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PubMed2004

The Aristotle score: a complexity-adjusted method to evaluate surgical results.

OBJECTIVES: Quality control is difficult to achieve in Congenital Heart Surgery (CHS) because of the diversity of the procedures. It is particularly needed, considering the potential adverse outcomes associated with complex cases. The aim of this project was to develop a new method based on the complexity of the procedures. METHODS: The Aristotle project, involving a panel of expert surgeons, started in 1999 and included 50 pediatric surgeons from 23 countries, representing the EACTS, STS, ECHSA and CHSS. The complexity was based on the procedures as defined by the STS/EACTS International Nomenclature and was undertaken in two steps: the first step was establishing the Basic Score, which adjusts only the complexity of the procedures. It is based on three factors: the potential for mortality, the potential for morbidity and the anticipated technical difficulty. A questionnaire was completed by the 50 centers. The second step was the development of the Comprehensive Aristotle Score, which further adjusts the complexity according to the specific patient characteristics. It includes two categories of complexity factors, the procedure dependent and independent factors. After considering the relationship between complexity and performance, the Aristotle Committee is proposing that: Performance = Complexity x Outcome. RESULTS: The Aristotle score, allows precise scoring of the complexity for 145 CHS procedures. One interesting notion coming out of this study is that complexity is a constant value for a given patient regardless of the center where he is operated. The Aristotle complexity score was further applied to 26 centers reporting to the EACTS congenital database. A new display of centers is presented based on the comparison of hospital survival to complexity and to our proposed definition of performance. CONCLUSION: A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score, electronically available, was introduced in the EACTS and STS databases. A validation process evaluating its predictive value is being developed.

Cardiac Surgical Procedures↗
PubMed1995

X-ray crystallographic studies on hexameric insulins in the presence of helix-stabilizing agents, thiocyanate, methylparaben, and phenol.

Three X-ray crystallographic studies have been carried out on pig insulin in the presence of three ligands, thiocyanate, methylparaben (methyl p-hydroxybenzoate), and phenol. In each case, rhombohedral crystals were obtained, which diffracted to 1.8, 1.9, and 2.3 A, respectively. Each crystal structure was very similar to that of 4-zinc pig insulin, which was used as a starting model for PROLSQ refinement (Collaborative Computational Project, Number 4, 1994). The R factors for the refined structures of thiocyanate insulin, methylparaben insulin, and phenol insulin were 19.6, 18.4, and 19.1, respectively. Each crystal structure consists of T3R3f insulin hexamers with two zinc ions per hexamer. In the R3f trimer of the thiocyanate insulin hexamer, one thiocyanate ion is coordinated to the zinc on the hexamer 3-fold axis, but there is no evidence of zinc ion binding in the off-axis zinc ion sites seen in the 4-zinc pig insulin structure. In the methylparaben insulin and phenol insulin hexamers, the phenolic ligands are bound at the dimer-dimer interfaces in the R3f trimers in a manner similar to that of phenol in R6 phenol insulin. The binding of methylparaben appears to make the hexamer more compact by drawing the A and the B chains closer together in the binding site. In all three structures presented herein, the conformations of the first three residues of the B chain in the R3f trimer are extended rather than alpha-helical, as is seen in R6 phenol insulin. The energetics of ligand binding in the insulin hexamer are discussed.

Animals↗
PubMed1997

Leptospirosis in Kolenchery, Kerala, India: epidemiology, prevalent local serogroups and serovars and a new serovar.

Leptospirosis is the most widespread zoonosis in the world. It is mostly an occupational disease especially in rural areas. Kolenchery is in the midlands of Kerala. The landscape consists of marshy land and dry land interspersed by rivulets and ponds. Irrigation of dry lands for cultivation during the summer months started in mid 1980s after the irrigation projects were commissioned. Cases of leptospirosis were rarely diagnosed in Kolenchery before 1987. Since then a yearly increase in incidence is observed. No major study on either epidemiology or clinical picture has been done on human leptospirosis in Kerala so far. The aim of this study was to define the major clinical presentations, epidemiology of the infection and demonstrate the predominant serogroups and serovars causing the illness in this limited geographical area. The study involves 976 cases of leptospirosis confirmed by culture and/or serological tests. Serogroups Autumnalis, Australis and Icterohaemorrhagiae were the commonest. Mortality rate was 5.32%. The increase in incidence is probably due to the geographical characteristics, continuous moisture of the soil due to irrigation in summer and year-round cultivation making food and cover available to host rodents. Close interaction of humans, animals, soil and water in this region make the spread of leptospirosis to humans easy. Confirmation of cases has been done by enzyme linked immunosorbent assay (ELISA) and/or microscopic agglutination test (MAT) and/or by culture. Serovar identification has been done in 21 cultures isolated from patients. One new serovar belonging to serogroup Australis has been identified from a patient and named serovar Australis bharathy.

