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At least 415 records · Page 23Linked to original sources
PubMed1998

Evaluation of an instructional model for emergency ultrasonography.

OBJECTIVE: To evaluate a 4-hour ultrasonography course in the setting of an emergency medicine (EM) training program. METHODS: EM residents and faculty at a large urban center were provided a 4-hour emergency ultrasonography course. Then, during an 18-month period, a nonconsecutive sample of ultrasonographic examinations were videotaped and later reviewed. The interpretations of the emergency, physician examinations were compared with the following reference standards: 1) an official ultrasound performed and interpreted by the departments of radiology or cardiology; 2) an operative report; 3) A CT scan or i.v. pyelogram (IVP); or 4) a cardiologist's or a radiologist's interpretation of the videotaped examinations. RESULTS: Of 258 examinations reviewed, 28 (11%) of these were excluded because the cardiologist or radiologist reviewing the videotape determined them to be "technically limited" studies. Of the remaining 230 examinations, there were: 127 gallbladder studies [disease prevalence = 0.58; sensitivity = 0.89; specificity = 0.80; kappa (kappa) = 0.69; 95% CI: 56-82%]; 39 echocardiograms to rule out pericardial effusions [disease prevalence = 0.15; sensitivity = 0.83; specificity = 0.97 kappa = 0.80; 95% CI: 54-100%]; 25 abdominal ultrasounds to rule out free peritoneal fluid [disease prevalence = 0.32; sensitivity = 0.88; specificity = 0.94; kappa = 0.81; 95% CI: 26-95%]; 16 renal ultrasounds to rule out hydronephrosis [disease prevalence = 0.25; sensitivity = 1.0; specificity = 0.92; kappa = 0.84; 95% CI: 56-100%]; 12 pelvic ultrasounds to rule in an intrauterine pregnancy [disease prevalence = 0.67; sensitivity = 1.0; specificity = 0.75; kappa = 0.80; 95% CI: 43-100%]; and 11 abdominal ultrasounds to rule out abdominal aortic aneurysms [disease prevalence = 0.09; sensitivity = 1.0; 95% CI: 2.5-91%; specificity = 1.0; 95% CI: 68-100%]. CONCLUSIONS: This 4-hour ultrasonography course has potential to serve as a foundation for an instructional model for ultrasonography training in the setting of an EM residency program.

Confidence Intervals↗
PubMed2001

Patient-focused, family-centered end-of-life medical care: views of the guidelines and bereaved family members.

A fundamental barrier to improving the quality of medical care at the end of life is the lack of measurement tools. The Toolkit of Instruments to Measure End of Life Care (TIME) aims to fill that void by creating measurement tools that capture the patient and family perspective. To develop a conceptual model for a retrospective survey of bereaved family members that incorporates both professional and family perspectives on what constitutes good care at the end of life, a qualitative literature review of existing professional guidelines and six focus groups with bereaved family members from acute care hospitals (n = 2), nursing homes (n = 2), and hospice/VNA home health services (n = 2) was performed. The focus groups were held in Arizona, New York, and Massachusetts and included 42 bereaved family members/friends contacted 3-12 months from the time of patient's death. Domains of care that define quality end-of-life care were defined. Focus group participants defined high quality medical care as: 1) providing dying persons with desired physical comfort; 2) helping dying persons control decisions about medical care and daily routines; 3) relieving family members of the burden of being present at all times to advocate for their loved one; 4) educating family members so they felt confident to care for their loved ones at home; and 5) providing family members with emotional support both before and after the patient's death. The qualitative literature review yielded similar results, except that the professional guidelines did not mention the advocacy burden felt by families. These two sources provided the foundation for a conceptual model of patient-focused, family-centered medical care and a new tool for surveying bereaved family members. Views of bereaved family members' stories and professional guidelines help to identify key domains of quality of end-of-life care. A new survey instrument provides a way to incorporate the perspectives of bereaved family members in measuring the quality of end-of-life care.

Bereavement↗
PubMed2005

Defects in mucosal immunity leading to ulcerative colitis.

