition Education and Referral Patterns from Pediatric Cardiology to Adult Cardiac Care.

    Science.gov (United States)

    Harbison, Anna L; Grady, Stafford; Chi, Kevin; Fernandes, Susan M

    2016-02-01

    ACC/AHA guidelines recommend a structured preparation for and transfer to adult-oriented cardiac care for adult survivors of pediatric onset heart disease (POHD). Given this, we sought to describe the transition and transfer practices for a cohort of young adults with POHD and to determine factors associated with successful transfer to adult-oriented cardiac care. We performed a single-center, retrospective chart review on patients ≥18 years of age, with POHD likely to require lifelong cardiac care, who were seen in outpatient pediatric cardiology (PC) between 2008 and 2011. Successful transfer was defined as the subsequent attendance at adult cardiology (AC) within 2 years of PC visit. We identified 118 patients who met study criteria. Mean age 22.4 ± 2.0 years, 59 % male, 64 % white and 40 % Hispanic. Mean transition education topics noted was 3.3 ± 1.8 out of 20 and covered the underlying cardiac disease (89 %), follow-up and current medications (56 %) and exercise limitations (34 %). Recommendations for follow-up were AC (57 %) and PC (33 %). Of those told to transfer to AC, 79 % successfully transferred. Characteristics of successful transfer included: prior cardiac surgery (p = 0.008), cardiac medication use (p = 0.006) and frequency of follow-up ≤1 year (p = 0.037). One-quarter of all subjects did not follow-up within at least 2 years. Despite published guidelines, transition education appears lacking and the approach to transfer to adult cardiac care is not consistent. Given the increased risk of morbidity and mortality in this patient population, standardization of transition education and transfer processes appear warranted. PMID:26385471

  3. Cardiology in Brazilian scientific journals: an overview Cardiologia em revistas científicas brasileiras: um panorama

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    Kavita Kirankumar Patel

    2012-06-01

    Full Text Available Cardiology has been and is a very significant fraction of the Brazilian contribution to science. In older days, the most significant part of this work was directed to foreign periodicals, but the quasi-simultaneous emergence of SciELO and PUBMED has ordained a redirection of much of this work to Brazilian periodicals. We here survey some of this more recent contribution for the benefit of readers of Revista Brasileira de Cirurgia Cardiovascular. This is offered as an update. Articles on the general themes of Cardiology and Pneumology published by four ISI Indexed Brazilian journals not specializing in cardiology are re-visited, after a search through 10 journals.A Cardiologia foi, e continua sendo, responsável por uma fracção muito significativa da contribuição brasileira para a ciência. No passado, os trabalhos mais importantes eram direcionados para periódicos estrangeiros, mas o surgimento quase simultâneo do SciELO e PUBMED facilitou um redirecionamento de grande parte desses trabalhos a periódicos brasileiros. Neste artigo, examinamos algumas das contribuições mais recentes em benefício aos leitores da Revista Brasileira de Cirurgia Cardiovascular. Esta discussão é oferecida como uma atualização. Artigos sobre os temas gerais da cardiologia e pneumologia publicados por quatro revistas brasileiras indexadas no ISI - não especializadas em cardiologia - são revistos.

  4. Conotruncal anomalies in the fetus: Referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India

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    Balu Vaidyanathan

    2013-01-01

    Conclusions: Pre-natal diagnosis of CTA, despite a high diagnostic accuracy, prompted utilization of post-natal tertiary cardiac care in a limited proportion of patients, including those with reparable lesions. Focus in developing countries should shift towards earlier referral, improving awareness about treatment options and a comprehensive evaluation for associated anomalies.

  5. Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system.

    Science.gov (United States)

    Lima, Valter C; Mattos, Luiz Alberto P; Caramori, Paulo R A; Perin, Marco A; Mangione, José A; Machado, Bruno M; Coelho, Wilson M C; Bueno, Ronaldo R L

    2006-10-01

    The authors review percutaneous coronary intervention (PCI) evolution and its growing application in myocardial revascularization for patients with coronary heart disease in Brazil and worldwide. PCI was introduced in 1977 using only the catheter balloon. Limitations of this method (acute occlusion and coronary restenosis) led to the adoption of coronary stents and more recently the advent of drug-eluting stents2, which were developed to drastically reduce restenosis rates. These developments allowed the exponential growth of percutaneous coronary intervention (PCI) procedures in Brazil which have replaced many bypass surgery procedures and have become the gold standard for the majority of symptomatic patients suffering from coronary artery disease. The preference for this procedure gained new dimensions in 2000 when the Brazilian Public Healthcare System (SUS) began reimbursing for stent procedures. This measure exemplified the importance of the Public Healthcare System's participation in incorporating medical advances and offering a high standard of cardiovascular treatment to a large portion of the Brazilian population. It is emphasized that prevention of in-stent restenosis is complex due to its unpredictable and ubiquitous occurrence. Control of this condition improves quality of life and reduces the recurrence of angina pectoris, the need to perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the

  6. Occult hepatitis B virus infection in liver transplant patients in a Brazilian referral center

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    T.C.A. Ferrari

    2014-11-01

    Full Text Available Estimates of occult hepatitis B virus (HBV infection prevalence varies among different studies depending on the prevalence of HBV infection in the study population and on the sensitivity of the assay used to detect HBV DNA. We investigated the prevalence of occult HBV infection in cirrhotic patients undergoing liver transplantation in a Brazilian referral center. Frozen liver samples from 68 adults were analyzed using a nested polymerase chain reaction assay for HBV DNA. The specificity of the amplified HBV sequences was confirmed by direct sequencing of the amplicons. The patient population comprised 49 (72.1% males and 19 (27.9% females with a median age of 53 years (range=18-67 years. Occult HBV infection was diagnosed in three (4.4% patients. The etiologies of the underlying chronic liver disease in these cases were alcohol abuse, HBV infection, and cryptogenic cirrhosis. Two of the patients with cryptic HBV infection also presented hepatocellular carcinoma. Markers of previous HBV infection were available in two patients with occult HBV infection and were negative in both. In conclusion, using a sensitive nested polymerase chain reaction assay to detect HBV DNA in frozen liver tissue, we found a low prevalence of occult HBV infection in cirrhotic patients undergoing liver transplant, probably due to the low prevalence of HBV infection in our population.

  7. Cardiology Mannequin

    Science.gov (United States)

    1979-01-01

    Education of medical students in cardiology requires access to patients having a variety of different forms of heart disease. But bringing together student, instructor and patient is a difficult and expensive process that does not benefit the patient. An alternate approach is substitution of a lifelike mannequin capable of simulating many conditions of heart disease. The mannequin pictured below, together with a related information display, is an advanced medical training system whose development benefited from NASA visual display technology and consultative input from NASA's Kennedy Space Center. The mannequin system represents more than 10 years of development effort by Dr. Michael S. Gordon, professor of cardiology at the University of Miami (Florida) School of Medicine.

  8. Nuclear cardiology

    International Nuclear Information System (INIS)

    Today, nuclear medicine techniques are routinely used in cardiological practice. They include procedures for the atraumatic investigation of different physiological processes in the various structures included in the central circulation: pericardium, myocardium, myocardial adrenergic innervation, cardiac chambers and valves, coronary microcirculation, and great vessels. Beside these in-Vivo procedures, they also comprise of in-Vitro methods for the detection and measurement in blood of various biological molecules of significance in the management of cardiac diseases. A common feature in this collection of in-Vivo and in-Vitro techniques is their ability to provide helpful clinical information for the diagnosis, prognosis and management of cardiac diseases. Their simplicity and safety for the patient allow their repeated use in the follow up of the progress of disease and in the assessment of the efficacy of the therapeutic measures

  9. Tele-cardiology.

    Science.gov (United States)

    Molefi, M; Fortuin, J; Wynchank, S

    2006-01-01

    After defining tele-medicine, we describe its situation in the public health service of South Africa and its application to cardiology. Methods of communication relevant to tele-cardiology are outlined, together with their bearing on primary healthcare. The range of tele-cardiological applications to electrocardiology, echocardiology, auscultation, imaging and pathology are indicated. Tele-cardiology's contributions to a range of cardiological problems and types of management are described briefly. Finally, a mention is made of the relevance of tele-medicine to education and the costs related to cardiology, with an indication of some future needs for tele-cardiology. PMID:16547558

  10. Nuclear cardiology

    International Nuclear Information System (INIS)

    This thesis deals with two topics in nuclear cardiology. In the first, left ventricular wall motion assessment using Fourier transform of local left ventricular time-activity curves in gated blood pool studies is evaluated. In the second, the interpretation of myocardial perfusion scintigrams is assessed which are obtained with thallium-201 or with another radiopharmaceutical with different physical, but identical biological properties. In all these investigations data acquisition and analysis by computer played an essential role. In chapter 1 the desirable properties of a nuclear medicine computer system are given and the computer system used for this work is described. Wall motion analysis of the left ventricle using Fourier transform of local time-activity curves in the left ventricular region in gated blood pool studies is described in chapter 2. In chapter 3 detection of non-perfused lesions in myocardial perfusion scintigraphy with thallium-201 is described. Detection of partly perfused lesions and the influence of scatter and photon energy on myocardial perfusion scintigraphy is described in chapter 4. (Auth.)

  11. Nuclear cardiology in Cuba

    International Nuclear Information System (INIS)

    This paper is a brief summary of the Nuclear Cardiology history in Cuba, mentioning the current main mortality causes, the usefulness and results of nuclear tests among the imaging techniques nowadays used in Cardiology, including gated-SPECT, PET and hybrid imaging combining anatomical and functional information. This paper also reviews our present worldwide performance in Nuclear Cardiology, with emphasis on our development and future trends, and proposes some recommendations. (author)

  12. Pediatric nuclear cardiology

    International Nuclear Information System (INIS)

    Nuclear cardiology methods have had less impact upon pediatric cardiology than upon adult cardiology. Most pediatric heart disease results from congenital malformations of the heart and great vessels, which is usually discovered in infancy, and is most often treated definitively in infancy or early childhood. Unfortunately, nuclear medicine techniques are limited in their spatial resolution - structures that overlie each other are separated with difficulty. As a result, nuclear cardiology is usually of limited value in the anatomic characterization of the congenital heart abnormalities. Nevertheless, it has been useful in the detection and quantification of the pathophysiologic consequences of many congenital cardiac malformations. The authors review application of nuclear medicine in pediatric cardiology, and attempt to assess each in terms of its clinical utility

  13. Reporting nuclear cardiology

    DEFF Research Database (Denmark)

    Trägårdh, Elin; Hesse, Birger; Knuuti, Juhani;

    2015-01-01

    available; therefore, an European position statement on how to report nuclear cardiology might be useful. The current paper combines the limited existing evidence with expert consensus, previously published recommendations as well as current clinical practices. For all the applications discussed in this......, and conclusion of the report. The statement also discusses recommended terminology in nuclear cardiology, image display, and preliminary reports. It is hoped that this statement may lead to more attention to create well-written and standardized nuclear cardiology reports and eventually lead to...

  14. Consenso de especialistas (SBC/SBHCI sobre o uso de stents farmacológicos: recomendações da sociedade brasileira de cardiologia/sociedade brasileira de hemodinâmica e cardiologia intervencionista ao sistema único de saúde Expert consensus (SBC/SBHCI on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system

    Directory of Open Access Journals (Sweden)

    Valter C. Lima

    2006-10-01

    perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the National Health Surveillance Agency (ANVISA. During this stage the interested company submits to the regulatory agency, results from clinical studies that demonstrate the efficacy and safety of the new device or pharmaceutical product. Frequently, in addition to clinical studies, approval records for clinical use from the regulatory agencies of other countries, mainly the United States of America and the European Community are also submitted. The successful completion of this stage means that the medication or device may be prescribed or used by the physicians in Brazil. The second stage in the incorporation of new healthcare technology involves the reimbursement or financing of the treatment that was approved in the previous stage based on its efficacy and safety. This stage can be more complex than the first one since the new technology, whether a substitution for established treatment methods or the introduction of a new treatment concept, are usually more expensive. The incorporation of new technology requires a cost-effectiveness analysis so that fund administrators can make decisions based on the universal scenario of limited resources to finance healthcare with treatments that are more and more burdensome. The difficulties of funding management are aggravated by medical and social ethical implications that arise when a treatment is approved based on its

  15. Nuclear cardiology in Iran

    International Nuclear Information System (INIS)

    Nuclear cardiology is one of the most active branches of nuclear medicine and plays important role in diagnosis in treatment of CAD patients. Few nuclear cardiology surveys were published in the literature, mostly from developed countries. A nuclear cardiology survey in Iran and analysis of the findings in comparison with other countries may lead to better decision making and improve practice in our country. A questionnaire was sent by mail or e-mail to all nuclear medicine centers in Iran asking for details of nuclear cardiology practice. Also ownership of the centers, number of gamma cameras and number of cardiac studies in each week were recorded. Some centers were studied using telephone interview. From 79 nuclear medicine centers in Iran, 55 centers (69.6%) filled the questionnaire including 28 centers in Tehran and 27 centers in other cities. There was 69 Gamma cameras in these centers, 62.3% with SPECT capability. It is estimated that we may have 100 gamma cameras in Iran. This study showed that about 68287 cardiac studies were done in Iran each year with Myocardial perfusion scan accounting for about 99 2% of the studies. Considering population of the country nuclear cardiology activity will be about 1.05 study/1000/year. Regarding radiotracers used, about 13.5% of studies were done with T I-201, with some centers using only Tc-99m-M I B I

  16. American Society of Nuclear Cardiology

    Science.gov (United States)

    ... of Nuclear Cardiology Official publication of the American Society of Nuclear Cardiology Clinical Guidelines Procedures, Appropriate Use Criteria, Information Statements and Joint Society Statements Member Login Enter Forgot your password? Meetings & ...

  17. Cardiology without borders

    Institute of Scientific and Technical Information of China (English)

    Michael Wolk

    2004-01-01

    @@ Cardiovascular disease takes place in a border-free world. The challenge at the American College of Cardiology (ACC) and anywhere else in the world is to hold patient care above the artificial barriers raised by geopolitical issues. Fundamentally, the goal of ACC members or of any cardiology societies in the world is to provide excellent patient care. Cardiovascular disease is essentially the same throughout the world. Where there are minor variations among individuals, as clinicians we find priceless opportunity to learn. Expanding- rather contracting -our experience base helps us as individuals to realize our best potential as practitioners.

  18. Computers in cardiology

    International Nuclear Information System (INIS)

    The present abstract book contains the abstracts of 90 lectures and 29 posters presented at the conference. They are dealing with the following themes: Echocardiography, databases, ECG interpretation, wall motion, arrhythmia processing systems, electrophysiological models, ECG-mapping, intensive care and hemodynamic monitoring, digital subtraction angiography, clinical electrophysiology, mechanical properties of the cardiovascular system, coronary artery measurements, arrythmia analysis, arrhytmia monitoring techniques, ECG waveform recognition and nuclear cardiology. (MG)

  19. Recent advances in nuclear cardiology

    DEFF Research Database (Denmark)

    Gutte, H.; Petersen, C. Leth; Kjaer, A.;

    2008-01-01

    Nuclear cardiology is an essential part of functional, non-invasive, cardiac imaging. Significant advances have been made in nuclear cardiology since planar (201)thallium ((201)TI) scintigraphy was introduced for the evaluation of left ventricular (LV) perfusion nearly 40 years ago. The use......-coronary cardiac diseases. The advances in nuclear cardiology are discussed under the four headlines of: 1) myocardial perfusion, 2) cardiac performance including LV and right ventricular (RV) function, 3) myocardial metabolism, and 4) experimental nuclear cardiology Udgivelsesdato: 2008/6...

  20. Computer diagnosis in cardiology

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    Graham Wilfred Ewing

    2009-09-01

    Full Text Available This article reports upon the emergence of a novel cognitive, computer-based technology which may lead to significantly improved methods of cardiological diagnosis and a rapid and inexpensive method of cardiological screening.The technology ‘Virtual Scanning’ illustrates how, in blood, the reaction of proteins and their reactive substrates releases light; that the colour and intensity of this bioluminescence is unique to each reaction and it’s rate; and that the development of pathologies influence cognition and visual perception. This illustrates that the function of the autonomic nervous system is linked to that of the physiological systems and that the rate of biochemical reactions, and the progression of disease, can be measured by a cognitive test procedure and used as an indication of the disease(s affecting heart function.The article discusses the limitations of the conventional biomarker technique, and the potential value of non-invasive cognitive techniques, such as Virtual Scanning, to the medical practitioner. Finally, it discusses how the ability of Virtual Scanning to diagnose disease from its presymptomatic origins may lead to improved diagnostic accuracy and significantly reduced costs.

  1. Nuclear medicine in cardiology

    Energy Technology Data Exchange (ETDEWEB)

    Torizuka, K.; Ishii, Y.; Yonekura, Y.; Yamamoto, K.; Tamaki, N. (Kyoto Univ. (Japan). Faculty of Medicine)

    1981-02-01

    Nuclear medicine in cardiology was reviewed. Electrocardiogram is obtained from the ..gamma..-ray measurement of a tracer by a single detector, which enables a bedsidemonitoring. Resolution and sensitivity are high and nuclear stethoscope with a computer is applicable for a background treatment. Myocardium is imaged by /sup 201/Tl scintigraphy. Relative difference of the perfusion indicates the ischemia which gaives roughly the size and portion of myocardial infarction. For transient ischemia stress myocardial perfusion imaging (SMPI) is also used. sup(99m)Tc pyrophosphate provides a clear image for myocardial infarction. Angiocardiogram is obtained repeatedly, by a single administration, using an equilibrium method. An attempt of three-dimensional display by 7 pin hole collimator and positron CT are also discussed.

  2. Nuclear medicine in cardiology

    International Nuclear Information System (INIS)

    Nuclear medicine in cardiology was reviewed. Electrocardiogram is obtained from the γ-ray measurement of a tracer by a single detector, which enables a bedsidemonitoring. Resolution and sensitivity are high and nuclear stethoscope with a computer is applicable for a background treatment. Myocardium is imaged by 201Tl scintigraphy. Relative difference of the perfusion indicates the ischemia which gaives roughly the size and portion of myocardial infarction. For transient ischemia stress myocardial perfusion imaging (SMPI) is also used. sup(99m)Tc pyrophosphate provides a clear image for myocardial infarction. Angiocardiogram is obtained repeatedly, by a single administration, using an equilibrium method. An attempt of three-dimensional display by 7 pin hole collimator and positron CT are also discussed. (Nakanishi, T.)

  3. Scientometric analysis of radiation cardiology

    International Nuclear Information System (INIS)

    The main bibliometric results in specific field of radiobiology - radiation cardiology - were discussed. This results indicate that cardiac morphogenesis and diseases in pollutant environment (radionuclides, smoking, hypo kinetic syndrome, etc.) is needed in additional investigations. (authors)

  4. Physician-Related Factors Affecting Cardiac Rehabilitation Referral

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    Bahieh Moradi

    2011-12-01

    Full Text Available Background: Despite the positive impact of cardiac rehabilitation (CR on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists. Methods: A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14- item investigator-generated survey, examining the physician’s attitudinal and knowledge factors affecting CR referral. Results: 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs (79.5% such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians’ fee were other factors reported by the physicians. Conclusion: Cardiologists’ inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies.

  5. Assessing Competence in Pediatric Cardiology

    Science.gov (United States)

    Johnson, Apul E.; And Others

    1976-01-01

    In response to the need to assure physician competence, a rating scale was developed at the University of Minnesota Medical School for use in evaluating clinical competence in pediatric cardiology. It was tested on first- and second-year specialists. Development and testing procedures are described. (JT)

  6. Physician Requirements-1990. For Cardiology.

    Science.gov (United States)

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  7. Diagnostic standards in nuclear cardiology

    International Nuclear Information System (INIS)

    Establishing the accurate diagnosis and the adequate treatment of choice in ischemic heart disease (IHD) has become an emergency issue, with increasing the number of IHD patients in Japan. It is therefore important to determine myocardial viability and its related pathophysiology such as stunning and hibernation, which is a prerequisite for widely performed coronary revascularization. From these points of view, cardiovascular nuclear medicine, involving thallium-201 myocardial perfusion scintigraphy and cardiac radionuclide angiography, has become a well-established method for diagnosing IHD. However, no diagnostic standards are available in the routine practice. The Japanese Circulation Society has started a committee for preparing 'diagnostic standards in nuclear cardiology' in April 1989. Out of 8,947 facilities nationwide, 1,126 (12.5%) possess gamma cameras. Of these facilities, 799(70.9%) perform nuclear cardiologic examination. A questinnaire was sent to the 799 facilities, and 410 (51.3%) responded. Based on the 1989's questionnaire results, 'diagnostic standards in nuclear cardiology' was discussed through one year in 1990, and was completed in 1991. This is a report dealing with the present 'diagnostic standards in nuclear cardiology', focusing on thallium-201 myocardial perfusion imaging, cardiac radionuclide angiography, Tc-99m acute infarct imaging, and new radionuclides and PET. Items are included as follows: (1) equipment and techniques, (2) diagnostic standards, (3) stress test, (4) candidates for the examination, and (5) diagnostic cautions. (N.K.) 71 refs

  8. Recent Advances in Nuclear Cardiology.

    Science.gov (United States)

    Lee, Won Woo

    2016-09-01

    Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine. PMID:27540423

  9. I diretriz de ressuscitação cardiopulmonar e cuidados cardiovasculares de emergência da Sociedade Brasileira de Cardiologia: resumo executivo I guideline for cardiopulmonary resuscitation and emergency cardiovascular care - Brazilian Society of Cardiology: executive summary

    Directory of Open Access Journals (Sweden)

    Maria Margarita Gonzalez

    2013-02-01

    the early recognition and delivery of cardiopulmonary resuscitation maneuvers focused on high-quality thoracic compressions and rapid defibrillation by means of the implementation of public access-to-defibrillation programs. These aspects are of the utmost importance and may make the difference on the patient's outcomes, such as on hospital survival with no permanent neurological damage. Early initiation of the Advanced Cardiology Life Support also plays an essential role by keeping the quality of thoracic compressions; adequate airway management; specific treatment for the different arrest rhythms; defibrillation; and assessment and treatment of the possible causes during all the assistance. More recently, emphasis has been given to post-resuscitation care, with the purpose of reducing mortality by means of early recognition and treatment of the post-cardiac arrest syndrome. Therapeutic hypothermia has provided significant improvement of neurological damage and should be performed in comatose individuals post-cardiac arrest. For physicians working in the emergency department or intensive care unit, it is extremely important to improve the treatment given to these patients by means of specific training, thus giving them the chance of higher success and of better survival rates.

  10. Global Imaging referral guidelines

    International Nuclear Information System (INIS)

    The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement

  11. Nobel Prizes: Contributions to Cardiology

    OpenAIRE

    Evandro Tinoco Mesquita; Luana de Decco Marchese; Danielle Warol Dias; Andressa Brasil Barbeito; Jonathan Costa Gomes; Maria Clara Soares Muradas; Pedro Gemal Lanzieri; Ronaldo Altenburg Gismondi

    2015-01-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiolo...

  12. Physician Referral Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  13. Mobile Apps in Cardiology: Review

    OpenAIRE

    Martínez-Pérez, Borja; de la Torre-Díez, Isabel; López-Coronado, Miguel; Herreros-González, Jesús

    2013-01-01

    Background Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. Objective The aim of this paper is to study...

  14. Patient doses in interventional cardiology

    International Nuclear Information System (INIS)

    Cardiovascular diseases are the first cause of death in Spain. The most usual procedures in interventional cardiology are coronariography and PTCA. The first is a diagnostic technique, and the second one is interventional. Our goal has been to study procedures made during the first six months in the Interventional Cardiology Unit of the Juan Ramon Jimenez Hospital (Huelva-Spain), taking into account radiation protection issues. We have studied 178 patients; 145 of them underwent coronariography, and 33 of the patients had PTCA too. Every case was analyzed taking into account technical and dosimetric parameters. We show parameters values gathered: Diagnostic techniques (valvular and non-valvular patients), and interventional techniques (coronariography and PTCA in different or in the same intervention). Higher doses were obtained with valvular patients, although the number of frames was similar. Attending to therapeutic procedures, the highest values were gotten with the 'double' interventions. Interventional procedures exceed in 60% doses gotten in diagnostic studies: this is because of the number of series and number of frames per series. Similar values obtained by other authors have been gotten. (author)

  15. [Radiation protection in interventional cardiology].

    Science.gov (United States)

    Durán, Ariel

    2015-01-01

    INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. PMID:26169040

  16. Nobel Prizes: Contributions to Cardiology

    International Nuclear Information System (INIS)

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male

  17. Nobel Prizes: Contributions to Cardiology

    Directory of Open Access Journals (Sweden)

    Evandro Tinoco Mesquita

    2015-01-01

    Full Text Available The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15% studies were important for cardiovascular area. There were 33 (16% laureates, and two (6% were women. Fourteen (42% were American, 15 (45% Europeans and four (13% were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

  18. Nobel Prizes: Contributions to Cardiology

    Directory of Open Access Journals (Sweden)

    Evandro Tinoco Mesquita

    2015-08-01

    Full Text Available The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15% studies were important for cardiovascular area. There were 33 (16% laureates, and two (6% were women. Fourteen (42% were American, 15 (45% Europeans and four (13% were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

  19. Nobel Prizes: Contributions to Cardiology

    Energy Technology Data Exchange (ETDEWEB)

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg, E-mail: ronaldo@floralia.com.br [Universidade Federal Fluminense, Niterói, RJ (Brazil)

    2015-08-15

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

  20. Nobel prizes: contributions to cardiology.

    Science.gov (United States)

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg

    2015-08-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize's history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male. PMID:25945466

  1. Nobel Prizes: Contributions to Cardiology

    Science.gov (United States)

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg

    2015-01-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male. PMID:25945466

  2. Myocardial scintigraphy. Clinical use and consequence in a non-invasive cardiological department

    DEFF Research Database (Denmark)

    Dümcke, Christine Elisabeth; Graff, J; Rasmussen, SPL;

    2006-01-01

    INTRODUCTION: Myocardial perfusion imaging (MPI) is increasingly used for the diagnosis of ischaemic heart disease. The method is particularly applied as a gate keeper before coronary angiography (CAG) in patients with intermediate probability for ischaemic heart disease. This study aimed to...... analyse the clinical use of MPI in a university hospital without invasive cardiological laboratory. MATERIAL AND METHODS: In the period 01.01.2002 to 31.12.2003, 259 patients (141 women, 118 men) were referred to MPI from our department of cardiology. RESULTS: Normal MPI was seen in 111 patients (43......%), whereas reversible ischaemia was seen in 88 patients (34%) and led to referral of 52 patients (59%) to CAG. 17 patients (19%) continued clinical control, and 19 cases (22%) were closed. Correlating results between MPI and all performed CAGs were found in 42 patients (61%), and divergent results were seen...

  3. Optimization of burn referrals

    DEFF Research Database (Denmark)

    Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne;

    2014-01-01

    INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmar...

  4. Referral expectations of radiology.

    Science.gov (United States)

    Smith, W; Altmaier, E; Berberoglu, L; Morris, K; O'Halloran, C

    1992-08-01

    In summary, the data suggest that the traditional role of the radiologist as an expert consultant who provides an accurate written report is still the dominant perception. This study emphasizes the importance of development of communication skills and communication standards, with particular emphasis on written data as the single most important factor in keeping a strong clinician referral base. PMID:10121759

  5. [Over diagnostic imaging in cardiology].

    Science.gov (United States)

    Carpeggiani, Clara

    2014-03-01

    Medical imaging is one of the major cause of rising health care costs. Diagnostic imaging has increased more rapidly than any other component of medical care. About 5 billion imaging tests are performed worldwide each year. According to recent estimates, at least one-third of all examinations are partially or totally inappropriate. Two out of 3 imaging tests employ ionizing radiations with radiology or nuclear medicine. The medical use of radiation is the largest man-made source of radiation exposure. Medical X-rays and γ-rays are a proven human carcinogen. The attributable long-term extra-risk of cancer due to diagnostic testing is around 10% in industrialized countries. Cardiologists prescribe and/or directly perform >50% of all imaging examinations, accounting for about two-thirds of the total effective dose given to patients. The dose of common cardiological examinations may be significant: 500 chest X-rays= a stress scintigraphy with sestamibi, 750 chest X-rays= a Multislice Computed Tomography, 1,000 chest X-rays= a coronary angiography and stenting. Unfortunately, few doctors are aware of the level of radiation their patients are exposed to during radiological tests and more intensive use of ionizing testing was not associated with greater awareness. Also as a consequence of unawareness, the rate of inappropriate examinations is unacceptably high in cardiology, even for procedures with high radiation load. Higher exposure doses correspond to higher long-term risks; there are no safe doses, and all doses add up in determining the cumulative risks over a lifetime. Doctors should make every effort so that «each patient should get the right imaging exam, at the right time, with the right radiation dose», as suggested by US Food and Drug Administration in the 2010 initiative to reduce unnecessary radiation exposure from medical imaging. This is best obtained through a systematic implementation of the "3 A's strategy" proposed by the International Atomic Energy

  6. Prevalence of referral reasons and clinical symptoms for endodontic referrals

    OpenAIRE

    Kim, Seonah

    2014-01-01

    Objectives To investigate the prevalence of different primary reasons for endodontic referrals and the clinical symptoms of the referred cases. Materials and Methods Clinical data of total endodontic treatment cases (1,014 teeth) including endodontic referral cases (224 teeth) between January 1, 2010 and December 31, 2012, at Kangdong Sacred Heart Hospital, were investigated retrospectively. The one major reason for referral, the clinical symptoms, and the resulting treatment procedures of re...

  7. Cardiac rehabilitation referral and enrolment across an academic health sciences centre with eReferral and peer navigation: a randomised controlled pilot trial

    Science.gov (United States)

    Ali-Faisal, Sobia F; Benz Scott, Lisa; Johnston, Lauren; Grace, Sherry L

    2016-01-01

    Objectives To describe (1) cardiac rehabilitation (CR) referral across cardiac units in a tertiary centre with eReferral; (2) characteristics associated with CR referral and enrolment and (3) the effects of peer navigation (PN) on referral and enrolment. This pilot was a 2 parallel-arm, randomised, single-blind trial with allocation concealment. Setting 3 cardiac units (ie, interventional, general cardiology, and cardiac surgery) in 1 of 2 hospitals of a tertiary centre. Participants CR-eligible adult cardiac inpatients were randomised to PN or usual care. 94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN. Outcomes were ascertained in 76 (80.9%) participants. Intervention The PN (1) visited participant at the bedside, (2) mailed a card to participant's home reminding about CR and (3) called participant 2 weeks postdischarge to discuss CR barriers. Outcome measures The primary outcome of enrolment was defined as participant attendance at a scheduled CR intake appointment (yes/no). The secondary outcome was referral. Blinded outcome assessment was conducted 12 weeks postdischarge, via CR chart extraction. Results Those who received care on the cardiac surgery unit (77.9%) were more likely to be referred than those treated on the general cardiology (61.1%) or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery, hypertension and hyperlipidaemia were significantly more likely, and those with congenital heart disease, cancer and a previous cardiac diagnosis were less likely to be referred. Participants referred to a site closer to home (76.2% of those referred) were more likely to enrol than those not (23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment (46.0%, p=0.24). Conclusions There is wide variability in CR referral, even within academic centres, and despite eReferral. Referral was quite high, and thus, PN did not improve CR utilisation. Results support triaging patients to the CR programme closest

  8. Nuclear cardiology for developing countries

    International Nuclear Information System (INIS)

    The role of nuclear medicine in developing countries must be oriented to the local needs for clinical practice, the health care of large populations and the demands for research with sometimes extremely limited resources. To help define the locally differing needs, it is stressed that nuclear medicine provides the unique opportunity to observe the body at the molecular level of organization and thus makes the body biochemically transparent. Depending on the particular diagnostic demands, complex imaging with gamma scintigraphy or emission tomography may be the only method to choose in some instances, but for others it may be an unnecessary luxury. Nuclear cardiology, with the purpose of non-invasively assessing cardiac function, myocardial perfusion and myocardial metabolism, is a particular challenge in both respects for developing countries. Given such requirements, single-probe devices with multipurpose application are less expensive than gamma cameras and promise advanced diagnostic uses. In one examination, left ventricular function, global cardio-pulmonary circulation and the general circulatory adaptation to exercise can be investigated by non-gated simultaneous blood pool measurements over four lung regions, the heart and the liver. In addition, such devices have the advantages of compactness, robustness and electronic stability. Despite enormous difficulties regarding funding, infrastructure, equipment and maintenance, developing countries should be encouraged to participate in the evolution of nuclear medicine by responding and adapting to defined needs and perhaps by maintaining at least one national centre of excellence with capacities for research and training. Funds are best secured by providing an indispensable service in co-operation with the various clinical disciplines. (author)

  9. Nuclear cardiology in Cuba present and perspectives

    International Nuclear Information System (INIS)

    Heart Diseases represent the first cause of death worldwide (WHO, 2011); 80% of these deaths in developing countries (WHO, 2011); Coronary Heart Disease is responsible of 69% of all cardiovascular deaths. In Cuba, National programs have been developed to control the most important associated coronary risk factors; Research projects have been also carried out as part of the Ministry of Public Health’s program on non-transmissible chronic diseases; Strengthening of Nuclear Cardiology in Cuba, as well as its adequate integration in a diagnosis algorithm, focusing on improving the quality of medical care, in accordance with the principles of evidence-based medicine. Recommendations: Extend Nuclear Cardiology throughout the country; Conduct cost-effectiveness studies comparing different imaging techniques in cardiology; Develop coronary flow and metabolic studies with PET; Introducing studying adrenergic innervation; Develop hybrid imaging in cardiology; Set up committees of experts to analyze the value of different imaging techniques in cardiology in accordance with the possibilities and resources of Cuba, aimed at the implementation of a medicine individualized for patients. (author)

  10. Assessing and Reducing Exposures to Cardiology Staff

    International Nuclear Information System (INIS)

    Interventional radiology and interventional cardiology practices represent the highest radiological workload in hospitals and have the potential for high exposures to staff operating near patients. The IAEA has promoted the Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR) project where the working group on interventional cardiology assessed levels of exposure and methods applied for individual monitoring, and designed an international database of occupational exposures. Worldwide surveys of interventional cardiologists from 32 countries and 81 regulatory bodies from 55 countries provided information on dosimetry practice: only 57% of regulatory bodies define the number and/or position of dosimeters for staff monitoring and less than 40% could provide doses. The survey results proved poor compliance with staff monitoring recommendations in a large fraction of hospitals and the need for staff monitoring harmonization and monitoring technology advancements. Given the new occupational dose limit for the lens of the eye, the existence of high eye doses in interventional cardiology practice and the general lack of knowledge of actual eye doses in interventional cardiology (and other similar interventional practices), ISEMIR recommends improving training in occupational radiation protection and monitoring methods for assessing eye lens doses, and urging hospital management to utilize the international database under development for benchmarking occupational doses in interventional cardiology and, hence, improve optimization of protection. (author)

  11. Safe sedation in modern cardiological practice.

    Science.gov (United States)

    Furniss, Stephen S; Sneyd, J Robert

    2015-10-01

    Safe sedation is fundamental to many modern cardiological procedures, and following the publication of the report on safe sedation by the Academy of Medical Royal Colleges, this report discusses sedation specifically in cardiological practice. The major areas within cardiology that use sedation are cardioversion, catheter ablation particularly of atrial fibrillation, transoesophageal echocardiography, implantable device (cardiovascular implantable electronic device) procedures and other procedures such as transcatheter aortic valve replacement. There is increasing demand for cardiological sedation but there is wide geographical variation in its use and there are also growing data to support non-anaesthetists giving sedation. The use of benzodiazepines, particularly for short procedures, is common, but even here good record-keeping and audit together with an understanding of the continuum of sedation and having appropriately trained staff and the necessary facilities are vital. Nurse administration of propofol may be appropriate for some procedures in cardiology that require at least moderate sedation. Appropriate training is essential and the use of capnography and target controlled infusion pumps for propofol administration is recommended. PMID:26085525

  12. Strategic Benefits of Referral Services

    OpenAIRE

    Anindya Ghose; Tridas Mukhopadhyay; Uday Rajan

    2003-01-01

    Internet referral services, hosted either by independent third-party infomediaries or by manufacturers serve as ``lead-generators'' in electronic marketplaces, directing consumer traffic to particular retailers. The conventional wisdom on Internet referral services is that they are valuable to consumers because they can be used to compare prices and get binding price quotes from retailers. Less clear is the role of such referral services for the manufacturers and the retailers. In addition, a...

  13. Measures of Knowledge and Attitude Toward Preventive Cardiology.

    Science.gov (United States)

    Allred, Charlene A.; And Others

    1985-01-01

    The development and validation of an inventory of preventive cardiology at the University of Virginia is described. The inventory contains two instruments designed to measure medical students' preinstructional and postinstructional knowledge of and attitude toward preventive cardiology. (Author/MLW)

  14. Cardiac magnetic resonance in clinical cardiology

    Institute of Scientific and Technical Information of China (English)

    Andreas; Kumar; Rodrigo; Bagur

    2015-01-01

    Over the last decades, cardiac magnetic resonance(CMR) has transformed from a research tool to a widely used diagnostic method in clinical cardiology. This method can now make useful, unique contributions to the work-up of patients with ischemic and non-ischemic heart disease. Advantages of CMR, compared to other imaging methods, include very high resolution imaging with a spatial resolution up to 0.5 mm × 0.5 mm in plane, a large array of different imaging sequences to provide in vivo tissue characterization, and radiationfree imaging. The present manuscript highlights the relevance of CMR in the current clinical practice and new perspectives in cardiology.

  15. Análise do encaminhamento das contas dos municípios brasileiros do ano de 2008 = Analysis of referral of the brazilian municipalities of accounts for the year 2008

    Directory of Open Access Journals (Sweden)

    José Dionísio Gomes da Silva

    2010-05-01

    Full Text Available A consolidação das contas anuais dos municípios e estados que constituem a República Federativado Brasil é um instrumento que possibilita a sociedade à observação global das informaçõesconsolidadas de todos os entes da federação. Esta pesquisa tem como objetivo geral analisar se osmunicípios brasileiros encaminharam os dados de suas contas, no ano de 2008, no prazo determinadopelo Art. 51 da LRF (30 de abril. Foram utilizadas as pesquisas descritiva, bibliográfica, documental equalitativa. A coleta de dados foi realizada no sítio do Instituto Brasileiro de Geografia e Estatística(IBGE para identificar a quantidade de municípios e sua distribuição pelas regiões, e no sítio daSecretaria do Tesouro Nacional (STN, a fim de obter as datas de encaminhamento das contas dessesmunicípios. Os resultados revelaram que dos 5.563 municípios brasileiros apenas 76,54% entregaramas suas contas anuais no prazo estabelecido no Art. 51 da LRF, 19,29% enviaram depois do prazo, e,por fim, 4,17% ainda não tinham encaminhado essas informações para a Secretaria do TesouroNacional (STN, até o dia de emissão do relatório utilizado para a coleta de dados da pesquisa.The consolidation of accounts of municipalities and states that constitute the Federal Republic of Brazilis an instrument that enables the company to the global observation of the consolidated information ofall the states. This research aims at analyzing whether the municipalities forwarded data from itsaccounts in 2008, the deadline established by Article 51 of the LRF (April 30. We used descriptiveresearch, literature, documentary and qualitative. Data collection was performed at the site of theBrazilian Institute of Geography and Statistics (IBGE to identify the number of municipalities and theirdistribution by regions, and the site of the National Treasury Secretariat (STN to obtain the dates ofreferral accounts of those municipalities. The results showed that from 5563 only 76

  16. Evaluation of Cardiology Training and Manpower Requirements.

    Science.gov (United States)

    Adams, Forrest H., Ed.; Mendenhall, Robert C., Ed.

    Begun in June, 1971 and completed in October 1973, the study had the following specific goals: to define the cardiologist's role; to determine cardiology training program objectives; to determine manpower needs for cardiologists; and to determine the educational needs of cardiologists. The major information was sought from all active cardiologists…

  17. An Evaluation of a Clerkship In Cardiology

    Science.gov (United States)

    Edson, John N.; and others

    1969-01-01

    Evaluation of the clinical clerkship in Cardiology for general practitioners proves there is an urgent need for continuing post graduate medical education for general practitioners. Clerkship was offered jointly by the Long Island College Hospital and the State University of New York Downstate Medical Center, Brooklyn, New York. (IR)

  18. Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil Foreign body aspiration in children and adolescents: experience of a Brazilian referral center

    Directory of Open Access Journals (Sweden)

    Sílvia Teresa Evangelista Vidotto de Sousa

    2009-07-01

    Full Text Available OBJETIVO: Descrever as características clínicas, radiológicas e endoscópicas da aspiração de corpo estranho por menores de 15 anos em um centro de referência em São Luís, MA. MÉTODOS:Estudo descritivo realizado a partir de dados de prontuários dos pacientes atendidos no Hospital Universitário Materno Infantil devido à aspiração de corpo estranho entre 1995 e 2005. Avaliamos 72 casos confirmados de aspiração de corpo estranho em relação à procedência, variáveis biológicas, clínico-radiológicas e endoscópicas. Para verificar se as frequências observadas das variáveis em estudo foram estatisticamente significantes, utilizamos o teste do qui-quadrado. RESULTADOS: A maioria do pacientes era procedente das cidades do interior (55,6%. As maiores frequências das diferentes variáveis estudadas foram as seguintes: faixa etária de 0-3 anos (81,9%; sexo masculino (63,9%; tempo de evolução > 24 h (66,7%; hipotransparência na radiografia de tórax (57,7%; localização do corpo estranho no pulmão direito (41,2% ou na laringe (20.5%; natureza orgânica do corpo estranho (83,3%; complicação como processo inflamatório localizado (59,4%; edema de glote como complicação do exame endoscópico (47,6%; e sementes (46,6%, espinha de peixe (28,3% e plásticos (25,5% como tipos mais frequentes de corpos estranhos aspirados. Não houve óbitos. CONCLUSÕES: Cuidados preventivos devem priorizar crianças menores de três anos de idade, do sexo masculino, provenientes de cidades do interior. O acesso dessas crianças às substâncias com risco potencial para aspiração, incluindo os alimentos, deve ser evitado. Exames radiológicos simples e de fácil acesso à população são subutilizados, o que compromete a qualidade do primeiro atendimento.OBJECTIVE: To describe the clinical, radiological and endoscopic characteristics of foreign body aspiration among individuals under the age of 15 treated at a referral center in the city of

  19. Entre a saúde coletiva e a saúde mental: um instrumental metodológico para avaliação da rede de Centros de Atenção Psicossocial (CAPS do Sistema Único de Saúde Public health and mental health: methodological tools to evaluate the Brazilian Network of Referral Centers for Psycho-Social Care (CAPS in the Brazilian Unified Health System

    Directory of Open Access Journals (Sweden)

    Rosana Teresa Onocko-Campos

    2006-05-01

    Full Text Available Trata-se de discussão preliminar sobre possível instrumental metodológico para pesquisa avaliativa da rede de Centros de Atenção Psicossocial (CAPS do SUS. Problematiza-se a relevância que a área da saúde mental deveria ter para a saúde coletiva, considerando a alta prevalência de transtornos psíquicos e relativa carência de estudos da interface dessas áreas. Destacam-se as características dos CAPS para demonstrar que são serviços particularmente complexos. Considera-se imprescindível a aproximação das duas áreas para a constituição de um campo interdisciplinar de saberes e práticas, e aponta-se a necessidade dessa convergência para o desenvolvimento de um processo avaliativo sistemático dos CAPS. Levando-se em conta a complexidade do objeto e visando gerar subsídios para a Reforma Psiquiátrica Brasileira, com base em instrumentos da pesquisa avaliativa, propõe-se: a importância de se resgatar a participação de diversos atores no processo avaliativo, a necessidade de coletar e sistematizar diversos estudos desenvolvidos na academia sobre o tema, e a importância de promover um novo território de pesquisa no âmbito das políticas públicas de saúde, que possa subsidiar formuladores, gestores e equipes na reformulação de suas práticas.This article presents a preliminary discussion of potential methodological tools for qualitative research on the Network of Referral Centers for Psycho-Social Care (CAPS in the Brazilian Unified Health System (SUS. The relevance of mental health within the field of public health is examined. The study focuses on the high prevalence of mental disorders and the disproportionate lack of studies on the interface between mental health and public health. The establishment of an interdisciplinary field between public health and mental health is proposed to meet common needs by achieving similar perspectives in knowledge and practice. A particular group of tools is proposed, emphasizing

  20. Onco-cardiology: Present and future.

    Science.gov (United States)

    Sueta, Daisuke; Hokimoto, Seiji

    2016-07-15

    "Onco-cardiology" is a term that indicates cardiotoxicity during treatment of malignant diseases. Many studies have demonstrated that chemotherapy agents induce cardiotoxicity in certain ratios. In clinical settings, active malignant diseases or a history thereof are often encountered in patients with cardiovascular disease (CVD); it is not uncommon for a patient to struggle with a prior treatment. We have previously demonstrated a close association between malignant diseases and coronary calcifications in coronary artery disease. The concurrence of arteriosclerotic diseases, including CVD, with malignant diseases should be carefully considered in clinical settings, particularly with regard to scheduled surgical procedures. Moreover, it is essential that all medical professionals associated with cancer care understand these associations. Our advocacy will provide new insight into onco-cardiology. PMID:27107544

  1. Use of smartphone technology in cardiology.

    Science.gov (United States)

    Nguyen, Hoang H; Silva, Jennifer N A

    2016-05-01

    Smartphone-based technologies along with broadband connectivity are changing the way modern cardiology is practiced. The ever broadening connectivity and increasing capabilities of smartphone-based technologies can better monitor, diagnose, and prevent cardiovascular diseases. Researchers can leverage the ubiquitous use of smartphone-based technologies and their constant stream of biometric data to establish large community-based clinical research studies. Patient engagement is enhanced with constant and on-demand access to physicians, daily self-monitoring, and expanding social networks. On the other hand, the exponential growth of smartphone-based technologies invariably disrupts the traditional healthcare model and leaves a vacuum in the infrastructure, medico-legal apparatus, and reimbursement systems that need to be addressed. In this review, we present a comprehensive discussion of the various applications utilizing smartphone-based technologies in cardiology. PMID:26686266

  2. Screening for mental disorders in cardiology outpatients

    DEFF Research Database (Denmark)

    Birket-Smith, M.; Rasmussen, A.

    2008-01-01

    The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86...... were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic and...... mental problems in each patient on visual analogue scales (VAS-som and VAS-men). The current treatments, including psychiatric and psychological treatments, were noted, and the survival was followed for 3 years. Of the 86 patients included, 34 (40%) had a diagnosis of mental disorder. Eleven (12.8%) had...

  3. Referral Infomediaries and Retail Competition

    OpenAIRE

    Yuxin Chen; Ganesh Iyer; Paddy Padmanabhan

    2001-01-01

    An important phenomenon on the Internet has been the emergence of "infomediaries" or Internet referral services such as Autobytel.com and Carpoint.com in the automobile industry, Avviva.com in real estate and Healthcareadvocates.com in medicine. These services offer consumers the opportunity to get price quotes from enrolled brick-and-mortar retailers as also information on invoice prices, reviews and specifications before they commence the shopping process. Internet referral services also di...

  4. Retinoblastoma Referral Pattern in Kenya

    OpenAIRE

    Joseph M Nyamori; Kahaki Kimani; Njuguna, Margaret W.; Helen Dimaras

    2014-01-01

    Purpose: Kenya is a large country with a widely dispersed population. As retinoblastoma requires specialized treatment, we determined the referral pattern for patients with retinoblastoma in Kenya to facilitate the formulation of a national policy. Materials and Methods: A retrospective study was performed for retinoblastoma patients who presented from January 1, 2006 to December 31, 2007. Data were collected on the referral process from presenting health facility to the hospital where pa...

