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PubMed2000

[Previous experiences with evaluation of practice guidelines].

Numerous expectations are associated with the development of guidelines. Referring to the experiences so far it can be stated that despite the large amount of guidelines that have been developed, little attention has been given to dissemination, implementation and evaluation of guidelines. The developed guidelines often do not follow international accepted quality criteria, for example many are not based on scientific evidence or they lack the involvement of all relevant parties. The main problems occur in the process from development to implementation of a guideline. Results from evaluation studies nevertheless show that guidelines can have positive effects on the process and outcome of medical care. More scientifically sound evaluation studies are needed to assess the effects of guidelines. Especially in Germany a lot more needs to be done to improve the quality of guidelines and the amount of evaluation studies.

Evidence-Based Medicine↗
PubMed1979

Deciphering deinstitutionalization: complexities in policy and program analysis.

Deinstitutionalization as a public policy promised to be a major departure from previous psychiatric practice. Decrying traditional "medical paradigms" and the custodial "warehousing" of mental patients, policy makers advanced a "bold new approach" for care in the community. Progressive humanitarian reform could go hand in hand with fiscal conservatism. Community Mental Health Centers were to be the heart of a new national effort. But the rhetoric of reform failed to coalesce the activities among competing federal and state interests and systems. Intended beneficiaries may have become unfortunate victims.

Community Mental Health Services↗
PubMed2001

A rapid screening procedure for cholesterol and dehydrocholesterol by electrospray ionization tandem mass spectrometry.

The mono-(dimethylaminoethyl) succinyl (MDMAES) ester is a new derivative for rapid, mild, and sensitive electrospray ionization tandem mass spectrometry (ESI-MS/MS) analysis of cholesterol and dehydrocholesterol. It is an order of magnitude more sensitive than the previous most practical alternative, the N-methylpyridyl ether derivative. The MDMAES derivative was used to develop a rapid screening procedure for the biochemical diagnosis of Smith-Lemli-Opitz syndrome (SLOS) by measuring the dehydrocholesterol/cholesterol ratio in plasma (5 microl) and plasma spotted onto filter paper. Details of the synthesis of [25,26,26,26,27,27,27-(2)H7]-7-dehydrocholesterol, used as a standard for quantitation, are included. The measurement of total sterols as MDMAES esters, after base hydrolysis of plasma, afforded a dehydrocholesterol/cholesterol ratio of 0.05-2.95 for SLOS patient samples (n = 5) compared with 0.001-0.003 for normal adult controls (n = 20). Direct hexane extraction of plasma without base hydrolysis enabled the measurement of free sterols with a total sample analysis time of <1 h. The free dehydrocholesterol/cholesterol ratio was 0.10-4.47 for SLOS patient samples (n = 5) and 0.003-0.011 for normal adult controls (n = 20).

Adult↗
PubMed2002

Crime and punishment. Instead of a slap on the wrist, crooked healthcare executives now are being sentenced to prison thanks to a crackdown on white-collar crime.

Lawmakers wondering how to handle white-collar crime might look to the healthcare industry, where crooked executives are being held criminally accountable for shady business dealings and corrupt practices that previously may have resulted in quiet dismissals. A confluence of factors has driven the crackdown, from escalating whistleblower lawsuits to a decade-long effort to halt Medicare and Medicaid fraud.

Chief Executive Officers, Hospital↗
PubMed2002

Postexposure feeding depression: a new toxicity endpoint for use in laboratory studies with Daphnia magna.

In situ bioassays with daphnids currently employ lethality as an endpoint, and although sublethal responses (reproduction and feeding rate) can be measured in the field, such endpoints pose major practical challenges. Previous studies have indicated that Daphnia magna exposed to toxic substances can exhibit delayed recovery in feeding behavior (postexposure feeding depression). This simple, robust response has the potential to be an ecologically relevant and potentially diagnostic endpoint. This study developed and tested the use of postexposure feeding depression as a toxicity endpoint in the laboratory environment. First, replicate numbers were manipulated to produce statistically reliable results. Second, postexposure feeding depression in D. magna was studied under laboratory conditions, by employing toxic substances with differing modes of action. Although most substances caused feeding inhibition during direct exposure, not all substances produced postexposure feeding depression. However, the use of lethality as a supplementary endpoint provided an alternative measure when no feeding depression was apparent after exposure. In combination, these endpoints offer a potentially more sensitive, ecologically relevant alternative to the use of lethality alone for in situ bioassay studies.

Animals↗
PubMed2002

Application of obturator to treat velopharyngeal incompetence.

