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PubMed1984

A microcomputer technique for the detailed behavioural, and automatic statistical, analysis of animal behaviour.

In view of the intense concentration and time investment required for the detailed assessment of animal behaviour, various strategies have been employed to facilitate the quantitative description of movements and postures of animals. In a recent communication, we outlined a microcomputer technique which enabled individual operators to record frequency and duration of a large number of behavioural elements. However, this method required the manual collation and transcription of summary data in order to effect statistical analysis, an operation which involved avoidable and time-consuming repeated data handling. The present communication details a microcomputer technique which aids the recording of frequency, real-time duration and real-time latency measures. Further, this program automatically collates, transcribes and executes statistical analysis (Kruskal-Wallis, Mann-Whitney) without involving manual data manipulation, other than at the initial behavioural analysis level and thus, represents an aid to reducing the total time investment required to effect complete behavioural analysis.

Animals↗
PubMed2006

The barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers.

BACKGROUND: The socio-economically disadvantaged populations are among the most vulnerable groups that are under-vaccinated. Therefore, the aim of this qualitative study was to understand the behaviours of mothers concerning the immunization of their children, the decision-making process, the perceived barriers, and the enabling factors to access the services in a suburban population in Istanbul. METHOD: Eight focus group discussions and two in-depth interviews were carried out with the mothers who have children younger than five years. RESULTS: While the responsibility of immunization was left totally to the mother, the socially subordinate role of women did not provide the means of getting the immunization services. The women were dependent mostly on social networks for getting the immunization services. Another important barrier to the services was related to the economical constraints and accessibility of the services. In addition, the lack of effective communication and information transfer between the health personnel and the mothers formed an important obstacle. CONCLUSION: This study underlines a need for an effective counselling tailored to the immunization session, which will maintain a positive relationship between the personnel and the mother.

Adult↗
PubMed2000

The management of cubital tunnel syndrome: a meta-analysis of clinical studies.

Despite extensive clinical experience in treating cubital tunnel syndrome, optimal surgical management remains controversial. A meta-analysis of 30 studies with accurate preoperative and postoperative staging was undertaken. Patients were staged preoperatively into minimum, moderate, and severe groups on the basis of clinical presentation. Treatment modalities included nonoperative management, surgical decompression, medial epicondylectomy, anterior subcutaneous transposition, and anterior submuscular transposition. Statistical analysis using a standard SAS database with analysis of variance and chi-square tests was used to assess the efficacy of each therapeutic modality. For minimum-staged patients, all modalities produced similar degrees of satisfaction. However, total relief occurred most after medial epicondylectomy and least after anterior subcutaneous transposition. Patients treated nonoperatively had the highest rate of recurrence. For moderate-staged patients, submuscular transposition was most efficacious, whereas patients with nonoperative management fared the worst. Finally, for severe-staged patients, current therapeutic modalities were not consistently effective, with medial epicondylectomy producing the poorest operative result. This article reveals statistically significant differences in outcomes among therapeutic modalities, which may assist in treatment planning; it introduces standardized methods to aid in determining, analyzing, and communicating treatment outcomes.

Cubital Tunnel Syndrome↗
PubMed1996

Caring and comfort metaphors used by patients in critical care.

OBJECTIVE: To examine the meaning of metaphors used by critical care patients about their ventilator weaning experience. DESIGN: Grounded theory. POPULATION, SAMPLE, SETTING: In 1992-1993, from a population of mechanically ventilated patients, a convenience sample of 20 adult patients was recruited from one 14-bed multispecialty ICU in a 740-bed teaching hospital in eastern Canada. METHODS: Transcripts of interviews were reviewed from the 20 original study transcripts, of which 18 included one or more metaphors for a total of 70. All were coded and classified with sub-themes analyzed for implicit meanings. FINDINGS: Four categories of metaphors were Physical Discomfort, Nurse Caring, Altered Self, and Patient Work. Data provide the elements for a mid-range theory of caring. CONCLUSIONS: Metaphors provide vivid images of significant patient concerns and are a way for people to express meaning and feeling. CLINICAL IMPLICATIONS: People communicate about their inner world through language. Examining patients' metaphors is a valuable approach to understanding the experiential world of patients in critical care so that nursing actions can be directed toward personal needs which may not be expressed openly. Providing interventions aimed at these personal needs will help patients find suitable levels of physical and emotional comfort.

