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At least 253 records · Page 14Linked to original sources
PubMed1997

Staging pelvic lymphadenectomy for localized carcinoma of the prostate: a comparison of 3 surgical techniques.

PURPOSE: Pelvic lymph node dissection continues to be the most effective method of staging extracapsular adenocarcinoma of the prostate. Three principal methods of pelvic lymph node dissection are currently available: intraperitoneal laparoscopic, minilaparotomy and the standard open modified pelvic lymph node dissection. In the hope of determining some of the relative advantages and disadvantages associated with each technique a comparison of these approaches was made. MATERIALS AND METHODS: Of 68 patients with histologically proved clinical stage T3N0M0 adenocarcinoma of the prostate who underwent staging pelvic lymph node dissection 38 underwent modified open, 19 laparoscopic and 11 minilaparotomy procedures. The efficacy of node sampling, resource expenditure and complication rates were compared among the 3 groups. RESULTS: No statistically significant difference was observed in terms of the number of nodes harvested with each technique. Resource expenditure analysis revealed significantly increased operative and procedural time requirements for laparoscopic pelvic lymph node dissection compared to modified open and minilaparotomy procedures. Total hospital stay was significantly longer for the modified open pelvic lymph node dissection (mean plus or minus standard deviation 6.5 +/- 0.9 days) compared to the laparoscopic (mean 2.7 +/- 1.1 days) and minilaparotomy (mean 3.3 +/- 0.2 days) groups. Multiple complications, such as ileus, lymphocele and urinary retention, were observed in the modified open pelvic lymph node dissection group. No complications were noted in the other 2 groups. CONCLUSIONS: Comparison of laparoscopic and minilaparotomy procedures to modified open pelvic lymph node dissection revealed similar staging efficacy, and decreased total hospital stay and complications. Laparoscopic pelvic lymph node dissection required increased operative time. Minilaparotomy should become the open surgical procedure of choice for pelvic lymph node dissection, particularly at institutions where the laparoscopy learning curve, equipment expense and time disadvantages cannot be overcome.

Adenocarcinoma↗
PubMed2004

Terminology access methods leveraging LDAP resources.

Health terminologies have become more complex, more massive, and more ubiquitous in the modern healthcare enterprise. Present technology makes the use of these terminologies by humans, unaided by machines, virtually impossible. However, system and message interoperability can be severely compromised if the software services deploying terminology content and interfaces are themselves non-standard. We review some characteristics for good terminology services and introduce an open-source, robust, widely deployed and widely available software resource to underpin terminology service implementations. The Lightweight Directory Access Protocol, or LDAP, is compared with alternative technologies. We describe a reference implementation of terminology services built around the HL7 Common Terminology Services using LDAP methods. We propose that LDAP is well suited as a common platform for federated, synchronized, and algorithmically distributed terminology content from multiple sources.

Algorithms↗
PubMed1998

Properties of cattle bone powder-coated composite particles as high-performance and open column liquid chromatographic column packings.

Cattle bone powder (CBP) from natural resources was employed as a protein adsorbent instead of chemically synthesized hydroxyapatite (HA). Though a small amount of impurities was detected, CBP possessed a crystallinity similar to HA. Using CBP/40PE prepared from CBP and polyethylene beads (40 microns) by dry impact blending as an HPLC column packing, considerable correlation was observed between the elution concentrations of proteins and their pI. Such behavior was caused by the relatively large adsorption capacity for basic proteins. CBP/40PE could completely separate gamma-globulin from BSA also as an open column chromatographic support, under relatively low concentration.

Adsorption↗
PubMed2006

Cost-effective use of breast biopsy techniques in a Veterans health care system.

