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PubMed2004

A PET provocation study of generalized social phobia.

In an investigation of the neural circuits that may mediate the subjective experience of social phobia (SP), six male patients with a primary DSM-IV diagnosis of generalized social phobia watched, in the presence of a group of "communication experts," a videotape of themselves giving an impromptu talk (Exposure condition). In the control Baseline condition, they viewed a videotape of a socially competent stranger giving a talk. Regional cerebral blood flow was measured thrice under each condition. The study revealed significant deactivations from Baseline during Exposure in the right lingual gyrus (BA 18) and in the right medial frontal gyrus (BA 11); significant activations during Exposure were not observed. Deactivation of these regions may reflect a strategy of visual avoidance employed by the patients to dampen their phobic experience.

Adolescent↗
PubMed2003

Neurobehavioral assessment of mood and affect in patients with neurological disorders.

Patients with neurological disorders are particularly susceptible to a variety of affective and mood disorders. Unfortunately, several factors confound the analysis of the individual case. These factors include the fact that neurological deficits may limit the capacity of the individual to communicate mood and feelings. In some cases, the deficits might mimic affective disorders. In this article we will review the traditional presentation of affective disorders in the normal patient. We offer a discussion of specific aspects of the neurobehavioral assessment that might confound the analysis of the individual case. The confounding factors include frontal lobe deficits, aspects of impairments in language, and memory disorders. We also direct attention to motor system deficits and other problems such as sleep disorders that might contribute to a better diagnosis of affective and mood disorders. Finally, we summarize this information and present a general approach for the analysis of the individual.

Anxiety Disorders↗
PubMedDate not supplied

Improving medical imaging report turnaround times.

Southern Ohio Medical Center (SOMC), a 232-bed community-based teaching hospital, is equipped with state-of-the-art equipment such as 2 16-slice computed tomography (CT) scanners, 3 MR scanners, 3 ultrasound scanners, 2 digital mammography units, and 3 nuclear medicine cameras. One hundred twenty-six employees--ranging from support personnel to technologists along with 7 board-certified radiologists--staff the medical imaging department. Procedure volume is approximately 164,000 per year and is performed in all American College of Radiology (ACR)-accredited modalities. Filmless since 1998, SOMC's medical imaging department has resulted in productivity gains to the estimated 164,000 procudures for fiscal year 2005. The catalyst for the department is a robust picture archiving and communication system (PACS). Working with the radiologists, staff, and transcription services, turnaround time was reduced to from 13 hours to 9 hours from exam start to report sign off. Additional technology intervention was essential to further decrease report turnaround time. SOMC served as a beta site for a radiology information system (RIS). The new RIS has allowed the medical imaging department to move from a paper department to a "pseudo paperless" department. Orders, history sheets, consents, and other forms are scanned into the RIS for staff and radiologist use. Requisitions are no longer printed, and staff has access to review workstations to ensure that patients are called back into the department for procedures. This new workflow has also reduced paper traffic within the department. The last piece of the technology puzzle to improve report turnaround time was voice recognition technology. From its implementation, voice recognition enhanced the RIS technology. All of the radiologists began to use the product as soon as it was available. They perform all the editing and corrections either by voice command or by manual typing. The medical imaging department has noted that voice command corrections and editing are more efficient for the radiologist. The overall impact on decreased radiology report turnaround times is not only seen in medical imaging, but also has a global affect within the hospital. SOMC plans to realize a reduction length of patient stays, and a faster process for plotting the course of patient treatment, e.g., faster visits from emergency department (ED) physicians to patients.

Diagnostic Imaging↗
PubMed1998

Quality of life in patients with lung cancer: a review of literature from 1970 to 1995.

