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PubMed2004

CD7 and CD28 are required for murine CD4+CD25+ regulatory T cell homeostasis and prevention of thyroiditis.

CD7 and CD28 are T cell Ig superfamily molecules that share common signaling mechanisms. To determine roles CD7 and CD28 might play in peripheral lymphocyte development and function, we have generated CD7/CD28-double-deficient mice. CD7- and CD28-single-deficient and CD7/CD28-double-deficient mice had normal levels of CD4 and CD8-single-positive T cells in thymus and spleen. However, CD28-deficient mice had decreased CD4+CD25+ T cells in spleen compared with wild-type mice, and CD7/CD28-double-deficient mice had decreased numbers of CD4+CD25+ T cells in both thymus and spleen compared with both wild-type and CD28-deficient mice. Functional studies demonstrated that CD4+CD25+ T cells from CD28-deficient and CD7/CD28-double-deficient mice could mediate suppression of CD3 mAb activation of CD4+CD25- wild-type T cells, but were less potent than wild-type CD4+CD25+ T regulatory cells. Thyroiditis developed in aged CD7/CD28-double-deficient mice (>1 year) that was not seen in age-matched control mice or single CD7- or CD28-deficient mice, thus suggesting in vivo loss of T regulatory cells allowed for the development of spontaneous thyroiditis. Taken together, these data demonstrated collaborative roles for both CD7 and CD28 in determination of number and function of CD4+CD25+ T regulatory cells in the thymus and peripheral immune sites and in the development of spontaneous thyroiditis.

Aging↗
PubMed1991

Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons--Florida and New York, 1988-1991.

During 1990 and 1991, outbreaks of multidrug-resistant tuberculosis (MDR-TB) in four hospitals (one in Miami and three in New York City) were investigated by CDC in collaboration with the reporting hospitals and state and local health departments. This report summarizes preliminary findings of the investigations and recommendations for prevention and control of MDR-TB outbreaks.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Nosocomial infections of gynecologic-obstetrical origin at a perinatal care hospital].

Nosocomial infections (NI) are still a major cause of morbidity among gynecology & obstetrics patients (GOP). At the Instituto Nacional de Perinatología (INPer), during 1989, there was an overall NI rate of 2.37 per 100 GOP discharged, while specific NI rates for the subgroups of puerperal and gynecologic surgery patients were 2.11 and 6.3 respectively. Endometritis and infected surgical wounds were the most frequent type of NI, having a multimicrobial etiology. There was a significant increase in hospital days of stay for those patients who developed NI. It is clearly necessary to improve the surveillance of NI as well as the collaboration among different wards dealing with GOP, in order to find more effective and efficient ways to prevent the development of NI.

Abortion, Induced↗
PubMedDate not supplied

Use of a statewide system to improve health and safety in child care facilities.

BACKGROUND: The Early Childhood Education Linkage System (ECELS) in Pennsylvania (PA) models ideals of the national Healthy Child Care America (HCCA) Campaign. Little is known about how child care providers use these newly developed statewide systems and about how users compare with nonusers of such a system. OBJECTIVES: Our objectives were 1) to assess knowledge and use of ECELS among child care providers in PA, 2) to compare users and nonusers of ECELS with regard to health concerns, advice-seeking preferences, and infant sleep positioning, and 3) to assess satisfaction among users of ECELS. METHODS: Cross-sectional telephone survey of directors of 400 licensed child care centers (CCCs) and providers of 400 registered family child care homes (FCCHs) in PA. RESULTS: The proportion of children with certain special health care needs mirrored the prevalence in the national child population. Of the facilities surveyed, 88% of CCCs and 71% of FCCHs had heard of ECELS. Among these, 85% had used ECELS's services in the previous 12 months. Significantly more nonusers than users consulted doctors, whereas more users consulted health professionals from government agencies and used printed materials. Of those who enrolled infants, 46% of users and 41% of nonusers reported placing infants on their backs only to sleep. Users who placed infants on their backs were more likely than nonusers to have a written policy about the correct practice (55% and 26%, respectively; P =.02). Overall, 46% of users and 28% of nonusers reported having a sleep position policy (P =.02). Users were at least 95% satisfied with ECELS's services. CONCLUSION: This statewide system reached most child care providers surveyed: more outreach is needed to providers in FCCHs. The health concerns, safety practices, and advice-seeking preferences of child care providers described in this article can inform others who are developing similar collaborative services in each state. Further research on the impact of HCCA programs on health and safety practices (such as correct infant sleep positioning) is warranted.

