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PubMed1996

Markedly improved skeletal muscle function with local muscle training in patients with chronic heart failure.

BACKGROUND: Reduced heart pump function and skeletal muscle abnormalities are considered important determinants for the low physical exercise capacity in chronic heart failure. Because of reduced ventricular function, traditional physical rehabilitation may cause underperfusion and low local work intensity, thereby producing suboptimal conditions for skeletal muscle training. HYPOTHESIS: The study was undertaken to determine the effects of local exercise training, designed as one- or two-legged knee extensor training, on exercise capacity in patients with moderate chronic heart failure. Because such exercise models use only about one quarter to half the muscle mass used in cycle ergometer training, the influence of a restricted circulatory capacity should therefore be limited. Further, we aimed to determine whether or not chronic heart failure skeletal musculature abnormalities are counteracted with such training. METHODS: Fourteen patients with chronic heart failure [age 58 +/- 3 years, ejection fraction (EF) 28 +/- 4%] were randomized to two different training protocols three times a week for 8 weeks and compared with a nontraining control group (n = 7, age 62 +/- 3, EF 27 +/- 3%). Group 2L (n = 7) underwent simultaneous two-legged knee extensor training (about 4 kg working muscle) for 15 min at 65-75% of VO2 max of the two-legged kick. Group 1L (n = 7) trained each leg at a time for 15 min of continuous one-legged dynamic knee extensor work with the same training load per muscle mass, that is, at 35% of VO2 max of the two-legged kick (about 2 kg working muscle). Peak VO2 of two-legged knee extensor exercise (l/min), two-legged endurance (W), and strength (Nm) were determined before and after the training period. The activity of citrate synthase (CS) was estimated in tissue samples from the quadriceps femoris muscle. RESULTS: Peak VO2 did not change with training. Two-legged knee extensor endurance exercise capacity increased by an average of 40-50% (p < 0.01) in all training patients in both the 2L and 1L groups, while no change was observed in the control group. Depressed skeletal muscle CS activity increased by 25-35% in both training groups (p < 0.01). Strength increased by 16% in the 2L group after training (p < 0.05), while no change was seen in the 1L and control groups. CONCLUSIONS: Skeletal muscle changes in stable moderate chronic heart failure are not entirely irreversible. A major factor contributing to these changes and to exercise limitation is deconditioning. Local muscle training is efficient and can at least partially improve skeletal muscle function in these patients. Different degrees of local activation, that is, one- or two-legged knee extensor exercise, do not seem to differ in terms of their effect on exercise capacity. Depressed skeletal muscle oxidative capacity adapts to such physical training with increased activity to an extent not different from that for healthy volunteers.

Adaptation, Physiological↗
PubMed2004

A developmental approach to diagnosis and treatment in a transitional living program.

We hope that the reader has been able to vicariously share with us in the excitement of work in a transitional living program. The young people with whom we share this environment stand on the threshold of adult life. They have suffered medical, psychological, environmental, and social insults. Psychosocial developmental assessment helps us define the details of threats to the foundations of adult personality functioning. These young men and women are woefully unprepared for self-care, social interaction, occupational choice, and adult personal relationships. The premise of transitional living is that relationship-based milieu therapy,guided by psychoanalytic develop mental principles, provides an opportunity to heal these conflicted and immature young people to a degree that can tip the scale of their future lives toward productivity, self-esteem, and commitment. Like residential therapy, transitional living provides milieu therapy, corrective education, and psychotherapy. Unlike residential therapy, transitional living is also embedded in the urban community. It facilitates the transition from dependent childhood to independent living by intensive work with the psychological conflicts and physical and social barriers to success in making this important step.

Adolescent↗
PubMed1990

Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods.

