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PubMed2005

[Development and evaluation of a psychoeducational group training programme for teachers of autistic pupils with mental retardation].

OBJECTIVES: Teachers of autistic pupils show profiles of increased stress that are caused by the social, communicational, and cognitive deficits of these children. The aim of the present study was to develop and evaluate a psycho-educational group training programme for teachers. METHODS: The curriculum covered theoretical issues of autism as well as educational skills focusing on "structured teaching" (TEACCH: Schopler, 1997). The training outcomes were evaluated within a pre-post (9 months) design. A total of 10 teachers working with 10 autistic children (mean age: 10 years) from schools for mentally retarded pupils participated in the training programme which included three one-day group sessions followed by six half-hour individual training sessions in the classroom (over a period of six months). The outcome variables were measured by means of teacher questionnaires assessing child behavioural symptoms, teachers' stress reactions, effects on the teachers' psychological adaptation, teacher-student-interaction and implementation of methods. RESULTS: The training programme resulted in significant effects (p < 0.5) on child symptoms as well as on teachers' stress reactions. In addition, the teachers' psychological adaptation and teacher-student-interaction improved. On average, teachers implemented about two structured teaching methods. CONCLUSIONS: These findings indicate some evidence for the clinical validity of the teacher training procedure examined, taking into consideration some methodological limitations.

Adult↗
PubMedDate not supplied

The Communication Clerk role in the emergency department.

OBJECTIVE: Analyse the clinical hours saved by the introduction of a dedicated Communications Clerk to the ED. METHODS: A Communications Clerk role was introduced at Flinders Medical Centre during 2002. Over a seven-week period the number of telephone calls taken and paging performed was logged. This function had previously been performed purely by clinical staff, and the number of clinical hours saved was evaluated. RESULTS: Over the study period the Communication Clerks worked for 509 h. A total of 7302 telephone calls were answered or made, and 924 pages made. The clinical hours saved was calculated at 243.3. The ratio of hours worked by the Communication Clerk to clinical hours saved overall was 2.1. CONCLUSION: The role of a Communication Clerk in a busy ED is an effective work practice change, particularly in relation to clinical hours saved.

Emergency Medical Service Communication Systems↗
PubMedDate not supplied

Communicative functioning in individuals with Angelman syndrome: a comparative study.

PURPOSE: To assess expressive communication in individuals with Angelman syndrome. METHOD: Communicative functioning of individuals with Angelman syndrome (AS) (n = 109) was compared with individuals with mixed etiologies (n = 117) using the Verbal Behaviour Assessment Scale (VerBAS). RESULTS: Within-group analyses of those with AS revealed that the communicative function of manding was significantly more developed than tacting and echoing, and that tacting was significantly more developed than echoing. Low mean total VerBAS-scores were found with individuals who had epilepsy and used anticonvulsant medication, and with those who had profound developmental disabilities. In the comparison group, the function of manding was significantly more developed than both tacting and echoing, while tacting did not differ from echoing. Between-groups analyses revealed that individuals with AS had significantly lower scores on tacting and echoing, but not on manding. CONCLUSION: The overall pattern of VerBAS scores for individuals with AS suggests a possible communicative phenotype.

Adolescent↗
PubMed2001

Myocardial laser revascularization in the year 2000 as seen by a Norwegian specialist panel. The process of evaluating and implementing new methods in clinical practice.

