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At least 1,423 records · Page 79Linked to original sources
PubMed2003

[Master sample and geoprocessing: technologies for household surveys].

OBJECTIVE: To reduce cost and time associated with household sampling process and to assess the feasibility of shared use of address data file of census enumeration areas in several epidemiological surveys using updated information from the National Survey of Households (PNAD). METHODS: Address data file comprising 72 census enumeration areas was kept as primary sampling units for the city of S o Paulo. During the period 1995-2000, three distinct household samples were drawn using the two-stage cluster sampling procedure. Geographic Information System (GIS) technology allowed delimiting boundaries, blocks and streets for any primary sampling unit and printing updated maps for selected sub-samples. RESULTS: Twenty-five thousand dwellings made up the permanent address data file of the master sample. A cheaper and quicker selection of each sample, plus gathering information on demographic and topographical profiles of census enumeration areas were the main contribution of the study results. CONCLUSIONS: The master sample concept, integrated with GIS technology, is an advantageous alternative sampling design for household surveys in urban areas. Using the list of addresses from the PNAD updated yearly, although limiting its application to the most populated Brazilian cities, avoids the need of creating an independent sampling procedure for each individual survey carried out in the period between demographic censuses, and it is an important contribution for planning sampling surveys in public health.

Censuses↗
PubMed2001

Post-marketing surveillance and vigilance for medical devices: the European approach.

The extent to which the medical device manufacturers are responsible for actively monitoring the performance of their products after they have successfully passed the rigorous pre-market approval process has always been a matter of diverse opinion. Within Europe, the law is unhelpfully vague on this point. While there are some comparatively clear obligations for reporting incidents to the authorities (known as the 'vigilance system'), little detail is given on how diligently the manufacturer should try to find out about such incidents. In the early stages of the European Community Directives covering medical devices, there was much emphasis upon formulating guidance to help interpret the vigilance reporting requirements. It is, however, only recently that attention has turned to attempting to clarify what is expected from post-marketing surveillance (PMS) in its broader sense. This article discuses both the vigilance and PMS processes and outlines the currently available European, and particularly UK, guidance documents which are aimed at promoting a more level playing field across industry where these activities are concerned. In particular, it explains the principle differences between vigilance and post-marketing surveillance: the former being the reporting of adverse incidents by manufacturers to the regulatory authorities and their subsequent sharing of key incident data between each other; the latter being the process by which information on overall devise performance is captured, analysed and acted upon. Nevertheless, it is still a struggle to gain widespread appreciation that these two activities are not in fact one and the same.

Equipment and Supplies↗
PubMed1993

Role of the dorsolateral pontine nucleus in two components of optokinetic nystagmus (OKN).

The anatomical features of the dorsolateral pontine nucleus (DLPN) implicate a role of the nucleus in the generation of smooth-pursuit eye movements. The DLPN receives convergent inputs from a variety of parieto-occipital cortical visual areas and projects its fibers to the flocculus and vermal lobules VI and VII. In addition to cortical afferent fibers, the DLPN receives descending fibers from the nucleus of the optic tract which is indicated as the first subcortical optokinetic nystagmus (OKN) relay. DLPN units respond not only to a discrete visual spot but also to large-field OKN stimuli. On the basis of the above anatomical and physiological features, OKN was investigated in 2 alert monkeys whose DLPN was physiologically identified and into which reversible lidocaine was injected. The present findings showed that a rapid rise in OKN velocity was reduced in both monkeys, whose lesions included the uppermost rostral part of the nucleus in the one monkey and the entire nucleus in the other, whereas optokinetic after-nystagmus velocity was affected only in the latter. Taken together with physiological data, the DLPN possibly shares the domain of low selectivity speed selection in OKN and does not play a main role in the generation of OKN.

Animals↗
PubMed2006

FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke.

