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PubMed2006

Using structured debate to teach a controversial topic: mammography for women in their 40s.

BACKGROUND: Screening mammography for women in their 40s is controversial, and counseling patients about it can be challenging. Debate is an educational tool that lends itself to teaching about controversial topics and improving communication skills but is underused in medical education. PURPOSE: The purpose of this intervention was to improve residents' willingness to discuss mammography with patients. METHODS: Second-year internal medicine residents participated in a 3-hr structured debate on screening mammography for women in their 40s. The intervention's effect was measured using pretest and posttest questionnaires. RESULTS: A total of 33 residents participated in 6 debates between January and June of 2003. Comparison of pretest and posttest questionnaires showed that participants became more comfortable discussing mammography screening and were more likely to discuss it with their patients after the debate. CONCLUSIONS: A structured debate resulted in residents reporting increased comfort level and willingness to discuss mammography with women in their 40s.

Adult↗
PubMed2004

[The dependence medical index (DMI): validation and comparison with the activity daily living and the instrumental activity daily living].

AIM: The aim of this study was the validation of the dependence medical index (DMI), a disability medical assessment tool in the elderly. METHODS: Study sample included 1054 subjects aged 65 and over, consecutively admitted to the University Department of Geriatric Medicine of Turin, Italy. A total of 356 of these subjects was classified as dependent to activity of daily living (ADL) and instrumental activity of daily living (IADL) scales. Some conditions causing medical dependence were detected, such as strength and/or motility impairment, incontinence, pressure sores, disturbances in speech and communication, decline in sight and/or hearing, terminal illness (death expected within 6 months), need for multiple and complex therapies, episodic disorientation, dizziness with tendency to fall, use of the wheel-chair. The relationship between dependence and the DMI was studied by discriminant analysis. A scale was created using the discriminant scores of each 15 medical indications for disability. RESULTS: The discriminant model of DMI was validated by cross-validation statistical method: its application permitted to classify correctly 73.1% of the sample. The DMI permitted to classify the dependent subjects in variable percentages: from 67% (DMI score > or =1) to 90% (DMI score > or =7). The best ratio between specificity and sensibility was for score 4 to DMI. CONCLUSION: The conclusion is drawn that DMI can be used to detect and evaluate the disability for medical reasons in elderly people.

Activities of Daily Living↗
PubMed2004

Ultrasound assessment of venous blood flow before and after laser therapy: approach to understanding the pathophysiology of twin-twin transfusion syndrome.

OBJECTIVE: To estimate direction and volume of blood exchange between the donor twin and recipient twin by ultrasound assessment of blood flow in the umbilical vein before and after selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS). METHODS: Forty-one TTTS patients underwent Doppler examination of the umbilical vein before and 24 h after SLPCV. The diameter and mean time-averaged velocity of the umbilical vein were estimated. Total umbilical venous flow (TUVF) was calculated as follows: TUVF (mL/min) = mean time-averaged velocity (cm/s) x mean cross-sectional area (cm2) x 60 (s). RESULTS: TUVF was significantly higher in the recipient (111.2 mL/min) than in the donor twin (44.8 mL/min) before SLPCV (P < 0.0001). However, TUVF was no different between the recipient and the donor twin after SLPCV (93.1 vs. 70.7 mL/min, recipient and donor twin, respectively, P = 0.11). The donor twin's TUVF increased after surgery (P < 0.0001), while the recipient twin's TUVF decreased (P = 0.041). The median postoperative increase in the donor twin's TUVF of 25.9 mL/min had a corresponding decrease of TUVF in the recipient twin of 18.1 mL/min (P = 0.27). CONCLUSIONS: Our data suggest that untreated TTTS is characterized by excessive umbilical venous blood flow in the recipient twin relative to the donor twin. Laser surgery results in concordant changes in umbilical venous flow in opposite directions between the donor and recipient twins, eliminating the initial imbalance. Our results lend support to the fundamental hypothesis of unbalanced blood flow exchange (net flow from donor to recipient) between monochorionic twins as the cause for TTTS and that laser surgery eliminates the pathophysiological cause.