Analysis of Variance↗
PubMed2002

Implementing a systematic course/clerkship peer review process.

OBJECTIVE: A systematic course/clerkship peer-review process was developed to meet several objectives: improvement of quality of course/clerkship, enhancement of understanding of individual course and overall curricular content, improvement of communication and collaboration between basic science and clinical disciplines across campuses, provision of forum to address curricular concerns of students and faculty, facilitation of data collection for LCME reviews and the AAMC CurrMIT project; and monitoring curricular equivalency at multiple clinical sites. DESCRIPTION: Previously each course had carried out an internal review process. These reviews varied considerably in terms of the data collected and how those data were used for quality improvement. Data and outcomes of the internal reviews were seldom shared with colleagues, students, or administrators. This limited communication discouraged collaboration and led to disparity in curricular content between campuses. A collaborative effort between the medical school's Office of Medical Education (OME) and the Education Council, the faculty governance committee composed of faculty from each basic science and clinical department on each campus, has led to the development and implementation of a systematic course/clerkship peer-review process. Two standing committees of the Education Council oversee the systematic review process. One committee is charged with oversight of the first two years of the curriculum and a second committee with oversight of the third and fourth years. A two-tiered course/clerkship review process was designed with all courses undergoing a limited annual review. A comprehensive, "nuts and bolts" review for required courses was to occur every three years. The limited annual review was based on course evaluations completed by students, collected and summarized by the OME, and presented to the Education Council. The comprehensive review of a required course/clerkship occurred over a six-to-eight-month period. Course directors on each campus completed a questionnaire and submitted materials. To facilitate cross-discipline communication and synergy, a subcommittee composed of both basic science and clinical faculty, principally course directors, and at least one medical student who had completed the course at each campus reviewed submitted materials and had a series of meetings with the course directors, support personnel, and department chairs. Final review reports presented to the Education Council identify issues, concerns, and recommendations for action. To date 11 required courses have completed the comprehensive review process. Simple oversights, significant curricular disparity between campuses, and opportunities for multidisciplinary collaboration have been identified and addressed. Student-rated satisfaction has improved for those courses that have been reviewed. DISCUSSION: The systematic course/clerkship peer-review process has been a success, although there was initial resistance to "outside review." We have not yet completed one cycle of comprehensive course reviews but already faculty and administration have a better understanding of individual course and overall curriculum content. Faculty have developed working relationships and are sharing educational strategies across disciplines and campuses, and identifying innovative collaborations. The annual review process is now perceived to lack depth and is under reconsideration.

Clinical Clerkship↗
PubMed2006

FIFA's approach to doping in football.

BACKGROUND AND OBJECTIVES: FIFA's anti-doping strategy relies on education and prevention. A worldwide network of physicians guarantees doping control procedures that are straightforward and leave no place for cheating. FIFA actively acknowledges its responsibility to protect players from harm and ensure equal chances for all competitors by stringent doping control regulations, data collection of positive samples, support of research, and collaboration with other organisations. This article aims to outline FIFA's approach to doping in football. METHOD: Description of FIFA's doping control regulations and procedures, statistical analysis of FIFA database on doping control, and comparison with data obtained by WADA accredited laboratories as for 2004. RESULTS: Data on positive doping samples per substance and confederation/nation documented at the FIFA medical office from 1994 to 2005 are provided. According to the FIFA database, the incidence of positive cases over the past 11 years was 0.12%, with about 0.42% in 2004 (based on the assumption of 20,750 samples per year) and 0.37% in 2005. Especially important in this regard is the extremely low incidence of the true performance enhancing drugs such as anabolic steroids and stimulants. However, there is a need for more consistent data collection and cross checks among international anti-doping agencies as well as for further studies on specific substances, methods, and procedures. With regard to general health impairments in players, FIFA suggests that principles of occupational medicine should be considered and treatment with banned substances for purely medical reasons should be permitted to enable players to carry out their profession. At the same time, a firm stand has to be taken against suppression of symptoms by medication with the aim of meeting the ever increasing demands on football players. CONCLUSION: Incidence of doping in football seems to be low, but much closer collaboration and further investigation is needed with regard to banned substances, detection methods, and data collection worldwide.

Doping in Sports↗
PubMed2004

Successful islet after kidney transplantations in a distance over 1000 kilometres: Preliminary results of the Budapest-Geneva collaboration.

