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PubMed1993

[Peroxidation of human high density lipoproteins by oxygen-derived free radicals].

The involvement of low density lipoprotein (LDL) peroxidation in atherogenesis is now admitted. The oxidation of high density lipoproteins (HDL) could contribute to the atherogenic process, by limiting their capacity to accept cholesterol from cell membranes. In this work, we studied the human HDL peroxidation initiated by OH. or OH./O2.- free radicals generated by gamma radiolysis. This method allows a quantitative and selective production of free radicals, and the resulting oxidation is less drastic than the chemical one. HDL oxidation was followed, as a function of the radiation dose, by the disappearance of endogenous vitamin E, the formation of thiobarbituric acid-reactive substances (TBARS) and the fluorescence at 440 nm. Human HDL turned out to be oxidizable by hydroxyl free radicals and oxygen potentiated this effect. The oxidative modification of HDL, leading to a rigidification of the HDL envelop, could contribute to reduce the ability of HDL to stimulate efflux of cholesterol from tissues.

Free Radicals↗
PubMedDate not supplied

Cervical spine arthrodesis in rheumatoid arthritis: a long-term follow-up.

Forty-one patients with rheumatoid arthritis involving the cervical spine had a posterior cervical arthrodesis. They were followed for a minimum period of seven years. The diagnoses prior to surgery included cranial settling, atlantoaxial subluxation, subaxial subluxation, and any combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone graft. In addition, one patient had an anterior vertebrectomy, and two had transoral resection of the odontoid. Follow-up consisted of a subjective questionnaire, standard radiographs, and physical examination, including a neurologic exam. This information was compared to preoperative data available in the patient's medical record, postoperative data, and the information obtained in a similar study undertaken in 1987. At the time of follow-up, thirteen patients were known to be dead. One patient could not be located. Of the remaining twenty-six patients, eighteen underwent the full examination, including physical exam and radiographs. The remaining nine patients were contacted and interviewed, but were unavailable for exam and radiographs. All patients considered the operation a success. Only one patient at follow-up had a non-union. This was stable over time. No patient had a deterioration in neurologic function. There was no significant degeneration or instability seen at levels adjacent to the fused segments as compared to the rest of the cervical spine. Posterior cervical spine arthrodesis for rheumatoid involvement of the neck is a safe, efficacious procedure with no significant deterioration of effects over time.

Arthritis, Rheumatoid↗
PubMed1993

Comparison of image quality and mean absorbed dose to the breast for two mammographic films.

A film intended for mammography (Kodak SO 155 MRH-1) was tested and compared to one (Kodak SO 177 Ortho M) used earlier. Both films including the cassette could resolve 20 lp/mm. For a processing time of 90 s the new film gave the same overall image quality and irradiation dose to the breast as the old system. If, instead, the processing time was increased to 150 s, a 43% reduction in kerma could be attained with the new film. With a developing temperature of 36 degrees C and 150 s processing time, the noise is clinically acceptable. A nonparametric test showed no significant difference between the 2 films on the 0.01 level. At an X-ray tube potential difference of 25 kV, the mean absorbed dose to a 4.5-cm-thick breast was reduced from 1.7 mGy with the old combination to 1.0 mGy with the new one. The measurements were made with a moving grid.

Humans↗
PubMed1995

Impediments to developing wide area networks in health care.

The availability and prominence of telecommunication technology has spurred research into generic wide area health care networks. Electronic exchange of patient data supposedly results in cost efficiencies, increased accessibility to health care resources, and improved delivery of health care services. Although a number of pilot networks have been built, none yet have a broad, heterogeneous base of users and applications. Properties of the health care process and delivery system delay the acceptance of generic wide area networks and end-user computer applications. As the technical problems seem well understood, it seems advisable to investigate these factors in telemedical research.

British Columbia↗
PubMed1994

[Sutures in reconstructive procedures in biliopancreatic surgery].