OBJECTIVES: To determine whether routine oral nutritional supplementation of a normal hospital diet improves outcome after stroke (Trial 1); whether early tube feeding improves the outcomes of dysphagic stroke patients (Trial 2); and if tube feeding via a percutaneous endoscopic gastrostomy (PEG) results in better outcomes than that via a nasogastric tube (NG) (Trial 3). DESIGN: The Feed Or Ordinary Diet (FOOD) trial was a family of three pragmatic, randomised controlled trials (RCTs). They shared facilities for randomisation, data collection, follow-up and coordination. Patients could be co-enrolled in more than one of these trials. SETTING: Patients were enrolled in 131 hospitals in 18 countries. PARTICIPANTS: A total of 5033 patients who had been admitted to hospital with a recent stroke were enrolled in the trials between November 1996 and July 2003. INTERVENTIONS: In Trial 1, patients who could swallow within the first 30 days of admission were allocated to normal hospital diet versus normal hospital diet plus oral nutritional supplements (equivalent to 360 ml of 1.5 kcal/ml, 20 g of protein per day) until hospital discharge. In Trial 2, dysphagic patients enrolled within 7 days of admission were allocated to early enteral tube feeding versus avoid any enteral tube feeding for at least 1 week. In Trial 3, dysphagic patients were allocated within 30 days of admission to receive enteral tube feeding via PEG versus NG. MAIN OUTCOME MEASURES: Survival and the modified Rankin scale (MRS), a measure of functional outcome (grade 0 indicating no symptoms and grade 5 indicating severe disability, requiring help day and night). The primary outcomes were measured 6 months after enrollment, blind to treatment allocation, by the patient or their proxy completing a postal or telephone questionnaire. RESULTS: In Trial 1, 4023 patients were enrolled by 125 hospitals in 15 countries. Only 314 (7.8%) patients were judged undernourished at baseline. Vital status and MRS at the end of the trial were known for 4012 (99.7%) and 4004 (99.5%), respectively. Of the 2007 allocated normal hospital diet, 253 (12.6%) died, 918 (45.7%) were alive with poor outcome (MRS 3-5) and 823 (41.1%) had a good outcome (MRS 0-2). Of the 2016 allocated oral supplements, 241 (12.0%) died, 953 (47.3%) were alive with poor outcome and 813 (40.4%) had a good outcome. The supplemented diet was associated with an absolute reduction in risk of death of 0.7% (95% CI -1.4 to 2.7; p = 0.5) and a 0.7% (95% CI -2.3 to 3.8, p = 0.6) increased risk of death or poor outcome. In Trial 2, a total of 859 patients were enrolled by 83 hospitals in 15 countries. MRS at the end of the trial was known for 858 (99.9%). At follow-up, of 429 allocated early tube feeding, 182 (42.4%) died, 157 (36.6%) were alive with poor outcome (MRS 4-5) and 90 (21.0%) had a good outcome (MRS 0-3). Of 430 allocated avoid tube feeding 207 (48.1%) died, 137 (31.9%) were alive with poor outcome and 85 (19.8%) had a good outcome. Early tube feeding was associated with an absolute reduction in risk of death of 5.8% (95% CI -0.8 to 12.5; p = 0.09) and a reduction in death or poor outcome of 1.2% (95% CI -4.2 to 6.6; p = 0.7). In Trial 3, 321 patients were enrolled by 47 hospitals in 11 countries. Of 162 allocated PEG, 79 (48.8%) died, 65 (40.1%) were alive with poor outcome and 18 (11.1%) had good outcome. Of 159 allocated NG, 76 (47.8%) died, 53 (33.3%) were alive with poor outcome and 30 (18.9%) had good outcome. PEG was associated with an increase in absolute risk of death of 1.0% (95% CI -10.0 to 11.9; p = 0.9) and an increased risk of death or poor outcome of 7.8% (95% CI 0.0 to 15.5; p = 0.05). CONCLUSIONS: The results of Trial 1 would be compatible with oral supplementation being associated with a 1-2% absolute benefit or harm, but do not support routine supplementation of hospital diet for unselected stroke patients who are predominantly well nourished on admission. In Trial 2, the data suggest that a policy of early tube feeding may substantially reduce the risk of dying after stroke and it is very unlikely that the alternative policy of avoiding early tube feeding would significantly improve survival. Improved survival may be at the expense of increasing the proportion surviving with poor outcome. These data might usefully inform the difficult discussions about whether or not to feed a patient with a severe stroke. In Trial 3, the data suggest that in the first 2-3 weeks after acute stroke, better functional outcomes result from feeding via NG tube than PEG tube, although there was no major difference in survival. These data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients. Future research might be focused on making NG tube feeding safer and more effective, also studies need to confirm the increased risk of gastrointestinal haemorrhage associated with tube feeding and, if confirmed, establish whether any interventions might reduce this risk. Future work might also aim to establish why worse functional outcomes occurred in PEG-fed patients because patients with prolonged dysphagia or intolerance of an NG tube are inevitably fed via a PEG tube.

