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At least 1,135 records · Page 63Linked to original sources
PubMed2002

[Adaptation of guidelines for the treatment of chronic heart failure in a specialized heart failure clinic].

BACKGROUND: Chronic heart failure is associated with high mortality and morbidity. In spite of a number of trials showing significant improvement in survival and reduction in hospitalization for patients who received ACE inhibitors/AT1 receptor antagonists (ACEI/ARB), beta-blockers and spironolactone, and notwithstanding the recommendations of national and international guidelines for the management of heart failure, substantial proportions of patients are not receiving this treatment. The aim of our study was to analyse 1. the efficiency of a specialized heart failure clinic in translating guidelines into clinical practice, and 2. the effect of optimized neurohormonal therapy on patient outcome. METHODS AND RESULTS: The data of patients with systolic heart failure and an ejection fraction < or = 35% referred to the Innsbruck Heart Failure and Transplantation Program between February 2000 and October 2001 were analysed. The number of patients treated with ACEI/ARB, beta-blocker and spironolactone increased significantly in the investigation period (p < 0.05). Equivalent dose for captopril and bisoprolol per patient developed from 66.4 +/- 42.8 to 96.5 +/- 41.9 mg (p < 0.001) and from 2.0 +/- 2.9 to 6.3 +/- 4.0 mg (p < 0.001), respectively. Optimization of neurohormonal therapy was associated with a significant improvement in NYHA class (2.5 +/- 0.8 vs. 1.9 +/- 0.8; p < 0.001). No relevant changes were noticed for blood pressure, serum creatinine, serum sodium, and serum potassium, whereas heart rate dropped significantly. Kaplan-Meier curves examining the time to first event of the combined end point of mortality and hospitalisation for worsening heart failure revealed a clear benefit for patients on combined neurohormonal therapy (ACEI/ARB and beta-blocker, n = 86) when compared with patients on neurohormonal monotherapy (ACEI/ARB or beta-blocker, n = 35), (p < or = 0.001). Differences remained significant (p = 0.022) after adjusting for NYHA class at referral, age, gender, etiology of the underlying cardiomyopathy, ejection fraction, and atrial fibrillation in Cox regression analysis. CONCLUSION: Guidelines for the management of chronic heart failure patients can be translated efficiently into clinical practice by a specialized heart failure clinic. Optimization of therapy is associated with an improvement in functional status and a decrease in mortality or hospitalization for worsening heart failure. Therefore the nationwide installation of specialized heart failure clinics is required.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Dental care for special needs patients: a survey of Texas pediatric dentists.

The purpose of this study was to determine the amount of time Texas pediatric dentists spent, as both residents and in their professional position, in the treatment of special needs patients. In addition, an attempt was made to determine the dental services offered to these patients along with the barriers to obtaining care. A survey was mailed to the 334 members of the Texas Academy of Pediatric Dentistry. From the returned surveys (61.9% or 207/334) the following conclusions were drawn: 1) Most respondents had a significant portion of their training program devoted to special patient care, 2) Virtually all reported treating some special needs patients in their professional position, 3) Most provided conscious sedation and general anesthesia and adjuncts to behavior management for these patients, 4) Insufficient financial reimbursement was a major reason cited for not providing dental services to more of these patients.

Anesthesia, Dental↗
PubMed2003

Long-term hematological effects in Special Forces trainees.

The present study assesses the impact of "sports anemia" on screening tests performed on participants in an endurance-training program. Medical charts of 48 naval Special Forces trainees and 48 submarine trainees were reviewed. We compared the results of red blood cell count, hemoglobin concentration, hematocrit (Hct), and mean corpuscular volume performed at recruitment and after 2 years. No differences were noted between baseline values. The Hct and red blood cell count decreased significantly in the Special Forces trainees after 2 years of training (p = 0.002 and p = 0.05, respectively), remaining unchanged in the submariners. Hct decreased by 2 +/- 4.14%, whereas red blood cell count decreased by 0.13 +/- 0.44 M/microL. A reduction in Hct may be expected in Special Forces trainees engaged in long-term endurance training. Because these lower values were not seen in an otherwise identical group of submarine trainees, they could be attributed to the endurance training.

