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PubMed1986

Two-dimensional gel electrophoresis, isoelectric focusing and agarose gel electrophoresis in the diagnosis of multiple sclerosis.

Two dimensional gel electrophoresis (2-DE), isoelectric focusing (IEF) and agarose gel electrophoresis (AGE) were used to examine cerebrospinal fluid (CSF) and sera from 22 patients with confirmed multiple sclerosis, 11 patients with probable multiple sclerosis and 20 control patients with non-inflammatory neurological diseases of the central nervous system (CNS). All of the 22 patients with confirmed multiple sclerosis showed abnormal patterns of oligoclonal IgG in all three methods. In the CSF from patients with probable multiple sclerosis, oligoclonal IgG was detectable in 18 percent with AGE, in 72 percent with IEF and 90 percent with 2-DE. No oligoclonal IgG was observed in subjects with non-inflammatory neurological diseases. Many artefacts in IEF, which lead to misinterpretation, are eliminated in the 2-DE system. Based on our observations and this study in particular, it is evident that some patients have IgG changes which can be detected only by 2-DE. The application of research-oriented 2-DE for routine clinical purposes is still limited by its cost and technical complexity.

Electrophoresis, Agar Gel↗
PubMed2004

Linkage disequilibrium mapping of yield and yield stability in modern spring barley cultivars.

Associations between markers and complex quantitative traits were investigated in a collection of 146 modern two-row spring barley cultivars, representing the current commercial germ plasm in Europe. Using 236 AFLP markers, associations between markers were found for markers as far apart as 10 cM. Subsequently, for the 146 cultivars the complex traits mean yield, adaptability (Finlay-Wilkinson slope), and stability (deviations from regression) were estimated from the analysis of variety trial data. Regression of those traits on individual marker data disclosed marker-trait associations for mean yield and yield stability. Support for identified associations was obtained from association profiles, i.e., from plots of P-values against chromosome positions. In addition, many of the associated markers were located in regions where earlier QTL were found for yield and yield components. To study the oligogenic genetic base of the traits in more detail, multiple linear regression of the traits on markers was carried out, using stepwise selection. By this procedure, 18-20 markers that accounted for 40-58% of the variation were selected. Our results indicate that association mapping approaches can be a viable alternative to classical QTL approaches based on crosses between inbred lines, especially for complex traits with costly measurements.

Bayes Theorem↗
PubMed1979

Control of the blood glucose in diabetes mellitus is it valuable? Is it feasible.

The controversy over the whether strict blood glucose control prevents or attenuates the complications of diabetes is still unresolved, but the available data support the value of good blood glucose control. The resolution of the controversy is not feasible at present because of the complexity and financial cost of a definitive prospective study and because we may not presently possess pharmacological agents which can accomplish the goal of long term strict control of the blood glucose. Finally, whereas we regard retinopathy, nephropathy and neuropathy as valid pathological endpoints, we are not secure in assuming that blood glucose represents the critical measurement for longitudinal assessment of metabolic control. Studies evaluating control based on blood and urine glucose assessments are complicated by the failure of the data to reflect changes in minute to minute regulation. Thus, the relative insensitivity of some of these parameters of control could account for failures to demonstrate a correlation between adequacy of therapy and diabetic complications.

Basement Membrane↗
PubMed1989

The economic impact of technology on diagnostic imaging at a university medical center.

Diagnostic imaging procedures and charges were analyzed for the most recent 15 years (1973-1988) and projected for 5 years in the future (1993) by using recent trends in a large, university-based radiology institute. During the 20 years, procedure volume doubles, total charges increase by a factor of 10 without adjusting for inflation and by a factor of three after adjusting for inflation. The major reason for the increase in charges is a change in the mix of procedures with increasing emphasis on new technology (CT, MR, sonography, and nuclear radiology) and interventional procedures. New technology and interventional procedures will change from 5% of total procedures in 1973 to a projected 27% in 1993. These more complex and more costly procedures have resulted in a considerably higher share of the charges for radiology and are projected to be responsible for 73% of a $109 million total charge by 1993. The charges for traditional radiology procedures have risen at approximately the inflation rate. These data document that the considerable benefit derived from new technology is associated with considerable cost and that new technology procedures are a major economic factor in modern diagnostic imaging.