OBJECTIVE: In Norway "Transmyocardial laser revascularization" as a routine method was prohibited by the Ministry of Health in 1995 due to lacking evidence of treatment effect and concerns about procedural morbidity and mortality. In 1999 Norwegian health authorities asked for a re-evaluation of the method based on a systematic review of literature. METHODS: Medline and Embase were searched and a total of 267 articles were identified. Publications were classified by an expert panel according to type of study and importance for the project. RESULTS: Based on the literature review the panel concluded that heart laser treatment does not have a life-saving effect, nor does it improve myocardial function. However, the method has a considerable short-term symptomatic effect, the mechanism of which is not understood. Neoangiogenesis, denervation and placebo may play a role. Based on the report the Norwegian health authorities recommended use of this method be restricted to scientific trials only. CONCLUSIONS: Based on a systematic literature review it was concluded that the only documented effect of heart laser treatment is symptom relief, the mechanism for which is unclear. It could partly or totally be a placebo effect. A conflict of interest may arise when new technologies are to be implemented in health care. The communication between professionals evaluating scientific results and decision makers is challenging. Quality assurance of this process may be obtained by use of expert panels working under the auspices of an official institution.

Heart Diseases↗
PubMed2004

[Efficacy and safety of endovascular treatment of brain aneurysms: experience in our setting].

INTRODUCTION: The objective of our study is to know the efficacy and safety of endovascular treatment in our setting. PATIENTS AND METHODS: a) prospective evaluation of patients with aneurysmal subarachnoid hemorrhage (SAH) or incidental aneurysm (Dec 1999-Dec 2002), and b) neurological, angiographic and evolutive evaluation of the endovascularly operated patients. RESULTS: A total of 79 patients were evaluated: 75 with SAH, 4 with incidental aneurysm. Arteriographies were performed in 74 (93.6%), detecting 58 aneurysms in 52 patients, 15 of the anterior communicating artery (25%) and 14 of the posterior communicating artery (24%). Fifty-two aneurysms were treated with Guglielmi Detachable Coiling (GDC) (89.6 %). Total occlusion (100 %) was obtained in 48 (82.7%) and partial occlusion in 4. Technique failure occurred in six cases. The earlier complications, after endovascular procedure (< 24 h), were one rebleeding, four angiographic spasms and ischemia and one coil displacement. During the first month, there were other cases of rebleeding and two cases of spasm and ischemia. Morbidity rate was 11.5 %. Death rate was 5.7 %. Follow-up period ranges between 6 and 42 months. After endovascular treatment 40 patients had a favourable outcome (Ranking 1-2) and 9 suffered moderate-severe incapacity (Ranking 3-5). We prescribed angiographic controls one year after the hemorrhagic event and there was only one case of aneurysmal recurrence. DISCUSSION: In our experience endovascular treatment is useful to treat ruptured and unruptured aneurysms, with similar surgical occlusion, morbidity and death rates.

Adult↗
PubMed1993

[Economic and structural aspects of modern medical technology].

Medical techniques are one of the few innovative factors that can improve the efficiency and economics of the health services. However, as illustrated for the example of Germany, the outlay and subsequent costs for expensive technical appliances in medicine account for only 1% of the total expenditure for health. But they provide the potential for improved quality and lower costs for the health service and the economy in general. The availability of modern medical technology is indispensable for research, health care, education, and training in medicine. Further innovative aspects arise. The digital images obtained by various methods (Fig. 13) can be collected by image archiving and communication systems (20), mutually related, and indexed for morphological and functional information, thus opening improved strategies for therapy. Major challenges are awaiting all of us.

Germany↗
PubMed1999

SPECT monitoring of improved cerebral blood flow during long-term treatment of elderly patients with nootropic drugs.

