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PubMed1977

[Simplfied technique of lumbar subarachnoid-peritoneal shunt (author's transl)].

The authors have developed a simplified technique of lumbar subarachnoid peritoneal shunt in which the spinal tube is easily introduced through a puncture needle without doing a laminectomy. Seventeen cases of communicating hydrocephalus of various orgin have been treated by this procedure. In this paper, we reported our shunting system and the technique of precedures, and discussed the clinical results and some advantages of this method. The spinal tube is a custom made Silastic tube with small side holes 2 mm apart from each other at slanting tip located within the first 1.0 cm of the end. French No. 5 tube is available for older children and for adults, and French No. 3.6 tube for infants. Total length of the tube measures 30 cm with 4 black markers at 5 cm intervals from the tip for assisting in positioning. The puncture needle is a modified Touhey needle. Two needles different in size are prepared according to the size of the tube. Outer diameter of these needles is 2.1 mn & 1.8 mn. Our operative procedures are divided into following three steps. 1) Puncture of the lumbar subarachnoid space and insertion of the spinal tube through the needle. 2) Introduction and placement of the peritoneal tube into some point of the peritoneal cavity. Concerning to this point, we have the three candidates, namely into the Douglas pouch, the suprahepatic space, and the bursa omental cavity. 3) Connection of the spinal tube and the peritoneal catheter end. We used a kind of flushing device only in some exceptional cases, and recently, we feel that it is not so necessary for this shunting. We have employed this technique in a total of 17 cases. Eleven cases of them are adults and the other 6 cases are children less than 2 years of age. Postoperative follow up period varied from 13 months to 1 month, and all the cases except two had good result, suggesting the shunt system is working well with no evidence of complications such as low pressure syndrome or radicular irritation. Some troubles occurred in two children. One was a disconnection between the spinal and the peritoneal tube, and the other was an obstruction at the peritoneal tube end. The authors believe that our L-P shunt has several advantages as listed below, 1)Procedure is very simple, in other words, there is no need of laminectomy. 2) The entire system is short. 3) No need to pass the catheter into the brain tissue. 4) Obstruction of the spinal catheter end is very unusual. 5) Alteration of communicating hydrocepalus into non communicating one by secondary obstruction of aqueduct of Sylvius is less likely with this shunting system. 6) Siphon effect might be minimal, if present. 7) As compared to V-A shunt, severe complication like septicemia will not occur in the L-P shunt. With this simple method and good material, we hope that this L-P shunt is employed more widely for the patients with communicating hydrocephalus.

Cerebrospinal Fluid Shunts↗
PubMed2000

Stress management intervention for primary prevention of hypertension: detailed results from Phase I of Trials of Hypertension Prevention (TOHP-I).

PURPOSE: Stress Management Intervention (SMI) was one of seven nonpharmacologic approaches evaluated in Phase I Trials of Hypertension Prevention (TOHP-I) for efficacy in lowering diastolic blood pressure (BP) in healthy men and women aged 30 to 54 years with diastolic BP 80-89 mm Hg. METHODS: A total of 242 and 320 participants were randomized to SMI or an "assessment only" SMI Control, respectively, at four clinical centers. The SMI consisted of 37 contact hours in 21 group and two individual meetings over 18 months and included: training in four relaxation methods, techniques to reduce stress reactions, cognitive approaches, communication skills, time management, and anger management within a general problem-solving format. Standardized protocols detailed methods and timing for collecting BP, psychosocial measures, and urinary samples from both SMI and SMI Control participants. RESULTS: In intention-to-treat analyses, although significant baseline to termination BP reductions were observed in both groups, net differences between the SMI and SMI Control groups' BP changes (mean (95% CI)) were not significant: -0.82 (-1.86, 0.22) for diastolic BP, and -0.47 (-1.96, 1.01) for systolic BP. Extensive adherence sub-group analyses found one effect: a significant 1.36 mm Hg (p = 0.01) reduction in diastolic BP relative to SMI Controls at the end of the trial for SMI participants who completed 61% or more of intervention sessions. CONCLUSIONS: While the TOHP-I SMI was acceptable to participants as evident from high levels of session completion, the absence of demonstrated BP lowering efficacy in intention-to-treat analyses suggests that the TOHP-I SMI is an unlikely candidate for primary prevention of hypertension in a general population sample similar to study participants. The isolated finding of significant diastolic BP lowering in SMI participants with higher adherence provides very weak evidence of SMI BP lowering efficacy and may be a chance finding. Whether similar or other stress management interventions can produce significant BP lowering in populations selected for higher levels of BP, stress, or intervention adherence remains to be demonstrated.

