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PubMed2002

Projection neurons and interneurons in the lateral geniculate nucleus undergo distinct forms of degeneration ranging from retrograde and transsynaptic apoptosis to transient atrophy after cortical ablation in rat.

The cytological responses of thalamic interneurons to selective degeneration of thalamocortical projection neurons after cortical damage in the adult brain are poorly understood. We used a unilateral neocortical lesion model (occipital cortex ablation) in the adult rat to test the hypothesis that interneurons and projection neurons in the lateral geniculate nucleus undergo distinct forms of degeneration. In situ nuclear DNA fragmentation in neurons in the lateral geniculate occurs maximally at 7 days postlesion. Geniculocortical projection neurons that are identified by the retrograde tracer Fluorogold die primarily with a morphology of endstage apoptosis prominent at 7 days postlesion. In contrast, interneurons, identified by their particular nuclear ultrastructure and by glutamic acid decarboxylase immunoreactivity, undergo an atrophic vacuolar pathology starting early during the period of projection neuron death and peaking after the projection neuron death is complete. This degeneration of interneurons is transient, because these neurons exhibit structural recovery and their numbers are not changed significantly postlesion. A rare subset of interneurons (less than one in 100 interneurons and less than one in 100 apoptotic cells) undergoes apoptosis concurrently with the projection neurons. We conclude that different types of neurons within the same thalamic nucleus respond differently to focal cortical target deprivation. Unlike the apoptosis-prone projection neurons, most interneurons undergo transient transsynaptic atrophy and recovery rather than cell death. Nevertheless, a small subset of lateral geniculate interneurons undergoes transsynaptic apoptosis in response to projection neuron apoptosis. The pathological responses of thalamic neurons to cortical trauma vary depending on cell type.

Animals↗

PubMed2006

Selecting indicators for patient safety at the health system level in OECD countries.

BACKGROUND: Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. PURPOSE: This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. METHODS: Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. RESULTS: Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. CONCLUSIONS: This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.

Benchmarking↗

PubMed2000

A telehealth project for supporting an isolated physiotherapist in a rural community of Hokkaido.

Almost all towns and villages in the rural areas of Hokkaido suffer shortages of health-care professionals, particularly therapists (e.g. physiotherapists, occupational and speech therapists). A therapist in a rural community must work as a general rehabilitation therapist. This adds to the stress of both the responsibility and the isolation and it seems to be the major reason why therapists do not generally stay in rural communities. A telehealth project to overcome this vicious circle in Hokkaido was started at Sapporo Medical University in 1997, and the town of Betsukai joined the project. This outlines the support given to an isolated physiotherapist working in Betsukai, as part of a larger rehabilitation project. Regular videoconferences helped the physiotherapist gain confidence in her work in the rural community.

Female↗

PubMed1999

University-community partnerships for health: a model interdisciplinary service-learning project.

This project is an example of a successful service-learning experiment at a major university. The program was successful in providing service-learning experiences for an interdisciplinary group of health-professions students, delivering essential health services to a community at risk, providing health-risk and demographic data, and offering opportunities for scholarly productivity for faculty. This was accomplished with a modest investment of internal start-up funding. Goals of the project were achieved, and the program and course were viewed as successful by students, faculty, and community partners.

Academic Medical Centers↗

PubMed1999

Pediatric asthma self-management: current concepts.

The concept of asthma self-management began in asthma camps in the 1970s. Today all asthma camps are required to provide an educational asthma self-management program. The interaction between children and educators is brief, and if the children do not continue in an associated program after camp, the benefits may be lost. Open Airways, the first program developed specifically for minority children, has been the prototype for community asthma self-management. School-based intervention programs have incorporated asthma education into the health curriculum. Some asthma education programs include an emphasis on the environment. Another approach is to develop intervention projects with parents, as in the Head Start program. This program has been very effective in increasing early recognition of asthma and decreasing recidivism in a high-risk population. Another type of project addressed the reading ability and reading comprehension of asthmatic children. Improvement in reading skills resulted in a 47% decrease in asthma recidivism. After 18 months, there were only two hospitalizations among the enrolled participants. Asthma self-management programs that are most effective for inner-city children provide an interactive, culturally relevant form of asthma education and address issues such as literacy and continuity.

Asthma↗

PubMed1999

A survey of Norwegian telemedicine.

To get an overview of Norwegian telemedicine, a questionnaire was sent to the contact persons of telemedicine programmes. There was an 83% response rate from 102 telemedicine programmes; there were 66 active research projects. Several larger networks had recently started operation, probably as a result of the Ministry of Health and Social Affairs' plan of action on information and communication technology in health care. Twenty-one programmes involved primary care or home care. Few programmes were using telemedicine to bridge established divisions of service responsibility or to make connections to institutions abroad. There were three large national research programmes in which telemedicine played an important role. Research projects were evaluating the economic, organizational and sociological aspects of telemedicine, as well as the medical. The oldest telemedicine activities were in northern Norway.