PURPOSE: In normal aging persons, oxygen and glucose consumption progressively decreases with reduced cerebral blood flow (CBF), which could be responsible for age-related changes in cognitive functions. A data processing model with the use of Tc-99m SPECT of the human brain has been developed and found to be sensitive for monitoring the effects of drugs that increase CBF. In this study, the effect of two vasodilator drugs (the combination of pentifylline and nicotinic acid versus piracetam) was compared with the effect of placebo on CBF. MATERIALS AND METHODS: Thirty elderly volunteers had three different procedures using the Peelproc method to spatially standardize and compare CBF patterns by SPECT before and after drug intervention. The 30 patients were divided into five groups of six persons each who were randomly assigned in a 1:1 ratio to the treatment sequences consisting of three phases: the combination of pentifylline and nicotinic acid (C), piracetam (N), and placebo (P), or C-N-P; P-N-C; P-C-N; N-C-P; C-P-N; or N-P-C. Phases 1 to 3 each consisted of a baseline recording of parameters (day 0), treatment for 60 days (days 1 to 60), and recording of parameters after treatment (day 61). RESULTS: In elderly human volunteers (ages, 52 to 70 years), after 2 months of oral treatment with a combination of pentifylline and nicotinic acid (800 mg pentifylline, 200 mg nicotinic acid daily), SPECT results for the Peel-proc program indicated a statistically significant improvement in CBF of the total brain, with a more pronounced improvement in the cerebellum and frontal regions, where a definite shift from abnormal to normal blood flow was detected. Spontaneous communication from most of the volunteers suggested that they experienced an improvement in memory and general well-being from the combination treatment. After 2 months of oral treatment with piracetam (2.4 g daily) in elderly human volunteers, SPECT results indicated a regional improvement in CBF, particularly in the cerebellum. However, no beneficial effects with this drug were spontaneously reported. CONCLUSION: The in vivo method to quantitatively monitor the progress of long-term drug therapy on CBF described here could be useful to assess and even direct changes in therapy.

Administration, Oral↗
PubMed1983

[Role of a hygiene department in the control of respirator disinfection].

Different methods of disinfection of ventilators are used in hospitals. They are chosen according to the type of apparatus, the configuration of its internal circuit, the system of disinfection available and the degree of contamination. There are three types of disinfection: a) partial disinfection, b) partial internal disinfection by connection to an apparatus of disinfection with liquid formaldehyde, c) total automatic internal and external disinfection with formaldehyde powder. The hospital public health team controls the different disinfection procedures. Samples were taken from 13 places on four ventilators (Engström, Bennett, Servo 900, RPR). They were taken on polyvalent and on three selective culture media (gram positive, gram negative and Pseudomonas aeruginosa). Three criteria were defined: absence of contamination, limited contamination and widespread contamination. After disinfection, satisfactory results were always observed. However, these results were observed only immediately after disinfection and before stocking and transport. The results of these controls, communicated within 48 h to the doctors, allow us to check the reliability of the method used.

Disinfection↗
PubMed2000

Can improving quality decrease hospital costs?

PURPOSE: To determine whether the concept of 'cost of quality' and the techniques used for its study in the industrial sector are also applicable to hospitals. DATA SOURCES: We undertook a systematic review of the literature published since 1992 (five electronic databases and a manual search) using keywords relating to quality of health care and costs. STUDY SELECTION: We selected all articles relating cost and quality, providing indicators for quality failure, determining the cost of failure, and itemizing the cost of quality. Twelve articles met these criteria (USA, nine; UK, one; Australia, one; France, one); six referred to total quality management, three to hidden costs, and three to adverse events. DATA ABSTRACTION: For each article, we recorded the test hypothesis, the focus of the study and the main results on costs and quality. RESULTS OF DATA SYNTHESIS: Preventing failure by applying total quality management to a variety of projects (managed care project, setting-up a standard procedure . . .) led to financial savings; quality was maintained, even enhanced. Better communication and co-ordination reduced hidden costs and also increased quality. Adverse events prolonged hospital stays by 1.74-4 days and increased costs. CONCLUSION: Very few detailed articles related cost and quality and, although they all noted a positive impact of an emphasis on quality, they nevertheless had their shortcomings. Study periods were too short, the indirect aspects of costs and savings were not taken into account, economic reference values were omitted. We conclude that more precise and strict methods for quantifying costs are needed.

Cost Savings↗
PubMed2006

Joint source-channel coding for wireless object-based video communications utilizing data hiding.