Nonoperative treatment has received little attention in the numerous scientific reports on knee ligament injuries. Great controversy still exists concerning the proper treatment of a knee with a ruptured ligament, especially the anterior cruciate ligament. However, according to the studies of the authors and an extensive review of the literature the indications for conservative management can be established to be all grade I and II sprains (partial tears) of knee ligaments as well as an isolated grade III sprain (complete tear) of the posterior cruciate ligament. In addition, an isolated complete rupture of an anterior cruciate, or medial or lateral collateral ligament may be treated nonoperatively in an older sedentary person. Other injuries obviously call for an operative approach at the acute stage. Nonoperative therapy protocols must be based on the knowledge of the biological phenomenon occurring during connective tissue healing process. In the first phase of ligament healing the injured knee needs 2 to 3 weeks immobilisation for undisturbed fibroblast invasion and proliferation of collagen fibres. This is achieved by immobilising the knee in a rehabilitative knee brace locked in 40 to 45 degrees of flexion. Thereafter, a gradually increasing controlled mobilisation is allowed in the brace to avoid the deleterious effects of immobilisation to cartilage, bone, muscles, tendons and ligaments, and to enhance the orientation of collagen fibres to the stress lines of the healing ligament. After 4 to 8 weeks the goal for rehabilitation is rapid and full recovery to work and sports. A functional knee brace may be used at this phase to give extra protection before final strengthening of the injured ligament. During the mobilisation and muscle training of the therapy protocol various specific techniques can be used for strengthening of the hamstring and quadriceps muscles, including isometric, isotonic, isokinetic and eccentric exercises with or without resistive equipments. In addition, electrical stimulation may help prevent muscle wasting due to immobilisation, and continuous passive motion may be used to correct persistent extension or flexion deficit. Normally, jogging is allowed approximately 3 to 6 months after the injury, and an athlete is generally able to return to full activity and competitive sports after 6 to 12 months. Quite frequently the whole question of successful rehabilitation after a knee ligamentous injury is more motivational rather than methodological and is thus often independent of attending physician's or physiotherapist's skill or will. Therefore, one of the most important things during rehabilitation is to motivate and encourage the patient for longstanding, intensive work.

Biomechanical Phenomena↗
PubMed2001

Acute versus chronic sodium bicarbonate ingestion and anaerobic work and power output.

BACKGROUND: The aim of this study was to compare and contrast the effects of acute versus chronic sodium bicarbonate ingestion. METHODS PARTICIPANTS: Eight male, (mean+/-SE): age, 20.8+/-0.4 yrs; height, 179.6+/-0.6 cm; body mass, 79.4+/-0.85 kg, Sigma7skf, 48.6+/-4.8 mm, VO2max=55.9+/-0.8 ml x kg(-1) x min(-1)) volunteer subjects, ingested NaHCO3 in either a dose of 0.5 g x kg(-1) body mass acutely or the same dose daily over a period of six days in order to determine whether there were any differences in performance of 90 sec maximal cycling ergometry. INTERVENTION: After subjects undertook an initial control (C) test session, all were then randomly assigned to one of two groups, acute or chronic NaHCO3 ingestion. Subjects in the acute ingestion (AI) group completed their supplemented test on day one, and then on the following day. Chronic ingestion (CI) subjects completed the test after one day of chronic ingestion as well as following six days of bicarbonate ingestion. Following ten days rest, subjects repeated the protocol in the opposite group. MEASURES: Blood samples were taken pre- and postingestion, daily, and pre- and postexercise and were analysed for, pH, Base excess (BE), HCO3-, PO2, PCO2, Na+, K+, Cl-, and lactate. RESULTS: Both the chronic (CI) and acute ingestion (AI) groups were significantly different to the control (C) value (p<0.001 and p<0.05, respectively). CONCLUSIONS: We would suggest using chronic ingestion as a means to improve high intensity work rather than the acute ingestion of sodium bicarbonate. The ingestion of sodium bicarbonate, over a period of six days, significantly improved work output two days after bicarbonate ingestion ceased.

Acid-Base Equilibrium↗
PubMed1988

Quantitative surface EMG during sustained and intermittent submaximal contractions.

