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PubMed2002

[Research on factors for dropout from treatment by outpatients of alcohol abuse or alcohol dependence (I)--Based on statements of medical treatment personnel].

This study have in view the elucidation of factors related to treatment dropouts of alcohol abuse and dependence outpatients. The medical staff of the clinic "S" held two workshops and the discussion data was analyzed by a Total Quality Management (TQM) method to see a strategy for avoiding dropout. There were three side characteristics, for dropout factors, i.e., patients' and clinic's and relations between two sides. To cope with patients' factors a better communication with patients by medical staff was suggested. For clinic "S", suggestions was given to improve treatment environment such as consultation and treatment systems and better relationship with patients.

Alcoholism↗
PubMed2002

Gene expression profiles in young adult Ciona intestinalis.

Comparison of 12,230 expressed sequence tags (ESTs) of 3' ends of cDNA clones derived from young adults of Ciona intestinalis allowed us to categorize them into 976 independent clusters. When the 5'-end sequences of 10,400 ESTs of the 976 clusters were compared with the sequences in databases, 406 of the clusters showed significant matches ( P < E-15) with reported proteins with defined functions, while 117 showed matches with putative proteins for which there is not enough information to categorize their function, and 453 had no significant sequence similarities to known proteins. The 406 clusters with sequence similarity to proteins with defined functions consisted of 304 clusters related to proteins with functions common to many kinds of cells, 73 related to proteins associated with cell-cell communication and 29 related to transcription factors. Spatial expression of all of the 976 clusters was examined by a newly improved whole-mount in situ hybridization method. A total of 430 clusters did not show distinct in situ hybridization signals, while 122 clusters showed ubiquitous distribution of signals, and 253 clusters showed signals in multiple tissues. The remaining 171 clusters showed signals specific to a certain organ or tissue: 16 showed epidermis-specific expression, 3 were specific to the neural complex, 1 to heart, 6 to body-wall muscle, 94 to pharyngeal gill, 3 to esophagus, 26 to stomach, 1 to intestine and 21 to endostyle. Many of these organ-specific genes encode proteins with no sequence similarity to known proteins. The present analysis thus highlights characteristic gene expression profiles of Ciona young adults and provides not only molecular markers for organs and tissues but also transcriptomic information useful for further genomic analyses of this model organism.

Animals↗
PubMed1990

[Technic and long-term results of cryogenic epilation in trichiasis and distichiasis].

The present paper communicates the technique and results of cryoepilation in 1,690 cases (94% trichiasis and 6% distichiasis). Only nitrogen cryotherapy devices are totally suitable for this, and the spray freezing method is to be preferred. The IKG unit developed by the authors, which has proved successful in particular for tumor therapy, is also ideal for cryoepilation. It generates a very tightly bundled nitrogen spray jet, thus permitting isolated freezing of the lid margin. In about 95% of the cases permanent epilation is achieved without undue trauma. In 5% the condition described by Fraunfelder as "secondary trichiasis" develops. Ocular pemphigoid is not a contraindication to cryotherapy.

Cryosurgery↗
PubMedDate not supplied

Retrospective evaluation of palliative care in Romania: the perspective of the involved professionals.

OBJECTIVE: Palliative care at home is a new service provision in Romania. This study evaluated retrospectively, after the patient's death, the provision of care at home from the perspective of professionals directly involved in the care process. The evaluation included assessment of the role of the professional, the functioning of the team, communication with patients and family, and overall judgment. The study is part of the development of palliative care at home, by multidisciplinary teams in Romania. METHODS: Over a period of eighteen months five teams with a total of 19 professionals, provided palliative care for 103 patients with cancer in its terminal stage. During this period 80 patients died. A questionnaire was sent to the professionals involved. All responded resulting in 181 evaluations. These evaluations are the basis for analysis. The data were analyzed using SPSS. RESULTS: Of the 181 cases evaluated, 63 indicated an emotional burden on the professionals. GP's and nurses reported such a burden more frequently. A lack of knowledge of how to treat a special case was reported 56 times. This was especially so when a case was judged to be different from other cases, which often included (unexpected) complications. GP's reported cases with complications more frequently than oncologists and nurses. The multidisciplinary teams functioned very satisfactorily in treating patients. Although communication with patients/families was generally judged positively, communication with patients was sometimes viewed as problematic. The overall verdict was that the care delivered to the 80 patients was positive. Most professionals reported that they would deal with the cases in the same way again. CONCLUSIONS: The patients who received palliative care and died, were treated well according to the professionals who evaluated the care process. Improvement of palliative care services at home may be achieved by provision of additional information on (acute) complications. Since palliative care at home is a new phenomenon in Romania, professionals working closely with the patient have to learn to cope with the emotional burden certain cases may include.

