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PubMed1995

Commissioning a national programme of research and development on the interface between primary and secondary care.

The first call for applications to the NHS research and development programme on the interface between primary and secondary care was advertised in February 1994. A total of 674 outline proposals were submitted and 54 (8%) secured funding. Projects have been commissioned in 16 of the 21 priority areas and around 6m pounds has been committed. Analysis shows that multidisciplinary applications are more likely to be funded and that the odds for a successful application are on average nearly doubled for each discipline represented up to five. A survey of applicants and peer reviewers found satisfaction with much of the commissioning process, but peer review and feedback were subject to criticism, particularly by unsuccessful applicants. The programme shows that it is possible to commission a large number of projects in an innovative area of research and development and has identified refinements that will further increase the efficiency and acceptability of the process.

Health Priorities↗
PubMed2002

A retrospective cohort study comparing microwave endometrial ablation with levonorgestrel-releasing intrauterine device in the management of heavy menstrual bleeding.

OBJECTIVE: To compare microwave endometrial ablation (MEA) with a levonorgestrel-releasing intrauterine device (Mirena) in the management of heavy menstrual bleeding. DESIGN: A retrospective cohort study SAMPLE: Thirty-nine women were treated with MEA and 23 women with Mirena, in the South East Regional Health Service of South Australia during 1998 to 2001; the mean duration of follow-up was 14.6 months. MAIN OUTCOME MEASURES: Primary measures included acceptability of the treatment process, effectiveness of the treatment, and satisfaction with outcomes. Secondary measures included side effects, complications and quality of life (using the SF-36). RESULTS: Acceptability of the treatment process and satisfaction with outcomes was very high for both procedures. Each treatment led to a statistically significant reduction in menstrual bleeding (p < 0.0001) and dysmenorrhoea scores (p < 0.002). CONCLUSIONS: There were no statistical differences between the two treatments for any of the primary or secondary outcome measures assessed. The treatments seem equally effective in the management of heavy menstrual loss.

Adult↗
PubMedDate not supplied

A follow-up study of psychiatric consultations in the general hospital: What happens to patients after discharge?

BACKGROUND: An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3-5 months after discharge. METHODS: We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients, and (3) a telephone interview with the patients' primary care physician, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. RESULTS: The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists' instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists' advice, and generally expressed positive comments about the consultation-liaison service. CONCLUSIONS: Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.

Aged↗
PubMed2005

Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework.

OBJECTIVE: To develop a framework that could be used by community pharmacies to self-assess their current level of safety culture maturity, which has high face validity and is both acceptable and feasible for use in this setting. DESIGN: An iterative review process in which the framework was developed and evaluated through a series of 10 focus groups with a purposive sample of 67 community pharmacists and support staff in the UK. MAIN OUTCOME MEASURES: Development of the framework and qualitative process feedback on its acceptability, face validity, and feasibility for use in community pharmacies. RESULTS: Using this process, a version of the Manchester Patient Safety Assessment Framework (MaPSAF) was developed that is suitable for application to community pharmacies. The participants were able to understand the concepts, recognised differences between the five stages of safety culture maturity, and concurred with the descriptions from personal experience. They also indicated that they would be willing to use the framework but recognised that staff would require protected time in order to complete the assessment. CONCLUSIONS: In practice the MaPSAF is likely to have a number of uses including raising awareness about patient safety and illustrating any differences in perception between staff, stimulating discussion about the strengths and weaknesses of patient safety culture within the pharmacy, identifying areas for improvement, and evaluating patient safety interventions and tracking changes over time. This will support the development of a mature safety culture in community pharmacies.

England↗
PubMedDate not supplied

A multi-agent architecture for teaching dermatology.

This work proposes the integration of computer-aided instruction systems in the curricula of medical education, and describes an intelligent tutoring system used for teaching Dermatology. The Dermatology Tutor uses a self-organized society of autonomous software agents which have different capabilities or roles. The society contains tutor, medical and information agents which participate in the tutoring process and collaborate through deliberation in order to achieve a tutoring task. The agents are built according to a BDI architecture, which implements the mental attitudes of beliefs (B), desires (D) and intentions (I). Each medical agent is a specialist in a medical field, while a tutoring agent, which implements a widely accepted dermatology teaching process, coordinates the overall operation of the system. Depending on the subject that is to be taught during any session, the tutoring agent forms teams of medical agents, which in turn use search agents to retrieve information. Although the presented multi-agent architecture is dedicated to teaching dermatology (since the tutor agent is specialized in Dermatology), it can be extended to other domains also with the incorporation of other tutor agents.

