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PubMed1991

Health status and health practices--Alameda and beyond.

Using the population of St John's, Newfoundland, we did a constructive replication of previous studies testing the association between health practices and health status. A telephone questionnaire was applied to all adults in a probabilistic sample of households (3300 subjects, 85% response rate). Several health practices and preventive behaviours indexes were developed and tested. An additive index of six practices (breakfast, sleeping, drinking, smoking, weight and exercise) using the Alameda County definitions, and an additive score of five practices (excluding breakfast and with revised definitions for smoking, drinking and exercise) were analysed using log-linear models; there was association between the indexes and self-assessed health status when controlling for sex, age and education, with the exception of the six-practice index in males. The association between these two indexes and several variables and constructs of health status showed that the best relationships were with self-assessed health status and with a construct including variables measuring subjective health.

Adult↗
PubMedDate not supplied

Effects of quality of treatment on prognosis in primary breast cancer patients treated in daily practice.

UNLABELLED: Information on treatment outcome outside clinical trials is sparse. This is the first study that relates surgical and medical quality of care in daily practice with outcome. BACKGROUND: In a previous study we showed, that the quality of chemotherapy as described by a guideline and given in daily practice to premenopausal primary breast cancer patients was suboptimal with only 68% and 53% of the patients receiving chemotherapy with a dose intensity (DI) and relative dose intensity (RDI) of > or = 85%, respectively. Many invalid reasons for delay and dose reductions were identified. PATIENTS AND METHODS: Premenopausal node-positive primary breast cancer patients treated from 1988 to 1992 were traced using two national registries. Relevant data were collected from their records. The following treatment-related variables were correlated with prognosis: type of surgery, number of investigated lymph nodes, radiotherapy, chemotherapy, interval between surgery and start of chemotherapy, DI, duration, delays and dose adjustments of chemotherapy and hospital size. RESULTS: Twenty-four of the 254 traced patients did not receive any chemotherapy, 230 received the recommended schedule of cyclophosphamide (C), methotrexate (M) and 5-fluorouracil (F). The median time of follow-up was 6.7 (range 0.9-10.2) years. The 5-year disease-free survival (DFS) and overall survival (OS) was 61% and 77%, respectively. In an univariate analysis DI < 65% correlated with a worse DFS and OS (p=0.05 and p=0.03, respectively). The use of chemotherapy correlated with a better DFS (p=0.03) than no use. In a multivariate analysis DI between 65 and 85% resulted in a better DFS (p=0.02) than DI > or = 85% and DI < 65%. CONCLUSION: The prognosis of the breast cancer patients in this population was comparable with the results of randomised trials using adjuvant CMF. The only treatment related variable of value for prognosis was DI. Unexpectedly DI between 65% and 85% resulted in the best prognosis in this population. The relevance of this observation remains unclear and warrants further investigation.

Breast Neoplasms↗
PubMed1996

[Test for the assessment of the diagnostic accuracy of mammography. Results of 103 tests carried out by Italian radiologists].

This study reports the results of some voluntary Italian radiologists performing 103 proficiency tests in clinical (100 patients, 32 cancers) and screening mammography (150 patients, 17 cancers). Relative to the average accuracy of a panel of expert radiologists, 12 of 49 readers (27%) and 32 of 54 readers (56%) passed the clinical and screening mammography test, respectively. The results were significantly correlated with the readers' previous experience (years of mammographic practice [< 2, 2-4, > 4] and number of mammograms read [< 5,000, 5-10,000, > 10,000]). The rate of passed test was: < 2 years = 0%, 2-4 years = 40%, > 4 years = 66.6% (P = 0.002); < 5,000 mammograms read = 15.3%, 5-10,000 = 28.5%, > 10,000 = 69.2% (P = 0.02). The best results were achieved by the readers with a previous reading experience of at least 10,000 mammograms, a figure which might be used as the reference for a future criterion of accreditation on a national basis. Proper training before reporting mammography is fundamental to ensure a good diagnostic performance. The low number of tests performed in most Italian mammographic practice facilities makes local training highly questionable and requires quite a long time. Reference centers, adequately equipped for training, should be identified for this purpose. Proficiency tests such as those described in the present study are useful to assess individual performance and should be a part of a training program.