Blood Flow Velocity↗
PubMed1981

Significance of intra- and extrahepatic portasystemic shunting in survival of cirrhotic patients.

Survival and incidence of hemorrhage and encephalopathy were studied in 121 medically managed cirrhotic patients according to the type of naturally occurring portasystemic shunting. Three types of shunting were distinguishable using scintillation splenoportography, a method whereby morphological and hemodynamic data on portal and hepatic circulation were obtained by external detection. The three patterns were: (1) extrahepatic shunting with partial splenic blood flow diversion, (2) spontaneous total splenic blood flow diversion, and (3) intrahepatic shunting corresponding to portohepatic communications with a diameter larger than 10 mum. The probability of 4-year survival was much lower in case of portasystemic shunting (18%) than in its absence (73%, P less than 0.01). Patients with intrahepatic shunting had a survival rate not significantly different from that of patients with extrahepatic shunting. However, they had the highest incidence of hemorrhage (71%), and hemorrhage was not due to rupture of esophageal varices. The highest incidence of encephalopathy was seen in patients with total splenic blood diversion (40%), but it was not significantly different from that of other cirrhotic patients. No group of patients can be significantly identified as a high-risk group.

Humans↗
PubMed1998

Pressure measurement evaluation and accuracy validation: the Gabarith test.

OBJECTIVE: The dynamic distortion introduced by manometric systems has been known for many years, with several methods developed to describe and quantify the degree of distortion. We developed the Gabarith as a technique to describe more accurately, and yet more simply, the dynamic accuracy of the chain of monitoring. SETTING: A pressure monitoring system transforms some input signal, i.e. the actual pressure waveform present in the artery, into some other shape of waveform, i.e. the waveform displayed on the patient monitor. This transformation is characterized by the transfer function of the total system. A complete technique to define the transfer function is to measure the response directly at many different frequencies and combine them to produce the dynamic response plot. METHOD: We described the dynamic response of a monitoring chain and we simplified the communication of this dynamic response to users by developing the Gabarith, as a tolerance envelope based on the frequency content of typical pressure waveforms. If a given monitoring chain's dynamic response (including a catheter, a pressure kit and a monitor) can be shown to fall within that tolerance envelope, the chain will provide adequate dynamic accuracy. CONCLUSION: "Gabarith tested" means that a pressure kit, in combination with a catheter and a monitor, has had its frequency response function measured and that the function falls within a tolerance band for dynamic accuracy. Passing a Gabarith means that a given level of accuracy will be reached when using the sets which have passed the corresponding test.

Blood Pressure Determination↗
PubMedDate not supplied

Dissection autoradiography: a screening technique using storage phosphor autoradiography to detect the biodistribution of radiolabelled compounds.

INTRODUCTION: This study reports an alternative, rapid, whole body autoradiography technique which utilises storage-phosphor imaging technology. Conventionally, tissue or whole body sections have been used to examine the distribution of radiolabelled test compounds. However, the information acquired relates only to the sections examined, and the amount of radioactivity within the whole organ cannot be quantified. We have developed a rapid semi-quantitative technique that produces a concise visual representation of the distribution of the isotope throughout the entire animal: dissection autoradiography (DAR). METHODS: By dissecting a mouse which has been administered 14C-labelled methotrexate (MTX) and drying the tissues on a gel dryer, whole organs and aliquots of body fluids can be exposed to a phosphor imaging plate. The data obtained was analysed with the software associated with the phosphor imaging system and, by using 14C standards, the amount of 14C per total organ or tissue was quantified relative to other samples. Another widely used method to detect radiolabelled material in vivo is tissue solubilisation (TS) followed by liquid scintillation counting (LSC). This conventional method was compared with DAR. RESULTS: The new technique described in this communication was found to have a high level of reproducibility (R(2)= 88-95%). Whilst DAR was less sensitive than TS and LSC, trends over time in the biodistribution of 14C-MTX throughout most tissues were consistent between techniques. DISCUSSION: Whilst TS and LSC was a more sensitive technique, it was labour intensive and expensive in terms of consumables and time when compared with DAR. Dissection autoradiography has the potential to be used to screen quickly large numbers of samples in the biodistribution studies of various conjugates, isomers, derivatives or formulations of a parent compound, following a variety of routes of administration.