Adolescent↗
PubMedDate not supplied

[Working experience of the analytical group of the specialized epidemic brigade].

The working experience of the analytical group as the section of the specialized antiepidemic brigade for the organization and realization of antiepidemic measures, made under the conditions of the antiterrorist operation in the Chechen Republic in the year 2000, is generalized. The necessity for equipping the specialized brigade with a modern computer with peripherals and the necessary specialized computer programs, as well as with modem and fax-telephone facilities, is shown. The necessity of equipping this brigade with the electronic variant of the information and legal data base (references on methods, sanitary norms and other normative documents on sanitation, hygiene, epidemiology, bacteriology and the organization of health service) is indicated.

Communicable Disease Control↗
PubMed2003

Crystallin genes: specialization by changes in gene regulation may precede gene duplication.

The crystallins account for 80-90% of the water-soluble proteins of the transparent lens. These diverse proteins are responsible for the optical properties of the lens and have been recruited from metabolic enzymes and stress proteins. They often differ among species (i.e. are taxon-specific) and may be expressed outside of the lens where they have non-refractive roles (a situation we call gene sharing). Crystallin recruitment has occurred by changes in gene regulation resulting in high lens expression. Duck lactate dehydrogenase/epsilon-crystallin and alpha-enolase/tau-crystallin are each encoded in single-copy genes, consistent with these enzymes acquiring a crystallin role, without loss of their nonlens metabolic function, by a change in gene regulation in the absence of gene duplication. The small heat shock protein/alpha-crystallins and avian argininosuccinate lyase/delta-crystallins were also recruited by a change in gene regulation leading to high lens expression, except this was followed by a gene duplication with further lens specialization of the alphaA and the delta1 (in chickens) crystallin genes. Cephalopod (squid and octopus) S-crystallins were recruited from glutathione S-transferase apparently after duplication of the original gene encoding the enzyme, although this remains uncertain. We speculate that one of the new genes (glutathione S-transferase/S11-crystallin) specialized for lens expression by a change in gene regulation and subsequently duplicated many times to form the lens-specialized, multiple S-crystallins that lack enzymatic activity. That similar transcription factors (e.g. Pax-6, retinoic acid receptors, maf, Sox, AP-1, CREB) regulate different crystallin genes suggest that common features of lens-specific expression have played a pivotal role for recruiting the diverse, multifunctional proteins as crystallins.

Animals↗
PubMedDate not supplied

Perioperative nursing: a special nursing specialty.

The intraoperative phase of perioperative nursing practice is a special specialty, as it combines the nursing model and the collaborative model for specialization. As a nursing model, it focuses on the behavioral sciences, education, and nursing as a caring science. As a collaborative model, it requires skilled care with an additional knowledge base acquired from medicine and the behavioral and biological sciences. The nature of the operating room may distort the image, because although nurses work closely with other health care team members in diagnosing and treating patients, in this special specialty the scope of practice is uniquely nursing.

Career Choice↗
PubMed2003

Developing a methodology to improve the allocation of specialized health resources for acutely injured persons.

Inappropriate triage following acute injury may result in misallocation of specialized health resources, increased health care costs, reduced or delayed access to care, and increased death and disability. Although triage criteria have been developed, they vary widely, and inappropriate triage rates are high (50% - 85%). The purpose of this project was to evaluate the ability of decision tree induction to predict need for specialized trauma resources in acutely injured persons. We considered any person who was admitted to the trauma center's ICU or died prior to being admitted to the ICU as needing specialized trauma resources.

Acute Disease↗
PubMed2004

Estimating the prevalence of uninsured children: an evaluation of data from the National Survey of Children with Special Health Care Needs, 2001. Data evaluation and methods research.

