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PubMed1981

[An experience with a mobile coronary care unit: from a study project to a permanent community service (author's transl)].

Mobile coronary care units and stratified systems for coronary care have received rather poor attention in Italy up until now. To evaluate advantages and disadvantages, organizational problems, costs, etc. of a mobile unit in an Italian community provided with a reference centre for acute coronary artery disease, a study project was started in 1977. The organization of such unit was based on that of the hospital in Belfast. The covered area (200,000 inhatitants) was carefully limited to keep delays at a minimum. A program of public education, stressing the necessity for early calls for medical intervention was developed. All calls were evaluated by a physician on duty in the CCU before intervention. The results of this experience, extended to four years, are reported showing that a Mobile Coronary Care Unit is valuable from a medical point of view, is economically sound and practical in a medium size Italian city such as Udine. According to this, the Mobile Coronary Care Unit was changed from a study project to a permanent community service.

Ambulances↗
PubMed2003

[2003 update of Standards, Options and Recommandations for radiotherapy for patients with salivary gland malignant tumors (excluding lymphona, sarcoma and melanoma)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers. and specialists from French public universities,general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been defined, the document is submitted for review by independent reviewers. RESULTS: This article presents the updated clinical practice guidelines concerning irradiation of patient with salivary gland tumors. The main recommendations are: 3 dimensional conformal radiotherapy (with or without intensity modulation) or 2D irradiation can be used; for surgical complete resected patients, postoperative photon radiotherapy should not be used in case of low grade stage I and 11 tumors(standard, level of evidence B2) but should be used for high grade stage II, II and IV tumors and for low grade stage III and IV tumors(standard, level of evidence B2). Neutron therapy should not be used in all of these cases (standard, level of evidence D); for patients presenting an incomplete macroscopic or microscopic surgical residual disease, postoperative irradiation must be delivered(standard). Neutron or photon therapy can be either delivered (options); for non operable patients neutron or photon therapy can be either delivered (options, level of evidence B2); for unresectable tumors or in case of recurrent neoplasms, exclusive neutron therapy or surgical tumor reduction combined with postoperative photon beam irradiation can be proposed (options, level of evidence C).

Combined Modality Therapy↗
PubMed2004

[Clinical Practice Guidelines: 2003 update of Standards, Options and Recommendations for the management patients with malignant tumors of the salivary glands (excluding lymphomas, sarcoma and melanoma) (full report)].

CONTEXT: The Standards, Options and Recommendations (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines for practitioners to improve the quality of health care for patients with cancer. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This document presents the full report of the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concern the place of fine needle aspiration biopsy in preoperative diagnosis, the place of cervical lymph node area surgical treatment, the place of postoperative irradiation and neutron therapy in the treatment of unresectable tumors and also the place of medical imaging, especially RMI, for the diagnosis of these tumors.

Humans↗
PubMed2003

[2003 Update of Standards, Options and Recommendations for management of patients with salivary gland malignant tumors (excluding lymphoma, sarcoma and melanoma) (summary report)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPG s according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concern the place of fine needle aspiration biopsy in preoperative diagnosis, the place of cervical lymph node area surgical treatment, the place of postoperative irradiation and neutron therapy in the treatment of unresectable tumors and also the place of medical imaging, especially RMI, for the diagnosis of these tumors.

Antineoplastic Agents↗
PubMed2003

Changing patterns of knowledge, reported behaviour and sexually transmitted infections in a South African gold mining community.

BACKGROUND: In 1998, a major HIV intervention project was started in a mining community in Carletonville, South Africa. This included community-based peer education, condom distribution, syndromic management of sexually transmitted infections (STI), and presumptive STI treatment for sex workers. OBJECTIVES: To investigate changes in sexual behaviour and the prevalence of STI before and 2 years after the start of the HIV prevention programme. METHODS: Cross-sectional surveys were carried out in 1998 and 2000 among mine workers, sex workers and adults in the community. Demographic and behavioural factors were recorded and participants were tested for syphilis, gonorrhoea and chlamydial infection and, at the start of the intervention, for HIV. RESULTS: In 1998, the prevalence of HIV among men and women in the general population, mine workers, and sex workers, was 20%, 37%, 29% and 69%, respectively. In 2000, syphilis, gonorrhoea and chlamydial infection had increased among mine workers; chlamydial infection had increased among men and women, and syphilis had increased among women. There was evidence of positive behaviour change but this was not substantial or universal. Knowledge of HIV/AIDS and awareness of the epidemic were high but condom use remained low. CONCLUSION: There was little evidence of significant behaviour change and the prevalence of curable STI increased. The prevention programme had had less impact than expected. Reasons for the reduced impact, and the lessons for future intervention projects are discussed. There is a need for further monitoring of the HIV epidemic especially as its impact increases.