Computer Systems↗
PubMed1999

[The percentage of articles which were accepted or rejected for publication in the Dutch Journal of Medicine in 1997].

OBJECTIVE: To determine the acceptance and rejection percentages of articles submitted to the editors of the Nederlands Tijdschrift voor Geneeskunde (NTvG) in 1997. DESIGN: Retrospective. METHOD: The data on all articles reviewed by the editors of the NTvG in 1997 were extracted from the registration system in April 1998. These included the outcome of the review process (rejection or acceptance for publication or no definite decision yet), the article category (e.g., original article, review article), and whether the article had been solicited by the editors or was a spontaneous submission. RESULTS: In 1997, 845 articles were received. Of these 28% (240) were rejected and 59% (497) were accepted for publication. On 13% (108) no decision had been made (in April 1998). Of the articles decided upon 36% were rejected (extrapolated). 705/845 (83%) articles were unsolicited: of these 33% (235) were rejected and 54% (382) accepted; on 13% (88) the decision was pending. The solicited articles numbered 140 (17%); of these 4% (5) were rejected and 82% (115) were accepted; on 14% (20) no decision had been made yet. CONCLUSION: The rejection of articles submitted to NTvG in 1997 was 36% (in 1990 38%). Solicited articles were rejected less frequently than unsolicited ones. The yearly number of articles submitted and the rejection percentage have not changed drastically during the last eight years.

Journalism, Medical↗
PubMed2001

Benchmarking initiatives in the water industry.

Customer satisfaction and service care are every day pushing professionals in the water industry to seek to improve their performance, lowering costs and increasing the provided service level. Process Benchmarking is generally recognised as a systematic mechanism of comparing one's own utility with other utilities or businesses with the intent of self-improvement by adopting structures or methods used elsewhere. The IWA Task Force on Benchmarking, operating inside the Statistics and Economics Committee, has been committed to developing a general accepted concept of Process Benchmarking to support water decision-makers in addressing issues of efficiency. In a first step the Task Force disseminated among the Committee members a questionnaire focused on providing suggestions about the kind, the evolution degree and the main concepts of Benchmarking adopted in the represented Countries. A comparison among the guidelines adopted in The Netherlands and Scandinavia has recently challenged the Task Force in drafting a methodology for a worldwide process benchmarking in water industry. The paper provides a framework of the most interesting benchmarking experiences in the water sector and describes in detail both the final results of the survey and the methodology focused on identification of possible improvement areas.

Benchmarking↗
PubMed1994

Interactions of fluoride and non-fluoride agents with the caries process.

Fundamental to the caries process and its inhibition is an understanding of the composition and structural relationships of dental mineral. These have received greater study in recent years, leading to a better understanding of the processes involved. Fluoride has been the most successful of the anti-caries agents to date, and many studies have concentrated on this ion. The anti-caries action of fluoride has been only partially explained by the early finding that fluoride-treated mineral was less soluble, and this criterion is now less widely accepted. The dissolutive process of caries is inhibited by fluoride, monofluorophosphate, trimetaphosphate, and zinc. However, only the first three of these show anti-caries activity. The presence of fluoride during in vivo and in vitro caries is conducive to the formation of an apparently intact surface zone. Current evidence is that this zone reforms during the caries process, thus acquiring fluoride and having larger crystallites compared with sound enamel. Trimetaphosphate also favors the formation of a surface zone. There is a clear beneficial involvement of fluoride, even at low levels, in the process of lesion remineralization. It is highly probable that this process results from re-growth of residual enamel crystallites rather than de novo precipitation of calcium phosphates. Levels of fluoride found in saliva can interact with dental mineral. Although zinc has been shown to adsorb upon apatite mineral and to restrict subsequent crystal growth, it does not appear to affect the action of fluoride, including remineralization, adversely. This may be due to the fact that the uptake of zinc is reversible.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

The short history of gastroenterology.

In this paper research on the stomach and bowel physiology is presented in a historical perspective. The author tries to show how digestive processes were interpreted by the ancients and how they tried to adjust them to the dominating humoral theory of disease. It is pointed out that the breakthrough which created a new way of understanding of the function of the digestive system was made by Andreas Vesalius and his modern model of anatomy. The meaning of acceptance of chemical processes in digestion by iatrochemics representatives in XVII century is shown. Physiological research in XIX century, which decided about a rapid development of physiology, especially the physiology of the gastrointestinal tract, is discussed. Experiments were performed by all main representatives of this discipline: Claude Bernard, Jan Ewangelista Purkyne, Rudolph Heidenhain and especially Ivan Pavlov, who, thanks to the discoveries in the secretion physiology, explained basic functions of the central nervous system. The XX century was dominated by the research showing the important role of the endocrine system and biological agents in the regulation of secretion and motility of the digestive system. The following discoveries are discussed: Ernest Sterling (secretin), John Edkins (gastrin) and André Latarjet and Lester Dragstedt (acetylcholine). It is underlined that Polish scientists play an important role in the development of the gastroenterological science--among others, Walery Jaworski, who made a historical suggestion about the role of the spiral bacteria in etiopathogenesis of the peptic ulcer, Leon Popielski, who stated the stimulating influence of histamine on the stomach acid secretion, Julian Walawski, who discovered enterogastrons--hormones decreasing secretion. As a supplement, there is the list of achievements in the field of the physiology and pathology of the gastrointestinal tract awarded with Nobel Prize and the list of most important Polish papers in this field.

