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At least 577 records · Page 32Linked to original sources
PubMed2005

Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke.

BACKGROUND AND PURPOSE: Spasticity is a disabling complication of stroke and different noninvasive treatments are used to reduce muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses largely used in the treatment of diseases involving bone and tendon as well as muscular contractures. The effect and duration of extracorporeal shock wave therapy (ESWT) was investigated on muscle hypertonia of the hand and wrist. METHODS: A total of 20 patients affected by stroke associated with severe hypertonia in upper limbs were evaluated. Placebo stimulation was performed 1 week before active stimulation in each patient. Evaluation was performed using the National Institutes of Health and Ashworth scales and video monitoring with a digital goniometer before and immediately after placebo or active stimulation. Motor nerve conduction velocity from abductor digiti minimi were recorded. Patients were monitored at 1, 4, and 12 weeks after active treatment. RESULTS: After active ESWT, patients showed greater improvement in flexor tone of wrist and fingers compared with placebo stimulation. At the 1- and 4-week follow-up visits, a significant decrease of passive muscle tonicity was noted on muscles in all patients receiving active treatment. At 12 weeks after therapy, 10 of the 20 patients showed persistent reduction in muscle tone. There were no adverse events associated with ESWT. CONCLUSIONS: ESWT reduces hypertonia of the wrist and finger muscles for > or =12 weeks after treatment. The possible mechanisms of action of ESWT are discussed.

Adult↗
PubMed1999

Rethinking access in an information age.

Medical information is part of the growing global resource that constitutes the World Wide Web. Researching health information is one of the most common reasons for using the Internet. In 1997, nearly half of U.S. users spent time looking for health information or support on the Internet. More recently, the Internet allows medically naive users to question physicians and other clinicians about health-related topics by e-mail and other digital communication methods. In the face of this growing technology, the term "access" now encompasses the availability of specialized information to the general public. This article reviews the meaning of access in terms of the growing information Movement, looks at opportunities this presents to clinicians, and analyzes barriers to widespread and appropriate information access.

Forecasting↗
PubMed2002

Capabilities of computerized clinical decision support systems: the implications for the practicing dental professional.

This article presents the use of captured data within the range of patient care activities of the dental practitioner with an emphasis on prosthodontic activities. It describes the use of computer technology in dentistry during a typical patient encounter in a dental care facility. The oral health record, the need for speech recognition technology, and existing documentation software are discussed. Ongoing development of the capabilities of Clinical Decision Support (CDS) systems is becoming an important part of the oral health setting; including systems applicable to prosthodontics. These systems all rely on a common standardized structure for the electronic (oral) health record (EHR/EOHR). Current developments in radiological technology and digital imaging are explained as well as fundamentals of decision support systems clarified. Recent developments in the representation of domain knowledge as well as the implementation of a dental nomenclature and metathesaurus are also presented. A quality matrix identifies target values for dental informatics while demonstrating an "importance-weighting" of dental characteristics.

Bayes Theorem↗
PubMed2003

Hearing aids. Loud and clear.

Improvements in hearing aid provision has been hampered by long waiting lists and a shortage of staff. Pilots last year showed the potential to increase capacity by using private sector capacity. A partnership between the NHS, the voluntary sector and two companies provides digital hearing aids free.

Health Care Sector↗
PubMed1993

Neoadjuvant hormonal therapy in stage C adenocarcinoma of the prostate.

This report describes the effects of neoadjuvant hormonal therapy on 16 patients (mean age = 65 y) with clinical stage C adenocarcinoma of the prostate (CaP) who underwent radical prostatectomy from December 1991 to June 1993 at the University of Colorado Health Sciences Center. Staging of CaP was determined by digital rectal exam, transrectal ultrasonography (TRUS), radionuclide bone scanning, abdominal and pelvic computed tomography scanning, transrectal coil magnetic resonance imaging, and serum acid phosphatase. Most patients underwent a laparoscopic lymph node dissection to rule out micrometastasis. Every patient was treated for 4 months with a combination of a gonadotrophin-releasing hormone (GnRH) agonist (Lupron) and an anti-androgen (flutamide, Eulexin). Serial prostate-specific antigen (PSA) levels, post-treatment prostate volume measured by TRUS, and whole-mount sectioning of the surgical specimen were studied. The PSA levels decreased from a mean of 39.1 ng/ml (Hybritech method) to a mean of 0.43 ng/ml; (p < 0.0001). Prostate volumes in all patients demonstrated a mean decrease of 52% (p < 0.0001), and pathological effects of hormonal deprivation were observed in all patients. By whole-mount sectioning of the radical prostatectomy specimens, 3 patients had organ-confined disease (stage B), 6 showed invasion of the capsule with surgical margins free of tumor (stage C1), 3 had extracapsular extension with positive surgical margins (stage C2), and 4 had extracapsular extension with seminal vesicle involvement (stage C3). We conclude that by downsizing and markedly decreasing serum PSA values, neoadjuvant hormonal therapy offers an alternative treatment for stage C carcinoma of the prostate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

