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PubMed2001

Bioanalysis of age-related changes of lipid metabolism in nonagenarians.

The aim of the present study was the bioanalysis of lipid metabolism in the aged patients and to study the relationship between these biochemical markers and longevity. Eleven nonagenarians, nine women and two men, aged 94+/-3 years and ten control patients, six women and four men, aged 84+/-5 years, followed at the Department of Metabolic Care and Gerontology, Charles University, Teaching Hospital entered the study. All subjects were self-sufficient, without major illnesses and free living. At the start of the project the free fatty acids (FFA), thiobarbituric reactive substances (TBARS), retinol, alpha tocopherol, ascorbic acid, cholesterol, triacylglycerols, phospholipids in serum, in lipoprotein fractions and fatty acids (FA) and phospholipids in erythrocyte membrane were determined. We used capillary gas chromatography for determination of fatty acids. Retinol and alpha tocopherol were analysed by reversed-phase high-performance liquid chromatography, other parameters were determined spectrophotometrically or spectrofluorometrically. We found significantly higher LDL polyunsaturated fatty acids (PUFA) 22:4n--3 (P=0.028) and 22:6n--3 (P=0.018) and a significant increase of HDL alpha tocopherol/cholesterol ratio (P=0.034) in nonagenarians. There were not any significant differences in erythrocyte membrane fatty acids and phospholipids. In serum we found significantly higher level of TBARS (3.22+/-1.22 vs 1.98+/-0.71 micromol/l, P=0.012) in nonagenarians, other parameters were not changed significantly. The higher concentration of PUFAs in LDL and alpha tocopherol in HDL might be parameters related to longevity.

Aged↗
PubMed1999

Beyond the classroom: integrating improvement learning into health professions education in Norway.

BACKGROUND: Students in the health professions must internalize the subject matter--professional knowledge--to acquire the necessary skills to serve as practitioners. Yet the ability to engage in continuous improvement is attainable only when combining professional knowledge with improvement knowledge. It is a challenge to strike a balance between theoretical teaching and practical training when working with personal quality improvement (QI), observing processes, and employing new methods and tools for problem solving and improvement work. EVOLUTION OF EFFORTS TO INTEGRATE IMPROVEMENT KNOWLEDGE INTO HEALTH PROFESSIONS EDUCATION: In February 1995 A National Strategy for Quality Improvement in Health Care stipulated that training in quality improvement be an integral part of the education of health care personnel. A program was developed at Bergen College in 1998 to integrate the philosophy and methodology of quality improvement (improvement knowledge) into students' learning of professional knowledge. This program involves a variety of pilot projects in personal improvement, practice-related instruction on training wards, observation practice, clinical studies, cross-education student projects, and thesis writing. PERSONAL IMPROVEMENT PROJECTS: With the starting point "quality is personal," students can work on personal change and improvement. If students learn methods and tools for improvement in their personal realm, they can transfer and use this knowledge in their professional work. Problems experienced by students in relation to their studies can be addressed by the Plan-Do-Check-Act problem-solving method. DISCUSSION: A longitudinal, personal-then-clinical, approach enables students to learn techniques and tools they can use as professionals, both in the care for patients and in contributing to organizational improvement.

Adult↗
PubMed2004

Concerns regarding the follow-up of children conceived after assisted reproduction in Latin America.

Children born through assisted reproduction are not usually followed up in Latin America. However, in spite of all the social-economic and cultural complexity of this part of the world, professionals involved in assisted reproduction should not relinquish the responsibility of following up these children. In May 2002, the Centre for Human Reproduction Sinhá Junqueira, started a specific project for evaluation and follow-up of its children. It is the first centre in Brazil, and probably in Latin America, with this aim, and this paper reports initial results concerning the intellectual development of these children.

Brazil↗
PubMed1989

Nursery rhymes, phonological skills and reading.

Nursery rhymes are an almost universal part of young English-speaking children's lives. We have already established that there are strong links between children's early knowledge of nursery rhymes at 3;3 and their developing phonological skills over the next year and a quarter. Since such skills are known to be related to children's success in learning to read, this result suggests the hypothesis that acquaintance with nursery rhymes might also affect children's reading. We now report longitudinal data from a group of 64 children from the age of 3;4 to 6;3 which support this hypothesis. There is a strong relation between early knowledge of nursery rhymes and success in reading and spelling over the next three years even after differences in social background, I.Q and the children's phonological skills at the start of the project are taken into account. This raises the question of how nursery rhymes have such an effect. Our answer is that knowledge of nursery rhymes enhances children's phonological sensitivity which in turn helps them to learn to read. This paper presents further analyses which support the idea of this path from nursery rhymes to reading. Nursery rhymes are related to the child's subsequent sensitivity to rhyme and phonemes. Moreover the connection between knowledge of nursery rhymes and reading and spelling ability disappears when controls are made for differences in these subsequent phonological skills.