A review of the literature was carried out covering the last 25 years (1970 to 1995) by searching through the MEDLINE and manually. The review consists of two companion parts. The first includes studies of quality of life in lung cancer patients in general, while the second part is restricted to defined samples of small and non-small cell lung cancer patients. Excluding non-English and review articles, in total 151 citations were identified and all have been reviewed. Over 50 instruments were used to measure quality of life in lung cancer studies. Of these, the European Organisation for Research and Treatment of Cancer Quality of Life Lung Cancer Questionnaire (EORTC QLQ-LC13) in conjunction with the core cancer questionnaire (QLQ-C30) was found to be the best developed instrument, although there were two other lung cancer-specific measures with good reliability and validity. Several topics in this chapter have been highlighted, including the importance of regularly measuring quality of life in lung cancer patients. Progress and achievements in areas such as performance status as a proxy of quality of life measure, psychological morbidity and symptom distress as predictive factors of quality of survival, and communication problems in quality of life studies of lung cancer patients have been emphasized and their implications in lung cancer care discussed. It is argued that palliation of symptoms, psychosocial interventions, and understanding patients' feelings and concerns all contribute to improving quality of life in lung cancer patients. It is concluded that the future challenge in treatment of lung cancer lies not only in improving the survival, but mainly the patients' quality of life regardless of cell type. Clinical trial and epidemiologic population-based outcome studies are recommended to provide this and to allow a better understanding of the contribution of the socioeconomic characteristics of the patients to their pretreatment and posttreatment quality of life.

Activities of Daily Living↗
PubMed2006

Urinary incontinence in dementia - a practical approach.

BACKGROUND: Urinary incontinence is a common problem in dementia. Almost invariably, the person with dementia will develop incontinence as the disease progresses. However, the primary reasons for incontinence are often not because of any significant pathology in the urinary system. Rather, it is due to factors outside the urinary system. The term 'functional incontinence' has hence been applied. Maintenance of continence requires mobility, manual dexterity, mental capacit and motivation. Clearly, the person with dementia is vulnerable to developing problems in these domains. OBJECTIVE: This article provides a comprehensive overview of how the stage and type of dementia may account for cognitive and functional deficits, the psycho-emotional world and behaviour of the patient, their care environment, and possible medical factors and pathology in the urinary system. DISCUSSION: Management is directed at turning around reversible factors, preserving independence and dignity of the patient, and providing sensitive and empathetic care even if the problem is not completely remediable. In those with more advanced dementia, timed and prompted voiding have shown the most promise.

Aged↗
PubMed2001

Propagation of intercellular calcium waves in C6 glioma cells transfected with connexins 43 or 32.

In this study, gap junction-deficient C6 glioma cells, transfected with either connexin 43 (Cx43) or 32 (Cx32), have been used to evaluate the ability of these connexins to pass intercellular Ca2+ waves. Ca2+ waves, observed with fluorescence imaging using fura-2 or fluo-3, were initiated by mechanical stimulation in the presence of a supra-perfusion of the extracellular fluid or by the non-contact technique of flash photolysis of intracellular caged-IP3. Following manual mechanical stimulation, the parental C6 glioma cells and cells expressing Cx43 and Cx32 gap junctions all propagated intercellular Ca2+ waves. Ca2+ waves in cells expressing Cx43 traveled approximately twice the distance as compared to waves in cells expressing Cx32 or parental cells. The cells expressing Cx43 were also about twice as sensitive to ATP as cells expressing Cx32. In the presence of a supra-perfusion of extracellular fluid, the Ca2+ waves in parental cells were almost abolished while the mechanically induced Ca2+ waves in the cells expressing Cx43 and Cx32 propagate similar but limited distances of several cells in a direction opposite to the fluid flow. The photolytic release of IP3, but not Ca2+, in cells expressing Cx43 or Cx32 resulted in the propagation of Ca2+ waves that traveled distances similar to those observed in the presence of supra-perfusion. Parental C6 glioma cells did not initiate intercellular Ca2+ waves when stimulated by photolysis. From these studies we conclude that (1) both Cx43 and Cx32 based gap junctions are permeable to IP3 and can serve to communicate Ca2+ waves, (2) that Ca2+ wave propagation via gap junctions was dependent on the diffusion of IP3 but not Ca2+, (3) that an extracellular messenger capable of communicating waves is released from only the stimulated cell, and (4) that simultaneous intracellular and extracellular signaling can occur to enhance the propagation of intercellular Ca2+ waves.

Adenosine Triphosphate↗
PubMed1991

Applying statistical control theory to bring together clinical supervision and psychotherapy research.

A three-factor experiment was designed to evaluate the potential for improving first-session performance of 6 trainee-therapists as measured by postsession client ratings (N = 48). Rather than through standardizing therapist behavior by using a training manual beforehand, therapist effects were handled through statistical control. This method not only provided control so that findings were not confounded with some kinds of therapist effect but also identified which therapists needed supervision to bring their performance more in line with others in the group. Reducing the number of therapists requiring "standardization" should lower training costs and enhance individual freedom. In the present study, more frequent empathic responses led to statistically significant beneficial effects on five of seven outcome measures. Suggestions volunteered by therapists improved overall session ratings on three variables and increased scores on a measure of passive dependence. Whether or not therapists asked questions had no main effects on any tested outcome measure.

