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PubMed1994

Loss of endothelium-dependent vasodilatation and nitric oxide release after myocardial protection with University of Wisconsin solution.

University of Wisconsin solution has proved to be a superior form of cardioplegia for cardiac transplantation, demonstrating better functional recovery than that provided by extracellular crystalloid solutions. Furthermore, experimental data have suggested a role for University of Wisconsin solution in protection of the neonatal heart during operations for congenital heart defects. However, significant concerns have been raised regarding potential endothelial injury from the high potassium concentration contained in University of Wisconsin solution that could affect its safety and thus its clinical application. Fourteen neonatal (aged 1 to 3 days) piglet hearts were harvested and supported on an isolated, blood-perfused circuit. Endothelium-dependent vasodilatation was measured by bradykinin (10(-6) mol/L) infusion and nitric oxide release was determined. Endothelium-independent vasodilatation was then induced by sodium nitroprusside (10(-6) mol/L) infusion. A 2-hour period of cold cardioplegic arrest was instituted with multidose University of Wisconsin solution (group 1, n = 7) or blood cardioplegia (group 2, n = 7). After reperfusion and stabilization, another stimulation with bradykinin and nitroprusside was carried out and nitric oxide was again measured. After 2 hours of arrest with University of Wisconsin solution, there was a near-complete loss of vasodilatation in response to bradykinin infusion; coronary blood flow reached 245% of baseline before arrest versus only 117% of baseline after arrest (p = 0.0011). This correlated with an inability of the endothelium to release nitric oxide (96 +/- 30 nmol/min before arrest versus -32 +/- 9 nmol/min after arrest, p = 0.0039. In group 2, the vasodilatory response to bradykinin was preserved after arrest and reperfusion; 265% of baseline before arrest versus 222% of baseline after arrest. These results demonstrate a loss of endothelium-dependent vasodilatation after multidose University of Wisconsin cardioplegia caused by the inability of the endothelium to release nitric oxide. In contrast, blood cardioplegia does not result in impaired endothelial function.

Adenosine↗
PubMedDate not supplied

One-hour exposure to University of Wisconsin solution does not impair endothelium-dependent relaxation or damage vascular smooth muscle of epicardial coronary arteries.

To determine whether University of Wisconsin solution impairs production of endothelium-derived relaxing factor or damages vascular smooth muscle function of epicardial coronary arteries, isolated segments of canine left circumflex coronary artery were exposed to either cold (7 degrees C) or normothermic (37 degrees C) University of Wisconsin solution or to cold (30 degrees C) or normothermic (37 degrees C) physiologic salt solution in vitro for 60 minutes. After incubation with the solutions, the vascular segments were studied in vitro in organ chambers. Exposure to cold or to normothermic University of Wisconsin solution did not alter endothelium-dependent relaxation (either maximal relaxation or ED50) of the segments in response to adenosine diphosphate or acetylcholine (10(-9) to 10(-4) mol/L). Also, contraction of the segments in response to potassium ions (voltage-dependent) or prostaglandin F2 alpha (receptor-dependent) and relaxation in response to isoproterenol (cyclic AMP-mediated) or sodium nitroprusside (cyclic GMP-mediated) were unaltered after exposure to cold University of Wisconsin solution. Direct exposure to normothermic University of Wisconsin solution induced transient vasoconstriction in segments with or without endothelium. Thus University of Wisconsin solution does not irreversibly impair release of endothelium-derived relaxing factor or alter function of vascular smooth muscle in epicardial coronary arteries.

Adenosine↗
PubMed1996

DNA computing based on splicing: universality results.

