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PubMed1995

Application of IUPAC-IFCC recommendations on quantities and units to WHO biological reference materials for diagnostic use. International Union of Pure and Applied Chemistry (IUPAC) and International Federation of Clinical Chemistry (IFCC).

This document deals with the nature of WHO biological reference materials, their development for the control of therapeutic substances and recommendations to improve their application in diagnosis. The nature of international units specified by WHO biological reference materials is contrasted with that of SI units, and the method for assigning values in international units to such reference materials is described. The document recommends the use of SI units (mole) with existing and proposed WHO biological reference materials whenever the elementary entity of the stated component can be recognized. It also recommends that the description of quantities having no recognized kind-of-quantity with a definable dimension should be clearly distinguished by the term "arbitrary" and include a reference to the procedure and calibrator used. The WHO is urged to involve appropriate non-governmental organizations in advising on the need for, and the suitability of international reference materials.

Chemistry, Clinical↗
PubMedDate not supplied

The development of a World Health Organisation international standard for islet cell antibodies: the aims and design of an international collaborative study.

Islet cell antibodies (ICA) are a specific marker for Type 1 (insulin-dependent) diabetes mellitus. ICA are found in the serum of over 80% of newly diagnosed patients and the levels of ICA are directly of prognostic value. Standardisation of ICA and the uniform reporting of ICA levels in international units is critical to preclinical/clinical research and the development of assays for ICA as diagnostics, in particular for the differential diagnosis of late onset Type 1 and Type 2 diabetes. Proficiency studies carried out by the Immunology of Diabetes Workshops on Standardization have clearly shown that a single reference material, serum sample 673, obtained by Dr J. Ludvigsson, has significantly reduced inter- and intra-assay variability in the reporting of ICA levels. Nevertheless, this material is a frozen serum of limited shelf-life and is difficult to distribute on a worldwide and routine basis. Therefore, the Immunology of Diabetes Workshop Standardization Committee and the Juvenile Diabetes Foundation International requested that the National Institute for Biological Standards and Control (NIBSC) organise an international collaborative study to compare the activities of lyophilised, stable ICA preparations. In addition, the purpose was to investigate if sample 673 could also serve as a standard for GAD65 and IA-2 antibodies. Twenty participants in eight countries have been recruited to the study.

Autoantibodies↗
PubMed2003

Extracranial internal carotid artery Salmonella mycotic aneurysm complicated by occlusion of the internal carotid artery: depiction by color Doppler sonography, CT and DSA.

Mycotic aneurysms of the extracranial carotid artery are rare. Seventy-four cases have been described in the medical literature and only eight secondary to Salmonella infection. To our knowledge, color Doppler sonography, computed tomography (CT), and digital subtraction angiography (DSA) findings relating to the diagnosis and follow-up of extracranial internal carotid artery mycotic aneurysm complicated by occlusion have not previously been described in the literature. We present a report of color Doppler sonography, CT, and DSA findings of a mycotic aneurysm of the right extracranial internal carotid artery due to Salmonella associated with occlusion of the internal carotid artery, promptly diagnosed and followed up using these imaging modalities.

Aged↗
PubMed1994

Capacity building for health social science: the International Clinical Epidemiology Network (INCLEN) social science program and the International Forum for Social Science in Health (IFSSH).

This paper describes the unfolding of two complementary efforts to build global capacity in health social science. The INCLEN model aims to infuse a genuine transdisciplinary perspective into international health through equipping social scientists to speak a common language with clinical epidemiologists and sensitising clinicians to the ways social sciences contribute to research and policy. Issues are raised pertinent to the model's viability, including recruitment of scholars for fellowships, curriculum substance, and mechanisms for integrating social science fellows when they return home. The future success of the INCLEN program, and comparable donor initiatives, depends upon a wider infrastructure of career supports played out at the international level in which donor and operating agencies nourish the emergence of an expanded body of health social scientists. The International Forum for Social Sciences in Health (IFSSH) has been formed to help build this infrastructure and provide impetus for a viable scientific community of health social scientists. The IFSSH 'global agenda' is portrayed and an illustration is given of how this agenda is being implemented in the Asia and Pacific region.

Career Choice↗
PubMed1988

The international standard for human interleukin-2. Calibration by international collaborative study.

Three lyophilized preparations of interleukin-2 coded 86/500, 86/564 and 86/504 have been evaluated in an international collaborative study for their suitability as an international standard. All of the preparations performed well in the different bioassay systems included in the study, and showed excellent stability on accelerated temperature degradation. Material similar to that in preparation 86/504 has served well as an interim reference reagent for interleukin-2 for 3 years. Therefore with the agreement of the study participants and the authorization of the Expert Committee on Biological Standardization of the World Health Organization, the preparation coded 86/504 was established in 1987 as the 1st international standard for interleukin-2, with a defined potency of 100 IU/ampoule.

