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PubMed1996

[Experimental models in research of the pathomechanism of diabetes mellitus].

The authors review the knowledge accumulated on animal models of diabetes during the last decade. The most commonly used diabetes models and the underlying disease processes are summarized, respectively. The best known diabetogenic substances, Streptozotocin and Alloxan are described, including their usage, dosage dosing intervals, and mechanism of action. The latest results are included in the article which discuss the possible role of free radical-induced injury of beta cells in Streptozotocin and Alloxan diabetes.

Alloxan↗
PubMed1996

[Organizational difficulties in liver transplantation].

Author overviews the evolution of liver transplantation from the point of view of organization in North America, in Europe and in Hungary partly on the basis of his own experience. It can be stated, that in North America the liver transplantation has become the universal method for the treatment of end-stage liver diseases, only after 20 year long period since the beginning. This first 20 years could be characterized by the monopoly of few giant transplant centers. This period was different and shorter in Europe due to integration run by Eurotransplant and Council of Europe. In Hungary the need and hope for a well organized, functioning liver transplant programme has become reality after difficult long period. Individual efforts, organizations, scientific-, clinical-, experimental work are being regarded valuable experience, because due to this effort some liver patients can live with good quality of life, the results are included to the present programme, on the other hand this accumulated knowledge can serve as a basis for further transplant activity.

Humans↗
PubMed1997

[Prophylaxis of infectious intestinal diseases before leaving for underdeveloped countries].

Traveling to underdeveloped countries requires several important preventive measures, such as vaccination and bringing electric water boiling apparatus. After arriving in the underdeveloped country, travelers must avoid unheated water, ice, beverages containing ice, raw vegetables, fruits cut by local people. However, many Japanese travelers do not pay attention to these points, resulting in increasing numbers of cases of tropical diseases such as cholera, dysentery, giardiasis, among orally contracted intestinal diseases. We must learn from Americans and British who are very cautious in traveling to these areas. In addition to educating travelers about preventive measures, doctors who will see patients returning from traveling in underdeveloped countries must be able to recognize and treat tropical diseases. Unfortunately, this is often not the case in Japan, causing delays in diagnosis and treatment. It is imperative to diagnose communicable diseases as quickly as possible to avoid unnecessary secondary infections. Thus, for a traveler accumulating knowledge on the current hygienic conditions in the tropical country must also be one of the necessary preparations.

Bacterial Infections↗
PubMed1997

Measuring attributes of primary care: development of a new instrument.

BACKGROUND: The purpose of this study was to evaluate the measurement properties of an instrument developed to measure seven key aspects of the delivery of primary care from the perspective of patients visiting their family physician, and to report the association of these aspects with patient satisfaction. METHODS: A cross-sectional study design was used to examine the responses of 2899 patients visiting 138 family physicians' offices in Northeast Ohio. A 20-item research tool, the Components of Primary Care Index (CPCI), was created to measure the domains of primary care based on the new Institute of Medicine definition and on additional domains based on the literature. Patient satisfaction was measured with the Medical Outcomes Study 9-item visit rating form. The usual provider continuity (UPC) index was calculated as the proportion of visits to the index physician with relation to all physician visits for the past year by patient report. The CPCI was subjected to item and factor analysis. Scale scores were computed, and the association with patient satisfaction with the visit was tested by correlation. RESULTS: The factor analysis resulted in four stable and internally consistent factors. The factors were named: interpersonal communication, physician's accumulated knowledge of the patient, coordination of care, and patients' preference to see their regular physician. Each of the CPCI scale scores was significantly associated with patient satisfaction with the visit. The UPC index, length of time as a patient, and intensity of visits were not as strongly associated with the patient satisfaction measure. CONCLUSIONS: The CPCI provides a brief and reliable measure of four important aspects of the delivery of primary care. The components of primary care are associated with patient satisfaction with visits to family physicians. The CPCI could be used with other outcomes and to assess the effect of interventions and systems changes on the delivery of critical aspects of primary care.

Adult↗
PubMed1997

The clinical usefulness of glucated haemoglobin in diabetes care evaluated by use of a medical technology assessment strategy.