Adolescent↗
PubMed2003

A preliminary empirical test of a culturally-relevant theoretical framework for the study of successful aging.

This article aims to shed preliminary empirical light on the assumptions underpinning a culturally relevant theoretical framework for the study of successful aging. On the basis of the Kluckhohnian theory of cultural variation, this framework suggests that congruence exists between value orientations concerned with man-nature, time, activity, and relationships, and the manner in which the construct of successful aging is understood. Methodologically speaking, the research project upon which this article is based started out by adapting and further developing the vignette-based instrument that Kluckhohn and Strodtbeck designed to test the theory of cultural variation. Vignette-based interviews were then conducted with 30 Iranian immigrants to Sweden as a preliminary test of the hypothesis of congruence. The results presented in this article suggest that, as posed in the framework in question, there is a relationship between the value orientations that people prefer and the various understandings of successful aging that they uphold. The results suggest also that there is a variety of ways in which the construct of successful aging can be understood, and that variety encompasses other ways of thinking about successful aging besides the master nature, future, productivity, and individuality-oriented views that characterize the gerontological debate. Although further research is necessary, these preliminary results do infer that this framework might offer a theoretically interesting approach to the study of individual, generational, and cross-cultural understandings of successful aging.

Adult↗
PubMed2001

Does lithium exert an independent antisuicidal effect?

AIM OF STUDY: Recent investigations have indicated that adequate lithium treatment lowers the suicide mortality associated with affective illness. One important question is whether the mechanism by which lithium prophylaxis may be effective in prolonging survival can be explained exclusively in terms of successful protection against the recurrence of depressive episodes, or whether one should consider an independent anti-suicidal factor. METHODS: We investigated a group of high-risk patients with recurrent affective disorders (n = 167) who had committed one or more suicide attempts before the start of lithium prophylaxis within a collaborative project by the International Group for the Study of Lithium Treated Patients (IGSLI). According to their recurrence-related response to long-term lithium prophylaxis, patients were classified into three groups: excellent (n = 45), moderate (n = 81) and poor responders (n = 41). Only depressive episodes resulting into hospitalisation were considered. A marked reduction in the number of suicide attempts was observed in the excellent lithium responders. However, we also found that over 80% of moderate responders and nearly 50% of poor responders did not exhibit any further suicidal behaviour during lithium treatment. Furthermore, we could demonstrate a significant reduction of suicide attempts per year as compared to a corresponding pre-lithium period in all three groups (0.10 vs. 0.33, 0.06 vs. 0.27, 0.02 vs. 0.26). There were four suicides in this high-risk group, corresponding to a suicide-related standardised mortality ratio (SMR) of 13.7. This contrasts sharply with an expected suicide SMR of approx. 100 in this population. Suicide risk was not related to the recurrence-preventing effect. CONCLUSION: The reduction in suicide attempts, in both responders and non-responders, indicates that lithium possesses a specific anti-suicidal effect besides its mood-stabilising property.

Adult↗
PubMed1993

[Quality control 100 years ago. "Narcosis statistics" by Gurlt from 1893].

Even 100 years ago the problem of quality assurance in anaesthesia was investigated. In 1890 the German Society of Surgery decided to start "Multicenter Statistics on Surgical Anaesthesia." The project was headed by Ernst Gurlt, surgeon in Berlin. In 1893 he reported on the basis of 62 questionnaires on approximately 50,000 anaesthetic procedures, mostly performed with chloroform. 9 fatal chloroform cases led to a mortality rate of 1:4,275. On the other hand among 6,213 cases with ether anaesthesia there was no death. Gurlt strictly recommended the administration of ether, seconded by contemporaries such as Garré, Trendelenburg, Roux and Juillard. Gurlt's report includes as appendix detailed information on the administered anaesthetics, application techniques, premedication, fatal and non-fatal complications extracted from 18 of the analysed questionnaires. Gurlt's publication is an early document of quality assurance in Germany.

Anesthesia, General↗
PubMed2005

The field performance of frontal air bags: a review of the literature.

