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PubMed1993

Living with mental illness: professional/family collaboration.

What started as a pilot project in the spring of 1990 has matured into a successful ongoing enterprise between professionals and families that continues to meet the needs of families experiencing the impact of mental illness. According to self-administered evaluations completed by those in attendance, and a subjective review by the planning committee, the program was an immediate success. It attained its overall education and mutual support objectives, and fostered successful collaboration between professionals and families. One hundred percent of family participants indicated that they would recommend the workshop to others in similar situations. In managing mental illness through collaborative partnerships, the family must be an integral part of each phase of project development. Family members are the "thermometer," measuring how closely the project is mirroring their needs. Since its inception, 370 people have participated in this dynamic project. This program demonstrates that through understanding, respect, and positive regard, families, friends, and professionals can work collaboratively to enhance the quality of life for all who are victimized by mental illness.

Adaptation, Psychological↗
PubMed1999

Guidelines for good scientific practice.

The Danish Committee on Scientific Dishonesty (DCSD) has existed for five years. As a preventive measure two sets of guidelines for the presentation of experimental reports and data documentation have been issued. Experiences from 24 cases of suspected scientific dishonesty have proven a need for further guidelines covering a wider range of scientific practice. Three key areas susceptible to conflicts between researchers and often resulting in subsequent accusations of scientific misconduct have been localized. Guidelines have, therefore, been prepared for these three areas: 1) Agreements at the start of cooperative research projects. 2) Rights and duties in storing and using research data. 3) Authorship. It is hoped that they will be helpful in prevention of conflicts and deviations from good scientific practice, and that they will be useful in the education of young researchers. The Danish Committee on Scientific Dishonesty. The Ministry of Research and Information Technology, Copenhagen.

Denmark↗
PubMed1995

Computerized assessment with primary care guidelines in The Netherlands.

To promote quality assurance and expertise in primary health care in the Netherlands the Dutch College of General Practitioners develops protocols, called standards. These standards concern medical action-taking in case of regular complaints and diseases in common practice. To improve dissemination of the standards and to develop effective and useful methods for quality assurance on the basis of the standards a project, called the Guidelines Automation Project (Richtlijnen Automatiseringsproject) was started to develop a computer program that can support quality assurance of medical action-taking in general practice on the basis of the NHG-standards. The main feature of the program is educational assessment. Other features of the program are: guidance for case data collection, stating of differential diagnoses, and disease profiles. These features also use patient case data as a starting point. In conclusion it is argued that all efforts towards an "electronic' use of protocols in the health care delivery system will fail, unless we arrive at a care record that both with respect to its structure and to its content, is being founded on sound formal principles. Several problems need to be solved first. The implementation, and exploitation of protocols, though relatively simple from a knowledge representation point of view, is not a straightforward task.

Family Practice↗
PubMed2004

[Risk assessment for eating disorders in a high school: a study based on the Eating Attitudes Test 26].

AIM: Disordered eating behaviours can lead to clinically evident and serious eating disorders (ED). Aim of this paper is to determine their extent among adolescents and to evaluate the associated characteristics. METHODS: All students of a high school (age 14-18) have been asked to fill up the Eating Attitudes Test (EAT-26) anonymously. EAT-26 is a self-reported questionnaire identifying subjects at risk for ED. This questionnaire included also an integrative section, aimed at investigating some ED-related variables (family composition, diet among relatives, social relationships, spare time activities, self-esteem). Collected data have been analyzed using EpiInfo6. RESULTS: The study involved all the 902 students of the school; 833 questionnaires have been distributed and 701 were collected (89.4% from girls, 10.3% from boys). The percentage of EAT-26 positive boys (i.e. scoring = or > 20) is 3%, while for girls is 13.7%. A positive test significantly correlates with low self-esteem (OR = 46.67, CI = 13.16-182.04), contentious relationships with the mother (OR = 2.20, CI = 1.12-4.29) and the father (OR=2.45, CI=1.24-4.80). No significant correlation has been found for being an only child, living in a single-parent family having limited/not having social relationships, having unsatisfactory social relationships, spending spare time mostly alone, watching TV more than 2 h per day. CONCLUSION: Our data suggest an increasing diffusion in the risk for ED among adolescents. Personal characteristics and behaviours related to this risk are good start points to program projects focusing on primary and secondary prevention of ED in high schools.

Adolescent↗
PubMed2004

Removal of persistent polar pollutants through improved treatment of wastewater effluents (P-THREE).