Health Care Surveys↗

PubMedDate not supplied

[An intervention model for smoking prevention strategies].

Tobacco smoke represents the main cause of preventable morbidity and mortality in Western countries: in Italy, approximately 85.000 persons die each year because of smoke-related illnesses. Starting from the objectives defined by the 2001/2003 National Healthcare Plan, the Department of Prevention of the "Roma B" Local Health Unit elaborated a three-year project for the fight against tobacco smoke. The general objectives of the project are: to prevent young people from starting to smoke, to promote stop-smoking initiatives (with the involvement of General Practitioners) and to protect non-smokers from passive smoking (in the context of a smoke-free health facilities program). A special technical-scientific committee was set up to evaluate the effectiveness of the smoking prevention interventions.

Algorithms↗

PubMed2003

[Implementing cardiovascular prevention in the real world: presentation of an integrated hospital-field model].

Numerous studies have documented that cardiovascular prevention in subjects at high risk has a large impact on the clinical outcomes. Data also show the efficacy of an early, intensive, well-structured, professionally expert, multidisciplinary intervention, making use of adequate behavioural and pharmacologic instruments, on the global risk. Such intervention is, however, available at present for very few healthcare users, while the majority, above all in primary prevention, receive a programme of low impact, with poor feedback between the hospital specialist and general practitioner (GP), and often limited to the simple prescription of treatment or to specialist check-ups and/or general advice on lifestyle. The project of implementation takes as its starting point this analysis and the premise that for an intervention of cardiovascular prevention to be effective, particularly in the long term, and really applicable to the broad population, it must be governed primarily by the GP--providing that s/he be adequately trained, utilize new and more dynamic caring modes, and be able to count concretely both on integration with the specialist and on the support of a multidisciplinary team for specific interventions. The paper presents the various stages of the project: from definition of the resources available (health district, GPs, hospital specialists) to the need for GP training, to the modes of operation: instruments for risk calculation, procedures followed, model of integration between GP and specialist, identification of the goals and indicators. This is a low cost project in terms of both the human and structural resources employed, utilizing what is already available in the healthcare system of our country. One of its most original aspects is the medical visit jointly conducted by the GP and hospital specialist, which realizes in concrete terms the integration of the skills: GPs can finally confront in the field the specialist of referral, acquire new skills, improve their daily mode of operating, while they will be gratified by a work more in line with their professional image, and become promoters of health. Finally, this project highlights the propositive and operative role assumed by cardiac rehabilitation and prevention, which, after developing over the years a specific know-how on the subject, now transmits these skills to other healthcare resources and creates a link with the local territory, so providing an appropriate response to the need to put into practice primary and secondary cardiovascular prevention.

Cardiac Rehabilitation↗

PubMed1998

APOM-project: a first study of pharmacy organization and management.

In 1994, a Ph.D.-study started regarding pharmacy, organization and management (APOM) in the Netherlands. The APOM-project deals with the structuring and steering of pharmacy organization. This article describes a summary of the theoretical background of the project and the empirical results of a pilot study (n = 24). No generalization to the population of pharmacies in the Netherlands was made. Three mixes of objectives in pharmacy organization were theoretically postulated; the product mix, the process mix, and the customer mix. Mainly, the purpose of the pilot study was method selection. Additionally, it was studied if thought and action of pharmacy managers corresponded, and, if theoretical pharmacy mixes corresponded with the empirical pharmacy mixes. Two methods were selected to be applied in a survey. Thought and action did not correspond for most pharmacy managers. Thought related to customer and product mainly, and action related to process and customer mainly.

Community Pharmacy Services↗

PubMed1993

Remote microglial activation in the quinolinic acid model of Huntington's disease.

Intrastriatal injection of quinolinic acid (QA) in the rat leads to several structural and biochemical events which resemble neuropathological changes seen in the striatum of Huntington's disease patients. In the present experiment the accompanying microglial response in striatal projection areas following QA injection was studied immunocytochemically using monoclonal macrophage/microglial markers. After injection of 240 nmol of QA a marked microglial reaction was observed in the entire striatum, whereas injection of the same amount of solvent resulted only in a local microglial reaction around the injection site. Activated microglia were also found in the globus pallidus (GP), the entopeduncular nucleus (EP), the substantia nigra (SN), and the ventroanterior/ventrolateral, the ventromedial, and, in some rats, the reticular thalamic nucleus. The remote microglial reaction started in the first-order projection areas at Day 1 (GP) or Day 3 (EP, SN) and was found in the second-order projection areas (thalamic nuclei) by Day 5. Areas projecting to the striatum such as the amygdala and intralaminar thalamic nuclei remained free of activated microglia. It is concluded that a microglial response in striatal projection areas accompanies excitotoxic striatal injury. Anterograde degeneration of striatal projection neurons can explain the microglial activation in first-order projection areas but other mechanisms such as neuronal hyperexcitation following removal of inhibitory striatal input must be responsible for the rapid transsynaptic microglial activation seen in the thalamus.

