Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “stepping”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Improving hemodialysis patient outcomes: a step-by-step approach.

Hemodialysis patient outcomes are often suboptimal, with one-sixth of patients receiving an inadequate dialysis dose, one-fourth using catheters for vascular access, and more than one-half being malnourished. This review describes a four-step approach for improving dialysis patient outcomes. First, select an outcome to improve. This can be a global outcome such as mortality, morbidity, quality of life, or health care costs or an intermediate outcome (such as dialysis dose) that has a demonstrated link with a global outcome. Second, determine barriers to optimal outcomes. Both patient factors (such as noncompliance) and provider factors (such as the process of care) may act as barriers. Third, intervene on specific barriers. Interventions may involve providing medical or surgical treatment, changing patient or provider behavior, or modifying the system of care. Fourth, disseminate the intervention to other settings. "Early adopters" (those who quickly adopt an innovation) and "opinion leaders" (well-respected local physicians) are especially influential in determining the rate of dissemination. By using this approach, physicians can move from helping an individual patient to improving the outcomes of many patients.

Humans↗
PubMed2006

Multiple-step polyclonal versus one-step monoclonal enzyme immunoassay in the detection of Helicobacter pylori antigen in the stools of children.

OBJECTIVE: Evaluation of a polyclonal and a monoclonal Helicobacter pylori stool antigen test (HpSAT) for the detection of Helicobacter pylori (HP) infection in children. METHODS: 43 children underwent a 13C-urea breath test (13C UBT) and a HpSAT for the detection of HP. A child was considered HP positive if the 13C UBT was positive. Two HpSATs were tested: the "Premier Platinum HpSA" test (PP HpSAT) (polyclonal enzyme immunoassay) and the "ImmunoCard STAT! HpSA" test (ICS HpSAT) (one-step immunochromatographic assay). RESULTS: The mean age of the children was 8.9 y (range 3.5-17.5 y). Of the 43 children, 18 (41.9%) were HP positive and 25 (58.1%) were HP negative. The PP HpSAT showed a sensitivity of 94.4% and a specificity of 100.0%. With the ICS HpSAT, equivocal results occurred in 5/42 (11.9%) of the tests due to a problem with the visual interpretation of the change in colour of the test-line. The ICS HpSAT had a sensitivity of 100.0% and a specificity of 76.0% when the test was considered positive in case of any change of colour of the test-line, which is the correct practice according to the manufacturer. The ICS HpSAT had a sensitivity of 100.0% and a specificity of 96.0% when the test was considered positive only in case of a "significant change of colour" of the test-line. CONCLUSION: Compared to the 13C UBT, the PP HpSAT shows a comparably good sensitivity and specificity, the ICS HpSAT has a comparably good sensitivity but lower specificity due to a high percentage of equivocal results when the test is used according to the manufacturer's instructions, and the ICS HpSAT has a comparably good sensitivity and specificity when a weakly positive test is considered negative for the diagnosis of HP infection in children. The ICS HpSAT is easy to perform with results available within 10 min, and is therefore of particular interest in ambulatory medicine.

Adolescent↗
PubMed1994

Local anesthesia for inguinal hernia repair step-by-step procedure.

OBJECTIVE: The authors introduce a simple six-step infiltration technique that results in satisfactory local anesthesia and prolonged postoperative analgesia, requiring a maximum of 30 to 40 mL of local anesthetic solution. SUMMARY BACKGROUND DATA: For the last 20 years, more than 12,000 groin hernia repairs have been performed under local anesthesia at the Lichtenstein Hernia Institute. Initially, field block was the mean of achieving local anesthesia. During the last 5 years, a simple infiltration technique has been used because the field block was more time consuming and required larger volume of the local anesthetic solution. Furthermore, because of the blind nature of the procedure, it did not always result in satisfactory anesthesia and, at times, accidental needle puncture of the ilioinguinal nerve resulted in prolonged postoperative pain, burning, or electric shock sensation within the field of the ilioinguinal nerve innervation. METHODS: More than 12,000 patients underwent operations in a private practice setting in general hospitals. RESULTS: For 2 decades, more than 12,000 adult patients with reducible groin hernias satisfactorily underwent operations under local anesthesia without complications. CONCLUSIONS: The preferred choice of anesthesia for all reducible adult inguinal hernia repair is local. It is safe, simple, effective, and economical, without postanesthesia side effects. Furthermore, local anesthesia administered before the incision produces longer postoperative analgesia because local infiltration, theoretically, inhibits build-up of local nociceptive molecules and, therefore, there is better pain control in the postoperative period.