This article presents a broad review of the literature on frontal air bag field performance, starting with the initial government and industry projections of effectiveness and concluding with the most recent assessments of depowered systems. This review includes as many relevant metrics as practicable, interprets the findings, and provides references so the interested reader can further evaluate the limitations, confounders, and utility of each metric. The evaluations presented here range from the very specific (individual case studies) to the general (statistical analyses of large databases). The metrics used to evaluate air bag performance include fatality reduction or increase; serious, moderate, and minor injury reduction or increase; harm reduction or increase; and cost analyses, including insurance costs and the cost of life years saved for various air bag systems and design philosophies. The review begins with the benefits of air bags. Fatality and injury reductions attributable to the air bag are presented. Next, the negative consequences of air bag deployment are described. Injuries to adults and children and the current trends in air bag injury rates are discussed, as are the few documented instances of inadvertent deployments or non-deployment in severe crashes. In the third section, an attempt is made to quantify the influence of the many confounding factors that affect air bag performance. The negative and positive characteristics of air bags are then put into perspective within the context of societal costs and benefits. Finally, some special topics, including risk homeostasis and the performance of face bags, are discussed.

Accidents, Traffic↗
PubMed2005

High Intensity Proton Accelerator Project in Japan (J-PARC).

The High Intensity Proton Accelerator Project, named as J-PARC, was started on 1 April 2001 at Tokai-site of JAERI. The accelerator complex of J-PARC consists of three accelerators: 400 MeV Linac, 3 GeV rapid cycle synchrotron and 50 GeV synchrotron; and four major experimental facilities: Material and Life Science Facility, Nuclear and Particle Physics Facility, Nuclear Transmutation Experiment Facility and Neutrino Facility. The outline of the J-PARC is presented with the current status of construction.

Biological Science Disciplines↗
PubMed2002

Improving the effectiveness of physician participation in local quality improvement efforts.

The authors present five success factors for medical students, residents, and fellows to consider when engaged in quality improvement projects: (1) add value, not work; (2) start small and build; (3) move quickly; (4) adapt, innovate, and collaborate; (5) produce understandable results. Using examples from the Veterans Affairs National Quality Scholars Fellowship Program, they describe how these factors were used successfully. While not the only steps to take, these critical success factors proved helpful in defining the problem to be addressed, engaging leadership, and anticipating the resolution of conflict.

Competency-Based Education↗
PubMed2005

The content of morning time conversations between nursing home staff and residents.

AIM: The aim of this paper was to investigate what nursing home staff and residents converse about when they first meet each other in the morning and to investigate who starts the conversation. It is a pilot project about communication in a nursing home in Sweden and a basis for a practice development programme. BACKGROUND: Studies in Sweden have shown that nurse assistants working in care of the older people felt they had too little training in how to communicate. Communicative behaviour influences patients, but little is known about the content of morning time communication in nursing homes. METHOD: Non-participant observation of 18 staff was carried out using an observation schema. Content analysis was performed. RESULTS: The findings were that it was the staff who initiated conversation and chose the content of conversation. The most common topic in morning time conversation was residents' health and sickness. CONCLUSION: Staff in nursing homes, both nurses and nurse assistants need to reflect on their interaction with residents and be conscious of their important role because they create the climate on the ward through conversation. Further studies are needed in order to explore residents' opinions of what the content of a good communication could be and also to find out how nurses and other staff members' communication with residents could be improved. Relevance to clinical practice. Staff need more training and knowledge about how to communicate with older people.

Adult↗
PubMed2006

Antibiotic consumption and generation of resistance in Streptococcus pneumoniae: the paradoxical impact of quinolones in a complex selective landscape.

The development of resistance to the different antibiotics by the majority of bacterial species of clinical importance seems unavoidable. However, not all drugs have the same efficiency to select for resistance. Large differences in the qualitative and quantitative consumption of antibiotics among countries are known to exist and several authors have consistently reported the direct relationship between consumption and selection of resistance for Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Escherichia coli and beta-lactams and macrolides use. In Spain, extensive surveillance started in 1996, and the Willow (SAUCE) Project, to monitor and update resistance in respiratory pathogens and to couple those data with data concerning national antibiotic consumption (IMS) from both a temporal and geographical approach. Temporally, despite a continuous increase of 16% in quinolone consumption from 1997 to 2001, basically due to the arrival of respiratory quinolones, levofloxacin and moxifloxacin, a continuous linear increase in the resistance rates to ciprofloxacin in S. pneumoniae was not observed. There also was an inverse correlation between provincial consumption of quinolones and resistance to ciprofloxacin. Several hypotheses are proposed and discussed to explain these apparent paradoxical observations, such as the replacement of ciprofloxacin by more potent antipneumococcal quinolones, the possibility of an antibiotic pressure threshold, the influence of other nonquinolone drugs on the expression of ciprofloxacin-resistance biological costs, and the influence of changes in temporal or spatial prevalence of particular clones.

Anti-Bacterial Agents↗
PubMedDate not supplied

Ethical conduct recommendations for quality improvement projects.

