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At least 505 records · Page 28Linked to original sources
PubMed2005

Results of a multi-level therapeutic approach for Alzheimer's disease subjects in the "real world" (CRONOS project): a 36-week follow-up study.

BACKGROUND AND AIMS: Recently, the Italian Ministry of Health started a national project (CRONOS project), aiming at assessing how a multi-level therapeutic approach--including 2-year free-of-charge treatment with cholinesterase inhibitors (ChE-I), pharmacologic and non-pharmacologic management of behavioral disorders, periodic multi-dimensional assessment, and informal caregivers' counseling-performs in subjects with mild-to-moderate Alzheimer's disease (AD). Five hundred and three Alzheimer Evaluation Units (AEUs) were instituted for this purpose all over Italy. In this paper we present the results of this approach in a large population of AD subjects followed for 36 weeks by 14 AEUs in Eastern Lombardy, Italy. METHODS: The project lasted for two years (September 2000-September 2002). Subjects eligible for the CRONOS project had a diagnosis of probable AD, a Mini Mental State Examination (MMSE) score at baseline ranging from 10 to 26, and onset of cognitive disorders between 40 and 90 years of age. Periodic clinical and multi-dimensional assessments, including MMSE, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were made at 12 and 36 weeks; ChE-I doses, psychotropic and antidepressant drugs were also re-assessed at all clinical examinations. Caregivers were instructed about dementia and drug-related problems. RESULTS: Of the 808 subjects who completed the 36-week follow-up, 441 were naïves (i.e., never previously treated with ChE-I drugs) and 367 non-naïves. At 12 weeks, both naïves (mean variation from baseline = 0.8 points) and non-naïves (mean variation from baseline = 0.5 points) improved their MMSE scores, while at 36 weeks only naïves improved (mean variation from baseline = 0.1) and non-naïves decreased (mean variation from baseline = -1.2). The IADL and ADL scores progressively and mildly declined from baseline to the 36th week (ADL, mean variation from baseline = -0.5 for naïves, -0.3 for non-naïves; IADL = -0.7 for naïves, mean variation from baseline = -0.4). However, when the MMSE, ADL and IADL variations were controlled for age, sex and education, no significant time effect was found (MMSE, Wilks' lambda p = 0.34; ADL, Wilks' lambda p = 0.25; IADL, Wilks' lambda p = 0.3, respectively). These patterns were apparently unrelated to ChE-I doses. Neuroleptic use doubled in naïves and antidepressants increased in both groups. CONCLUSIONS: This multi-level therapeutic approach seems to slow down progression in cognitive and functional performance, in both naïve and non-naïve subjects. The possibility of recurrent examinations by specialized physicians, accurate, lose management of psychotropic drugs, and informal counseling to caregivers probably aid in achieving such results in a "real world" population of AD elderly subjects living at home. Future studies are needed to assess whether a multi-level therapeutic approach including higher ChE-I dose may perform better in these subjects.

Activities of Daily Living↗
PubMed2005

Perspectives on human genetic variation from the HapMap Project.

The completion of the International HapMap Project marks the start of a new phase in human genetics. The aim of the project was to provide a resource that facilitates the design of efficient genome-wide association studies, through characterising patterns of genetic variation and linkage disequilibrium in a sample of 270 individuals across four geographical populations. In total, over one million SNPs have been typed across these genomes, providing an unprecedented view of human genetic diversity. In this review we focus on what the HapMap Project has taught us about the structure of human genetic variation and the fundamental molecular and evolutionary processes that shape it.

Alleles↗
PubMed1998

Unexpected death during a brain scintigraphy.

Brain scintigraphy was performed for differential diagnosis of suspected subdural hemorrhage in a 79-year-old woman. Planar pertechnetate (99mTcO4-) brain scan with AP, PA, lateral and vertex projections was planned. The procedure was started with AP-projection, continuing with lateral projections. After these images the patient was determined dead and the planned scannings were aborted. There was a clear difference in the intracranial uptake (choroid plexuses) in the lateral views as well as in the uptake in the venous sinuses. The findings in the AP view were normal and no signs of subdural hemorrhage were observed. The patient died during a routine nuclear medicine procedure, and cessation of intracranial circulation was observable on 99mTcO4- scans; the lack of uptake in cerebral sinuses confirmed the lack of intracerebral flow. In this rare case, brain death could be timed accurately using a static nuclear medicine procedure. Autopsy confirmed sudden brain circulatory disorders and general arteriosclerosis.

Aged↗
PubMed2001

Projecting severe sequelae of injection-related hepatitis C virus epidemic in the UK. Part 2: Preliminary UK estimates of prevalent injection-related hepatitis C carriers, and derivation of progression rates to liver cirrhosis by gender and age at hepatitis C virus infection.

