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PubMed1988

Unimpaired first-set and second-set skin graft rejection in agammaglobulinemic mice.

B cell and antibody-deprived B10.BR chronically suppressed by rabbit antimouse IgM serum rejected first-set allogeneic skin grafts as rapidly as control mice. We confirmed this finding using BALB/c mice born from B cell-deprived mothers and chronically treated with anti-IgM antibodies. Such mice had previously been shown to be agammaglobulinemic except for the suppressing monoclonal rat antimouse IgM antibody in their serum. These results indicate that in mice neither first nor accelerated second-set skin graft rejection reactions depend upon preexisting natural or specifically induced antibodies.

Agammaglobulinemia↗
PubMedDate not supplied

Use of the nursing minimum data set to describe nursing interventions for select nursing diagnoses and related factors in an acute care setting.

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1991. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described.

Acute Disease↗
PubMed2001

Comparison of 'model-free' and 'model-based' linkage statistics in the presence of locus heterogeneity: single data set and multiple data set applications.

Earlier work [Knapp et al.: Hum Hered 1994;44:44-51] focusing on affected sib pair (ASP) data established the equivalence between the mean test and a test based on a simple recessive lod score, as well as equivalences between certain forms of the maximum likelihood score (MLS) statistic [Risch: Am J Hum Genet 1990;46:242-253] and particular forms of the lod score. Here we extend the results of Knapp et al. [1994] by reconsidering these equivalences for ASP data, but in the presence of locus heterogeneity. We show that Risch's MLS statistic under the possible triangle constraints [Holmans: Am J Hum Genet 1993;52:362-374] is locally equivalent to the ordinary heterogeneity lod score assuming a simple recessive model (HLOD/R); while the one-parameter MLS assuming no dominance variance is locally equivalent to the (homogeneity) recessive lod. The companion paper (this issue, pp 199-208) showed that when considering multiple data sets in the presence of locus heterogeneity, the HLOD can suffer appreciable losses in power. We show here that in ASP data, these equivalences ensure that this same loss in power is incurred by both forms of the MLS statistic as well. The companion paper also introduced an adaptation of the lod, the compound lod score (HLOD/C). We confirm that the HLOD/C maintains higher power than these 'model-free' methods when applied to multiple heterogeneous data sets, even when it is calculated assuming the wrong genetic model.

Chromosome Mapping↗
PubMed2006

Dissociating task-set selection from task-set inhibition in the prefrontal cortex.

Patients with focal lesions in the left (n=7) and right (n=4) prefrontal cortex were compared with controls (n=16) in a task-switching experiment using four different, simple spatial tasks. Each of these tasks involved a left-right decision, either regarding an arrow, the word "left" or "right," a circle position, or the direction of a moving line. We compared performance on trials that required rule switches versus rule repetitions (local switch costs) and we compared performance between blocks with bivalent stimuli (two dimensions present) and blocks with univalent stimuli (only one dimension present) to assess global switch costs. Patients with left prefrontal lesions, but not patients with right prefrontal lesions, exhibited increased costs on trials in which the relevant dimension switched (local switch costs), but also on no-switch trials with bivalent stimuli (global costs). We also assessed task-set inhibition in the form of the backward-inhibition effect [increased response times to recently abandoned tasks; Mayr, U., & Keele, S. Changing internal constraints on action: The role of backward inhibition. Journal of Experimental Psychology: General, 129, 4-26, 2000]. Although left frontal patients showed normal inhibition, right frontal patients showed no evidence for inhibition. These results suggest a neurocognitive dissociation between task-set selection and inhibition.

Acoustic Stimulation↗
PubMedDate not supplied

Convergent validity of minimum data set-based performance quality indicators in postacute care settings.

This study assessed the validity of standardized assessment data collected with the Minimum Data Set (MDS) in postacute care settings and used to create performance indicators. Our results show that performance indicators derived from information collected with the MDS demonstrate convergent validity with data collected with other research or standardized assessment instruments. Results were most favorable for areas of physical functioning, cognitive and communicative functioning, and clinical complexity. Results were encouraging for affective functioning, but further research and development in this area is clearly needed. There is a pressing need for better quality data on performance measurement in the postacute environment, given the rapid growth in the volume of services and expenditures for such care and the associated need to ensure that patients receive the most appropriate care possible.

Aged↗
PubMed1980

Practice settings and prescribing profiles: the simulation of tension headaches to general practitioners working in different practice settings in the Montreal area.

