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At least 307 records · Page 17Linked to original sources
PubMed2004

Quality of life in keratoconus.

PURPOSE: Keratoconus is a chronic, noninflammatory disease of the cornea with onset in early adulthood. As these years are important to financial and social health, keratoconus may have more severe impact on quality of life than would be expected given its clinical severity. We examined the vision-related quality of life of patients in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. DESIGN: Cross-sectional study. METHODS: The National Eye Institute-Visual Function Questionnaire (NEI-VFQ) was administered to 1166 CLEK Study patients at their first annual follow-up examination. Associations between clinical and demographic factors and NEI-VFQ scale scores were evaluated. RESULTS: Binocular entrance visual acuity worse than 20/40 was associated with lower quality of life scores on all scales except General Health and Ocular Pain. A steep keratometric reading (average of both eyes) >52 diopters (D) was associated with lower scores on the Mental Health, Role Difficulty, Driving, Dependency, and Ocular Pain scales. Scores for CLEK patients on all scales were between patients with category 3 and category 4 age-related macular degeneration (AMD) except General Health, which was better than AMD patients, and Ocular Pain, which was worse than AMD patients. CONCLUSIONS: Keratoconus is a disease of relatively low prevalence that rarely results in blindness, but because it affects young adults, the magnitude of its public health impact is disproportionate to its prevalence and clinical severity.

Adult↗
PubMed2000

Sperm and ova conservation: existing standards of practice in North America.

BACKGROUND AND PROCEDURE: Rapid advances have occurred in both reproductive medicine and survival from childhood cancer. To establish the current level of best clinical practice for sperm, ovarian, and prepubertal tissue collection and storage, a cross-sectional survey of a major pediatric oncology collaborative study group (Pediatric Oncology Group, POG) was performed. RESULTS: Of the 110 centers surveyed, 69 questionnaires (63%) were completed. No responding center had guidelines regarding which young people should be offered sperm, ovarian, or prepubertal testicular tissue conservation; 93% centers had offered sperm and 10% ova conservation; 15% had offered sperm conservation to males prior to completion of sexual development and 3% to girls prior to sexual maturation. All centers were more likely to offer sperm conservation than ova conservation for any given disease. The most common diseases for which conservation was offered were Hodgkin and non-Hodgkin lymphoma, and sarcomas. Fertility counseling was offered in a variety of settings by 71% of centers by health care professionals, including doctors, nurses, social workers, psychologists, and geneticists. CONCLUSION: There was little agreement regarding appropriate indications for, and method of, gamete preservation in children's cancer centers. It is hard to establish best clinical practice from these data. Unresolved medical, legal, and ethical issues necessitate the development of a voluntary code of practice and guidelines in order to ensure good clinical practice.

Adolescent↗
PubMed2004

Characteristics of liver cirrhosis in Italy: results from a multicenter national study.

BACKGROUND: In 1992, the characteristics of liver cirrhosis in Italy were assessed in a cross-sectional study among 1829 cirrhosis patients attending 21 tertiary centres. AIM: To evaluate the characteristics of cirrhosis patients 9 years later. PATIENTS: A total of 2185 consecutive cirrhosis patients were enrolled over a 6-month period in 79 hospitals located throughout Italy, randomly selected by means of systematic cluster sampling. RESULTS: The main agent associated with cirrhosis was hepatitis C virus, which was found in 69.9% of the patients and was the only etiologic factor in 51.1% of the patients. Hepatitis B surface antigen was present in the serum of 13.0% of the cases (in 7.3%, it was the only etiologic factor). A history of alcohol abuse was found in 31.9% of the cases (12.4% without viral infection). Patients with hepatitis C virus-related cirrhosis were older (mean age of 64.4 years) and more likely to be female (male:female ratio of 0.7), compared to patients with other pathogenic factors. Virus-related cirrhosis was more likely to be observed in southern Italy, whereas alcohol-related cirrhosis was prevalent in the North. CONCLUSIONS: As found in the 1992 study, the results of the present study show that in Italy, liver cirrhosis is mainly associated with hepatitis C virus infection, reflecting the high prevalence of this infection in the general population.

Aged↗
PubMedDate not supplied

Awareness, treatment and control of the metabolic syndrome and its components: a multicentre Greek study.