Academic Medical Centers↗
PubMed2002

Laboratory methods for diagnosis and detection of drug resistant Mycobacterium tuberculosis complex with reference to developing countries: a review.

OBJECTIVE: To outline principles, advantages and limitations of the currently available laboratory methods for diagnosis and detection of drug resistance of Mycobacterium tuberculosis complex. DATA SOURCE: Published series of peer reviewed journals and manuals written on laboratory methods that are currently used for diagnosis and detection of drug resistance of Mycobacterium tuberculosis complex were reviewed using the index medicus, pubmed and medline search. Conventional bacteriological microscopy and culture, BACTEC, and molecular-based techniques were included. Basic principles, advantages and limitations of the cited techniques have been highlighted. CONCLUSION: Conventional bacteriological microscopy and culture are usually used for diagnosis of tuberculosis (TB) particularly in developing countries. However, their limited sensitivity, specificity and delayed results make this provision inadequate. Despite the development of quicker and more sensitive novel diagnostic techniques, their complexity and high cost has limited their use in many poor-resource countries. Due to the rapidly growing TB problem in these countries, there is urgent need to assess promising alternative methodologies in settings with high disease prevalence.

Bacteriological Techniques↗
PubMed1992

Contract management survey.

More hospitals are looking to contract management firms for help in controlling rising costs and handling complex reimbursement systems. Companies are responding to hospitals' changing needs by providing innovative services. Total hospital contracts rose 10.4% last year, according to the 94 companies responding to MODERN HEALTHCARE's 1992 contract management survey.

Commerce↗
PubMed1996

Avoiding potential problems when selling accounts receivable.

Accounts receivable financing is a potential tool for managing a provider organization's working capital needs. But before entering into a financing agreement, organizations need to consider and take steps to avoid serious problems that can arise from participation in an accounts receivable financing program. For example, the purchaser may cease purchasing the receivables, leaving the organization without funding needed for operations. Or, the financing program may be inordinately complex and unnecessarily costly to the organization. Sometimes the organization itself may fail to comply with the terms of the agreement under which the accounts receivable were sold, thus necessitating that restitution be made to the purchaser or provoking charges of fraud. These potential problems should be addressed as early as possible--before an organization enters into an accounts receivable financing program--in order to minimize time, effort, and expanse and maximize the benefits of the financing agreement.

Accounts Payable and Receivable↗
PubMed1996

Service plans and clinical interventions targeted by the oncology pharmacist.

Pharmacists are faced with a changing health care environment where they are being asked to demonstrate "value-added" to patient care. Because of the toxicity, complexity, intensity, and cost of cancer treatment, oncology pharmacists have opportunities to prevent adverse drug reactions, reduce costs, optimize drug regimens, and improve patient outcomes. Programs implemented by pharmacists practicing on a 40-bed adult inpatient oncology unit are described, including (1) chemotherapy quality improvement, (2) treatment of febrile neutropenia, and (3) management of peripheral blood cell transplant patients.

Adult↗
PubMed1997

Project administration departments improve information systems initiatives.

As integrated delivery systems evolve and grow, the information services organizations (ISOs) that serve them are increasingly called upon to undertake complex, high-cost, high-risk information systems projects. Because it is critical that such projects be managed efficiently and effectively, it is desirable to form a project administration department within the ISO to design and oversee a formal, consistent, and rigorous approach to project management. This department can assume responsibility for developing and implementing the processes, tools, functions, methodologies, and standards that ensure each project is performed consistently, on time, and within the established budget. The specific responsibilities of a project administration department will vary and evolve according to the needs of the healthcare system.

Communication↗
PubMed1999

Substance abuse treatment cost offsets vary with gender, age, and abstinence likelihood.

The cost-offset effect has been promoted as a way for substance abuse treatment to pay for itself by generating reductions in health care utilization in other areas. Clients (n = 5,434) that were abstinent for 24 months following substance abuse treatment had lower posttreatment utilization than clients that had relapsed. An examination of cost offsets revealed a complex interplay between gender, age, and type of utilization (medical versus psychiatric). Cost offsets were especially pronounced for women over 40 years old.

Adolescent↗
PubMed2000

Design and estimation for the National Health Interview Survey, 1995-2004.