OBJECTIVE: To evaluate the effect of a system of velopharyngeal incompetence (VPI) management after the application of obturator. METHODS: Using nasopharyngofiberoscope (NPF) and a computer analysis system, we quantitatively analyzed the improved state of velopharyngeal incompetence in 100 patients with unilateral and/or bilateral cleft palate. RESULTS: The velopharyngeal closure (VPC) can be greatly improved by using a temporary oral prosthesis (obturator) and speech training. An objective quantitative standard was established to evaluate the change of velopharyngeal closure of cleft palate patients after surgery and conservative treatment. CONCLUSIONS: The method used is more succinct, accurate and practical than previous methods. In order to reflect the state of velopharyngeal incompetence, the concept of improvement rate of velopharyngeal incompetence (IRVPI) is put forward.

Adolescent↗
PubMedDate not supplied

[Discordancies between classical and API 20E microtest biochemical identification of Vibrio and Aeromonas strains].

The present study reveals some discordancies of diagnosis considering Vibrionaceae strains when tested by comparison with API 20E (BioMerieux) system and classical biochemical reactions, aspects already mentioned in the literature by other authors. If any misidentification has not an important impact (e.g. identification of Aeromonas schubertii as A. sobria), others as misidentification of Aeromonas as Vibrio strains or the failure to recognize Vibrio strains raise major epidemiological problems. The present study was performed on 25 aquatic strains, comparatively identified by means of API 20E system and classical biochemical tests (using media prepared in Vibrio Laboratory of Cantacuzino Institute). All 25 strains were identified as Vibrio fluvialis by API 20E system, while using the classical tests one strain proved to belong to Pseudomonadaceae (O/F test of oxidative type), one was identified as Aeromonas schubertii, 2 Aeromonas hydrophila and 4 Aeromonas caviae. Discordancies between API 20 E system and classical tests were registered for: gelatinase (20%), LDC 12% and ADH, ODH, O/F test, saccharose, manite, inosite (4% each). The misidentification of Aeromonas as Vibrio strains by API 20E hinders the recognition of Aeromonas infections implicated more and more frequently in human pathology in immunodeficient as well as in immunocompetent hosts. Our results demonstrate that the use of API 20E system has some limits in the diagnostic of some bacterial genera (Vibrio, Aeromonas), and the introduction of these systems in the current laboratory practice requires previous information and studies regarding their efficiency and availability for the diagnostic of particular bacterial genera and species.

Aeromonas↗
PubMed2005

Usability study on two handheld computers to retrieve drug information.

UNLABELLED: Objective :Performing a usability study on two handheld computers (personal digital assistant and tablet PC), as tools for retrieving drug information. MATERIALS AND METHODS: A randomised crossover study was performed: 34 students in pharmacy and medicine used the two handheld tools in a randomised order, to answer a questionnaire containing 12 questions covering all the aspects of a drug database and a qualitative analysis on six different items to measure access to drug information. The availability of the drug information database Vidal on PDA and on tablet PC implied our choice of the database. Three main criteria for evaluation were chosen: success rates, time-on-task, and number of clicks. RESULTS: There were no significant differences between the two groups neither on age, sex, medical discipline, study years nor previous computer practice. The success rate is significantly higher with the PDA for only one question. The PDA is significantly faster than the tablet PC on 7 of the 12 questions and generates fewer clicks for 3 questions. Compared to the tablet PC, it appears that the PDA is better in terms of clearness, navigability and usefulness for professional practice and it is the only tool which is significantly preferred to all other supports. CONCLUSION: In this study with students, the PDA is significantly more effective quantitatively and qualitatively than the tablet PC to retrieve drug information.

Attitude to Computers↗
PubMed1990

[Probability of the combination use of cisplatin and carboplatin].

To investigate whether each of cisplatin (CDDP) and carboplatin (CBDCA) was AUC (Area Under the Curve)-dependent or time-dependent drug, Human Tumor Clonogenic Assays (HTCA) were performed in various exposure times of CDDP or CBDCA using PC-9 cells. From the result of this study, it was shown that CDDP and CBDCA were AUC dependent drugs. Furthermore, to evaluate the combination effect of CDDP and CBDCA, we carried out HTCA using PC-9 and PC-14 (human lung adenocarcinoma cell lines) cells, and evaluated the combination effect by the median effect analysis of Chou, T.C. and Talalay, P. The combination effects were above the additive effects at the AUC ratios of free Pt in the exposure medium of 3.2, 6.5, 13.1 (CBDCA/CDDP). Especially in the combination of 3 hours exposure of CBDCA followed by 1 hour exposure of CDDP, the Combination Index by median effect analysis was from 0.74 to 0.86 at the AUC ratio of 13.1. But the combination effect was antagonistic at that of 19.5. CDDP and CBDCA, which are AUC dependent drugs, have shown different side effects in previous clinical practice. And the combination effect of both drugs is more than additive effect at the AUC ratios of free Pt of 3.2, 6.5, 13.1 (CBDCA/CDDP). It is considered that the combination chemotherapy of CDDP and CBDCA for patients of lung adenocarcinoma may be useful.