Breast Diseases↗
PubMed2004

[Preliminary results from the SFAR-iNSERM inquiry on anaesthesia-related deaths in France: mortality rates have fallen ten-fold over the past two decades].

A National Confidential Inquiry was conducted among death certificators and anaesthetists. A sample of 3700 death certificates from the year 1999 were randomised, after selection of words relating to anaesthesia, surgery, obstetrics, endoscopy, procedural complications, and violent death, with different ratios according to the words and the age; 500 additional certificates relating to deaths in hospital were evaluated to verify the exhaustive nature of the mention of procedures in the certificates. The certificator was sent a simplified form each time the role of the procedure in death could not be excluded (response rate 97%). The anaesthetist was offered a peer review whenever the role of the anaesthetic procedure could not be ruled out (uptake rate 97%). An expert committee analysed the (anonymized) files to determinate the mechanism of the accident and its relationship to anaesthesia. The mortality rates were estimated from the 1996 "Anaesthesia in France" survey. The annual rates of deaths that were totally or partially related to anaesthesia were respectively 7 (CI95%: 2-12) and 47 (31-63) per million. These mortality rates increased with comorbidity, from 4 per million in patients of ASA physical status class 1 to 554 per million in class 4. Similarly, these rates increased with age, from 7 per million in patients less than 45 years old, to 32 in older patients. Most accidents were of ventilatory (38%: airway management: 6%, aspiration pneumonitis: 9%), cardiac (31%: ischaemia: 25%, including anaemia-related), and vascular origin (30%: hemorrhage: 12%, vasodilation by spinal anaesthesia: 6%, anaphylaxis: 3%). The main surgical procedures involved were orthopaedic (50%: hip fracture, haemorrhagic surgery) and digestive (24%: occlusion, peritonitis). INSERM had previously collected data on complications associated with anaesthesia between 1978 and 1982: the annual rates of deaths that were totally or partially related to anaesthesia were respectively 76 and 263 per million. Compared to these previous data, the anaesthesia-related mortality rate fell ten-fold over the last two decades, while the number of anaesthetic procedures at least doubled. In addition, the number of procedures involving old people and patients with poor physical status was multiplied by four. It seems logical to attribute these results to safety and practice guidelines published after the previous inquiry. Progress remains to be made: the present rate of 1/145000 will serve as a basis for systematic analysis of accidents.

Aged↗
PubMed1992

Voice therapy practices and techniques: a survey of voice clinicians.

Members of the American Speech-Language-Hearing Association Special Interest Division on Voice were asked to rate statements which emanated from a previously conducted national survey regarding the practice of voice therapy (Larson and Mueller, 1991). Respondents rated eight data-based statements on a five-point scale as to agreement/disagreement. Results indicated strong agreement with previous findings with the exception of the item addressing treatment time. Implications of these results are discussed.

American Speech-Language-Hearing Association↗
PubMed2003

Relationship between quality of diabetes care and patient satisfaction.

OBJECTIVE: Patient satisfaction is regarded as a component of the quality of medical care. We examined the association between quality of care and patient satisfaction. DESIGN: Cross-sectional study. SETTING: Population-based random sample in North Carolina, United States, 1997. PARTICIPANTS: 591 African-Americans aged > or = 18 years with self-reported diabetes were interviewed for providers' delivery of 10 preventive measures and patients' performance of four preventive measures for diabetes care. MAIN OUTCOME MEASURES: Satisfaction with health care providers with respect to 11 items, on a 4-point scale (excellent, good, fair, and poor). Average satisfaction scores were compared according to levels of quality of care. RESULTS: Patient satisfaction was positively associated with income, employment, diabetes education, ease of getting care during the last year, having health care coverage and having one physician for diabetes care (P < 0.05 for each). Adjusted for age, sex, education, employment, and income, 8 of 10 preventive care practices by providers during the previous year--monitoring of concentrations of glycosylated hemoglobin (HbA1c) and cholesterol; performing eye, foot, and gum examinations; and physician counseling on self-monitoring of blood glucose concentrations, exercise, and weight reduction--were associated with higher satisfaction scores (P < 0.05). Patients' performance of three of four preventive practices--taking medications for diabetes as prescribed, performing daily self-examination of the feet, and going for an eye examination with dilation of the pupils--were also associated with higher satisfaction scores (P < 0.05). CONCLUSION: Quality of diabetes care was positively associated with patient satisfaction with provider of care. Prospective studies are needed to confirm this association and its direction.

