Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “integrative element”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources
PubMed2000

Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practice.

This article provides an overview of the Quality Enhancement Research Initiative (QUERI), an ambitious attempt to develop a data-driven national quality-improvement program for the Veterans Health Administration (VHA) that is fully integrated within VHA's Strategic Framework for Quality Management, as discussed elsewhere in this supplement. QUERI is designed to ensure the systematic translation of findings and products (quality tools that promote use of research findings) to promote optimal patient outcomes and system-wide improvements. In developing QUERI, a framework was created to integrate structural elements (organizational characteristics) and process considerations (those actions and action sequences associated with positive change) with outcomes (both at the patient level and at the systems level). In developing this framework, a process for translation of evidence into action was born. The QUERI process depends on having or discovering accurate information about what services are needed, who needs them, how they should be provided, and relevant outcomes and costs. This article describes the 6-step QUERI process and presents an overview of relevant programmatic details, including QUERI's rigorous review process, and VHA's unique qualifications for establishing a national model for quality improvement.

Benchmarking↗
PubMed2001

Production of the next-generation library virtual tour.

While many libraries offer overviews of their services through their Websites, only a small number of health sciences libraries provide Web-based virtual tours. These tours typically feature photographs of major service areas along with textual descriptions. This article describes the process for planning, producing, and implementing a next-generation virtual tour in which a variety of media elements are integrated: photographic images, 360-degree "virtual reality" views, textual descriptions, and contextual floor plans. Hardware and software tools used in the project are detailed, along with a production timeline and budget, tips for streamlining the process, and techniques for improving production. This paper is intended as a starting guide for other libraries considering an investment in such a project.

Computer Communication Networks↗
PubMed2003

Economic analysis of oral and topical therapies for onychomycosis of the toenails and fingernails.

OBJECTIVE: Several antifungal agents are indicated for onychomycosis, a fungal infection of the toenails and fingernails. These agents differ in their dosing regimen, efficacy, adverse events profile, potential for drug interaction, and cost. We conducted a pharmacoeconomic analysis of oral and topical therapies for onychomycosis from the perspective of a hypothetical managed care payer to determine the most cost-effective agent. DESIGN: A decision analytic model was developed to evaluate the pharmacoeconomic profiles of itraconazole-continuous (Sporanox, Janssen Pharmaceutica), itraconazole-pulse (Sporanox, Janssen Pharmaceutica), terbinafine (Lamisil, Novartis Pharmaceuticals), and ciclopirox (Penlac, Dermik Laboratories) in the treatment of fingernail and toenail onychomycosis. METHODOLOGY: We conducted a meta-analysis of the available literature to populate the decision analytic model with clinical point estimates for success, failure, and relapse. A panel of expert dermatologists defined resources consumed during the onychomycosis treatment process. These resources were then assigned values, using publicly available data sources, to reflect the U.S. managed care perspective. These clinical and economic data elements were integrated in the decision analytic model to arrive at the expected cost of treatment for each drug. Additionally, incremental cost-effectiveness was calculated for treatment success and disease-free days achieved by each therapy. Finally, a policy-level analysis of the budgetary impact of using the therapies for onychomycosis in a managed care setting was conducted. RESULTS: The meta-analysis demonstrated terbinafine to be the therapeutic alternative with the highest success rate for both fingernails (96.55 percent) and toenails (81.15 percent). Terbinafine also had the lowest relapse rate (6.42 percent) and the highest number of disease-free days for both fingernails and toenails. Subsequently, in terms of cost-effectiveness, terbinafine dominated all other comparators for fingernails and toenails. CONCLUSIONS: Based on the patient-level analysis, we concluded that terbinafine is the most cost-effective therapy in the treatment of onychomycosis from a managed care perspective. Furthermore, at the policy level, increased utilization of terbinafine among onychomycosis patients is likely to reduce the managed care organizations' per member per month cost.

Adult↗
PubMed2003

Empowering patients: total product life cycle for medical devices.

