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PubMed2006

Sin, suffering, and the need for the theological virtues.

This article examines the account of the relationship between sin and suffering provided by J. L. A. Garcia in "Sin and Suffering in a Catholic Understanding of Medical Ethics," in this issue. Garcia draws on the (Roman) Catholic tradition and particularly on the thought of Thomas Aquinas, who remains an important resource for Catholic theology. Nevertheless, his interpretation of Thomas is open to criticism, both in terms of omissions and in terms of positive claims. Garcia includes those elements of Thomas that are purely philosophical, such as natural law and acquired virtue, but neglects the theological and infused virtues, the gifts and fruits of the Holy Spirit, and the beatitudes. These omissions distort his account of the Christian life so that he underplays both the radical problem posed by sin (and suffering), and the radical character of the ultimate solution: redemption in Christ through the grace of the Holy Spirit.

Attitude to Health↗
PubMed1999

An economic evaluation of Tomudex (raltitrexed) and 5-fluorouracil plus leucovorin in advanced colorectal cancer.

Our objective was to establish the balance between costs and effects of treatment with Tomudex (raltitrexed) as an alternative to treatment with 5-fluorouracil (5-FU) plus leucovorin (LV) in patients with advanced colorectal cancer. Data were used from an international, open label randomized clinical trial. Costs were calculated by multiplying resource utilization data with Dutch estimates of unit costs. Effects have been expressed in terms of 6 months and 1 year survival, and in terms of the number of patients without severe adverse events including WHO grade 3 and 4 leucopenia, mucositis, anemia and severe asthenia. Cost effectiveness is expressed in terms of costs per additional day of survival and costs per additional patient without any severe adverse event. The clinical results did not show significant survival differences implying great uncertainty about the cost-effectiveness of raltitrexed in terms of additional costs per additional life-year gained. However, 80% of the initially higher cost of raltitrexed ($3132 per patient) is compensated by savings due to a more convenient administration scheme leading to a net cost of $626 per patient treated. Weighed against the decrease in adverse events, a cost-effectiveness ratio results of $3936 per additional patient free of any severe adverse event. More favorable estimates result when the convenience of the administration scheme is valued in positive monetary terms.

Antineoplastic Agents↗
PubMed2002

Termination of resuscitation: the art of clinical decision making.

Despite all of the progress in reanimating patients in cardiac arrest over the last half century, resuscitation attempts usually fail to restore spontaneous circulation. Thus, the most common of all resuscitation decisions after initiation remains the decision to stop. An entire library of research and guidelines for terminating resuscitative efforts has been developed in the past decade. However, this most central decision is often left open to chance, provider preference, family wishes, futility judgments, and resource concerns-a host of subjective considerations at the bedside and beyond. This article sheds light on these considerations, acknowledging the pivotal role that resuscitation science and guidelines can play in the multifactorial decision to discontinue resuscitative efforts.

Cardiopulmonary Resuscitation↗
PubMed2025

The Mycobacterium tuberculosis Transposon Sequencing Database (MtbTnDB): A Large-Scale Guide to Genetic Conditional Essentiality.

Characterizing genetic essentiality across various conditions is fundamental for understanding gene function. Transposon sequencing (TnSeq) is a powerful technique to generate genome-wide essentiality profiles in bacteria and has been extensively applied to Mycobacterium tuberculosis (Mtb). Dozens of TnSeq screens have yielded valuable insights into the biology of Mtb in vitro, inside macrophages, and in model host organisms. Despite their value, these Mtb TnSeq profiles have not been standardized or collated into a single, easily searchable database. This results in significant challenges when attempting to query and compare these resources, limiting our ability to obtain a comprehensive and consistent understanding of genetic conditional essentiality in Mtb. We address this problem by building a central repository of publicly available Mtb TnSeq screens, the Mtb transposon sequencing database (MtbTnDB). The MtbTnDB is a living resource that encompasses to date ≈150 standardized TnSeq screens, enabling open access to data, visualizations, and functional predictions through an interactive web app (www.mtbtndb.app). We conduct several statistical analyses on the complete database, such as demonstrating that (i) genes in the same genomic neighborhood have similar TnSeq profiles, and (ii) clusters of genes with similar TnSeq profiles are enriched for genes from similar functional categories. We further analyze the performance of machine learning models trained on TnSeq profiles to predict the functional annotation of orphan genes in Mtb. By facilitating the comparison of TnSeq screens across conditions, the MtbTnDB will accelerate the exploration of conditional genetic essentiality, provide insights into the functional organization of Mtb genes, and help predict gene function in this important human pathogen.

DNA Transposable Elements↗
PubMed1992

Myth of the empowering manager: communicating a vision.

