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PubMed1985

Post-polio sequelae and the psychology of second disability.

Thousands of persons who had poliomyelitis are reporting new physical symptoms that are eroding physical abilities, regained only after strenuous and lengthy rehabilitation, that were thought to have been permanently restored. These symptoms are causing persons to feel they are becoming disabled for a second time by the same disease. These new symptoms are psychologically traumatic also because they are unexpected, their cause is unknown and there is a lack of knowledge and understanding concerning them within the medical community. Society's negative and pejorative attitude toward the disabled is discussed to explain the psychological trauma associated with any first or second disability. Psychological processes that promote acceptance of disability are outlined with special emphasis on the post-polio experience. Post-polio support groups are described as one means to obtain the resources necessary to surmount the physical and psychological difficulties associated with post-polio sequelae.

Adaptation, Psychological↗

PubMed1978

Preventing unplanned pregnancies.

A two-year study was undertaken in 1975--1976 to plan, implement and evaluate innovatory family planning educational and service delivery pilot projects, among those at-risk in Sydney. The study was done in three stages, described in the three parts of this paper. Part 1 describes the process of analyzing the major factors and outcomes in unplanned pregnancy and determining some characteristics of women experiencing unplanned pregnancies, from abortion and adoption records. The characteristics analyzed are: are, marital status, occupation, socio-economic status, and ethnic group. Part II describes the process of determing acceptable communication channels and services they would use. Twenty-five women were interviewed in each of eight at-risk categories. Recommendations are made about suitable educational methods, and family planning services. Part 3 describes the implementation and evaluation of pilot projects. Four major projects are described: (i) in a two lower socio-economic housing area(s), (ii) among Greek men, (iii) among South Americans, and (iv) in two factories. Recommendations are made about future educational programmes and services.

Adolescent↗

PubMedDate not supplied

Implementing a research governance framework for clinical and public health research.

Research conduct in Australia and worldwide is mostly unaudited. The purpose of good research governance is to ensure integrity in research through accountability, transparency and responsibility. Institutional responsibility for research governance has been adopted by Monash University's Department of Epidemiology and Preventive Medicine, providing clear lines of accountability for researchers as well as support and guidance. A research audit tool has been developed, identifying areas where practice could be improved especially among less experienced researchers; the most common adverse findings concerned research protocols and procedure manuals. The need for participant confidentiality, privacy and data security was found to be understood, and adhered to widely by all researchers. An evaluation of the effect of audit on researchers found that the process was well accepted.

Australia↗

PubMed1987

Financial analysis in the health administration curriculum: a survey of ACEHSA programs.

Among the continuing curriculum issues in health administration programs is the appropriate amount of financial analysis. This field covers economics and financial management, with both subjects being given importance in the ACEHSA accreditation guidelines. This paper reports on a national survey of health administration programs intending to discover the importance placed on the study of economics and financial management. A second survey gathered information from alumni and preceptors of a specific ACEHSA program (the University of Massachusetts at Amherst) on their perception of the appropriate curriculum content for financial analysis. The most important conclusion of this study is the discovery that the long-accepted schism between school of public health and school of management programs does not exist. There are far more similarities than differences, at least in terms of financial management and economics. Financial analysis is a broad area and at present a great amount of diversity among programs is acceptable. The accreditation process may require narrower standards for this important content area.

Curriculum↗

PubMedDate not supplied

How to be viewed as a sage in your elder years.

Journal Writing, meditation, and telling our stories by reviewing our lives and harvesting the wisdom we've gained are productive activities for the present. The practice of journal writing is an integral part of accepting the aging process and making the elder years enjoyable and fulfilling. Meditation provides a way to center yourself and is particularly helpful during stressful times. It increases your chances of not worrying and improves your ability to concentrate. Another task of successful age-ing that is fueled by journal writing and meditation is life review and passing on your knowledge to others. These disciplines are explored as tools for inner growth and instruction is provided to help get you started.

Aged↗

PubMed1997

B-cell lymphomagenesis and human autoimmune models.

