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PubMed1981

Observations on detecting left ventricular thrombus with two dimensional echocardiography: emphasis on avoidance of false positive diagnoses.

Observations made in detecting left ventricular thrombus with two dimensional echocardiography in 25 patients are reviewed. In 20 patients thrombus was documented on angiography, surgery postmortem examination or serial two dimensional echocardiographic findings; in the remaining five patients two dimensional echocardiographic findings of thrombus were unequivocal. In all 25 patients wall motion abnormalities ranging from hypokinesia to frank dyskinesia were present at the site of the thrombus. Twenty-three patients had an apical thrombus; two had thrombus adjacent to the inferior wall. Clear delineation of the endocardium and thrombus margin was considered essential to the correct diagnosis of thrombus. Both intracavitary motion of the thrombus margin and a layering effect were noted infrequently although they were of benefit in identifying an intracardiac mass as thrombus. In addition, serial evaluations were helpful in establishing the correct diagnosis. False positive diagnoses can be minimized if one understands certain technical limitations of this method and correctly identifies apical structures that are not thrombi. Axial and lateral resolution problems inherent with this technique can produce intracavitary echoes that may simulate thrombi. In addition, normal or pathologic structures at the apex may also simulate thrombi. These structures include the papillary muscles, muscular trabeculae, chordal structures and tangential information from normal myocardium. Varying the sector orientation or acoustic window, or both, will aid in correctly identifying these structures and distinguishing them from left ventricular thrombi.

Blood Coagulation↗
PubMed1989

Breast-feeding and health professionals: a study in hospitals in Indonesia.

This paper presents findings on knowledge, attitudes, and practices regarding breast-feeding management in the modern health sector in Indonesia. The methodology applied was a survey which was carried out in teaching hospitals in major cities throughout Indonesia. The results showed that although the perinatal health care providers' attitudes toward breast-feeding were very positive, there were many areas in which knowledge was incomplete and in which wide variation existed or incorrect advice given to breast-feeding mothers. The content of advice on breast-feeding was not always sound. Many thought that a wide range of illnesses were a contraindication to breast-feeding, nearly one in five thought that breast-feeding should follow a fixed schedule rather than the baby's needs, and only 54% thought that breast-feeding should be initiated immediately after delivery. Most of the providers did not seem to have the knowledge to cope with the common problem of insufficient breast-milk supply syndrome. Similarly, although support for the concept of rooming-in was strong, about one-third of respondents did not think the mother and infant should be together for the full 24 hr implied by true rooming-in. Fears about the possibility of increased risk of infection with rooming-in were expressed These and other misconceptions about rooming-in imply that a consistent, well-designed training program needs to be carried out in the modern health sector which will provide the necessary information to health care providers about this important aspect of early infant care.

Adult↗
PubMed2026

Misalignment between ultra-processed status and 'better for you' claims on premix alcohol products.

BACKGROUND: Premix alcohol products (also known as ready-to-drink beverages) are a rapidly expanding alcohol category and frequently marketed using 'better for you' claims (e.g., 'Low sugar', 'Natural'). Little is known about the extent to which these products are ultra-processed or whether marketing claims align with ultra-processed status. This study aimed to address this evidence gap by auditing ingredient disclosure on premix products, assessing the ultra-processed status of these products, and determining the prevalence of 'better for you' claims with a particular focus on claims relating to ultra-processed status. METHODS: 534 premix alcohol products sold in major Australian retail outlets were assessed. Products were evaluated for compliance with mandatory ingredient disclosure, classified according to ultra-processed status based on the presence of indicators of ultra-processing (additives and other industrial ingredients), and analysed to determine the prevalence and types of 'better for you' marketing claims. RESULTS: Only 79% of assessed products displayed an ingredients list. Among compliant products, 98% contained at least one additive or ingredient indicative of ultra-processing, most commonly flavours, carbonating agents, colours, and sweeteners. One-third (33%) of products containing an ultra-processing indicator displayed a claim suggesting naturalness or minimal processing. Substantially higher proportions of ultra-processed products than non-ultra-processed products carried health-related claims. DISCUSSION AND CONCLUSIONS: Premix beverages available in Australia are overwhelmingly ultra-processed, yet many are marketed in ways that may mislead consumers about their composition and healthfulness. Stronger regulatory oversight of ingredient disclosure and marketing claims in this sector is urgently needed to support informed consumer decision-making.

Alcoholic Beverages↗
PubMed2005

Emergency medical services in Zimbabwe.

Emergency medical services in Zimbabwe are of a very variable standard, and exist in many forms: *Reasonably well-developed urban emergency medical services systems mixed with very poorly resourced and under-developed rural services. *Very high patient workloads, with severely ill medical patients and a large proportion of major trauma and multiple-casualty situations (public safety is given a low priority, and public transport is poorly regulated). *Long emergency response times and patient transport distances. *Somewhat under resourced and under developed emergency departments, with large numbers of critically ill acute patients, as well as many non-emergency/chronic patients who have no other access to appropriate health care. This paper provides a description of the development of ambulance services and acute health care in Zimbabwe, and outline the current demands on the system. Particular reference is made to the City of Harare Ambulance Service, which is considered to be the most developed of the local authority services.

