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PubMedDate not supplied

[Nursing workers' (dis)comfort: a matter of social (in)justice].

An exploratory, descriptive study carried out with 52 Nursing workers from a university hospital. Its purpose was to identify the levels of comfort concerning both work and care received by clients, workers' needs and strategies to increase their levels of comfort. An analysis of interviews showed that most participants (79% and 85%) referred high and average levels of comfort, respectively, in relation to work and health care. Comfort was related mainly to response they heard from clients, and to an harmonic relationship among team members. Discomfort was related to the hospital precarious structure and insufficient resources for health care, besides the need workers have for better work conditions in order to provide quality nursing care. Our conclusion was that attention given to workers' needs will maximize comfort concerning both work and health care provided.

Job Satisfaction↗
PubMed1995

A European project assessing the appropriateness of hospital utilization: background, objectives and preliminary results. The Project Steering Group and the Coordinating Center.

This paper presents the background, objectives and preliminary results of a coordinated European Project involving researchers in seven countries aimed at harmonizing methods to assess inappropriate use of hospital care and qualifying its determinants. After briefly reviewing the philosophy of the European Union "Concerted Action" program in the context of current attempts at reforming the way health care is financed and delivered in several member states, the paper presents results obtained so far. Besides a method workshop where the approaches and methodologies used were compared, during the first year the following tasks have been undertaken: (a) identification and appraisal of a few dozen empirical studies conducted in various countries; (b) qualitative comparison of the instruments used to assess appropriateness; (c) initial development of a common list of reasons for inappropriate hospital use of potential relevance in European health care systems. While the project has already undoubtedly indicated the great potential of European collaboration in health services research, the large number of unpublished studies traced indicates--among other things--the need to create channels through which results of this type of research can be disseminated.

Algorithms↗
PubMed2002

Specialist training in rheumatology in Europe.

Rheumatology is a broad discipline managing a spectrum of different conditions and there are divergences in what is routinely treated by rheumatologists both within and between countries. The free movement of doctors throughout the European Community has lead to moves to harmonize specialist training to ensure common standards of care. The Union Européene des Médecins Spécialistes (UEMS) has developed recommendations for the specialist training of rheumatologists in Europe that recognizes the broad definition of the discipline and the diversity of clinical practice in Europe. The core curriculum aims to provide a common standard around which to develop locally applicable national curricula. The provision of high quality care requires some assessment of training and competency as well as continuing professional development and ways of ensuring the provision of this throughout the European Community to a mutually high standard are being developed. The future may see more overlap in the training of all the disciplines concerned with the management of those with musculoskeletal conditions to their benefit.

Curriculum↗
PubMed2000

MedView-design and adoption of an interactive system for oral medicine.

MedView is a joint project with participants from oral medicine and computer science. The aim of the project is to build a large database from patient examinations and produce computerized tools to extend, view, and analyze the contents of the database. The contents of the data base is based on a formalization of health-care processes and clinical knowledge in oral medicine harmonized within the network SOMNET. We give an overview of the current status of the MedView project and discuss background and future directions.

Artificial Intelligence↗
PubMed2005

[How to prevent nosocomial infections? An international overview].

Nosocomial infections take the bulk of all complications emerging hospitals and they are eminent indicators for the quality of health care and nursing. One of the most prominent clinical infections are infections associated with venous catheter, ventilation, and bladder catheter. They increase the risk for sepsis and septic shocks. A survey of international studies about the prevention of hospital acquired infections advises, that the incidence can be lowered by continuous presence of hospital infection control nurses, by standardised assessment and analysis of the infection rates with targeted adaption of evidence-based hygienic requirements--also referred to as surveillance--and by an adequate number of skilled staff in nursing and health care. From a European point of view, a harmonization of the requirements for qualifying of hospital infection control nurses and implementing of a European health agency would be desirable.

Aged↗
PubMed1999

When the lung fails. Acute respiratory distress syndrome in children.

Caring for the child with ARDS is a challenge. Many new ventilatory techniques have been introduced to maximize a good outcome. Nevertheless, it is obvious that regardless of therapy, expert nursing care is critical. Astute observation, knowledge of the different therapies, identification of complications, and attention to the needs of the child and family are needed to make care truly holistic.

Acute Disease↗
PubMed2000

Educational issues in rheumatology.

