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Biomedical subjects

T Lang

Publications and source records attributed to T Lang.

At least 109 records · Page 6Linked to original sources

An experience of utilization review in Europe: sequel to a BIOMED project.

OBJECTIVE: To develop and test a utilization review screening tool for use in European hospitals. SETTING: In 1993 a group of researchers financed by a European Union grant reviewed the use of utilization review in Europe. They quickly noticed a lack of specifically designed instruments able to take into account the health care and cultural differences across Europe, and available for use in different health care systems. Hence, they embarked upon the task of developing and testing a utilization review screening tool for use in European hospitals. RESULTS: The European Union-Appropriateness Evaluation Protocol's list of reasons was developed and assessed. This is a common taxonomy that classifies days identified as unnecessary and provides a list of levels of care to identify patients' needs. This new protocol not only substitutes for the multiple previous local versions of the Appropriateness Evaluation Protocol, but will also facilitate comparisons of the varying experiences in European countries. MAIN FINDINGS: Development of utilization review in Europe has been carried out mostly on a voluntary basis and the main objective was not control. The experience varies widely: from France, where utilization review is still developing and research has been implemented by local teams, to Portugal, where utilization review programmes have been initiated by government authorities. At this point different initiatives in quality improvement, and more specifically in utilization review, are being developed within the European context.

Europe↗

Reliability study of the European appropriateness evaluation protocol.

OBJECTIVE: To help to co-ordinate and harmonize research on utilization review in Europe, the US Appropriateness Evaluation Protocol (f¿EP) was adapted for use in the European setting. The aim of this paper is to assess the reliability of the European version of the AEP (EU-AEP). DESIGN: Nineteen English-language medical records were reviewed by a physician reviewer from each of six participating countries: Austria, France, Italy, Spain, Switzerland and the UK. Each of the six reviewers was asked to assess the appropriateness of the 19 admissions and 31 hospitalization days (19 admission days and 12 randomly selected days of hospital stay, excluding days of discharge) using the revised review instrument. To evaluate inter-rater reliability, the kappa statistic was used to measure overall and pair-wise agreement for the assessment of appropriateness of admission and of day of care, respectively. RESULTS: For admission, the overall kappa statistic among the six reviewers was 0.64, with kappa values for each pair of reviewers in the range 0.46-0.86. For day of care, the kappa was 0.59, with pair-wise kappa coefficients in the range 0.25-0.95. CONCLUSION: The observed agreement could be considered substantial, especially if the fact that medical records were hand-written in a language native to only one of the reviewers is considered. Besides all the study limitations, this finding provides at least preliminary support for the application of the EU-AEP as a reliable instrument in the European setting, including application in comparative studies involving two or more countries.

Europe↗

Psychosocial factors in children and adolescents with migraine and tension-type headache: a controlled study and review of the literature.

We investigated 341 children and adolescents to evaluate the relevance of psychosocial factors in idiopathic headache. According to the criteria of the International Headache Society, 151 subjects had migraine and 94 had tension-type headache (TTH). Ninety-six subjects were headache-free controls. Psychosocial factors covered family and housing conditions, school problems, relations in the peer group, and several other items. We found that migraine patients did not differ from headache-free controls. Patients with TTH more often had divorced parents than the headache-free controls, and they had fewer peer relations than migraineurs and controls. In addition, migraine patients were significantly more often absent from school due to headache. All other psychosocial factors failed to discriminate between the three study groups. In conclusion, this controlled study in children and adolescents suggests that migraine is not related to family and housing conditions, school situation, or peer relations, whereas TTH is associated with a higher rate of divorced parents and fewer peer relations.

Adaptation, Psychological↗

Garlic or jalapeño peppers for treatment of Helicobacter pylori infection.

