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PubMed1976

[Dosage problems of sodium nitroprusside (author's transl)].

Sodium nitroprusside has proved a useful completion of anaesthesiologist's armament. Nevertheless there still exist some doubts concerning correct dosage. This uncertainity is aggravated by communications in literature about fatal outcomes of hypotensions induced with this drug. For the patient's safety, we recommend not to exceed an infusion rate of 15mcg/kg/minute or a total of 1.5-3mg/kg irrespective of the time of administration. In any case the development of metabolic acidosis or the occurence of tachyphylaxis or resistance should be a strong argument for discontinuing nitroprusside and changing to an other method of hypotensive anaesthesia. A useful aid is the control of infusion rate by the IVAC-531-machine.

Acidosis↗
PubMed2002

Epithelial (epidermoid) splenic cysts in childhood: surgical management of eight cases.

We report eight cases of splenic epithelial cysts in childhood to summarize our clinical experience and to discuss surgical management. Six boys and two girls, aged 8 to 14 years (mean 10.8 years) were diagnosed over a 16-year period. No patients had a history of preceding trauma or related infection. Presenting symptoms were dull (two) or acute (one) left hypochondrium pain and diffuse abdominal pain (one). In four children the cyst was an incidental finding. Ultrasound and/or CT revealed cysts of diameter 2.9 to 14 cm and radionuclide scan showed a reduced uptake in the splenic area of concern. At operation variable amounts--up to 1500 mL--of liquid were aspirated from the cysts. Splenic artery ligation was undertaken in six cases adjunctively to cystectomy. One total splenectomy was performed because the splenic parenchyma was totally replaced by the cyst. Recurrence occurred in one case, in which multiple tiny communicating cysts were detected. Histology revealed epithelial (n = 5) or stratified squamous (n = 3) lining. Five patients were seen again 0.5 to 5 years later and they were asymptomatic and with a normal ultrasound, CT, or radionuclide scan. Cyst excision was an effective treatment. Adjunctive splenic artery ligation when performed controlled hemorrhage. Other surgical methods to manage splenic cysts are discussed.

Adolescent↗
PubMed2002

Orienting interns to being second-year residents.

BACKGROUND: Although orientation to the first year of residency is universal in family practice residencies, there is no published information on preparing first-year residents to become upper-level residents, an almost equally dramatic change. METHODS: We conducted a national survey of all 484 family practice residency directors by e-mail and regular mail. RESULTS: The total response was 365 (75.4%). Slightly more than half (185) of the residencies had a formal program to prepare for the transition to second-year resident. Both faculty, and upper-level residents taught or exchanged information using multiple methods of teaching but mostly lectures and seminars. Topics included practical issues related particularly to new responsibilities, teaching and supervising skills, and the general topics of leadership and communication. An important minority objected to these orientations, expressing concern that they distracted from the ultimate goal of training competent practitioners. CONCLUSIONS: Orientation to the second year of residency is common, brief, and specific. No evaluation of the value of these programs exists.

Family Practice↗
PubMed2002

Measuring functional status in Thai children with disabilities.

OBJECTIVE: The purpose of this study was to compare normal children with age-appropriate functional abilities and children with identified disabilities in Thailand. SUBJECTS AND METHOD: Data were collected for 157 nondisabled children and 80 children with cerebral palsy. Their ages ranged from 6 to 100 months. The Functional Independence Measure for children (WeeFIM) is an instrument used to assess independence in self-care, sphincter control, transfers, locomotion, communication, and social cognition. RESULTS: The WeeFIM of the disabilities scored consistently lower in all areas than those of the nondisabled children (p<0.05). Total score, motor score, and cognitive subscores increased with age. When data from Thai children was compared with that from American and Japanese children, total WeeFIM mean scores for each age group and Pearson's correlation coefficients between each age group and total WeeFIM scores showed similar trends. CONCLUSION: WeeFIM can be used as a disability-measuring instrument for Thai children.

Activities of Daily Living↗
PubMed1995

Implementing total quality management in an academic surgery setting: lessons learned.

Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States. This description will illustrate the lessons we have learned in our attempt to change a complex organization and will enable readers to determine whether an analogy exists between our organization's response to problem solving and theirs.

Academic Medical Centers↗
PubMed1999

Surgical considerations for invasive breast cancer.