The concept that B-cell lymphomagenesis represents a multistep process is widely accepted. Pathogenetic events should be better defined both in early and late stages of lymphoproliferation. In the past few years, novel study approaches have been focused on understanding the mechanisms of lymphomagenesis. In particular, immune stimulation by infectious agents or autoantigens, T-cell help, altered immunocompetence, and local cytokine networks seem to be crucial in favouring B-cell expansions. In turn, actively proliferating B cells are at higher risk of undergoing genetic alterations that make the clone capable of fully autonomous growth, i.e., fully neoplastic. Peculiar human autoimmune diseases predisposing to B-cell lymphoma represent relevant models to characterize and dissect the temporal sequence of the different lyphomagenetic events. The present review, particularly, focuses on Sjoegren's syndrome, and on recent findings regarding the putative role of hepatitis C virus in B-cell lymphoproliferation. The biologic and clinical implications may be of major relevance for other B-cell disorders characterized by higher prevalence and morbidity.

Journal Article↗

PubMed1999

IFN-gamma exposes a cryptic cytotoxic T lymphocyte epitope in HIV-1 reverse transcriptase.

The proteasome, an essential component of the ATP-dependent proteolytic pathway in eukaryotic cells, is responsible for the degradation of most cellular proteins and is believed to be the main source of MHC class I-restricted antigenic peptides for presentation to CTL. Inhibition of the proteasome by lactacystin or various peptide aldehydes can result in defective Ag presentation, and the pivotal role of the proteasome in Ag processing has become generally accepted. However, recent reports have challenged this observation. Here we examine the processing requirements of two HLA A*0201-restricted epitopes from HIV-1 reverse transcriptase and find that they are produced by different degradation pathways. Presentation of the C-terminal ILKEPVHGV epitope is impaired in ME275 melanoma cells by treatment with lactacystin, and is independent of expression of the IFN-gamma-inducible proteasome beta subunits LMP2 and LMP7. In contrast, both lactacystin treatment and expression of LMP7 induce the presentation of the N-terminal VIYQYMDDL epitope. Consistent with these observations we show that up-regulation of LMP7 by IFN-gamma enhances presentation of the VIYQYMDDL epitope. Hence interplay between constitutive and IFN-gamma-inducible beta-subunits of the proteasome can qualitatively influence Ag presentation. These observations may have relevance to the patterns of immunodominance during the natural course of viral infection.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2000

[Viral safety: European and French directives].

The viral safety of IVIg is defined by transposition of European Directives. Directive 89/381/CEE defines plasma-derived medicinal products (pd-MP) which should be registred through a Marketing Authorization (75/318/CEE) and requires specific criteria for donation acceptability and fractionation processing. Recommendations and Notes for Guidance are prepared by the "Biotechnology Working Party" (BWP), Committee for Proprietary Medicinal Products (CPMP) ad hoc group. "Note for Guidance on Virus Validation Studies: CPMP/BWP/268/95" defines, for conventional viruses, the validation study as regards viral elimination /inactivation steps (relevant virus, scale reduction system and statistical interpretation of the results). "Note for Guidance on 'blood products'- CPMP/BWP/269/95" defines the key issues of viral safety: starting material, viral elimination /inactivation steps within the fractionation processing and in process controls. Pd-MP used as excipients are also covered. BWP/CPMP recommends that exclusion criteria only be considered for sporadic, familial or iatrogenic Creutzfeldt-Jakob disease (CJD), while withdrawal should be undertaken, according to the precaution principle, when a donor is suffering from nv-CJD (February 1998). Also, screening tests currently under development for transmissible spongiform encephalopathies are encouraged to be introduced for fractionation products (January 1999). Some donor exclusion criteria for conventional viruses and prions are specific to France. In conclusion, measures taken to ensure pd-MP viral safety are constantly changing. Its evaluation can only be done when considering numerous parameters within a global context.

Biotechnology↗

PubMed1975

The non-contact ("air puff") tonometer: variability and corneal staining.

We investigated the possibility of significant corneal trauma (as revealed by slit lamp observation of the fluorescein instilled eye), and massage effects following determination of intraocular pressure with the A. O. Non-Contact tonometer (NCT). Fifteen different, normal human eyes were each applanated 150 successive times with the NCT; leading to the conclusion that only minor, superficial corneal epithelial defects sometimes resulted and that, in line with other studies, the initially higher readings (about 1 mm), obtained with the NCT, were most likely due to patient apprehension, while the subsequently lower readings represented patient acceptance of the process and were not a result of true aqueous massage. As in an earlier study, we found the instrument's variability to be about plus and minus 1 or plus and minus 2 mm and probably due to the subject's own cardiac cycle.

