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PubMedDate not supplied

[Comparative evolution of the incidence of bronchopulmonary tuberculosis and bronchopulmonary cancer (data of the TB dispensary No. 1 in Galaţi)].

Over a period of 10 years a decrease was noted in the area of the Tuberculosis Dispensary of the Galatzi District, of the incidence through tuberculosis of the adult by approximately 50%, and an increase of the pulmonary cancer incidence three fold. The incidence curves of these two diseases, which were far apart 10 years ago, are much nearer now, and it may be presumed that in a not too remote future they will cross each other. The pneumophysiology network should be prepared further to face the increasing flow of patients with non-tuberculous diseases. With this view physicians should be re-cycled, and various types of specialists should be trained for cytologic diagnosis, and the technical equipment of antituberculous hospitals should be updated.

Adult↗
PubMed1984

[Level of knowledge on cardiovascular health in schools].

In order to determine the status of cardiovascular health knowledge, a standardized questionnaire was administered to 325 students (currently) in their last year, in 18 high schools of Trieste. The schools were divided into 3 groups according to their teaching programmes: technical schools (Group A), teacher-training colleges (Group B) and junior high schools (Group C). The adopted questionnaire was that developed by the cardiovascular centre of the University of Iowa, slightly modified by the authors, but keeping the "multiple choice" pattern. The questions were focused on the three major areas of anatomy, physiology and pathology. All the students answered the questionnaire although none with 100% accuracy. The highest performance (95% of correct answers) was given in the field of the physiology of the heart of effort, the lowest one concerned the position of the heart in the chest (20%). Fifty-seven per cent of the students refrained from answering the question on myocardial ischaemia. The total score (based on the number of correct answers, incorrect ones and the number of blanks) revealed a significantly different level of cardiovascular health knowledge between the various school groups: group C (64.13 +/- 7.55) performed better than group A (67.15 +/- 9.45, P less than 0.001), which in turn was more successful than group B (71.6 +/- 10.0, P less than 0.001). In comparison to the group of 325 students, the score obtained by a sample group of hospital nursing students, showed a significantly higher level of health knowledge (46.1 +/- 1.56, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

[Mental disorders during intensive therapy].

The life conditions of patients in intensive care units, who are life-threatening somatically as well as psychically, correspond to the bodily and psychic (psychosomatic) extreme situations. Guarding, interdiction and anxiety determine psychosocially, deficiency of sleep, perception, orientation and communication apart from dispositional and actual somatic factors of a disease determine psychophysiologically the appearance of psychic disturbances during intensive care. The psychopathology of the beginning symptomatic psychoses and disturbance syndromes does not justify to take a new clinical picture, a specific intensive care syndrome as basis for them. Own results of inquiries of intensive care unit patients emphasize the great importance of an actual communicative contact between personnel and patients for a positive behaviour-influencing attitude of the patients in the intensive care milieu. The latter is decisively coined by the affective climate (working climate) of such institutions. The creation of more favorable environmental factors urgently needs psychologic advice, instruction and motivation of the personnel which is onesidedly trained for somatic emergency cases and technical perfection.

Adjustment Disorders↗
PubMed1994

[Radiation exposure from nuclear medicine studies in children].

Nuclear medical examinations of children have to be performed with special regard to the problems of radiation protection because of the high radiation sensitivity esp. of infants and young children. The present contribution describes how any unnecessary radiation exposure can be avoided by the correct choice and planning of a nuclear medical study, by using the appropriate radiopharmaceutical as well as by the exact calculation of the amount of activity applied, depending on body surface resp. body weight of the child. A technically optimized method which employs the best technical equipment and personnel, being specially trained for working with children, are important conditions to achieve optimal results of nuclear medical tests. Due to the difficulties of direct dose measurements, large variations in the biokinetic behaviour of radiopharmaceuticals and the restriction to standard phantoms, individual dose calculations or dose estimations in pediatrics cause great problems. This is reflected by often large variations of dosimetrical data given in the literature.

Adolescent↗
PubMedDate not supplied

Adaptive computing for people with disabilities.

