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PubMed1999

Morbidity and mortality patterns, health beliefs, and health risk factors of Karen highlanders of northwest Thailand.

Morbidity and mortality patterns, health care practices, and health care beliefs were assessed over three seasons in Pwo and Sgaw Karen preschool children living in the highlands of northwest Thailand. The sample consisted of all preschool children from 77 Pwo and 71 Sgaw households. Although the Pwo and Sgaw Karen residing in the highlands of northwest Thailand live in isolated villages in the same ecozone, utilize similar technologies, have similar access to health facilities, and maintain a certain level of sociocultural homogeneity through their identification as Karen, Pwo preschool children exhibit significantly higher levels of morbidity and mortality than their Sgaw counterparts. It is argued that these differences in morbidity and mortality are primarily the function of historical patterns which resulted in an earlier contact of the Sgaw with modem societies and particularly with an earlier exposure to western health care.

Adult↗
PubMed2000

Advances in immunohistochemistry: impact on surgical pathology practice.

Over the past decade, the many advances in immunohistochemical techniques have revolutionized the field of immunohistochemistry. Most notable is discovery of the use of heat for antigen retrieval, which permits consistent and reliable demonstration of antigens in routine surgical pathology specimens despite variations in the duration of fixation and tissue processing schedules. As a result, immunohistochemical studies play an increasingly important role in surgical pathology, such as help in rendering a diagnosis in a crushed specimen, classification of tumors, prediction of the likely origin of a carcinoma, demonstration of micrometastases, provision of prognostic information, and demonstration of microorganisms. To serve such purposes, immunohistochemical stains must be performed at a high standard with consistent and reproducible results. The stains must be interpreted cautiously in the appropriate context, and potential pitfalls such as endogenous biotin activity must be recognized. The increased demand for immunohistochemical tests raises the issue of cost containment, which can be achieved through a number of ways, such as deletion of nonvalue-added tests, deletion of antibodies that no longer serve a purpose, replacement of the conventional positive control with a multitissue control mounted on the same slides of the test cases, various means of savings on antibodies, and continuing to use "expired" antibodies. To keep abreast of modem developments in the field in this era of information explosion, the internet can play an important role by providing updated information or database and a platform for rapid exchange of knowledge.

Antibodies↗
PubMed2000

Telerehabilitation services using web-based telecommunication.

A World Wide Wide-based telerehabilitation platform has been demonstrated in a laboratory environment. This platform allows a rehabilitation provider to thoroughly evaluate the progress of a patient remotely with the same care and measurement precision that would be possible if the provider and the patient were in the same room. The platform was designed to be Web-based so that the service could be offered at the same price without regard to long distance telecommunication facility charges. The Web-based implementation allows enough bandwidth for a simultaneous video teleconference and a precision data acquisition mode even when the Web connection is a low cost analog modem computer interface at both ends of the connection.

Ambulatory Care↗
PubMedDate not supplied

Molecular diagnostics in the treatment of childhood acute lymphoblastic leukemia.

Somatically acquired genetic alterations play an important role in the pathogenesis of acute lymphoblastic leukemia. The molecular analysis of these alterations has increased our understanding of the mechanisms of leukemogenesis. In addition, this information has led to improvements in our abilities to predict treatment response and to deliver the optimal intensity of treatment to individual patients. For example, the prognosis for patients with acute lymphoblastic leukemia whose leukemic cells express the TEL-AML1 fusion is favorable when they are treated on modem chemotherapy protocols, whereas patients whose leukemic lymphoblasts contain the MLL-AF4 or the BCR-ABL fusion sometimes require allogeneic hematopoietic stem cell transplantation for cure. Molecular techniques are also used to detect minimal residual disease and genetic polymorphisms that are important in optimizing drug therapy.

Child↗
PubMed2000

Telecare of diabetic patients with intensified insulin therapy. A randomized clinical trial.

BACKGROUND: Patients with insulin dependent diabetes require frequent advice if their metabolic control is suboptimal. A telemedical system for transmission of self monitoring blood glucose values from the patients' home to the diabetes center with a combined modem-interface is described. Data are processed by PC and advice is given by telephone. The study focuses on metabolic outcome, fiscal and administrative aspects. METHODS: A prospective, randomized trial with 46 patients with intensified insulin therapy was conducted, 30 patients used telecare and 16 conventional care. RESULTS: HbA1c, as a parameter of metabolic control, dropped from 8.3% to 7.3% in the telecare group and from 8.0% to 6.8% in the conventional group after 8 months of observation. There was no significant difference between the two groups. Time expenditure for telemanagement, compared to conventional advice, was moderately higher, but there was a substantial amount of time on the patients side that could be saved mainly by reduction of to travel time and work stoppage. Setting up an optimal telemanagement scenario a cost analysis was done. This yields a cost saving of about 650 EURO per year. CONCLUSION: Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management.