The EU-project P-THREE started with the establishment of analytical methods for persistent polar pollutants (P3) and quality assurance, followed by screening of P3 in influents and effluents of known wastewater (WW) treatment plants (TP), receiving waters and tap water produced thereof in several European countries. A final selection of analytes for further studies has been performed. Model MBR reactors have been constructed and an optimisation on synthetic wastewater spiked with P3 (linear alkylbenzene sulfonates (LAS), naphthalene sulfonates) has been performed. An initial dynamic modelling of treatment processes has also started. Advanced oxidation process (AOP) treatment has been done in groundwater with isoproturon and nonylphenol ethoxylates (NPEO). The analysis of individual P3 and potential degradation products was also performed. An integrated systeme analysis of the WW treatment processes has also been initiated.

Alkanesulfonic Acids↗
PubMed2005

[More and faster notification of infectious disease if notification is carried out by the laboratories instead of the diagnosing physician].

OBJECTIVE: To investigate if notification by the laboratories of a number of Group B diseases (meningococcal disease, whooping cough and hepatitis A) which according to the Communicable Disease Law of 999 must be reported to the local public health authority, would increase the number of reports and the speed at which the reports were made. DESIGN: Comparative study. METHOD: In the participating regions (Den Bosch and north-east Brabant) it was decided that the laboratories would notify the authorities of cases ofmeningococcal disease, whooping cough and hepatitis A. The notifications were compared with those from the middle-Brabant region which was used as a control. This took place in 1997/'98, prior to the start of the notification project and in 2000/'02 when it was running. The number of positive cases of infectious disease confirmed by the laboratories that were reported to the local health authorities and to the Inspectorate of Public Health Services was examined - this is known as the degree of notification. The number of days from diagnosis to notification of the local health authorities was also examined - this is known as the speed of notification. RESULTS: The degree of notification for these three diseases improved from 6I-89% to 87-95% if the authorities were notified by the laboratories. In the control region the degree of notification improved from 29-4I% to 54-60%. The speed of notification increased significantly if notification was done by the laboratories. CONCLUSION: Based on these results it is recommended that the Communicable Disease Law be adapted to allow the laboratories to notify the authorities of cases of infectious disease.

Communicable Disease Control↗
PubMed2005

Detection and removal of pathogenic biofilms on medical implant surfaces.

Advances in sensor technology have had a significant impact in medical research and practice in the last decade. However, within the hospital environment problems still exist where the application of sensing technology could provide the solution. The presence of antibiotic resistant bacteria within hospitals and the risk of serious infection that they pose is a cause for concern. This paper describes a research project that has recently started at the University of Ulster investigating the potential of "Sense and Destroy" tactics to reduce the spread of medical device related infections. It is proposed that Electrical Impedance Spectroscopy (EIS) probes implanted within a catheter may be used to detect subclinical biofilm formation. Furthermore, if the presence of a biofilm is detected, activation of a photocatalytic coating on the catheter wall may be used to inactivate the responsible microorganisms.

Biofilms↗
PubMed2005

[Study on the present status of the areas with high iodine concentration in drinking water and edible salt at household levels in Ohio of Yellow River].

OBJECTIVE: To understand the present condition of iodine excess areas and edible salt at household levels in Ohio of Yellow River,which will provide the evidence to control it. METHODS: A cross section in one time was adopted for the epidemiological survey based on the east, west, south, north and central in all of townships from 8 counties. 2 samples of drinking water from each village were tested their water iodine content as well as the data regarding to their recourses and the depth of wells. 5 samples of edible salt were collected from each village for quantitative analysis. RESULTS: We investigated 451 villages in 92 townships of 8 counties. 800 samples of drinking water were tested which values of iodine content were (110.93 +/- 152.26) microg/L in main, 55.83 microg/L (0.84 - 997.82 microg/L) in medium. 102.39 thousand population are at risk for iodine excess and living in 24 townships of 7 counties where iodine concentration is over 150 microg/L in drinking water, with (327.72 +/- 192.19) microg/L in mean value or 253.87 microg/L (150.78 - 997.82 microg/L) in medium. The rate of iodized salt is 97.2%. All the iodine excess areas are located in alluvial plain of Yellow River. The etiology of high iodine in shallow well water may be supposed to be iodine aggregation formed by Yellow River in terms of thousands of flood in thousands of years. But iodine excess in deep well water may be related to rotten, deposit marine living beings rich in iodine millions upon millions years ago. CONCLUSION: There were distinctive features of iodine excess in drinking water from both shallow well and deep well, 24 iodine excess areas in Ohio of Yellow River. It has suggested that iodized salt intervention should be stopped in the areas and starting the health education project, survey of iodized salt in the region.