Animals↗
PubMed2003

Managing cancer side effects to improve quality of life: a cancer psychoeducation program.

This study aimed to develop and pilot test a community-based education program that addresses the prevention and management of the major side effects of cancer and its treatment according to a Patient Active Empowerment Model. This piloted program evaluated the health and quality of life outcomes for patients with cancer. The program was implemented through a half-day patient education conference. This conference included clinical information concerning disease and treatment-related side effects, an overview of treatment methods, information to help improve communication between the patient and healthcare team, education materials and experiences to empower patients and caregivers, and integration of specific mind-body techniques to strengthen key educational messages and reinforce the importance of side effect management. A total of 32 patients completed both the program and psychometric assessments on the day of the intervention and 30 days later. The participants were primarily white women with an average age of 57 years. Breast cancer was the most prevalent type of cancer experienced by the participants. The pilot results for this small sample showed that from baseline to follow-up evaluation, patients reported significant decreases in depressive symptoms and problems with work or other daily activities that resulted from emotional distress. Some improvements in health and well-being were greater for those who had not experienced fever or infection, those who had no children, and those who were working. Participants indicated that the program was useful in its ability to help them manage treatment side effects. Although the findings presented in this article are based only on a pilot program evaluation and a small sample, they do suggest that the program may be effective in educating patients about specific cancer side effects and empowering them to cope more effectively with their illness. Results showing that subgroups of individuals may have benefited more from the intervention provide important information about specific components of the program that may be particularly salient and potential changes that might be usefully implemented.

Adaptation, Psychological↗
PubMed2000

Communication between primary care physicians and radiation oncologists regarding patients with cancer treated with palliative radiotherapy.

PURPOSE: The purpose of this study was to assess the satisfaction and information needs of primary care physicians (PCPs) regarding communication with radiation oncologists (ROs), with respect to patients who receive palliative radiotherapy (RT). A selected objective was to evaluate the agreement between PCPs' expectations and the content of the RO letter sent after completion of RT. PCPs' knowledge of the role of palliative RT and their awareness of available patient support services were also determined. METHODS: The PCPs of patients discharged from the Cross Cancer Institute after receiving palliative RT were surveyed using a mail-out questionnaire. Questions regarding communication, RT knowledge, and awareness of support services were asked. The corresponding RO letter was reviewed. RESULTS: A total of 148 PCPs were identified and were mailed questionnaires, with 114 (77%) responding. Overall, 80% (87 of 109) of PCPs found the RO letter to be useful in patient management. However, there was poor (< 53%) agreement between PCPs' expectations and the actual content of the RO letter. Knowledge of the indications and effectiveness of palliative RT was limited, with PCPs obtaining a median score of 4 of a possible 8. Only 27% (31 of 114) of PCPs were aware of all five of the patient support services listed. CONCLUSION: Results show that although the majority of PCPs found the RO letter useful, they believed that the letter lacked important information while containing unnecessary details. Communication between PCPs and ROs needs improvement, especially considering that PCPs seem to have limited knowledge of palliative RT.

Adult↗
PubMed1997

Down-regulation of gap junctional intercellular communication between osteoblastic MC3T3-E1 cells by basic fibroblast growth factor and a phorbol ester (12-O-tetradecanoylphorbol-13-acetate).