Studies on TGF-beta 1 gene expression in the intima of the human aorta in regions with high and low probability of developing atherosclerotic lesions.

Certain regions of the human aorta are at greater risk for early and more severe atherosclerotic lesions development than others. Cornhill and coworkers (Cornhill FJ et al.: Arteriosclerosis 5:415, 1985) created maps for the probability of developing atherosclerosis defining the high-probability region (HPR) in the dorsal descending thoracic aorta and the low-probability region (LPR) in the ventral descending thoracic aorta. Our study examines the hypothesis that transforming growth factor beta -1 (TGF-beta 1), a well-known suppressor of growth and function in many human cell lines, is one of the inhibitors of human atherogenesis. The present experiment analyzes the expression of mRNA for TGF-beta 1 in both the HPR and the LPR of aortas from young (age 17 to 25 y) males of black (n = 8) and white (n = 7) race. The level of TGF-beta 1 gene expression was assessed in the aortic intima in both the HPR and the LPR, using National Institutes of Health Image 1.47, an Apple Macintosh application capable of digital image processing, analysis, and morphometric measurement. There was significantly lower (P = 0.002, alpha = 0.05) TGF-beta 1 gene expression in the HPR than in the LPR in the 22- to 25-y age group. There was no significant difference in the 17- to 21-y age group and between the HPR and the LPR in the entire study group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Telehealth. Part II. A total system approach.

Digitization and telecommunications technology makes possible greater access to health care for remote and underserved populations. But although many telehealth programs were implemented over the last 25 years, few have survived withdrawal of external funding. This, in spite of data indicating few hardware problems and that in general patients are satisfied with their experiences of telehealth. What's the problem? Why are telehealth programs marginally successful at best?

Health Services↗
PubMedDate not supplied

Tracking health care costs: growth accelerates again in 2001.

For the first time in more than a decade, health care spending per capita rose at a double-digit rate in 2001, growing 10 percent. Spending on hospital services (both inpatient and outpatient) surged by 12 percent in 2001, reflecting increases in both hospital payment rates and use of hospital services. Hospital spending was the key driver of overall cost growth, accounting for more than half of the total increase. Prescription drug spending growth declined for the second straight year and was overtaken by spending on outpatient hospital services as the fastest-growing component of total spending. Driven by these cost trends and other factors, premiums for employment-based health insurance increased 12.7 percent in 2002--the largest increase since 1990. But taking account of the sizable amount of "benefit buy-down" in 2002, the true increase in the cost of health insurance for employers and employees was about 15 percent. Early evidence from 2002 suggests that health care cost trends are now beginning to slow, possibly setting the stage for more moderate premium growth in the future.

Cost Sharing↗
PubMedDate not supplied

Internet use among community college students: implications in designing healthcare interventions.

The Internet has become a commonly used venue for seeking healthcare information. Young adults search the Internet for health information more than any other group, yet little is known about use patterns among community college students. The authors surveyed a diverse community college to assess students' use of the Internet for health-related information. More than 80% had home Internet access, regardless of race or gender. Men and women searched for health information in almost equal numbers. Most students were interested in searching for diet/nutrition topics, and least interested in smoking information. Although the digital divide appears to be closing, varying levels of interest in a variety of important health topics remain. Understanding these differences could guide the design of more effective Web-based health interventions.

Adolescent↗
PubMed2006

Sex dimorphism in digital formulae of children.