The paper extends some of the most recently obtained results on the computational universality of specific variants of H systems (e.g. with regular sets of rules) and proves that we can construct universal computers based on various types of H systems with a finite set of splicing rules as well as a finite set of axioms, i.e. we show the theoretical possibility to design programmable universal DNA computers based on the splicing operation. For H systems working in the multiset style (where the numbers of copies of all available strings are counted) we elaborate how a Turing machine computing a partial recursive function can be simulated by an equivalent H system computing the same function; in that way, from a universal Turning machine we obtain a universal H system. Considering H systems as language generating devices we have to add various simple control mechanisms (checking the presence/absence of certain symbols in the spliced strings) to systems with a finite set of splicing rules as well as with a finite set of axioms in order to obtain the full computational power, i.e. to get a characterization of the family of recursively enumerable languages. We also introduce test tube systems, where several H systems work in parallel in their tubes and from time to time the contents of each tube are redistributed to all tubes according to certain separation conditions. By the construction of universal test tube systems we show that also such systems could serve as the theoretical basis for the development of biological (DNA) computers.

Alternative Splicing↗
PubMed2004

Clinical trial performance of community- vs university-based practices in the submacular surgery trials (SST): SST report no. 2.

OBJECTIVE: To compare the performance of community- vs university-based clinical centers in 3 multicenter randomized clinical trials of intraocular surgery. METHODS: Each Submacular Surgery Trials clinical center was classified as a university-based center, if the contract to perform as a center was signed by a university official, or as a community-based center. The 2 groups of centers were compared on performance, assessed cumulatively by the Submacular Surgery Trials Quality Assurance and Monitoring Subcommittee. OUTCOME MEASURES: Patient accrual, completion of scheduled examinations, completion of masked vision examinations 2 years after enrollment (the designated primary study end point evaluation time), timeliness of submission of retinal photographs required by protocol to the Photograph Reading Center, completion of health- and vision-related quality-of-life interviews, and timeliness of submission of the primary outcome data to the Coordinating Center after completion of the examination. RESULTS: Almost all centers performed at a very high (good) level, although there was a trend for some community-based centers to be at the lower end of most distributions. CONCLUSIONS: Most community- and university-based centers performed well in these multicenter clinical trials. Monitoring performance and periodically providing feedback to clinical center investigators may encourage excellent performance in areas critical to the success of clinical trials, regardless of whether the center is community or university based.

Choroidal Neovascularization↗
PubMed1998

Compliance with universal precautions among pediatric residents.

BACKGROUND: There are few data on the rate of compliance with universal precautions among pediatricians. We hypothesized that compliance in pediatrics would be poor because of the intrinsic difficulties in performing invasive procedures in small subjects. DESIGN: Prospective, observational study. SETTING: Tertiary care children's hospital. STUDY PARTICIPANTS: A convenience sample of pediatric house staff. MAIN OUTCOME MEASURES: Pediatric house staff members were observed while performing invasive procedures. Procedure type, number of attempts required, and patient's age and diagnosis were recorded. Degree of compliance with universal precautions was judged by means of Centers for Disease Control and Prevention guidelines. Comparisons between the compliant and noncompliant groups were analyzed by chi2 and 2-tailed t test. RESULTS: A total of 128 procedures performed by 43 house officers, 4 advanced medical students, and 3 chief residents or fellows were observed. Sixty-nine (53.9%) of the 128 procedures were performed correctly according to universal precaution guidelines. Rate of compliance did not appear to be influenced by small patient size, as judged by the lack of association with the age of the patient (mean+/-SD, 4.8+/-5.7 years among those in whom universal precautions were properly used vs 4.9+/-5.4 years among patients in whom precaution guidelines were breached; P=.96). Moreover, the number of attempts required in compliant procedures (1.31+/-0.53) was almost identical to that in noncompliant procedures (1.28+/-0.49; P=.73). Additionally, compliance did not improve with advanced level of training. CONCLUSIONS: Failure of compliance among pediatricians has no apparent association with procedure difficulty, and compliance rates continue to be poor through the course of pediatric training. These findings underline the need for effective education concerning universal precautions throughout pediatric residency, and they suggest that such efforts will not be precluded by obstacles intrinsic to performing invasive procedures on young subjects.

Humans↗
PubMed1997

The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment.