To address the relation between osteoblast growth and cell-to-cell communication, we examined the effects of basic fibroblast growth factor (bFGF) and 12-O-tetradecanoylphorbol-13-acetate (TPA), both potent stimulators of osteoblastic proliferation, on gap junctional intercellular communication between osteoblastic MC3T3-E1 cells. The level of intercellular communication was estimated by a photobleaching method. TPA inhibited the degree of intercellular communication in two different time-dependent manners. The early (< 1 h) inhibition by TPA was consistent with an increase in the phosphorylation of connexin 43 (Cx43). The later inhibition was caused by reduction in the total amount of Cx43 on the plasma membrane, due to the decrease in the level of Cx43 transcripts. These qualitative and quantitative modulations by TPA were inhibited by a selective inhibitor of protein kinase C, GF109203X. bFGF also attenuated the gap junctional intercellular communication. However, short exposure (< 5 h) to bFGF did not affect the communication. The fact that the growth factor immediately stimulated the phosphorylation of Cx43 indicates that the phosphorylation site(s) affected by bFGF was not involved in the inhibition of communication. The decrease in the intercellular communication level was detected by the longer exposure (> 8 h) to bFGF and paralleled the decline in the Cx-mRNA level. This inhibitory effect of bFGF was abolished by the addition of a tyrosine kinase inhibitor, herbimycin A. Thus, gap junctional intercellular communication between osteoblasts was down-regulated by osteoblastic mitogens through different mechanisms of the modulation of Cx43.

3T3 Cells↗
PubMed2004

[Estimate methods used with complex sampling designs: their application in the Cuban 2001 health survey].

OBJECTIVES: To look at the individual features of three different methods used to estimate simple parameters--means, totals, and percentages, as well as their standard errors--and of logistic regression models, and to describe how such methods can be used for analyzing data obtained from complex samples. METHODS: Data from Cuba's Second National Survey of Risk Factors and Non-Communicable Chronic Ailments [Segunda Encuesta Nacional de Factores de Riesgo y Afecciones Crónicas No Transmisibles], which was conducted in 2001, were studied. A complex, stratified multi-stage cluster sampling design was used. Cuba's 14 provinces and the municipality of Isla de la Juventud served as the strata, while the clusters consisted of sampled geographic areas (SGA), blocks, and sectors. Samples were weighted in inverse proportion to their probability of being selected, and estimates were performed by sex and age group (15-34, 35-54, 55-74, and 75 or more years). Taylor approximations were used to estimate variances. Three statistical methods were compared: conventional analysis, which assumes all data were obtained through simple random sampling; weighted analysis, which only takes into account the weight of the samples when performing estimates; and adjusted analysis, which looks at all aspects of the sampling design (namely, the disparity in the probability of being included in the sample and the effect of clustering on the data). RESULTS: The point estimates obtained with the three different types of analytic methods were similar. Standard error (SE) estimates for the prevalence of overweight and of arterial hypertension that were obtained by conventional analysis were underestimated by 19.3% and by more than 11.5%, respectively, when such estimates were compared to those obtained with the other two analytic methods. On the other hand, weighted analysis generated SE values that were much smaller than those obtained with the other two types of analyses. The same pattern was noted when odds ratios were calculated using the different methods. CONCLUSIONS: Analytic methods that take into account the way the data are structured as well as the study design give a more realistic picture of the problem under study and provide more exact estimates of the study parameters and their SE than conventional analytic methods. Because data from epidemiologic and public health research are often obtained through complex sampling designs, the methods described in this paper and the statistical packages that utilize them should be used more widely.

Cuba↗
PubMed1991

Control systems for the electric heart.

Methods to predict and control cardiac output (CO) accurately in total artificial heart (TAH) recipients have varied significantly in the last few decades. Early models exhibited minimal control mechanisms and involved fixed pumping parameters. Elaborate electromechanical systems that have recently evolved require intricate communication between the circulating blood volume and the electric pump to maintain blood flow to critical organs. Attempts to quantitate specific end-organ blood flow, metabolic alterations, and oxygen delivery and, finally, to link these functions to the control of the TAH have not succeeded. Current devices seek to predict the needed CO by monitoring preload, afterload, or a combination of both. No consensus has developed concerning the appropriate physiologic parameters that should be surveyed in vivo and then used to regulate the output of the TAH.

Electric Power Supplies↗
PubMed1996

Occupational therapy task observation scale (OTTOS): a rapid method for rating task group function of psychiatric patients.

