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PubMedDate not supplied

[The development of public health research].

The overall assessment of the public health research (PHR) development in Mexico is a previous condition to promote PHR at a national scale. This assessment has been delayed because standard PHR identification criteria within the health research field have been missing. In this paper the guidelines to determine the PHR fields of application are presented, as well as the bibliometric indices to determine its current stage of development; a PHR methodological classification scheme is also proposed. To estimate the PHR production in Mexico, the above criteria were used to analyze the content of a data base created from two national data bases (Biblat and Periódica), and from one international data base on biomedical literature (Medline); a manual search was implemented to identify studies missing studies in the data bases but published in Salud Pública de México, the most prominent national journal in this field. The review period in Medline extended from 1979 to 1986. About 2,269,905 international scientific references were recorded, 5,189 of which belonged to national authors. Approximately 180,000 papers were related to the PHR; in 552 of these works, the main author was from Mexico. After adding up to this figure, the number of articles found in the manual search and after correcting for any misclassification error, the PHR data base contained 971 papers; approximately half of them were not investigation reports, but commentaries, reviews and position papers. Outbreak studies were 3 per cent and mortality 2.2 per cent; prevalence works were the most common (8.4%), but analytic studies were very infrequent (4%). Communicable diseases, noncommunicable diseases and mental health ranked among the main topics of interest; all other topics were infrequent or absent. These results highlight the need to carry out four main tasks to promote nationally the PHR in the short term.

Databases, Bibliographic↗
PubMedDate not supplied

A newly developed therapeutic surgical and cardiac intensive care monitor.

A computerized intensive care monitor patterned after a clinical system operating at the University of Alabama has been developed. The system, which has been operating in an intensive care unit since February 1973, is equipped with conventional bedside biomedical instrumentation, special-purpose devices, and keyboard/display terminals interfaced with a minicomputer. Measurement of vital parameters as well as the automatic infusion of blood controlled by the computer in a closed loop feedback mode is available. Communication with the computer via the bedside terminals permits the display and retrieval of clinical data, entry of blood gas measurements and pressure limits for blood infusion, the revision of measurement status, and the control of the computer in measuring cardiac output. The administration of blood and intravenous fluid may be achieved under computer or manual option.

Acid-Base Equilibrium↗
PubMed1989

The Lesion Game: a special communication.

The Lesion Game is a personal computer program that allows the user to view and study muscle innervations and nerve lesions of the brachial plexus. The core of the program is a table that consists of 44 brachial plexus lesions, 50 muscles, and 2 sensations (for brachium and forearm) of the upper extremity, which are innervated by the brachial plexus. After the program randomly selects a lesion, the user attempts to find the lesion in as few guesses (manual muscle tests) as possible. As muscles are selected (muscle tested), the computer searches the table to find the appropriate "strength" of weak or normal, based on the location of the randomly selected lesion. After displaying the strength of the muscle selected, a graphic representation of the strength is shown on a diagram of the brachial plexus. The graphic aspect of the program helps the user to visualize areas of the brachial plexus that may still contain the lesion. While playing the Lesion Game, the user can view a detailed picture of the brachial plexus, view all the possible lesions of the Lesion Game, or view charts of upper extremity innervations. An additional program mode allows beginning users to view and study muscle innervations without having to solve lesions. The program is extremely simple to use because it is entirely mouse-driven.

Brachial Plexus↗
PubMedDate not supplied

Predictors of somatic symptoms in depressive disorder.

We explored the relative contribution of potential psychological predictors of somatic symptoms in outpatients with major depressive disorder, including; 1) severity of depression; 2) general anxiety; 3) hypochondriacal worry; 4) somatosensory amplification; and, 5) alexithymia by sampling 100 consecutive outpatients with DSM-IV diagnoses of major depressive disorder attending the psychiatry clinics of general hospitals in Turkey. The subjects were rated by clinicians on depressive symptomatology (Hamilton Depression Rating Scale), and anxiety (Hamilton Anxiety Scale), and completed self-report measures of Hypochondriacal worry (7-item version of the Whiteley Index), the Somatosensory Amplification Scale, and the Toronto Alexithymia Scale. Multivariate models tested the independent contribution of each of the scales to the level of somatic symptoms as measured by a modified version of the SCL-90 somatization scale. At the bivariate level, somatic symptoms were associated with female gender and lower educational level, as well as the Hamilton Depression and Anxiety scales, the Whitely Index, and the Somatosensory Amplification and Alexithymia scales. In multiple regression models incorporating all variables, female gender and higher scores on the anxiety, somatosensory amplification and alexithymia scales all made independent contributions to the level of somatic symptoms and accounted for 54% of the variance. Therefore, somatic symptoms in depression are related to concomitant anxiety, tendency to amplify somatic distress, and difficulty identifying and communicating emotional distress. However, these factors do not account for the tendency for women to report more somatic symptoms.

