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PubMedDate not supplied

Patients report positive impacts of collaborative care.

Collaborative Care refers to a partnership between healthcare professionals and patients who feel confident to manage their health conditions. Using an Internet-based assessment of health needs and healthcare quality, we surveyed 24,609 adult Americans aged 19 to 69 who had common chronic diseases or significant dysfunction. In these patients, we examined the association of Collaborative Care with specific measures for treatment effect, disease control, prevention, and economic impacts. These measures were adjusted for respondents' demographic characteristics, burden of illness, health behaviors, and overall quality of healthcare. Only 21% of respondents participated in good Collaborative Care, 36% attained fair Collaborative Care, and 43% experienced poor Collaborative Care. Regardless of overall care quality or the respondents' personal characteristics, burden of illness, or health behaviors, good Collaborative Care was associated with better control of blood pressure, blood glucose level, serum cholesterol level, and treatment effectiveness for pain and emotional problems. Some preventive actions were better, and some adverse economic impacts of illness were mitigated.

Adult↗
PubMed2002

Benchmarks for the forward observables at RHIC, the Tevatron-run II, and the LHC.

We present predictions on the total cross sections and on the rho parameter for present and future pp and (-)pp colliders, and on total cross sections for gammap-->hadrons at cosmic-ray energies and for gammagamma-->hadrons up to sqrt[s]=1 TeV. These predictions are based on an extensive study of possible analytic parametrizations invoking the largest hadronic dataset available at t=0. The uncertainties on total cross sections reach 1.9% at the Relativistic Heavy Ion Collider, 3.1% at the Tevatron, and 4.8% at the Large Hadron Collider, whereas those on the rho parameter are, respectively, 5.4%, 5.2%, and 5.4%.

Journal Article↗
PubMed1993

Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption--I.

This WHO collaborative project is the first phase of a programme of work aimed at developing techniques for early identification and treatment of persons with hazardous and harmful alcohol consumption. The aim of the present study was to determine the prevalence of hazardous and harmful alcohol use among patients attending primary health care facilities in several countries, and to examine the correlates of drinking behaviour and alcohol-related problems in these culturally diverse populations. The broader purpose was to determine whether there was justification for developing alcohol screening instruments for cross-national use. One thousand, eight hundred and eighty-eight subjects in Australia, Bulgaria, Kenya, Mexico, Norway and the USA underwent a comprehensive assessment of their medical history, alcohol intake, drinking practices, and any physical or psychosocial problems related to alcohol. After non-drinkers and known alcoholics had been excluded, 18% of subjects had a hazardous level of alcohol intake and 23% had experienced at least one alcohol-related problem in the previous year. Intrascale reliability coefficients were uniformly high for the drinking behaviour (dependence) and adverse psychological reactions scales, and moderately high for the alcohol-related problems scales. There were strong correlations between the various alcohol-specific scales, and between these scales and measures of alcohol intake. Although the prevalence of hazardous and harmful alcohol consumption varied from country to country, there was a high degree of commonality in the structure and correlates of drinking behaviour and alcohol-related problems. These findings strengthen the case for developing international screening instruments for hazardous and harmful alcohol consumption.

Adult↗
PubMed1999

The World Health Organization International Consortium in Psychiatric Epidemiology (ICPE): initial work and future directions -- the NAPE Lecture 1998. Nordic Association for Psychiatric Epidemiology.

OBJECTIVE: To provide an overview of the World Health Organization (WHO) International Consortium in Psychiatric Epidemiology (ICPE), to introduce the World Mental Health 2000 (WMH2000) Initiative and to discuss methodological issues that the ICPE is grappling with in planning the WMH2000 Initiative. METHOD: We review the history, mission and organization of the ICPE and the rationale behind the WMH2000 Initiative. We review methodological research underlying major design and implementation decisions regarding the WMH2000 surveys. RESULTS: The ICPE is an international consortium created to facilitate cross-national comparative epidemiological research using the WHO Composite International Diagnostic Interview (CIDI). The first-phase core ICPE surveys, which we are currently analysing, include over 33 000 interviews in seven countries, with an additional set of over 30 000 interviews in seven countries ready to be added to the master file within the next year. The WMH2000 Initiative will include a third series of CIDI surveys that include an anticipated 100000 additional interviews in 10 countries. A series of complex methodological challenges confront us in designing and implementing the WMH2000 surveys. These include issues in the conceptualization and measurement of impairment and disablement, the implementation of standardized quality control procedures across countries, and the blending of epidemiological and clinical interviewing methods to obtain a valid cross-national characterization of disorder prevalences. Our current plans regarding these issues are discussed. CONCLUSION: Valid and representative general population epidemiological data on patterns, predictors and adverse consequences of psychiatric disorders are needed as a foundation for public health initiatives. The efforts of the ICPE promise to provide data of this sort for many regions in the world. Formidable methodological and logistical challenges arise in implementing this agenda, but we are confident that these challenges can be met by building on the firm foundation already established in the ongoing ICPE collaboration.