Health Knowledge, Attitudes, Practice↗
PubMed1997

Optimal vaccination strategies--for whom?

A SIRS model with vaccination is considered. The vaccination is assumed to have side effects (for simplicity, these side effects are modeled as a probability of becoming ill because of vaccination). It is the interest of the total population to minimize the prevalence of disease; hence, the vaccination rate that minimizes the prevalence will be determined. In Section 2, the individual is considered: an individual tries to minimize his or her own risk. This angle of approach results in a vaccination rate dependent on the prevalence of the disease. The bifurcations of this system are analyzed, and the optimal vaccination coverage for the individual is computed. This coverage is then compared with the optimal vaccination coverage for the total population: it is found that they disagree for some parameter sets.

Communicable Disease Control↗
PubMed1998

Impact of education for physicians on patient outcomes.

OBJECTIVES: This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1) the treatment practices and communications and education behavior of physicians, 2) the health status and medical care utilization of their pediatric patients with asthma, and 3) the satisfaction with care of the subjects' parents. METHODS: A total of 74 general practice pediatricians were assigned to either a program or a control group in a randomized controlled study. Data were collected from physicians at baseline, and 69 (93%) provided follow-up data 5 months after the program. Data were also collected from 637 of their patients at baseline, and in a 22-month window after the intervention, 472 (74%) of this number provided follow-up data. RESULTS: After the seminar, physicians in the program group were more likely than were control group physicians to address patients' fears about medicines, review written instructions, provide a sequence of educational messages, write down how to adjust the medicines at home when symptoms change, and report that they spent less time with their patients. Parents of the children treated by program physicians were significantly more likely than were control group parents to report that the physician had been reassuring, described as a goal that the child be fully active, and gave information to relieve specific worries. After a visit with the physician, these parents were also more likely to report that they knew how to make management decisions at home. After the intervention compared to controls, patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler. After the intervention, children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms; however, there were no differences in emergency department visits and hospitalizations. Among children who were placed on inhaled corticosteroids during this study, however, children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits, nonemergency physician office visits, emergency department visits, and hospitalizations. CONCLUSIONS: The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration, had significant impact on the prescribing and communications behavior of physicians, led to more favorable patient responses to physicians' actions, and led to reductions in health care utilization.

Asthma↗
PubMed2004

Undergraduate medical students' views about a reflective portfolio assessment of their communication skills learning.

INTRODUCTION: To date, no studies have examined preclinical medical students' views about portfolios. Since portfolios are becoming increasingly valued in medical education, this study explores second-year medical students' views about a reflective portfolio assessment of their communication skills. METHODS: 178 second-year medical students at the University of Nottingham completed the 18-item reflective portfolio questionnaire (RPQ) (alpha = 0.716) and a personal details questionnaire three days before submitting their portfolio assessment for communication skills. Data were analysed using univariate and multivariate statistics on SPSS Version 10.0. RESULTS: Total scores on the RPQ ranged from 40 to 75 (mean 58.28, SD 7.08). Significant relationships existed between RPQ total scores and students' ratings of their reflection skills (rs = 0.322, P < 0.001), RPQ total scores and students' confidence building another portfolio (T = 4.381, d.f. = 176, P < 0.001), and RPQ total scores and students' marks for their reflective portfolio assessment (rs = 0.167, P = 0.029). Students with more positive views about reflective portfolios were more likely to rate their reflection skills as good, receive better marks for their portfolio assessment, and be more confident building another portfolio. DISCUSSION: This study begins to highlight preclinical medical students' views about reflective portfolios. However, further research is required using qualitative studies to explore students' views in depth. Medical educators should be encouraged to consider introducing portfolios as a method of formative and summative assessment earlier in the medical curriculum.