  5. Estudo comparativo entre o manejo da asma em uma unidade de referência da rede pública de Porto Alegre (RS e as proposições do III Consenso Brasileiro no Manejo da Asma Asthma management in a public referral center in Porto Alegre in comparison with the guidelines established in the III Brazilian Consensus on Asthma Management

    Directory of Open Access Journals (Sweden)

    Waldo Mattos

    2006-10-01

    Full Text Available OBJETIVO: Avaliar se as diretrizes do III Consenso Brasileiro no Manejo da Asma estão sendo aplicadas em uma população de asmáticos em um hospital de referência da rede pública de Porto Alegre (RS. MÉTODOS: Todos os pacientes adultos que iniciaram tratamento entre 1999 e 2002 foram avaliados. O tratamento recebido foi classificado em concordante ou discordante do Consenso. As características clínicas da asma e a freqüência do tratamento por especialista foram comparadas entre os grupos. RESULTADOS: Foram avaliados os prontuários de 357 pacientes, com média de idade de 41 anos, sendo 106 homens (29,7% e 251 mulheres (70,3%, 33 tabagistas (9,2%. O tratamento foi considerado discordante em 246 pacientes (70%, sendo que, neste grupo, houve ausência de tratamento com corticóide inalatório em pacientes com asma persistente em 174 deles (71%. Volume expiratório forçado no primeiro segundo normal, idade entre doze e dezoito anos e asma intermitente foram observados com maior freqüência entre os pacientes com tratamento concordante (p OBJECTIVE: To determine whether the guidelines put forth in the III Brazilian Consensus on Asthma Management are being applied in a population of asthma patients treated at a public hospital that is a referral center for asthma in the city of Porto Alegre, Brazil. METHODS: All adult asthma patients who began their treatment between 1999 and 2002 were evaluated. The treatment given was classified as consistent or inconsistent with the Consensus guidelines. The clinical features of asthma and the frequency of treatment provided by a specialist were compared between the two groups (those receiving guideline-consistent treatment and those receiving guideline-inconsistent treatment. RESULTS: The charts of 357 patients were evaluated. The study sample consisted of 106 males (29.9% and 251 females (70.3%. The mean age was 41 years, and 33 (9.2% of the patients were smokers. The treatment was considered

  6. Evaluating the benefits of nuclear cardiology

    International Nuclear Information System (INIS)

    This paper reviews the role of nuclear cardiology in the context of health care evaluation and resource utilisation. Nuclear cardiology procedures are used to detect disease, to define the extent of disease, to predict the outcome of therapy and to monitor the response to treatment. The evaluation of effectiveness will depend on the role for which the tests are being used. The evaluation of diagnostic tests most commonly follows the five level Fineberg classification. I) Technical capacity; II) diagnostic accuracy; III) diagnostic impact; IV) therapeutic impact; V) patient outcome. Tests may succeed or fail at each of these hierarchical levels. In addition to the clinical impact which is evaluated, the appropriate use of health care resources has to be considered , i.e. the cost effectiveness of the investigation. For this the costs of diagnosis and treatment in the resources used, together with the direct cost on the patient and patient carers needs to be considered. In addition to these direct costs to the community and to the patient and the carers the secondary downstream costs and opportunity costs have to be taken into account. The common methods for assessing the costs and benefits include cost minimization, cost effectiveness, cost utility, and cost benefit studies. The advantage and appropriate use of these methods are reviewed. There are seven clinical methods for evaluating diagnostics tests in nuclear cardiology which are: I) Case reports; II) consensus studies; III) databases; IV) management impact studies; V)modeling techniques; VI) management impact studies; VII) randomized control trial. Each of these has a role with advantages and disadvantages which are reviewed. It is no long sufficient to investigate the usefulness of a diagnostic test used in nuclear cardiology in isolation but it as to be within the context of the health care system and the resource used

  7. ICRP PUBLICATION 120: Radiological Protection in Cardiology

    International Nuclear Information System (INIS)

    Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission’s published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions

  8. Patient cumulative radiation exposure in interventional cardiology

    International Nuclear Information System (INIS)

    Interventional cardiology procedures can involve potentially high doses of radiation to the patients. Stochastic effects of ionising radiation - radiation-induced cancers in the long term - may occur. We analysed clinical characteristics and dosimetric data in a population of patients undergoing interventional cardiology. In all, 1 591 patients who had undergone coronarography and/or angioplasty in the course of a year at the Saint-Gatien Clinic in Tours (France) were included. Information on patients' individual clinical characteristics and Dose-Area Product values were collected. Organ doses to the lung, oesophagus, bone marrow and breast were mathematically evaluated. The median age of patients was 70 years. Their median cumulative dose-area product value was 48.4 Gy.cm2 for the whole year and the median effective dose was 9.7 mSv. The median organ doses were 41 mGy for the lung, 31 mGy for the oesophagus, 10 mGy for the bone marrow and 4 mGy for the breast. Levels of doses close to the heart appear to be rather high in the case of repeated interventional cardiology procedures. Clinical characteristics should be taken into account when planning epidemiological studies on potential radiation-induced cancers. (authors)

  9. Acceptance testing and QA in interventional cardiology

    International Nuclear Information System (INIS)

    Interventional radiology has seen rapid growth in the field of cardiology over the past decade. This growth has been facilitated by advances in imaging technology and the development of increasingly sophisticated dedicated radiological equipment. Interventional cardiology (IC) procedures are complex and may involve prolonged irradiations, which may subject patients and operators to higher levels of risk than those, which normally prevail. Currently interventional cardiology contributes over 10% to annual collective dose in the UK in spite of contributing to a total annual frequency of 0.68%. The EU Medical Exposures Directive, 97/43/Euratom, identifies interventional radiology as an area of special concern. Acceptance testing and routine quality assurance (QA) programmes are particularly important in the field of interventional cardiology given the above. The requirements for acceptance testing and QA are underpinned in the EU Medical Exposures Directive and consequent national legislation. A QA survey of 16 interventional cardiology systems in Ireland was carried out by the Department of Medical Physics and Bioengineering, St. James's Hospital, Dublin. This is the continuation of a recently published survey and represents over half of the interventional cardiology systems in Ireland including new technology digital flat panel systems and dedicated mobile equipment in trailors. Acceptance testing and QA protocols were developed and reviewed in accordance with current international and national guidelines, standards and literature. Testing included assessing the performance of the X ray tube and generator, the automatic exposure control (AEC) device in fluoroscopy and digital acquisition modes and a subjective assessment of image quality using the Leeds test objects. Radiation shielding calculations and measurements were performed to determine the structural shielding required by new installations and electrical, mechanical and general radiation safety was also

  10. A case study of technology transfer: Cardiology

    Science.gov (United States)

    Schafer, G.

    1974-01-01

    Research advancements in cardiology instrumentation and techniques are summarized. Emphasis is placed upon the following techniques: (1) development of electrodes which show good skin compatibility and wearer comfort; (2) contourography - a real time display system for showing the results of EKGs; (3) detection of arteriosclerosis by digital computer processing of X-ray photos; (4) automated, noninvasive systems for blood pressure measurement; (5) ultrasonoscope - a noninvasive device for use in diagnosis of aortic, mitral, and tricuspid valve disease; and (6) rechargable cardiac pacemakers. The formation of a biomedical applications team which is an interdisciplinary team to bridge the gap between the developers and users of technology is described.

  11. Transition from image intensifier to flat panel detector in interventional cardiology: Impact of radiation dose

    Directory of Open Access Journals (Sweden)

    Roshan S Livingstone

    2015-01-01

    Full Text Available Flat panel detector (FPD technology in interventional cardiology is on the increase due to its varied advantages compared to the conventional image intensifier (II systems. It is not clear whether FPD imparts lower radiation doses compared to II systems though a few studies support this finding. This study intends to compare radiation doses from II and FPD systems for coronaryangiography (CAG and Percutaneous Transluminal Coronary Angioplasty (PTCA performed in a tertiary referral center. Radiation doses were measured using dose area product (DAP meter from patients who underwent CAG (n = 222 and PTCA (n = 75 performed using FPD angiography system. The DAP values from FPD were compared with earlier reported data using II systems from the same referral center where the study was conducted. The mean DAP values from FPD system for CAG and PTCA were 24.35 and 63.64 Gycm 2 and those from II system were 27.71 and 65.44 Gycm 2 . Transition from II to FPD system requires stringent dose optimization strategies right from the initial period of installation.

  12. Radiological protection in interventional cardiology in Chile

    International Nuclear Information System (INIS)

    In September 2000, an expert mission was assigned to Chile, under the regional project named 'International BBS in Medical Practices Radiation Protection and Quality Assurance In Interventional Radiology' (ARCAL XLIX). The objective of the mission was to evaluate the level of radiation protection (RP) and safety in interventional cardiology ( IC ) installations. A team of local cardiologists, medical physicists and technologists was created for this purpose and during one week, several cardiology laboratories were evaluated and some basic quality controls (QC) were carried out. A basic pilot training course in radiation protection was imparted at the Hospital of the University of Chile in Santiago de Chile and some of the key objectives for a future national quality assurance programme were presented during the national congress of IC. In addition, a national survey on radiation protection aspects was circulated and its results evaluated. These activities enabled the local team to become familiar with the methodology of assessment of the level of protection and the organization of a programme, which was illustrated with the examples of similar European programmes. As result of these actions, several proposals were made to both the local authorities and the IAEA. The most important were: a) to initiate a basic QC programme, b) to organize a training in RP for cardiologists in order to formalize their accreditation, c) to improve personal occupational dosimetry, d) to initiate a programme of patient dosimetry, e) to optimize the technical and clinical protocols, f) to create a national registry of incidents with skin injuries. (author)

  13. Cardiological telemonitoring in rehabilitation and sports medicine.

    Science.gov (United States)

    Vainoras, Alfonsas; Marozas, Vaidotas; Korsakas, Stasys; Gargasas, Liudas; Siupsinskas, Laimonas; Miskinis, Vytenis

    2004-01-01

    The paper presents the development results of teleconsultative cardiology systems and their application in rehabilitation and sport medicine. The first teleconsultative cardiology (TELECARD) system was developed for outpatient departments in the city of Kaunas, using Internet links. It was based on the CompCardioSignal terminal. One branch of the TELECARD system with a mobile CompCardioSignal terminal was used for functional state evaluation of Lithuanian sportsmen during the 2000 Sydney Olympic Games. The examined results have shown that every sportsman responded differently to acclimatization and the TELECARD system provided support to physicians and coaches for making optimal decisions regarding the sportsmen's adaptation and other situations. The final telemetry system was used for rower monitoring. It was based on the new CompCardioSignal terminal with three EASI ECG leads and synchronously recorded motion signals for evaluation of human reaction to physical load. The developed telemonitoring systems were a useful tool for evaluation of human reaction to physical load in rehabilitation and sports activities. PMID:15718601

  14. The use of MR in cardiological diagnostics

    International Nuclear Information System (INIS)

    Image diagnostics is playing an important role in cardiology, and magnetic resonance tomography (MR) is one of many methods used in examinations of the heart. Based on studies of the literature and his own experience the author surveys the potential of MR in today's and tomorrow's diagnostics of heart diseases. Among the image diagnostic methods MR is the one that can give the most extensive information about the heart's anatomy and function. In a non-invasive way and without the use of ionizing radiation, MR can represent the anatomy in selectable planes, visualize and quantify the heart's pumping function and functioning of the cardiac valves, and give detailed information about the regional contractility, blood flow and viability of myocard. MR is capable of giving important and to some extent unique contributions to heart diseases, both congenital and contracted heart disease. Because of failing availability and competence MR is still little used in cardiological diagnostics, but the method undoubtedly has the potential to play a very important role in the future

  15. Inappropriate circumcision referrals by GPs.

    OpenAIRE

    Griffiths, D.; Frank, J D

    1992-01-01

    One hundred and twenty boys were referred by GPs over a 12-month period to a paediatric urologist for circumcision. The reasons for referral were: ballooning in 36, non-retraction in 28, balanoposthitis in 36 or a combination in 15. On examination 53% had a retractile, 21% a partially retractile and 21% a non-retractile foreskin. Six patients had obvious balanitis xerotica obliterans. Only one quarter of the patients required a circumcision. The penis was not examined by the referring doctor ...

  16. Referrals to a facial pain service.

    Science.gov (United States)

    Lang, M; Selvadurai, T; Zakrzewska, J M

    2016-04-01

    Aim To assess the quality of referral letters to a facial pain service and highlight the key requirements of such letters.Method The source of all referral letters to the service for five years was established. For one year the information provided in 94 referrals was assessed. Using a predetermined checklist of essential information the referral letters were compared to these set criteria.Results The service received 7,001 referrals and, on average, general dental practitioners (GDPs) referred 303 more patients per year than general medical practitioners (GMPs). Seventy-one percent of all referrals were from primary care practitioners, the rest were from specialists. Over 70% of GMP and 52% of GDP letters included a past medical history, with GMPs more likely to suggest a possible diagnosis and include previous secondary care referrals. The mean score for GMP referrals compared to the standard proforma (maximum of 12) was 5.6 and for GDP referrals 5.0. A relevant drug history was included by 75.6% GMP compared to 38.7% of GDPs. GMPs were more likely to include any relevant mental health history.Conclusions The overall quality of referral letters is low which makes it difficult for the specialists to provide robust treatment plans. PMID:27056518

  17. The place of imagery in cardiology: some examples

    International Nuclear Information System (INIS)

    The authors present five cases to illustrate the diagnostic procedure that can be used in cardiology and the importance of imagery techniques. For each case the article shows the reason for the choice of technique and the limits to diagnosis

  18. Transcultural Diabetes Nutrition Algorithm: Brazilian Application

    Directory of Open Access Journals (Sweden)

    Fabio Moura

    2015-09-01

    Full Text Available The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy and regular physical activity (structured exercise represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.

  19. Radiologists' responses to inadequate referrals

    Energy Technology Data Exchange (ETDEWEB)

    Lysdahl, Kristin Bakke [Oslo University College, Faculty of Health Sciences, Oslo (Norway); University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Hofmann, Bjoern Morten [University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Gjoevik University College, Faculty of Health Care and Nursing, Gjoevik (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway)

    2010-05-15

    To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)

  20. Preliminary reference levels in interventional cardiology

    International Nuclear Information System (INIS)

    This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gy x cm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gy x cm2 and 75 Gy x cm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain ''tolerances'' from the proposed levels taking into account the complexity of the procedure and the patient's size. (orig.)

  1. Radiography in cardiology [cardiac disorders, cardiac insufficiency

    International Nuclear Information System (INIS)

    The diagnostic procedure in cardiology nearly always requires an X-ray examination of the thorax. This examination is very informative when it is correctly performed and interpreted. The radiographs need to be read precisely and comprehensively: this includes the evaluation of the silhouette of the heart (size, form and position) as well as the examination of extra-cardiac thoracic structures allowing among other things to search for signs of cardiac insufficiency. The conclusion of the X-ray examination can be drawn after having brought together information concerning the case history, the clinical examination and the study of the radiographs. The radiologist finds himself in one of three situations: (1) the information provided by the X-ray pictures is characteristic of a disease and permits a diagnosis, (2) the X-ray pictures indicate a group of hypotheses; further complementary tests could be useful and (3) the X-ray pictures provide ambiguous even contradictory information; it is necessary to complete the radiological examination by other techniques such as an ultrasonographic study of the heart

  2. Filter's importance in nuclear cardiology imaging

    International Nuclear Information System (INIS)

    Full text: Nuclear Medicine is a medical speciality which employs tomography procedures for the diagnosis, treatment and prevention of diseases. One of the most commonly used apparatus is the Single Photon Emission Computed Tomography (SPECT). To perform exams, a very small amount of a radiopharmaceutical must be given to the patient. Then, a gamma camera is placed in convenient positions to perform the photon counting, which is used to reconstruct a full 3 dimensional distribution of the radionuclide inside the body or organ. This reconstruction provides a 3-dimensional image in spatial coordinates, of the body or organ under study, allowing the physician to give the diagnostic. Image reconstruction is usually worked in the frequency domain, due to a great simplification introduced by the Fourier decomposition of image spectra. After the reconstruction, an inverse Fourier transform must be applied to trace back the image into spatial coordinates. To optimize this reconstruction procedure, digital filters are used to remove undesirable components of frequency, which can 'shadow' relevant physical signatures of diseases. Unfortunately, the efficiency of the applied filter is strongly dependent on its own mathematical parameters. In this work we demonstrate how filters interfere on image quality in cardiology examinations with SPECT, concerning perfusion and myocardial viability and the importance of the medical physicist in the choice of the right filters avoiding some serious problems that could occur in the inadequate processing of an image damaging the medical diagnosis. (author)

  3. Cardiology education using hypermedia and digital imagery.

    Science.gov (United States)

    Klingler, J W; Andrews, L T; Leighton, R F

    1992-07-01

    A computer-based educational system for the study of cardiovascular imaging is described. This system, based on HyperCard * and a standard Macintosh II, integrates hypertext retrieval, computer graphics, sound, and medical images into a single interactive environment stored on a standard hard disk. This 'hypermedia' approach allows arbitrary complexity coupled with direct, immediate, easy traversal of the images and related text, which provides the opportunity for students to move at their own pace, choose their own direction through the material and repeat as often as desired. Storage on magnetic medium allows for easy updating with new studies and material in order to keep pace with advances in medical imaging technology. The system could be mastered onto CD-ROM for ease of distribution if so desired. The system includes a tutorial on the basics of digital image representation and example studies from cineangiography, nuclear medicine, echocardiography and magnetic resonance imaging of the heart. Quantitative techniques for evaluation of left ventricular function are explained using computer graphics overlays on the original medical images. Color encoded functional images are also included as an aid to visualization of ventricular performance data. The system has proven useful as a primer for digital imaging in cardiology prior to specific case study in a traditional mentor relationship. PMID:1458869

  4. Toward a personal health society in cardiology.

    Science.gov (United States)

    Fayn, Jocelyne; Rubel, Paul

    2010-03-01

    In this paper, we present a new generation of health services that has emerged due to the development of advanced information and communication technology (ICT) solutions, like the Enhanced Personal, Intelligent, and Mobile system for Early Detection and Interpretation of Cardiac Syndromes (EPI-MEDICS). It is a personal self-care system that allows any citizen to self-record high-quality ECGs on demand with a smart portable device, which is endowed with powerful ICT capabilities: self-adaptive embedded intelligence, mobile health record management support on SmartMedia card, embedded Web server, and wireless communication. The EPI-MEDICS solution design also provides ambient, intelligent, and pervasive computing services offering any citizen a ubiquitous, reliable, and efficient management of his/her own cardiac status. A multicentric evaluation performed in Europe with a series of device prototypes and the performance assessment of the original methods of signal synthesis that were designed to guarantee a high interoperability level of the recorded data within the clinical practice, as well as of the decision-support methodologies that were developed for an early detection of life-threatening myocardial ischemia and arrhythmia, at home or anywhere, demonstrate the pertinence of going toward a personal health society in cardiology, which still yields the highest mortality rate in industrialized countries. PMID:20007033

  5. Recent advances of MIBG imaging in cardiology

    International Nuclear Information System (INIS)

    The sympathetic nervous system plays an important role in the regulation of cardiovascular function both in healthy subjects and in patients with heart disease. Cardiac neurotransmission imaging allows in vivo noninvasive assessment of presynaptic storage, release and reuptake of neurotransmitters. Iodine-123 labeled metaiodobenzylguanidine (MIBG) is an analogue of the sympatholytic agent guanethidine and behaves in a manner that is similar to norepinephrine, a neurotransmitter of the sympathetic nervous system in the heart. Qualitative and quantitative assessment of MIBG uptake and washout kinetics has evaluated alterations of the cardiac sympathetic function in various heart diseases, such as cardiomyopathies, coronary artery disease, diabetic heart and arrhythmias. As reduced MIBG uptake has been related to the clinical indices of severity and prognosis, it can be used to evaluate the therapeutic effects on the cardiac sympathetic dysfunction. For example, angiotensin converting enzyme inhibitors and β-blockers which have been shown to improve functional capacity and prognosis in patients with heart failure, have been demonstrated to increase MIBG uptake and reduce its washout rate in these patients, indicating favorable effects on the sympathetic nervous system. Thus, MIBG imaging has become a promising noninvasive tool and a widely available modality for the assessment of prognosis and effects of medical therapy in various forms of cardiac pathology. The usefulness and recent advances of MIBG imaging in cardiology will be noted in this article. (author)

  6. Occupational dose measurement in interventional cardiology, dosimetry comparison study

    International Nuclear Information System (INIS)

    The number of cardiology interventional procedures has significantly increased recently. This is due to the reliability of the diagnostic equipment to diagnose many heart disease. In the procedures the x-ray used results in increasing radiation doses to the staff. The cardiologists and other staff members in interventional cardiology are usually working close to the area under examination and receive the dose primarily from scattered radiation from the patient. Therefore workers in interventional cardiology are expected to receive high doses. This study overviews the status of occupational exposure at the three cardiology centers at three different hospitals in Khartoum compared with that received by workers at other medical practices (radiotherapy, nuclear medicine and diagnostic radiology) in the Institute of Nuclear and Technology (INMO) at El Gezira. The TLD Harshaw 6600 reader was used in the assessment of effective dose for Hp (10). Two TLDs were used by each worker at the three cardiology centres, one worn under a protective apron and the other worn outside and above the apron as specified by the ICRP. Each worker at the other sections was facilitated with one dosimeter to be worn on the chest. The annual doses received by 14 cardiologists, 13 nurses and 9 technologists at the three cardiology centres were in the range: (0.84-4.77), (0.15-2.08), (0.32-1.10) mSv respectively. In the INMO the annual doses received by 7 doctors, 5 nurses and 14 technologists were in the range: (0.12-0.51), (0.11-0.65), (0.03-1.39) mSv respectively. The results showed that the annual doses received by the workers do not exceed 20 mSv. The study also indicated that doses received by workers in interventional cardiology, in particular the cardiologists are high compared to that received at the other medical sections.(Author)

  7. "When are you seeing my patient?"--an analysis of the cardiology consultation service in a teaching hospital.

    LENUS (Irish Health Repository)

    Cronin, E

    2010-05-01

    The provision of an efficient consultation service is essential to the efficient functioning of any hospital. Surprisingly little is known about this activity. We present the first reported evaluation of a cardiology consultation service in an attempt to determine the characteristics, efficiency and workload implications of such a service. We performed an audit of the in-patient cardiology consultation service over a four week period. During this period, 125 consultations were seen, of which 85 (68%) were requested by medical specialties. Consultations were seen in a timely fashion, with 76 (61%) being seen on the same day that the request was received. The most common problem was chest pain, (49 patients; 38%) which was felt to be of cardiac origin in only a minority (20; 40%) of cases. Consultations had significant resource implications for our department, with 35 (28%) procedures being performed, 25 (20%) patients\\' care being taken over, and a further 27 (21.6%) new out-patient referrals generated. Our results indicate that the consultation service considered was efficiently delivered but contributed significantly to the department\\'s workload. The most frequent consultation request was for chest pain that was often non-cardiac in nature.

  8. Brazilian energy

    International Nuclear Information System (INIS)

    Brazilian Energy provides all the information necessary for energy companies to invest and operate in Brazil, including: a review of Brazil's natural resources; an assessment of privatisation strategies at the federal, state and regional level; an analysis of the electricity industry and the future for Electrobras; an analysis of the oil industry and, in particular, Petrobras; a discussion of the fuel alcohol industry; the discovery of local natural gas, its prospects and the involvement of the auto industry; an assessment of the problems facing the coal industry and its future; a discussion of the regulatory framework for the newly privatised companies; the importance of intra-regional energy links and the booming membership of Mercosur; the difficulties experienced by foreign investors doing business in Brazil; brief profiles of the key energy companies; profiles of key people influencing the privatisation process in Brazil. Brazilian energy is essential reading for those wishing to advise and assist Brazil in this period of change and development, as well as those who wish to invest or become key players in the Brazilian energy sector. (author)

  9. 12 CFR 612.2301 - Referrals.

    Science.gov (United States)

    2010-01-01

    ... violation of State or local criminal law, the institution shall notify the appropriate State or local law... SUSPECTED CRIMINAL VIOLATIONS Referral of Known or Suspected Criminal Violations § 612.2301 Referrals. (a..., appropriate investigation, and reporting of criminal activity. Within 30 calendar days of determining...

  10. Quality of information on hospice referral.

    OpenAIRE

    Donaldson, N.; Carter, H; Green, R.

    2000-01-01

    Good quality referral information provides hospice staff with essential information at a time when patients are particularly vulnerable. An Ideal Referral Criteria tool for measuring the quality of general practitioners' information was piloted at one hospice site. Overall inter-rater reliability was 90%, with individual categories ranging from 19% to 34%. Cronbach's alpha was 0.35. Further psychometric testing is recommended.

  11. Pediatric Cardiology Boot Camp: Description and Evaluation of a Novel Intensive Training Program for Pediatric Cardiology Trainees.

    Science.gov (United States)

    Ceresnak, Scott R; Axelrod, David M; Motonaga, Kara S; Johnson, Emily R; Krawczeski, Catherine D

    2016-06-01

    The transition from residency to subspecialty fellowship in a procedurally driven field such as pediatric cardiology is challenging for trainees. We describe and assess the educational value of a pediatric cardiology "boot camp" educational tool designed to help prepare trainees for cardiology fellowship. A two-day intensive training program was provided for pediatric cardiology fellows in July 2015 at a large fellowship training program. Hands-on experiences and simulations were provided in: anatomy, auscultation, echocardiography, catheterization, cardiovascular intensive care (CVICU), electrophysiology (EP), heart failure, and cardiac surgery. Knowledge-based exams as well as surveys were completed by each participant pre-training and post-training. Pre- and post-exam results were compared via paired t tests, and survey results were compared via Wilcoxon rank sum. A total of eight participants were included. After boot camp, there was a significant improvement between pre- and post-exam scores (PRE 54 ± 9 % vs. POST 85 ± 8 %; p ≤ 0.001). On pre-training survey, the most common concerns about starting fellowship included: CVICU emergencies, technical aspects of the catheterization/EP labs, using temporary and permanent pacemakers/implantable cardiac defibrillators (ICDs), and ECG interpretation. Comparing pre- and post-surveys, there was a statistically significant improvement in the participants comfort level in 33 of 36 (92 %) areas of assessment. All participants (8/8, 100 %) strongly agreed that the boot camp was a valuable learning experience and helped to alleviate anxieties about the start of fellowship. A pediatric cardiology boot camp experience at the start of cardiology fellowship can provide a strong foundation and serve as an educational springboard for pediatric cardiology fellows. PMID:26961569

  12. Eye lens dose in interventional cardiology.

    Science.gov (United States)

    Principi, S; Delgado Soler, C; Ginjaume, M; Beltran Vilagrasa, M; Rovira Escutia, J J; Duch, M A

    2015-07-01

    The ICRP has recently recommended reducing the occupational exposure dose limit for the lens of the eye to 20 mSv y(-1), averaged over a period of 5 y, with no year exceeding 50 mSv, instead of the current 150 mSv y(-1). This reduction will have important implications for interventional cardiology and radiology (IC/IR) personnel. In this work, lens dose received by a staff working in IC is studied in order to determine whether eye lens dose monitoring or/and additional radiological protection measures are required. Eye lens dose exposure was monitored in 10 physicians and 6 nurses. The major IC procedures performed were coronary angiography and percutaneous transluminal coronary angioplasty. The personnel were provided with two thermoluminescent dosemeters (TLDs): one calibrated in terms of Hp(3) located close to the left ear of the operator and a whole-body dosemeter calibrated in terms of Hp(10) and Hp(0.07) positioned on the lead apron. The estimated annual eye lens dose for physicians ranged between 8 and 60 mSv, for a workload of 200 procedures y(-1). Lower doses were collected for nurses, with estimated annual Hp(3) between 2 and 4 mSv y(-1). It was observed that for nurses the Hp(0.07) measurement on the lead apron is a good estimate of eye lens dose. This is not the case for physicians, where the influence of both the position and use of protective devices such as the ceiling shield is very important and produces large differences among doses both at the eyes and on the thorax. For physicians, a good correlation between Hp(3) and dose area product is shown. PMID:25809107

  13. Contrast-induced nephropathy in interventional cardiology

    Directory of Open Access Journals (Sweden)

    Sudarsky D

    2011-07-01

    Full Text Available Doron Sudarsky, Eugenia NikolskyCardiology Department, Rambam Health Care Campus and Technion-Israel Institute of Technology, Haifa, IsraelAbstract: Development of contrast-induced nephropathy (CIN, ie, a rise in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2–3 days after contrast administration, is strongly associated with both increased inhospital and late morbidity and mortality after invasive cardiac procedures. The prevention of CIN is critical if long-term outcomes are to be optimized after percutaneous coronary intervention. The prevalence of CIN in patients receiving contrast varies markedly (from <1% to 50%, depending on the presence of well characterized risk factors, the most important of which are baseline chronic renal insufficiency and diabetes mellitus. Other risk factors include advanced age, anemia, left ventricular dysfunction, dehydration, hypotension, renal transplant, low serum albumin, concomitant use of nephrotoxins, and the volume of contrast agent. The pathophysiology of CIN is likely to be multifactorial, including direct cytotoxicity, apoptosis, disturbances in intrarenal hemodynamics, and immune mechanisms. Few strategies have been shown to be effective to prevent CIN beyond hydration, the goal of which is to establish brisk diuresis prior to contrast administration, and to avoid hypotension. New strategies of controlled hydration and diuresis are promising. Studies are mixed on whether prophylactic oral N-acetylcysteine reduces the incidence of CIN, although its use is generally recommended, given its low cost and favorable side effect profile. Agents which have been shown to be ineffective or harmful, or for which data supporting routine use do not exist, include fenoldopam, theophylline, dopamine, calcium channel blockers, prostaglandin E1, atrial natriuretic peptide, statins, and angiotensin-converting enzyme inhibitors.Keywords: contrast-induced nephropathy, contrast media

  14. Eye lens dose in interventional cardiology

    International Nuclear Information System (INIS)

    The ICRP has recently recommended reducing the occupational exposure dose limit for the lens of the eye to 20 mSv y-1 , averaged over a period of 5 y, with no year exceeding 50 mSv, instead of the current 150 mSv y-1 . This reduction will have important implications for interventional cardiology and radiology (IC/IR) personnel. In this work, lens dose received by a staff working in IC is studied in order to determine whether eye lens dose monitoring or/and additional radiological protection measures are required. Eye lens dose exposure was monitored in 10 physicians and 6 nurses. The major IC procedures performed were coronary angiography and percutaneous transluminal coronary angioplasty. The personnel were provided with two thermoluminescent dosemeters (TLDs): one calibrated in terms of Hp(3) located close to the left ear of the operator and a whole-body dosemeter calibrated in terms of Hp(10) and Hp(0.07) positioned on the lead apron. The estimated annual eye lens dose for physicians ranged between 8 and 60 mSv, for a workload of 200 procedures y-1. Lower doses were collected for nurses, with estimated annual Hp(3) between 2 and 4 mSv y-1. It was observed that for nurses the Hp(0.07) measurement on the lead apron is a good estimate of eye lens dose. This is not the case for physicians, where the influence of both the position and use of protective devices such as the ceiling shield is very important and produces large differences among doses both at the eyes and on the thorax. For physicians, a good correlation between Hp(3) and dose area product is shown. (authors)

  15. Comparison of nuclear cardiology in the United States and Europe

    International Nuclear Information System (INIS)

    Nuclear Cardiology is a widely available and a widely accepted tool for diagnosis and management of coronary artery disease both in the US and in Europe. Although the most common indications for nuclear studies are similar in the US and Europe, different social and economical environments may affect the practice of Nuclear Cardiology. The aim of this paper is to identify key issues and to provide some information on the similarities and differences which characterize the practice of Nuclear Cardiology in the US and Europe. This paper takes into account the training requirements, the relationships between different professional societies, the accessibility, the choice of imaging protocols, tracers and stressors, the impact of managed care and the role of cardiologists, nuclear physicians and technologists in nuclear labs. The economical differences which may affect the field of high technology, imply a wide range of variability concerning the availability of nuclear cardiology studies in different countries (1:1/10). Moreover the legislation which regulates the practice of nuclear medicine may differ from country. Thus in our opinion there are several important factors both in the US and Europe limiting the development of nuclear cardiology independently of its intrinsic clinical value

  16. Contributions of nuclear cardiology to prognosis and risk stratification in coronary artery disease

    International Nuclear Information System (INIS)

    Myocardial perfusion imaging in patients with suspected or known coronary artery disease and stable symptoms enables not only accurate diagnosis of disease but also entails prognostic value. Myocardial perfusion SPECT contributes to assessment of future cardiac events independently of other clinical parameters. A normal stress myocardial perfusion scan is associated with a favorable prognosis in all pre-test risk subsets similar to that of the general population independent of history, symptoms, and exercise electrocardiography test variables. Cardiac risk and benefit from invasive therapeutic strategies increase in relation to the severity of the abnormality of perfusion and function assessed by gated myocardial perfusion SPECT. Thus, stress myocardial perfusion imaging may serve as a gatekeeper for referral to coronary angiography enabling effective risk stratification in patients with suspected or documented coronary artery disease. In severe coronary artery disease accompanied by left ventricular dysfunction preoperative prediction of reversibility of functional impairment and improvement in survival after revascularization can be achieved by viability testing using nuclear cardiology. Absence of viability is associated with no significant difference in functional and survival outcomes, irrespective of treatment strategy. Therefore, unnecessary revascularization can be avoided in cases with absent evidence of viability. (orig.)

  17. Methods and clinical applications in nuclear cardiology: a position statement

    International Nuclear Information System (INIS)

    Nuclear cardiological procedures have paved the way for non-invasive diagnostics of various partial functions of the heart. Many of these functions cannot be visualised for diagnosis by any other method (e.g. innervation). These techniques supplement morphological diagnosis with regard to treatment planning and monitoring. Furthermore, they possess considerable prognostic relevance, an increasingly important issue in clinical medicine today, not least in view of the cost-benefit ratio. Our current understanding shows that effective, targeted nuclear cardiology diagnosis - in particular for high-risk patients - can contribute toward cost savings while improving the quality of diagnostic and therapeutic measures. In the future, nuclear cardiology will have to withstand mounting competition from other imaging techniques (magnetic resonance imaging, electron beam tomography, multislice computed tomography). The continuing development of these methods increasingly enables measurement of functional aspects of the heart. Nuclear radiology methods will probably develop in the direction of molecular imaging. (orig.)

  18. Brazilian gemstones

    Science.gov (United States)

    Franco, Rui Ribeiro

    1981-04-01

    Brazil counts as a gemmological province because of the variety of gem minerals present in the country. Most Brazilian states and territories produce gemstones, the State of Minas Gerais being the most important producer both in volume and in number of species. Diamonds are chiefly derived by panning from alluvial deposits in Minas Gerais, Mato Grosso and Goiás. Among other gemstones, the most important are aquamarines, beryls, chrysoberyls, topazes, amethysts, tourmalines, emeralds and agates, and their respective varieties. The occurrences of these gemstones, as well as of a great number of others, are described for each state in which they are found.

  19. Brazilian Society of Dermatology against leprosy*

    Science.gov (United States)

    Lastória, Joel Carlos; de Abreu, Marilda Aparecida Milanez Morgado

    2016-01-01

    The Brazilian Society of Dermatology promoted a national campaign against leprosy in 2012, involving their State Regional, Accredited Services of Dermatology and Referral Services in Leprosy. Consisted of clarification to the population about the disease and a day of medical voluntary service. Ninety services (57 Accredited Services and 33 Reference Services) participated, distributed in 23 states. The campaign examined 3,223 people and 421 new cases were diagnosed, 54,4% female, 74,3% between 19 and 64 years and 8,3% in children under 15 years. Of the 217 classified cases, 58,5% was paucibacillary and 41,5% was multibacillary. The results were posted on the Brazilian Society of Dermatology website.

  20. Practical application of natriuretic peptides in paediatric cardiology

    DEFF Research Database (Denmark)

    Smith, Julie; Goetze, Jens P; Andersen, Claus B;

    2010-01-01

    conclude that in premature neonates with persistent arterial ducts; in teenagers with tetralogy of Fallot and pulmonary regurgitation; and in children with heart transplants and potential allograft rejection cardiac peptides can provide the clinician with additional information, but in children with atrial......It is still uncertain if cardiac natriuretic peptides are useful biomarkers in paediatric cardiology. In this review we identify four clinical scenarios in paediatric cardiology, where clinical decision-making can be difficult, and where we feel the paediatric cardiologists need additional...

  1. Weekly Interdisciplinary Colloquy on Cardiology: A Decade of Experiment.

    Science.gov (United States)

    Wehrmacher, William H.; And Others

    1981-01-01

    An experimental, continuing, weekly interdisciplinary colloquy on cardiology is described. It is organized between the departments of medicine and physiology of Loyola University Medical Center to promote interaction between basic scientists and practicing physicians in the medical school. (Author/MLW)

  2. Comparison of Two Educational Strategies in Teaching Preventive Cardiology.

    Science.gov (United States)

    Stroup-Benham, Christine A.; And Others

    This study assessed the impact of two educational strategies: text only versus text plus small group discussion, among two groups of third-year internal medicine clerkship students in a preventive cardiology course. The course was a required, 12-week Internal Medical clerkship at the University of Texas Medical Branch. The first group reviewed…

  3. Burnout, Perceived Stress, and Depression among Cardiology Residents in Argentina

    Science.gov (United States)

    Waldman, Silvina V.; Diez, Juan Cruz Lopez; Arazi, Hernan Cohen; Linetzky, Bruno; Guinjoan, Salvador; Grancelli, Hugo

    2009-01-01

    Objective: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these…

  4. DIHYDROPYRIDINE CALCIUM ANTAGONISTS. POSITION OF NIFEDIPINE IN MODERN CARDIOLOGY PRACTICE

    OpenAIRE

    A. A. Garganeeva

    2016-01-01

    Position of nifedipine in modern cardiology practice is highlighted. Nifedipine usage for arterial hypertension therapy , including combined one, stroke prevention, treatment of hypertensive crisis and ischemic heart disease is considered. Advantages of nifedipine innovative formulations are presented. Possible usage of nifedipine in pulmonary hypertension as well as pregnancy is discussed specially.

  5. 32 CFR 701.9 - Referrals.

    Science.gov (United States)

    2010-07-01

    ... DoD/DON FOIA referral policy is based upon the concept of the originator of a record making a release... outside the Executive Branch of Government (e.g., Congress, State and local government agencies,...

  6. A proposed referral centre based on HL7/XML.

    Science.gov (United States)

    Chen, T S; Liao, B S; Lee, C H; Gough, T G

    2002-01-01

    With the growth of the Inteernet, hospitals have also applied HL7 (Health Level Seven) to exchange data between them. The referral system is identified as an appropriate application system. The effect of referral is to transfer the patient to a suitable hospital in a timely fashion, and to arrange appropriate treatment for the patient. Taking advantage of the Internet to exchange referral data can, not only accelerate the process of patient referral, but also avoid the unnecessary repeat examinations to decrease the waste of medical resources. This article builds up a referral-related message according to the HL7 standard, and develops a referral centre using the Internet environment, making use of XML (eXtensible Markup Language) standard to transform the referral-related data to XML format and exchange referral data between platforms. This electronic referral mechanism is expected to offer other hospitals experience of improved referral practice. PMID:15460680

  7. Position paper on the importance of psychosocial factors in cardiology: Update 2013

    Directory of Open Access Journals (Sweden)

    Ladwig, Karl-Heinz

    2014-05-01

    with implanted cardioverter defibrillators (ICDs a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered.Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.

  8. QA in interventional cardiology: The lessons learned

    International Nuclear Information System (INIS)

    This presentation describes the methodology, shows the results and analyse the difficulties presented during implementation of the QA programmes in two Interventional Cardiology (IC) Centers of Uruguay in the context of an IAEA coordinated research project that explored the possibility of establishing guidance levels for interventional radiology procedures. First, cardiologists, technicians and nurses received specific information about the QA programme. X ray system tests methodologies were based on the DIMOND European Research Project. Characterizations were performed of the two X ray systems (Picker CV-PRO-1997- and Philips Integris 3000-1995). In clinical conditions (with couch and mattress), for all image intensifier diameters and all fluoroscopy and cine modes, Kerma rate and Kerma per frame (entrance patient dose) were measured with an ionization chamber (10x5-6 E, Radcal) at the entrance of four Plexiglas (PMMA) phantom thicknesses (16, 20, 24 and 28 cm). Simultaneously, spatial resolution and low contrast were evaluated at clinical distance to the monitor by a cardiologist and a physicist, using TOR [18FG] Leeds plate located in the center of the PMMA phantom and in the isocenter of the C-arm. In the same conditions, but for 10, 20 and 30 cm PMMA thicknesses, Kerma rate and Kerma per frame and image quality were studied with NEMA phantom (Standard XR21-2000). Constancy tests were performed with Leeds object test using 4 mm Cu attenuators and Leeds image plate. Kerma rates and Kerma per frame for the same conditions (geometry, cine or fluoroscopy modes, dose modes, image intensifier diameter, FOV and PMMA thickness) were different for each X ray system. As can be seen, values are high in the Philips unit. However, direct (subjective) observation of low and high contrast details of the Leeds test showed similar results. That would require objective evaluation (MTF, noise, contrast and SNR), but they consume more time. Differences in Kerma rate and Kerma per

  9. Nuclear cardiology in the UK: activity and practice 1997

    International Nuclear Information System (INIS)

    A questionnaire was sent to 251 nuclear medicine centres asking for details of nuclear medicine activity, and nuclear cardiology activity and practice in 1997. One hundred and seventy-one (68%) centres replied. Nuclear medicine activity was estimated at 11.8 studies/1,000 population/year, and 9.5% of these studies were within cardiology (1.12 studies/1,000/year). Myocardial perfusion imaging (MPI) studies accounted for 77% and radionuclide ventriculography (RNV) for 22% of all nuclear cardiology. On a national basis this represents activity levels of 0.86 and 0.25 studies/1,000/year for MPI and RNV, respectively. Of the 171 responding centres, 102 (60%) performed MPI studies and 81 (79%) of these reported that activity was increasing. However, MPI activity was unevenly distributed between hospitals. Two centres accounted for 13% of total MPI; others had far lower activity rates, and 51/102 (50%) centres performed less than 200 MPI studies/year. Comparison with previous surveys showed that nuclear medicine activity had almost doubled since 1990 (it was 6.0 studies/1,000 population in 1990, 9.3 studies/1,000 in 1994 and 11.8 studies/1,000 in 1997). Over the same period, nuclear cardiology activity had also risen, the greatest increase being seen for the last 3 years (it was 0.7 studies/1,000 population in 1990, 0.82 studies/1,000 in 1994 and 1.12 studies/1,000 in 1997). Despite these encouraging figures, MPI activity for 1997 remained well below that recommended by the British Cardiac Society in 1994 (2.6 studies/1,000/year) as adequate to serve the needs of patients with cardiac disease in the UK; it was also below the European average activity for the same year (2.2 studies/1,000/year). The anticipated increased workload for nuclear cardiology is encouraging despite the wide and varied practice of nuclear cardiology around the UK. The nuclear medicine community now needs to address the issues that will prevent it keeping up with demand, such as restricted camera

  10. Referral Finder: Saving Time and Improving The Quality of In-hospital Referrals.

    Science.gov (United States)

    Cathcart, Jennifer; Cowan, Neil; Tully, Vicki

    2016-01-01

    Making referrals to other hospital specialties is one of the key duties of the foundation doctor, which can be difficult and time consuming. In Ninewells hospital, Scotland, in our experience the effectiveness of referrals is limited by contact details not being readily accessible and foundation doctors not knowing what information is relevant to each specialty. We surveyed foundation doctors on their experience of the existing referral process to identify where we needed to focus to improve the process. The doctors reported significant delays in obtaining contact details from the operator, and found they did not know the specific information needed in each referral. To increase the information available to foundation doctors, we set up a page on the staff intranet called 'Referral Finder'. This page includes contact details, guidelines for referral, and links to relevant protocols for each specialty. By making this information readily accessible our objective was to increase the speed and quality of referrals. When surveyed two months after the web page was established, foundation doctors reported a reduction in calls to operator from baseline and reported achieving more effective referrals. When asked to comment, many doctors asked if the page could include details for other hospitals in our health board and provide more specialty specific information. This feedback prompted us to extend the scope of the page to include the district general hospital in our region, and update many of the existing details. Doctors were then surveyed after the updates, 100% agreed that the website saved time and there was a 49.3% reduction in doctors who reported not knowing the specific information needed for a referral. Having adequate information improved referrals and resulted in time saved. This would allow more time for patient care. The quality improvement project was praised among doctors as a useful, innovative and replicable project. PMID:27158494

  11. Neurology referrals to a liaison psychiatry service.

    LENUS (Irish Health Repository)

    Fitzgerald, P

    2012-02-03

    The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.

  12. Nuclear Cardiology. Guidance and Recommendations for Implementation in Developing Countries

    International Nuclear Information System (INIS)

    Nuclear cardiology represents one of the most widely used non-invasive techniques for the assessment of coronary artery disease and other cardiovascular conditions. It has been proven as a cost effective tool for the management of cardiac patients and usually has a decisive role in diagnosis, prognosis and risk stratification, as well as in evaluation of therapy. Clinical scenarios in which nuclear cardiology can be helpful are continuously expanding, with the identification of special subgroups of patients as potential beneficiaries of these methods and the emergence of technological developments in instrumentation and software that tend to enhance the cost-benefit ratio and the reliability of results. Many developing countries have introduced nuclear cardiology, with increasing use of this technique in view of the epidemic of cardiovascular disease that is taking place in most low to middle income countries. Longer life expectancies, changes in lifestyle, diabetes, overweight and obesity are thought to be some of the factors underlying the rapidly growing incidence of this life threatening condition. Today, cardiovascular diseases are the most common cause of death in adults in most, if not all, countries of the world, although specific diseases show different relative weights according to local socioeconomic conditions. Thus, proper utilization of available resources such as nuclear cardiology and other imaging methods is essential to effectively combat these diseases. The practice of nuclear cardiology, however, is not homogeneous worldwide, owing to differences in technological capabilities, availability of consumables, education and training of human resources, and access to evidence based medicine, among other factors. Evidence based medicine is the judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available

  13. Antiplatelet drugs in cardiological practice: Established strategies and new developments

    OpenAIRE

    Kroetz, Florian

    2008-01-01

    Florian Krötz, Hae-Young Sohn, Volker KlaussCardiology, Medical Policlinic, Ludwig-Maximilians-Universität, Ziemssenstr. 1, 80336 MünchenAbstract: A common pathophysiological course in vascular diseases is an overwhelming activation and aggregation of blood platelets, which results in atherothrombosis. By causing the last decisive step of cerebral, coronary, or peripheral arterial ischemia thrombotic complications of atherosclerotic disease represent a major player ...

  14. A qualitative model for computer-assisted instruction in cardiology.

    OpenAIRE

    Julen, N.; Siregar, P.; Sinteff, J. P.; Le Beux, P.

    1998-01-01

    CARDIOLAB is an interactive computational framework dedicated to teaching and computer-aided diagnosis in cardiology. The framework embodies models that simulate the heart's electrical activity. They constitute the core of a Computer-Assisted Instruction (CAI) program intended to teach, in a multimedia environment, the concepts underlying rhythmic disorders and cardiac diseases. The framework includes a qualitative model (QM) which is described in this paper. During simulation using QM, dynam...

  15. Market Conditions and General Practitioners’ Referrals

    OpenAIRE

    Iversen, Tor; Ma, Albert

    2009-01-01

    We study how market conditions influence referrals of patients by general practitioners (GPs). We set up a model of GP referral for the Norwegian health care system, where a GP receives capitation payment based on the number of patients in his practice, as well as fee-for-service reimbursements. A GP may accept new patients or close the practice to new patients. We model GPs as partially altruistic, and compete for patients. We show that a GP operating in a more competitive market refers more...

  16. Comparison of EuroMISE Minimal Data Model for Cardiology and HL7 V3 DAM: Cardiology Rel. 2

    Czech Academy of Sciences Publication Activity Database

    Seidl, Libor; Hanzlíček, Petr

    2011-01-01

    Roč. 7, č. 1 (2011), s. 33-36. ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : data model * EuroMISE MDMC * HL7 V3 DAM cardiology * comparison Subject RIV: IN - Informatics, Computer Science http://www.ejbi.eu/images/2011-1/Seidl_en.pdf

  17. Dose to patients and professionals in cardiology interventional: Progress of multicenter group Doccaci

    International Nuclear Information System (INIS)

    The multidisciplinary group and multicenter DOCCACI (dosimetry and quality assurance in interventional cardiology), sponsored by the section of haemodynamics of the Spanish society of Cardiology, is intended to propose reference levels to doses received by patients in interventional cardiology procedures such as recommended by the International Commission on radiological protection It also investigates the doses received by professionals, in particular dose in Crystallyne whose recommended limit dose has been reduced recently from 150 to 20 mSv/year. (Author)

  18. The role of referrals in financing technology-based ventures

    OpenAIRE

    Heuven, Joris Marinus Johannes

    2009-01-01

    Many referral mechanisms can be found in the context of entrepreneurship. Networks and third party referrals play a prominent role in spotting entrepreneurial opportunities and in acquiring the resources necessary for growth. In this dissertation, the focus is on the role of referrals in acquiring of one specific type of resource, namely financial resources. Referrals play an important role in both getting new ventures connected to financial resource providers and in the due diligence process...

  19. The referral process characteristics and children /adolescents with intellectual disabilities

    OpenAIRE

    Rovšek, Matej

    2013-01-01

    The research object of the present dissertation is the examination of the referral process characteristics of children and adolescents with intellectual disability into education and schooling curriculas, with a special emphasis on examining the efficacy of the referral process and the connection of different agents with the referral efficacy such as the pre-school curriculas, the socio-economic status, years of schooling, grade retention, academic grades, location of the Referral Process Co...

  20. 28 CFR 541.41 - Institutional referral.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institutional referral. 541.41 Section 541.41 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT... alone or together with an inmate's prior history, may warrant consideration for a control unit...

  1. Behavior Analytic Consultation for Academic Referral Concerns

    Science.gov (United States)

    Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary

    2016-01-01

    Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…

  2. 10 CFR 1014.7 - Referral to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by...

  3. 24 CFR 17.9 - Referral to Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by...

  4. 8 CFR 235.6 - Referral to immigration judge.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form...

  5. REFERRAL FROM PRIMARY CARE TO HOSPITALS IN SAUDI ARABIA: 1) QUALITY OF REFERRAL LETTERS AND FEEDBACK REPORTS

    OpenAIRE

    Jarallah, Jamal S.

    1998-01-01

    Background: Referral between primary care and hospitals is of great importance for patient care and follow-up. This study was conducted because of the importance of the quality of referral letters and feedback reports. Objectives: To evaluate the quality of referrals from primary health care (PHC) centers to general hospital in four regions in Saudi Arabia. Methods: This was a cross-sectional study of a random sample of referrals from the PHC centers. The first sampling unit was the general h...