Adult↗
PubMed2004

A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients.

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21-25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had "good" outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.

Journal Article↗
PubMed2005

Computer-assisted image analysis of bronchioloalveolar carcinoma.

In clinical trials, response rate is an important endpoint for assessing the efficacy of an anticancer drug. The Response Evaluation Criteria for Solid Tumors (RECIST) has been widely used as a standard method to assess response. The RECIST requires only 1-dimensional measurement of tumor size. However, bronchioloalveolar carcinoma (BAC), which commonly presents as infiltrative or micronodular lesions, is not always readily assessable by RECIST. During the past 2 years, we have been developing computer-based programs to more accurately measure tumor size on chest computed tomography (CT) scans. In a first-generation computer-assisted image analysis (CAIA) system, we were able to capture and quantify lesions on CT scans by linking the software programs of eFilm, HyperSnap, and Scion. We have applied this CAIA approach to measuring BAC response to gefitinib in the Southwest Oncology Group (S0126) trial. However, this first-generation CAIA system involves multiple manual steps and is therefore labor intensive. We are now developing a fully automated CAIA program based on a versatile software platform, ImageJ, created at the National Institutes of Health. Taking theoretical and physical considerations into account, Java plug-in programs for ImageJ are created to automatically analyze CT scans in the Digital Imaging and Communications in Medicine format. We have demonstrated the feasibility of an ImageJ-based automated CAIA program for measuring BAC bidimensionally on CT scans. This automated CAIA system will be applied in a prospective clinical trial of the GVAX vaccine in patients with BAC.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1989

Development and evaluation of a dual-pump microcomputer-based closed-loop arterial pressure control system.

Hypertension after cardiac surgery is common and is associated with increased morbidity. It is usually managed by the infusion of short acting vasodilators. The use of a closed-loop computer system to control the infusion of a vasodilator has been shown to compare favourably with manual control. We have developed a closed-loop system for the ATARI 1040ST microcomputer to control arterial pressure by the simultaneous infusion of two vasodilators. The control program is based on a proportional-integral-derivative algorithm which has been adapted to allow control of two IMED 929 infusion pumps from one RS-232 port. All communication between the user and computer is carried out with a 'mouse', thus increasing acceptability of the system to ward staff. Cardiovascular data are collected on-line from the patient monitor via a custom-built analogue to digital convertor. This system was used to study glyceryl trinitrate and sodium nitroprusside in 24 patients requiring vasodilators after cardiopulmonary bypass. The study showed that in 14 of the patients hypertension was controlled by GTN alone and 10 required supplementary SNP. We have demonstrated that this dual-pump automatic arterial pressure control system is a satisfactory and safe method of administering two vasodilators simultaneously. It is suitable for both routine clinical and research uses.

Blood Pressure↗
PubMedDate not supplied

The plantar compartments of the foot: a roentgen approach I. Experimental observations.

The integrity of the plantar muscle compartments of the human foot were studied utilizing radiographic and anatomic techniques in an attempt to determine potential pathways for spread of soft tissue infection. One of three major plantar muscle compartments--medial, intermediate or lateral--in 24 unembalmed cadaveric feet was injected percutaneously under fluoroscopy with radiopaque Methyl-methacrylate using both manual and automatic injection techniques with pressure callibration. Following freezing, specimens were sectioned, radiographed, and dissected or partially macerated. Frequency and patterns of extravasation of contrast material were documented and recorded. The results obtained support the concepts that: a) there are three distinct plantar muscle compartments that are maintained by intermuscular septae; and b) there are potential communicating pathways provided by specific anatomic structures.

Foot↗
PubMed2004

[Initial management of primary postpartum hemorrhage].

Accurate management of primary postpartum hemorrhage requires perfect knowledge of a recent protocol accessible at all times. Staff members and equipment need to be adjusted to the emergency situation. The first step is to establish a rapid diagnosis. This could be done with collecting bags, placed immediately after the birth. Once the diagnosis has been established, it has to be communicated to the whole team including obstetricians, midwives and anesthetists. A search for the cause of the hemorrhage is premordial. Abdominal uterine palpation confirms the diagnosis of uterine atony, the most frequent cause of postpartum hemorrhage. Two management schemes are possible depending on whether or not there is retention of the placenta. When the placenta is retained, manual removal has to be performed to empty the uterine cavity and to rule out uterine rupture. After placental delivery, manual control of the uterine cavity is always required. Uterine massage has to be performed after the intrauterine manoeuvres and must not be stopped too quickly. Rapidly other origins can be excluded: episiotomy or low genital tract lacerations requiring rapid repair, coagulation disorders requiring specialised care, or hematomas. During the same time, uterotonic drugs have to be used. Oxytocin (intravenous injection of 5 to 10 IU) is generally employed. Prostaglandins cannot be proposed as publications reporting their efficiency are not validated. Meanwhile, the anesthetists will have begun the first measures of resuscitation.