OBJECTIVE: There have been a number of reports that natural foods such as garlic, honey, and capsaicin can inhibit Helicobacter pylori in vitro and each report has suggested the natural ingredient be used for treatment of the infection. We investigated whether garlic or capsaicin-containing peppers would actually inhibit H. pylori in vivo. METHODS: We performed a prospective crossover study in healthy H. pylori-infected adults. We used the urea breath test to assess the status of the H. pylori infection. On separate days subjects received three test meals consisting of beef, tortillas, and salad with one of the following: fresh garlic (10 sliced cloves), capsaicin (six sliced fresh jalapeños), two tablets of bismuth subsalicylate (Pepto-Bismol, positive control), or nothing added (negative control). Breath testing was done before the first meal, the evening meal, and the following morning. At least 2 days elapsed between the test substances. RESULTS: Twelve subjects participated (seven men, five women), with an average age of 41.4 yr, range 27-51 yr. Ten subjects received garlic, six received jalapeños, and 11 received bismuth. Neither garlic nor capsaicin had any in vivo effect on H. pylori (median urease activity 28.5 vs 39.8 and 43.7 vs 46.6 before and after garlic and jalapeños, respectively) (p > 0.8). Bismuth had a marked inhibitory effect (median 55.8 vs 14.3 before and after bismuth) (p < 0.001), respectively. CONCLUSIONS: This study did not support a role for either garlic or jalapeños in the treatment of H. pylori infection. Caution must be used when attempting to extrapolate data from in vitro studies to the in vivo condition.

Adult↗

Dual versus triple therapy of Helicobacter pylori infection: results of a multicentre trial.

OBJECTIVE: To compare dual therapy (omeprazole and amoxicillin) with triple therapy (omeprazole, amoxicillin, and clarithromycin) in the treatment of Helicobacter pylori infection. The efficacy of 1 mg/kg/day omeprazole was randomly compared with 2 mg/kg/day. STUDY DESIGN: 252 patients (median age, 11.0 years; range, 3-18) presenting with chronic abdominal pain underwent endoscopy and a 13C-urea breath test. Gastric biopsy specimens were taken for histological examination and for the rapid urease test. Patients were treated for two weeks: group A (n = 63) received amoxicillin (50 mg/kg; maximum, 2 g/day), group B (n = 73) received amoxicillin and clarithromycin (20 mg/kg; maximum, 1 g/day). Both groups were randomly treated with either 1 or 2 mg/kg omeprazole (maximum, 80 mg/day). Diagnostic procedures were repeated four weeks after the end of treatment. RESULTS: 11 patients were excluded; 136 patients were H pylori positive (56%), 105 of whom were re-examined after treatment. Helicobacter pylori was eradicated in 52% of group A and 83% of group B. The dose of omeprazole had no influence on the eradication rate. Specificity and sensitivity of the rapid urease test were 94% and 93%, respectively. Specificity and sensitivity of the 13C-urea breath test were 93% and 95%, respectively. CONCLUSIONS: Dual therapy can no longer be recommended. Triple therapy is more effective than dual therapy in the eradication of H pylori infection. The lower dose of 1 mg/kg omeprazole was as effective as 2 mg/kg.

Adolescent↗

Dry versus conventional laser imagers: film properties and image quality.

The authors compared image quality and stability with a dry laser imager versus a conventional wet laser imager. Hard copies of 56 magnetic resonance imaging and computed tomographic studies were analyzed for gray-scale distribution and temperature stability. Results with the dry laser imager did not reach the quality of results with a wet laser imager, but the performance and ecologic criteria were sufficient to make use of this technique advantageous.

Calibration↗

Validity of fan-beam dual-energy X-ray absorptiometry for measuring fat-free mass and leg muscle mass. Health, Aging, and Body Composition Study--Dual-Energy X-ray Absorptiometry and Body Composition Working Group.