Evidence accumulated over the last decade demonstrates that what we call 'ulcerative colitis' is actually a heterogeneous group of diseases resulting from different pathogenic mechanisms with a common symptomatic expression. Subgroups of patients with ulcerative colitis can be stratified by presence or absence of serum autoantibodies, which are thought not to be pathogenic but to mark for a distinct disease phenotype. In recent years, animal-based experimental systems have emerged that reflect human ulcerative colitis and have potential to accelerate our understanding of its pathogenesis. Genetic and immunological data from human studies in combination with results from animal model systems are the foundation of a hypothesis, which includes a role for microbial antigen exposure in the initiation, perpetuation, and amplification of the disease. In ulcerative colitis, it appears as though the T-cell response to the antigens is not T-helper (Th) 1 dominant as in the case of Crohn's disease but rather is either Th2 [interleukin (IL)-4, IL-13] or is mediated by specialized cells such as natural killer (NK) T cells (IL-13). Lamina propria T cells from ulcerative colitis patients produce significantly greater amounts of IL-13. Ulcerative colitis is associated with an atypical Th2 response mediated by a distinct subset of NK T cells that produce IL-13 and are cytotoxic for epithelial cells. The way in which this response affects the ultimate cascade of inflammatory events has yet to be determined.

Animals↗
PubMed2002

[Therapy optimization studies torn between science and funding].

There is no doubt that clinical studies are valuable cornerstones in the development of rational diagnostics and therapy, for the patients' safety, for quality assurance as well as for the development of a body of evidence in medicine. Well recognized multicentric study groups are active in several medical disciplines in Germany. Public funding resources however are miserable as compared to other countries. For example in hematology and oncology funds are almost exclusively available by private foundations as the Deutsche Krebshilfe only. Additionally physicians and institutions who are actively promoting clinical studies have to pay charges for patients' insurance and for registration of studies by the authorities. Furthermore there are increasing difficulties obtaining reimbursement for patients' care in clinical studies. In this context outdated regulations of the German Sozialgesetzbuch V lawbook play an important role. In summary a pronounced reform deficit paired with bureocratic tendencies has become manifested. The most important demands are in this situation: a reliable and realistic regulatory basis for treatment-related clinical studies has to be created. Studies on treatment strategies with registered drugs have to be free from the obligatory patients' insurance which is required for study with non-registered drugs. It has to be clarified that in these studies some regulations of good clinical practice as obligatory external monitoring and source data verification are not feasible and will not be required. The Sozialgesetzbuch V has to be adapted and the actual ban of clinical studies in private practice has to be ended. Treatment related clinical studies have to be free from charges of ethical committees and regulatory authorities. Thereby the financial overload of clinical studies could be reduced and some motivation for further bureocratic proliferation is removed. Finally a longterm, reliable funding resource has to be created independently from the pharmaceutical industry. A possible model could be a foundation for treatment-related studies which is financed by public funds and by funds from the reimbursement companies.

Arthritis, Rheumatoid↗
PubMed1981

Testicular cancer as a model for a curable neoplasm: The Richard and Hinda Rosenthal Foundation Award Lecture.

The combination of platinum, vinblastine, and bleomycin was first used at Indiana University in 1974. Thirty of 47 patients (64%) survived for 5 years, and 27 (57%) are currently disease free (NED) and cured of their neoplasm. From 1976 to 1978, 78 consecutive patients were entered on a random prospective study that indicated that equal therapeutic results could be achieved with a lower dosage (0.3 mg/kg) of vinblastine. Fifty-two (67%) patients are continuously NED, and 57 (73%) are currently NED for 2 or more years. Our third-generation study, done in conjunction with the Southeastern Cancer Study Group, tested the hypothesis of whether maintenance vinblastine was necessary to ensure optimal cure rates in disseminated testicular cancer. One hundred thirteen patients entered this maintenance study, and the results demonstrated that cure in a far-advanced cancer could be achieved with only 12 weeks of therapy (remission induction) because the relapse rate in such patients was only 7%. The cure rate for patients presenting with locoregional disease (Stages A and B) should approach 100%. Platinum, vinblastine, and bleomycin will regularly produce a 70% complete remission rate, and a further 10% of patients will be rendered NED with surgical resection of residual disease. The relapse rate with four courses of remission induction therapy in a large cooperative group study (Southeastern Cancer Study Group) was only 7%. The high success rate in disseminated disease has allowed the option of high cure rate in Stage B disease (positive retroperitoneal nodes) with or without adjuvant chemotherapy. At Indiana University, 137 patients have been followed with Stage A and B nonseminomatous testicular cancer from 1973 to 1979 with a minimum follow-up of 2 years, and currently 135 are alive and well. Successful treatment strategies in testicular cancer have yielded a cure rate unparalleled in cancer treatment.

