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PubMed2005

[Necessity and problems with case-related costing for intensive care patients].

To evaluate whether a German refined diagnosis-related groups (GR-DRGs)-based reimbursement of hospitals/departments covers costs per case, total cost per case accounting is necessary. The aim of the present paper is to delineate the necessity and problems with costs per case accounting for intensive care medicine. The new performance category 8-980 "complex intensive care treatment", in force from 2005 onwards, was integrated into the OPS catalogue to document intensive care work. Whether this will lead to more achievement-oriented cost accounting, has to be demonstrated by the calculations of the institute for reimbursement in hospitals. Basic financing of hospital allowance on a daily basis should be supplemented by extra charges due to analytical concepts of personnel share and to cost-consuming organ replacement procedures. This might lead to a more achievement-oriented cost accounting per case in the ICU.

Costs and Cost Analysis↗
PubMed2000

Lifetime stressors and recurrent depression: preliminary findings of the Adult Life Phase Interview (ALPHI).

BACKGROUND: The well-established association between stress and depression is explored in a lifespan context in relation to adverse childhood experience. A new retrospective interview instrument, the Adult Life Phase Interview (ALPHI) examined the number of chronic stressors (or 'adversities') experienced over the adult life course in relation to chronic or recurrent clinical depression. The role of such lifetime adversity in mediating the relationship between childhood neglect/ abuse and adult disorder was examined. METHOD: The ALPHI uses an investigator-based, contextual approach suited to retrospective and time-linked enquiries. Reliability of the instrument was found to be satisfactory. Its association with both lifetime clinical depression and childhood neglect or abuse was examined in a community series of 198 women, consisting of 99 sister pairs, where one-half of the series was selected for having had adverse childhood experience and the other for comparison. RESULTS: Adult adversity, both at settled/fixed times and at times of major life change, was significantly higher among those with prior childhood neglect or abuse. Both a high adult adversity score and childhood neglect or abuse were related to chronic or recurrent episodes of clinical depression, with logistic regression indicating both indices contributed independently to disorder. The same results held when controls were made for sister status, given possible familial bias in experience, and for age, since women under age 25 had fewer adult phases and less adversity. CONCLUSIONS: Characteristics of adult life phases and change-points are described and the relevance of the measure for intensive survey work seeking to investigate relationships between lifespan experience and depression is discussed.

Adult↗
PubMed2005

Alveolar oxygen uptake kinetics with step, impulse and ramp exercise in humans.

The breath-by-breath VO2A of five male subjects (21.2 years +/-3.2; 78.8 kg +/-5.9; 179.6 cm +/-5.8) was measured during a cycling exercise. Starting from a 10 W baseline, the subjects performed (i) ON and OFF step transitions (ST-ON; ST-OFF) to 50, 90, and 130 W; (ii) a ramp (R) exercise with work rate gradually increasing by 20 W min(-1); (iii) impulse transitions (I) to 250 and 410 W lasting 10 and 5 s, respectively. The VO2A data was modelled using non-linear weighted least square regressions. The amplitudes of the VO2A response turned out to be proportional to the input work rate intensities in all the modalities of exercise. Time constants (tau) and time delays (t (d)) of ST-ON and R responses were not significantly different, whereas those of ST-OFF were characterised by longer tau values. tau and t (d) of I responses turned out to be identical to those of ST-ON when the VO2A responses were fitted using a five-component model. These results suggest that: (i) the system controlling alveolar gas exchange behaves linearly when it is forced by ST and R inputs (the ON and OFF phases being considered separate); (ii) the analysis of the I response depends strongly on the models selected to fit the VO2A data. The asymmetry between the ON and OFF responses mirrors that found between the splitting and resynthesis rates of phosphocreatine, and these results support the notion that phosphocreatine could be the main controller of the skeletal muscle respiratory turnover in humans.

Adolescent↗
PubMed2005

Effects of menstrual phase on performance and recovery in intense intermittent activity.