Animals↗

PubMed2000

Information dissemination and training: two key issues for consolidating and strengthening the results of health telematic projects.

The concepts expressed in this paper concerns the activities to be developed within HEALTHLINE, a European project under the Telematics Application programme. HEALTHLINE is an umbrella project which takes initiatives and provides links to other international projects on health telematics. The projects involved are NIVEMES and RISE; they represent the starting point from which a common approach will be developed. The experience gained from these projects has highlighted two emerging requirements: information dissemination and training. To fulfil the needs of information, an Internet corner will be set up; it will allow citizens and health professionals to find and exchange information as well as to discuss themes concerning health care. Due to the most advanced technologies recently introduced, the Health care sector has had to modify its traditional ways of working to aid professionals in exploiting new training techniques and Health Care provision methods. HEALTHLINE will focus on training and on the development of the use of new tools and services. Furthermore, the project will exploit the training methodologies based on multimedia technology for developing training-on-the-job modules. The entire system, in its final stage, will consist of a network for co-operating training and information dissemination; European sites in the project will share information, training material and provide education and information on tele-health, medical and health-care issues to health care providers, beneficiaries and the general public.

Computer User Training↗

PubMedDate not supplied

Preparing manuscripts for submission to medical journals: the paper trail.

CONTEXT: Preparing a manuscript for publication in a medical journal is hard work. OBJECTIVE: To make it easier to prepare a readable manuscript. APPROACH: Start early--A substantial portion of the manuscript can be written before the project is completed. Even though you will revise it later, starting early will help document the methods and guide the analysis. Focus on high-visibility components--Pay attention to what readers are most likely to look at: the title, abstract, tables, and figures. Strive to develop a set of tables and figures that convey not only the major results but also the basic methods. Develop a systematic approach to the body of the paper--A standard framework can make it easier to write the introduction, methods, results, and discussion. An obvious organization with frequent subheadings and consistent labels makes the paper easier to read. Finish strong--Improve the paper by sharing it with others and by learning how to elicit and receive their feedback. Take the time to incorporate useful feedback by revising frequently.

Data Display↗

PubMed2000

[A pilot project with mammography--results from the first screening round].

BACKGROUND: Organised mammography screening can reduce mortality from breast cancer. A pilot project for organised mammography screening was started in four Norwegian counties in 1995/1996. This paper evaluates the results from the first screening round with focus on early indicators predicting future mortality reduction. MATERIALS AND METHODS: All women aged 50-69 were offered two-view mammography biennially. The screening examinations were performed in dedicated screening units, and the mammograms were read at breast diagnostic centres located in university hospitals. All test results and information about diagnostic procedures and treatment were reported to The Cancer Registry of Norway and registered in a central screening database. This database was essential in order to monitor and evaluate the pilot project. RESULTS: 79.5% of the invited women accepted and about 127,000 women were examined. The detection rate was 6.7 cancers per 1,000 women screened. 53.1% of the invasive tumours were less than 15 mm; about one fifth of the patients had axillary lymph node metastasis. INTERPRETATION: The obtained results met the predefined aims. Thus a future mortality reduction of at least 30% is expected. The parliamentary decision on expanding the pilot project to a nationwide programme seems well founded.

Aged↗

PubMed2002

The co-ordination of a RTD project at European level: difficulties and traps by the different steps.

When a scientist wants to set up and co-ordinate a Research and Technical Development (RTD) project for the first time, he is confronted with a certain number of factors, which, generally, are completely unknown. To co-ordinate a research project, it is not sufficient to have, as starting point, a set of interesting and innovative scientific themes. In fact, after the first preparatory steps, he is confronted with a number of difficulties such as the sinking of the project before it is put forward for financing. The different visions from the scientific and industrial partners are sometimes completely opposite (4): so it is necessary to understand and to assess the requirements of every participant. The industrial partner approach is, for example, linked to this assessment, bearing in mind that his involvement is indispensable for the viability of the project. First of all, this work aims to warn scientists who wish to start up in such an adventure, and secondly serve as a 'vademecum for the co-ordinator' in order to achieve successful completion of work that requires big investments in energy and time.

Biocompatible Materials↗

PubMed1994

Practical audit workshops for nurses.