The question of the suture technique in digestive surgery as in reconstructive biliopancreatic surgery remains of interest to all surgeons throughout the world. On the basis of the biochemical process in anastomose healing the author accepted the one-layer operative technique as a routine. The dilemma was only in pancreatic reconstructive surgery, where the two-layer technique was also performed. Minimal postoperative morbidity with no mortality justifies our stand. Our conclusion is based on 241 operated patients in a ten years period.

Anastomosis, Surgical↗
PubMed1997

Cooperative learning in the clinical setting.

The modern clinical practice setting presents nurses with challenges about which they must think critically and develop increasingly autonomous problem-solving approaches. It is essential to provide nursing students with opportunities to practice critical thinking so that they can develop this crucial skill. Cooperative learning strategies are interactive teaching methods that stimulate students to think critically, communicate effectively with peers, and accept responsibility for learning through group process activities. Group care planning is one such cooperative strategy that also promotes a positive attitude about care planning and sharpens time management skills. Cooperative assessment and care planning foster the development of critical thinking and effective problem resolution, preparing students for patient care problems they will likely encounter in future positions.

Education, Nursing, Continuing↗
PubMed1997

A case for diagnoses.

It is common practice to record treatment rendered, but not the diagnostic basis for these treatment decisions. This practice appears to undervalue diagnosis, as well as hamper feedback to practitioners and the profession about the effectiveness of treatments relative to specific diagnoses. It also leaves dentists open to liability for litigation and impedes research. A case is made that dentistry should follow medicine in exploring the use of standardized computer-codable diagnoses as part of record keeping. A two-step process is suggested to promote initial acceptance.

Decision Making↗
PubMed1998

[Determination of the usefulness of selected biochemical parameters for assessing the advanced atheromatous changes in human coronary arteries].

It is generally accepted that atherosclerosis is a dynamic process in which many factors of lipid, hemostatic or other nature play their negative and positive roles. The purpose of the study was to determine the relationship between the atheromatous changes in coronary arteries being assessed angiographically and the lipid and hemostatic risk factors, as well as to select biochemical parameters, which would be helpful for prognosing the degree of intensity with regard to atheromatous changes in coronary arteries. Studies of lipid parameters and hemostasis system were performed in 31 men with atherosclerosis of coronary vessels being angiographically estimated. The degree of intensity concerning the atheromatous changes was defined in a point scale according to Gensini based on the magnitude of coronary artery stenosis and its localization in respect of significance for myocardial function. The studied patients were divided into two groups, which differed by the degree of the intensity of atheromatous changes in coronary arteries: group I--men with mild (M-CAD, score < 32) n = 15, group II--men with severe atherosclerotic changes (S-CAD, score > or = 32) n = 16. The characteristics of both groups are given in table 1. All patients were on nitrates, salicylates, beta-blockers and calcium channel blockers. No antilipemics or anticoagulants were administered. The following biochemical parameters were determined in all men: cholesterol-Ch; triglycerides-TG; phospholipids-PL; apolipoproteins: Apo A, Apo A-I, Apo B; lipoproteins: VLDL, LDL, HDL and their lipids and proteins components; lipoprotein (a)-Lp(a); fibrinogen-Fb; euglobulin lysis time-ELT; inhibitor tissue plasminogen activator PAI-1; antithrombin III--AT III; spontaneous platelet aggregation-SPA, platelet factor 4-PF 4 and glucose. Table 2 lists the lipid parameters in serum and lipoprotein fractions. The levels for apolipoproteins A, A-I, B, lipoprotein (a), hemostatic parameters and glucose are given in table 3. Tables 4 and 5 present the results of multiple regression analysis for severity of atherosclerotic changes (score--dependent variable y) lipid and hemostatic parameters and glucose (independent variables x) in both groups. Prognostic variables necessary for the best fit in the model of relationship studied have been selected. Independent variables x are listed in descending order according to the absolute value of b*x. On the basis of the performed statistical analysis of the results of studies it has been ascertained that the biochemical parameters differentiating the patients with regard to the intensity of atheromatous changes are the coefficients: LDL-Ch/HDL-Ch and Apo B/Apo A ratio, LDL-PL, Fb and ELT whose values were higher as well as HDL-Apo A-I whose value was lower in the group of men with more severe atherosclerotic changes in coronary arteries (S-CAD). The stepwise multivariate analysis indicates that the most profound prognostic significance in risk of coronary atherosclerosis is claimed successively by: glucose, LDL-PL, HDL-Apo A-I, AT III, Fb, ELT, PAI-1, SPA, Lp(a), Apo B and PF 4. The results of the accomplished studies point out that the above-mentioned lipid, hemostatic parameters and glucose may be helpful in prognosing the severity of coronary atherosclerosis.