Animals↗
PubMed1994

International collaborative study of the candidate international standards for human tumour necrosis factors alpha (hTNF-alpha) and beta (hTNF-beta) and for murine tumour necrosis factor alpha (mTNF-alpha).

Four ampouled preparations of human tumour necrosis factor alpha (hTNF-alpha), one ampoule of human tumour necrosis factor beta (hTNF-beta) and one ampoule of mouse tumour necrosis factor alpha (mTNF-alpha) were evaluated by 20 laboratories in nine countries for their suitability to serve as international standards for these materials. A further three preparations of recombinant hTNF-alpha were included in the study so that hTNF-alpha preparations from different sources and with various structures could be compared. The preparations were assayed using in vitro bioassays and immunoassays. On the basis of the results reported here, with the agreement of participants in the study and with the authorisation of the Expert Committee on Biological Standardization (ECBS) of the World Health Organization (WHO), the preparation of hTNF-alpha in ampoules designated 87/650 was established as the international standard for hTNF-alpha with a defined potency of 40,000 international units per ampoule. Estimates relative to hTNF-alpha for both hTNF-beta and mTNF-alpha showed a substantial inter-laboratory variability in cytotoxic activity indicating that no preparations of hTNF-alpha would be suitable as a reference standard for either hTNF-beta or mTNF-alpha. However, given the current need for reference preparations for these materials, the ampouled preparations of hTNF-beta (87/640) and mTNF-alpha (88/532) were assigned potencies in arbitrary units and are available as reference reagents.

Animals↗
PubMed2006

An international summer school on health informatics: a collaborative effort of the Amsterdam Medical Informatics Program and IPhiE--the International Partnership for Health Informatics Education.

PURPOSE: Today, the need for health informatics training for health care professionals is acknowledged and educational opportunities for these professionals are increasing. To contribute to these efforts, a new initiative was undertaken by the Medical Informatics Program of the University of Amsterdam-Academic Medical Center and IPHIE (IPhiE)-the International Partnership for Health Informatics Education. In the year 2004, a summer school on health informatics was organized for advanced medical students from all over the world. METHODS: We elaborate on the goals and the program for this summer school. In developing the course, we followed the international guidelines of the International Medical Informatics Association-IMIA. Students provided feedback for the course through both summative and formative evaluations. As a result of these evaluations, we outline the lessons we have learned and what consequences these results have had in revising the course. RESULTS: Overall the results of both the summative and formative evaluation of the summer school showed that we succeeded in the goals we set at the beginning of the course. Students highly appreciated the course content and indicated that the course fulfilled their educational needs. The decision support and image processing computer practicums however proved too high level. We therefore will redesign these practicums to competence requirements of medical doctors as defined by IMIA. All participants recommended the summer school event to other students. CONCLUSIONS: Our experiences demonstrated a true need for health informatics education among medical students and that even a 2 weeks course can fulfill health informatics educational needs of these future physicians. Further establishment of health informatics courses for other health professions is recommended.

Curriculum↗
PubMed2006

The experience of international doctoral education in nursing: an exploratory survey of staff and international nursing students in a British university.

As part of the internationalization of higher education, increasing numbers of international doctoral students are coming to study in British nursing schools. This paper reports on a small-scale exploratory survey that sought to investigate the educational experiences of these students and their supervisors in one British School of Nursing. Both staff and students saw great value in international education. However both groups identified the need for greater support to facilitate adjustment in a number of areas, including: understanding the PhD process, studying in a second language, working within a different academic culture, managing the supervision relationship, and finding a sense of community. This was a small study, but the findings confirm key issues identified in the limited available literature. Recommendations include staff training and the development of additional in-puts for students. Future research should include qualitative, longitudinal and multi-site studies to more thoroughly assess the process and outcomes of international doctoral education in nursing.

Education, Nursing, Graduate↗
PubMed1988

Highly-skilled international migrants, careers and internal labour markets.

"This paper is addressed to the interplay of careers and internal labour markets (ILMs) in explaining the international migration of professional and technical personnel, particularly within transnational corporations (TNCs). It begins by reviewing the current state of the theoretical art, focusing on five main elements: the international spatial division of labour; the concept of career; the organization of ILMs; the lubrication of the migration system by recruitment, placement and relocation agencies; and reintegration of returning expatriates. There follows a discussion of selected aspects of the volume and characteristics of ILM migrations among the highly-skilled, using government, employer organization's and individual company data."

