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At least 145 records · Page 8Linked to original sources
PubMed1990

[Cardiovascular risk factors. An audit of their detection in primary care].

After having found that the prevalences of hypertension, hypercholesterolemia, obesity and smoking were low in our adult population on care, we developed a study to investigate the causes of the problem and to introduce measures for its solution following the methodology of the medical audit. The indexes showed that the performance of preventive cardiovascular activities (PCVA) was low: blood pressure measurement 45%, blood cholesterol determination 23%, height and weight measurement 8% and questioning on smoking habits 40%. After the implementation of corrective measures, indexes of 79%, 76%, 71% and 56%, respectively, have been achieved. In addition, a defective recording of the detected risk factors was found: 87% in the clinical history record, 72% in the age and sex card; after the corrective measures, the rates were 98% and 91% respectively. The present study demonstrates the effectiveness of quality control measures carried out by the professionals responsible for care to improve its quality.

Age Factors↗
PubMed1999

Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) were isolated from clinical specimens from 130 to 140 patients/year in 1989-1991 in our hospital. In February 1992, a control program was initiated: screening tests in 3 intensive care units (ICUs) and contact-isolation precautions in all units. The septic surgical unit served as an isolation ward for surgical patients from whom ESBLPE was isolated. In 1992, the incidence of ESBLPE acquisition failed to decrease, and most acquisitions occurred in 3 ICUs. Critical evaluation of implementation of isolation procedures in these ICUs prompted corrective measures for barrier precautions. The incidence of acquired cases subsequently decreased, and a second evaluation determined that these measures had been correctly applied. The incidence of acquired cases in the septic surgical unit was lower than those in the other units. Decreases were also found in the incidence of acquisition of other hand-transmitted multidrug-resistant organisms. Barrier precautions, screening tests for ICU patients, and grouping of cohorts after ICU discharge are effective in controlling the spread of multidrug-resistant microorganisms by cross-contamination. The outbreak was effectively controlled without restricting antimicrobial use.

Anti-Bacterial Agents↗
PubMedDate not supplied

Variability in radiographic measurement of bowleg deformity in children.

The tibial metaphyseal-diaphyseal (MD) and tibial-femoral (TF) angles were measured on the radiographs of 33 knees in young children (aged 12-36 months) with bowleg deformity. Four observers of differing experience measured the films in a blinded fashion to determine the intraobserver and interobserver variability of these measurements. The clinical implications of these variabilities are described. Very little instruction and experience is necessary to make these measurements correctly and precisely. Measurement of the MD angle was superior to measurement of the TF angle. Contrary to published opinion, rotation can have a small but potentially significant effect on the measured MD angle.

Anthropometry↗
PubMed1998

Effect of change in sodium excretion on change in blood pressure corrected for measurement error. The Trials of Hypertension Prevention, Phase I.

Intraperson variability in both blood pressure (BP) and sodium excretion dilutes associations and leads to underestimates of the dose-response relation. The authors applied statistical correction techniques to data from the Trials of Hypertension Prevention (TOHP), Phase I, carried out 1987-1990. Men and women with high normal diastolic BP (80-89 mmHg) were randomized to sodium reduction (n = 327) or a usual care comparison group (n = 417). Regression estimates of the effects of change in sodium and sodium/potassium ratio (Na/K ratio) on blood pressure change in the pooled sample were corrected for both the within-person variance of the excretion measures and the within-person covariance with blood pressure using a multivariate error correction. The estimated cross-sectional reliability was 0.36 for square root(Na) and 0.42 for square root(Na/K ratio) and that for change was 0.31 and 0.28, respectively. Corrected coefficients suggested a decrease of 4.4 mmHg in systolic BP (95% confidence interval (CI) 0.1-8.8) and 2.8 mmHg in diastolic BP (95% CI -0.2 to 5.8) per 100 mmol/24 hour reduction in sodium, and of 3.4 mmHg in systolic BP (95% CI 0.8-6.1) and 1.7 mmHg in diastolic BP (95% CI 0.0-3.5) per unit decrease in Na/K. These results are comparable with those from the Intersalt Study, and suggest that the true effect of sodium change on blood pressure change in normotensives over 18 months is underestimated by more than half in uncorrected data.

Adult↗
PubMed1991

Philosophy of measurement by means of immunoassays.