OBJECTIVE: We designed a simple rating instrument, the Occupational Therapy Task Observation Scale (OTTOS), to facilitate evaluation and documentation of patient performance during occupational therapy task groups and to improve the communication between occupational therapists and other treatment team members. METHOD: After analysis of other rating instruments, a preliminary version of OTTOS was designed, extensively field tested, and further modified. Interrater reliability was determined, and validity was tested against three established rating instruments: the Bay Area Functional Performance Evaluation, the Comprehensive Occupational Therapy Evaluation Scale, and the Milwaukee Evaluation of Daily Living Skills. RESULTS: The final version of OTTOS contains two parts, 10 items for evaluation of specific task functions and 5 items for rating general behavior. Field use demonstrated that the scale successfully tracked changes in functional capacity and included most facets of patient function evaluated during task groups. Use of OTTOS required minimal training, and scoring required less than 2 min for each patient. The correlation between the scores of experienced occupational therapists was high (.92 for the total scores). The correlation between OTTOS and the other rating instruments ranged from .880 to .340; the highest correlations, as expected, were with test subscales that most closely resembled OTTOS: CONCLUSION: Preliminary data indicated that OTTOS offers a reliable and valid method for rapidly rating the function of patients with psychiatric illness attending task groups. In addition, use of OTTOS improved the communication between occupational therapists and other health care providers, facilitated the education of occupational therapy students, and met the documentation requirements of third-party payers.

Humans↗
PubMed2006

Reliability and validity of communication skills questionnaire (CSQ).

A new and easy evaluation method of communication skills has been developed using the Communication Skills Questionnaire (CSQ), which can be self-administered or administered by family members and medical staff. The reliability and validity of this CSQ were evaluated. Eighty-seven patients with mental disorders and 100 normal controls participated in a self-rating evaluation of the CSQ, and 55 family members and four medical personnel also participated in objective rating. The CSQ contained 29 items and these items were divided into three categories: cooperative skills (17 items), assertive skills (six items) and general communication skills (six items, mainly non-verbal skills). Internal consistencies of all groups were between 0.91 and 0.97. Test-retest reliability values for patients, family members and medical staff were between 0.90 and 0.95. Interrater reliability of medical staff was 0.73. The total scores had a moderate positive correlation with Global Assessment of Functioning (GAF) score and doctor's impression of communication skill evaluated on a 10-point scale. The patient group had a lower CSQ score than that of controls and the score differences between controls and patients with schizophrenia, mood disorders or eating disorders were statistically significant. This questionnaire is a good psychometric method of evaluating the communication skills of patients.

Adult↗
PubMed2002

[Changes of phosphorylation states of Cx43 protein in Chinese hamster lung cells induced by SiO2].

OBJECTIVE: To investigate whether cellular gap-junctional communication(GJIC) down-regulation and the internalization of connexin 43(Cx43) in Chinese hamster lung fibroblasts (CHL) induced by silica-stimulated pulmonary alveolar macrophages (PAM) supermatant is related with the phosphorylation states of Cx43 protein. METHODS: Western-blot analysis was used to identify phosphorylated Cx43 species. RESULTS: Samples from membrane protein, total protein and nucleoprotein in CHL cells with 50-500 micrograms/ml doses of silica-stimulated PAM supernatants showed NP, P1, P2, P3 four immunoreactive bands of Cx43 protein by contrast with the control group and 0 microgram/ml SiO2 group. And with the dose of SiO2 increased, the increment of the levels of P2 and P3 was observed. Moreover, the groups treated with SiO2 and protein kinase C inhibitor, Palmitoyl-DL-Camitine chloride (PMC), simutaneously showed reduced level of P2 and P3, as compared with the groups treated with SiO2 only. CONCLUSION: The inhibition of GJIC and the internalization of Cx43 by SiO2 in CHL cells may relate to the changes of phosphorylation states of Cx43, and its mechanism may be similar to that of phorbol 12-myristate 13-acetate (TPA), i.e. via PKC activation pathway.

Animals↗
PubMed1996

The rapid village survey in tuberculosis control.