Adult↗
PubMed2004

[Clinical practice guideline: 2003 update of Standards, Options et Recommendations for first line palliative chemotherapy in patients with metastatic colorectal cancer (summary report)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for first line palliative chemotherapy in patients with metastatic colorectal cancer previously validated in 1995, then updated in 1997 and published again in 1998. These recommendations do not cover second line treatment. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been developed, they are reviewed by independent reviewers. RESULTS: This article is a summary version of the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concerned (1) Which patients should be treated? (2) What is the best treatment duration? (3) Which treatment should be administered? The new data identified concerning which patients to treat and the duration of treatment were consistent with the data presented in the initial report and did not modify the original recommendations from 1997. The new data available represent stronger evidence than those in the original report (Two good-quality meta-analyses published since 1997). A new guideline concerning patients who are 75 years old or more has been added. Concerning, the new evidence identified has modified the guidelines for the therapeutic schema to adopt from 1997. These modifications concern irinotecan, oxaliplatin, oral fluoropyrimidines and methotrexate. Treatment with irinotecan or oxaliplatin associated with continuous 5FU infusion, modulated with folinic acid (LV5FU2-like) has become a standard. The use of oral fluoropyrimidines has become an option for patients who refuse hospitalisation or treatment by infusion. The use of methotrexate combined with 5FU is no longer recommended.

Antimetabolites, Antineoplastic↗
PubMed2003

[Standards, Options and Recommendations 2002 for the management of adult patients with intracranial gliomas (summary report)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE: To define clinical practice guidelines for the management of adult patients with intracranial glioma in collaboration with the Association of French-speaking Neuro-oncologists (Anocef) and the French society of neurosurgeons (SNCLF). These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHOD: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the place of the surgery, radiotherapy, chemiotherapy, imagery and concomitant medical treatments in the specific treatment strategy of grade III and IV glioma, grade II glioma, gliomatosis cerebri, pilocytic astrocytoma, subependymoma, xanthoastrocytoma, intracranial ependymoma and brain stem glioma.

Adult↗
PubMed1996

The experience of care project: students as participant observers in the hospital setting.

BACKGROUND: The Experience of Care Project advocates a form of qualitative research, participant observation, in medical settings with the goals of (1) identifying ways to increase compassion within hospital systems and (2) training students so that they will become more compassionate physicians. METHOD: The Experience of Care Project was started in October 1993 at Penn State University Hospital, The Milton S. Hershey Medical Center. As of December 1995, 108 cases have been investigated by two professors and 18 students from Pennsylvania State University College of Medicine and six students from Elizabeth City State University in Elizabeth City, North Carolina. At the Hershey Medical Center and at a hospital in Elizabeth City, North Carolina, the participant observers accompany patients and their families during hospital stays, in an effort to better understand the experiences and perspectives of patients and families and to provide a collection of computerized narratives that can be used to examine problems in patient care. RESULTS: Three types of patient dilemmas illustrate the concerns frequently reported by observers: problems with (1) information flow, (2) false expectations, and (3) scheduling. The observational data were saturated with examples falling in all three categories, which are not mutually exclusive; similar incidents were witnessed in a variety of locations by many different observers. The students participating in the project used these examples as the basis of class discussions. One finding was the discrepancy between problems noted by observers-often based on complaints the patients and their families directly articulated to the observers- and patients' satisfaction as recorded in standardized questionnaires. In written evaluations, the students claimed that the project gave them significant insights into the nature of patient care. CONCLUSION: The Experience of Care Project has created a collection of computerized narratives about patients that suggest ways for increasing compassion and communication within hospital systems. Many concerns could be alleviated through programs that enhance patient participation and education. Participant observation can serve as a useful training tool to accomplish the goal of emphasizing humane care within medical education.

Aged↗
PubMed2005

CONCOR, an initiative towards a national registry and DNA-bank of patients with congenital heart disease in the Netherlands: rationale, design, and first results.