Adult↗
PubMed2001

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

OBJECTIVE: The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. DESIGN: A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. METHODS: All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. RESULTS: During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. CONCLUSION: This study is the first effort to establish comprehensive criteria for evaluating handheld prescribing systems and to evaluate the performance and features of a handheld, electronic prescribing system. The results demonstrated that the evaluated system: 1) was simple to install; 2) successfully interfaced with a commonly used practice management system; 3) was user-friendly and easy to operate; 4) offered a robust variety of standard features; and, 5) resulted in a high rate of success for transmitting electronic prescriptions. The criteria established for the evaluation of features of an electronic prescribing system can be used to critically evaluate the performance and features of other handheld and personal computer-based electronic prescribing systems.

Adult↗
PubMed2000

Revolutions in ophthalmology.

Cataract is the major cause of blindness worldwide. The transition of couching of cataract to most modem phaco-emulsification gained popularity with more scientific capsulorhexis. Ongoing research is taking place with laser technologies for removal of cataract. Surgery has an important role in advanced corneal diseases. Corneal transplantation is the most successful form. The refractive errors can be corrected by laser-assisted in-situ keratomileusis, intrastromal corneal rings and phacic intra-ocular lenses. Current research is going on to identify the gene responsible for glaucoma and once this is identified, medical therapy can be developed to control the disease. Thermocautery or photocoagulation and indenting the globe so as to bring the choroid nearer the break by scleral buckling forms the basis of modern surgery of retinal detachment. Vitreoretinal diseases, macular degeneration, diabetic retinopathy are no longer considered problematic. We are optimistic that more clinical breakthroughs are expected in the 21st century with new advances of ophthalmic researches.

Cataract↗
PubMed2001

[Effects of characteristics of nutrition during the 1st year of life on some health indicators of young children].

Some health and development indicators were comparably analyzed at 218 children at age up to 3 years depending on the mode of feeding during first 12 month. The research was made at two stages. The first stage was done from 1990 till 1994. This period was characterized by so call traditional approach of the feeding system. The second one took place from 1995 till 1999. This period was characterized by new approach implementation such as free breast feeding, availability of modem infant formulas (adapted breast milk substitutes), changes at feeding system resulted to postponed because starting. The result of our research stated, that new approaches implementation at first year feeding system leaded to significant decreasing of the rate of the nutritional-depended diseases during the first year. Rates of incidence of acute-respiratory diseases, food allergy, functional stomach and gut-intestinal disorders low morphological indicators were depended on the way of feeding during the first 12 month. The differences hold on up to the end of the 3-d year. The results of research stated, that optimal health and development indicators were at breast feeding infants. Positive breast feeding long term influence depended of its duration, which must be at least for 6 month.

Age Factors↗
PubMed2000

The role of the Picasso phone system in distance consultation for remote Pacific Islands.

The U.S. affiliated Pacific Island nations spend an average of over 10% of total health budget on off-island referral care to tertiary centers. Tripler Army Regional Medical Center (TAMC) has been the major provider of this service for many years. Prior to 1995 communication to consultants at TAMC was by long distance telephone, fax and regular mail. Connecting to a specialist sometimes took hours and clearly a better communication link was needed. The AT&T Picasso phone, an instrument the size of a small briefcase was developed to reliably transmit still images over the regular phone. Freeze-frame images captured at the sending end by a cam recorder were transmitted to a remote receiver unit, where they were displayed and stored. A typical medical consultation involved about three images, with each transmission over the 28.8 Kbps modem taking about one minute. A separate consultation form submitted by fax to TAMC was attached to the transferred images. Four Picasso phones were used to test their usefulness in linking isolated Pacific islands to a metropolitan medical center. For the first time ever, coloured patient images, data, X-rays etc were transmitted with a faxed written medical report. The Picasso phone was the spark of the Telemedicine development in the US affiliated Pacific islands.

Humans↗
PubMed2001

An experimental health smart home and its distributed internet-based information and communication system: first steps of a research project.