Adaptive computing is a relatively new area, and little has been written in the nursing literature on the topic. "Adaptive computing" refers to the professional services and the technology (both hardware and software) that make computing technology accessible for persons with disabilities. Nurses in many settings such as schools, industry, rehabilitation facilities, and the community, can use knowledge of adaptive computing as they counsel, advise, and advocate for people with disabilities. Nurses with an awareness and knowledge of adaptive computing will be better able to promote high-level wellness for individuals with disabilities, thus maximizing their potential for an active fulfilling life. People with different types of disabilities, including visual, mobility, hearing, learning, communication disorders and acquired brain injuries may benefit from computer adaptations. Disabled people encounter barriers to computing in six major areas: 1) the environment, 2) data entry, 3) information output, 4) technical documentation, 5) support, and 6) training. After a discussion of these barriers, the criteria for selecting appropriate adaptations and selected examples of adaptations are presented. Several cases studies illustrate the evaluation process and the development of adaptive computer solutions.

Computers↗
PubMed1993

Factors influencing combined orthognathic and rhinoplastic surgery.

Until recently, little has been written concerning the area of combined orthognathic and rhinoplastic surgery. This may be due to the paucity of surgeons trained in these disciplines and the technical difficulty of the simultaneous performance of surgical procedures. A general approach to combine orthognathic and rhinoplastic treatment planning is presented in this paper. The advantages and disadvantages of combined orthognathic and rhinoplastic surgery are discussed and guidelines for performing combined surgery are given.

Adolescent↗
PubMed1993

[Patterns of drug abuse among youngsters of upper social class].

Street drug use, and alcohol abuse among young adults from a high social class range were studied in the posh seaside resort of Punta del Este (Uruguay) during the (austral) summer vacation (February 1993). In this connection, an anthropological methodology was applied: Four young people were trained in systematic record and observation technics abilities. Results suggest two clearly defined social-cultural patterns with regard to both cannabis, and cocaine use. Both patterns take place within a social environment agreeable to drug use as well as strongly connected with social interaction ways peculiar to high-class youth.

Adolescent↗
PubMed1993

Skin biopsies of pigmented skin lesions performed by general practitioners and hospital specialists.

The performance of skin biopsies by general practitioners has been examined in several recent studies. The aim of this study was to examine the difference between skin biopsies of pigmented skin lesions taken by general practitioners and those taken by hospital specialists. Reviewing all histopathology records at one hospital over a five year period revealed that there were 1000 patients who had had skin biopsies. General practitioners had carried out skin biopsies for 55% of these patients. Hospital specialists excised significantly more lesions that had increased in size (P < 0.001) or changed in colour (P < 0.001). General practitioners excised more lesions that had bled (P < 0.001). Hospital specialists excised more of the 15 melanomas diagnosed (80%) (P < 0.05), and general practitioners excised more squamous papillomas (P < 0.01). Forty per cent of melanomas excised were not suspected by the clinician. General practitioners were able to detect the majority of suspicious lesions, but because of the uncertainty of clinical diagnosis, all specimen's should be submitted for histopathological diagnosis. It is important that future general practitioners are trained in both the diagnostic and technical aspects of skin biopsy if they intend to perform this minor operation.

Adolescent↗
PubMed1993

Support groups address residents' personal development.

Graduate medical education traditionally has emphasized the teaching of biomedical knowledge and technical skills. However, physicians-in-training also need opportunities to explore their emotional reactions that occur during the process of patient care and medical training. The promotion of personal growth and self-awareness should be important components of graduate medical education. Easily implemented, a resident support group is one forum that addresses this obvious gap in medical education. This article reviews the goals and structure of support groups, with the hope that more training programs will implement them.

Education, Medical, Graduate↗
PubMed1993

[Laparoscopic cholecystectomy].