Achievement↗
PubMed2004

Construction of a human glycogene library and comprehensive functional analysis.

Eighteen years have passed after the first mammalian glycosyltransferase was cloned. At the beginning of April, 2001, 110 genes for human glycosyltransferases, including modifying enzymes for carbohydrate chains such as sulfotransferases, had been cloned and analyzed. We started the Glycogene Project (GG project) in April 2001, a comprehensive study on human glycogenes with the aid of bioinformatic technology. The term glycogene includes the genes for glycosyltransferases, sulfotransferases adding sulfate to carbohydrates and sugar-nucleotide transporters, etc. Firstly, as many novel genes, which are the candidates for glycogenes, as possible were searched using bioinformatic technology in databases. They were then cloned and expressed in various expression systems to detect the activity for carbohydrate synthesis. Their substrate specificity was determined using various acceptors.

Animals↗
PubMed2004

Using codon optimization, chaperone co-expression, and rational mutagenesis for production and NMR assignments of human eIF2 alpha.

Producing a well behaved sample at high concentration is one of the main hurdles when starting a new project on an interesting protein. Especially when one attempts to overexpress a eukaryotic protein in bacteria, some difficulties are encountered, such as low expression level, low solubility, or even lack of folded structure. Overexpression in prokaryotic systems is highly desirable for cost-effective production of different isotope-labeled samples needed for NMR studies. Here we describe generally applicable methods for obtaining highly concentrated protein samples efficiently. This approach was developed as we tried to produce a NMR-suitable sample of the 35 kDa human translation initiation factor eIF2 alpha, a protein that expresses poorly in E. coli and has very low solubility. First, an E. coli codon-optimized gene was synthesized on a thermal cycler, which increased the expression level by a factor of two. Second, we used co-expression of bacterial chaperone proteins, which largely increased the fraction of correctly folded protein found in the soluble phase. Third, we used rational mutagenesis guided by both the sequence alignment among homologues and the homology of one domain to a known fold for improving solubility and stability of the target protein by tenfold. Combining all these methods made it possible to produce from a one-liter preparation a 0.5 mM sample of human eIF2 alpha that showed well-resolved NMR spectra and enabled nearly complete assignment of the protein. These methods may be generally useful for studies of other eukaryotic proteins that are otherwise difficult to express and exhibit poor solubility.

Amino Acid Sequence↗
PubMed2004

[Outcomes and experiences of caring for families with children with cleft lip and palate at the Children's Hospital of Zurich].

The development and establishment of Advanced Nursing Practice is an important step toward an effective and sustainable care. Five diploma nurses of the Children's Hospital of Zurich started an ANP project in the field of children with cleft lip and palate under the guidance of an ANP Nurse. The purpose of this project was to address the needs of the families and to establish state-of-the-art care. Action research methodology built the background because it offers methods that connect theory and practice. Family management and organizational elements (project team, organization and new services) were the basic elements of the project. The goal of this paper is to present the first evaluation of this project. For instance, today, the families have the opportunity to visit the hospital before the first surgery. For the children, pain management and nutrition after surgery were adapted to state of the art knowledge. The evaluation also shows areas that need to be further developed in the future. The results emphasize, that the ANP-team projects with family management as core activity empowered the team members and led to an adaptation of nursing practices towards the needs of the families.

Child↗
PubMed2002

John G. Lindberg and the discovery of exfoliation syndrome.