CONTEXT: The government of Taiwan introduced universal health insurance to cover all citizens in 1995. This national health insurance program was proposed to assure the accessibility to health care at reasonable cost. Evaluation of the consequences, including health care utilization and expenditure, is crucial for policy adjustment. OBJECTIVES: To evaluate the effect of Taiwan's national health insurance on health care utilization. DESIGN: Cohort survey conducted before and after the implementation of the national health insurance program. PARTICIPANTS: A total of 1021 randomly selected Taiwanese adults. MAIN OUTCOME MEASURES: Physician visits in the 2 weeks prior to the survey and hospital admissions and emergency department visits in the immediate past year. RESULTS: After the introduction of universal health insurance, the newly insured consumed more than twice the amount of outpatient physician visits (0.21 vs 0.48, P<.05) and hospital admissions (0.04 vs 0.11, P<.05) than before universal health insurance was implemented, bringing them to the same amount of health care contacts as the previously insured group. The newly insured also experienced an insignificant increase in emergency department visits. In contrast, the previously insured group had a small but statistically significant increase in outpatient visits (0.48 vs 0.59, P<.05) and insignificant changes in hospital admissions and emergency department visits. CONCLUSION: The universal health insurance removed some barriers to health care for those newly insured. The copayment design in the insurance scheme seemed to have an insignificant effect on curbing medical care utilization. Taiwanese health policy analysts should seriously consider the growth of health care expenditures since the implementation of universal health insurance.

Adult↗
PubMed2003

Performance on the CERAD Word List Memory task: a comparison of university-based and community-based groups.

BACKGROUND: Evaluation of patients for Alzheimer's disease often compares an individual's performance on cognitive tests to established norms. The purpose of this study was to compare performance on the CERAD Word List Memory tasks in normal controls from an Alzheimer's disease registry and in community volunteers. METHODS: Scores on Word List Memory tasks were evaluated in cognitively intact participants enrolled in a university-based Alzheimer's disease registry (n=103) and in a sample of community volunteers (n=51). Scores for the two samples were also compared with previously published data from registry-based normal controls and from a representative community-based sample. RESULTS: University-based participants outperformed community volunteers, with most marked differences on Delayed Recall and on a Savings score that contrasted immediate to delayed recall. University-based participants performed similarly to previously published scores for normal controls from another university-based Alzheimer's disease registry, while community volunteers were consistent with published scores available from a representative community sample. CONCLUSIONS: Accurate neuropsychological assessment of Alzheimer's disease may require consideration of potentially subtle differences between older adults tested at university centers and those tested in the community.

Aged↗
PubMed1996

Two rules for early prediction of bacteremia: testing in a university and a community hospital.

BACKGROUND: Two rules (model 1 and model 2) were previously derived and prospectively validated at the same institution to predict the likelihood of bacteremia. The objective of the present study was to test and compare the performance of the rules in patients admitted to two sites of inpatient care: a university hospital and a community hospital. METHODS: Clinical and laboratory data (including the variables contained in the two models) were collected within 24 hours in all patients admitted to the Department of Medicine of the Beilinson Medical Center, a university hospital in central Israel, and Emek Hospital, a community hospital in northern Israel, because of an acute infectious disease. The scores of the models were compared with the results of blood cultures. RESULTS: The percentage of bacteremia was 15% in the university and 18.5% in the community hospital. The area under the receiver-operating characteristic curve was 0.56 + or - 0.04 SE for model 1, and 0.67 + or - 0.04 SE for model 2 in the university hospital; and 0.59 + or - 0.05 SE versus 0.63 + or - 0.04 SE, respectively, in the community hospital. At the best calibration, model 1 defined low-risk groups of 205 patients in the university hospital, and 66 patients in the community hospital, with prevalences of bacteremia of 13% and 15%. The high-risk groups defined by model 1 had prevalences of 30% and 32%. Model 2 defined low-risk groups with prevalences of bacteremia of 7% (8 of 114) and 8% (6 of 76); and high-risk groups with percentages of 29% and 38%. CONCLUSIONS: The overall accuracy of the two models deteriorated significantly. Both models defined groups at high risk of bacteremia, but the percentages of bacteremia and of death in the low-risk groups do not encourage withholding blood cultures in these patients. The failure of the two models points toward the need for external validation, and for monitoring performance of prediction models over time.