Animals↗
PubMed2026

Risk governance of transgenic plants: bridging science, policy, and public trust.

Transgenic plants and genome editing technologies are revolutionizing agriculture through sustainable approaches to food security, pest management, and adaptation to climate change; but their widespread use is hampered by regulatory systems that are fragmented, ethics considerations, and an ongoing lack of trust from the general public. In contrast to other literature that evaluates regulation processes and public acceptance separately, our review paper introduces a new, holistic approach that includes both technical risk assessment from a scientific perspective, and Codex Alimentarius and OECD standards, and the socio-legal and judicial environment of how the national policy decisions are actually made. The paper provides a comparative, historical analysis of the key difference between product- and process-based risk governance in the USA, the EU, and India. Through the use of case studies with global significance like MON810 maize, Bt Brinjal, and the April 2024 Philippine Court of Appeals' order for cease-and-desist of Golden Rice, we discuss the increasing tension between administrative scientific approvals and precautionary judicial orders. We further explore the emerging exemptions to regulation of Site-Directed Nuclease (SDN-1 and SDN-2) genome edited crops which led to India's revolutionary 2025 commercialization of climate-resilient rice crops. Our review ends with a forward-looking approach to biotechnology regulation policy, making an appeal to shift from static historical dichotomies towards flexible risk-proportionate and internationally coordinated regulatory systems. Finally, we show that global success of agricultural biotechnology is not just about safety verification, but rather about establishment of transparent and communicable institutions that can transform scientific risk assessments into legitimate risk management decisions.

Plants, Genetically Modified↗
PubMed1997

Rejection of spontaneously accepted rat liver allografts with recipientinterleukin-2 treatment or donor irradiation.

While MHC incompatible DA (RTl(a)) to Lewis (RT1(1), LEW) rat liver allografts are acutely rejected, the reciprocal LEW to DA liver grafts are spontaneously accepted. The mechanism of this acceptance remains unclear. We evaluated the effect of donor treatment with total body irradiation (TBI) or gadolinium chloride (GdCl3), and recipient treatment with exogenous IL-2 after transplantation on the survival of the spontaneously accepted liver grafts. Male LEW and DA rats were used as donors and recipients for orthotopic liver allo- or iso-graft transplants. The LEW liver donor was treated by TBI (10 gray) 7 days before transplantation, or LEW donor Kupffer cell phagocytosis was blocked with GdCl3 (7 mg/kg) on days -2 and -1 pretransplant. In an attempt to reverse LEW liver graft acceptance, 180,000 units human IL-2 (hIL-2) were administered daily IP to the DA liver recipients from days 1 to 7 after liver grafting. While untreated LEW recipients rejected DA liver grafts within 13 days, DA recipients accepted LEW livers indefinitely (>302 days). In contrast, irradiation of the LEW liver donor prevented the spontaneous acceptance by DA recipients, and resulted in acute rejection of the liver grafts in 9-20 days. However, spontaneous graft tolerance was restored by parking the irradiated LEW donor liver in naive LEW rats for 48 hr before retransplantation to DA recipients (>50 days). When LEW donors were treated with GdCl3, which is known to block Kupffer cell phagocytosis and antigen processing, the spontaneous acceptance of the LEW liver grafts by DA recipients was unaffected. However, when exogenous rhIL-2 was given daily, LEW liver allografts were rejected by the DA recipients. The resulting liver failure correlated with a progressive increase in serum bilirubin and the development of a predominantly lymphocytic portal tract infiltration, bile duct epithelial damage, and portal vein endothelitis, which is consistent with acute allograft rejection. LEW and DA recipients of liver isografts developed no toxicity and survived indefinitely (>100 days) when treated with the same dose of IL-2. These results indicate that spontaneous rat liver allograft acceptance is associated with the presence of radiosensitive cells in the donor liver that may interact with recipient T cells to inhibit (Th1) production of IL-2.