Anesthesia, Local↗
PubMed2005

Energetic consequences of walking like an inverted pendulum: step-to-step transitions.

Walking like an inverted pendulum reduces muscle-force and work demands during single support, but it also unavoidably requires mechanical work to redirect the body's center of mass in the transition between steps, when one pendular motion is substituted by the next. Production of this work exacts a proportional metabolic cost that is a major determinant of the overall cost of walking.

Gait↗
PubMed2006

A step by step guide to phylogeny reconstruction.

The aim of this paper is to enable those who have never reconstructed a phylogeny to do so from scratch. The paper does not attempt to be a comprehensive theoretical guide, but describes one rigorous way of obtaining phylogenetic trees. Those who follow the methods outlined should be able to understand the basic ideas behind the steps taken, the meaning of the phylogenetic trees obtained and the scope of questions that can be answered with phylogenetic methods. The protocols have been successfully tested by volunteers with no phylogenetic experience.

Amino Acid Sequence↗
PubMed2000

Step-by-step engineered multiparticle entanglement

After quantum particles have interacted, they generally remain in an entangled state and are correlated at a distance by quantum-mechanical links that can be used to transmit and process information in nonclassical ways. This implies programmable sequences of operations to generate and analyze the entanglement of complex systems. We have demonstrated such a procedure for two atoms and a single-photon cavity mode, engineering and analyzing a three-particle entangled state by a succession of controlled steps that address the particles individually. This entangling procedure can, in principle, operate on larger numbers of particles, opening new perspectives for fundamental tests of quantum theory.

Journal Article↗
PubMed2007

Reassessment of the late steps of coenzyme B12 synthesis in Salmonella enterica: evidence that dephosphorylation of adenosylcobalamin-5'-phosphate by the CobC phosphatase is the last step of the pathway.

We report that cobC strains of Salmonella enterica serovar Typhimurium are impaired in the ability to salvage cobyric acid (Cby), a de novo corrin ring biosynthetic intermediate, under aerobic growth conditions. In vivo and in vitro evidence support the conclusion that this new phenotype of cobC strains is due to the inability of serovar Typhimurium to dephosphorylate adenosylcobalamin-5'-phosphate (AdoCbl-5'-P), the product of the condensation of alpha-ribazole-5'-phosphate (alpha-RP) and adenosylcobinamide-GDP by the AdoCbl-5'-P synthase (CobS, EC 2.7.8.26) enzyme. Increased flux through the 5,6-dimethylbenzimidazole and cobinamide (Cbi) activation branches of the nucleotide loop assembly pathway in cobC strains restored AdoCbl-5'-P synthesis from Cby in a cobC strain. The rate of the CobS-catalyzed reaction was at least 2 orders of magnitude higher with alpha-RP than with alpha-ribazole as substrate. On the basis of the data reported herein, we conclude that removal of the phosphoryl group from AdoCbl-5'-P is the last step in AdoCbl biosynthesis in serovar Typhimurium and that the reaction is catalyzed by the AdoCbl-5'-P phosphatase (CobC) enzyme. Explanations for the correction of the Cby salvaging phenotype are discussed.

Bacterial Proteins↗
PubMed2002

To step or not to step: an approach to clinically diagnosed polyps with no initial pathologic finding.

We determined whether there were additional diagnostic findings in additional level sections performed on polyps with no pathologic diagnosis (NPD) or those in which only lymphoid aggregates (LAs) were seen initially and determined the level at which findings were identified. All colorectal biopsy specimens submitted with a clinical diagnosis of polyp during a 6-month period were included (N = 733). Initially, 3 level sections were cut for each polyp, and if a cause for the polyp was found, no additional levels were evaluated. If LAs or no cause for the polyp was found, 5 additional levels through each block were examined. Any diagnostic findings and the level at which they were identified were recorded. A discrete cause for the polyp was identified in routine levels in 574 cases (78.3%). Deeper levels were performed in 159: 23 for clarification of a suspected diagnosis, 38 for LAs, and 98 for NPD. Findings were identified in 31 (22.8%) of 136 stepped for LA or NPD with neoplastic findings in 13 (9.6%). Most diagnoses were identified in levels 4 or 5, but tubular adenomas were found in levels 7 and 8. These results support level sectioning specimens submitted as polyps with NPD or LAs on initial sections.