BACKGROUND: Breast health has become an increasingly important issue among the veteran population. Options for the evaluation of a breast mass or a suspicious mammographic finding include open surgical biopsy at the Veterans Affairs (VA) hospital or percutaneous image-guided biopsy at an affiliated academic institution. We examined the costs and trends in the use of surgical versus percutaneous image-guided biopsy procedures in this diagnostic algorithm. METHODS: A retrospective review was performed of 62 patients who presented to the VA General Surgery Clinic with a breast mass or abnormal mammogram from 2003 to 2005. The Massachusetts Utilization Multiprogramming System and the Decision Support System software packages were used to track costs of procedures, by Current Procedure Terminology code and date of service, performed at the affiliated academic institution and at the VA hospital. These data were analyzed and described using the R statistical computing environment. RESULTS: Forty-six patients were evaluated using open biopsy techniques in the VA operating room, including 8 incisional biopsies, 21 excisional biopsies, and 17 needle-localization excisional biopsies. Sixteen patients were evaluated using minimally invasive biopsies at the affiliated academic institution, including 3 ultrasound-guided cyst aspirations, 6 ultrasound-guided core biopsies/vacuum-assisted core biopsies, 10 stereotactic breast biopsies, and 1 fine-needle aspiration. The average cost to evaluate a breast mass or abnormal mammographic finding in the operating room was 4,368.00 dollars (SD, 2,586.00 dollars), with a median cost of 3,479.00 dollars. The average cost to evaluate a breast mass or mammographic abnormality using percutaneous image-guided procedures was 1,267.00 dollars (SD, 536.00 dollars), with a median of 1,239.00 dollars. From 2003 to 2005, the proportion of percutaneous biopsies increased from 13% to 48%, whereas the proportion of open biopsies decreased from 88% to 52%. CONCLUSIONS: Over a recent 3-year period, we observed a 3.8-fold increase in the use of percutaneous image-guided techniques for the evaluation of breast lesions in the VA Tennessee Valley Healthcare System. Diagnosis by percutaneous techniques allows planning for a definitive surgery if a lesion is malignant or possible avoidance of a surgical intervention if the lesion is benign. Our data show that the costs associated with open biopsy techniques exceed those associated with percutaneous biopsies. For VA hospitals with available resources, the option of image-guided percutaneous biopsy techniques is a cost-effective alternative to open surgical biopsy.

Biopsy, Fine-Needle↗
PubMed2006

Patient experiences with pulmonary fibrosis.

This survey describes the experiences of patients diagnosed with pulmonary fibrosis, focusing on the issues of patient education and resources. A survey of 52 defined-choice and open-ended questions regarding the diagnosis and management of pulmonary fibrosis was delivered. A total of 1448 respondents comprised the study group. Two-thirds of respondents reported a clear lack of information and resources on pulmonary fibrosis at the time of diagnosis. Less than half of respondents reported they felt well-informed about treatment options, the role of supplemental oxygen, pulmonary rehabilitation, and transplantation. These results suggest there is a substantial need for improved patient education regarding the diagnosis and management of pulmonary fibrosis.

Aged↗
PubMed1997

An economic evaluation of laparoscopy and open surgery in the treatment of tubal pregnancy.

BACKGROUND: Laparoscopy has generally replaced open surgery in the treatment of ectopic pregnancy. This study assesses the impact of the introduction of laparoscopy in the surgical treatment of tubal pregnancy on costs. METHODS: Consecutive patients undergoing primary surgery for tubal pregnancy between January 1992 and December 1995 were included in the study. Surgery was performed laparoscopically or by open surgery. Cost for each treatment was calculated by multiplying resources used with calculated resource unit prices. The analysis was stratified for radical and conservative surgery. RESULTS: Data of 255 patients were analysed. Tubal pregnancy was successfully treated in all patients. Costs per patient were US$ 3,490 for radical open surgery, US$ 1,872 for radical laparoscopic surgery, US$ 3420 for conservative open surgery and US$ 2,125 for conservative laparoscopic surgery. Differences in costs were caused by a decreased duration of hospital stay after laparoscopy, and, in case of conservative surgery, by an increased persistent trophoblast rate after laparoscopy. CONCLUSIONS: Laparoscopy is equally effective as open surgery in the treatment of tubal pregnancy, and considerably reduces costs.

Adult↗
PubMed1992

AIDS prevention is thicker than blood. Zimbabwe.