Musculoskeletal conditions are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Nearly a quarter of all consultations in primary care are concerned with rheumatic disease, yet undergraduate education in rheumatology is under-developed all over the world and does not get the attention it deserves. This has important consequences for the early diagnosis of rheumatic disease and the proper care of rheumatic patients in general, as well as for the esteem of rheumatology as a profession. Because the high prevalence and impact of rheumatic disease are not reflected in medical curricula, the International League of Associations for Rheumatology developed the Undergraduate Medical Education in Rheumatology 2000 Project. The project embodies three fundamental concepts: (1) to convince medical faculties and schools educating health professionals world wide that skills in examination, a knowledge of the management of musculoskeletal disease and a positive attitude to disability are the basis of good medical practice; (2) that rheumatology is valuable for acquiring skills in problem-solving, clinical reasoning and understanding basic genetic, immunological and biochemical mechanisms, as illustrated by rheumatic disease; and (3) to orient these programmes to the needs of individual patients in the context of the population at large, knowing that 20% of all primary care consultations involve musculoskeletal disease. The movement of doctors throughout the world, especially within Europe, is leading to initiatives to harmonize standards of specialist training. The importance of ensuring the highest standard of clinical care, achieving the greatest gain in health alongside a rapid advance in knowledge and clinical practice, is increasing the priority for continuing medical education and methods to ensure that doctors remain competent at all stages of their career.

Education, Medical↗
PubMed2006

A call for international harmonization in therapeutic risk management.

Therapeutic risk management is required to ensure that the benefits of a particular drug outweigh the risks in general practice. Current risk management strategies and handling of risk management and pharmacovigilance issues differ across borders. Differences in key regulatory decisions on the same product around the world, including the handling of safety issues with cisapride, dofetilide, and isotretinoin, bring into question the robustness of these decisions and the procedures currently in place to manage the risks to the public of products with potentially unfavorable risk-benefit balances. These differences may be partly due to differences in health care systems, regulatory requirements and procedures, and cultures. Greater international harmonization in approaches to risk management potentially would improve safety of medicines around the world by developing a greater uniformity in acquiring and interpreting risk-benefit evidence. The appropriateness and effectiveness of risk management interventions in different regions should be examined, and international strategies should be 'fine-tuned' for each regional health care setting. Recently issued international guidance on risk management and pharmacovigilance may help to improve consistency of decision-making around the world and promote better international communication and collaboration.

Drug Therapy↗
PubMed2004

Continuous head-localization and data correction in a whole-cortex MEG sensor.

Continuous monitoring of the position of a subject's head is an essential part of improving localization accuracy and resolution in MEG. We describe a procedure that has been developed for whole-cortex MEG sensors. The system uses three (or more) small head coils driven continuously by low-amplitude sinusoidal currents with frequencies chosen so they do not interfere with MEG measurements and with each other and are easily separated from power-line signals and harmonics. Analysis of the response of the MEG sensors to the head coils allows continuous monitoring of the position (update times as short as T=2/fpower) using a 3-parameter minimization. The best-fit positions of the head coils are then combined to determine the head translation and rotation. Analysis of phantom data recorded with a 275-channel CTF MEG system in a shielded room shows that coil positions can be determined with an accuracy of approximately 2 mm with an update period T=1/15 s even when the head coils are moving approximately 25 mm at speeds up to 40 mm/s. Data are corrected by expressing the scalar potential for the magnetic field as a spherical-harmonic series, and then determining the effect of rotations and translations on the terms of the series. Since the MEG helmet covers only approximately 60% of the full sphere, care must be taken in determining the coefficients of the spherical-harmonic series to ensure that the modeled magnetic field does not become unrealistically large in the region where there are no MEG sensors (i.e. in the lower 40% of the sphere). Our approach has been to use a minimum-field-energy criterion that minimizes the squared gradient averaged over 4pi sr and radii from 96 to 145 mm while matching the MEG measurements.

Cerebral Cortex↗
PubMed1999

Reducing costs of laparoscopic hysterectomy.

STUDY OBJECTIVE: To establish the role of laparoscopic hysterectomy using reuseable surgical equipment. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: Tertiary major teaching hospital. PATIENTS: Fifty consecutive women carefully selected for laparoscopic hysterectomy. INTERVENTIONS: The ultrasonically activated (harmonic) scalpel was used for coagulative cutting of pedicles and ligaments attached to the uterus and adnexa, backed by bipolar diathermy. No nonabsorbable material was left in the pelvis at the conclusion of the procedures. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, uterine weight, histology, operating time, recovery, analgesic requirements, and hospital stay were recorded. Complications were noted and critically assessed for constructive quality assurance appraisal. Outcomes were satisfactory according to both patients and gynecologists. CONCLUSION: This pilot study suggests that the method is an efficacious, cost-effective, and well-controlled technique of laparoscopic hysterectomy.

Adult↗
PubMed1997

Use of harmonic scalpel for division of short gastric vessels at laparoscopic Nissen fundoplication. A new method.