To overcome critical islet processing and to ensure patient safety and quality care, we have established an international collaboration between two geographically distant transplant centers for islet transplantation. Four pancreata were harvested and immediately preserved by the two-layer method (oxygenated perfluorocarbon+University of Wisconsin) and subsequently transported for the automated method isolation to Geneva. After purification, the islets were cultured overnight and transported the next day back to Budapest. Three consecutive kidney transplant patients with type 1 diabetes mellitus underwent islet transplantation via percutaneous transhepatic portal embolization using the bag-method. The immunosuppression consisted of daclizumab, sirolimus, and low-dose tacrolimus. Mean donor age was 43.7 years, mean body mass index: 26.5. The islet isolation process began within 8 hours from the donor aorta cross-clamp in all cases. The isolation success rate was 80% (4 of 5). In Budapest, the islets were assessed for viability. No complications occurred during the transplantation, and the portal pressure remained within the normal range. The first patient received 12,000 IU/BW from two donors and the insulin requirement decreased from 40 U/d to 10 U/d. The second patient received 7200 IU/BW from a single donor and became immediately insulin free. The third patient was given 7100 IU/BW; the insulin requirement decreased from 39 U/d to 14 U/d. Posttransplant follow-up for the three patients are 7 months, 4 months, and 2 weeks, respectively. All patients achieved metabolic stability. These preliminary results demonstrate the feasibility of an international collaborative islet transplantation program at a distance over 1000 km.

Adult↗
PubMed2003

Current understanding of the biology of advanced bladder cancer.

Transitional cell carcinoma (TCC) is reported to be the fifth most common solid malignancy in the U.S. Although radical cystectomy will cure a substantial number of patients with minimally invasive TCC, many patients with deeply muscle-invasive or extravesical disease who are treated with radical cystectomy alone die of metastatic TCC, as do patients with metastatic disease. The differing clinical course and the limited value of established prognosticators make analysis of new molecular parameters of interest in predicting the prognosis of patients with bladder cancer, particularly those in high-risk groups who are at risk of disease progression and recurrence. In the current review, a comprehensive MEDLINE/PubMed search of articles pertaining to the biology of TCC from 1965 to the present was performed, as well as a bibliographic review of cross references. TCC follow the general concept of multistep carcinogenesis and proceed through two distinct genetic pathways responsible for generating different TCC morphologies, namely the inactivation of cyclin-dependent kinase inhibitors in low-grade TCC and early p53-mediated abnormalities in high-grade TCC. TCC progression correlates with genetic instability and the accumulation of collaborative genetic lesions mainly involving p53, retinoblastoma, and growth factors. The bulk of these data are derived from cases of localized/locally advanced disease and none are ready yet for routine clinical application; however, the current knowledge has led to the clinical testing of novel biologic observations in several important trials. Understanding of the molecular biology of advanced bladder cancer continues to improve. It is likely that in the new millennium, real breakthroughs in the identification and therapy of high-risk, poor-prognosis patients will come from an integration of molecular modalities in the clinical application.

Antigens, Neoplasm↗
PubMed1995

A two-generation reproduction study in rats receiving drinking water containing vinyl acetate.

Vinyl acetate (VA) is a commonly used chemical in polymerization and copolymerization processes and as a chemical intermediate. As part of a collaborative effort between VA producers of the United States and British Petroleum, the present study was carried out to provide a base set of data for risk assessment. Groups of male and female Crl:CD(SD)BR rats were given 0, 200, 1000, or 5000 ppm VA via the drinking water over two generations. In addition, a cross-mating trial of control and 5000-ppm male and female rats was conducted in the F1 generation to investigate the slightly decreased litter production in the high-dose group. No treatment-related mortality was observed in any of the groups. Water consumption was significantly reduced in the 5000-ppm groups in both generations and in the 1000-ppm F1 female rats. The body weights of the F0 and F1 male rats and the F1 female rats in the 5000-ppm group tended to be slightly lower than those of the control group. Body weight gain was significantly decreased during lactation in the F0 females at 5000 ppm and in the F1 females at 1000 and 5000 ppm. Pup weights in the F1 generation, but not in the F2 generation, were significantly lower than those of the control on lactation Day 21. The number of litters produced in the F1 generation in the 5000-ppm group was slightly lower than that of the control group and was attributed to lower fertility. Fewer pups were produced when control females were mated with the 5000-ppm males; however, the decrease was due to poor mating performance rather than decreased fertility. No decrease was apparent when the 5000-ppm females were mated with the control group males. Under the conditions of this study, the no-observed adverse effort level was considered to be 1000 ppm.