Usually, giving blood is generous. Sometimes, however, it is lethal. In countries such as the US, India and Brazil, where blood donors can get paid by the pint, drug addicts, street dwellers and others who have little to sell except their bodies flock to for-profit blood centers. Many of these people carry the AIDS virus. A survey in the Indian state of Maharashtra revealed that 27% of blood donors tested positive for AIDS antibodies--a slightly higher rate than the same survey found among prostitutes. If 1 private blood bank tests for AIDS antibodies and turns HIV-positive volunteers away--forget about treating them--those poor and desperate enough can often find another, less scrupulous clinic. Or a clinic that doesn't do the testing properly. Although the 1988 Brazilian constitution banned the sale of blood, private clinics continue to flourish and nobody knows whose veins the blood is flowing from. The inevitable result is a frightening rate of contamination. An estimated 85% of Brazilian hemophiliacs have become infected with the HIV virus by contaminated blood or blood products. Even in countries that eschew blood sales and rely on donated supplies, the danger of HIV contamination is still present. HIV infection often does not generate antibodies for weeks; sometimes months or even years. In many 3rd World communities without adequate equipment, blood storage is impossible. The cost of testing emergency donations is so high that the choice may be narrowed--either go without testing or do without blood. Despite all these obstacles, Zimbabwe has shown that a 3rd World country where public health care takes precedence over private profit can make the blood supply network a force for reducing the spread of AIDS rather than increasing it. All blood donations in Zimbabwe were voluntary even before AIDS became an issue. When AIDS was accorded recognition as a serious issue, the country had no clinic for HIV testing. Concerned with the rapid spread of AIDS among the general population, the National Blood Transfusion Service (NBTS) began testing in 1985. Zimbabwe was the 3rd country in the world to begin routine testing. The NBTS is a nonprofit organization headed by representatives from the ministry of health, the Red Cross, and private donors. Because the NBTS was the only group in the country testing blood, many people who suspected they might be infected volunteered to donate blood just so they could have the test. Unfortunately, their suspicions were often justified. The service has found that regular donors now have a far lower incidence of HIV-positive since 1989, when alternative testing services were opened. Analysts believe much of the credit goes to the AIDS counseling given before each blood donation. Each individual is interviewed by a nurse who takes a comprehensive medical history. The education session also includes how AIDS might be contracted. The NBTS quickly discovered that the incidence of HIV antibodies was far lower among students aged 17-19. Since then, the service has thrown much of its resources into school blood campaigns. The service has also opened 5 new collection branches, 1 in each province. Samples from each donation are sent to 1 of the 2 national centers for testing. AIDS is still spreading in Zimbabwe, but thanks to the efforts of NBTS, hospital patients can feel secure.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Who is in charge? Animal vs experimenter control.

In the 1920s Curt Richter (1927) stated that the central problem for psychology was to discover the determinants of the initiation and termination of bouts of behavior. Ignoring this challenge, experimentation in animal psychology has been dominated by the session paradigm in which animals work in brief sessions for a resource of which they have been deprived. In this open economy, no behavioral strategy of the animal can meet its demand, and the beginnings and ends of bouts are controlled by the experimenter; thus, Richter's problem cannot be addressed. In contrast, in a free-feeding, closed economy, the animal controls the initiation and termination of feeding and can regulate its intake, and bout patterns can be observed. If the paradigm is modified to simulate a habitat where resources are distributed discontinuously and the animal must work to discover and procure access to a commodity before it can be used, behavioral strategies allowing the animal to regulate its intake while tending to maximize the ratio of benefits to costs are revealed. We offer an answer to Richter's question based on a cost/benefit analysis of feeding behavior in this foraging paradigm. We show that the time and energy costs of resource acquisition and resource consumption are powerful determinants of the pattern of resource use, and that they have different and independent effects. The former costs are reduced by reducing the frequency of initiating bouts, and the latter costs, by altering the rate and amount of consumption. Further, the time window of these relations is much longer than expected from analyses in the session paradigm. We conclude that the recurrent nature of behavior is due to the discontinuous distribution of resources rather than to cycles of physiological depletion and repletion, and that the determinants of bout initiation and termination lie in the economics of the allocation of time and effort to different resources and activities.