BACKGROUND: In Part 2, we illustrate how available data can be used to obtain preliminary estimates for Scotland of prevalent injection-related hepatitis C carriers and of maternally hepatitis C virus (HCV)-infected infants. Novel approaches to reducing uncertainty about the number of Scotland's HCV infected children of injector parents are discussed in brief. Three approaches, one direct and two indirect, to estimating the number of current and ever-injectors are presented for England and Wales. METHODS: Diagnosed HCV infections in injectors and HCV test uptake by current injectors are combined with survey estimates for the ratio of ever-injectors to current injectors to estimate prevalent injection-related hepatitis C carriers. Household surveys give direct but potentially biased estimates of the number of current and ever-injectors. Indirect estimates make use of hepatitis C diagnoses in injectors, HCV prevalence and test-uptake by injectors, or exploit international comparisons. We comment on key reporting problems that inhibit synthesis of HCV progression studies; and suggest how to derive preliminary gender-and-age specific progression rates to liver cirrhosis for use in projections. RESULTS: Preliminary estimates for Scotland of prevalent injection-related hepatitis C carriers are: central estimate 39,000, inner uncertainty 16,000-59,000; of maternally hepatitis C virus (HCV)-infected infants central estimate 260, uncertainty 110-1100; and for England and Wales estimates of the number of prevalent ever-injectors are central estimate 360,000, uncertainty 240,000-835,000. Both hepatitis C prevalence in injectors and estimated numbers of current injectors are similar in Australia, and England and Wales (but not so for Scotland), Australian work on projections of severe HCV sequelae from hepatitis C infections may therefore be a suitable starting point for projections for England and Wales. Australia anticipates a doubling in the number of persons living with hepatitis C cirrhosis from 8500 in 1997 to over 17,000 in 2010. DISCUSSION: Australian projections of severe HCV sequelae used progression rates that, for simplicity, were independent of gender and of age at HCV infection. Faster HCV progression for males, and their higher injector prevalence, means that the impact of HCV infection on, for example, liver cancer may be evident to a greater extent and earlier in males.

Adolescent↗
PubMed2003

Is proteomics heading in the wrong direction?

Proteomics is now considered to be one of the most important 'post-genome' approaches to help us understand gene function. In fact, several genomics companies have launched large-scale proteomics projects, and have started to annotate the entire human proteome. The 'holistic view' painted by a human proteome project is seductive, but is it realistic?

Animals↗
PubMedDate not supplied

Parasite genome projects and the Trypanosoma cruzi genome initiative.

Since the start of the human genome project, a great number of genome projects on other "model" organism have been initiated, some of them already completed. Several initiatives have also been started on parasite genomes, mainly through support from WHO/TDR, involving North-South and South-South collaborations, and great hopes are vested in that these initiatives will lead to new tools for disease control and prevention, as well as to the establishment of genomic research technology in developing countries. The Trypanosoma cruzi genome project, using the clone CL-Brener as starting point, has made considerable progress through the concerted action of more than 20 laboratories, most of them in the South. A brief overview of the current state of the project is given.

Animals↗
PubMedDate not supplied

Sentinel lymph node identification in breast cancer: feasibility study.

The aim of the study was to evaluate in our institute the technique of sentinel node (SN) identification and biopsy in the surgical treatment of early breast cancer. Between June 1998 and November 1999 54 patients (age range, 31-75 years) where studied. Inclusion criteria were age less than 75 years, indication for conservative surgery, absence of palpable axillary nodes, Karnofksy index >70. Lymphoscintigraphy was performed 16-18 hours prior to surgery, following injection of 0.1-0.2 mL of 99mTc-Nanocoll: the administered activity was 3-4 MBq in group A (44 pts) and 7-8 MBq in group B (10 pts). The colloids were administered by transdermal supralesional injection in 49 patients with palpable nodules and by intraparenchymal ultrasound-guided injection in five patients with non-palpable nodules. Planar projections were performed starting from the 5th until the 80th min (or 180th in the event of late migration). In 10 patients further projections were acquired 14-18 h following tracer administration. All nodes identified by gamma probe (MR 100 Pol.Hi.Tech) were histologically evaluated by immunohistochemistry and standard histology. Scintigraphic visualization of the SN was obtained in 49 patients: in 38 of these patients there was only one SN while in 11 patients there were two or three SNs. The delayed scan made in 10 patients did not show any further nodes. In all patients given US-guided perilesional injections migration was late (after at least 60 min). Our study confirms the validity of the scintigraphic procedure, its safety for patients and health care workers, and the feasibility of interdisciplinary collaboration.

Adult↗
PubMed2006

SPIRE: the SPIDER reconstruction engine.

SPIRE is a Python program written to modernize the user interaction with SPIDER, the image processing system for electron microscopical reconstruction projects. SPIRE provides a graphical user interface (GUI) to SPIDER for executing batch files of SPIDER commands. It also lets users quickly view the status of a project by showing the last batch files that were run, as well as the data files that were generated. SPIRE handles the flexibility of the SPIDER programming environment through configuration files: XML-tagged documents that describe the batch files, directory trees, and presentation of the GUI for a given type of reconstruction project. It also provides the capability to connect to a laboratory database, for downloading parameters required by batch files at the start of a project, and uploading reconstruction results at the end of a project.