Adenoma↗
PubMed1995

Marketing dental implants: a step-by-step approach.

Introducing dental implants into a practice requires planning and commitment. Part of the planning process is learning new clinical skills, but another essential component is developing a marketing approach. The author offers a seven-step plan for adding dental implants to your repertoire.

Dental Implants↗
PubMed2006

One small step for manuals: Computer-assisted training in twelve-step facilitation.

OBJECTIVE: The burgeoning number of empirically validated therapies has not been met with systematic evaluation of practical, inexpensive means of teaching large numbers of clinicians to use these treatments effectively. An interactive, computer-assisted training program that sought to impart skills associated with the Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) Twelve-Step Facilitation (TSF) manual was developed to address this need. METHOD: Twenty-five community-based substance use-treatment clinicians were randomized to one of two training conditions: (1) access to the computer- assisted training program plus the TSF manual or (2) access to the manual only. The primary outcome measure was change from preto posttraining in the clinicians' ability to demonstrate key TSF skills. RESULTS: The data suggested that the clinicians' ability to implement TSF, as assessed by independent ratings of adherence and skill for the key TSF interventions, was significantly higher after training for those who had access to the computerized training condition than those who were assigned to the manual-only condition. Those assigned to the computer-assisted training condition also demonstrated greater gains in a knowledge test assessing familiarity with concepts presented in the TSF manual. CONCLUSIONS: Computer-based training may be a feasible and effective means of training larger numbers of clinicians in empirically supported, manual-guided therapies.

Adult↗
PubMed2000

Perioperative cardiovascular evaluation. Step-by-step approach to risk assessment and follow-up care.

One of the integral responsibilities in primary care medicine is medical consultation, especially when a surgical procedure is contemplated. A good grasp of the elements of multiple specialties and an understanding of the complexity of a proposed operation are essential for an appropriate preoperative evaluation. This article covers the steps in assessing cardiovascular risk in candidates for noncardiac surgery, including consideration of patient-specific and surgery-specific factors. The authors also recommend close postoperative follow-up to reduce morbidity and mortality.

Algorithms↗
PubMed1998

Medicare+Choice PSO formation: a step-by-step decision process.

The introduction of the Medicare + Choice program has opened up new opportunities for healthcare providers to contract directly with Medicare through provider-sponsored organizations (PSOs). Because the time, resources, and risks inherent in forming and operating a Medicare + Choice PSO are substantial, providers should approach this new opportunity methodically. A seven-step process can take providers from assessment to contract application.

Capitation Fee↗
PubMed2000

Normal high density lipoprotein inhibits three steps in the formation of mildly oxidized low density lipoprotein: steps 2 and 3.

Treatment of human artery wall cells with apolipoprotein A-I (apoA-I), but not apoA-II, with an apoA-I peptide mimetic, or with high density lipoprotein (HDL), or paraoxonase, rendered the cells unable to oxidize low density lipoprotein (LDL). Human aortic wall cells were found to contain 12-lipoxygenase (12-LO) protein. Transfection of the cells with antisense to 12-LO (but not sense) eliminated the 12-LO protein and prevented LDL-induced monocyte chemotactic activity. Addition of 13(S)-hydroperoxyoctadecadienoic acid [13(S)-HPODE] and 15(S)-hydroperoxyeicosatetraenoic acid [15(S)-HPETE] dramatically enhanced the nonenzymatic oxidation of both 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine (PAPC) and cholesteryl linoleate. On a molar basis 13(S)-HPODE and 15(S)-HPETE were approximately two orders of magnitude greater in potency than hydrogen peroxide in causing the formation of biologically active oxidized phospholipids (m/z 594, 610, and 828) from PAPC. Purified paraoxonase inhibited the biologic activity of these oxidized phospholipids. HDL from 10 of 10 normolipidemic patients with coronary artery disease, who were neither diabetic nor receiving hypolipidemic medications, failed to inhibit LDL oxidation by artery wall cells and failed to inhibit the biologic activity of oxidized PAPC, whereas HDL from 10 of 10 age- and sex-matched control subjects did. We conclude that a) mildly oxidized LDL is formed in three steps, one of which involves 12-LO and each of which can be inhibited by normal HDL, and b) HDL from at least some coronary artery disease patients with normal blood lipid levels is defective both in its ability to prevent LDL oxidation by artery wall cells and in its ability to inhibit the biologic activity of oxidized PAPC.

