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PubMed2004

Influence of Innovative Techniques on Midterm Results in Patients with Minimally Invasive Direct Coronary Artery Bypass and Off-Pump Coronary Artery Bypass.

Abstract Background: There is a paucity of midterm results comparing the efficacy of minimally invasive direct coronary artery bypass (MIDCAB) and off-pump coronary artery bypass (OPCAB) with standard coronary artery bypass grafting (CABG). In addition, the advent of innovative techniques may have improved midterm results for patients who undergo MIDCAB and OPCAB (MID-OPCAB). The purpose of this study was to evaluate the midterm survival results of higher-risk patient groups who have undergone CABG or MID-OPCAB with or without the use of innovative techniques. Methods: From January 1992 through March 2002, 3670 consecutive patients underwent coronary artery bypass procedures, and their predicted surgical risks were calculated according to the logistic EuroSCORE. The cases of 52 MIDCAB patients and 1796 CABG patients with similar higher-risk EuroSCOREs (11.5 versus 11.4, respectively) who underwent operations from January 1992 to December 1997 were compared (study A). The cases of 89 patients with MID-OPCAB (employing "innovative techniques") and 796 patients with CABG (EuroSCORE, 13.2 versus 13.3, respectively) whose operations took place between 1998 and 2002 were also compared (study B). The National Death Index was used to access mortality data, and Kaplan-Meier curves were constructed for each group of patients. Numbers of arterial grafts, numbers of anastomoses, major complications, in-hospital lengths of stay (LOS), and 30-day mortality rates were noted. Results: In study A, there were no significant differences in the 30-day mortality rates (2.5% versus 3.9%), incidences of major complications (11.5% versus 16.6%), and LOS (13 days versus 11.7 days) for the MID-OPCAB and CABG patients, respectively. CABG patients received more arterial grafts (47.1% versus 28.9%; P =.011), received more distal anastomoses (3.4 versus 2.7; P <.001), and had better survival as estimated by Kaplan-Meier curves (94.5 months versus 82.1 months; P =.023). In study B, there were no differences in 30-day mortality rates (3.1% versus 2.3%) and incidences of major complications (10.1% versus 12.7%) for MID-OPCAB and CABG patients, respectively. CABG patients received more arterial grafts (72% versus 57.3%; P =.004) and more distal anastomoses (3.5 versus 2.8; P <.001). However, LOS was shorter for MID-OPCAB patients (7.2 days versus 9.6 days; P =.019), and there was no difference in survival time as estimated by Kaplan-Meier curves (47 months versus 46.4 months; P =.534). Conclusions: The advent of innovative surgery significantly improved LOS and "equalized" the rate of survival to 5 years in higher-risk MID-OPCAB patients, compared with similar-risk CABG patients.

Journal Article↗
PubMed2004

Not so fast! The dark side of computers in health care.

There are now computers in numerous health care devices, from thermometers to ventilators, and there are pitfalls to avoid in our increasing dependence on computers. To be useful, information must be delivered in the right context. Computer systems must be protected from worms, viruses, and other harmful code, and they must prevent unauthorized access to data. The source of all underlying decision algorithms must be known and appropriate for the population being served. And there must be contingency plans to mitigate losses caused by system unavailability.

Computer Security↗
PubMed2004

Stop shuffling paper. Case study: document management offers efficiency, access.

Document image management (DIM) technology for patient charts can organize tasks, automate redundant chores, improve access to data and decrease error. DIM allows multiple users to share patient information and has audit and security features. The technology offers a strategic benefit for practices preparing for health care's ongoing transition from paper-based systems to electronic ones.

Documentation↗
PubMed2004

Long-term survival in primary breast cancer: correlation with estrogen and progesterone receptor assay results and adjuvant tamoxifen therapy.

BACKGROUND: The presence of sex steroid receptors in breast cancer tissue is of considerable diagnostic/prognostic value. However, the relative utility of the diverse assays used for receptor detection/quantitation is disputed. We compared the utility of a monoclonal antibody-based semiquantitative immunohistochemical assay of estrogen receptor alpha (irERalpha) and of quantitative single-point radioligand assays of "cytosolic" estrogen (ERc) and progesterone receptors (PRc). MATERIAL/METHODS: Correlations were studied between the receptor levels in 235 breast cancers in patients treated between 1987 and 1990. Relationships were then analyzed between tumor receptor status, overall survival (OS; end-point: 10 years postmastectomy), age, axillary nodal status, and adjuvant tamoxifen in primary breast cancer patients for whom the respective data were accessible (N < or =121). RESULTS: Univariate analysis showed no correlation between OS and the ERc status, whereas positive irERalpha status was a favorable (p<0.05) prognosticator for the 5-year follow-up, and positive PRc status for the 10-year follow-up. Lymph node-positive patients who received adjuvant tamoxifen (2 x 10 mg/day) for a minimum of 12 months had significantly longer OS than those who did not receive the treatment. Multivariate regression of Cox proportional risk showed significance of axillary metastases, adjuvant tamoxifen, and ER status, but not of age and PRc status as independent prognosticators of OS. CONCLUSIONS: These results show the prognostic utility of the PRc radioligand assay, a slight prognostic advantage of the irERalpha assay over the radioligand ERc assay, and stress the importance of adjuvant antiestrogen therapy for overall survival in node-positive primary breast cancer patients.