John G. Lindberg, a young Finnish ophthalmology resident, started a research project in 1914 aiming at an academic dissertation. His plan was to elucidate Axenfeld's observations on iris changes in senile eyes. Axenfeld had described two types of degeneration of the iris: a hyaline degeneration of the iris pupillary zone causing poor pupillary dilatation with mydriatics and an atrophy of the iris pigment epithelium at the pupillary border. For his research Lindberg had to construct a slit-lamp biomicroscope by studying Gullstrand's monograph on the matter; slit-lamp biomicroscopes were not commercially available at that time. A Sach's lamp was used for transillumination of the iris. While conducting his research Lindberg paid attention to greyish flakes and fringes at the pupillary border. He also noted how this strange material formed a membrane on the anterior lens surface. Documentation was made by skillful hand drawings. The new phenomenon was found to be as common in cataract patients as in non-cataractous controls older than 55 years. The phenomenon was observed in 50% of glaucoma patients. Age was the decisive factor; the phenomenon was more prevalent with advancing age. Lindberg published his results as a thesis at the University of Helsinki in 1917. When attending a Nordic Congress of Ophthalmology in 1921, Lindberg met Norwegian ophthalmologist, Birger Malling, and gave him his thesis and explained the new findings. In 1920-21 Lindberg worked at Axenfeld's clinic in Freiburg, Germany. During this period he met in Basel, Switzerland, a Swiss ophthalmologist, Alfred Vogt. He told Vogt about his research and provided him with copies of his thesis. Both Malling and Vogt published papers on exfoliation in 1923 without referring to Lindberg's work. Lindberg did not, however, interfere with these papers. Thus Lindberg was forgotten by his contemporaries as a scientist. However, his main conclusions on exfoliation are still valid today. The life of this remarkable ophthalmologist is described in the present paper.

Exfoliation Syndrome↗
PubMed1998

Faculty mentoring programme--ways of reducing anonymity.

Increasing anonymity and the lack of personal contact between professor and student due to high enrolment is one of the major problems at German universities. Therefore, the Faculty of Medicine of the University of the Saarland started a pilot project in 1995. The intention was to reduce anonymity within the faculty by introducing a faculty mentoring programme (Studientutorium). A group of up to 12 students from different years is allocated a faculty member on a personal basis. The member responds to questions and problems concerning such areas as the curriculum, career planning or doctoral thesis as well as to personal problems. After 2 years participants were interviewed about the programme for the first time and the acceptance turned out to be high.

Education, Medical, Undergraduate↗
PubMed2003

CELT: a computerised evaluative learning tool for continuing professional development.

OBJECTIVES: To evaluate a computerised, evaluative learning tool (CELT) designed to encourage self-directed learning and help users make changes in practice following learning. The study aimed to evaluate how CELT was used and to ascertain user perceptions of the program. DESIGN: Qualitative analysis of interviews and quantitative analysis of entries made using the software. SETTING AND SUBJECTS: West of Scotland region, comprising six Health Board areas with a total of 2176 general practitioners (GPs), 39 of whom took part in the study. RESULTS: Of the 39 GPs who started on the project, 34 used CELT. Of these 34, 28 GPs sent in files and six did not. Of the 28 GPs who sent in files, 25 entered data and 76% (22/29) considered the program easy to use. The program was used 7 days a week during the day and night. It raised participants' awareness of the educational value of everyday experiences and led to increased thought about learning. In 41% (45/111) of entries there was evidence that some action had been initiated by users as a result of learning. CONCLUSIONS: CELT was designed to encourage self-directed learning and help users make changes in practice following learning. The study has shown that it can be used to deliver individual continuing professional development. It encourages a disciplined approach to learning, promotes thought about learning needs and increases the ability of GPs to learn from everyday experiences. In some instances, users were able to apply what had been learned.

Adult↗
PubMed2000

[CancerNet online--a contribution to improving oncologic management].

OBJECTIVE: We started the CancerNet project to evaluate the suitability of the internet to improve the quality of health care and the physician-patient relationship by offering worldwide access to high quality guidelines and standards. METHODS: Since early 1994 we have offered access to the National Cancer Institute's guidelines for current cancer therapy to physicians via WWW. These guidelines, which are provided by the NCI in accordance with the rules for evidence-based medicine, are accompanied by general information for non-professionals. Every month about 500 text-documents are HTML-encoded, linked together to about 10,000 abstracts available online as well as to MEDLINE. CancerNet is offered in English, Spanish, and German (only patient information) (http://www.meb.uni-bonn.de/cancernet/). RESULTS: From analyzing log files and user surveys in 1996, 1997, 1998, 1999, and 2000, we know that offering guidelines and patient information via the web fits most expectations of our users (physicians, health professionals, scientists, and laymen) on a high quality medical information service. Since 1994 nearly 2 million users, including more than 200,000 physicians, used our service. About 95% rated our service excellent or good.

Data Collection↗
PubMedDate not supplied

Best care for the elderly at Forsyth Medical Center.