In recent years, joint source-channel coding for multimedia communications has gained increased popularity. However, very limited work has been conducted to address the problem of joint source-channel coding for object-based video. In this paper, we propose a data hiding scheme that improves the error resilience of object-based video by adaptively embedding the shape and motion information into the texture data. Within a rate-distortion theoretical framework, the source coding, channel coding, data embedding, and decoder error concealment are jointly optimized based on knowledge of the transmission channel conditions. Our goal is to achieve the best video quality as expressed by the minimum total expected distortion. The optimization problem is solved using Lagrangian relaxation and dynamic programming. The performance of the proposed scheme is tested using simulations of a Rayleigh-fading wireless channel, and the algorithm is implemented based on the MPEG-4 verification model. Experimental results indicate that the proposed hybrid source-channel coding scheme significantly outperforms methods without data hiding or unequal error protection.

Algorithms↗
PubMed1976

[Total and partial sleep deprivation in the treatment of depression: preliminary communication].

Sleep deprivation (SD) has been proved to be an effective measure of antidepressive treatment (especially in endogenous depression). In a new study, 125 SD were examined on 93 depressed patients. The therapeutic benefit of SD on endogenous depression consists not only of the nightly clear up but also of provoking or improving a typical day wave the day after DS. A period of at least 36 h is necessary to survey the total effect of this method. The best results are achieved in patients with severe endogenous depression, especially in those with the typical day wave and distinct somatic symptoms. The effect of partial SD (for the second half of the night) is almost the same as that of total SD. The advantages of partial SD are: the patient can stand it easier, more often, and - in the company of a suited person - even at home. Finally, it is less complicate in clinical routine than selective REM-deprivation.

Depression↗
PubMed2006

Prognostic variables and prognostic groups for malignant melanoma. The information from Cox and Classification And Regression Trees analysis: an Italian population-based study.

The common way to analyse the prognostic role of selected variables in cutaneous melanoma patients is by means of Cox proportional hazard model. The prognostic effect of the simultaneous presence of more than one independent variable in the same patient is, however, difficult to establish. This hampers the possibility of tailoring a survival expectance for a selected patient as well as to communicate it to the patient himself/herself. The objectives of the study were to compare information on cutaneous melanoma prognosis from multivariate Cox proportional hazard model and from Classification And Regression Trees analysis. Classification And Regression Trees analysis is an automatic method that splits data by means of a binary recursive process creating a 'tree' of groups with different profiles according to the analysed outcome, for example, the risk of death. This approach automatically produces data that is easily interpreted by clinicians. A total of 1403 invasive cutaneous melanoma patients, 1110 from the Tuscan Cancer Registry and 293 from the Reggio Emilia Cancer Registry, Italy, were included. Cases were incident during 1996-2001 and followed up at the end of 2003. Cox proportional hazard model and Classification And Regression Trees analysis were applied to the following variables: age, sex, Breslow thickness, Clark level, registry, subsite and morphologic type. The Classification And Regression Trees analysis identified 10 categories with statistically different survival; this results were summarized into six classes of different risks based on Breslow thickness, age and sex. The best prognostic group (5-year observed survival, 98.1%) included those subjected with Breslow less than 0.94 mm and age 19-44 years. The same thickness but an older age (50-69 years) was associated with a statistically significant different prognosis (5-year observed survival, 92.8%). The Cox proportional hazard model found sex, age, Breslow thickness, Clark and morphologic type to have a significant independent prognostic value. In conclusion, compared with the conventional approach based on Cox hazard model, Classification And Regression Trees analysis produces data closer to the clinical need of defining the prognostic profile of a specific patient. This may help the clinician both in the communication of risk and in the follow-up strategy.

Adult↗
PubMed1995

Developmental expression of connexins in the chick embryo myocardium and other tissues.