Data Collection↗
PubMedDate not supplied

Infection control education for undergraduates.

Healthcare-associated infection (HCAI) is recognised as a major and increasing problem to health (Scottish Executive 2002a). National strategies are being considered to address the problem. This article describes how one Scottish higher education institution collaborated to identify, adapt and implement the Cleanliness Champions programme--a national infection control educational initiative--in established undergraduate nursing and midwifery curricula. The result was that undergraduate nursing and midwifery students were included in the national campaign to tackle HCAI in Scotland.

Attitude of Health Personnel↗
PubMed2006

[Subclinical Cushing's syndrome in adrenal incidentalomas].

In the heyday of high-tech medicine, the incidental discovery of an adrenal mass is a frequent event owing to the routine use of sophisticated radiological techniques. The potential harm to health associated with incidentally discovered cortical adenoma, the most frequent tumor among adrenal incidentalomas, is unclear at present. Incidentally discovered adrenal adenoma may secrete cortisol autonomously, in a way that is no longer under close control by pituitary feedback, in 5 to 20% of cases. At present, data are insufficient to estimate the outcome of patients with subclinical Cushing's syndrome. However, evidence is gathering that subclinical Cushing's syndrome may contribute to develop the phenotype of insulin resistance thus portending to atherosclerosis and relevant cardiovascular complications. It is tempting to speculate that subclinical Cushing's syndrome represents a very mild variant of endogenous glucocorticoid excess syndrome. Even if progression to overt glucocorticoid excess is rare, subclinical Cushing's syndrome has the potential to carry an adverse prognosis. At present, data are insufficient to indicate the superiority of a surgical or nonsurgical approach to manage patients with subclinical hyperfunctioning adrenal cortical adenoma. It is of the utmost importance to establish collaborative prospective studies with clearly defined entry criteria and standardized evaluation protocols and treatment modalities to appraise the natural history and long-term morbidity of clinically inapparent adrenal adenoma and subclinical Cushing's syndrome.

Adrenal Cortex Neoplasms↗
PubMed1993

An international comparative study of HIV prevalence and risk behaviour among drug injectors in 13 cities. WHO Collaborative Study Group.

Although reported rates of human immunodeficiency virus (HIV) infection and related risk behaviours among drug injectors vary considerably throughout the world, and comparison of findings is often hampered by methodological variability among centres. In 1989 the World Health Organization initiated a comparative study of current drug-injecting behaviour and HIV infection using a standardized methodology. Centres were asked to recruit at least half of their samples outside drug treatment settings in order to achieve as representative a group of injectors as possible. Respondents were interviewed using a questionnaire designed by an international working group, and they were asked to provide blood and/or saliva specimens for voluntary testing. Data from 13 centres (Athens, Bangkok, Berlin, Glasgow, London, Madrid, Naples, New York, Rome, Rio de Janeiro, Santos, Sydney and Toronto) are reported here. A total of 6,390 injectors were recruited to the study from October 1989 to March 1992, with sample sizes ranging from 85 at Santos (Brazil) to 1,300 in New York. Weekly or daily sharing of injecting equipment was reported by less than a quarter of injectors in all centres. A high proportion of those sharing made some effort to clean equipment before use, although not always by efficient methods. In all centres, the majority of respondents were sexually active; however, rates of unprotected sexual intercourse were high, particularly between regular sexual partners. The overall HIV prevalence rate was 22 per cent, ranging from 0 per cent in Athens to 60 per cent in Santos. Caution should be exercised in postulating a link between HIV prevalence and current risk behaviour, particularly since injectors appear to behave in similar ways across a diverse range of study locations. This is the first report on an international collaborative study for which a large number of injectors were successfully recruited from a variety of settings. The wealth of data now available provides a greater understanding of the social epidemiology of drug injecting, which is essential for the implementation and evaluation of campaigns and interventions designed to limit the spread of HIV infection.

AIDS Serodiagnosis↗
PubMed2005

An integrative approach to the biomechanical function and neuromuscular control of the fingers.