Animals↗
PubMed2003

Cost-effective treatment for ureteropelvic junction obstruction: a decision tree analysis.

PURPOSE: We determined the optimal treatment for primary ureteropelvic junction obstruction based on cost using a decision tree model. MATERIALS AND METHODS: A comprehensive literature search for articles addressing surgical correction of ureteropelvic junction obstruction was performed and data were abstracted on operative time, hospital stay, complications and success rate. The overall cost and individual cost centers at our institution for antegrade endopyelotomy, retrograde ureteroscopic endopyelotomy, Acucise (Applied Medical Resources, Laguna Hills, California) endopyelotomy, laparoscopic pyeloplasty and open pyeloplasty were compared. A decision tree model estimated the cost of treatment and followup for each modality using commercially available software. Sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost. RESULTS: Based on cost center review retrograde ureteroscopic endopyelotomy was the least costly procedure ($2,891). In the decision tree model the rank order of overall treatment costs was: retrograde ureteroscopic endopyelotomy ($3,842), Acucise endopyelotomy ($4,427), antegrade endopyelotomy ($5,297), laparoscopic pyeloplasty ($7,026) and open pyeloplasty ($7,119). Despite various hospital stay, operative time, equipment cost and success rate data 1-way sensitivity analysis revealed that antegrade endopyelotomy, laparoscopic pyeloplasty and open pyeloplasty were never cost effective compared with retrograde ureteroscopic endopyelotomy or Acucise endopyelotomy, while 2-way sensitivity analysis favored retrograde ureteroscopic endopyelotomy. CONCLUSIONS: Primary cost variables for ureteropelvic junction obstruction treatments include operative time, hospital stay, equipment cost and success rate. Decision tree analysis showed that retrograde ureteroscopic or Acucise endopyelotomy is the most cost-effective treatment modality at our institution. However, cost is only 1 of a number of factors that are considered when deciding on an optimal course of treatment.

Cost-Benefit Analysis↗
PubMed1995

Preparing for Post-Registration Education and Practice (PREP): the support role of the library.

A survey of 5% of trained nursing staff in the Plymouth area provided indications of the impact of changes in post-registration education and practice on the library service of the Tor & South West College of Health in Plymouth. The survey comprised, first, a structured interview to obtain details of professional development plans and preferences, number of courses attended recently, learning styles, use made of ward/unit resources (particularly journals) and optimum periods for library opening. The second part of the survey was a vignette information problem. The responses (written by the participants) provided an indication of information-seeking skills and perceptions of various information sources, both formal (publications) and informal (colleagues and organizations). Analysis indicated that the most popular method of learning was attending a study day, and the most popular combination of learning styles was study day combined with further reading. Reading or journals was selective. Most staff would have to rely on a library for journal literature, particularly the new journals. One third of the sample appeared lacking in information-seeking skills. One third appeared confident in information-seeking skills, and this group was associated with the use of more than two sources of information and use of a library. No single library in Plymouth would be adequate for the sources of information required, indicating the need for better networking and/or integration.

Education, Nursing, Continuing↗
PubMedDate not supplied

Implementation of an innovation in the ophthalmic operating room: the Memory lens.

I have participated in the evolution of the cataract procedure for the last 23 years. This year, as nursing director for an eye surgery center, I was responsible for the implementation of a new prerolled intraocular lens: The Memory lens. I review 5 implementation strategies, which are: Be open to recently approved products Utilize all company resources Introduce, train, train, train Evaluate, review, review, review Enjoy the questions and attention from others considering the innovation The implementation of this innovation confirmed both my and the operating room staff's ability to change and reaffirmed their commitment to achieve the resultant patient benefits.

Cataract Extraction↗
PubMed2000

Needs analysis of a cancer education program in south western Sydney.