As a manager, you control access to resources as well as social networks. Creating a communication environment open to change requires becoming more involved in the work experience. There are no shortcuts in developing a successful management style. To manage successfully requires a great deal of commitment and high levels of self-confidence, self-esteem, and professionalism on the part of management.

Decision Making, Organizational↗
PubMed1997

Open your laboratory to the Internet.

The Internet can open many opportunities for laboratories. A wide variety of information resources are available via the Web, which can be researched more quickly and efficiently with a search engine. A laboratory can pursue marketing and advertising of its services on the Web as well. Consultation and collaboration can be accomplished via e-mail, listservs, and newsgroups. An Intranet can be created on a local area network to share electronic data within an organization. In addition, the rapid technological advances make the possibilities for tomorrow's communications limitless.

Communications Media↗
PubMedDate not supplied

Affinity program raises awareness of Greenwich hospital geriatric center.

In Greenwich, Conn., Greenwich Hospital uses an affinity program called GENERATIONS to help market its Geriatric Health and Resource Center. The program has attracted 4,000 members since opening in October 1999. They are drawn to an array of discount offers, frequent educational programs, and sponsored trips and activities.

Advertising↗
PubMed1989

[Families is transformation: a Polynesian case (Maatea, Moorea, Society Islands)].

"Using a survey of a set of households in a village community in Moorea (Society Islands, French Polynesia), the author examines family transformations using a 'substantive' approach. Analysis of the resources of each household in the context of the recent opening up to the consumer society gives information on the evolution of incomes, the subsistence level, the building up of surpluses and the degree of 'equipment'. Analysis of the social form of households reveals the multiplicity of family types and variable cycles of transformation from one type to another. This information, which cuts across the social form and mode of management of the households, leads the author to identify five distinct types of household, each with a coherent model of operation. Far from observing a uniform evolution of the extended family towards the nuclear family, the author shows that the opposite evolution is just as possible. The plural, fluctuating nature of the family institution in Polynesia today is noted above all." (SUMMARY IN ENG)

Developing Countries↗
PubMed2004

Medical information asymmetry in the cyberworld of manuel castells.

Before 1997, the Internet was strongly associated with universities and higher education, including medical research. There were only small virtual communities at that time, but all their members had equal access to the entire body of information placed on the net. Each networking participant was able not only to retrieve but also to create and distribute medical information. This state was a symmetry, of sorts, between passive and active Internet usage. Since that time, however, significant commercialization of the Internet (including the medical domain) has been increasing its asymmetry. We currently observe a division into providers, serving and distributing medical information on the net, and consumers, who receive pre-prepared "products". This brings new challenges for both academic and practicing e-health physicians. First, while all large-scale initiatives to certify medical portals have so far failed, the public must be educated to chose valuable, high quality medical information themselves. Secondly, this imbalance favors abusive commercial behavior, such as spam, spreading viruses and advertising without content-related information. Stimulating a restoration of the previous idea of the Internet for non-profit activities seems to be best way to avoid the continuation of Internet "degeneration". Manuel Castells has defined future industrial and postindustrial progress of humanity as activity in global virtual communities, interchanging ideas, knowledge and information. The role of medical professionals seems to be to educate patients and their families on how to search for quality medical information and to stimulate other medical professionals, researchers as well as patients' supportive groups to be active themselves. Reducing the medical information asymmetry will provide a positive influence on the progress of e-health in the future. Open source software may help reduce costs by creating adequate resources.

Humans↗
PubMed1985

[Current participation of the nurse in the activities covered in the "expanded role of nursing"].

The article reports on a survey conducted in Colombia to evaluate the part played by the nurse in the functions covered by what has come to be called "the expanded role of nursing." According to the survey, there are 2,213 practicing nurses, who are clustered in the principal cities of the country. Those who participated in the study are young nurses holding staff positions in such institutions as university and social security hospitals. Their training is mostly at the university level, and they have had five years or less of experience. The article notes that, to perform the duties of the expanded role, the nurse must participate in accordance with her training, interest and motivation. The participation may be conditioned by factors in the nurse herself (prior knowledge, former training, previous participation, and responsibility) and by factors in the working environment (the person who instructed her on her role, the post she holds, her length of service/length of her work day, permission received from the institution to exercise her function, and the medical and nursing agreement). Parodoxically, the nurse is being made a participant in new functions at hospitals where there are medical resources and not in regions and places where those resources are scarce or nonexistent. The expanded role of nursing opens to the nurse a range of activities that enable her to provide quality care to the patient and to his or her family and community, to extend the coverage of health services, and offer treatment effectively.

Colombia↗
PubMedDate not supplied

[Curative treatment of malaria Plasmodium falciparum, P. vivax and P. ovale malaria with mefloquine].