The essential of laparoscopic Nissen fundoplication is creating a loose and tension free wrap requiring mobilisation of the gastric fundus. Division of the short gastric vessels (SGV) is a standard component of that procedure which requires considerable part of the operation time, and despite of a careful dissection sometimes significant blood loss can be occurred. The Ultracision Harmonic Scalpel (HS) makes the process quicker safer and can cause less intraoperative complication. This study compares our original method of vessel control (at 10 cases, Group 1), to the Ultracision Harmonic Scalpel (at 10 cases, Group 2) Times for SGV division, estimated blood loss and intraoperative and postoperative complications were evaluated. In the favour for Group 2 a significant reduction was reached in the time required for division of SGV to mobilize the fundus. As the most common postoperative complication, the dysphagia concerns we found significant difference in the two groups and dysphagia was mild at Group 2. Application of HS provide safer, easier and faster division of SGV resulting significant savings of time and less prone to thermic trauma and recommended at LNF operations to avoid potential intra- and postoperative complications.

Blood Loss, Surgical↗
PubMed1993

Transboundary effects on health care services in the European Community.

This article deals with the rights that community law gives to the medical and allied professions to exercise their professional activities in a member state other than their state of origin. Firstly, the scope of the general economic provisions of the European Community (EC) Treaty is broadly described. Secondly, the specific rules of the EC secondary legislation concerning the harmonization of the national legislations on professional qualifications in the health care sector are reviewed. Lastly, an example is given of the application of these rules in the health care sector by the Court of Justice of the European Community. It is submitted that the exercise of these rights can contribute to transboundary cooperation within the EC in the rendering of health care services to patients in the member states. This is specially relevant in frontier areas.

Allied Health Personnel↗
PubMed2026

Genetic testing practices across European epilepsy centers: An ERN EpiCARE survey.

OBJECTIVE: Genetic testing plays an increasing role in the diagnostic pathway for rare and complex epilepsies. However, significant heterogeneity persists in access, implementation, and interpretation across Europe. This study aimed to assess genetic testing practices, accessibility, and challenges across expert epilepsy centers within the European Reference Network for Rare and Complex Epilepsies (ERN EpiCARE) and to identify key challenges and areas for harmonization. METHODS: A cross-sectional survey was developed by the ERN EpiCARE Clinical Genetics Working Group and distributed to 50 EpiCARE member centers across 27 European countries. The questionnaire collected quantitative and qualitative information on available genetic testing modalities, turnaround times, use of rapid testing, multidisciplinary team (MDT) organization, genetic counseling practices, and perceived challenges. Survey findings were complemented by a structured discussion held during the ERN EpiCARE General Assembly. RESULTS: Responses were received from 46 centers (51 responses). Most centers reported access to genetic testing, predominantly through in-house facilities. Whole-exome sequencing was available in 85% of centers, and gene panels were available in 78%. Whole-genome sequencing was available in 59% of centers, frequently restricted to research or performed externally. Turnaround times for standard genetic testing were most commonly between 1 and 6 months. Genetic testing strategies varied by epilepsy subtype, with gene panels most frequently used as first-tier testing, and exome sequencing preferentially applied in developmental and epileptic encephalopathies. Considerable heterogeneity was observed in MDT organization, access to genetic counseling, reimbursement, data-sharing and registry infrastructures. SIGNIFICANCE: Although genetic testing is widely available across ERN EpiCARE centers, substantial disparities persist in its organization, accessibility, and implementation. Addressing these gaps through strengthened multidisciplinary collaboration, harmonized diagnostic strategies, and enhanced European-level coordination will be essential to ensure equitable access to high-quality genetic care for individuals with epilepsy. PLAIN LANGUAGE SUMMARY: Genetic testing is increasingly integrated in the diagnostic pathway for rare and complex epilepsies and treatment decisions. An ERN EpiCARE survey assessed how genetic testing is implemented across specialist epilepsy centers in Europe and identified persistent organizational, financial, and clinical barriers. Although most centers had access to advanced genomic testing, important differences were identified in access, reimbursement, turnaround times, and multidisciplinary expertise. European collaboration and harmonized practices are needed to support equitable access to high-quality genetic care for people living with epilepsy.

European reference networks↗
PubMed2005

Soft tissue fillers for management of the aging perioral complex.

Rejuvenative therapy of the lower face has traditionally been surgical in nature, with office-based treatments such as soft tissue fillers relegated to "second tier" status. However, traditional rhytidectomy does not significantly affect the perioral complex and leaves the central lower face unaltered and unimproved. If it is left untreated, there is a clear disparity between the rejuvenated neck and aged perioral area. Soft tissue augmentation of the perioral area can provide rapid aesthetic improvement. Careful analysis of this area and appropriate treatment can harmonize these areas and produce a globally aesthetic result.

Biocompatible Materials↗