Aged↗
PubMed2004

Serial processing in melody identification and the organization of musical semantic memory.

Unlike the visual stimuli used in most object identification experiments, melodies are organized temporally rather than spatially. Therefore, they may be particularly sensitive to manipulations of the order in which information is revealed. Two experiments examined whether the initial elements of a melody are differentially important for identification. Initial exposures to impoverished versions of a melody significantly decreased subsequent identification, especially when the early exposures did not include the initial notes of the melody. Analyses of the initial notes indicated that they are differentially important for melody identification because they help the listener detect the overall structure of the melody. Confusion errors tended to be songs that either were drawn from the same genre or shared similar phrasing. These data indicate that conceptual processing influences melody identification, that phrase-level information is used to organize melodies in semantic memory, and that phrase-level information is required to effectively search semantic memory.

Auditory Perception↗
PubMedDate not supplied

Utilization of reinforcement contracts to increase written evidence of the nursing assessment.

This study investigated if nursing personnel would increase written evidence of the nursing process if favorable consequences were arranged. The charting of 23 nurses was observed and tabulated for a three-week period. These base-line data were averaged and shared with each nurse, at which time each nurse set a goal (relative to increased charting) and chose a reward contingent upon achieving that goal. During the next three weeks the nurses were again observed, at the end of which results were tabulated and rewards given. The two periods were repeated. Results showed a sharp increase in charting during each reinforcement phase and a fall off during the second base-line period that was lower than the first base-line. The target behavior, therefore, was found to be increased by systematic reinforcement.

Behavior Therapy↗
PubMed1999

Here is what you can do to protect patient privacy.

Although the free exchange of information is a necessary part of patient care, it's important to ensure that data aren't inadvertently shared with the wrong people. To avoid inappropriate disclosure, save patient-specific conversations for private areas, not hospital hallways or elevators. It's also important to take steps to keep case management forms secure, double-check requests for provider-to-provider faxes, and make sure post-discharge requests for information are routed through the health information management department. Case management departments also should have a confidentiality policy that defines how computerized files are maintained to prevent security breaches, how information releases are handled, and other aspects of information management.

Case Management↗
PubMed1999

Life support in the intensive care unit: a qualitative investigation of technological purposes. Canadian Critical Care Trials Group.

BACKGROUND: The ability of many intensive care unit (ICU) technologies to prolong life has led to an outcomes-oriented approach to technology assessment, focusing on morbidity and mortality as clinically important end points. With advanced life support, however, the therapeutic goals sometimes shift from extending life to allowing life to end. The objective of this study was to understand the purposes for which advanced life support is withheld, provided, continued or withdrawn in the ICU. METHODS: In a 15-bed ICU in a university-affiliated hospital, the authors observed 25 rounds and 11 family meetings in which withdrawal or withholding of advanced life support was addressed. Semi-structured interviews were conducted with 7 intensivists, 5 consultants, 9 ICU nurses, the ICU nutritionist, the hospital ethicist and 3 pastoral services representatives, to discuss patients about whom life support decisions were made and to discuss life-support practices in general. Interview transcripts and field notes were analysed inductively to identify and corroborate emerging themes; data were coded following modified grounded theory techniques. Triangulation methods included corroboration among multiple sources of data, multidisciplinary team consensus, sharing of results with participants and theory triangulation. RESULTS: Although life-support technologies are traditionally deployed to treat morbidity and delay mortality in ICU patients, they are also used to orchestrate dying. Advanced life support can be withheld or withdrawn to help determine prognosis. The tempo of withdrawal influences the method and timing of death. Decisions to withhold, provide, continue or withdraw life support are socially negotiated to synchronize understanding and expectations among family members and clinicians. In discussions, one discrete life support technology is sometimes used as an archetype for the more general concept of technology. At other times, life-support technologies are discussed collectively to clarify the pursuit of appropriate goals of care. CONCLUSIONS: The orchestration of death involves process-oriented as well as outcome-oriented uses of technology. These uses should be considered in the assessment of life-support technologies and directives for their appropriate use in the ICU.

