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PubMed2006

Metabolomics as a functional genomic tool for understanding lipid dysfunction in diabetes, obesity and related disorders.

With the rise of systems biology, a number of approaches have been developed to globally profile a tier of organization in a cell, tissue or organism. Metabolomics is an approach that attempts to profile all the metabolites in a biological matrix. One of the major challenges of this approach, as with other 'omic' technologies, is that the metabolome is context-dependent and will vary with pathology, developmental stage and environmental factors. Thus, the possibility of globally profiling the metabolome of an organism is a genuine analytical challenge, as by definition this must also take into consideration all relevant factors that influence metabolism. Despite these challenges, the approach has already been applied to understand the metabolism in a range of animal models, and has more recently started to be projected into the clinical situation. In this review, the technologies currently being used in metabolomics will be assessed prior to examining their use to study diseases related to the metabolic syndrome, including Type II diabetes, obesity, cardiovascular disease and fatty liver disease.

Animals↗
PubMed2000

The maturation of Eurosurveillance.

The recent union of the monthly bulletin Eurosurveillance and its all-electronic sister Eurosurveillance Weekly into a unique project marked the start of a new stage in their development. Eurosurveillance began publication in 1996 and Eurosurveillance Wee

Journal Article↗
PubMed1998

Low-bandwidth telemedicine for remote orthotic assessment.

A model for performing remote orthotic assessments using low-bandwidth computer communication technology (video conferencing) was developed, tested, and evaluated. System evaluation involved comparing a series of remote assessments with on-site assessments. While most on-site and on-line results were similar, discrepancies which occurred were attributed to between-clinician differences, measurement technique differences, technical and learning obstacles at the start of the project, and within subject variations during the day. On-line assessment efficiency improved with each on-line session and corresponded with increased confidence in the system, easier system use, and better overall satisfaction. An on-line debriefing session was held with all project clinicians. These clinicians supported continued use of the communication system for rehabilitation consultation and education. Clinically. preliminary face-to-face meetings and a regular practice schedule were recommended. Technically, the system was considered good; however, suggested improvements included using a high quality speaker-phone system, streamlining the video capture process, and providing more reliable telecommunication connections.

Computers↗
PubMed1998

A model of cost-outcome analysis for assistive technology.

During the CERTAIN study (research carried out in 1994-96 within the Technology Initiative for Disabled and Elderly (TIDE) programme of the European Union), a number of real life case studies of provision of assistive technology to disabled persons were investigated in order to assess the applicability of socio-economic principles, methods and techniques already available from Health Care Technology Assessment studies. A retrospective study on cost, effectiveness and utility resulting from the implementation of assistive technology was carried out over a sample of disabled persons who had adopted technical aids before the start of the project. The sample was selected in such a way to include different pathologies (steady or progressive), impairments, ages, technology and social environment. Each case was described by considering all clinical, technical and social aspects; a common structure for case reporting was developed and tested; attempts were carried out to apply and refine concept and tools derived from health technology assessment studies; on the grounds of such experience a decision support model was elaborated for the choice between different alternatives in order to maximize the client's quality of life while making efficient use of scarce resources. A computer implementation of such a model was also developed, along with a mathematical structure of cost analysis. Within a national research programme such findings were further exploited, leading to the development of a prototype cost-outcome instrument designed for use in clinical practice in the provision of assistive technology to individual cases.

Activities of Daily Living↗
PubMed1976

ECDIN, an EC data bank for environmental chemicals.

All environmentally relevant information is computer stored for each organic chemical manufactured in quantities above 1.000 tons per year (whether it is considered as potentially toxic or not), known toxic chemicals (independently of their production figures) and certain classes of inorganic chemicals. The main data fields ("attributes" for each chemical) are: 1. substance identification and physicochemical data; 2. production and use data; 3. handling, transportation, and disposal; 4. environmental involvement (breakdown under biotic and abiotic conditions, average concentrations in environmental matrices); 5. biological effects and toxicity; 6. protection standards, administrative and regulatory data. Structure and substructure codification permits screening for substances with similar structures and coupling to GC-MS-computer analysis units with full or approximative structure outputs. A pilot project has been started permitting queries via direct and inverted file. It will include all available information on a limited number of compounds (some 5.000) from different chemical and use classes. The further software development foresees automatic indexing, automatic encoding of formatted data, automatic query formulation and search on a probabilistic basis for natural-language source data. Easy data flow is ensured by a networking between the central unit at the EC research Centre in Ispra (Italy) and specialised national data centres (ECDIN = European Chemicals Data and Information Network).

Chemical Industry↗
PubMed1997

A reengineering success story: process improvement in emergency department x-ray cycle time, leading to breakthrough performance in the ED ambulatory care (Fast Track) process.