The 1992 NIH Consensus Development Conference reported that "breast conservation treatment is an appropriate method of primary therapy for the majority of women with stage I and II breast cancer and is preferable because it provides survival equivalent to total mastectomy and axillary dissection while preserving the breast." This conclusion has been solidly confirmed by recent updates of all of the prospective clinical trials performed. The uneven utilization of this BCS indicates the personal discomfort of some surgeons in recommending it or in communicating their recommendations to patients. The appropriate candidate for mastectomy is the patient in whom it is evident that BCS will not control the tumor. This conclusion may be drawn after one or even two attempts at revision have shown more extensive microscopic disease. The experience with preoperative chemotherapy programs such as NSABP Protocol B-18 shows that even for larger tumors primary excision or excision after preoperative chemotherapy provides reasonable rates of local control with no evidence of diminished distant control or survival. Very large tumors, often accompanied by other grave signs, are best treated by primary chemotherapy, because they are essentially not stage I or stage II disease. Although recognizing that better long-term cure rates are a function of the treatment of micrometastases with adjuvant chemotherapy, surgeons should remember the need to balance cosmetic factors with techniques required for good local control. Cosmetic factors are always important, but the primary concern is adequate removal of the primary tumor with pathologically negative margins. The best way to prevent the need for a salvage mastectomy following local recurrence is to obtain adequate control at the initial procedure, but this does not mean that aggressive local surgery is needed, and it certainly does not mean that a primary mastectomy is needed except in unusual cases.

Attitude of Health Personnel↗
PubMed2004

The silent child--mothers' experiences before, during, and after stillbirth.

BACKGROUND: The quality of care received by a woman who gives birth to a dead baby is crucial for her long-term well-being, and limiting the period between diagnosis of intrauterine death and induction of delivery decreases her anxiety risk. The primary objective of this study was to explore why induction of delivery for most women should not be delayed more than 24 hours from the diagnosis of intrauterine death. A secondary objective was to determine how the time between diagnosis and delivery should be spent. METHODS: Twelve women were interviewed about their experience before and during the diagnosis of their baby's death and the event of birth. Interviews took place 6 to 18 months after the delivery and were analyzed using a phenomenological methodology. RESULTS: Women experienced premonition, difficulty communicating their worry, cessation of verbal communication with staff, unreality and numbing, desire to get rid of the dead child immediately, going through childbirth, and total silence. Many women believed that they were not respected as a human being during the process of diagnosing the intrauterine death. Themes emerged indicating caregivers should not reduce to zero the time between diagnosis of intrauterine death and induction of delivery. Time may be needed to obtain medical information about the delivery and to prepare the woman for meeting with and saying goodbye to her long-awaited but now silent baby. CONCLUSION: The period between diagnosis of intrauterine death and induction of delivery may give health professionals a major opportunity to improve a woman's ability to cope with the event of stillbirth and prepare her to meet with her loved but now silent baby. Further clinical research can identify supportive mechanisms for parents, and sources of iatrogenic psychological trauma that should be eliminated.

Adaptation, Psychological↗
PubMed2005

The development and implementation of a regional network of physiotherapists for exercise therapy in patients with peripheral arterial disease, a preliminary report.

BACKGROUND: Exercise therapy (ET) is the main conservative and proven effective treatment of patients with intermittent claudication. Currently, the most frequent exercise prescription is a single 'go home and walk' advise, without supervision or follow-up. There is no evidence to support the efficacy of this advise and compliance is known to be low. Therefore, a systematic approach was used to guarantee quality and standardisation of treatment, optimal guideline adherence and improved of inter-professional communication between vascular surgeons and physiotherapists. In this preliminary report we would like to outline the steps taken for the development and implementation of the Network Exercise Therapy Parkstad. METHODS: In October 2003 all 59 regional physiotherapy practices were invited to attend a symposium regarding ET in a physiotherapeutic setting. Attending physiotherapists interested in providing ET and willing to follow a certified course on ET, were asked to register. Three tastk groups were formed to accomplish the set targets: Exercise therapy education, Exercise therapy implementation and continuity, and Inter-professional communication in the Parkstad region. RESULTS: In total 27 physiotherapists, from 22 different practices followed the educational program and are now trained and accredited to provide ET according to the guideline of the Royal Dutch Society for Physiotherapy. A web-based database was designed to contain information on disease specific items provided by the vascular surgery department, and aspects with respect to ET registered by the physiotherapist. The information is regularly updated and available online. Access to the database is restricted to vascular surgeons and physiotherapists in the network. The secondary purpose of the database is to register essential benchmark data for future analysis of ET in a physiotherapeutic setting in the Netherlands and to enable physiotherapists continuous feedback on patient performance. A triage system was developed to detect patients with a compromised cardiac history. This group receives ET at the in-hospital department of revalidation with the possibility of immediate consultation of a cardiologist in case of cardiac complications or even CPR. CONCLUSION: The Network Exercise Therapy Parkstad of supervised ET is the first initiative in the Netherlands to provide ET close to the patient's home environment. With the implementation of supervised ET in an outpatient physiotherapeutic setting for all eligible patients with symptomatic PAD, the access to care has been improved. A web-based communication system provides physiotherapists and vascular surgeons with all the necessary and continues updated patient information. Future research, currently in progress, will investigate the therapeutic benefits and cost-effectiveness of exercise therapy in a physiotherapeutic setting.