INTRODUCTION: There are no data concerning the degree of awareness, treatment and control of the metabolic syndrome (MetS) and its components or associated vascular risk in the general population. METHODS: A cross-sectional analysis was made of a representative sample of Greek adults (n=9669, 49% men and 51% women), living in urban, semi-urban and rural areas (55%, 23% and 22%, respectively). The National Cholesterol Education Program (NCEP-ATP III) and the International Diabetes Federation (IDF) definitions for the MetS were used. RESULTS: The age-standardised prevalence of the MetS in the general population was 24.5% [95% CI 23.4-25.7%] (n=2369). This was similar in men and women and increased with age. Among subjects with the NCEP MetS the prevalence of hypertension was 71%, elevated blood glucose 55%, low high-density lipoprotein cholesterol 58%, high triglycerides 63% and abdominal obesity 82%. Only one third of subjects were aware of the MetS component conditions, less than one quarter were on treatment, and very few (< or =10%) were controlled for MetS components. Awareness of MetS individual component conditions (e.g. arterial hypertension), and consequently effective control, was lower than that reported in other cohorts, including subjects without MetS. Only 5% of subjects were aware of MetS as an entity, 2% were treated for all component conditions and only 1% were controlled. Using the IDF definition, the prevalence of MetS was higher (43.4%) and awareness, treatment and control of MetS and its components were significantly lower. CONCLUSIONS: The prevalence of MetS is high in Greece but is not recognised among the general population. Therefore, treatment and control of MetS and component conditions are extremely low. If the situation does not improve soon, MetS will cause a further increase in the vascular disease epidemic in the years to come. This calls for urgent education of the public and the medical community.

Adult↗
PubMed2004

A collaborative clinical trial protocol writing system.

Increasing complexity in medicine has caused clinical trial experts with disparate backgrounds from multiple organizations to collaborate when developing clinical trial protocols. Although many protocol-authoring tools provide computerbased decision support to assist in protocol writing, few of them provide sufficient collaboration support for a group of protocol writers. The iterative group writing activities among interdisciplinary clinical trial experts call for advanced tool support. Here we present a web-based protocol writing system with integrated support for collaborative reviewing and collaborative editing. The system uses a shared database to store threaded review comments and version information for electronic protocols. It also captures rich group event information to provide cross-activity awareness and to facilitate self-coordination within the collaborative writing team. We believe that our system can help streamline collaborative clinical trial protocol writing processes.

Clinical Protocols↗
PubMed1987

A collaborative report: rhinoviruses--extension of the numbering system from 89 to 100.

To define the number of rhinovirus serotypes, cross neutralization tests and characterization studies were completed on 25 candidate prototype rhinoviruses submitted to a third phase of a collaborative program. Based on the results, 11 distinct prototype strains were designated and the numbering system was extended to include 100 rhinoviruses. In addition, recent evidence indicates that over 90% of rhinoviruses isolated in three areas of the country could be typed with antisera for rhinovirus types 1-89.

Neutralization Tests↗
PubMedDate not supplied

Bsoft: image and molecular processing in electron microscopy.

Software for the processing of electron micrographs in structural biology suffers from incompatibility between different packages, poor definition and choice of conventions, and a lack of coherence in software development. The solution lies in adopting a common philosophy of interaction and conventions between the packages. To understand the choices required to have such common interfaces, I am developing a package called "Bsoft." Its foundations lie in the variety of different image file formats used in electron microscopy-a continually frustrating experience to the user and programmer alike. In Bsoft, this problem is greatly diminished by support for many different formats (including MRC, SPIDER, IMAGIC, SUPRIM, and PIF) and by separating algorithmic issues from image format-specific issues. In addition, I implemented a generalized functionality for reading the tag-base STAR (self-defining text archiving and retrieval) parameter file format as a mechanism to exchanging parameters between different packages. Bsoft is written in highly portable code (tested on several Unix systems and under VMS) and offers a continually growing range of image processing functionality, such as Fourier transformation, cross-correlation, and interpolation. Finally, prerequisites for software collaboration are explored, which include agreements on information exchange and conventions, and tests to evaluate compatibility between packages.

Computer Systems↗
PubMed1985

The international collaborative study establishing the first international standard for timothy (Phleum pratense) grass pollen allergenic extract.

A selected candidate international reference preparation of timothy grass (Phleum pratense)-pollen extract was studied together with two other freeze-dried timothy pollen allergenic extracts in a multinational study. The collaborators used RAST inhibition, histamine release, quantitative immunoelectrophoresis (crossed immunoelectrophoresis/crossed radioimmunoelectrophoresis and rockets), isoelectric focusing, and other methods. The total allergenic potencies measured in RAST inhibition were evaluated for validity of linearity and parallel-line response. The relative concentrations of some important individual allergenic components were measured. The relative potencies for the total allergenic activity and the timothy components studied in each preparation were expressed relative to the selected candidate. This preparation was established in 1983 by the World Health Organization expert committee on biologic standardization as the international standard for timothy grass-pollen extracts with assigned units of 100,000 IU per ampule.