This article describes the journey of a multidisciplinary reengineering team, which worked to reduce a critical, high-leverage process in an emergency department setting. The process selected was emergency department radiology services. This process was selected on a rational basis. The team knew tht 60 percent of our emergency department patients were truly ambulatory, and that most could be seen in a "fast track" process as part of our emergency department's core mission. However, we knew from customer satisfaction data, that patients would like to be "in and out" of emergency department Fast Track in less than an hour. Over half of our Fast Track patients require x-rays. For most, this was their sole reason for seeking emergency care. Our state, at the start of the project, included an average x-ray cycle time of over 60 minutes. The associated Fast-Track cycle time was over 90 minutes median. It was clear to the emergency department leadership, as well as to members of the Fast-Track management team, that a cycle time of 30 minutes or less for x-ray service was needed as a necessary condition to an hour or less Fast Track cycle time. It was also felt that a more rapid x-ray cycle time would allow for more rapid turn over of ED rooms, leading to a virtual greater capacity to the ED. It was hoped that this would lead to a reduction in the time from arrival to treatment by the emergency physician for all patients.

Ambulatory Care↗
PubMed1999

[Role of the government for development of umbilical cord blood bank system in Japan].

In Japan, development of umbilical cord blood transplantation is still on its preliminary stage. However, the nation-wide requests for dissemination of cord blood is growing. The Ministry of Health and Welfare established the "Committee on Umbilical Cord Blood Transplantation" last year and the committee has made the action plan to develop the nation-wide cord blood bank system. Our society is going to start the collaborative projects cooperated with medical professionals, politicians and community people.

Blood Banks↗
PubMed1999

[History of the elimination of bovine tuberculosis in the Czech Republic].

In 1968 in the Czech republic the programme of elimination of tuberculosis in cattle caused by germs of Mycobacterium bovis was successfully completed. The project proper was started in 1959 by examination of the whole population of cattle with tuberculin tests. The situation which was revealed was disastrous: the prevalence in cattle was on average 21.03% whereby it reached 32.26% in milking cows, i.e. every third cow had TB, as was also confirmed in slaughterhouses. Hundreds of cases in humans caused by M. bovis were notified. The annual economic losses were more than a billion crowns. The health campaign was based on the method "test and slaughter" and on the replacement of heavily infected herds by TB free ones. It was necessary to replace 1,360,000 heads of TB cattle. This called for the solution of many complicated methodical, legislative, organizational, economic and social problems. Mandatory pasteurization of milk was introduced. Tuberculin tests of the whole cattle population (on average twice a year) supplemented by epizootological, laboratory and postmortem examinations led to the detection of all foci. The final results are up to the present time reflected in the substantially better production capacity of the cattle, TB free milk and a marked decline of M. bovis in humans.

Animals↗
PubMed1999

[Sleep disorders in healthy children follows often a "learnt" behavioral pattern. Diurnal rhythm disturbances are dominating among children with functional disabilities].

A children's sleep disorders clinic was started as a project supported by the Swedish National Board for Health and Welfare in 1994. During the first three years 71 children, 21 girls and 50 boys aged 0.5-26 years, were clinically examined by a child neurologist/somnologist and a child psychologist. Psychological follow-up was offered. Twenty-five children were healthy, in the others several types of medical conditions were found. Twenty-five children were mentally retarded. In children with physical impairments the most common sleep problems were circadian sleep disturbances, in the healthy ones habitual insomnias were the most common finding. Taking a detailed history was important for correct sleep diagnosis and was often therapeutic. In healthy children with habitual insomnia psychological support was often successful. Melatonin was of benefit in circadian sleep disorders, and only in these. Other medications were used in a restrictive way, mostly as a temporary support.

Abnormalities, Multiple↗
PubMed1999

[The factors that influence the use of clinical protocols according to the opinion of health center coordinators. The Research Group on the Evaluation and Improvement of Clinical Protocols].

OBJECTIVES: To find the factors that affect the use of clinical protocols in primary care, in the view of primary care team coordinators, and the reasons why they are little followed, and to bring together suggestions for improvement. DESIGN: An opinion study, through a telephone survey. SETTING: Primary health care. The health centres in Murcia with protocolized activity: 31 at the start of the project. PARTICIPANTS: The coordinators and those in charge of nursing, 62 people in all. MEASUREMENTS AND MAIN RESULTS: After a pilot study, a structured telephone survey was carried out, administered by a trained interviewer who posed two open questions: why do you think that the professionals at your centre do not use the existing protocols more often? and: what suggestions would you make to improve the protocols and have them used more? A specialist company did the field-work in June and July 1996. There was a 98% reply rate. To the first question, coordinators thought that low use could be explained by excess demand and lack of time for consultations (33% of all replies), although they also cited other organisational problems in the centre, defects in protocols and lack of training. Those in charge of nursing gave very similar replies, with excess demand (39%) predominating. To the second question, on increasing the use of protocols, coordinators suggested that the protocols needed to be improved (44.8% of replies), and also cited the need for improvements in organisation and on-going training. Very similar answers came from the nursing side, where 43.5% highlighted the need to improve the protocol documents. CONCLUSIONS: The coordinators assumed that the clinical protocols were used little and could be improved. In their view the basic reason for their low use is excessive pressure from the patient-load. The key to using them more is improvement in the protocol documents.