Decision Trees↗
PubMed2005

Investigation of misfiled cases in the PACS environment and a solution to prevent filing errors for chest radiographs.

RATIONALE AND OBJECTIVE: The aim of the study was to survey misfiled cases in a picture archiving and communication system environment at two hospitals and to demonstrate the potential usefulness of an automated patient recognition method for posteroanterior chest radiographs based on a template-matching technique designed to prevent filing errors. MATERIALS AND METHODS: We surveyed misfiled cases obtained from different modalities in one hospital for 25 months, and misfiled cases of chest radiographs in another hospital for 17 months. For investigating the usefulness of an automated patient recognition and identification method for chest radiographs, a prospective study has been completed in clinical settings at the latter hospital. RESULTS: The total numbers of misfiled cases for different modalities in one hospital and for chest radiographs in another hospital were 327 and 22, respectively. The misfiled cases in the two hospitals were mainly the result of human errors (eg, incorrect manual entries of patient information, incorrect usage of identification cards in which an identification card for the previous patient was used for the next patient's image acquisition). The prospective study indicated the usefulness of the computerized method for discovering misfiled cases with a high performance (ie, an 86.4% correct warning rate for different patients and 1.5% incorrect warning rate for the same patients). CONCLUSION: We confirmed the occurrence of misfiled cases in the two hospitals. The automated patient recognition and identification method for chest radiographs would be useful in preventing wrong images from being stored in the picture archiving and communication system environment.

Database Management Systems↗
PubMed2006

Health care consumers' experiences of information communication technology--a summary of literature.

BACKGROUND: There is an increasing interest in reaching consumers directly through the Internet and different telecommunication systems. The most important contacts in health care will always be the face-to-face meetings, but the tools of health informatics can be seen as a means to an end, which is to provide the best possible health care. A variety of applications have been described in different references. To our knowledge there has been no review of a research-based state of the art in the field of consumers' experiences in using different applications in health informatics. According to the benefits in using information communication technology (ICT) as being cost-effective and timesaving it is of great importance to focus on and examine consumers' experiences. It is important that it is user friendly and regarded as valuable and useful. AIM: The aim of this study was to describe consumers' subjective experiences of using electronic resources with reference to health and illness. DESIGN AND/OR METHOD: A systematic literature search was performed in databases CINAHL, Medline and Cochrane, as well as a manual search. Retrieved references (n=14) were appraised according to their scientific structure and quality. A broad search was performed in order to find as many different applications as possible. Our primary intention was to identify existing references describing consumers' experiences with ICT. RESULTS: In spite of this broad search few references were found. Twelve references remained and three themes were identified: support and help, education and information, and telecommunication instead of on-site visiting. Consumers felt more confident and empowered, their knowledge increased and their health status improved due to the ICT resources. Lack of face-to-face meetings or privacy did not appear to be a problem. CONCLUSION: ICT can improve the nurse-patient relationship and augment well-being for consumers. More research is needed to measure consumers' experiences and factors that influence it.

Biotechnology↗
PubMed1991

Gap-junctional permeability in early and cleavage-arrested ascidian embryos.

Using the whole-cell voltage clamp technique, we have studied junctional conductance (Gj), and Lucifer Yellow (LY) coupling in 2-cell and 32-cell ascidian embryos. Gj ranges from 17.5 to 35.3 nS in the 2-cell embryo where there is no passage of LY, and from 3.5 to 12.2 nS in the later embryo where LY dye spread is extensive. In both cases, Gj is independent of the transjunctional potential (Vj). Manually apposed 2-cell or 32-cell embryos established a junctional conductance of up to 10 nS within 30 min of contact. Furthermore, since we did not observe any significant number of cytoplasmic bridges at the EM and Gj is sensitive to octanol, it is probable that blastomeres in the 2-cell and 32-cell embryos are in communication by gap junctions. In order to compare Gj in the two stages and to circumvent problems of cell size, movement and spatial location, we used cytochalasin B to arrest cleavage. Gj in cleavage-arrested 2-cell embryos ranged from 25.0 to 38.0 nS and remained constant over a period of 2.5 h. LY injected into a blastomere of these arrested embryos did not spread to the neighbour cell until they attained the developmental age of a 32- to 64-cell control embryo. Our experiments indicate a change in selectivity of gap junctions at the 32-cell stage that is not reflected by a macroscopic change in ionic permeability.