Starting from the explanation of the terms "comparison" and "quantification" a concept of a metrologically correct measuring system is derived. The paper discusses how this concept can be applied to immunoassays. The investigation led to the following conclusions: 1. Immunoassays are not principally either comparative tests or quantitative tests. Whether or not a correct measuring system can be construed for an immunoassay test depends on the intended use and the conditions in the specific individual case. 2. If certain requirements, which are discussed in detail, are fulfilled, immunoassays can be used for measuring the substance composition of biological materials. Critical points are the unambiguous definition of the "chemical entity" of the analyte to be determined (especially of macromolecules), the calibration of the measuring system by means of standards, and the problem of matrix effects.

Immunoassay↗
PubMed2005

Measurement of endometrial stripe thickness by obstetrics and gynecology residents.

OBJECTIVE: How well do obstetrics and gynecology residents measure the endometrial stripe by transvaginal sonography? STUDY DESIGN: Three obstetrics and gynecology residents at the University of Texas Medical Branch from each year level were tested for their ability to perform endometrial stripe measurements. Measurements of endometrial stripe thickness within 1 mm of the reference value that was obtained by an expert sonographer were deemed to be correct. RESULTS: Residents correctly measured the endometrial stripe in 14 of 24 cases (58%). Postgraduate year-4 residents correctly measured endometrial stripe thickness in 5 of 6 cases (83%); lower level residents were correct in 9 of 18 cases (50%). The most common error that was noted was an incorrect image plane in 25 of 47 attempts (53%). Fewer errors were committed by upper level as compared with lower level residents (P < .05). CONCLUSION: By the end of residency, residents can accurately measure the endometrial stripe using transvaginal sonography. Emphasis should be placed on the improvement of the measurement skills.

Endometrium↗
PubMed1994

Electrocardiographic repolarization measurements at rest and during exercise in normal subjects and in patients with coronary artery disease.

Normal values for simple and rate-corrected measures of the duration and dispersion of electrocardiographic (ECG) repolarization during treadmill exercise were obtained in 94 clinically normal men, and the behavior of these measures during ischemia was examined in 79 men with catheterization-proven disease or with stable angina, all of whom had normal resting ECGs. Temporal measures of repolarization, exemplified by QTc, were found to be moderately sensitive for disease only when highly specific criteria were derived from data at peak exercise heart rates that were significantly higher in normal subjects than in patients; sensitivities of rate-corrected measures declined markedly when criteria were derived from matched heart rate data in normal subjects. In contrast, the standard deviation of the mean measured J-point to T-wave peaks across the V1 to V6 precordial leads (SD-SoTm), a measure of precordial dispersion of repolarization, was unrelated to exercise heart rate in normal subjects; SD-SoTm exceeding the 95% value at matched intraexercise heart rates in normal subjects was found at peak exercise in 38% of men with coronary disease, including some patients with otherwise false-negative standard exercise test responses.

Angina Pectoris↗
PubMed1995

Measurement and correction of ultrasonic pulse distortion produced by the human breast.

Ultrasonic wavefront distortion produced by transmission through breast tissue specimens was measured in a two-dimensional aperture. Differences in arrival time and energy level between the measured waveforms and references that account for geometric delay and spreading were calculated. Also calculated was a waveform similarity factor that is decreased from 1.0 by changes in waveform shape. For nine different breast specimens, the arrival time fluctuations had an average (+/- s.d.) rms value of 66.8 (+/- 12.6) ns and an associated correlation length of 4.3 (+/- 1.1) mm, while the energy level fluctuations had an average rms value of 5.0 (+/- 0.5) dB and a correlation length of 3.4 (+/- 0.8) mm. The corresponding waveform similarity factor was 0.910 (+/- 0.023). The effect of the wavefront distortion on focusing and the ability of time-shift compensation to remove the distortion were evaluated by comparing parameters such as the -30-dB effective radius, the -10-dB peripheral energy ratio, and the level at which the effective radius departs from an ideal by 10% for the focus obtained without compensation, with time-shift estimation and compensation in the aperture, and with time-shift estimation and compensation performed after backpropagation. For the nine specimens, the average -10-dB peripheral energy ratio of the focused beams fell from 3.82 (+/- 1.83) for the uncompensated data to 0.96 (+/- 0.18) with time-shift compensation in the aperture and to 0.63 (+/- 0.07) with time-shift compensation after backpropagation. The average -30-dB effective radius and average 10% deviation level were 4.5 (+/- 0.8) mm and -19.2 (+/- 3.5) dB, respectively, for compensation in the aperture and 3.2 (+/- 0.7) mm and -22.8 (+/- 2.8) dB, respectively, for compensation after backpropagation. The corresponding radius for the uncompensated data was not meaningful because the dynamic range of the focus was generally less than 30 dB in the elevation direction, while the average 10% deviation level for the uncompensated data was -4.9 (+/- 4.1) dB. The results indicate that wavefront distortion produced by breast significantly degrades ultrasonic focus in the low MHz frequency range and that much of this degradation can be eliminated using wavefront backpropagation and time-shift compensation.