Adaptation, Psychological↗
PubMed2005

A quantitative survey of intern's knowledge of communication skills: an Iranian exploration.

BACKGROUND: It is a high priority that health care providers have effective communication skills. It has been well documented that the doctor-patient relationship is central to the delivery of high quality medical care, and it has been shown to affect patient satisfaction, to decrease the use of pain killers, to shorten hospital stays, to improve recovery from surgery and a variety of other biological, psychological and social outcomes. This study sought to quantify the current knowledge of interns in Iran about communication skills. METHODS: A cross-sectional study using a self-report questionnaire was conducted among interns. Data analysis was based on 223 questionnaires. The internal consistency of the items was 0.8979. RESULTS: Overall, knowledge levels were unsatisfactory. Results indicated that interns had a limited knowledge of communication skills, including identification of communication skills. In addition, there was a significant difference between the mean scores of interns on breaking bad news and sex education. The confidence of males about their communication skills was significantly higher than for females. Analysis of the total scores by age and sex showed that there was a statistically significant main effect for sex and the interaction with age was statistically significant. Free response comments of the interns are also discussed. CONCLUSIONS: It is argued that there is a real need for integrating a communication skills course, which is linked to the various different ethnic and religious backgrounds of interns, into Iranian medical curricula. Some recommendations are made and the limitations of the study are discussed.

Adult↗
PubMed2001

Pattern of acute pancreatitis.

OBJECTIVE: The aim of this communication was to study the clinical pattern of acute pancreatitis with special reference to aetiology, severity, seasonal variation and outcome in the high altitude region of Asir. METHODS: This is a cross-sectional, hospital-based study. All consecutive cases of acute pancreatitis admitted to Asir Central Hospital, Abha, Saudi Arabia over a two and half-year period (May 1996 - October 1998) were included. Clinical and laboratory data were analyzed to determine the severity of the attack according to Ranson's criteria. RESULTS: There was a total of 73 attacks of acute pancreatitis in 69 patients. Mean patient age was 51.01 years (range = 13-120 years) and the male to female ratio was 0.6:1. In 68.5%, gallstones were the associated cause and idiopathic acute pancreatitis was diagnosed in 25%. Using Ranson's severity prediction criteria, 44% of the attacks were classified as "severe", but only 22% of the patients so classified developed complications. Pseudocysts and Pancreatic abscess complicated three cases. Complications were significantly correlated with cold seasons (P = 0.04), intervention by Endoscopic retrograde cholangiopancreatography (P = 0.02) and severity (P = 0.02). CONCLUSION: This study revealed that acute pancreatitis seen in Asir region is predominantly biliary-associated and is more frequent in females. Although near half of the attacks were classified as severe pancreatitis, according to Ranson's criteria, complications occurred in only 22% of the attacks and this may indicate that Ranson's criteria needs to be modified before application in our setting.

Acute Disease↗
PubMed1996

[Minimally invasive myocardial revascularization. Initial experience with myocardial revascularization without extracorporeal circulation].

The authors present an account on the first phase of application of minimally invasive techniques of revascularization of the heart into clinical practice at their department. Since December 1994 to the end of January 1995 in selected 15 patients from a total of 240 patients with IHD 16 arterial and 8 venous grafts were sutured on the beating heart from median sternotomy. None of the patients died and none need reoperation. All patients are free from anginous complaints after operation and their clinical condition is satisfactory. Revascularization of the heart by means of arterial and venous grafts on the beating heart from median sternotomy is a technically reproducible method which enables us to elaborate further minimally invasive procedures for the treatment of IHD. The presented paper is a preliminary communication without claims of statistical validity of the achieved results.

Aged↗
PubMed1997

A hand held two-channel vibro-tactile speech communication aid for the deaf: characteristics and results.

The OSCAR-project (Optimal Speech Communication Assistance for Residual Abilities) within the TIDE frame is aiming at processing the speech signal in such a way so that it can be more effectively aurally perceived than with an ordinary hearing aid in case of a very small residual hearing. In case of total deafness the code will be tactile and in some cases a multi modal approach will be tried. One of the sub-results of the OSCAR-project is a hand held vibro-tactile speech communication aid for profoundly hard of hearing and deaf persons. The main idea of the aid is that it should not be a general tactile hearing aid, but rather give optimum tactile support to lip-reading in a close communication situation. It should be used when speech communication is necessary and other methods of communication i.e. sign language, lip-reading, reading and writing etc. does not work. The aid conveys two types of information via its two vibro-tactile transducers; the syllabic rhythm and frication. This paper describes some characteristics of the aid and some results.