BACKGROUND: Connexins are cell surface proteins that form specialized regions of cell-cell communication called gap junctions. These allow impulse conduction in in voluntary muscle tissue such as the heart, but also allow the formation of communities of like cells during development of organs. METHODS: We used an antipeptide antibody to connexin 43 in immunolocalization studies and an anti-peptide antibody to an external loop domain common to most connexins in Western blotting of total heart protein to measure the accumulation of connexins in the heart as it develops from 33 hours to 21 days (hatching), and in the adult. RESULTS: Immunolocalization revealed that connexin 43 is widely distributed in the earliest organ rudiments. It is especially prominent in the neural tube and its derivatives, in the lens and nasal placodes, in the foregut and its derivatives, in the somites, in the mesonephric tubules, and in the heart and major arteries. Heart tissue staining grew more intense with development through day 8. However, at day 11 and day 15, and in the adult, heart staining diminished. Endocardium and valve tissue did not stain. Western blotting of heart homogenates with the antibody directed against the external loop domain peptide showed 26, 32, 43, 45, and 56 kilodalton connexins, which changed in relative abundance, displaying unique patterns during development. CONCLUSIONS: Our results show patterns of connexin immunolocalization in early germ layers and organ rudiments that are similar to those known in the mouse, but with certain differences. Our results show a distinctive pattern of multiple connexin gene expression in the developing heart from days 2-21.

Animals↗
PubMed1978

A new one-stage surgical technique for postlaryngectomy speech.

A new one-stage surgical technique for the postlaryngectomy speech applied to the 17 patients and its results are described herein. The essential part of this technique consists of the construction of a tracheo-esophageal shunt using only the remainder of the trachea obtained at the time of laryngectomy to reestablish an air communication between the trachea and the gullet. Fourteen patients of the 17 patients thus operated upon developed conversational abilities equivalent to the normal subject, except that they use a finger during the speech for the occlusion of the tracheal opening. This technique can be applied to almost all candidates for total laryngectomy with or without neck dissection. The initial speech was developed in 25 days after operation in average. The inflow of the salivas and/or fluids into trachea is not problematic in these patients. It has been well known that an air communication reestablished between the natural air way and the gullet could reproduce a vocal function after total laryngectomy [5]. Despite very few surgical techniques for this purpose have been described and applied clinically, although a tremendous effort has been made for the complete removal of the malignancy and the avoidance of recurrence up to the present [1--4, 6]. A new surgical method for achieving a tracheo-esophageal shunt for the postoperative vocal function is described herein.

Esophagus↗
PubMed2000

Staged biventricular repair of pulmonary atresia or stenosis with intact ventricular septum.

BACKGROUND: Since 1991 we have performed a multistage palliative approach to biventricular repair of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum in infants with a detectable right ventricular infundibulum. METHODS: A total of 25 patients (19 pulmonary atresia and 6 critical pulmonary stenosis) underwent initial palliation consisting of a transarterial pulmonary valvotomy and a polytetrafluoroethylene shunt between the left subclavian artery and pulmonary trunk. Among the 23 survivors, 15 underwent balloon valvotomy. Six of these patients later required additional palliative surgery that consisted of repeat pulmonary valvotomy, adjustment of an atrial communication, and resection of the hypertrophied muscles in the right ventricle. RESULTS: Of the 25 patients, 23 (92%) survived. In all, 20 patients underwent definitive operations: 18 (90%) biventricular repair (12 pulmonary atresia, and 6 critical pulmonary stenosis), one bidirectional Glenn, and one Fontan procedure. The actuarial probability of achieving a biventricular repair at 36 months of age was 69%. In 18 patients right ventricular end-diastolic volume significantly increased but tricuspid valve diameter did not change. CONCLUSIONS: The multistage palliation procedure to promote right ventricular growth makes a definitive biventricular repair of pulmonary atresia or critical pulmonary stenosis with intact ventricular septum possible in the majority of infants with a patent infundibulum.

Cardiac Surgical Procedures↗
PubMed2006

Hospital staff perceptions of parental involvement in paediatric hospital care.

