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Evaluation of small pulmonary arteries by 16-slice multidetector computed tomography: Optimum slab thickness in condensing transaxial images converted into maximum intensity projection images.

OBJECTIVE: The purpose of this study was to determine the optimal slab thickness for condensing transaxial images into maximum intensity projection (MIP) images in the evaluation of small pulmonary arteries using 16-slice multidetector-row computed tomography (MDCT). METHODS: Helical computed tomography (CT) scans were obtained from lung apices to bases using 16-slice MDCT [120 kV(peak), 180 mA, beam width of 10 mm, beam pitch of 1.375, and reconstruction thickness of 1.25 mm] in 29 patients suspected of having a pulmonary embolism. Four kinds of image series (1.25-mm thick original transaxial source images and 3 kinds of reconstructed images using the MIP technique with slab thicknesses of 2.5 mm, 5 mm, and 10 mm) were obtained from each patient and forwarded to monitors of a picture archiving and communication system for analysis by 2 independent observers. The observers recorded the name of the segmental (20 total; 10 in each lung) and subsegmental (40 total; 20 in each lung) arteries that were traceable in each image series. Image quality of the 4 image types were graded into 5 scales based on their degree of vascular opacification, the sharpness of the vascular margins of the contrast-enhanced CT angiograms, and the visibility of lung parenchyma (excellent [5] to nondiagnostic [1]) and compared. RESULTS: In both the 1.25-mm thick original transaxial and 2.5-mm thick MIP images, a higher percentage of subsegmental arteries was traceable (91.3% [2119/2320 observations] and 87.2% [2023/2320 observations], respectively; P <0.05) than in the 5-mm and 10-mm thick MIP images (66.4% [1540/2320] and 40.5% [940/2320], respectively). No statistically significant difference was observed between the 1.25-mm thick transaxial and 2.5-mm thick MIP images in this respect. Image quality of 2.5-mm thick MIP images was superior to that of the 5-mm and 10-mm thick MIP images (P < 0.0001). No statistically significant difference was found between the scores of the image quality of the 1.25-mm thick original transaxial images and the 2.5-mm thick MIP images. CONCLUSION: After reducing the image number by one half, 2.5-mm thick MIP images using 16-slice MDCT are found to provide satisfactory images, which are comparable to 1.25-mm thick transaxial images for the analysis of subsegmental pulmonary arteries in patients suspected of pulmonary embolism.

Adult↗
PubMed2006

Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center.

BACKGROUND: Civilian and military mass casualty incidents (MCI) are an unfortunate reality in the 21st century, but there are few situational training exercises (STX) to prepare for them. To fill this gap, we developed a MCI STX for U.S. Army Forward Surgical Teams (FST) in conjunction with the U.S. Army Trauma Training Center. METHODS: After a standardized briefing, each FST has 60 minutes to unpack, setup, and organize a standard equipment cache into an emergency room, operating room, and intensive care unit. In an adjacent room, five anesthetized swine are prepared with standardized, combat-relevant injuries. The number and acuity of the total casualties are unknown to the FST and arrive in waves and without warning. A realistic combat environment is simulated by creating resource limitations, power outages, security breaches, and other stressors. The STX concludes when all casualties have died or are successfully treated. FSTs complete a teamwork self-assessment card, while staff and FST surgeons evaluate organization, resource allocation, communication, treatment, and overall performance. Feedback from each FST can be incorporated into an updated design for the next STX. RESULTS: From 2003-2005, 16 FSTs have completed the STX. All FSTs have had collapses in situational triage, primary/ secondary surveys, and/or ATLS principles (basic ABCs), resulting in approximately 20% preventable deaths. CONCLUSIONS: We concluded (1) a MCI can overwhelm even combat- experienced FSTs; (2) adherence to basic principles of emergency trauma care by all FST members is essential to effectively and efficiently respond to this MCI; (3) by prospectively identifying deficiencies, future military or civilian performance during an actual MCI may be improved; and (4) this MCI STX could provide a template for similar programs to develop, train, and evaluate civilian surgical disaster response teams.

Animals↗
PubMed2003

Differences between patient and staff perceptions of aggression in mental health units.