  6. Referral Criteria from Community Clinics to Pediatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Jacob Urkin

    2008-01-01

    Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

  7. Nuclear cardiology in Senegal: a luxury or a need?

    International Nuclear Information System (INIS)

    Aim: to sensitize at the same time experts and public authorities on the interest of the establishment of nuclear cardiology in Senegal. Material and method: the radioimmunoassay of micro-albuminuria, early marker of cardiovascular morbid-mortality was carried out in the nuclear medicine department of Dakar on a population of 100 diabetic patients (74 of type 1 and 26 of type 2) presenting one or more traditional cardiovascular risk factors. Out of these patients, 39% had abnormal rest ECG, asymptomatic in half of the cases. Results: prevalence of micro-albuminuria is high (24%). There is no significant difference in distribution between type I and type 2. Micro-albuminuria > 30 mg/24 h exists in 16,3% of patients with lipid abnormalities (ratio: total cholesterol/HDL cholesterol > 5), 30% of obese, 75% of hypertensive patients and 43,6% of patients with abnormal rest ECG, who would benefit from myocardial perfusion imaging (MPI): about 17% of patients involved in this study. No or weak correlation is found between micro-albuminuria and traditional risk factors. Conclusion: From these results and available epidemiological data in 2005, the estimate of the requirements in nuclear cardiology for the Senegalese diabetic population, indicates that 3740 patients should have benefited that year from it. Considering that this figure underestimates the real needs, taking into account the needs brought back to a population of 10 million inhabitants and the expect expansion of the diabetic disease, it appears justified to include the nuclear cardiology in the national programmes of prevention of the public health in Senegal. (author)

  8. Current status of nuclear cardiology in the Republic of Korea

    International Nuclear Information System (INIS)

    Since its introduction 20 years ago, nuclear cardiology in the Republic of Korea has grown impressively and is now widely used as a noninvasive procedure in the diagnosis and functional evaluation of various types of heart diseases. All of the classes of procedures, that is, first-pass radionuclide cardioangiography, gated blood pool scan, myocardial perfusion imaging, and myocardial infarct imaging, are being employed frequently and have been the subject of numerous studies. First-pass radionuclide ventriculography is being used in the detection and quantification of intracardiac shunts, the evaluation of chamber size, function, or cardiopulmonary dynamics in various disease states. With gated blood pool scans, several parameters of cardiac function are being measured in a variety of conditions including coronary heart disease. Quantifications of regurgitations are also being done. Both thallium-201 and technetium-99m pyrophosphate are being used in the diagnosis of coronary artery disease. Besides clinical imaging, active research in the field of nuclear cardiology has also been taking place in the Republic of Korea. Examples include investigations on new imaging agents such as 111In-antimyosin monoclonal antibody and hexakis technetium(I) cations, or instrumental developments such as the nuclear stethoscope. Despite such noteworthy accomplishments, however, there have also been some obstacles to further developments in the Republic of Korea, such as the unavailability of a cyclotron. Nevertheless, considering the rate of expansion these procedures are showing and the effort we are putting into further development, the future for nuclear cardiology in the Republic of Korea appears quite promising and may become an example for other developing countries. (author). 28 refs, 5 figs, 2 tabs

  9. Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees.

    Science.gov (United States)

    Shannon, Patricia J; Vinson, Gregory A; Cook, Tonya L; Lennon, Evelyn

    2016-07-01

    In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed. PMID:25735618

  10. Nuclear cardiology in the era of cardiac CT and MRI

    International Nuclear Information System (INIS)

    Full text: Current indications for classical nuclear cardiology are summarized (diagnosis, prognosis, myocardial viability, ventricular function). First, the use of nuclear cardiology is discussed within the clinical context (typical vs. atypical history of ischemia, findings on resting ECG etc.). An overview of different perfusion tracers is given both for SPECT (thallium, MIBI, microspheres) and PET (NH4, H2O, Rb). The advantages of gated imaging are mentioned, thus combining information regarding perfusion, ventricular function, regional wall motion and thickening. Then specificity and sensitivity data for detection of significant coronary artery disease are reviewed in both diabetic and non-diabetic patients: sensitivity values of 86% are reached for coronary artery stenosis of >50% in both populations. Sensitivity increases to around 90% for coronary artery stenosis of >70%. The issue of risk stratification and prognosis in both populations is raised: Negative predictive values as high as 0.97 for death and 0.94 for death or myocardial infarction are reached when patients have normal myocardial perfusion scans (follow-up 23+/-17 months). The current strengths and weaknesses of CT and MR imaging for detection of coronary artery disease are mentioned, including dobutamine stress MRI and perfusion imaging. With dobutamine stress MRI, sensitivity values between 83% and 91% are observed. When comparing dobutamine stress MRI with dobutamine echocardiography, image quality has a huge impact on sensitivity and specificity values with echo, but only minimal impact on MRI sensitivity/specificity values. In a second part of the talk, the advantages of positron emission tomography (PET) and its use in clinical cardiology (mainly detection of viability) are discussed. First, advantages of positron tomography are listed: short half life of the tracer, physiological labelling, absolute quantification, tomographic imaging. Different cardiac tracers are mentioned, such as

  11. Metabolomics, a promising approach to translational research in cardiology

    Directory of Open Access Journals (Sweden)

    Martino Deidda

    2015-12-01

    In this article, we will provide a description of metabolomics in comparison with other, better known “omics” disciplines such as genomics and proteomics. In addition, we will review the current rationale for the implementation of metabolomics in cardiology, its basic methodology and the available data from human studies in this discipline. The topics covered will delineate the importance of being able to use the metabolomic information to understand the mechanisms of diseases from the perspective of systems biology, and as a non-invasive approach to the diagnosis, grading and treatment of cardiovascular diseases.

  12. The Paediatric Cardiology Hall of Fame – Donald Nixon Ross.

    Science.gov (United States)

    Somerville, Jane

    2015-10-01

    Donald Nixon Ross, FRCS (4 October 1922 to 7 July 2014) was a South African-born British cardiothoracic surgeon, who developed the pulmonary autograft, known as the Ross procedure, for the treatment of aortic valve disease, and also performed the first heart transplant in the United Kingdom in 1968. This paper, written by Jane Somerville, Professor of Cardiology [Retired], Imperial College London, London, United Kingdom, provides the personal recollections about Donald Ross from Jane Somerville, and thus provides a unique snapshot of cardiac surgical history. PMID:26574617

  13. Brazilian minerals annual report

    International Nuclear Information System (INIS)

    Statistics of Brazilian mineral resources and production in 1976 are presented. Data included refer also to economic aspects, market, taxes, governments incentives, manpower, exportation, importation, etc

  14. Brazilian minerals annual report

    International Nuclear Information System (INIS)

    Statistics of Brazilian mineral resources and production in 1977 are presented. Data included refer also to economic aspects, market, taxes, government incentives, manpower, exportation, importation, etc

  15. Impact of a Preventive Cardiology Curriculum on Knowledge and Attitudes of First-Year Medical Students.

    Science.gov (United States)

    Veitia, Marie C.; And Others

    1993-01-01

    A study of 54 first-year Marshall University (West Virginia) medical students found that a preventive cardiology curriculum improved both knowledge of and attitudes about preventive cardiology in general and on all 4 subscales (epidemiological evidence, risk factor characteristics, pathophysiology, primary interventions). (Author/MSE)

  16. Myocardial scintigraphy. Clinical use and consequence in a non-invasive cardiological department

    DEFF Research Database (Denmark)

    Dümcke, Christine Elisabeth; Graff, J; Rasmussen, SPL; Madsen, Jan Lysgård; Møller, Søren

    2006-01-01

    analyse the clinical use of MPI in a university hospital without invasive cardiological laboratory. MATERIAL AND METHODS: In the period 01.01.2002 to 31.12.2003, 259 patients (141 women, 118 men) were referred to MPI from our department of cardiology. RESULTS: Normal MPI was seen in 111 patients (43...

  17. Obstetric Referrals: Scenario at A Primary Health Centre in Gujarat

    Directory of Open Access Journals (Sweden)

    Hiteshree C Patel, Birender B Singh, Mahua Moitra, S L Kantharia

    2012-01-01

    Full Text Available Background: Pregnancy and childbirth is associated with health risks for both the mother and child. Timely and prompt referral service has been identified as one of the effective strategies to combat related risks and adverse outcomes. In rural areas, this problem is compounded by multiple factors and referral often plays a key role to ensure favorable outcome. Objectives: Documentation of common indications & identification of constraints related to referrals in pregnancy related cases in a PHC of Gujarat. Methodology: Secondary data analysis of referral slips of referred cases from one PHC, Gujarat was done. Referral slips between 2004 and 2009 were analyzed. A total 155 pregnancy related referrals were made during this period. Results: Referral rate was 15.2%. The average age of women was 23.46±4.1 years, 12.2% women belonged to the high risk age group and 5.8% women were grand multipara. Referrals were nearly equally distributed between OPD and emergency hours highlighting the need for 24X7 services at the PHCs. Majority of referrals were during the intranatal period (64.5%, followed by antenatal cases (23.9% and postnatal cases(11.6%. The common reasons for referral were non progressive labour (14.8%, severe anemia (10.3%, pre-eclampsia (10.3%, malpresentation (9.7% and postpartum hemorrhage (9.7%. Out of 62.6% who required pre-referral treatment, 43.3% didn’t get pre-referral treatment. Majority of pre-referral treatment were not given in intranatal period (58.9%. Conclusion: This study recommends the development of a standard referral protocol, proper training in this regard and universal adherence to this in practice.

  18. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study

    OpenAIRE

    Schiattarella Pier; Farina Francesca; Raia Rosa; Esposito Roberta; Lomoriello Vincenzo; Versiero Marco; Santoro Alessandro; Galderisi Maurizio; Bonito Manuela; Olibet Marinella; de Simone Giovanni

    2010-01-01

    Abstract Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population. Three hundred four consecutive non cardiologic outpatients underwent a sequential assessment including...

  19. Predictive validity of the Brazilian version of the Expected Treatment Outcome Scale in cocaine-dependent outpatients at a drug treatment referral center Validade preditiva da versão em português da Escala do Desfecho Esperado do Tratamento em pacientes ambulatoriais dependentes de cocaína em um centro especializado

    Directory of Open Access Journals (Sweden)

    Marcelle Maria Lobo Dinis

    2005-09-01

    Full Text Available BACKGROUND: High dropout rates among patients under treatment for cocaine dependence have stimulated research into predictors of treatment outcome. OBJECTIVE: To assess the predictive value of the Brazilian version of the Expected Treatment Outcome Scale. METHODS: The original English version of the scale was translated and back-translated. A total of 210 subjects participating in a 10-week randomized double-blind clinical trial (nefazodone versus placebo completed the questionnaire at their first appointment. Mean Expected Treatment Outcome Scale scores were compared with treatment outcomes. RESULTS: There were ten subjects (5% who failed to complete at least six items, and 37 (17.5% failed to complete 1 to 3 items. The most frequently unanswered questions involved time estimates (treatment time and abstinence and third-party judgments. The mean score was 34.4 (9.3 (median, 33.9. There were no differences in mean scores between subjects evaluated in the first to the fifth appointment 35.2 (9.3 or in the sixth to the eleventh appointment 35.2 (9.3 (p = 0.13; completing the treatment 33.8 (10.3 or not 34.6 (9.1 (p = 0.64; remaining abstinent for three weeks 34 (9.3 or not 34.8 (9.4 (p = 0.58, and medication compliance 33.9 (8.8 or noncompliance 35.3 (10.3 (p = 0.34. The ROC curve of Expected Treatment Outcome Scale scores, when dropout was defined as not appearing for all 11 appointments, was linear, with an area under the curve of .54 (range, .44-.64, suggesting that the scale is ineffective in discriminating between cases and noncases. CONCLUSION: In this study, the Brazilian version of the Expected Treatment Outcome Scale was found to have no predictive value for treatment adherence and abstinence in cocaine-dependent subjects subjected to a standardized treatment protocol.INTRODUÇÃO: Altas taxas de abandono de tratamento por dependentes de drogas têm intensificado a pesquisa sobre fatores preditivos. OBJETIVO: Estudar a validade preditiva

  20. Employee-referral schemes and discrimination law

    OpenAIRE

    Connolly, M

    2015-01-01

    Employee-referral schemes (‘introduce a friend’) are in common usage in recruitment. They carry a potential to discriminate by perpetuating an already unbalanced workforce (say, by gender and ethnicity). With this, or course, comes the risk of litigation and bad publicity as well as any inherent inefficiencies associated with discrimination. This article is threefold. First, it examines the present state of the law. Second, it is based on a survey of employers who use these schemes. Third, it...

  1. Simulation-based planning of surgical interventions in pediatric cardiology

    Science.gov (United States)

    Marsden, Alison

    2012-11-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  2. Simulation based planning of surgical interventions in pediatric cardiology

    Science.gov (United States)

    Marsden, Alison L.

    2013-10-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  3. Investigation of radiation skin dose in interventional cardiology

    International Nuclear Information System (INIS)

    Background - The study investigated the radiation skin doses for interventional patients in cardiology; two procedures which have the highest radiation dose are Radiofrequency Catheter Ablation (RFCA) and Percutaneous Transluminal Coronary Angioplasty (PTCA). Methods and Results - 56 patients were randomly selected and investigated; 23 patients in the RFCA group and 33 in the PTCA group. Skin and effective dose were calculated from Dose Area Product (DAP). Thermoluminescent Dosimetry was the second method of dose measurement used. Patients were followed-up for a three month period to check for possible skin reactions resulting from the radiation dose during the procedure. Radiation skin doses in 14 patients were calculated to be more than 1 Gy, including three patients who received more than 2 Gy, the threshold dose for deterministic effects of radiation. 7 patients (12.5%) reported skin reactions as a result of the radiation received to their backs during the procedure. Mean DAP and estimated effective doses were 105 Gycm2 and 22.5 mSv for RFCA, and 32 Gycm2 and 6.2 mSv for PTCA procedures respectively. Conclusion - Complex procedures in Interventional Cardiology can exceed the threshold level for deterministic effects in the skin. (author)

  4. Pricing and Referrals in Diffusion on Networks

    CERN Document Server

    Leduc, Matt V; Johari, Ramesh

    2015-01-01

    When a new product or technology is introduced, potential consumers can learn its quality by trying the product, at a risk, or by letting others try it and free-riding on the information that they generate. We propose a dynamic game to study the adoption of technologies of uncertain value, when agents are connected by a network and a monopolist seller chooses a policy to maximize profits. Consumers with low degree (few friends) have incentives to adopt early, while consumers with high degree have incentives to free ride. The seller can induce high degree consumers to adopt early by offering referral incentives - rewards to early adopters whose friends buy in the second period. Referral incentives thus lead to a `double-threshold strategy' by which low and high-degree agents adopt the product early while middle-degree agents wait. We show that referral incentives are optimal on certain networks while intertemporal price discrimination (i.e., a first-period price discount) is optimal on others.

  5. Clinical and economic outcomes assessment in nuclear cardiology

    International Nuclear Information System (INIS)

    The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical information at similar or lower comparative costs. With an ever-increasing emphasis on cost containment, outcome assessment forms the basis of preserving the quality of patient care. Today, outcomes assessment encompasses a wide array of subjects including clinical, economic, and humanistic (i.e., quality of life) outcomes. For nuclear cardiology, evidence-based medicine would require a threshold level of evidence in order to justify the added cost of any test in a patient's work-up. This evidence would include large multicenter, observational series as well as randomized trial data in sufficiently large and diverse patient populations. The new movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, it has seen a dramatic shift in the quality of outcomes data published in nuclear cardiology. This includes the use of statistically rigorous risk-adjusted techniques as well as large populations (i.e., >500 patients) representing multiple diverse medical care settings. This has been the direct result of the development of multiple outcomes databases that have now amassed thousands of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combined endpoints (e.g., death, myocardial infarction, or unstable angina). New technologies for the diagnosis of coronary artery disease have contributed to the rising costs of care. In the United States and in Europe, costs of care have risen dramatically, consuming an ever-increasing amount of available resources. The overuse of diagnostic angiography often leads to unnecessary revascularization that does not lead to

  6. Optimisation of patient and staff exposure in interventional cardiology

    International Nuclear Information System (INIS)

    The Council Directive of the European Community 97/43/Euratom (MED) deals with the health protection of individuals against dangers of ionising radiation in relation to medical exposure, and also focuses attention on some special practices (Art. 9), including interventional radiology, a technique involving high doses to the patient. The paper presents the European approach to optimisation of exposure in interventional cardiology. The DIMOND research consortium (DIMOND: Digital Imaging: Measures for Optimising Radiological Information Content and Dose) is working to develop quality criteria for cineangiographic images, to develop procedures for the classification of complexity of therapeutic and diagnostic procedures and to derive reference levels, related also to procedure complexity. DIMOND project also includes aspects of equipment characteristics and performance and content of training in radiation protection of personnel working in interventional radiology field. (author)

  7. Exploiting expert systems in cardiology: a comparative study.

    Science.gov (United States)

    Economou, George-Peter K; Sourla, Efrosini; Stamatopoulou, Konstantina-Maria; Syrimpeis, Vasileios; Sioutas, Spyros; Tsakalidis, Athanasios; Tzimas, Giannis

    2015-01-01

    An improved Adaptive Neuro-Fuzzy Inference System (ANFIS) in the field of critical cardiovascular diseases is presented. The system stems from an earlier application based only on a Sugeno-type Fuzzy Expert System (FES) with the addition of an Artificial Neural Network (ANN) computational structure. Thus, inherent characteristics of ANNs, along with the human-like knowledge representation of fuzzy systems are integrated. The ANFIS has been utilized into building five different sub-systems, distinctly covering Coronary Disease, Hypertension, Atrial Fibrillation, Heart Failure, and Diabetes, hence aiding doctors of medicine (MDs), guide trainees, and encourage medical experts in their diagnoses centering a wide range of Cardiology. The Fuzzy Rules have been trimmed down and the ANNs have been optimized in order to focus into each particular disease and produce results ready-to-be applied to real-world patients. PMID:25417018

  8. Open source cardiology electronic health record development for DIGICARDIAC implementation

    Science.gov (United States)

    Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

    2015-12-01

    This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

  9. Categories by Heart: Shortcut Reasoning in a Cardiology Clinic

    Directory of Open Access Journals (Sweden)

    Katarina Jacobsson

    2014-09-01

    Full Text Available This article examines the practice of doctors and nurses to invoke the categories of age, sex, class, ethnicity, and/or lifestyle factors when discussing individual patients and patient groups. In what situations are such references explicitly made, and what does this practice accomplish? The material consists of field notes from a cardiology clinic in Sweden, and a theory of descriptive practice guided the analysis. When professionals describe patients, discuss decisions, or explain why a patient is ill, age, sex, class, ethnicity, and/or lifestyle serve as contextualization cues, often including widespread results from epidemiological research about groups of patients at higher or lower risk for cardiac disease. These categories work as shortcut reasoning to nudge interpretations in a certain direction, legitimize decisions, and strengthen arguments. In general, studying the descriptions of patients/clients/students provides an entrance to professional methods of reasoning, including their implicit moral assumptions.

  10. On New Spain and Mexican medicinal botany in cardiology.

    Science.gov (United States)

    de Micheli-Serra, Alfredo Alessandro; Izaguirre-Ávila, Raúl

    2014-01-01

    Towards the middle of the XVI century, the empirical physician Martín de la Cruz, in New Spain, compiled a catalogue of the local medicinal herbs and plants, which was translated into Latin by Juan Badiano, professor at the Franciscan college of Tlatelolco. On his side, Dr. Francisco Hernández, the royal physician (protomédico) from 1571 until 1577, performed a systematic study of the flora and fauna in this period. His notes and designs were not published at that time, but two epitomes of Hernández' works appeared, respectively, in 1615 in Mexico and in 1651 in Rome. During the XVIII century, two Spanish scientific expeditions arrived to these lands. They were led, respectively, by the Spanish naturalist Martín Sessé and the Italian seaman, Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. These expeditions collected and carried rich scientific material to Spain. At the end of that century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his botanic work. In the last years of the colonial period, the fundamental works of Humboldt and Bonpland on the geographic distribution of the American plants were published. In the modern age, the first research about the Mexican medicinal botany was performed in the laboratory of the Instituto Médico Nacional [National Medical Institute] under the leadership of Dr. Fernando Altamirano, who started pharmacological studies in this country. Later, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico City, on Dr. Ignacio Chávez' initiative. The Mexican botanical-pharmacological tradition persists alive and vigorous at the Instituto Nacional de Cardiología and other scientific institutions of the country. PMID:24960330

  11. User satisfaction with referrals at a collaborative virtual reference service Virtual reference services, Reference services, Referrals, User satisfaction

    Directory of Open Access Journals (Sweden)

    Nahyun Kwon

    2006-01-01

    Full Text Available Introduction. This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference service. Method. The data analysed for this study were 420 chat reference transaction transcripts along with corresponding online survey questionnaires submitted by the service users. Both sets of data were collected from an electronic archive of a southeastern state public library system that has participated in 24/7 Reference of the Metropolitan Cooperative Library System (MCLS. Results. Referrals in the collaborative chat reference service comprised approximately 30% of the total transactions. Circulation-related questions were the most often referred among all question types, possibly because of the inability of 'outside' librarians to access patron accounts. Most importantly, user satisfaction with referrals was found to be significantly lower than that of completed answers. Conclusion. The findings of this study addressed the importance of distinguishing two types of referrals: the expert research referrals conducive to collaborative virtual reference services; and the re-directional local referrals that increase unnecessary question traffic, thereby being detrimental to effective use of collaborative reference. Continuing efforts to conceptualize referrals in multiple dimensions are anticipated to fully grasp complex phenomena underlying referrals.

  12. Referral patterns in elderly emergency department visits

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    2013-12-01

    Full Text Available OBJECTIVE: To assess elderly individuals' demand for emergency department (ED care, in terms of the characteristics, processes, outcomes, costs by referral pattern. DATA SOURCE: All ED visits involving patients aged 65 and older, extracted from the 2010 dataset of an Local Health Agency, in North-Eastern Italy (no. = 18 648. STUDY DESIGN: Retrospective cohort study. PRINCIPAL FINDINGS: Patients were referred by primary care professionals (PCPs in 43.1% of cases, 1.4% came from nursing homes (NH, and 55.5% were self-referred (SR. The SR group had a higher adjusted odds ratio (aOR for non-urgent conditions (1.98 CI 1.85-2.12, but a lower aOR for conditions amenable to ambulatory care (0.53 CI 0.48-0.59, and a lower consumption of resources. The SR group tend to occur more frequently out of hours, and to coincide with a shorter stay at the ED, lower observation unit activation rates, lower hospitalization rates and a lower consumption of services than other two groups. The average costs for all procedures were lower for the SR patients (mean = 106.04 € ± SD 84.90 € than for those referred by PCPs (mean = 138.14 € ± SD 101.17 € or NH (mean = 143.48 € ± SD 95.28 €. CONCLUSION: Elderly patients coming in ED have different characteristics, outcomes and recourses consume by referral pattern.

  13. Verification in referral-based crowdsourcing.

    Directory of Open Access Journals (Sweden)

    Victor Naroditskiy

    Full Text Available Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through "referral-based crowdsourcing": the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge.

  14. Psychiatric referrals in two general hospitals.

    Directory of Open Access Journals (Sweden)

    Doongaji D

    1989-07-01

    Full Text Available A prospective study was undertaken to compare the patterns of psychiatric referrals in two general hospitals in Bombay viz. the King Edward Memorial Hospital (64 cases and the Jaslok Hospital and Research Centre (62 cases. It was observed that depressive symptoms were the most common presenting symptoms in these patients attending either of the hospitals. Similarly, the commonest diagnoses were depression and organic mental disorder. Attempted suicide with organophosphorous compounds was the commonest reason for hospitalization at K.E.M. Hospital (p less than 0.001. A significant number of these patients were females (p less than 0.05. The psychiatric referrals at Jaslok had been hospitalized mainly for suspected medical or neurological illness (p less than 0.001. These patients belonged to higher economic strata and hence had a better paying capacity compared to patients at KEM hospital, a significant number of whom were unemployed (p less than 0.001. The duration of pre-referred illness of patients and their stay at Jaslok hospital were longer as compared to those at KEM Hospital (p less than 0.01. The number of non-relevant special investigations carried out on patients in Jaslok was more (p less than 0.01. Further analysis of diagnoses revealed that a significant number of patients at KEM Hospital were admitted as primary psychiatric illness (p less than 0.05.

  15. Brazilian uranium exploration program

    International Nuclear Information System (INIS)

    General information on Brazilian Uranium Exploration Program, are presented. The mineralization processes of uranium depoits are described and the economic power of Brazil uranium reserves is evaluated. (M.C.K.)

  16. SFC/SFBMN guidelines update for nuclear cardiology procedures: stress testing in adults and children

    International Nuclear Information System (INIS)

    The guidelines update for nuclear cardiology procedures are studied in this article. We find the minimum technique conditions for the stress testing practice, the recommendations for the different ischemia activation tests, the choice of the stress test. (N.C.)

  17. Clinical - cardiologic data of 170 dogs - general aspects of diagnosis and therapy

    International Nuclear Information System (INIS)

    The paper presents an actual continuous cardiologic follow up study on 170 unselected dogs. Each proband underwent a complete cardiologic examination (history, auscultation, ECG, radiologic examination, in some cases also echocardiography). Data were grouped by age, sex, breed, congenital and acquired cardiac diseases, and by therapy. 81 (47.65 percent) of the 170 dogs were suffering from an acquired, 25 (14.70 percent) from a congenital cardiac disease. 64 dogs (37.65 percent) showedno clinical signs of heart disease

  18. A telemedicine network for remote paediatric cardiology services in north-east Brazil

    OpenAIRE

    2015-01-01

    Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart...

  19. Dutch general practitioners' referral of children to specialists: a comparison between 1987 and 2001

    NARCIS (Netherlands)

    H.B. Otters (Hanneke); J.C. van der Wouden (Hans); F.G. Schellevis (François); L.W.A. van Suijlekom-Smit (Lisette); B.W. Koes (Bart)

    2004-01-01

    textabstractBACKGROUND: Although children are frequently referred to specialists, detailed information on referral patterns of them is scarce. Even less information is available on how referral patterns evolve over time. AIMS: To examine current referral patterns for children aged

  20. 49 CFR 1503.703 - Civil penalty letter; referral.

    Science.gov (United States)

    2010-10-01

    ... civil penalty action and that the matter is closed. (e) Referral for prosecution and collection. If the... 49 Transportation 9 2010-10-01 2010-10-01 false Civil penalty letter; referral. 1503.703 Section... AND ENFORCEMENT PROCEDURES Judicial Assessment of Civil Penalties § 1503.703 Civil penalty...

  1. 49 CFR 209.133 - Referral for prosecution.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Referral for prosecution. 209.133 Section 209.133... Penalties § 209.133 Referral for prosecution. If an inspector, including a certified state inspector under... case, and if it appears that assessment of a civil penalty would not be an adequate deterrent to...

  2. 49 CFR 1018.71 - Referral of a compromise offer.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral of a compromise offer. 1018.71 Section... § 1018.71 Referral of a compromise offer. The Board may refer a debtor's firm written offer of compromise which is substantial in amount to GAO or to DOJ if the Board is uncertain whether the offer should...

  3. Accuracy of referrals for visual assessment in a stroke population

    Science.gov (United States)

    Rowe, F J

    2011-01-01

    Purpose To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Patients and methods Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Results Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1–94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of −0.048, 0.019). Conclusion More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved. PMID:21127506

  4. 14 CFR 385.6 - Referral to the Reviewing Official.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Referral to the Reviewing Official. 385.6... Referral to the Reviewing Official. When the staff member finds that the public interest so requires, or... shall, in lieu of exercising the authority, submit the matter to the Reviewing Official for decision....

  5. 7 CFR 3.21 - Referrals of Debts to Justice.

    Science.gov (United States)

    2010-01-01

    ... suspended or terminated in accordance with 31 CFR parts 902 and 903. Agencies shall follow the procedures set forth in 31 CFR part 904 in making such referrals. ... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section...

  6. 5 CFR 177.108 - Referral to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  7. 44 CFR 11.17 - Referral to Department of Justice.

    Science.gov (United States)

    2010-10-01

    ... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief...

  8. 40 CFR 1620.8 - Referral to Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice...

  9. 8 CFR 1235.6 - Referral to immigration judge.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration...

  10. Open-access ultrasound referrals from general practice.

    LENUS (Irish Health Repository)

    Hughes, P

    2015-03-01

    Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

  11. Nuclear cardiology: Its role in cost effective care

    International Nuclear Information System (INIS)

    would not otherwise have been achieved if the early disease remained undetected. This publication presents a comprehensive overview of CVDs as a public health problem in developing countries, the relative role of nuclear cardiology methods within a scenario of unprecedented technology advances, and the evidence behind appropriateness recommendations. The potential expanding role of non-invasive functional imaging through the transition from diagnosis of obstructive CAD to defining the global burden of CVDs is also discussed, as well as the need for thorough training, education, and quality in nuclear cardiology practice. This report will be of interest for all medical practitioners involved in the management of CAD, including internists, cardiologists, and nuclear medicine physicians, as well as hospital administrators and health care stakeholders.

  12. Radiation doses to the staff of a nuclear cardiology department

    International Nuclear Information System (INIS)

    The last years, new radiopharmaceuticals are used in a Nuclear Medicine (NM) Department. Nowadays, Single Photon Emission Computed Tomography (SPECT) is a method of routine imaging, a fact that has required increased levels of radioactivity in certain patient examinations. The staff that is more likely to receive the greatest radiation dose in a NM Department is the technologist who deals with performance of patient examination and injection of radioactive material and the nurse who is caring for the patients visiting the Department some of which being totally helpless. The fact that each NM Dept possesses equipment with certain specifications, deals with various kind of patients, has specific design and radiation protection measures which can differ from other NM Depts and uses various examination protocols, makes essential the need to investigate the radiation doses received by each member of the staff, so as to continuously monitor doses and take protective measures if required, control less experienced staff and ensure that radiation dose levels are kept as low as possible at all times. The purpose of the current study was to evaluate radiation dose to the nuclear cardiology department staff by thermoluminescent dosemeters (TLDs) placed on the the skin at thyroid and abdominal region as well as evaluating protection measures taken currently in the Dept

  13. Clinical value of thallium 201 in a cardiology service

    International Nuclear Information System (INIS)

    At present the most widely used element in isotopic cardiology is undoubtedly 201Tl. In the few years since its appearance many publication testify to its growing use in the external detection of coronary thrombosis, the discovery of ischemia exertion, the non-traumatic observation of patients after an aortocoronary bridging operation, the diagnosis of coronary deficiency associated with another heart disease (aorta narrowing, mitral prolapsus, obstructive cardiomyopathy) and in combination with two other radioisotopic methods. The present work is intended as a modest contribution, still very recent, to the critical study of this new technique in all its present aspects. Part one presents the various characteristics responsible for the advantages and limits of 201Tl, then describes the techniques and apparatus used. The production, dosimetry, toxicity and biological behaviour of 201Tl are also discussed. A hundred and twenty-five examinations were performed in the Nuclear Medicine Service of the Limoges UHC between May 1977 and October 1978. The results are analysed in part two. This is followed by a discussion which attempts, in the light of our experience, to situate the place occupied by 201Tl in the range of complementary examinations useful in declared or assumed coronary cases. We then propose an examination procedure and precise indications we believe to be justified, accounting for economic problems before considering the future prospects of myocardium scintigraphy

  14. Antiplatelet drugs in cardiological practice: Established strategies and new developments

    Directory of Open Access Journals (Sweden)

    Florian Krötz

    2008-06-01

    Full Text Available Florian Krötz, Hae-Young Sohn, Volker KlaussCardiology, Medical Policlinic, Ludwig-Maximilians-Universität, Ziemssenstr. 1, 80336 MünchenAbstract: A common pathophysiological course in vascular diseases is an overwhelming activation and aggregation of blood platelets, which results in atherothrombosis. By causing the last decisive step of cerebral, coronary, or peripheral arterial ischemia thrombotic complications of atherosclerotic disease represent a major player in death cause statistics of most western countries. The development of novel therapies against platelet-dependent thrombosis and the concurrent improvement of existing therapeutic strategies thus is a paramount focus of pharmaceutical research. Currently, efficiency, dosing and indications of established antiplatelet substances are being re-evaluated, whilst new, so far unrecognized molecular targets for inhibition of platelet activity come up front. This not only allows for interesting new therapeutical options, but also widens our insight into the role platelets play in atherosclerosis in general. This article summarizes the relevant pathophysiology of platelet activation, presents current concepts in antiplatelet drug therapy, and highlights the role of platelets in vascular diseases apart from atherothrombosis.Keywords: atherothrombosis, antiplatelet drug therapy, pathophysiology, platelet activation

  15. [About the origin, evolution and irradiation of Mexican cardiology].

    Science.gov (United States)

    de Micheli, Alfredo

    2014-01-01

    The Mexican cardioangiology started in the nineteen century thanks to first endeavors of surgeons and physicians related to local academies and to School of Medicine, established in 1833 by Dr. Valentin Gómez Farías. Dr. Manuel Carpio, the future first head of department of physiology in this school, translated to Spanish language and published, in 1823, the article On pectoriloquo of the French physician Marat and later performed some experiments on the heart' motion. During the Secont Empire (1864-1867), the physician Samuel von Basch performed studies to define the arterial hypertension, called by him "latent atherosclerosis", i.e. the "essential hypertension". Once he had returned to his country, he invented in 1880, a sphygmomanometer of mercury column, that was the model for the instrument constructed by the Italian physician Scipione Riva-Rocci and presented in 1896. In our time, Dr. Demetrio Sodi Pallares systematized a metabolic therapy called "polarizing therapy", i.e. capable of repolarizing the heart's cells partly depolarized due to hypoxia or direct aggressions. These were the first steps in Mexico on the way to a promising medicine starting and the great adventure of Mexican cardiology. PMID:25260577

  16. Quality Change in Brazilian Automobiles

    OpenAIRE

    Renato Fonseca

    2015-01-01

    In this paper I investigate the quality evolution of Brazilian autos. To measure the quality evolution of Brazilian autos, I have assembled a data set for Brazilian passenger cars for the period 1960/94, to which I have applied the hedonic pricing methodology. To the best of my knowledge, this is the first time an index of quality change has been constructed for the Brazilian automobile industry. The results presented here have two major implications. They allow a better understanding of prod...

  17. The Brazilian Nuclear Energy Program

    International Nuclear Information System (INIS)

    A survey is initially of the international-and national situation regarding energetic resources. The Brazilian Nuclear Energy Policy and the Brazilian Nuclear Program are dealt with, as well as the Nuclear Cooperation agreement signed with the Federal Republic of Germany. The situation of Brazil regarding Uranium and the main activities of the Brazilian Nuclear Energy Commission are also discussed

  18. Failure of psychiatric referrals from the pediatric emergency department

    Directory of Open Access Journals (Sweden)

    Delgado Sergio V

    2007-08-01

    Full Text Available Abstract Background Recognition of mental illness in the pediatric emergency department (PED followed by brief, problem oriented interventions may improve health-care seeking behavior and quality of life. The objective of this study was to compare the frequency of mental health follow up after an enhanced referral compared to a simple referral in children presenting to the PED with unrecognized mental health problems. Methods A prospective randomized control trial comparing an enhanced referral vs. simple referral in 56 families of children who were screened for mental health symptoms was performed in a large tertiary care PED. Children presenting to the PED with stable medical problems were approached every fourth evening for enrollment. After consent/assent was obtained, children were screened for a mental health problem using both child and parent reports of the DISC Predictive Scales. Those meeting cutoffs for a mental health problem by either parent or child report were randomized to 1 simple referral (phone number for mental health evaluation by study psychiatrist or 2 enhanced referral (short informational interview, appointment made for child, reminder 2 days before and day of interview for an evaluation by study psychiatrist. Data analysis included descriptive statistics and Chi-Square test to calculate the proportion of children with mental health problems who completed mental health follow-up with and without the enhanced referral. Results A total of 69 families were enrolled. Overall 56 (81% children screened positive for a mental health problem as reported by either the child (self report or mother (maternal report of child mental health problem. Of these, 33 children were randomized into the enhanced referral arm and 23 into the simple referral arm. Overall, only 6 families with children screening positive for a mental health problem completed the psychiatric follow up evaluation, 2 in the enhanced referral arm and 4 in the simple

  19. Assessment of patients' skin dose during interventional cardiology procedures

    International Nuclear Information System (INIS)

    During the last 30 years the use of Interventional Cardiology (IC) procedures has increased significantly, mainly due to the benefits and advantages of the method that offers more accurate diagnosis and treatment along with less complications and hospitalization. However, IC procedures are based on the use of x-ray radiation, mostly localized at certain areas of patient's body and for extended periods of time. Consequently, patient may receive high radiation dose and deterministic effects, such as erythema, epilation or even dermal necrosis may be observed. Therefore, the need for reducing radiation dose is highly important. In order to achieve this, good knowledge of the dose levels delivered to the patient during IC procedures is essential since radiation effects are known to increase with dose. It is of great interest to know the point where the maximum skin dose (MSD) is noted since individual sensitivity may vary. MSDs greater than 1 Gy should be recorded. Patient dosimetry during IC procedures is a complex task since these type of procedures depend on various factors, such as complexity and severity of case, different specifications of x-ray equipment and patient's physical characteristics. Moreover, cardiologist's experience plays an important role. For these reasons, Food and Drug Administration (FDA), the International Commission on Radiological Protection (ICRP) as well as the World Health Organization (WHO), have published documents on radiation safety and ways to reduce skin injuries during IC procedures. Various methods have been proposed for measuring MSD such as the use of slow radiotherapy films, thermoluminescent detectors (TLD), scintillation detectors, Dose-Area Product (DAP) meter, as well as a combination of DAP and air kerma. A literature review on MSDs measured during IC procedures showed that doses ranged from 300 to 43000 mGy

  20. Protection Against X-ray Treatment in Intervention Cardiology

    International Nuclear Information System (INIS)

    The aim of this paper is to show basic propositions on protection against ionizing radiation in intervention cardiology. X-ray treatment should also be subjected to all radiological standards and principles of protection against radiation as well as all other radiological examinations. A cardiologist takes over the role of a radiologist after successfully completing additional education. The measures for reducing radiation include professional team, X-ray machines, a diagnostic room and, first of all, a patients body. A long-life diascopy is replaced by aimed photos. Concerning the X-ray machines, filtration, limiting of the bundle of rays and usage of reinforced foils are the important parts. Protection of thyroid gland, eye lenses, ovaries or spermaries and haematic organs must be ensured by safety measures. People who work with x-ray machines must have protective means in working order and personal dosimeters. Protective power of aprons, gloves and glasses must be at least 0.25 mm thick concerning lead. A medical check-up before working with radiation includes a general medical check-up with a working anamnesis and an ophtalmological, gynoecological, dermatological check-up and a psycho test as well as a haematologic analysis, an analysis of chromosome aberration and an urinanalysis. A legal and a physical person who has been appointed to work with the sources of ionizing radiation is obliged to appoint a person responsible for protection against ionizing radiation. The danger which accompanies exposure to radiation cannot be completely eliminated. However, the risk must be limited and reduced by means of administrative, organizational and technological measures. (author)

  1. The present role of nuclear cardiology in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Clark, A.N.; Beller, G.A. [Virginia University, Charlottesville (United States). Cardiovascular Division Department of Medicine

    2005-03-01

    Many advances have been made in the field of nuclear cardiology in the past decade for enhancing the diagnostic and prognostic value of stress myocardial variability using SPECT technology. Gated SPECT for determining regional and global function have provided incremental diagnostic and prognostic information in the evaluation of patients with suspected or known coronary artery disease. Left ventricular ejection fraction and regional myocardial wall thickening can now be simultaneously evaluated with regional perfusion particularly with the use of the {sup 99m}Tc-labeled perfusion agents such as sestamibi and tetrofosmin. Many studies have shown that the extent and severity of stress-induced perfusion defects have incremental prognostic value over exercise electrocardiographic stress test variables alone. Patients with normal perfusions scans have <1% combined cardiac death and myocardial infarction rates per year and thus have an excellent prognosis. Diabetics are particularly benefited from stress perfusion imaging for detection of coronary artery disease and risk assessment. Diabetics have a worse prognostic than non diabetics for the same amount of hypoperfusion on stress SPECT studies. Quantitative rest perfusion imaging with {sup 201}Tl or with one of the {sup 99m}Tc-labeled imaging agents, or PET imaging with {sup 18}F-deoxyglucose can accurately distinguish viable from irreversibility injured myocardium providing useful information for identifying which patients with ischemic cardiomyopathy benefit most from coronary revascularization with a subsequent improvement in left ventricular function and enhanced survival. Finally, serial stress perfusion imaging can be employed to monitor the efficacy of medical therapy that improves endothelial function and myocardial blood flow reserve.

  2. Radiation dose and image quality for paediatric interventional cardiology

    International Nuclear Information System (INIS)

    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 μGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 μGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures

  3. Radiation dose and image quality for paediatric interventional cardiology

    Energy Technology Data Exchange (ETDEWEB)

    Vano, E [Radiology Department, Medicine School, Complutense University and San Carlos University Hospital, 28040 Madrid (Spain); Ubeda, C [Clinical Sciences Department, Faculty of the Science of Health, Tarapaca University, 18 de Septiembre 2222, Arica (Chile); Leyton, F [Institute of Public Health of Chile, Marathon 1000, Nunoa, Santiago (Chile); Miranda, P [Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Avenida Antonio Varas 360, Providencia, Santiago (Chile)], E-mail: eliseov@med.ucm.es

    2008-08-07

    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 {mu}Gy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 {mu}Gy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  4. 40 CFR 13.33 - Referrals to the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Referrals to the Department of Justice... COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral. The... Justice, Washington, DC 20530. (2) Unless otherwise provided by DOJ regulations or procedures, EPA...

  5. How do obstetric providers discuss referrals for prenatal genetic counseling?

    Science.gov (United States)

    Bernhardt, Barbara A; Haunstetter, Carrie Mastromarino; Roter, Debra; Geller, Gail

    2005-04-01

    To investigate referrals of pregnant women to genetic counseling, we analysed transcripts from audiotaped first prenatal visits of 104 patients (72 actual patient visits and 32 simulated patient visits) with 32 providers (obstetricians and nurse-midwives). All patients had at least one indication for referral. Only 10% of visits with actual patients included a genetic counseling referral. When genetic counseling was discussed, it was only briefly described, primarily as an information session. This study shows that the majority of pregnant women with an indication for referral for genetic counseling are not referred. In addition, obstetric providers' inadequate descriptions of prenatal genetic counseling may result in women being poorly prepared for genetic counseling sessions. PMID:15959642

  6. Are referrals to occupational therapy for developmental coordination disorder appropriate?

    OpenAIRE

    Dunford, C; Street, E.; O'Connell, H; Kelly, J; Sibert, J

    2004-01-01

    Aims: To assess children referred to the Occupational Therapy Service in Gwent with a presumptive diagnosis of developmental coordination disorder (DCD) in order to investigate the appropriateness of their referral.

  7. Delays in Referral of Soft Tissue Sarcomas

    Directory of Open Access Journals (Sweden)

    G. D. Johnson

    2008-01-01

    Full Text Available Introduction and aims. It is well established that soft tissue sarcomas (STSs are more effectively treated in a specialist centre. However, delays in time taken for a patient to be referred to a specialist centre may lead to a poorer prognosis. This study aims to identify the length of these delays and where they occur. Patients and methods. Patients with a proven STS were included. They were recruited from both outpatient clinics and from the surgical ward of the Royal Orthopaedic Hospital (Birmingham, UK. A structured interview was used to take a detailed history of the patients' treatment pathway, before arriving at the specialist centre. Dates given were validated using the case notes. Results. The median time for the patient to present to a specialist centre from the onset of symptoms was 40.4 weeks. The median delay until presentation to a medical professional (patient delay was 1.3 weeks. Median delay in referral to a specialist centre (service delay was 25.0 weeks. Discussion. Medical professionals rather than patients contribute the greatest source of delay in patients reaching a specialist centre for treatment of STS. Adherence to previously published guidelines could decrease this delay for diagnosis of possible sarcoma. Steps should be taken to refer patients directly to a diagnostic centre if they have symptoms or signs suggestive of STS.

  8. Brazilian librarians and Twitter

    OpenAIRE

    Barros, Moreno

    2011-01-01

    Brazil leads the world in social networks. This essay focuses on the results of a two-year experience of Brazilian librarians using Twitter in their work field. Two types of presence on Twitter are identified. A new approach is proposed to answers the critical questions librarians are facing regarding service provision based on Twitter.

  9. Referral Hiring and Gender Segregation in the Workplace

    OpenAIRE

    Troy Tassier

    2008-01-01

    Segregation by type of work or discrimination are two common explanations for gender segregation in the workplace. A third, gender segregation due to referral hiring through segregated social networks, is less well explored. In this paper, I use an agent-based model of referral hiring to demonstrate that it could create high levels of gender segregation near those observed in data. But the model cannot account for all of the segregation observed. Eastern Economic Journal (2008) 34, 429–440. d...

  10. Negative Biopsy after Referral for Biopsy-Proven Gastric Cancer

    OpenAIRE

    Tae, Chung Hyun; Lee, Jun Haeng; Min, Byung-Hoon; Kim, Kyoung-Mee; Rhee, Poong-Lyul; Kim, Jae J

    2016-01-01

    Background/Aims Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. Methods A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and ...

  11. Present and future of nuclear cardiology. Where we come from and where we are going

    International Nuclear Information System (INIS)

    The present of nuclear cardiology techniques with gated-SPECT, positron emission tomography, cardiac magnetic resonance, cardiac mIBG scintigraphy and anatomical and functional images of three-dimensional SPECT-CT fusion may be the future for some centers, a future more or less distant for others. The prediction of the ways that will be followed by the different radioisotope scans in the field of cardiology is to some extent uncertain and depends on the development of other noninvasive techniques and on the possibility of reducing the dose of irradiation, decreasing the undesirable effects of ischemia-inducing drugs, but also on the evolution of macroeconomics in different countries, and of course on the level of experience and excellence in nuclear cardiology laboratories and the confidence generated on clinical cardiologists. (author)

  12. Dosimetric data and radiation risk analysis for new procedures in interventional cardiology

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate radiation doses to the patients and operators during interventional cardiology procedures, with a particular focus on the transcatheter aortic valve implantation (TAVI). Patient doses for 5549 diagnostic and therapeutic procedures and 76 TAVI were examined, as well as occupational doses to Cardiology Dept. operators. The average patient dose for TAVI was double that of PTCA and six times higher than a simple CA; statistically significant differences were shown in the average patient dose for both trans-femoral and trans-apical access; the measurements show a corresponding increase in the average occupational dose for the cardiologist. Interventional cardiology could increase the collective dose and occupationally exposed worker doses; this increase could be significant if the use of certain procedures is extended to younger people; particular attention in the choice of procedure, optimisation and staff education and organisation is therefore suggested. (authors)

  13. Heart Failure Association of the European Society of Cardiology Specialist Heart Failure Curriculum

    DEFF Research Database (Denmark)

    McDonagh, Theresa A; Gardner, Roy S; Lainscak, Mitja;

    2014-01-01

    . The second year allows completion of the optional modules of advanced imaging, device therapy for implanters, cardiac transplantation, and mechanical circulatory support. The second year can also be devoted to continuation of specialist heart failure training and/or research for those not wishing to......It is well established that organized care of heart failure patients, including specialist management by cardiologists, improves patient outcomes. In response to this, other national training bodies (the UK and the USA) have developed heart failure subspecialty curricula within their Cardiology...... Training Curricula. In addition, European Society of Cardiology (ESC) subspecialty curricula exist for Interventional Cardiology and Heart Rhythm Management. The purpose of this heart failure curriculum is to provide a framework which can be used as a blueprint for training across Europe. This blueprint...

  14. The Brugada syndrome: a complex cardiological problem in the experience of the specialist in internal medicine

    Directory of Open Access Journals (Sweden)

    F. Frabetti

    2013-05-01

    Full Text Available BACKGROUND Brugada syndrome, a disease burdened by elevated risk of sudden unexpected cardiac death, often affects young aged subjects that have structurally healthy heart. The diagnostic itinerary is complex: anamnesis, ECG, pharmacological test and electrophysiological study. Its phenotypes are three. METHOD We have identified 13 cases (10 men and 3 women, 12 estimated at the Cardiological Outpatients’ Department and 1 at the First-aid Station. RESULTS 2 cases belonged to phenotype 1, 4 cases to phenotype 2 and 7 cases to phenotype 3. CONCLUSIONS Our work of specialists in internal medicine, toward this syndrome, is: an accurate anamnesis, a correct interpretation of ECG, fast sending of high risk cases to advanced level cardiological competences, a selection of cases to submit to pharmacological test, to address middle risk patients to cardiological competences, offering our cooperation in the follow-up.

  15. User satisfaction with referrals at a collaborative virtual reference service Virtual reference services, Reference services, Referrals, User satisfaction

    OpenAIRE

    Nahyun Kwon

    2006-01-01

    Introduction. This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference service. Method. The data analysed for this study were 420 chat reference transaction transcripts along with corresponding online survey questionnai...

  16. Pediatric cardiology. Clinical and practical experiences with heart diseases of children, juveniles and young adults

    International Nuclear Information System (INIS)

    The book on pediatric cardiology covers the following chapters: (I) Fundamentals and diagnostics: pediatric cardiologic anamnesis, electrocardiograms, thorax X-radiography, MRT and CT of the heart, nuclear medical diagnostics, exercise tests, heart catheter examination, electrophysiological tests. (II) Leading symptoms: Cyanosis, cardiac murmur, thorax pain, palpitation, syncopes. (III) Disease pictures: congenital heart defects, acquired heart defects, cardiomyopathies, heart rhythm disturbances, heart insufficiency, arterial hypertension, pulmonary hypertension, other heart involving syndromes. (IV) Therapy: Catheter interventional therapy, post-surgical pediatric cardiac therapy, surgery involving the life-support machine, mechanical cardiovascular support systems, initial treatment of newborns with critical heart defects, heart transplantation, vaccination of children with heart diseases, medicinal therapy.