Patients today demand a stake in the care of their own health. The expectation is that patients who take responsibility for their own care will communicate more effectively with their health care team and be productive citizens in our society. Medical technology today and those products visible on the horizon, coupled in a telehealth network, provide promise to empower patients to participate fully in the management of their own health. Technology alone, however, will not integrate the elements required for an effective telehealth system. This chapter considers the non-technical matters of this issue such as trends in the medical device industry, trends in the point of care, public health care policies, and the role of government regulation, working together to achieve these public health goals.

Equipment and Supplies↗
PubMed2004

The mechanisms of morphological-motor functioning in elementary school female first- to fourth-graders.

Four morphological and 7 motor variables were assessed in a sample of 2,235 female children (subdivided into 4 groups) aged 7-11 years, elementary school first- to fourth-graders from the Primorje-Gorski Kotar County, Republic of Croatia. The study objective was to analyze the morphological-motor structures according to age. Factor analysis was done for each of the four subject groups. Results clearly showed the morphological-motor functioning of the girls to change with age. Developmental processes lead to the formation of a general morphological factor defined as ectomesomorph and two general mechanisms responsible for motor efficiency in the form of strength regulation and speed regulation. The results obtained were found to be consistent with the existing relevant models related to the morphological, motor, functional and cognitive systems. The more so, these results allow for a supramodel to design, which will integrate relevant elements of all these models to define the function of the body as a whole.

Age Factors↗
PubMed2004

[Scholarly communication in the digital era: has a new era really begun?].

In this paper the author examines the issue concerning the future direction of scholarly publications. The scholarly community has sufficient expertise and incentive to collaborate on the design of a new model for scholarly communication that takes advantage of networking technology and extends the traditional benefits of print publications. The "multicanality" presents a unique approach that integrates the elements of scholarly communication beginning at the author's keyboard and ending in the library's archives. The "multicanality" simplifies the work of authors, editors and librarians, and reduces related publishing expense. The needed technical expertise is already available to begin it.

Biomedical Research↗
PubMed2005

[Link between resistance and failure in community-acquired respiratory infections].

Resistance is one of failure's reasons. We tried, through clinical experience, to approach the magnitude and nature of the links, between phenotypically defined acquired resistance and clinical failure, in community acquired respiratory infections. An efficient resistance mecanism, able to suppress antibiotic action, is clearely associated to a risk of clinical failure (e.g. betalactamase secretion, target modification using methilation for macrolides, target mutation for fluoroquinoles). Resistance mecanism due to reduction of target affinity (pneumococcus and betalactams) progressively decreasing beta lactam activity depending on its expression, is at present time, not clearely associeted with clinical failure. Critical concentration, defining phenotypical resistance, is predictive of failure if it identifies a bacterial population owning an efficient resistance mecanism. It will not be predictive of failure if that concentration do not detect the resistance mecanism (e.g. parC mutation and levofloxacin) or if the link between antibiotic and resistant bacteria is not binary but depends also on pharmacokinetic parameters (pneumococcus and betalactam). Using resistance as a parametre for antibiotic choice, must integrate several elements: presence or not of a resistance mecanism, type and efficiency of the mecanism, links with clinical failure and antibiotic concentration, type and site of infection. Critical concentration is not allways the magic number that predict failure or success.

Anti-Bacterial Agents↗
PubMed2005

Liens entre résistance et échec dans les infections respiratoires communautaires.