Attitude of Health Personnel↗
PubMed2000

Competition is no barrier to cooperation for children's hospital groups.

While many think the competitive nature of modern health care may prevent rival organizations from working together, two groups that specialize in children's hospitals have proven them wrong by joining forces to benchmark on bed control. The National Association of Children's Hospitals and Related Institutions, an association of 150 children's hospitals based in Alexandria, VA, has started a benchmarking project with Medical Management Planning, a Bainbridge Island, WA-based benchmarking and consulting company.

Bed Occupancy↗
PubMed2001

Rehabilitation of the hospital infrastructure in a developing country.

Mongolia is in fact not a developing country at all but a country of transitional economy (since 1990) with a fairly comprehensive health care infrastructure. However, the health care is facing great difficulties comparable to those in a developing country. Hospital infrastructure rehabilitation was a part of a wider health sector development project with 3 remote aimags (provinces) as the target areas. The Mongolian system of health care has been built up over many years as a country-wide network of community-based feldschers and doctors, supported by a hierarchy of hospitals and mobile emergency teams. Health standards are also impacted by many factors (better housing, water supplies, better roads and rail links) outside the control of the Ministry of Health, and of health care providers. The majority of the rural hospitals lack the basic facilities. There are operating theatres without running water, hospitals with electricity only from 8 to 10 in the evening etc. The hygienic standard is unacceptable. Central heating systems do not function. Many of the facilities are underutilised and in poor condition due an ongoing lack of maintenance. The project aimed for a network that would offer services for all people, including nomadic people. The number of rural hospitals was slightly reduced and some of them were upgraded to first referral unit with basic clinical services. Approximately one third of the rural hospitals had to be rebuilt. The project recommended and started multiphased long-term master planning for those 3 aimag hospitals, all of which displayed difficulties similar to the rural hospitals.

Delivery of Health Care↗
PubMed2002

[Adenotonsillectomy in children: not yet scientifically validated].

Tonsillectomy, in 90% of cases combined with adenoidectomy, is one of the most frequently carried out operations on children in the Netherlands: in 1998 there were 33,471 operations in children aged 0-14 years. This high frequency is in stark contrast to the scientific basis for the efficacy of this intervention. A meta-analysis carried out recently revealed just one good study. The lack of scientifically based clinical guidelines, partly explains the large international and regional differences in the number of operations carried out. In the Netherlands only 35% of the children operated on satisfy one of the criteria for which the effectiveness of (adeno)tonsillectomy has been established: frequent recurrent tonsillitis or obstructive sleep apnoea. A project has been started in the Netherlands to further study the effectiveness of this intervention, the results of which must contribute to a more thoroughly substantiated indication.

Adenoidectomy↗
PubMed1999

Filling the gap. JICA Reproductive Health Project. Nghi Loe district.

Our district, which is composed of 33 communes, is economically poor with unacceptably low health conditions. Many health problems could not be adequately addressed due to the lack of needed resources and technology. But the Japan International Cooperation Agency project, which was started in 1997, has been effectively assisting us in improving the health situation, especially in reproductive health. We highly appreciate the support, which has helped us to disseminate health information to the general public, especially pregnant women. Health workers such as midwives and assistant doctors have been able to improve their skills after attending the training courses. The provision of equipment and instruments has been of great help. We would not have been able to procure them on our own budget, even over the next 10 years. One of our major concerns is the big gap in the health conditions among communes. The health conditions of people in the mountainous area are lower compared to the people in communes in and near the center of the district. The difference exists not only in the health field, but also education and economic fields. To fill the gap, we are encouraging the advanced communes to continue to develop their programs while giving much stronger assistance to the less advanced communes.

Asia↗
PubMed2002

Why entrepreneurs don't scale.

