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PubMedDate not supplied

Management of encopresis in early adolescence in a medical-psychiatric unit.

The aim of this work is to present the role of a medical-psychiatric unit in the treatment of chronic resistant encopresis in adolescence as an effective alternative to the standard approach. Four case reports are presented. The integrative program is based on full patient cooperation and involves separating the patient from the family environment and the use of medical intervention combined with modified behavioral therapy and parental education and guidance. The patient is given full responsibility for the cure. The median full hospital stay for our patients was 2 weeks, and outcome in all cases was complete remission. This experience suggests that chronic resistant encopresis in adolescents requires a different approach from the standard because of the patient's developmental stage and the often hostile family dynamics. A medical-psychiatric setting provides an excellent management milieu and can lead to a dramatic improvement in this chronic disabling condition.

Adolescent↗
PubMed1997

The kinetic behaviour of a two-enzyme system in biphasic media: coupling hydrolysis and lipoxygenation.

Analysis of the kinetic behaviour of a two-enzyme-system carrying out two consecutive reactions was investigated in macroheterogeneous biphasic media (octane/buffer pH 9.6, v/v = 1:1). The lipase-catalysed hydrolysis of trilinolein and the subsequent lipoxygenation of the liberated linoleic acid, were coupled in a modified Lewis cell with a well-defined liquid/liquid interfacial area. Trilinolein was dissolved in the organic phase and hydrolysed in the presence of Mucor javanicus lipase at the organic/aqueous interface. Linoleic acid, liberated after hydrolysis was transferred to the aqueous phase and reacted with lipoxygenase. This reaction consumed linoleic acid and produced hydroperoxides, which favoured the transfer of residual linoleic acid, since they possess surface active properties. Catalysis and transfer influenced each other reciprocally. At low substrate concentrations, cooperativity phenomena were observed in the experimental and also the modelled two-enzyme systems. When the initial substrate concentration was high, the kinetic behaviour of the two-enzyme system in a compartmentalised medium, seemed to be independent of the substrate concentration, unlike that observed in homogeneous monophasic enzymology. The numerical integration program used to model the two-enzyme system was based on results obtained in separate studies of the following three phenomena: (1) trilinolein hydrolysis in biphasic medium. (2) linoleic acid transfer across a liquid/liquid interface and (3) lipoxygenation in an aqueous media. Results obtained by modelling were similar to the results observed experimentally.

Hydrolysis↗
PubMed1997

Decentralisation from acute to home care settings in England.

The impact of technology and resource constraints on acute care, the concept of a 'primary-care led National Health Service' (NHS), and the emphasis on developing community-based alternatives to institutional care have contributed to a reshaping of the respective roles of acute and home care services over the past 10-15 years in the United Kingdom. In England, recent reforms are allowing GP Fundholders, District Health Authorities representing a specific geographic area, and local government social services departments to purchase both acute and community-based care. In addition, new constraints on further expansion of institutional long-term care are encouraging the substitution of home care for the elderly needing long term care services. The result has been a dramatic increase in use of home care services. However, resource and supply constraints impede further home care expansion. Other forces within the NHS continue to foster unnecessary post-acute institutionalization. The successful decentralization of acute services from hospitals to home care requires an integrated program across the continuum of health and social services. In practice, no such concerted program exists.

Ambulatory Care↗
PubMed2001

Salmonella seroprevalence at the population and herd level in pigs in The Netherlands.

The aim of this study was to provide baseline data on the population and herd Salmonella seroprevalence in sows and finishers. For the population estimates in 1996 and 1999 and the herd prevalences for sows and gilts, blood samples from swine vesicular disease (SVD) and pseudorabies monitoring programmes were used and tested in an indirect Salmonella enzyme-linked immunosorbent assay (ELISA). The herd prevalence for finishers was determined using blood samples collected at two slaughterhouses. The population prevalence for finishers in 1996 and 1999 was 23.7 and 24.5%, respectively, and for sows 40.5 and 60.4%, respectively. The prevalence in free range (FR) finishers was significantly higher (44.6%) than in intensively housed finishers in 1999, identifying a hazard group for possible extra pork and pork product contamination. Of 406 finishing herds, 9% were completely seronegative for Salmonella (cut-off OD%>10). Of these 406 finishing herds, 69.7% had Salmonella-status I (low prevalence), 21.7% status II (moderate prevalence) and 8.6% status III (high prevalence) (cut-off OD%>40). In 46 multiplying sow herds, 20 breeding sow herds and 20 matching replacement gilt herds, the average herd prevalences were 54, 44.4 and 19.3%, respectively. Two gilt herds were completely seronegative. The prevalence in the gilt herds was never higher than in the matching breeding sow herds. Agreement on methodology and calibration of ELISA tests would make these results comparable between countries and is a prerequisite for a co-ordinated and integrated program to reduce Salmonella in pork in the European Union.

