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PubMed2000

[Tobacco prevention in apprentices--evaluation of a general practice project "not smoking is cool!"].

PURPOSE: In recent years the incidence of adolescent smokers has increased steeply. Taking this into account, current anti-smoker campaigns should be reconsidered. Great importance must be attached to the apprentice group, since adolescents in professional training have frequently not been reached sufficiently by the preventive efforts. This study presents a tobacco prevention campaign among adolescents which was conducted in a large Swiss industrial company in 1998. METHODS AND SAMPLE: A total of 430 apprentices took part in the prevention campaign which intentionally targeted adolescent behaviour. Of these, 40 apprentices were trained as mediators for tobacco prevention in advance. On the prevention day, the mediators communicated their know-how and experiences to their working groups. To evaluate the campaign, the apprentices were surveyed via standardised questionnaires on their smoking habits before the prevention campaign began. One month after the prevention day they were surveyed again on their current smoking habits and how the campaign had affected them. RESULTS: The study showed that apprentices smoke heavily despite high awareness of the negative consequences. Some 30% of the trainees admitted smoking regularly. Another 11% said they were occasional tobacco consumers. No significant gender difference was noticeable. Especially striking was that the adolescents often justified their own smoking as habit and dependence on tobacco. The prevention campaign was well received by the adolescents. It set about half of the smokers thinking over their smoking habits. No change in smoking habits, however, could be demonstrated one month after the campaign. CONCLUSIONS: Prevention among adolescents beyond the mandatory school period is a special challenge, since one cannot take advantage of the school's network. Within the scope of the campaign described here, it was possible to reach 430 apprentices of a major company. The study shows a great need for on-target smoking prevention in this sector. In the future, studies should examine whether tobacco prevention campaigns for apprentices should already contain secondary prevention elements from the outset. They should also assess if the effects could be further improved by introducing structural and other ongoing health-promotion measures.

Adolescent↗
PubMed2001

The Laser-assisted Optical Rotational Cell Analyzer (LORCA) as red blood cell aggregometer.

The Laser-assisted Optical Rotational Cell Analyzer (LORCA) is unique in its capacity to measure at least two important hemorheological parameters, i.e., deformability of red blood cells (RBC) as well as their aggregation behaviour. In this communication the main principles and characteristics of the aggregometer mode of this instrument are described. Via syllectometry (i.e., laser backscatter versus time), the method allows the measure of both static and kinetic parameters of the aggregation process, e.g., total extent of aggregation, aggregation half time and a combination of these, defined as aggregation index. When the syllectogram deviates from that representing normal rouleaux formation, e.g., in the case of RBC clump formation, this is signalled by a fit error. Maximal flexibility is obtained by various options like an automated re-iteration procedure (which enables to measure the aggregation tendency and/or the aggregate stability) and aggregation at low shear rate. Experiments dealing with reproducibility, stability and sensitivity of the instrument are described. The latter include a few "classic" methods for inducing subtle changes in RBC aggregation behaviour both regarding cellular factors (heat treatment) and changes in medium constituents (fibrinogen, dextrans).It can be concluded that the aggregometer mode of the LORCA considerably increases the feasibility of this instrument for hemorheological investigations.

Cryoglobulinemia↗
PubMed2003

Functional Outcome Questionnaire for Aphasia: overview and preliminary psychometric evaluation.

OBJECTIVE: To perform a preliminary evaluation of a questionnaire designed to assess functional outcomes of treatment for aphasia. METHODS: The Functional Outcome Questionnaire for Aphasia (FOQ-A) is an inventory consisting of 32 caregiver-completed items rating the person with stroke's ability to perform various communication behaviors on a 5-point scale. The total score for the FOQ-A is reported as a mean of all completed items. The FOQ-A was administered by research assistants to caregivers of patients with left hemisphere stroke (n = 18). RESULTS: The FOQ-A showed acceptable initial reliability and validity properties. As predicted, the FOQ-A displayed high positive correlations with standardized functional communication measures. The FOQ-A also showed only weak associations with other measures (health-related quality of life, caregiver strain). CONCLUSIONS: Overall results of our preliminary psychometric examination of the FOQ-A were promising. The findings suggested that the FOQ-A may be a sensitive measure of functional communication abilities and does not appear to be biased heavily by caregiver strain. Plans for further evaluation of the FOQ-A are discussed.