Adult↗
PubMed2005

[The processes of manuscript evaluation and publication in Medicina Clínica. The editorial committee of Medicina Clínica].

The decision-making process includes a series of activities undertaken in biomedical journals from the moment a manuscript is received until it is accepted or rejected. Firstly, the manuscript is evaluated by the members of the Editorial Board, who analyze both its suitability for the journal and its scientific quality. After this initial evaluation, the article is evaluated by peer reviewers, an essential process to guarantee its scientific validity. Both the Editorial Board and the peer reviewers usually use checklists which are of enormous help in this task. Once the biomedical article has been accepted, the publication process is started, which in turn includes a series of steps, beginning with technical and medical review of the article's contents and ending with the article's publication in the journal. The present article provides a detailed description of the main technical and ethical issues involved in the processes of decision-making and publication of biomedical articles.

Authorship↗
PubMed2005

Impact of a transfer center on interhospital referrals and transfers to a tertiary care center.

BACKGROUND: The partnership of faculty physicians and senior clinical hospital administrators in the decision to accept interhospital transfers has not been fully studied. Transfers to academic medical centers on the basis of economics have been of particular concern. OBJECTIVES: To evaluate the impact of joint decision making on transfer acceptance, and to evaluate the basis for decisions to transfer patients to an academic medical center. METHODS: This was a database study of requested adult interhospital transfers, excluding psychiatric transfers, occurring between January 1, 2003, and December 31, 2003, by using data from a computerized patient-tracking system. Where possible, comparisons with the prior calendar year (i.e., prior to implementation of the administrative review process) were made. Incidence of refusal to accept requested transfers and payer mix of transfer patients were the main outcomes of interest. RESULTS: More than 90% of the adult patients were transferred for conditions that required tertiary care or met Emergency Medical Treatment and Labor Act (EMTALA) requirements. The patient conditions that did not meet tertiary care needs included obstetric patients who did not have prenatal care, patients who had hand and facial trauma, and patients who weighed more than 300 pounds. The payer mix of transfer patients remained stable when using the administrator and physician team to determine acceptance of transfers. During the evaluation period, approximately 91,500 patients statewide lost some level of Medicaid coverage. CONCLUSIONS: The value of an administrator and physician team as partners in the interhospital transfer process was demonstrated. Active management of interhospital transfers supports transfer of patients who require tertiary care or who meet EMTALA criteria, thus conserving limited bed capacity and ensuring financial equity, while caring for the uninsured and underinsured patients throughout the state.

Adult↗
PubMed1992

The quality of medical science.

Is the quality of science aimed at understanding and treating disease inferior to more basic investigations of basic biology, or does the different quality of medical science reflect a distinct nature? This duality in the meaning of quality is central to any critique of the quality of medical science. The nature of medical science, which deals with the dysfunction of integrated genetic, epigenetic, environmental, or stochastic phenomenon, is distinct from that of basic science which seeks to describe discrete biological processes. In physical sciences it is generally accepted that there are practical boundaries between disciplines such as quantum physics, thermodynamics, and chemistry even though, in theory, such investigations are related. In meteorology, the development of chaos theory establishes that there are even theoretical limits to the ability to predict large scale processes from their essential, constituent processes. So too, the quality of medical science may be distinct from that of basic biology.