China↗
PubMedDate not supplied

[Antibiotic-resistance in Italy: activity of the first year of the surveillance project AR-ISS].

The antibiotic resistance surveillance project AR-ISS, started in 2001, is based on a network of 62 sentinel microbiological laboratories throughout the country. The laboratories collect and transmit data to the Istituto Superiore di Sanità on the antibiotic susceptibility of bloodstream isolates of 7 species: Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis/faecium, Klebsiella pneumoniae/oxytoca ed Escherichia coli. They also send selected bacterial strains for further characterization. Results of the first year of surveillance are presented and are compared with data from the previous study EARSS-Italia and from other European countries. Oxacillin resistance in S. aureus appears to be stable, however, it remains one of the highest in Europe (41,5%). No strain with intermediate susceptibility or resistance to vancomycin has been isolated. In S. pneumoniae, the level of penicillin resistance is moderate (10,8%), but macrolide resistance has increased greatly (37,6% versus 28,6% of the previous study), following a tendency common to several European countries. Unexpectedly, vancomycin resistance in E. faecium was found to be 18%, the highest in Europe. Presumptive ESBL production in Gram-negative organisms can be estimated at 20% in Klebsiella and 1% in E. coli. Ampicillin and ciprofloxacin resistance in E. coli (respectively 50% and 18%) are among the highest in Europe. In conclusion, the rate of antibiotic resistance in the species studied is worrisome and requires continuing monitoring. Although some activities of AR-ISS need improvements, the surveillance has the potentiality to produce relevant and representative data about antibiotic resistance in Italy that can be used for comparison at the European level.

Adolescent↗
PubMed2006

Agent based simulations in healthcare.

Agent Based Simulations (ABS) is a relatively recent computer paradigm. As opposed to "top down" conventional computer simulations, the ABS approach is a "bottom-up" modelling technique where a medium to high number of independent agents is modelled. These agents' interactions sometimes cause unexpected "emergent" system behaviour. ABS is particularly suitable in the social context such as healthcare where a large number of human agents interact and co-operate for common goals. Today ABS in the social context is often used together with the recently introduced network analysis techniques and network visualization tools for modelling and simulating social agents within organisations. At Akdeniz University we are starting a number of projects for applying ABS technology in healthcare. In this paper we present two of the ongoing projects in this field. Firstly we have developed a prototype simulator for the long term monitoring of Chronic Obstructive Pulmonary Disease (COPD) as a major public health problem. We present the COPD simulator, its agents, parameters and working principles. Secondly we want to apply ABS and the network analysis techniques to visualise and explore informal social networks amongst staff at the Akdeniz University Hospital to assess and evaluate properties of the organisation in terms of its ability to innovate and share knowledge. In our applications, we primarily aim to use ABS in a web-based platform to create a virtual environment for discussion, visualising and running what-if scenarios to test out various options for managing healthcare, as well as sharing information and creating a virtual community.

Computer Simulation↗
PubMedDate not supplied

National registry of cervical cytologic diagnoses in The Netherlands.

The national cervical cytology registry being developed in the Netherlands is described. A large-scale screening program for cervical cancer has been in effect since 1975 in the region of the cities of Nijmegen, Utrecht and Rotterdam. At the start of the pilot projects, laboratories agreed upon a uniform protocol for reporting cytologic findings and recommendations for follow-up examinations in cases of abnormalities. Based on the results of the three pilot projects, in 1985 the Dutch government decided to organize a nationwide screening program for cervical cancer. All pathology laboratories involved in this national screening program are using the same screening protocol and the same coding system for cytologic and histologic diagnoses. By the end of 1989, all pathology laboratories will be linked to a central pathology diagnosis data base (PALGA). Linkage of screening results to previous and follow-up cytologic and histologic findings will enable epidemiologic studies on a regional or national level. Each physician who has submitted specimens will, next to the cytology reports, periodically receive reviews of the number of smears submitted, the cellular composition (quality) of those smears and the follow-up findings. The execution of requests for follow-up examination will be supervised by the participating pathology laboratories. The national cervical cytology registry will enable registration of all relevant cytologic and histologic diagnoses in a uniform way, but will also establish a unique high-quality national data bank, which will be of great value in the analysis of the effectiveness of the national screening program for cervical cancer. It will enable measurement of the impact of various screening protocols and give insight into the behavior of cervical cancer and the progressive or regressive character of its early stages. It will also offer the opportunity to initiate and evaluate quality control protocols.

Cervix Uteri↗
PubMed1989

[Disclosure of ancient medical tests and its problems--the Corpus Medicorum Graecorum et Latinorum. Accomplished and planned goals].