Administration, Oral↗
PubMed2004

History of the American College of Toxicology (ACT).

This manuscript is one of two written to celebrate the 25th Anniversary of the American College of Toxicology (ACT). This history of ACT describes its evolution from an entrepreneurial, risk taking model to a conservative business model, fully accepted in the scientific community. ACT started with a small group of scientists who were dissatisfied with the relatively narrow approach to full membership then taken by the Society of Toxicology (SOT). They were excited by new research and collaborative opportunities resulting from an enhanced public awareness of the impact of chemicals on the environment and emerging new methodologies to evaluate human risks of exposure to be chemicals and pharmaceuticals. These toxicologists, many of whom were from industry and government, rather than academia, were tired of being considered socond class citizens and envisioned more open and cross-disciplined approaches. They favored balanced input by academia, industry and government in the overall toxicologic evaluation and risk assessment process. The history of the founding and early development of ACT, as well as the College's growth and eventual acceptance into the scientific community, including its impact on the status quo during the Society's first 25 years, are told by its successive presidents.

Animals↗
PubMed1999

A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis.

OBJECTIVE: To determine if any significant differences exist between laparoscopic appendectomy (LA) and open appendectomy (OA). DESIGN: A meta-analysis of randomized controlled trials (RCTs) comparing LA to OA. DATA SOURCES: An extensive literature search was conducted for appropriate articles published between January 1990 and March 1997. Articles were initially retrieved through MEDLINE with MeSH terms "appendicitis" or "appendectomy" and "laparoscopy". Additional methods included cross-referencing bibliographics of retrieved articles, hand searching abstracts from relevant meetings and consultation with a content expert. STUDY SELECTION: Only RCTs published in English in which patients had a preoperative diagnosis of acute appendicitis were included. DATA EXTRACTION: The outcomes of interest included operating time, hospital stay, readmission rates, return to normal activity and complications. The Cochrane Collaboration Review Manager 3.0 was used to calculate odds ratios (OR), weighted mean differences (WMD) and 95% confidence intervals (CI). The random-effects model was used for statistical analysis. DATA SYNTHESIS: Twelve trials met the inclusion criteria. Because there were insufficient data in some trials, operating time, hospitalization and return to work were assessed in only 8 trials. Mean operating time was significantly longer with LA (WMD 18.10 minutes, 95% CI 12.87 to 23.15 minutes). There were fewer wound infections in LA (OR 0.40, 95% CI 0.24 to 0.69), but no significant differences in intra-abdominal abscess rates (OR 1.94, 95% CI 0.68 to 5.58). There was no significant difference in the mean length of hospital stay (WMD -0.16 days, 95% CI -0.44 to 0.15 days) or readmission rates (OR 1.16, 95% CI 0.54 to 2.48). However, the return to normal activity was significantly earlier with LA (WMD -5.79 days, 95% CI -7.38 to -4.21 days). Sensitivity analyses did not affect the results. CONCLUSION: This meta-analysis suggests that operating room time is significantly longer, hospital stay is unchanged but return to normal activities is significantly earlier with LA.

Abdominal Abscess↗
PubMed2001

Multisite survey of pediatric residents' continuity experiences: their perceptions of the clinical and educational opportunities.