Six practical audit workshops were run for nurses working in the Greater Glasgow Health Board. Between 15 and 25 nurses came for a morning session and returned 6 weeks later for an afternoon session. The participants came from all grades, specialties and units across the health board. The morning session included a basic introduction to the principles and stages of the audit cycle and information on different audit methods. The majority of the time was devoted to small group discussions where individuals were able to develop their own ideas for audit projects relevant to their working situations. Together with one of the organizers, the members of the groups helped each other in the design of the different projects. Almost 65% of attenders (78 out of 122) returned 6 weeks later for the afternoon session and most had begun an audit project in the time interval. These projects were at various stages around the audit cycle. The afternoon sessions started with a talk by a nurse involved in an audit project, followed by the participants returning to their small groups to discuss the successes and problems involved in their own audits. The groups provided further support and advice based on a wide range of different experiences during the intervening time. The projects carried out were impressive both in the quality and the variety of topics covered. Ninety per cent of those attending felt that the knowledge gained from the exercise was of practical use in their own working environment. A measure of the success of the workshops was that several of the later afternoon talks were given by nurses who had attended the earlier workshops.

Education, Nursing, Continuing↗

PubMed1988

Amino acids and keto acids in the treatment of chronic renal failure.

Clinical trials using very low protein supply supplemented with amino acid or keto acid preparations have shown the possibility of slowing the rate of decline of renal function in patients with advanced chronic renal failure together with preservation of nutritional status. The possible mechanisms by which this effect is obtained are reviewed. The potential advantages of keto acids upon amino acids, the optimal composition of the preparations used, and the best time to start treatment in chronic uremics are discussed. Projection of recent data indicate that a prolongation of renal autonomy of about 4 years instead of a spontaneous duration of 15 months until dialysis can be expected using keto acid treatment if started when plasma creatinine reaches 500 mumol/l.

Amino Acids↗

PubMed1995

Quality assurance network in central Europe. External audit on output calibration for photon beams.

The EROPAQ project for TLD monitoring of photon beams started in June 1994 with the set-up of the TLD system: calibration, reading and evaluation procedures. The acceptance level of +/- 3% was set for the TLD intercomparisons. The policy of the project was to check all beams in 47 participating radiotherapy centres and to recheck all the beams in those centres, where a deviation exceeding +/- 3% occurred in one or more of the beams. Out of 129 beams checked, 100 beams (78%) were found within the +/- 3% limit. Eleven beams show deviations larger than +/- 6%, and immediate corrective action was undertaken. Out of 47 centres checked, 22 did not participate in any external audit in a preceding 5 years. In these centres 68% (34/50) of the total number of gamma and x-ray beams checked but only 59% (20/34) of gamma beams were within the acceptance level, while in the 25 centres, which participated in an external audit before, these figures were 84% (66/79) and 88% (35/40) respectively. The sources of discrepancies were thoroughly investigated, discussed with the participants and the errors corrected. Poor results were in several cases associated with very old design of radiotherapy units and old dosimetry systems, equipped with inadequate ionization chambers. In several centres, an insufficient training of the physicists in clinical dosimetry was observed. Thanks to the corrective action, a great improvement of calibration of the beams was achieved. Standard deviation of the distribution of the results for all x and gamma beams checked decreased from SD = 7.4% at the first check to SD = 2.5% at the second check.

Calibration↗

PubMed1993

Apical transgastric echocardiography: new imaging projections.

New transgastric echocardiographic projections, obtained by monoplane transoesophageal echocardiography are presented. Starting from the transgastric short-axis view, the probe is first advanced 3-5 cm and slightly rotated clockwise. From this projection either a tricuspid valve long-axis or a subcostal-like 4-chamber view is obtained. Advancing the probe 48-55 cm from the incisor teeth and rotating it counter clockwise with maximal anterior flexion, an apical long-axis view is obtained. The left ventricle, including the apex, the left ventricular outflow tract, the aortic valve, the proximal ascending aorta and the left atrium are imaged. In this projection the Doppler beam is parallel to the left ventricular outflow tract, resulting in more accurate flow velocity measurements than from the oesophagus. Additional morphological and Doppler information on right ventricular outflow tract obstruction are obtained by slight changes in transducer position. The feasibility of these new transgastric imaging projections was assessed in 196 consecutive patients undergoing diagnostic TEE (104 conscious patients) or peroperative TEE monitoring (92 anaesthetized patients). Eighty-nine patients had coronary heart disease, 55 had valvular heart disease, nine had congenital heart disease, 22 had aortic aneurysm or dissection and 21 were studied for detection of cardiac sources of embolism. The morphology of the right ventricular outflow tract was visualized in detail in all patients, and high quality Doppler tracings parallel to the direction of flow were obtained. The subcostal-like view was successful in 86 out of 196 subjects (44%). The apical 4 and/or 5-chamber view was obtained in 139 subjects (71%).(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography, Doppler↗