The aim of the study was to examine the accuracy of fan-beam dual-energy X-ray absorptiometry (DEXA) for measuring total body fat-free mass (FFM) and leg muscle mass (MM) in elderly persons. Participants were 60 men and women aged 70-79 yr and with a body mass index of 17.5-39.8 kg/m(2). FFM and MM at four leg regions were measured by using DEXA (Hologic 4500A, v8.21). A four-compartment body composition model (4C) and multislice computed tomography (CT) of the legs were used as the criterion methods for FFM and MM, respectively. FFM by DEXA was positively associated with FFM by 4C (R(2) = 0.98, SE of estimate = 1.6 kg). FFM by DEXA was higher [53.5 +/- 12.0 (SD) kg] than FFM by 4C (51.6 +/- 11.9 kg; P < 0.001). No association was observed between the difference and the mean of the two methods. MM by DEXA was positively associated with CT at all four leg regions (R(2) = 0.86-0.96). MM by DEXA was higher than by CT in three regions. The results of this study suggest that fan-beam DEXA offers considerable promise for the measurement of total body FFM and leg MM in elderly persons.

Absorptiometry, Photon↗

H-2M molecules, like MHC class II molecules, are targeted to parasitophorous vacuoles of Leishmania-infected macrophages and internalized by amastigotes of L. amazonensis and L. mexicana.

In their amastigote stage, Leishmania are obligatory intracellular parasites of mammalian macrophages, residing and multiplying within phagolysosomal compartments called parasitophorous vacuoles (PV). These organelles have properties similar to those described for the MHC class II compartments of antigen-presenting cells, sites where peptide-class II molecule complexes are formed before their expression at the cell surface. After infection with Leishmania amazonensis or L. mexicana, endocytosis and degradation of class II molecules by intracellular amastigotes have also been described, suggesting that these parasites have evolved mechanisms to escape the potentially hazardous antigen-presentation process. To determine whether these events extend to other molecules of the antigen-presentation machinery, we have now studied the fate of the MHC molecule H-2M in mouse macrophages infected with Leishmania amastigotes. At least for certain class II alleles, H-2M is an essential cofactor, which catalyses the release of the invariant chain-derived CLIP peptide from the peptide-binding groove of class II molecules and facilitates the binding of antigenic peptides. H-2M was detected in PV of mouse macrophages infected with various Leishmania species including L. amazonensis, L. mexicana, L. major and L. donovani. PV thus contain all the molecules required for the formation of peptide-class II molecule complexes and especially of complexes with parasite peptides. The present data indicate, however, that if this process occurs, it does not lead to a clear increase of SDS-stable compact (alpha)(beta) dimers of class II. In PV that contained L. amazonensis or L. mexicana, both class II and H-2M molecules often colocalized at the level where amastigotes bind to the PV membrane, suggesting that these molecules are physically associated, directly or indirectly, and possibly interact with parasite components. Furthermore, as class II molecules, H-2M molecules were internalized by amastigotes of these Leishmania species and reached parasite compartments that also contained class II molecules. Immunostaining of H-2M within parasites was increased by treatment of infected macrophages with the cysteine protease inhibitors Z-Phe-AlaCHN2 or Z-Phe-PheCHN2 or by incubation of the parasites with the same inhibitors before infection. These data thus support the idea that amastigotes of certain Leishmania species capture and degrade some of the molecules required for antigen presentation. To examine whether endocytosis of class II molecules by the parasites occurs through interactions with parasite components involving their peptide-binding groove, we made use of the fact that a large fraction of the class II molecules of H-2M(alpha) knock-out H-2(b) mice are occupied by the peptide CLIP and are unable to bind other peptides. We found that, in Leishmania-infected macrophages of these mutant mice, class II-CLIP complexes reached PV and were internalized by amastigotes. These results thus prove that endocytosis of class II molecules by amastigotes (1) is H-2M-independent and (2) does not necessarily involve the peptide-binding pocket of these molecules. Altogether, these data are compatible with an endocytic mechanism based on general properties shared by classical and non-classical class II molecules.

Animals↗

[Reliability and validity of the French version of the first part of the Appropriateness Evaluation Protocol (AEPf): pertinent criteria of hospitalization stay].