Allied Health Personnel↗
PubMed2003

Identification and quantification of mutagenic halogenated cytosines by gas chromatography, fast atom bombardment, and electrospray ionization tandem mass spectrometry.

Oxidative modification of nucleic acids has been implicated in carcinogenesis. One potential mechanism involves halogenation by the myeloperoxidase and eosinophil peroxidase systems of phagocytes. In the current studies, three mass spectrometric methods for the in vitro and in vivo analysis of halogenated cytosines and deoxycytidines were compared: gas chromatography-electron ionization-mass spectrometry (GC-EI-MS) with a quadrupole instrument, fast atom bombardment or electrospray ionization (ESI) tandem MS with a four-sector magnetic instrument, and liquid chromatography ESI tandem MS (HPLC-ESI-MS/MS) with an ion-trap instrument. GC-EI-MS with selected ion monitoring of dimethyl-tert-butylsilyl derivatives of nucleobases was the most sensitive method. High-energy collisionally induced dissociation MS/MS analysis with a four-sector magnetic instrument yielded detailed structural information about halogenated nucleoside adducts but required relatively large amounts of material. The most sensitive analysis of intact halogenated deoxycytidine was achieved with extracted ion chromatograms using HPLC-ESI-MS/MS with an ion-trap instrument. Our results indicate that GC-EI-MS is the methodology of choice for ultrasensitive analysis of halogenated cytosines. HPLC-ESI-MS/MS provides greater structural detail for these compounds and may rival GC-EI-MS in sensitivity with more advanced liquid chromatography applications. The mass spectrometric methods we have developed should be useful for evaluating the role of phagocyte-derived oxidants in halogenating nucleobases, nucleosides, and DNA at sites of inflammation.

Bromodeoxycytidine↗
PubMed1998

Funding strategies for emergency medicine research.

The importance of adequate funding for sustaining research efforts cannot be overemphasized. This article addresses funding strategies for emergency physicians including the necessity of establishing a research track record, developing a well-written grant proposal, and anticipating the grant review process. Funding sources are reviewed with an emphasis on federal institute support and private foundations (including the Emergency Medicine Foundation) in the United States. Sources of current grant support information available from the Internet are provided. Recommendations for enhancing research funding in emergency medicine are made, including enhancement of formal research training, promotion of emergency medicine research and investigators, federal study section membership, and collaboration with established investigators.

Academies and Institutes↗
PubMed2002

Towards 2020 strategic triad partnerships in ICT and healthcare: bridging the chasms in Canada and the European Union.

This study examines the management challenges and practices of partnerships between the information and communication technology and healthcare sectors through interviews with selected executives of ICT and healthcare organizations in Canada, Germany, Sweden and the United Kingdom. Underscoring the implications for current and future healthcare executives in Canada, the article also takes a glimpse of the world of strategic partnerships management between these two sectors in the year 2020.

Canada↗
PubMed2001

Application of industrial scale genomics to discovery of therapeutic targets in heart failure.

In recent years intense activity in both academic and industrial sectors has provided a wealth of information on the human genome with an associated impressive increase in the number of novel gene sequences deposited in sequence data repositories and patent applications. This genomic industrial revolution has transformed the way in which drug target discovery is now approached. In this article we discuss how various differential gene expression (DGE) technologies are being utilized for cardiovascular disease (CVD) drug target discovery. Other approaches such as sequencing cDNA from cardiovascular derived tissues and cells coupled with bioinformatic sequence analysis are used with the aim of identifying novel gene sequences that may be exploited towards target discovery. Additional leverage from gene sequence information is obtained through identification of polymorphisms that may confer disease susceptibility and/or affect drug responsiveness. Pharmacogenomic studies are described wherein gene expression-based techniques are used to evaluate drug response and/or efficacy. Industrial-scale genomics supports and addresses not only novel target gene discovery but also the burgeoning issues in pharmaceutical and clinical cardiovascular medicine relative to polymorphic gene responses.

Databases, Genetic↗
PubMed2005

Cost-effectiveness analysis for priority setting in health: penny-wise but pound-foolish.

Cost-effectiveness analysis has much conceptual attractiveness in priority setting but is not used to its full potential to assist policy-makers on making choices in health in developed or in developing countries. We call for a shift away from present economic evaluation activities-that tend to produce ad hoc and incomparable economic evaluation studies and, therefore, add little to the compendium of knowledge of cost-effectiveness of health interventions in general-toward a more systematic approach. Research efforts in economic evaluation should build on the foundations of cost-effectiveness research of the past decades to arrive at an informative methodology useful for national policy-makers. This strategy means that governments should steer sectoral cost-effectiveness analysis to obtain systematic and comprehensive information on the economic attractiveness of a set of new and current interventions, using a standardized methodology and capturing interactions between interventions. Without redirecting the focus of economic evaluation research, choosing in health care bears the risk to remain penny-wise but pound-foolish.