Resistance is one of failure's reasons. We tried, through clinical experience, to approach the magnitude and nature of the links, between phenotypically defined acquired resistance and clinical failure, in community acquired respiratory infections. An efficient resistance mecanism, able to suppress antibiotic action, is clearely associated to a risk of clinical failure (e.g. betalactamase secretion, target modification using methilation for macrolides, target mutation for fluoroquinoles). Resistance mecanism due to reduction of target affinity (pneumococcus and betalactams) progressively decreasing beta lactam activity depending on its expression, is at present time, not clearely associeted with clinical failure. Critical concentration, defining phenotypical resistance, is predictive of failure if it identifies a bacterial population owning an efficient resistance mecanism. It will not be predictive of failure if that concentration do not detect the resistance mecanism (e.g. parC mutation and levofloxacin) or if the link between antibiotic and resistant bacteria is not binary but depends also on pharmacokinetic parameters (pneumococcus and betalactam). Using resistance as a parametre for antibiotic choice, must integrate several elements: presence or not of a resistance mecanism, type and efficiency of the mecanism, links with clinical failure and antibiotic concentration, type and site of infection. Critical concentration is not allways the magic number that predict failure or success.

Journal Article↗
PubMedDate not supplied

[The meaning of type 2 diabetes mellitus from the patient's perspective].

INTRODUCTION: Medical anthropology considers the sociocultural aspects of illnesses, from the biomedical definition of the experience of the one who suffers the illness. This is what makes the difference between a disease and an illness, in other words, an explanatory model of illness. OBJECTIVES: To show the cultural consensus elaborated and shared by a group of diabetics through personal experience, of the causes, symptoms, treatment and complications of type 2 diabetes mellitus; to highlight the importance this has in the daily medical practice, and to understand the meaning of type 2 diabetes from the patient's perspective. MATERIAL AND METHODS: 88 patients were studied in an interactive process, with an interview outline that was applied in an open form at the waiting rooms for outpatients at two family medicine units of the Mexican Institute of Social Security (IMSS) in Guadalajara, Jalisco. RESULTS: The way in which patients construct a definition and an explanation of their illness is a syncretism of lived experiences done in a procedural manner. In this reconciliation, patients with diabetes integrate biomedical elements, alternative medicines, deities and even sorcery. CONCLUSIONS: These previously mentioned factors should be considered when in contact with the patient if one thinks that the influence of a doctor or institutional health care provider has the objective of achieving a greater effectiveness in the long-term handling of these patients.

Diabetes Mellitus, Type 2↗
PubMed2006

Tumoral, quasitumoral and pseudotumoral lesions of the superficial and somatic soft tissue: new entities and new variants of old entities recorded during the last 25 years. Part XII: appendix.

In an eleven part series published in Pathologica, we have presented various tumoral, quasitumoral and pseudotumoral lesions of the superficial and somatic soft tissue (ST), which emerged as new entities or as variants of established entities during the last quarter of a century. Detailed clinicomorphological and differential diagnostic features of approximately sixty entities were chosen on the basis of their clinical significance and morphologic distinctiveness. The series included fibrous and myofibroblastic tumors (e.g. solitary fibrous tumor, high grade classic and pigmented dermatofibrosarcoma protuberans, inflammatory myofibroblastic tumor and myofibrosarcomas), fibromyxoid and fibrohistiocytic neoplasms (e.g., Evans' tumor, phosphaturic mesenchymal tumor, inflammatory myxohyaline tumor), special adipocytic/vascular/and smooth muscle lesions (e.g., chondroid lipoma, Dabska's tumor, ST hemangioblastoma, lipoleiomyosarcoma), epithelioid mesenchymal malignancies of diverse lineages (e.g., epithelioid liposarcoma, proximal-type epithelioid sarcoma, neuroendocrine extraskeletal chondromyxoid sarcoma), ST Ewing's tumor and peripheral nerve sheath tumors (perineuriomas and pigmented and rosetting tumors of the schwannoma/neurofibroma group), extranodal dendritic or histiocytic proliferative processes (follicular dendritic cell sarcoma, Rosai-Dorfman disease, Castleman's disease, and plexiform xanthomatous tumor), and tumors with myoepithelial differentiation. The section devoted to selected pseudotumoral entities considered representatives of the hamartoma group (neural fibrolipomatous hamartoma, ectopic hamartomatous thymoma, rudimentary meningocele), metabolic diseases (amyloid tumor, nephrogenic fibrosing dermopathy, tophaceous pseudogout, pseudoinfiltrative parathyromatosis), stromal tissue reactions to trauma (fibroosseous pseudotumors of digits) and infections (bacillary angiomatosis), and normal organs (glomus coccygeum). To conclude the descriptive phase, supplementary material has now been collected and appended in an attempt to provide a quick digest of essential knowledge both for comparison and differential diagnosis. The data have been tailored to synthesize diverse sources, integrating clinical elements and references to articles that previously appeared in Part I ("Introduction"), Part II ("The List and Review of New Entities") and Parts III to XI ("Excerpta"). At the very least we hope this final part ("Appendix") will provide the reader with a useful tabular organization of ST lesions and a reference resource.