BACKGROUND: The Appropriateness Evaluation Protocol (AEP) is a tool used to identify hospitalization days that are appropriate with respect to simple technical criteria, and the reasons for hospitalization days that do not meet these criteria. The goal of the study was to validate the clinical criteria of AEPf, required for identifying the reasons which explain these inappropriate hospital days. METHODS: The validity of a French version of criteria of appropriateness (AEPf) was assessed in a sample of 502 hospital days in medical and surgical wards of six French teaching hospitals. The reliability of the AEPf-based conclusions was studied by the measure of the concordance between two independent measures of AEPf for the same hospital day. Validity of AEPf was studied by the measure of the concordance between AEPf-based conclusions and the judgments of physicians using implicit criteria to assess the necessity of the hospital day studied. The degree of concordance was estimated by the Kappa coefficient. RESULTS: AEPf reproducibility was high (Kappa coefficient: 0.81; 95% confidence interval (95% CI): 0.76-0.87). Validity was also high (Kappa coefficient: 0.61; 95% CI: 0.53-0.68). CONCLUSION: The French version of the AEP was thus shown to be both reliable and valid to identify hospitalisation days appropriate with respect to hospital's technical equipment and specific resources. However, the reproducibility of the assessment of reasons for hospital days that did not meet AEP criteria will require a validation.

Chi-Square Distribution↗

Aut2p and Aut7p, two novel microtubule-associated proteins are essential for delivery of autophagic vesicles to the vacuole.

AUT2 and AUT7, two novel genes essential for autophagocytosis in the yeast Saccharomyces cerevisiae were isolated. AUT7 was identified as a low copy suppressor of autophagic defects in aut2-1 cells. Aut7p is a homologue of the rat microtubule-associated protein (MAP) light chain 3 (LC3). Aut2p and Aut7p interact physically. Aut7p is attached to microtubules via Aut2p, which interacts with tubulins Tub1p and Tub2p. aut2- and aut7-deleted cells are unable to deliver autophagic vesicles and the precursor of aminopeptidase I to the vacuole. Double membrane-layered autophagosome-like vesicles accumulate in the cytoplasm of these cells. Our findings suggest that microtubules and an attached protein complex of Aut2p and Aut7p are involved in the delivery of autophagic vesicles to the vacuole.

Amino Acid Sequence↗

Inherited platelet glycoprotein polymorphisms and a risk for coronary heart disease in young central Europeans.

Among central Europeans polymorphisms of GPIIIa, GPIb, GPIIb, and GPIa named human platelet antigen-1 (HPA-1), -2, -3, and -5 are the clinically most relevant systems in which alloimmunization occurs. These genetically determined polymorphisms of glycoproteins may render platelets sensible for plaque formation and thus could increase risk for coronary artery disease (CAD). We therefore determined gene frequencies of HPA-1, -2, -3, and -5 in European patients suffering from CAD (n = 92; median age, 46 years) or CAD accompanied by diabetes mellitus (DM) (n = 30; median age, 60 years, DM I/II, 5/25) and compared the data obtained with those in DM patients without CAD (n = 80; median age, 43 years; DM I/II, 53/27) and a control group (newborns, n = 906). Triglyceride and cholesterin levels as well as the percentage of smokers was significantly higher in the CAD group compared with the diabetics without DM (p < 0.005). No significant difference of the frequencies of any HPA-type between CAD patients with or without DM, diabetics, or controls could be detected. This was also true when evaluating a subgroup of patients aged 45 years or younger. To include a mutual influence of the described HPA-polymorphisms, we condensed the four HPA genotypes to joint glycoprotein variants. Again the same frequencies were found in patient groups and controls, when analyzing the five most common condensed joint glycoprotein variants. The analysis of the combined published studies shows that the pooled HPA-1 allele frequencies are identical in controls and CAD patients. Thus, no significant association between the polymorphisms of any of the studied HPA systems and the development of CAD can be found in central Europeans.

