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At least 595 records · Page 33Linked to original sources
PubMed2003

The value of the ultrasonic microprobe in the detection and treatment of rectal varices: a case report.

An 81-year-old woman with idiopathic portal hypertension was admitted to our hospital with anal bleeding. Colonoscopy revealed tortuous rectal varices extending 5 cm proximal of the dentate line. The rectal varices were considered to be the most likely cause of the bleeding, although the precise site could not be determined. The vessel images of the intramural rectal varices were clearly delineated using the water repletion method via an ultrasonic microprobe (UMP). The peri-rectal collateral veins and communicating veins between the intramural rectal varices and the peri-rectal collateral veins could be observed via the UMP. We performed endoscopic injection sclerotherapy (EIS) three times using 5% ethanolamine oleate, the total amount of sclerosant used being 5 ml. Ten days after EIS, colonoscopy revealed both ulcers and shrinkage of the varices in the rectum. The UMP revealed the disappearance of variceal vessels and peri-rectal collateral veins.

Journal Article↗
PubMed1998

Implementation of an oral and maxillofacial radiology image management and communication system.

OBJECTIVES: To implement an oral and maxillofacial radiology image management and communication system (OMFR IMACS) in the School of Dentistry, National Taiwan University. METHODS: An OMFR IMACS has been implemented over 3 years in three phases: (1) Establishment of an OMFR image processing laboratory for research and graduate student training; (2) Installation of network infrastructure and (3) Total system integration. RESULTS AND CONCLUSIONS: Intraoral, panoramic, cephalometric, and TMJ radiographs are directly processed with digital image acquisition devices or are converted into a digital format for viewing via UTP cable through FastEthernet in the eleven different divisions of the school. The system archives about 400 Mb of imaging data daily, representing 80% of the workload of the OMFR Division. The system is now used parallel to the conventional film-library system and has been integrated as part of the oral health service.

Humans↗
PubMed2006

A simple method to selectively scale down the self-interaction correction.

The method of Perdew and Zunger is commonly used to correct the self-interaction error of approximate density functionals. However, it has been shown that this orbital-based self-interaction correction (SIC) tends to overcorrect and often impairs molecular properties. We have recently proposed a method to improve the performance of the SIC by scaling it down in many-electron regions. In this communication, we present a simplification of this scheme. For every occupied orbital, we introduce a scaling factor determined by the ratio of the orbital density to the total spin-density. Thus, the magnitude of the correction is adjusted depending on how much orbital densities overlap with one another. Such a modification of the Perdew-Zunger SIC does not add any appreciable time to the computation, but significantly improves the accuracy for a number of benchmark properties.

Journal Article↗
PubMed1998

Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients.

OBJECTIVES: Many patients have limited English proficiency and require an interpreter. The authors evaluated the effect of current interpreting practices on Spanish-speaking patients' satisfaction with the patient-provider relationship. METHODS: A cross-sectional survey was conducted of 457 patients seen in a public hospital emergency department. Measures were satisfaction with the provider's friendliness, respectfulness, concern, ability to make the patient comfortable, and time spent for the exam. RESULTS: A total of 237 patients communicated adequately with their provider without the use of an interpreter (group 1), 120 patients communicated through an interpreter (88% of whom were ad hoc interpreters; group 2), and 100 patients communicated directly with the provider but said an interpreter should have been called (group 3). Compared with patients in group 1, patients who communicated through an interpreter (group 2) rated their provider as less friendly, less respectful, less concerned for the patient as a person, and less likely to make the patient comfortable. Patients who said an interpreter should have been called (group 3) had the lowest satisfaction ratings; compared with group 2, they were less satisfied with their provider's friendliness, concern for the patient as a person, efforts to make the patient comfortable, and amount of time spent. CONCLUSIONS: Patients who communicated through an interpreter or who did not have an interpreter when they thought one was necessary were less satisfied with the patient-provider relationship. Further efforts are needed to ensure interpreter availability and proper interpretation technique.

Adult↗
PubMedDate not supplied

Patient-specific computational fluid dynamics modeling of anterior communicating artery aneurysms: a study of the sensitivity of intra-aneurysmal flow patterns to flow conditions in the carotid arteries.