  17. Cardiology in the young : where we have been. Where we are. Where we are going.

    Science.gov (United States)

    Jacobs, Jeffrey P

    2014-12-01

    Cardiology in the Young is devoted to cardiovascular issues affecting the young, and older patients with congenital heart disease, or with other cardiac diseases acquired during childhood. The journal serves the interests of all professionals concerned with these topics. By design, the journal is international and multidisciplinary in its approach, and members of the editorial board take an active role in its mission, helping to make it an indispensable reference for paediatric and congenital cardiac care. All aspects of paediatric and congenital cardiac care are covered within the journal. The content includes original articles, brief reports, editorials, reviews, and papers devoted to continuing professional development. High-quality colour figures are published on a regular basis, and without charge to the authors. Regular supplements are published containing the abstracts of the annual meetings of the Association for European Paediatric and Congenital Cardiology, along with other occasional supplements. These supplements are supplied free to subscribers. The vision of Cardiology in the Young is to use print and electronic media to improve paediatric and congenital cardiac care. The mission of Cardiology in the Young is to be a premier global journal for paediatric and congenital cardiac care - an essential journal that spans the domains of patient care, research, education, and advocacy, and also spans geographical, temporal, and subspeciality boundaries. Cardiology in the Young was officially launched in December, 1990. The late Lucio Parenzan was Editor-in-Chief from 1990 through Volume 4, Number 1, January 1994. Professor Robert Anderson and Giancarlo Crupi then shared the Editor-in-Chief position until the end of 1995. Then, from 1995 through 2007, Professor Robert Anderson served as the sole Editor-in-Chief of Cardiology in the Young . Edward Baker, MD, FRCP, FRCPCH, served as Editor-in-Chief of Cardiology in the Young from 2007 to 2013. In January, 2014

  18. Laboratory reconstruction of personal doses in interventional radiology and cardiology

    International Nuclear Information System (INIS)

    People working in interventional cardiology represent one of the most occupationally exposed groups. As recommended by the ICRP, these workers should be equipped with two personal dosemeters, one of them worn on the neck outside the protective collar and the second one on the trunk under the protective apron. It is proved that this double dosimetry method provides more precise estimate of effective dose. In connection with the new lower limit of the eye lens dose, the demands on the eye lens dose estimate increase. The aim of our experiment was to examine the relation between eye lens dose and the quantities Hp(10),Hp(3) or Hp(0.07) measured with conventional personal dosemeters worn on neck and chest. Irradiation conditions imitating the common operation of interventional radiology were created in the laboratory. The patient's body was substituted for a slab PMMA phantom (30 cm x 30 cm x 15 cm). An anthropomorphic Random phantom representing a physician was clothed in a protective apron and a collar, with equivalent of 0.5 mm Pb for both. Three personal multicomponent whole-body thermoluminescent dosemeters (TLD), which allow to measure personal dose equivalents Hp(10),Hp(3) and Hp(0.07), were fixed the Random phantom, one on the collar on the neck and two on the chest over and under the apron. The use of the third dosemeter outside the apron, beyond the recommended double dosimetry, was motivated by the fact that the double dosimetry is not preferred in the Czech Republic yet. Moreover, a special TLD called EYE-D, measuring Hp(3), was employed to determine eye lens dose. It was placed on the Random phantom's temple in the proximity of the eye closer to the radiation source. The utilized PMMA slab phantom was irradiated with X-ray source with the quality RQR5 in four typical irradiation geometries, i.e. radiation beam entered the patient from the front, back, left and right side, which was simulated by the respective arrangement of both the phantoms

  19. Air kerma rates measurement in an interventional cardiology suite

    International Nuclear Information System (INIS)

    In Interventional Cardiology (IC), the assessment of the radiation that the physicians are exposed to is extremely important because the irradiation is not uniform and the received doses are substantially high. During the procedure, the radiation control is complex and there are several reasons for the high exposure levels. It is necessary to perform dosimetric assessments in different parts of the physicians' body and in different specific points of the examination room. By analyzing this information it is possible to determine the probable causes and to provide recommendations, aiming at optimizing the radiological protection. This work had the following objectives: to assess the exposition levels at representative points of critical anatomical regions of the physicians' body who perform IC examinations; to provide means to implement personal monitoring procedures; and to make them aware of the radiation risks. Measurements of air kerma rates were performed in 45 points around the examination table, along the room. Such measurements were made in the conditions frequently used in coronary angiography and coronary angioplasties procedures: adult patient phantom; RAO, LAO and AP incidences; fluoro and digital modes; 13cm and 17cm magnification modes; frequencies of 30f/s (fluoro) and 15 f/s (digital); typical field size used during examinations. Data were obtained at the lenses, chest, hands, gonads and knees levels. For AP incidence, the lowest contributions for scattered radiation and a more homogeneous distribution of radiation were observed. The highest air kerma rates were obtained during digital acquisition mode and for LAO incidence on interventional radiologists, anaesthesists and nurses. The most critical anatomical regions were the knees and gonads. Air kerma rates of about 7,8mGy/h were registered in some places. At physicians' hands position, rates of about 5mGy/h were reached. In several points and levels measured (workload ∼ 6 examinations/day), this

  20. Dermatology referrals in a neurological set up

    Directory of Open Access Journals (Sweden)

    Deeptara Pathak Thapa

    2014-07-01

    Full Text Available Introduction: Dermatology is a specialty, which not only deals with dermatological problems with outpatient but also inpatients referrals. The importances of Dermatologist in hospital setting are rising due to changing condition of medical care. Since no peer-reviewed articles are available for dermatological problems in a neurological set up, we conducted this study to know about pattern of skin disorders in neurological patients. Material and Methods: The present study was a prospective study in a neurological setup, which included data from hospital dermatology consultation request forms over a period of one year. The data included demographic profile of the patient investigation where needed, neurological diagnosis and final dermatological diagnosis. The data was analyzed using SPSS. Results: A total of 285 patients who were requested for consultation were included in the study. Face was the commonest site of involvement (19.6%. Laboratory examination of referred patients revealed abnormal blood counts in 2% cases, renal function tests in 0.7% and urine in 0.4% cases. CT scan showed abnormal findings in 65.6% patients. The most common drug used in these patients was phenytoin (29.1%. The most common dermatological diagnosis was Infection and Infestation (34.7% followed by eczema (46.6%. Drug rash was seen in 3.9% cases. Out of which one had phenytoin induced Steven Johnson syndrome. Skin biopsy was done in 5 patients. Topicals was advised in 80%. Upon discharge 10% of inpatients didn’t require any follow-up. The patients who were followed up after 4 weeks, about 48% had their symptoms resolved with topicals and oral treatment as required. About 38% required more than two follow ups due to chronic course of the diseases. Conclusions: This present study discussed about various manifestations of skin disorders in a neurological set up and emphasizes the role of dermatologist in treating skin problems both in outpatient as well as inpatient

  1. The Adult Congenital and Pediatric Cardiology Section: increasing the opportunities for the congenital heart disease community within the American College of Cardiology.

    Science.gov (United States)

    Martin, Gerard R; Mitchell, Stephanie; Beekman, Robert H; Feinstein, Jeffrey A; Jenkins, Kathy J; Landzberg, Michael; Webb, Gary

    2012-01-01

    The Adult Congenital and Pediatric Cardiology (AC/PC) Section was established to develop a clear voice within the American College of Cardiology and address the myriad issues facing the congenital heart disease profession. The Section is governed by the AC/PC Council, which includes pediatric cardiologists, adult congenital cardiologists, a cardiac care associate, and a fellow-in-training member. The Council is responsible for bidirectional communication between the College's Board of Trustees and the AC/PC Section members. Since its founding in 2004, Section objectives have been defined by the College's mission: to advocate for quality cardiovascular care through education, research promotion, and the development and application of standards and guidelines and to influence health care policy. The pillars of the College-advocacy, quality, education, and member engagement-serve as the defining template for the Section's strategy. The Section has developed work groups in advocacy, clinical practice, education and training, quality, and publications. A separate leadership group has been developed for adult congenital heart disease. Work groups are open to all Section members. Recognition of the importance of lifelong care in congenital heart disease led Section leaders to incorporate pediatric cardiology and adult congenital heart disease content into each of the work groups. There are more than 1,200 Section members, with nearly 400 members actively contributing to Section activities. This article outlines Section efforts to date and highlights significant successes to date. PMID:22192673

  2. Brazilian Trichoptera Checklist II

    Directory of Open Access Journals (Sweden)

    Henrique Paprocki

    2014-10-01

    Full Text Available A second assessment of Brazilian Trichoptera species records is presented here. A total of 625 species were recorded for Brazil. This represents an increase of 65.34% new species recorded during the last decade. The Hydropsychidae (124 spp., followed by the Hydroptilidae (102 spp. and Polycentropodidae (97 spp., are the families with the greatest richness recorded for Brazil. The knowledge on Trichoptera biodiversity in Brazil is geographically unequal. The majority of the species is recorded for the southeastern region.

  3. Brazilian Synchrotron Radiation Project

    International Nuclear Information System (INIS)

    The proposal for a Brazilian national laboratory for synchrotron radiation is presented. The first design study led to a system consisting of a LINAC, an injection ring and a low emittance storage ring. The main ring is designed to be upgraded to 3GeV with an emittance of 4 x 10-8 rad.m. The design study also indicated the possibility of using the injection ring as a soft x-Rays/VUV source

  4. BRAZILIAN NEWS PORTALS CHARACTERISTICS

    Directory of Open Access Journals (Sweden)

    Heloiza G. Herckovitz

    2011-02-01

    Full Text Available A content analysis of four Brazilian news media portals found that economic news dominated the top headlines with little attention paid to education, the environment and welfare. Other trends included a focus on local events and national news sources, reliance on few sources, mostly official ones, and a low percentage of news that fitted the concept of newsworthiness (a combination of both social significance and deviance concepts. Other findings of a study of 432 top news stories published by UOL, Estadão, iG and Terra during a 15-day period between February and March 2008 indicate that the top portions of the portals’ front pages carry news that lacks story depth, editorial branding, and multimedia applications. The results suggest that online news portals are in their infancy although Brazil has the largest online population of Latin America. This study hopes to shed light on the gatekeeping process in Brazilian news portals. Brazilian media portals have yet to become a significant editorial force able to provide knowledge about social issues and public affairs in a socially responsible fashione.

  5. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

    International Nuclear Information System (INIS)

    Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in

  6. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

    Energy Technology Data Exchange (ETDEWEB)

    Lindner, Oliver; Burchert, Wolfgang [University Hospital of the Ruhr University, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia Bochum, Bad Oeynhausen (Germany); Pascual, Thomas N.B.; Kashyap, Ravi; Dondi, Maurizio; Paez, Diana [International Atomic Energy Agency, Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, Vienna (Austria); Mercuri, Mathew [Columbia University Medical Center and New York-Presbyterian Hospital, Division of Cardiology, Department of Medicine, New York, NY (United States); Acampa, Wanda [National Council of Research, Institute of Biostructures and Bioimaging, Naples (Italy); Flotats, Albert [Universitat Autonoma de Barcelona, Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain); Kaufmann, Philipp A. [University Hospital Zurich, Department of Nuclear Medicine and Cardiac Imaging, Zurich (Switzerland); Kitsiou, Anastasia [Sismanoglio Hospital, Department of Cardiology, Athens (Greece); Knuuti, Juhani [University of Turku, and Turku University Hospital, Turku PET Centre, Turku (Finland); Underwood, S.R. [Imperial College London, National Heart and Lung Institute, London (United Kingdom); Royal Brompton and Harefield Hospitals, Department of Nuclear Medicine, London (United Kingdom); Vitola, Joao V. [Quanta Diagnostico and Terapia, Curitiba (Brazil); Mahmarian, John J. [Houston Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, TX (United States); Karthikeyan, Ganesan [All India Institute of Medical Sciences, Department of Cardiology, New Delhi (India); Better, Nathan [Royal Melbourne Hospital and University of Melbourne, Department of Nuclear Medicine, Melbourne (Australia); Rehani, Madan M. [International Atomic Energy Agency, Radiation Protection of Patients Unit, Vienna (Austria); Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Einstein, Andrew J. [Columbia University Medical Center and New York-Presbyterian Hospital, Division of Cardiology, Department of Medicine, New York, NY (United States); Columbia University Medical Center and New York-Presbyterian Hospital, Department of Radiology, New York, NY (United States); Collaboration: for the INCAPS Investigators Group

    2016-04-15

    Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in

  7. Barriers to palliative radiotherapy referral: A Canadian perspective

    Energy Technology Data Exchange (ETDEWEB)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D. [Univ. of Ottawa. Ottawa, ON (Canada)

    2007-07-15

    Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral.

  8. Barriers to palliative radiotherapy referral: A Canadian perspective

    International Nuclear Information System (INIS)

    Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral

  9. Test of a Cardiology Patient Simulator with Students in Fourth-Year Electives.

    Science.gov (United States)

    Ewy, Gordon A.; And Others

    1987-01-01

    Students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS), a life-size mannequin capable of simulating a wide variety of cardiovascular conditions. The CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation. (Author/MLW)

  10. The application of dual-isotope technique in nuclear cardiology and its scatter correction

    International Nuclear Information System (INIS)

    Acquisition of both stressed and rest myocardial perfusion simultaneously is possible when dual-isotope technique is used. And using this technique authors also can obtain data of myocardial perfusion and metabolism imaging with different clinical significance under the same physiological condition. The clinical application of dual-isotope in nuclear cardiology and its scatter correction was reviewed

  11. Clinical and scientific progress related to the interface between cardiology and psychology

    DEFF Research Database (Denmark)

    Erdman, R A M; Pedersen, Susanne S.

    2011-01-01

    In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body pa...

  12. European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

    NARCIS (Netherlands)

    McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlstroem, Ulf; Ekman, Inger; Lainscak, Mitja; McDonald, Kenneth; Ryder, Mary; Stroemberg, Anna; Jaarsma, Tiny

    2011-01-01

    The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This documen

  13. The establishment of local diagnostic reference levels for paediatric interventional cardiology

    International Nuclear Information System (INIS)

    Background: There is a paucity of information worldwide on radiation exposure in paediatric interventional cardiology. At present Nationally established Diagnostic Reference Levels exist for adult interventional cardiology procedures in the UK but little data is available for paediatrics. In addition, interventional cardiology has been identified as one the highest contributors to medical exposure to ionising radiation and children are more radiosensitive than adults. Objective: This study sought to determine current radiation dose levels in paediatric interventional cardiology (IC) with a view to establishing local diagnostic reference levels (LDRL). Methods: Radiation dose and examination details were recorded for 354 paediatric patients examined by IC in a specialised paediatric centre in Europe. Radiation doses were recorded using a Dose Area Product meter along with examination details. Procedures were categorised as either diagnostic (A) or therapeutic (B). Data was further sub-divided into five age ranges; (1) newborn <1 year (2) 1 <5 years (3) 5 <10 years (4) 10 <15 years (5) 15 years and over. Proposed LDRL were calculated from the mean dose area product readings. Results: The mean patient age was 2.6 years (range 0.0 days–16 years) and weight was 14.9 kg (range 2.4–112 kg). LDRL for the five age groupings were calculated as 190, 421, 582, 1289 and 1776 cGycm² respectively. Conclusion: Local dose reference levels have been proposed for paediatric IC and can be used as a benchmark for other hospitals to compare against their own radiation doses

  14. Paediatric cardiology programs in countries with limited resources: how to bridge the gap.

    Science.gov (United States)

    Sulafa, K M Ali

    2010-07-01

    Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres. PMID:23960607

  15. Investigation of the fluoroscopy units used in radiology and cardiology

    International Nuclear Information System (INIS)

    A nationwide survey was launched in 2002 in Switzerland in order to investigate the use of fluoroscopy and to establish national reference levels (RL) for dose intensive procedures particularly in interventional radiology. The two year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on twelve types of examinations: six diagnostic and six interventional. The performance of the fluoroscopy units used in these healthcare centres (image quality and dose) was assessed extensively. This characterization was useful since, unlike the American RAD-IR study where the fluoroscopy units where similar (Siemens, with Cu filtration), a large variability in the brands and the technical specifications of the fluoroscopy units used in the participating centres are registered in our case. The units are often programmed according to the anatomical region under investigation. Knowledge of the parameters used for the various categories of examinations is crucial for analysis of the results of the survey. First, the DAP meters of the fluoroscopy units were checked using an external reference DAP meter put on top of the measuring device of the fluoroscopy unit. The units were then characterized in terms of the image quality and the patient dose associated to the various modes used. Assessment of the image quality consisted of establishing the spatial resolution limit at the middle of a Leeds TOR(CDR) Test Object. The dose measurements were performed using an 11 cm3 ionization chamber connected to a Radcal 3036 dosemeter and a 20 cm thick PMMA phantom. The characteristics of the fluoroscopy units (dose rate, dose per frame, image quality index and spatial resolution) were established for three imaging modes (radiography, fluoroscopy and cine), various diameters (or magnifications) of the image intensifier and various imaging frequencies and for six categories of examinations: 1) barium based examinations, 2) bile

  16. Managing Migration: The Brazilian Case

    OpenAIRE

    Eduardo L. G. Rios-Neto

    2005-01-01

    The objective of this paper is to present the Brazilian migration experience and its relationship with migration management. The article is divided into three parts. First, it reviews some basic facts regarding Brazilian immigration and emigration processes. Second, it focuses on some policy and legal issues related to migration. Finally, it addresses five issues regarding migration management in Brazil.

  17. Brazilian energy overview

    International Nuclear Information System (INIS)

    The Brazilian energy overview compared with the rest of the world is presented, as well as the current situation and prospects for the future. In a first part, the evalution from the past through the present time is considered, and in a second part, attention is given on the future prospects for Brazil and the different countries in connection with the energy field. It is expected that the current per capita energy consumption in Brazil, in all of its various forms, now totalling 6 million kcal/inh, will reach at least 22 million kcal/inh toward the end of this century

  18. Genetic Risk Assessment for Women with Epithelial Ovarian Cancer: Referral Patterns and Outcomes in a University Gynecologic Oncology Clinic

    OpenAIRE

    Petzel, Sue v.; Vogel, Rachel Isaksson; Bensend, Tracy; Leininger, Anna; Argenta, Peter A.; Geller, Melissa A.

    2013-01-01

    Little is known about genetic service utilization and ovarian cancer. We identified the frequency and outcome of genetic counseling referral, predictors of referral, and referral uptake for ovarian cancer patients. Using pathology reports, we identified all epithelial ovarian cancer patients seen in a university gynecologic oncology clinic (1/04–8/06). Electronic medical records (EMR) were used to document genetic service referral, time from diagnosis-to-referral, point-in-treatment at referr...

  19. When your words count: a discriminative model to predict approval of referrals

    Directory of Open Access Journals (Sweden)

    Adol Esquivel

    2009-12-01

    Conclusions Three iterations of the model correctly predicted at least 75% of the approved referrals in the validation set. A correct prediction of whether or not a referral will be approved can be made in three out of four cases.

  20. 25 CFR 217.4 - Referral of questions by the joint managers.

    Science.gov (United States)

    2010-04-01

    ... party's proposal, if any, for solution. Such referrals shall be in writing, addressed to the other joint... DISTRIBUTION CORP. § 217.4 Referral of questions by the joint managers. The business committee and the board...

  1. Specialist pediatric palliative care referral practices in pediatric oncology: A large 5-year retrospective audit

    Directory of Open Access Journals (Sweden)

    Arunangshu Ghoshal

    2016-01-01

    Conclusions: Oncologists referred patients late in the course of disease trajectory. Most of the referrals were made for counseling and communication, but many patients had high symptom burden during referral.

  2. The Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR): Interventional Cardiology

    International Nuclear Information System (INIS)

    In the last three decades, the use of image guided interventional procedures in cardiology has increased significantly, bringing great benefit to millions of patients around the world. As technology improves, the medical capabilities of these procedures continue to expand, adding further to the armamentarium for diagnosis and treatment of patients with cardiac problems. All of these procedures require health professionals (including interventional cardiologists, electrophysiologists, nurses and medical radiation technologists) to be present in the room and alongside the patient when radiation is being used, which may result in occupational exposure. While it has been long known that there is significant potential for health professionals in attendance during interventional cardiology to receive non-trivial occupational exposures, reported details have been typically limited to a few specific interventional cardiology facilities and situations. A more global perspective has been lacking, as is the availability of a systematic means for improving occupational radiation protection in interventional cardiology facilities throughout the world. In 2006, the IAEA published the Fundamental Safety Principles (IAEA Safety Standards Series No. SF-1), which sets out the fundamental safety objective and principles of protection and safety. In 2011, the IAEA published Radiation Protection and Safety of Sources: International Basic Safety Standards (IAEA Safety Standards Series No. GSR Part 3 (Interim Edition)), which sets out the requirements for meeting the fundamental safety objective and applying the principles specified in the Fundamental Safety Principles. The establishment of safety requirements and provision of guidance on occupational radiation protection is a major component of the support for radiation protection and safety provided by the IAEA to Member States. This publication was developed under the IAEA's statutory responsibility to facilitate worldwide application

  3. Activity and practice of nuclear cardiology in the Czech Republic, 2001

    International Nuclear Information System (INIS)

    Radionuclide myocardial perfusion imaging (MPI) has been on the rise in Europe and the USA. Details on nuclear cardiology in the Czech Republic are not available as yet, as it is impossible to obtain comprehensive data from official registers owing to different methods of reporting and data evaluation. A questionnaire concerning nuclear cardiology activity and practice in 2001 was sent to all nuclear medicine departments in the Czech Republic. All 48 departments completed the questionnaire. In 2001, 50 planar and 54 tomographic (SPET) scintillation cameras were used. The average age of the SPET cameras was 5 years (13% of SPET cameras were >8 years old). Out of the 48 centres, 39 (81%) provided a nuclear cardiology service; the total number of cardiological studies was 15,740 in 2001 (1.5 studies/1,000 population/year). The most frequently employed method was MPI (81.7%), the frequency of which had increased by 10% compared with 2000; 26 of the 39 (67%) departments reported that MPI activity was increasing. Nevertheless, the Czech Republic nuclear cardiology activity remained below the European average (2.2/1,000 population in 1994) and, particularly, below activity in the USA (15/1,000 in 1997). The activity was rather unevenly spread. Whereas two centres with >1,000 studies/year accounted for 20% of the total MPI studies, 16 of 39 (41%) departments exhibited low activity (99mTc-MIBI (60% of total MPI), followed by 201Tl (21%) and 99mTc-tetrofosmin (19%). ECG-gated SPET was employed by 20/39 (51%) centres, of which 11 (28%) performed it as a standard examination; 39% of the total MPI studies included this technique. Thirteen percent (5/39) of the departments used attenuation correction, and 69% (27/39) of the departments used a prone projection. Equilibrium radionuclide ventriculography, with 2,317 examinations (14.7%), ranked second among all nuclear cardiology methods, followed by first-pass angiocardiography (406 studies, 2.6%) and 18F-FDG (163 studies, 1

  4. Brazilian Nanotechnology Initiative

    Science.gov (United States)

    Fazzio, Adalberto

    2015-03-01

    In Brazil there is intense research activity in nanotechnology, most of these developed in universities and research institutes. The Brazilian Nanotechnology Initiative (BNI) aims to integrate government actions to promote the competitiveness of the Brazilian industry. This initiative is founded on support for research and development in the laboratories of the National Laboratories for Nanotechnology (SisNANO), starting from an improvement in infrastructure and opening of laboratories for users of academia and business, promoting interaction and transfer knowledge between academia and business. Country currently has 26 thematic networks of nanotechnology, 16 -Virtual-National Institutes of Technology, seven National- Laboratories and 18 Associate Laboratories, which comprise the SisNANO. Seeking to expand and share governance with other government actors, the Interministries Committee for Nanotechnology was set up, composed of 10 ministries, and has the task of coordinating the entire program of the Federal Government Nanotechnology.Cooperation activities are an important part of BNI. Currently Brazil has cooperation programs with U.S., China, Canada and European Union among others. Recently, Brazil decided to join the European NanoReg program where 60 research groups are joining efforts to provide protocols and standards that can help regulatory agencies and governments.

  5. Towards successful coordination of electronic health record based-referrals: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Paul Lindsey A

    2011-07-01

    Full Text Available Abstract Background Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP, the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs (i.e., e-referrals, lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system. Methods We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process. Results Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported. Conclusions Despite facilitating information transfer between PCPs and

  6. General practitioner outpatient referrals: do good doctors refer more patients to hospital?

    OpenAIRE

    Reynolds, G A; Chitnis, J G; Roland, M O

    1991-01-01

    OBJECTIVE--To investigate the relation between general practitioners' referral rates to individual specialties and the individual areas of expertise of the referring doctors. DESIGN--Data collected on referral patterns in one group practice over nine months. SETTING--General practice in suburban Birmingham consisting of five partners and a trainee. RESULTS--In 395 referrals there were large differences in referral patterns among partners for otorhinolaryngology, ophthalmology, general surgery...

  7. GPs' referral to mental health care during the past 25 years.

    OpenAIRE

    Verhaak, P.F.M.; van de Lisdonk, E H; Bor, J.H.J.; Hutschemaekers, G. J. M.

    2000-01-01

    Previous research has shown that mental disorder in the community has remained fairly constant over the past 30 years. As a result there has been a shift in mental health care from primary care to specialised mental health care. This shift should be visible in higher referral figures from general practice. In this longitudinal analysis of mental health referrals (1971 to 1997), the authors aimed to answer whether these higher referral rates have occurred, whether there are increases in referr...

  8. Primary care nurses: effects on secondary care referrals for diabetes?

    NARCIS (Netherlands)

    Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de

    2010-01-01

    BACKGROUND: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with t

  9. 29 CFR 15.8 - Referral to Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Department of Justice. 15.8 Section 15.8 Labor Office of the Secretary of Labor ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND RELATED... Justice. An award, compromise or settlement of a claim under § 2672 title 28, United States Code, and...

  10. Haemorrhage after home birth: audit of decision making and referral

    NARCIS (Netherlands)

    Smit, M. de; Dijkman, A.; Rijnders, M.; Bustraan, J.; Dillen, J. van; Middeldorp, J.; Havenith, B.; Roosmalen, J. van

    2013-01-01

    In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwi

  11. Referral tracking system shows accurate bottom-line assessment.

    Science.gov (United States)

    Henkel, J

    1990-12-01

    Rose Medical Center in Denver, Colo., needed a way to track referrals from its many offsite care centers to determine their impact on revenue. Programmers at Rose developed a microbased system, eventually bought by SMS, that measures profitability against investment to become a true decision support tool for hospital executives. PMID:10108212

  12. 40 CFR 304.21 - Referral of claims.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 27 2010-07-01 2010-07-01 false Referral of claims. 304.21 Section 304.21 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS ARBITRATION PROCEDURES FOR SMALL SUPERFUND COST...

  13. Use of automated external defibrillators in a Brazilian airline. A 1-year experience

    Directory of Open Access Journals (Sweden)

    Alves Paulo Magalhães

    2001-01-01

    Full Text Available After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.

  14. The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction

    DEFF Research Database (Denmark)

    Lewinter, Christian; Bland, John M; Crouch, Simon; Doherty, Patrick; Lewin, Robert J; Køber, Lars; Hall, Alistair S; Gale, Christopher P

    2014-01-01

    BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI...

  15. Cognitive Set and Clinical Inference: Referral Information May Not (Always) Affect Psychosocial Assessment.

    Science.gov (United States)

    Abraham, Ivo L.

    1986-01-01

    Studied the effects of general referral information about a client on subsequent clinical inferences. Nursing students (N=54) were randomly assigned to "referral information" or "no referral information" conditions before being presented with additional data. Clinical inferential tasks included the assessment of maladjustment, client stress,…

  16. 22 CFR 304.9 - Referral to the Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of...

  17. 6 CFR 11.13 - Referrals to the Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection...

  18. 38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.953 Minimum amount of referrals to the Department of Justice. (a) Except as otherwise provided in...

  19. 10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive...

  20. The Relationship between Reading Fluency Intervention and the Need for Special Education Referrals

    Science.gov (United States)

    Polcyn, Dawn M.

    2012-01-01

    Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate…

  1. A comparison of the quality of the information available on the internet on interventional radiology, vascular surgery, and cardiology

    OpenAIRE

    Alsafi, A.; Kaya, G.; Patel, H; M S Hamady

    2013-01-01

    Context and Aims: Internet use is rapidly expanding and increasingly plays a substantial role in patient education. We sought to evaluate and compare the quality of information available to patients online on three closely linked specialties: Interventional radiology (IR), cardiology, and vascular surgery. Materials and Methods: We searched the leading three search engines for the terms: "Interventional Radiology", "cardiology," and "vascular surgery," collating the top 50 hits from each sear...

  2. Testosterone and cardiovascular risk: myths and new truth about cardiological safety of androgen replacement therapy in men

    OpenAIRE

    S. Yu. Kalinchenko; I. A. Tyuzikov; L. O. Vorslov; Yu A Tishova

    2014-01-01

    In a critical review of the literature highlights issues cardiological safety of testosterone therapy in men with cardiovascular diseases, based on research evidence over the past 25 years, as well as a detailed analysis of a number of recent publications, was summoned by the ambiguous attitude of experts and researchers in connection with them demonstrated high frequency of adverse cardiological outcomes in men on the background of androgen replacement therapy. Most modern randomized studies...

  3. The rise of Brazilian agriculture

    DEFF Research Database (Denmark)

    Jensen, Hans Grinsted; Vink, Nick; Sandrey, Ron

    2014-01-01

    The purpose of this article is to explore some of the possible lessons for South African agriculture from the Brazilian experience. To this end, the article discusses the performance of Brazilian agriculture in terms of land and labour use, production, and exports. This is followed by aspects of...... Brazilian agricultural policies, namely farmer support, the research and technology transfer system and land issues. The implications for South African agriculture can be summarized as the recognition that history, geography, the development path and agricultural policies all matter. The article then...... identifies five important lessons for agricultural development in South Africa....

  4. Inspection of cardiology departments in Norway: are they making it great in radiation protection?

    International Nuclear Information System (INIS)

    Staff involved in interventional cardiology receive the highest occupational doses in Norway, and skin burns of patients have been reported. To identify the level of radiation protection (RP) for patients and staff, and compliance with the RP regulation, the Norwegian Radiation Protection Authority carried out inspections. The inspections were conducted (2013-14) as quality system reviews, based on document reviews, interviews, on-site inspections and observations of interventional procedures. The inspections revealed that most of the hospitals had non-compliancies according to the RP regulation. Most deviations were associated with education in RP and follow-up of patients who had received high radiation doses. Lack of systematic optimisation of procedures and estimation of eye lens doses to evaluate the risk for cataracts were also common. Inspections turned out to increase the awareness of RP in cardiology and are identified as an effective tool for improving RP. (authors)

  5. Neuropsychological Testing in Interventional Cardiology Staff after Long-Term Exposure to Ionizing Radiation.

    Science.gov (United States)

    Marazziti, Donatella; Tomaiuolo, Francesco; Dell'Osso, Liliana; Demi, Virginia; Campana, Serena; Piccaluga, Emanuela; Guagliumi, Giulio; Conversano, Ciro; Baroni, Stefano; Andreassi, Maria Grazia; Picano, Eugenio

    2015-10-01

    This study aimed at comparing neuropsychological test scores in 83 cardiologists and nurses (exposed group, EG) working in the cardiac catheterization laboratory, and 83 control participants (non exposed group, nEG), to explore possible cognitive impairments. The neuropsychological assessment was carried out by means of a battery called "Esame Neuropsicologico Breve." EG participants showed significantly lower scores on the delayed recall, visual short-term memory, and semantic lexical access ability than the nEG ones. No dose response could be detected. EG participants showed lower memory and verbal fluency performances, as compared with nEG. These reduced skills suggest alterations of some left hemisphere structures that are more exposed to IR in interventional cardiology staff. On the basis of these findings, therefore, head protection would be a mandatory good practice to reduce effects of head exposure to ionizing radiation among invasive cardiology personnel (and among other exposed professionals). PMID:26400563

  6. Inspection of cardiology departments in Norway: are they making it great in radiation protection?

    Science.gov (United States)

    Silkoset, R D; Widmark, A; Friberg, E G

    2015-07-01

    Staff involved in interventional cardiology receive the highest occupational doses in Norway, and skin burns of patients have been reported. To identify the level of radiation protection (RP) for patients and staff, and compliance with the RP regulation, the Norwegian Radiation Protection Authority carried out inspections. The inspections were conducted (2013-14) as quality system reviews, based on document reviews, interviews, on-site inspections and observations of interventional procedures. The inspections revealed that most of the hospitals had non-compliances according to the RP regulation. Most deviations were associated with education in RP and follow-up of patients who had received high radiation doses. Lack of systematic optimisation of procedures and estimation of eye lens doses to evaluate the risk for cataracts were also common. Inspections turned out to increase the awareness of RP in cardiology and are identified as an effective tool for improving RP. PMID:25813484

  7. Mental disorders and general well-being in cardiology outpatients--6-year survival

    DEFF Research Database (Denmark)

    Birket-Smith, Morten; Hansen, Baiba H; Hanash, Jamal A;

    2009-01-01

    OBJECTIVE: Long-term survival in a sample of cardiology outpatients with and without mental disorders and other psychosocial risk factors. METHODS: In a cardiology outpatient setting, 103 consecutive patients were asked to participate in the study. Of these, 86 were included and screened for mental...... disorder with the Primary Care Evaluation of Mental Disorders; Structured Clinical Interview for DSM-III-R, Non-Patient Edition, psychosis screening; the Clock Drawing Test; and the WHO-5 Well-Being Index. The cardiologists were asked in each patient to rate the severity of somatic disease and mental...... problems on visual analogue scales (VAS-somatic and VAS-mental). Cardiac diagnosis, noncardiac comorbidity, history of mental disorder, and the number of daily social contacts were noted. Survival was followed for 6 years. RESULTS: At baseline, 33 (38.4%) patients had mental disorder, 6 dementia, 11 major...

  8. [The beginning of Mexican cardiology in the springtime of the Mexican National Academy of Medicine].

    Science.gov (United States)

    de Micheli, Alfredo

    2016-01-01

    The National Academy of Medicine was founded 141 years ago during the French intervention. Under the sponsorship of this brand-new medical association, Mexican cardioangiology took its first steps in the medical and surgical field as well. After the falling of the second empire, the medical and surgical advances of this discipline continued. The corresponding publications appeared in different volumes of the "Gaceta Médica de México"; at present journal of the Academy still published in our time. These steps permitted the development of the true cardiologic speciality during 40s of the twentieth century, due to the vision of Professor Ignacio Chávez, father of Mexican cardiology. Some examples of application are the epistemologic criteria in cardiologycal domains such as the conception of Riva-Rocci's sphygmomanometer in Italy in the nineteenth century and the so-called cardiac metabolic therapy in Mexico of our time, are included. PMID:26549154

  9. International project on individual monitoring and radiation exposure levels in interventional cardiology.

    Science.gov (United States)

    Padovani, R; Le Heron, J; Cruz-Suarez, R; Duran, A; Lefaure, C; Miller, D L; Sim, H K; Vano, E; Rehani, M; Czarwinski, R

    2011-03-01

    Within the Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR), a new International Atomic Energy Agency initiative, a Working Group on interventional cardiology, aims to assess staff radiation protection (RP) levels and to propose an international database of occupational exposures. A survey of regulatory bodies (RBs) has provided information at the country level on RP practice in interventional cardiology (IC). Concerning requirements for wearing personal dosemeters, only 57 % of the RB specifies the number and position of dosemeters for staff monitoring. Less than 40 % of the RBs could provide occupational doses. Reported annual median effective dose values (often <0.5 mSv) were lower than expected considering validated data from facility-specific studies, indicating that compliance with continuous individual monitoring is often not achieved in IC. A true assessment of annual personnel doses in IC will never be realised unless a knowledge of monitoring compliance is incorporated into the analysis. PMID:21051431

  10. Summary of the 4th Annual Scientific Session of Cardiology in South China

    Institute of Scientific and Technical Information of China (English)

    刘伊丽

    2002-01-01

    @@ The 4th Annual Scientific Session of South China was held from April 5 ~ 8, 2002 in Guangzhou. More than one thousand cardiologists came from Guangzhou,Guangxi, Hunan and Hainan Province participated in the meeting and 143 abstracts were presented. A distinguished faculty from the United States, Canada,Germany, Britain, Honkong, Beijing and Shanghai were invited to join this conference and gave a series of special lectures about the newest advances in cardiology.

  11. NORMAN HOLTER AND HIS METHOD OF REMOTE CARDIOLOGIC MONITORING. CASE HISTORY

    Directory of Open Access Journals (Sweden)

    A. A. Rassadina

    2013-01-01

    Full Text Available This publication is devoted to the personality and creative designs of uncommon American scientist, the engineer and the inventor – Norman Jefferis «Jeff» Holter. Norman Jefferis Holter introduced the terminology of «nuclear medicine» for the name of the new at that time area which associated with employment of the achievements of the nuclear physics in the medical goals. Also he is the author of ambulatory cardiological monitoring.

  12. Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics

    OpenAIRE

    Mario Montealegre-Gallegos; Feroze Mahmood; Han Kim; Remco Bergman; Mitchell, John D.; Ruma Bose; Hawthorne, Katie M.; T David O′Halloran; Vanessa Wong; Hess, Philip E.; Robina Matyal

    2016-01-01

    Background: Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. Methods and Results: During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for...

  13. Prescription pattern of fixed dose drug combination in cardiology department in a tertiary care hospital

    OpenAIRE

    Pramod Kumar Manjhi; Lalit Mohan; Manish Kumar; Harihar Dikshit; Singh, B. P.; Anuj Kumar Pathak; Sanjeev Kumar

    2016-01-01

    Background: A cardiovascular disease (CVD) is one of the most common causes of mortality and morbidity globally. The drastic change in the lifestyle of population during 21st century has had a great impact on health especially cardiovascular diseases. Objective of this study was to assess the prescription pattern of fixed dose drug combinations (FDCs) in the department of cardiology in a tertiary care hospital. Methods: The prescriptions of 210 patients suffered by cardiovascular disorders...

  14. Cardiopulmonary exercise testing – Its application in cardiology and occupational medicine

    OpenAIRE

    Małgorzata Kurpesa; Katarzyna Jerka; Alicja Bortkiewicz

    2014-01-01

    Cardiopulmonary exercise testing is a method used to assess the exercise capacity. It is used in cardiology to define the diagnostic and prognostic information, the treatment and its effectiveness. This method is also useful in sport medicine and in occupational medicine. The cardiopulmonary exercise test involves measuring of gas exchange during exercise testing. The article presents the main parameters assessed during the test and the indications and contraindications for conducting the tes...

  15. Position paper on the importance of psychosocial factors in cardiology: Update 2013

    OpenAIRE

    Ladwig, Karl-Heinz; Lederbogen, Florian; Albus, Christian; Angermann, Christiane; Borggrefe, Martin; Fischer, Denise; Fritzsche, Kurt; Haass, Markus; Jordan, Jochen; Jünger, Jana; Kindermann, Ingrid; Köllner, Volker; Kuhn, Bernhard; Scherer, Martin; Seyfarth, Melchior

    2014-01-01

    [english] Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008.Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated...

  16. NORMAN HOLTER AND HIS METHOD OF REMOTE CARDIOLOGIC MONITORING. CASE HISTORY

    OpenAIRE

    A. A. Rassadina; S. A. Tarakanov; V I Kuznetsov

    2013-01-01

    This publication is devoted to the personality and creative designs of uncommon American scientist, the engineer and the inventor – Norman Jefferis «Jeff» Holter. Norman Jefferis Holter introduced the terminology of «nuclear medicine» for the name of the new at that time area which associated with employment of the achievements of the nuclear physics in the medical goals. Also he is the author of ambulatory cardiological monitoring.

  17. Clinical use of nuclear cardiology in the assessment of heart failure

    International Nuclear Information System (INIS)

    Nuclear cardiology is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays an important role in their assessment and management. Quantitative gated single positron emission computed tomography is used to assess quantitatively cardiac volume, left ventricular ejection fraction, stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging can not only identify nonischemic heart failure and ischemic heart failure, but also demonstrate myocardial viability. Diastolic heart failure also termed as heart failure with a preserved left ventricular ejection fraction is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate and time to peak filling rate. With newer techniques such as three-dimensional, quantitative gated single positron emission computed tomography can assess movement of the left ventricle, and wall thickening evaluation aids its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using 123I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using 123I-15-(p-iodophenyl) 3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to improve heart failure diagnosis. Nuclear cardiology techniques contribute significantly to identifying patients with heart failure and to guiding their management decisions. (authors)

  18. Pulmonary Edema Assessed by Ultrasound: Impact in Cardiology and Intensive Care Practice.

    Science.gov (United States)

    Blanco, Pablo A; Cianciulli, Tomás F

    2016-05-01

    Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring. PMID:26841270

  19. A Computer System for Integration and Analysis of Cardiology Patient Information

    OpenAIRE

    Uretz, Eugene F.; Murphy, Tom; Millar, Roger; Jones, Jerry; Messer, Joseph V.

    1981-01-01

    A two phased approach to the statistical and mathematical analyses of cardiology data distributed over many large (Hewlett-Packard Image 1000) computer data bases is presented. During the first phase, patients satisfying specified criteria in each of the data bases are selected and specific data of these patients required for analyses during the second phase are retrieved and merged into a single random access file. During the second phase, statistical and mathematical analyses of the merged ...

  20. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology study

    Directory of Open Access Journals (Sweden)

    Schiattarella Pier

    2010-11-01

    Full Text Available Abstract Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population. Three hundred four consecutive non cardiologic outpatients underwent a sequential assessment including physical examination, pocket size imaging device and standard Doppler-echo exam. Pocket size device was used by both expert operators and trainees (who received specific training before the beginning of the study. All the operators were requested to give only visual, qualitative insights on specific issues. All standard Doppler-echo exams were performed by expert operators. One hundred two pocket size device exams were performed by experts and two hundred two by trainees. The time duration of the pocket size device exam was 304 ± 117 sec. Diagnosis of cardiac abnormalities was made in 38.2% of cases by physical examination and in 69.7% of cases by physical examination + pocket size device (additional diagnostic power = 31.5%, p In conclusion, pocket size device showed a relevant additional diagnostic value in comparison with physical examination. Sensitivity and specificity were good in experts and suboptimal in trainees. Specificity was particularly influenced by the level of experience. Training programs are needed for pocket size device users.

  1. Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery.

    Science.gov (United States)

    Rajabali, Naheed; Rolfson, Darryl; Bagshaw, Sean M

    2016-09-01

    Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement. Frailty is common among patients admitted to the intensive care unit and correlates with an increased risk for adverse events, increased resource use, and less favourable patient-centred outcomes. Analogous findings have been described across selected acute cardiology and cardiac surgical settings, in particular those that commonly intersect with critical care services. The optimal methods for screening and diagnosing frailty across these settings remains an active area of investigation. Routine assessment for frailty conceivably has numerous purported benefits for patients, families, health care providers, and health administrators through better informed decision-making regarding treatments or goals of care, prognosis for survival, expectations for recovery, risk of complications, and expected resource use. In this review, we discuss the measurement of frailty and its utility in patients with critical illness and in cardiology and cardiac surgery settings. PMID:27476983

  2. Referrals to a regional allergy clinic - an eleven year audit

    Directory of Open Access Journals (Sweden)

    Hewson Paul

    2010-12-01

    Full Text Available Abstract Background Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i differences over time and by demographics, (ii types of allergy, (iii co-occurrence, and (iv spatial distributions. Methods Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. Results Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65% than males. Airborne allergies were the most frequent (623, and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410 patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142 had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg. There were age differences by types of allergy; people referred with food allergies were

  3. Brazilian Eratosthenes Project

    Science.gov (United States)

    Langhi, R.; Vilaça, J.

    2014-10-01

    The objective of Brazilian Eratosthenes Project is the development and application of teaching training actions according the ``docent autonomy" concept to basic Astronomy Education. Argentina coordinates the project in South America, but Brazil works in this project since 2010 with the theme ``Projeto Eratóstenes Brasil" in the homepage: http://sites.google.com/site/projetoerato. Two schools measure a sticks shadow and communicate their results. After, they calculate an average radius of Earth. The stick (gnomon) should stay in vertical position in the leveled ground. Since 2010, the project received hundreds of Brazilian schools with different experiments that were constructed with autonomy, because our site doesn't show some itinerary pre-ready to elaborate the experiments. To collect data for our research, we will use interviews via Skype with the teachers. These data are useful to researches about Science Education area and the Teaching Formation. Teaching professional practice could change and we see modifications in the teachers work, what depends of their realities and context. This project intents to respect the docent autonomy. This autonomy to responsible modifications during continued formation is called ``activist formative model" according Langhi & Nardi (Educação em Astronomia: repensando a formação de professores. São Paulo: Escrituras Editora, 2012). This project discusses about researches in Astronomy Education - still extreme rare in Brazil, when we compare with other areas in Science Education. We believe that actions like this could motivate the students to learn more Astronomy. Furthermore, this national action can be a rich source of data to investigations about teaching formation and scientific divulgation.

  4. The new Brazilian nuclear policy

    International Nuclear Information System (INIS)

    Since March 15, 1990, when Fernando Collor's Government was inaugurated, the Brazilian President has been pursuing a nuclear policy aimed at ensuring compliance with the constitutional principles and rules that determine the utilization of nuclear energy solely for peaceful uses and purposes. The development of Brazilian nuclear policy has followed several stages, which are reported in this paper from a legal and institutional point of view. (author)

  5. Dose to patients and professionals in cardiology interventional: Progress of multicenter group Doccaci; Dosis a pacientes y a profesionales en cardiologia intervencionista: Avances del grupo multicentrico DOCCACI

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, R. M.; Vano, E.; Fernandez, J. M.; Goicolea Ruigomez, J.; Pifarre, X.; Escaned, J.; Rovira, J. J.; Garcia del Blanco, B.; Carrera, F.; Diaz, J. F.; Ordiales, J. M.; Nogales, J. M.; Hernandez, J.; Bosa, F.; Rosales, F.; Saez, J. R.; Soler, M. M.; Romero, M. A.

    2013-07-01

    The multidisciplinary group and multicenter DOCCACI (dosimetry and quality assurance in interventional cardiology), sponsored by the section of haemodynamics of the Spanish society of Cardiology, is intended to propose reference levels to doses received by patients in interventional cardiology procedures such as recommended by the International Commission on radiological protection It also investigates the doses received by professionals, in particular dose in Crystallyne whose recommended limit dose has been reduced recently from 150 to 20 mSv/year. (Author)

  6. THE REFERRAL BACK TO COURT IN CASE OF EXTRADITION

    Directory of Open Access Journals (Sweden)

    SIMONA TACHE

    2012-05-01

    Full Text Available Article 522 ind.1 Criminal procedure code, governing the referral back to court in case of extradition, refers to article 405-408 provisions review applicable to appeal, but this reference is limited to retrial procedure and solutions that can be pronounced by the court.The review procedure and the retrial procedure after extradition have a distinct finality: if the review involves removal of essential errors to the facts withheld in a final decision, the purpose of referral back to court in case of extradition is to guarantee the right of of extradited person, who was tried and convicted in the absence, to have a fair trial and, mainly, to exercise the right to defence in a new procedural cycle, which implies the possibility for the person to be heard, to question the witnesses or other parts of the process and to administer favorable evidence, both on the facts, as well as circumstantial.

  7. Substance Use Screening, Brief Intervention, and Referral to Treatment.

    Science.gov (United States)

    2016-07-01

    The enormous public health impact of adolescent substance use and its preventable morbidity and mortality show the need for the health care sector, including pediatricians and the medical home, to increase its capacity related to substance use prevention, detection, assessment, and intervention. The American Academy of Pediatrics published its policy statement "Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians" in 2011 to introduce the concepts and terminology of screening, brief intervention, and referral to treatment (SBIRT) and to offer clinical guidance about available substance use screening tools and intervention procedures. This policy statement is a revision of the 2011 SBIRT statement. An accompanying clinical report updates clinical guidance for adolescent SBIRT. PMID:27325638

  8. The impact of misdiagnosing celiac disease at a referral centre

    OpenAIRE

    Biagi, Federico; Bianchi, Paola I; Campanella, Jonia; Zanellati, Giovanni; CORAZZA, GINO R.

    2009-01-01

    In the past few years, the number of celiac disease diagnoses not confirmed at the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, a tertiary referral centre, was particularly high. Therefore, a decision was made to investigate the reasons why these diagnoses were wrong and by whom they had been made. The clinical histories of all celiac patients referred to the centre were re-evaluated. Between December 1998 and January 2007, 614 patients who were diagnosed at other institutions and p...

  9. Accuracy of telepsychiatric assessment of new routine outpatient referrals

    OpenAIRE

    Peters Trish; Arya Dinesh; Singh Surendra P

    2007-01-01

    Abstract Background Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews. Method This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases...

  10. Elevated levels of serum creatinine: recommendations for management and referral

    OpenAIRE

    Mendelssohn, D C; Barrett, B. J.; Brownscombe, L M; Ethier, J; Greenberg, D E; Kanani, S D; Levin, A.; Toffelmire, E B

    1999-01-01

    BACKGROUND: The potential benefits of earlier referral to a nephrologist of patients with elevated levels of serum creatinine include identifying and treating reversible causes of renal failure, slowing the rate of decline associated with progressive renal insufficiency, managing the coexisting conditions associated with chronic renal failure and facilitating efficient entry into dialysis programs for all patients who might benefit. METHODS: A subcommittee of the Canadian Society of Nephrolog...

  11. Referrals In Industrial Markets: Some Backgrounds And Empirical Results

    OpenAIRE

    Helm, S.

    1998-01-01

    Personal communication in industrial markets has to be considered an intra- as well as interorganizational phenomenon. Buyers will diffuse their positive and negative experiences, thereby support or contradict the marketing efforts of a supplier. The paper deals with buyer's referral and word-of-mouth behavior, points out some methods to cope with informal communication in industrial markets, and presents some results of an empirical research about the customers of a German machine tool produ...

  12. Physical Attractiveness Or Referrals: Which Matters The Most?

    OpenAIRE

    Subhani, Muhammad Imtiaz

    2012-01-01

    There is a blend of various factors on which the hiring of employee is based upon. This paper investigates and interrogates the contribution of physical attractiveness and referrals in the hiring of employee and further ponders on which matters the most from the above outlined variables when an employee is hired. The findings of the paper clearly confirm that it is the physical attractiveness which matters the most when an organization (hiring manager) goes for hiring on any hierarchical level.