Animals↗
PubMed1987

[Preparation and evaluation of fish portions from shrimp by-catch].

Fish portions were obtained from a mixture of fish flesh from shrimp by-catch. Physical, chemical, microbiological and sensory tests were done to evaluate quality of raw materials, formulations and processing conditions. Several technological procedures proved to be feasible for this product. Stability of frozen products for four months was determined by physical, chemical and microbiological tests, the results of which indicated its stability during the study period. Findings of our study, therefore, suggest the potential of shrimp by-catch for the preparation of fish portions in view of its high acceptability and simple processing technique, by using marine resources not fully utilized at present.

Animals↗
PubMed1994

Interaction of cell culture with downstream purification: a case study.

Separation of product from secreting mammalian cells in the culture both means the transition from product generation to product isolation. This interface within a biotech production process has to perform a proper solid/liquid phase separation of the cell suspension to make the product containing fluid amenable for further purification. These subsequent steps require fluid with low occurrence of contaminants in order to function properly. The goal of this study was to evaluate some economic and fast cell separation methods for the preparation of a product fluid ready for use in further ultrafiltration and chromatographic processes. We have performed experiments to test the usefulness of disc stack centrifuges and tangential flow microfiltration units at large scale. Both systems revealed outstanding prospects with regard to throughput and scale up properties. However, the centrificgation did not lead to a fluid sufficiently free of particles for direct ultrafiltration or chromatography. Thus, an additional filtration step was necessary. On the other hand microfiltration led to an acceptable quality of process fluid directly. By optimisation of process parameters an effective, reproducible and robust cell separation can be obtained. However, our experience has been that such optimal conditions are somewhat specific for a narrow range. Thus, even the equipment functioning well with one type of cell would possibly not perform as well with another cell or even with the same cell under conditions slightly different to the usual situation.

Animals↗
PubMed2002

Effects of the rate of muscle post mortem pH fall on the technological quality of turkey meat.

1. This experiment evaluated the influence of the rate of post mortem pH fall on the processing ability of turkey meat. 2. Four hundred and twenty male turkeys from a selected pure line (grand-parental female line, BUT Ltd) were slaughtered at 16 weeks of age in a commercial plant and pH was measured in the Pectoralis superficialis (PS) and Ilio tibialis (IT) muscles, at 20 min post mortem. Three groups of PS muscle differing in pH20 and two groups of IT muscle differing in pH20 were constituted and processed as cured-cooked white meat and turkey ham, respectively. 3. The technological yield was lower in the groups showing the lowest pH20 (97.4% at pH20 5.90 vs 98.6 and 98.3% at pH20 6.24 and 6.55, respectively, for white meat and 97.2% (pH20 6.28) vs 98.3% (pH20 6.56) for turkey hams). The groups showing the lowest pH20 also showed higher drip loss in commercially packed products. 4. Acceptability tests of processed products were carried out in the commercial plant. Texture and taste of white meat were better in the highest pH group but the overall impression was similar in the lowest and the highest pH groups (mean scores of 4.2 and 4.1, respectively), due to better colour in the former (mean scores of 4.4 for the lowest pH20 group vs 4.0 and 3.9 for the medium and highest pH20 groups, respectively). 5. For turkey hams, the meat processed from the highest pH group got the best score for all items.

Animals↗
PubMed1985

Factors governing the effective remediation of negative affect and its cognitive and behavioral consequences.

The present experiment tested the hypothesis that the remediation of negative emotion will be most effective when the remedial procedure matches the experience or cognition that induced the negative state--process-specificity hypothesis. Other hypotheses examined were that negative states induced by cognitive reflection related to the self would be resistant to remediation, even by a same-process positive procedure, and that changes in emotional expressions may make it appear that a negative state has been effectively remediated when lingering effects on behavior and cognition indicate that it has not. Negative emotional states were induced in second-grade children by one of four processes, all of which involved social rejection content: cognition that focused on (a) the self (thinking about oneself being rejected by a peer) or (b) another person (thinking about a peer being rejected); or experience that related to (c) oneself (actually being socially rejected) or (d) observing another (vicarious: seeing a peer be socially rejected). These inductions were then followed by a positive, remedial induction whose content was the reverse (social acceptance) and whose process did or did not match that of the negative induction. As predicted, except for negative self-cognitions, it was found that the behavioral (altruism) and cognitive (performance on a block design task) consequences of negative emotion were alleviated when the positive remediation was of the same type as the original induction. Emotional expressions were consistently positive following remediation, regardless of their type. The results are discussed in terms of differing processes for maintaining negative emotion as a function of the character of induction, and the implications for the understanding of clinical depression in children are noted.