Computational Biology↗
PubMed1973

Routine operation of an Elliott 903 computer in a clinical chemistry laboratory.

Experience gained in the last four years concerning the capabilities and limitations of an 8K Elliott 903 (18-bit word) computer with magnetic tape backing store in the routine operation of a clinical chemistry laboratory is described. Designed as a total system, routine operation has latterly had to be confined to data acquisition and process control functions, due primarily to limitations imposed by the choice of hardware early in the project. In this final report of a partially successful experiment the opportunity is taken to review mistakes made, especially at the start of the project, to warn potential computer users of pitfalls to be avoided.

Chemistry, Clinical↗
PubMed2003

A case study of domestic defluoridation of ground water in Jaipur, India.

This study was undertaken to assess the success of the intervention programmes of Centre for Community Economics and Developmental Consultants Society (CECOEDECON) initiated in the rural areas of Jaipur district of Rajasthan, India. The programme focussed on capacity building among villagers to create awareness about fluorosis and used Nalgonda technique for removal of excess florides from ground water in selected areas. The data and information were collected from respondents in six village related to aworeness and incidence of fluorosis, awareness regarding the CECOEDECON project and the use and effectiveness of domestic defluoridation technology. Analysis of collected data revealed that level of awareness was highest (68%) among the respondents of Barkheda and Yarlipura villages where the project was withdrawn in 1998. It was observed that the level of awareness decreased over time and it was found lowest in the villages where project was withdrawn in 1996. About 87% of the respondents reported that most of the women are members of the Mahila Mandal started under CECOEDECON project. Some of the respondents (38%) mentioned that they were experiencing problems after the withdrawal of project teams. Thus, it is evident that follow up programmes play an important role in sustenance of the use of defluoridation techniques in villages along with the infrastructure to take care of minor repairs and supply of chemicals.

Adult↗
PubMed2000

Science in practice: can health care reform projects in central and eastern Europe be evaluated systematically?

Since the beginning of the 1990s, health care reform projects have taken place in many of the former Communist countries, but these projects are rarely evaluated systematically. Evaluation, however, is an important tool for increasing their rationality and continuity. The aim of this paper is to identify the difficulties in the efforts towards systematic evaluation and draw lessons for the future. For this aim, the requirements for a more rigorous, controlled evaluation are compared with our experiences of evaluating a health care reform project in the Slovak republic. From this comparison a number of discrepancies arise: it was difficult to set clear and realistic goals at the start of the project; the outcomes of the project could not always be measured, nor could 'the process' always be distinguished from the outcomes. Systematic evaluation was further hampered by an insufficient degree of structuration of the project, in advance and during the implementation, and by the absence of a tradition and infrastructure for data collection. On the basis of the experiences and relevant literature, recommendations for future evaluations are formulated. The main lesson is that, given the context, often it will not be possible to use an ambitious evaluation design, and concessions need to be made. At the same time, continuous efforts towards more systematic evaluation procedures should be made, but it is wise and more sustainable to do this in an incremental way.

Costs and Cost Analysis↗
PubMed1999

The sustainability of telemedicine projects.

Although there are instances where the provision of health care is successfully driven by the profit motive, in most countries it is considered a public service. The provision of telemedicine services assuredly meets an important social need to extend health care to remote and rural areas in developing countries. While there are potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. Telemedicine undoubtedly yields cost savings in certain circumstances, but few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. With their low expenditures per person, developing countries face a daunting challenge in making such public services sustainable. Pilot projects should be a first step in demonstrating the cost-effectiveness and benefits of telemedicine, but such projects should also be sustainable. Sponsors of such pilot projects must have a clear plan from the start about how the project can continue after the sponsorship comes to an end. This paper examines ways in which telemedicine services can be made sustainable.

Capital Financing↗
PubMed1993

Starting a hospital-based home health agency: Part II--Key success factors.

In Part II of a three-part series, the financial, technological and legislative issues of a hospital-based home health-agency are discussed. Beginning a home healthcare service requires intensive research to answer key environmental and operational questions--need, competition, financial projections, initial start-up costs and the impact of delayed depreciation. Assessments involving technology, staffing, legislative and regulatory issues can help project service volume, productivity and cost-control.

Cost Control↗
PubMed1991

[Computer as replacement for the current medical record? Introduction of a pilot project of the St. Gallen ophthalmology clinic].

Computerized data processing is more and more used in hospitals and medical offices. There are no doubts about the usefulness of a computer for administrative tasks. At our Dept. of Ophthalmology we started a pilot project to enter the medical records into the computer. The pros and cons of such an information system are discussed. Entering medical records into the computer did not prove to be definite advantage for the physician.

Computer Systems↗