Mefloquine (WR 142-490, RO 21.5998), and antimalarial 4-quinoleine-methanol, active on multiresistant strains of P. falciparum is a resourceful product because of its pharmacocinetics and the possibility it opens of a single day curative therapy. Its mean half-live is 15 days, with important individual variations from 8 to 23 days as well as racial one within North-American, Asiatic or African patients. A 1,25 to 1,50 g dose divided in 2 or 3 intakes during 16 hours has proved to be effective in 34 P. falciparum cases. Lower doses, near 1 g seem sufficient for P. vivax (6 cases) and P. ovale fits (4 cases). Clinical and biological acceptance are good, according to this limited study. The use of mefloquine might nowadays be reserved for geographical areas where resistance to P. falciparum is significantly high. Its diffusion in Africa, south of the Sahara, though conceivable, might be discarded for the time beeing.

Adolescent↗
PubMed1983

Nutritional care of the surgical neonate.

The function of the nutritionist was to identify and anticipate nutritional problems, to facilitate complete care for each infant, and to serve as an educational resource to staff, patients, and families. Neonatal nutrition is an open and challenging field for nutritionists. An expanded role for the nutritionist as a member of the physician-nutritionist team, as demonstrated in this article, may provide direction for the organization of such a team in other health care facilities with neonatal intensive care units.

Dietetics↗
PubMedDate not supplied

Psychosocial care of breast cancer patients.

Research in the field of Psychooncology has yielded useful data that may be helpful in clinical practice and in minimising psychosocial distress among breast cancer patients and their families. After the initial crisis following the diagnosis, the majority of patients adjust fairly well by mobilizing personal resources and social support. Adjustment may be enhanced by promoting open communication, offering support to the patient as to the whole family, and by aiding them in decision making. Comparisons of mastectomy to breast conservation have not consistently favored one surgery for all women, therefore, patients should be given the option to choose their preferred type of surgery. Since 20-30% of patients experience long-standing distress, early identification of patients at risk for severe adjustment disorders is important to provide them with professional support. Various kinds of psychosocial interventions have proven to be effective in reducing distress and improving patients' quality of life.

Breast Neoplasms↗
PubMed2006

A model of mandibular movements during speech: normative pilot study for the Brazilian Portuguese language.

The precision of speech articulation is related to the possibility and freedom of the mandibular movements, modifying the spaces in order to allow the different articulatory positions of each sound. Electrognathography allows the objective delineation and registration of the mandibular movements, determining the level of opening, translations and velocity of these movements. Its use is a resource that can establish quantitative diagnostic parameters. The aim of this study was to verify the amplitude, velocity and characterization of the mandibular movements during speech using computerized electrognathography. Participants were 40 adults, male and female, with no temporomandibular disorders; with no missing teeth; with no dental occlusion alterations or dentofacial deformities; with no dental prostheses; and with no communication, neurological or cognitive deficits. The mandibular movements were observed during the sequential naming of pictures containing all the phonemes of the Brazilian Portuguese language. The registrations were obtained using electrognathography (BioENG-BioPak system), assessing the spatial position, course and velocity of the mandibular movements. The mean values of velocity were: 88.65 mm/sec during opening and 89.90mm/sec during closing. The mean values of amplitude were: sagittal opening: 12.77 mm, frontal opening: 11.21 mm, protrusion: 1.22 mm; retrusion 5.67 mm; translations to the right: 1.49 mm and to the left: 1.59 mm. The velocity of opening is directly related to that of closing. The amplitude of opening demonstrates a direct correlation with the velocity of opening and closing. All participants presented lateral translations during the course of the jaw. The assessment of speech in normal individuals is characterized by: discreet mandibular movements with an anteroposterior component and lateral translations. This study allowed for the delineation of a profile of the mandibular movements during speech in asymptomatic individuals.

Adolescent↗
PubMed2003

PhysioNet: an NIH research resource for complex signals.

The Research Resource for Complex Physiologic Signals, supported by the National Institutes of Health (NIH), is intended to promote and facilitate investigations in the study of cardiovascular and other complex biomedical signals. The resource website (www.physionet.org) has 3 interdependent components: 1) PhysioBank is an archive of well-characterized digital recordings of physiologic signals and related data, including databases of electrocardiogram and heart rate time series from patients with heart failure, coronary disease, sleep apnea syndromes, and cardiac arrhythmias; 2) PhysioToolkit is a library of open-source software for physiologic signal processing and analysis; and 3) PhysioNet, for which the resource is named, is an on-line forum for dissemination and exchange of recorded biomedical signals and open-source software for analyzing them. PhysioNet, in cooperation with the annual Computers in Cardiology conference, hosts a series of challenges inviting participants to tackle clinically interesting problems that are either unsolved or not well solved. PhysioNet invites contributions of databases and software from the biomedical community.