Health care organizations are very interested in the unique needs and resource utilization the aging population will create. This article describes the commitment of a large acute-care hospital to create a senior-friendly environment. The care of hospitalized elders has become a central focus to identify and prioritize improvement opportunities. An interdisciplinary team of professionals passionate about the care of the elder population was developed to champion the efforts, and the NICHE project was their starting point. This article describes the team and the methods they used to modify models and design processes to meet the needs of the organization and this patient population. Successes and opportunities for continued improvement also are identified.

Accidental Falls↗
PubMed2003

Liveweight gain and copper status of young deer treated or untreated with copper oxide wire particles on ten deer farms in Canterbury.

AIMS: To measure the liveweight response of young deer to copper supplementation on a range of deer farms in the Canterbury region of the South Island, New Zealand, and relate any response to plasma copper concentration. METHODS: On each of 10 farms throughout north and mid-Canterbury, young deer (4-7 months old) were allocated by liveweight to two groups of 45-50. The deer in one group each received 5 g copper oxide wire particles (COWP) at the start of the project (March-June 2000) and a further 10 g COWP 3 months later (+Cu group), while the other group received no copper supplementation (-Cu group). Liveweight (+/-1 kg) of all deer was recorded monthly. A 10 ml blood sample was taken from a sub-sample of 10 animals in each group at the beginning of the trial and from the same animals 3 and 6 months later for measurement of plasma copper concentration. RESULTS: There was no significant effect (p=0.96) of treatment with COWP on liveweight gain (overall mean liveweight gain = 169 g/day). This result was consistent for all farms and for both periods. Mean plasma copper concentration declined from 12.5 (SD 3.4) to 10.3 (SD 3.0) micromol/l in +Cu groups, and to a significantly lower level (p<0.001) of 8.6 (SD 3.2) in -Cu groups after 3 months, at which time 38% of -Cu animals were considered hypocupraemic (<8 micromol/l). At the end of the second 3-month period there was no significant treatment effect on plasma copper concentration, which averaged 9.4 (SD 2.3) micromol/l. Of the feed samples submitted (n=46), only 17% had a copper concentration <5.0 mg/kg dry matter (DM), 13% had a molybdenum concentration >1.0 mg/kg, and 21% had a sulphur content >3.5 g/kg. CONCLUSIONS: Under the conditions of these trials, no response in liveweight gain to copper supplementation was observed despite evidence of hypocupraemia in 38% of -Cu animals, which gained weight at similar rates to those that had adequate plasma copper levels. The extent of the hypocupraemia was either not sufficiently severe, or not maintained for a long enough period to cause copper deficiency resulting in reduced liveweight gain. No other signs of copper deficiency were evident. There is scope for deer farmers to reassess the need for copper supplementation in young deer.

Journal Article↗
PubMed2004

Prediction of the coding sequences of mouse homologues of FLJ genes: the complete nucleotide sequences of 110 mouse FLJ-homologous cDnas identified by screening of terminal sequences of cDNA clones randomly sampled from size-fractionated libraries.

We have been conducting a mouse cDNA project to predict protein-coding sequences of mouse KIAA-homologous genes since 2001. As an extension of this project, we also started to accumulate mouse cDNA clones homologous to the human FLJ cDNA clones which are another long cDNA resource produced in our institute. We have isolated the cDNA clones from size-fractionated cDNA libraries derived from five different mouse tissues and natural killer T-cells. Although the human FLJ cDNA clones were originally derived from human spleen libraries, one-third of their mouse homologues were obtained from the brain library. We designated these homologues "mFLJ" plus a 5-digit number and herein characterized 110 mFLJ cDNA clones. We assigned an integrity of the CDSs from the comparison of the 110 cDNA clones with the corresponding human FLJ cDNA clones. The average size of the 110 mouse cDNA sequences was 3.8 kb and that of the deduced amino acid sequences from their longest CDS in each cDNA was 663 amino acid residues. Homology and/or motif search against public databases revealed new domains and/or motifs in 26 mFLJ gene products which provide additional speculation regarding the function of FLJ genes.

Animals↗
PubMed2003

Process evaluation of a cluster randomized trial of tailored interventions to implement guidelines in primary care--why is it so hard to change practice?