Allergens↗
PubMed2001

Beyond erythropoiesis: novel applications for recombinant human erythropoietin.

Erythropoietin (EPO) primarily is produced in the kidney and acts as a principal mediator of the physiologic response to hypoxia by increasing red blood cell production. Astrocytes and neurons in the central nervous system (CNS) also are known to produce EPO in response to hypoxia/ischemia. EPO appears to play a neuroprotective role based on preclinical data demonstrating the ability of recombinant human erythropoietin (r-HuEPO) to shield neurons from hypoxic/ischemic stress when administered intracerebraventricularly. In CNS models, systemically administered r-HuEPO has not been intensely investigated because large glycosylated molecules generally were deemed incapable of crossing the blood-brain barrier (BBB). A collaborative research effort identified expression of EPO receptors on human brain capillaries and a specific receptor-mediated transport of r-HuEPO across the BBB after a single intraperitoneal (IP) injection in rodents, with subsequent protection against various types of neuronal damage. For example, administration of r-HuEPO 24 hours before or up to 6 hours after focal ischemic stroke significantly reduced the extent of infarction. r-HuEPO also attenuated concussive brain injury, kainate-induced seizure activity, and autoimmune encephalomyelitis. These preclinical findings suggest that r-HuEPO may have therapeutic potential for stroke, head trauma, and epilepsy; additional studies are needed to confirm and extend these encouraging observations in animal models.

Animals↗
PubMed2001

Chemical contamination of the East River (Dongjiang) and its implication on sustainable development in the Pearl River Delta.

A recent survey reveals that water quality and river sediments of Dongjiang (the East River) have been mildly contaminated by heavy metals and organic chemicals, such as copper, lead, PCBs, PAHs and HCHs. According to photogrammertic surveys, the sources of contamination are closely related to human activities, such as domestic and industrial discharges, agricultural chemical applications and soil erosion due to deforestation. The level of water and sediment contamination is most serious at the mid-river section near the urban of Weizhou. Due to natural dilution and diffusion, the levels of contamination are slightly decreased at the medium low section of the River near Qiaotou and Matan. Nevertheless, the levels of contamination increase again in the lower river section near Shenzhen, which is a highly developed economic zone. Since Dongjiang is the major source of potable water supply for Hong Kong (nearly 80% of potable water of Hong Kong is abstracted from Dongjiang) and the other parts of the Pearl River Delta (PRD), such organic and inorganic pollution merit concern. Ironically, most of the industrial and commercial activities in the watershed of Dongjiang are business investments of Hong Kong citizens. Cross-border environmental efforts should be enhanced with collaboration of different jurisdictions to achieve targets of regional sustainability.

Agriculture↗
PubMed1998

Productive international faculty exchange: one Columbia University to Gothenburg University example.

This article describes the preparation, implementation and outcomes of a visiting professor exchange experience from the United States to Sweden, and provides recommendations for other faculty who may be asked to enact a similar international role. The major goals of the visit were to coalesce the themes of the earlier administrative contacts into specific projects, and to model a scholarly faculty role consistent with the Columbia University School of Nursing mission as a World Health Organization Collaborating Centre for International Nursing Development. Professional nursing activities during the exchange visit were comprised of three main categories: teaching, consultation, and socialization. Strategies are described that enhanced the bilingual lectures for the Swedish students. The relationships that developed from consulting at the college and on site at various clinical locations culminated in the mutual identification of collaborative research projects and plans for the cross-cultural adaptation of the author's parent education model. Recommendations are made concerning the range of philosophical, institutional, professional and personal resources needed for international exchanges.

Education, Nursing, Graduate↗
PubMed2002

Dynacortin is a novel actin bundling protein that localizes to dynamic actin structures.