INTRODUCTION: Survival of patients with congenital heart disease has dramatically improved after surgical repair became available 40 years ago. Instead of a mortality of 85% during childhood following the natural course, over 85% of these infants are now expected to reach adulthood. However, data on long-term outcome is scarce due to the lack of large, national registries. Moreover, little is known about the genetic basis of congenital heart defects. In 2000, the Interuniversity Cardiology Institute of the Netherlands and the Netherlands Heart Foundation have taken the initiative to develop a national registry and DNA-bank of patients with congenital heart disease in the Netherlands named CONCOR. OBJECTIVES: The aims of the CONCOR project are to facilitate investigation of the prevalence and long-term outcome of specific congenital heart defects and their treatment, to develop an efficient organisational structure for the improvement of healthcare for patients with congenital heart disease, and to allow investigation of the molecular basis of congenital heart defects. METHODS: After informed consent, research nurses enter data of participating patients into the CONCOR database using a web application. Data is transferred over the Internet via a secure connection. About 20 ml blood is withdrawn from the patient, and the DNA is isolated and stored. From each participating patient family history on congenital heart disease is obtained. RESULTS: Within two and a half years more than 4200 patients have agreed to participate. More than 99% of the patients that were asked have given their consent to participate in CONCOR. From 60% of these patients DNA has already been obtained. Mean age of the patients included is 34 years; more than 85% of the patients are younger than 45 years. Late complications occur frequently and the incidence increases with advancing age. 18% of the patients are known with supraventricular or ventricular arrhythmias. 2% of the included patients suffered a cerebrovascular accident, 139 (3%) had endocarditis. 6% of the patients has pulmonary hypertension or Eisenmenger syndrome. More than 15% of the patients reported an affected family member with congenital heart disease in the first, second, or third degree. 6% has an affected first-degree relative, and 4% a second-degree relative. Already 10 research projects have started using the CONCOR data and DNA. CONCLUSION: The population of patients with congenital heart disease is young and rapidly growing. Late complications occur frequently and the incidence increases with advances age. The CONCOR registry and DNA-bank facilitates research on prevalence and long-term outcome and allows investigation of the molecular basis of congenital heart disease.

Academies and Institutes↗
PubMed2005

Evaluating "Starting Well", the Scottish national demonstration project for child health: outcomes at six months.

This paper presents early findings from the evaluation of Starting Well, an intensive home visiting program aimed at improving the health of pre-school children in disadvantaged areas of Glasgow, Scotland. Using a quasi-experimental design, detailed survey, observation and interview data were collected on a cohort of 213 intervention and 146 comparison families over the first six months of the child's life. After controlling for relevant background characteristics, multivariate regression analysis revealed higher child dental registration rates and lower rates of maternal depressive symptoms in the intervention cohort. Findings are interpreted as positive evidence of early program impact. Implications, limitations and future plans for analysis are discussed. EDITORS' STRATEGIC IMPLICATIONS: Starting Well draws on elements of an Australian parent education program and an American home visitation model. The authors demonstrate how the program implementation, research questions, and measurement are designed to fit their Glasgow population and the Scottish public health system. Their quasi-experimental data suggest that this primary prevention program is a promising strategy for improving maternal and child health outcomes.

Child Welfare↗
PubMed2001

Proteome analysis of Corynebacterium glutamicum.

By the use of different Corynebacterium glutamicum strains more than 1.4 million tons of amino acids, mainly L-glutamate and L-lysine, are produced per year. A project was started recently to elucidate the complete DNA sequence of this bacterium. In this communication we describe an approach to analyze the C. glutamicum proteome, based on this genetic information, by a combination of two-dimensional (2-D) gel electrophoresis and protein identification via microsequencing or mass spectrometry. We used these techniques to resolve proteins of C. glutamicum with the aim to establish 2-D protein maps as a tool for basic microbiology and for strain improvement. In order to analyze the C. glutamicum proteome, methods were established to fractionate the C. glutamicum proteins according to functional entities, i.e., cytoplasm, membranes, and cell wall. Protein spots of the cytoplasmic and membrane fraction were identified by N-terminal sequencing, immunodetection, matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) and electrospray ionization-mass spectrometry (ESI-MS). Additionally, a protocol to analyze proteins secreted by C. glutamicum was established. Approximately 40 protein spots were observed on silver-stained 2-D gels, 12 of which were identified.