Ambulatory Care↗
PubMed2003

The psychosocial context of young adult sexual behavior in Nicaragua: looking through the gender lens.

CONTEXT: Understanding the nature and magnitude of gender differences in sexual norms among young adults in Nicaragua, and how these differences affect sexual behavior, is important for the design of reproductive health programs. METHODS: A representative cross-sectional survey was conducted in six departments in the Pacific region of Nicaragua in 1998. A total of 552 never-married women and 289 never-married men aged 15-24 were interviewed about their perceptions of social pressure to engage in premarital sex; perceived social approval of and attitudes toward premarital sex and premarital pregnancy; perceived sexual activity among peers and siblings; communication with parents on sexuality issues; the psychosocial context of sexual debut; and preferred sources of information on sexuality issues. RESULTS: Most young men (83%) reported that they had received direct encouragement from at least one person in the last year to engage in premarital sex, and at least half perceived that their father, siblings, other relatives and friends approved of premarital intercourse. A significantly greater proportion of men than of women reported that curiosity or gaining experience motivated their sexual debut (61% vs. 21%). Men perceived themselves to have a higher risk of unplanned and unprotected sex than did women. In contrast, women held more negative attitudes toward premarital sex and were more often discouraged by parents or siblings from engaging in sex. CONCLUSIONS: Reproductive health programs for young Nicaraguans need to address gender-based double standards, which raise the risk of unplanned, unprotected sex and unintended pregnancy.

Adolescent↗
PubMed2001

Burden of disease analysis in rural Ethiopia.

We describe the design and results of a study conducted to determine the magnitude and healthy years of life lost due to morbidity and mortality for major causes in rural Ethiopia. The design included a cross-sectional household survey to determine the magnitude and causes of morbidity and a retrospective longitudinal study to determine the magnitude and causes of mortality. The study was conducted between June 1 and July 12, 1998, within the Butajira Rural Health Project (BRHP) setting. The source population were all people residing in the district and the study population were the sample of households for the BRHP which are the inhabitants of nine rural and one urban Kebeles (villages) in Butajira area, which is located about 130 Kms south of Addis Ababa. The sample was previously selected randomly using probabilities proportional to size, constituting 10% of the total district population (approximately 32,000) and has been under continuous demographic surveillance since 1987. All individuals who were sick two weeks preceding the survey and all those who deceased in the two years prior to the survey were included in the present analysis. The Disability-Adjusted Life Years (DALYs) lost was used as a measure of the burden of disease from the analyzed data. According to the results, prevalence of morbidity within the preceding two weeks was 13.8% (95% CI = 12.8-14.8). In addition, there were 875 deaths during the preceding two years making an annual mortality rate of 13.5 per 1,000 populations (95% CI = 13.13-13.87). The total burden of disease in terms of DALYs lost calculated from these data was 59,125 per 100,000 populations (95% CI = 58,591-59,659). Communicable, maternal, perinatal and nutritional problems contributed to 72% of the total DALYs lost; non-communicable diseases contributed to 24% of the DALYs lost while the proportion of DALYs lost due to injuries was only 4%. The results were similar to previous estimates for countries in Sub-Saharan Africa.

Adolescent↗
PubMed2006

[Evaluation of eco-environmental quality based on artificial neural network and remote sensing techniques].