With the introduction of measurements of glycated haemoglobin in a single blood sample as an index of long-term blood glucose control, the clinically usefulness of these measurements was questioned. The aim of this study was to evaluate measurements of glycated haemoglobin as a new test for metabolic regulation in diabetes management by use of a medical technology assessment strategy. Technology assessment in medicine has been defined as "the art and science of evaluating medical practices", but the strategy has to be adjusted to the medical technology in question always including the following three stages: (a) problem definition and identification of medical technology, (b) analysis by testing the technology with consideration to its benefit and harm, its costs, and its social consequences, and (c) synthesis of the accumulated knowledge about the technology. Based on the out-put from the problem definition we found it necessary to investigate some of the identified problems ourselves before implementation of routine measurements of glycated haemoglobin. Several studies were accomplished to validate the laboratory technology in terms of analytical reliability and its clinical usefulness. We wanted to (1) define goals of analytical quality of assays of glycated haemoglobin based on clinical goals, (2) establish a laboratory method for measurements of glycated haemoglobin fulfilling the defined goals, (3) investigate the ability of measurements of glycated haemoglobin to characterize impaired glucose tolerance, (4) evaluate the clinical usefulness of measurements of glycated haemoglobin in the assessment of metabolic regulation in non-insulin-dependent diabetes mellitus (NIDDM), (5) compare physicians' assessment of metabolic control in insulin-dependent diabetes mellitus (IDDM) with measurements of glycated haemoglobin and determine whether knowledge of glycated haemoglobin values would result in improved metabolic control, and (6) evaluate the organizational and economical consequences of introducing regular measurements of glycated haemoglobin. The analysis required a multi-disciplinary approach. Based on our own studies and the available data information we found that measurements of glycated haemoglobin should be regarded the most clinically appropriate test of long-term glycemia and should be introduced into routine management of adult patients with IDDM and NIDDM with the following guidelines concerning methodologies, clinical utility, organizational consequences. The individual laboratory has to establish and secure its own method since at present we are still without an internationally accepted reference method or reference material. The method should measure HbA1c without measuring the labile intermediate pre-HbA1c and provide separate detection of haemoglobin variants. We investigated the analytical goals for the performance characteristics of assays based on biological variation and on the clinical significance of a certain change in concentrations in the individual. Different strategies lead to different analytical goals of CVA between 2-4%. An oral glucose tolerance test is still required to establish the diagnosis of diabetes. Measurements of glycated haemoglobin have been suggested as an alternative but a considerable overlap between the WHO-defined groups of normal and impaired glucose tolerance was observed. In patients with IDDM our studies demonstrated the limitations of traditional clinical judgement and the laboratory procedures in providing an accurate assessment of blood glucose control and that knowledge of HbA1c values allowed the clinician to identify patients in poor glycemic control and lead to improvement in glycemic control. In patients with NIDDM our study showed that measurements of HbA1c provided information that was otherwise not obtainable in the usual clinical setting in primary health care. Measurements of glycated haemoglobin were easily accepted by patients with diabetes. (ABSTRACT TRUNCA

Adult↗
PubMed1997

[Impairment of peripheral nerve excitability].

Functional abnormalities, especially the excitability changes of axon in the peripheral nerve involvement, were reviewed. In GBS and CIDP, the correlation between conduction block and anti-ganglioside antibodies have been discussed. Using anti GM1 antibody positive sera, the suppression of voltage-gated sodium channels (VGSC) has been reported. Although this findings have not been confirmed, the involvement of VGSC may be an important mechanism for eliciting conduction block. In Isaacs' syndrome, voltage-gated potassium channels (VGKC) were suppressed by autoantibodies to VGKC. Furthermore, in generalized myokymia syndrome which shows only myokymia and muscle cramp without grip myotonia, VGKCs are also suppressed in some cases. These findings suggest that some patients with myokymia and neuromyotonia are induced by anti-VGKC antibodies. For evaluating the axonal excitability in vivo, the threshold electrotonus method have been developed and applied for the involvement of peripheral nerves. In ALS, impairment of potassium conductance was shown and was speculated to have the possible rrelation with fasciculation. Thus threshold electrotonus method will be an important method for evaluating axonal excitability in human. The accumulated knowledge about the involvement of axonal ion channels will expand and will be categorized as axonal channelopathies.

Axons↗
PubMedDate not supplied

How to complete a medical insurance form.