Antineoplastic Agents↗
PubMed2006

A hybrid two-component system protein of a prominent human gut symbiont couples glycan sensing in vivo to carbohydrate metabolism.

Bacteroides thetaiotaomicron is a prominent member of our normal adult intestinal microbial community and a useful model for studying the foundations of human-bacterial mutualism in our densely populated distal gut microbiota. A central question is how members of this microbiota sense nutrients and implement an appropriate metabolic response. B. thetaiotaomicron contains a large number of glycoside hydrolases not represented in our own proteome, plus a markedly expanded collection of hybrid two-component system (HTCS) proteins that incorporate all domains found in classical two-component environmental sensors into one polypeptide. To understand the role of HTCS in nutrient sensing, we used B. thetaiotaomicron GeneChips to characterize their expression in gnotobiotic mice consuming polysaccharide-rich or -deficient diets. One HTCS, BT3172, was selected for further analysis because it is induced in vivo by polysaccharides, and its absence reduces B. thetaiotaomicron fitness in polysaccharide-rich diet-fed mice. Functional genomic and biochemical analyses of WT and BT3172-deficient strains in vivo and in vitro disclosed that alpha-mannosides induce BT3172 expression, which in turn induces expression of secreted alpha-mannosidases. Yeast two-hybrid screens revealed that the cytoplasmic portion of BT3172's sensor domain serves as a scaffold for recruiting glucose-6-phosphate isomerase and dehydrogenase. These interactions are a unique feature of BT3172 and specific for the cytoplasmic face of its sensor domain. Loss of BT3172 reduces glycolytic pathway activity in vitro and in vivo. Thus, this HTCS functions as a metabolic reaction center, coupling nutrient sensing to dynamic regulation of monosaccharide metabolism. An expanded repertoire of HTCS proteins with diversified sensor domains may be one reason for B. thetaiotaomicron's success in our intestinal ecosystem.

Animals↗
PubMed2004

Terminal dyspnea and respiratory distress.

Dyspnea is a subjective experience that can be reported by the patient. Respiratory distress is an observable corollary, and represents the physical or emotional suffering that results from the experience of dyspnea. Recognizing and understanding this subjective phenomenon poses a challenge to intensive care unit (ICU) clinicians when caring for the patient who is dying in the ICU. Dyspnea and cognitive impairment are highly prevalent in the terminally ill ICU patient. A Respiratory Distress Observation Model may provide a theoretical foundation for the assessment of this phenomenon that is grounded in emotional and autonomic domains of neurologic function. Treatment of dyspnea and respiratory distress relies on nonpharmacologic interventions and opioids and sedatives. As with pain, the treatment of dyspnea and respiratory distress relies on close evaluation of the patient and treatment to satisfactory effect. Empirical evidence suggests that quality care with control of distressing symptoms does not hasten death. Withholding opioids or sedatives in the face of unrelieved dyspnea or respiratory distress has no moral foundation.

Analgesia↗
PubMed2003

Evaluating health plan quality 1: a conceptual model.

OBJECTIVE: To develop a theoretical foundation for measuring health plan quality from a physician's perspective. STUDY DESIGN: Literature review and theory development. METHODS: We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures. Based on an assessment of the literature, we proposed a conceptual model that organizes health plan care management practices into a coherent structure for measuring health plan quality. RESULTS: A conceptual model of health plan operation that organizes managerial practices into a structure for measuring health plan quality from a physician's perspective was developed. CONCLUSION: Health plan quality is distinct from quality of care, and physicians can provide unique, timely, and reliable information about aspects of health plan quality.

Attitude of Health Personnel↗
PubMed2005

A descriptive study of the implementation of the EFQM excellence model and underlying tools in the Basque Health Service.