We present a study and whole experimental tele-monitoring and medical tele-surveillance system for maintaining patients at home. The project features networked sensors, in a fully equipped apartment, operated by an advanced information and communication system based on Internet, Java, and object oriented modeling. The sensors are connected, mainly wirelessly, with a in-home software module devoted to signals analysis and detection of critical situation such as falls, sickness, sudden palsy, stroke, hypothermia, etc. This module communicates, either via modem or ethernet network, with a remote medical control station in charge of appropriate response to received information and alarms. The system is designed to be a powerful information and communication tools for medical and social workers. It offers a series of functions such as medical file management, user profiles and rights management, drafting and management of ordinances and visit notes, confidentiality of medical information, and management of scenarios of detectable events. The access to the system is allowed to authorized users only (physicians, emergentists, social workers, etc.), and is available on as much authorized computers as needed, by means of a Java applet invoked from any traditional web browsers.

Computer Communication Networks↗
PubMedDate not supplied

EuCliD (European Clinical Database): a database comparing different realities.

Quality and variability of dialysis practice are generally gaining more and more importance. Fresenius Medical Care (FMC), as provider of dialysis, has the duty to continuously monitor and guarantee the quality of care delivered to patients treated in its European dialysis units. Accordingly, a new clinical database called EuCliD has been developed. It is a multilingual and fully codified database, using as far as possible international standard coding tables. EuCliD collects and handles sensitive medical patient data, fully assuring confidentiality. The Infrastructure: a Domino server is installed in each country connected to EuCliD. All the centres belonging to a country are connected via modem to the country server. All the Domino Servers are connected via Wide Area Network to the Head Quarter Server in Bad Homburg (Germany). Inside each country server only anonymous data related to that particular country are available. The only place where all the anonymous data are available is the Head Quarter Server. The data collection is strongly supported in each country by "key-persons" with solid relationships to their respective national dialysis units. The quality of the data in EuCliD is ensured at different levels. At the end of January 2001, more than 11,000 patients treated in 135 centres located in 7 countries are already included in the system. FMC has put the patient care at the centre of its activities for many years and now is able to provide transparency to the community (Authorities, Nephrologists, Patients.....) thus demonstrating the quality of the service.

Clinical Trials as Topic↗
PubMedDate not supplied

Dysregulative lymphoma theory revisited; what can we learn from cytokines, CD classes and genes?

Based largely on animal experiments, a dysregulative lymphoma theory was designed some 15 years ago as a basis for computer simulation studies. The basic concept of this theory was that lymphomas arise when persistent immunostimulation coincides with some kind of immune deficiency. The present article reviews exemplary data from human lymphoma cases in an attempt to further support or to reject the hypothesis. T- and B-cell lymphomas according to the REAL classification were reviewed with regard to the functional effects of their CD markers and their ligands, interleukin activities and cytogenetic changes. The results are summarized and further discussed. Essentially in all cases, a combination of enhanced stimulation of lymphoid cells and functional deficiency is identified, thus supporting the general pathogenetic hypothesis of malignant lymphomas. Despite using the most modem lymphoma classification, however, lymphoma entities and theirfunctional changes are so heterogeneous that cases need to be studied individually when it comes to pathogenetic considerations.

Animals↗
PubMed2001

[Modern western medical education in Fujian].

The modem western medical education in Fujian mainly stemmed from three aspects: medical schools established by Missionary, western schools managed by government and western medical education in the Soviet District of Western Fujian. These three educational modalities promoted the development of modern western medical education in Fujian.

China↗
PubMed2002

Impact of voice- and knowledge-enabled clinical reporting--US example.

This study shows qualitative and quantitative estimates of the national and the clinic level impact of utilizing voice and knowledge enabled clinical reporting systems. Using common sense estimation methodology, we show that the delivery of health care can experience a dramatic improvement in four areas as a result of the broad use of voice and knowledge enabled clinical reporting: (1) Process Quality as measured by cost savings, (2) Organizational Quality as measured by compliance, (3) Clinical Quality as measured by clinical outcomes and (4) Service Quality as measured by patient satisfaction. If only 15 percent of US physicians replaced transcription with modem clinical reporting voice-based methodology, about one half billion dollars could be saved. $6.7 Billion could be saved annually if all medical reporting currently transcribed was handled with voice-and knowledge-enabled dictation and reporting systems.

Artificial Intelligence↗
PubMedDate not supplied

[The first system of image transmission and neurosurgical telecommunication in Poland].