Animal Husbandry↗
PubMedDate not supplied

Cost-effective use of operating room supplies based on the REMEDY database of recovered unused materials.

It is estimated that $200 million worth of prepared materials are discarded unused in operating rooms in the United States each year. Although some of these materials have been successfully recovered for overseas donation, they nevertheless constitute an undesirable burden on health care efficiency. This situation has prompted a reevaluation of the procedures that result in the overpreparation of surgical supplies, in the hope of reducing hospital, patient, and third-party payer expenditures. A database, which was initially developed to track the overseas donation of recovered supplies from Yale-New Haven Hospital, is now being applied to measure approaches to waste reduction. This report summarizes the application of this database to an integrated program designed to modify nursing procedures and physician prespecified supply lists.

Budgets↗
PubMed2004

An environmentally sustainable decision model for urban solid waste management.

The aim of this work is to present the structure and the application of a decision support system (DSS) designed to help decision makers of a municipality in the development of incineration, disposal, treatment and recycling integrated programs. Specifically, within a MSW management system, several treatment plants and facilities can generally be found: separators, plants for production of refuse derived fuel (RDF), incinerators with energy recovery, plants for treatment of organic material, and sanitary landfills. The main goal of the DSS is to plan the MSW management, defining the refuse flows that have to be sent to recycling or to different treatment or disposal plants, and suggesting the optimal number, the kinds, and the localization of the plants that have to be active. The DSS is based on a decision model that requires the solution of a constrained non-linear optimization problem, where some decision variables are binary and other ones are continuous. The objective function takes into account all possible economic costs, whereas constraints arise from technical, normative, and environmental issues. Specifically, pollution and impacts, induced by the overall solid waste management system, are considered through the formalization of constraints on incineration emissions and on negative effects produced by disposal or other particular treatments.

Cities↗
PubMed2006

Survey of asthma care in Taiwan: a comparison of asthma specialists and general practitioners.

BACKGROUND: Asthma is a common disease in Taiwan. The promotion of quality care for asthmatic patients should focus not only on new treatment remedies but also on patient adherence to treatment and a continuous education program integrated into treatment plans. One reason for patients' poor response to treatment is the lack of asthma knowledge on the part of physicians in terms of attitudes toward treatment. OBJECTIVE: To investigate the current status of asthma treatment among asthma specialists and general practitioners and their relative acceptance of and adherence to treatment guidelines. METHODS: One thousand questionnaires were distributed to physicians throughout Taiwan using a randomized sampling procedure. The questionnaire asked about the use of different kinds of medications, including inhaled corticosteroids, to treat asthma; adherence to asthma treatment guidelines; the use of a peak flow meter for monitoring asthma status; and self-efficacy in the treatment of asthma. RESULTS: A total of 526 questionnaires were returned. Of these, 90.4% of specialists and 63.2% of general practitioners would follow the guidelines for patient care (P = .002). It was significant that 79.8% of specialists but only 41.9% of general practitioners would instruct patients to use a peak flow meter to monitor symptoms (P < .001). Asthma specialists also seemed to be significantly more competent than general practitioners regarding asthma knowledge, instruction of inhalation techniques, use of peak flow meters to monitor symptoms, and making an action plan. CONCLUSIONS: To minimize the knowledge gap between specialists and general practitioners regarding asthma treatment, recognized treatment guidelines need to be popularized or simplified. Furthermore, the continuing education of general practitioners in asthma knowledge and management skills is important.

Administration, Inhalation↗
PubMed1999

VisualiSAR: a web-based application for clustering, structure browsing, and structure-activity relationship study.

VisualiSAR is a program designed to display chemical structures, find similarities and differences between them, and highlight relationships that might exist. The program integrates cluster analysis for the grouping of structurally related compounds, modal analysis of molecular fingerprints for the sorting and highlighting of chemical features, and a Web-based interface for flexibility and ease of use. VisualiSAR has proved useful for a number of applications including the discernment of structure-activity relationships (SAR) of high-volume screening data, and general structure browsing. This article discusses the design of the tool and illustrates two applications.

Computer Simulation↗
PubMed2001

Bacterial fatty-acid biosynthesis: a genomics-driven target for antibacterial drug discovery.

In this review we demonstrate how the interplay of genomics, bioinformatics and genomic technologies has enabled an in-depth analysis of the component enzymes of the bacterial fatty-acid biosynthesis pathway as a source of novel antibacterial targets. This evaluation has revealed that many of the enzymes are potentially selective, broad-spectrum antibacterial targets. We also illustrate the suitability of some of these targets for HTS. Furthermore, we discuss how the availability of a robust selectivity assay, mode-of-action assays and numerous crystal structures provide an excellent set of tools with which to initiate integrated programs of research to identify novel antibiotics targeted at these enzymes.