The exquisite mechanical functionality and versatility of the human hand emerges from complex neuro-musculo-skeletal interactions that are not completely understood. I have found it useful to work within a theoretical/experimental paradigm that outlines the fundamental neuro-musculo-skeletal components and their interactions. In this integrative paradigm, the laws of mechanics, the specifications of the manipulation task, and the sensorimotor signals define the interactions among hand anatomy, the nervous system, and manipulation function. Thus, our collaborative research activities emphasize a firm grounding in the mechanics of finger function, insistence on anatomical detail, and meticulous characterization of muscle activity. This overview of our work on precision pinch (i.e., the ability to produce and control fingertip forces) presents some of our findings around three Research Themes: Mechanics-based quantification of manipulation ability; Anatomically realistic musculoskeletal finger models; and Neural control of finger muscles. I conclude that (i) driving the fingers to some limit of sensorimotor performance is instrumental to elucidating motor control strategies; (ii) that the cross-over of tendons from flexors to extensors in the extensor mechanism is needed to produce force in every direction, and (iii) the anatomical routing of multiarticular muscles makes co-contraction unavoidable for many tasks. Moreover, creating realistic and clinically useful finger models still requires developing new computational means to simulate the viscoelastic tendinous networks of the extensor mechanism, and the muscle-bone-ligament interactions in complex articulations. Building upon this neuromuscular biomechanics paradigm is of immense clinical relevance: it will be instrumental to the development of clinical treatments to preserve and restore manual ability in people suffering from neurological and orthopedic conditions. This understanding will also advance the design and control of robotic hands whose performance lags far behind that of their biological counterparts.

Biomechanical Phenomena↗
PubMed1999

RAG-2 promotes heptamer occupancy by RAG-1 in the assembly of a V(D)J initiation complex.

V(D)J recombination occurs at recombination signal sequences (RSSs) containing conserved heptamer and nonamer elements. RAG-1 and RAG-2 initiate recombination by cleaving DNA between heptamers and antigen receptor coding segments. RAG-1 alone contacts the nonamer but interacts weakly, if at all, with the heptamer. RAG-2 by itself has no DNA-binding activity but promotes heptamer occupancy in the presence of RAG-1; how RAG-2 collaborates with RAG-1 has been poorly understood. Here we examine the composition of RAG-RSS complexes and the relative contributions of RAG-1 and RAG-2 to heptamer binding. RAG-1 exists as a dimer in complexes with an isolated RSS bearing a 12-bp spacer, regardless of whether RAG-2 is present; only a single subunit of RAG-1, however, participates in nonamer binding. In contrast, multimeric RAG-2 is not detectable by electrophoretic mobility shift assays in complexes containing both RAG proteins. DNA-protein photo-cross-linking demonstrates that heptamer contacts, while enhanced by RAG-2, are mediated primarily by RAG-1. RAG-2 cross-linking, while less efficient than that of RAG-1, is detectable near the heptamer-coding junction. These observations provide evidence that RAG-2 alters the conformation or orientation of RAG-1, thereby stabilizing interactions of RAG-1 with the heptamer, and suggest that both proteins interact with the RSS near the site of cleavage.

Base Sequence↗
PubMed1997

[The intervention center at the Rikshospital. Experiences from the first year of activity].

In order to co-ordinate and promote the development of new clinical applications by structuring collaboration and communication across traditional specialty boundaries, a first of its kind hospital department was opened at Rikshospitalet in June 1996. The Interventional Centre is a multidisciplinary centre for research and development, teaching and quality management of imaging-guided minimally invasive therapy, endoscopic surgery and interventional radiology. The department is a full fusion of state-of-the art operating theatre with an advanced radiology department and with fully up-to-date ultrasound and endoscopy facilities for integrated use in the treatment of the patient. The department is cross-disciplinary organised. A small staff of 14 persons are responsible for the day-to-day running of the centre. Specialists from other hospital departments work together with the centre's permanent staff to develop new procedures. During the first year, 19 research projects were started and a total of 510 procedures performed within the fields of Radiology, Neurosurgery, Gastroenterology, Cardiology, Cardiovascular surgery and Paediatric cardiology, and also within the fields of image processing and telecommunication.

Centralized Hospital Services↗
PubMed2004

[Laparoscopy: potential and limitations in outpatient and short-term inpatient surgery].