The information submitted is knowledge accumulated over years of experience teaching dentists how to bill medical insurance. This is supplemented with a good number of personal expert witness testimonies in criminal and malpractice insurance cases. The objective is to prevent problems before they start with the prudent use of information. My experience in court testimony on these issues has shown me that there is an army of lawyers, insurance company fraud examiners, and dentists working for the aforementioned, just waiting for you to improperly use this method of insurance reimbursement. Use this only if you understand the nuances of what it is you are doing! For example, any procedure you bill to dental insurance using CDT-2 codes can be billed to medical insurance using medical insurance CPT-95 codes. The difference is that if the procedure is not a covered medical expense, it will not be paid by the medical insurance carrier. I strongly suggest that you do not fall into the trap of obfuscating these codes. There are a number of so-called insurance "gurus" teaching dentists how to write confusing and misleading operative reports so as to obtain reimbursement for procedures that normally would not be covered. I beseech you--please do not do it! The penalties are severe. You will experience a significant increase in payments from the medical insurance when procedures are submitted in the proper manner. More and more computerized dental insurance management programs are offering their clients the ability to automatically cross-code and submit dental/medical insurance claims. It is a recognized ability of dentists to do such. Billing responsibly is of the utmost importance.

Forms and Records Control↗
PubMed1998

The changing face of work in the United States: implications for individual, institutional, and societal survival.

Changes in the world of work are posing major challenges to workers, institutions, and society. Not only has the nature of work been affected by the changing work environment, increased global competition, and technological revolutions, but the characteristics of the workforce can only be described as revolutionary. Societal forces have resulted in what the authors call the "changing complexion of the workforce", the "feminization of the workforce", and the "graying of the workforce". Traditional theories of work motivation, employer-employee relations, and the role of psychology must also evolve to accommodate this challenge. The collision of these structural and demographic forces has resulted in major upheaval in society and the world of work. The authors discuss implications of these changes and urge psychologists to use their accumulated knowledge and wisdom to positively impact social policy for the greater good of people, institutions, and society.

Cultural Diversity↗
PubMed1998

Evaluating psychoanalytic papers. Towards the development of common editorial standards.

Psychoanalysis has insecure foundations. Many of its core theories and therapeutic principles are contested from both within and without the discipline. While it often has little difficulty embracing new ideas it has terrible trouble rejecting old ones. Typically those within the discipline have dealt with this situation by destructive rationalisation, denial, splitting and idealization. Foremost is the tendency to multiply schools and paradigms and to rely on rhetoric and argument by authority. It is argued that to counter such inevitably destructive processes we need to find a way of improving constructive engagement with each other and to achieve a discipline that can grow on the secure foundations of gradually accumulating knowledge. Giving examples, the author describes the ongoing development of a methodology for evaluating psychoanalytic papers according to a common standard. It is proposed that it is possible to conduct reasoned international and cross-cultural peer review. This means that we can in principle evaluate and reach agreement as to the merit of psychoanalytic papers even though their authors may have backgrounds in profoundly different local style and local traditions of argument. Moreover, it is suggested, this can be done without creating the monster of an internationally homogenised style that would numb creativity and original thought.

Communication↗
PubMed1998

[Total parenteral nutrition. History. Present time. Future].

Total parenteral nutrition (TPN) has been available for only 30 years. However, history in this field goes back more than 350 years with the first landmark being the description of general blood circulation by William Harvey in 1628. His discovery is the anatomical basis for intravenous infusions. Many investigations were performed during the following centuries showing that solutions containing electrolytes and glucose could be given intravenously in man. The accumulated knowledge of protein metabolism formed the basis for studies on intravenous nutrition with protein hydrolysates, peptides and amino acids. The observation in the late 30-s by Robert Elman that amino acids in the form of protein hydrolysate could be safely administered intravenously in man was the first major step toward TPN. During the following years, major efforts were made to find methods to prepare infusion solutions with a high energy content and low osmotic pressure. The most realistic alternative seemed to be fat in the form of an emulsion. Many studies of a large number of various fat emulsions were made however, all of these emulsions caused severe adverse reactions in man. The first safe fat emulsion, intralipid, was made available in the early 60s. This was the second major step toward TPN. It was then no problem to include vitamins, electrolytes and trace elements in the fat emulsions and the solutions of amino acids and glucose. A few years later it was shown that a central venous catheter could be used to administer the infusion fluid intravenously. Many clinical investigations and reports have shown that the newly developed intravenous nutritional regimens are adequate alternatives to the ordinary diet. In this way it has been possible to maintain or obtain a good nutritional condition in most situations when oral or tube feeding can not be used. TPN has been shown to be of very great clinical importance to prevent and treat starvation often related to high morbidity and mortality.