UNLABELLED: The National Survey of Children with Special Health Care Needs revealed that 8.3% of children under 18 years of age were uninsured, a rate lower than the rate estimated by other national surveys. This report presents the results of an evaluation of the quality of this estimate, based on analyses of non-response, question design, interviewer and respondent effects, and the weighing and estimation process. National and State-level statistics on health insurance coverage for children with special health care needs (CSHCN) and for children without special needs are included in an appendix. SOURCE OF DATA: The National Survey of CSHCN is a survey module of the State and Local Area Integrated Telephone Survey. This survey of parents and guardians collected health insurance coverage information for a national sample of 215, 162 children. Data were collected from October 2000 through April 2002. RESULTS: Compared with other surveys, weighted data from the National Survey of CSHCN describe a population with a slightly larger proportion of Hispanic children and children from households with higher incomes. The National Survey of CSHCN was also the only survey to use a child-level design: A randomized experiment that varied the health insurance questions found that repeating the coverage questions for each child produced lower unisurance rates than household-level questions that first asked if anyone in the househol was insured. CONCLUSION: Question design differences explain much of the discrepancy between survey estimates of the uninsurance rate, but a definitive conclusion regarding the relative accuracy of the uninsurance rates is not possible.

Adolescent↗
PubMed2003

[Study on the soil fertility changes in planting base to develop the special fertilizer for cultivation of Chrysanthemum morifolium].

OBJECTIVE: To study the changes of soil fertility in Sheyang county where Chrysanthemum morifolium has been cultivated for more than 30 years and to develop the special fertilizer for cultivation of C. morifolium. METHOD: The pH values, organic matter and the contents of total and available N, P, K and Zn in the soil layer of 0 to 40 cm, as well as the total N, P, K and Zn contents in the flowers, roots, stems and leaves of the plants, were analysed. The balanced fertilization plan for cultivation of C. morifolium was put forward. In addition, the formula of special fertilizer for cultivation of C. morifolium was determined according to flower yield and utilization rate of N, P, and K. RESULTS AND CONCLUSION: The soil had high pH values and high soil salt contents, with unbalanced application of N, P, and K fertilizers and a shortage of available Zn after cultivation of C. morifolium. The contents of soil organic carbon, N and P declined with increasing cultivation time of C. morifolium, which resulted from the improper rotations and fertilization. The balance fertilization practice and the special fertilizer utilization are effective ways to improve soil fertility for C. morifolium.

Chrysanthemum↗
PubMed2003

[The problem of specialization in otolaryngology on the turn of the XIX century--Warsaw physician contribution].

The problem of specialization in otolaryngology in the end of the XIX and the beginning of XX century in Warsaw is described in detail. The programmes of specialization and specialistic examinations at that time did not exist. The professional trainings of Warsaw physicians in otolaryngology carried out abroad, especially in Vienna, Berlin, Paris and London are presented. The professional training at Warsaw otolaryngological hospital wards, out-patient clinics, infirmieries and consulting-rooms are stressed in more details. Number of physicians specialized in otolaryngology increased in the beginning of the XX century. The Warsaw physicians wrote many scientific papers and several books, they were also competent teachers of a great number of distinguished otolaryngologists. The achievements of Warsaw doctors at the time of the formation of Polish Otolaryngological Society in 1921 are pointed out.

History, 19th Century↗
PubMed2004

Special fasciculiform cataract caused by a mutation in the gammaD-crystallin gene.