In an earlier occupational study the EMG was found to be unchanged during a whole working day. The purpose of this study was therefore to examine EMG changes during experiments in a laboratory environment comparable to occupational work. The surface EMG of the quadriceps muscle of 16 subjects was analysed during 3 experiments: (I) 10% maximal voluntary contraction (MVC) sustained for 1 h, and with a constant work intensity of the muscle; (II) 20% MVC for 5 sec alternating with a rest of 5 sec for 1 h; (III) 20% MVC was sustained until exhaustion. In the latter the endurance time decreased with increasing MVC. The results indicated that the methods used in this study can be trusted to reveal changes in EMG due to fatigue in a group of subjects but not in the individual subject. The decrease in mean power frequency (MPF) and the increase in root mean square amplitude (RMS) were most pronounced during the first 10 min of the 10% sustained contraction, indicating a decrease in the conduction velocity along the muscle fibres or synchronization of motor unit firing. In contrast, at 20% intermittent contraction the MPF was unchanged. Between 10 and 60 min of contraction time the increase in RMS amplitudes associated with none or only slight changes in MPF indicated recruitment of new motor units for both types of contraction. The lack of EMG fatigue during a whole day in an earlier occupational study may be because the work performed required varying degrees of muscle force.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Plasma lactate decline during passive recovery from high-intensity exercise.

PURPOSE: An athlete's ability to repeatedly perform at high intensities during intermittent exercise could be related to an accelerated plasma lactate removal ability during recovery periods. METHODS: We determined the decline in plasma lactate levels during passive recovery after an incremental exercise test to exhaustion on a bicycle ergometer in five trained and five untrained male subjects. Venous blood samples were taken during exercise and recovery for the analysis of plasma lactate concentration. The endurance fitness of the subjects was characterized using a variable known as the maximum turn point power output (MTP), measured in W x kg(-1). MTP describes the workload at which lactate levels rise significantly above resting concentrations. RESULTS: The decline in plasma lactate levels during recovery was determined at selected intervals from the exponential recovery curve plotted as a percentage of peak plasma lactate versus time. No significant relationships were found between the recovery parameters measured from the curve and the MTP values of these subjects (Spearman's rank order correlation; r(s) values from -0.042 to -0.31). CONCLUSIONS: Therefore, we can conclude that training confers no advantage to the decline in plasma lactate while recovering passively from exercise at equivalent relative maximal work intensities.

Adult↗
PubMed2001

Dissemination of educational classes for families of adults with schizophrenia.

Despite the well-documented efficacy of psychoeducational and behavioral approaches in family interventions for persons with serious mental illness (1), clinicians have rarely included these methods in their professional repertoires (2). Journal publications, books, continuing education courses, and advocacy by the National Alliance for the Mentally Ill and its local affiliates have induced few professionals to provide family psychoeducation. Mental health professionals adopt new services primarily for the same reason that employees of any firm change their work practices-namely, because the authority structure and contingencies of reinforcement that impinge on their daily activities are altered in a direction favoring change. Therefore, administrative clout must be brought to bear to mandate the inclusion of family psychoeducation in the spectrum of services provided by a clinic, mental health center, community support program, hospital, or independent provider (3). In addition, the consequences of clinicians' services must differentially reward the use of these methods of involving families in services for the seriously mentally ill (4). Differential rewards could come from performance standards and evaluations, performance-based pay, third-party payments, positive feedback from clients and families, public recognition, and increased self-efficacy. Use of in-service training or workshops to persuade clinicians to adopt innovations such as family psychoeducation and family management techniques has a checkered and unremarkable track record. For example, brief training has failed completely in efforts to bring about adoption of family interventions. On the other hand, more extended efforts to train staff, including organizational consultation, have been more successful (5). In one study, two days of staff training produced no change, whereas intensive training over several months resulted in the implementation of new family programs at the majority of study sites (6). Staff from sites that received extensive training but did not adopt the interventions rated family interventions as less consistent with their professional philosophy and agency norms and identified more obstacles to intervention, notably intense work pressure, uncertainty about financing the intervention, agency bureaucracy, lack of leadership, skepticism about the interventions, problems with confidentiality, and inability to provide services in the evenings or on weekends (6). In this Rehab Rounds column, Amenson and Liberman describe a three-phase, multilevel dissemination effort designed to overcome the above-mentioned barriers to the incorporation of family psychoeducation into the routine care provided at community mental health centers in an ethnically diverse urban setting. Moreover, Amenson and Liberman demonstrate the need for continued support and nurturance of the project to ensure that the original enthusiasm associated with a novel intervention is not lost once it becomes a standard part of treatment.