Before establishing a cancer education program in South Western Sydney (SWS), a study was conducted to investigate the level of interest and presentation format preferred by patients with cancer and their relatives/friends regarding five types of cancer-related information: medical, psychological, and physical care issues as well as support services and available resources. A questionnaire using a Likert scale and open- and close-ended questions was distributed to the local cancer population and their families comprising a total sample size of 141. The results showed a uniformly high level of interest in learning about all five cancer-related topics with a preferred program format that consisted of a mixed media presentation of 1 to 6 weeks duration, consisting of 1- to 2-hour weekly sessions. A cancer education program based on the needs assessment findings was developed and implemented at Liverpool Hospital, which was positively evaluated by participants.

Analysis of Variance↗
PubMed1991

Hominoid dietary evolution.

During the later Palaeocene and early Miocene, catarrhine primates and the evolving hominoids had adaptations for frugivorous diets, with the emphasis on soft foods. Early in the middle Miocene the hominoids underwent a major shift, both in morphology and in habitat, with the morphology characterized by thickened enamel on the molars, enlarged incisors and massive jaws. The diet indicated by this morphology is interpreted as still mainly frugivorous but with changed emphasis, possibly towards harder objects. The thick-enamelled hominoids are found associated with more open forest habitats, and the distribution of food resources in equivalent habitats today is discontinuous both in time and in space, leading to evolutionary pressures particularly affecting locomotion, brain size and social behaviour. The earliest known hominid fossils differed little in dental and mandibular morphology from the middle Miocene apes, and the implied dietary similarity, together with ape-like patterns of dental development and retained arboreal adaptations of the postcrania, suggests little change in the foraging strategies of the earliest hominids compared with their ape ancestors and further suggests similarity in evolutionary grade. This similarity may have extended to other aspects of behaviour, for example to patterns of tool making and use, which may have been similar in the common ancestor of apes and humans to the pattern shared by the earliest australopithecines and chimpanzees.

Animals↗
PubMed2025

Long-read sequencing of single cell-derived melanoma subclones reveals divergent and parallel genomic and epigenomic evolutionary trajectories.

Tumor evolution is driven by various mutational processes, ranging from single-nucleotide variants (SNVs) to large structural variants (SVs) to dynamic shifts in DNA methylation. Current short-read sequencing methods struggle to accurately capture the full spectrum of these genomic and epigenomic alterations due to inherent technical limitations. To overcome that, here we introduce an approach for long-read sequencing of single-cell derived subclones, and use it to profile 23 subclones of a mouse melanoma cell line, characterized with distinct growth phenotypes and treatment responses. We develop a computational framework for harmonization and joint analysis of different variant types in the evolutionary context. Uniquely, our framework enables detection of recurrent amplifications of putative driver genes, generated by independent SVs across different lineages, suggesting parallel evolution. In addition, our approach revealed gradual and lineage-specific methylation changes associated with aggressive clonal phenotypes. We also show our set of phylogeny-constrained variant calls along with openly released sequencing data can be a valuable resource for the development of new computational methods.

Journal Article↗
PubMed2005

A copper chaperone for superoxide dismutase that confers three types of copper/zinc superoxide dismutase activity in Arabidopsis.

The copper chaperone for superoxide dismutase (CCS) has been identified as a key factor integrating copper into copper/zinc superoxide dismutase (CuZnSOD) in yeast (Saccharomyces cerevisiae) and mammals. In Arabidopsis (Arabidopsis thaliana), only one putative CCS gene (AtCCS, At1g12520) has been identified. The predicted AtCCS polypeptide contains three distinct domains: a central domain, flanked by an ATX1-like domain, and a C-terminal domain. The ATX1-like and C-terminal domains contain putative copper-binding motifs. We have investigated the function of this putative AtCCS gene and shown that a cDNA encoding the open reading frame predicted by The Arabidopsis Information Resource complemented only the cytosolic and peroxisomal CuZnSOD activities in the Atccs knockout mutant, which has lost all CuZnSOD activities. However, a longer AtCCS cDNA, as predicted by the Munich Information Centre for Protein Sequences and encoding an extra 66 amino acids at the N terminus, could restore all three, including the chloroplastic CuZnSOD activities in the Atccs mutant. The extra 66 amino acids were shown to direct the import of AtCCS into chloroplasts. Our results indicated that one AtCCS gene was responsible for the activation of all three types of CuZnSOD activity. In addition, a truncated AtCCS, containing only the central and C-terminal domains without the ATX1-like domain failed to restore any CuZnSOD activity in the Atccs mutant. This result indicates that the ATX1-like domain is essential for the copper chaperone function of AtCCS in planta.