This paper presents results of a study designed to: 1) test for a sex difference in the relative lengths of the finger bones, including the second-to-fourth digit ratio (2D:4D), using left-hand radiographs taken in young children, 2) test whether sex differences can be explained by sex differences in fetal growth, and 3) test the serial stability of sex differences in relative digit lengths, including 2D:4D. Results are presented from 1,060 subjects of the California Child Health and Development Studies. One serial replication at about 9 years old is available from 271 subjects. Results indicate that relative digit lengths are sex-dimorphic in children (Manning et al. [1998] Hum. Reprod. 13:3000-3004, [2004] Early Hum. Dev. 80:161-168). Sex differences in digit length ratios are more pronounced within sibships, where shared family factors are controlled, and are not strongly associated with gross measures of fetal growth, like birth length or weight. Thus, sex differences in the fetal growth of the body are not implicated in sex differences in digital formulae, leaving open the possibility of more direct hormonal and/or genetic causation. However, 2D:4D declined between ages 6-8 in a longitudinal sample, and was a less consistent sex-dimorphic marker than 3D:4D across ethnic groups, suggesting that 3D:4D may be a better marker of perinatal sex differentiation. Prior conflicting findings about 2D:4D may be partly explained by variations in age and ethnicity of populations studied.

Bone Development↗
PubMed2003

E-oncology and health portals: instructions and standards for the evaluation, production organisation and use.

In 2002 the Italian Ministry of Health promoted the institution of a network and a web portal, E-oncology (2), for the seven NHS research institutions specialising in oncology (Istituti di Ricovero e Cura a Carattere Scientifico-IRCCS). One of the aims was to gather and provide information on tumoral pathologies to operators and the public. For an optimum organisation of a health web site it is necessary to comply with the standards internationally used. The World Wide Web Consortium (W3C) has developed guidelines for accessibility and usability of the sites, implemented in Italy through governmental issues. Many international organisations adopt rules and codes of conduct to validate biomedical information and have organised quality portals such as NLM, OMNI, MEDCIRCLE, HON etc. Some terminological standards, such as the MESH thesaurus and UMLS, have been produced by the libraries for a correct management and an effective information retrieval, and are currently used by the most important biomedical web sites. The Dublin Core, metadata standard for the integration of information deriving from heterogeneous archives, has also been developed by the libraries. The easy access to information dims the complex architecture necessary for the construction of a web site. The contribution of different professionals is necessary to guarantee the production of quality medical/health web sites, among them librarians have always been involved with the management of knowledge and their skills are extremely valuable. Furthermore, the libraries' network is essential in order to guarantee universal access to health information, mostly still against payment, and to contribute to overcoming the 'digital divide' and 'second-level digital divide'.

Evaluation Studies as Topic↗
PubMed2003

Wireless application for complex wound management.

This project was to develop a web based wireless system to be used by community care nurses. Wound care constitutes approximately one half of home health care nursing visits. The system was implemented with a digital camera and a handheld computer with a wireless connection to a web based server. A database was used to control access to the clinical cases and to serve as a data repository. When new images were uploaded to the server a wound expert was notified via pager. The images and data could be viewed from any computer with an internet connection.

Community Health Nursing↗
PubMedDate not supplied

Sexual orientation and variation in physical and mental health status among women.

OBJECTIVE: To assess and compare the physical and mental health status of women of differing sexual orientation within a population-based sample. METHODS: We used a population-based telephone survey performed using random digit dialing techniques. Our study population was drawn from the 1999 Los Angeles County Health Survey and included women age 18-64 years who reported their sexual orientation (98%, n = 4135). These analyses include 4023 heterosexuals, 69 bisexuals, and 43 lesbians. RESULTS: We assessed the unique association of sexual orientation with physical and mental health status using bivariate and multivariate analyses. Both lesbians and bisexuals were more likely than heterosexual women to report a diagnosis of heart disease. Among women with a depressive disorder, lesbians were more likely than heterosexuals to be using an antidepressant medication. Compared with heterosexuals within the preceding 30 days, lesbians reported significantly more days of poor mental health, and bisexuals reported significantly more days of poor physical health. However, there were no significant differences by sexual orientation in impaired ability to perform daily activities due to physical or mental health. CONCLUSIONS: In this rare opportunity to use population-based data to study lesbian and bisexual health, we found that sexual orientation as a nonheterosexual woman was associated with increased rates of poor physical and mental health. We believe these findings support the need for the increased systematic study of the relationship between sexual orientation and health.

Adolescent↗
PubMed2002

Assessment of digit preference in self-reported year at menopause: choice of an appropriate reference distribution.