Attitude↗
PubMed1989

Absence of effect in stochastic processes: its influence on test validation and test use.

Negativity in stochastic processes presents problems in interpretation because it is never possible to attain an absolutely adequate assurance of safety with such processes. Thus, it is extremely difficult to have complete confidence in the utility of validation studies of new methods in comparison to those that are accepted to be well established, especially when these processes are stochastic in the statistical sense of this term. The regulatory scientist who must make decisions on the basis of available evidence, therefore, has to make a number of assumptions in dealing with negativity. It is important to review the validity and usefulness of these assumptions from time to time to ensure that they cannot be replaced by improved methodology in the light of new scientific knowledge.

Animals↗
PubMed1992

The role of grades in gaining admission to highly selective medical schools.

The authors examine the role of grades in the admission decisions at a group of 19 highly selective medical schools by analyzing over 8,000 applications from Cornell University students for the entering medical school classes of 1982 through 1989. The results illustrate the great influence of the grade-point average (GPA) on the admission decision. Between the GPA levels of 3.0 and 3.8, the chance of acceptance increased by a factor of about two for each increment of .2 in the GPA. For a subset of the nine most selective of the 19 institutions, the chance of acceptance increased by a factor of five for each increment of .2. At these nine schools, of 1,157 applications with a GPA of less than 3.4, only four were approved. The authors suggest the evidence indicates that students often receive encouragement to continue the application process even though the chances of eventual acceptance are negligible.

Educational Status↗
PubMed2000

Angulation errors in parallel-hole and fanbeam collimators: computer controlled quality control and acceptance testing procedure.

UNLABELLED: Angulation errors in collimators of 1 degrees or even less can seriously diminish the resolution of SPECT images. We have developed a computer-controlled quality control procedure that can be used for acceptance testing and regular routine checks. METHODS: Using a marker point source and a computer-controlled x-y positioning table, we investigated 7 parallel-hole and 3 fanbeam collimators. The results are presented as collimator surface maps, which are easy to interpret visually. RESULTS: The measurement accuracy for absolute angulation errors was better than 0.32 degrees. Regional variations in channel tilt could be detected with an accuracy better than 0.16 degrees. Six parallel-hole collimators were found acceptable for high-resolution SPECT imaging. For a parallel-hole collimator that had to be replaced because of nonoptimal image quality, our measurements clearly identified regions of directionally uniform angulation errors. Two fanbeam collimators showed slight concavities. CONCLUSION: Automation of the measurement and evaluation process make this procedure suitable for both acceptance tests and routine quality control checks. It can be applied to parallel-hole, fanbeam, converging, and diverging collimators, regardless of their individual geometry. No technical collimator specifications are needed. Our results reveal subtle mechanical deformations of collimators. They also show that for a detailed investigation, angulation error surface maps should be used to discover regional preferences in channel orientation.

Equipment Design↗
PubMed1993

Assessing the quality of pharmaceutical care. II. Application of concepts of quality assessment from medical care.

OBJECTIVE: To present a framework that facilitates quality assessment of pharmaceutical care (PC) so that the profession and the public may identify pharmacists in ambulatory settings who provide quality care in all aspects of the their practices. DATA SOURCES: A MEDLINE search augmented by a review of International Pharmacy Abstracts was used to identify pertinent quality assessment and pharmacy practice literature; indexing terms included quality assurance, healthcare, pharmacists, community pharmacy services, ambulatory, pharmacy, and process and outcome assessment. STUDY SELECTION: All identified quality assessments of community pharmacy practice were considered. Studies that documented the effectiveness of specific pharmacist activities and patient satisfaction were also included. DATA EXTRACTION: The literature was independently reviewed by the primary author. DATA SYNTHESIS: The structure-process-outcome paradigm is presented as a framework for quality assessment of PC. Structure should be assessed at periodic intervals because it identifies the potential for the provision of quality care. Process, the care that pharmacists provide, must be documented and linked to outcomes before either structure or process can be used to make inferences about the quality of PC. Technical and interpersonal processes should be examined. Outcomes require an interdisciplinary approach that not only considers other medical care inputs but also recognizes the psychologic, economic, and social factors that affect health status and quality of life. Process and outcome must both be assessed to distinguish the contribution of pharmacists from that of other healthcare providers. Examples of criteria are provided and a model to integrate PC within the healthcare system is discussed. CONCLUSIONS: It is pharmacists' duty to ensure that patients receive an acceptable level of PC. The structure-process-outcome paradigm provides a framework to identify and link pharmacists' processes with patients' outcomes.