Atrial Fibrillation↗
PubMed2002

Spontaneous respiration via an open trachea for resection of a high tracheal stenosis in a child.

The successful management of tracheal stenosis requires compromise between the competing interests of the surgical and anaesthetic teams and the resources available. A seven-year-old girl with marked tracheal stenosis was successfully managed spontaneously breathing via an open trachea and a laryngeal mask. Anaesthesia was maintained by propofol infusion. When the trachea was opened, supplemental oxygen was administered via a modified cholangiocatheter placed into the distal segment. At no point was the trachea intubated.

Anastomosis, Surgical↗
PubMed2026

Fracture-related infection following open forefoot fractures caused by dropped objects.

INTRODUCTION: This study evaluated the rate of fracture-related infection (FRI) of open forefoot fractures caused by dropped objects, and examined associations of treatment characteristics, including intravenous and oral antibiotics and operative debridement, with FRI. METHODS: Patients aged 18-80 years who sustained an open metatarsal or phalanx fracture caused by a dropped object between January 2021 and June 2024 were retrospectively identified from two Level 1 trauma centers. The primary outcome was FRI, determined based on the FRI consensus criteria. FRI rates were compared between those who underwent irrigation and debridement (I&D) at bedside versus in the operating room, and between those who received oral versus intravenous (IV) antibiotics. Patient characteristics were also analyzed to determine host factors associated with FRI. RESULTS: A total of 86 patients (median age 41 years [IQR: 29-56], 58% male) were included. Eighty-five patients (99%) received antibiotics, 31 (36%) of whom received intravenous antibiotics. Sixty-six patients (77%) received an I&D at presentation, 57 (66%) at bedside and 9 (10%) in the operating room. Thirteen patients (15%, 95% CI: 8.3%-24%) developed FRI. No significant difference in FRI rate was found between patients who underwent I&D at bedside versus in the operating room (12% versus 11%, p > 0.99). Among patients who did not undergo I&D in the operating room, no significant difference in FRI rate was found between patients who received oral versus IV antibiotics (17% versus 13%, p = 0.74). Insulin-dependent diabetes was associated with an increased risk of FRI (60% versus 12%, p = 0.02). CONCLUSIONS: In this cohort, one in seven patients developed FRI. No statistically significant differences in FRI rates were observed by I&D setting (bedside versus operative) or antibiotic route (oral versus IV), including in a subgroup analysis excluding patients treated with operating room I&D. These findings are limited by sample size and potential treatment selection bias and should not be interpreted as evidence of equivalence. Management should be individualized based on clinical judgement, resource availability, and patient factors. These findings can help guide the management protocols for "dropped objects" open forefoot fractures presenting to urgent care and the emergency department. LEVEL OF EVIDENCE: Therapeutic Level III.

Humans↗
PubMed2004

Acute and chronic paediatric intensive care patients: current trends and perspectives on resource utilization.

BACKGROUND: Advances in paediatric critical care have resulted in increased survival of critically ill patients, many of whom require long-term ventilation as a means of life support. AIM: To determine current trends in resource utilization, and problems in the care of acute and chronic paediatric intensive care patients. DESIGN: Open observational study. METHODS: We evaluated consecutive admissions (n = 1629) to a 10-bed paediatric intensive care unit (PICU) over a 5-year period. Three previously defined criteria for resource utilization were used: mean length of stay (LOS); length of mechanical ventilation (LOMV); and LOMV/LOS ratio. RESULTS: A total of 10 310 patient bed days and 5223 ventilator days were used. Mean LOS increased from 5.3 +/- 12 days in 1998 to 8.7 +/- 27 days in 2001 (p < 0.05). Although LOMV/LOS ratio (50.7%) was significantly correlated with Paediatric Risk of Mortality score (p < 0.0001), there was no significant change in mortality rate (12.6% vs. 12%). Patients hospitalized for >2 weeks (n = 320, 20%) used 55% of LOS and 57% of LOMV, in contrast to the 1298 (80%) hospitalized for <7 days, who used only 29% of LOS and 20% of LOMV. Patients hospitalized for >3 months (11, 0.7%) consumed 17% of LOS and 23% of LOMV. Five of these (45%) were eventually discharged home, two on ventilators. CONCLUSION: The increasing trend of occupation of PICU bed and ventilator days by critically ill children may be related to the increasing trend for hospitalization of chronic care patients. Severity scoring systems were predictive of resource consumption, but not of the overall trend in mortality rate.

Acute Disease↗