Adult↗
PubMed2000

Clenbuterol administration does not attenuate the exercise-induced pulmonary arterial, capillary or venous hypertension in strenuously exercising Thoroughbred horses.

The present study was carried out to ascertain whether beta2-adrenergic receptor stimulation with clenbuterol would attenuate the pulmonary arterial, capillary and venous hypertension in horses performing high-intensity exercise and, in turn, modify the occurrence of exercise-induced pulmonary haemorrhage (EIPH). Experiments were carried out on 6 healthy, sound, exercise-trained Thoroughbred horses. All horses were studied in the control (no medications) and the clenbuterol (0.8 pg/kg bwt, i.v.) treatments. The sequence of these treatments was randomised for every horse, and 7 days were allowed between them. Using catheter-tip-transducers whose in-vivo signals were referenced at the point of the left shoulder, right heart/pulmonary vascular pressures were determined at rest, sub-maximal exercise and during galloping at 14.2 m/s on a 3.5% uphill grade--a workload that elicited maximal heart rate and induced EIPH in all horses. In the control experiments, incremental exercise resulted in progressive significant increments in right atrial as well as pulmonary arterial, capillary and venous (wedge) pressures and all horses experienced EIPH. Clenbuterol administration to standing horses caused tachycardia, but significant changes in mean right atrial or pulmonary vascular pressures were not observed. During exercise performed after clenbuterol administration, heart rate as well as right atrial and pulmonary arterial, capillary and wedge pressures also increased progressively with increasing work intensity. However, these values were not found to be statistically significantly different from corresponding data in the control study and the incidence of EIPH remained unaffected. Since clenbuterol administration also does not affect the transpulmonary pressure during exercise, it is unlikely that the transmural force exerted onto the blood-gas barrier of exercising horses is altered following i.v. clenbuterol administration at the recommended dosage.

Adrenergic beta-Agonists↗
PubMed2001

Inhibition of nitric oxide synthase with L-NAME does not increase lactate production at rest or during short-term high-intensity exercise in Thoroughbred horses.

The present study was carried out to determine whether inhibition of nitric oxide (NO) synthase promotes anaerobic metabolism in exercising horses, resulting in a significantly increased blood lactate concentration. N(omega)-nitro-L-arginine methyl ester (L-NAME) is a potent inhibitor of NO synthase that has been tested in horses and other species. Two sets of experiments, namely placebo (saline control) and L-NAME (20 mg/kg, i.v.) studies, were carried out on seven healthy, sound, exercise-trained, Thoroughbred horses in random order, 6 to 7 days apart. In both experiments, an incremental exercise protocol was used and data were obtained at rest, during submaximal exercise performed at 8 m/s on a 4.5% uphill grade, and during galloping at 14 m/s on a 4.5% uphill grade--a workload that not only elicited maximal heart rate and induced exercise-induced pulmonary haemorrhage, but also could not be sustained for more than 90 s. Measurements were also made in the recovery period. Mixed-venous blood samples, obtained at matched intervals in the two sets of experiments, were analysed in triplicate for determining the lactate concentration. Following administration of L-NAME, significant bradycardia occurred at rest (27 +/- 1 vs 37 +/- 2 beats/min in the placebo trials; p<0.0001) as well as during submaximal exercise (183 +/- 4 vs 200 +/- 4 beats/min in the placebo trials; p<0.001), but the heart rate increased during galloping at 14 m/s on a 4.5% uphill grade to reach values observed in the placebo trials (215 +/- 2 beats/min) and significant differences were not found. At rest, the mixed-venous blood lactate concentration was similar in the two experiments. With exercise, the mixed-venous blood lactate concentration increased progressively as work intensity increased in both trials, but significant differences were not found between the placebo and the L-NAME experiments during submaximal exercise, near-maximal exercise or recovery. These experiments demonstrated that inhibition of NO synthase in Thoroughbred horses does not promote enhanced anaerobic metabolism at rest or during short-term incremental exercise leading to galloping at maximal heart rate.

Animals↗
PubMed2004

Athens 2004: the pollution climate and athletic performance.