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the effects of unequal physiologic flow conditions in the internal carotid arteries (ICAs) on the hemodynamics of anterior communicating artery aneurysms. METHODS: Patient-specific computational fluid dynamics models of 2 cerebral aneurysms were constructed from bilateral 3D rotational angiograms. The flow dynamics of the aneurysm sac were analyzed under the effect of unequal mean flows, phase shifts, and waveforms between the ICAs. A total of 9 simulations were performed for each patient; cine flow velocity simulations and unsteady wall shear stress (WSS) maps were created for each flow condition. Time-dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed. RESULTS: Mean flow unbalances in the feeding vessels tended to shift the regions of elevated WSS towards the dominating inflow jet and to change the magnitude of the WSS peaks. The overall qualitative appearance of the WSS distribution and velocity simulations was not substantially affected. Phase and waveform asymmetry increased the temporal complexity of the hemodynamic patterns and tended to destabilize the flow pattern. CONCLUSIONS: Differences in the relative phase and waveform shape in ICAs can significantly affect the complexity and stability of the hemodynamic force distributions. The magnitude of these effects is related to the geometry of the aneurysm and the feeding vessels. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than 1 avenue of inflow should be incorporated into flow models.

Angiography↗
PubMedDate not supplied

The Epidemiologic Surveillance Project: a computer-based system for disease surveillance.

The Epidemiologic Surveillance Project (ESP) is a computer-based surveillance system for the rapid transmission and analysis of national morbidity data. These data are transmitted weekly by state health department computers to the Centers for Disease Control (CDC), using a commercial electronic mail facility (MINET). Participating state health departments transmit data through existing computer systems using a standard record and data transmission protocol. State and national data are rapidly analyzed at the CDC, and reports of these analyses are transmitted through MINET to the states. Maps based on these data and other tabular displays of demographic and epidemiologic characteristics of the diseases being tracked are periodically prepared and distributed. Because the efficiency, speed, and uniformity of tabulation of this system are greater than those of systems that use protocol and telephonic reports of case totals, the ESP may be a model for future surveillance systems.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

Content analysis of the crew communication with external communicants under prolonged isolation.

BACKGROUND: The communication between space crews and outside monitoring personnel in Mission Control gives us valuable information about crewmember psychological health. Studying the formal parameters of similar communication during ground-based space simulation missions helps us understand the psychological climate of confined groups over time, and this information can be applied to long-term space missions. HYPOTHESES: We hypothesized that psychological closing and information filtration will be observed in a confined crew as the mission progresses and will differ by the type of communication (e.g., audio vs. computer-generated) with the outside monitors in the simulated Mission Control (MC). In addition, communication patterns will vary with the specific group of people on-duty outside. METHOD: Audio and computer communications between space simulation crews and MC teams were analyzed during two isolation studies lasting 135 and 90 d at the Institute for Biomedical Problems in Moscow. A number of temporal, content and quantitative parameters of verbal activity were examined. RESULTS: The total intensity of communication dropped after month 1 of the missions. The Commander had the highest intensity of communication. There was evidence for the presence of psychological closing and information filtration in the crews over time, with some variation based on type of communication. Communication patterns differed with different outside teams. CONCLUSIONS: The communication between confined groups and outside monitoring personnel is affected by psychological closing and information filtration and by the make-up of the teams that comprise the monitoring groups.

Adult↗
PubMed2000

Half the families of intensive care unit patients experience inadequate communication with physicians.

OBJECTIVE: Effective communication of simple, clear information to families of intensive care unit (ICU) patients is a vital component of quality care. The purpose of this study was to identify factors associated with poor comprehension by family members of the status of ICU patients. DESIGN: Prospective study. SETTING: University-affiliated medical intensive care unit. PATIENTS AND METHODS: A total of 102 patients admitted to an ICU for >2 days. INTERVENTION: The representatives of 76 patients who were visited by at least one person during their ICU stay were interviewed. RESULTS: Mean patient age was 54+/-17 yrs and mean Simplified Acute Physiology Score II at admission was 40+/-20. The representative was the spouse in 47 cases (62%). Among representatives, 25 (33%) were of foreign descent and 12 (16%) did not speak French. Mean duration of the first meeting with a physician was 10+/-6 mins. In 34 cases (54%), the representative failed to comprehend the diagnosis, prognosis, or treatment of the patient. Factors associated with poor comprehension by representatives included patient-related, family-related, and physician-related factors. Patient-related factors included age <50 yrs (p = .03), unemployment (p = .01), referral from a hematology or oncology ward (p = .006), admission for acute respiratory failure (p = .005) or coma (p = .01), and a relatively favorable prognosis (p = .04). Family-related factors were foreign descent (p = .007), no knowledge of French (p = .03), representative not the spouse (p = .03), and no healthcare professional in the family (p = .01). Physician-related factors were first meeting with representative <10 mins (p = .03) and failure to give the representative an information brochure (p = .02). Moreover, after the first meeting, caregivers accurately predicted poor comprehension by representatives (p = .03). CONCLUSIONS: Patient information is frequently not communicated effectively to family members by ICU physicians. Physicians should strive to identify patients and families who require special attention and to determine how their personal style of interrelating with family members may impair communication.