Game sport and training require repeated high intensity bursts. This study examined differences between high intensity, intermittent work in two phases of the menstrual cycle. Six physically active young women (age 19-29) performed 10 6-s sprints on a cycle ergometer in both the mid-follicular (FP) (days 6-10) and late-luteal phases (LP) (days 20-24) of the menstrual cycle. Work, power, oxygen intake (VO2) parameters, and capillarized blood lactate were measured. Data are analyzed using the Friedman and Wilcoxon matched pairs tests. There was no difference between menstrual phases in peak 6-s power (6.8(0.6) W kg(-1) in FP, 6.9(0.6) W kg(-1) in LP), the drop off in work (1.2(3.5) J kg(-1) in FP and 1.0(2.7) J kg(-1) in LP), or in the sprint VO2 (23.7(1.5) mL kg(-1) min(-1) in LP and 24.3(2.4) mL kg(-1) min(-1) in FP). Capillarized blood lactate was also similar in both phases of the menstrual cycle both at 1 min (9.2(2.7) mmol L(-1) in FP, 9.2(3.1) mmol L(-1)) and at 3 min (9.0(2.2) mmol L(-1) in FP, 9.2(2.2) mmol L(-1) in LP). However, the average 6-s work was greater in the LP (39.3(3.4) J kg(-1)) than during the FP (38.3(3.1) J kg(-1)) (P=0.023). The recovery VO2 was also greater in the LP than the FP (26.3(2.4) mL kg(-1) min(-1) in LP, 25.0(2.6) mL kg(-1) min(-1) in FP, P=0.023). Average work over a series of sprints and the VO2 consumed between sprints may be slightly greater during the LP than the FP of the menstrual cycle.

Adult↗
PubMed2006

Prolonged exercise does not cause lymphocyte DNA damage or increased apoptosis in well-trained endurance athletes.

Recent research has demonstrated that lymphocyte apoptosis sensitivity appears to be related to training status and exercise intensity. This work investigated the effect of prolonged, submaximal treadmill running on percentage (%) apoptosis, % necrosis and DNA strand breaks in lymphocytes and related these to changes in total lymphocyte and blood cortisol concentrations in well-trained runners. Venous blood samples (n = 14) were taken immediately before (PRE), immediately after (IPE) and 3 h after (3PE) 2.5 h of treadmill running at 75% of VO2 max from eight well-trained male endurance athletes (age 34.2 +/- 2.44 years) and analysed for cellular content and serum cortisol concentrations. Lymphocytes were isolated from whole blood and % apoptotic and necrotic cell were detected by flow cytometry using Annexin V-FITC and propidium iodide uptake. DNA strand breaks were measured by single-cell gel electrophoresis. Despite a significant (P < 0.001) exercise-induced increase in mean serum cortisol concentrations and reduction in lymphocyte counts, the mean % Annexin-V positive cells (13.3 +/- 6.78 in PRE, 11.3 +/- 5.51 in IPE and 12.8 +/- 6.75 in 3PE samples) were not significantly different at the three time-points (P > 0.05). Mean DNA strand breaks in the lymphocytes also did not change significantly (P > 0.05) rising from 25.7 +/- 2.16 to 26.9 +/- 1.89 and 27.1 +/- 1.38 microm in IPE and 3PE samples, respectively. The exercise-induced changes in total blood lymphocyte counts and cortisol concentrations did not result in a significant change in % apoptotic lymphocytes or DNA strand breaks in the endurance-trained athletes during this prolonged, submaximal exercise.

Adult↗
PubMed2000

Co-activity of the trapezius and upper arm muscles with finger tapping at different rates and trunk postures.

In the context of finding a model that describes the pathophysiological mechanisms leading to muscle pain at low-intensity repetitive work, in this study we investigated whether a simplified finger motor task that requires little mental demand can cause increased muscle activity in the upper arms and neck, and examined the impact of the variation of two parameters, finger tapping rate and body posture. Using the 5th and 95th percentiles from the surface electromyogram of six muscles of the fingers, upper arm and neck, we determined the static and dynamic components of the muscle activity. Correlation methods were used to find a component in the muscle activity that originated from the rhythm of the finger tapping. Further investigations included tapping steadiness and finger force. It was found that in many, but not all subjects, low or even high activity was constantly present in the upper arm and trapezius muscles, sometimes even during relaxation. Fast tapping and a forward-leaning body posture caused considerable increases, while a slightly reclined posture helped to reduce co-activity. However, motor control patterns varied strongly between individuals. Since certain subjects showed no co-activity at all we can assume that trapezius and upper-arm activation is not necessarily required for the completion of a task similar to ours. This may explain why some VDU users develop work-related musculoskeletal disorders while others remain healthy.