  13. Referral for minor mental illness: a qualitative study.

    OpenAIRE

    Nandy, S.; Chalmers-Watson, C; Gantley, M; Underwood, M.

    2001-01-01

    BACKGROUND: Mild depression and anxiety are common problems in general practice. They can be managed by the general practitioner (GP) alone or referred. Previous quantitative studies have shown a large variation between GPs in terms of referral behaviour. The reasons for this variation are not fully understood. AIM: To describe and analyse GP's decision-making processes when considering who should be treating patients with minor mental illness, using a qualitative method. DESIGN OF STUDY: A q...

  14. Familial breast cancer: management of ‘lower risk' referrals

    OpenAIRE

    Young, D; McLeish, L; Sullivan, F.; Pitkethly, M; M. Reis; Goudie, D; Vysny, H; Ozakinci, G; Steel, M

    2006-01-01

    Up to 40% of referrals from primary care to ‘breast cancer family clinics' prove to be of women whose assessed risk falls below the guidelines' threshold for management in secondary or tertiary care, despite recommendations that they should be screened out at primary care level. A randomised trial, involving 87 such women referred to the Tayside Familial Breast Cancer Service compared two ways of communicating risk information, letter or personal interview. Both were found to be acceptable to...

  15. Trends in NHS doctor and dentist referrals to occupational health

    OpenAIRE

    Lalloo, Drushca; Demou, Evangelia; Macdonald, Ewan

    2016-01-01

    BACKGROUND: Ill-health in doctors can affect performance and fitness to practice, and consequently patient care and safety, placing an important responsibility on National Health Service (NHS) occupational health (OH) services. Anecdotal discussions amongst NHS occupational physicians suggest an increase in the number of doctor attendances over time, with continuing focus on mental illness. AIMS: To analyse OH referrals in doctors and dentists over 3 years. METHODS: A retrospec...

  16. Expert Consensus for Discharge Referral Decisions Using Online Delphi

    OpenAIRE

    Bowles, Kathy H.; Holmes, John H.; Naylor, Mary D.; Liberatore, Matthew; Nydick, Robert

    2003-01-01

    This paper describes the results of using a modified Delphi approach designed to achieve consensus from eight discharge planning experts regarding the decision to refer hospitalized older adults for post-discharge follow-up. Experts reviewed 150 cases using an online website designed to facilitate their interaction and efforts to reach agreement on the need for a referral for post-discharge care and the appropriate site for such care. In contrast to an average of eight weeks to complete just ...

  17. Midwifery workforce profile in Limpopo Province referral hospitals

    Directory of Open Access Journals (Sweden)

    Sam T. Ntuli

    2014-01-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Background: In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas.Objective: To determine the profile of registered nurses (RNs involved in maternity care in public referral hospitals of the Limpopo Province, South Africa.Method: A cross-sectional descriptive study was conducted in all maternity units of Limpopo’s public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0.Results: The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62. The majority (152/210; 70% were 40 years and older, 56% (117/210 had been working for more than 10 years, and 63/210 (30% were due to retire within 10 years. Only 22% (46/210 had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9% of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study.Conclusion: This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province.

  18. Diabetes Mellitus in Outpatients in Debre Berhan Referral Hospital, Ethiopia

    OpenAIRE

    Tesfa Dejenie Habtewold; Wendwesen Dibekulu Tsega; Bayu Yihun Wale

    2016-01-01

    Introduction. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Objective. To assess the prevalence and associated factors of diabetes mellitus among outpatients of Debre Berhan Referral Hospital. Methods and Materials. A cross-section...

  19. Referrals for pediatric weight management: the importance of proximity

    Directory of Open Access Journals (Sweden)

    Hagedorn Douglas WJ

    2010-11-01

    Full Text Available Abstract Background Limited access to weight management care can have a negative impact on the health and well-being of obese children and youth. Our objectives were to describe the characteristics of clients referred to a pediatric weight management centre and explore potential differences according to proximity. Methods All demographic and anthropometric data were abstracted from standardized, one-page referral forms, which were received by a pediatric weight management centre in Edmonton, AB (Canada between April, 2005 and April, 2009. Results Referrals (n = 555; 52% male; age [mean +/- standard deviation]: 12.4 +/- 2.6 y; BMI: 32.3 +/- 6.8 kg/m2; BMI percentile: 98.4 +/- 1.7; BMI z-score: 2.3 +/- 0.4 were received from 311 physicians. Approximately 95% of referrals were for boys and girls classified as obese or very obese. Based on postal code data, individuals were dichotomized as either living within (local; n = 455 or beyond (distant; n = 100 the Edmonton Census Metropolitan Area. Numerous families resided several hundred kilometres away from our centre. Overall, distant clients were taller, weighed more, and were more overweight than their local counterparts. For distant clients, the degree of overweight was higher in youth versus children. Conclusion Pediatric weight management services must be designed to optimize access to health services, especially for distant clients who may be at increased obesity-related health risk.

  20. Aperture referral in dioptric systems with stigmatic elements

    Directory of Open Access Journals (Sweden)

    W. F. Harris

    2012-12-01

    Full Text Available A previous paper develops the general theory of aperture referral in linear optics and shows how several ostensibly distinct concepts, including the blur patch on the retina, the effective cornealpatch, the projective field and the field of view, are now unified as particular applications of the general theory.  The theory allows for astigmatism and heterocentricity.  Symplecticity and the generality of the approach, however, make it difficult to gain insight and mean that the material is not accessible to readers unfamiliar with matrices and linear algebra. The purpose of this paper is to examine whatis, perhaps, the most important special case, that in which astigmatism is ignored.  Symplecticity and, hence, the mathematics become greatly simplified. The mathematics reduces largely to elementary vector algebra and, in some places, simple scalar algebra and yet retains the mathematical form of the general approach.  As a result the paper allows insight into and provides a stepping stone to the general theory.  Under referral an aperture under-goes simple scalar magnification and transverse translation.  The paper pays particular attention to referral to transverse planes in the neighbourhood of a focal point where the magnification may be positive, zero or negative.  Circular apertures are treated as special cases of elliptical apertures and the meaning of referred apertures of negative radius is explained briefly. (S Afr Optom 2012 71(1 3-11

  1. Assessing Brazilian educational inequalities

    Directory of Open Access Journals (Sweden)

    Benoit Lorel

    2008-03-01

    Full Text Available This paper provides an evaluation of schooling inequality in Brazil using different indicators such as the Education Gini coefficient, the Education Standard Deviation and the Average number of Years of Schooling. We draw up a statistical description of Brazilian human capital dispersion in time over the last half century, across regions and states. Our analysis suggests several conclusions: 1 Strong reduction of educational inequalities measured by Education Gini index. 2 A three parts picture of Brazil seems to emerge, reflecting initial conditions. 3 High increase of the Average number of Years of Schooling. 4 A significant link between Education Gini and the average education length. 5 Education Standard Deviation leads to inverted results compared to Education Gini. 6 Brazilian data are consistent with an Education Kuznets curve if we consider Education Standard Deviation.Esse trababalho busca avaliar o grau de desigualdade educacional no Brasil baseado-se em diferentes indicatores tais como: o índice de Gini educacional, os anos médios de escolaridade e no desvio padrão educacional. Tenta-se colocar uma descrição estatistica da distribuição do capital humano no Brasil, incluindo as diferenças estaduais e regionais observadas durante a ultima metade do século. As conclusões da nossa análise são as seguintes: 1 Forte reduç ão das desigualdades educativas calculadas com o Gini educacional. 2 Um retrato tripartido do Brasil parece se formar refletindo as condições iniciais. 3 Um forte aumento dos níveis de escolarização. 4 Uma relação significativa entre o Gini educacional e os anos médios de estudos. 5 O desvio padrão educacional leva aos resultados inversos do Gini educacional. 6 Os dados brasileiros admitem uma curva de Kuznets educacional se considerarmos o desvio padrão educacional.

  2. The lebanese society of cardiology: plans and perspectives, navigating against contrary winds and progressing against all odds.

    Science.gov (United States)

    Kossaify, Antoine; Moussallem, Nicolas

    2014-01-01

    Scientific societies in medicine theoretically aim to improve a medical field as a science; however, this role is expanding nowadays to seeking also the improved practice of a certain medical field. In this regard, the current Lebanese Society of Cardiology (2013-2015) has laid many plans and considered many perspectives. These concern mainly, but not exclusively, the increase of public awareness regarding prevention, investment in research, implementation of guidelines, support of continuous medical education, organization of cardiology symposia and congresses, and achievement of national registries regarding main cardiac conditions, as well as the society's main objective of decreasing the burden of cardiovascular diseases in Lebanon. Nonetheless, the implementation of such plans and perspectives is facing contrary winds related to a multifaceted phenomenon: the dominance of private medicine with a subsequent lack of teamwork, the dominance of private media, the social and political unrest in Lebanon, significant discrepancies in the scientific background of cardiologists, and the absence of a standardized national cardiology licensing exam. Importantly, the implementation of such plans and perspectives requires individual commitment, along with the cooperation of the Order of Physicians, the Syndicate of Hospitals in Lebanon (representing private hospitals) and the Ministry of Health. Moreover, industry must be more committed to medical scientific societies; the support of cardiology events organized without the auspices of the Lebanese Society of Cardiology is not encouraged because of the presence of significant conflict of interest. PMID:25452697

  3. Protection against ionizing radiation by leaded glass googles during interventional cardiology

    International Nuclear Information System (INIS)

    Background: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). Aim: To assess if the degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. Material and Methods : A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort of seven members of an interventional cardiology service, exposed to 1057 consecutive procedures. Results:The monthly dose equivalent measurement performed in front of the goggles ranged between 1.1 and 6.5 mSv,for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv,respectively.The degree of attenuation of the dose at eye level ranged from 40% to 57.7%,respectively. The projected annual exposure would reach 33 mSv for the interventional cardiologist. Conclusions: With a similar load of work and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years)

  4. The impact of carotid plaque presence and morphology on mortality outcome in cardiological patients

    Directory of Open Access Journals (Sweden)

    Pasanisi Emilio

    2006-03-01

    Full Text Available Abstract Background Carotid plaque severity and morphology can affect cardiovascular prognosis. We evaluate both the importance of echographically assessed carotid artery plaque geometry and morphology as predictors of death in hospitalised cardiological patients. Methods 541 hospitalised patients admitted in a cardiological division (age = 66 ± 11 years, 411 men, have been studied through ultrasound Duplex carotid scan and successively followed-up for a median of 34 months. Echo evaluation assessed plaque severity and morphology (presence of heterogeneity and profile. Results 361 patients showed carotid stenosis (67% with 70% stenosis, 4% with near occlusion and 2% with total occlusion. During the follow-up period, there were 83 all-cause deaths (15% of the total population. Using Cox's proportional hazard model, age (RR 1.06, 95% CI 1.03–1.09, p = 0.000, ejection fraction > 50% (RR = 0.62, 95% CI 0.4–0.96, p = 0.03, treatment with statins (RR = 0.52, 95% CI 0.29–0.95, p = 0.34 and the presence of a heterogeneous plaque (RR 1.6; 95% CI, 1.2 to 2.14, p = 0.002 were independent predictors of death. Kaplan – Meier survival estimates have shown the best outcome in patients without plaque, intermediate in patients with homogeneous plaques and the worst outcome in patients with heterogeneous plaques (90% vs 79% vs 73%, p = 0.0001. Conclusion In hospitalised cardiological patients, carotid plaque presence and morphology assessed by ultrasound are independent predictors of death.

  5. [Evaluation of Brazilian online pharmacies].

    Science.gov (United States)

    Gondim, Ana Paula Soares; Falcão, Cláudio Borges

    2007-04-01

    The growing number of Internet users brought forth an increase in the search for Brazilian online pharmacy services. Aiming at evaluating the validity of information disseminated in these websites, a descriptive study was carried out in 18 virtual pharmacies concerning legal aspects, accessibility, sources of information and drug advertising. It was found 15 pharmacies did not have authorization of the Brazilian National Health Surveillance Agency; the manager pharmaceutical officer's name could not be found in 17 of them; 17 pharmacies marketed drugs with no registration, especially herbal medicines, and did not show either information on adverse drug reactions or this agency's alerts and health recommendations. Since health control and drug commerce in Brazilian online pharmacies have not been yet regulated by proper government agencies, these gaps found in the sites can pose risk to the users' health. PMID:17384808

  6. Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations

    Directory of Open Access Journals (Sweden)

    2015-05-01

    Full Text Available Cardiovascular diseases are the main causes of mortality and morbidity in Brazil. Their primary and secondary preventions are a priority for the health system and require multiple approaches for increased effectiveness. Biomarkers are tools used to identify with greater accuracy high-risk individuals, establish a faster diagnosis, guide treatment, and determine prognosis. This review aims to highlight the importance of biomarkers in clinical cardiology practice and raise relevant points regarding their application and perspectives for the next few years. This document was divided into two parts. This second part addresses the application of biomarkers in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism, and cardiorenal syndrome.

  7. [Pay for performance approach and its possible future influence on revenues in German interventional cardiology units].

    Science.gov (United States)

    Miljak, Tomislav; Rupp, Wolfgang

    2016-01-01

    Pay-for-performance in German health care system is still uncommon but--in view of scheduled legislative projects--could gain more influence in future. Beside others, risc adjusted in-hospital mortality and the door-to-ballon-time inpatients with ST-elevation myocardial infarction could become quality- and performance indicators in interventional cardiology units. As a result, process optimization based on these indicators could have an impact on both patient value (as already today) and revenues (from 2017 onwards). PMID:26800075

  8. Influence of dosemeter position for the assessment of eye lens dose during interventional cardiology

    OpenAIRE

    Principi, Sara; Ginjaume Egido, Mercè; Duch Guillen, María Amor; Sanchez, Roberto Mariano; Ferenandez, Jose Miguel; Vaño, Eliseo

    2015-01-01

    The equivalent dose limit for the eye lens for occupational exposure recommended by the ICRP has been reduced to 20 mSv y-1 averaged over defined periods of 5 y, with no single year exceeding 50 mSv. The compliance with this new requirement could not be easy in some workplace such as interventional radiology and cardiology. The aim of this study is to evaluate different possible approaches in order to have a good estimate of the eye lens dose during interventional procedures. Measurements wer...

  9. PET/CT cardiology: an area whose boundaries are still out of sight

    International Nuclear Information System (INIS)

    Positron emission tomography (PET) and X-ray computed tomography (CT) performed with PET/CT cameras allow us to obtain concurrently information on the presence and degree of alterations of myocardial perfusion and metabolism and on coronary arteries calcification. Furthermore, by gated myocardial perfusion studies, PET may provide crucial information on regional coronary blood flow reserve and endothelial dysfunction. A number of recent papers provide some insight on the potential of PET/CT in cardiology and in the assessment of various cardiovascular diseases including various types of vasculitis and metabolic diseases

  10. Nuclear cardiological investigations in patients classified as physically disabled following myocardial infarction

    International Nuclear Information System (INIS)

    110 patients classified as physically disabled as a consequence of myocardial infarction were reinvestigated by means of nuclear cardiological methods. Resting 201Tl perfusion scintigraphy showed a normal distribution of radioactivity, while radionuclide ventriculography revealed a normal left ventricular ejection fraction and a normokinetic left ventricle in 20 patients. The investigation of a further 19 patients demonstrated only minimal pathological changes. The results in 34 patients revealed severe myocardial damage, and in a further 19 cases the development of left ventricular aneurysm. The results clearly show the value of 201Tl scintigraphy and radionuclide ventriculography in assessments of the degree of physical disability after myocardial infarction. (author) 15 refs.; 3 tabs

  11. Optimisation of interventional cardiology procedures; Optimisation des procedures en cardiologie interventionnelle

    Energy Technology Data Exchange (ETDEWEB)

    Bar, Olivier [SELARL, Cardiologie Interventionnelle Imagerie Cardiaque - CIIC, 8, place de la Cathedrale - 37042 Tours (France)

    2011-07-15

    Radiation-guided procedures in interventional cardiology include diagnostic and/or therapeutic procedures, primarily coronary catheterization and coronary angioplasty. Application of the principles of radiation protection and the use of optimised procedures are contributing to dose reduction while maintaining the radiological image quality necessary for performance of the procedures. The mandatory training in patient radiation protection and technical training in the use of radiology devices mean that implementing continuous optimisation of procedures is possible in practice. This optimisation approach is the basis of patient radiation protection; when associated with the wearing of protective equipment it also contributes to the radiation protection of the cardiologists. (author)

  12. THE ROLE OF P-GLYCOPROTEIN IN RATIONAL PHARMACOTHERAPY IN CARDIOLOGY

    Directory of Open Access Journals (Sweden)

    A. V. Shulkin

    2015-09-01

    Full Text Available On the basis of the analysis of published data the role of P-glycoprotein, carrier protein, in rational pharmacotherapy in cardiology was shown on the example of its substrates – digoxin, antiplatelet agents and anticoagulants. Determination of C3435T polymorphism of multidrug resistance gene (MDR1, encoding P-glycoprotein, in pharmacotherapy with digoxin, antiplatelet drugs (clopidogrel tikagrelol, prasugrel and anticoagulants (dabigatran etexilate, rivaroxaban, edoxaban is not feasible in routine practice. Drug in- teractions have clinical implications for the efficacy and safety of pharmacotherapy in coadministration of these drugs with P-glycoprotein substrates, inducers and inhibitors.

  13. On the use of DICOM cine header information for optimisation: Results from the 2002 European DIMOND cardiology survey

    International Nuclear Information System (INIS)

    The paper explores the level of information contained within the DICOM header in images from various cardiology systems. Data were obtained in the European DIMOND survey on image quality (Italy (Ireland)) (Belgium)) (Greece)) and Spain). Images from five standard diagnostic cardiology procedures carried out in six European hospitals have been analysed. DICOM header information was extracted to a database in order to analyse how it could help in the optimisation of the procedures. The level of data contained in the headers differs widely between cardiology systems. None of the X-ray systems in the 2002 survey archives the dosimetric data in the DICOM header. The mean number of runs per procedure ranges between 7.5 and 15.4 and the mean number of frames per procedure between 575 and 1417. Differences in kV p, mA, pulse time, distances and C-arm angulations are substantial and suggest that there exists a wide range for optimisation. (authors)

  14. Making Heritage in Brazilian Quilombos

    Directory of Open Access Journals (Sweden)

    Mary Lorena Kenny

    2011-06-01

    Full Text Available The Brazilian Palmares Cultural Foundation has recognized 1,624 communities as remanescentes de quilombos, or remnants, of traditional Black settlements. Since 1988, the constitution has guaranteed these groups collective land titles, generating heated debate and conflict concerning authenticity, assimilation, and land rights. Heritage has become an important vehicle for legitimizing identity and securing territory rights. I examine quilombola heritage in the sertão, an area not popularly acknowledged as having a history of slavery or Afro Brazilian cultural traditions.

  15. Brazilian Congress structural balance analysis

    CERN Document Server

    Levorato, Mario

    2016-01-01

    In this work, we study the behavior of Brazilian politicians and political parties with the help of clustering algorithms for signed social networks. For this purpose, we extract and analyze a collection of signed networks representing voting sessions of the lower house of Brazilian National Congress. We process all available voting data for the period between 2011 and 2016, by considering voting similarities between members of the Congress to define weighted signed links. The solutions obtained by solving Correlation Clustering (CC) problems are the basis for investigating deputies voting networks as well as questions about loyalty, leadership, coalitions, political crisis, and social phenomena such as mediation and polarization.

  16. Who is being referred to cancer genetic counseling? Characteristics of counselees and their referral.

    OpenAIRE

    Riel, E. van; Dulmen, S. van; Ausems, M.G.E.M.

    2012-01-01

    Both physician and patient play a role in the referral process for cancer genetic counseling. Access to such counseling is not optimal because some eligible patients are not being reached by current referral practice. We aimed to identify factors associated with the initiator of referral. During a 7-month period, we recorded demographic characteristics like gender, personal and family history of cancer, ethnicity and eligibility for genetic testing for 406 consecutive counselees using a speci...

  17. The Effects of Conflict Resolution training on Students With Previous Discipline Referrals

    OpenAIRE

    Gunn, Reamous Jr.

    1999-01-01

    THE EFFECTS OF CONFLICT RESOLUTION TRAINING ON STUDENTS WITH PREVIOUS DISCIPLINE REFERRALS by Reamous Gunn, Jr. Educational Leadership and Policy Studies (ABSTRACT) The purpose of this study was to determine the effects of conflict resolution training on the number and severity of discipline referral offenses committed by high school students in one urban school. Effectiveness was measured by the number and severity of student discipline referrals to the school administra...

  18. Substance Abuse Treatment Providers' Referral to Self-Help: Review and Future Empirical Directions

    OpenAIRE

    Laudet, Alexandre B.

    2000-01-01

    As duration and intensity of services decline, the treatment system's success in engaging substance-using clients in self-help (SH) will increasingly influence client outcomes. Clinicians play an important role in involving clients with SH, yet little is known about how referral decisions are made or about the referral process itself. This paper reviews clinicians' attitudes toward SH and their role in referring clients to SH, and identifies types of research needed to elucidate the referral ...

  19. QUALITY OF PRIMARY CARE REFERRAL LETTERS AND FEEDBACK REPORTS IN BURAIDAH, QASSIM REGION, SAUDI ARABIA

    OpenAIRE

    Al-Alfi, Mohammed A.; Al-Saigul, Abdullah M.; Ashraf M Abed-Elbast; Sourour, Atef M.; Ramzy, Hasnin A.

    2007-01-01

    Objective: To evaluate the quality of referral letters and feedback reports written according to the standards of Quality Assurance Manual of Ministry of Health from primary health care centers (PHCC′s) in Buraidah. Methodology: This study was conducted during October and November 2004. A total of 330 referral letters and feedback reports were randomly selected from six PHCCs (20% from PHCCs in Buraidah City). About 55 referral and feedback letters were selected from each PHCC by systemat...

  20. eNotification: Adapting eReferral for Public Health Notifiable Disease Reporting in New Zealand

    OpenAIRE

    Jones, Nicholas F.; Calder, Lester

    2012-01-01

    Objectives New Zealand is currently implementing a standard for the electronic referral of patients from primary care to District Health Board (DHB) provided specialist services (eReferral). Medical Officers of Health working within DHB public health services receive referrals through a legally mandated disease notification system. Although laboratories have reported notifiable diseases electronically since 2007 clinical and risk factor information are still reported by fax or telephone. This...

  1. Audit from preschool developmental surveillance of vision, hearing, and language referrals.

    OpenAIRE

    Rona, R J; Reynolds, A; Allsop, M; Morris, R. W.; Morgan, M.; Mandalia, S

    1991-01-01

    Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speec...

  2. Brazilian Mothers' Socialization Goals: Intracultural Differences in Seven Brazilian Cities

    Science.gov (United States)

    Seidl-de-Moura, Maria Lucia; Lordelo, Eulina; Vieira, Mauro Luis; Piccinini, Cesar Augusto; Siqueira, Jose de Oliveira; Magalhaes, Celina Maria Colino; Pontes, Fernando Augusto Ramos; Salomao, Nadia Maria; Rimoli, Adriana

    2008-01-01

    The present study aimed to investigate Brazilian mothers' socialization goals. The participants in the study were 349 primiparous mothers, whose ages ranged from 17 to 47 years (mean = 26.6 years), who had children aged between 1 and 48 months (mean = 16.4 months). The families were living in seven different cities representing each of the five…

  3. Barriers of Referral System to Health Care Provision in Rural Societies in Iran

    Directory of Open Access Journals (Sweden)

    Manijeh Eskandari

    2013-08-01

    Full Text Available Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran. Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis.Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found. Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential.

  4. Community referral in home management of malaria in western Uganda: A case series study

    Directory of Open Access Journals (Sweden)

    Nsungwa-Sabiiti Jesca

    2006-03-01

    Full Text Available Abstract Background Home Based Management of fever (HBM was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children Methods A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral. Results Overall referral rate was 8% (117/1454. Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93% "urgent referrals" accessed referral care but 8 (31% delayed >24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50% were urgently referred; most delayed ≥ 2 days before accessing referral care. Conclusion The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa.

  5. Suicide Prevention Referrals in a Mobile Health Smoking Cessation Intervention.

    Science.gov (United States)

    Christofferson, Dana E; Hamlett-Berry, Kim; Augustson, Erik

    2015-08-01

    Automated mobile health (mHealth) programs deliver effective smoking cessation interventions through text message platforms. Smoking is an independent risk factor for suicide, so the Department of Veterans Affairs incorporated information about the Veterans Crisis Line into its SmokefreeVET smoking cessation text messaging program. Almost 7% of all SmokefreeVET enrollees have accessed this information. Because of the reach and automated nature of this and similar programs, we recommend including a referral to a suicide prevention hotline for all smoking cessation mHealth interventions. PMID:26066949

  6. [Body packer: review and experience in a referral hospital].

    Science.gov (United States)

    Madrazo, Zoilo; Silvio-Estaba, Leonardo; Secanella, Luis; García-Barrasa, Arantxa; Aranda, Humberto; Golda, Thomas; Biondo, Sebastiano; Rafecas, Antoni

    2007-09-01

    Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients. PMID:17916283

  7. La interconsulta y la referencia Interconsultation and referral

    Directory of Open Access Journals (Sweden)

    José Díaz Novás

    2005-08-01

    Full Text Available Se aborda el tema de la ínterconsulta y la referencia como habilidades esenciales del Médico de Familia, se explica su naturaleza y cómo llevar a cabo estos procedimientos, enfatizándose en la importancia de su desarrollo correcto, las causas que los motivan y la responsabilidad del médico con el paciente.Interconsultation and referral as essential skills of the family physician are approached. Their nature is also explained, as well as how to implement these procedures, making emphasis on the importance of their correct development, the causes motivating them and the responsibility of the doctor with the patient.

  8. Low dose in nuclear cardiology: state of the art in the era of new cadmium-zinc-telluride cameras.

    Science.gov (United States)

    Acampa, Wanda; Buechel, Ronny R; Gimelli, Alessia

    2016-06-01

    The use of myocardial perfusion imaging has seen a tremendous growth during the last decade and has become the most commonly used non-invasive imaging tool for risk stratification in patients with suspected and known coronary artery disease. Adherence to radiation safety best practices varied significantly between laboratories but the possibility to use the new cameras in nuclear cardiology can reduce dramatically the radiation dose without losing accuracy. Moreover, the physical characteristics of ultrafast technology could be able to open new doors for the evaluation of old parameters, changing the impact of nuclear cardiology in the diagnostic strategies. PMID:26985078

  9. Influence of Ceiling Suspended Screen Positioning to the Scatter Radiation Levels in Interventional Cardiology

    International Nuclear Information System (INIS)

    The objective of this paper is to identify the effects of the ceiling suspended screen position to the scatter radiation levels in the interventional cardiology. The scatter radiation in terms of ambient dose equivalent H*(10) was measured for various positions of protective screen in the positions of the first operator, nurse and radiographer, at elevations 100-190 cm and in four different angulations of the x-ray tube. To assess the effectiveness of the protective screen, the scattered dose was also measured in the absence of any protection in all four angulations and elevations. To simulate real clinical situation the measurements were performed in the presence of 30 cm PMMA phantom using standard clinical protocol. The utility of protective screen varied for different positions and angulations. Scatter radiation levels varied in the range 70 - 3400 μSv/h for the first operator, 140 - 3200 μSv/h for the nurse and 50 - 560 μSv/h for radiographer. Ceiling suspended screens can provide a substantial level of protection (up to factor 18) in interventional cardiology, but they have to be properly managed and positioned to achieve sufficient level of protection. The guidance for optimal protection is provided in the paper.(author)

  10. Kerma rate evaluation in the air in a room interventional cardiology

    International Nuclear Information System (INIS)

    In recent years, the number of interventional cardiology procedures is increasing. However, due to the long time of fluoroscopy in these procedures, care teams can receive high doses of radiation. The radiation scattered by the patient is not uniform, and their assessment is of utmost importance. This study aimed to estimate and map the kerma rate in the air at the time of the gonads, in an interventional cardiology room, seeking to optimize the dose absorbed by individuals occupationally exposed to ionizing radiation. For data collection, the room was divided into quadrants of 1m2, totaling 40 collection points. The simulator was positioned so that its entry surface was located in the interventional reference point. Were chosen the conditions that simulate angiography and angioplasty procedures performed in the service. The data were obtained for height of 1 meter, gonad region. The results obtained for kerma rates in air, in quadrants, show that higher measured values was in the vicinity of the X-ray tube. Has been found that the medical staff are more exposed, because of its location during the procedure, around the table. The law of the inverse square distance of the farthest points of the X-ray tube were verified

  11. Influence of dosemeter position for the assessment of eye lens dose during interventional cardiology.

    Science.gov (United States)

    Principi, Sara; Ginjaume, Mercè; Duch, Maria Amor; Sánchez, Roberto M; Fernández, Jose M; Vano, Eliseo

    2015-04-01

    The equivalent dose limit for the eye lens for occupational exposure recommended by the ICRP has been reduced to 20 mSv y(-1) averaged over defined periods of 5 y, with no single year exceeding 50 mSv. The compliance with this new requirement could not be easy in some workplace such as interventional radiology and cardiology. The aim of this study is to evaluate different possible approaches in order to have a good estimate of the eye lens dose during interventional procedures. Measurements were performed with an X-ray system Philips Allura FD-10, using a PMMA phantom to simulate the patient scattered radiation and a Rando phantom to simulate the cardiologist. Thermoluminescence (TL) whole-body and TL eye lens dosemeters together with Philips DoseAware active dosemeters were located on different positions of the Rando phantom to estimate the eye lens dose in typical cardiology procedures. The results show that, for the studied conditions, any of the analysed dosemeter positions are suitable for eye lens dose assessment. However, the centre of the thyroid collar and the left ear position provide a better estimate. Furthermore, in practice, improper use of the ceiling-suspended screen can produce partial protection of some parts of the body, and thus large differences between the measured doses and the actual exposure of the eye could arise if the dosemeter is not situated close to the eye. PMID:25514919

  12. Paediatric interventional cardiology: flat detector versus image intensifier using a test object

    International Nuclear Information System (INIS)

    Entrance surface air kerma (ESAK) values and image quality parameters were measured and compared for two biplane angiography x-ray systems dedicated to paediatric interventional cardiology, one equipped with image intensifiers (II) and the other one with dynamic flat detectors (FDs). Polymethyl methacrylate phantoms of different thicknesses, ranging from 8 to 16 cm, and a Leeds TOR 18-FG test object were used. The parameters of the image quality evaluated were noise, signal-difference-to-noise ratio (SdNR), high contrast spatial resolution (HCSR) and three figures of merit combining entrance doses and signal-to-noise ratios or HCSR. The comparisons showed a better behaviour of the II-based system in the low contrast region over the whole interval of thicknesses. The FD-based system showed a better performance in HCSR. The FD system evaluated would need around two times more dose than the II system evaluated to reach a given value of SdNR; moreover, a better spatial resolution was measured (and perceived in conventional monitors) for the system equipped with flat detectors. According to the results of this paper, the use of dynamic FD systems does not lead to an automatic reduction in ESAK or to an automatic improvement in image quality by comparison with II systems. Any improvement also depends on the setting of the x-ray systems and it should still be possible to refine these settings for some of the dynamic FDs used in paediatric cardiology.

  13. Evaluation of doses to staff involved in interventional cardiology in two Khartoum hospitals

    International Nuclear Information System (INIS)

    In interventional cardiac procedures, staff operates near the patient in a non-uniformly scattered radiation field. Consequently, workers may receive, over a period of time, relatively high radiation doses. The measurement of individual doses to personnel becomes critical due to the use of protective devices and, as a consequence of the large number of methods proposed to assess the effective dose, In this study, staff doses were measured in two cardiac centers: Ahmed Gasim Hospital and Cardiac Center, Khartoum. The objective was to measure personal dose equivalent and accordingly estimate the effective dose which is received by staff in interventional cardiology. Measurements were performed using electronic personal dosimeters (EPDs) worn over lead apron during the examination and were read immediately following each examination. A total number of 40 radiation worker were monitored for a period of two weeks. The highest doses received by the cardiologist followed by nurses and then X-ray technicians. Staff received mean effective doses that ranged from 24 to 110 μSv estimated for four weeks. Recommendations on how to reduce staff doses in interventional cardiology are presented. (Author)

  14. Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology.

    Science.gov (United States)

    de Sá Ferreira, Arthur; Lopes, Agnaldo José

    2013-04-01

    Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables (frequency, rhythm, wideness, length, deepness, and qualities) developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories: the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yinyang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiology to provide a more evidence-based medical practice. PMID:23546634

  15. Anticoagulation control in atrial fibrillation patients present to outpatient clinic of cardiology versus anticoagulant clinics

    Institute of Scientific and Technical Information of China (English)

    DU Xin; MA Chang-sheng; LIU Xiao-hui; DONG Jian-zeng; WANG Jun-nan; CHENG Xiao-jing

    2005-01-01

    @@ Nonvalvular atrial fibrillation (NVAF) is the most common sustained cardiac arrhythmia in clinical practice, which if untreated results in a doubling of cardiovascular morbidity and mortality. AF is an independent predictor of stroke, with an annual risk 5 to 6 times higher than patients in sinus rhythm.1 During recent years, several randomised clinical trials conducted by investigators around the world involving 13 843 participants with NVAF have demonstrated convincingly the value of warfarin therapies for stroke prevention in high risk patients.2-8 However, the dose response of warfarin is complex and its activity is easily altered by concurrent medications, food interactions, alcohol and illnesses. Adherence to medical advice and routine monitoring of the international normalized ratio (INR) is important, because low anticoagulant intensity predisposes the patients to thromboembolic complications and high intensity to haemorrhage. Studies suggested that anticoagulant clinics could improve the quality of anticoagulation control,9 and anticoagulant clinics are common in western countries. However, in China, most AF patients taking warfarin usually attend the outpatient clinic of cardiology, while the quality of anticoagulation control is never investigated. We therefore assessed anticoagulation control in the outpatient clinic of cardiology, and the quality of anticoagulation control since the establishment of anticoagulant clinics.

  16. Influence of dosemeter position for the assessment of eye lens dose during interventional cardiology

    International Nuclear Information System (INIS)

    The equivalent dose limit for the eye lens for occupational exposure recommended by the ICRP has been reduced to 20 mSv y-1 averaged over defined periods of 5 y, with no single year exceeding 50 mSv. The compliance with this new requirement could not be easy in some workplace such as interventional radiology and cardiology. The aim of this study is to evaluate different possible approaches in order to have a good estimate of the eye lens dose during interventional procedures. Measurements were performed with an X-ray system Philips Allura FD-10, using a PMMA phantom to simulate the patient scattered radiation and a Rando phantom to simulate the cardiologist. Thermoluminescence (TL) whole-body and TL eye lens dosemeters together with Philips DoseAware active dosemeters were located on different positions of the Rando phantom to estimate the eye lens dose in typical cardiology procedures. The results show that, for the studied conditions, any of the analysed dosemeter positions are suitable for eye lens dose assessment. However, the centre of the thyroid collar and the left ear position provide a better estimate. Furthermore, in practice, improper use of the ceiling-suspended screen can produce partial protection of some parts of the body, and thus large differences between the measured doses and the actual exposure of the eye could arise if the dosemeter is not situated close to the eye. (authors)

  17. The Brazilian nuclear power programme

    International Nuclear Information System (INIS)

    The booklet contains survey articles on the nuclear power problems of Brazil, the German-Brazilian nuclear power agreement, the application of international safety measures, and 'Brazil and the non-proliferation of nuclear weapons'. The agreement is given in full wording. (HP)

  18. BRAZILIAN EXPORTS OF MANUFACTURED WOOD

    Directory of Open Access Journals (Sweden)

    Rafael de Azevedo Calderon

    2010-08-01

    Full Text Available The present work deals with the Brazilian exports of sawnwood of non-coniferous, veneer sheets and plywood, from 1961 to 2002. The data regarding the three studied products, sawnwood of non-coniferous, veneer sheets and plywood, were joined through the method of Fisher so that an econometric evaluation of the market of the three products could be carried out. Supply and demand models of the Brazilian exports were specified. The results were satisfactory and they match with the literature. The supply of exports presented a positive answer in relation to the exporter's remuneration, to the production, to the use of the installed capacity (cycles of domestic economical activity and to the tendency, and negative in relation to the internal demand. The demand for the Brazilian exports was influenced positively by the world income, participation index and tendency, and negatively for the relative price. The low elasticity-price of the found demand can have implications in the conservation of the Brazilian forest resources because the exporters can increase the prices, reduce the amounts and still increase the incomes.

  19. Deforestation in the Brazilian Amazon

    NARCIS (Netherlands)

    Boekhout van Solinge, T.

    2015-01-01

    This essay takes a (green) criminological and multidisciplinary perspective on deforestation in the Brazilian Amazon, by focusing on the crimes and damages that are associated with Amazonian deforestation. The analysis and results are partly based on longer ethnographic stays in North Brazil (Amazon

  20. Gramscian Thought and Brazilian Education

    Science.gov (United States)

    Dore, Rosemary

    2009-01-01

    In the history of Brazilian education, it is only since the 1980s, during the redemocratization of Brazil, that proposals for public education in a socialist perspective have been presented. The past two decades have been marked by a growing interest in Gramscian thought, mainly in the educational field, making possible the elaboration of…

  1. The Brazilian sugarcane innovation system

    International Nuclear Information System (INIS)

    Ethanol has recently been of great interest worldwide because it is a viable economic alternative to petroleum products and it is a renewable source of energy that mitigates the emission of greenhouse gases. Brazilian bioethanol from sugarcane is the most successful case at the world level because of its low cost and low level of greenhouse gas emissions. Brazil's success with sugarcane cannot be understood as based solely on a natural comparative advantage, but as a result of efforts that culminated in a positive trajectory of technological learning, relying mostly on incremental innovations. The purpose of this article is to analyze the key aspects of the innovation system built around the Brazilian sugarcane industry. It is based on the national innovation systems approach according to which innovation results from the interaction of different institutional actors. Institutional arrangements are analyzed as the basis for the innovative process, in particular R and D and the innovation policies and strategies of the main players in the sugarcane sector, including sugar and ethanol mills, industrial goods suppliers, public and private research institutions, and governmental agencies. - Research Highlights: → The Brazilian success in bioethanol is due to the sugarcane innovation system. → Private funds for R and D became central after IAA closure. → Nowadays Brazilian innovation system is transforming to keep its leadership. → Public funds for research in the second generation bioethanol.

  2. Congenital heart disease screening: which referral factors are most important

    International Nuclear Information System (INIS)

    To identify the referral factors for fetal echocardiography which are associated with congenital cardiac defects in the fetus. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Radiology Department, CMH, Rawalpindi, from January 2007 to November 2010. Methodology: All patients referred for fetal echocardiography with one or more risk factors for the development of congenital heart disease, and those patients with incidental discovery of congenital heart disease on antenatal ultrasound were evaluated. Patients with no risk factors who were found to have normal fetal echocardiography were excluded from the study. Univariate logistic regression analysis was carried out for each variable. The variables with statistical significance of less than 0.05 were subjected to multivariate logistic regression. Fetal echocardiographic diagnosis was taken as the dependent variable and all other variables were the independent variables. Results: Two hundred and sixty four patients were evaluated by fetal echocardiography for congenital heart disease. The statistically significant factor was detection of congenital heart disease on routine ultrasound examination. Conclusion: A routine obstetric scan should include evaluation of the heart with four-chamber and base-of-heart views to exclude cardiac anomalies. A cardiac anomaly picked up on routine ultrasound scan is the most important indication for referral for fetal echocardiography. Fetal arrhythmias and echogenic focus in the left ventricle do not have a significant association with structural cardiac malformation. (author)

  3. Accuracy of telepsychiatric assessment of new routine outpatient referrals

    Directory of Open Access Journals (Sweden)

    Peters Trish

    2007-10-01

    Full Text Available Abstract Background Studies on the feasibility of telepsychiatry tend to concentrate only on a subset of clinical parameters. In contrast, this study utilises data from a comprehensive assessment. The main objective of this study is to compare the accuracy of findings from telepsychiatry with those from face to face interviews. Method This is a primary, cross-sectional, single-cluster, balanced crossover, blind study involving new routine psychiatric referrals. Thirty-seven out of forty cases fulfilling the selection criteria went through a complete set of independent face to face and video assessments by the researchers who were blind to each other's findings. Results The accuracy ratio of the pooled results for DSM-IV diagnoses, risk assessment, non-drug and drug interventions were all above 0.76, and the combined overall accuracy ratio was 0.81. There were substantial intermethod agreements for Cohen's kappa on all the major components of evaluation except on the Risk Assessment Scale where there was only weak agreement. Conclusion Telepsychiatric assessment is a dependable method of assessment with a high degree of accuracy and substantial overall intermethod agreement when compared with standard face to face interview for new routine outpatient psychiatric referrals.

  4. Cardiology; Cardiologie

    Energy Technology Data Exchange (ETDEWEB)

    Manrique, A.; Agostini, D.; Py, M.; Guillo, P.; Weinmann, P.; Benabib, C.; Toussaint, J.F.; Eder, V.; Alibelli, M.J.; Franken, P. [Societe Fran ise de Medecine Nucleaire et Imagerie Moleculaire, 75 - Paris (France); Valli, N.; Garrigue, S.; Gatta, B.; Vialard, M.J.; Hossini, M.; Clementy, J.; Haissaguerre, M.; Ducassous, D.; Barat, J.L. [Hopital du Haut Leveque Univ. Victor Segalen, 33 - Bordeaux (France); Tran, N.; Groubatch, F.; Poussier, S.; Villemot, J.P.; Maskali, F.; Laurens, M.H.; Karcher, G.; Py, M. [Centre Hospitalier Universitaire, 54 - Nancy (France); Franken, P.R.; Vanhove, C. [AZ-VUB Bruxelles (Belgium)

    2005-11-15

    Medical examinations such SPECT or scintigraphy are used to establish a diagnosis, to provide the follow up in the case of cardiac diseases. three examples are detailed, monitoring of myocardium viability under SPECT, evaluation of patients reached by a Brugada syndrome with scintigraphy at Mibg {sup 123}I, analysis of transplant of mesenchyme cells with pinhole-SPECT among rats having a chronic myocardium infarction. (N.C.)

  5. Fetal cardiology

    International Nuclear Information System (INIS)

    Doppler echocardiography makes it possible to diagnose congenital heart disease in early pregnancy. It allows us to study the anatomical configuration of the fetal heart, and additionally, to evaluate the physiological conditions of the fetus. Evaluation of the direction, velocity, wave form pattern, and quantification of blood flow at the various sites in the fetal heart helps us to assess the characteristics of the fetal circulation and condition of the fetal heart. In order to use this technique in pathological situations, an initial study of the developing normal human fetal circulation was necessary. The authors studied 34 uncomplicated pregnancies by serial Doppler echocardiography. The studies were performed every 4 weeks from 16-weeks gestation to term. The pulsed Doppler sector scanner provided cardiac cross-sectional images, mitral and tricuspid blood velocities were obtained from apical four-chamber views. Angle corrected maximal and mean temporal velocities were calculated by digitizing the Doppler frequency shift recording on a graphic tablet computed with a minicomputer. The angle between the Doppler interrogation beam and the direction of blood flow was kept as small as possible in order to minimize the error

  6. The Effects of Implementing a Positive Behavior Intervention Support Program on Office Discipline Referrals

    Science.gov (United States)

    Thomas, Cheryl Denise

    2015-01-01

    The purpose of this study was to determine if the implementation of PBIS (Positive Behavioral Intervention Support) program had a positive significant effect in decreasing office discipline referrals in a local elementary school. A sample independent t-Test was used to examine data on the school's average office discipline referrals for two years…

  7. 45 CFR 73.735-1304 - Referral of matters arising under the standards of this part.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Referral of matters arising under the standards of this part. 73.735-1304 Section 73.735-1304 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION STANDARDS OF CONDUCT Reporting Violations § 73.735-1304 Referral of matters arising under the standards of this part. (a)...

  8. The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger

    Directory of Open Access Journals (Sweden)

    Van Lerberghe Wim

    2004-04-01

    Full Text Available Abstract Background For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. Methods Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. Results Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. Conclusions Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns.

  9. Strategies for Students with Behavioral Issues Prior to Referral for Special Education Assessment

    Science.gov (United States)

    Vallejos, Antoinette Martinez

    2010-01-01

    By law, public schools need to exhaust all general education services prior to referral for special education services (IDEA, 1990). Unfortunately, many teachers are unaware of the pre-referral interventions they can employ to teach children displaying behavior problems. The review of literature focused on the following: (a) legislative history,…

  10. Referral Pattern and Special Interests in Children and Adolescents with Asperger Syndrome: A Turkish Referred Sample

    Science.gov (United States)

    Tanidir, Canan; Mukaddes, Nahit M.

    2014-01-01

    Objectives: To investigate the most frequent reasons for referral, the most common special interests, age at first referral to a mental health service, and the age of diagnosis in children and adolescents with Asperger syndrome living in Turkey. Methods: This study includes 61 children and adolescents diagnosed with Asperger syndrome using…

  11. Issue of fraud raised as MD self-referral comes under spotlight in Ontario.

    OpenAIRE

    Cohen, L.

    1996-01-01

    Physician self-referral, fraud and conflict of interest are causing increasing concern in Ontario, where 100 physicians are now being investigated for such activities. These and related offences recently have been pushed to the top of the agenda of the provincial college, which recently asked physicians to vote on what kind of self-referral regulations they prefer.

  12. Patterns of Risk in Adult Protection Referrals for Sexual Abuse and People with Intellectual Disability

    Science.gov (United States)

    Cambridge, Paul; Beadle-Brown, Julie; Milne, Alisoun; Mansell, Jim; Whelton, Beckie

    2011-01-01

    Background: Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods: Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual…

  13. Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

    Science.gov (United States)

    Nunkoosing, Karl; Haydon-Laurelut, Mark

    2011-01-01

    The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

  14. Exploring Primary Referral Source Impact on Student Initial Perceptions of Counseling

    Science.gov (United States)

    Blau, Gary; DiMino, John; Sheridan, Natalie; Stein, Alexander; Casper, Steven; Chessler, Marcy; Beverly, Clyde

    2015-01-01

    There has been no published research to date comparing the impact of different primary referral sources for a student seeking counseling services on student initial counseling perceptions. Using 82 undergraduates in counseling, this study partitioned these students into two referral groups, where 1 = self-referred (myself), N = 45 versus 2 =…

  15. Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands.

    NARCIS (Netherlands)

    Groenewoud, J.H.; Otten, J.D.M.; Fracheboud, J.; Draisma, G.; Ineveld, B.M. van; Holland, R.; Verbeek, A.L.M.; Koning, H.J. de

    2007-01-01

    In mammography screening with double reading, different strategies can be used when the readers give discordant recommendations for referral. We investigated whether the results of the Dutch breast cancer screening programme can be optimised by replacing the standard referral strategy by consensus.

  16. 22 CFR 213.37 - Referrals to the Department of Justice.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37... Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS cross... of Justice's Nationwide Central Intake Facility as required by the Claims Collection...

  17. 7 CFR 792.18 - Referral of debts to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be...

  18. 7 CFR 1403.17 - Referral of debts to Department of Justice.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action....

  19. 49 CFR 1018.72 - Referral to the Department of Justice.

    Science.gov (United States)

    2010-10-01

    ... prescribed by 4 CFR 105.2. Care must be taken to preserve all files, records, and exhibits on claims referred... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount...

  20. 42 CFR 411.353 - Prohibition on certain referrals by physicians and limitations on billing.

    Science.gov (United States)

    2010-10-01

    ... limitations on billing. 411.353 Section 411.353 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... § 411.353 Prohibition on certain referrals by physicians and limitations on billing. (a) Prohibition on...) Limitations on billing. An entity that furnishes DHS pursuant to a referral that is prohibited by paragraph...

  1. Skin Disease in the Uninsured: Diagnoses, Management Decisions, and Referral Outcomes of an Urban Free Clinic.

    Science.gov (United States)

    Rosenbaum, Brooke E; Freitas, Derek; Nosal, Sarah C; Meydani, Ahou

    2016-01-01

    An understanding of the burden of skin disease in the uninsured population is needed to address the unique barriers they face to access dermatologic care. We conducted a retrospective chart review of patients seen for skin conditions over three years at the New York City (NYC) Free Clinic, a weekly primary care clinic operated by the NYU School of Medicine and the Institute for Family Health. Main outcomes of this study were descriptive analyses of demographic characteristics, diagnoses, management strategies, and referral outcomes, as well as key factors influencing referral to a dermatologist and referral attendance. Diagnosis was a significant predictor of referral (ptravel distance had no significant association with non-attendance. While demand for dermatologic care by uninsured patients in NYC is high, referral non-attendance remains a substantial barrier to care. PMID:27180711

  2. The start of the transplant journey: referral for pediatric solid organ transplantation.

    Science.gov (United States)

    Shellmer, Diana; Brosig, Cheryl; Wray, Jo

    2014-03-01

    The focus of the majority of the psychosocial transplant literature is on post-transplant outcomes, but the transplant journey starts much earlier than this, at the point when transplantation is first considered and a referral for transplant evaluation is made. In this review, we cover information regarding the meaning of the referral process for solid organ transplantation. We discuss various factors of the referral for transplantation including the impact of referral on the pediatric patient and the family, potential expectations and misconceptions held by pediatric patients and parents, the role of health literacy, decision-making factors, and the informational needs of pediatric patients and parents. We elucidate steps that providers can take to enhance transplant referral and provide suggestions for much needed research within this area. PMID:24438194

  3. In-Hospital Cardiology Consultation and Evidence-Based Care for Nursing Home Residents with Heart Failure

    Science.gov (United States)

    Aronow, Wilbert S.; Rich, Michael W.; Goodlin, Sarah J.; Birkner, Thomas; Zhang, Yan; Feller, Margaret A.; Aban, Inmaculada B.; Jones, Linda G.; Bearden, Donna M.; Allman, Richard M.; Ahmed, Ali

    2013-01-01

    Objectives To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF). Participants Hospitalized NH residents (n= 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998–2001. Design Observational. Measurements of Evidence-Based Care Pre-admission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n=494), in-hospital LVEF estimation for HF patients without known LVEF (n=452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-or-ARBs) to systolic HF (LVEF 100 mm Hg. Results Pre-admission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio {AOR}, 3.49; 95% CI, 2.16–5.66; p <0.001). In-hospital LVEF was estimated in 71% and 28% of patients receiving and not receiving cardiology consultation, respectively (AOR, 6.01; 95% CI, 3.69–9.79; p <0.001). ACEIs-or-ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07–0.81; p=0.022). Conclusion In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF. However, it did not translate into higher odds of discharge prescriptions for ACEIs-or-ARBs to NH resident with systolic HF who were eligible for the receipt of these drugs. PMID:21982687

  4. A brief overview of Sino-Brazilian relations

    Institute of Scientific and Technical Information of China (English)

    Hinia Lan Wan

    2011-01-01

    This paper reviews the Sino-Brazilian relations approaching a Brazilian perspective and outlines bilateral trade features,challenges and opportunities.It is basically a reflection after analyzes on the existing literature related to Brazilian foreign rela

  5. The competitiveness of Brazilian tourist destinations

    OpenAIRE

    Barbosa, Luiz Gustavo Medeiros

    2013-01-01

    This thesis proposes a construct to measure the competitiveness of Brazilian tourist destinations and orient the actions of public and private tourism managers. The model of this study is based on a relevant literature review, a panel with specialists that have expertise in Brazilian tourism and field research. The investigation was carried out in 15 Brazilian tourist cities, representative of the socioeconomic diversity that characterises the heterogeneity of a developing country. The result...