OBJECTIVE: This study examined the views of patients and staff involved in incidents of aggression to help understand emotions experienced, perceptions of causes, and recommendations for ways of reducing the frequency of aggression. METHODS: A total of 29 staff and 29 patients from four psychiatric inpatient units who were involved in 47 incidents of aggression over a four-month period were interviewed shortly after the incidents. RESULTS: Significant differences were found between staff and patient perceptions of the causes of aggression and recommendations for reducing it. Many staff members perceived the patient's illness as the cause of the aggression and believed that, to manage aggression, changes in medication were largely indicated. In contrast, patients perceived illness, interpersonal factors, and environmental factors as being almost equally responsible for their aggression, and nearly all patients emphasized the need for improved staff-patient communication and more flexible unit rules in helping reduce aggression. Patients and staff were generally satisfied with the way the aggressive incidents were managed, but more staff than patients had an opportunity to debrief. CONCLUSIONS: Staff and patients had different perceptions of causes of aggression and ways to reduce it. Staff supervision and training should highlight the need for understanding patients' perspectives.

Adult↗
PubMed2003

Biomarkers in drug discovery and development: from target identification through drug marketing.

Biomarkers of disease play an important role in medicine and have begun to assume a greater role in drug discovery and development. The challenge for biomarkers is to allow earlier, more robust drug safety and efficacy measurements. Their role in drug development will continue to grow for the foreseeable future. For biomarkers to assume their rightful role, greater understanding of the mechanism of disease progression and therapeutic intervention is needed. In addition, greater understanding of the requirements for biomarker selection and validation, biomarker assay method validation and application, and clinical endpoint validation and application is needed. Biomarkers need to be taken into account while the therapeutic target is still being identified and the concept is being formulated. Biomarkers need to be incorporated into a continuous cycle that takes what is learned from the discovery and development of one series of biomarkers and translates it into the next series of biomarkers. Optimum biomarker development and application will require a team approach because of the multifaceted nature of biomarker selection, validation, and application, using such techniques as pharmacoepidemiology, pharmacogenetics, pharmacogenomics, and functional proteomics; bioanalytical method development and validation; disease process and therapeutic intervention assessments; and pharmacokinetic/pharmacodynamic modeling and simulation to improve and refine drug development. The potential for biomarkers in medicine and drug development will be limited by the least effective component of the processes. The team approach will minimize the potential for the least effective component to be fatal to the rest of the process. As scientific/regulatory foundations for biomarkers in medicine and drug development begin to be established, successes and applications will need to be effectively communicated with all of the stakeholders, including not only internal and external drug developers and regulators but also the medical community, to ensure that biomarkers are totally integrated into drug discovery and development as well as the practice of medicine.

Biomarkers↗
PubMed1999

Incidence of very mild to severe dementia and Alzheimer's disease in Denmark: the Odense Study.

OBJECTIVE: Calculation of incidence of dementia and AD, including cases in the earliest phases of the diseases. BACKGROUND: Establishment of incidence estimates is important for the future planning of the health care system, and incidence studies can offer insights into risk factors. METHODS: A total of 5,237 persons age 65 to 84 years were randomly drawn among people living in the municipality of Odense, Denmark. Of this sample 3,086 persons were eligible for the incidence study. All participants were examined with CAMCOG, the cognitive section of The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), and the follow-up period was 2 years. Using multiple linear regression, the CAMCOG cutoff score was individualized to detect even minor cognitive decline with optimal precision. Possibly demented persons were further examined with the remaining part of the CAMDEX and neuropsychological tests. AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable AD, and vascular dementia and dementia of other types were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria for dementia. Finally, the severity of dementia was determined according to the Clinical Dementia Rating scale. RESULTS: The incidence rate for very mild to severe dementia was 29.5 per 1,000 person-years and 20.9 for AD, and the rates were similar for men and women. CONCLUSION: Application of an individualized cutoff for the screening instrument resulted in detection of a substantial number of cases with very mild dementia, which subsequently resulted in higher incidence rates than those reported in most other studies.

Age Distribution↗
PubMed2003

Dying in the ICU: perspectives of family members.

