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Biomedical subjects

D J West

Publications and source records attributed to D J West.

At least 37 records · Page 2Linked to original sources
PubMed1998

Qualitative evaluation of a health management education partnership.

Results of ongoing cooperation of four educational institutions in the field of Health Management Education in Slovakia are reviewed. The specific benefit of multilateral collaboration for the situation in central Europe is discussed in the context of a Health Management Education Partnership (HMEP). The project is based on a grant from the United States Agency for International Development (USAID) with assistance from the American International Health Alliance (AIHA). The U.S. partner is the University of Scranton, Scranton, Pennsylvania. Three organizations are involved in the partnership from the Slovak Republic: Trnava University, University of Matej Bel in Banska Bystrica and the Health Management School (HMS) in Bratislava, each having specific priority and focus in health management education. The HMEP program is designed to reach about 30 teachers of health administration as well as 200 undergraduates, senior and middle managers from health service organizations every year. The collaborative endeavor stimulates the communication and creation of personal and human relations, not only on an individual and institutional level, but on a community as well as national and international level. The project supports the development of knowledge and skills, professional identity and educational processes in health management. The emphasis is on increasing the quality of education and training in Slovakia through multilateral collaboration, curricula development, professional development, symposia, support of consultancies and accreditation. Specific areas of content are designed to address health policy, law, ethics, insurance and quality improvement.

Accreditation↗
PubMed1998

Accreditation processes in the Slovak Republic.

This article provides a conceptual framework for understanding changes occurring in the accreditation process for institutions of higher learning in the Slovak Republic. Health sector transformation is occurring rapidly throughout the Central and Eastern European region as former socialist states are experimenting with market-oriented approaches. Educators and universities are playing an important role in the development of knowledge, skills and abilities of current and future health practitioners. Accreditation is viewed as an important process in the continuing development of quality health service management curricula and preparing competent practitioners for the health care field. Historical considerations are examined as well as future directions for accreditation in the Slovak Republic.

Accreditation↗
PubMed1998

Privatization, social structures and delivery of health care in the Slovak Republic.

Each country in Central and Eastern Europe has developed a variety of strategies for implementing interventions and improvements in their health care delivery system. Transformation efforts in the Slovak Republic have focused on decentralization, privatization, democratization and liberalization. While the pressures for change have unevenly fallen throughout Central and Eastern Europe, the Slovak Republic has initiated structural changes, particularly in the area of privatization. The concept of privatization requires further discussion especially when considering the principle of subsidiarity and the need to develop coherent social structures. Areas for structural changes in the Slovak Republic are examined in the area of privatization of transformation efforts. Characteristics of successful voluntary organizations in private economies are discussed with appropriate future concerns identified for further analysis.

Accreditation↗
PubMed1997

Safety and immunogenicity of a bivalent Haemophilus influenzae type b/hepatitis B vaccine in healthy infants. Hib-HB Vaccine Study Group.

OBJECTIVE: To assess the safety, tolerability and immunogenicity of COMVAX, a liquid, bivalent Haemophilus influenzae type b-hepatitis B vaccine, containing the polyribosylribitol phosphate (PRP)-Neisseria meningitidis outer membrane protein complex conjugate used in the Hib vaccine, PedvaxHIB, and the yeast-derived hepatitis B surface antigen (HBsAg) used in the HB vaccine, RECOMBIVAX HB. DESIGN: Eight hundred eighty-two healthy infants, approximately 2 months of age, were enrolled in an open, multicenter (n = 11) clinical trial and randomized to receive either COMVAX (7.5 micrograms of PRP/5 micrograms of HBsAg in 0.5 ml) or concurrent injections of the liquid formulation of PedvaxHIB (P) (7.5 micrograms of PRP in 0.5 ml) and RECOMBIVAX HB (R) (5 micrograms of HBsAg in 0.5 ml) at 2, 4 and 12 or 15 months of age. Safety and tolerability were monitored after each injection. The serum concentrations of anti-PRP and anti-HBs were determined at the time of each vaccination, 2 months after the second vaccination and 1 month after the third vaccination. RESULTS: COMVAX was well-tolerated and proved to be immunologically comparable with a series of concomitant P+R injections. There were no serious adverse experiences attributable to the study vaccines. The most commonly reported nonserious adverse experiences were all events prelisted on diary cards given to parents. These included generally mild and transient signs of inflammation at the injection site (pain/ soreness, erythema, swelling/induration), somnolence and irritability. Because children are at peak risk of invasive Hib disease during the first year of life, 6 months of age (2 months after the second dose of vaccine) was designated the time of primary interest with regard to the development of anti-PRP. At that time 94.8% of the infants given COMVAX had > 0.15 microgram/ml of anti-PRP and 72.4% had > 1.0 microgram/ ml, with a geometric mean concentration (GMC) of 2.5 micrograms/ml, compared with 95.2%, 76.3% and 2.8 micrograms/ml, respectively, in recipients of P+R. The third injection given at 12 or 15 months of age induced a secondary rise in antibody. The proportions with > 0.15 microgram/ml and > 1.0 microgram/ml of anti-PRP increased to 99.3 and 92.6%, respectively, and the GMC rose to 9.5 micrograms/ml among COMVAX recipients, compared with 98.9%, 92.3% and 10.2 micrograms/ml in children given concurrent injections of P+R. In contrast to Hib few infants in countries with low endemicity of HBV infection are at near term risk of exposure to virus. Consequently the anti-HBs response after the last dose of vaccine was designated the outcome of primary interest. At 13 to 16 months of age (1 month after the third dose of vaccine) 98.4% of children given COMVAX had a protective anti-HBs concentration of > or = 10 mIU/ml with a GMC of 4468 mIU/ml, compared with 100% and a GMC of 6944 mIU/ml among children given P+R. CONCLUSIONS: COMVAX is well-tolerated by healthy infants and can induce immunity against invasive Hib disease and HBV infection using only three injections compared with six injections if separate courses of monovalent PedvaxHIB and RECOMBIVAX HB are given.