Adult↗
PubMed2005

Treatment outcomes in 4 modes of orthodontic practice.

BACKGROUND: This study is a continuation of a previously published report on the outcome of orthodontic treatment provided in offices representing different modes of practice. METHODS: The sample consisted of duplicate pretreatment (T1) and posttreatment (T2) dental casts of 348 patients from traditional private orthodontic practices (5 offices, 134 patients), company-owned practices (5 offices, 107 patients), offices associated with practice-management organizations (2 offices, 60 patients), and general dental practices (2 offices, 47 patients). Methods were used to obtain random, representative samples from each office, starting with lists of patients who were treated consecutively with full fixed orthodontic appliances. The dental casts were measured by 2 independent judges who used the unweighted PAR score. RESULTS: Good interjudge agreement was shown on the initial casts, but the agreement was not as strong on the final casts. CONCLUSIONS: The measurements showed that treatment outcomes were generally satisfactory, although some significant differences between offices and management modes were shown.

Adolescent↗
PubMed1997

Case-control study of GP attendance rates by suicide cases with or without a psychiatric history.

BACKGROUND: Targets for reduction in suicide deaths have been set against a background of an increasing number of people committing suicide. It is often assumed that a reduction can be effected by increasing the detection in primary care of patients at risk. This presupposes that there are indicators that enable suicide risk to be detected reliably. AIM: To compare the characteristics of those who commit suicide with an age- and sex-matched control group in terms of level of general practitioner attendance, diagnosis and pharmacological treatment of mental illness, and to compare those suicides with and without a psychiatric history in terms of general practitioner attendance and history of pharmacological treatment. METHOD: From a total of 48 deaths attributed to suicide and undetermined causes in the Forth Valley in 1993, general practice case notes were located for 41. Live controls were matched to index cases by age, sex and practice. Information on consultations, referrals to secondary care, medication and diagnoses in the previous 10 years was extracted from general practice and, for suicides, psychiatric case notes. RESULTS: Over the 10-year period, suicide patients attended their general practitioner at a higher level than control subjects. However, the number of suicide patients who attended their general practitioner in the month before their death did not differ in comparison with control subjects over a similar period. Suicide cases, in comparison with control subjects, were more likely to have received a psychiatric diagnosis from their general practitioner, been prescribed psychotropic medication and received referral to specialist mental health services. Those suicide patients with a psychiatric history had a significantly higher number of general practitioner consultations than those without a psychiatric history in four out of the five years preceding death. Those suicide patients without a psychiatric history did not differ significantly from control subjects on any of the variables assessed. CONCLUSION: For those people committing suicide who do not have a psychiatric history and whose consultation patterns do not differ from the norm, it is difficult to suggest how general practitioners might improve their detection of relevant suicidal risk factors. For those patients with a psychiatric history who commit suicide, until we have more detailed information regarding the specific content of general practitioner's consultations before death and how these differed from other consultations of the deceased, then it is premature to assume that general practitioners are failing to identify indicators of impending suicide.

Adult↗
PubMed1996

Practice and Component Submovements: The Roles of Programming and Feedback in Rapid Aimed Limb Movements.

An experiment is reported in which subjects (N = 30) practiced rapid aimed limb movements (wrist rotations), with either full visual feedback, no visual feedback, or delayed visual feedback. Previous research has indicated that, with practice, subjects increase the distance and duration of ballistic primary submovements and decrease the distance and duration of corrective secondary submovements. The design of the present experiment permitted the determination of whether these practice-related changes are results of improved programming of the primary submovement or of more efficient processing involved in the production of secondary submovements. The results suggest that improved programming occurs with practice. Furthermore, it appears that visual feedback is not solely responsible for the production of secondary submovements.

Journal Article↗
PubMed1991

An evaluation of experimental practices for abatement of residential lead-based paint: report on a pilot project.