OBJECTIVE: To describe the perspectives of family members to the care provided to critically ill patients who died in the ICU. DESIGN: Multicenter, prospective, observational study. SETTING: Six university-affiliated ICUs across Canada. METHODS: Patients who received mechanical ventilation for > 48 h and who died in the ICU were eligible for this study. Three to four weeks after the patient's death, we mailed a validated questionnaire to one selected family member who made at least one visit to the patient in the ICU. We obtained self-rated levels of satisfaction with key aspects of end-of-life care, communication, and decision making, and the overall ICU experience. MAIN RESULTS: Questionnaires were mailed to 413 family members; 256 completed surveys were returned (response rate, 62.0%). In the final hours before the death of the patient, family members reported that patients were "totally comfortable" (34.8%), "very comfortable" (23.8%), or "mostly comfortable" (32.0%). Family members felt "very supported" (57.0%) and "supported" (30.7%) by the health-care team. Most (82.0%) believed that the patient's life was neither prolonged nor shortened unnecessarily. Most family members (90.4%) preferred some form of shared decision making. Overall, 52% of families rated their satisfaction with care as "excellent," 31% rated care as "very good," 10% as "good," 4% as "fair," and 2% as "poor." Overall satisfaction with end-of-life care was significantly associated with completeness of information received by the family member, respect and compassion shown to patient and family member, and satisfaction with amount or level of health care received. CONCLUSIONS: The majority of families of patients who died in participating ICUs were satisfied with the end-of-life care provided. Adequate communication, good decision making, and respect and compassion shown to both the dying patient and their family are key determinants to family satisfaction.

Aged↗
PubMed2000

Treatment refusal: analysis of 15 cases.

BACKGROUND: In this paper, we investigate the reasons for treatment refusal at Linkou and Kaohsiung Chang Gung Memorial Hospitals, and offer ways to improve the doctor-patient relationship. METHODS: Cases were collected during a 2-year period according to the criterion of notification of "refused treatment" on consultation sheets, with a total of 1631 consultation sheets. All cases were discussed once a week in detail by psychiatrists and the consulting medical staff, and were followed up from 1 to 4 weeks. All cases were treated by the processes of informed consent and crisis intervention. The final results for the reasons of treatment refusal and psychiatric diagnoses were made by psychiatrists and the consulting medical staff. RESULTS: The number of cases compatible with the criterion was 15 (10 men and 5 women). The reasons for treatment refusal included poor communication, inadequate information, lack of competency, denial and shock reaction, reappearance of the suffered experience, and autonomy of patients. The distribution of psychiatric diagnoses included 8 with major depressive disorders, 2 with delirium, 1 with schizophrenic disorder, 1 with adjustment disorder, 1 with acute stress disorder (post-traffic accident), 1 with alcohol dependence, and 1 was deferred. After adequate processes of informed consent and crisis intervention, 12 persons accepted medical treatment. CONCLUSION: We should give patients adequate informed consent and crisis intervention to establish a good doctor-patient relationship and to respect the patients' autonomy for their choice of treatment.

Adolescent↗
PubMed2005

Health promotion in occupational health.

OBJECTIVES: To describe a Swedish approach to occupational health and its implications for health promotion. METHODS: We start business with a new customer by creating a health policy for the whole company. Every year a follow-up is presented to top management where decisions are taken on what to do for the coming period. RESULTS: The result from a paper mill is presented where cost savings were five times more than expected. We have found that close follow-up and the use of personalized reminders is very useful for individuals. We have also found the importance of working more with "the softer side" i.e. looking into a person's total life situation. Management training activities are essential. This training includes for instance personality, communication and conflict handling seminars and every manager has to go through those seminars. The focus is moved from sick care to health improvement. The result is measured in long-term health for individuals. To reach that level you have to be healthy and have no absences for at least two years. CONCLUSION: The Swedish occupational health system is a unique system for creating health. With a specially trained staff including MDs, nurses, physiotherapists, psychologists, management consultants and engineers, and working from prevention to treatment, they can create a total view of both individual health and customer company wealth. Working closely together in teams and in close cooperation with customers, they can initiate great changes in both these dimensions.

Administrative Personnel↗
PubMed1997

A study on biliary ductal system and bile fistula in the American alligator, Alligator mississippiensis.

The anomalous arrangement of bile ducts in the Crocodylia has not been fully appreciated. A clear understanding of biliary anatomy is necessary in order to create complete bile drainage in these reptiles. The object of this study was to clarify the anatomy of the bile ductal system and to establish total bile fistulas in the American alligator, Alligator mississippiensis. Bile duct anatomy was studied in 104 juvenile alligators, and bile fistulas were constructed in seven alligators. In 93 out of 104 (89%) of the juveniles dissected there was an interconnection between the right and left hepatic duct before the right hepatic duct emptied into the gallbladder. The left hepatic duct then entered the duodenum independently of the cystic duct which drained the gallbladder directly into the duodenum. In 8% of the animals, the left hepatic duct did not enter the duodenum but joined with the right duct, forming a common hepatic duct that emptied into the gallbladder. In 3% of the cases, the right hepatic duct emptied into the gallbladder, while the left duct had no communication with the right hepatic duct and drained separately into the duodenum. This arrangement of bile ducts is similar to that seen in birds and reflects the common ancestry of crocodiles and birds. In other reptiles, the biliary system shows much more variability and is different from the alligator. In five of seven alligators in which total biliary diversion was attempted, the biliary catheter remained in place and stayed patent from 2-7 weeks. Bile flow was extremely low (1.5-2.5 ml/24 h) when compared to that of mammals (80-100 ml/24 h). This study demonstrates the variable nature of the biliary ductal system in Alligator mississippiensis and suggest a method for constructing an effective total bile fistula in these animals.