Adult↗
PubMed2002

Reliability and validity of a new caliper for measuring patellar thickness.

The process of patellar resurfacing during total knee arthroplasty involves measuring patellar thickness. The optimal residual patellar bone thickness has been questioned. The surgeon's ability to measure patellar thickness currently rests on a standard caliper. Standard methods involve use of a smooth-mouthed caliper, which can overestimate patellar thickness because of soft tissue interposition. This brief communication introduces a new spiked caliper design that can be used to measure patellar bone thickness more accurately. Improved accuracy in measuring patellar bone thickness allows the operating surgeon to assess more correctly a patient's patellar bony status. This knowledge may result in fewer postoperative fracture complications resulting from deficiencies of bone owing to excessive resection.

Arthroplasty, Replacement, Knee↗
PubMed2004

Ecological footprint of Shandong, China.

Ecological footprint has been given much attention and widely praised as an effective heuristic and pedagogic device for presenting current total human resource use in a way that communicates easily to almost everyone since 1996 when Wackernagel and Rees proposed it as a sustainable development indicator. Ecological footprint has been improving on its calculation and still can be a benchmark to measure sustainable development although there are still ongoing debates about specific methods for calculating the ecological footprint. This paper calculates the ecological footprint of Shandong Province, China with the methodology developed by Wackernagel and analyzes the current situation of sustainable development in Shandong.

Animals↗
PubMed1997

Resident partnerships: an effective strategy for training in primary care.

BACKGROUND AND OBJECTIVES: To facilitate resident training in the ambulatory setting, a few family practice residency programs use a partnership system to train residents. Partnerships are pairs of residents from the same year that rotate together on inpatient services. We identified and characterized the advantages and disadvantages of partnership programs in family practice residencies. METHODS: We conducted a national survey of family practice residencies, followed by phone interviews with residency directors of programs with partnerships. RESULTS: A total of 305 of 407 (75%) residencies responded; 10 programs fit our definition of partnership. Program directors were positive about resident partnerships. Benefits included improved outpatient continuity, enhanced medical communication skills, and emotional and intellectual support. Disadvantages were decreased inpatient exposure and difficulty coordinating residents' schedules. CONCLUSIONS: Directors were favorable about partnerships, which seem to be an underutilized technique to improve residency training.

Family Practice↗
PubMed2000

Profile of medical student teaching in radiology: teaching methods, staff participation, and rewards.

RATIONALE AND OBJECTIVES: The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching. MATERIALS AND METHODS: Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods. RESULTS: Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments. CONCLUSION: Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.

Clinical Clerkship↗
PubMed1980

[Statistical method of determining distribution of foci in infectious diseases].

Primary infections in organized groups have been found to correspond to the Poisson distribution. This fact is the basis of the statistical method for determination of lhe distribution of foci, the equation is proposed wherein the following data are used: the total number of cases, the total number of organized groups, the number of groups tree of infection, the average size of a group, and the time of observations. The use of foci distribution index for the statistical determination of distribution of foci in varicelfa and parotitis has allowed the author to reveal regularities characteristic of the epidemic process in these infections.

Communicable Diseases↗
PubMed1995

The long-term effectiveness of a radiology memorandum.

RATIONALE AND OBJECTIVES: This informal prospective study was designed to document the long-term effectiveness of a radiology department policy memorandum as a communication tool. A memorandum outlining the departmental policy regarding radiographic imaging of pregnant or possibly pregnant patients served as the study model. METHODS: A departmental obstetric policy memorandum was distributed to all radiology personnel, including faculty and residents. The effectiveness of the memorandum was measured by the ability of all department personnel to answer specific test questions about the policy 1 year after its distribution. RESULTS: Nine (41%) in the faculty/fellow group and seven (41%) residents gave partially correct answers about policy content. There were no totally correct policy content answers in either group. Thirty-eight (64%) of the technology staff knew the entire policy content. CONCLUSION: Staff radiologists, fellows, and residents demonstrated an unacceptable level of knowledge concerning the policy content and location. Technologists, technology students, and clerks demonstrated a more acceptable level of knowledge of the policy than did radiologists. A single memorandum without repetition or constant surveillance is not an effective communication tool to alert radiologists to the importance of understanding and implementing policy directives.