In this pilot study, we prospectively evaluated experimental practices for abating lead-based paint in six dwellings. These experimental abatements were based upon a new approach to abatement which reflects current understanding of low-level lead toxicity in children and the role of lead-contaminated dust as an important contributor to children's total body burden. Our previous study of traditional abatement practices in Baltimore showed them to be inadequate for reducing lead in both house dust and children's blood. Our experimental abatements resulted in significant reductions in house dust-lead levels (PbD) which persisted during 6-9 months of followup. Geometric mean PbD at floors, window sills, and window wells were respectively 5.6, 49.6, and 316.7 mg/m2 at preabatement, and respectively 0.6, 4.4, and 10.8 mg/m2 at 6-9 months. Experimental abatements involved (1) treatment of lead-painted surfaces above and below 4 ft from the floor, including interior and exterior components of windows; (2) sealing or covering of wooden floors; (3) procedures for containment of dust during abatement; and (4) a final cleanup using a high-efficiency particle air (HEPA) vacuum. We recommend that more research be done to further evaluate and compare the long-term efficacy of these and other abatement methodologies.

Dust↗
PubMed2005

HierS: hierarchical scaffold clustering using topological chemical graphs.

An exhaustive ring-based algorithm, HierS, has been developed in order to provide an intuitive approach to compound clustering for analyzing high-throughput screening results. The recursive algorithm rapidly identifies all possible ring-delimited substructures within a set of compounds. Molecules are grouped by shared ring substructures (scaffolds) so that common scaffolds obtain higher membership. Once all of the scaffolds for a set of compounds are identified, the hierarchical structural relationships between the scaffold structures are established. The complex network of hierarchical relationships is then utilized to navigate compounds in a structurally directed fashion. When the scaffold hierarchy is traversed, over-represented structural features can be rapidly identified so that excess compounds that contain them can be removed without significantly impacting the structural diversity landscape of the compound set. Furthermore, the removed compounds can provide the opportunity to follow-up on active compounds that had previously been discarded because of practical limitations on follow-up capacity. A Web-based interface has been developed that incorporates this algorithm in order to allow for an interactive analysis. In addition, biological data are coupled to scaffolds by the inclusion of activity histograms, which indicate how the compounds in each scaffold class performed in previous high-throughput screening campaigns.

Algorithms↗
PubMed1999

The relationship of rural persons' multidimensional health locus of control to knowledge of cancer, cancer myths, and cancer danger signs.

The purpose of the study was to determine if a relationship exists between multidimensional health locus of control and knowledge of breast cancer, prostate cancer, cancer myths, and danger signs. A descriptive correlational design was used. A convenience sample of 78 rural men and 79 rural women participated in the study. Participants completed three questionnaires: (a) the Cancer Danger Signs Questionnaire, (b) the Cancer Myths Questionnaire, (c) the Prostate Cancer Knowledge Test (completed by the men) and the Breast Cancer Knowledge Test (completed by the women). Results indicated that an internal score on the Multidimensional Health Locus of Control (MHLOC) scale did not predict knowledge of breast cancer in women, prostate cancer in men, cancer myths, or danger signs. Women who scored high on the Powerful Others subscale of the MHLOC had statistically significant high scores on knowledge of breast cancer, but not on cancer myths and danger signs. The MHLOC and its subscales did not predict knowledge of prostate cancer, cancer myths, or cancer danger signs for the male participants. The implications of these results for rural nursing practice and their relationship to previous research are discussed.

Adult↗
PubMed2002

NMR Nomenclature: Nuclear Spin Properties and Conventions for Chemical Shifts. IUPAC Recommendations 2001.

A unified scale is recommended for reporting the NMR chemical shifts of all nuclei relative to the (1)H resonance of tetramethylsilane. The unified scale is designed to provide a precise ratio, Xi, of the resonance frequency of a given nuclide to that of the primary reference, the (1)H resonance of tetramethylsilane (TMS) in dilute solution (volume fraction, varphi<1%) in chloroform. Referencing procedures are discussed, including matters of practical application of the unified scale. Special attention is paid to recommended reference samples, and values of Xi for secondary references on the unified scale are listed, many of which are the results of new measurements. Some earlier recommendations relating to the reporting of chemical shifts are endorsed. The chemical shift, delta, is redefined to avoid previous ambiguities but to leave practical usage unchanged. Relations between the unified scale and recently published recommendations for referencing in aqueous solutions (for specific use in biochemical work) are discussed, as well as the special effects of working in the solid state with magic-angle spinning. In all, nine new recommendations relating to chemical shifts are made. Standardised nuclear spin data are also presented in tabular form for the stable (and some unstable) isotopes of all elements with non-zero quantum numbers. The information given includes quantum numbers, isotopic abundances, magnetic moments, magnetogyric ratios, and receptivities, together with quadrupole moments and line-width factors (where appropriate).