Estimated associations between self-reported age at menopause and health may be attenuated if self-report is inaccurate. In a cross-sectional study, it is not possible to assess validity or reproducibility. Instead, one can examine digit preference, e.g., overreporting of numbers ending in zero or five. Typically, analyses use equal proportions-10% probability for each digit-as the reference distribution. Depending on the age distribution of the sample and on the underlying distribution of age at the event, however, an alternative reference distribution may be more appropriate. As an illustration, the authors examined digit preference in the self-reported calendar year at the final menstrual period in cross-sectional data from 2,151 naturally postmenopausal women in the Study of Women's Health Across the Nation (1995-1997), a multisite, multiethnic study of women aged 40-55 years. With chi-square tests, the distribution of terminal digit for self-reported year at the final menstrual period was compared with several reference distributions. The observed distribution was much closer to a reference distribution based on previously published data than it was to equal proportions. Future assessments of digit preference in cross-sectional studies should consider alternatives to equal proportions, particularly for samples with small age ranges and events with a restricted underlying age distribution.

Adult↗
PubMed2006

Low-technology heart failure care in home health: improving patient outcomes.

This article reports a study that pilot tested the effectiveness of a low-technology structured intervention to standardize home healthcare management of patients with heart failure (HF) within a home health agency (HHA). The purpose of this study was to use low-technology equipment to improve care for patients with HF enrolled in a home health agency. The 9-week intervention was targeted toward the home health nurses and included telephone and home visits, a teaching tool, digital scales, and a log/notebook filled out by the patients in the study. Patient outcomes included decreased rehospitalization, decreased symptoms of HF, and increased quality of life.

Aftercare↗
PubMed2005

[Health telematics projects in the perspective of the German federal states].

Starting in autumn 2005 with pilot projects, the new German electronic health card (EHC) and electronic health professional cards (HPC) will be implemented in the German health system. These cards are constituents of the full coverage networking of more than 120,000 doctor's practices, 22,000 pharmacies, 2,200 hospitals and 300 health insurance companies. The functions of the EHC, for example electronic prescriptions, the digital medication recording and the European emergency database, need both the interactions with the HPCs and with a complex network of IT systems and telecommunication services, i. e. with a comprehensive health telematics infrastructure. Model regions for the construction of a telematics infrastructure have been established in numerous federal states, e. g. Baden- Wurttemberg, Bavaria, Bremen, Lower Saxony, North Rhine-Westphalia, Rhineland-Palatinate, Saxony and Schleswig-Holstein, and also recently in Mecklenburg-Vorpommern and Brandenburg. These model regions are designed in a way that allows smooth integration of the specifications of the so-called solution architecture of the EHC and also of electronic HPCs as soon as these are available. The implementation of first pilot trials in the model regions, each with 10,000 insured, is planned for the second half of 2005. A project task force was founded by a group from the German federal states in December 2004. The objective of these implementations is to establish a fully networked health system providing patients various e-Health applications which can be used any place and any time.

Computer Communication Networks↗
PubMed2002

Wall Street comes to Washington: market watchers and policy analysts evaluate the health care system.

Consumers will pay more for health care as employers respond to a third year of double-digit insurance premium increases in 2003. Firms will shift more costs to workers through higher deductibles and copayments to protect their bottom lines and increase worker awareness of the cost of care, according to a panel of market and health policy experts at the Center for Studying Health System Change's (HSC) seventh annual Wall Street roundtable. But don't look for large employers to make radical changes to workers' health benefits. So far, most employers are cautiously eyeing new insurance products, including consumer-driven health plans and tiered hospital and physician networks. As costs continue spiraling upward, a hospital building boom is underway, raising concerns about a new medical arms race and increased costs.

Cost Sharing↗
PubMedDate not supplied

Evaluation of electronic, digital blood pressure monitors: perceptions and ease of operation.

Blood pressure (BP) monitors intended for home health care were evaluated according to human-factors criteria, such as ease of operation, clarity of instruction booklet, perceived accuracy, and general preference. In the first phase, five types of BP monitors with various design characteristics were evaluated by pharmacy school students. A general preference was expressed for the electronic, digital BP monitors. In the second phase, four electronic, digital BP monitors were evaluated. Wide variations were observed in the perceptions of and preferences for these monitors. Approximately 64 to 70 per cent of the general preference for any of these instruments could be explained by perception of accuracy, instruction booklet preference, and ease of operation. There was no user preference for LED compared with LCD data readout. When compared with the method used by the evaluator's physician, all four electronic, digital BP monitors received satisfactory ratings.

Adult↗