Amino Acid Sequence↗
PubMedDate not supplied

Origin and distribution of Daltonism in Italy.

A research project was started in Italy in order to map dyschromatopsies in this country. Field data was collected by the authors in Liguria, Veneto, Emilia-Romagna, Apulia, Sicily, and by other authors in Lazio, Calabria, Basilicata, and Sardinia. The samples were all composed of more than 500 male subjects, of homogeneous origin, and assessed using the Ishihara (1973) and the Farnsworth (1947) tests. Statistical analysis identified two groups showing different mean percentages: one, coastal (n = 13,091; 6.50%) and the other, inland (n = 17,881; 5.21%). The results stimulated an ecological-ergonomic hypothesis based on nutrition (i.e., food gathering strategies) and the kind of light prevailing in the habitat. If trichromacy has been brought about by frugivore feeding (Polyach, 1957), dichromacy may have been maintained by giving a selective advantage to fishermen (originally fishing one fish at a time by hand). This is valid for both sea or fresh water habitats, characterized by blue-green prevailing light and with sharp discrimination for blue-gray shapes and colors (usually, 70% of dichromats are deutans). To support this hypothesis a field survey was carried out among 661 Sicilian traditional fishermen, which furnished the highest rates of dyschromatopsia in Italy: 7.90%. In conclusion, we can hypothesize that endogamous fishermen groups bordering the coastal areas of continents, searching for waters abounding in fish, could have determined a greater incidence of color blindness in the coastal regions, while exogamous marriages between fishermen and peasants contributed to the lower diffusion of the genes responsible in inland areas.

Color Vision Defects↗
PubMed2004

Pax6 guides a relay of pioneer longitudinal axons in the embryonic mouse forebrain.

We have characterized a system of early neurons that establish the first two major longitudinal tracts in the embryonic mouse forebrain. Axon tracers and antibody labels were used to map the axon projections in the thalamus from embryonic days 9.0-12, revealing several distinct neuron populations that contributed to the first tracts. Each of the early axon populations first grew independently, pioneering a short segment of new tract. However, each axon population soon merged with other axons to form one of only two shared longitudinal tracts, both descending: the tract of the postoptic commissure (TPOC), and, in parallel, the stria medullaris. Thus, the forebrain longitudinal tracts are pioneered by a relay of axons, with distinct axon populations pioneering successive segments of these pathways. The extensive merging of tracts suggests that axon-axon interactions are a major guidance mechanism for longitudinal axons. Several axon populations express tyrosine hydroxylase, identifying the TPOC as a major pathway for forebrain dopaminergic projections. To start a genetic analysis of pioneer axon guidance, we have identified the transcription factor Pax6 as critical for tract formation. In Pax6 mutants, both longitudinal tracts failed to form due to errors by every population of early longitudinal axons. Taken together, these results have identified potentially important interactions between series of pioneer axons and the Pax6 gene as a general regulator of longitudinal tract formation in the forebrain.

Animals↗
PubMed1985

Progress in screening for early breast cancer.

Ten years have now passed since the American Cancer Society/National Cancer Institute sponsored Breast Cancer Detection Demonstration Projects (BCDDP) started to evaluate the use of mammography, physical examination, thermography, and breast self-examination in screening women for the presence of unsuspected breast cancer. Criteria have been developed to evaluate population screening as an approach to cancer control and breast cancer screening techniques. Combined physical examination and mammography have been particularly successful in detecting early breast cancer. Although the number of screening programs for breast cancer has increased in the past decade, real progress has been surprisingly slow and the issues in breast cancer screening have proved to be subtle and complex.

Adult↗
PubMed2007

IgE-mediated food allergy diagnosis: Current status and new perspectives.