PURPOSE: To identify ultrastructure changes and genetic defects associated with a special fasciculiform autosomal dominant congenital cataract (ADCC) affecting a large Chinese family. METHODS: Members of the Chinese family affected by this special fasciculiform ADCC were studied. Clinical examinations, light and transmission electron microscopy of the removed lens tissue, linkage analyses using polymorphisms of microsatellite markers, and mutational analyses of candidate genes by direct sequencing were performed. RESULTS: The thirteen affected individuals in the family showed no variability between one another. The lens fiber cells showed focal degeneration, dense globular intracellular deposits, and an enlarged intercellular space. This ADCC was associated with a locus on chromosome 2q33-35 (maximum lod score [Zmax]=3.34; theta=0.05). Mutational analyses of the candidate genes (gamma-crystallin; CRYG), identified a C->A heterozygous transversion at nucleotide position 70 in the gammaD-crystallin gene (CRYGD) exon2, which co-segregated with the presence of ADCCs and was not observed in 100 unrelated controls. CONCLUSIONS: This study identified ultrastructure changes and genetic defects associated with a special fasciculiform ADCC affecting a large Chinese family. It appeared to be caused by a missense mutation in the CRYGD gene, further supporting the notion that alterations to CRYG play an important factor in human cataract formation.

Cataract↗
PubMedDate not supplied

The Miami Special: a simple tool for quality section mounting in Mohs surgery.

High quality frozen sections are fundamental in Mohs surgery, and one of the main elements in tissue processing is the mounting of the specimen. The Miami Special has been used for this purpose at the University of Miami for over 30 years. Since 1989 the Miami Special has languished in the literature among a growing list of mounting instruments. Therefore, new generations of Mohs surgeons may not be acquainted with the advantages of this instrument. This article describes the Miami Special and outlines its use for the benefit of current practitioners.

Florida↗
PubMed2004

Access to the medical home: results of the National Survey of Children with Special Health Care Needs.

OBJECTIVE: The purpose of this article is to report the findings of the National Survey of Children With Special Health Care Needs regarding parent perceptions of the extent to which children with special health care needs (CSHCN) have access to a medical home. METHODS: Five criteria, selected to reflect the characteristics of a medical home as defined by the American Academy of Pediatrics (AAP) policy statement on the medical home, were analyzed to describe the extent to which CSHCN receive care characteristic of the medical home concept. These criteria included having 1) a usual place for sick/well care, 2) a personal doctor or nurse, 3) no difficulty in obtaining needed referrals, 4) needed care coordination, and 5) family-centered care received. Items from the Survey were selected and clustered to characterize each of the 5 components. Criteria for each item were established with the requirement that the criteria must be met for all items in a component to receive credit for the component. RESULTS: Results of the survey indicate that 1) approximately half of CSHCN receive care that meets all 5 components established for medical home; 2) most CSHCN have a usual source of care and a personal doctor or nurse, but other components of the medical home, especially elements of care coordination and family-centered care, are lacking; 3) access to a medical home is significantly affected by race/ethnicity, poverty, and the limitations imposed on daily activity by the child's special health care need; and 4) parents of children who do have a medical home report significantly less delayed or forgone care, significantly fewer unmet health care needs, and significantly fewer unmet needs for family support services. The 5 components described represent major characteristics of the comprehensive care model recommended for all children by the AAP. CONCLUSIONS: The findings suggest that although some components of the medical home concept have been achieved for most CSHCN, the comprehensive care model described by the AAP policy statement on the medical home is not yet in place for a significant number of CSHCN and their families.

Child↗
PubMed2004

Implementing community-based systems of services for children and youths with special health care needs: how well are we doing?

OBJECTIVE: To provide a baseline measure of the proportion of US children who meet the Maternal and Child Health Bureau's core outcomes for children with special health care needs (CSHCN). Those core outcomes include the following: 1) families of CSHCN will partner in decision making and will be satisfied with the services that they receive; 2) CSHCN will receive coordinated, ongoing comprehensive care within a medical home; 3) families of CSHCN will have adequate private and/or public insurance to pay for the services that they need; 4) children will be screened early and continuously for special health care needs; 5) community-based service systems will be organized so that families can use them easily; and 6) youths with special health care needs will receive the services necessary to make transitions to adult life, including adult health care, work, and independence. METHODS: A national household survey was conducted using telephone interviews. We analyzed data on 38,866 CSHCN included in the 2001 National Survey of CSHCN and 13,579 children included in the 2001 National Health Interview Survey. We assessed the proportion of US children who met each of the 6 core outcomes for CSHCN using data from 2 surveys. RESULTS: Success rates ranged from 6% (the core outcome on successful transition to adulthood) to 74% (the core outcome on organization of the service system). For 5 of the 6 core outcomes, success rates exceeded 50%. CONCLUSION: Our results indicate that, for the most part, the United States is well positioned to meet the 6 core outcomes. However, much more work lies ahead before success can be claimed. This is especially true for the core outcome on transition to adulthood, for which only 6% of children in the target population are now meeting this goal.