Adenocarcinoma↗
PubMedDate not supplied

Radiology in family practice: a prospective study of 14 community practices.

This study prospectively examined x-rays obtained in the offices of 14 family physicians who read all their own office x-rays and then select those they want a radiologist to read. Each physician completed a standardized report form for 100 consecutive x-rays or for all x-rays obtained for three months, whichever came first. A total of 1,127 x-rays were evaluated. The results indicate that: 1) 86.5% of all x-rays were of three types (chest x-ray, 50.8%; upper extremity, 18.9%; lower extremity, 16.8%); 2) 85.3% of all x-rays were obtained to: a) confirm a clinical diagnosis, b) establish a diagnosis, c) screen for potential problems; 3) 84.8% of the referred x-rays were referred to a) confirm the family physician's interpretation, b) interpret equivocal findings, c) provide medicolegal support, d) improve interpretation skills; 4) the referral rate to a radiologist was 11.6%, with chest x-rays referred most frequently; 5) the same five major ICD-9-CM diagnostic categories were associated with 90.1% of all x-rays obtained and 86.5% of all x-rays referred; 6) the types of x-rays obtained in community practice and in a previously studied residency training practice were similar; 7) 55.6% of office x-rays were read as "normal;" and 8) the family physicians' discordancy rate with the radiologists on referred films was 12.5%.

Family Practice↗
PubMedDate not supplied

Early oral contraceptive use as a prognostic factor in breast cancer.

The survival of 193 premenopausal breast cancer patients was investigated in relation to their history of early use of oral contraceptives. The women were born in 1939 or later and diagnosed in the southern health care region of Sweden. Women, who had started their oral contraceptive use (OC-use) before 20 years of age had a significantly lower survival rate as compared with those who had never used OC and late users (p = 0.02 and = 0.04 respectively, generalized Wilcoxon test). For women who started OC-use between 20 to 25 years of age, a tendency for a shorter survival was seen in comparison with women who had never used OC (p = 0.18). For all patients simultaneously, the relative risk adjusted for age at diagnosis increased for earlier OC-start. When only stages II and III were considered in a stratified multivariate model, a significantly elevated risk was seen for early users of OC irrespective of age or of adjuvant treatment given. The estrogen and progesterone receptor concentrations of the primary tumor were significantly lower among early users (p = 0.001 and p = 0.05 respectively).

Age Factors↗
PubMed1987

[Trigeminal somatosensory evoked potentials: II. Some clinical experiences].

Compared to other somatosensory evoked potentials (SEP), little information has been published so far on trigeminal somatosensory evoked potentials (TSEP) in the various kind of disorders. This may be due to few recording technique suitable for clinical practice. We previously reported a new recording method and showed the normal pattern of TSEP. The purpose of this report is to examine its reliability for clinical use. Sixty patients, with either a complaint of facial numbness or an organic lesion supposed to involve facial sensory pathway, were investigated. Their age ranged from 13 to 74 years old (mean 47.0). They consisted of 34 organic lesions (30 brain tumors and 4 cerebrovascular diseases) and 26 non-organic lesions (16 hemifacial spasms, 6 trigeminal neuralgias and other miscellaneous disorders). TSEP was recorded by the stimulation of the half of the contralateral upper or lower lip with the clip-shaped electrode. C'5 or C'6 (midpoint between Cz and the external auditory porus) was used as an active electrode and Fz as a reference. Two hundred or four hundred responses were averaged by a Nicolet Pathfinder II. All recordings were repeated at least twice to confirm the reproducibility. (1) Among 21 patients with a complaint of facial numbness except for neuralgia, the abnormality rate of TSEP was significantly different (p less than 0.02) between organic and non-organic lesions. The former was 87.5% (14 out of 16 cases) and the latter was 20% (1 out of 5 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Effect of gangliosides on the cytotoxic activity of natural killers from Syrian hamsters].

The ability of various gangliosides to inhibit the cytotoxic activity of natural killers (NK-cells) from Syrian hamsters towards human lymphoma MOLT-4 cells was studied. The inhibitory effect was found to depend on the structure and concentration of the gangliosides. At concentrations corresponding to those in the blood of tumour-bearing hosts, SiaLacCer and Sia2LacCer inhibited the NK-activity. A significant inhibition was also found for (NeuAc)2GgOse3Cer, whereas NeuGcGgOse3Cer and NeuAcGgOse4Cer were practically inactive. Previously it was shown that Sia2LacCer which is either absent or very low in normal blood, is produced by a number of tumours and that tumour cells "shed" considerable amounts of gangliosides. On this ground, it was proposed that elevated concentrations of SiaLacCer and Sia2LacCer in the blood of tumour-bearing animals may inhibit the NK-activity and thus contribute to the "escape" of tumour cells from host immune surveillance.

Animals↗