Adult↗
PubMed2003

Diversity of an ectomycorrhizal fungal community studied by a root tip and total soil DNA approach.

Molecular methods based on soil DNA extracts are increasingly being used to study the fungal diversity of ectomycorrhizal (EM) fungal communities in soil. Contrary to EM root tip identification, the use of molecular methods enables identification of extramatrical mycelia in soil. To compare fungal diversity as determined by root tip identification and mycelial identification, six soil samples were analysed. Root tips were extracted from the six samples and after amplification, the basidiomycete diversity on the root tips was analysed by denaturing gradient gel electrophoresis (DGGE). The soil from the six samples was sieved, total soil DNA was extracted and after amplification, the basidiomycete diversity in the soil fractions was analysed by DGGE. Fourteen different bands were excised from the DGGE gel and sequenced; fungal taxon names could be assigned to eight bands. Out of a total of 14 fungal taxa detected in soil, 11 fungal taxa were found on root tips, of which seven were EM fungal taxa. To examine whether the sieving treatment would affect EM species diversity, two different sieve mesh sizes were used and in addition, the organic soil fraction was analysed separately. DGGE analysis showed no differences in banding pattern for the different soil fractions. The organic fraction gave the highest DGGE band intensities. This work demonstrates that there is a high correspondence between basidiomycete diversity detected by molecular analysis of root tips and soil samples, irrespective of the soil fraction being analysed.

Basidiomycota↗
PubMed2006

Spike propagation in dendrites with stochastic ion channels.

We investigate the effects of the stochastic nature of ion channels on the faithfulness, precision and reproducibility of electrical signal transmission in weakly active, dendritic membrane under in vitro conditions. The properties of forward and backpropagating action potentials (BPAPs) in the dendritic tree of pyramidal cells are the subject of intense empirical work and theoretical speculation (Larkum et al., 1999; Zhu, 2000; Larkum et al., 2001; Larkum and Zhu, 2002; Schaefer et al., 2003; Williams, 2004; Waters et al., 2005). We numerically simulate the effects of stochastic ion channels on the forward and backward propagation of dendritic spikes in Monte-Carlo simulations on a reconstructed layer 5 pyramidal neuron. We report that in most instances there is little variation in timing or amplitude for a single BPAP, while variable backpropagation can occur for trains of action potentials. Additionally, we find that the generation and forward propagation of dendritic Ca(2+) spikes are susceptible to channel variability. This indicates limitations on computations that depend on the precise timing of Ca(2+) spikes.

Action Potentials↗
PubMed1990

The influence of bacterial contaminations on the biodegradation of PLA implants.

Metal implants employed in orthopaedic surgery have certain disadvantages. Intensive research work is therefore being done in the field of biodegradable implants, the behavior of which in the case of possible contamination or infection at the operation site has not yet been studied. In-vitro experiments on PLA-test bodies were performed to clarify the influence of bacteria on the polymer degradation. The investigated parameters were germ growth, course of the pH-value of the culture media, bending stiffness of the PLA-test bodies and the decrease in their molecular weight. The experiments performed did not demonstrate an accelerated degradation of PLA specimen in vitro incubated in different bacterial contaminated media. Therefore bacterial contamination may possibly not lead to a premature collapse of the PLA used in connection with fracture treatment by biodegradable osteosynthesis implants.

Bacterial Infections↗
PubMed1991

Overconfidence among physicians and nurses: the 'micro-certainty, macro-uncertainty' phenomenon.

Overconfidence in clinicians was examined in two independently designed studies, each using a different research approach. The first study examined treatment choices of physicians in treating breast cancer, and the second rapid decision making among nurses working in Intensive Care Units. In both studies, individual respondents were highly confident they had made the right choice ('micro-certainty'), although there was no consensus across respondents as to what the optimal treatment would be ('macro-uncertainty'). The difference between micro-certainty of individuals and macro-uncertainty within the clinical community may cast some light on the persistence of practice variation. The implications of overconfidence in clinical treatment for patients, practitioners, and professional regulation are discussed.