Adult↗
PubMed2005

Identification of inappropriate drug prescribing by computerized, retrospective DUR screening in Korea.

BACKGROUND: In Korea, the drug use process has changed significantly since the new pharmacy law was implemented in 2000, separating the prescribing and dispensing functions between physicians and pharmacists and mandating prospective drug use review (DUR) practice by pharmacists immediately before dispensing medications. However, a high prevalence of inappropriate prescribing has been suspected by the public, pharmacists, and health insurance managers, possibly due to suboptimal DUR practice by pharmacists. OBJECTIVE: To assess overall patterns of drug usage and potential problems of inappropriate use in outpatient settings by analyzing prescription data that were electronically submitted to the national health insurance manager with a computerized DUR system and develop a computerized adjudication system model for drug claims. METHODS: The national prescription drug claims data that were submitted electronically by pharmacies located in the northern part of Korea during 15 days in 2002 were retrospectively screened against the predetermined DUR standards of the selected criteria on drug dosage, duration of therapy, and drug interaction using the DUR screening system. The results of all the DUR conflicts were further validated manually by an expert panel and statistically analyzed to determine drug use patterns. RESULTS: Of 31,994,260 drugs prescribed, 3,325,760 (10.4%) items showed a conflict with at least one of the DUR standards. The average number of drugs prescribed on each prescription was 4.07, and even more troubling was the high incidence of under-dosing, over-dosing, and contraindicated drug prescribing. CONCLUSIONS: It is evident that inappropriate drug prescribing is very common in Korea; thus, a great deal of attention is urgently needed in the country with respect to proper prescribing and supportive interventions.

Adult↗
PubMed2003

Estimation of malaria transmission in high-risk provinces of Morocco.

The malaria transmission level of Plasmodium vivax was monitored in four high-risk provinces in Morocco. Intensive mosquito collection by light traps and manual catches resulted in the capture of four species: Anopheles labranchiae, An. sergenti, An. cinereus, and An. claviger. All An. sergenti and An. labranchiae females collected were tested for the presence of two phenotypes of P. vivax (PVK210 and PVK247) antigen by enzyme-linked immunosorbent assay (ELISA). No P. vivax antigen was detected in 1347 mosquitoes analysed. A parallel parasitological investigation was conducted. Of 2665 slides examined from a population of 4343 people for detection of P. vivax, no slide was positive. The results confirm the break in malaria transmission in residual foci. The use of ELISA is recommended in future epidemiological studies of human malaria.

Altitude↗
PubMedDate not supplied

[Modular project of the Picture Archiving and Communication System (PACS). Preliminary operational experience. I].

Since september 1988 a PAC System (Comm View by AT & T and Philips) has been operating in the Radiology Department of the University Hospital, Trieste. A research project is presently in progress aiming at providing factual evidence for the evaluation of this kind of systems as far as operational, technical, clinical and economic aspects are concerned. The general approach to this research consists in implementing and monitoring a PACS in a stepwise way, starting with a small system connected to some digital modalities only, in order to test the feasibility and effectiveness of the system within a Radiology Department, and to test the possibility of matching the PACS to the Radiological System. The present paper describes in detail the present configuration of this entry-level system and its technical features. The planned development (october 1989) is also depicted. Further developments devise at managing in an integrated way all the radiological images of the four hospitals of Trieste. At present, the PACS is currently used to manage and store on optical disks all the images acquired from the connected modalities plus the related reports, and to perform the reporting sessions for CT examinations (brain and abdomen). The present research effort is devoted to two main areas: clinical evaluation and operational analysis. The object of the operational analysis was the assessment of the impact of PACS on the operations of a Radiology Department. The general approach followed for this research consists in analysing the procedures as they are performed in the conventional way (manual operations), and comparing them to the way they are, or could be, performed using a PACS System (automatic operations). This stage of the project is divided into three phases, concerning respectively the analysis of the organization and operations before PACS, the analysis of the impact of PACS in its initial configuration and the forecast of the influence of PACS in its future setting. A first evaluation concerned the activities carried out from the moment the images are generated to the moment they are ready to be achieved. They include image acquisition, reporting, delivering and returning of images from the departments. The time required to carry out each of the activities involved was recorded, both in the manual and in the automatic version; furthermore, a more detailed analysis was performed on the reporting procedure. The conclusions reached through this analysis are that this kind of operation is mostly affected by the way the Radiology Department is managed, rather than by the tools employed.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Systems↗
PubMed1989

Presentation level determination for CV tokens using a computer-controlled adaptive procedure.