It's well known that many executives who excel at starting businesses or projects fizzle out--in other words, they fail to "scale"--as their ventures grow. But the reasons have remained fuzzy. In this article, leadership coach John Hamm identifies four management tendencies that work for small-company or business-unit leaders but become Achilles' heels as those individuals try to run larger organizations. The first tendency is loyalty to comrades. In entrepreneurial mode, you need to lead as though you're in charge of a combat unit on the wrong side of enemy lines. But blind loyalty can become a liability in managing a complex organization. The second tendency, task orientation, is critical in driving toward a big product launch, but excessive attention to detail can cause a large organization to lose sight of its long-term goals. The third tendency, single-mindedness, is important in a visionary unleashing a revolutionary product or service on the world but can limit the company's potential as it grows. And the fourth tendency, working in isolation, is fine for the brilliant scientist focused on an ingenious idea. But it's disastrous for a leader whose expanding organization increasingly relies on many other people. Leaders who scale deal honestly with problems and quickly weed out nonperformers. They see past distractions and establish strategic priorities. They learn how to deal effectively with diverse employees, customers, and external constituencies. And, most important, they make the company's continuing health and welfare their top concern.

Administrative Personnel↗
PubMed2003

Ensuring supplies of quality diethylcarbamazine citrate (DEC).

In 1997, the World Health Organization (WHO) made a commitment to eliminate lymphatic filariasis. The WHO Global Program to Eliminate Lymphatic Filariasis (WHO-FIL) needed a reliable supply of diethylcarbamazine citrate (DEC) of known acceptable quality at an affordable price, so in August 1999, it started the DEC Project. Today's standards required development of a modern stability-indicating assay method for DEC and for DEC tablet dissolution. ADD Advanced Drug Delivery Technologies (Switzerland) developed a high-pressure liquid chromatography assay, which was independently validated and is in the United States Pharmacopoeia 25 (2002). After a global search, the project found that almost all existing and potential DEC active pharmaceutical ingredient (API) and tablet manufacturers are in low-income countries. The project constructed an audit team to conduct on-site audits to assess good manufacturing practices according to European Union standards. National/state inspectors accompany the audit team. The team prequalified one DEC API manufacturer and three DEC tablet manufacturers. The project plans to increase the number of prequalified DEC manufacturers. Now, WHO-FIL only purchases from prequalified manufacturers. Consolidation of several national program DEC requirements into a limited international competitive bid reduced the price for DEC tablets between 30% and 45%, compared to previous small-scale WHO purchases.

Chromatography, High Pressure Liquid↗
PubMed2003

[Experiences from practical guideline development--proposal of a more standardized guideline development process].

In this article, the authors of the ,,General Practitioners' Guideline for the Diagnosis and Treatment of Urinary Incontinence" describe the logical and procedural steps involved in the development process of this evidence-based GPs' guideline for the management of urinary incontinence. Specifically, the following factors have been identified as crucial for a successful primary care guideline development process: The work group (authors) should comply in size with current recommendations for successful project work teams. It is recommended that authors should belong to opposing ends of the spectrum of practical versus theoretical medicine. We argue that the integration of both practical experience and theoretical knowledge/research experience be combined in order to collate guideline recommendations that are firmly grounded in scientific evidence and both applicable and acceptable in everyday practice. Proper work on a guideline development project should only start after ensuring that the well-known theoretical requirements for sensible guidelines are met, i.e. the problem in our special focus should be widespread or of considerable economic/public health importance, be amenable to proper medical intervention, and some quality issue regarding the current handling of this problem should have been demonstrated. Subsequently, a clear logical analysis of the problem's inherent functional/logical/practical subdivisions has to be conducted. Each author is then allocated his or her fair share of the work. The next step is considered to be extremely important and consists of discovering one's "illusive correlation", i.e. inherent ideas one has on the subject without being aware of one's own bias. The proposed "trick" now consists of making the implicit bias an explicit fact in the further guideline development process. The remaining work steps build on the integration of one's preformed ideas with current, published opinion from standard textbooks, as well as existing guidelines and non-guideline recommendations on the subject; plus taking into account the practical experience gathered from interviews and "on-location-visits". This integration process is performed within a structured framework to facilitate objectivity and transparency of the entire guideline.

Evidence-Based Medicine↗
PubMed2001

Ecological distribution of mosquito larvae of the Anopheles punctulatus group on Niolam (Lihir) Island, Papua New Guinea.

We surveyed the larval habitats of members of the Anopheles punctulatus group of mosquitoes on Niolam (Lihir) Island, Papua New Guinea. Identification of this group was undertaken by polymerase chain reaction-restriction fragment length polymorphism analysis of the amplified internal transcribed spacer unit 2 of rDNA, because morphologic separation of member species is unreliable. The most widespread malaria vector species and their most common larval habitats were identified to aid source-reduction programs for malaria control. The most ubiquitous species was An. punctulatus, followed by An. farauti no. 2. then An. farauti s.s. Anopheles punctulatus has increased relative to An. farauti s.l. since the start of development projects on Lihir Island. The most common larval habitats were shallow temporary pools with clay substrate and with plants or floatage. These habitats, mostly encountered alongside poorly drained roads, may be increased by development projects.

Animals↗