Traditional cholecystectomy has been the standard surgical treatment of the gallstone disease for more than 100 years. The technical development led to a new surgical procedure and its rapid acceptance. This is laparoscopic cholecystectomy. Its application is becoming widespread in therapy too. But most of the surgeons are lack of technical experiences in this field. Currently it restricts the indications those are anyway the same of standard cholecystectomy. Besides its many advantages, laparoscopic cholecystectomy has its own disadvantages and being an invasive procedure, there are possibilities of complications. The latest can be reduced by the adequate choice of patients, the careful learning of the operative technic and by turning to open surgery (conversion) when it is necessary. Its morbidity is nearly equal to complications of standard cholecystectomy, but mortality rate is lower (0.05-0.2%). Our morbidity of performed 300 laparoscopic cholecystectomies was 6.4%. We had no death. The hospitalization became as short as 4 days. Our early clinical results (90%) are the same of traditional cholecystectomy. Laparoscopic cholecystectomy as a new surgical procedure involves the efficiency of the standard cholecystectomy and the noninvasive endoscopic technic. Laparoscopic cholecystectomy performed by well trained surgeons is a safe surgical procedure, its early results are excellent and makes the choice of surgical treatment, used in bile surgery richer.

Acute Disease↗
PubMedDate not supplied

[National Task Force on Home and Ambulatory Artificial Nutrition. NADYA. The NADYA Group].

When a patient needs parenteral or enteral nutrition, be it in a transitory way or as a permanent form, and hospitalization is not strictly required, this treatment should take place in the home of the patient whenever possible. The support with artificial nutrition can be equally efficient, improving the life expectancy ad the quality of life of patients who would otherwise be faced with a much prolonged hospital stay. The Ambulatory and Home Artificial Nutrition group (NADYA) is a multidisciplinary team of health care professionals, from different areas of the national territory, who are dedicated to Clinical Nutrition. With the objective of promoting health and well-being of patients undergoing treatment, and to ease the therapeutic activity of the implicated professionals, this group has developed a series of suggestions for the practice of enteral or parenteral nutrition in the home of the patient. These suggestions include specifications about the technical team, criteria for selection and training of the patients, routes of access, formulas and material needed, follow up characteristics, and associated complications, and the represent a consensus of the regulations necessary for the guarantee of an adequate level of security and efficiency of the at home care of patients who require artificial nutrition support.

Ambulatory Care↗
PubMedDate not supplied

[Example of active therapeutic follow-up: itraconazole].

The systematic fungal infections are very serious diseases, the crude mortality in invasive aspergillosis reaches 75 to 100 per cent. Systemic mycosis tends to develop in immunocompromised patients with subsequent physiopathological state, causing a risk of impairment in their digestive absorption potential; in addition these patients are polymedicated and the emergence of multiple drug interactions is frequent. Itraconazole is a very potent antifungal drug with large safety margin and the drug monitoring to maintain a satisfactory plasma level. Immunocompromised patients with suspected malabsorption and treated with oral capsule itraconazole were monitored during two years. In such difficult patients (approximately equal to 500 cases), the result has shown good trough steady-state plasma levels in 72 per cent and insufficient in 28 per cent of the observed patients. However concomitant treatments with antacids produce, in a lot of cases (approximately equal to 48 per cent), a noticeable decrease of the itraconazole availability for these patients. A training program was established to perform the analytical determination of itraconazole and hydroxyitraconazole in biological samples by HPLC method. Analytical validation procedures were associated to this training program which included 115 scientific, technical staff (pharmacists, biochemists ...) from 56 hospitals and institutes.

Antifungal Agents↗
PubMedDate not supplied

[Proposal of a thoraco-pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease].

BACKGROUND: The aim of the study was to give guidelines for the management of a pulmonary rehabilitation program in patients affected by COPD. MATERIALS AND METHODS: 52 patients affected by COPD with chronic respiratory failure and hypoxemia have been evaluated. All patients underwent a personalized rehabilitation program joining traditional technics of rehabilitation and an exercise training. The study was divided into three different phases: traditional pulmonary rehabilitation; exercise training by treadmill; home care rehabilitation. In order to follow-up the outcome of the patients, the 12 minutes walking test and the pulmonary function tests were used. RESULTS: The study showed clearly an improvement of fitness of the patients after exercise training These results were confirmed after one year follow-up. CONCLUSIONS: In conclusion, in the light of these results, the exercise training and, overall, the home care rehabilitation, acquire an important role in the management of patients affected by COPD.

Exercise Therapy↗
PubMed2001

Validity of surgical simulation for the assessment of operative skill.