  6. Pathways to Internationalize Brazilian Journals of Psychology

    OpenAIRE

    Estêvão C. Gamba; Abel Laerte Packer; Rogerio Meneghini

    2015-01-01

    AbstractThe science of psychology has been developing in the country of Brazil over the last 50 years. Nonetheless, most of the science in this field is published only in Brazilian journals. Overall, Brazil has yet to share its science with the international community. The potential to internationalize the science generated by Brazilian psychologists exists, though. One way would be to scale up the publication of Brazilian psychologists in international journals. Another way would be to inter...

  7. Different causes of referral to ophthalmology emergency room

    Directory of Open Access Journals (Sweden)

    Alireza Keshtkar Jafari

    2012-01-01

    Full Text Available Background: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients′ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6% were males. While 299 patients (9.5% were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%. In patients referred due to trauma (1950 patients, work-related injuries occurred in 955 patients (49% and occurred accidentally (by chance in 819 patients (42%. The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%. The most common etiologies of eye trauma (1950 patients were metal filings (814 patients; 41.8%, blunt trauma (338 patients; 17.3%, fireworks (236 patients; 12.1% and sharp objects (222 patients; 11.4%. Globe injury was diagnosed in 1865 patients (95.7% of trauma cases. In patients referred due to non-traumatic reason (1200 patients, eye infection occurred in 482 patients (40.2% and 299 patients (24.9% were referred for non-urgent reasons. There was little difference

  8. Diagnostic radiology and nuclear cardiology: their use in assessment of equine cardiovascular disease

    International Nuclear Information System (INIS)

    Survey thoracic radiography, although limited by physical considerations in the adult horse, can supply clinically useful information about changes in cardiac size and function. The radiographic features of cardiomegaly, altered pulmonary circulation, pulmonary edema, and pleural effusion as manifested in the horse are discussed. Nuclear cardiology can be performed in the standing horse. The initial transit of a radioactive tracer through the central circulation provides information about cardiac chamber size, efficiency of ventricular contraction, valvular competence, and presence of intracardiac or extracardiac shunts. Computer analysis of similar studies allows quantitation of several useful cardiac parameters including ventricular ejection fraction and shunt size (QP/QS). Gated blood pool nuclear studies are better suited to evaluate cardiac response to stress but are difficult to perform in the conscious horse with standard imaging equipment

  9. Assessment of the occupational exposure in real time during interventional cardiology procedures

    International Nuclear Information System (INIS)

    Interventional cardiology (IC) procedures can be complex, requiring the operators to work near the patient, during long exposure times. Owing to scattered radiation in the patient and the fluoroscopic equipment, the medical staff are exposed to a nonuniform radiation field and can receive high radiation doses. In this study, it is proposed to analyse staff doses obtained in real time, during IC procedures. A system for occupational dosimetry in real time was used. In order to identify some parameters that may affect the staff doses, Monte Carlo (MC) calculations, using MCNPX v.2.7.0 code and voxel phantoms, were performed. The data obtained from measurements, together with MC simulations, allowed the identification of actions and behaviours of the medical staff that could be considered a risk under routine working conditions. The implementation of this monitoring system for exposure of personnel may have a positive effect on optimisation of radiological protection in fluoroscopically guided cardiac procedures. (authors)

  10. Assessment of the occupational exposure in real time during interventional cardiology procedures.

    Science.gov (United States)

    Baptista, M; Figueira, C; Teles, P; Cardoso, G; Zankl, M; Vaz, P

    2015-07-01

    Interventional cardiology (IC) procedures can be complex, requiring the operators to work near the patient, during long exposure times. Owing to scattered radiation in the patient and the fluoroscopic equipment, the medical staff are exposed to a non-uniform radiation field and can receive high radiation doses. In this study, it is proposed to analyse staff doses obtained in real time, during IC procedures. A system for occupational dosimetry in real time was used. In order to identify some parameters that may affect the staff doses, Monte Carlo (MC) calculations, using MCNPX v.2.7.0 code and voxel phantoms, were performed. The data obtained from measurements, together with MC simulations, allowed the identification of actions and behaviours of the medical staff that could be considered a risk under routine working conditions. The implementation of this monitoring system for exposure of personnel may have a positive effect on optimisation of radiological protection in fluoroscopically guided cardiac procedures. PMID:25848113

  11. Performance of several active personal dosemeters in interventional radiology and cardiology

    International Nuclear Information System (INIS)

    Active personal dosemeters (APDs) are very useful instruments for optimizing radiation protection of workers and for increasing worker’s awareness of unexpected exposures. The challenge of monitoring personal equivalent doses with APDs in interventional fluoroscopy is that they must be sensitive to low energy photon beams and be able to record high dose rates. The aim of this work is to verify both the performance and the reliability of four active personal dosemeters (APDs) and one direct ion storage (DIS) dosemeter in typical X-ray radiation fields used during interventional radiology and cardiology (IR/IC) procedures. The values of the personal dose equivalent at a depth of 10 mm measured by the APDs are compared with the response of a whole body thermoluminescence dosemeter (TLD) as a reference dosemeter. The response is found to be satisfactory in the tested situations.

  12. Measurements of eye lens doses in interventional radiology and cardiology: Final results of the ORAMED project

    International Nuclear Information System (INIS)

    Within the ORAMED project (Optimization of Radiation Protection of Medical Staff) a coordinated measurement program for occupationally exposed medical staff was performed in different hospitals in Europe ( (www.oramed-fp7.eu)). The main objective was to obtain a set of standardized data on extremity and eye lens doses for staff involved in interventional radiology and cardiology and to optimize radiation protection. Special attention was given to the measurement of the doses to the eye lenses. In this paper an overview will be given of the measured eye lens doses and the main influence factors for these doses. The measured eye lens doses are extrapolated to annual doses. The extrapolations showed that monitoring of the eye lens should be performed on routine basis.

  13. First results of an eye lens dosimetry survey in an interventional cardiology department.

    Science.gov (United States)

    Ferrari, P; Mariotti, F; Campani, L; Castelluccio, D M; Pierotti, L; Pettinato, C; Golfieri, R; Marzocchi, A; De Palma, A

    2015-06-01

    The eye lens annual dose limit for exposed personnel to ionizing radiation has recently been revised by the ICRP--International Commission on Radiological Protection and the proposed new limit has been accepted by European legislation through the Council Directive 2013/59/EURATOM 2013. Among medical exposed personnel, the staff performing interventional cardiology are usually affected by relevant doses. For this reason a survey, employing dosemeters characterized in terms of H(p)(3), was performed in order to get the order of magnitude of the doses received by the eye lens, at least as a first guess.The survey showed that the annual dose limit can easily be reached if a proper radiation protection approach is not implemented. PMID:26052799

  14. Measurements of eye lens doses in interventional cardiology using OSL and electronic dosemeters†.

    Science.gov (United States)

    Sanchez, R M; Vano, E; Fernandez, J M; Ginjaume, M; Duch, M A

    2014-12-01

    The purpose of this paper is to test the appropriateness of OSL and electronic dosemeters to estimate eye lens doses at interventional cardiology environment. Using TLD as reference detectors, personal dose equivalent was measured in phantoms and during clinical procedures. For phantom measurements, OSL dose values resulted in an average difference of -15 % vs. TLD. Tests carried out with other electronic dosemeters revealed differences up to ±20 % versus TLD. With dosemeters positioned outside the goggles and when TLD doses were >20 μSv, the average difference OSL vs. TLD was -9 %. Eye lens doses of almost 700 μSv per procedure were measured in two cases out of a sample of 33 measurements in individual clinical procedures, thus showing the risk of high exposure to the lenses of the eye when protection rules are not followed. The differences found between OSL and TLD are acceptable for the purpose and range of doses measured in the survey. PMID:24464819

  15. Diagnostic radiology and nuclear cardiology. Their use in assessment of equine cardiovascular disease.

    Science.gov (United States)

    Koblik, P D; Hornof, W J

    1985-08-01

    Survey thoracic radiography, although limited by physical considerations in the adult horse, can supply clinically useful information about changes in cardiac size and function. The radiographic features of cardiomegaly, altered pulmonary circulation, pulmonary edema, and pleural effusion as manifested in the horse are discussed. Nuclear cardiology can be performed in the standing horse. The initial transit of a radioactive tracer through the central circulation provides information about cardiac chamber size, efficiency of ventricular contraction, valvular competence, and presence of intracardiac or extracardiac shunts. Computer analysis of similar studies allows quantitation of several useful cardiac parameters including ventricular ejection fraction and shunt size (QP/QS). Gated blood pool nuclear studies are better suited to evaluate cardiac response to stress but are difficult to perform in the conscious horse with standard imaging equipment. PMID:2934115

  16. Sustancias de contraste para estudios radiográficos en cardiología intervencionista

    OpenAIRE

    Luis Roberto Llerena Rojas; Lorenzo D. Llerena Rojas

    2002-01-01

    Las sustancias de contraste (SC) radiográficas utilizadas en Cardiología se clasifican en: 1. Iónicas de osmolalidad muy alta (OMA); 2. No iónicas de osmolalidad no muy alta (ONMA); 3. Iónicas de ONMA; 4. No iónicas Isosmolares. Todas las SC de OMA son iónicas, monómeras y triyodadas: un anillo de benceno con 3 átomos de yodo. Las iónicas de ONMA son dímeras y hexayodadas: dos anillos de benceno y 6 átomos de yodo. Las no iónicas de ONMA son monómeras y triyodadas y las isosmolares dímeras y ...

  17. The importance of pre-clinical animal testing in interventional cardiology.

    Science.gov (United States)

    Suzuki, Yoriyasu; Yeung, Alan C; Ikeno, Fumiaki

    2008-11-01

    The treatment of cardiovascular disease has changed dramatically over the past 2 decades, allowing patients to live longer and better quality lives. The introduction of new therapies has contributed much to this success. Nowhere has this been more evident than in interventional cardiology, where percutaneous cardiovascular intervention has evolved in the past 2 decades from a quirky experimental procedure to a therapeutic cornerstone for patients with symptomatic cardiovascular disease. The development of these technologies from the earliest stages requires preclinical experiments using animal models. Once introduced into the clinical arena, an understanding of therapeutic mechanisms of these devices can be ascertained through comparisons of animal model research findings with clinical pathological specimens. This review provides an overview of the emerging role, results of preclinical studies and development, and evaluation of animal models for percutaneous cardiovascular intervention technologies for patients with symptomatic cardiovascular disease. PMID:19142381

  18. Evaluation of occupational and medical doses on interventional cardiology procedures by Monte Carlo method

    International Nuclear Information System (INIS)

    Interventional cardiology consists on a set of medical procedures which are mainly focused on diagnosing and treating patients who suffer cardiovascular diseases. Even though the usage of X-ray is justified on this case, it is greatly advised to evaluate the dose which professionals and patients will be exposed due to the fact that the complexity and length of the procedures often require high doses. The objective of this work is to estimate the radiation dose on both a patient and a physician through conversion coefficient (CCs) of effective dose (E) and equivalent dose (H) during a coronary angiography examination.The dose CCs was estimated using the Visual Monte Carlo code (VMC) and a pair of simulators anthropomorphic voxel (Female Adult VoXel). The CCs were normalized in terms of kerma-area product (KAP). As expected, for all situations studied, the patient in anteroposterior projection (AP) obtained the highest conversion coefficient of equivalent dose and effective dose (author)

  19. Measurements of eye lens doses in interventional cardiology using OSL and electronic dosemeters

    International Nuclear Information System (INIS)

    The purpose of this paper is to test the appropriateness of OSL and electronic dosemeters to estimate eye lens doses at interventional cardiology environment. Using TLD as reference detectors, personal dose equivalent was measured in phantoms and during clinical procedures. For phantom measurements, OSL dose values resulted in an average difference of 215 % vs. TLD. Tests carried out with other electronic dosemeters revealed differences up to ±20 % versus TLD. With dosemeters positioned outside the goggles and when TLD doses were >20 μSv, the average difference OSL vs. TLD was 29 %. Eye lens doses of almost 700 μSv per procedure were measured in two cases out of a sample of 33 measurements in individual clinical procedures, thus showing the risk of high exposure to the lenses of the eye when protection rules are not followed. The differences found between OSL and TLD are acceptable for the purpose and range of doses measured in the survey (authors)

  20. Skin Dose to Patients from Interventional Radiology and Cardiology Procedures with Potentially Long Fluoroscopy Times

    International Nuclear Information System (INIS)

    The increasing frequency and complexity of interventional procedures means that there is an increasing potential for the patient to suffer radiation-induced skin injuries. Dose measurements were initiated in a number of radiology, neuroradiology and cardiology departments in the Northern Ireland region carry out interventional procedures with potentially long fluoroscopy times. The intention was to measure patient skin dose and thus estimate the likelihood of deterministic effects occurring from such examinations. For each patient, several thermoluminescence dosemeters were placed on the areas of skin the radiologist or cardiologist considered were most likely to receive the greatest irradiation. Results are presented which indicate that several types of procedure have the potential to produce deterministic effects to patients' skin. It was concluded that skin dose should be routinely measured for each patient undergoing an interventional radiology procedure which has potentially a long fluoroscopy time. (author)

  1. Tools for assessing quality of life in cardiology and cardiac surgery.

    Science.gov (United States)

    Gierlaszyńska, Karolina; Pudlo, Robert; Jaworska, Izabela; Byrczek-Godula, Kamila; Gąsior, Mariusz

    2016-03-01

    The holistic concept of health, popularization of knowledge, as well as social and economic factors have contributed to the growing interest in research concerning quality of life in cardiovascular diseases. The value of direct measurements of the patient's well-being and the extent of their functioning in everyday life (i.e., health-related quality of life; HRQoL) has gained appreciation. Questionnaires are the most popular method of measuring quality of life. On the basis of the literature, we can conclude that the Short-Form Health Survey (SF-36) questionnaire is one of the most widely used tools measuring the quality of life of patients undergoing cardiological treatment and cardiac surgery. PMID:27212988

  2. Cardiopulmonary exercise testing – Its application in cardiology and occupational medicine

    Directory of Open Access Journals (Sweden)

    Małgorzata Kurpesa

    2014-10-01

    Full Text Available Cardiopulmonary exercise testing is a method used to assess the exercise capacity. It is used in cardiology to define the diagnostic and prognostic information, the treatment and its effectiveness. This method is also useful in sport medicine and in occupational medicine. The cardiopulmonary exercise test involves measuring of gas exchange during exercise testing. The article presents the main parameters assessed during the test and the indications and contraindications for conducting the test. It also reveals the results of recently published clinical trials on the use of cardiopulmonary exercise test in patients with cardiovascular disease and in the working population. The study included variability of respiratory parameters during the cardiopulmonary exercise test and after its completion, as well as their impact on the prognostic value. In addition, the results of a study involving an optimal choice of interval training on the basis of oxygen consumption at peak exercise are summarized. Med Pr 2014;65(5:665–674

  3. Permeability measuremens of brazilian Eucalyptus

    OpenAIRE

    Marcio Rogério da Silva; Gilmara de Oliveira Machado; Jay Deiner; Carlito Calil Junior

    2010-01-01

    The permeability of Brazilian Eucalyptus grandis and Eucalyptus citriodora wood was measured in a custom build gas analysis chamber in order to determine which species could be successfully treated with preservatives. Liquid permeability was tested using an emulsion of Neen oil and a control of distillated water. Air was used to test the gas phase permeability. For both Eucalyptus grandis and Eucalyptus citriodora, the longitudinal permeability of gas was shown to be about twice as great as t...

  4. Monitoring of doses to patients in interventional cardiology: first results from three Serbian hospitals

    International Nuclear Information System (INIS)

    The aim of this work is to assess level of radiation dose to patients in interventional cardiology procedures in three large Serbian hospitals and to investigate possibility for setting of trigger levels if dose quantities exceed certain levels. Three dedicated interventional cardiology laboratories were included in the survey. Information on annual workload was estimated based on number of coronary angiography (CA) procedures and percutaneous coronary interventions (PCI). Patients doses were assessed in terms of air kerma area product (PKA) and air kerma in international reference point (KIRP). Results were compared with internationally proposed Diagnostic Reference Levels (DRL) and similar surveys results. Average total annual number of procedures was 820, 1100 and 2500 in three hospitals, respectively, while total number of dose measurements was 337. All three centers reported PKA values higher than 100 Gy·cm2 and even values above 200 Gy·cm2, corresponding to 42% and 16% of all measurements. Measured KIRP value higher than 5 Gy was reported in one center, indicating that skin doses associated possibility of skin injuries were observed. PKA mean hospital values for CA ranged from 33 to 78 Gy·cm2 and for PCI from 73 to 113 Gy·cm2, while associated vales for KIRP were: 0.45-1.2 Gy and 1.1-1.8 Gy, respectively. Comparison of obtained results with international DRL indicated that significant number of procedures is not optimally performed as in some centers more than a half of patients receive doses above DRL. The presented results are valuable input for dose optimization strategies and increased awareness related to importance of dose management. With respect to high dose values, risk for stochastic effects and tissue reactions, dose management methods were proposed. (Author)

  5. Patient dose assessment in various Interventional radiology and cardiology procedures in Algeria (IAEA regional project results)

    International Nuclear Information System (INIS)

    Full text: Purpose: To evaluate patient doses in Interventional Radiology (IR) and Cardiology (IC) procedures in Algeria, within the framework of an International Atomic Energy Agency (IAEA) regional project on radiation protection of patients and medical exposure control (RAF 9033). Materials and Methods: Three public hospitals (CHU Bab el Oued, CHU Parnet and CHU Mustapha) and one specialised Cardiology Service (Clinique Maouche) were chosen for the study. For Maximum Skin Dose (MSD) evaluation, gafchromic films XR type R were used, placed on patient's back before the procedure. The Dose Area Product (DAP) and MSD were measured in 57 IR and IC procedures, either diagnostic or therapeutic. Results: The results revealed large variations in MSD (0.06-3.3 Gy) and DAP (5.5-332 mGycm2). Mean MSD was 0.227 Gy in cerebral angiography, 0.202 Gy in coronary angiography, 1.162 Gy in Percutaneus Transluminal Coronary Angioplasty (PTCA) and 0.128 in abdominal angiography. The correlation of DAP and MSD was significant (r = 0.7). The correlation was DAP and fluoroscopy time was also significant (r = 0.8). Conclusion: The highest MSD values were found in PTCA which is a therapeutic procedure. Two PTCAs out of the 57 procedures measured in total had MSD over the threshold of 2 Gy for deterministic effects (MSD1 = 3.0 Gy and MSD2 3.3 Gy). The large variations in MSD reveal the need to continuously monitor patient doses in IR and IC procedures with special emphasis in PTCA procedure. (author)

  6. Use of nuclear cardiology examinations to predict slow recovery from takotsubo cardiomyopathy

    International Nuclear Information System (INIS)

    Takotsubo cardiomyopathy is generally believed to have a good prognosis. However, there are considerable differences among individuals in the severity of abnormal left ventricular wall motion and in the time required for normalization. We investigated the usefulness of nuclear cardiology examinations for the differentiation of severe cases of takotsubo cardiomyopathy, which are associated with long-term wall motion abnormality. The participants were 18 patients diagnosed with takotsubo cardiomyopathy. Assessment was performed using rest TL-201 or technetium-99m sestamibi myocardial perfusion single positron emission computed tomography (SPECT) (MPS); myocardial fatty acid metabolism was evaluated by using I-123 beta-methyl-iodophenyl-pentadecanoic acid (BMIPP). A polar map was constructed from SPECT short-axis views, and was divided concentrically into 3 regions: the apical, intermediate, and base areas. The ratio of the apex to the intermedia, using mean uptake percentages, was defined as the apical uptake ratio (AUR). Participants in whom local wall motion normalized in ≤28 days or >28 days, as determined by echocardiography, were grouped into the normal recovery group (13 patients) or the slow recovery group (5 patients), respectively. AUR in MPS was 0.96±0.04 in the normal recovery group and 0.80±0.05 in the slow recovery group (p=0.008). Similarly, AUR in BMIPP significantly differed: 0.81±0.03 in the normal recovery group and 0.67±0.03 in the slow recovery group (p=0.014). The use of nuclear cardiology examinations to evaluate local uptake ratio in the apex is useful for identifying severe takotsubo cardiomyopathy, in which abnormal local wall motion may persist. (author)

  7. A telemedicine network for remote paediatric cardiology services in north-east Brazil

    Science.gov (United States)

    Hazin, Sheila Maria Vieira; Regis, Cláudio Teixeira; Soares de Araújo, Juliana Sousa; Albuquerque, Fernanda Cruz de Lira; Moser, Lúcia Roberta Didier Nunes; Hatem, Thamine de Paula; Gomes de Freitas, Carolina Paim; Mourato, Felipe Alves; Tavares, Thiago Ribeiro; Gomes, Renata Grigório Silva; Severi, Rossana; Santos, Cícera Rocha; Ferreira da Silva, Jailson; Rezende, Juliana Landim; Vieira, Paulo Coelho; Filho, José Luiz de Lima

    2015-01-01

    Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently. PMID:26668441

  8. TERAPIA ELÉCTRICA EN CARDIOLOGÍA Electrical Therapy in cardiology

    Directory of Open Access Journals (Sweden)

    Guillermo Mora Pabón

    2005-01-01

    Full Text Available La terapia eléctrica en cardiología está encaminada a transferir electrones al miocardio, su mayor utilidad está dada en la cardioversión y desfibrilación. La terapia eléctrica cumple las leyes de la electricidad y el mayor factor a vencer es la impedancia o resistencia al flujo de electrones. Para mejorar la efectividad de la terapia eléctrica se han ideado diferentes formas en la onda de choque, en la duración y la polaridad. La terapia eléctrica ha logrado consolidarse como el tratamiento de elección del paro cardiorrespiratorio secundario a fibrilación ventricular y taquicardia ventricular sin pulso. Es igualmente el tratamiento de elección en taquiarritmias con compromiso hemodinámico. Pese a sus grandes ventajas tiene efectos secundarios que se deben conocer adecuadamente para dar un tratamiento oportuno.Electrical shock in cardiology are pursuid transfer of electrons to the myocardium. Its main indications are`s cardioversion and defibrillation. The electrical shock therapy follows laws of electricity laws and consequently, its main difficulty is the impedance or resistance of electrons flow. To make better the effectiveness of this therapy, a number of improvements have been made on the shock wave, its duration, and polarity. The electric shock therapy has become the preferred treatment when dealing with cardiorespiratory arrest secondary, ventricular fibrillation and pulseless ventricular tachycardia. Similarly, it is the preferred treatment for ventricular tachyarrhythmia associated with hemodynamic compromise. Despite its significant advantages, this treatment causes secondary effects, which should adequately be known in order to provide a timely treatment.

  9. Alternative fuels: a Brazilian outlook

    International Nuclear Information System (INIS)

    This paper focuses on studies and information related to the use of alternative fuels in Brazil. The first part of this paper deals with the economics of different biomass technologies. The analysis consists of a careful costing of all operations involved. The study deals with wood, sugar cane and cassava, since these crops are exploited for commercial purposes in Brazil. Corn, although a useful raw material for producing ethanol in the United States, is not used for this purpose in Brazil. The second part deals with the industrial technologies used to convert biomass into energy. We consider several forms of energy derived from biomass and evaluate the economics of the processes. When opportune, we compare costs with those of the North American market. Market analysis and displacement of conventional energy are the subject of the third part of the paper. While the cost of each product is evaluated in most cases; in others the current market price is used. Finally, we raise the issues of institutional problems and planning and offer some conclusions on the future of biomass as an alternative energy source. The technological discussion in this paper is based on the Brazilian experience in producing ethanol and other fuels from biomass. It is possible to extrapolate the Brazilian experience to other developing countries. The observations made in this chapter are based on the conditions prevalent in the Brazilian south-central agricultural region, specifically the state of Sao Paulo. (author). 91 refs., 16 figs., 11 tabs

  10. Brazilian Studies Then and Now

    Directory of Open Access Journals (Sweden)

    Anthony Pereira

    2012-09-01

    Full Text Available In 1912 the Brazilian diplomat and scholar Manuel de Oliveira Lima gave six lectures at Stanford University that encapsulated his views of what we now call Brazilian Studies. This article summarizes Oliveira Lima’s lectures. It then points out three aspects of Oliveira Lima’s worldview that are problematic from the perspective of the twenty-first century: his Eurocentrism; the unproblematic nature of the nation-state in his thinking; and his largely negative view of Brazil’s racial heritage. The third part of the essay analyzes three aspects of Oliveira Lima’s lectures that are still contemporary. These are the need to establish an adequate comparative context for the study of Brazil; the difficulty of justifying an academic discipline that revolves around the study of a single country; and the challenge of uniting disparate and specialized disciplines in order to appreciate Brazil’s complexity and trajectory in the modern world. In the conclusion, some guidelines for maintaining Brazilian Studies as a vibrant field are suggested.

  11. Parents with Learning Disabilities and Speech and Language Therapy. A Service Evaluation of Referrals and Episodes of Care

    Science.gov (United States)

    Stansfield, Jois

    2012-01-01

    The speech and language therapy (SLT) service in an area of northern England receives referrals of parents who have learning disabilities. The aim of this study was to identify current referral patterns and quantify the level of demand upon the SLT service from this relatively new referral population to enable to service to meet the needs of these…

  12. Acceptance of referral for partners by clients testing positive for human immunodeficiency virus

    Directory of Open Access Journals (Sweden)

    Netsanet F

    2013-01-01

    Full Text Available Fetene Netsanet,1 Ayalew Dessie21IMA World Health SuddHealth Multi Donor Trust Fund-Basic Package of Health Services Project, Juba, South Sudan; 2United States Agency for International Development, Private Health Sector Program, Abt Associates Inc, Addis Ababa, EthiopiaBackground: Human immunodeficiency virus (HIV-positive individuals who do not disclose their HIV status to their partners are more likely to present late for HIV and acquired immune deficiency syndrome (AIDS care than those who have disclosed their HIV status to their partners. A major area of challenge with regards to HIV counseling for clients is disclosure of their HIV status to their partners. The main methods of partner notification are patient referral, provider referral, contract referral, and outreach assistance. The emphasis on a plausible and comprehensive partner referral strategy for widespread positive case detection in resource-limited countries needs to be thought out and developed.Methods: A qualitative study was conducted among newly HIV-positive clients to identify partners for notification and acceptance of referral by their partners. Health service providers working in HIV testing and counseling clinics were also provided with semistructured questionnaires in order to assess their view towards partner notification strategies for clients testing positive for HIV.Results: Fifteen newly diagnosed HIV-positive clients were counseled to provide referral slips to their partners. All clients agreed and took the referral card. However, only eight were willing and actually provided the card to their partners. Five of the eight partners of clients who tested HIV-positive and who were provided with referral cards responded to the referral and were tested for HIV. Three were positive and two were negative. Nine of 11 counselors did not agree to requesting partner locator information from HIV-positive clients for contractual referral and/or outreach assistance. The findings

  13. Performance of Primary Dental Care Services: An Ecological Study in a Large Brazilian City

    Directory of Open Access Journals (Sweden)

    Rita Sibele Souza Esteves

    2013-01-01

    Full Text Available This study explored the association between area-level primary dental care performance and area-level demographics, dental treatment need, and health care service indicators. An ecological cross-sectional study was performed in Belo Horizonte, Brazil, in 2010. The 142 primary health care (PHC units were grouped based on the following variables: access to individual dental treatment, frequency of dental emergencies, and frequency of individual preventive procedures. The independent variables analyzed were demographic variables, dental treatment need, and health care service indicators. The data were obtained from the information systems of the Brazilian Ministry of Health and the city of Belo Horizonte. We explored the associations between membership in a specific PHC cluster type and the independent variables using multinomial logistic regression with a significance level of 5%. Variables such as the high/very high vulnerability of population, rate of completed treatment, and rate of referrals of users to secondary care were independently associated with the clusters (P<0.05. The performance of primary dental care services was associated with patient demographics, dental treatment need, and referrals. The results of this study have implications for the planning of public policies.

  14. Referral decisions of teachers and school psychologists for twice-exceptional students

    Science.gov (United States)

    Hoffman, Jennifer Marie

    The accurate and timely referral and identification of twice-exceptional students remains a challenge. In a statewide study, the referral decisions for both special education and gifted programming evaluations made by four participant groups (i.e., general education teachers, special education teachers, gifted education teachers, and school psychologists) were compared. Participants were randomly assigned to read one of three identically described students in a vignette that differed only in the presence of a diagnostic label--- autism spectrum disorder (ASD), specific learning disability (SLD), or no diagnostic label. In all, special education teachers made the most special education referrals, while gifted education teachers made the most gifted programming referrals, both regardless of the diagnostic label present. The students with diagnostic labels were recommended for special education referrals significantly more than for gifted programming, while this difference was not evident in the no diagnostic label condition. Moreover, the student with the ASD label was the most likely to be referred for evaluations for both special education and gifted programming out of all three vignette conditions. Overall findings indicated the importance of considering the referral source as well as how the presence of a diagnostic label might influence educational referral decisions, particularly in how this might influence overall multidisciplinary team decisions for these unique learners.

  15. Competitiveness in the Brazilian oil industry. The Brazilian 'oil diamond'

    International Nuclear Information System (INIS)

    It is recognized the economic benefits that might follow the opening process of the Brazilian oil and natural gas industry, which shall experience a fast expansion with the arrival of national and international private investors. However, we should not neglect the broader impact of this process on the future development of all that cluster of national agents that lived around and served the former national oil monopoly, managed by the Brazilian National Oil Company, Petrobras. This work focuses on this larger perspective, discussing about the capacity of Brazil to sustain and expand its competitiveness in the oil business as well as to obtain the maximum economic development from the exploration of its oil and gas reserves. We adopt the work of Michael Porter, from the University of Harvard, about the Competitive Advantage of Nations, as a theoretical model to analyze the Competitive Advantage of Brazil in the global oil industry. By introducing the concept of ''oil diamond'', adapted from the notion introduced by this author, we develop a new understanding of national competitiveness in the oil sector. In this paper, we present the general model as well as a brief characterization of the results found for Brazil Subsequently, we focus on just one leg of the model, for which we discuss, with more detail, about the competitive condition of the country in the opening-up scenario. This leg regards the so-called supporting and supplementary industries that constitute what is denominated in the French tradition the ''para petroleum'' industry. We analyze the conditions for the Brazilian domestic ''para petroleum industry'' to survive and grow in the new competitive environment. (authors)

  16. Referral in the General Practice in the centre of Portugal: electronic data from two groups of Health Centres

    OpenAIRE

    Botas, Philippe; Santiago, Luiz Miguel; Miranda, Paula; Pereira, Carolina

    2014-01-01

    Introduction: Referral is one of the core competencies of General Practitioners. In 1992, the European study of referrals from Primary to Secondary care indicated a referral rate (RR) of 5.56% in Portugal. In 2003, the RR related to a Health Centre (HC) in the north of Portugal was 10.11 %. At 2012’s WONCA Europe, the authors presented a research introducing a standardized population indicator, Adjusted Referral Calculation (ARC), to study referral in a HC. Objective: Following on from pr...

  17. Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain

    Directory of Open Access Journals (Sweden)

    Villa Guillermo

    2012-08-01

    Full Text Available Abstract Background A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. Methods A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Results Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY. When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %. Conclusions Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both

  18. Neuropathy in the hemodialysis population: a review of neurophysiology referrals in a tertiary center.

    LENUS (Irish Health Repository)

    O'Regan, John

    2012-01-01

    This was a retrospective observational study of neurophysiology referrals over 8 years from a tertiary referral center in Ireland. A total of 68 of the 73 referrals yielded one or more abnormalities. Thirty-nine (53%) patients had one or more mononeuropathies; iatrogenic mononeuropathies believed to be associated with arterio-venous fistula creation occurred in 15 patients. Polyneuropathy was identified in 43 patients (59%). Access to an experienced neurophysiology department offers valuable insight into dialysis-associated neuropathies, especially when associated with arterio-venous fistulae.

  19. Paediatric referrals in rural Tanzania: the Kilombero District Study – a case series

    Directory of Open Access Journals (Sweden)

    Menendez Clara

    2002-04-01

    Full Text Available Abstract Background Referral is a critical part of appropriate primary care and of the Integrated Management of Childhood Illness (IMCI strategy. We set out to study referrals from the aspect both of primary level facilities and the referral hospital in Kilombero District, southern Tanzania. Through record review and a separate prospective study we estimate referral rates, report on delays in reaching referral care and summarise the appropriateness of pediatric referral cases in terms of admission to the pediatric ward at a district hospital Methods A sample of patient records from primary level government health facilities throughout 1993 were summarised by age, diagnosis, whether a new case or a reattendance, and whether or not they were referred. From August 1994 to July 1995, mothers or carers of all sick children less than five years old attending the Maternal and Child Health (MCH clinic or outpatient department (OPD of SFDDH were interviewed using a standard questionnaire recording age, sex, diagnosis, place of residence, whether the child was admitted to the paediatric ward, and whether the child was referred. Results From record review, only 0.6% of children from primary level government facilities were referred to a higher level of care. At the referral hospital, 7.8 cases per thousand under five catchment population had been referred annually. The hospital MCH clinic and OPD were generally used by children who lived nearby: 91% (n = 7,166 of sick children and 75% (n = 607 of admissions came from within 10 km. Of 235 referred children, the majority (62% had come from dispensaries. Almost half of the referrals (48% took 2 or more days to arrive at the hospital. Severe malaria and anaemia were the leading diagnoses in referred children, together accounting for a total of 70% of all the referrals. Most referred children (167/235, 71% were admitted to the hospital paediatric ward. Conclusions The high admission rate among referrals

  20. 36th Brazilian Workshop on Nuclear Physics

    CERN Document Server

    Brandão de Oliveira, José Roberto; Barbosa Shorto, Julian Marco; Higa, Renato

    2014-01-01

    The Brazilian Workshop on Nuclear Physics (RTFNB, acronym in Portuguese) is organized annually by the Brazilian Physics Society since 1978, in order to: promote Nuclear Physics research in the country; stimulate and reinforce collaborations among nuclear physicists from around the country; disseminate advances in nuclear physics research and its applications; disseminate, disclose and evaluate the scientific production in this field.

  1. Zipf Law for Brazilian Cities

    OpenAIRE

    Moura Jr., Newton J.; Ribeiro, Marcelo B.

    2005-01-01

    This work studies the Zipf Law for cities in Brazil. Data from censuses of 1970, 1980, 1991 and 2000 were used to select a sample containing only cities with 30,000 inhabitants or more. The results show that the population distribution in Brazilian cities does follow a power law similar to the ones found in other countries. Estimates of the power law exponent were found to be 2.22 +/- 0.34 for the 1970 and 1980 censuses, and 2.26 +/- 0.11 for censuses of 1991 and 2000. More accurate results w...

  2. How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money.

    Science.gov (United States)

    Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya

    2015-09-21

    Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money. PMID:26377292

  3. Staff eye lens and extremity exposure in interventional cardiology: Results of the ORAMED project

    International Nuclear Information System (INIS)

    Within the ORAMED project a coordinated measurement program for occupationally exposed medical staff was performed in different hospitals in Europe. The main objectives of ORAMED were to obtain a set of standardized data on doses for staff in interventional cardiology and radiology and to optimize staff protection. Doses were measured with thermoluminescent dosemeters on the ring finger and wrist of both hands, on legs and at the level of the eyes of the main operator performing interventional procedures. In this paper an overview of the doses per procedure measured during 646 interventional cardiology procedures is given for cardiac angiographies and angioplasties (CA/PTCA), radiofrequency ablations (RFA) and pacemaker and defibrillator implantations (PM/ICD). 31% of the monitored procedures were associated with no collective protective equipment, whereas 44% involved a ceiling screen and a table curtain. Although associated with the smallest air kerma – area product (KAP), PM/ICD procedures led to the highest doses. As expected, KAP and doses values exhibited a very large variability. The left side of the operator, most frequently the closest to the X-ray scattering region, was more exposed than his right side. An analysis of the effect of parameters influencing the doses, namely collective protective equipment, X-ray tube configuration and catheter access route, was performed on the doses normalized to KAP. Ceiling screen and table curtain were observed to reduce normalized doses by atmost a factor 4, much smaller than theoretical attenuation factors typical for such protections, i.e. from 10 to 100. This observation was understood as their inappropriate use by the operators and their non-optimized design. Configurations with tube above the patient led to higher normalized doses to the operator than tube below, but the effect of using a biplane X-ray suite was more complex to analyze. For CA/PTCA procedures, the upper part of the operator’s body received

  4. Occupational doses in interventional cardiology: Experiences in obtaining worldwide data as part of the ISEMIR project

    International Nuclear Information System (INIS)

    The International Atomic Energy Agency (IAEA) initiated in early 2009 the Information System on Occupational Exposure in Medicine, Industry and Research, referred to as the ISEMIR project. The project is specifically aimed at improving occupational radiation protection in those areas of radiation use in medicine, industry and research where non-trivial occupational exposures occur. Interventional Cardiology (IC) was the first such area identified and a working group was formed in February 2009 - the Working Group on Interventional Cardiology (WGIC). One of the first actions of the WGIC was to devise questionnaires to gain insight into occupational radiation protection in IC around the world. This included a questionnaire addressed to national or state radiation protection (RP) regulatory bodies (RBs), asking, inter alia: the numbers of workers with personal dosimetry involved in IC procedures in 2008; values of occupational doses (effective dose) in the national authority's database (or database accessible by the national authority); and whether the RP RB defines the number and position of dosimeters for staff monitoring in IC. Responses were received from 81 RBs (56 national RBs and 25 state RBs) out of 191 attempted contacts. About half the RBs (41 out of 81) stated that they were not able to provide occupational dose data for IC, citing reasons that included: no central dose register in the country or state; no easy access to the central dose register by the RB; the RB only had records of doses if they exceed some particular threshold (e.g. investigation or action level); no specific classification for interventional cardiologists, or other persons in IC in the database. The other RBs (40 out of 81) were able to provide some occupational dose data, ranging from detailed dose values to data that were inconsistent and/or ambiguous. Some of the dose data supplied were not suitable for further analysis for reasons that included: reported dose data were

  5. Bridging the Gap, Facing the Challenge—the 26th Great Wall International Congress of Cardiology (GW-ICC)

    OpenAIRE

    Zhang, Yingmei; Ren, Jun

    2016-01-01

    The joint venue of the 26th Great Wall International Congress of Cardiology (GW-ICC) & Asia Pacific Heart Congress 2015 (APHC 2015) & International Congress Cardiovascular Prevention and Rehabilitation 2015 (ICCPR 2015) were held from October 29 to November 01, 2015 at the China National Convention Center (CNCC), Beijing, China. This year’s conference focused on cardiovascular disease prevention, health promotion, education and training, as well as disease management and rehabilitation.

  6. Bridging the Gap, Facing the Challenge-the 26(th) Great Wall International Congress of Cardiology (GW-ICC).

    Science.gov (United States)

    Zhang, Yingmei; Ren, Jun

    2016-02-01

    The joint venue of the 26(th) Great Wall International Congress of Cardiology (GW-ICC) & Asia Pacific Heart Congress 2015 (APHC 2015) & International Congress Cardiovascular Prevention and Rehabilitation 2015 (ICCPR 2015) were held from October 29 to November 01, 2015 at the China National Convention Center (CNCC), Beijing, China. This year's conference focused on cardiovascular disease prevention, health promotion, education and training, as well as disease management and rehabilitation. PMID:26885499

  7. Class attendance and cardiology examination performance: a study in problem-based medical curriculum

    Directory of Open Access Journals (Sweden)

    Bamuhair SS

    2016-02-01

    Full Text Available Samira S Bamuhair,1 Ali I Al Farhan,1,2 Alaa Althubaiti,1 Saeed ur Rahman,1,2 Hanan M Al-Kadri1,3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 2Department of Family Medicine and Primary Health Care, 3Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia Background and aims: Information on the effect of students' class attendance on examination performance in a problem-based learning medical curriculum is limited. This study investigates the impact of different educational activities on students' academic performance in a problem-based learning curriculum. Methods: This is a retrospective cohort study conducted on the cardiology block at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All students who undertook the cardiology block during the academic year 2011–2012 were included. The students' attendance was measured using their overall attendance percentage. This percentage is a product of their attendance of many activities throughout the block. The students' performance was assessed by the final mark obtained, which is a product of many assessment elements. Statistical correlation between students' attendance and performance was established. Results: A total of 127 students were included. The average lecture attendance rate for the medical students in this study was found to be 86%. A significant positive correlation was noted between the overall attendance and the accumulated students' block mark (r=0.52; P<0.001. Students' attendance to different education activities was correlated to their final mark. Lecture attendance was the most significant predictor (P<0.001, that is, 1.0% increase in lecture attendance has predicted a 0.27 increase in students' final block mark. Conclusion: Class attendance has a positive effect on students' academic performance with stronger effect for lecture attendance compared to

  8. Analysis of inpatient dermatologic referrals: insight into the educational needs of trainee doctors.

    LENUS (Irish Health Repository)

    Ahmad, K

    2012-01-31

    AIM: To analyse inpatient consultation referrals to the Dermatology Department and to identify the educational needs of junior\\/trainee doctors. METHODS: Consultation data of inpatients referred to the Dermatology Department between 2001 and 2006 was reviewed. RESULTS: There were 703 referrals identified. Patients were referred from all wards in the hospital. There were a total of 113 different dermatological diagnoses in the group. One-fifth (22%) consultations were for skin infections, 12% had atopic dermatitis, 8% had psoriasis and 8% had clear or suspected drug cause for their rash. In 391 cases, the Consultant Dermatologist\\'s diagnosis was different to the inpatient referral diagnosis on the consultation referral form. CONCLUSIONS: Our results emphasise the need for junior dermatology trainees to undertake extra training in both the dermatologic conditions. This data supports the need for expansion of service provision of dermatology in the region.

  9. The value of appropriate assessment prior to specialist referral in men with prostatic symptoms.

    LENUS (Irish Health Repository)

    Quinlan, M R

    2012-02-01

    BACKGROUND: Referrals to Urology OPD of men with a likely diagnosis of BPH are common. AIMS: To review referrals to OPD of men with lower urinary tract symptoms (LUTS) to establish how many could have been managed without specialist assessment. METHODS: We reviewed records of 200 male patients referred to OPD with LUTS. We assessed whether the referral source had performed digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Bother Score or PSA level. RESULTS: 74% of patients were referred by GPs. In 31.5% of cases DRE was performed prior to referral. One GP had completed an IPSS, none a Bother Score. 96% had a PSA checked before OPD. Ultimately, 88.5% of our patients were diagnosed with BPH. CONCLUSIONS: With better pre-assessment in the form of DRE, IPSS and Bother Score, allied to a PSA check, many patients with LUTS could be managed in a primary care setting.

  10. Referral to the accident and emergency department following the use of community alarms

    OpenAIRE

    Youssef, G.; Underhill, T; Tovey, C

    2000-01-01

    Objectives—To assess the degree of appropriate referral to the accident and emergency (A&E) department following the use of a community alarm where a mobile warden works in conjunction with the community alarm control centre.

  11. Public child welfare staff knowledge, attitudes, and referral behaviors for an evidence based parenting program

    Directory of Open Access Journals (Sweden)

    Daniel J. Whitaker

    2015-08-01

    Full Text Available Little is known about how the knowledge, attitudes, and behaviors of the public child welfare work force influence implementation of evidence-based practice (EBP as most research has focused on the private workforce. This paper reports on public child welfare staff knowledge, attitudes, and practices in a state implementing the EBP, SafeCare®. A survey of public child welfare staff (N = 222 was conducted to assess knowledge, familiarity, and referral barriers and practices. Knowledge of and familiarity with SafeCarewere low, especially among front line staff (case managers. Attitudes toward SafeCare were fairly positive, but somewhat less so than attitudes toward a standard, non-evidenced based parenting program. Case managers were significantly less likely to have made a referral (15% than other staff (46%. Job tenure had few effects on familiarity, knowledge, attitudes, or referrals. The strongest predictors of having made referrals were familiarity with SafeCare and job position.

  12. 34 CFR 364.50 - What requirements apply to the processing of referrals and applications?

    Science.gov (United States)

    2010-07-01

    ... INDEPENDENT LIVING SERVICES PROGRAM AND CENTERS FOR INDEPENDENT LIVING PROGRAM: GENERAL PROVISIONS What... 34 CFR 365.30 to ensure expeditious and equitable handling of referrals and applications for...

  13. Service referral for juvenile justice youths: associations with psychiatric disorder and recidivism

    NARCIS (Netherlands)

    M. Hoeve; L.S. McReynolds; G.A. Wasserman

    2013-01-01

    Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receiv

  14. Topical anaesthesia in children: reducing the need for specialty referral.

    LENUS (Irish Health Repository)

    O'Connor, Gabrielle

    2012-01-31

    OBJECTIVE: The management of wounds in children is stressful, not only for the child, but also for parents and staff. In our Emergency Department (ED), we currently do not have a paediatric sedation policy, and thus children requiring suturing, not amenable to distraction and infiltrative anaesthesia, are referred to specialty teams for general anaesthesia. We proposed that the introduction of a topical anaesthetic gel (lidocaine, adrenaline, tetracaine - LAT) might help to reduce the number of referrals, by allowing the ED staff to perform the procedures, in combination with nonpharmacological approaches. METHODS: We carried out a retrospective review of ED records of all children aged 14 years or less attending with wounds, over an 8-month period, from 01 May 2007 to 31 January 2008. RESULTS: Two hundred and one (50.6%) patients presented before the introduction of LAT gel, whereas 196 (49.3%) patients presented afterwards. A total of 39 (19.4%) patients were referred for specialty review pre-LAT, whereas only 19 (9.7%) patients were referred in the LAT group. Of these, 31 (15.4%) pre-LAT and 15 (7.7%) LAT group required general anaesthesia. There is a significant difference between these two groups, using Fischer\\'s exact test, P=0.018. CONCLUSION: We have found that the introduction of topical anaesthetic gel in ED has significantly reduced the number of children with wounds referred to specialty teams for general anaesthesia. This has important implications for patient safety and hospital resources.

  15. Evaluation and Referral of Children With Signs of Early Puberty.

    Science.gov (United States)

    Kaplowitz, Paul; Bloch, Clifford

    2016-01-01

    Concerns about possible early pubertal development are a common cause for referral to pediatric medical subspecialists. Several recent studies have suggested that onset of breast and/or pubic hair development may be occurring earlier than in the past. Although there is a chance of finding pathology in girls with signs of puberty before 8 years of age and in boys before 9 years of age, the vast majority of these children with signs of apparent puberty have variations of normal growth and physical development and do not require laboratory testing, bone age radiographs, or intervention. The most common of these signs of early puberty are premature adrenarche (early onset of pubic hair and/or body odor), premature thelarche (nonprogressive breast development, usually occurring before 2 years of age), and lipomastia, in which girls have apparent breast development which, on careful palpation, is determined to be adipose tissue. Indicators that the signs of sexual maturation may represent true, central precocious puberty include progressive breast development over a 4- to 6-month period of observation or progressive penis and testicular enlargement, especially if accompanied by rapid linear growth. Children exhibiting these true indicators of early puberty need prompt evaluation by the appropriate pediatric medical subspecialist. Therapy with a gonadotropin-releasing hormone agonist may be indicated, as discussed in this report. PMID:26668298

  16. The Westgate Service and Related Referral, Assessment, and Treatment Processes.

    Science.gov (United States)

    Bennett, Alice L

    2015-12-01

    The formerly named "Dangerous and Severe Personality Disorder" (DSPD) units are no longer standalone services within the criminal justice system in England and Wales. These sites now provide personality disorder treatment services in the high-security prison estate as part of the new national Offender Personality Disorder (OPD) Pathway Strategy. The OPD Pathway intends to take responsibility for the assessment, treatment, and management of offenders who are likely to have a personality disorder and who present a high risk of re-offending (men and women) and serious harm to others (men). Further PD treatment and progression services are being commissioned in lower security prisons and in the community as part of the new PD Strategy. While the suitability criteria for the two male high-security PD treatment sites are the same, the individual units have their own assessment and treatment methods. This article aims to communicate the referral, assessment, and treatment methods employed within the prison-based Westgate Personality Disorder Treatment Service, HMP Frankland. PMID:24927739

  17. When should social service referral be considered in phenylketonuria?

    Directory of Open Access Journals (Sweden)

    Margreet van Rijn

    2015-03-01

    Full Text Available Lifelong low-phenylalanine (Phe dietary management is the foundation of care in phenylketonuria (PKU. However, strict monitoring of food intake places a burden on patients and their caregivers, and adherence to the required diet frequently decreases in later childhood and adolescence. Rarely, parents of children with PKU refuse to recognise the importance of treatment and follow-up for this chronic condition. Here, two case studies are presented that document consideration of placement of children into foster care or kinship homes as a last resort to improve persistently high Phe concentrations. In the first case, social service referral led to a 3-year-old girl being placed in a kinship home with her grandparents, resulting in excellent Phe control thereafter. In the second case, discussion with the parents of possible placement of a 12-year-old child into foster care was sufficient to have a positive effect on Phe control. A staged approach for managing intractable non-adherence in PKU is proposed.