Communication↗
PubMed1995

Digital optical card. A promising technology for documentation and communication of images.

PURPOSE: To assess a patient-oriented digital optical card (OC) for documentation and communication of images using the analysis of breast microcalcifications to illustrate its resolution power. METHODS: Fifty film mammograms with histologically proved clustered microcalcifications were digitized using a 5 lp/mm CCD-scanner. A region of interest containing the cluster was selected for documentation on an OC as an overview OC-image and as a magnified OC-image (5 lp/mm). The shape (spherical/nonspherical) as well as the total number of microcalcifications were quantitatively analyzed by 2 radiologists. RESULTS: The detection rate for total number of overall and spherical microcalcifications using digital media was significantly reduced (p < 0.01) compared to analog mammography. There were no significant differences in the detection rate of nonspherical microcalcifications between film mammograms (100%) and magnified section OC-images (92.7%). The overview OC-image revealed 72% of those calcifications (p < 0.01). CONCLUSION: According to our results, this technology is not appropriate for diagnosis of breast microcalcifications, but may be a promising communication digital medium for transmitting an image/report unit to referring physicians.

Breast Neoplasms↗
PubMed2004

Assessment of a 360-degree instrument to evaluate residents' competency in interpersonal and communication skills.

OBJECTIVE: To test the reliability of the 360-degree evaluation instrument for assessing residents' competency in interpersonal and communication skills. METHOD: Ten-item questionnaires were distributed to residents and evaluators at Monmouth Medical Center in Long Branch, New Jersey, in March/April, 2002. The scoring scale was 1-5; the highest score was 50. Data were maintained strictly confidential; each resident was assigned a code. Completed data sheets were collated by category and entered into a spreadsheet. The total and mean scores by each category of evaluator were calculated for each resident and a rank order list created. Shrout-Fleiss (model 2) intraclass correlation coefficients measured reliability of ratings within each group of evaluators. Reliability/reproducibility among evaluators' scores were tested by the Pearson correlation coefficient (p <.05). RESULTS: Intraclass correlation coefficients showed a narrow range, from.85-.54. The highest ranked resident overall ranked high and the lowest was low with most evaluators. The rank order among fellow residents was markedly different from other evaluator categories. Pearson correlation coefficients showed significant correlation between faculty and ancillary staff, (p =.002). Patients as evaluators did show intraclass correlation, but did not correlate significantly with other categories. Scores from colleagues correlated negatively with all other categories of evaluators. CONCLUSIONS: The 360-degree instrument appears to be reliable to evaluate residents' competency in interpersonal and communication skills. Information from the assessment may provide feedback to residents. Areas of improvement identified by the scores would suggest areas for improvement and further ongoing assessment.

Clinical Competence↗
PubMedDate not supplied

Communication and health protection issues arising from a flooding emergency.