The purpose of this study was to determine whether physicians practicing in one type of setting manage a medical problem differently than those practicing in another type of setting. The investigation took the form of presenting physicians with a simulated case of tension headache with a history going back three years, for which diazepam had been taken daily for the past year. Four simulated patients (aged 20-23) visited a stratified random sample of 111 general practitioners practicing in health centers funded by government (CLSCs) and in private group practice clinics in the Montreal area. Fifty-one per cent of group practice physicians recommended therapy rated as "inadequate" compared to 25 per cent in CLSCs; in addition, the data show significant differences between CLSC and group practice physicians in performing various aspects of the clinical examination. Alternative explanations for the observed differences are discussed.

Adult↗
PubMed2005

[The implementation process of a new model of intensive rehabilitation in a hospital setting: the development of an innovative practice within the context of integration of settings, services and treatment models].

This article describes the process of implementation of an internal intensive rehabilitation program at Douglas hospital for people with severe mental disorders. A discussion of contemporary paradigms of rehabilitation implies the integration of biological and psychosocial perspectives in the characterization and treatment of the pathology. The discussion of the reorganization of the entire rehabilitation services of the Program for severe mental disorders leads to specifying the organizational and regional context of the implementation. The axes of implementation in priority are the following : analysis of needs, training, reorganization of work and modification of the setting of care. These activities are implemented in reference to scientific developments that are empirically relevant and assessed regularly. Future challenges include the pursuit of integration of treatment models, of settings and services within the context of the hierarchy of mental health care in Québec.

Hospital Restructuring↗
PubMed1997

Modelling cardiac patient set residuals using rough sets.

Many medical studies deal with the assessment of the prognostic or diagnostic power of some particular test with respect to some particular medical condition. However, even though a test is deemed to be powerful in this respect, the test may not be strictly needed to perform for everyone. If the test is costly or invasive, this issue is of particular interest. This paper presents a methodology based on rough set theory and Boolean reasoning that can be used to identify those patients for whom performing the test is redundant or superfluous. Furthermore, the methodology enables one to automatically construct a set of descriptive and minimal if-then rules that model the patient group in need of the test. A reanalysis of a previously published real-world dataset of patients with chest pain is used as a case study.

Coronary Disease↗
PubMed1998

Setting standards for nursing data sets in information systems.

The American Nurses Association (ANA) has established the Nursing Information and Data Set Evaluation Center (NIDSEC). The purpose of this Center is to develop and disseminate standards pertaining to information systems that support the documentation of nursing practice, and to evaluate voluntarily submitted information systems against these standards. The need for an evaluation center arises out of a long history of calls for standards pertaining to nursing data and to information systems. Standards have been developed to evaluate the completeness, accuracy and appropriateness of four dimensions of nursing data sets and the systems that contain them 1) nomenclature, 2) clinical content, 3) clinical data repository, and 4) general system characteristics. Once the standards and scoring mechanisms were established, they were tested for reliability and validity. A Content Validity Index (CVI) of 0.875 was established for the scoring tool.

American Nurses' Association↗
PubMed1992

Anxiogenic properties of yohimbine. II. Influence of experimental set and setting.

To study the pharmacological induction of stress along with psychological stress and their possible interaction, 20 mg yohimbine and placebo orally were administered to 8 panic patients on placebo treatment, 7 panic patients on alprazolam treatment and 12 controls in a double-blind crossover design. Two structured situations which can be considered as 'neutral' stressors were included: a mental arithmetic task and a continuous performance task. Mental arithmetic induced robust increases in ratings of panicky, anxiety, nervousness, heart rate and electrodermal activity, while the continuous performance task induced increases exclusively in skin conductance reaction. Patients responded to these tasks less than controls with regard to subjective ratings and electrodermal activity. Yohimbine did not potentiate the response to the tasks in the patients. In controls, heart rate during the mental arithmetic task, but not during rest, was increased after yohimbine. In contrast to other yohimbine challenge studies no panic attacks were observed. It is hypothesized that the experimental design together with an instructional set that reduces expectancy factors and the inclusion of structured and time-limited tasks in a challenge paradigm is able to reduce the anxiogenic effects of yohimbine.

Adaptation, Psychological↗
PubMed1991

Effects of changes in articulator settings on generated occlusal tracings. Part I: Condylar inclination and progressive side shift settings.

An occlusal scribing device attached to a fully adjustable articulator was used to generate occlusal tracings. The tracings were analyzed to determine the effect changes in progressive side shift and condylar inclination settings had on molar occlusal morphology. The progressive side shift adjustment affected the cusp height and ridge and groove position, primarily in the nonworking excursion. The condylar inclination adjustment affected the cusp heights in the protrusive and nonworking excursion without affecting the working excursion.

Dental Articulators↗
PubMed2005

The effectiveness of hylan G-F 20 in patients with knee osteoarthritis: an application of two sets of response criteria developed by the OARSI and one set developed by OMERACT-OARSI.