Journal Article↗
PubMed1997

Preventive intervention as means of clarifying direction of effects in socialization: anxious-withdrawn preschoolers case.

An indicated preventive intervention research program integrating attachment, attributional, and behaviorist perspectives was conducted to test the hypothesis that parent-child relationship disturbances directly effect the child's adjustment to the preschool. Anxious-withdrawn preschool children and their mothers were divided equally into treatment and control groups, and assessed on maternal self-report of parenting stress, behavioral ratings of mother-child interaction, and teacher ratings of the children in the preschool classroom. Results showed significant changes in the treatment of group: mothers in the treatment group moderated their level of control to a more appropriate, less intrusive level, while children in the treatment group showed an increase in cooperation and enthusiasm during a problem solving task with mother. Teacher-rated social competence and anxious-withdrawn behavior indicated improvement, although only the former was significant. The demonstration of effects of this home intervention for the mother on the child's behavior in the preschool confirm the transactional model underlying this study and demonstrate the utility of a parent-child interaction training component for the prevention of behavioral-emotional problems in young children.

Adult↗
PubMed2001

Does the Wisconsin Card Sorting Test measure prefontral function?

This review describes a research program aimed at evaluating the validity and specificity of the Wisconsin Card Sorting Test (WCST), one of the most widely used tests of prefrontal function in clinical and experimental neuropsychology. In spite of its extensive use, voices of caution have arisen against the use of WCST scores as direct markers of prefrontal damage or dysfunction. Adopting a cognitive neuroscience approach, the present research program integrates behavioral, physiological, and anatomical information to investigate the cognitive and neural mechanisms behind WCST performance. The results show that WCST performance evokes conspicuous physiological changes over frontal as well as posterior brain regions. Moreover, WCST scores confound very heterogeneous cognitive and neural processes. This confounding effect may have led many authors to overlook the relative importance of certain dysfunctional states such as those indexed by random errors. These findings strongly suggest that WCST scores cannot be regarded as valid nor specific markers of prefrontal lobe function. However, they do provide some relevant clues to update our current knowledge about prefrontal function. In the long run, the integrative approach of cognitive neuroscience may help us design and develop more valid and sensitive tools for neuropsychological assessment.

Brain Mapping↗
PubMed2006

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field.

OBJECTIVES: Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion. METHODS: A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician. RESULTS: Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%-99%), a specificity of 96% (95% CI 94%-98%), a positive predictive value (PPV) of 82% (95% CI 71%-90%), and a negative predictive value (NPV) of 99% (95% CI 97%-100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%-98%), a specificity of 97% (95% CI 94%-98%), a PPV of 73% (95% CI 59%-85%) and an NPV of 99% (95% CI 97%-100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes. CONCLUSIONS: ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.

Ambulances↗
PubMed2001

Tadpoles assay: its application to a water toxicity assessment of a polluted urban river.

The acute toxicity assay with premetamorphic tadpoles of Bufo arenarum as sentinel organism was applied to evaluate the quality of two water samples taken from three sites of the Reconquista River, an urban watercourse which is recipient of both untreated industrial effluents and domestic wastes. The results of the 96 hr bioassays were compared with the physicochemical parameters determined in the samples. Mortality rates in each sample were compared using the Bonferroni's test and a stepwise regression analysis of mortality and physicochemical parameters was done. In this way, it was possible to build up consistent descriptive models which showed that pH, Cl- Cd2+ and Cu2+ concentrations in the river water were significant independent variables and might explain, under the experimental conditions, the recorded toxicity effects of the tested samples. Because of its simplicity, low cost and reliability it was suggested the tadpoles bioassay be included in the set of tests used in integrated program of freshwater pollution.

Animals↗
PubMed1996

The course, treatment, and outcome of substance disorder in persons with severe mental illness.

Individuals with co-occurring substance abuse and severe mental illness are particularly vulnerable to negative outcomes. This paper reviews findings on the longitudinal course of dual disorders in traditional treatment systems, which provide separate mental health and substance-abuse programs; describes the movement toward programs that integrate both types of treatment at the clinical level; reviews evidence related to outcomes in integrated treatment programs; and discusses health-care policy changes that would encourage effective treatments.

Humans↗
PubMed2000

The effect of integrating substance abuse treatment with prenatal care on birth outcome.

OBJECTIVE: To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes. STUDY DESIGN: The subjects were women who voluntarily enrolled in Project Link, an intensive outpatient substance abuse treatment program at Women and Infants Hospital, Providence, RI. A total of 87 women received substance abuse treatment in conjunction with their prenatal care; the comparison group of 87 women received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered. The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories. Univariate and multivariate analyses were performed. The key outcomes were gestational age at delivery, birth weight, preterm delivery, Apgar scores, and neonatal intensive care admission rate. Factors controlled in the multivariate models included demographics, socioeconomic status, parity, and prenatal care. RESULTS: Infants born to women who enrolled prenatally were 400 gm heavier (p < 0.001), and their gestational age was 2 weeks longer (p < 0.001) than infants of mothers enrolled postpartum. In addition, they were approximately one-third as likely to be born with a low birth weight (p < 0.01) and approximately one-half as likely to be admitted to the neonatal intensive care unit (p < 0.05). CONCLUSION: Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum.