Demography↗
PubMed1999

The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report.

BACKGROUND: Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion. CASE REPORT: A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm. RESULTS: Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA. CONCLUSION: This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.

Anastomosis, Surgical↗
PubMed2001

An international collaborative study to establish the 1st international standard for HIV-1 RNA for use in nucleic acid-based techniques.

Twenty-six laboratories from 10 different countries participated in a collaborative study to establish the 1st International Standard for HIV-1 RNA for use in nucleic acid-based techniques (NAT). Three candidate preparations were tested all based on genotype B viruses. The candidates were tested by each laboratory at a range of dilutions in four independent assays and the results collated and analysed statistically. All three candidates gave results that were tightly grouped, with little difference between the results from different laboratories or from the use of different assays. Studies of relative potency showed good agreement between laboratories. There were no significant differences between five commercial assay types, except that candidate XX showed a slightly lower potency compared to YY and ZZ with a single commercial assay. The reason for this was not established. Degradation studies showed that the freeze-dried preparations were stable at -20,4 and 20 degrees C for 26 weeks, the longest period studied, but that they became difficult to reconstitute after 3 weeks at 45 degrees C and 9 weeks at 37 degrees C. As a result of the study, the World Health Organisation (WHO) Expert Committee on Biological Standardisation (ECBS) established the preparation referred to as candidate YY (NIBSC Code No. 97/656) as the 1st International Standard for HIV-1 RNA for use with NAT with an assigned potency of 100000 International Units per vial.

HIV Infections↗
PubMed2002

Malignant internal mammary lymph nodes during mobilization of the internal mammary artery.

Malignant internal mammary node involvement may occur with a primary neoplasm or with metastasis. The incidental discovery of malignant internal mammary nodes from an unknown primary origin has not been previously described. Cardiac surgeons should be aware of pathologic internal mammary artery (IMA) nodes and any abnormally enlarged nodes encountered in the course of IMA mobilization should be sent for histological examination. The incidental discovery of malignancy does not preclude the use of the IMA as a bypass conduit. Once a diagnosis of malignancy is established, meticulous exhaustive investigation may be indicated to identify the primary lesion and definitive treatment instituted if appropriate.

Adenocarcinoma↗
PubMed2004

International collaborative study to establish the 3rd International Standard for Streptokinase.

An international collaborative study was organized to calibrate a replacement for the current (2nd) International Standard (IS) for Streptokinase, stocks of which are almost exhausted. Two candidate preparations were assayed against the 2nd IS in a study involving 16 laboratories in 12 countries: preparation 88/824 (coded B), and preparation 00/464 (C and D, coded duplicates). Laboratories could use two methods provided, either a fibrin clot lysis assay or a solution chromogenic method, or an in-house method. Laboratories were encouraged to perform more than one method if possible. With the exception of one laboratory which gave outlying results for preparation 00/464, there was good agreement within and between laboratories and no significant differences between potencies using the different methods employed. This study demonstrates that a solution chromogenic assay is an acceptable format for potency determination of the streptokinase preparations in this study and fibrin is not necessary. It has now been agreed that a solution chromogenic plasminogen activation assay replace the current euglobulin reference method for streptokinase activity determination in the European Pharmacopoeia. Study participants, SSC of the International Society on Thrombosis and Haemostasis and the Expert Committee on Biological Standardization (ECBS) at the World Health Organization approved preparation 00/464 (C,D in the study) as the 3rd IS for Streptokinase with a potency of 1030 IU per ampoule.

Drug Stability↗
PubMed2000

Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group.

BACKGROUND AND PURPOSE: Among subcortical infarctions, internal borderzone infarcts (IBI) are considered to be separate entities from perforating artery infarcts (PAI). The purpose of the present study is to examine the relationship between the presence of IBI and the degree of angiographically defined internal carotid artery (ICA) stenosis in symptomatic patients. METHODS: A review of 1253 brain CTs from patients recruited by the North American Symptomatic Carotid Endarterectomy Trial was performed, using templates for the identification of subcortical and cortical vascular territories. RESULTS: A total of 413 patients had visible ischemic lesions on the side ipsilateral to their symptomatic ICA. Of these, 138 had PAI, 108 had IBI, 122 had cortical infarcts, and 45 had a combination of different lesions. Mean (+/-SD) lesion diameter was larger for IBI (11.0+/-5.9 mm) than for PAI (7.1+/-4.7 mm) (P<0.001 for comparing 2 means). IBI was associated with higher degrees of ICA stenosis (P<0. 001). Sixty-three percent of the patients with IBI had severe (70% to 99%) ICA stenosis compared with 42% of patients with PAI; 18% of the IBI patients had stenosis of 90% or more compared with 8% of the patients with PAI. Multiple logistic regression did not identify any patient characteristics as confounders. CONCLUSIONS: Among subcortical infarctions, IBI are associated with higher degrees of ICA stenosis in symptomatic patients. Differentiating between internal borderzone and perforating artery infarcts is important, because each may arise from different mechanisms, namely, carotid disease and small-vessel disease, respectively.