Adult↗
PubMed2004

Novel genetic approaches to the resolution of complex diseases.

Up to very recent times, genetics as been the science of monogenic disorders based on Mendelian laws. Completion of human genome sequencing as well as that of other species, including mainly the mouse and rat are now providing the opportunity to resolve complex diseases, i.e., those based on several genes and significantly modified by the environment. This complex paradigm, however, requires novel strategies. We propose an integrated use of experimental genetic animal models, with that of relatively isolated human populations with large families and accessible genealogical data. Foreseeably, genetics will be part of this novel medicine in which the prediction of diseases will be based on individual genomic makeup.

Animals↗
PubMed2003

Overview of devolution of health services in the Philippines.

INTRODUCTION: In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. In 1992, the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. AIM: The aim of this review is to (i) Provide a background to the introduction of devolution to the health system in the Philippines and to (ii) describe the impact of devolution on the structure and functioning of the health system in defined locations. METHOD: International literature was reviewed on the subjects of decentralization. Rapid appraisals of health management systems were conducted in both provinces. Additional data were accessed from the rural health information system and previous consultant reports. RESULTS: Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. It was found that in 1992-1997, system effects included a breakdown in management systems between levels of government, declining utilization particularly in the hospital sector, poor staff morale, a decline in maintenance of infrastructure and under financing of operational costs of services. CONCLUSION: The aim of decentralization is to widen decision-making space of middle level managers, enhance resource allocations from central to peripheral areas and to improve the efficiency and effectiveness of health services management. The findings of the historical review of devolution in the Philippines reveals some consistencies with the international literature, which describe some negative effects of decentralization, and provide a rationale for the Philippines in undertaking a second wave of reform in order to 'make devolution work'.

Journal Article↗
PubMedDate not supplied

[The Dialysis Outcomes and Practice Patterns Study (DOPPS): results of the Italian cohort].

BACKGROUND: The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective, longitudinal, observational study examining the relationship between dialysis unit practices and outcomes for hemodialysis (HD) patients in seven developed countries France, Germany, Italy, Spain, United Kingdom, Japan and the United States. Results of the DOPPS in Italy are the subject of this report. METHODS: A national representative sample of 20 dialysis units (21 in Germany) was randomly selected in each of the European DOPPS countries (Euro-DOPPS). In these units, the HD in-center patients were included on a facility census, and their survival rates continuously monitored. A representative sample of incident (269 in Italy, 1553 in the Euro-DOPPS) and prevalent (600 in Italy, 3038 in the Euro-DOPPS) patients was randomly selected from the census for more detailed longitudinal investigation with regard to medical history, laboratory values and hospital admission. RESULTS: Comparing the Italian and Euro-DOPPS cohorts we found comparable mean age for prevalent patients (61.4 vs. 59.5 yrs), but incident patients were older in Italy. Italian prevalent patients had less cardiovascular disease, more satisfactory nutritional status and more frequent use of native vascular access. These data were associated with a comparable mortality (15.7 vs. 16.3 deaths/100 patient yrs), but morbidity was lower in Italy. Kt/V levels were comparable in the two cohorts (1.32 vs. 1.37), but 35% of Italian patients showed a Kt/V below the recommended target. Moreover, hemoglobin levels were below 11 g/dL in 60% of Italian patients. CONCLUSIONS: The DOPPS results bring to light several positive aspects and the opportunity for further possible improvements for Italian patients, but at the same time highlight some critical points that could represent a risk for dialysis quality.

Aged↗
PubMed2005

Questionnaire on health systems and national resources for control of respiratory health in low-income countries.

BACKGROUND: Due to increased exposure to risk factors such as ageing and tobacco smoking, chronic respiratory diseases (CRDs) have become a major cause of morbidity and mortality worldwide. Data on CRDs and their management in developing countries (DC) are nevertheless sparse and not comparable. OBJECTIVE: To implement and validate a standardised self-administered questionnaire to be proposed to health authorities to assess the resources of their health system for dealing with respiratory diseases. METHODS: The questionnaire concerned social security, description of the health system, human resources available within the system, initial training and continuing education of health personnel, existence of a list of essential drugs, vaccine coverage and specific resources involved in CRD and tobacco control. RESULTS: The validity of the criteria of the questionnaire was tested in Reunion Island, where health data are accessible and reliable, and was found to be satisfactory. Its acceptability and relevance were deemed appropriate in Tunisia and in Mozambique. CONCLUSION: The self-administered questionnaire is a simple, reliable and cheap tool. Although designed for the study of respiratory diseases, it can easily be transposed and adapted to other pathologies.