SETTING: Khon Kaen Province, North-East Thailand. OBJECTIVE: To develop a rapid and cheap method of surveying a population cluster (a village) to establish the prevalence of sputum-positive tuberculosis. DESIGN: Based on previous experience a standardized 'rapid village survey' method was designed and tested. In this method a survey team of health workers is constituted and trained. Before and at the beginning of a visit to a village the population receives information about tuberculosis, and only individuals with chest symptoms are invited to report voluntarily to the survey team for examination. Active tracing of a previously compiled 'list of suspects and contacts' complements the identification of cases. The number of community members to be examined is thus much lower. A cluster sample of the provincial population was made (20,730 people in 40 villages). The population in each village was surveyed first by the Rapid Village Survey method, then, 1 week later, by the conventional method of examining every individual registered in each village. RESULTS: In the rapid village survey 14 cases of sputum-positive tuberculosis were detected and in the conventional survey 15 cases. CONCLUSION: The rapid method produces results comparable to the survey of the total sample population for less than half of the cost.

Communicable Disease Control↗
PubMed2001

Australian major incident nomenclature: it may be a 'disaster' but in an 'emergency' it is just a mess.

BACKGROUND: A standardized major incident nomenclature has practical applications for medical communication and audit of the medical response to incidents. METHODS: A telephone and fax survey of major incident nomenclature in State and Territory health service emergency management plans and 'disaster' legislation was carried out on 13 August 1999. RESULTS: Within Australia there were a total of 13 different terms to describe incidents that could produce casualties: there were four definitions of the word 'disaster', eight definitions of the word 'emergency' and one definition of the word 'incident'. CONCLUSION: Australia lacks a uniform system of classifying and recording mass casualty incidents. This prevents both the independent clinical audit of the medical response to an incident and the cross-border comparison of the effectiveness of trauma systems to deal with multiple casualties. Australia's geography highlights the need to develop a nomenclature that allows medical practitioners, in isolated environments, to accurately describe an incident and the medical support that is required. The Potential Injury-Creating Event (PICE) nomenclature is a simple system to describe the functional impact of an event upon a community and the level of medical support required. It can be used to provide the basis for the uniform reporting of the medical management of major incidents within Australia.

Australia↗
PubMed1996

EEG-based communication: prospects and problems.

Current rehabilitation engineering combines new prosthetic methods with recent developments in personal computers to provide alternative communication and control channels to individuals with motor impairments. Despite these advances, all commercially available systems still require some measure of voluntary motor control. Thus, these systems are not useful for individuals who are totally paralyzed. Electroencephalographic (EEG) activity may provide the basis for a system that would completely bypass normal motor output. EEG-based communication technology might provide assistive devices for individuals who have little or no reliable motor function. This paper reviews the prospects for and problems of EEG-based communication. It summarizes current approaches to development of this new technology, describes the major problems that must be resolved, and focuses on issues critical for its use by those with severe motor disabilities.

Brain↗
PubMed2003

Effectively displaying broad scope sub-licensee radioactive material inventory allocations and possession quantities.

As part of its annual broad scope license radiation protection program review, the University of Texas Health Science Center at Houston radiation safety program discovered that although inventory control and monitoring mechanisms were being effectively implemented at the sublicensee level, a method did not exist to demonstrate compliance with collective broad scope license possession limits at the institutional level. To address this shortcoming, the radiation safety program data warehouse system was modified, and an automatic summary report showing collective sub-licensee maximum possession authorizations was created. But this report did not effectively present the summary information in a manner that key stakeholders could readily comprehend, as the data was not referenced to collective institutional possession limits. So a graphic version of the summary report was created wherein, for each isotope possessed, the collective institutional limit was displayed, along with the totals of all the individual sub-licensee maximum possession limits and current amounts on hand. This simple graphic served to effectively communicate the current status of the institution's radiation source inventory to the radiation safety committee, executive management, and state regulatory officials. The effort has served to simplify the sometimes-complicated source inventory control process and has facilitated subsequent program reviews. In the future, the method is expected to assist the radiation protection program in anticipating when broad license amendments may be needed to accommodate operational changes.

Licensure↗