Adolescent↗
PubMed1982

Speech and swallow following Staffieri voice restoration procedure.

The Loyola University and Hines Veterans Administration Surgical Service completed the Staffieri procedure to construct a pharyngoesophageal flap at the time of total laryngectomy in 12 patients. Following surgery, 11 patients produced speech that was highly intelligible. Ultimately, seven continued to rely on this method of speech as their primary means of communication. Voice quality was judged to be rough, strained, wet, and breathy in a majority of patients. Aspiration of liquids was evident in 11 of 12. Four underwent revisions to reduce the size of the fistula and to correct swallowing problems.

Aged↗
PubMed2005

Perceived sufficiency and usefulness of IEC materials and methods related to HIV/AIDS among high school youth in Addis Ababa, Ethiopia.

This study was conducted to assess the perceived sufficiency and usefulness of HIV/AIDS information, education and communication (IEC) messages and materials as well as to identify preferences for IEC sources and methods. Data were collected using a self-administered questionnaire and focus group discussions. A total of 901 students in Addis Ababa, Ethiopia, participated in the study. Over three quarters of the respondents believed in the usefulness of IEC. IEC materials were perceived to be useful in increasing knowledge about HIV/AIDS by 456 (51%), to influence attitude by 357 (40%) and to acquire safer sexual practices by 382 (42%) of the respondents. None of the information sources and messages available for high school students highly satisfied the sufficiency indicators. Even though no single information source was highly preferred, radio and television ranked top. Life skills training was the most desired intervention by the students. IEC on HIV/AIDS was able to acquaint students with the disease rather than equipping them with knowledge and skill needed in their daily life. Therefore, appropriate and mutually reinforcing IEC messages with emphasis on life skill training are recommended.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Application of keyhole approach in operation of intracranial aneurysms].

OBJECTIVE: To explore the operative technique and evaluate the effect of intracranial aneurysms via keyhole approach. METHODS: Fifty-six intracranial aneurysm patients, 23 with anterior communicating artery (AcomA) aneurysm, 29 with posterior communicating artery (PcomA) aneurysm, and 4 with internal carotid artery-posterior communicating artery aneurysm, totally with 58 lesions, were treated by microsurgery, via supraorbital keyhole approach in 22 cases, pterional approach in 18, and transorbital approach in 16. Adjuvant endoscopy was used in 33 patients. RESULTS: Fifty-eight lesions of aneurysm were clipped in all the patients and no one died. No approach-related severe complication occurred. Bilateral PcomA aneurysms in 2 cases were clipped via unilateral keyhole approach. CONCLUSION: It is workable to treat intracranial aneurysms via keyhole approach. Keyhole approach not only reduces the operation-related trauma and shorten the operation time, but also obtains ideal results.

Adult↗
PubMed1983

Sample sizes for the exact test of 'no interaction' in 2 X 2 X 2 tables.

The exact two-sided test of the hypothesis of 'no interaction' in a 2 X 2 X 2 table with fixed totals of rows X columns is considered. A method of approximating the power of the test, based on the limiting conditional distribution of a cell entry (Godambe and Harkness, 1975, Communications in Statistics 4, 699-709), is introduced and found to provide a close fit. This method can be utilized to calculate the sample sizes required to detect interaction effects with a pregiven power.

Breast Neoplasms↗
PubMedDate not supplied

Speaking and interruptions during primary care office visits.

BACKGROUND: Patients and physicians value effective communication and consider it an essential part of the medical encounter. This study examined physician-patient communication patterns, and interruptions in communication, during patient visits with family practice and internal medicine residents. METHODS: Observational data obtained from 60 routine primary care office visits included the time that resident physicians and patients spoke and the number and types of interruptions. A total of 22 family practice and internal medicine residents participated, 9 from family practice and 13 from internal medicine. RESULTS: Patients spoke, uninterrupted, an average of 12 seconds after the resident entered the room. One fourth of the time, residents interrupted patients before they finished speaking. Residents averaged interrupting patients twice during a visit. The time with patients averaged 11 minutes, with the patient speaking for about 4 minutes. Computer use during the office visit accounted for more interruptions than beepers. Verbal interruptions, a knock on the door, beeper interruptions, and computer use all interfered with communication, and increased frequency of interruptions are associated with less favorable patient perceptions of the office visit. Female residents interrupted their patients less often than did male physicians. All residents interrupted female patients more often than male patients. Early and increased interruptions were associated with patients' perception that they should have talked more. Third-year residents interrupted patients less frequently than did first-year residents. CONCLUSIONS: Numerous interruptions occurred during office visits. Gender was associated with the pattern of interruptions. Physicians frequently interrupted patients before the patients were finished speaking. Computer use also interrupted physician-patient communication.