Journal Article↗
PubMedDate not supplied

The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy.

OBJECTIVE: To investigate the frequency and types of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. DESIGN: Retrospective information obtained by chiropractors through standardized interview of patients on return visit within 2 weeks of previous treatment. SETTING: The private practice of 87 Swedish chiropractors (response rate 81%). SUBJECTS: Twenty consecutive (presumably naive) patients per chiropractor (1504 valid questionnaires returned, 86% of optimal number of replies). INTERVENTION: Spinal manipulation with or without additional therapy provided by chiropractors. MAIN OUTCOME MEASURES: Self-reported improved nonmusculoskeletal symptoms (reactions). RESULTS: At least I reaction was reported after the previous treatment in 21% to 25% of cases. Of these responses, 26% were related to the airway passages (usually reported as "easier to breathe"), 25% were related to the digestive system (mostly reported as "improved function"), 14% were classified under eyes/vision (usually reported as "improved vision"), and 14% under heart/ circulation (about half of these reported as "improved circulation"). The number of spinal areas treated was positively associated with the number of reactions. CONCLUSION: A minority of chiropractic patients report having positive nonmusculoskeletal reactions after spinal manipulative therapy but such reports cluster predominantly around specific symptoms. It would be interesting to find out if these can be verified objectively and, if so, to investigate if they are caused by the treatment or if they are signs of natural variations in human physiology.

Adolescent↗
PubMed2001

Learning related modulation of functional retrieval networks in man.

The medial temporal lobe has been implicated in studies of episodic memory tasks involving spatio-temporal context and object-location conjunctions. We have previously demonstrated that an increased level of practice in a free-recall task parallels a decrease in the functional activity of several brain regions, including the medial temporal lobe, the prefrontal, the anterior cingulate, the anterior insular, and the posterior parietal cortices, that in concert demonstrate a move from elaborate controlled processing towards a higher degree of automaticity. Here we report data from two experiments that extend these initial observations. We used a similar experimental approach but probed for effects of retrieval paradigms and stimulus material. In the first experiment we investigated practice related changes during recognition of object-location conjunctions and in the second during free-recall of pseudo-words. Learning in a neural network is a dynamic consequence of information processing and network plasticity. The present and previous PET results indicate that practice can induce a learning related functional restructuring of information processing. Different adaptive processes likely subserve the functional re-organisation observed. These may in part be related to different demands for attentional and working memory processing. It appears that the role(s) of the prefrontal cortex and the medial temporal lobe in memory retrieval are complex, perhaps reflecting several different interacting processes or cognitive components. We suggest that an integrative interactive perspective on the role of the prefrontal and medial temporal lobe is necessary for an understanding of the processing significance of these regions in learning and memory. It appears necessary to develop elaborated and explicit computational models for prefrontal and medial temporal functions in order to derive detailed empirical predictions, and in combination with an efficient use and development of functional neuroimaging approaches, to further the understanding of the processing significance of these regions in memory.

Adult↗
PubMed1979

The specificity of schizophrenic thought disorder.