Many laparoscopic operations can usually be performed on an outpatient or at least short-term inpatient basis. Since the postoperative risk is easily estimated and can be determined on the 1st or 2nd postoperative day, it quickly becomes clear whether the healing process will be undisturbed or complications will occur. Prerequisites are comprehensive information to the patient as well as his cooperation and that of his social setting. From a medical standpoint, suitable administrative and infrastructural conditions must be arranged that enable safe, efficient preop preparation and guarantee reliable postoperative care of the patient. The newly begun shift in the German health care delivery system toward outpatient and short-term inpatient treatment must be introduced carefully and step by step, since the resultant reduction in postoperative inpatient care goes hand in hand with reduced patient comfort and without question places a greater burden on the patient's social setting.Clearly, optimal collaboration with local doctors is necessary to accompany this nationwide reduction in hospital stay, and the distribution of responsibility among the various physicians must be clarified. However, independently these elements, the success of outpatient and short-term inpatient laparoscopy still can be guaranteed only by surgeons' high experience and minimal complications.

Ambulatory Surgical Procedures↗
PubMed1998

[Nosocomial urinary tract infections: retrospective study in a pediatric hospital].

Urinary tract infections (UTI) are the most frequent nosocomial infection in the adult, yet very few data are available concerning these infections in children. In a retrospective 1-year study in a paediatric hospital, we analysed the incidence of nosocomial UTI and the characteristics of the affected children. The incidence was of 1.97/1,000 admissions which represented 6.8% of all UTI diagnosed by the microbiology laboratory. Most cases were in surgery and neurology wards. The frequency was inversely proportional to the age, with 50% of children being less than 2 years old. Pathogens most frequently isolated were E coli (39%), Pseudomonas sp (12.1%) and Enterococcus sp (12.1%). When compared with the organisms found in all the urine cultures during the same period, two organisms were more frequently found in nosocomial urinary tract infections: Pseudomonas sp and Candida sp. Most patients presented one or more risk factors, mainly:bladder catheterisation (41.4%), prior antibiotic therapy (62%), cerebral palsy (6.9%). No bacteriema was observed. The diagnosis of nosocomial UTI must be interpreted with caution and needs close collaboration between microbiologists and paediatricians. These infections increase the cost of hospitalisation, but only exceptionally do they present with complications. Some risk factors are inherent in hospital conditions, but others can be reduced by improving hand washing or by changing catheterisation practices.

Adolescent↗
PubMedDate not supplied

A body-system approach to infection control and discharge planning.

Discharge planning is a complex process that must address all patient needs, including safety and infection control. A tremendous amount of collaboration and consideration of all factors that impact on utilization, quality assurance, and discharge planning are necessary from the infection control nurse and discharge planning nurse. The Joint Commission on Accreditation of Healthcare Organizations has adopted standards to address timely and smooth transitions of patients to appropriate posthospital care. Infection control policies must address these standards.

Aged↗
PubMed2000

Eradication of a resistant Pseudomonas aeruginosa strain after a cluster of infections in a hematology/oncology unit.

OBJECTIVES: This report chronicles an outbreak of a multiply resistant strain of Pseudomonas aeruginosa and the measures required to contain this outbreak. METHODS: Laboratory-based ward-liaison surveillance allowed the detection of a multiply resistant strain of P. aeruginosa infecting patients in our hematology/oncology unit. Sampling of the immediate environment was carried out. Pulsed field gel electrophoresis was used to compare the patients' organisms with those found in the environment. Extensive dismantling of the drainage system, repeated cleaning and disinfection, and a review of the departmental antibiotic policy were some of the infection control measures instigated. RESULTS: During a period of 11 months, three patients in the hematology department and two patients in the oncology department were infected with multiply resistant P. aeruginosa. There were two cases of pneumonia, one of which was fatal, and two cases of neutropenic septicaemia. Pulsed field gel electrophoresis performed on the isolates showed that the isolates from geographically separate areas could be divided into two strains that were closely related but distinct. Two genotypically identical strains were also isolated from the plumbing systems in the areas of each ward where patients had been treated. CONCLUSIONS: The potential for serious nosocomial infections with P. aeruginosa is well recognized. Eradication of the organism from the environment may require the co-ordinated efforts of clinicians, nurses, pharmacy and hospital engineers, working in collaboration with the hospital infection control team. To date, the same strains have not been isolated despite repeated surveillance over the past 18 months and therefore these measures have, in our opinion, successfully removed the potential for nosocomial infection with this resistant organism in our hospital.

Bacteremia↗
PubMedDate not supplied

Joining forces, joining futures: hospice at the crossroads.

Faced with health-policy changes, increased competition, and limited funding, hospices must either find more efficient ways to provide end-of-life care or risk organizational demise. Increasingly, hospices are re-evaluating their organizations to stretch resources and remain viable. Prevalent restructuring options for addressing environmental pressures are integration, alliance, and collaboration with other organizations. This study examines the restructuring phenomenon by evaluating trends among nonprofit hospices in six states. The study identifies demographic characteristics predictive of organizational decisions to join forces, and it examines the dominant political and economic reasons that propel or impede restructuring decisions. In addition, the study evaluates the results of restructuring actions.