Dynacortin is a novel protein that was discovered in a genetic suppressor screen of a Dictyostelium discoideum cytokinesis-deficient mutant cell line devoid of the cleavage furrow actin bundling protein, cortexillin I. While dynacortin is highly enriched in the cortex, particularly in cell-surface protrusions, it is excluded from the cleavage furrow cortex during cytokinesis. Here, we describe the biochemical characterization of this new protein. Purified dynacortin is an 80-kDa dimer with a large 5.7-nm Stokes radius. Dynacortin cross-links actin filaments into parallel arrays with a mole ratio of one dimer to 1.3 actin monomers and a 3.1 microm K(d). Using total internal reflection fluorescence microscopy, GFP-dynacortin and the actin bundling protein coronin-GFP are seen to concentrate in highly dynamic cortical structures with assembly and disassembly half-lives of about 15 s. These results indicate that cells have evolved different actin-filament cross-linking proteins with complementary cellular distributions that collaborate to orchestrate complex cell shape changes.

Actins↗
PubMed2001

Suggested principles of professional ethics for the online provision of mental health services.

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.

Clinical Competence↗
PubMed2001

Suggested principles of professional ethics for the online provision of mental health services.

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide both clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.

Clinical Competence↗
PubMed1997

Insulin signaling.

The following article is another in a series of papers presented at the Annual Meeting of the Western Association of Physicians. The WAP meets in Carmel, usually in the first week of February, along with sister organization the Western Society for Clinical Investigation and the Western Federation for Clinical Research. These meetings are designed to offer members and guest physicians broad updates in multiple specialties of medicine and basic science. This eclectic approach provides broad cross-fertilization of ideas, often leading to scientific collaboration. Readers of The Western Journal of Medicine are encouraged to register and attend the meetings. The scheduled program for future meetings will be published in the December issue of the journal.

Blood Glucose↗
PubMedDate not supplied

Cross-training for obstetrics using an internship program.

During these changing times in the healthcare environment, staff development and management must work together to provide competent staffing models. This article focuses on an innovative pilot internship program that was developed and implemented collaboratively by the management/staff development team. The article describes a cross-training program for new graduates in obstetrics at a major southeastern university hospital. The article focuses on a present and future opportunity for staff development--"cross-training."

Academic Medical Centers↗
PubMed2003

Prevalence and management of inflammatory bowel disease: a cross-sectional study from central England.

OBJECTIVES: To estimate the prevalence of inflammatory bowel disease (IBD) from the information in general practitioners' records and to describe patient management, including the prescribing of 5-aminosalicylates and adherance to treatment in ulcerative colitis, and frequency of advice given concerning cessation of smoking. METHODS: Fifteen general practices were recruited through the Trent Focus Collaborative Research Network, UK, to take part in a cross-sectional study. They identified confirmed cases of IBD and used a pro-forma to collect data for collation and analysis. RESULTS: Searches identified 344 IBD cases from a combined list of 86 801 patients, suggesting a prevalence of 396 per 100 000 (95% confidence interval, 356-440). Practices considered 32% of patients to be under the sole care of general practitioners; only 59% had been seen in secondary care during the previous year and the numbers of outpatient and general practitioner consultations were similar. Smoking cessation advice was documented for similar numbers of smokers with Crohn's disease and ulcerative colitis. Excluding patients who had undergone surgery, only 65% of patients with ulcerative colitis had been prescribed a 5-aminosalicylate in the previous 6 months and good treatment adherence was suggested in only 42% of ulcerative colitis patients taking a 5-aminosalicylate. Prescribing of aminosalicylates was more common in patients under specialist or shared care than those under general practitioner care only; this remained significant in a regression model also including extent of disease (P < 0.0001). CONCLUSIONS: General practitioners play an important role in caring for patients with IBD and may need relevant education and support. Aminosalicylates appear to be under-used in patients with ulcerative colitis.

Adult↗
PubMedDate not supplied

A change from the top. One system self-manages its reorganization project.

Changes in healthcare arising from economic, legislative, social, and medical pressures will place greater demands on senior managers' future decision making. To maintain its position as a healthcare leader during these volatile times, the Sisters of Charity of the Incarnate Word Health Care System (SCH), Houston, embarked on a self-managed reorganization project in January 1989. The system's senior management team (SMT) established guiding principles that served as the basis for its goals and objectives. A mission statement helped keep the team focused on its goals. A revised SCH Strategic Direction served as the foundation for change. After analyzing the corporate office organizational chart in light of the new strategic direction, the SMT began a reorganization process. This involved the redefinition of many roles, elimination of some positions, and relocation of some functions. Staff attended workshops to adjust to the reorganization. At the workshops employees were given the opportunity to ask questions and participate in the organization's reshaping. The new collaborative management style has been in place two years. As staff develop more supportive cross-functional teams and specialized committees, they are able to tap deeper into their extensive creative resources and collaborate on a vision for SCH.

Catholicism↗