Humans↗
PubMed1990

Modulation of RNA expression by intracellular calcium. Existence of a threshold calcium concentration for induction of VL30 RNA by epidermal growth factor, endothelin, and protein kinase C.

We investigated the role of intracellular [Ca2+] in mediating the independent signal transduction pathways leading to induction of VL30 RNA expression by multiple agonists in the Rat-1-derived RVL-3 cell line. This cell line contains a single integrated VL30 element, and displays a rapid transcriptional activation of VL30 following stimulation by epidermal growth factor, endothelin, or the phorbol ester tumor promoter 12-O-tetradecanoylphorbol acetate (Rodland, K. D., Brown, A. M. C., and Magun, B. E. (1987) M. Cell. Biol. 7, 2296-2298). Neither epidermal growth factor nor endothelin is dependent upon protein kinase C for activation of VL30 expression, as both of these agonists induce normal levels of VL30 RNA expression, even in cells which have been severely depleted of protein kinase C following chronic 12-O-tetradecanoylphorbol acetate exposure. Induction of VL30 RNA expression by either endothelin or 12-O-tetradecanoylphorbol acetate was blocked by concomitant exposure of RVL-3 cells to the intracellular Ca2(+)-chelating agent 1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid at a concentration sufficient to buffer intracellular [Ca2+] below 200 nM, and VL30 RNA was induced by the application of the Ca2+ ionophore A23187 in the absence of agonist. Normal levels of VL30 expression in response to epidermal growth factor were observed at 165 nM [Ca2+], but were significantly inhibited at 115 nM [Ca2+]. Both the protein kinase C-dependent and protein kinase C-independent pathways leading to VL30 transcription were dependent upon the presence of an intracellular [Ca2+] exceeding 115 nM. The dependence upon intracellular Ca2+ transients for transcriptional induction by endothelin appears to be a characteristic of VL30 expression, as 1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid treatment did not prevent the endothelin-induced transcription of the protooncogenes c-jun and c-fos.

Animals↗
PubMed1990

Viruses and cancer, with particular focus on human papillomaviruses in neoplastic lesions of the cervix uteri.

Oncogenic viruses serve as useful experimental tools and models of cellular transformation and cancer biology. Tumour virology has made enormous contributions towards the molecular elucidation of malignancy, especially in the concept of oncogenes and anti-oncogenes. Here we consider the criteria, mechanisms and co-factors of viral carcinogenesis. Some viruses associated with cancers in man and animals are reviewed, with special focus on the role of human papillomaviruses (HPV) in cervical cancer. Southern hybridization and polymerase chain reaction (PCR) data demonstrating the presence of genital HPV types 11, 16, 18 and 31 in cervical neoplastic lesions from Singapore patients are presented. Sensitivity standardisation and specificity of the Southern and PCR techniques are emphasised. Common themes in viral oncology are highlighted, such as epidemiological associations; viral type, host and tissue specificities; transforming genetic elements; viral integration; and interaction with co-factors.

Female↗
PubMed1990

Access to infancy: different ways of remembering.