The interacademical project "Corpus Medicorum Graecorum", started in 1907 in Berlin, reflects the evolution of the classical philologists' approach to ancient medicine. The Corpus was meant to make available reliable critical editions of the ancient medical texts to historians of science as indispensable tools for their research work. The work done to realize this purpose has shown, however, that the whole primary and secondary tradition of these texts must be taken into consideration. The translations into modern languages and the commentaries included in the more recent volumes should help to make accessible the ancient texts to as many interested persons as possible.

Greece, Ancient↗
PubMed1989

Voluntary village health workers in Papua New Guinea.

The aid post orderly system remains the cornerstone of primary health services in Papua New Guinea (PNG). Inadequate supervision limits its impact. Recent promotion of voluntary village health aides (VVHA) is leading some provincial Divisions of Health to start large-scale projects, which are even more likely to break down through poor supervision. VVHAs are in general inappropriate to provide widespread curative care in PNG. Health personnel should rather reinforce and support existing services. However, voluntary village aide schemes may be appropriate in localized disadvantaged areas. Health planners should consider carefully their goals in setting up such schemes; how they are going to develop projects; and, if villagers want VVHA schemes, the staff required for training and supervision. Monitoring and evaluation should be incorporated into the initial design and provide feedback to participants. Intensive supervision may be appropriate for a defined period, with subsequent closure of the project, or its absorption into the existing health care framework.

Community Health Workers↗
PubMed1979

[Preliminary physiological and psychological results under various electroclimatic conditions (author's transl)].

Before the start of a research project which was to stretch over a period of several years, characteristics of the control space were to be defined. Therefore the influence of spherics and 50 Hz-alternating fields in the unscreened control space were studied.--Pupils (Foster children) were the test subjects. Each test subject was subjected to the conditions of the control space as well as the testing space.--Two classes of parameters were studied. Blood sugar, blood pressure and pulse rate were recorded as physiological dimensions. Short-term memory, powers of concentration as well as the subjective well-being were the psychological parameters.--As to the parameters examined, no significant difference between testing and control space conditions was recorded. In order to examine whether the climatic factors of the control space have an antagonistic effect on the variables in question, their influence was studied separately in two further investigations. In order to clarify this problem, spherics-impulses in the 10 Khz range were given in screened space ("Vorversuch 2"/preliminary experiment 2), then--in, "Vorversuch 3"/preliminary experiment 3 - a 50 Hz-alternating field was applied. For each of the climatic factors under examination the influence on each single parameter was negative. The assumption of an antagonistic effect which would hinder the definition of standard spatial conditions was thereby shown to be incorrect.

Adult↗
PubMed1983

Hospice care: perspectives on a Blue Cross Plan's community pilot program.

A community approach to the provision of hospice care utilizing existing community institutions in the metropolitan Washington, DC, area was started as a pilot project among three entities: the Washington Home, a licensed, skilled nursing facility, which served as the hospice inpatient unit; Georgetown University Hospital and its home care program, which were to serve as the sole referral sources; and Group Hospitalization, Inc., the local Blue Cross Plan. Insufficient referrals resulted in expansion of referral sources to include other hospice home care providers and acute care hospitals in the general community. As other community hospices developed, the Blue Cross Plan expanded the pilot program and fostered the communitywide coordination of hospice services.

Blue Cross Blue Shield Insurance Plans↗
PubMed1981

Trial designs for multicentre clinical studies of investigational phases I B to III with praziquantel.

Following very promising results with 2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin-4-one (praziquantel, EMBAY 8440, Biltricide) in animal experiments on toxicity and efficacy and after confirming excellent tolerability in healthy volunteers, WHO could be won over to the further clinical development of this compound. In close cooperation trial protocols and case report sheets standardised as far as possible were set up for intercontinental multicentre trials in investigational phases II A, II B, and III, respectively. Thus, in investigational phase II A, studies were conducted simultaneously in Africa, Asia and South America. In all those endemic areas not only good tolerability in patients but also high efficacy against local Schistosoma species could be confirmed in double blind trials. In the extended phase II B, patients were allotted to 3 strata of different intensity of infection in order to find out if differentiating dosages would be necessary according to degree of worm burden, patient's age, and occurrence of more frequent and/or severe adverse reactions in patients with hepatolienal complications. There is not yet a satisfactory answer to all of these questions. In the investigational phase III already under way we hope to fill those gaps and also to find the optimum dosage for large scale use under field conditions. The profile of praziquantel, however, has already been established to an extent that first community health projects have been successfully started and others are in an advanced stage of planning.

Clinical Trials as Topic↗