  18. Optimal Referral Reward Considering Customer’s Budget Constraint

    Directory of Open Access Journals (Sweden)

    Dan Zhou

    2015-12-01

    Full Text Available Everyone likes Porsche but few can afford it. Budget constraints always play a critical role in a customer’s decision-making. The literature disproportionally focuses on how firms can induce customer valuations toward the product, but does not address how to assess the influence of budget constraints. We study these questions in the context of a referral reward program (RRP. RRP is a prominent marketing strategy that utilizes recommendations passed from existing customers to their friends and effectively stimulates word of mouth (WoM. We build a stylized game-theoretical model with a nested Stackelberg game involving three players: a firm, an existing customer, and a potential customer who is a friend of the existing customer. The budget is the friend’s private information. We show that RRPs might be optimal when the friend has either a low or a high valuation, but they work differently in each situation because of the budget. Furthermore, there are two budget thresholds, a fixed one and a variable one, which limit a firm’s ability to use rewards.

  19. Comparison of postmenopausal endogenous sex hormones among Japanese, Japanese Brazilians, and non-Japanese Brazilians

    Directory of Open Access Journals (Sweden)

    Maciel Maria

    2011-02-01

    Full Text Available Abstract Background Differences in sex hormone levels among populations might contribute to the variation in breast cancer incidence across countries. Previous studies have shown higher breast cancer incidence and mortality among Japanese Brazilians than among Japanese. To clarify the difference in hormone levels among populations, we compared postmenopausal endogenous sex hormone levels among Japanese living in Japan, Japanese Brazilians living in the state of São Paulo, and non-Japanese Brazilians living in the state of São Paulo. Methods A cross-sectional study was conducted using a control group of case-control studies in Nagano, Japan, and São Paulo, Brazil. Participants were postmenopausal women older than 55 years of age who provided blood samples. We measured estradiol, estrone, androstenedione, dehydroepiandrosterone sulfate (DHEAS, testosterone and free testosterone by radioimmunoassay; bioavailable estradiol by the ammonium sulfate precipitation method; and sex hormone-binding globulin (SHBG by immunoradiometric assay. A total of 363 women were included for the present analyses, comprising 185 Japanese, 44 Japanese Brazilians and 134 non-Japanese Brazilians. Results Japanese Brazilians had significantly higher levels of estradiol, bioavailable estradiol, estrone, testosterone and free testosterone levels, and lower SHBG levels, than Japanese. Japanese Brazilians also had significantly higher levels of bioavailable estradiol, estrone and DHEAS and lower levels of SHBG and androstenedione than non-Japanese Brazilians. Levels of estradiol, testosterone and free testosterone, however, did not differ between Japanese Brazilians and non-Japanese Brazilians. These differences were observed even after adjustment for known breast cancer risk factors. We also found an increase in estrogen and androgen levels with increasing body mass index, but no association for most of the other known risk factors. Conclusions We found higher levels of

  20. Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

    Science.gov (United States)

    2010-01-01

    Background Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status. Methods Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different. Conclusion Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction. PMID:20459873

  1. Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

    Directory of Open Access Journals (Sweden)

    Erbel Raimund

    2010-05-01

    Full Text Available Abstract Background Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology the relationship between patient satisfaction (as measured by the recommendation rate and accreditation status. Methods Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55% became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds and patient (age, gender characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI 63.4 - 67.8% and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5% was not significantly different. Conclusion Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction.

  2. Brazilian Strategies to Overcome Molybdenum Crisis: Present and Future Perspectives of the Multipurpose Research Reactor

    International Nuclear Information System (INIS)

    Nuclear Medicine applications in Brazil have been widely growing in the past few decades, following the world trends. Procedures in oncology and cardiology can be highlighted among its major contributions. Nowadays more than 80% of diagnosis procedures are performed with 99mTc, readily available from the elution of 99Mo-99mTc generators. The Brazilian demand, attended solely by IPEN-CNEN/SP, reaches out more than 320 generators per week with a total activity of about 16.7 TBq (450 Ci), which corresponds to 4% of the overall 99Mo global demand at an importation cost of US$20 million/year, most of it from Canada. The recent 99Mo supply crisis deeply affected the distribution of generators in Brazil. A short term solution was achieved with the purchase of 99Mo from Argentine and more recently from South Africa and also the distribution of generators produced by IBA and Israel. Mid term and long term projects are under way aiming the nationalization of the production of 99Mo. Both solutions will use the recently approved new Brazilian Multipurpose Reactor (BMR) that will be built near Sao Paulo city and will have a 30 MW power. The mid term project consists on the production of (n,γ) 99Mo and distribution of 99mTc and monodoses of radiopharmaceuticals labelled with 99mTc to hospitals near Sao Paulo. The long term project deals with the production of 99Mo through the fission of 235U using LEU targets. This work describes the efforts taken by IPEN-CNEN/SP to overcome the recent 99Mo supply crisis and an up-to-date on the projects aiming the nationalization of the 99Mo production. (author)

  3. Psychiatric referrals from the police : an examination of police officers' action and interaction with psychiatrists

    OpenAIRE

    Rogers, Anne Elizabeth

    1989-01-01

    There are two main foci in this research. The first has to do with police officers' management of psychiatric referrals, using their powers under Section 136 of the Mental Health Act, the second with interprofessional relations between the police and psychiatrists. A Section 136 case is defined so as to include all referrals where a mental health disposal is initiated by the police as opposed to a court or other mental health professional. The research is an attempt to describe police offi...

  4. Access to specialty care in autism spectrum disorders-a pilot study of referral source

    Directory of Open Access Journals (Sweden)

    West Therese

    2011-05-01

    Full Text Available Abstract Background In the United States, a medical home model has been shown to improve the outcomes for children with special health care needs. As part of this model, primary care physicians provide comprehensive medical care that includes identification of delayed and/or atypical development in children and coordination of care with specialists. However, it is not clear if families of children with Autism Spectrum Disorder (ASD rely on the medical home model for care of their child to the same extent as families of children with other special health care needs. This study aims to add to the understanding of medical care for children with ASD by examining the referral source for specialty care. Methods This retrospective study was accomplished by evaluating parent completed intake data for children with ASD compared to those with other neurological disorders in a single physician Pediatric Neurology Practice at a major urban medical center in Northern New Jersey. To account for referral bias, a similar comparison study was conducted using a multispecialty ASD practice at the same medical center. Parent reported "source of referral" and "reason for the referral" of 189 ASD children and 108 non-ASD neurological disordered children were analyzed. Results The specialty evaluations of ASD were predominantly parent initiated. There were significantly less referrals received from primary care physicians for children with ASD compared to children with other neurodevelopmental disorders. Requirement of an insurance referral was not associated with a primary care physician prompted specialty visit.We identified different patterns of referral to our specialty clinics for children with ASD vs. children with other neurolodevelopmental disorders. Conclusion The majority of the families of children with ASD evaluated at our autism center did not indicate that a primary care physician initiated the specialty referral. This study suggests that families of

  5. Paediatric imaging radiation dose awareness and use of referral guidelines amongst radiology practitioners and radiographers

    OpenAIRE

    Portelli, Jonathan L.; McNulty, Jonathan P.; Bezzina, Paul; Rainford, Louise

    2015-01-01

    Objectives The objectives are to investigate radiology practitioners’ and radiographers’ radiation dose awareness and use of referral guidelines for paediatric imaging examinations. Methods A prospective cross-sectional survey was conducted amongst radiology practitioners and radiographers working at a primary paediatric referral centre in Malta. Part of the survey asked participants to indicate the typical effective dose (ED) for several commonly performed paediatric imaging examinations, an...

  6. Designing Referral Network Structures and Decision Rules to Streamline Provision of Urgent Health and Human Services

    OpenAIRE

    Gibbons, Deborah E.; Samaddar, Subhashish

    2009-01-01

    This study uses fully factorial computer simulation to identify referral network attributes and referral decision rules that streamline the routing of people to urgent, limited services. As an example of a scenario, the model represents vaccine delivery in a city of 100,000 people during the first 30 days of a pandemic. By modeling patterns of communication among health care providers and daily routing of overflow clients to affiliated organizations, the simulations determine c...

  7. Factors associated with mental health clinicians’f referrals to 12-step groups

    OpenAIRE

    Matusow, Harlan; Rosenblum, Andrew; Fong, Chunki; Laudet, Alexandre; Uttaro, Thomas; Magura, Stephen

    2012-01-01

    As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually-diagnosed clients to 12-step groups. This study examined the relationships among clinicians’ 12-step experiences, attitudes and referral practices in 6 NYC mental health clinics. A path analysis model showed that greater interest in learning about 12-step (12-step interest) directly predicted 12-step referral practices and th...

  8. Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services*

    OpenAIRE

    Adams, Carolyn E.; Bader, Julia; Horn, Kathryn V.

    2009-01-01

    Generally, satisfaction with timing of hospice referral was measured in mortality follow back surveys of patients who died in hospice. In contrast in this study, investigators assessed timing of the hospice referral in patients/families enrolled in hospice for a minimum of two weeks. About 1/3 of patients/families identified it would have been easier if they started hospice earlier. Barriers to early hospice access were associated primarily with access to the healthcare system.

  9. Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service

    OpenAIRE

    McAlinden, Colm; Corson, Helen; Sheen, Nik; Garwood, Peter

    2016-01-01

    Background The Primary Eyecare Acute Referral Service (PEARS) and the Wales Eye Health Examination (WEHE) operate as enhanced optometry services for patients residing in Wales, enabling the examination of a patient presenting with an acute eye problem (PEARS) or the examination of patients at higher risk of eye disease (WEHE). The purpose of the study is to assess the demographics of patients accessing these services, referral patterns and clinical management in one Health Board in Wales (Ane...

  10. Referral letter: evaluation of quality of communication between Primary Health Care and Otolaryngology.

    OpenAIRE

    Pelegrín-Hernández JP, Hernández-Cervantes AE, Estevez-Monción A, Hellín-Meseguer D, Amorós-Rodriguez LM.

    2012-01-01

    The Referral letter, is a fundamental tool in the link between Primary Care and second care level. So the main objective of this study is to evaluate the quality of this document on Otolaryngology Department as a high demand specialty. For this purpose, we conducted a prospective, descriptive and observational study, which analyzed all referral letter sent it from Primary Health Care Centers for a month, and used quality criteria previously defined by Izabal et al.The study included 144 refe...

  11. Patient referral patterns and the spread of hospital-acquired infections through national health care networks.

    OpenAIRE

    Tjibbe Donker; Jacco Wallinga; Hajo Grundmann

    2010-01-01

    Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2...

  12. Patient Referral Patterns and the Spread of Hospital-Acquired Infections through National Health Care Networks

    OpenAIRE

    Donker, Tjibbe; Wallinga, Jacco; Grundmann, Hajo

    2010-01-01

    Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2...

  13. Paget–Schroetter syndrome: the importance of urgent referral and appropriate management

    OpenAIRE

    Fenton, Daniel; Constantinou, Jason; Srilekha, Attavar; Richards, Toby; Harris, Peter

    2011-01-01

    The authors present the case of a young healthy male who was admitted with a case of acute primary subclavian vein thrombosis, otherwise known as Paget–Schroetter syndrome. The patient was successfully treated by catheter directed thrombolysis using a Trellis device and thoracic outlet decompression following prompt referral to the vascular team. The case highlights importance of early referral in the prevention of the long-term sequelae which can occur as a result of this rare condition.

  14. Survey based investigation into general practitioner referral patterns for spinal manipulative therapy

    OpenAIRE

    Kier, Annabel; George, Matthew; McCarthy, Peter W

    2013-01-01

    Background In the UK Physiotherapy, Chiropractic and Osteopathy are all statutory regulated professions. Though guidelines have supported the use of Spinal Manipulative Therapy (SMT) for low back pain (LBP), General Practitioners (GP) referral patterns to the 3 registered professions that perform SMT are generally unknown. Method A short questionnaire was designed and piloted. Demographic information, patient referral to SMT and the GPs own personal utilisation of SMT were obtained. 385 GP’s ...

  15. Assessment of providers' referral decisions in Rural Burkina Faso: a retrospective analysis of medical records

    Directory of Open Access Journals (Sweden)

    Ilboudo Tegawende

    2012-03-01

    Full Text Available Abstract Background A well-functioning referral system is fundamental to primary health care delivery. Understanding the providers' referral decision-making process becomes critical. This study's aim was to assess the correctness of diagnoses and appropriateness of the providers' referral decisions from health centers (HCs to district hospitals (DHs among patients with severe malaria and pneumonia. Methods A record review of twelve months of consultations was conducted covering eight randomly selected HCs to identify severe malaria (SM cases among children under five and pneumonia cases among adults. The correctness of the diagnosis and appropriateness of providers' referral decisions were determined using the National Clinical Guidebook as a 'gold standard'. Results Among the 457 SM cases affecting children under five, only 66 cases (14.4% were correctly diagnosed and of those 66 correctly diagnosed cases, 40 cases (60.6% received an appropriate referral decision from their providers. Within these 66 correctly diagnosed SM cases, only 60.6% were appropriately referred. Among the adult pneumonia cases, 5.9% (79/1331 of the diagnoses were correctly diagnosed; however, the appropriateness rate of the provider's referral decision was 98.7% (78/79. There was only one case that should not have been referred but was referred. Conclusions The adherence to the National Guidelines among the health center providers when making a diagnosis was low for both severe malaria cases and pneumonia cases. The appropriateness of the referral decisions was particularly poor for children with severe malaria. Health center providers need to be better trained in the diagnostic process and in disease management in order to improve the performance of the referral system in rural Burkina Faso.

  16. Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

    OpenAIRE

    Jolly Kate; Duda Joan L; Daley Amanda; Eves Frank F; Mutrie Nanette; Ntoumanis Nikos; Rouse Peter C; Lodhia Rekha; Williams Geoffrey C

    2009-01-01

    Abstract Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial ...

  17. Medication prescribing errors and associated factors at the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia

    OpenAIRE

    Zeleke, Abebe; Chanie, Tesfahun; Woldie, Mirkuzie

    2014-01-01

    Background Medication error is common and preventable cause of medical errors and occurs as a result of either human error or a system flaw. The consequences of such errors are more harmful and frequent among pediatric patients. Objective To assess medication prescribing errors and associated factors in the pediatric wards of Dessie Referral Hospital, Northeast Ethiopia. Methods A cross-sectional study was carried out in the pediatric wards of Dessie Referral Hospital from February 17 to Marc...

  18. Clinical neurophysiology referral patterns to a tertiary hospital--a prospective audit.

    LENUS (Irish Health Repository)

    Renganathan, R

    2012-02-03

    BACKGROUND: Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. AIM: To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. METHODS: We did a prospective audit of the referral patterns to the neurophysiology department over a 12 -week period. RESULTS: Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. CONCLUSIONS: Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.

  19. A study on first intake assessments of in-patient referrals to psychiatric rehabilitation services

    Directory of Open Access Journals (Sweden)

    Geetha Desai

    2014-01-01

    Full Text Available Background: Psychiatric rehabilitation is an important component in mental health services. The rehabilitation needs of patients with mental illness have been highlighted in various studies. The studies on in-patient referrals to rehabilitation services however are sparse. This study describes the clinical and demographic details and the reasons for referrals to rehabilitation services during the in-patients stay. Materials and Methods: A semi-structured pro forma was used for the assessment of in-patients referred for the psychiatric rehabilitation services. The pro forma included socio-demographic details such as background, family resources, illness related details such as symptom status, risk assessment, medication details. The total number of referrals for a period of 5 months was collected and coded. Results: The total number of referrals for a period of 5 months was 216 and there were 197 forms available for the study. The mean age of the sample was 31.48 ± 10.46 years. Vocational rehabilitation was the commonest reason for referral to the in-patient services. Severe mental disorders were the most common diagnosis of patients refereed to the services. Conclusions: Patients with severe mental illness were most often referred to the in-patient services. This indicates that we need include to rehabilitation in the management plan at the earliest. Vocational rehabilitation is the most common reason for referrals and there is a need to develop services to cater to these needs.

  20. Pathways to Internationalize Brazilian Journals of Psychology

    Directory of Open Access Journals (Sweden)

    Estêvão C. Gamba

    2015-01-01

    Full Text Available AbstractThe science of psychology has been developing in the country of Brazil over the last 50 years. Nonetheless, most of the science in this field is published only in Brazilian journals. Overall, Brazil has yet to share its science with the international community. The potential to internationalize the science generated by Brazilian psychologists exists, though. One way would be to scale up the publication of Brazilian psychologists in international journals. Another way would be to internationalize the existing Brazilian journals. With regard to the latter possibility, a metric analysis of scientometrics databases suggests that the reasons for the low impact of articles published in Brazilian journals are manifold, but the low performance is mainly explained by the scarce employment of the lingua franca-English language-in the articles. This article discusses the role that SciELO, a Brazilian scientific publisher, has played in indexing and assisting the best Brazilian psychology journals in raising their horizons, in terms of internationalizing their output, while at the same time serving as an instrument of promotion for national studies of psychology within the country of Brazil.

  1. Multiple procedures and cumulative individual radiation exposure in interventional cardiology: A long-term retrospective study

    International Nuclear Information System (INIS)

    Various studies address discrepancies between guideline recommendations for coronary angiographies and clinical practice. While the issue of the appropriateness of recurrent angiographies was studied focusing on the role of the cardiologist, little is known about individual patients' histories and the associated radiation exposures. We analyzed all patients with coronary artery disease (CAD) in an academic teaching practice who underwent at least one angiography with or without intervention between 2004 and 2009. All performed angiographies in these patients were analyzed and rated by three physicians for appropriateness levels according to cardiology guidelines. Typical exposure data from the medical literature were used to estimate individual radiation exposure. In the cohort of 147 patients, a total of 441 procedures were analyzed: between 1981 and 2009, three procedures were performed per patient (range 1-19) on average. Appropriateness ratings were 'high/intermediate' in 71 %, 'low/no' in 27.6 % and data were insufficient for ratings in 1.4 %. Procedures with 'low/no' ratings were associated with potentially avoidable exposures of up to 186 mSv for single patients. Using retrospective data, we exemplify the potential benefit of guideline adherence to decrease patients' radiation exposures. (orig.)

  2. A practical method for skin dose estimation in interventional cardiology based on fluorographic DICOM information

    International Nuclear Information System (INIS)

    A practical method for skin dose estimation for interventional cardiology patients has been developed to inform pre-procedure planning and post-procedure patient management. Absorbed dose to the patient skin for certain interventional radiology procedures can exceed thresholds for deterministic skin injury, requiring documentation within the patient notes and appropriate patient follow-up. The primary objective was to reduce uncertainty associated with current methods, particularly surrounding field overlap. This was achieved by considering rectangular field geometry incident on a spherical patient model in a polar coordinate system. The angular size of each field was quantified at surface of the sphere, i.e. the skin surface. Computer-assisted design software enabled the modelling of a sufficient dataset that was subsequently validated with radiochromic film. Modelled overlap was found to agree with overlap measured using film to within 2.2 deg. ± 2.0 deg., showing that the overall error associated with the model was <1 %. Mathematical comparison against exposure data extracted from procedural Digital Imaging and Communication in Medicine files was used to generate a graphical skin dose map, demonstrating the dose distribution over a sphere centred at the interventional reference point. Dosimetric accuracy of the software was measured as between 3.5 and 17 % for different variables. (authors)

  3. Entrance surface air kerma in x-ray systems for paediatric interventional cardiology: a national survey

    International Nuclear Information System (INIS)

    The aims of this work were to report the results of a national survey on entrance surface air kerma (ESAK) values for different phantom thicknesses and operation modes in paediatric interventional cardiology (IC) systems and to compare them with previous values. The national survey also offers suggested investigation levels (ILs) for ESAK in paediatric cardiac procedures. ESAK was measured on phantoms of 4-16 cm thickness of polymethyl methacrylate slabs. For low fluoroscopy mode (FM), ESAK rates ranged from 0.11 to 33.1 mGy min-1 and for high FM from 0.34 to 61.0 mGy min-1. For cine mode, values of ESAK per frame were from 1.9 to 78.2 μGy fr-1. The ILs were suggested as the third quartile of the values measured. This research showed lower ESAK values than in previous research, particularly for ESAK values in cine modes. This work represents a first step towards launching a national programme in paediatric dosimetry for IC procedures. (authors)

  4. CardioSmart365: Artificial Intelligence in the Service of Cardiologic Patients

    Directory of Open Access Journals (Sweden)

    Efrosini Sourla

    2012-01-01

    Full Text Available Artificial intelligence has significantly contributed in the evolution of medical informatics and biomedicine, providing a variety of tools available to be exploited, from rule-based expert systems and fuzzy logic to neural networks and genetic algorithms. Moreover, familiarizing people with smartphones and the constantly growing use of medical-related mobile applications enables complete and systematic monitoring of a series of chronic diseases both by health professionals and patients. In this work, we propose an integrated system for monitoring and early notification for patients suffering from heart diseases. CardioSmart365 consists of web applications, smartphone native applications, decision support systems, and web services that allow interaction and communication among end users: cardiologists, patients, and general doctors. The key features of the proposed solution are (a recording and management of patients' measurements of vital signs performed at home on regular basis (blood pressure, blood glucose, oxygen saturation, weight, and height, (b management of patients' EMRs, (c cardiologic patient modules for the most common heart diseases, (d decision support systems based on fuzzy logic, (e integrated message management module for optimal communication between end users and instant notifications, and (f interconnection to Microsoft HealthVault platform. CardioSmart365 contributes to the effort for optimal patient monitoring at home and early response in cases of emergency.

  5. Management of stable angina: A commentary on the European Society of Cardiology guidelines.

    Science.gov (United States)

    Ambrosio, Giuseppe; Komajda, Michel; Mugelli, Alessandro; Lopez-Sendón, José; Tamargo, Juan; Camm, John

    2016-09-01

    In 2013 the European Society of Cardiology (ESC) released new guidelines on the management of stable coronary artery disease. These guidelines update and replace the previous ESC guidelines on the management of stable angina pectoris, issued in 2006. There are several new aspects in the 2013 ESC guidelines compared with the 2006 version. This opinion paper provides an in-depth interpretation of the ESC guidelines with regard to these issues, to help physicians in making evidence-based therapeutic choices in their routine clinical practice. The first new element is the definition of stable coronary artery disease itself, which has now broadened from a 'simple' symptom, angina pectoris, to a more complex disease that can even be asymptomatic. In the first-line setting, the major changes in the new guidelines are the upgrading of calcium channel blockers, the distinction between dihydropyridines and non-dihydropyridine calcium channel blockers, and the presence of important statements regarding the combination of calcium channel blockers with beta-blockers. In the second-line setting, the 2013 ESC guidelines recommend the addition of long-acting nitrates, ivabradine, nicorandil or ranolazine to first-line agents. Trimetazidine may also be considered. However, no clear distinction is made among different second-line drugs, despite different quality of evidence in favour of these agents. For example, the use of ranolazine is supported by strong and recent evidence, while data supporting the use of the traditional agents appear relatively scanty. PMID:27222385

  6. Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values.

    Science.gov (United States)

    Vano, E; Fernandez, J M; Resel, L E; Moreno, J; Sanchez, R M

    2016-03-01

    The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn over the lead apron). Patient and staff dose measurements were collected in a sample of 34 urology interventions (nephrolithotomies). The same dosimetry system was used in other medical specialties for comparison purposes. Median and 3rd quartile values for urology procedures were: patient doses 30 and 40 Gy cm(2); personal dose equivalent Hp(10) over the apron (μSv/procedure): 393 and 848 (for urologists); 21 and 39 (for nurses). Median values of over apron dose per procedure for urologists resulted 18.7 times higher than those measured for radiologists and cardiologists working with proper protection (using ceiling suspended screens) in catheterisation laboratories, and 4.2 times higher than the values measured for vascular surgeons at the same hospital. Comparison with passive dosimeters worn near the eyes suggests that dosimeters worn over the apron could be a reasonable conservative estimate for ocular doses for interventional urology. Authors recommend that at least the main surgeon uses protective eyewear during interventional urology procedures. PMID:26583458

  7. Clustering of Enterococcus faecalis infections in a cardiology hospital neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Tânia Mara Varejão Strabelli

    2006-04-01

    Full Text Available Early identification of an outbreak is one of the main advantages of routine epidemiological surveillance. Enterococcus spp. used to be regarded as microorganisms of low pathogenicity, because they are part of the normal microbial flora of the gastrointestinal and genitourinary tract. Recently, they have emerged as important pathogenic agents, sometimes causing infections with high mortality rates. We studied a clustering of primary bloodstream infections caused by Enterococcus faecalis in a cardiology hospital neonatal intensive care unit (NICU. Four cases of primary bloodstream infection by E. faecalis were detected from April 15 to May 13, 2004, during active infection surveillance. The isolates were sensitive to glycopeptides. Some aspects of the management of these patients, including the date of insertion and placement of a central venous catheter, prescription of a specific medication, contiguity of beds, personnel attending the patients, and occurrence of diarrhea were analyzed to look for factors that might affect the spread of the microorganisms. Measures taken to hamper the spread included contact precautions throughout the unit, cleansing and disinfection of equipment and surfaces, bathing children with 2% chlorhexidine-gluconate-containing soap, professional reeducation, and reinforcement of all measures to prevent infections. We suggest that there is a need to re-evaluate preventive infection measures and to review the strategies aimed at decreasing the nosocomial infection rate in the NICU.

  8. Radiological protection optimization derived from radiation induced lesions in interventional cardiology finding

    International Nuclear Information System (INIS)

    Interventional Cardiology is one of the specialties in which patients are submitted to the greatest radiation doses with x ray systems used for diagnostic purposes and then, it is also a specialty of high occupational radiation risk. In the last years, several cases of radiation induced lesions produced on patients derived of new complex interventional procedures have been described. As consequence, different rules for avoiding this kind of incidents have been recommended by International Organisations and regulatory Bodies. Nevertheless it has been devoted relatively few attention to the evaluation of the occupational risks that inevitably are also high in these facilities. In this work, some cases of radioinduced skin lesions produced on patients submitted to cardiac ablation procedures are described. Radiological protection considerations of interest for the regulatory Bodies are made, that permit to minimize the probability of these incidents, in what to the X-rays equipment is referred as well as to the operation procedures and level of radiation protection training of the medical specialists. (author)

  9. The usefulness of the nuclear cardiology in the cellular implant in patients with severe myocardial damage

    International Nuclear Information System (INIS)

    The recent therapeutic advances as the cellular implant as well as those different protocols of image acquisition in the field of the Nuclear Cardiology its have allowed that the patient with severe myocardial damage and without some possibility of revascularization is benefited with these advances. Doubtless the Tl-201 par excellence has an important paper for standardize the more appropriate therapeutic behavior for the heart attack patient; reason by this investigation protocol was developed. The objective of the study was to identify the heart attack regions without viable tissue with SPECT in patient with important myocardial damage without some possibility of traditional revascularization; for the 'Stem cell' cellular implantation therapy. The methodology it was carried out by a study of myocardial perfusion in 10 patients with important myocardial damage previous cellular implants, with PICANUC/ SPECT methodology and using a software (Emory Tool Box) for the image processing validated by the University of Emory Atlanta GA; and using as tracer the Tl - 201 to identify the heart attack regions without presence of viable tissue with an analysis model of 17 segments standardized for the left ventricle; qualifying this way the myocardial perfusion in: 0 (normal), 1 (light), 2 (moderate), 3 (severe), 4 (absent) and x (bad technique). The conclusions were that the SPECT study with PICANUC methodology with Tl-201 is safe and effective for the precise localization for the cellular implantation via direct intra myocardial. (Author)

  10. Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology

    International Nuclear Information System (INIS)

    Patient and staff dose values in an interventional cardiology laboratory for different operational modes and several patient thicknesses (from 16 to 28 cm, simulated using polymethylmethacrylate) are presented. When increasing patient thicknesses and depending on fluoroscopy and cine modes, occupational doses can increase >30 times the baseline level. Scatter dose rates at the cardiologist's position with no radiation protective tools ranged from 1 to 14 mSv h-1 for fluoroscopy, and from 10 to 47 mSv h-1 during cine acquisition. Patient entrance surface air kerma rates increased by nearly 3 and staff dose rates by up to 2.6 when fluoroscopy was moved from the low to the high mode, for a typical 20 cm thickness. The respective increase factors were 6 and 4.2 when patient thickness rose from 16 to 28 cm, and by 10 and 8.3, when comparing cine acquisition with the low fluoroscopy mode. The knowledge of typical dose rates for each X-ray system in use in catheterisation laboratories is essential in order to optimise protection of patients and staff. (authors)

  11. Application of a visualization method of image data base in nuclear cardiology

    International Nuclear Information System (INIS)

    Medical imaging is undoubtedly one of the medical branches which benefited at most by the offsprings of computer science development. We present here a visualization software of image data base, making use of the last innovations in the field of multimedia application. The objective of such a software is to provide a reference tool for a given medical specialty offering at the same time, a high quality iconography, a rigorous content of the comments and the matching of graphical interfaces. Applied to nuclear cardiology and implanted on CD ROM, it contains a given number of clinical cases (around 150) which sweep quasi-exhaustively the subject. Each case centered around scintigraphic examination (myocardial tomographs, ventriculographs, SPECT, etc) makes available 'static' pictures (series of cross sections, planispheric images, ECG), animated cartoons (synchronized series, 3D visualization, etc) and also the clinical history of the patient and the records of complementary examinations (coronary-graphic, for instance). Being independent of the image data base which it visualizes, our software is easily applicable to other nuclear medicine specialties (neurology, renal exploration) and also to other modalities. It is multilingual already (French and English) and soon will be supplemented by a code dedicated to knowledge assessment intended to be an efficient tool in education and continuous formation. A Macintosh version will be soon obtainable and a demonstration diskette is free available on request

  12. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology

    International Nuclear Information System (INIS)

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 μSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm2, respectively. The median ratios for dosemeters worn over the apron by operators ( protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 μSv Gy-1 cm-2, respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y-1 and per operator were necessary to reach the new lens dose limit for the three interventional specialties. (authors)

  13. Multiple procedures and cumulative individual radiation exposure in interventional cardiology: A long-term retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Weltermann, Birgitta M.; Rock, Thomas; Berndt, Peter; Viehmann, Anja; Reinders, Sabrina; Gesenhues, Stefan [University of Duisburg-Essen, Institute for General Medicine, University Hospital, Essen (Germany); Brix, Gunnar; Schegerer, Alexander [Federal Office for Radiation Protection, Department of Radiation Protection and Health, Neuherberg (Germany)

    2015-09-15

    Various studies address discrepancies between guideline recommendations for coronary angiographies and clinical practice. While the issue of the appropriateness of recurrent angiographies was studied focusing on the role of the cardiologist, little is known about individual patients' histories and the associated radiation exposures. We analyzed all patients with coronary artery disease (CAD) in an academic teaching practice who underwent at least one angiography with or without intervention between 2004 and 2009. All performed angiographies in these patients were analyzed and rated by three physicians for appropriateness levels according to cardiology guidelines. Typical exposure data from the medical literature were used to estimate individual radiation exposure. In the cohort of 147 patients, a total of 441 procedures were analyzed: between 1981 and 2009, three procedures were performed per patient (range 1-19) on average. Appropriateness ratings were 'high/intermediate' in 71 %, 'low/no' in 27.6 % and data were insufficient for ratings in 1.4 %. Procedures with 'low/no' ratings were associated with potentially avoidable exposures of up to 186 mSv for single patients. Using retrospective data, we exemplify the potential benefit of guideline adherence to decrease patients' radiation exposures. (orig.)

  14. Recommendations to reduce extremity and eye lens doses in interventional radiology and cardiology

    International Nuclear Information System (INIS)

    The main aim of the Work Package 1 (WP1) of the ORAMED project, Collaborative Project (2008–2011), supported by the European Commission within its 7th Framework Programme, was to obtain a set of standardized data on extremity and eye lens doses for staff in interventional radiology and cardiology (IR/IC) workplaces and to recommend a series of guidelines on radiation protection in order to both guarantee and optimize staff protection. Within the project, coordinated measurements were performed in 34 hospitals in 6 European countries. Furthermore, simulations of the most representative workplaces in IR and IC were performed to determine the main parameters that influence the extremity and eye lens doses. The work presented in this paper shows the recommendations that were formulated by the results obtained from both measurements and simulations. The presented guidelines are directed to operators, assistant personnel, radiation protection officers and medical physics experts. They concern radiation protection issues, such as the use of room protective equipment, as well as the positioning of the extremity and eye lens dosemeters for routine monitoring.

  15. Forecasting of Corrosion Properties of Steel Wires for Production of Guide Wires for Cardiological Treatment

    Directory of Open Access Journals (Sweden)

    J. Przondziono

    2013-01-01

    Full Text Available The study presents evaluation of the influence of strain in drawing process and of surface modification on resistance to electrochemical corrosion of wires made of stainless steel for production of guide wires used in invasive cardiology. The results of static tensile test enabled us to determine the course of flow curve of wires made of X10CrNi 18-8 steel as well as mathematical form of flow stress function. Resistance to electrochemical corrosion was evaluated on the ground of registered anodic polarisation curves by means of potentiodynamic method. The tests were performed in solution simulating human blood on samples that were electrolytically polished and samples that were polished and then chemically passivated. Exemplary anodic polarisation curves were given. It was proved that with the applied strain, corrosion properties decrease. It was found that chemical passivation improves wire corrosion characteristics. Statistical analysis showed that there is a significant dependence between corrosion properties (polarisation resistance Rp and strain ε applied in drawing process. Functions that present the change Rp=f(ε were selected. The issue is of importance to guide wire manufacturers because application of the suggested methodology will enable us to forecast corrosion characteristics of wire with the required strength drawn with the applied strain.

  16. Eye dosimetry in interventional radiology and cardiology: current challenges and practical considerations.

    Science.gov (United States)

    Ciraj-Bjelac, O; Rehani, M M

    2014-12-01

    Interventional radiology and cardiology are areas with high potential for risk to eye lens. Accurate assessment of eye dose is one of the most important aspects of correlating doses with observed lens opacities among workers in interventional suites and ascertaining compliance with regulatory limits. The purpose of this paper is to review current approaches and opportunities in eye dosimetry and assess challenges in particular in accuracy and practicality. The possible approaches include practical dosimetry using passive dosemeters or active dosemeters with obvious advantage of active dosimetry. When neither of these is available, other approaches are based on either retrospective dose assessment using scatter radiation dose levels or correlations between patient dose indices and eye doses to the operators. In spite of all uncertainties and variations, estimation of eye dose from patient dose can be accepted as a compromise. Future challenges include development of practical methods for regular monitoring of individual eye doses and development of better techniques to estimate eye dose from measurements at some reference points. PMID:24262928

  17. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland

    Directory of Open Access Journals (Sweden)

    Sébastien Deferm

    2016-01-01

    Full Text Available Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice.

  18. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland.

    Science.gov (United States)

    Deferm, Sébastien; Meyns, Bart; Vlasselaers, Dirk; Budts, Werner

    2016-01-01

    Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D) imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice. PMID:27195174

  19. Combined cardiological and neurological abnormalities due to filamin A gene mutation

    Science.gov (United States)

    de Wit, Marie Claire Y.; de Coo, Irenaeus F. M.; Lequin, Maarten H.; Halley, Dicky J. J.; Roos-Hesselink, Jolien W.

    2010-01-01

    Background Cardiac defects can be the presenting symptom in patients with mutations in the X-linked gene FLNA. Dysfunction of this gene is associated with cardiac abnormalities, especially in the left ventricular outflow tract, but can also cause a congenital malformation of the cerebral cortex. We noticed that some patients diagnosed at the neurogenetics clinic had first presented to a cardiologist, suggesting that earlier recognition may be possible if the diagnosis is suspected. Methods and results From the Erasmus MC cerebral malformations database 24 patients were identified with cerebral bilateral periventricular nodular heterotopia (PNH) without other cerebral cortical malformations. In six of these patients, a pathogenic mutation in FLNA was present. In five a cardiac defect was also found in the outflow tract. Four had presented to a cardiologist before the cerebral abnormalities were diagnosed. Conclusions The cardiological phenotype typically consists of aortic or mitral regurgitation, coarctation of the aorta or other left-sided cardiac malformations. Most patients in this category will not have a FLNA mutation, but the presence of neurological complaints, hyperlaxity of the skin or joints and/or a family history with similar cardiac or neurological problems in a possibly X-linked pattern may alert the clinician to the possibility of a FLNA mutation. PMID:20730588

  20. Can nurses in cardiology areas prepare patients for implantable cardioverter defibrillator implant and life at home?

    Science.gov (United States)

    Tagney, Jenny

    2004-01-01

    This study explored nurses' confidence and competence in preparing patients for having an implantable cardioverter defibrillator implanted and for life at home after discharge. Whilst research has identified various physical and psychosocial effects to patients and their partners associated with device implant and subsequent lifestyle adjustments, no research has explored nurses' knowledge of the device or these effects. A survey was designed using a purposive sample of 152 nurses from cardiology areas in four large teaching hospitals and a 28-point postal questionnaire to explore knowledge of the device and its impact. Most subjects were not confident in their abilities to prepare patients for implant or life at home after implant. Knowledge of the device and its effects appeared poorly understood by all nurses, irrespective of additional qualifications, length of time since qualifying or area of work. Many participants were aware of the poor knowledge level of nurses and identified it as a weakness in current care practices. Lack of understanding may impair preparation of patients for implantation of or for living with an implantable cardioverter defibrillator, and feasible strategies to change this situation will require careful consideration and further investment. PMID:15152752

  1. The foundation and launch of the Melbourne Interventional Group: a collaborative interventional cardiology project.

    Science.gov (United States)

    Ajani, A E; Szto, G; Duffy, S J; Eccleston, D; Clark, D J; Lefkovits, J; Chew, D P; Warren, R; Black, A; New, G; Walton, A; Lew, R; Shaw, J; Horrigan, M; Sebastian, M; Yan, B P; Brennan, A; Meehan, A; Reid, C; Krum, H

    2006-02-01

    The Melbourne Interventional Group (MIG) is a voluntary collaborative venture of interventional cardiologists practicing at 12 major public and private hospitals in Victoria, designed to record data pertaining to percutaneous coronary interventions (PCI) and perform long-term follow-up. The potential advantages of collaboration involve large-scale analysis of current interventional strategies (e.g. drug-eluting stents, evaluation of new technologies and cost-effective analysis), provide a basis for multi-centred clinical trials and allow comparison of clinical outcomes with cardiac surgery. The established registry documents demographic, clinical and procedural characteristics of consecutive patients undergoing PCI and permits analysis of those characteristics at 30 days and 12 months. The registry is co-ordinated by the Centre of Clinical Research Excellence (CCRE), a research body within the Department of Epidemiology and Preventive Medicine (Monash University, Melbourne). The eventual goal of MIG is to provide a contemporary appraisal of Australian interventional cardiology practice, with opportunities to improve in-hospital and long-term outcomes of patients with coronary artery disease. PMID:16473790

  2. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network

    Directory of Open Access Journals (Sweden)

    Pei-Fang (Jennifer Tsai

    2016-01-01

    Full Text Available For hospitals’ admission management, the ability to predict length of stay (LOS as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS, heart failure (HF, and acute myocardial infarction (AMI in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed.

  3. Overcoming a perfect storm: an academic cardiology section's story of survival.

    Science.gov (United States)

    Calvin, James E

    2007-03-01

    Increasingly, academic institutions are grappling with financial pressures that threaten the academic mission. The author presents an actual case history in which a section of cardiology in an academic health center was confronted with huge projected deficits that had to be eliminated within the fiscal year. The section used eight principles to shift from deficit to profitability (i.e., having revenue exceed costs). These principles included confronting the brutal facts, managing costs and revenue cycles, setting expectations for faculty, and quality improvement. The section accomplished deficit reduction through reducing faculty salaries (nearly $2 million) and nonfaculty salaries ($1.3 million) and reducing operational costs while maintaining revenues by increasing individual faculty productivity and reducing accounts receivable. In the face of these reductions, clinical revenues were maintained, but research revenue and productivity fell (but research is being fostered now that clinical services are profitable again). These principles can be used to stabilize the financial position of clinical practices in academic settings that are facing financial challenges. PMID:17327712

  4. [Personalized therapy in cardiology. Biomarkers, pharmacogenetics and therapy of monogenic diseases].

    Science.gov (United States)

    Eschenhagen, T; Blankenberg, S

    2013-02-01

    Improved therapy and prophylaxis of cardiovascular diseases have contributed to an increase in life expectancy like no other field of medicine. However, many cardiological diseases remain untreatable and standard therapies often work only in a minority of patients or cause more harm than benefit. Personalized approaches appear to be a promising solution. Monogenic heart diseases are paradigmatic for this approach and can in rare cases be treated mutation specifically. Overall, however, success remains limited. Next generation sequencing will facilitate the identification of mutations causing diseases. Cell culture models based on induced pluripotent stem cells open the perspective of individualized testing of disease severity and pharmacological or genetic therapy. In contrast to monogenic diseases genetic testing plays no practical role yet in the management of multifactorial cardiovascular diseases. Biomarkers can identify individuals with increased cardiovascular risk. Furthermore, biomarker-guided therapy represents an attractive option with troponin-guided therapy of acute coronary syndromes as a successful example. Individual responses to drugs vary and are partly determined by genes. Simple genetic analyses can improve response prediction and minimize side effects in cases such as warfarin and high doses of simvastatin. Taken together personalized approaches will gain importance in the cardiovascular field but this requires the development of better methods and research that quantifies the true value of the new knowledge. PMID:23371262

  5. A practical method for skin dose estimation in interventional cardiology based on fluorographic DICOM information.

    Science.gov (United States)

    Matthews, Lucy; Dixon, Matthew; Rowles, Nick; Stevens, Greg

    2016-03-01

    A practical method for skin dose estimation for interventional cardiology patients has been developed to inform pre-procedure planning and post-procedure patient management. Absorbed dose to the patient skin for certain interventional radiology procedures can exceed thresholds for deterministic skin injury, requiring documentation within the patient notes and appropriate patient follow-up. The primary objective was to reduce uncertainty associated with current methods, particularly surrounding field overlap. This was achieved by considering rectangular field geometry incident on a spherical patient model in a polar coordinate system. The angular size of each field was quantified at surface of the sphere, i.e. the skin surface. Computer-assisted design software enabled the modelling of a sufficient dataset that was subsequently validated with radiochromic film. Modelled overlap was found to agree with overlap measured using film to within 2.2° ± 2.0°, showing that the overall error associated with the model was < 1 %. Mathematical comparison against exposure data extracted from procedural Digital Imaging and Communication in Medicine files was used to generate a graphical skin dose map, demonstrating the dose distribution over a sphere centred at the interventional reference point. Dosimetric accuracy of the software was measured as between 3.5 and 17 % for different variables. PMID:25994848

  6. Use of active personal dosemeters in interventional radiology and cardiology: Tests in hospitals – ORAMED project

    International Nuclear Information System (INIS)

    Although active personal dosemeters (APDs) are not used quite often in hospital environments, the possibility to assess the dose and/or dose rate in real time is particularly interesting in interventional radiology and cardiology (IR/IC) since operators can receive relatively high doses while standing close to the primary radiation field. A study concerning the optimization of the use of APDs in IR/IC was performed in the framework of the ORAMED project, a Collaborative Project (2008–2011) supported by the European Commission within its 7th Framework Program. This paper reports on tests performed with APDs on phantoms using an X-ray facility in a hospital environment and APDs worn by interventionalists during routine practice in different European hospitals. The behaviour of the APDs is more satisfactory in hospitals than in laboratories with respect to the influence of the tube peak high voltage and pulse width, because the APDs are tested in scattered fields with dose equivalent rates generally lower than 1 Sv.h−1. .

  7. Radiation dose and image quality for paediatric interventional cardiology systems. A national survey in Chile

    International Nuclear Information System (INIS)

    Radiation dose and image quality for paediatric protocols in all five X-ray fluoroscopy systems used for interventional cardiology procedures existing in Chile have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object (TO) and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-16 cm of PMMA). Images from fluoroscopy (low (FL), medium and high) and cine (CI) modes have been archived in DICOM format. Signal-to-noise ratio (SNR), figure of merit (FOM) and high-contrast spatial resolution (HCSR) have been computed from the images. The ratio between the maximum and the minimum value of ESAK per frame for a given fluoroscopy mode between the five systems ranges from 2 to 5 and from 14 to 38 for CI mode. SNR, FOM and HCSR showed a great variability for the different acquisition modes (AMs) and PMMA thickness. In the near future, it is urgent to upgrade Chilean legislation on radiation protection to incorporate quality assurance programmes that will allow us to evaluate and optimise the X-ray systems used in medical applications. Increments in doses per frame when increasing phantom thickness and when used CI runs instead of FL runs can be considered by the cardiologist in the good management of patient dose and allow them to select the best imaging AM during clinical procedures. (authors)

  8. [The cardiology community and health reform. Some reflections to open a debate].

    Science.gov (United States)

    Schweiger, C

    2000-01-01

    A recently introduced health care reform in Italy will modify substantially the scenario in which all physicians and also the cardiac specialists working in and out of the hospitals will operate. Therefore it is important that the cardiological community, who manages a large proportion of human and financial resources of the Italian National Health Service, knows the reform and interacts with the national and local authorities for the best implementation of the basic principles on which the reform has been founded. These principles are the following: the Italian health service will guarantee all citizens the so-called "essential levels of care" identified in accordance with four distinctive features. They must: 1) safeguard real needs of care (i.e. cosmetic surgery is not considered), 2) be evidence based, 3) be appropriate for individual patients, 4) be cost-effective. In a context of scarce resources and rapidly increasing demand of care this basic strategy seems to be the only one suitable for a National Health Service, but the application of this principle in the real world of care seems a very difficult task, and the role of medical associations is obviously crucial for a good outcome. This report illustrates some articles of the law that deal with the medical profession: guidelines and appropriateness of the criteria; accreditation, clinical competence and quality control; continuing medical education. PMID:10832116

  9. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

    Science.gov (United States)

    Vano, E; Sanchez, R M; Fernandez, J M

    2015-07-01

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties. PMID:25848117

  10. The billing process at a teaching hospital specialized in cardiology and pulmonology

    Directory of Open Access Journals (Sweden)

    Gabriela Favaro Faria Guerrer

    2014-09-01

    Full Text Available The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences between patient charts and the patient’s hospital bill. doi: 10.5216/ree.v16i3.23487.

  11. CHANGES OF INTERCELLULAR COOPERATION IN PERIPHERAL BLOOD IN TREATED PATIENTS WITH CARDIOLOGIC DISEASES

    Directory of Open Access Journals (Sweden)

    L. N. Korichkina

    2016-01-01

    Full Text Available Aim. To study changes of intercellular cooperation in peripheral blood induced by treatment in patients with arterial hypertension (HT, ischemic heart disease (IHD and chronic heart failure (CHF.Material and methods. 610 patients were involved into the study, including 250 patients with HT of stages I-III (50 untreated patients, 150 patients with IHD and 210 patients with CHF of stages I-III. All patients were treated except 50 hypertensive ones. 80 healthy patients (40 men, 40 women were included into control group. Blood smears of patients were evaluated (Romanovsky's stain. A number of leukocyte, autorosettes and autorosettes with erythrocyte lysis was calculated. The cellular association consisting of a neutrophil, monocyte or eosinocyte with 3 or more erythrocytes skintight to their surface defined as autorosettes. Erythrocytes number and hemoglobin level determined in peripheral blood.Results. Single autorosettes in peripheral blood were observed in patients of control group and in untreated patients with HT. Treated patients with HT, IHD and CHF had increased number of autorossets and autorosettes with erythrocytes lysis. This phenomenon resulted in reduction of erythrocytes number and hemoglobin level in peripheral blood.Conclusion. Treated patients with cardiologic diseases had changes in intercellular cooperation. It should be considered at intensive and long term therapy.