Athens sits in a basin approximately 450 km2 in area, surrounded by mountains and open sea. Anthropogenic emissions in conjunction with the topographical and meteorological conditions can result in high air pollution within the city. The pollutants of concern for athletes competing in Athens 2004 appear to be nitrogen dioxide (NO2), ozone and particulate (PM10) pollution. Exposure to elevated ozone concentrations has been reported to give rise to symptoms that include cough, chest pain, difficulty in breathing, headache, eye irritation and a decrease in forced expiratory volume in one second. All of these effects are likely to impact upon performance, and several studies of cyclists suggest this to be the case. In contrast, the impact of ambient concentrations of NO2 appears to be negligible on normal activities, but at high exercise intensities the impact remains unclear. The use of currently available information and models to predict the effect of ozone and other pollutants on elite athletes is problematical, since such models are based upon significantly lower ventilation rates than those achieved by some elite athletes. In addition, it is already known that the response to ozone can vary somewhat between individuals. Since the individuals who will be competing in Athens are physiologically very different to the participants in most published studies, it is difficult to predict individual responses. There is some evidence to indicate that adaptation to the adverse health and performance effects of ozone can occur, so that performance is partially recovered on re-exposure. The adaptation is not seen in all studies and appears to be dependent on several factors, including the initial sensitivity of the individual to ozone. Antioxidant supplementation has also been shown in some studies to partially ameliorate the adverse effects of ozone by counteracting the oxidative stress mechanism associated with this pollutant. Whether this transfers to performance enhancement per se remains unclear at present. Additional research is required to gain a sound understanding of the effects of a complex mixed air pollution exposure on the pulmonary function and performance of athletes exercising at high work intensities.

Air Pollutants↗
PubMed2002

The diversity of work: differences, similarities and relationships concerning characteristics of the organisation, the work and psychological work reactions in intensive care and non-intensive care nursing.

The aim of this study was to examine differences in organisational characteristics, work characteristics and psychological work reactions, and to investigate relationships between these variables in intensive care units (ICUs) and non-ICUs. Questionnaires were distributed to intensive care (n = 184) and non-intensive care nurses (n = 927) working in 15 general hospitals in the Netherlands. MANOVA showed that ICU nurses reported significantly higher uncertainty, higher complexity, and higher decision authority than non-ICU nurses. Emotional exhaustion was significantly lower among ICU nurses. Regarding the pattern of relationships, the LISREL-analyses revealed that the indirect proposed pattern of relationships was invariant across the two samples, which means a validation of our research model.

Adult↗
PubMed1996

No effect of cycling experience on leg cycle ergometer efficiency.

Estimates of muscular efficiency in competitive and recreational cyclists at similar work intensities and cycling frequencies were examined. Twelve healthy college-age male nonsmoker volunteers were grouped as either competitive (CC; N = 6) or recreational (RC; N = 6) cyclists based upon previous cycling experience. Subjects were studied at pedaling frequencies of 50 and 80 rpm during bouts of graded and submaximal endurance (75% VO2peak) exercise. Between rest and 250 W, we observed no intergroup differences in VO2 (energy input) at either 50 or 80 rpm. Estimates of whole body (gross) muscular efficiency ranged from 15% to 24% in competitive and 13% to 22% in recreational cyclists at 50 rpm but were not different. Delta (delta) efficiencies ranged from 20% to 34% in competitive and from 21% to 28% in recreational cyclists. Delta efficiency decrease from 27% to 21% in competitive cyclists, from 25% to 21% in recreational cyclists as a function of pedaling frequency, and was not different between groups. Competitive cyclists rode longer at both 50 rmp (27 +/- 5 min vs 14 +/- 2 min; P < 0.05) and 80 rpm (35 +/- 4 min vs 20 +/- 4 min; P < 0.05). At 50 rpm (3.08 +/- 0.02 l.min-1 vs 2.78 +/- 0.05 l.min-1; P < 0.01) and 80 rpm (3.14 +/- 0.01 l.min-1 vs 2.7 +/- 0.04 l.min-1; P < 0.001), the mean VO2 was also greater in competitive cyclists. Although both groups showed superior endurance at 80 compared with 50 rpm and total work was approximately double competitive cyclists at each pedaling frequency, we observed no differences in whole body muscular efficiency during sustained exercise at 75% VO2peak. Our results suggested that previous cycling experience was of minor importance when comparing cycle ergometer efficiency between these two groups. The increased endurance at higher pedaling frequencies during submaximal exercise is not explained by altered muscular efficiency.