Adolescent↗

PubMedDate not supplied

[Nephrogenic adenoma of the urinary bladder. A lesion that can be confused with carcinoma. Report of 4 cases].

Nephrogenic Adenoma (NA) was first illustrated in 1949 by Davis, who described a case he interpreted as a "hamartoma". One year later Friedman and Kuhlenbeck described eight further examples in detail and named this lesion nephrogenic adenoma. This process is generally accepted to be metaplastic. At cystoscopy and on microscopic examination nephrogenic adenoma may simulate a neoplasm. The clinical and pathologic findings in four patients are described. The patients were two women and two men 20-60 years of age. All of them had a history of some inciting injury (infection/calculus). The four cases were initially misdiagnosed as a carcinoma. Several features of NA may cause particular diagnostic difficulty. Tiny tubules may simulate signet ring cells, the haphazard distribution of the tubules or single cell growth may also simulate the appearance of an invasive adenocarcinoma. A variety of clinical and pathologic differences should enable the distinction of these lesions. Although this is occasionally difficult. An emphasis here is placed on the diagnostic problems that they may pose for the surgical pathologist. Clinicians and pathologists should be aware about this type of lesions in order to avoid pitfalls in the diagnosis and treatment of them.

Adenocarcinoma↗

PubMed2001

[Depression in the elderly. Principles of treatment].

DRUG THERAPY: Drug therapy must be reassessed regularly to avoid overdosing or poor observance. Use of multiple drugs must be carefully monitored. PSYCHOTHERAPY: Listening to the patient and establishing an understanding friendly relationship are essential to successful psychotherapy in the depressed elderly. SUPPORT: Repulsion is common because old age evokes death. The reactions of family and friends may take on many forms, sometimes leading to counter-transfer. EIGHT SIMPLE RULES FOR PRESCRIPTION: Ask key questions. Treat what is essential. Prescribe few drugs starting at low dose. Check observance. Favor good diet and hygiene. Help the patient accept the aging process. Avoid pseudo placebos. Use appropriate dose timing.

Aged↗

PubMedDate not supplied

The compliance and science of Blend Uniformity Analysis.

According to 21CFR section 211.110(a) pharmaceutical manufacturers are legally required to demonstrate the adequacy of their mixing operations. The CFR, however, is intentionally silent on how this should be accomplished. The situation changed dramatically in 1993 as a consequence of The US vs. Barr Laboratories when Judge Alfred Wolin ruled for the government that the appropriate sample size for Blend Uniformity Analysis (BUA) is, at most, three times the weight of the final dosage unit. This ruling defined the Current Good Manufacturing Practices (cGMPs) for BUA in greater detail than is specified in 21CFR section 211.110(a). It also established a precedent that has been the focus of an almost decade long controversy between pharmaceutical manufacturers and the FDA. At the heart of the matter is the inability of current sampling technology to consistently and reliably provide small representative samples from significantly larger static powder blends. The sample thief is the state-of-the-art powder sampling technology used by the pharmaceutical industry today for purposes of BUA. Unfortunately, sample thieves are intrusive devices that are prone to sampling error. Sampling error can lead to powder samples that are not representative of the bulk blend from which they were collected. In general, sampling error increases as the concentration of the drug substance and the size of the sample decrease. Since Judge Wolin's ruling, sampling error has made it difficult, if not impossible, to validate the manufacturing processes for some acceptably uniform pharmaceutical products. This article reviews the compliance history of BUA as well as the associated scientific literature.

Chemistry, Pharmaceutical↗

PubMed1976

Admission procedures: A survey of current methodology.

A survey was conducted by the Department of Medical Technology at Wayne State University to determine current admission procedures for student selection. With more applicants applying for clinical education than can be accepted, the selection process becomes critical. Questionnaires were sent to institutions throughout the United States with accredited programs in medical technology. Among the findings, trends indicate the use of grade point average, separate evaluation of science grades, use of an admissions committee, and a dependence on references and transcripts in selecting students. In addition, the study shows that in all the accredited programs surveyed, including universities, hospitals, Veterans Administration hospitals, and others, an average of 82 students apply each year for the 15 available positions, a ratio of 5.5:1.