Forecasting↗
PubMed1998

Trichomoniasis of the breast diseased by fibrocystic mastopathy: pathogenic rather than saprophytic relationship (Trichomonas in fibrocystic mastopathy process).

Because of the striking similarity between histopathological pictures of chronic trichomonal cervicitis uteri, the tissue reaction after subcutaneous inoculation of Trichomonas culture in experimental animals and female breast diseased by fibrocystic mastopathy, the detection of Trichomonads was undertaken in surgically removed diseased breast parts. In 12 FCM patients, subjected to segmental breast resection, the imprint smears were prepared from dissected specimens and after supravital staining immediately examined by light microscopy. The mucous content from dilated ducts was inoculated in the culture media. The dissected tissues have been further histologically analysed by standard method. In nine out of 12 examined FCM cases the direct microscopy revealed aflagellary, pseudocystic, leucocytoid form of Trichomonads. The cultures were positive in 4 cases: in 3 patients Trichomonas tenax was identified and in the last one T vaginalis. Histopathological findings in all 12 examined cases have shown the changes characteristic for FCM. On the basis of the accumulated knowledge about pathogenic capacity of Trichomonads, it can be with great certainty claimed that these protozoa, even in their pseudocystic form are able to cause the all appearances characteristic for FCM. This first report about Trichomonas infection in the middle of FCM process gives the unexpected hope in solving of its etiology and new insight into antitrichomonal host reaction which is frequently associated with epithelial dysplasia and unrarely with precancerous lesions as earlier observed in cervix uteri.

Female↗
PubMed2005

Attitude importance and the accumulation of attitude-relevant knowledge in memory.

People who attach personal importance to an attitude are especially knowledgeable about the attitude object. This article tests an explanation for this relation: that importance causes the accumulation of knowledge by inspiring selective exposure to and selective elaboration of relevant information. Nine studies showed that (a) after watching televised debates between presidential candidates, viewers were better able to remember the statements made on policy issues on which they had more personally important attitudes; (b) importance motivated selective exposure and selective elaboration: Greater personal importance was associated with better memory for relevant information encountered under controlled laboratory conditions, and manipulations eliminating opportunities for selective exposure and selective elaboration eliminated the importance-memory accuracy relation; and (c) people do not use perceptions of their knowledge volume to infer how important an attitude is to them, but importance does cause knowledge accumulation.

Attitude↗
PubMed1980

Innovations in social psychiatry.

Social psychiatry, like social medicine of which it is a part, has two basic sciences - biology and sociology. People with psychiatric disorders suffer from acute breakdowns or chronic impairments which can be severely disabling in themselves, but these are often precipitated, amplified or maintained by social pressures and social disadvantages and by personal reactions, such as a loss of self-esteem and self-confidence. It is impossible, therefore, to draw a line between the medical and the social aspects of treatment, care and prevention. The chief innovations during the past 40 years have been made in the context of a change-over from a system of care based on large institutions towards a more open but much looser and less-coordinated system of smaller units managed by staff from different professions who have developed their own, sometimes conflicting, views as to the best ways of helping the mentally disabled. Nevertheless, knowledge has accumulated which, if properly applied, could lead to a better quality of life for the ill and disabled and a decrease in the burden placed upon relatives. Further innovations are not required which will lead to the development of a responsible, comprehensive and integrated mental health service. It is not yet known whether social measures taken to relieve or prevent lesser psychiatric disorders will lead to a decrease in the incidence or prevalence of more severe conditions and this question deserves further investigation. There is evidence, however, that relatively inexpensive help can be useful in the short term. Progress will depend upon the accumulation of new knowledge. One of the most encouraging trends has been the improvement of evaluative designs and methods aimed at testing ideas for improving services, thus allowing planners to make better informed decisions.

Community Mental Health Services↗
PubMed1995

Life-span development of odor identification, learning, and olfactory sensitivity.