Antibodies, Bacterial↗
PubMed1997

Immunogenicity of hepatitis B vaccine in preterm infants.

OBJECTIVE: To determine the immunogenicity of hepatitis B vaccine in preterm infants when the first dose of vaccine is delayed until hospital discharge. METHODS: One hundred two preterm infants (23 to 36 weeks gestational age) born to hepatitis B surface antigen-negative mothers were enrolled. Immunization was initiated just before hospital discharge with subsequent doses 1 and 6 months later. Serum specimens were obtained before the administration of each vaccine dose and 3 months after the last dose and were tested for antibody to hepatitis B surface antigen (antiHBs). RESULTS: Eighty-seven infants (85%) completed the study. Ninety percent (n = 78) of infants who completed the study seroconverted (antiHBs > or = 10 mIU/mL); 10% (n = 9) remained seronegative at study completion. The geometric mean antibody titer to hepatitis B surface antigen for infants who seroconverted was 200 mIU/mL. Nonresponders (NR) differed from responders (R) in birth weight (NR = 2090 g, R = 1560 g) gestational age (NR = 33 weeks, R = 31 weeks), and weight gain before vaccine initiation (NR = 244 g, R = 633 g). There were no differences in weight or age at vaccine initiation, Apgar scores, interval between vaccine doses, or bacterial infections, steroid use, or transfusions before vaccine initiation. CONCLUSIONS: Ninety percent of preterm infants responded to hepatitis B vaccine when the first dose of vaccine was delayed until hospital discharge. Nonresponders were more likely to be preterm infants of higher birth weight and higher gestational age, and to have gained less weight before vaccine initiation.

Gestational Age↗
PubMed1996

Vaccine induced immunologic memory for hepatitis B surface antigen: implications for policy on booster vaccination.

This paper reviews published literature on the long-term persistence of immunologic memory for HBsAg after a course of hepatitis B vaccine and the functional significance this has for policy on booster vaccination. Several studies have shown that vaccine induced antibody (anti-HBs) specific for the surface antigen (HBsAg) of hepatitis B virus (HBV) is protective at a serum concentration of 10 milli-International Units per milliliter (mIU ml-1). When acquired passively (e.g. from hepatitis B immune globulin), susceptibility to infection returns as antibody declines. However, vaccine induces active synthesis of anti-HBs accompanied by immunologic memory for HBsAg that affords ongoing protection independent of antibody. Persistent memory over periods of 5 years or more is evident from large, rapid increases in antibody following booster vaccination, even in subjects who have lost antibody. Complementary studies, using an in vitro enzyme linked immunosorbent assay (spot-ELISA), show that the number of memory B lymphocytes able to produce anti-HBs does not diminish as the level of antibody declines. That immunologic memory provides effective immunity is suggested by serologic studies over periods of 5 years or more of vaccinees frequently exposed to HBV. Although many failed to maintain at least 10 mIU ml-1 of antibody, there have been very few clinically significant breakthrough infections. Thus, it appears unnecessary to give healthy vaccinees a booster vaccination when the level of anti-HBs falls below 10 mIU ml-1. Current studies suggest good retention of immunologic memory in healthy vaccinees over periods of 5-12 years. While additional studies will better define the limits of this phenomenon, routine booster vaccination should not be needed to sustain immunologic memory and protection within 5 years and perhaps longer after the primary vaccination series.

Hepatitis B Surface Antigens↗
PubMed1996

Interviewing pharmacists for positions in patient-focused health care organizations.