Analysis of Variance↗
PubMed2005

Atherosclerotic plaque in carotid arteries in systemic lupus erythematosus: frequency and associated risk factors.

CONTEXT AND OBJECTIVE: Atherosclerotic disease is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. No previous study has estimated carotid disease prevalence in such patients in Brazil. The aim was to evaluate the prevalence of atherosclerotic plaque in carotid arteries, in SLE patients and controls, and to verify possible associations between risk factors and carotid plaque. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo--Escola Paulista de Medicina. METHODS: Carotid plaque prevalence was assessed by B-mode ultrasound in 82 female SLE patients of mean age 34.0 years and 62 controls of mean age 35.7 years. Plaque was defined as a distinct area of hyperechogenicity and/or focal protrusion of the vessel wall into the lumen. Risk factors for coronary disease and SLE-related variables were determined. RESULTS: 50% of patients and 29% of controls presented carotid plaque. Older age, longer disease duration, higher Systemic Lupus International Collaborating Clinics (SLICC) score, higher levels of low-density lipoprotein and greater diabetes, obesity, premature ovarian failure and family history of coronary artery disease were found in patients with carotid plaque than in those without plaque. Patients with plaque were younger than controls with plaque. SLE diagnosis, obesity, older age, higher SLICC score and longer disease duration were independent risk factors for carotid plaque. CONCLUSION: Young patients with SLE present higher prevalence of carotid plaque than controls. SLE diagnosis was a significant risk factor for carotid atherosclerosis.

Adolescent↗
PubMed2001

Hepatitis services at an injecting drug user outreach clinic.

AIMS: To provide a culturally appropriate, accessible and affordable hepatitis outreach clinic for injecting drug users, a traditionally hard-to-reach population. METHODS: The community-based clinic, a collaborative project between the Wellington Drugs and Health Development Project and Capital Coast Health, was established in Wellington in 1997. Characteristics of the first 100 injecting drug users with hepatitis C assessed through the clinic are presented. RESULTS: Of 51 patients found to be hepatitis C positive, five have received hepatitis C treatment, four at the outreach and one at a base hospital. 25 have been vaccinated for hepatitis B. The clinic has established trust and rapport with the injecting-drug-user community. CONCLUSIONS: The hepatitis outreach clinic is an innovative project, crossing the primary/secondary interface of health services provision and providing personal health services within a public health initiative. The success of this model indicates potential value in offering outreach hepatitis clinics for injecting drug users in the major cities to close a gap in health service provision.

Adult↗
PubMed1993

[Clinical epidemiology of an outbreak of nosocomial infection caused by Staphylococcus aureus resistant to methicillin and aminoglycosides: efficacy of control measures. Comité de Control de Infecciones].

BACKGROUND: The appearance of outbreaks of nosocomial infections due to methicillin resistant Staphylococcus aureus (MRSA) is a current problem in Spain. The clinical and molecular epidemiology of these outbreaks as well as the efficacy of their control measures are a matter of controversy. METHODS: An outbreak of MRSA nosocomial infections in the Hospital Clínic i Provincial of Barcelona, a 953-bed University Hospital, with a total of 347 cases from September 1989 to October 1991 is described. The control measures used include prospective and continued surveillance of all MRSA isolations, identification of the reservoir, use of different types of isolation and control of nasal carriers among health care workers. The MRSA strains isolated were studied by standard microbiological procedures, phage-typing and extrachromosomal (plasmid) DNA analysis by means of restriction endonuclease analysis (REAP). RESULTS: From the Intensive Care Units, the outbreak extended to the medical and surgical wards. Seventy-one percent of the cases corresponded to infected patients and 29% to asymptomatic carrier patients. The MRSA strain responsible of the outbreak had a notable antibiotic multiple-resistance pattern. The studies performed showed that most of the strains belonged to phage group III and were lysed by phage 77. Plasmid DNA analysis showed that 95% of the strains isolated had a unique homogeneous profile. Despite the different control measures used, the MRSA infection has acquired a medium level endemic rate in the Hospital Clínic i Provincial. CONCLUSIONS: The introduction and spread of methicillin-resistant MRSA in a teaching hospital with more than 500-bed may be rapid and affecting large number of patients. Effective control measures carries multiple problems, which must be addressed with the collaboration of all hospital employees. The molecular typing techniques used (REAP) further identified that the outbreak is due to one single MRSA strain, with an epidemiologic behavior identical to the one showed by the epidemic strains previously described in the United Kingdom and Australia.

Aminoglycosides↗