Adult↗
PubMed2003

PACS utilization in radiologic research.

RATIONALE AND OBJECTIVES: The authors investigated patterns of utilization of the digital picture archiving and communication system (PACS) in radiologic publications in order to ascertain whether there may be a correlation between PACS use and demographic/cultural factors such as geographic location, radiologic specialization, and use of advanced radiologic technologies. MATERIALS AND METHODS: A total of 1,037 articles in 22 randomly selected issues of AJR: American Journal of Roentgenology and of Radiology (1999-2001) were reviewed for the rate of PACS use and the type of PACS used. Articles for which PACS use or nonuse was established were further classified according to originating continent or region, imaging modality, study design (whether retrospective or prospective), and the use of advanced radiologic technology. The use of a PACS was then correlated with these factors. The data were recorded and statistics were prepared by means of statistical software. The nonparametric (chi2) test also was run by using this software. RESULTS: PACS had been used and reported in the preparation of 225 of the 1,037 articles. The type of PACS used was mini PACS (eg, systems using digital imaging and communications in medicine [DICOM] protocols or precursors) in 55 (24%) and department- or hospital-wide PACS in 161 (72%). Most of the articles for which use of a PACS was reported had originated in North America (60%), Europe (22%), or Asia (14%). PACS were used in almost half of retrospective studies and in one-fourth of prospective studies (P < .01). A low correlation was found between utilization of PACS and use of other advanced technologies. CONCLUSION: Although PACS were utilized in the preparation of a substantial proportion of articles published in the two major radiology journals, there was a great disparity in the rate of PACS use among world regions. The proportion of studies originating in North America for which a PACS was used was nearly three times the number of similar studies originating in Europe, and more than four times the number originating in Asia.

Chi-Square Distribution↗
PubMed2003

Communication between programs and applicants during residency selection: effects of the match on medical students' professional development.

PURPOSE: Communication between programs and applicants during the Match has raised concern among medical educators. This study explores the patterns of such communication and its effect on the ethical and professional development of medical students. METHOD: In March and April 2001, the authors made a secure, anonymous questionnaire available online to 1,362 medical students who were graduating from ten U.S. medical schools and who participated in the 2001 Match. Data analysis included chi square, ANOVA, and correlation tests as appropriate. RESULTS: A total of 740 students (54.3%) completed the questionnaire. Patterns of communication between programs and applicants varied significantly by medical school and specialty. Communication initiated by applicants came predominantly from those from less highly ranked medical schools (p =.000), and those applying to specialties with lower fill rates (p =.000). Programs initiated significantly more communication with applicants from more highly ranked schools (p =.006), and with those applying to specialties with higher fill rates (p =.000). The amount of pressure felt by applicants was related to the level of communication, whether initiated by applicants (p =.028) or programs (p =.000). Applicants who felt more pressure were significantly more likely to make misleading statements to programs (p =.000). CONCLUSIONS: Communication between applicants and programs during the Match varies and may have adverse effects on the ethical and professional development of medical students. This study provides support for proposals to limit communication between programs and applicants during the residency selection process.

Analysis of Variance↗
PubMed2004

Preventing ectopic pregnancies: how often does transperitoneal transmigration of sperm occur in effecting human pregnancy?