OBJECTIVES: This report presents an overview, a detailed description of the sample design features, and estimation structures for the 1995-2004 National Health Interview Survey (NHIS). It is intended to serve the same role for the current (1995-2004) National Health Interview Survey design as the NCHS publication, Series 2, No. 110, Design and Estimation for the National Health Interview Survey, 1985-94, did for the previous design. METHODS: The 1995-2004 NHIS sample design uses cost-effective complex-sampling techniques including stratification, clustering, and differential sampling rates to achieve several objectives. These objectives include improved reliability of racial, ethnic, and geographical domains. This report provides a description of those methods. RESULTS: This report presents the operating characteristics of the 1995-2004 NHIS. The general sampling structure is presented along with a discussion of the weighting and variance estimation techniques. This report is intended for the general users of NHIS data systems. A companion report, Series 2, No. 126, National Health Interview Survey: Research for the 1995-2004 Redesign, provides a finer level of detail on the redesign process.

Data Interpretation, Statistical↗
PubMed2001

Economic analysis of tuberculosis diagnostic tests in disease control: how can it be modelled and what additional information is needed?

As the goal of tuberculosis (TB) control programmes is to get as many cases as possible onto correct treatment, the critical role of diagnosis is obvious. Under-diagnosis contributes to further spread of the disease, while over-diagnosis wastes scarce resources on inappropriate treatment. Various techniques are available with which to diagnose TB, including sputum smear microscopy, chest X-ray, antibiotics and culture. While it may be possible to improve the application of these diagnostic tools, there is universal recognition of their limitations. Although new technologies have been developed, their appropriateness for use in resource-poor settings has been questioned due to concerns associated with their complexity and high cost. Given the constrained resources of most countries heavily affected by TB, economic evaluation provides a powerful tool to facilitate the prioritisation of resources. However, economic appraisals of diagnostic procedures provide several unique methodological challenges, including specification of appropriate alternatives, measuring costs, and measuring outcomes. Nevertheless, the use of decision analytic models can provide an opportunity to explore many of these issues. This paper presents key problems in the diagnostic process, reviews existing diagnostic techniques, and discusses possible improvements of these techniques and the introduction of new techniques. Next it examines the usefulness of modelling the economics of TB diagnosis, highlighting gaps in information requirements. Finally, the article identifies economic and epidemiological factors that are likely to change results in different settings.

Algorithms↗
PubMed2002

Person identification from the EEG using nonlinear signal classification.

OBJECTIVES: This paper focusses on the person identification problem based on features extracted from the ElectroEncephaloGram (EEG). A bilinear rather than a purely linear model is fitted on the EEG signal, prompted by the existence of non-linear components in the EEG signal--a conjecture already investigated in previous research works. The novelty of the present work lies in the comparison between the linear and the bilinear results, obtained from real field EEG data, aiming towards identification of healthy subjects rather than classification of pathological cases for diagnosis. METHODS: The EEG signal of a, in principle, healthy individual is processed via (non)linear (AR, bilinear) methods and classified by an artificial neural network classifier. RESULTS: Experiments performed on real field data show that utilization of the bilinear model parameters as features improves correct classification scores at the cost of increased complexity and computations. Results are seen to be statistically significant at the 99.5% level of significance, via the chi 2 test for contingency. CONCLUSIONS: The results obtained in the present study further corroborate existing research, which shows evidence that the EEG carries individual-specific information, and that it can be successfully exploited for purposes of person identification and authentication.

Electroencephalography↗
PubMed2001

[Nosocomial infection: medical responsibility regarding the law].

The nosocomial infection, infection transmitted to a patient at the time of medical care, constitutes a complex nosological framework. The knowledge of the risk factors is essential to their good management. It underlies all the lawful texts concerning the fight against the nosocomial infections. These texts propose to us definitions established in a context of public hygiene and health. The complexity and the cost of the management of all these risks can only be compared with jurisprudential simplification, which results from this in responsibility matters. In a pro indemnity concern, the position of the "Cour de Cassation" is closely akin to the rigor of the "Conseil d'état", which imposes the uncompromising presumption of fault against supposed guilty, persons or entities. It is necessary to redefine the risks towards praetorian right. It is the role of the legal expert, auxiliary of the judge, to provide in equity an informed opinion on the facts. The factual criteria must allow a modulation of responsibility concerning the fault, the serial risk or the medical risk.