Adult↗
PubMed2006

Evaluating the organization and delivery of breast cancer services: use of performance measures to identify knowledge gaps.

OBJECTIVES: This paper identifies gaps in our knowledge about the quality of breast cancer care in Canada to understand where programs and resources are required to enhance health services and research capacity. METHODS: A modified Delphi approach was employed involving a 15-member multidisciplinary panel of health professionals and two rounds of rating followed by deliberation to develop evidence- and consensus-based performance measures. A literature search for Canadian health services research in breast cancer was conducted based on the indicator topics. Eligible articles were identified in indexed databases of medical literature and funded research from 1995 to 2006. RESULTS: The multidisciplinary panel selected 34 indicators spanning access to services, patient outcomes, diagnosis and staging, surgery, adjuvant therapy, pathology, and follow-up care. A total of 78 articles (66 quantitative; 12 exploratory) on these topics were reviewed. Apart from two aspects of care (communication of treatment options, supportive care), the yield of Canadian breast cancer health services research did not increase subsequent to a review conducted 10 years ago which recommended greater efforts in this area. CONCLUSIONS: Research involving quantitative and qualitative methods is needed to increase our understanding about the organization and delivery of services for breast cancer diagnosis, treatment and follow-up care. Since it is unclear how to balance competing research demands, innovative strategies are required to assemble resources for health services research on breast cancer. This could include the promotion of partnerships between researchers and policy-makers across jurisdictions, and the pooling of resources between organizations, regions or networks.

Breast Neoplasms↗
PubMed1998

The development of a statewide continuous evaluation system for the Texas Children's Mental Health Plan: a total quality management approach.

The article presents a description of processes involved in developing and implementing a statewide continuous evaluation system for the Texas Children's Mental Health Plan (TCMHP) and quality management tools used to approach implementation challenges. Implementation issues are discussed relating to stakeholder involvement, evaluation design evolution, measurement method modification, evaluation integration, staff training, data quality control, communication of results, and use of results in decision making. A review of implementation processes suggests evaluation design and activities should be seen as constantly evolving in response to ongoing stakeholder input. Involving stakeholders in design and implementation can result in increased data quality, data-informed decision making to improve service delivery, and increased public accountability. The TCMHP evaluation system development demonstrates that quality management tools can provide a useful framework to work through design and implementation problems, and a continuous evaluation system can provide an infrastructure for meeting data needs in a managed care environment.

Adolescent↗
PubMed2005

The University of Texas at Dallas/Callier Center for Communication Disorders Doctor of Audiology Program.

PURPOSE: The purpose of this article is to describe the history and resources of the doctor of audiology (AuD) program at the University of Texas at Dallas (UTD)/Callier Center for Communication Disorders, as well as to provide an overview of the program. METHOD: Data from 1999, when the AuD program was approved by the Texas Higher Education Coordinating Program, to the present were reviewed. CONCLUSIONS: The UTD/Callier Center AuD program includes more than 40 faculty members, spans 3 campuses, and has 8 research laboratories. Total enrollment is 32 students (8 students are admitted each year for the 4-year program). Students have access to extensive resources and learning opportunities. The clinical and research programs at the UTD/Callier Center are actively involved in providing high-quality, in-depth education to future doctors of audiology.

Audiology↗
PubMed1984

The regulation of hypoxanthine guanine phosphoribosyl transferase activity through transfer of PRPP by metabolic cooperation.