BACKGROUND: Surgical simulators are being promoted as a means of assessing a surgeon's technical skills. Little evidence exists that simulator performance correlates with actual technical ability. This study was undertaken to determine the criterion and construct validity of currently available surgical simulations in the evaluation of technical skill. METHODS: Simulator assessment was carried out on 36 basic surgical trainees, 37 surgically naïve first-year medical students and 16 experienced general surgical consultants. Some 26 trainees and 36 students underwent repeat assessment after 6 months. A previously validated, 19-point technical skill assessment form, based on direct observation of trainee performance in the operating theatre, was also completed by each trainee's supervising consultant. RESULTS: An insignificant or weak correlation was found between simulator performance and both duration of basic surgical experience and consultant assessment of technical skill. Six months of basic surgical training led to an improvement in performance, not seen in an untrained control group, in only one of the six simulations tested. Discrimination between surgically naïve and experienced subjects was only demonstrated, in part, for four of the six tasks. CONCLUSION: The assessment of technical skill needs to be improved. Work is needed to establish the reliability and validity of currently available simulation models before they are formally introduced for high-stakes assessment.

Clinical Competence↗
PubMed2000

A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program.

In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality ("acceptable or technically limited") was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.

Clinical Competence↗
PubMed2004

High-fidelity simulation-based training in neonatal nursing.

Simulation-based training is a novel approach that facilitates the use of higher order thinking skills. Simulation-based training challenges medical professionals to develop cognitive, technical, and behavioral skills through the use of mannequins, working medical equipment, and human colleagues. During scenarios, trainees must make use of their knowledge base, analyze and synthesize factors contributing to the crises, and evaluate the effects of their actions. Feedback indicates that simulation-based training programs are more pertinent to and better accepted by adult learners than traditional programs. The instructional methodologies used in simulation-based training programs are more in line with the tenets of adult learning.

Education, Nursing, Graduate↗
PubMed1994

Improved utilization of spacing methods--intrauterine devices (IUDs) and low-dose combined oral contraceptives (OCs)--through re-orientation training for improving quality of services. Indian Council of Medical Research Task Force on IUD and Hormonal Contraceptives.

A multicentre study was conducted by the Indian Council of Medical Research (ICMR) for improving the utilization of intrauterine devices (IUDs) and oral contraceptives (OCs) at the Post Partum Centres (PPCs) run by District/State Health Authorities. The ICMR's network of Human Reproduction Research Centres (HRRCs) had the technical responsibility for providing re-orientation training to health functionaries (medical and paramedical) of the PPCs for better quality of services and follow-up care for IUD and OC users. The uniform training module was utilized by all HRRCs which specifically assured for improving the counselling/motivational skills as well as screening procedures and management of side-effects and follow-up care by the health functionaries. A total of 4,808 IUD acceptors (2,446 of CuT 200 and 2,362 of CuT 380A) were observed for 84,070 women-months of use (42,433 and 41,637 months for CuT 200 and CuT 380A, respectively). The cumulative method failure rate at the end of two years was 0.7 per 100 users with CuT 200 and 0.3 per 100 users with CuT 380A. No perforations were reported with either types of the CuT devices. The reasons for discontinuations, like pain/bleeding and pelvic infections, were similar with both types of devices. The continuation rates with either CuT 200 or CuT 380A were around 89 and 76 per 100 users at the end of first year and second year of use, respectively, and were comparable. These observations at the post partum centres were similar to those observed earlier by the ICMR in phase III controlled clinical study. A total of 1,961 women were enrolled in the low-dose combined oral contraceptive (OC) group and were followed for 26,462 women-months of use. Two subjects reported pregnancy during regular use of pill, giving the method failure rate of 0.2 per 100 users at 2 years. The continuation rates of OC users were 58 and 37 per 100 users at the end of first year and second year, respectively. The major reasons for discontinuations were lost to follow-up, desire for pregnancy and other personal reasons. In spite of all efforts made by PPC staff as well as HRRCs to do follow-up, the lost to follow-up at two years was around 20 percent for IUD and 31 percent for oral pill users. These data suggest that while the re-orientation training package improved the quality of care resulting in higher continuation rates of IUDs and OCs at PPCs, the issue of follow-up care still requires further improvement in the National Programme.

Adult↗
PubMed2003

Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library.

Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

Academic Medical Centers↗