In June 2005, the work of the EU Integrated Project EuroPrevall was started. EuroPrevall is the largest research project on food allergy ever performed in Europe. Major aims of the project are to generate for the first time reliable data on the prevalence of food allergies across Europe and on the natural course of food allergy development in infants. Improvement of in vitro diagnosis of food allergies is another important aim of the project. The present review summarizes current knowledge about the clinical presentation of food allergy and critically reviews available diagnostic tools at the beginning of the project period. A major problem in diagnosis is a relatively poor 'clinical specificity', i. e. both positive skin tests and in vitro tests for specific IgE are frequent in sensitized subjects without food allergy symptoms. So far, no in vitro test reliably predicts clinical food allergy. EuroPrevall aims at improving the predictive value of such tests by proceeding from diagnosis based on allergen extracts to purified allergen molecules, taking into account the affinity of the IgE-allergen interaction, and evaluating the potential of biological in vitro tests such as histamine release tests or basophil activation tests including assays performed with permanently growing cell lines.

Allergens↗
PubMed2006

Proteomic analysis of individual variation in normal livers of human beings using difference gel electrophoresis.

Normal Chinese Liver Proteome Expression Profile is one of the major parts of Human Liver Proteome Project. Before starting the studies, it is necessary to examine the interindividual variation of normal liver proteome and evaluate the minimal size of samples for proteomic analysis. In this study, normal liver samples from ten individual volunteers were collected and the proteome profiles of these samples were analyzed using 2-D difference gel electrophoresis (DIGE) combined with MALDI-TOF/TOF MS. The individual liver tissue lysates were labeled with Cy3 and Cy5 while the pooled sample was labeled with Cy2 as an internal standard, which minimized gel-to-gel variation. After analysis by the DeCyder software, up to 2056 protein spots were detected on the master gel. The CV of standardized abundance was calculated for the protein spots that were matched across all ten gels. The CV values of these protein spots ranged from 6.4 to 108.5% and the median CV was approximately 19%, which demonstrated that the protein expression of normal liver among different individuals was relatively stable. The eight proteins with CV values over 50% were identified which would be a caveat when considering these proteins as potential disease-related markers. Moreover, the one-way ANOVA feature showed a correlation between sample size and individual variations. The results showed that when the sample size exceeded 7, the individual variations were not significant to the whole pool. Our results are an important basis for liver protein expression profiles and comparative proteomics of liver disease.

Electrophoresis, Gel, Two-Dimensional↗
PubMed1994

Specified diagnosis in 532 cases of back pain.

In the city of Malmö, Sweden, a project was started to improve the rehabilitation of patients with back pain. Among 532 patients with back pain who were on sick leave for an average of 98 days the year preceding the consultation, very few specific diagnoses were made in spite of a thorough clinical and radiological examination. Only five of the patients were cured by surgery. During the same period 103 patients were operated on for disc herniation or nerve root stenosis at the Orthopaedic Department at Malmö General Hospital. Thus the routines for somatic diagnosis of the medical service in Malmö are adequate and an improvement would have very little effect on the expenditures for sick leave and early retirement. As suggested in this paper social and psychological factors are of greater importance in the rehabilitation and we should focus less on the physical problems of the patient.

Adult↗
PubMed1996

Automatic record keeping in anaesthesia--a nine-year Italian experience.

In 1986, in Buccheri La Ferla Hospital, Palermo, an anaesthesia information management project was started. Its aim was to develop a computerized anaesthesia workstation. Today, the system is in daily clinical use and has reached most of its original goals: Automatic collection of physiological signals and patient monitor trends is possible by means of analog-digital conversion or by using serial data transfer. A centralized display is included in the system to allow easy control of the progress of the anaesthetic procedures in the hospital. Available in the workstation, there is an on-line help function to assist pharmacological calculations and administration of anaesthesia drugs. Mail messages can be sent to different anaesthesia workstations and data can be shared between them. Information collected during preoperative visits is automatically transferred from a portable personal computer to the system. There is a nine-year patient data-base with both preoperative and perioperative anaesthesia information which can be accessed from each of the workstations. Today, the system is in daily routine use and comprises eight anaesthesia workstations and two portable personal computers used for preoperative visits. The operation schedule with anaesthetists' notes is printed both for surgical wards and for O.R., using information stored from preoperative visits to the system. For automated data collection a trend resolution of one minute has been used. The postoperative orders are printed from the system in the recovery room and given to the wards with the patient. The feedback from the seventeen anaesthetists and twenty-four nurses who use the system routinely is positive. Today, 16,000 patient records are available in the database. This number increases by 3,300 every year. With increasing computer utilization in patient treatment there have been no legal or administrative controversies. Based on nine years' experience, it is clear that the use of computers in anaesthesia practice improves quality of patient care.

Analog-Digital Conversion↗