In the present study, vegetation, soil brightness, and moisture indices were extracted from Landsat ETM remote sensing image, heat indices were extracted from MODIS land surface temperature product, and climate index and other auxiliary geographical information were selected as the input of neural network. The remote sensing eco-environmental background value of standard interest region evaluated in situ was selected as the output of neural network, and the back propagation (BP) neural network prediction model containing three layers was designed. The network was trained, and the remote sensing eco-environmental background value of Fuzhou in China was predicted by using software MATLAB. The class mapping of remote sensing eco-environmental background values based on evaluation standard showed that the total classification accuracy was 87. 8%. The method with a scheme of prediction first and classification then could provide acceptable results in accord with the regional eco-environment types.

Climate↗
PubMed1990

Kinetic Family Drawings-Revised: a method of determining the impact of cancer on the family as perceived by the child with cancer.

In a 5-year, longitudinal study, the impact of childhood cancer on the family was studied through use of interviews and selected instruments, including the Kinetic Family Drawings-Revised (KFD-R). developed by Spinetta (1981). From the sample of 40 families, 8 children with cancer, ages 6 to 18 years, drew 18 pictures appropriate for analysis using the KFD-R. The total and subscale scores of communication, self-image, and emotional tone increased over time for the sample, indicating an increase in negative perception of self and family interaction. Differences in the trends of the scores were seen in children with leukemia as compared with children with solid tumors and in children who had relapsed versus those who were experiencing a long-term remission.

Adaptation, Psychological↗
PubMedDate not supplied

[Anxiety, depression, stress in "depersonalization" and "derealization"].

We quote the terms "depersonalization" and "derealization" though meaningless in an absolute sens, and feel it is suitable to define them as: "The diminishing of the feeling of significance experiences (vivencia) of the ego and of the reality". Theme of the communication: twofold: Remember a frequent omission--with important exceptions--is a lack of focus on the terrible pathos which acquires a certain intensity this syndrome. I have working in this direction since 1960 and specifically since 1988 with a total of 3.592 patients affective and obsessive-compulsive, from which I selected 242, with "depersonalization" and "derealization" syndromes. 60 of them clinically severe. As assessed by the clinical phenomenological method. The observation time varied from three months and aigth and half years. "Under the auspices of egodistonia with a correct judgement of reality" in following areas: Environmentally (speak of "symptom of Tantalus"...). In the diminishing of sense of body. The patient involuntary memory. In the area of thought. In the area of the perception of time. Independent of those other stress situation which are known to a accompany the appearance of the syndrome of the "depersonalization" and "derealization" we think that this may produce at times symptoms of post-traumatic stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed2006

Introducing a model for communicable diseases surveillance: cell phone surveillance (CPS).

BACKGROUND AND GOAL: Surveillance systems for communicable diseases are primarily passive in most countries, including Iran. Laboratory-based surveillance and use of cell phone surveillance may be a useful method. MATERIAL AND METHOD: We established a new model for gathering data directly from district laboratories to regional laboratories and from them to national manager of public health laboratories by using cell phone. We assessed the coverage of Mobile and Cell phone in the laboratory Technicians, and Directors of Public Health in 27 universities in Iran by a simple data collection form to evaluate the feasibility of this method. And then this method was piloted for the last Cholera outbreak in Iran in 2005. RESULT: From data of 27 universities with 184 cities, we gathered 769 data health directors' mobile, total mobile penetrating rate, SMS users, and SMS penetrating rate was 57.9%, 77.1%, and 44.6% between Directors in Medical Universities of Iran and 54.5%, 54.9% and 29.9% in Directors of Laboratory. In the Cholera epidemic in Iran in summer 2005, CDC of MOH registered near 900 cases of cholera from 70000 rectal soap's exam in whole of country. The median reporting interval was under one day. CONCLUSION: Although the advent of the cell phone will probably change the way in which surveillance is delivered by health system, further studies are warranted to evaluate this method for laboratory based surveillance of lethal infections.

Academic Medical Centers↗
PubMed1999

Attitudes and information needs of Chinese migrant cancer patients and their relatives.