The feasibility of using a computer-controlled adaptive procedure to find maximum monotic performance for consonant-vowel (CV) stimuli was evaluated and compared to the procedure typically used to determine a performance-intensity function in two experiments. In experiment I, the computer-controlled adaptive procedure and the typical manual procedure were evaluated on 26 normally hearing listeners. Results indicated that the shape of the performance-intensity functions was similar for both procedures with the computer-controlled adaptive procedure selecting a higher presentation level. The test-retest reliability for the computer-controlled adaptive procedure was good with a mean difference on retest of 1.2 dB. In experiment II, the same procedures were evaluated using 9 sensorineural hearing impaired subjects. Again similar configuration between functions was observed. The primary advantage of the computer-controlled adaptive procedure for both subject groups is efficiency in terms of time of administration and number of CV stimuli used.

Adolescent↗
PubMed1999

Interactive navigation and bronchial tube tracking in virtual bronchoscopy.

An interactive virtual environment for simulation of bronchoscopy is developed. Medical doctor can safely plan their surgical bronchoscopy using the virtual environment without any invasive diagnosis which may risk the patient's health. The 3D pen input device of the system allows the doctor to navigate and visualize the bronchial tree of the patient naturally and interactively. To navigate the patient's bronchial tree, a vessel tracking process is required. While manual tracking is tedious and labor-intensive, fully automatic tracking may not be reliable. We propose a semi-automatic tracking technique called Intelligent Path Tracker which provides automation and enough user control during the vessel tracking. To support an interactive frame rate, we also introduce a new volume rendering acceleration technique, named as IsoRegion Leaping. The volume rendering is further accelerated by distributed rendering on a TCP/IP-based network of low-cost PCs. With these approaches, a 256 x 256 x 256 volume data of human lung, can be navigated and visualized at a frame rate of over 10 Hz in our virtual bronchoscopy system.

Bronchoscopy↗
PubMed2003

NMR solution structure of attractin, a water-borne protein pheromone from the mollusk Aplysia californica.

Water-borne protein pheromones are essential for coordination of reproductive activities in many marine organisms. In this paper, we describe the first structure of a pheromone protein from a marine organism, that of attractin (58 residues) from Aplysia californica. The NMR solution structure was determined from TOCSY, NOESY, and DQF-COSY measurements of recombinant attractin expressed in insect cells. The sequential resonance assignments were done with standard manual procedures. Approximately 90% of the 949 unambiguous NOESY cross-peaks were assigned automatically with simultaneous three-dimensional structure calculation using our NOAH/DIAMOD/FANTOM program suite. The final bundle of energy-refined structures is well-defined, with an average rmsd value to the mean structure of 0.72 +/- 0.12 A for backbone and 1.32 +/- 0.11 A for heavy atoms for amino acids 3-47. Attractin contains two antiparallel helices, made up of residues Ile9-Gln16 and I30-S36. The NMR distance constraints are consistent with the three disulfide bonds determined by mass spectroscopy (C4-C41, C13-C33, and C20-C26), where the first two could be directly determined from NOESY cross-peaks between CH beta protons of the corresponding cysteines. The second helix contains the (L/I)(29)IEECKTS(36) sequence conserved in attractins from five species of Aplysia that could interact with the receptor. The sequence and structure of this region are similar to those of the recognition helix of the Er-11 pheromone of the unicellular ciliate Euplotes raikovi, suggesting a possible common pathway for intercellular communication of these two distinct pheromone families.

Amino Acid Sequence↗
PubMed2006

Cultural aspects of telepsychiatry.