OBJECTIVES: To survey a large group of residents from different institutions to delineate whether there are significant perceptive differences pertaining to the clinical and educational strengths and weaknesses of their continuity experiences by the 3 types of continuity sites. BACKGROUND: The residency review committee requires a 3-year continuity experience for pediatric residents. Residents receive this experience at a variety of practice sites: hospital-based sites (HBS), community health centers (CHC), and private practices (PP)/health maintenance organizations (HMOs). DESIGN/METHODS: Continuity clinic directors who attended the Ambulatory Pediatric Association Continuity Clinic Special Interest Group at the 1999 annual Pediatric Academic Societies Meeting were invited to participate in this cross-sectional study. Thirty-six agreed and distributed a 60-item questionnaire to their residents at the end of the academic year. The questionnaire addressed quality and quantity of the educational and patient care experiences, overall satisfaction, and future career plans. RESULTS: Of the 1167 categorical residents (71%) who returned the questionnaire, 28% were postgraduate level (PL)-1s, 34% were PL-2s, and 37% were PL-3s. Ninety-four percent of the 36 programs had residents in HBS (n = 807 residents), 58% in CHC (n = 106), and 69% in PP/HMO (n = 254). Compared with other groups, residents in HBS were more likely to report having seen patients more than once, being involved during patients' hospitalizations, taking phone calls from patients, and perceiving that the parents identified them as the primary care provider. HBS and CHC residents felt more autonomous and were more likely to believe that they were advocates for their patients, compared with PP/HMO residents. The number of patients seen per session was greater in PP/HMO, whereas residents in PP/HMO were more likely to perceive that they had received the right amount of exposure to practice management and billing issues and the appropriate amount of nursing and office support. Although numbers of newborn visits were reported as adequate across sites, residents in HBS and CHC believed that they did not see enough adolescents. The majority of residents at all sites agreed that their preceptor was a good role model, was available for questions, and delivered the appropriate amount of teaching and feedback. Approximately two thirds of residents from all sites were satisfied with their experience and believed that it was preparing them for their future career. CONCLUSIONS: All 3 types of continuity sites have both strengths and weaknesses. No single type of continuity site met all expectations for clinical care or training. Most residents at all 3 types of sites reported overall satisfaction and believed that their continuity experience helped to prepare them for future career goals. The residency review committee, in collaboration with pediatric continuity educators, needs to prioritize what constitutes the essential experiences in resident continuity practices and to reemphasize that the ongoing relationship is an important component of the continuity experience.

Community Health Services↗
PubMed1993

Psychiatric morbidity in social workers' clients. A comparison between an inner-city area and a small town.

The rate of psychiatric disorder in a social services sample in a small town was compared to the rate in an inner-city sample. Nearly 40% of respondents in the small town had a positive General Health Questionnaire score and 37% had case status (ID greater than 5) on the Present State Examination. Most of these were cases of neurotic depression and were generally recognised as such by the social workers. The type of intervention undertaken by social workers differed in the two settings. Small-town social workers were more likely to offer advice, guidance, exploration and mobilisation of resources. The small-town social workers were more likely to have success in helping their clients with problems of social isolation and marital disharmony than were their inner-city counterparts. Mental illness problems, however, showed less improvement than in the inner-city sample, with over one-third of the small-town cases remaining unwell throughout the 12-month follow-up. Both previous psychiatric history and current depression were indicators of a poor outcome. The present findings provide further support for the argument that unless there is close collaboration between social workers, the medical profession, and health care teams, people who present their problems to social services are unlikely to have their mental health problems addressed adequately.

Adult↗
PubMed2004

Considerations for preparing collaborative international research: a Ugandan experience.

This article describes issues to consider when planning and conducting international research projects. Key considerations include building collaboration, developing a comprehensive and feasible research plan, funding and budgets, addressing human subjects concerns, and analyzing and disseminating project findings. These considerations and related methodological issues are discussed in the context of a replication pilot project conducted outside Kampala, Uganda. Ongoing dialog, flexibility, and collaboration, in addition to good science, are critical to developing successful international research projects.

Cooperative Behavior↗
PubMedDate not supplied

Quality improvement in nursing homes in Texas: results from a pressure ulcer prevention project.

BACKGROUND: Pressure ulcer prevalence, cost, associated mortality, and potential for litigation are major clinical problems in nursing homes despite guidelines for prevention and treatment. OBJECTIVE: To improve the use of pressure ulcer prevention procedures at nursing homes in Texas through implementation of process of care system changes in collaboration with a state quality improvement organization (QIO). DESIGN: Preintervention and postintervention measurement of performance for process of care quality indicators and of pressure ulcer incidence rates. SETTING: Twenty nursing homes in Texas. PARTICIPANTS: Quality improvement teams at participating nursing homes. MEASUREMENT: Data were abstracted from medical records on performance measures (quality indicators) and pressure ulcer incidence rates between November 2000 and August 2002. Descriptive and inferential statistics were used. INTERVENTIONS: Process of care system changes consisting of tools and education to prevent pressure ulcers were introduced to participating nursing homes. RESULTS: Participating nursing homes showed statistically significant improvement in 8 out of 12 quality indicators. Pressure ulcer incidence rates also decreased, although not quite significantly. Furthermore, facilities with the greatest improvement in quality indicator scores had significantly lower pressure ulcer incidence rates than the facilities with the least improvement in quality indicator scores (S = 131.0, P = .03). This suggests that the interventions positively affected not only the process of care but also led to a decrease in pressure ulcer incidences. CONCLUSIONS: These results show that nursing homes in a collaborative effort with a QIO were able to improve their processes of care. Although significant improvement was noted on most of the quality indicators, opportunity remains for further improvement. Furthermore, these results suggest that implementation of process of care system changes by nursing homes in a collaborative relationship with a QIO may yield improvements in measures of patient outcome (eg, pressure ulcer incidence).