Correction of Hearing Impairment↗
PubMed2004

What do surgery residents do on their call nights?

BACKGROUND: Surgical resident education is entering a critical era of achieving core competencies despite work hour restrictions. An assessment of on-call activity is needed to maximize educational merit. METHODS: A time-motion study of resident on-call activity was performed at a university medical center and an urban affiliate hospital. Residents were followed by "shadow" residents who concurrently recorded resident activity. RESULTS: Activities of daily living and patient evaluation comprised the majority of on-call activity. Residents slept a median of 200 minutes per night. Cross-coverage activities accounted for 41% of pages and 19% of patient evaluation. Direct patient contact comprised only 7% of call night duties. Communication activity occupied 15% of total minutes, and a mean of 16 pages were received nightly. Significant differences in activities existed between resident levels and hospitals. CONCLUSIONS: Call activity consists primarily of activities of daily living, patient evaluation, and communication. Sleep accounts for nearly one third of all on-call activity. These data may be useful in improving both patient care and resident call experience.

After-Hours Care↗
PubMed2004

An examination of the appropriateness of using a common peer assessment instrument to assess physician skills across specialties.

PROBLEM STATEMENT: To determine whether a common peer assessment instrument can assess competencies across internal medicine, pediatrics, and psychiatry specialties. METHOD: A common 36 item peer survey assessed psychiatry (n = 101), pediatrics (n = 100), and internal medicine (n = 103) specialists. Cronbach's alpha and generalizability analysis were used to assess reliability and factor analysis to address validity. RESULTS: A total of 2,306 (94.8% response rate) surveys were analyzed. The Cronbach's alpha coefficient was.98. The generalizabililty coefficient (mean of 7.6 raters) produced an Ep(2) =.83. Four factors emerged with a similar pattern of relative importance for pediatricians and internal medicine specialists whose first factor was patient management. Communication was the first factor for psychiatrists. CONCLUSIONS: Reliability and generalizability coefficient data suggest that using the instrument across specialties is appropriate, and differences in factors confirm the instrument's ability to discriminate for specialty differences providing evidence of validity.

Clinical Competence↗
PubMed2005

A comprehensive literature review of haplotyping software and methods for use with unrelated individuals.

Interest in the assignment and frequency analysis of haplotypes in samples of unrelated individuals has increased immeasurably as a result of the emphasis placed on haplotype analyses by, for example, the International HapMap Project and related initiatives. Although there are many available computer programs for haplotype analysis applicable to samples of unrelated individuals, many of these programs have limitations and/or very specific uses. In this paper, the key features of available haplotype analysis software for use with unrelated individuals, as well as pooled DNA samples from unrelated individuals, are summarised. Programs for haplotype analysis were identified through keyword searches on PUBMED and various internet search engines, a review of citations from retrieved papers and personal communications, up to June 2004. Priority was given to functioning computer programs, rather than theoretical models and methods. The available software was considered in light of a number of factors: the algorithm(s) used, algorithm accuracy, assumptions, the accommodation of genotyping error, implementation of hypothesis testing, handling of missing data, software characteristics and web-based implementations. Review papers comparing specific methods and programs are also summarised. Forty-six haplotyping programs were identified and reviewed. The programs were divided into two groups: those designed for individual genotype data (a total of 43 programs) and those designed for use with pooled DNA samples (a total of three programs). The accuracy of programs using various criteria are assessed and the programs are categorised and discussed in light of: algorithm and method, accuracy, assumptions, genotyping error, hypothesis testing, missing data, software characteristics and web implementation. Many available programs have limitations (eg some cannot accommodate missing data) and/or are designed with specific tasks in mind (eg estimating haplotype frequencies rather than assigning most likely haplotypes to individuals). It is concluded that the selection of an appropriate haplotyping program for analysis purposes should be guided by what is known about the accuracy of estimation, as well as by the limitations and assumptions built into a program.

Algorithms↗
PubMed2006

The EMITT study: development and evaluation of a medication information transfer tool.