We have developed a method of relating changes in hypoxanthine guanine phosphoribosyl transferase (HGPRTase) activity to the rate of phosphoribosyl pyrophosphate (PRPP) synthesis in isolated cell lines and in co-cultures of different cell lines. Using this approach, we have determined the response of the HGPRTase activity of communication-competent and communication-incompetent cells to changes in PRPP content. The HGPRTase activity of HGPRT+ communication-competent NS cells responds to changes of their own PRPP level, as well as to changes of the PRPP level of HGPRT- cells with which they are co-cultured. In contrast, the HGPRTase activity of the HGPRT+, but communication-incompetent L929 cells responds to changes of their own PRPP content but not to changes of the PRPP content of the cocultured HGPRT- cells. These and other experiments show that PRPP is freely exchangeable between communication-competent cells and that the intracellular activity of HGPRTase in one cell can be regulated by changes in the levels of its substrate in another cell through metabolic cooperation. The results also indicate that HGPRTase normally functions at a small fraction of its total activity, and that this can be greatly increased by raising the intracellular PRPP levels. Furthermore, it is found that when communication-competent cells establish intercellular communication, they share a common pool of PRPP and of purine nucleotides. This approach can be used as the basis of a biochemical method for the quantitation of metabolic cooperation between cells.

Adenine↗
PubMed1999

Progress with the HeartSaver Ventricular Assist Device.

BACKGROUND: Ventricular assist devices (VADs) have been shown to be effective for short- or long-term circulatory support. Devices are either being adapted or newly designed for longer term or permanent support, with the goal to provide patients with improved quality of life. Since 1990, a program has been in place to develop a totally implantable, permanent VAD. METHODS: A multidisciplinary team is developing this VAD with specific goals in mind: (1) that it have an intrathoracic position, (2) that it be a totally implantable device without any percutaneous connections, and (3) that it be possible to communicate with the device from remote locations. These goals would allow for complete patient mobility and flexibility for follow-up. RESULTS: The electrohydraulically actuated VAD combines the blood pump, volume displacement chamber, energy converter, and internal electronic module into a single compact unit. The device called the HeartSaver VAD is powered by a transcutaneous energy transfer system and can be remotely monitored and controlled. Prototypes of different versions of the device have been tested in vitro and in vivo with satisfactory performance. CONCLUSIONS: The prototypes of the HeartSaver VAD have functioned well under test conditions and fulfilled the outlined goals. Further development and testing of the design are being conducted before clinical availability.

Animals↗
PubMed1998

Cerebral aneurysms causing visual symptoms: their features and surgical outcome.

Cerebral aneurysms causing visual symptoms before surgery are relatively rare. We have experience with 17 cases of such aneurysms and report their clinical features and surgical outcome. The locations of aneurysms presenting with visual dysfunction in our series are as follows: internal carotid (IC)-cavernous aneurysms in six of 29 total cases, 21%; IC-ophthalmic aneurysms in nine of 36 total cases, 25%; and anterior communicating artery (A com A) aneurysms in two of 217 total cases, 1%. The size of the aneurysms, the period between the onset of symptoms and surgical treatment, the pre- and post-operative visual function, and the surgical methods used to treat the aneurysm were analyzed. All the visually symptomatic cases featured large (15-24 mm) or giant (> 25 mm) aneurysms. Visual symptoms occurred before aneurysmal rupture in all cases but one. The type of visual field defect and the degree of reduced visual acuity were highly variable, without a typical clinical presentation. Five out of six IC-cavernous aneurysms were treated surgically with common carotid artery (CC) ligation or IC ligation with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis. Three of these cases showed improvement of visual symptoms after surgery. Six out of nine IC-ophthalmic aneurysms were treated surgically (CC ligation or direct clipping), with four cases showing improvement of visual symptoms after surgery. One case of an A com A aneurysm featured a ruptured aneurysm that had physically penetrated the optic chiasm, while the other case was a giant unruptured aneurysm. The interval between the onset of symptoms and surgical treatment was the only factor identified which affected the clinical outcome of the aneurysms presenting with visual dysfunction. All cases that were determined to show improvement of visual function were treated surgically within 3 months of the onset of symptoms. Cerebral aneurysms presenting with visual dysfunction before surgery are most commonly large or giant, and unruptured. Recovery of visual function can most often be expected when surgical treatment is performed expeditiously, before the visual dysfunction becomes irreversible.