Adolescent↗
PubMed1998

[Current practices in anesthesia for cesarean section in german university clinics. Results of a survey in the year 1996].

UNLABELLED: Obviously there is a world-wide trend towards regional anaesthesia for caesarean section (CS). Data on the current practice in Germany are lacking. METHODS: In 1996 questionnaires on obstetric anaesthesia were mailed to all University departments of anaesthesia. RESULTS: All 38 University Hospitals with obstetric units replied (100%). Mean annual delivery rate was 1156 with a mean CS-rate of 24%. For scheduled CS the University departments used general anaesthesia in most cases (60%), followed by epidural (31%) and spinal anaesthesia (9%). General anaesthesia was predominantly used for more urgent (87%) or emergency deliveries (99%). Spinal anaesthesia was offered to patients as an option of anaesthesia for CS in 16 of 38 departments, epidural anaesthesia in 36 of 38. The majority of university hospitals (22 of 38) performed more than 25% of their CS in epidural anaesthesia; 14 departments had a ratio of at least 50% of regional anaesthesia. 28 of 32 centres administered some kind of acid aspiration chemoprophylaxis as a routine management. Special devices for the management of a difficult airway were provided in 61% of the hospitals within the delivery unit. In 70% the anaesthesiologist was responsible for the postoperative pain management following CS. CONCLUSION: A significant trend towards regional anaesthesia for CS has taken place in German university hospitals: According to a former survey regional anaesthesia was used in less than 10% of CS in 1977, whereas in the current evaluation from 1996 this figure was significantly higher (40%). Nevertheless, compared to other countries the rate of general anaesthesia still is rather high.

Anesthesia, Epidural↗
PubMed2002

[University clinics as centers of radiologic performance alliances in the ambulatory and inpatient sector].

PROBLEM: Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. METHODS: The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the "Imaging services--teleradiological center of excellence". Legal, technical and organizational prerequisites were analyzed. RESULTS: Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. CONCLUSION: Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services.

Delivery of Health Care↗
PubMed2006

Depression amongst Nigerian university students. Prevalence and sociodemographic correlates.

BACKGROUND: This study aimed to estimate the prevalence and examine the socio-demographic correlates of depressive disorder among university students in Western Nigeria. METHODS: A representative sample of students living in the halls of residence of a federal university (n = 1,206) completed sets of questionnaires on socio-demographic details, problems encountered in the university, alcohol use and smoking. Depressive disorder was assessed using the Mini International Neuropsychiatric Interview (MINI). RESULTS: A total of 101 (8.3%) students met the criteria for depressive disorder with 68 (5.6%) having minor depressive disorder and 33 (2.7%) having major depressive disorder. The factors that were significantly associated with depressive disorders in the students include problems with accommodation (OR 2.72, 95% CI 1.79-4.16), very large family size (OR 2.8, 95% CI 1.42-5.73), female gender (OR 2.21, 95% CI 1.46-3.35), heavy cigarette smoking (OR 3.67, 95% CI 2.23-6.05) and high level of alcohol consumption (OR 9.44, 95% CI 3.32-26.89). CONCLUSIONS: Depression is common among Nigerian university students and significantly associated with sociodemographic factors. An effective model for the prediction of the development of depression in university students need to be developed and evaluated and interventions aimed at reducing the incidence of depression among this population need further research.

Adult↗
PubMed2005

Comparison of university and private-practice orthodontic treatment outcomes with the American Board of Orthodontics objective grading system.