Clinical Competence↗
PubMed2003

[Infection surveillance in North Rhine-Westphalia--standard reports, barometer and early warning system].

The increasing significance of communicable diseases requires new surveillance tools. Modern electronic instruments in analysis and communication replace the former "handbased" statistics and allow the development of early warning systems. In North Rhine-Westphalia (NRW) the Institute of Public Health started an approach to develop a modular surveillance system prior to the the implementation of the new German infectious disease protection act. The first module called "Automated infectious disease notifications and information system (AIM+)" generates various standard hypertext reports which are published as "Infectious disease reports NRW" on the internet (www.loegd.nrw.de). In addition the infectious disease information is linked with a geographical information system (GIS) giving spatial and temporal patterns. The second module called "Infectious disease barometer NRW" offers a quick actual overview highlighting several selected diseases. It can be electronically sent out to any interested person. The third module "Early warning system" realizes an effective early detection system by combining six statistical procedures with a total of 11 separate methods. In case of detecting clusters and outbreaks it automatically generates warning reports to the responsible parties. All three modules together improve the epidemiological surveillance of the population in NRW, support the translation of information to prevention and control measures, and therefore strengthen epidemiological policy-making.

Communicable Disease Control↗
PubMed2006

Does pervasive developmental disorder protect children and adolescents against drug and alcohol use?

AIM: The aim of this paper is (1) to compare the rates of reported drug and/or alcohol use (DAU) in treatment seeking adolescents with Pervasive Developmental Disorders (PDD), and those with other psychiatric diagnoses (psychiatric controls) seen in tertiary child and adolescent mental health services and (2) to explore the relationship of psychopathology, environmental stressors, and social communication difficulties to DAU. METHOD: Data from the chart review of children and adolescents aged between 12 and 18 years with psychiatric diagnosis seen in tertiary child and adolescent mental health services between 1992 and 2001 (n=1484) was used to investigate the relationship between DAU, psychopathology, environmental stressors and items related to social communication. RESULTS: A total of 97 subjects (7%) met criteria for PDD. Subjects with PDD report significantly lower DAU than psychiatric controls, 3% vs. 17% respectively (P<0.000). Factors reflecting PDD such as speech and language difficulties, developmental difficulties, discordant peer relationships in adolescents are negatively associated with DAU, while conduct problems, affective symptoms, inadequate parental supervision or control have positive association with DAU. DAU was present in PDD only when comorbid with Attention Deficit Hyperactivity Disorder (ADHD). CONCLUSION: Adolescents with speech and language difficulties, developmental difficulties and discordant peer relationships, all reflecting PDD, are less likely to have DAU.

Adolescent↗
PubMed2006

A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms.

BACKGROUND: Somatizing patients are a challenge to general practitioners (GPs). A cluster randomized controlled trial was conducted to asses the effect of specific communication techniques delivered by GPs on somatizing patients' self-perceived health. METHOD: Thirty-nine GPs were assigned randomly to two parallel groups. GPs in the intervention group treated somatic patients according to specific communication techniques focused on offering a physical explanation - release of hormones - and approaching sensitive topics in the patient's experience indirectly. Control GPs used the standard Goldberg reattribution technique. A total of 156 patients, aged 18-65 years, were selected randomly from a list of 468 patients with six or more active symptoms for women and four or more for men. All patients had six programmed 30-min consultations. Health-related quality of life (assessed with the 36-item Short-Form Health Survey, SF-36) and a summary utility index were used as outcome measures. Patients were interviewed at home at baseline and at 3, 8 and 12 months after the beginning of the intervention. RESULTS: Patients in both groups improved in all dimensions of the SF-36. The time course of the quality of life was significantly better for the intervention group in five of the eight scales of the SF-36 (bodily pain, mental health, physical functioning, vitality, and social functioning) and in the utility index (p<0.039). CONCLUSIONS: Communication techniques were found to have a clinically relevant impact on body pain. This finding, together with a trend towards better scores in the remaining scales, justifies the use of these techniques in psychosocial interventions delivered to patients with medically unexplained symptoms.