Adult↗
PubMed1999

Vascular surgical society of great britain and ireland: integrated care pathways for vascular surgery

BACKGROUND: Integrated care pathways (ICPs) represent a multidisciplinary approach to clinical patient care. METHODS: A 1-year prospective trial of the use of ICPs for elective vascular surgical procedures was undertaken. A multidisciplinary group constructed ICPs for patients admitted for open repair of abdominal aortic aneurysm, carotid endarterectomy or femoropopliteal bypass grafting. Patient management followed ICPs on a daily basis with signatures required to confirm that each action had been taken. Variances from the ICPs were carefully recorded. Audit of variance data allowed subsequent revision of the ICPs and hence provision of the best possible nursing and clinical practice. METHODS: A total of 33 patients were entered into the study; 16 had a femoropopliteal bypass graft, eight carotid endarterectomy and nine open repair of an abdominal aortic aneurysm. ICPs were well received by patients and staff. They improved communication, promoted an appreciation of each health group's role in patient care, increased nursing autonomy, reduced calls to junior medical staff, improved patient education and confidence, and caused a marked reduction in length of hospital stay. Overall, patients were discharged 13 per cent earlier after open abdominal aortic aneurysm repair, 22 per cent earlier after carotid endarterectomy and 38 per cent earlier after femoropopliteal bypass grafting. CONCLUSION: ICPs have clear benefits. They improve overall clinical efficiency and enhance clinical governance. Successful use of ICPs depends upon 'clinical champions' and effective project management. Sufficient resources and training are essential.

Journal Article↗
PubMed2001

The novel untranslated exon "exon 0T" encoded between the exon 0 and exon 1 of the rat estrogen receptor alpha (ER alpha) gene.

We have recently isolated two untranslated first exons, exon 0N and exon 0S, of rat estrogen receptor alpha (ER alpha) gene from the liver by use of 5'-rapid amplification of the cDNA ends (5'-RACE) method. In this communication, we further analyzed the 5'-untranslated region (UTR) of the ER alpha mRNA in rat anterior hypophysis in order to investigate the existence of the other 5'-untranslated exon(s) of rat ER alpha gene. Total RNA from the anterior hypophysis of 8-week-old female Wistar strain male rats was subjected to 5'-RACE with antisense primers located in exon 1 of the rat ER alpha gene and one of the positive clones (clone 35) was sequenced. The nucleotide sequence of clone 35 revealed the insertion of a previously unidentified exon (which we termed "exon 0T") between exon 0 (the first reported 5'-UTR form of rat ER alpha mRNA) and exon 1 of rat ER alpha mRNA. Analysis of rat genomic DNA indicated that exon 0T was located between exon 0 and exon 1 of rat ER alpha gene. We further investigated the distribution of ER alpha mRNA containing exon 0T in several brain regions and various peripheral tissues of 8-week-old male and female Wistar strain rats by use of reverse transcription-polymerase chain reaction (RT-PCR). The distribution of the ER alpha mRNA (0T-1) was essentially similar to that of ER alpha mRNA in which exon 0 was spliced onto exon 1 reported previously. These results indicate that (1) exon 0T is a novel untranslated exon of rat ER alpha gene which is located between exon 0 and exon 1 on rat genomic DNA, (2) exon 0T is inserted between exon 0 and exon 1 of ER alpha mRNA by alternative splicing, and (3) this alternative splicing may occur in tissues where the transcription of ER alpha gene is initiated from exon 0.

5' Untranslated Regions↗
PubMed2001

Radiologists' productivity in the interpretation of CT scans: a comparison of PACS with conventional film.