Alligators and Crocodiles↗
PubMed1998

The role of the general practitioner in the community care of people with HIV infection and AIDS: a comparative study of high- and low-prevalence areas in England.

BACKGROUND: Policy for the care of people suffering from HIV and AIDS has changed over the past decade. Schemes for shared primary and secondary care have been met with varying success, and patients may be reluctant to become involved. No systematic evaluation comparing the views of primary care providers and users in areas of varying HIV prevalence has been published. AIM: To examine the role of general practice in areas of England with low and high human immunodeficiency virus (HIV) prevalence and to compare barriers to general practice care in each area. METHOD: We used focus groups, semistructured questionnaires and interviews in north London (high HIV prevalence) and Nottingham (low HIV prevalence). RESULTS: Four focus groups took place in London. A total of 411 general practitioners (GPs) in London and 405 in Nottingham replied to postal questionnaires. Overall, 121 primary care staff in 40 London practices and 26 staff in five Nottingham practices were interviewed. In all, 54 people infected with HIV were interviewed in London and 20 in Nottingham. Providers and users regarded the 24-hour availability and the familiar environment of general practice as its key assets. Lack of expertise and time were its disadvantages. Providers were concerned about inadequate communication with specialist services. Although providers were concerned about confidentiality, whether they had liberal and sympathetic attitudes was more important in deciding whether people with HIV used the service. In the low-prevalence area, general practice involvement was the result of individual initiatives, and practices were not integrated into specialist care. In the high-prevalence area, HIV care was more usual in general practice, but there was also little integration with HIV services. CONCLUSIONS: In high-prevalence districts, a strategy to make HIV care routine for all GPs may be appropriate. In low-prevalence areas, a network of selected, strategically located, relatively high-involvement practices may be more effective in meeting the primary care needs of people with HIV infection and acquired immunodeficiency syndrome (AIDS).

Community Health Services↗
PubMed2001

Topiramate on ictal seizure semiology: a quantitative, randomized, low and medium dose-controlled study.

OBJECTIVE: Intensive and quantitative evaluation of the severity and frequency of seizures and ictal signs during topiramate (TPM) treatment. METHODS: Twenty patients with refractory partial seizures undergoing presurgical evaluation were randomized into a low dosage (100 mg daily) and a parallel medium dosage (200 mg daily) group of TPM add-on medication. Study phases included a 3-day baseline video-EEG phase, a 10-day TPM titration phase without video-EEG and a 3-day TPM dose maintenance phase with video-EEG. During the baseline and the dose maintenance phase seizures were recorded using video-EEG monitoring and the following parameters were measured: duration (lasting seconds of each seizure and ictal sign), intensity (on a 0-3 scale), N/24 h (numbers of attacks per 24 h), D/24 h (duration per 24 h) of both seizures and defined ictal signs. RESULTS: A total of 399 seizures during the baseline phase and the dose maintenance phase were intensively analyzed. Intergroup comparison suggested that duration, N/24 h and D/24 h of all seizures decreased more in the medium dosage group computing the reduction from baseline to the dose maintenance phase (P<0.05). There were statistically more significant reductions in the duration, intensity and N/24 h of ictal signs like hypermotoric movements, fumbling and vocalization in the medium dosage group (P<0.05). CONCLUSION: Topiramate has an early dose-dependent effect on ictal seizures. SHORT COMMUNICATION: The present study intensively analyzed the duration, intensity, N/24 h and D/24 h of ictal seizure manifestations. The quantitative data suggested that topiramate had an early effect on ictal phenomena like ictal hypermotoric movements, fumbling and vocalization (P<0.05); effects were more prominent in the medium dosage group (200 mg daily) than the low dosage group (100 mg daily).

Adolescent↗
PubMed2006

Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients.