Biomedical Technology↗
PubMed1997

The search for the elusive electronic medical record system--medical liability, the missing factor.

Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.

Humans↗
PubMed2002

A profile of injuries in Jamaica.

This study analyses 6 months of data from three hospitals participating in the computerized emergency room-based Jamaica Injury Surveillance System (JISS) since 1999. The categories of injuries tracked were unintentional, violence-related and motor vehicle-related. The resultant data showed that injuries comprised 17% (12,179) of all Accident and Emergency (A&E) department registrations for the period. The highest percentage of injuries were violence-related (51%, 6,380), followed by unintentional injuries (33%, 4,030) and motor vehicle-related (15%, 1,769). Injury profiles varied by institution with the majority of Cornwall Regional Hospital's and Kingston Public Hospital's injuries being intentional while that of May Pen Hospital was unintentional. The data also demonstrate that young males are at highest risk for all types of injuries as well as for the more severe injuries requiring hospital admission. The risk factor data provided through the JISS will inform and guide private and public sector efforts to address the problem of injuries in Jamaica.

Accidents↗
PubMed2006

Prevalence of mental disorders among Māori in Te Rau Hinengaro: the New Zealand Mental Health Survey.

OBJECTIVE: To describe the prevalence of mental disorders (period prevalence across aggregated disorders, 12 month and lifetime prevalence) among Māori in Te Rau Hinengaro: The New Zealand Mental Health Survey. METHOD: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken between 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over, including 2,595 Māori. Ethnicity was measured using the 2001 New Zealand census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorder. The overall response rate was 73.3%. This paper presents selected findings for the level and pattern of mental disorder prevalence among Māori. RESULTS: Māori lifetime prevalence of any disorder was 50.7%, 12 month prevalence 29.5% and 1 month prevalence 18.3%. The most common 12 month disorders were anxiety (19.4%), mood (11.4%) and substance (8.6%) disorders and the most common lifetime disorders were anxiety (31.3%), substance (26.5%) and mood (24.3%) disorders. Levels of lifetime comorbidity were high with 12 month prevalence showing 16.4% of Māori with one disorder, 7.6% with two disorders and 5.5% with three or more disorders. Twelve-month disorders were more common in Māori females than in males (33.6%vs 24.8%) and in younger age groups: 16-24 years, 33.2%; 25-44 years, 32.9%; 45-64 years, 23.7%; and 65 years and over, 7.9%. Disorder prevalence was greatest among Māori with the lowest equivalized household income and least education. However, differences by urbanicity and region were not significant. Of Māori with any 12 month disorder, 29.6% had serious, 42.6% had moderate and 27.8% had mild disorders. CONCLUSION: Mental disorders overall and specific disorder groups (anxiety, mood and substance) are common among Māori and measures of severity indicate that disorders have considerable health impact. Findings provide a platform for informing public health policy and health sector responses to meeting mental health needs of Māori.

Adolescent↗
PubMed1998

Funding strategies for emergency medicine research.

The importance of adequate funding for sustaining research efforts cannot be overemphasized. This article addresses funding strategies for emergency physicians, including the necessity of establishing a research track record, developing a well-written grant proposal, and anticipating the grant review process. Funding sources are reviewed with an emphasis on federal institute support and private foundations (including the Emergency Medicine Foundation) in the United States. Sources of current grant support information available from the Internet are provided. Recommendations for enhancing research funding in emergency medicine (EM) are made, including enhancement of formal research training, promotion of EM research and investigators, federal study section membership, and collaboration with established investigators.

Academies and Institutes↗
PubMed2004

Comparisons of patients with comorbid psychiatric and substance use disorders: implications for treatment and service delivery.

OBJECTIVE: Individuals with co-occurring psychiatric and substance use disorders are treated in mental health and substance abuse treatment systems, yet research on comorbid disorders rarely includes comparisons across systems. Knowledge about patients who share the label "comorbid" but are found in different treatment sectors should illuminate service issues and inform policy development. Differences across systems should provide support for separate treatments; similarities should indicate the value of the integration of services. The hypothesis that there are meaningful clinical differences between patients with comorbid mental health disorders and patients in drug treatment was tested. METHOD: As part of a larger longitudinal study, 106 patients with comorbid illness from mental health (N=106) and drug treatment (N=120) settings were compared regarding diagnosis, drug use, and problem severity. Data were obtained by using the Diagnostic Interview Schedule for DSM-IV and the Addiction Severity Index. RESULTS: Few differences between groups emerged. There were no diagnostic differences except that schizophrenia spectrum disorders were more common among mental health (43%) than drug treatment (31%) patients. Although more drug abuse than mental health subjects reported drug use in the 30 days before treatment entry, the average number of days of drug use in this period was not different. CONCLUSIONS: These findings document the high prevalence of severe mental illness in drug treatment clients and of serious drug problems in mental health patients. Only minimal differences emerged between the groups and none that indicated need for specialized treatments in separate systems of care.

Comorbidity↗