Bannister and Salmon (1966), in a repertory grid study, reported that 'thought-disordered schizophrenics lost significantly more reliability and social agreement when shifted from object to people construing than normal'. This conclusion is of doubtful validity, since the between-grids variable, people vs. objects, was confounded with at least five other variables of possible relevance, three of which have been found by subsequent workers (McPherson & Buckley, 1970; Williams, 1971; Heather, 1976) to affect performance on grids. The main aim of the present experiment was to determine the effects of as many as possible of these variables. The subsidiary aim was to replicate, or otherwise, the findings of Frith & Lillie (1972) and Haynes & Phillips (1973) that the effective discriminator between thought-disorder schizophrenics and other groups on repertory grid tests is not intensity of relationship between constructs but pure (element or internal) consistency. Six grids involving all feasible combinations of rating familiar and unfamiliar people and objects on psychological and physical constructs were administered to 10 thought-disordered schizophrenics, 10 non-thought-disordered schizophrenics and 10 normals. As regards the main aim of the experiment it was found that there was no significant grids x diagnoses interaction on pure consistency, but that there was one on intensity, even with pure consistency partialled out. Taking previous work into consideration, it appears that this effect is weak, inconsistent from experiment to experiment, and anomalous in the present study. As regards the subsidiary aim, the findings of the two previous experiments cited above were confirmed. The discrepant results of McPherson et al. (1973) are considered, and it is noted that they held only for a subsample of the schizophrenic group in that experiment, the results for the total sample of schizophrenics, manics and depressives not being inconsistent with those of other experiments. The theoretical and practical implications of these and previous finding are indicated.

Female↗
PubMedDate not supplied

"One voice-one vision" for Wisconsin pharmacy.

OBJECTIVE: To describe how a new organization, reflecting a new vision and unifying the pharmacists of Wisconsin, was created by bringing together organizationally the resources and memberships of the Wisconsin Pharmacists Association and the Wisconsin Society of health-System Pharmacists. SETTING: State of Wisconsin. DESCRIPTION: The boards of directors of the two precursor organizations initiated an exploration of the desirability and feasibility of creating a single, new organization to represent, with a unified voice, all of Wisconsin's pharmacists. This two-year effort resulted in the creation of the Pharmacy Society of Wisconsin (PSW) on January 1, 1998. INNOVATION: The new organization builds on the strengths and resources of two pharmacy organizations that previously represented divergent views and practice settings. PSW offers a new vision and level of service to its members and to pharmacy students. It presents a single voice to patients, other health care providers, and governmental agencies. RESULTS: The creation of the Society was supported unanimously by the two boards of directors and by 98% of the voting membership of the two previous organizations. CONCLUSION: Through a deliberate and extensive planning and organizational process, two vigorous professional organizations were able to recognize the importance of combining their resources into a new single organization. The pharmacists of Wisconsin responded to a call for a new vision and a unified voice. The opportunity exists for American pharmacy to examine how it will be best served by its professional organizations.

Humans↗
PubMed1990

Cervical cytology in the Vale of Trent faculty of the Royal College of General Practitioners, 1985-8.

OBJECTIVE: To assess changes in the organisation and performance of cervical cytology programmes in the practices of members of the Vale of Trent faculty of the Royal College of General Practitioners. DESIGN: Retrospective audits completed in 1985 and 1988 by general practitioners on a sequential sample of 100 records of women aged 35-64 in their practice. SETTING: General practices in which one or more partners were members or associates of the Vale of Trent faculty of the college, of which 76 participated in the first audit and 55 (82% of 67 eligible practices) in the second. SUBJECTS: Sequential samples of 100 women born between 1 January 1920 and 31 December 1949 (first audit) and between 1 January 1923 and 31 December 1952 (second audit) whose surnames began with P or B respectively. MAIN OUTCOME MEASURES: Percentage of women in each practice with a record of cervical cytology performed in the previous five years and percentage with no recorded smear. RESULTS: Of the 76 practices completing the audit in 1985, 55 (82% of those eligible) repeated the exercise in 1988. Performance was not significantly different in practices that did and did not respond. The median percentage of women who had had a smear in the previous five years was 49% and 69% in 1985 and 1988 respectively (p less than 0.001) and that of women with no record of a cervical smear was 28% and 16% respectively (p less than 0.001). All but six practices showed improvement in both outcome measures. In both audits an active call system was associated with a significantly increased performance (p less than 0.05). In nine practices (16%) 80% or more of the samples of women had had a smear in the previous five years. CONCLUSION: Organisation and performance of practices audited improved between 1985 and 1988. Although this might result from participation in the first audit, it probably represents a more general trend within primary care. ACTION: Between the two audits more practices (87% v 67%) had developed a policy on screening, and this was more likely to include the aim of performing regular smears on all sexually active women (98% v 80%).

Adult↗