Adolescent↗

Mild chronic anemia following heart transplantation: a syndrome with prognostic relevance?

The clinical relevance of mild chronic anemia in patients after heart transplantation (HTX) has not yet been demonstrated. Forty-five outpatients who had undergone HTX 2-99 months prior to investigation and who had not received blood transfusions or erythropoietin (EPO) before data acquisition were observed over a period of 37 months. Anemia was found in 36 of the 45 patients and was normocytic, normochromic, and slightly anisocytotic (coefficient of variation = 16 +/- 2, normal 11.5-14.5). Anemic patients showed elevated EPO levels, whereas in nonanemic patients EPO levels were normal. Survival after HTX differed significantly in anemic and nonanemic patients (P < 0.02), with 100% survival in the nonanemic and 85% in the anemic group. Chronic anemia in patients after HTX shows a typical pattern. Even when mild, anemia in patients after HTX seems to be of prognostic value and thus might be an indicator of chronic disorders.

Adolescent↗

Prevalence, treatment, and control of hypertension in the French population: data from a survey on high blood pressure in general practice, 1994.

A survey was conducted in a cohort of 235 general practitioners (GP) selected by Sofres Medical who were representative of the French medical population, to measure the percentage of patients with hypertension, treated hypertensives and patients with controlled hypertension. Data were collected over 1 week of office consultation. Practitioners were initially instructed to use the same type of mercury sphygmomanometer, equipped with pneumatic cuffs of different sizes. Three consecutive blood pressure (BP) measurements were made and the last two were recorded. Practitioners had to carry out their own survey over a period of 1 week on all patients > 18 years of age who visited their offices. Patients were considered as hypertensive (HP) if the mean of the two recorded BP measurements was > or = 140/90 mm Hg or if they were taking antihypertensive drug treatment. Three cutoff points were used to define controlled hypertension: < 140/90 mm Hg (overall population of HP), < 160/95 mm Hg (HP < 65 years of age), and < 160/90 mm Hg (HP > or = 65 years of age). Among 12,351 patients (mean age, 48.6 years; women, 58%), 5020 were HP, (41%) of whom 2035 were without treatment (41%) and 2985 were receiving antihypertensive drug treatment (59%). Two hundred-thirty patients (4.6%) remained at high risk with moderate or severe hypertension (BP > or = 180 [systolic] or 105 [diastolic] mm Hg), ie, 1 patient/week/GP. The study confirms the high prevalence of hypertension in general practice and shows that 7 of 10 patients have an acceptable control of their BP (< 160/95 or < 160/90 mm Hg according to age) but only 24% of treated HP achieved the target of a BP level < 140/90 mm Hg, representing 28% of the 18 to 64 year old group and 21% of the elderly group. French GP did not choose an optimal control, and the medical community is waiting for answers to crucial questions, ie, does optimal BP control significantly improve the absolute cardiovascular risk? How far should blood pressure be lowered?

Antihypertensive Agents↗

Social and economic factors as obstacles to blood pressure control.

Further improvement in blood pressure control at the population level will result from dealing with hard-to-solve problems, such as access to care, long-term management of a chronic disease, and societal influences on lifestyle. Additional knowledge and experimental data are needed, reinforced by clear public health choices in this direction.

Antihypertensive Agents↗

An attempt to improve blood pressure control in the French population: information and outcome awareness at the general practitioner level.

To improve blood pressure (BP) control in general practice, 3122 general practitioners agreed to participate in a result awareness program. A survey carried out 6 months after participating physicians had been informed of the outcome of treatments they had given showed that blood pressure control (cut-off point: BP < 140/90 mm Hg) had not improved. However, using less stringent criteria, a slight improvement in blood pressure control could be observed. Although this improvement was marginal, results are sufficiently encouraging to warrant another study after a new awareness campaign among the medical population.

Adult↗