BACKGROUND: Health care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences in the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received. METHODS: A cross-sectional survey was conducted of a population-based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African-American (n = 66), and white (n = 92) women age > or = 55 years (total n = 257) and who were between 3-9 months after their primary breast carcinoma diagnosis. RESULTS: Approximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African-Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician-patient communication, social support, and health variables. Compared with African-American and white women, Latina women were more likely to identify a family member as the final treatment decision-maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43-26.20, for less acculturated Latinas; and AOR of 4.48; 95% CI, 1.09-18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast-conserving surgery (BCS) when the family made the final treatment decision (AOR of 0.39; 95% CI, 0.18-0.85). CONCLUSIONS: Family appears to play a powerful role in treatment decision-making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate patients' family members as potential key participants in medical decision-making, rather than merely as translators and providers of social support.

Black or African American↗
PubMed1996

[Traumatic hemarthrosis of the knee joint--clinical significance of nuclear magnetic resonance tomography].

A prospective study was performed on 94 patients with hemarthrosis of the knee to assess the value of MR imaging (MRI) in detection of bleeding sources and selection of therapy modalities. Patients were examined clinically within a week after knee trauma; the investigations performed included puncture of the joint to confirm hemarthrosis, a conventional X-ray to exclude fractures, MRI and arthroscopy. MRI was performed for diagnosis of acute lesions, definition of bleeding sources by morphological criteria, and allocation of patients to conservative or surgical therapy. Arthroscopy was performed to control MRI, to visualize bleeding sources, and to maintain therapy if necessary. The 94 patients were found on arthroscopy to have a total of 123 bleeding sources, which were correctly defined by MRI in each of 107 cases as an acute lesion communicating with the joint space; 16 bleeding sources were not found and there were 10 false-positive reports. In keeping with our treatment strategies, arthroscopy disclosed lesions requiring surgical therapy in 77 of 94 patients (82%) and lesions that would be adequately treated by conservative therapy in 17 of 94 patients (18%). MRI predicted surgical or conservative therapy correctly before arthroscopy in 83 of 94 patients (88%). In conclusion, MRI has a high predictive value in definition of acute lesions that will lead to hemarthrosis of the knee. This noninvasive method allows screening out of the relatively small portion of patients without severe lesions, who then do not have to be subjected to further invasive therapy.

Adolescent↗
PubMed2004

Hormone replacement therapy and health behavior in postmenopausal polio survivors.

OBJECTIVES: Little is known about menopause and hormone replacement therapy (HRT) use in women with disabilities. The objectives of this study were to explore the health behaviors, health outcomes, and efficacy of HRT in a group of postmenopausal polio survivors and to compare selected outcomes to nationally representative cohorts. METHODS: One hundred and thirty-one postmenopausal polio survivors completed self-report surveys on health behaviors, HRT use, functional status, and psychosocial well-being. During a physical examination, fasting cholesterol and body mass index (BMI) were collected. Independent sample t-tests and Chi-square analysis were used to compare HRT users and non-users on health behaviors and health outcomes; logistic regression was used to predict HRT use. RESULTS: Prevalence of HRT use was 58%. Only BMI predicted HRT use (OR = 0.30, CI: 0.11-0.81). HRT users had better high density lipoprotein (HDL), low density lipoprotein, total cholesterol/HDL ratios, lower BMIs, were more confident when communicating with their physicians, more likely to discuss menopause with their physician, and experienced greater overall stress. HRT was not associated with health behavior, health-related quality of life, mood, or life satisfaction. Compared to non-disabled women, more of these women had higher total cholesterol, obesity, more sleeping problems, and were less likely to vigorously exercise or smoke. CONCLUSIONS: HRT did not confer substantial benefits in these postmenopausal polio survivors to warrant them using HRT at a higher rate than their non-disabled peers. Comparisons to their non-disabled peers suggested they may be at higher risk for adverse health problems associated with postmenopause.

Adult↗
PubMed2006

Effects of androgens on behavioral and vomeronasal responses to chemosensory cues in male terrestrial salamanders (Plethodon shermani).

Chemosensory stimuli and sex steroid hormones are both required for the full expression of social behaviors in many species. The terrestrial salamander, Plethodon shermani, is an emerging nonmammalian system for investigating the nature and evolution of pheromonal communication, yet little is known regarding the role of sex steroid hormones. We hypothesized that increased circulating androgen levels in male P. shermani enhance chemoreception through morphological, behavioral, and physiological mechanisms. Experimental elevation of plasma androgens increased development of cirri, morphological structures thought to enhance the transfer of chemosensory cues from the substrate to the vomeronasal organ (VNO). Elevated plasma androgens also increased expression of a chemo-investigatory behavior (nose tapping) and increased preference for some female-derived chemosensory cues. Male-produced courtship pheromones activated a large number of cells in the VNO as measured by the method of agmatine uptake. However, androgen levels did not affect the total number of vomeronasal cells activated by male-produced courtship pheromones. Future studies will determine whether androgens potentially modulate responsiveness of the VNO to female-derived (as opposed to male-derived) chemosensory cues.