OBJECTIVE: To describe the implementation of the European Foundation for Quality Management (EFQM) excellence model as a common framework for quality management in a regional health care service. DESIGN: Prospective, descriptive observational study. SETTING: Thirty-one organizations (hospitals, primary care organizations, mental health institutions, and emergency services) of the Basque Health Service (serving a population of 2200000 inhabitants) in Basque Country, Spain. METHODS: Since 1995, the experiences with the EFQM excellence model were initiated by training, the design of quality tools and application guidelines, and actions related to criteria of the EFQM model. RESULTS: Four assessment cycles in which most of the organizations have participated were completed. Scores for most of the criteria improved, particularly in 'processes'. The overall patients' satisfaction was higher than 89% in all settings, in most of the cases higher than 95%. Ten organizations (32%) exceeded 400 points in an external evaluation with the EFQM excellence model, and 2 (6%) 500 points. Eighty-three percent of hospitals have some ISO-certified areas of activity. In the primary care setting, 40% of people were attended in a certified center. CONCLUSIONS: Stimulating actions towards quality have resulted in progressive implementation of the EFQM model, this approach being possibly related to positive evolution of some outcomes. Key factors identified have been pursuing the objective of total quality management during several years and the assignment of the resources for training and implementation of quality systems.

Benchmarking↗
PubMed2000

Metal Incorporation into and Dimerization of M(3)E(4) Clusters (M=Mo, W; E=S, Se) in Supramolecular Assemblies with Cucurbituril: A Molecular Model of Intercalation This work was supported by the Russian Foundation for Basic Research (research grant 99-03-32788) and an EU INTAS collaboration (research grant 96-1256). A.V.V. thanks the Royal Society for financial supporting of his visit to the University of Newcastle upon Tyne. We also thank the EPSRC (UK) for funding.

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Journal Article↗
PubMed1995

A vector projection method for predicting the specificity of GalNAc-transferase.

The specificity of UDP-GalNAc:polypeptide N-acetylgalactosaminytransferase (GalNAc-transferase) is consistent with the existence of an extended site composed of nine subsites, denoted by P4, P3, P2, P1, P0, P1', P2', P3', P4', where the acceptor at P0 is being either Ser or Thr. To predict whether a peptide will react with the enzyme to form a Ser- or Thr-conjugated glycopeptide, a vector projection method is proposed which uses a training set of amino acid sequences surrounding 90 Ser and 106 Thr O-glycosylation sites extracted from the National Biomedical Research Foundation Protein Database. The model postulates independent interactions of the 9 amino acid moieties with their respective binding sites. The high ratio of correct predictions vs. total predictions for the data in both the training and the testing sets indicates that the method is self-consistent and efficient. It provides a rapid means for predicting O-glycosylation and designing effective inhibitors of GalNAc-transferase.

Amino Acid Sequence↗
PubMed1998

Fuzzy-trace theory and false memory: new frontiers.

We describe the origins of fuzzy-trace theory, including Piagetian, interference, information-processing, and judgment and decision-making influences. The contrasting properties of gist and verbatim memory serve as its foundation and, in recent models of spontaneous and implanted false memories, explain seemingly contradictory developmental trends, such as reverse developmental findings, differential time courses for true and false memories, and conflicting effects of trace strength. However, approaches that integrate fuzzy-trace theory with neurological, social, emotional, and motivational perspectives are needed. A method for accomplishing this integration, using the recent models, is introduced and new research that spans these perspectives is discussed. Relations to other contemporary theories, especially source-monitoring and dual-process theories, are also explained. We conclude by rejecting the notion that spontaneous false memories are actually "true" and distinguish gist and verbatim senses of the term "true" that have different consequences in real life.

Humans↗
PubMed1997

The end-joining reaction in V(D)J recombination.

V(D)J recombination consists of a DNA cleavage reaction catalysed by RAG1 and RAG2, followed by an end-joining reaction that utilizes the cell's double-strand break repair machinery. Genes essential for the end-joining reaction include: XRCC4 encoding a protein of unknown enzymatic function; XRCC5 and XRCC6 encoding 86 and 70 kDa subunits of the Ku autoantigen, a DNA end-binding protein that is also the regulatory subunit of DNA-dependent protein kinase (DNA-PK); and XRCC7 encoding the catalytic subunit (DNA-PKcs) of DNA-PK. Recent progress in understanding the cleavage reaction, coupled with what was previously known about Ku, DNA-PK, and double-strand break repair, provide the foundation for a working model of how V(D)J recombination might be catalysed.