Cross Infection↗
PubMed1999

[The development of mouse bioreactor expressing human tissue plasminogen activator (tPA) in mammary gland by transfecting spermatozoa in testicular duct].

The most established methods for development of transgenic animals are the microinjection of DNA into the fertilized eggs, but it is still a procedure of certain complexity and high cost. Therefore, the idea of using sperm as a vehicle to carry exogenous DNA into eggs is very attractive, and there have been some successful reports. Though the methods are rather simple they sometimes have low reproducibility. To improve the technique we transinfected the spermatozoa in testicular duct, not in vitro, to produce mice which expressed human tissue plasminogen activator (tPA) in mammary gland. The results demonstrated that: (1) 5 transinfected mice mated 10 female mice in 10 days after operation, (2) 79 founders were developed and 42 survived, (3) using PCR to detect foreign DNA integrated into the genome of founders, 7 out of 42 founders were positive (16.67%), (4) The expression level of tPA was 48-80 ng/ml in the milk of 5 PCR positive founders and (5) the foreign DNA integrated into the genome was detected in 2 out of 4 1st offspring by PCR technique.

Animals↗
PubMedDate not supplied

[Epidemiology and prevention in dialysis].

During the last years, prevention of hospital infections assumed the role of primary objective for active interventions and dedicated laws for safety in work areas and for facilities accreditation defined responsibilities and preventive measures to reduce the biological risk. Dialysis centers are areas where the infective risk is high but the strict application of the Universal Measures and of specific recommendations are sufficient to reduce the risk of diffusion and transmission of pathogens. The late referral of the ESRD patient, with or without infectious comorbidity, shows an intervention field, in which a local epidemiological survey gives useful data and stimulates the data management at hospital level (Epidemiologists and nefrologists) and family doctors, to improve the disease management of very complex and high cost patients.

Bacterial Infections↗
PubMed1992

[Should accommodative strabismus be operated on?].

Hypermetropia is probably not the real cause of accommodative squint. The arguments for this view are the absence of binocular vision in more than half and of the presence of a vertical deviation in about one third of cases of accommodative strabismus. Furthermore, after reduction of this vertical deviation by means of simultaneous surgery upon the horizontal and oblique muscles, binocular vision recovers spontaneously, the accommodative component of the squint disappears and visual acuity improves without glasses. Recent neurophysiologic research explains the beneficial effect of simultaneous surgery. According to these investigations there are two systems of accommodation and convergence; a quick phasic one, where accommodation is linked with convergence and a slow tonic one without interaction. The tonic system is responsible for the neutralization of the excess of convergence induced by hyperaccommodation. Tonic vergence depends on fixation disparity which is eliminated by a vertical deviation and restored by the surgical reduction of this vertical deviation. The fact of wearing positive correction produces and consolidates a hypo-accommodation, revealing a latent hypermetropia which could compromise emmetropisation. Furthermore, this correction being associated with squint, is a source of psychological complexes and the cost of an optical treatment is high, considering that spectacles need to be renewed frequently and many times during lifetime. On the other hand, simultaneous surgery removes an important obstacle to fusion and makes the patient independent of spectacles, not only regarding the squint, but also visual acuity.

Ethics, Medical↗
PubMed1992

Strategies for implementation and quality assurance for mammographic screening.

Compliance with screening mammography guidelines is affected by complex factors, including cost, accessibility, education, and attitudes of referring physicians. High-volume mammography facilities have lower fees and higher quality. Quality assurance is the focus of the voluntary American College of Radiology Mammography Accreditation Program, and over half of all mammography units are accredited. Nonetheless, pressure for mandatory quality standards is increasing. Mobile mammography reduces costs and increases access, but it presents challenges in financing and quality assurance. These screening issues, especially quality assurance, are not taught adequately in radiology residency training programs. Yet public awareness of the benefits of early detection has resulted in more lawsuits for failure to diagnose and delay in diagnosis. Preventive measures reduce medicolegal risks. On a personal level, the psychologic trauma of screening mammography is greater than was previously suspected. However, associated anxiety and stress do not seem to affect compliance with screening guidelines adversely.

Female↗