OBJECTIVE: To identify and describe the key communication and health protection issues surrounding a flooding emergency. METHODS: A telephone questionnaire was used to assess health and safety information sources, information recalled, and behavioral responses among residents of the town of Feilding, New Zealand following a major flood in February 2004. This was supplemented by key informant interviews and a newspaper content analysis. RESULTS: A total of 154 adult residents were surveyed (76% of those successfully contacted and eligible). Of the respondents, 79% recalled being provided with health and safety information from authorities. The major sources were: radio (41%), pamphlets (23%), and newspapers (20%). The regional newspaper had extensive coverage of this flooding emergency but "health" only was mentioned in 46 (7%) of the 664 flood-related articles. Of those who recalled receiving information from authorities, most (89%) perceived that it was adequate. Nevertheless, 18% actively sought out information (mainly about water safety and availability). In the post-flood period, 73% of all respondents boiled water; however, only 4% maintained boiling water or bottled water use for the necessary nine-week period. Some forms of emergency preparations did not change substantially from before the flood, compared to four months afterwards (e.g., having a radio with batteries increased from 62% to 68%). Perceived health concerns around the flooding were low, though 59% were concerned about the risk of water contamination. Actual self-reported, health consequences from the flood were rare, as only two (1%) people out of 154 reported flood-related health problems. CONCLUSIONS: Health and safety information generally was communicated successfully and was regarded as appropriate by the population of this flood-affected town. Nevertheless, there are further improvements needed in the emergency response by both residents and authorities.

Adult↗
PubMedDate not supplied

Using infant mannequins in objective standardized clinical examinations: are there unintended consequences?

OBJECTIVE: In objective standardized clinical examination (OSCE) of infants, real infants are generally not used. Instead, the standardized patient portrays a parent who answers a student's questions, and there is no physical examination. One way to assess physical examination skills in these encounters is to have students demonstrate the appropriate examination on a mannequin. But before using this approach, we wanted to assess whether having students examine mannequins affects their history-collecting or communication skills. METHODS: Third-year medical students were randomized to 2 versions of an infant OSCE case. During the encounter, controls were handed a printed listing of all physical examination (PE) findings. Students in the mannequin group were told relevant PE findings only after the students had examined a part of the mannequin. Student performances on the OSCE case and perceptions about the case were compared. RESULTS: Thirty-two students were in the control group, and 35 students examined mannequins. No differences were found in total case score (P = .78), or on history-gathering skills (P = .86) and communication skills subscales (P = .78). In addition, questionnaires completed by students after the encounter indicated that the infant mannequins did not affect student perceptions about the realism of the case (P = .91). CONCLUSIONS: Student performances at collecting the clinical history or communicating with the standardized patient were not adversely affected by inclusion of an infant mannequin. This suggests mannequins can be used to assess students' knowledge of the relevant case-specific PE without adverse effect.

Adult↗
PubMed2002

[Function and responsibility of an interdisciplinary tumor center. Need for a "cancer center" for multimodal therapy concepts].

BACKGROUND AND OBJECTIVE: Cancer will be the leading cause of death in industrialized countries within the next few years. A successful treatment represents a great challenge within the next years and requires multimodality treatment approaches. An multidisciplinary tumour center is essential for coordination and communication between different departments and institutions and is important to maintain standards in diagnostic and therapeutic procedures. METHODS: Two years ago, a cancer center was founded in Marburg. The central facility of its work is a twice weekly tumour conference, where patients requiring multimodality treatment approaches are presented and treatment procedures are fixed and documented. Furthermore, guidelines for diagnosis and treatment of the various cancer diseases will be established and the transfer of clinical and experimental research to the actual patient treatment is intended. RESULTS: A total of 407 patients were discussed within the first year. Leading cancer entities were lung cancer, colorectal cancer and tumours of the upper GI-tract. The tumour conference has improved the communication between all involved disciplines. The process of standardisation of diagnostic and therapeutic procedures is ongoing. The next step will be the documentation of the further follow up of all patients discussed in the tumour conference. CONCLUSIONS: In the communication between all disciplines involved in cancer patient care, success, be it a survival benefit or an improvement in quality of life, is most likely. All the described tasks are best organized within a cancer center.

Adolescent↗
PubMed2002

Resorbable defect analog PLGA scaffolds using CO2 as solvent: structural characterization.

After tooth extraction, the immediate wound treatment by implanting an exact copy of the root could prevent alveolar bone atrophy. The implant should have an interconnected porosity in order to promote tissue in-growth. This communication reports a novel method to realize such net-shaped porous scaffolds fabricated within a few minutes. Porosity and micro-architecture are evaluated by Hg-porosimetry and by image analysis of electron and light microscopy as well as by computed micro-tomography. The total porosity of the scaffold corresponds to (63 +/- 3)%, mainly related to open interconnected porosity. Micro-tomography, as a noninvasive 3D method, is best suited to uncover pores of about 100 microm, a diameter especially important for tissue in-growth. The differentiation between open and closed porosity, however, depends on the method chosen. This effect is attributed to the spherical pores with an orifice only detected in the 3D analysis. Consequently, the closed porosity is overestimated by 8% evaluating 2D images. Finally, the mean pore diameter is found to be 106 and 100 microm for 2D and 3D analysis, respectively. Although the porosity of the scaffold needs to be further optimized for clinical applications, the procedure proposed is a promising route in manufacturing open porous implants without the use of any organic solvent.