Adolescent↗
PubMed2003

Branching out: a molecular fingerprint of endothelial differentiation into tube-like structures generated by Affymetrix oligonucleotide arrays.

The process of endothelial differentiation into a network of tube-like structures with patent lumens requires an integrated program of gene expression. To identify genes upregulated in endothelial cells during the process of tube formation, RNA was prepared from several different time points (0, 4, 8, 24, 40, and 48 hours) and from three different experimental models of human endothelial tube formation: in collagen gels and fibrin gels driven by the combination of PMA (80), bFGF (40 ng/ml) and bFGF (40 ng/ml) or in collagen gels driven by the combination of HGF (40 ng/ml) and VEGF (40 ng/ml). Gene expression was evaluated using Affymetrix Gene Chip oligonucleotide arrays. Over 1000 common genes were upregulated greater than twofold over baseline at one or more time points in the three different models. In the present study, we discuss the identified genes that could be assigned to major functional classes: apoptosis, cytoskeleton, proteases, matrix, and matrix turnover, pumps and transporters, membrane lipid turnover, and junctional molecules or adhesion proteins.

Animals↗
PubMed2002

Women's views of two interventions designed to assist in the prophylactic oophorectomy decision: a qualitative pilot evaluation.

INTRODUCTION: A qualitative pilot evaluation of two different decision interventions for the prophylactic oophorectomy (PO) decision: a Decision Chart and a computerized clinical guidance programme (CGP) was undertaken. The Decision Chart, representing current practice in decision interventions, presents population-based information. The CGP elicits individual values to allow for quality-adjusted life years to be calculated and an explicit guidance statement is given. Prophylactic oophorectomy involves removal of the ovaries as an adjunct to hysterectomy to prevent ovarian cancer. The decision is complex because the operation can affect a number of long-term outcomes including breast cancer, coronary heart disease and osteoporosis. METHODS: Both interventions were based on the evidence and were administered by a facilitator. The Decision Chart is a file, which progressively reveals information in the form of bar charts. The CGP is a decision-analysis based program integrating the results from a cluster of Markov cycle trees. The research evidence is incorporated with woman's individual risk factors, values and preferences. A purposive sample of 19 women awaiting hysterectomy used the decision interventions (10 CGP, nine Decision Chart). In-depth semi-structured interviews were undertaken. Interviews were transcribed and analysed to derive themes. RESULTS: Reactions to the different decision interventions were mixed. Both were seen as clarifying the decision. Some women found some of the tasks difficult (e.g. rating health status). Some were surprised by the "individualized" guidance, which the CGP offered. The Decision Chart provided some with a sense of empowerment, although some found that it provided too much information. CONCLUSIONS: Women were able to use both decision interventions. Both provided decision clarification. Problems were evident with both interventions, which give useful pointers for future development. These included the possibility for women to see how their individual risks of different outcomes are affected in the Decision Chart and enhanced explanation of the CGP tasks. Future design and evaluation of decision aids, will need to accommodate differences between patients in the desire for amount and type of information and level of involvement in the decision-making process.

Adult↗
PubMed2002

Health outcomes and medicaid costs for frail older individuals: a case study of a MCO versus fee-for-service care.

Older individuals receiving both Medicare and Medicaid benefits are known to have a disproportionate burden of illness and high medical care costs. Elder Health, Inc., a private, for-profit managed care organization operating in Maryland under capitation rates from both Medicare and Medicaid, has tailored a medical practice to these individuals, with the stated objective of providing integrated care. This study compared 200 Elder Health patients with a closely matched group of dually eligible older individuals receiving care in fee-for-service practices. There was a baseline in-home structured interview with the patient, followed 1 year later with a telephone interview. Other data sources were Medicaid claims data and Elder Health's utilization records. The outcomes of interest were the patients' health and functional status, their satisfaction with care, rates of use of medical services, and costs to Medicaid. Elder Health patients had similar general health status, better functional status, and greater satisfaction with access to care but less satisfaction with information giving than the fee-for-service group. They received more primary care and preventive services and had less than half the number of hospital days. Costs to Medicaid were nearly identical. Institutional and community-based long-term care costs were not included in the analysis.As pressures mount for the Health Care Financing Administration to expand its prepaid contracts with private health plans and the need for integrated programs increase, quantitative assessment of innovative delivery models such as Elder Health, Inc. will be essential to ensure that patients' and the publics' interests are well served.

Aged↗