Adult↗
PubMed1997

Euthanasia and international human rights law: prolegomena for an international debate.

In this paper we examine in what respects international human rights law can provide a basis for the establishment of an international debate on euthanasia. Such a debate seems imperative, as in many countries euthanasia is considered taboo in the context of medical practice, yet at the same time, supposedly, decisions are taken to intentionally shorten patients' lives. In the Netherlands, the act of euthanasia will not lead to the prosecution of the physician involved if the physician has complied with certain procedures. The Dutch debate centres on procedures marginalizing important moral aspects of euthanasia. An international debate, addressing the fundamental morality of euthanasia and of other medical decisions involving the end of life, will eventually enhance medical practice in the Netherlands as well as in other countries.

Euthanasia↗
PubMed1987

Acute cardiovascular responses to internal carotid artery occlusion during carotid endarterectomy and to the restoration of internal carotid flow.

Heart rate, central venous pressure, radial artery pressure and electrocardiograph were recorded in 14 patients undergoing carotid endarterectomy under general anaesthesia supplemented with fentanyl and halothane and muscle relaxation as required. Induction of anaesthesia was followed by a significant reduction in systolic arterial pressure and a rise in central venous pressure (CVP). Thereafter CVP did not vary significantly and heart rate did not change significantly at any stage. After internal carotid artery occlusion, mean systolic pressure at one minute, 143 (SD 17) mmHg, and three minutes, 160 (SD 27) mmHg, were both significantly higher than prior to occlusion, 132 (SD 17) mmHg (P less than 0.01 and P less than 0.002 respectively). Similar significant changes occurred in diastolic pressure after carotid occlusion (P less than 0.02 and P less than 0.002 respectively). The restoration of flow through the internal carotid artery in patients operated on without a shunt was associated with a significant reduction in mean systolic pressure. The mean systolic pressure at one minute, 145 (SD 20) mmHg, and three minutes, 135 (SD 19) mmHg, were both significantly lower than that before restoration of flow, 159 (SD 17) mmHg (P less than 0.02 and P less than 0.05 respectively). Changes in mean diastolic pressure in this group at these times, while in the same direction, were not significant. The observed hypertensive response to carotid occlusion may assist in preserving cerebral perfusion while the internal carotid artery is occluded, but may be hazardous for patients with ischaemic heart disease.

Aged↗
PubMed1992

International collaborative study by in vitro bioassays of the first international standard for porcine inhibin.

A lyophilized preparation of inhibin from porcine ovarian follicular fluid, ampoule code 86/690, was made internationally available as a research standard for in vitro bioassays in 1987. A study involving ten participants in eight countries assessed the stability and suitability of this research standard to serve as an international standard. Each of the participants used in vitro assays, the majority of which depended upon the inhibition of release of follicle-stimulating hormone from dispersed rat anterior pituitary cells. The research standard 86/690 was compared with coded ampoules of 86/690 stored under conditions of accelerated thermal degradation and with inhibins from different species. Intra- and interlaboratory variation for estimates of potency of a coded duplicate ampoule of the research standard provided the basis for comparisons of non-identical inhibins, but the fourfold variability of potency estimates for identical ampoules was such that no conclusions about the differences seen for non-identical inhibins could be made. Predictions of stability from consensus estimates of potency of ampoules that have undergone accelerated thermal degradation indicated that the research standard had satisfactory stability. On the basis of this study, the research standard 86/690 was deemed sufficiently stable and suitable to serve as a standard for in vitro bioassays and was established by the World Health Organization Expert Committee on Biological Standardization as the First International Standard for Porcine Inhibin. The possible presence, in biological extracts (standard or sample), of other bioactive proteins, such as activin and follistatin, complicates the quantitative interpretation of bioassay data. A standard of highly purified human inhibin is now required as a standard for immunoassays used for clinical research purposes; sufficient quantities of recombinant human inhibins have recently been donated for ampouling and evaluation by bio- and immunoassay in the subsequent phase of the standardization of inhibins.

Animals↗