BACKGROUND: Continuity of care is required as patients move from the care of one pharmacist to another. The appropriate transfer of medication information between pharmacists as well as to patients at these times is essential in order to prevent drug-related problems (DRPs). OBJECTIVE: To develop a tool to transfer medication information between various pharmacists caring for the same patients. Secondary objectives were to evaluate the tool based on utility in practice and satisfaction of pharmacists. METHODS: The project consisted of a needs assessment involving in-depth interviews with patients and pharmacists and a literature review. These data were used to develop an optimal tool for medication information transfer between pharmacists in different practice settings. The tool was evaluated in a feasibility pilot for potential utility and pharmacist satisfaction. RESULTS: The tool created called EMITT (electronic medication information transfer tool) facilitates the communication of information to outpatient pharmacists including a letter and an up-to-date list of the patient's drugs. A total of 187 medication issues were communicated within 40 transferred letters, 61 of which required active follow-up, which potentially prevented 348 DRPs if the receiver of the information acted on the information that was provided. The 3 most common issues that required follow-up were restarting a held medication (n = 13), adjustment of doses based on laboratory results (n = 11), and starting a new indicated medication in the future (n = 7). CONCLUSIONS: A tool can be created to help address the gap in communication between pharmacists when patients move between interfaces of care by evaluating the needs of healthcare professionals involved in the information transfer process. It is envisioned that the elements of our tool can be easily adapted to other institutions to improve medication information transfer.

Documentation↗
PubMed2006

Illness and injury among children attending summer camp in the United States, 2005.

OBJECTIVES: The purpose of this work was to describe illnesses and injuries sustained by campers at summer camps, calculate illness and injury rates, and identify risk factors for camp-related illness and injury. METHODS: A convenience sample of camps selected from the US summer camp population participated in this pilot illness and injury surveillance study. Camps completed weekly reports detailing the number of campers on site and the number of adverse events sustained and provided specific information about each adverse event. RESULTS: A total of 177 camper illnesses and injuries occurred during 122,379 camper-days, with a median rate of 1.15 adverse events per 1000 camper-days. The majority of reported events were illnesses (68.0%), 11.8% of which were communicable and seen in multiple individuals at camp. Of the injury events (32.0%), cut/scratch/scrape were the most common diagnoses (33.3%), followed by fracture (14.6%) and sprain/strain (10.4%); horseback riding and capture the flag were identified as injury-producing activities. CONCLUSIONS: Internet- and telephone-based surveillance systems can be successfully used to conduct illness and injury surveillance among children attending summer camp. Data collected via such systems can be used to calculate illness and injury rates, to describe patterns of illness and injury, and to identify risk factors for camper-related illness and injury. Given the millions of children attending summer camp yearly, a surveillance system such as this can provide the data needed to develop evidence-based prevention interventions to decrease the number of youth whose camp experiences are negatively affected by illness and injury.

Adolescent↗
PubMed1997

[Validity of partial laryngectomy for glottic carcinoma].

To evaluate the effect of partial laryngectomy for the treatment of glottic carcinoma, 126 patients with glottic carcinoma were reviewed. Between 1974 and 1994, 132 patients with glottic carcinoma were treated. Up to Dec. 1994, 126 cases (95%) had been followed-up and analyzed statistically in this paper. According to TNM classification (UICC 1987), 98 (77.8%) of them were T1.2, 28 (22.2%), T3.4. One patient was T4N1, and the rest 125 were No. All patients were M0 on admission. A total of 126 patients underwent partial laryngectomy. Among these patients, 89 were treated with surgical procedures alone, and 4 received pre-operative 33 post-operative, radiotherapy. Survival curves were plotted by the method of Kaplan and Meier. The results showed that three-year, five year and ten-year survival rates for 126 patients were 94.7%, 89% and 86.1% respectively; Those for group of T1.2 were 97.8%, 95.1% and 93.3%; For T3.4 were 83.2%, 62.7% and 52.3%. All patients preserved their voice and were able to communicate by speech after operation. The function of larynx was satisfactory. It was concluded that partial laryngectomy is preferable choice for the treatment of glottic carcinoma.

Adult↗
PubMed2005

[Closure of extrocardiac Fontan fenestration by using the Amplatzer duct occluder].