In this paper the developmental hypothesis is presented that verbalization is a crucial element in integration and differentiation of the self. Material from four patients is used to illustrate paraverbal manifestations of psychophysiological distress in the transference-counter-transference relationship at moments of separation. These led to the reconstruction of a line of pathological development which was initiated in these patients by experiences of helplessness and rage at a time when affects and sensations were not clearly differentiated and no words were attached to them to integrate the body ego into the ego and self. Retrieval and gathering-in of these experiences to the ego took place initially through the analyst's perception of signal states of tension and confusion, which became part of the construction of the image of the patient as a toddler, and then led to verbalization of the affects and sensations involved.

Anxiety, Separation↗
PubMed1985

The fine structure of tumor blood vessels. I. Participation of non-endothelial cells in tumor angiogenesis.

This report provides fine structural evidence that, dependent upon the malignancy, tumor as well as mesenchymal cells may participate actively in the neovascularization of experimental tumors grown in transparent tissue chambers implanted into skinfolds of syrian hamsters. Such non-endothelial cells may help to promote angiogenesis in two different ways: (1) They are incorporated into capillary sprouts thereby accelerating the growth rate of the latter independent of endothelial cell proliferation. (2) Extravascular cells (tumor and mesenchymal elements) become integrated in varying numbers into the linings of comparatively large blood-perfused vessels. This facilitates the rapid establishment and functional remodelling of the microvascular bed to adapt the microcirculation to the varying local demands of the growing tumor. If these results can be confirmed for other tumors, and if they are independent of the tumor's environment and the experimental protocol, then we will have to reconsider the significance of tumor angiogenesis as a realistic biological model from which general conclusions with regard to neovascularization in non-tumorous tissues may be drawn.

Animals↗
PubMed1989

[Echographic finding of a liver mass in the first years of life].

On the basis of personal experience of echographic finding of liver mass in the early years of life, the origin is recalled and symptomatology with ultrasounds outlined: 1) they may be occasional findings without corresponding clinical signs (cystic dysplasic forms); 2) they may be metastases of known tumours (neuroblastoma); 3) they may be primary neoplasias (haemangiomas); 4) they may be signs of a state of immunodeficiency (abscess foci). It is stated that the data supplied by echography are often aspecific or permit diagnosis only if integrated with elements provided by other techniques and/or by clinical and biohumoral data.

Diagnosis, Differential↗
PubMed1986

The Aerospace Medical Research Laboratory: a leader in the development of life support.

The progress in the development of life support for the crewman parallels the changing flight envelope of the airplane and spacecraft. A constant in this history is man. In spite of elaborate attempts to refine the selection of the crew, the basic lists of requirements has not changed. Only the urgency and the need for providing the entire list of requirements have been seen. Generally, progress in the flight envelope has demanded more reliable and often more complex provisions to support the crew. The debate as to how this should be done has often centered on the argument about having man wear or carry the life support elements versus integration of these provisions into the vehicle. This debate initiated the concept of risks/benefits, a debate that has now reached all aspects of man's endeavors, including his medical care. This paper will discuss the major milestones of providing life support, some of the key contributors (a role that General Armstrong played in a great way), and how this has provided the base for the next steps in aviation and space operations.

Aerospace Medicine↗
PubMed1987

Design considerations in development of a prototype, piezoelectric internal fixation plate: a preliminary report.

The piezoelectric internal fixation plate represents a new concept in orthopaedic implants. The purpose of this device is to provide stable bone fixation while delivering internally generated, microampere direct currents to prevent or treat nonunion of a fracture or osteotomy. Clinically, currents of this type have been effective in treatment of nonunion, but application has required separate, implanted, or external battery or radiofrequency powered circuits. The "piezoplate" being developed contains an integral piezoelectric element that generates current in response to either physiological loading such as weightbearing or to externally applied ultrasound. Currents are processed by a rectifying circuit for delivery to bone by electrodes. Specially designed series/parallel piezoelectric elements and dual processing circuits are required to generate optimum rectified currents from the low-frequency, high-voltage signals generated by weightbearing, as well as the high-frequency, low-voltage signals produced by ultrasound. This paper reports on the current status of development and describes design parameters of this device which combines the modalities of mechanical fixation and electrical stimulation in a single implant.

Animals↗