OBJECTIVE: Secondary analyses of a previously conducted 1-year randomized controlled trial were performed to assess the application of responder criteria in patients with knee osteoarthritis (OA) using different sets of responder criteria developed by the Osteoarthritis Research Society International (OARSI) (Propositions A and B) for intra-articular drugs and Outcome Measures in Arthritis Clinical Trials (OMERACT)-OARSI (Proposition D). METHODS: Two hundred fifty-five patients with knee OA were randomized to "appropriate care with hylan G-F 20" (AC+H) or "appropriate care without hylan G-F 20" (AC). A patient was defined as a responder at month 12 based on change in Western Ontario and McMaster Universities Osteoarthritis Index pain and function (0-100 normalized scale) and patient global assessment of OA in the study knee (at least one-category improvement in very poor, poor, fair, good and very good). All propositions incorporate both minimum relative and absolute changes. RESULTS: Results demonstrated that statistically significant differences in responders between treatment groups, in favor of hylan G-F 20, were detected for Proposition A (AC+H=53.5%, AC=25.2%), Proposition B (AC+H=56.7%, AC=32.3%) and Proposition D (AC+H=66.9%, AC=42.5%). The highest effectiveness in both treatment groups was observed with Proposition D, whereas Proposition A resulted in the lowest effectiveness in both treatment groups. The treatment group differences always exceeded the required 20% minimum clinically important difference between groups established a priori, and were 28.3%, 24.4% and 24.4% for Propositions A, B and D, respectively. CONCLUSION: This analysis provides evidence for the capacity of OARSI and OMERACT-OARSI responder criteria to detect clinically important statistically detectable differences between treatment groups.

Analgesics↗
PubMed2003

Cost analysis of employing multi-test allergy screening to guide serial endpoint titration (SET) testing versus SET alone.

OBJECTIVE: We analyzed the cost differences between 2 different modalities of allergy testing. Study design and setting Material costs, labor costs, and overhead expenditures were compared for 2 different allergy-testing algorithms. Fifty patients were placed in each group. The first group was tested for 14 allergens and 2 control substances by using multi-test II. These patients were compared with 50 patients tested for similar allergens and control substances by using serial endpoint titration. RESULTS: The initial round of tests with serial endpoint titration was nearly 3 times as costly as the multi-test for the 14 allergens and 2 control substances. Conclusion and significance Multi-testing is a cost-effective initial testing modality that can screen out negative results and enable the identification of positive reactions. These results could then be further investigated by using serial endpoint titration or RAST to quantify the patient's sensitivity and establish a starting dose for immunotherapy.

Algorithms↗
PubMed1994

The value of the Uniform Clinical Data Set System (UCDSS) in a hospital setting.

BACKGROUND: The Health Care Financing Administration designed the Uniform Clinical Data Set System (UCDSS) to help peer review organizations (PROs) identify problems with patient care. The system currently is being piloted in five states and may be used for the PRO review of Medicare patients from all states by January 1995. This study tested whether UCDSS could be used with modifications for effective internal hospital quality review. METHODS: The UCDSS includes a computer program for collecting information from the medical record and 359 computerized algorithms that evaluate quality of care. For this study, 2,313 randomly chosen medical records from a tertiary care teaching hospital were abstracted with the UCDSS at the time of discharge. Cases flagged by the UCDSS algorithms as having potential quality-of-care problems were referred to a clinical reviewer to evaluate whether the flag was a true positive and to identify reasons for false-positive flags. The algorithms were modified based on this hospital's experience by adding the reasons for false-positive flags as exceptions to the algorithm rules. RESULTS: To abstract the data with the UCDSS required a median time of 45 minutes and a mean time of 55 minutes per medical record. The percentages of algorithm flags that were confirmed upon physician review to have a quality problem were estimated to be 21% for the UCDSS and 43% for the modified UCDSS. The confirmed problem rate varied substantially by algorithm. Confirmed problems were the source of numerous departmental and individual discussions and led to changes in five departmental procedures. CONCLUSIONS: Although the results of this study are preliminary and require further verification, they suggest that with modifications and careful attention to implementation, the UCDSS may be an expensive but potentially useful tool for in-hospital quality review. In-hospital employment of the UCDSS offers more opportunities for practical use of algorithms for continuous quality improvement rather than the sometimes punitive use of system findings by PROs.

Abstracting and Indexing↗
PubMed2004

Thermodynamics of forming water clusters at various temperatures and pressures by Gaussian-2, Gaussian-3, complete basis set-QB3, and complete basis set-APNO model chemistries; implications for atmospheric chemistry.