Animals↗
PubMed2002

The biophysical limitations in physiological transport and exchange in plants grown in microgravity.

This paper describes how changes in the physical behavior of fluids and gases in microgravity can limit the physiological transport and exchange in higher plants. These types of effects are termed indirect effects of microgravity because they are not due to gravity interacting with the mass of the plant body itself. The impact of limiting gravity-dependent transport phenomena has been analyzed by the use of mathematical modeling to simulate and compare biophysical transport in the 1g and spaceflight environments. These data clearly show that the microgravity environment induces significant limitations on basic physiological and biochemical processes within the aerial and rootzone portions of the plant. Furthermore, this mathematical model provides a solid foundation for explaining the physiological effects that have been noted in past spaceflight experiments.

Air Movements↗
PubMed2004

Have sex differences in spatial ability evolved from male competition for mating and female concern for survival?

Drawing on the theoretical and empirical foundations of two evolutionary models, we argue that, among humans and other mammals, a twofold selection process would parsimoniously account for sex-linked advantages in spatial contexts. In males, a superiority for both solving navigation-related spatial problems and understanding physical principles that apply to the behavior of projectiles could have been inherited from mating-oriented male competition involving extensive ranging and agonistic displays. In females, a form of superior spatial memory may have been shaped in relation to a costly reproduction system compelling them to safeguard their survival and that of their offspring by fostering low-risk strategies consisting of restricted navigation as well as concentration on nearby spatial cues. Based on the combined action of competition and survival pressures, we submit new predictions as to spatial sex differences in several species including humans.

Animals↗
PubMed2005

Psychosocial evaluation and combination treatment of men with erectile dysfunction.

The Sexual Tipping Point forms the foundation of a biopsychosocial model to help conceptualize a combination treatment, where sex coaching and sexual pharmaceuticals are integrated into a clinical approach, which addresses organic, psychologic, and cultural issues for men with erectile dysfunction (ED). At any moment in the intervention pro-cess, the clinician determines the most elegant solution, which focuses the majority of effort on fixing the predominant factor while not ignoring the others. Clinicians using this model, can fully conceptualize ED by understanding the predisposing, precipitating,and maintaining psychosocial aspects of their patient's diagnosis and management, as well as organic causes and risk factors. The sex status or focused sex history, and continuous reassessment based on follow-up are the core elements of this method. Restoration of lasting and satisfying sexual function requires a multidimensional understanding of all of the forces that created the dysfunction, whether a solo clinician or multidisciplinary team approach is used. Each clinician needs to carefully evaluate their own competence and interests when considering the treatment of a man's ED, so that regardless of the modality used, the patient receives optimized care to restore sexual function and satisfaction.

Combined Modality Therapy↗
PubMed2005

Modeling As(V) removal by a iron oxide impregnated activated carbon using the surface complexation approach.

The objective of this research was to model As(V) removal onto a iron oxide impregnated activated carbon (FeAC) using the surface complexation model (SCM) approach. As(V) removal by FeAC was due to the impregnated Fe oxide, not the base carbon material and was a strong function of pH. The two-monoprotic site-triple layer model adequately described As(V) removal using 2 fitting parameters compared with the 3 parameters needed for the diprotic site model. This, along with a better representation of the recognized As(V) removal mechanism (ligand exchange with -OH) as well as the acid-base behavior makes the two-monoprotic approach the better model for As(V) removal by the impregnated iron oxide although the diprotic model was able to describe the pH dependent removal of As(V). Both models were also able to predict As(V) removal at different adsorbent/adsorbate ratios using K(As) determined from a single FeAC adsorption experiment. Thus, fewer adsorption experiments are required in order to model As(V) removal in equilibrium and column systems. The results described in this work will be used as a foundation in developing a dynamic model to predict As(V) adsorption in a fixed-bed adsorber.

Arsenic↗