Aorta↗
PubMed1975

[Modification of step-by-step aortography].

A modified technic of step aortography was suggested and used clinically. Following it a metallic obturator, used for closing a top portion of a catheter, is introduced hydraulically. The suggested modification would allow angiographic studies of a more short duration, that is of special importance in case of an emergency investigation.

Adult↗
PubMed2003

Pretargeted radioimmunotherapy of cancer: progress step by step.

To enhance the therapeutic efficacy of radioimmunotherapy of cancer, several pretargeting strategies have been developed. In pretargeted radioimmunotherapy, the tumor is pretargeted with an antibody construct that has affinity for the tumor-associated antigen on the one hand and for a radiolabeled hapten on the other. The radiolabeled hapten is administered in a later phase, preferably after the antibody construct has cleared from the circulation. In pretargeted radioimmunotherapy, 2 main approaches can be distinguished: pretargeting strategies based on the avid interaction between streptavidin (SA) or avidin and biotin, and pretargeting strategies based on the use of bispecific antibodies. In pretargeting strategies based on biotin and SA or avidin, the use of a clearing agent that could remove the pretargeting construct from the circulation markedly improved the targeting of the radiolabeled biotin to the tumor. Thus, multistep injection schemes in which 3-5 different agents are subsequently injected were developed. In bispecific antibody-based pretargeting strategies, the use of bivalent haptens improved the efficacy of the tumor targeting, and a 2-step pretargeted radioimmunotherapy strategy is now being tested in cancer patients. Preclinical studies as well as studies on cancer patients have shown that these pretargeting strategies can result in higher radiation doses to the tumor than can directly radiolabeled antitumor antibodies. Here, the development and state of the art of the most effective approaches for pretargeted radioimmunotherapy are reviewed.

Animals↗
PubMed2003

"Step by step" treatment of lateral semicircular canal canalolithiasis under videonystagmoscopic examination.

Aim of the work was to describe a new physical therapeutic approach for benign paroxysmal positional vertigo determined by canalolithiasis of the lateral semicircular canal. A review is made of the literature, and personal experience is reported. A total of 55 cases were observed, 40 geotropic forms, 15 apogeotropic forms. Liberatory manoeuvres were carried out observing the nystagmus during videonystagmoscopic examination, thus attempting to solve the problem in the first treatment session. Monitoring the patient under videonystagmoscopic examination, progression of the otolithic mass towards the non-ampullary segment is documented by the appearance of a nystagmus directed towards the healthy side (and, therefore, inhibitory, due to ampullofugal deflection of the ampullary cupula) during the individual steps of the rehabilitation treatment. Of the 40 geotropic forms, 30 were successfully treated with the Vannucchi-Asprella technique, and the other 10 with the Vannucchi-Asprella manoeuvre followed by a Lempert barbecue rotation. Of the 15 apogeotropic forms, 6 were solved with the Vannucchi-Asprella manoeuvre, 2 with the Vannucchi-Asprella technique followed by Lempert, 6 with the inverted Gufoni technique, followed by Lempert, 1 transformed into geotropic with inverted Gufoni plus Lempert and then resolved by means of a Vannucchi-Asprella manoeuvre. In all cases, therapeutic success was achieved in the first session. Treatment of benign paroxysmal positional vertigo of the lateral semicircular canal does not allow every case to be fully solved at the first attempt with any technique proposed up to now, in particular, for the apogeotropic forms. Being aware of the different techniques, choosing that most appropriate for the patient's "physical" needs, and, above all, verifying under videonystagmoscopic examination the progression in an ampullofugal direction of the otolithic mass during treatment enable excellent therapeutic results to be obtained in the treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, by modifying the rehabilitation strategy while it is being carried out. Videonystagmoscopic examination monitoring of the nystagmus during treatment of benign paroxysmal positional vertigo of the lateral semicircular canal, is taking the place of the rigid schematism of the manoeuvres proposed, so far, allowing the treatment programme to be adapted to the individual case, thus enabling a solution to be reached in the first rehabilitation session by means of tailored therapy.

Humans↗
PubMed2003

A step-by-step guide to home telehealth program planning.

Many home health providers have become familiar with the idea of home telehealth service, but planning its optimal delivery nevertheless presents a challenge. This article presents the first steps agencies need to take before the "televisiting" can begin.

Guidelines as Topic↗