Aged↗
PubMed1999

Methodologies used in surveillance of surgical wound infections and bacteremia in Australian hospitals.

BACKGROUND: The prevalence of nosocomial infection in Australian hospitals is estimated to be between 5.5% and 6.3%. Since 1989, infection control professionals (ICPs) in hospitals accredited by the Australian Council on Health Care Standards (ACHS) have been encouraged to collect nosocomial infection data according to ACHS methodology. METHOD: In 1996, we surveyed members of the Australian Infection Control Association to examine the time spent on surveillance, the practice of surveillance of all hospital infections (hospital-wide surveillance), case-finding methods, case definitions, and reporting routinely used by ICPs in acute care hospitals. We also examined the ICPs' education and experience in infection control (IC). RESULTS: The survey was completed and returned by 65% (644 of 993) of Australian Infection Control Association members. Of the ICPs who completed the survey, 47.8% (308 of 644; 95% CI, 43.9%-51.7%) met the criteria for inclusion, because they coordinated an IC program in an acute care or surgical hospital and performed surveillance for either surgical wound infection, intravascular device-related bacteremia, or non-device-related bacteremia. Of the ICPs who reported their facility's accreditation status, 93.5% participated in ACHS system. Most (97.6%) ICPs had completed hospital-based general registered nurse training. Only 1.9% (6 of 308) of ICPs reported completion of continuing education relating to hospital epidemiology. The number of years of IC experience ranged from zero to 35 years, with a median of 4 years. ICPs spent a substantial proportion of their total weekly IC time on surveillance irrespective of ACHS accreditation; 19.5 hours in ACHS hospitals and 15.6 hours in non-ACHS hospitals (P =.33). More than three quarters (76.0%) of ICPs performed hospital-wide surveillance. The case-finding methods, definitions of infections, and reporting formats varied greatly. The definition most commonly applied by ICPs (6.8%; 95% CI, 4.1%-10.4%) to define surgical wound infection was infection within 30 days after the operative procedure, plus purulent drainage, plus isolation of organisms from a culture from the incision site, plus diagnosis by a medical officer. A 5-item definition of a patient being asymptomatic, plus afebrile on admission, plus infection occurring at least 48 hours after admission, plus the patient having a fever of >38 degrees C, plus a recognized culture from one or more bottles was used by 15.7% (95% CI, 11.3%-21.0%) of ICPs to define a case of bacteremia. CONCLUSION: Surveillance is the core business of Australian ICPs and consumes a substantial proportion of their time. The importance of surveillance, the epidemiologic limitations of the current ACHS system, and the nonstandard methods we report indicate that improved methodology is required for case finding and reporting of nosocomial infections. Australian ICPs should complete training in the principles of surveillance and epidemiology. With this training, ICPs can work collaboratively with other health care professionals to develop epidemiologically sound, local, nosocomial surveillance systems and lobby for a voluntary, national, standardized, risk-adjusted system of targeted nosocomial surveillance.

Australia↗
PubMed2002

[A practical diagnostic approach to mental deficiency in 2002].

The identification of an etiology in children with mental deficiency is a major challenge in routine pediatrics. As the result of a workshop leaded by the Société française de neurologie pédiatrique (SFNP), we propose a three steps diagnostic procedure, taking into account several frequent clinical observations leading to further targeted investigations. The yield of systematic imaging and biological screening remains very low, when performed for a non specific isolated mental retardation, without any characteristic clinical features. Yet, it is mandatory for an accurate genetic counseling to know not only the clinical diagnosis of developmental delay, but also the pathophysiology and the underlying molecular mechanism. The SFNP's proposal points out the necessity of a comprehensive clinical process including cautious neurodevelopmental assessment, reliable cognitive and adaptive skills evaluation, and collaboration between different specialists.

Adolescent↗
PubMedDate not supplied

Physician hospital consumer collaboration.

The authors describe a disease management initiative designed to address issues of noncompliance in a diabetic population. The program design was a collaborative effort between a payer and a public health organization representing Hartford Hospital and Hartford Physicians Association. Interventions included a patient self-assessment, phone counseling, and a monetary reward for program participation.

Blue Cross Blue Shield Insurance Plans↗