Providing pharmaceutical care requires pharmacists to have the personal attributes necessary to function as part of a health care team. Assessing candidates' personal or behavioral values during the employment interview can be a valuable tool to determine future performance. The use of a structured interviewing format designed to identify predetermined key behavioral indicators as an assessment tool is described. Through detailed probing, candidates' previous actions in specific situations are used as predictors of future performance by the interviewing organization. Use of the interviewing tool described improves the likelihood of selecting candidates with behavioral values deemed important to the organization.

Clinical Competence↗
PubMed1996

Technetium-99m-DMSA studies in pediatric urinary infection.

UNLABELLED: Urinary tract infection (UTI) is a common condition in children and may lead to renal scarring with a risk of later hypertension and renal insufficiency. We made a cross-sectional study of the 99mTc-DMSA findings in 496 children referred for following symptomatic UTI to a Department of Nuclear Medicine and we categorized the results, to provide a framework for further study. METHOD: A standard 99mTc-DMSA protocol was used to study 496 children (157 males, 339 females) aged from birth to 14 yr. Findings were classified according to the image appearance and relative function of each kidney. These were related to age, sex, history and timing of UTI and the results on micturating cysto-urethrography (MCU). RESULTS: Images were normal, with function within limits (45%-50% in one kidney), in approximately half the boys and girls studied. The other images were classified as equivocal in 68 children, abnormal unilaterally in 105 and bilaterally in 76, and they were subdivided according to the image appearance. No image changes could be identified that were specifically associated with acute UTI. Diffuse change alone was uncommon. A high proportion of abnormal images was found in infant boys, older girls with recurrent UTI and those children with vesico-ureteric reflux (VUR). Of the bilateral abnormal images, 98% were seen in children with VUR. CONCLUSION: Our findings suggest that infective renal change may be superimposed on underlying congenital lesions (perhaps detectable antenatally) or may be acquired following UTI in the presence of reflux and are thus potentially preventable. This study also suggests that VUR is almost certain to have occurred in a child who has bilateral abnormal 99mTc-DMSA images following UTI and is also commonly present in those with definite unilateral defects.

Adolescent↗
PubMed1995

Technical note: femoral angiography using the reverse shuffle technique.

We report our findings using the "reverse shuffle" technique of stepping table femoral angiography. This technique represents a simple modification of the conventional stepping table sequence entailing a reverse table movement allowing acquisition of early and late films in the distal positions. It was developed in order to minimize the number of runs required in each examination. In a retrospective study 52/53 (98%) of angiograms using the reverse shuffle technique required only a single run compared with 30/51 (58%) using the conventional technique. We believe that the reverse shuffle should be used where possible when stepping table angiography is performed. Furthermore, the incorporation of a reverse table movement may also be advantageous in angiography using automated digital subtraction angiography (DSA) stepping systems.

Aged↗
PubMed1995

Strategic issues requiring public accountability: food for thought.

Although the exact outline of U.S. health reform has become fuzzy because of political events, it seems clear that major changes in the manner in which health care is delivered and financed are under way. The initiative for the most part has been assumed by state government and by the health care field itself, as managed care becomes ever more entrenched and the health care system becomes ever more integrated. An expected outcome of these changes will be demands for greater public accountability on the part of health care providers and organizations. In this article, the author discusses some of the issues--professional compensation, documenting community service, ensuring public input into planning efforts, economic credentialing and quality of care, and managing ethics under managed competition--that will have to be addressed at the local level as these shifts take place.

Community-Institutional Relations↗
PubMed1994

Isolation of serotonin from the accessory salivary glands of the marine snail Nucella lapillus.

We report here the presence of a bioactive compound in the secretion of the accessory salivary glands (ASGs) of Nucella lapillus. We have purified the compound using HPLC and identified it as serotonin by mass spectrometry, UV spectroscopy, HPLC and capillary electrophoresis. Serotonin was not found in the secretions of the acinous salivary glands or the hypobranchial gland. The amount of serotonin in the secretion of the ASGs does not show seasonal or regional variation.

Animals↗
PubMed1994

Antibody responses of healthy infants to a recombinant hepatitis B vaccine administered at two, four, and twelve or fifteen months of age.

Hepatitis B vaccine was administered to healthy infants on two investigational schedules that fall within ranges recommended by the U.S. Public Health Service Advisory Committee on Immunization Practices and by the American Academy of Pediatrics Committee on Infectious Diseases. A month after receiving vaccine at 2, 4, and 12 or 15 months of age, 98% and 100% of the children had > 10 mIU antibodies to hepatitis B surface antigen per milliliter, with gemometric mean titers of 1358 mIU/ml and 3424 mIU/mL, respectively.

Female↗