INTRODUCTION: Treatment outcomes and duration of treatment for patients treated in university graduate orthodontic programs and private orthodontic practices were assessed and compared with the ABO objective grading system. METHODS: The treatment records of 139 randomly selected adolescents who had received comprehensive orthodontic treatment were examined. Seventy-seven subjects had been treated in 3 postgraduate orthodontic clinics, and 62 had been treated in 3 private orthodontic practices. Pretreatment, all subjects had Class II Division 1 malocclusions and ANB angles equal to or greater than 4 degrees . All patients were treated with premolar extractions. Posttreatment dental casts were measured and scored with the ABO objective grading system. RESULTS: No significant differences were found between the groups in the alignment, buccolingual inclination, and overjet components. Patients treated in private practice had significantly lower scores for marginal ridge height and occlusal relationship. Patients treated in the university programs had significantly lower scores for occlusal contact and interproximal contact components. CONCLUSIONS: There was no significant difference in the overall score, thus no significant difference in the overall quality of orthodontic treatment outcome between patients treated in university programs and private practices. However, the university group had a significantly larger sample variance for the overall score. There was no significant difference in the duration of the treatment between patients treated in a university setting and in a private practice.

Adolescent↗
PubMedDate not supplied

The journey toward geriatric excellence in a non-research-intensive university.

In response to the unprecedented rise in the U.S. older adult population, nurse educators have intensified efforts to produce graduates who are sensitive to older adults' health care concerns. Critical to accomplishing this goal is strengthening curricula to include specialized gerontological content. Although the science of gerontological nursing has grown significantly over the past several decades, large-scale research projects are often confined to research or doctoral level universities in which typically more support is available. Faculty members in smaller universities in which a great number of nursing students are educated do not always have the resources to readily contribute to science. Such a challenge was faced by one nursing school in a small Jesuit New England university. This article illustrates a process to develop excellence in gerontological nursing education, as well as to promote scholarship and collaboration among faculty members at baccalaureate or master's level universities. Three years ago, the John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing, awarded grants to select nursing programs for curricular enhancement. Implementation of this project at a small Jesuit university led to synergy among faculty that resulted in joint publications, presentations, and newly funded projects. In addition, the school earned local and national recognition for excellence in gerontological nursing education/care. The process leading to the outstanding success of this curricular endeavor is presented as a replicable model for schools in other baccalaureate or master's level settings.

Attitude of Health Personnel↗
PubMed2005

Awareness and knowledge of epilepsy among students in a Malaysian university.

PURPOSE: University students represent a better-educated group of society and it is important that they possess the correct knowledge and attitude towards healthcare issues. The aim of this study was to determine the current level of awareness and knowledge of epilepsy among students at a public university in Malaysia. METHODS: A survey was conducted within the main campus of the Universiti Sains Malaysia (USM), Penang, Malaysia. Students were required to answer a series of questions on awareness and knowledge of epilepsy. The questionnaire was written in the Malay language. RESULTS: Over a one-week period, 289 students completed the self-administered questionnaire. It was found that 86.5% of students had heard or read about epilepsy, while 55.6% had observed an epileptic seizure. Only 30.7% said that they knew the cause of epilepsy and 5.3% thought epilepsy was caused by evil spirits. Epilepsy was considered hereditary by 66.9% of respondents, while 4.9% thought it was contagious. Furthermore, 60% of students did not think that epilepsy was a shameful illness. CONCLUSIONS: The findings indicate a generally favorable level of awareness and knowledge of epilepsy among students at the university. Nevertheless, there is still a need to improve certain aspects of knowledge and understanding of epilepsy among university students.

Adult↗
PubMed2005

[Authors' affiliations and addresses in published articles. Lack of care penalizes French universities in international rankings].

OBJECTIVE: To assess, through the example of the université Claude Bernard Lyon 1, whether the poor international visibility of French universities may be due in part to a lack of care by researchers in listing their affiliations and address on their scientific publications. METHOD: Querying the heading "address" of Medline, Embase.com and Pascal Biomed for 2003 in searches for publications from Université Claude Bernard Lyon 1. RESULTS: In 300 bibliographic entries studied, we found 44 different forms of the university's name. Only 15% of the addresses were correct, and 44% did not mention the author's affiliation with the university. DISCUSSION: Authors' lack of care in listing their affiliations and address and the absence of a standardized official name for the university may explain the poor visibility of French universities. Recommendations about this topic might help to promote the reputation and work of French researchers internationally.