Adolescent↗
PubMed2000

Variability of molecular descriptors in compound databases revealed by Shannon entropy calculations

A method is introduced to calculate and compare the variability of molecular descriptors in compound databases. Descriptor variability analysis is based on histograms recording the distribution of molecular descriptors and calculation of Shannon entropy (SE), a metric originally applied in digital communication. SE values reflect the variability of descriptor settings. We have calculated a total of 92 molecular descriptors in the ACD and NCI databases and ranked them according to their variability. Significant differences in entropy are observed for a number of descriptors. However, the most variable descriptors are similar in the ACD and NCI databases. Such high-entropy descriptors are preferred tools to discriminate between compounds or account for the diversity of chemical libraries.

Journal Article↗
PubMedDate not supplied

An integrated approach to hospital strategic planning, quality assurance, and continuous quality improvement.

Like many other healthcare organizations today, the authors' facility, a 306-bed acute care community hospital in Michigan, strives to visualize and make a transition from traditional quality assurance to continuous quality improvement. The Juran Trilogy provided the insight that strategic planning, measurement, and continuous improvement must exist side by side. At the authors' facility, this realization resulted in the hospital quality plan, which treats each of these components as part of the foundation for quality. The authors explain this model and the reporting and communication mechanisms that support it.

Communication↗
PubMed2005

Hereditary breast/ovarian and colorectal cancer genetics knowledge in a national sample of US physicians.

BACKGROUND: Clinically relevant genetics knowledge is essential for appropriate assessment and management of inherited cancer risk, and for effective communication with patients. This national physician survey assessed knowledge regarding basic cancer genetics concepts early in the process of introduction of predictive genetic testing for breast/ovarian and hereditary non-polyposis colorectal cancer (HNPCC) syndromes. METHODS: A stratified random sample was selected from the American Medical Association Masterfile of all licensed physicians. In total, 1251 physicians (820 in primary care, 431 in selected subspecialties) responded to a 15 minute questionnaire (response rate 71%) in 1999-2000. Multivariate logistic regression analyses were conducted to identify demographic and practice characteristics associated with accurate response to three knowledge questions. RESULTS: Of the study population, 37.5% was aware of paternal inheritance of BRCA1/2 mutations, and 33.8% recognised that these mutations occur in <10% of breast cancer patients. Only 13.1% accurately identified HNPCC gene penetrance as >or=50%. Obstetrics/gynaecology physicians, oncologists, and general surgeons were significantly more likely than general and family practitioners to respond accurately to the breast/ovarian questions, as were gastroenterologists to the HNPCC question. CONCLUSIONS: These nationally representative data indicate limited physician knowledge about key cancer genetics concepts in 1999-2000, particularly among general primary care physicians. Specialists were more knowledgeable about syndromes they might treat or refer elsewhere. Recent dissemination of practice guidelines and continued expansion of relevant clinical literature may enhance knowledge over time. In addition to educational efforts to assist physicians with the growing knowledge base, more research is needed to characterise the organisational changes required within the healthcare system to provide effective cancer genetics services.

Adult↗
PubMed2002

Infections and course of disease in mild forms of Guillain-Barré syndrome.

OBJECTIVE: Twenty-eight percent of patients with the Guillain-Barré syndrome remain able to walk unaided. Studying patients with the mild form of Guillain-Barré syndrome can further contribute to knowledge of the spectrum of the syndrome and explore whether this subgroup may need treatment with IV immunoglobulin. METHODS: Patients fulfilling the National Institute of Neurologic and Communicative Disorders and Stroke criteria for Guillain--Barré syndrome were included in a nationwide survey over a 2-year period. Clinical characteristics and serum samples were collected prospectively. In addition, a questionnaire was completed concerning the course and outcome of the disease. RESULTS: A total of 139 patients were included. Nineteen of the patients (14%) included were mildly affected, and 120 (86%) were severely affected. Infections with Epstein-Barr virus were found more frequently in mildly affected patients (p = 0.02). Antiganglioside antibodies were less frequently found in the mildly affected patients (p = 0.03). The degree of severity of the disease between mildly and severely affected patients was different on the day of admission (p < 0.01). Thereafter, the groups showed a remarkably similar rate of progression. Thirty-eight percent of mildly affected patients report problems in hand function and an inability to run at 3 and 6 months (all women, p = 0.02). CONCLUSION: The difference in severity of Guillain--Barré syndrome seems to be determined in an early phase of the disease. Preceding infections and antiganglioside antibodies may influence the initial immune attack, determining the severity of the disease. The presence of residual signs in patients with mild disease may advocate the use of early treatment in mildly affected patients.