Decision Making↗
PubMed1996

Helping health professionals involved in cancer care acquire key interviewing skills--the impact of workshops.

To assess the impact of workshops on key interviewing skills, 169 health professionals involved in cancer care interviewed a simulated patient immediately before and after the workshops and 6 months later. Each interview was audiotaped, transcribed and rated by trained raters using a newly developed rating system which permits an utterance by utterance analysis. The workshops led to significant increases in the use of three behaviours which promote patient disclosure of key concerns. Namely, open directive questions, questions with a psychological focus and clarification of psychological aspects. However, there was no increase in the use of educated guesses and empathic statements which promote disclosure of key problems and feelings. There were significant reductions in behaviours which inhibit disclosure including the use of questions with a physical focus, utterances clarifying physical aspects and the giving of advice prematurely. These significant gains were still evident 6 months later, but there had been some decline over time. There were also significant improvements in the ability of health professionals to elicit patients key problems. Before the workshop, 75 (44%) participants were able to identify at least 60% of their patients' main problems (a criterion of clinical competence) compared with 119 (70%) at 6-month follow-up, an increase in numbers of 59%. Before training, health professionals used as many behaviours which inhibit disclosure as those that promote it. This was unaffected by their professional discipline, prior training or age. It highlights the need for health professionals involved in cancer care to have training in these communication skills. We believe that more intensive group work in smaller groups which focuses on the feelings and attitudes of participants as well as their interviewing behaviour would lead to an increase in the use of educated guesses and empathy and better exploration of patients' feelings.

Clinical Competence↗
PubMed1993

The right to refuse treatment--an ethical case study.

Every day throughout the UK medical professionals working within Intensive Therapy Units (ITUs) are faced with the ethical dilemma of whether it is right to withhold extraordinary treatments from patients. Within this case study an ethical dilemma arises from the question: 'Is it morally sound to treat this patient who, we knew, would have refused our care had he been able to give a written legally binding request not to receive extraordinary medical therapy?' This paper concentrates on the ethical decision-making process and seeking to find a solution to an everyday dilemma within moral philosophy. Personal and professional values and the prima facie principle of non-maleficence within which the doctrine of ordinary and extraordinary means, the doctrine of double effect and the slippery slope argument are discussed in their context relevant to an ITU situation. The nurse's role as patient advocate is addressed as the case study highlights the difficulties encountered in fulfilling this responsibility. It is hoped that the issues raised will help in clarifying how a real ethical dilemma for all the ITU team can be addressed and so help others faced with similar dilemmas. The decision-makers within this dilemma were the patient, family, and the ITU multidisciplinary team. The term extraordinary treatment is understood within biomedical ethics to encompass all medicines, therapies, and operations, which cannot be obtained or used without excessive expense, pain or other physical inconvenience, or which, if used, would not offer a reasonable hope of benefit.

Critical Care↗
PubMed1994

Intestinal barrier failure and the development of the systemic inflammatory response syndrome.

At the present time, terms used to describe the clinical entity of sepsis are used inappropriately and interchangeably. The source and foci of infection are often unidentified, yet it is clear that some form of inflammatory episode is occurring. The following paper seeks to clarify the terminology used to describe 'sepsis' and link this with a non-bacteraemic source of this inflammatory response--the small intestine. The importance of accurately reflecting oxygen extraction and oxygen consumption by cells is addressed and a movement from the current emphasis on haemodynamic measurement to variables which reflect metabolic rate and lactic acidosis is discussed. Issues which are the concern of nurses working in intensive care are examined, in terms of primary prevention and secondary management.

Critical Care↗
PubMed2005

Pattern of relapse after first line treatment of advanced stage germ-cell tumors.