Chronic Disease↗
PubMedDate not supplied

Cancer mortality in a Hanoi population, Viet Nam, 1996-2005.

BACKGROUND: Hitherto, cancer mortality data have not been available in Viet Nam, so that the real public health problem with this disease has yet to be addressed and recognized in the country with a population of over 80 million in South East Asia. The aim of the present pilot study was to examine cancer mortality in a commune population of Hanoi city, 1996-2005. METHODS: Cancer data was accessed from the database of the population-routine-based death registration performed by medical workers at commune health stations based on the guidelines of the Ministry of Health at Hanoi city. All deaths occurring in the community were registered. This registration process was monthly reviewed for each fatal case regarding the name, age, sex, address, occupation, date-place-cause of death, and information concerning to pre-death medical care during the study period from Jan. 1996 to Dec. 2005. The list of death and residents of the study population was carefully cross-checked with other information sources to avoid under- or over-registration. The world population structure was used to estimate age-standardized cancer mortality rates per 100,000, (ASR). RESULTS: During 60,770 person-years estimated from Jan. 1996 to Dec. 2005, 320 deaths and their causes were registered. Among them, 100 cancer cases of all sites (66 males and 34 females) were included. Cancer mortality rates were 222 and 109 (Crude), 353 and 115 (ASR), for males and females, respectively. For both genders combined, lung cancer was the most common, 27 cases, followed by liver, 26 cases and stomach, with 19. Proportion of death from cancer was about 31% of all causes. CONCLUSIONS: The present findings suggest that in Viet Nam, a developing country, cancer is indeed an important public health problem.

Adolescent↗
PubMed2006

A human protein atlas based on antibody proteomics.

The Human Protein Atlas is a comprehensive database that provides the protein expression profiles for a large number of human proteins, presented as immunohistological images from most human tissues. This review provides an overview of the contents of the atlas, discusses the project strategy and highlights the importance of open access for data validation and quality. Essential procedures that are implemented during antibody production and image generation, such as the use of protein epitope signature tags (PrEST) antigens, monospecific antibodies, tissue microarrays and thorough quality validation, are also discussed. The Human Protein Atlas is related to four other expression atlas initiatives, including, in particular, an upcoming protein atlas developed by the Sanger Institute.

Animals↗
PubMed2006

[Content informatics and professional analysis of Hungarian health-related websites].

INTRODUCTION: The number of health-related homepages is increasing and their content is exceeding. The visitor, let him/her be a private visitor or an expert, a patient or relative would like to access relevant data, trust the accuracy and up-to-date state of the web content. It is in the nature of these kind of services, that visitors would share their question and remarks with the authors specialized in a particular topic. Among others these circumstances led to the format and content-related regulation of websites. OBJECTIVE: In a nationwide research the authors examined, to what extent the Hungarian sites meet the requirements of the Health on Net codification and the criteria of the European Union Committee. METHOD: By studying the quality criteria-related websites, the authors examined each Hungarian website to see how the Hungarian pages live up to the regulations. The work concentrates on the content, but it does not neglect functional analysis either. CONCLUSION: The authors conclude, that in spite of shortcomings, home webpages aim to keep the directives of the European Union.

European Union↗
PubMedDate not supplied

Development of population-based cancer mortality registration in the North of Viet Nam.

BACKGROUND: Regional cancer distributions provide useful pointers to potential environmental risk factors. Cancer death registration data are also basic for checking completeness of population-based registration of cancer incidence. The aim of the present project was to develop population-based cancer mortality registration in various regions in the North of Viet Nam. METHODS: Cancer data were accessed from the database of population-routine-based death registration performed by medical workers at commune health stations based on the guidelines of the Ministry of Health. All deaths occurring in the communities were registered and the registration process was monthly reviewed for each fatal case regarding the name, age, sex, address, occupation, date-place-cause of death, and information concerning to pre-death medical care during the study period from 1999 to 2005. The list of deaths and residents of the study population were carefully cross-checked with other information sources to avoid under or over registration. The study sites were Red River Delta areas and a high-mountain area. The world population structure was used to estimate age-standardized cancer mortality rates per 100,000 (ASR). RESULTS: During 4,330,620 person-years estimated during 1999 to 2005, 21,108 deaths were registered. The crude death rate from all causes was 487.4/100,000. Among them, 4,244 cancers in all sites (2,835 in males and 1,409 in females) were registered, giving mortality rates/100,000 of 134.6 and 63.3 (crude), and 155.7 and 54.3 (ASR), for males and females, respectively. The rate for the high-mountain area was only half (45.5) those in the Red River Delta (95.2-117.4). Male to female ratios were ranked from 2.2 to 3.1. Cancer accounted for about 20% of all causes of death. CONCLUSIONS: The present findings suggest that in Viet Nam, development of reliable population-based cancer mortality registration is feasible and practical.