OBJECTIVE: Transperitoneal transmigration of sperm constitutes the mechanism by which ectopic pregnancies occur in unilaterally obstructed fallopian tubes. This study was undertaken to determine how often sperm transmigrate across the peritoneal cavity to effect human pregnancy. DESIGN: In women with non-communicating rudimentary uterine horn pregnancies, the ratio of total uterine horn pregnancies to prior contralateral hemi-uterine pregnancies was calculated to infer the overall transperitoneal sperm transmigration rate. The prior parity frequency distribution was also determined to calculate the best-fit per-pregnancy probability of attaining a rudimentary horn pregnancy with each subsequent gestation using maximum likelihood estimation. SETTING: 20th century. SAMPLE: Non-communicating rudimentary uterine horn pregnancies reported from 40 countries. METHODS: Two hundred and seventy-two cases were identified using manual and computerised searches of Index Medicus, Excerpta Medica, the Index-Catalogue of the Library of the Surgeon-General's Office and standard reference tracing. MAIN OUTCOME MEASURES: The ratio of total prior non-rudimentary uterine horn pregnancies to rudimentary uterine horn pregnancies and the frequency distribution of prior maternal parities. RESULTS: Prior to the incident 272 uterine horn pregnancies, the number of observed pregnancies was 292 (ratio = 0.93), implying an aggregate sperm transmigration rate of 0.48. Using the prior parity frequency distribution, the best-fit probability of attaining a rudimentary horn gestation per-pregnancy was 0.51 (95% CI 0.48-0.56). CONCLUSIONS: Intraperitoneal sperm transmigration occurs approximately half the time in effecting spontaneous human pregnancies. To minimise the risk of ectopic tubal pregnancy in woman with unilaterally damaged fallopian tubes, salpingectomy should be the preferred surgical treatment, rather than attempting tubal salvage and repair.

Adult↗
PubMed2001

Functional imaging studies: linking mind and basic neuroscience.

OBJECTIVE: The imaging of brain activity with positron emission tomography (PET) and functional magnetic resonance imaging has assumed a central position in psychiatry. Functional imaging signals arise from changes in the neurophysiological parameters of glucose and oxygen consumption mediated by blood flow. METHOD: Recent in vivo (13)C nuclear magnetic resonance (NMR) neurochemical studies have established a quantitative coupling between the rates of glucose oxidation and glutamate neurotransmitter flux in rats and humans, thereby linking measured neurophysiological parameters to brain function. RESULTS: These results show that in the awake, resting, and unstimulated states, 70%-80% of brain energy consumption is devoted to the same glutamate/glutamine neurotransmitter signaling as are the small percentages stimulated by tasks. Furthermore, in anesthetized animals, in which unstimulated activity is reduced, the total signal rather than a particular increment is required for a response. CONCLUSIONS: On this basis, the total signal, as well as the difference in the signal, measures cortical neurotransmitter flux. The total signal in a region therefore contains valuable information about required brain activity. Although signal change is often more easily measured, certain PET and (13)C NMR methods can quantify total regional signal activity and thereby provide another measure of neurotransmitter activity.

Animals↗
PubMed2005

The effect of educational intervention on intercultural communication: results of a randomised controlled trial.

BACKGROUND: Due to worldwide migration to Western countries, physicians are increasingly encountering patients with different ethnic backgrounds. Communication problems can arise as a result of differences in cultural backgrounds and poor language proficiency. AIMS: To assess the effectiveness of an educational intervention on intercultural communication aimed to decrease inequalities in care provided between Western and non-Western patients. DESIGN OF STUDY: A randomised controlled trial with randomisation at the GP level and outcome measurements at the patient level. SETTING: General practice in Rotterdam. METHOD: Thirty-eight Dutch GPs in the Rotterdam region, with at least 25% of inhabitants of non-Western origin, and 2407 visiting patients were invited to participate in the study. A total of 986 consultations were finally included. The GPs were educated about cultural differences and trained in intercultural communication. Patients received a videotaped instruction focusing on how to communicate with their GP in a direct way. The primary outcome measure was mutual understanding and the secondary outcomes were patient's satisfaction and perceived quality of care. The intervention effect was assessed for all patients together, for the 'Western' and 'non-Western' patients, and for patients with different cultural backgrounds separately. RESULTS: An intervention effect was seen 6 months after the intervention, as improvement in mutual understanding (and some improvement in perceived quality of care) in consultations with 'non-Western' patients. CONCLUSIONS: A double intervention on intercultural communication given to both physician and patient decreases the gap in quality of care between 'Western' and 'non-Western' patients.

Adolescent↗