Bacterial Infections↗
PubMed2006

A geographic information systems-based, weights-of-evidence approach for diagnosing aquatic ecosystem impairment.

A Geographic Information Systems-based, watershed-level assessment using Bayesian weights of evidence (WOE) and weighted logistic regression (WLR) provides a method to determine and compare potential environmental stressors in lotic ecosystems and to create predictive models of general or species-specific biological impairment across numerous spatial scales based on limited existing sample data. The WOE/WLR technique used in the present study is a data-driven, probabilistic approach conceptualized in epidemiological research and both developed for and currently used in minerals exploration. Extrapolation of this methodology to a case-study watershed assessment of the Great and Little Miami watersheds (OH, USA) using archival data yielded baseline results consistent with previous assessments. The method additionally produced a quantitative determination of physical and chemical watershed stressor associations with biological impairment and a predicted comparative probability (i.e., favorability) of biological impairment at a spatial resolution of 0.5 km2 over the watershed study region. Habitat stressors showed the greatest spatial association with biological impairment in low-order streams (on average, 56% of total spatial association), whereas water chemistry, particularly that of wastewater effluent, was associated most strongly with biological impairment in high-order reaches (on average, 79% of total spatial association, 28% of which was attributed to effluent). Significant potential stressors varied by land-use and stream order as well as by species. This WOE/WLR method provides a highly useful "tier 1" watershed risk assessment product through the integration of various existing data sources, and it produces a clear visual communication of areas favorable for biological impairment and a quantitative ranking of candidate stressors and associated uncertainty.

Bayes Theorem↗
PubMed2004

[Development and assessment of simulated patient based curricular unit in order to improve clinical skills in adolescent medicine of pediatric and family practice residents].

OBJECTIVE: This study describes the development and evaluation of a curricular program aimed at improving the clinical and communication skills required for managing the clinical encounter with adolescents, among pediatric and family practice residents using the technique of standardized patients. METHODS: A daylong curricular unit which included: clinical interviews with simulated patients presenting typical clinical problems occurring among adolescents; a teaching unit explaining the principles of communication with adolescents and a clinical discussion and feedback session using video clips. Forty-eight residents in pediatrics and family practice undertook the curricular unit. A total of 120 doctor-simulated patient interviews were documented using six patients' case scenarios representing somatization disorder, eating disorder, chronic illness and non-compliance, pregnancy, drug abuse and menstrual disorder. RESULTS: The doctors' self-estimation of clinical skills associated with adolescent medicine that was documented at the beginning of the curricular unit was generally reported as low. In most of the cases the participants did not identify the main problem and diagnoses that were presented. The problems least correctly diagnosed were eating disorder and non-compliant chronic illness. Only in the cases of somatization and pregnancy more than half of the residents identified the problems that were presented. At the end of the curricular unit the doctors expressed a very high level of satisfaction with the program. CONCLUSION: The present study developed and evaluated a short and structured curricular unit dealing with the principles of communication with adolescent patients using the technique of simulated/standardized patients. It was found that the lack in these skills, which was identified in pediatric and family practice residents, could be bridged using this educational technique.

Adolescent↗
PubMed1996

Total quality management and the reduction of inpatient violence and costs in a forensic psychiatric hospital.

OBJECTIVE: The study evaluated the effects of using the principles of total quality management (TQM) to reduce aggressive incidents in the dining rooms at a state forensic hospital. METHODS: A ten-member, multidisciplinary team, which included a patient representative and a private-sector mentor, used the TQM FADE method (focus, analyze, develop, and execute) to address the problem. The team analyzed violent mealtime incidents, reviewed mealtime policies and procedures, and conducted a patient survey. Five recommendations were made: substitute plastic utensils for silverware, play music selected by the hospital's music therapists, allow patients at the highest privilege levels to leave the dining room after eating, open the main courtyard and gym during meals, and train food service workers in therapeutic communication. RESULTS: One year after implementation of the recommendations, aggressive incidents in the dining rooms were reduced by 40 percent, assaults using silverware were eliminated, and a total of 70 nursing staff hours a day were saved by eliminating silverware control procedures in the dining rooms. The milieu in the dining rooms has been improved by the addition of music and more flexible procedures. CONCLUSIONS: TQM techniques can be effectively applied in public-sector institutions to analyze and solve problems such as mealtime violence.

Antisocial Personality Disorder↗