Adolescent↗
PubMed1992

A network model for improving access to food and nutrition data.

In this article we propose a network in which existing food composition and consumption databases are linked through a master database of complete and detailed food descriptions. The proposal arises from an analysis of the importance of food data, their descriptive and analytical nature, and their uses. Lack of detail and standardization in food description hinders the retrieval of food and nutrition data from various databases and the integration of such data. Standardized food descriptions can be developed and maintained in the master database, which can then serve as the interface to the many existing databases of analytical data (especially food composition data) and to databases containing data on food production, consumption, and effects, thereby linking these databases in a coordinated system, or network. The ability to link food-related databases by standardized food descriptions offers a powerful tool for scientists and practitioners in the field of food and nutrition.

Computer Communication Networks↗
PubMed1991

[The value of classification for therapy and prognosis of acute pancreatitis. Analysis of a patient sample of the Heidelberg Surgical University Clinic 1986-1989].

116 patients admitted for acute pancreatitis were analysed. In 80% of patients presenting biliary pancreatitis cholecystectomy and bile duct exploration was the prevalent treatment, in 7.8% pancreatic necrosis was removed. Indications to operate on patients with non-biliary pancreatitis included enhancement of pancreatic inflammation revealed by computed tomography and multi-organ-failure or sepsis complicating the course of the disease (incidence of laparotomy 20.3%, incidence of necrosectomy 12.3%). According to this concept 2 out of 3 patients presenting partial pancreatic necrosis recovered without operation. Lethality of patients with acute necrotizing pancreatitis (6.9%) was accounted 25%, over-all mortality 6%. Methods used for classification of severity of acute pancreatitis (Mainz classification, Ranson criteria) turned out to be not reliable. Clinical staging of pancreatitis was not in accordance with intraoperative findings in 51.9% of cases. As a prerequisite for stage-dependent therapy new objective data to access severity and clinical course of acute pancreatitis have to be worked out.

Acute Disease↗
PubMed1989

[Vaccination protection and advice to travellers. Statistical data on the activity of the International Vaccination Center of Bordeaux (France) in 1988].

Most travellers to tropical countries are young adults aged between 25 and 44; they tend to be of average or high socioeconomic status, to have a university education and to live in urban areas. The number of countries visited is high (111). Half the travellers go to Senegal, Ivory Coast and French Guiana. Asian countries are underrepresented among the clients of the Bordeaux centre because they do not require yellow-fever vaccination. The main reasons for travel are pleasure (73%) and business (23%). The length of stay is closely correlated with the reason for travel. Considerably more people travel in the winter period. The most frequently performed vaccinations are yellow fever, tetanus and poliomyelitis, in roughly equal numbers. A major role of a vaccination centre in the eyes of the public is to provide travellers with information and advice. A specialist centre of this kind, kept regularly informed about epidemiological developments around the world, is best equipped to advise on effective malaria prophylaxis. The centre's health-education role extends to all risks associated with travelling, in particular the sexually transmitted diseases and specifically tropical diseases, and also the consequences of changes in climate or altitude and failure to take general hygiene precautions. Computerized data banks accessible to the general public are certainly an information medium for the future, but at present are still underused.

Adolescent↗
PubMed1986

A technique for multiplanar reformation and three-dimensional analysis of computed tomographic data: application to adult hip disease.

A commercially available system which is able to accept input from computed tomographic (CT) or magnetic resonance (MR) scanners was used preoperatively to generate multiplanar reformations (MPR) and three-dimensional (3D) images depicting the osseous morphologic alterations and femoral-acetabular relationships in 25 adult patients with a variety of hip diseases. Polyethylene surface representations of femora and acetabulae were constructed by the 3D-contouring of CT data and were then compared to resected specimens from patients who subsequently underwent total hip arthroplasty. Information provided by this imaging strategy was useful in both selecting and guiding the most appropriate surgical procedure, and the models depicted actual osseous contours with reasonable accuracy. The system employed has distinct advantages over other previously described 3D imaging strategies, which include a menu-driven user-friendly interface, data base access via reference images, 3D sectional analysis, and contour file editing for selective visualization of desired structures.

Acetabulum↗