OBJECTIVES: We performed a retrospective analysis of first relapses after cisplatin-based chemotherapy in patients with advanced germ-cell tumors, in order to better define the appropriate follow-up. METHODS: These patients were treated between 1986 and 1998 in two institutions. They were either followed after first-line chemotherapy at the same center or referred for relapse. RESULTS: Ninety-six patients relapsed (17.5% of the total number of patients treated in the same time period). Thirty-five (36.4%) patients had serum tumor marker levels (AFP, hCG and LDH) normal values. Sites of relapse were: abdominal in 47 (49%) patients, thoracic in 17 (17.7%), thoraco-abdominal in 15 (15.6%), and brain in 8 (8.3). Seven (7.3%) patients had elevated markers only, 1 (1%) had isolated supra-clavicular lymph node, 1 (1%) had bone metastasis only. Eighty-two patients (85%) relapsed during the first 18 months of follow-up. All patients with brain metastases at relapse and those who obtained sCR after chemotherapy relapsed within 8 months of follow-up. Sixteen patients underwent resection of growing teratoma. CONCLUSIONS: These results allow to recommend extensive follow-up during the first two years after response to first line treatment. It includes marker level determination and whole body CT scan and less intensive work-up there after.

Adult↗
PubMed2006

High intrachromosomal similarity of retrotransposon long terminal repeats: evidence for homogenization by gene conversion on plant sex chromosomes?

Retrotransposons are ubiquitous in the plant genomes and are responsible for their plasticity. Recently, we described a novel family of gypsy-like retrotransposons, named Retand, in the dioecious plant Silene latifolia possessing evolutionary young sex chromosomes of the mammalian type (XY). Here we have analyzed long terminal repeats (LTRs) of Retand that were amplified from laser microdissected X and Y sex chromosomes and autosomes of S. latifolia. A majority of X and Y-derived LTRs formed a few separate clades in phylogenetic analysis reflecting their high intrachromosomal similarity. Moreover, the LTRs localized on the Y chromosome were less divergent than the X chromosome-derived or autosomal LTRs. These data can be explained by a homogenization process, such as gene conversion, working more intensively on the Y chromosome.

Base Sequence↗
PubMedDate not supplied

The functional impact of an individualized, graded, outpatient pulmonary rehabilitation in end-stage chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the functional impact of an individualized outpatient pulmonary rehabilitation program in end-stage chronic obstructive pulmonary disease (COPD). METHODS: Patients with end-stage COPD were admitted into a 6-week comprehensive outpatient pulmonary rehabilitation program that was "packaged" for each patient. We compared spirometric parameters, exercise tolerance, level of breathlessness, and intensity of work before and after rehabilitation. RESULTS: Of 45 eligible patients, only 14 consented to participate in the study. All 14 patients had forced expiratory volume in 1 second <35% of predicted, and 10 patients (72%) had a 6-minute walk test <180 m. The level of breathlessness was between 7 (moderate to severely breathless) and 10 (maximally breathless) on the Visual Analogue Scale in all patients. After the program, there was significant improvement in the FEV 1 P = 0.04), forced vital capacity P = 0.0045), 6-minute walk test P = 0.00047), and shuttle-walk test (9 of 14 patients). All patients had some improvement in level of dyspnea. CONCLUSIONS: Individualized outpatient pulmonary rehabilitation in end-stage COPD can produce a measurable improvement in spirometry and exercise tolerance with a favorable impact on the level of physical activity.

Aged↗
PubMed2005

Smoking habits and attitudes to smoking 2001 among hospital staff at a Danish hospital--comparison with a similar study 1999.

BACKGROUND: Smoking is the main preventable cause of lifestyle-related diseases and smoking cessation interventions have shown to be cost-effective. It is important to know the smoking habits and attitudes towards smoking among the hospital staff because of the impact the staff have on the patients. Two studies were conducted to attain this information. METHODS: This study analyzes the results of a survey conducted in the summer of 2001 and compares them to a similar study conducted in 1999. 970 anonymous questionnaires were distributed in 2001. RESULTS: The number of smokers among the staff has significantly decreased from 33% to 26% over the 2-year period. Those who do still smoke are less willing to quit and are reluctant to accept help to stop smoking. Fewer are bothered by passive smoking now compared to 1999 and approximately 2/3 of the responders do not find it acceptable to implement sanctions against the members of staff who break the prohibition. CONCLUSION: It is worth providing resources to smoking cessation intervention. The intensive preventive work carried out at the hospital may have resulted in significantly fewer smokers among the staff which again facilitate the staff's effort to help the patients stop smoking.

Adult↗