The Gaussian-2, Gaussian-3, complete basis set- (CBS-) QB3, and CBS-APNO methods have been used to calculate Delta H degrees and Delta G degrees values for neutral clusters of water, (H(2)O)(n), where n = 2-6. The structures are similar to those determined from experiment and from previous high-level calculations. The thermodynamic calculations by the G2, G3, and CBS-APNO methods compare well against the estimated MP2(CBS) limit. The cyclic pentamer and hexamer structures release the most heat per hydrogen bond formed of any of the clusters. While the cage and prism forms of the hexamer are the lowest energy structures at very low temperatures, as temperature is increased the cyclic structure is favored. The free energies of cluster formation at different temperatures reveal interesting insights, the most striking being that the cyclic trimer, cyclic tetramer, and cyclic pentamer, like the dimer, should be detectable in the lower troposphere. We predict water dimer concentrations of 9 x 10(14) molecules/cm(3), water trimer concentrations of 2.6 x 10(12) molecules/cm(3), tetramer concentrations of approximately 5.8 x 10(11) molecules/cm(3), and pentamer concentrations of approximately 3.5 x 10(10) molecules/cm(3) in saturated air at 298 K. These results have important implications for understanding the gas-phase chemistry of the lower troposphere.

Atmosphere↗
PubMed1998

Influence of pulse oximeter settings on the frequency of alarms and detection of hypoxemia: Theoretical effects of artifact rejection, alarm delay, averaging, median filtering or a lower setting of the alarm limit.

OBJECTIVE: The potential benefit of a reduced frequency of false pulse oximeter low oxyhemoglobin saturation (SpO2) alarms is that the attention of personnel is only directed to patients who experience hypoxemia. The present study was undertaken to better understand the effects of different settings of the pulse oximeter on false (artifact) and true (hypoxemia) alarms. METHODS: Using the original SpO2 data of 200 postoperative patients, we calculated off-line the effects of five methods (artifact rejection, alarm delay (2-44 s, 2 s increments), averaging (10-90 s), median filtering (10-90 s) and decreasing the alarm limit from 90% to 85%) on the number of (true- and false) alarms. RESULTS: 830 episodes of hypoxemia (SpO2 < or = 90%) and 73 episodes of severe hypoxemia (SpO2 < or = 85%) occurred. With a SpO2 alarm limit of 90%, the alarm was triggered 1535 times (830 true, 705 false). Artifact rejection reduced alarms by almost 50%. An alarm delay of 6 s or an averaging or median filtering epoch of 10 s resulted in an alarm reduction of almost 50%. No differences were found in the reduction of alarms between averaging and median filtering. Changing the alarm limit to 85% reduced the number of alarms by 82%. A similar reduction of alarms was obtained with either an alarm delay of 18 s or an averaging or median filtering epoch of 42 s. However, an alarm limit of 85% reduced the number of false alarms less than the other three algorithms (p < 0.01). CONCLUSIONS: The data from the present study suggest that in order to effectively suppress false alarms caused by pulse oximeter artifacts, it may be preferable to use a longer filtering epoch of approximately 40 s, rather than to decrease the lower alarm limit.

Artifacts↗
PubMed2003

A first full outer capsid protein sequence data-set in the Orbivirus genus (family Reoviridae): cloning, sequencing, expression and analysis of a complete set of full-length outer capsid VP2 genes of the nine African horsesickness virus serotypes.

The outer capsid protein VP2 of African horsesickness virus (AHSV) is a major protective antigen. We have cloned full-length VP2 genes from the reference strains of each of the nine AHSV serotypes. Baculovirus recombinants expressing the cloned VP2 genes of serotypes 1, 2, 4, 6, 7 and 8 were constructed, confirming that they all have full open reading frames. This work completes the cloning and expression of the first full set of AHSV VP2 genes. The clones of VP2 genes of serotypes 1, 2, 5, 7 and 8 were sequenced and their amino acid sequences were deduced. Our sequencing data, together with that of the published VP2 genes of serotypes 3, 4, 6 and 9, were used to generate the first complete sequence analysis of all the (sero)types for a species of the Orbivirus genus. Multiple alignment of the VP2 protein sequences showed that homology between all nine AHSV serotypes varied between 47.6 % and 71.4 %, indicating that VP2 is the most variable AHSV protein. Phylogenetic analysis grouped together the AHSV VP2s of serotypes that cross-react serologically. Low identity between serotypes was demonstrated for specific regions within the VP2 amino acid sequences that have been shown to be antigenic and play a role in virus neutralization. The data presented here impact on the development of new vaccines, the identification and characterization of antigenic regions, the development of more rapid molecular methods for serotype identification and the generation of comprehensive databases to support the diagnosis, epidemiology and surveillance of AHS.

African Horse Sickness↗