Animals↗
PubMed2001

Kaiser Permanente's "metadata-driven" national clinical intranet.

This paper describes the approach taken to build Kaiser Permanente's national clinical intranet. A primary objective for the site is to facilitate resource discovery, which is enabled by the use of "metadata", or data (fields and field values) that describe the various resources available. Users can perform full text queries and/or fielded searching against the metadata. Metadata serves as the organizing principle of the site--it is used to index documents, sort search results, and structure the site's table of contents. The site's use of metadata--what it is, how it is created, how it is applied to documents, how it is indexed, how it is presented to the user in the search and the search results interface, and how it is used to construct the table of contents for the web site--will be discussed in detail. The result is that KP's national clinical intranet has coupled the power of Internet-like full text search engines with the power of MedLine-like fielded searching in order to maximize search precision and recall. Organizing content on the site in accordance with the metadata promotes overall consistency. Issues currently under investigation include how to better exploit the power of the controlled terminology within the metadata; whether the value gained is worth the cost of collecting metadata; and how automatic classification algorithms might obviate the need for manual document indexing.

Computer Communication Networks↗
PubMed2006

Music therapy for autistic spectrum disorder.

BACKGROUND: The central impairments of people with autistic spectrum disorder (ASD) include social interaction and communication. Music therapy uses music and its elements to enable communication and expression, thus attempting to address some of the core problems of people with ASD. OBJECTIVES: To review the effects of music therapy for individuals with autistic spectrum disorders. SEARCH STRATEGY: The following databases were searched: CENTRAL, 2005, (Issue 3); Medline, (1966 to July 2004); Embase, (1980 to July 2004); LILACS, (1982 to July 2004); PsycINFO, (1872 to July 2004); CINAHL, (1982 to July 2004); ERIC, (1966 to July 2004); ASSIA, (1987 to July 2004); Sociofile, (1963 to July 2004); Dissertation Abstracts International, (late 1960's to July 2004). These searches were supplemented by searching specific sources for music therapy literature and manual searches of reference lists. Personal contacts to some investigators were made. SELECTION CRITERIA: All randomised controlled trials or controlled clinical trials comparing music therapy or music therapy added to standard care to "placebo" therapy, no treatment or standard care. DATA COLLECTION AND ANALYSIS: Studies were independently selected, quality assessed and data extracted by two authors. Continuous outcomes were synthesised using a standardised mean difference (SMD) in order to enable a meta-analysis combining different scales, and to facilitate the interpretation of effect sizes. Heterogeneity was assessed using the I(2) statistic. MAIN RESULTS: Three small studies were included (total n = 24). These examined the short-term effect of brief music therapy interventions (daily sessions over one week) for autistic children. Music therapy was superior to "placebo" therapy with respect to verbal and gestural communicative skills (verbal: 2 RCTs, n = 20, SMD 0.36 CI 0.15 to 0.57; gestural: 2 RCTs, n = 20, SMD 0.50 CI 0.22 to 0.79). Effects on behavioural problems were not significant. AUTHORS' CONCLUSIONS: The included studies were of limited applicability to clinical practice. However, the findings indicate that music therapy may help children with autistic spectrum disorder to improve their communicative skills. More research is needed to examine whether the effects of music therapy are enduring, and to investigate the effects of music therapy in typical clinical practice.

Autistic Disorder↗
PubMedDate not supplied

Content analysis: review of methods and their applications in nutrition education.

Content analysis is a set of qualitative and quantitative methods for collecting and analyzing data from verbal, print, or electronic communication with numerous applications in nutrition education research. Textual information from interviews, focus groups, and open-ended survey questions can be evaluated using content analysis. Selection of method(s) depends on the type(s) and length of material to be analyzed, results desired, and researchers' preferences and technological capabilities. This article reviews options available to content analysts--from manual to fully computerized. Overcoming the challenges inherent in using these methodologies is recommended because of their usefulness in the information-based messaging discipline of nutrition education.

Data Collection↗
PubMed2004

Using standardized video cases for assessment of medical communication skills: reliability of an objective structured video examination by computer.