Adolescent↗
PubMed2006

Influence of blood donation on O2 uptake on-kinetics, peak O2 uptake and time to exhaustion during severe-intensity cycle exercise in humans.

We hypothesized that the reduction of O2-carrying capacity caused by the withdrawal of approximately 450 ml blood would result in slower phase II O2 uptake (VO2) kinetics, a lower VO2peak and a reduced time to exhaustion during severe-intensity cycle exercise. Eleven healthy subjects (mean +/- S.D. age 23 +/- 6 years, body mass 77.2 +/- 11.0 kg) completed 'step' exercise tests from unloaded cycling to a severe-intensity work rate (80% of the difference between the predetermined gas exchange threshold and the VO2peak) on two occasions before, and 24 h following, the voluntary donation of approximately 450 ml blood. Oxygen uptake was measured breath-by-breath, and VO2 kinetics estimated using non-linear regression techniques. The blood withdrawal resulted in a significant reduction in haemoglobin concentration (pre: 15.4 +/- 0.9 versus post: 14.7 +/- 1.3 g dl(-1); 95% confidence limits (CL): -0.04, -1.38) and haematocrit (pre: 44 +/- 2 versus post: 41 +/- 3%; 95% CL: -1.3, -5.1). Compared to the control condition, blood withdrawal resulted in significant reductions in VO2peak (pre: 3.79 +/- 0.64 versus post: 3.64 +/- 0.61 l min(-1); 95% CL: -0.04, - 0.27) and time to exhaustion (pre: 375 +/- 129 versus post: 321 +/- 99 s; 95% CL: -24, -85). However, the kinetic parameters of the fundamental VO2 response, including the phase II time constant (pre: 29 +/- 8 versus post: 30 +/- 6 s; 95% CL: 5, -3), were not altered by blood withdrawal. The magnitude of the VO2 slow component was significantly reduced following blood donation owing to the lower VO2peak attained. We conclude that a reduction in blood O2-carrying capacity, achieved through the withdrawal of approximately 450 ml blood, results in a significant reduction in VO2peak and exercise tolerance but has no effect on the fundamental phase of the VO2 on-kinetics during severe-intensity exercise.

Adult↗
PubMed1984

Endocrine response to physical efforts with equivalent total work loads but different intensities in man.

The purpose of this study was to determine relationships between some exercise-induced neurohormonal changes and either exercise intensity, or its duration, or the total work output. Plasma catecholamine, cortisol, growth hormone and insulin concentrations were measured in healthy male subjects having performed three bicycle-ergometer exercise tests of the same total work output (2160 J kg-1) but differing in intensity and duration. The results showed that during the relatively short exercise plasma noradrenaline, adrenaline and cortisol responses depend more on work intensity than on the total work output. No relationship was demonstrated between the exercise-induced increases in plasma growth hormone concentration and work intensity or its duration, while the plasma insulin concentration was more decreased during the effort of lower intensity, but longer duration than during a short exercise of high intensity.

Adult↗
PubMedDate not supplied

Sentinel node biopsies in melanoma patients: a protocol for accurate, efficient, and cost-effective analysis by preselection for immunohistochemistry on the basis of Tyr-PCR.