Analysis of Variance↗
PubMed2006

Litigation in otolaryngology - trends and recommendations.

BACKGROUND: Seeking to identify where litigious claims against otolaryngologists are targeted (i.e. areas of highest risk) within the NHS and private sector would have positive implications in risk management and limiting the amount of litigation against otolaryngologists. METHOD: The National Health Service Litigation Authority (NHSLA) and Medical Defence Union (MDU) were contacted and anonymous data obtained on claims within ENT. RESULTS: 887 claims were notified - 457 NHSLA and 430 MDU. The commonest claim in both groups was failure or delay in diagnosis (12 per cent NHSLA, 23 per cent MDU). The other commonest claims were all related to complications (nerve damage 10 per cent, deafness 8 per cent and dental damage 5 per cent). Dissatisfaction with results was 8 per cent total and, within the private sector, was almost exclusively in rhinology. CONCLUSIONS: This study once again emphasizes the need for thorough clinical assessment, record keeping and good communication with patients. Recognising these areas of highest risk may limit future claims.

Humans↗
PubMed2003

A follow-up of medical graduates of a problem-based learning curriculum.

INTRODUCTION: There is little information available on the effects of problem-based undergraduate curricula on doctors and their performances after graduation. Therefore, we conducted a questionnaire study of all graduates of the new medical programme at the Faculty of Health Sciences, Linköping University. METHODS: All 446 medical students who had graduated from the new programme were asked to fill in a questionnaire about selected activities during their studies and their careers after graduation. They were also asked to evaluate the quality of their undergraduate education retrospectively. Statistical analysis was performed using descriptive, multivariate and bivariate approaches. RESULTS: A total of 77% of the graduates responded. They showed a high degree of overall contentment with their undergraduate education and felt well prepared for professional life during their preregistration period and specialist education (mean = 4.0 on a 6-point Likert scale ranging from 0 to 5). They felt especially well prepared in terms of skills for communication with patients, collaboration with other health professionals and development of critical thinking/scientific attitudes. The students' age at the beginning of their studies correlated positively with their contentment as graduates, especially in terms of preparation for patient communication and collaboration with other health professionals. No differences between students originally admitted via a local admission procedure and those admitted via a national procedure were detected concerning retrospective evaluation of undergraduate medical education. CONCLUSION: Graduates of the new curriculum showed a high degree of satisfaction with their undergraduate education and its preparation of them for medical practice. Specifically, they were very content with the particular emphases of the new curriculum.

Adult↗
PubMed1998

Stroke risk factors and development of collateral flow in carotid occlusive disease.

BACKGROUND AND PURPOSE: Blood flow through collateral vessels compensates for reduced blood flow through stenotic or occluded extracranial carotid arteries. Previous studies have shown that extent of collateral flow influences likelihood of stroke and its outcome. Here we analyzed the relationship between stroke risk factors (hypertension, coronary artery disease, diabetes mellitus, tobacco smoking and hypercholesterolemia) and number of patent intracranial collaterals detected by transcranial Doppler ultrasonography. SUBJECTS AND METHODS: We studied 182 patients with various degrees of angiography proven unilateral stenosis of the internal carotid artery. Contribution of the anterior and posterior communicating arteries to the perfusion of the cerebral hemisphere on the side of the stenosis or occlusion was evaluated by a series of compression tests performed during continuous insonation of the middle cerebral artery. The number of detected collateral vessels was correlated with analyzed stroke risk factors. RESULTS: Subjects with stenosis more than 75% or occlusion of the internal carotid artery had a higher frequency of two major intracranial collateral vessels (P< or =0.01 and P< or =0.001, respectively). Hypertensive patients with stenosis more than 75% or total carotid occlusion were more likely to have only a single collateral vessel than patients without hypertension (P< or =0.01 and P< or =0.05, respectively). Other risk factors did not influence the patency of preformed collateral vessels. CONCLUSIONS: Hypertension hindered the development of preformed intracranial collateral vessels in our patients with carotid occlusive disease.

Aged↗