Affect↗
PubMedDate not supplied

How documentation outcomes guide the way: a patient health education electronic medical record experience in a large health care network.

BACKGROUND: Despite Joint Commission on Accreditation of Healthcare Organizations' standards in patient health education (PHE), the patient education process oftentimes remains underreported in many patients' medical records. The primary focus of this project was to create a usable electronic medical record (EMR)-based method of documentation of PHE within a large Department of Veterans Affairs (VA) health care network using clinical staff involvement, routine monitoring, and consistent feedback. METHODS: A team of clinical staff was formulated to review current literature, seek out best practices, examine existing VA PHE templates, and create and monitor a user-friendly EMR process for documenting the assessment of patient learning needs and the outcomes of teaching and education. Professional team focus groups, pilot testing, usage monitoring, local action planning, and feedback surveys were selected strategies utilized to create and evaluate success and make timely revisions. RESULTS/RESPONSE: Monthly usage reports were provided to the local PHE teams. An EMR monitoring system for clinical reminders provided an appropriate and tested mechanism to collect specific usage data. Since 2003, steady improvement has been reported with use partly due to greater acceptance of the process and growing competition among network sites. The newly created PHE EMR has since been modified to enhance the quality of documentation as staff becomes more adept at using these tools. CONCLUSION: Staff involvement in format design and development combined with consistent feedback and evaluation resulted in improved documentation compliance. Future work is focused on the quality of evaluations of patient learning needs and electronic recording of patient teaching and education.

Hospitals, Veterans↗
PubMed2004

Evaluation of a program aimed at increasing referrals for asthma education of patients consulting at the emergency department for acute asthma.

BACKGROUND: Emergency department (ED) visits for asthma may reflect poor asthma control, often due to insufficient asthma education and medical follow-up. However, few patients consulting an ED for asthma are referred for education. AIMS: To describe a model for automatic referral to educational interventions targeting patients consulting at the ED for acute asthma, to demonstrate how this model can be integrated into current care, and to increase referrals for asthma education. METHODS: The program combines a short ED-based educational intervention with the goal of motivating patients and their families to pursue an educational program with an automatic referral to an asthma education center (AEC) after agreement with ED physicians. The program was implemented in nine acute care centers with a high number of ED visits for asthma. The main study parameter was the number of patients referred to an AEC after 4 months of program implementation, as compared with 4 months before. In addition, we assessed potential barriers to successfully establishing the program. RESULTS: In the first 4 months of the program, 1,104 patients were referred to an AEC, compared with 110 for the same period the year before; 106 patients (15%) patients could not be contacted, 114 patients (16.1%) refused the intervention, 488 patients (68.9%) made appointments, and 346 patients (48.9%, or 72.8% of scheduled patients) honored their appointments. CONCLUSION: We describe a model of educational intervention for asthmatic patients consulting at the ED. We found that ED professionals can motivate patients to attend an asthma education program and that an automatic referral process is well accepted by ED staff. Such intervention can help to reduce asthma-related morbidity, but local barriers to implementation of such program should be addressed.

Acute Disease↗
PubMed2005

Molecular evolution of evolutionary novelties: the vagina and uterus of therian mammals.

Innovations are an integral part of the evolutionary process if we accept the fact that more complex organisms derived from anatomically simple ones. All major taxa are distinguished not only by their closer genealogical relatedness relative to other species but also by the possession of novel anatomical and physiological features. The question is whether the origin of these novel characters can be simply understood as adaptations, like all other phenotypic differences that arise by natural selection, or whether the origin of these characters requires more profound genetic changes. In this paper, we argue that innovations constitute a distinct class of evolutionary processes that require a research program complementary to the study of adaptation. The distinguishing feature of innovations is the origin of novel organ identity gene functions specific to the novel character. By implication, research into the origin of novel characters has to identify the developmental regulatory links that were involved in the evolution of these characters. We suggest that novel regulatory links will include the evolution of cis-regulatory elements as well as novel protein-protein interactions among transcription factor proteins. The latter hypothesis suggests that innovations should leave a trace in the evolution of the protein coding regions of transcription factor genes. We illustrate this idea with results on the evolution of HoxA-11 and HoxA-13 in the stem lineage of placental mammals. These genes are essential for female reproductive tract development and function. We show that, as predicted, these genes experience strong directional selection in the stem lineage of placental mammals and that these amino acid substitutions affect residues at the surface of the protein, consistent with their expected role in protein-protein interactions. We conclude that a careful analysis of sequence variation in developmental genes can aid in testing which developmental changes were instrumental in the origin of novel morphological characters.

Animals↗