BACKGROUND: Immunohistochemistry (IHC) of serial sectioning is considered the gold standard for detection of melanoma activity in sentinel node (SN) biopsies. However, this is cost and labor intensive. In contrast, tyrosinase reverse transcription-polymerase chain reaction (RT-PCR) is simple and quick, but it is hampered by its extreme sensitivity. This study was performed to test whether a strategy that combines the two methods, using tyrosinase RT-PCR to preselect nodes for IHC, could be accurate and cost effective. METHODS: In 36 patients, SNs were identified by scintigraphy and patent blue uptake. Of each SN, one cross section was analyzed first by hematoxylin and eosin staining. Next, all nodes were examined by serial sectioning and IHC of one-half and tyrosinase RT-PCR of the other. Before comparison, all results were documented in a blinded manner. Material costs and workload estimates were noted per SN. RESULTS: Fifty-five SNs were retrieved from the 36 patients. Hematoxylin and eosin staining of the first cross section revealed tumor positivity in 3 patients (6 SN). Tyrosinase RT-PCR was positive in 11 of the remaining 33 patients (19 of 49 SN). Of these same 11 patients, only 5 were shown to have tumor-positive SNs by using IHC on serial sections (7 SN). All these nodes had been positive for tyrosinase on PCR. For IHC, an average of 40 sections were prepared and examined per SN at a cost of $200(U.S.)/SN. In contrast, routine tyrosinase RT-PCR costs $37(U.S.)/SN, and takes 5% of the time necessary for IHC. A strategy including hematoxylin and eosin staining on the first cross section, followed by tyrosinase RT-PCR on half of each negative (half) node, could preselect nodes to be taken through serial sectioning. In these series, such a strategy would have prevented serial sectioning and IHC of 30 SN from 22 patients. Apart from a considerable gain in efficiency, this would have reduced material costs by a minimum of $6000 (U.S.). This discrepancy would be even higher if work intensity of analysts and pathologists were considered. CONCLUSIONS: In routine analysis of SN biopsies in melanoma patients, tyrosinase RT-PCR can be used effectively to preselect nodes for further IHC of serial sections. This method seems both time and cost effective.

Biopsy↗
PubMed2004

[Occupational risks among a nursing staff working in an intensive care unit].

This is a descriptive study that detected the main occupational risks to which the nursing staff working in an intensive care unit are exposed. The data were collected through individual interviews, using a structured script. It was verified that the workers are exposed to the risks of accidents related to the care procedures to the patients and to the environment work. It was observed that most of the workers wore gloves, masks and gown as protection barriers and a low percentage wore goggles as a safety measure. The results demonstrated that the work environment has to be modified in order to reduce the risks in care procedures and to the environment work, besides the training, awareness of security rules and provision of security materials for the nursing staff.

Adult↗
PubMed1993

The Resource-Based Relative Value Scale. Methods, results, and impacts for ophthalmology.

In January 1992, the Health Care Financing Administration implemented sweeping legislation that reformed the way Medicare pays for physicians' services. The cornerstone of the reform consists of a new fee schedule based on the Resource-Based Relative Value Scale. This article summarizes the methods and data used to derive the scale for ophthalmology. The results and impacts of the new Medicare payment rates for ophthalmology are also assessed. Using our methods and assumptions, ophthalmologists stand to lose 16% of their Medicare revenues under a fully implemented relative value-based fee schedule. Overall, the fees for performing evaluation and management services will increase, while those for most surgical procedures and diagnostic tests will decrease. Physicians' practice decisions and medical students' specialty choices could be affected. Ophthalmologists who perform work-intensive surgical procedures and spend the majority of their time in the operating room will continue to earn much higher incomes than those who do not.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Resident burnout.

Intense work demands, limited control, and a high degree of work-home interference abound in residency training programs and should strongly predispose resident physicians to burnout as they do other health care professionals. This article reviews studies in the medical literature that address the level of burnout and associated personal and work factors, health and performance issues, and resources and interventions in residents. MEDLINE and PubMed databases were searched for peer-reviewed, English-language studies reporting primary data on burnout or dimensions of burnout among residents, published between 1983 and 2004, using combinations of the Medical Subject Heading terms burnout, professional, emotional exhaustion, cynicism, depersonalization and internship and residency, housestaff, intern, resident, or physicians in training and by examining reference lists of retrieved articles for relevant studies. A total of 15 heterogeneous articles on resident burnout were thus identified. The studies suggest that burnout levels are high among residents and may be associated with depression and problematic patient care. However, currently available data are insufficient to identify causal relationships and do not support using demographic or personality characteristics to identify at-risk residents. Moreover, given the heterogeneous nature and limitations of the available studies, as well as the importance of having rigorous data to understand and prevent resident burnout, large, prospective studies are needed.

Burnout, Professional↗