Adolescent↗
PubMed1992

Specialized treatment for behavior problems of institutionalized persons with mental retardation.

The extent of use and effectiveness of special treatment options (in-house behavior shaping units, specialized outside referral agencies, and mobile intensive treatment teams) in dealing with behavior problems of persons with mental retardation was determined. A survey was completed by 144 institutions throughout the United States; 86% of all facilities recognized a need for special treatment options to deal with clients who had severe behavior problems. Sixty-eight percent of the institutions had presently or in the recent past used at least one of the three treatment options. Comparisons of these options in terms of perceived effectiveness, length of intervention, and type of problem addressed were reported.

Affective Symptoms↗
PubMed2004

[Study on ultrastructure changes and the genetic locus for a special phenotype cataract].

OBJECTIVE: To report the ultrastructure changes and map the genetic locus for a special phenotype autosomal dominant congenital cataract (ADCC) in a large Chinese family. METHODS: A large four-generation Chinese family affected by this special phenotype ADCC was analyzed. Clinical examinations, light and transmission electron microscopy analysis of the removed lens tissue were performed. Blood samples were taken for DNA extraction and two-point linkage analyses between the polymorphisms of microsatellite markers near the gamma-crystallin gene (CRYG) and the disease-associated locus was also determined. RESULTS: The lens fiber cells displayed abnormal inter- and intracellular alterations, including irregular refractivity, focal degeneration and irregular and enlarged intracellular spaces. Linkage analysis showed that there was linkage between the ADCC disease-associated locus and D2S2208, D2S2382 and D2S164. CONCLUSIONS: There were characteristic alterations to the lens fiber cells of this special phenotype ADCC and the CRYGD gene might be the disease-associated.

Cataract↗
PubMed1992

Family support networks: help for families of children with special needs.

Families of children with special needs offer special challenges for the primary care physician. The variety of developmental disabilities and chronic illnesses, the rapid pace of research, and the array of stresses on these families may make care time consuming and frustrating. Well-developed family support networks complement the care offered by physicians. These networks offer coping support for families, education and service availability information, advocacy training, and support for siblings of children with special needs.

Adaptation, Psychological↗
PubMed2004

National survey of children with special health care needs: Wisconsin-specific data.

BACKGROUND: The National Center for Health Statistics developed and conducted (2000-2002) the National Survey of Children with Special Health Care Needs (CSHCN), a module of the State and Local Area Integrated Telephone Survey (SLAITS). OBJECTIVE: The purpose of this paper is to present the Wisconsin-specific data derived from analysis of the national survey and to make a comparison with the United States as a whole. RESULTS: In Wisconsin, approximately one fifth (21%) of households have CSHCN, and 13.4% of children have a special health care need; US comparison data are 20% and 12.8%, respectively. When examined by type of special need, Wisconsin shows slightly higher proportions of CSHCN in all categories, when compared with U.S. data, with the exception of limitation in activity. Families in Wisconsin with CSHCN are more likely to report being involved with medical decision making and satisfied with services they receive (67%); having a medical home (57%); having adequate insurance; easy use of community-based service systems (81%); and receiving services to make transition to adult life (7.5%). CONCLUSION: Though Wisconsin has a slightly higher proportion of CSHCN than the United States as a whole, a greater proportion of Wisconsin families receive important services. These measurements allow us to strive for further improvement through coordination of services in the private health care delivery sector with public health programs.

Adolescent↗