The distinction between QI, research, and clinical care projects has never been clear. However, QI projects may raise ethical concerns, and organizations need to ensure that patients involved in QI projects are adequately protected. The recommendations within the VHA report are intended as a starting point for dialogue to provide guidance for the responsible ethical conduct of QI projects. Discussion and oversight will need to occur at several levels within organizations to ensure ethical care is being provided.

Codes of Ethics↗
PubMedDate not supplied

The Vanderbilt University fast track to IAIMS: transition from planning to implementation.

Vanderbilt University Medical Center is implementing an Integrated Advanced Information Management System (IAIMS) using a fast-track approach. The elapsed time between start-up and completion of implementation will be 7.5 years. The Start-Up and Planning phases of the project are complete. The Implementation phase asks one question: How does an organization create an environment that redirects and coordinates a variety of individual activities so that they come together to provide an IAIMS? Four answers to this question are being tested. First, design resources to be "scalable"--i.e., capable of supporting enterprise-wide use. Second, provide information technology planning activities as ongoing core functions that direct local efforts. Third, design core infrastructure resources to be both reusable and expandable at the local level. Fourth, use milestones to measure progress toward selected endpoints to permit early refinement of plans and strategies.

Academic Medical Centers↗
PubMed2006

Parental literacy and infant health: an evidence-based healthy start intervention.

Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire's lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality.

Educational Status↗
PubMedDate not supplied

Identification of transcribed sequences (ESTs) in the Trypanosoma cruzi genome project.

Random single pass sequencing of cDNA fragments, also known as generation of Expressed Sequence Tags (ESTs), has been highly successful in the study of the gene content of higher organisms, and forms an integral part of most genome projects, with the objective to identify new genes and targets for disease control and prevention and to generate mapping probes. In the Trypanosoma cruzi genome project, EST sequencing has also been a starting point, and here we report data on the first 797 sequences obtained, partly from a CL Brener epimastigote non-normalized library, partly on a normalized library. Only around 30% of the sequences obtained showed similarity with Genbank and dbEST databases, half of which with sequences already reported for T. cruzi.

Animals↗
PubMed2006

Ethnobotany and ethnopharmacy--their role for anti-cancer drug development.

Local and traditional knowledge has been the starting point for many successful drug development projects over the last decades. Here we discuss some examples of anti-cancer drugs which have had enormous impact as anti-cancer agents (camptothecan, taxol and derivatives) and a few examples of drugs currently under various stages of preclinical development. Ethnobotanists investigate the relationship between humans and plants in all its complexity, and such research is generally based on a detailed observation and study of the use a society makes of plants. The requirements of modern research on natural products as, for example, outlined in the Convention on Biological Diversity (Rio Convention) and the overall approach in ethnobotanical research are also discussed. Selected phytochemical-pharmacological studies based on traditional plant use are used to highlight the potential of ethnobotany driven anti-cancer research. The link between traditionally used plants and targets of the NF-kappaB pathway is discussed using on an EU-funded, multidisciplinary project as an example. Lastly the potential of chemopreventive agents derived from traditional food plants is briefly addressed.

Animals↗
PubMed1995

NOVA Awards. Building healthier communities.

The following profiles of this year's winners of the second annual NOVA Awards, sponsored by the American Hospital Association and Hospitals & Health Networks magazine, exemplify humanity, which is what health care is all about. The winners all set out to boost the health and well-being of their communities. That frequently means expanding the traditional hospital mission to ensure that disadvantaged and underserved people not only get good health care, but also safer streets, nutritious food, a decent place to live, and a future for their children. They're all part of a community's ecology. None of these projects is finished. But you have to start somewhere to get somewhere else.

American Hospital Association↗
PubMed1999

Recent advances in telemedicine.

With continuing advances in information technology, the applications of computers in medicine are increasing rapidly. Modern information technology not only affects the delivery of health care, but also significantly influences the doctor-patient relationship. Since the 1990s, technologic developments in high-bandwidth telecommunications systems and digitizing devices have led to a surge of interest in telemedicine. In recent years, the Internet, with its powerful penetration and scalability, has become an increasingly popular medical information resource and a new platform for telemedicine. The impact of modern technology on the advancement of telemedicine in Taiwan started with the 1995 National Information Infrastructure project, which uses networks of different bandwidths for teleconsultation and distance education programs. In 1998, National Taiwan University and Taipei Medical College in Taiwan, and the University of Pittsburgh and the University of Iowa in the USA, began cooperation on a new Cyber Medical Center (CMC) project that integrates the technologies of multimedia, database management, a multiple-site videoconferencing system, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the Web. In the future, telemedicine systems in Taiwan are expected to combine the Internet and cable television to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend health services to every household.

Humans↗