BACKGROUND: The information needs of ethnic minorities often differ from that of the dominant culture, leading to dissatisfaction among both patients and health professionals. AIMS: This research project aims to identify attitudes towards cancer and associated information and communication needs of Chinese patients and their relatives in Sydney, thereby providing a framework for the provision of culturally appropriate cancer care for Chinese-Australians. METHODS: A qualitative data collection strategy was selected as the most appropriate method, because no validated measures are available and no previous research has examined attitudes and needs of Chinese-Australian cancer patients. Patients were recruited from three major teaching hospitals in Sydney and from a Chinese cancer support organisation. Sampling was discontinued when informational redundancy was achieved. Four focus groups and 26 individual telephone interviews were conducted with a total of 36 cancer patients and 12 relatives born in China, Singapore and Malaysia. RESULTS: While individual differences were observed, a majority view was expressed on a range of issues. Non-disclosure of a poor prognosis was favoured, and the role of the family in liaising between health professionals and the patient was emphasised. Patients preferred a confident and clear diagnosis and treatment recommendation. Most patients wished to incorporate Chinese culture-specific treatments into their care. The need for interpreters and psychological and spiritual support was emphasised. CONCLUSIONS: Providing information in a culturally sensitive manner will assist doctors in providing optimum care and support for ethnic minority groups in this country.

Attitude to Health↗
PubMed2003

Trainees' opinions of the skills required of basic surgical trainees.

BACKGROUND: The Edinburgh Basic Surgical Trainee Assessment Form (EBSTAF) is a feasible, reliable and construct valid tool for assessment of surgical trainees. Our aim was to determine its acceptability as a formative training tool. METHODS: Thirty-three trainees on the South-East Scotland Basic Surgical Training Program ranked the 70 skills examined by the form as essential, important, useful, or irrelevant. Responses were compared with those of consultant surgeons obtained during development of the form. RESULTS: There was total agreement in 44 skills (63%, kappa = 0.34). Trainees assigned greater importance to 24 (34%). For individual skills domains, trainees assigned significantly greater value: communication, 86% versus 78%; application of knowledge, 75% versus 67%; team-working, 84% versus 77%; clinical skills, 86% versus 83%; and technical skills, 84% versus 79%. Responses were internally consistent (alpha = 0.74 to 0.93). CONCLUSIONS; Trainees attach greater value than consultants to the qualities assessed by EBSTAF. Trainees therefore agree with consultant opinion on what is important in a surgical trainee, supporting use of this form as a formative training tool.

Attitude of Health Personnel↗
PubMed2006

Efficient quantum circuits for Schur and Clebsch-Gordan transforms.

The Schur basis on n d-dimensional quantum systems is a generalization of the total angular momentum basis that is useful for exploiting symmetry under permutations or collective unitary rotations. We present efficient {size poly[n,d,log(1/epsilon)] for accuracy epsilon} quantum circuits for the Schur transform, which is the change of basis between the computational and the Schur bases. Our circuits provide explicit efficient methods for solving such diverse problems as estimating the spectrum of a density operator, quantum hypothesis testing, and communicating without a shared reference frame. We thus render tractable a large series of methods for extracting resources from quantum systems and for numerous quantum information protocols.

Journal Article↗
PubMed2006

Propofol formulated with long-/medium-chain triglycerides reduces the pain of injection by target controlled infusion.

BACKGROUND: Propofol is a widely used intravenous anesthetic although its injection pain is a common and unpleasant problem. Long-/medium-chain triglyceride (LCT/MCT) propofol has been introduced, as its low free propofol content is expected to reduce injection pain compared with LCT propofol. Target controlled infusion (TCI) differs from conventional induction in the initial infusion pattern. During induction using TCI, we investigated injection pain caused by two propofol solutions with different triglyceride compositions. METHODS: Fifty patients, ASA I-II, with adequate communicative ability, were randomly assigned to two groups. TCI was conducted with Diprifusor for LCT and with BeComSim (custom-made software) for LCT/MCT. The target blood concentration was set at 4 microg/ml for both groups. At 30, 60, and 120 s after the infusion, patients were asked questions regarding the severity of pain on a 0-10 pain score. The total dose of propofol and the time required to induce anesthesia were also investigated. RESULTS: The LCT/MCT propofol group had a larger number of pain-free patients and showed lower severity of pain than the LCT group [the number of pain-free patients being 11 and 3, respectively (P < 0.05), and median maximum pain being 0 and 4.5, respectively (P < 0.01)]. The dose and time required for induction were not significantly different between the groups (dose of 84 +/- 27 and 80 +/- 24 mg, respectively, and time of 119 +/- 60 and 107 +/- 55 s, respectively). CONCLUSION: Our study showed that the frequency and severity of pain during TCI induction with propofol could be significantly reduced using LCT/MCT propofol rather than LCT propofol.

Adult↗