Attitude↗
PubMed2001

Influences of self-beliefs, social support, and comfort in the university environment on the academic nonpersistence decisions of American Indian undergraduates.

This study investigated the influence of self-beliefs, social support, and comfort in the university environment on the academic nonpersistence decisions of 83 American Indian undergraduates. The self-belief construct comprised self-esteem and 2 dimensions of college-related self-efficacy. The social support cluster consisted of 3 variables: family support, friend support, and perception of being mentored. The 3rd cluster, comfort in the university environment, was measured by perceptions of university environment, cultural congruity, and college stress. Although each of the 3 constructs significantly accounted for academic nonpersistence decisions, social support was the strongest predictor, followed by comfort in the university environment, and then self-beliefs. Students who perceived being mentored were more likely to report decreased nonpersistence decisions. Similarly, students who had more positive perceptions of the university environment were more likely to make fewer nonpersistence decisions. Finally, higher self-esteem and greater college-related self-efficacy were associated with decreased nonpersistence decisions. Research-informed practice implications for increasing the academic persistence of American Indian students include fostering mentoring relationships and providing interventions to increase social support, self-esteem, and self-efficacy.

Adolescent↗
PubMed2004

Universal precautions: a survey of community nurses' experience and practice.

BACKGROUND: Universal precautions are a set of guidelines which aim to protect health care workers from blood-borne infections. Community nurses often have to deliver care to people in less than ideal home conditions, their ability to comply with all universal precautions may therefore be compromised. AIMS AND OBJECTIVES: This paper presents the findings of a questionnaire survey which aimed to explore community nurses' experience and practices of using universal precautions. DESIGN AND METHODS: A questionnaire survey was used for this study. All community learning disability nurses, community mental health nurses and generic community nurses from one Welsh Health Authority were surveyed (n = 543) with a response rate of 70%. RESULTS: The majority of community nurses reported compliance with universal precautions, although a small number of nurses stated that they re-sheathed needles, inappropriately stored sharps containers, inadequately wore gloves and experienced difficulties in handwashing. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: Community nurses work in a unique and unpredictable environment, which may result in nurses being unable to comply with existing universal precautions guidelines. The production of new infection control guidelines for the community by the National Institute of Clinical Excellence in June 2003, has addressed some of the difficulties faced by community nurses.

Attitude of Health Personnel↗
PubMed2004

[Health care ethics committees in German university clinics. A survey of all medical directors and directors of nursing].

OBJECTIVE: Health Care Ethics Committees (HEC) are new ways of implementing clinical ethics in hospitals and nursing homes. In the US all health care institutions must provide some structure to handle ethical conflicts in everyday patients' care. However, in Germany only a minority of hospitals, often members of the Protestant or Catholic Hospital Associations, have founded HEC. No studies exist in regard to the situation at German university hospitals. METHODS: In November 2002 we posted a questionnaire with 13 items to all medical directors (M) and directors of nursing (N) of the 36 German university hospitals. RESULTS: The response rate was 82 %. Limitation of treatment, informed consent and the conflict between beneficience and autonomy are the most relevant ethical issues in everyday practice. N estimated the need for additional support of their staff in ethical issues higher than M. Improvement of interdisciplinary teamwork, further education in ethics and ethical guidelines have been identified in order to improve ethical professional performance. However, N mentioned the lack of time and the low priority of ethics more often than M as problems in implementing theses measures. Five German university hospitals are planning to establish a HEC and two hospitals want to employ a clinical ethicist. CONCLUSION: Our data show a high need for information about HEC in German university hospitals. The tasks, working methods and chances for further development of HEC are neither known nor used in the majority of German university hospitals.

Codes of Ethics↗