Alveolar Bone Loss↗
PubMed2006

Clinicians' attitudes regarding barriers to the implementation of psychiatric advance directives.

OBJECTIVE: Psychiatric advance directives (PADs) may include documenting advance instructions (AIs) and/or designating health care agents (HCAs). Laws authorizing PADs have proliferated in the past decade, but there has been little research regarding perceptions of barriers to the implementation of PADs among groups of mental health professionals. METHODS: A total of N=591 mental health professionals (psychiatrists, psychologists, and social workers) completed a survey regarding their perceptions of potential barriers to the effective implementation of PADs. RESULTS: Across the three professional groups barriers related to operational features of the work environment (e.g., lack of communication between staff, lack of access to the document) were reported at a higher rate than clinical barriers (e.g., inappropriate treatment requests, consumers' desire to change their mind about treatment during crises). However, psychiatrists were more likely to report clinical barriers to implementation than both psychologists and social workers. In multivariable analyses, legal defensiveness, employment in public sector mental health services, and a belief that treatment refusals will outweigh the benefits of PADs were associated with more perceived barriers, whereas age and endorsing positive perceptions of PADs were associated with fewer perceived barriers. CONCLUSION: Psychiatrists, psychologists and social workers tend to perceive significant potential barriers to PADs, related to operational aspects of these professionals' work environment as well as certain clinical features of PADs for persons with severe mental illness. Additionally, legal defensiveness and general endorsement of PADs appear to shape perceptions of barriers to the effective implementation of PADs.

Adult↗
PubMed1983

An improved colony hybridization method with significantly increased sensitivity for detection of single genes.

By introducing a simple modification of existing methods, colony hybridization has been used to detect single copy genes coding for a heat-stable enterotoxin in wild-type strains isolated from patients with diarrhea. The modification described in this communication results in an approximately 100-fold increase in sensitivity, probably by increasing the total denatured plasmid DNA fixed to the paper.

Cloning, Molecular↗
PubMed2004

The prevalence of diffuse idiopathic skeletal hyperostosis in Korea.

OBJECTIVE: To identify the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a large Asian population group. METHODS: A total of 3595 subjects (1616 men and 1979 women) over 50 years of age, residing in 2 cities in Korea, were included in this study. The mean age of the study population was 64.25 +/- 9.06 years. We reviewed lateral chest radiographs through Picture Archiving and Communication Systems (PACS) and identified DISH according to Resnick's and Julkunen's criteria. RESULTS: One hundred and four (2.9%) of the 3595 subjects were diagnosed with DISH according to classical Resnick criteria. A slight increase in prevalence (4.1%) could be seen using Julkunen's criteria. The prevalence of DISH increased with age, except for the 90-99 year age group. Men were approximately 7 times more likely to have DISH than women using Resnick's criteria. CONCLUSION: DISH is an age-related skeletal disorder whose overall prevalence is much lower in Koreans than in other Western populations. Interestingly, the prevalence of DISH was 7 times higher in men. We propose that ethnic factors are important elements in the prevalence of DISH.

Aged↗
PubMed1989

Overview of results with tracheoesophageal puncture after total laryngectomy.

Ten years have passed since the introduction of the tracheoesophageal puncture. The voice restoration field has dramatically changed upon the introduction of this new technique. This permits the patients to speak as early as ten days after surgery. An overview of the results of the past ten years are presented. In this communication the technique, historic highlights, and the published experience with tracheoesophageal puncture as a secondary, primary and in extended laryngopharyngectomy with flap reconstruction are discussed. Tracheoesophageal puncture with placement of voice prosthesis for voice restoration after total laryngectomy, has become an accepted technique. The popularity of this method originally proposed by Singer and Blom has been widespread. This new method of vocal rehabilitation after total laryngectomy, has permitted patients to speak as early as ten days after their surgery. This is a great advance in the rehabilitation of the cancer patient.

Humans↗