Telepsychiatry may involve working with clinicians, patients and systems of care that are both geographically and culturally distinct. In this context, culturally appropriate care is an important component of telepsychiatry. The outline for cultural formulation from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides general principles for addressing these issues. Two components of the outline are particularly relevant in telepsychiatry: (1) how the cultural background of patients (i.e. their cultural identity) influences their comfort with technology; and (2) the effect of cultural differences on the patient-provider relationship. Cultural differences between patient and provider are often highlighted in telepsychiatry by the patient and provider location (e.g. rural versus urban differences). Familiarity with the rural community and regular contact and feedback are important. Future research should examine the effect of telepsychiatry on patient-provider relationships, patient attitudes towards care and, most importantly, patient outcomes.

Attitude of Health Personnel↗
PubMed2004

Psychometric properties of the STAT for early autism screening.

The STAT is an interactive screening measure for autism that assesses behaviors in the areas of play, communication, and imitation skills. In Study 1, signal detection procedures were employed to identify a cutoff score for the STAT using developmentally matched groups of 2-year-old children with autism and with nonspectrum disorders. The resulting cutoff yielded high sensitivity, specificity, and predictive values for the development sample as well as for an independent validation sample. Study 2 examined psychometric properties of the STAT and revealed acceptable levels of interrater agreement, test-retest reliability, and agreement between STAT risk category and ADOS-G classification. The STAT demonstrates strong psychometric properties and shows promising utility as a Level 2 screening measure for autism.

Autistic Disorder↗
PubMed1986

The DSM-III classification of the functional psychoses and the Norwegian tradition.

The relationship of the DSM-III categories to the national diagnostic usage of ICD is of importance for communication between psychiatrists. Here the theoretical relationship between the DSM-III categories and the Norwegian use of ICD-8 within the area of functional psychoses is discussed. An empirical investigation of these theoretical assumptions has been done on a hospital material diagnosed independently in the two classificatory systems. The empirical investigation gives support to the concordance of DSM-III schizophreniform, schizoaffective, and bipolar disorder and the Norwegian ICD-8 counterparts. The concordance is less for schizophrenic disorders and major depression. It is also found that the Norwegian diagnoses of reactive psychoses spread over many DSM-III diagnoses. In particular more of the reactive psychoses than predicted fall within the schizophrenic spectrum of DSM-III.

Affective Disorders, Psychotic↗
PubMed1985

Therapist response modes in prescriptive vs. exploratory psychotherapy.

Therapists' use of verbal response modes was compared in two forms of psychotherapy offered to 27 clients in a crossover design, where each client saw the same therapist throughout both treatments. This design isolated effects due to treatment techniques, specified in manuals followed by therapists, from those due to therapist or client differences. As predicted, therapists used more interpretation and exploration in an exploratory, relationship-oriented therapy, and asked more closed and open questions, and gave more general advisements and information, during a prescriptive, cognitive/behavioural therapy. The magnitude of the differences obtained ranged from a twofold to a sixfold difference in the percentages of each response mode offered in the two treatments. Also as predicted, therapists were more verbally active in the prescriptive therapy. These findings confirm previous research showing large differences in therapist contributions to different types of psychotherapy, demonstrating that these are not attributable to personal characteristics of therapists or clients.

Adult↗
PubMed1996

Capacity-building activities for local leadership in Egypt from the local to the national and regional levels.

In order to make the Sustainable Ismailia Project institutionally sustainable, the National Project Manager identified the need to build the capacity of local leadership. The Training Section, in UNCHS, proposed a capacity-building program designed to respond to this demand focusing on the skill-training and attitude formation needed for effective local leadership. The proposed program is adapted from the "Training for Elected Leadership" series widely tested and used in many regions. It combines direct training for local officials from villages in Ismailia, and indirect training for trainers from the Ministry of Local Administration (MLA). After the course, the MLA trainers would design a training program which they will implement nationally. The Minister for Local Administration decided to finance the translation and production of the manuals, while the Governor of Ismailia offered to cover the trainees' expenses. The UNCHS Training and Capacity-Building Section would provide technical guidance and coordinate and implement the program. Once the Arabic version of the training materials would be available, UNCHS would use it regionally to reach out to other Arab States. This example illustrates how concerned stakeholders cooperate to address capacity-building needs. The UNCHS Training Section assumes the role of facilitator and acts as a catalyst for the formulation of such activities. The feeling of ownership of the locally produced/adapted training materials enhances the propensity of their effective and extensive use. This approach has succeeded across regions, cultures, and languages with out-reaching multiplier effects.

Africa↗