Ambulatory Care↗
PubMedDate not supplied

Validating existing data in the Environmental Technology Verification Program.

Establishing the credibility of existing data is an ongoing issue, particularly when the data sets are to be used for a secondary purpose, i.e., not the original reason for which they were collected. If the secondary purpose is similar to the primary purpose, the potential user may have little difficulty establishing credibility since the acceptance criteria for both purposes should be similar. If the secondary purpose is different, then data credibility may be more difficult to establish because the experiment generating the data may not have been conducted optimally for the secondary purpose and all of the necessary quality assurance data ("metadata") may not have been collected. In either case, a process will be required to determine the acceptability of the data. For this reason, at the time the U.S. Environmental Protection Agency (EPA) Environmental Technology Verification (ETV) program was established, similar certification and verification programs run by states or foreign countries routinely used existing data sets, for cost reasons, rather than generate new data by testing. The issue of whether existing data could be used in the ETV program immediately surfaced. In response, a policy and a process that addressed existing data were written and published in Appendix C of the ETV Quality and Management Plan (Hayes et al., 1998). This paper discusses how the ETV program determines the credibility of existing data used to verify the performance of environmental technologies.

Data Interpretation, Statistical↗
PubMed1999

Use of two varieties of hard-to-cook beans (Phaseolus vulgaris) and cowpeas (Vigna unguiculata) in the processing of koki (a steamed legume product).

Koki is a nutritious cowpea-based food product usually processed by steam cooking whipped cowpea (Vigna unguiculata) paste mixed with spices and palm oil. A study was carried out to investigate the effect of the partial replacement of cowpeas (CP) with hard-to-cook (HTC) beans on the chemical, nutritional and sensory characteristics of koki. Towards this objective, two varieties of beans--Phaseolus vulgaris (red kidney beans--RKB and mottled brown beans--MBB), each with the HTC defect, were separately incorporated into cowpea paste in the following Bean:CP ratios 0:100, 20:80, 30:70, 40:60, 50:50, 60:40 and processed into koki. Incorporation of dry HTC beans into cowpeas in the making of koki affected the bulking properties of the uncooked paste, the nutrient composition, essential amino acid content, antinutritional factors, digestibility as well as the sensory attributes of cooked koki. Sensory tests showed that a highly acceptable, nutritious and digestible koki can be processed from cowpeas partially replaced with dry HTC bean paste up to levels of about 40-50% depending on the variety of dry bean used.

Amino Acids↗
PubMed1999

Secondary mechanisms in traumatic brain injury: a nurse's perspective.

Effective management of brain-injured patients requires that nurses have a specialized body of knowledge relating to the pathophysiology and treatment of traumatic brain injury (TBI). Current research in this area has focused on the cascade of secondary injury which leads to the irreversible tissue damage following TBI. Such processes involve excitatory amino acids, neurotransmitters, ion changes, lipid peroxidation, oxygen free radicals, opioids, lactic acidosis and magnesium to name but a few. Given that no accepted treatment paradigm exists to attenuate these secondary processes, nurses may have to autonomously devise individual care plans based on their current understanding of brain injury pathophysiology.

Brain Injuries↗