Amino Acid Sequence↗
PubMed2006

mGrid: a load-balanced distributed computing environment for the remote execution of the user-defined Matlab code.

BACKGROUND: Matlab, a powerful and productive language that allows for rapid prototyping, modeling and simulation, is widely used in computational biology. Modeling and simulation of large biological systems often require more computational resources then are available on a single computer. Existing distributed computing environments like the Distributed Computing Toolbox, MatlabMPI, Matlab*G and others allow for the remote (and possibly parallel) execution of Matlab commands with varying support for features like an easy-to-use application programming interface, load-balanced utilization of resources, extensibility over the wide area network, and minimal system administration skill requirements. However, all of these environments require some level of access to participating machines to manually distribute the user-defined libraries that the remote call may invoke. RESULTS: mGrid augments the usual process distribution seen in other similar distributed systems by adding facilities for user code distribution. mGrid's client-side interface is an easy-to-use native Matlab toolbox that transparently executes user-defined code on remote machines (i.e. the user is unaware that the code is executing somewhere else). Run-time variables are automatically packed and distributed with the user-defined code and automated load-balancing of remote resources enables smooth concurrent execution. mGrid is an open source environment. Apart from the programming language itself, all other components are also open source, freely available tools: light-weight PHP scripts and the Apache web server. CONCLUSION: Transparent, load-balanced distribution of user-defined Matlab toolboxes and rapid prototyping of many simple parallel applications can now be done with a single easy-to-use Matlab command. Because mGrid utilizes only Matlab, light-weight PHP scripts and the Apache web server, installation and configuration are very simple. Moreover, the web-based infrastructure of mGrid allows for it to be easily extensible over the Internet.

Computational Biology↗
PubMed2004

Patient safety culture and leadership within Canada's Academic Health Science Centres: towards the development of a collaborative position paper.

Currently, the Academy of Canadian Executive Nurses (ACEN) is working with the Association of Canadian Academic Healthcare Organizations (ACAHO) to develop a joint position paper on patient safety cultures and leadership within Academic Health Science Centres (AHSCs). Pressures to improve patient safety within our healthcare system are gaining momentum daily. Because AHSCs in Canada are the key organizations that are positioned regionally and nationally, where service delivery is the platform for the education of future healthcare providers, and where the development of new knowledge and innovation through research occurs, leadership for patient safety logically must emanate from them. As a primer, ACEN provides an overview of current patient safety initiatives in AHSCs to date. In addition, the following six key areas for action are identified to ensure that AHSCs continue to be leaders in delivering quality, safe healthcare in Canada. These include: (1) strategic orientation to safety culture and quality improvement, (2) open and transparent disclosure policies, (3) health human resources integral to ensuring patient safety practices, (4) effective linkages between AHSCs and academic institutions, (5) national patient safety accountability initiatives and (6) collaborative team practice.

Academic Medical Centers↗
PubMedDate not supplied

Discharge planning: establishing an effective coordination team.

This article investigates the developing role of the discharge coordinator and explores how safe, effective and timely discharge from hospital can be achieved. In January 1996, a team of four discharge coordinators were jointly appointed by the King's Healthcare NHS Trust in partnership with the local social services department. The coordinators were appointed to work with the multidisciplinary teams to improve trustwide discharge planning practice. The team focused on six core objectives: central coordination, open interagency communication, continuing education, patient advocacy, information resource and audit of discharges. Despite the ward staff's early difficulties regarding the nature of the role, the team did begin to collaborate effectively when working alongside all members of the multidisciplinary team and with patients and families.

Benchmarking↗