OBJECTIVE: The goal was to develop a fast and efficient neurosurgical teleconsulting network to improve acute neurosurgical patient care, to reduce transport costs and unnecessary occupation of neurosurgical beds. METHODS: Modems with 56 kilobits/s data transmission speed are used. CT images are transmitted straight from CT scanner via modem/telephone lines to receiving personal computer in Department of Neurosurgery. Receiving PC runs with Microsoft Windows operating system and the network software MultiView (EMED, Inc.). Network connects Department of Neurosurgery Polish Academy of Sciences in Warsaw with transmitting hospitals in Ciechanów and Ostrołeka. RESULTS: The system is fast, one study consisting 18 images is transmitted in about 5 minutes and it is simple to use, to date more than 1000 CT images have been transmitted. Operator acceptance has been very high. The system has improved acute neurosurgical patient care. Transfer of appropriate patients has been accelerated and unnecessary transfer is almost eliminated. CONCLUSION: Applied Neurosurgical Teleconsulting System has significantly improved acute neurosurgical patient care and has reduced transport expenses. Better availability of neurosurgical consultation has been achieved. The network is simple to use and has gained physician acceptance. It has to be emphasized that the creation and using of the system is relatively not expensive.

Computer Communication Networks↗
PubMedDate not supplied

Electronic home monitoring of congestive heart failure patients: design and feasibility.

The efficacy of electronic monitoring in the home care of heart failure (HF) patients has not been widely reported. We developed a Vital Sign System (VSS) monitoring device capable of measuring the weight, blood pressure, and heart rate of congestive heart failure (CHF) patients in the home and transmitting these measurements via modem to a World Wide Web server. In this study of 22 CHF patients, we tested the reliability of the VSS electronic measurements compared to manual measurements taken by visiting home care nurses and ease of use of the VSS units as rated by both patients and home care nurses. The correlation of electronic to manual measurements was high (weight r=0.99; systolic blood pressure [SBP] r=0.84; diastolic blood pressure [DBP] r=0.54; heart rate [HR] r=0.88). The mean difference between electronic and manual measurements was within an acceptable range for clinical surveillance and care of CHF patients (weight 1.6 lbs; SBP 8.8 mm Hg; DBP 9.2 mm Hg; HR 0.7 bpm) The devices were rated favorably by both nurses and patients. The VSS monitoring device is a reliable, feasible, and favorably rated technology for home surveillance of CHF patients. (c)1999 by CHF, Inc.

Journal Article↗
PubMed2002

Opinions of imams about family planning and their use of methods in Kayseri, Turkey.

OBJECTIVES: Imams are religious leaders who have significant influence on the social attitudes and behavior of a society. This study examined the views of imams on family planning and their personal preference of birth control methods. MATERIALS AND METHODS: Using a pre-prepared questionnaire, an on-site individual interview was conducted face-to-face with each of 164 imams at Kayseri, a city in Central Anatolia. RESULTS: All of the imams included in the study knew of at least one family planning method. Withdrawal was the most widely known method of family planning (84.2%). Among imams, 88.4% approved the use of birth control. While only 61.8% of the imams used at least one method of family planning, 20.1% used none at all. Of the family planning methods used, we considered 43.1% efficient (modem) and 18.7% inefficient (traditional). The most important factor affecting preference of traditional methods was religious suitability. CONCLUSION: Contrary to common belief, imams viewed family planning positively and used family planning methods at a rate similar to that of the general public. If provided with accurate information, we believe that imams may have a positive contribution to make in the development of family planning programs.

Adult↗
PubMed2002

Effects of occupational exposure to a mixture of solvents on the inner ear: a field study.

Some clinical and laboratory studies indicate that industrial solvents such as toluene, styrene, xylene, trichloroethylene and carbon disulfide or their mixtures may affect the inner ear, although the mechanism of this process is still not well understood. The aim of this investigation was to assess the incidence of hearing and vestibular disorders (using modem audiological and vestibular tests) in 61 workers exposed to a mixture of organic solvents at the production of paints and varnishes; the control group included 40 age-matched non-exposed subjects. Environmental and biological monitoring revealed that the most significant exposure can be attributed to the following mixture constituents: ethylbenzene, xylene and trimethylbenzene isomers such as pseudocumene, mesitylene and hemimellitene. Electronystagmographic examinations showed the symptoms of vestibular dysfunction, as well as the decreased duration, amplitude and slow phase angular velocity of induced nystagmus in 47.5% of the subjects exposed versus 5% of controls. This was accompanied by sensorineural high frequency hearing loss, identified by means of pure tone audiometry in 42% of those exposed versus 5% controls, and reduced amplitudes of transiently evoked and distortion-product otoacoustic emissions. The findings closely correspond with the rate of the total exposure to the solvent mixture. A possible mechanism responsible for ototoxicity of solvents is discussed.

Adult↗