Adolescent↗
PubMed2004

Measurement and correction of respiration-induced B0 variations in breast 1H MRS at 4 Tesla.

Respiratory motion is well known to cause artifacts in magnetic resonance spectroscopy (MRS). In MRS of the breast, the dominant artifact is not due to motion of the breast itself, but rather it is produced by B0 field distortions associated with respiratory motion of tissues in the chest and abdomen. This susceptibility artifact has been reported to occur in the brain, but it is more apparent in the breast due to the anatomic proximity of the lungs. In the breast, these B0 distortions cause shot-to-shot frequency shifts, which vary an average of 24 Hz during a typical 1H MRS scan at 4 T. This variation can be corrected retrospectively by frequency shifting individual spectra prior to averaging. If not corrected, these shifts reduce spectral resolution and increase peak fitting errors. This work demonstrates the artifact, describes a method for correcting it, and evaluates its impact on quantitative spectroscopy. When the artifact is not corrected, quantification errors increase by an average of 28%, which dramatically impacts the ability to measure metabolite resonances at low signal-to-noise ratios.

Artifacts↗
PubMedDate not supplied

Unmet visual needs of Alzheimer's disease patients in long-term care facilities.

INTRODUCTION: The purpose of this study was to determine the prevalence of uncorrected visual disorders in nursing home patients with Alzheimer's disease (AD) and to determine whether appropriate corrective measures were taken by nursing home staff. This study was conducted at 2 community nursing homes in the St Louis area. Whereas previous studies have shown that visual impairment is common among all residents of nursing facilities, our study was focused specifically on residents with AD. This population is less able to effectively express needs and more likely to endure unaddressed visual deficits. For AD patients, it is important to offer appropriate corrective remedies in order to maintain as much functional independence as possible. METHODS: A retrospective cohort study was conducted in 2 private, skilled nursing facilities in St Louis County thought to be representative of community nursing homes in the United States. All subjects were patients with a diagnosis of dementia of probable AD. Demographic information collected included age, sex, and race. Mini-Mental State Examination scores were also obtained. The patients, their families, and nursing staff were interviewed to determine the patients' visual history, corrective measures, and the usage of corrective eyewear before and after admission to the nursing homes. The data were summarized to demonstrate how many patients suffered from uncorrected errors of refraction and what factors contributed to their visual status. RESULTS: Of the total of 85 patients included in the study, 80 (94.1%) required glasses for correction of presbyopia, myopia, or both. However, 25 of the 80 residents had not actively been using glasses since entering the nursing home. Of these 25 residents not wearing proper eyewear, 9 residents were too cognitively impaired to request them, 8 residents had broken or misplaced them, and 8 residents had prescriptions that were no longer sufficient to correct their vision. DISCUSSION: Our study found that nearly one third of the visually impaired nursing home residents with AD (25 of 80 patients) were not using their required eyewear. These 25 patients were the population of most interest because they were most likely to benefit from intervention. Many of these patients were not using glasses because they had been lost, damaged, or were no longer sufficient to correct their vision. CONCLUSIONS: We have presented 3 recommendations intended to prevent uncorrected visual acuity in nursing home residents with dementia: (1) Label eyewear in appropriate patient populations to provide rapid identification in the event of misplacement, (2) recommend that an extra pair of glasses be made available if the current pair would be lost or damaged, and (3) ensure that all residents have annual or biannual eye exams. If adequate steps are taken to prevent unnecessary visual impairment in AD patients, it would limit their dependence on others, reduce the burden on nursing staff, and improve the patients' overall quality of life.

Aged↗
PubMed2002

Interface corrective force measurements in Boston brace treatment.

Brace application has been reported to be effective in treating idiopathic adolescent scoliosis. The exact working mechanism of a thoracolumbo spinal orthosis is a result of different mechanisms and is not completely understood. One of the supposed working mechanisms is a direct compressive force working through the brace upon the body and thereby correcting the scoliotic deformity, achieving optimal fit of the individual orthosis. In this study we measured these direct forces exerted by the pads in a Boston brace in 16 patients with idiopathic adolescent scoliosis, using the electronic PEDAR measuring device (Novel, Munich, Germany). This is designed as an in-shoe measuring system consisting of two shoe insoles (size 8 1/2), wired to a computer, recording static and dynamic pressure distribution under the plantar surface of the foot. After positioning the inserts between the lumbar and thoracic pads and the body, we measured the forces acting upon the body in eight different postures. In all positions the mean corrective force through the lumbar brace pad was larger than the mean corrective force over the thoracic brace pad. Some changes in body posture resulted in statistically significant alterations in the exerted forces. There was no significant correlation between the magnitude of the compressive force over the lumbar and thoracic brace-pad and the degree of correction of the major curve. Comparing the corrective forces in a relatively new (<6 months) and old (>6 months) brace, there was no statistically relevant difference, although the corrective force was slightly larger in the new braces. We think that the use of this pressure measurement device is practicable and of value for studies of the working mechanism of brace treatment, and in the future it might be of help in achieving optimal fit of the individual orthosis.