Educational Measurement↗

PubMedDate not supplied

[Ethical problems in dialysis in elderly patients].

The incidence and prevalence of elderly patients are progressively increasing in most dialysis facilities with consequent medical assistance difficulties and the need to find a suitable care unit. Particularly in this age group, the clinical assessment is often difficult and the selection criteria vary widely, not only from country to country, but also from one dialysis unit to another unit in the same area. The authors discuss some of the more complex arguments for and against dialysis in elderly patients. For some of the more difficult cases, Kantian deontology and its three ethical principles of beneficence, non-maleficence and autonomy can facilitate the decision-making process regarding the acceptance or refusal of the therapy. The central role of the patients themselves, the involvement of the family, the discussion of the individual case within the dialysis team, and the good performance of the pre-dialysis program are particularly important. In certain cases it is possible to actually discontinue the treatment, or not initiate it, by using different arguments in competent or incompetent patients. In conclusion, the difficult choice of whether to treat or turn down an elderly patient must depend exclusively on the medical clinical assessment of each case, whereas economical considerations can incorrectly influence that choice.

Age Factors↗

PubMedDate not supplied

Rehabilitation of insensitive hands.

This article highlights the physical, social and emotional problems faced by persons with insensitive hands and problems of disuse, misuse and overuse. Evaluation of sensation and residual functional capabilities is the first step in planning the process of rehabilitation. Acceptance of disability by the patients and their attitude are important for successful rehabilitation. Possible solutions are suggested.

Disability Evaluation↗

PubMed1992

[Is regression of atherosclerosis possible?].

Experimental studies have shown the regression of atherosclerosis in animals given a cholesterol-rich diet and then given a normal diet or hypolipidemic therapy. Despite favourable results of clinical trials of primary prevention modifying the lipid profile, the concept of atherosclerosis regression in man remains very controversial. The methodological approach is difficult: this is based on angiographic data and requires strict standardisation of angiographic views and reliable quantitative techniques of analysis which are available with image processing. Several methodologically acceptable clinical coronary studies have shown not only stabilisation but also regression of atherosclerotic lesions with reductions of about 25% in total cholesterol levels and of about 40% in LDL cholesterol levels. These reductions were obtained either by drugs as in CLAS (Cholesterol Lowering Atherosclerosis Study), FATS (Familial Atherosclerosis Treatment Study) and SCOR (Specialized Center of Research Intervention Trial), by profound modifications in dietary habits as in the Lifestyle Heart Trial, or by surgery (ileo-caecal bypass) as in POSCH (Program On the Surgical Control of the Hyperlipidemias). On the other hand, trials with non-lipid lowering drugs such as the calcium antagonists (INTACT, MHIS) have not shown significant regression of existing atherosclerotic lesions but only a decrease on the number of new lesions. The clinical benefits of these regression studies are difficult to demonstrate given the limited period of observation, relatively small population numbers and the fact that in some cases the subjects were asymptomatic. The decrease in the number of cardiovascular events therefore seems relatively modest and concerns essentially subjects who were symptomatic initially. The clinical repercussion of studies of prevention involving a single lipid factor is probably partially due to the reduction in progression and anatomical regression of the atherosclerotic plaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

Aqueous ozone decomposition onto a Co2O3-alumina supported catalyst.

The aqueous ozone decomposition in the presence of a Co2O3-Alumina catalyst was investigated. Activity and estability assays were conducted by reusing the same catalyst in consecutive runs. The catalyst was shown to significantly increase the ozone abatement rate without loss in activity after five consecutive experiments. The process can be acceptably simulated by a double homogeneous-heterogeneous decomposition mechanism. An increase in the working temperature resulted in an opposite effect by increasing the extension of the homogeneous decomposition and lowering the extension of the heterogeneous decomposition. Similarly, different trends were observed by adding two distinct free radical scavengers (terc-butyl alcohol and carbonates).

Aluminum Oxide↗

PubMed2005

Five steps to electronic health record success.

There's no denying that the electronic health record is on its way. By taking the following five well-planned steps, healthcare CFOs and CIOs can help make electronic record implementation in their hospitals as smooth as possible: Define "electronic health record" across the entire organization, Set appropriate expectations, Choose the technology carefully, Accept and promote process changes, Carefully plan the transition from paper-based to electronic records.

Guidelines as Topic↗