OBJECTIVE: We compared radiologists' times in the interpretation of CT using hardcopy films with the interpretation using a soft-copy picture archiving and communication system (PACS) computer workstation. MATERIALS AND METHODS: One hundred CT examinations were selected at random and reviewed by four board-certified radiologists experienced in soft-copy interpretation. We performed time-motion analysis to determine the total time required to display, interpret, and dictate the individual findings of CT using conventional hard-copy interpretation on a viewbox and soft-copy interpretation, using a four-monitor high-resolution (2048 x 1536 pixel) workstation. RESULTS: Time-motion analysis showed a reduction of 16.2% in the overall time required for soft-copy interpretation of CT compared with that of film. Time savings with soft-copy interpretation were observed for all four participating radiologists. The benefit of soft-copy interpretation was increased for examinations in which there were comparison studies. CONCLUSION: We found that soft-copy interpretation of CT using a PACS workstation requires less time than interpretation using conventional film hung on a viewbox. The transition to filmless imaging has the potential to improve radiologists' productivity and report-turnaround time.

Efficiency↗
PubMed2003

[Treatment of posterior-communicating wide-necked aneurysms with endovascular stent and Guglielmi detachable coils].

OBJECTIVE: To summarize our clinical experience in treating posterior-communicating wide-necked aneurysms using endovascular stent and Guglielmi detachable coils (GDCs). METHODS: The coronary stents were implanted across the neck of 32 posterior-communication wide-necked aneurysms. Microcatheters were introduced into the aneurysm sac through stent mesh, GDCs were used to embolize aneurysms. RESULTS: All operations were successful. Total occlusion was achieved in 26 patients, over 90% in 4, 60 - 70% in 2. The patients were perfectly recovered with patency of the parent arteries. CONCLUSION: Endovascular therapy combined with stent implatation and GDC placement is a valid approach to the treatment of posterior-communication wide-necked aneurysms.

Adult↗
PubMed2003

[Diagnostic problems in case of middle ear carcinoma].

A case of 64 year-old man with middle ear carcinoma and temporal bone was described. He was treated by surgery and radiotherapy. Main symptoms communicated by the patients were discharge followed by pain of the ear. Further, diagnostic problems and methods of treatment are discussed as well as unsuccessful course of the disease, due to extension of the carcinoma, which caused the no total resection of tumour.

Carcinoma↗
PubMed2004

[Poor scientific behavior in communication of biomedical results].

INTRODUCTION: The generically known as poor scientific behavior exists in different degrees with regard to biomedical communications and publications. From authentic fraud in the data up to the called "tricks" for curriculum fattening. MATERIAL AND METHODS: The objective of this work is to review the works presented in the XVIII Congress of the Andalusian Society of Internal Medicine (Marbella, October 2001), comparing them with the abstracts books of six more scientific meetings and congresses both regional and national. RESULTS: Of the 183 works evaluated in this review, 22 (12.02%) were doubled and 13 (7.10%) fragmented, in other words, a total of 35 (19.33%). The groups that presented communications were 36, and 17 of them (47.22%) carried out one or both fraudulent tactics. CONCLUSIONS: Despite the little bibliographic reference, in our environment exists the duplication and the fragmentation of works presented, in general as a system for curriculum increase. We advocate a higher clarity and commitment in the relationship between editors and authors, and an upsurge of the aspects of punishable deontological regulation on the one hand and of the ethics or a priori commitment on the other one.

Behavior↗
PubMed1999

Redirection of hepatic venous drainage after total cavopulmonary shunt in left isomerism.