In the first of three studies, children (aged 8 to 14 years) were found to perform worse than young and middle-aged adults in unprompted identification of doors, with average performance much like that of elderly adults. Comparisons on other tasks, specifically odor threshold, prompted odor identification, and object naming (Boston Naming Test), across the life span (five groups) revealed that children have the same excellent olfactory sensitivity as young adults and merely lack odor-specific knowledge that accumulates slowly through life. Such knowledge apparently accumulates so slowly that age-associated discriminative losses, measurable by early middle age, begin to wear away gains obtained through experience before odors can become overlearned. In the second study, a novel adaptive psychophysical method, the step procedure, confirmed the equivalent sensitivity of children and young adults. In the third study, a paired-associate task illustrated the sluggish course of odor learning. Young adults outperformed children, though the youngest group, first graders, made up ground relatively fast. For children and adults, common odors facilitated performance relative to novel odors. The outcome highlighted the relevance of semantic factors in odor learning irrespective of age.

Adolescent↗
PubMed1993

Clinical laboratory test reference (CLTR).

As the healthcare system undergoes a transformation in scope and funding, there remain many unfinished projects which will be essential for the next generation of automated medical support services. The most demanding and labor intensive tasks for this new frontier deal with the accumulation of knowledge which can be used as a clinical database to support supervisory functions in a physician operated interactive care delivery environment. These databases will contain the worlds accumulated knowledge in specialized areas. They will be organized by topic or clinical service, and have significant impact on the quality of care as well as medical malpractice exposure. This article will describe a clinical pathology database that has been adapted for medical practice. The database contains information about laboratory tests and their interpretation. The data is structured for rapid reading and has references where indicated. The database can be used in a stand alone program or integrated into an information system within an application program. The files are reviewed on a continuing basis and quarterly updates are made available to subscribers.

Clinical Laboratory Information Systems↗
PubMed1996

The body that knows: from Cashinahua epistemology to a medical anthropology of lowland South America.

This article develops an anthropology of the body in its material and social environment among the Cashinahua (Huni Kuin) from Brazilian and Peruvian Amazonia. The Cashinahua body, it shows, is thought of as produced by others, not as growing naturally. Growth can be defined as the corporeal accumulation of knowledge in the form of "soul." The article describes the verbal, medical, and other techniques used to transform it into "a body that knows." In the Cashinahua understanding, a healthy body is one that constantly learns through the senses and expresses the accumulated knowledge in social action and speech. An ill body is one that no longer knows. Curing, therefore, acts to restore a person's capacity to know. The whole article defends the proposition, then, that a prior condition for any medical anthropology in the Cashinahua case is a thorough examination of Cashinahua epistemology. Finally, through comparative discussion of other peoples in lowland South America, it seeks to show that this is also the case more widely in the ethnographic region. Ultimately, it suggests that ethnography in lowland South America undermines the possibility of a "medical anthropology" per se.

Adult↗
PubMed2001

[Living conditions and life experiences of working-class groups in Rio de Janeiro: rethinking dengue control and popular mobilization].

Using narratives of an experience with popular mobilization during the 1986-91 dengue epidemic in the city of Rio de Janeiro, the authors discuss the scientific research and technical counseling involving basic sanitation conditions for vulnerable social groups. They present research results on water distribution in the slums from the Leopoldina area of the city. The research stemmed from demands by community leaders at local forums discussing health conditions. Gathering, systematizing, and analyzing the data were based on what they call "shared knowledge construction", resulting by crossing accumulated scientific knowledge with popular knowledge produced as a result of living conditions and life experiences among working-class groups. Finally, the authors comment on the need for local health professionals to be aware of relationships between epidemic and endemic processes and protection of life.

Brazil↗
PubMed2004

Challenges of accurately defining the nutrient requirements of heat-stressed poultry.

The number of factors that influence the nutrient requirements of heat-stressed poultry, through alterations in metabolism and biological responses, are much greater than those that influence the nutrient requirements of poultry at thermoneutral temperatures. Therefore, multiple dietary nutrient specifications adjusted for different intensities of heat stress experienced in different geographical locations, and for different management options used to combat such conditions, are likely to be required by poultry nutritionists. Financial constraints on the construction of suitable research facilities have limited the accumulation of knowledge concerning dietary nutrient specifications for heat-stressed poultry. Thus, input from commercial enterprises has contributed significantly to the accumulation of existing knowledge. Knowledge of the energy and amino acid requirements of birds during heat stress are best known, whereas vitamins and trace minerals remain among the least-researched groups of nutrients.

Adaptation, Physiological↗