INTRODUCTION: A direct or tubular communication between the systemic venous system and the systemic atrium, generally called fenestration, is surgically created to improve the postoperative period of patients undergoing total cavopulmonary connection. However, a fenestration prompts a potentially deleterious right to left shunt, and is generally closed after the postoperative period. Direct fenestrations can be closed using coils, or devices designed for atrial septal defect closure. However, no devices have been designed for closure of extracardiac fenestrations. We report our experience concerning the closure of extracardiac Fontan fenestration by the Amplatzer duct occluder (ADO). METHODS: From January 2001 to December 2002, we closed extracardiac Fontan fenestrations using the ADO device in 10 consecutive patients. Indications to fenestration closure were: low velocity shunt through the fenestration, mild desaturation, and absence of effusions. RESULTS: All patients had a successful closure of the fenestration. The procedure was performed through the femoral vein in 7 cases and through the right jugular vein in 3. Mean central venous pressure increased not significantly from 12 to 13-mmHg. Mean oxygen saturation increased significantly from 90 to 97% (p<0.001). Immediate shut abolition was obtained in 9 cases. No complications were observed. At a median follow-up of 12 months (range 6-18 months), all patients are free of symptoms and have a normal oxygen saturation at rest as well as at exertion. CONCLUSION: The ADO device allowed closing the extracardiac Fontan fenestration in all patients with no mortality, no morbidity and a rate of 100% of complete closure at mid-term follow-up.

Adolescent↗
PubMed2006

Short communication metabolic and mitochondrial effects of switching antiretroviral-experienced patients to enfuvirtide, tenofovir and saquinavir/ritonavir.

OBJECTIVE: Investigate the metabolic and mitochondrial effects of switching a highly active antiretroviral therapy (HAART) regimen with a high mitochondrial toxicity profile to a HAART with a theoretically low mitochondrial toxicity. PATIENTS AND METHODS: Six consecutive HAART-experienced patients receiving at least one dideoxy-nucleoside reverse transcriptase inhibitor (NRTI) switched to enfuvirtide plus tenofovir plus saquinavir/ritonavir (T20+TDF+SQV/r). Blood samples were collected at baseline, 12 and 24 weeks after the switch, and viral load (VL) and lymphocyte CD4+ T-cell count were determined. Metabolic parameters consisted of fasting serum triglycerides, cholesterol (total and fractions), glucose, insulin, C-peptide and lactate. Mitochondrial assessment consisted on mitochondrial DNA (mtDNA) quantification, COX-II mitochondrial protein expression rate, mitochondrial respiratory chain complex III and IV activities, and oxygen consumption in peripheral blood mononuclear cells. For baseline mitochondrial comparisons, we included six HIV-infected patients naive for ART. RESULTS: Switched patients exhibited a mean increase of 26 CD4+ T-cells/mm3 and a mean decrease of 1.1 log in VL (P = NS for both). Lactate, lipids and glycaemia remained stable during the study; only insulin levels increased significantly (P < 0.05). Switched patients exhibited, at baseline, low mitochondrial measurements, being significant only for complex III and IV activities with respect to naive patients (P < 0.05 for both). MtDNA content did not rise significantly during the study. However, we observed increases in COX-II mitochondrial protein synthesis (124%, P < 0.05), complex III activity (127%, P < 0.05), complex IV activity (86%, P = 0.37) and oxygen consumption (194%, P < 0.05). CONCLUSION: Switching a HAART-containing dideoxy-NRTI to T20+TDF+SQV/r minimally alters metabolic parameters and exerts beneficial effects on mitochondrial function at 24 weeks. Mitochondrial improvement should be considered as an additional advantage of this rescue therapy.

Adenine↗
PubMed1990

Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project.

To test whether communitywide health education can reduce stroke and coronary heart disease, we compared two treatment cities (N = 122,800) and two control cities (N = 197,500) for changes in knowledge of risk factors, blood pressure, plasma cholesterol level, smoking rate, body weight, and resting pulse rate. Treatment cities received a 5-year, low-cost, comprehensive program using social learning theory, a communication-behavior change model, community organization principles, and social marketing methods that resulted in about 26 hours of exposure to multichannel and multifactor education. Risk factors were assessed in representative cohort and cross-sectional surveys at baseline and in three later surveys. After 30 to 64 months of education, significant net reductions in community averages favoring treatment occurred in plasma cholesterol level (2%), blood pressure (4%), resting pulse rate (3%), and smoking rate (13%) of the cohort sample. These risk factor changes resulted in important decreases in composite total mortality risk scores (15%) and coronary heart disease risk scores (16%). Thus, such low-cost programs can have an impact on risk factors in broad population groups.

Adult↗
PubMed2003

Development of potentially better practices for the neonatal intensive care unit as a culture of collaboration: communication, accountability, respect, and empowerment.

OBJECTIVE: The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement. METHODS: The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature. RESULTS: Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management. CONCLUSIONS: The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.

Benchmarking↗