  12. Eye dosimetry in interventional radiology and cardiology: current challenges and practical considerations

    International Nuclear Information System (INIS)

    Interventional radiology and cardiology are areas with high potential for risk to eye lens. Accurate assessment of eye dose is one of the most important aspects of correlating doses with observed lens opacities among workers in interventional suites and ascertaining compliance with regulatory limits. The purpose of this paper is to review current approaches and opportunities in eye dosimetry and assess challenges in particular in accuracy and practicality. The possible approaches include practical dosimetry using passive dosemeters or active dosemeters with obvious advantage of active dosimetry. When neither of these is available, other approaches are based on either retrospective dose assessment using scatter radiation dose levels or correlations between patient dose indices and eye doses to the operators. In spite of all uncertainties and variations, estimation of eye dose from patient dose can be accepted as a compromise. Future challenges include development of practical methods for regular monitoring of individual eye doses and development of better techniques to estimate eye dose from measurements at some reference points. (authors)

  13. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland

    Science.gov (United States)

    Deferm, Sébastien; Meyns, Bart; Vlasselaers, Dirk; Budts, Werner

    2016-01-01

    Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D) imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice. PMID:27195174

  14. Poor diet quality among Brazilian adolescents with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Luana Fiengo Tanaka

    2015-04-01

    Full Text Available OBJECTIVE: This study aimed to assess diet quality among adolescents with HIV/AIDS. METHOD: A cross-sectional study was conducted involving patients with HIV/AIDS treated in a referral hospital in Sao Paulo, Brazil. Eighty-eight adolescents (10-19 years of age participated in the study. Information on disease history and use of medication were obtained from medical records. The participants responded to two 24-hour diet recalls. Diet quality was assessed by means of the Healthy Eating Index-2005 (HEI-2005 adapted to the Brazilian population. Pearson's correlation coefficients were calculated. Mean HEI-2005 scores were compared according to the independent variables using either the Student's t-test or the Mann-Whitney test. RESULTS: The mean HEI-2005 score was 51.90 (SE = 0.90. The components with the lowest means were whole grains and sodium. Components with highest means were total grains and oils. No correlations were found between the independent variables and HEI score. Adolescents living in foster homes had higher means for total fruit and lower means for meat and beans in comparison to adolescents living with their families. Girls had higher means for milk and lower means for calories from solid fats, alcoholic beverages, and added sugars in comparison to boys. CONCLUSIONS: Adolescents with HIV/AIDS exhibited a similar eating pattern to that of adolescents in the general population: high consumption of added sugar, saturated fat, and sodium, and insufficient ingestion of whole grains and fruits. Special attention should be paid to the diet of adolescents with HIV/AIDS, who are at greater risk of developing cardiovascular and other chronic diseases.

  15. SBR Brazilian organophilic/clay nanocomposites

    International Nuclear Information System (INIS)

    The aim of this work is the obtaining of SBR composites using a Brazilian raw bentonite and the same bentonite treated with an organic salt. The clays were characterized by XRD. The clay addition in the composites was 10 pcr. The composites were characterized by XRD and had measured theirs tension strength (TS). The composite with Brazilian treated clay showed TS 233% higher than a composite with no clay, 133% higher than a composite with Cloisite 30B organophilic clay and 17% lower than a composite with Cloisite 20 A organophilic clay. XRD and TS data evidence that the composite with Brazilian treated clay is an intercalated nanocomposite. (author)

  16. Experience with Evans syndrome in an academic referral center

    Directory of Open Access Journals (Sweden)

    José Carlos Jaime-Pérez

    2015-08-01

    Full Text Available OBJECTIVE: To document the experience of one referral service with patients diagnosed with Evans syndrome, the treatment and response and to briefly review current treatment strategies and results.METHODS: Patients enrolled in this study fulfilled criteria for Evans syndrome. Data were retrieved from the clinical files and electronic databases of the Department of Hematology, Hospital Universitario "Dr. José Eleuterio González". Treatment modalities and response and the use of additional therapies were evaluated. The literature was reviewed in the context of the clinical course of the studied patients.RESULTS: Six patients were diagnosed with Evans syndrome in the study period. Patient 1 was treated with steroids, relapsed twice and was again treated with steroids. Patient 2 treated initially with steroids plus intravenous immunoglobulin was subsequently lost to follow-up. A good response was achieved in Patients 3 and 4, who were treated with steroids plus rituximab; patient 4 also received danazol as a second-line therapy. However both relapsed and subsequently underwent splenectomy at ten and nine months, respectively. One patient, number 5, treated with steroids, danazol and rituximab did not relapse within four years of follow-up and Patient 6, who received steroids plus danazol did not relapse within three years of follow-up.CONCLUSION: Evans syndrome is an uncommon hematologic condition rarely diagnosed and not widely studied. Clinicians must have it in mind when evaluating a patient with a positive direct antiglobulin test, anemia and thrombocytopenia, since prognosis depends on its early recognition and opportune therapy, but even this leads to variable results.

  17. Coronary computed tomography angiography and its increasing application in day to day cardiology practice.

    Science.gov (United States)

    Markham, R; Murdoch, D; Walters, D L; Hamilton-Craig, C

    2016-01-01

    Coronary artery disease (CAD) is the leading single cause of death in Australia affecting around 1.4 million people. Coronary computed tomography angiography has an established role in the assessment of patients with low to intermediate pretest probability for CAD who have chest pain and is typically used with the aim to rule out significant coronary artery stenosis. Use was initially limited because of concerns over radiation exposure, a Medicare rebate restricted to specialist referrals and an absence of data supporting its use as an alternative to functional testing in patients with chest pain. Recent advances in scanner technology and image sequencing, along with data from randomised control trials, have addressed these issues and indicate that coronary computed tomography angiography will play a greater role in the assessment of CAD in the coming years. PMID:26813899

  18. How well are European Society of Cardiology (ESC) guidelines adhered to in patients with syncope?

    LENUS (Irish Health Repository)

    O'Dwyer, C

    2010-01-01

    The ESC guidelines on syncope were published in 2001 and updated in 2004. Adherence to the recommendations enables early stratification of low and high risk patients and prevents unnecessary investigations and admissions. Vasovagal syncope (VVS) is the commonest cause of syncope in all age groups and a low risk condition. The study objective was to determine whether the ESC guidelines were adhered to prior to referral to a syncope unit; 100 consecutive patients with unexplained syncope (52 +\\/- 23 (15-91) years); 53 female. Sixty-six patients had VVS. Forty nine (75%) of patients with VVS had undergone unnecessary investigations prior to diagnosis and 31 (47%) were admitted to hospital for investigation. Research from other countries confirms that adherence to the ESC guidelines expediates accurate diagnosis, improves resource utilization and reduces health care cost. Greater awareness amongst Irish practitioners of guidelines may improve syncope management and reduce costs.

  19. Essays on the history of Brazilian dipterology: II. notices about Brazilian Diptera (17th century)

    OpenAIRE

    Nelson Papavero; Márcia Souto Couri

    2012-01-01

    Essays on the history of Brazilian dipterology. II. Notices about Brazilian Diptera (17th century). Notices from the Brazilian Diptera from the 17th century come mainly from two foreign invasions occurred in Brazil, the first one by the French in Maranhão and the second by the Dutch in northeastern Brazil. This paper includes reports of Fathers Claude d'Abbeville and Yves d'Evreux and from Piso and Marcgrave, the last two presenting the first illustrations of Brazilian Diptera. The paper also...

  20. Essays on the history of Brazilian dipterology: II. notices about Brazilian Diptera (17th century

    Directory of Open Access Journals (Sweden)

    Nelson Papavero

    2012-06-01

    Full Text Available Essays on the history of Brazilian dipterology. II. Notices about Brazilian Diptera (17th century. Notices from the Brazilian Diptera from the 17th century come mainly from two foreign invasions occurred in Brazil, the first one by the French in Maranhão and the second by the Dutch in northeastern Brazil. This paper includes reports of Fathers Claude d'Abbeville and Yves d'Evreux and from Piso and Marcgrave, the last two presenting the first illustrations of Brazilian Diptera. The paper also includes reports of Friar Laureano de la Cruz, Father João de Sotto Mayor and Maurício de Heriarte.

  1. Health Professionals' Perspectives on Exercise Referral and Physical Activity Promotion in Primary Care: Findings from a Process Evaluation of the National Exercise Referral Scheme in Wales

    Science.gov (United States)

    Din, Nafees U.; Moore, Graham F.; Murphy, Simon; Wilkinson, Clare; Williams, Nefyn H.

    2015-01-01

    Background and objectives: Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise…

  2. Zipf Law for Brazilian Cities

    CERN Document Server

    Moura, N J; Jr., Newton J. Moura; Ribeiro, Marcelo B.

    2006-01-01

    This work studies the Zipf Law for cities in Brazil. Data from censuses of 1970, 1980, 1991 and 2000 were used to select a sample containing only cities with 30,000 inhabitants or more. The results show that the population distribution in Brazilian cities does follow a power law similar to the ones found in other countries. Estimates of the power law exponent were found to be 2.22 +/- 0.34 for the 1970 and 1980 censuses, and 2.26 +/- 0.11 for censuses of 1991 and 2000. More accurate results were obtained with the maximum likelihood estimator, showing an exponent equal to 2.41 for 1970 and 2.36 for the other three years.

  3. Trends in breastfeeding research by Brazilian nurses

    Directory of Open Access Journals (Sweden)

    Mônica Oliveira B. Oriá

    2005-02-01

    Full Text Available Exclusive breastfeeding is acknowledged as important for survival, optimal growth, and development of infants. The current review presents a synthesis of research output by Brazilian nurses on breastfeeding over the last 20 years, analyzes the theoretical and methodological issues emerging from studies on breastfeeding in Brazil, and provides directions for future research and practice by nurses in the area breastfeeding. Studies included in this review were identified through LILACS searches of Portuguese-language sources. Articles were organized and analyzed chronologically by comparing the evolution of the Brazilian Breastfeeding Program. The incomplete research output of the Brazilian nursing profession in regard to breastfeeding research needs to be addressed. In addition, specific cultural, sociological, and anthropological characteristics of Brazilian regional settings remain to be explored. Emphasis on potential confounders and critical interrelations is warranted.

  4. Brazilian nuclear programme - energy in Brazil

    International Nuclear Information System (INIS)

    The brazilian energetic model, highly dependent of petroleum, have been changed in the sense to adopt diversified and regionalized solutions. This paper describes the role and the perspective of the nuclear energy in this context. (M.I.)

  5. Myths and truths about Brazilian hospitality

    OpenAIRE

    Ferraz, Valéria de Souza

    2012-01-01

    The Brazilians image is often associated with sympathy and joy. However these characteristics do not necessarily make them hospitable. To be hospitable it´s not just have a smile or be helpful, you must have hospitability, that is, the ability to offer hospitality. Hospitality is a social phenomenon that manifests in the domestic, commercial or public context. It is believed that the Brazilian has a natural talent for the domestic hospitality, which extends somehow into the ...

  6. Brazilians sentenced to sewage-related diseases

    OpenAIRE

    Édison Carlos

    2016-01-01

    There is no furthest behind infrastructure in Brazil than the lack of sewage disposal, particularly the shortage of services for treating water, and for collecting and treating waste. The scarcity of these essential services to human dignity has been plaguing millions of Brazilians, as indicated by the data of the National Sanitation Information System 2014. We have 35 million Brazilians without access to services for treating water, where half the population has no sewage collection an...

  7. Ethics and science in brazilian legal discourse

    OpenAIRE

    Cota Marçal, Antônio; Nasser Cury, Paula Maria

    2012-01-01

    The Brazilian Constitution of 1988 declares Brazil as a Democratic State of Law. This formally democratic legal status has been facing difficulties when it comes to its material implementation. Brazilian legal procedures are still greatly influenced by the catholic heritage from Portugal in the times of colonization, translated in the present times into a strong moral set of dogmas that still reflects upon the legal production and interpretation in the country. Recently in Brazil, a debate br...

  8. Assessment of Referrals into the Soft Tissue Sarcoma Service: Evaluation of Imaging Early in the Pathway Process

    OpenAIRE

    Emma Rowbotham; Shaheel Bhuva; Harun Gupta; Philip Robinson

    2012-01-01

    Purpose. To prospectively evaluate regional referrals into a soft tissue sarcoma service from outside the tertiary centre with local hospital imaging. Materials and Methods. Consecutive referrals were prospectively assessed for: patient demographics, source, referral date, date received by Multidisciplinary Team (MDT), lesion size, local radiology, MDT radiology and final diagnoses. Radiology diagnosis was categorised benign, indeterminate or malignant by consensus. Delays were defined as >10...

  9. A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality

    OpenAIRE

    Stewart Mairi; Montana Carolyn; Slade Mike; Chew-Graham Carolyn; Gask Linda

    2007-01-01

    Abstract Background Generic community mental health teams (CMHTs) currently deliver specialist mental health care in England. Policy dictates that CMHTs focus on those patients with greatest need but it has proved difficult to establish consistent referral criteria. The aim of this study was to explore the referral process from the perspectives of both the referrers and the CMHTs. Methods Qualitative study nested in a randomised controlled trial. Interviews with general practitioner (GP) refe...

  10. Mental health service provision for adults with intellectual disability: sources of referrals, clinical characteristics and pathways to care

    OpenAIRE

    Tsakanikos, Elias

    2006-01-01

    There is a certain amount of ambiguity and confusion over the provision of mental health services for people with intellectual disabilities (ID) referred by both primary care services (Primary Care (PC) / Social Services (SS)) and secondary care services (Generic Mental Health Services (GMHS)). Psychosocial and clinical characteristics of new referrals (N = 791) were compared with regard to their source of referral. GMHS referrals were more likely to have schizophrenia spectrum disorder, pers...

  11. Futebol mulato: racial constructs in Brazilian football

    Directory of Open Access Journals (Sweden)

    Tiago Fernandes Maranhao

    2011-05-01

    Full Text Available The aim of this paper is to review Gilberto Freyre’s ideas about futebol mulato and the way these ideas have spread the notion of the Brazilian mulatto as a symbol of a ‘racial democracy’, unique in Brazil, around the world. The notion first appeared in 1938 in an article by Freyre for the Diários Associados, an important Brazilian newspaper. Football (soccer was employed by Freyre as the special arena where the multiracial Brazilian nation could shine and show the world a different way of being, opposed to the white and ‘rational’ way of European football. In Freyre’s work, the so-called ‘football-art’ was compared to poetry, while the European style was equated with prose. This essay argues that Freyre’s ideas were useful in constructing the Brazilian identity, a nation of harmony in all its aspects, including the area of race, and how the idea of the mulatto has been used to minimise social disparities within Brazilian society. Freyre’s ideas remain contemporary; many Brazilian intellectuals still refer to these concepts. As well, the press in this huge country, and especially in World Cup years, uses the concepts of mulatto and football-art to characterize Brazil and differentiate it from other countries.

  12. 3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

    Directory of Open Access Journals (Sweden)

    Luiz Gonzaga Coelho

    2013-04-01

    Full Text Available Significant progress has been obtained since the Second Brazilian Consensus Conference on Helicobacter pylori Infection held in 2004, in São Paulo, SP, Brazil, and justify a third meeting to establish updated guidelines on the current management of H. pylori infection. The Third Brazilian Consensus Conference on H pylori Infection was organized by the Brazilian Nucleus for the Study of Helicobacter, a Department of the Brazilian Federation of Gastroenterology and took place on April 12-15, 2011, in Bento Gonçalves, RS, Brazil. Thirty-one delegates coming from the five Brazilian regions and one international guest, including gastroenterologists, pathologists, epidemiologists, and pediatricians undertook the meeting. The participants were allocated in one of the five main topics of the meeting: H pylori, functional dyspepsia and diagnosis; H pylori and gastric cancer; H pylori and other associated disorders; H pylori treatment and retreatment; and, epidemiology of H pylori infection in Brazil. The results of each subgroup were submitted to a final consensus voting to all participants. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Seventy per cent and more votes were considered as acceptance for the final statement. This article presents the main recommendations and conclusions to guide Brazilian doctors involved in the management of H pylori infection.

  13. Overall measurements of dose to patients in common interventional cardiology procedures

    International Nuclear Information System (INIS)

    This study was designed to measure peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD) and fluoroscopy time (FT) for interventional cardiology procedures and to evaluate whether patient doses were higher than that in other published data. Three cardiac procedure types, including coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA) and radio frequency (RF) ablation, were entered into the study. Data of four special metrics (PSD, DAP, CD and FT) for these procedures were collected and measured. A total of 238 patients who underwent interventional radiology procedures participated in this study. For every procedure, data about PSD were resulted from six TLD arrays and DAP, CD and FT were collected from the displayed monitor. The mean, standard deviation (SD), range and third quartile of the distribution of PSD, DAP, CD and FT recorded and measured on spot were calculated for all procedures. High-dose cases were specifically recorded. There was wide variation in the doses observed for different instances of the same procedure. PSD for PTCA and RF ablation ranged from 0.1 Gy to more than 3 Gy. Of 238 instances, there were 22 (9.2 %) with PSDs greater than 2 Gy and 4 (1.7 %) than 3 Gy. The third quartile of the distribution for PTCA had exceeded the DIMOND preliminary reference levels by 41.1 % in DAP and 25.0 % in FT. Mean DAP was in the range of reported values for CAG procedure, but higher than all data obtained in literatures for PTCA. Data from this study are in the range of most reported values for CAG and RF ablation procedure, while higher than that obtained in some literatures for PTCA. In case of a constant delivering of high doses to patient and physician himself, thorough training of interventionalists and staff is necessary, and the legislation has to be revised and set dose constrains especially for the interventional high-dose procedures. (authors)

  14. Emergency Surgery after Failed Percutaneous Transmitral Commissurotomy (PTMC) at Armed Forces Institute of Cardiology (AFIC)

    International Nuclear Information System (INIS)

    Objective: The aim of this study was to analyze the outcome of emergency after PTMC. Design: A cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology (AFIC) Rawalpindi from January 2005 to June 2009. Patients and Methods: A cross-sectional study of 12 patients (2.3 percent) out of 523 who underwent PTMC and developed significant mitral regurgitation (MR) or cardiac tamponade (CT) was examined to analyze the outcome of emergency surgery. Transthoracic echocardiography (TTE) was used to select patients of MS with minimal calcification and transesophageal echocardiography (TEE) was used to rule out left atrial (LA) clot. Inuoe balloon was used in all cases for PTMC. Results: Out of twelve who presented for surgery after failed PTMC, 9(75 percent) had significant MR and 3(25 percent) had CT. Majority of patients were female (83.3 percent) with mean age of 30.9+-5.12 years. In patients with MR, anterior mitral leaflet (AML) tear was found in 8(66.7 percent) and posterior mitral leaflet tear in 1(8.3 percent). LA clot was found in 1(8.3 percent) patient who caused cerebral infarction. All patients underwent mitral valve replacement (MVR) with prosthetic valve on cardiopulmonary bypass (CPB). Two patients (16.7 percent) died; one because of cerebral infarction and one due to low cardiac output syndrome (LCOS). Conclusion: With increasing experience of PTMC the magnitude of failure cases is decreasing as was seen in our case in which failed percentage was just 2.3 percent. Moreover, percentage of success of emergency surgery was good i.e. 83.3 percent. In case of failure a well coordinated effort between cardiologist and surgical team can prevent mortality significantly. (author)

  15. Fetal cardiology: changing the definition of critical heart disease in the newborn.

    Science.gov (United States)

    Słodki, M; Respondek-Liberska, M; Pruetz, J D; Donofrio, M T

    2016-08-01

    Infants born with congenital heart disease (CHD) may require emergent treatment in the newborn period. These infants are likely to benefit the most from a prenatal diagnosis, which allows for optimal perinatal planning. Several cardiac centers have created guidelines for the management of these high-risk patients with CHD. This paper will review and compare several prenatal CHD classification systems with a particular focus on the most critical forms of CHD in the fetus and newborn. A contemporary definition of critical CHD is one which requires urgent intervention in the first 24 h of life to prevent death. Such cardiac interventions may be not only life saving for the infant but also decrease subsequent morbidity. Critical CHD cases may require delivery at specialized centers that can provide perinatal, obstetric, cardiology and cardiothoracic surgery care. Fetuses diagnosed in mid-gestation require detailed fetal diagnostics and serial monitoring during the prenatal period, in order to assess for ongoing changes and identify progression to a more severe cardiac status. Critical CHD may progress in utero and there is still much to be learned about how to best predict those who will require urgent neonatal interventions. Despite improved therapeutic capabilities, newborns with critical CHD continue to have significant morbidity and mortality due to compromise that begins in the delivery room. Fetal echocardiography is the best way to predict the need for specialized care at birth to improve outcome. Once the diagnosis is made of critical CHD, delivery at the proper time and in appropriate institution with specific care protocols should be initiated. More work needs to be done to better delineate the risk factors for progression of critical CHD and to determine which newborns will require specialized care. The most frequently described forms of critical CHD requiring immediate intervention include hypoplastic left heart syndrome with intact or severely restricted

  16. Development of a tele-stethoscope and its application in pediatric cardiology.

    Science.gov (United States)

    Hedayioglu, F L; Mattos, S S; Moser, L; de Lima, M E

    2007-01-01

    Over the years, many attempts have been made to develop special stethoscopes for the teaching of auscultation. The objective of this article is to report on the experience with the development and implementation of an electronic stethoscope and a virtual library of cardiac sounds. There were four stages to this project: (1) the building of the prototype to acquire, filter and amplify the cardiac sounds, (2) the development of a software program to record, reproduce and visualize them, (3) the testing of the prototype in a clinical scenario, and (4) the development of an internet site, to store and display the sounds collected. The first two stages are now complete. The prototype underwent an initial evaluation in a clinical scenario within the Unit and during virtual out-patient clinical sessions. One hundred auscultations were recorded during these tests. They were reviewed and discussed on-line by a panel of experience cardiologists during the sessions. Although the sounds were considered "satisfactory" for diagnostic purposes by the cardiology team, they identified some qualitative differences in the electronic recorded auscultations, such as a higher pitch of the recorded sounds. Prospective clinical studies are now being conducted to further evaluate the interference of the electronic device in the physicians' capability to diagnose different cardiac conditions. An internet site (www.caduceusvirtual.com.br/ auscultaped) was developed to host these cardiac auscultations. It is set as a library of cardiac sounds, catalogued by pathologies and already contains examples from auscultations of the majority of common congenital heart lesions, such as septal defects and valvar lesions. PMID:17249332

  17. Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics

    Directory of Open Access Journals (Sweden)

    Mario Montealegre-Gallegos

    2016-01-01

    Full Text Available Background: Proficiency in transthoracic echocardiography (TTE requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. Methods and Results: During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions. The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. Conclusion: Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE.

  18. Radiation doses in flat detector digital systems in Interventional Cardiology procedures

    International Nuclear Information System (INIS)

    The purpose of the study was to investigate patient radiation doses in flat detector (FD) digital X-ray systems in Interventional Cardiology procedures in three of the busiest haemodynamic departments in Greece and compare the results with the corresponding reference levels (RLs). Material and method: 569 Coronary Angiography (CA) and 571 Percutaneous Transluminal Coronary Angioplasties (PTCA) were investigated since these two procedures are the most frequently performed in haemodynamic units. Patient data collected were: sex, age, weight, height, Dose Area Product (DAP), fluoroscopy time (T) and total number of frames (F). Results: Median values of DAP and F in CA were: 31.0 Gycm2 and 752 in Hospital A, 35.3 Gycm2 and 487 in Hospital B and 21.1 Gycm2 and 461 in Hospital C. Median values of DAP and F in PTCA were: 63.2 Gycm2 and 1274 in Hospital A, 90.3 Gycm2 and 974 in Hospital B and 35.6 Gycm2 and 582 in Hospital C. Concerning T, the timer in Hospital C malfunctioned, whereas in hospitals A and B examination time was 4.7 and 3.6 min for CA and 10.3 and 12.7 min for PTCA, respectively. The results reveal a noted variability between hospitals especially in PTCA. However, patient dose values are lower than RLs (45 and 85 Gycm2 in CA and PTCA respectively). Conclusions: Large variations between patient dose values and main technical parameters were revealed when using FD digital systems in Greece. Dose optimization can be greatly achieved through continuous staff education in radiation protection issues. Moreover, the standardization of IC procedures in digital flat panel systems will definitely decrease patient and staff doses. (author)

  19. How electricity was discovered and how it is related to cardiology.

    Science.gov (United States)

    de Micheli-Serra, Alfredo; Iturralde-Torres, Pedro; Izaguirre-Ávila, Raúl

    2012-01-01

    We relate the fundamental stages of the long road leading to the discovery of electricity and its uses in cardiology. The first observations on the electromagnetic phenomena were registered in ancient texts; many Greek and Roman writers referred to them, although they provided no explanations. The first extant treatise dates back to the XIII century and was written by Pierre de Maricourt during the siege of Lucera, Italy, by the army of Charles of Anjou, French king of Naples. There were no significant advances in the field of magnetism between the appearance of this treatise and the publication of the study De magnete magneticisque corporibus (1600) by the English physician William Gilbert. Scientists became increasingly interested in electromagnetic phenomena occurring in certain fish, i.e., the so-called electric ray that lived in the South American seas and the Torpedo fish that roamed the Mediterranean Sea. This interest increased in the 18th century, when condenser devices such as the Leyden jar were explored. It was subsequently demonstrated that the discharges produced by "electric fish" were of the same nature as those produced in this device. The famous "controversy" relating to animal electricity or electricity inherent to an animal's body also arose in the second half of the 18th century. The school of thought of the physicist Volta sustained the principle of a single electrical action generated by metallic contact. This led Volta to invent his electric pile, considered as the first wet cell battery. Toward the middle of the XIX century, the disciples of the physiologist Galvani were able to demonstrate the existence of animal electricity through experiments exploring the so-called current of injury. On the path of Volta's approach, many characteristics of electricity were detailed, which ultimately led to their usage in the industrial field. The route followed by Galvani-Nobili-Matteucci led to the successes of Waller, Einthoven, etcetera, enabling the

  20. Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Maria Antonieta P. de Moraes

    2013-11-01

    Full Text Available OBJECTIVE: To assess the effectiveness of healthcare team guidance in the implementation of a glycemic control protocol in the non-intensive care unit of a cardiology hospital. METHODS: This was a randomized clinical trial comparing 9 months of intensive guidance by a healthcare team on a protocol for diabetes care (Intervention Group, n = 95 with 9 months of standard care (Control Group, n = 87. Clinicaltrials.gov: NCT01154413. RESULTS: The mean age of the patients was 61.7±10 years, and the mean glycated hemoglobin level was 71±23 mmol/mol (8.7±2.1%. The mean capillary glycemia during hospitalization was similar between the groups (9.8±2.9 and 9.1±2.4 mmol/l for the Intervention Group and Control Group, respectively, p = 0.078. The number of hypoglycemic episodes (p = 0.77, hyperglycemic episodes (47 vs. 50 in the Intervention Group and Control Group, p = 0.35, respectively, and the length of stay in the hospital were similar between the groups (p = 0.64. The amount of regular insulin administered was 0 (0-10 IU in the Intervention Group and 28 (7-56 IU in the Control Group (p<0.001, and the amount of NPH insulin administered was similar between the groups (p = 0.16. CONCLUSIONS: While guidance on a glycemic control protocol given by a healthcare team resulted in a modification of the therapeutic strategy, no changes in glycemic control, frequency of episodes of hypoglycemia and hyperglycemia, or hospitalization duration were observed.

  1. Spatial and temporal overview of research in pediatric and congenital cardiology: trends and global challenges.

    Science.gov (United States)

    Bräutigam, Martina; Kempny, Aleksander; Radke, Robert; Baumgartner, Helmut; Diller, Gerhard-Paul

    2014-08-01

    Available information on the global distribution of research output in pediatric cardiology (PC) is sparse. This study took a bibliometric approach to characterize research output, assess the level of competition, describe the geographic distribution of the leading research centers in the field, and investigate determinants of research output. In addition, the study characterized the journals publishing PC research and identified temporal trends in research interest over time. Publications presenting original research in PC between 1995 and 2011 were identified. A total of 9,410 relevant articles were identified based on a PubMed search followed by subsequent electronic filtering and manual review. A dramatic increase in PC publications was seen during the study period (from 309 in 1995 to 1,075 in 2011). This was accompanied by an increase in impact factors and an overproportional rise in PC contributions relative to the general PubMed trend. Research in PC was shown to be highly competitive and becoming increasingly so (Herfindahl-Hirschman index of 1.64%). Research output correlated with gross domestic product, national levels of corruption, education, urbanization, geography, and presence of national centers of excellence. The data presented in this report allow benchmarking of different cities and countries and provide insights into the potential determinants of high-quality publications and the spectrum of publishing journals. The report also highlights the central role of subspecialty journals and shows that PC research output is related to national wealth, surrogates of appropriate use of resources, an adequate workforce, and education. Additionally, it emphasizes the potential beneficial effects of establishing centers of excellence in the field. PMID:24584212

  2. Appropriate use criteria in clinical routine practice: implications in a nuclear cardiology lab.

    Science.gov (United States)

    Gimelli, Alessia; Rovai, Ilaria; Liga, Riccardo; Pasanisi, Emilio Maria; Marzullo, Paolo

    2016-06-01

    The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a cohort of consecutive patients referred to our nuclear cardiology laboratory to perform stress myocardial perfusion imaging (MPI) and to assess the relationships between test appropriateness and the evaluation of ischaemia. A cohort of 251 consecutive patients, admitted to our Institute from January to March 2015, who underwent stress/rest MPI on a dedicated cardiac camera equipped with cadmium-zinc-telluride detectors, was selected. The level of clinical appropriateness of each MPI test was categorized in each patient according to the AUC criteria. According to the accepted criteria, the majority of the MPI stress-tests could be classified as clinically appropriate (218 of 251, 87 % of the tests), while only 16 (6 %) and 17 (7 %) resulted of uncertain appropriateness or clearly inappropriate, respectively. Of the 251 appropriate tests, 22 (10 %), 65 (30 %), and 131 (60 %) showed the presence of a mild (SDS < 4), moderate (4 ≥ SDS < 7), and severe (SDS ≥ 7) ischemic burden, respectively, while none of the inappropriate test showed moderate-to-severe ischaemia (P < 0.001 for comparisons). The rate of inappropriate MPI tests is considerably low in a high-volume laboratory. Appropriate and inappropriate studies identify patients at high and low probability of significant ischemia, respectively, providing insights on the effects of the level of appropriateness on stress-test results. PMID:26961179

  3. Dose assessment during the commissioning of flat detector imaging systems for cardiology

    International Nuclear Information System (INIS)

    Incident air kerma (IAK) and entrance surface air kerma (ESAK) have been measured for a range of copper (Cu) absorbers (1-10 mm) and polymethylmethacrylate (PMMA) slabs (12-28 cm) with kilovolt values ranging from 61 to 120 during the commissioning of an X-ray system equipped with a flat detector used in interventional cardiology procedures. Numerical parameters on image quality have also been measured for different X-ray beam qualities using the plastic wall of the ionisation chamber. When moving from 1 to 10 mm of Cu, IAK per frame increased to a factor of 38 for cine and 27 for fluoroscopy. A cine frame requires 60-116 times more IAK than a fluoroscopy frame. As for PMMA, when the backscatter factor is included (simulating real conditions with patients), and when moving from 12 to 28 cm, the increases in ESAK are 16 times for cine and 10 times for fluoroscopy. Because of the differences in X-ray beam quality for cine and fluoroscopy modes, the Cu thicknesses necessary to drive the generator to equivalent kilovolts resulted in the following values (cine and fluoroscopy, respectively): 12 cm of PMMA (1 and 1.5 mm Cu), 20 PMMA (2.5 and 3.5 mm Cu) and 28 cm PMMA (4.5 and 8.5 mm Cu). With the analysis of IAK, ESAK and image quality, one can verify the appropriate settings of the X-ray system and obtain baseline information for constancy checks and help cardiologists in the management of patient doses by knowing the dose increase factors and image quality changes when increasing patient thickness or using different C-arm projections. (authors)

  4. A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality

    Directory of Open Access Journals (Sweden)

    Stewart Mairi

    2007-07-01

    Full Text Available Abstract Background Generic community mental health teams (CMHTs currently deliver specialist mental health care in England. Policy dictates that CMHTs focus on those patients with greatest need but it has proved difficult to establish consistent referral criteria. The aim of this study was to explore the referral process from the perspectives of both the referrers and the CMHTs. Methods Qualitative study nested in a randomised controlled trial. Interviews with general practitioner (GP referrers, CMHT Consultant Psychiatrists and team leaders. Taping of referral allocation meetings. Results There was a superficial agreement between the referrers and the referred to on the function of the CMHT, but how this was operationalised in practice resulted in a lack of clarity over the referral process, with tensions apparent between the views of the referrers (GPs and the CMHT team leaders, and between team members. The process of decision-making within the team was inconsistent with little discussion of, or reflection on, the needs of the referred patient. Conclusion CMHTs describe struggling to deal with GPs who are perceived as having variable expertise in managing patients with mental health problems. CMHT rhetoric about defined referral criteria is interpreted flexibly with CMHT managers and Psychiatrists concentrating on their own capacity, roles and responsibilities with limited consideration of the primary care perspective or the needs of the referred patient. Trial Registration number ISRCTN86197914

  5. Improving service delivery by evaluation of the referral pattern and capacity in a clinical genetics setting.

    Science.gov (United States)

    McCann, Emma; Baines, Elizabeth A; Gray, Jonathon R; Procter, Annie M

    2009-08-15

    Quality improvement in specialist services such as clinical genetics is challenging largely due to the complexity of the service and the difficulty in obtaining accurate, reproducible, and measurable data. The objectives were to evaluate the pattern of referrals to the All Wales Medical Genetics Service (AWMGS) North Wales Genetics team based in three separate hospitals, define the capacity of the team and implement change to improve equity, timeliness and efficiency of care delivery to patients. The methodology required collating the monthly referral rates retrospectively for each center over a 2.5-year period and plotting on statistical process control charts. Process mapping of the referral process in each center was undertaken, differences documented and a common pathway implemented. "Did not attend" and "time to first appointment" rates were also measured in one center. PDSA methodology was used to implement "patient focused booking." The results show that the range for referral rates in any given month for each center was 3-33 referrals. The range for referral rate for the whole team was 18-64 per month. Since January 2004 the average number of monthly referrals to the North Wales service has increased by 50%. The potential range in monthly referrals varies between centers and the range of the variability has also increased also in two out of the three centers. Introduction of Patient Focused Booking reduced the "Failed to Attend" rate and 100% of patients were offered a choice of appointments. In addition 100% had a first face-to-face contact within 6 weeks if they chose. The measurement of improvement involved firstly introducing a series of continuous measures to provide a baseline for the process prior to the implementation of any changes and secondly to indicate the impact of the changes following implementation. The measures implemented included process (referrals numbers, percentage of patients offered a choice of appointments), outcome (percentage of

  6. Single-photon emission computer tomography (SPECT) and positron emission tomography (PET) imaging in cardiology

    International Nuclear Information System (INIS)

    Nuclear imaging procedures are well-established diagnostic tools in clinical cardiology, providing noninvasive information about myocardial perfusion, cardiac function and metabolism. Scintigraphic parameters provide relevant information that aids in everyday clinical decision making for referring physicians. During the past two decades the clinical role of nuclear medicine procedures in cardiology has evolved significantly. At the beginning, the diagnostic role of nuclear medicine in detecting myocardial ischemia in patients with suspected coronary artery disease has been emphasized and myocardial perfusion imaging with exercise or pharmacological stress testing is a widely accepted technique for the detection and localization of coronary artery disease. The development of Tc-99m labeled perfusion tracers permits combined myocardial perfusion and left ventricular (LV) function studies at a single testing interval. Thus, the potential advantages of simultaneous assessment of myocardial perfusion ad LV function have been recently outlined. Gated imaging of the perfused myocardium is a well-established technique for this purpose, with a single injection of a Tc-99m labeled perfusion tracer. Recent data have demonstrated the impact and clinical role of these studies in the diagnosis of patients with suspected or known coronary artery disease. The addition of functional information to perfusion data has shown to improve the detection of multi-vessel disease. Subsequently, cardiac radionuclide imaging has made significant advances in the determination of prognosis in patients with ischemic heart disease, preoperative risk assessment for patients undergoing non-cardiac surgery and assessment of the efficacy of revascularization in patients undergoing coronary artery bypass surgery or interventional procedures. A key role of myocardial perfusion imaging has been its ability to provide prognostic information in patients after acute myocardial infarction, in patients with

  7. The cost-effectiveness of exercise referral schemes

    Directory of Open Access Journals (Sweden)

    Anokye Nana K

    2011-12-01

    Full Text Available Abstract Background Exercise referral schemes (ERS aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting. Methods A decision analytic model was developed to estimate the cost-effectiveness of ERS from a UK NHS perspective. The costs and outcomes of ERS were modelled over the patient's lifetime. Data were derived from a systematic review of the literature on the clinical and cost-effectiveness of ERS, and on parameter inputs in the modelling framework. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY. Deterministic and probabilistic sensitivity analyses investigated the impact of varying ERS cost and effectiveness assumptions. Sub-group analyses explored the cost-effectiveness of ERS in sedentary people with an underlying condition. Results Compared with usual care, the mean incremental lifetime cost per patient for ERS was £169 and the mean incremental QALY was 0.008, generating a base-case incremental cost-effectiveness ratio (ICER for ERS at £20,876 per QALY in sedentary individuals without a diagnosed medical condition. There was a 51% probability that ERS was cost-effective at £20,000 per QALY and 88% probability that ERS was cost-effective at £30,000 per QALY. In sub-group analyses, cost per QALY for ERS in sedentary obese individuals was £14,618, and in sedentary hypertensives and sedentary individuals with depression the estimated cost per QALY was £12,834 and £8,414 respectively. Incremental lifetime costs and benefits associated with ERS were small, reflecting the preventative public health context of the intervention, with this resulting in estimates of cost

  8. Endoscopicretrogradecholangiopancreatography outcome from a single referral center in Iran

    Institute of Scientific and Technical Information of China (English)

    Amir H Mohammad Alizadeh; Esmaeil S Afzali; Mirhadi Mousavi; Yaghoub Moaddab; Mohammad R Zali

    2010-01-01

    BACKGROUND: Endoscopic retrograde cholangiopancreato-graphy (ERCP) is the ifrst choice for diagnostic evaluation of the pancreatic and biliary tree and can be accompanied by a high diagnostic sensitivity and a poor therapeutic outcome. In the current study, we described our experiences in the indications, ifndings, and technical success of ERCP in a sample of the Iranian population admitted to a referral center in Iran. METHODS: In a retrospective review database-based study, 780 patients (393 males and 387 females;mean age 57.5 years) who had undergone diagnostic and therapeutic ERCP with the primary diagnosis of hepatobiliary disorder between 2006 and 2008 at Taleghani Hospital in Tehran were reviewed. The key data were demographic characteristics, clinical information, laboratory parameters, as well as post-ERCP complications. RESULTS: A history of cholecystectomy was found in about one-third (36.3%) of participants and 80 (10.3%) out of 780 patients had a previous history of biliary stone. A minority (1.4%) of the patients suffered from hepatobiliary carcinomas, and 11 patients had cirrhosis. The most common clinical manifestations in the patients undergoing diagnostic ERCP were icterus (47.3%), weight loss (31.2%), and dark urine (26.9%). Selective biliary cannulation was technically successful in 87.0% of the patients; however, cannulation failed in 13.0%. The most frequent ifnal diagnosis of ERCP was common bile duct stone that was detected in 40.1% of the patients. The ERCP results in 11.0%of the patients were normal. Regarding appropriate treatment, successful stenting was performed in 43 patients (15.2%). Among post-ERCP complications, pancreatitis was the most adverse event with an incidence rate of 3.3%. Other complications including local bleeding, cholangitis and gastrointestinal perforation, rarely occurred. Post-ERCP pancreatitis was reported in 1.8%of men and 3.6%of women (P=0.120). Pancreatitis was more common in women below 70 years than

  9. Referral to the Hospital And Emergency Ambulance Service Uses Patterns of the Inmates and Convicts

    Directory of Open Access Journals (Sweden)

    Emine Oncu

    2014-03-01

    Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.

  10. Perceptions and Referral Trends into Phase I Oncology Trials: Results of a Clinical Survey

    Directory of Open Access Journals (Sweden)

    Andre Brunetto

    2011-01-01

    Full Text Available Introduction. A survey was sent to referring oncologists (ROs to explore the reasons behind their referral patterns and perceptions of Phase I studies before and after being provided with outcome data from advanced colorectal cancer (ACRC patients who participated in Phase I trials at the Royal Marsden Hospital (RMH. Results. The response rate was 32/50 (64%. The most common reason for referral was exhaustion of standard treatments (31%, and the main reason for referring to the RMH was proximity to patients (28%. The most frequent clinical parameter assessed prior to referral was performance status (93%. ROs spent a median of 15 min (range: 5–45 min discussing general aspects of Phase I trials. In the second part of the questionnaire, after reviewing clinical outcome data of ACRC patients who participated in Phase I trials, 47% would change their approach, specifically, spend more time to discuss risks and benefits of Phase I trials (9%, consider prognostic factors before referral (13%, and increase the number of referrals (25%. Conclusion. This is the first report focusing on communication between ROs and a specialist Phase I unit. Outcome reporting can improve communication with ROs and importantly has the potential for better patient selection considered for Phase I oncology trials.

  11. Referral letter: evaluation of quality of communication between Primary Health Care and Otolaryngology.

    Directory of Open Access Journals (Sweden)

    Pelegrín-Hernández JP, Hernández-Cervantes AE, Estevez-Monción A, Hellín-Meseguer D, Amorós-Rodriguez LM.

    2012-11-01

    Full Text Available The Referral letter, is a fundamental tool in the link between Primary Care and second care level. So the main objective of this study is to evaluate the quality of this document on Otolaryngology Department as a high demand specialty. For this purpose, we conducted a prospective, descriptive and observational study, which analyzed all referral letter sent it from Primary Health Care Centers for a month, and used quality criteria previously defined by Izabal et al.The study included 144 referral letters, which 40.3% were male and 59.7% women, mean age was 50 years. In reference to the quality level, we found that 77.1%, was acceptable, 13.9% good and 9% poor. Regarding compliance with quality criteria, we were found very different results, appearing as readability parameters and current condition in a high number of psychiatric liaison, against personal history and physical exam came barely reflected. In conclusion we can say, there are an improvement can be done, mainly in the sections on physical examination and medical history. To achieve this goal is important and appropriate to develop a referral guide, which clearly establishes the guidelines to follow in the referral patient process.

  12. Referral for anorectal function evaluation is indicated in 65% and beneficial in 92% of patients

    Institute of Scientific and Technical Information of China (English)

    Maria M Szojda; Erik Tanis; Chris JJ Mulder; Richelle JF Felt-Bersma

    2008-01-01

    AIM: To determine the indicated referrals to a tertiary centre for patients with anorectal symptoms, the effect of the advised treatment and the discomfort of the tests.METHODS: In a retrospective study, patients referred for anorectal function evaluation (AFE) between May 2004 and October 2006 were sent a questionnaire, as were the doctors who referred them. AFE consisted of anal manometry, rectal compliance measurement and anal endosonography. An indicated referral was defined as needing AFE to establish a diagnosis with clinical consequence (fecal incontinence without diarrhea, 3rd degree anal sphincter rupture, congenital anorectal disorder, inflammatory bowel disease with anorectal complaints and preoperative in patients for re-anastomosis or enterostoma, anal fissure, fistula or constipation). Anal ultrasound is always indicated in patients with fistula, anal manometry and rectal compliance when impaired continence reserve is suspected. The therapeutic effect was noted as improvement, no improvement but reassurance, and deterioration.RESULTS: From the 216 patients referred, 167 (78%)returned the questionnaire. The referrals were indicated in 65%. Of these, 80% followed the proposed advice.Improvement was achieved in 35% and a reassurance in 57% of the patients, no difference existed between patient groups. On a VAS scale (1 to 10) symptoms improved from 4.0 to 7.2. Most patients reported no or little discomfort with AFE.CONCLUSION: Referral for AFE was indicated in 65%.Beneficial effect was seen in 92%: 35% improved and 57% was reassured. Advice was followed in 80%. Better instruction about indication for AFE referral is warranted.

  13. Cardiac troponins-Translational biomarkers in cardiology: Theory and practice of cardiac troponin high-sensitivity assays.

    Science.gov (United States)

    Adamcova, Michaela; Popelova-Lencova, Olga; Jirkovsky, Eduard; Simko, Fedor; Gersl, Vladimir; Sterba, Martin

    2016-01-01

    Tn is a unique translational biomarker in cardiology whose potential has not been diminished in the new era of high sensitive assays. cTns can be valuable markers in cardiac diseases as well as in infectious diseases and respiratory diseases. Furthermore, the role of cTns is growing in the routine evaluation of cardioxicity and in determining the efficacy/safety ratio of novel cardioprotective strategies in clinical settings. cTns can detect myocardial injury not only in a wide spectrum of laboratory animals in experimental studies in vivo, but also in isolated heart models or cardiomyocytes in vitro. The crucial issue regarding the cross-species usage of cardiac troponin investigation remains the choice of cardiac troponin testing. This review summarizes the recent proteomic data on aminoacid sequences of cTnT and cTnI in various species, as well as selected analytical characteristics of human cardiac troponin high-sensitivity assays. Due to the highly phylogenetically conserved structure of troponins, the same bioindicator can be investigated using the same method in both clinical and experimental cardiology, thus contributing to a better understanding of the pathogenesis of cardiac diseases as well as to increased effectiveness of troponin use in clinical practice. Measuring cardiac troponins using commercially available human high-sensitivity cardiac troponin tests with convenient antibodies selected on the basis of adequate proteomic knowledge can solve many issues which would otherwise be difficult to address in clinical settings for various ethical and practical reasons. Our survey could help elaborate the practical guidelines for optimizing the choice of cTns assay in cardiology. © 2016 BioFactors, 42(2):133-148, 2016. PMID:26876101

  14. [Distance methods of cardiologic monitoring in diagnostics of high loading effects on organism of sportsman and cosmonaut].

    Science.gov (United States)

    Kuznetsov, V I; Ryzhakov, N I; Tarakanov, S A; Nikitenko, A N; Rassadina, A A; Kozlenok, A V; Moroshkin, V S

    2012-01-01

    Increase of cardiovascular tension is a common thing for professional athletic training. Cardiovascular pathologies can be prevented by permanent physiological monitoring using, among others, the methods of cardiologic monitoring so far available in stationary diagnostic centers. On-line remote diagnostics during training is potent to enhance effectiveness and efficiency of sporting people's health management. In addition, RD will also enable extensive investigations of the bodily responses of individually determined training loads. The paper gives an overview of the current RM technologies. PMID:23457962

  15. Impact of Sterilisation and Strain Hardening in Drawing Process on Resistance to Electrochemical Corrosion of Wires Intended in Cardiology

    Directory of Open Access Journals (Sweden)

    Przondziono J.

    2016-03-01

    Full Text Available The study presents results of tests of impact of work hardening in cold drawing process, surface treatment and sterilisation on resistance to electrochemical corrosion of wires made of stainless steel X2CrNiMo 17-12-2 intended for cardiology. Potentiodynamic tests were performed on the ground of registered anodic polarisation curves in artificial plasma solution. Static uniaxial tension test made the ground for determination of strength characteristics of wires and the flow curve. Functions presenting the change of polarisation resistance according to strain applied in drawing process were selected.

  16. A review of tuberculosis-related referrals among children in Ireland.

    LENUS (Irish Health Repository)

    Iroh Tam, P Y

    2012-02-01

    BACKGROUND: Immigration has been shown to have an increasingly important effect on the epidemiology of tuberculosis (TB) in developed countries. AIM: To review patterns of TB-related referrals to a paediatric infectious diseases clinic. METHODS: Retrospective chart review of TB-related referrals of children attending the Rainbow Clinic at OLCHC between 2003-2005. RESULTS: Forty-seven children were assessed: 18 referred from public health clinics, 5 from general practitioners, and 24 from paediatricians. Most common reason for referral was history of TB exposure (60%). Eighteen (38%) were female, 29 (62%) were male. Thirteen (28%) had latent TB, and 17 (36%) had active disease. Of children with TB disease, 25 (83%) were Caucasian Irish, and the remainder was African. Twenty-five children completed TB treatment and were discharged, and 2 (7%) were lost to follow-up. CONCLUSION: Our study highlights the problem of TB in children, the majority of whom are native to this country.

  17. Dalayed referral of lower limb amputees for rehabilitation; an audit study

    International Nuclear Information System (INIS)

    determine the causes of delayed referral of lower limb amputees for rehabilitation. Study Design: Descriptive study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from April 2012 to July 2012. Patient and Methods: Thirty two patient cases of lower limb amputation were included. They were referred cases to AFIRM from operational areas and CMHs all over Pakistan for provision of prosthesis and rehabilitation. Results: A total of 32 lower limbamputees' male patients with mean age 29 years were included in the study. Transtibial level was the most common amputation 19(57.6 %). Improvised Explosive Device (IED) was the most common mode of injury 19(57.6 %). 34.37 % patients were delayed due to leave granted to them at local set ups before referral to AFIRM for rehabilitation. Conclusion: Delayed referral for rehabilitation has poor impact on rehabilitation of an amputee. (author)

  18. Paediatric orbital fractures: the importance of regular thorough eye assessment and appropriate referral.

    Science.gov (United States)

    Kassam, Karim; Rahim, Ishrat; Mills, Caroline

    2013-01-01

    The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated "red flags", and appropriate referral are discussed in this short paper. PMID:24349804

  19. Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

    Directory of Open Access Journals (Sweden)

    Karim Kassam

    2013-01-01

    Full Text Available The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated “red flags”, and appropriate referral are discussed in this short paper.

  20. High Age Predicts Low Referral of Hyperthyroid Patients to Specialized Hospital Departments

    DEFF Research Database (Denmark)

    Carlé, Allan; Pedersen, Inge Bülow; Perrild, Hans; Ovesen, Lars; Jørgensen, Torben; Laurberg, Peter Marsvin

    2013-01-01

    Background: Hospital-based studies may be hampered by referral bias. We investigated how the phenomenon may influence studies of hyperthyroid patients. Methods: By means of a computer-based linkage to the laboratory database and subsequent detailed evaluation of subjects with abnormal test results......, we prospectively identified all 1,148 patients diagnosed with overt hyperthyroidism in a four-year period in and around Aalborg City, Denmark. Each patient was classified according to nosological type of hyperthyroidism. We studied the referral pattern of patients to local hospital units, and...... analyzed how referral depended on subtype of disease, sex, age, and degree of biochemical hyperthyroidism. Results: In a 4-year period, 1,032 hyperthyroid patients were diagnosed at primary care offices, and 435 of these (42.2%) were referred to specialized units, 92 patients had hyperthyroidism diagnosed...