BACKGROUND: A cluster randomized trial of tailored interventions to support the implementation of guidelines for sore throat and urinary tract infection found little or no change in the main outcomes, which were antibiotic prescriptions, use of laboratory tests and use of telephone consultations. There was great variation between the practices in the change in these outcomes. OBJECTIVES: Our aim was to evaluate how the interventions were received and to understand why practices did or did not change. METHODS: The trial was conducted in general practices in Norway. Data for this process evaluation were collected from the 120 practices that completed the trial. Multiple methods were used: observations, semi-structured telephone interviews, a postal survey and data extracted from electronic medical records. We investigated factors that might explain a lack of change, including: agreement with the guidelines; communication within each practice; degree of participation in the project; taking time to discuss the guidelines and their implementation; use of the components of the interventions; and routines for telephone consultations. Possible explanatory factors were explored in relation to variation in change and the overall extent of change in rates of use of antibiotics, laboratory tests and telephone consultations. RESULTS: Sixty-three per cent of practices agreed with the guidelines. Only 35% reported having regular meetings, and 33% discussed the project before its start, although 75% reported agreement about participating within the practice. Only 33% reported meeting to discuss the guidelines. Use of the components of the interventions ranged from 11% for the increased fee for telephone consultations to 48% for the computerized decision support. Forty-four per cent reported problems with telephone routines. No single factor explained the observed variation in the extent of change across practices. CONCLUSIONS: Inadequate time, resources and support were the most salient factors that might explain a lack of change. Problems with internal communication and telephone routines were important contributing factors in many practices.

Cluster Analysis↗
PubMed1998

Enhancing health programme efficiency: a Cambodian case study.

In 1995, the Cambodian Urban Health Care Association (CUHCA) was set up as facilitator between private health care providers and patients, guaranteeing good quality health care and fair pricing to patients and providing training and logistic support to providers. Providers were engaged on a fee-for-service basis and competition encouraged. CUHCA's objectives followed the same line of thought as the 1993 World Development Report, aiming at influencing the unregulated private health care market through competition mechanisms. But soon after the start of the project the basic problem was recognized to be not the absence of effective government regulation but rather that consumers lack the requisite knowledge to make good choices in the market for health services. CUHCA had not adequately addressed the demand for health services. The original supply-side strategy of improving health services by increasing competition was a failure. In order to improve CUHCA's health programme efficiency the association's objectives were subsequently redefined and its functioning reorganized. CUHCA now tries to educate consumers and provides good quality services so that consumers will be able to act on the basis of their newly acquired knowledge. CUHCA's health centres serve as model clinics for first-line health care. Community educators organize information, education and communication (IEC) activities. Staff help school teachers to improve formal health education in schools and CUHCA assists local leaders in sanitation development. Only full-time personnel are employed, encouraging team spirit and communication with the target population. Salaries are based on team performance. The CUHCA programme demonstrates that, depending on the market situation, health programme models need to address both the supply and the demand for services in order to be efficient. Where consumers lack essential knowledge to make appropriate choices in the health service market, interventions should focus on health education and social marketing and provide models of quality care catering to informed consumer choice.

Cambodia↗
PubMed1998

National quality of care activities in Germany.

Quality assurance activities in Germany have a long tradition of being oriented to structural quality. For many years quality assurance in hospitals was limited to pathologist's examinations and ward rounds. The separation of health care services into in-patient and out-patient sectors has made it difficult to introduce a total quality management system. After passage of a revised social security act on quality assurance, physicians' organizations started quality management projects, which for the most part are still in the pilot phase. Many institutions and commissions are trying to develop quality assurance activities focusing on formulating practice guidelines. However, in order to make quality management a truly vital part of health care in Germany, adequate computerized documentation systems will need to be introduced.

Delivery of Health Care↗
PubMed1998

Faculty development: a field of dreams.

This chapter describes the faculty development efforts of the eight schools that participated in The Robert Wood Johnson Foundation's "Preparing Physicians for the Future: Program in Medical Education." The authors define "faculty development" as the "enhancement of educational knowledge and skill of faculty members so that their educational contributions can extend to advancing the educational program rather than just teaching within it." Faculty development programs varied widely among the schools. Some schools had active programs in place, others initiated programs at the start of the project. This chapter explores the faculty development topics and methods, both shared and unique, among the eight schools. It then looks at the ways the schools motivated their faculties to participate in their programs. Finally, it describes some of the outcome measures that were used to gauge the effectiveness of the faculty development programs. The authors conclude that the eight schools' approaches and levels of commitment to their faculty development programs varied. They present lessons learned from the successes and failures of the various programs.

Curriculum↗