Attitude of Health Personnel↗
PubMed1999

What every general practitioner should know about the laser vision correction revolution.

With tens of millions of Americans potential candidates for laser vision correction (LVC), increasing numbers of patients are asking their general practitioners for advice and information on this revolutionary procedure. The following article will provide general practitioners a broad view of LVC, including valuable data and resources to share with their patients. The latest techniques in LVC--including step-by-step descriptions of the procedures and clinical outcomes--are outlined in detail, along with what steps MCOs are taking to address this growing trend.

Astigmatism↗
PubMed2001

Cross-tool communication: from protocol authoring to eligibility determination.

To be effective, informatics tools for clinical trial protocols must inter-operate and share knowledge. We demonstrate a simple XML-based communication of eligibility criteria information between two independently-developed informatics tools. Using a shared DTD model of criteria, an authoring tool (developed within the Protégé environment) can send a list of eligibility criteria to a commercial system for automatic eligibility determination (the "iKnowChart" system by iKnowMed). The criteria model, developed as a Protégé ontology, includes both the terminology and the logic needed to compute eligibility for a given patient. As a demonstration of cross-tool communication, we have encoded criteria from an active clinical trial protocol (E1199), and shown how use of the authoring tool can effectively update the eligibility knowledge and the behavior of the commercial iKnowChart system. As part of the cross-tool knowledge sharing, we use Common Data Elements, an oncology terminology developed by the National Cancer Institute.

Clinical Protocols↗
PubMed1992

Analysis of United Network for Organ Sharing (UNOS) United States of America (USA) Pancreas Transplant Registry data according to multiple variables.

As of 1992, more than 4,200 pancreas transplants were reported to the International Pancreas Transplant Registry. Of these, more than 2,600 were performed in the United States, and of these, more than 2,100 have been transplanted since the inception of the UNOS Registry in October 1987. The analyses here are only of the UNOS data. Pancreas transplants performed in conjunction with a liver (either cluster or noncluster) or a heart were excluded from the analysis, and only those performed as a solitary procedure or in conjunction with a kidney were included. Emphasis was placed on those performed with the bladder drainage (BD) technique (96%). In the overall analysis of BD cadaveric pancreas transplants (n = 1,879), 1-year patient survival and pancreas graft function survival rates were 91% and 71%, respectively, 87% and 66% at 2 years, and 81% and 59% at 3 years. There were no differences according to gender, but 1-year graft survival rates were significantly higher in recipients 45 years or younger (72%) (n = 1,679) than in those older than 45 (64%) (n = 200). There were no significant differences according to graft preservation times of less than 12 (n = 749), 12-24 (n = 940), 24-30 (n = 79), and more than 30 (n = 9) hours, function rates at 1 year being 71%, 72%, 72%, and 44%, respectively. When analyzed according to the 3 major recipient categories (simultaneous pancreas/kidney transplants [SPK] [n = 1604]; pancreas after kidney transplants [PAK] [n = 166]; and pancreas transplants alone [PTA] [n = 109]), patient survival rates were no different (91%, 92%, and 92% at 1 year, respectively), but pancreas graft survival rates were significantly higher in the SPK than in the PAK and PTA categories (75%, 48%, and 49%, at 1 year, respectively). In the SPK group, kidney graft survival rates at 1 year were 84%. Outcomes were also compared according to whether induction immunotherapy included ALG, OKT3, or neither. In the SPK category, there was no difference among the protocols, with 1-year graft survival rates being 76% in the ALG (n = 838), 76% in the OKT3 (n = 416), and 72% in the Neither (n = 299) group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2004