AIM: This paper reports a study of hospital staff perceptions of parental involvement in children's hospital care. BACKGROUND: Previous research has shown that parents are expected and encouraged by hospital staff to be actively involved in the care of their hospitalized children. At the same time, parents have expressed a need for improved communication with paediatric hospital staff to clarify both parental and staff expectations and preferences about this involvement. Few studies, however, have studied hospital staff perceptions of parental involvement in the care of hospitalized children and their implications for clinical work. METHODS: A cross-sectional questionnaire study was conducted among paediatric hospital staff in October of 2003. Questionnaires were distributed to a total of 338 staff, including all physicians, Registered Nurses and nursing auxiliaries working on oncology, surgery and neurology units in three university children's hospitals in Sweden. RESULTS: A total of 207 questionnaires were returned, yielding a response rate of 61%. Exploratory and confirmatory factor analyses of the 26-item questionnaire resulted in the creation of two indices, Work Routines and Work Strain. Oncology staff reported having better work routines for involving parents in their children's care and they experienced less strain from parental demands compared with staff on other paediatric units. Staff perceptions and workplace routines regarding parental involvement did not differ statistically significantly by profession or by length of work experience. CONCLUSION: Staff perceptions of parental involvement may be related to clinical specialty. Oncology units may find it easier to establish routines for parental involvement, thereby experiencing less work strain in their interactions with parents. There is a need to further study staff perceptions of parental involvement and their implications for the staff work situation in both Sweden and other countries.

Adult↗
PubMed2005

Dietary fat and risk of breast cancer.

BACKGROUND: Breast cancer is one of the major public health problems among women worldwide. A number of epidemiological studies have been carried out to find the role of dietary fat and the risk of breast cancer. The main objective of the present communication is to summarize the evidence from various case-control and cohort studies on the consumption of fat and its subtypes and their effect on the development of breast cancer. METHODS: A Pubmed search for literature on the consumption of dietary fat and risk of breast cancer published from January 1990 through December 2003 was carried out. RESULTS: Increased consumption of total fat and saturated fat were found to be positively associated with the development of breast cancer. Even though an equivocal association was observed for the consumption of total monounsaturated fatty acids (MUFA) and the risk of breast cancer, there exists an inverse association in the case of oleic acid, the most abundant MUFA. A moderate inverse association between consumption of n-3 fatty acids and breast cancer risk and a moderate positive association between n-6 fatty acids and breast cancer risk were observed. CONCLUSION: Even though all epidemiological studies do not provide a strong positive association between the consumption of certain types of dietary fat and breast cancer risk, at least a moderate association does seem to exist and this has a number of implications in view of the fact that breast cancer is an increasing public health concern.

Journal Article↗
PubMed1999

Psychiatric assessment of candidates for bone marrow transplantation: a psychodynamically-oriented approach.

OBJECTIVE: To seek possible relationships between psychological factors and survival after an intensive medical therapy, using bone marrow transplantation as a model. METHOD: Candidates for bone marrow transplantation underwent two to three psychodynamically-oriented psychiatric interviews that explored family functioning ("F"), individual psychological maturity ("I"), and the capacity to form and communicate a mature psychological construct of the transplant ("T") process. The results were recorded in a semiquantitative manner, assigning a possible score of 1 to 3 for each parameter, for a possible total of 3 to 9 (the "F.I.T." assessment). Survival after the transplant was analyzed retrospectively in relation to the F.I.T. assessment. RESULTS: In a series of 112 candidates interviewed prior to transplant, those with the lowest F.I.T. assessment tended not to survive as long. By one year, 95 percent of individuals assigned the lowest score (F.I.T. = 3) had died, whereas 96 percent of those assigned the highest scores (F.I.T. = 7-9) remained alive. The strongest predictors were the "I" and "T" parameters. CONCLUSION: This approach to assessment of candidates for bone marrow transplantation may identify individuals who require added, supportive measures, both medical and psychological. Furthermore, the results suggest possible leads in the search for how psychological factors might influence the physiologic response to a toxic stress.

Bone Marrow Transplantation↗