OBJECTIVE: Using standardized video cases in a computerized objective structured video examination (OSVE) aims to measure cognitive scripts underlying overt communication behavior by questions on knowledge, understanding and performance. In this study the reliability of the OSVE assessment is analyzed using the generalizability theory. METHODS: Third year undergraduate medical students from the Academic Medical Center of the University of Amsterdam answered short-essay questions on three video cases, respectively about history taking, breaking bad news, and decision making. Of 200 participants, 116 completed all three video cases. Students were assessed in three shifts, each using a set of parallel case editions. About half of all available exams were scored independently by two raters using a detailed rating manual derived from the other half. Analyzed were the reliability of the assessment, the inter-rater reliability, and interrelatedness of the three types of video cases and their parallel editions, by computing a generalizability coefficient G. RESULTS: The test score showed a normal distribution. The students performed relatively well on the history taking type of video cases, and relatively poor on decision making and did relatively poor on the understanding ('knows why/when') type of questions. The reliability of the assessment was acceptable (G = 0.66). It can be improved by including up to seven cases in the OSVE. The inter-rater reliability was very good (G = 0.93). The parallel editions of the video cases appeared to be more alike (G = 0.60) than the three case types (G = 0.47). DISCUSSION: The additional value of an OSVE is the differential picture that is obtained about covert cognitive scripts underlying overt communication behavior in different types of consultations, indicated by the differing levels of knowledge, understanding and performance. The validation of the OSVE score requires more research. CONCLUSION AND PRACTICE IMPLICATIONS: A computerized OSVE has been successfully applied with third year undergraduate medical students. The test score meets psychometric criteria, enabling a proper discrimination between adequately and poorly performing students. The high inter-rater reliability indicates that a single rater is permitted.

Communication↗
PubMed2006

Facial and affective reactions to tastes and their modulation by sadness and joy.

This study examined adults' affective and facial reactions to tastes which differ in quality and valence, and the impact of sadness and joy on these reactions. Thirty-six male and female subjects participated voluntarily. Subjects each tasted 6 ml of a sweet chocolate drink, a bitter quinine solution (0.0015 M) and a bitter-sweet soft drink. Following a baseline period, either joy or sadness was induced using film clips before the same taste stimuli were presented for a second time. Subjects rated the drinks' pleasantness and intensity of taste immediately after each stimulus presentation. Facial reactions were videotaped and analysed using the Facial Action Coding System (FACS [P. Ekman, W.V. Friesen, Facial Action Coding System: Manual. Palo Alto, CA: Consulting Psychologists Press; 1978., P. Ekman, W. Friesen, J. Hager, Facial Action Coding System. Salt Lake City, Utah: Research Nexus; 2002.]). The results strongly indicated that the tastes produced specific facial reactions that bear strong similarities to the facial reactivity patterns found in human newborns. The data also suggest that some adults' facial reactions serve additional communicative functions. Emotions modulated taste ratings, but not facial reactions to tastes. In particular, ratings of the sweet stimulus were modulated in congruence with emotion quality, such that joy increased and sadness decreased the pleasantness and sweetness of the sweet stimulus. No emotion-congruent modulation was found for the pleasantness and intensity ratings of the bitter or the bitter-sweet stimulus. This 'robustness' of bitter taste ratings may reflect a biologically meaningful mechanism.

Adult↗
PubMed1989

[A survey on elements of an effective hospital infection control program for Korea].

The main purpose of this survey was to identify for elements of an effective hospital infection control program for Korea. Nurses and doctors who had participated in an education program for infection control or were responsible for hospital infection control were selected as data informers. The data were collected from 51 subjects by employing a Delphi technique in a series of three rounds from September 1, 1987, to March 31, 1988. In each round the responses to questionnaires were analyzed and the results were communicated back to the individuals. Finally 32 elements of effective hospital infection control program were reduced to 10 elements. 10 elements are as follows; 1) Hospital administrator's knowledge of importance and necessity for HIC (hospital infection control) 2) Supporting HIC administratively 3) Constituting infection control committee and role of ICC 4) Developing an educational program and providing a work manual for the hospital infection control staff 5) Educating and informing medical staff about hospital infection 6) Surveillance for hospital infection 7) Developing patient care technique 8) Controlling the hospital environment 9) Executing regular health examinations of all medical staff 10) Recruiting the medical staff sufficiently Three rankings of response rate about 32 elements are as follows: 1) Hiring a full time staff member for the HIC (66%) 2) Establishing a hospital policy and standards for the HIC (66%) 3) Activating the infection control committee and taking administrative action to support the ICC (63%) In addition the rankings of importance score by Likert 5 scale are as follows: 1) Washing hands scrupulously (4.88) 2) Nurses participation as key members of the ICC (4.75) 3) Reviewing and evaluating all ongoing aseptic techniques (4.69) In conclusion, first of all, administrative support must be given to hiring a full time staff member and to organization of infection control committee for the HIC in Korea.

Cross Infection↗