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2005 rates. Final rule.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems; and to implement a number of changes made by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 that was enacted on December 8, 2003. In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 2004. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. Among the policy changes that we are making are: Changes to the classification of cases to the diagnosis-related groups (DRGs); changes to the long-term care (LTC)-DRGs and relative weights; changes in the wage data, labor-related share of the wage index, and the geographic area designations used to compute the wage index; changes in the qualifying threshold criteria for and the approval of new technologies and medical services for add-on payments; changes to the policies governing postacute care transfers; changes to payments to hospitals for the direct and indirect costs of graduate medical education; changes to the payment adjustment for disproportionate share rural hospitals; changes in requirements and payments to critical access hospitals (CAHs); changes to the disclosure of information requirements for Quality Improvement Organization (QIOs); and changes in the hospital conditions of participation for discharge planning and fire safety requirements for certain health care facilities.

Humans↗
PubMed2004

Get physicians on board with information and incentives.

Creating a physician-friendly approach to DM. It's a 'must' if you want to achieve optimal results, but getting physicians on board a DM initiative is no easy task. Find out how one Pennsylvania-based plan has gradually won its provider network over by streamlining its DM offerings, sharing claims and performance data, and offering one-on-one assistance to practices that want to improve.

Attitude of Health Personnel↗
PubMed2005

Software support in automation of medicinal product evaluations.

Medicinal product evaluation is one of the most important tasks undertaken by government health departments and their regulatory authorities, in every country in the world. The automation and adequate software support are critical tasks that can improve the efficiency and interoperation of regulatory systems across the world. In this paper we propose a software solution that supports the automation of the (i) submission of licensing applications, and (ii) evaluations of submitted licensing applications, according to regulatory authorities' procedures. The novelty of our solution is in allowing licensing applications to be submitted in any country in the world and evaluated according to any evaluation procedure (which can be chosen by either regulatory authorities or pharmaceutical companies). Consequently, submission and evaluation procedures become interoperable and the associated data repositories/databases can be shared between various countries and regulatory authorities.

Automation↗
PubMed2005

An ontology-based methodology for the migration of biomedical terminologies to electronic health records.

Biomedical terminologies are focused on what is general, Electronic Health Records (EHRs) on what is particular, and it is commonly assumed that the step from the one to the other is unproblematic. We argue that this is not so, and that, if the EHR of the future is to fulfill its promise, then the foundations of both EHR architectures and biomedical terminologies need to be reconceived. We accordingly describe a new framework for the treatment of both generals and particulars in biomedical information systems that is designed: 1) to provide new opportunities for the sharing and management of data within and between healthcare institutions, 2) to facilitate interoperability among different terminology and record systems, and thereby 3) to allow new kinds of reasoning with biomedical data.

Forms and Records Control↗
PubMed2006

Health-e-child: an integrated biomedical platform for grid-based paediatric applications.

There is a compelling demand for the integration and exploitation of heterogeneous biomedical information for improved clinical practice, medical research, and personalised healthcare across the EU. The Health-e-Child project aims at developing an integrated healthcare platform for European Paediatrics, providing seamless integration of traditional and emerging sources of biomedical information. The long-term goal of the project is to provide uninhibited access to universal biomedical knowledge repositories for personalised and preventive healthcare, large-scale information-based biomedical research and training, and informed policy making. The project focus will be on individualized disease prevention, screening, early diagnosis, therapy and follow-up of paediatric heart diseases, inflammatory diseases, and brain tumours. The project will build a Grid-enabled European network of leading clinical centres that will share and annotate biomedical data, validate systems clinically, and diffuse clinical excellence across Europe by setting up new technologies, clinical workflows, and standards. This paper outlines the design approach being adopted in Health-e-Child to enable the delivery of an integrated biomedical information platform.

Databases as Topic↗