BACKGROUND: Conversion from total cavopulmonary shunt (TCPS) to the Fontan circulation can improve cyanosis in patients with potential risks of development of pulmonary arteriovenous fistula (PAVF). METHODS: Inclusion of the hepatic veins in the pulmonary circulation was employed using an intra-atrial tube graft in 5 patients with left isomerism previously undergoing TCPS. Prior to the conversion, abnormal communication was identified between the azygos vein and either the hepatic or the portal vein in all. PAVF was seen in 3. RESULTS: All patients survived the procedure. Postoperative catheterization showed 13 +/- 2 mm Hg of superior caval venous pressure, and 2.3 +/- 0.4 L/min/m2 of cardiac index. Pulmonary arteriovenous fistula progressed markedly in the right lung even after the conversion in 2 patients, in whom the hepatic veins had been exclusively diverted to the left lung. Arterial oxygen saturation became below 65%, with exercise capacity reduced, in these 2 patients. The other patients remain asymptomatic. CONCLUSIONS: Total cavopulmonary shunt can be efficiently converted to the Fontan circulation by appropriately redirecting hepatic venous drainage to perfuse both lungs in a balanced fashion.

Aortography↗
PubMed2000

Passive energy return after repeated stretches of the hamstring muscle-tendon unit.

UNLABELLED: It has been shown that five repetitive static stretches of human hamstring muscle, each lasting 90 s and separated by 30 s, altered the passive properties on a short-term basis. However, a total of 7.5 min (5 x 90 s) of stretching for a single muscle group may be an unrealistic stretching program. PURPOSE: The present investigation examined whether three repeated 45-s static stretches had a measurable effect on the passive properties of the hamstring muscle-tendon unit, in vivo. METHODS: Resistance to stretch was defined as the passive moment (Nm) offered by the hamstring muscle group during passive knee extension using a KinCom dynamometer as previously described (Kinetic Communicator, Chattecx Corp., Chattanooga, TN). The static stretch exercise was administered to the left lower extremity of all subjects and consisted of a dynamic phase of passive knee extension to a predetermined final joint angle followed by a 45-s static phase. The procedure was repeated for a total of three 45-s static stretches with 30-s rest period between stretches. RESULTS: There was a significant decline in resistance over the 45-s the static phase in stretch 1 (20 +/- 3%) and stretch 3 (18 +/- 3%), P < 0.001. Further, the absolute or relative decline in resistance over time stretch 1 and 3 were equivalent. The mean resistance in stretch 1 and 3, expressed as the log(e) of time, yielded an equal and highly linear relationship (r2 = 0.96 +/- 0.01); the slope and intercept did not differ. In the dynamic phase of the stretch, the energy of stretch 1 and 3 were similar. CONCLUSIONS: These data suggest that the static stretching protocol used in the present study had no short-term effect on the viscoelastic properties of human hamstring muscle group.

Adult↗
PubMed2006

New onset of hydroceles in boys over 1 year of age.

AIM: The presentation, and medical and surgical management of all new onset non-congenital hydroceles in boys older than 1 year of age were examined. Of particular interest was the outcome of those patients who presented with a non-communicating hydrocele that developed after the first year of life and was managed conservatively. METHODS: All patients older than 12 months of age who were evaluated as outpatients with the diagnosis of hydrocele from January 1994 to January 2001 were identified. Possible risk factors and predisposing conditions were determined. For the patients who had surgical correction, surgical indications were identified. For non-surgical patients, long-term outcomes were recorded. RESULTS: A total of 302 patients older than 12 months of age with the diagnosis of new onset hydrocele were identified. Of these, 35% were non-communicating, 59% were communicating, and 6% were hydroceles of the spermatic cord. In terms of surgery, 97% of communicating hydroceles, 71% of hydroceles of the spermatic cord, and 34% of non-communicating hydroceles had operative management. Seventy patients with non-communicating hydroceles did not receive surgery and 51 (73%) were contacted for long term follow-up. In these 51 patients, 76% of non-communicating hydroceles resolved completely, 6% decreased in size but were still present, 14% remained the same size, and 4% had an unknown status. The average time to resolution was 5.6 months with a median time of 3 months. The time range to resolution was from 1 day to 24 months. Follow-up averaged 73.7 months with a range of 33 to 120 months. CONCLUSIONS: Approximately 75% of new onset, non-congenital, non-communicating hydroceles resolve spontaneously irrespective of size. An observation period of 6-12 months would be appropriate prior to repair.

Adolescent↗