Adolescent↗
PubMed1999

Deadtime correction in measurement of fractional renal accumulation of 99Tcm-MAG3.

Fractional renal accumulation of a radiotracer is often used to measure renal function with camera-based methods. We evaluated the effect of deadtime count loss on the calculation of fractional renal accumulation of 99Tcm-mercaptoacetyltriglycine (99Tcm-MAG3). In 15 patients, dynamic renal scintigraphy was performed after the injection of 250 MBq of 99Tcm-MAG3. A reference source was placed on the periphery of the field of view of the gamma camera to monitor the loss of counts in dynamic imaging. The activity in the syringe was also counted with the camera to measure the injected dose, and the deadtime count loss in the syringe was computed from the observed count rate and deadtime in imaging a point source. Fractional renal accumulation, the ratio of renal accumulation on dynamic imaging to the injected dose, was assessed with and without correction for deadtime loss. Fractional renal accumulation was over-estimated by 4.1% with no deadtime correction, when the value after correction for loss in both syringe counts and dynamic imaging was used as a standard. It was underestimated by 4.0% with correction for syringe counts only. The results suggest that correction for count loss only in measuring the injected dose does not lead to a significant improvement in the accuracy of estimating renal function with camera-based methods.

Algorithms↗
PubMed1998

Correction of spurious blood cell counts in a patient with cryoglobulinemia reversed by the use of citrate-anticoagulated blood.

Cryoglobulins may interfere with automated cell counting when proteins precipitate or blood cells aggregate. This results in spurious platelet or leukocyte counts, false values for red blood cell parameters and abnormal scattergrams. Usually it can be reversed by warming blood specimens to 37 degrees C. We describe the case of a 63-year-old woman with autoimmune disease in whom the diagnosis of cryoglobulinemia was suspected due to typical changes in blood cell counts. Artifacts were resistant to warming of the sample to 37 degrees C in both EDTA- and heparin-anticoagulated blood specimens. In contrast, the use of citrate as anticoagulant allowed correct measurements. This case underlines the role of assessment of blood counts in the detection of cryoglobulinemia. Correct measurements of automated blood counts in cryoglobulinemia may depend on the use of alternative anticoagulants.

Anticoagulants↗
PubMed1998

Digital imaging colposcopy: corrected area measurements using shape-from-shading.

The quantitative measurement of areas on the cervix is of interest to researchers studying the natural history of human papilloma viral lesions. Measurement of areas from images obtained through a colposcope are, however, inherently in error due to the image being a two-dimensional projection of a three-dimensional object. The ability to correct for these errors through use of digital imaging colposcopy and a practical application of a shape from shading algorithm was developed in this study. The shape from shading technique requires empirical measurement of the relationship between observed light intensity and the viewing angle (referred to as a reflection map). It was found that a population mean reflection map provided a correction that was about as accurate as using an individual's own reflection map (making it unnecessary to measure a map for each exam). Digital red filtering of the images increased accuracy and precision of measurement.

Adolescent↗
PubMedDate not supplied

Detection nonuniformity measurements and corrections for cone beam transmission CT on a gamma camera.

Cone beam transmission CT (CB-CT) improves SPECT imaging by providing high-quality attenuation maps for attenuation compensation and for correlated SPECT and CT imaging. The present work measures the detection nonuniformity for CB-CT implemented with a gamma camera, and applies nonuniformity corrections to make CB-CT more uniform and accurate. Two cone beam collimators were investigated, as well as the uncollimated cone beam geometry, using both uniformity images and CB-CT reconstructions of a uniform circular cylinder. Uniformity images were acquired as a function of point source position relative to the nominal focal point. The uniformity images for both collimators were highly nonuniform, with some regions differing by more than 15% from the average image counts per pixel, indicating that the holes do not focus to the same point. The most uniform images were obtained with the point source located at or near the nominal focal point. Radiographs estimated the misfocusing of the holes to be about 0.6 degrees in some regions. There were no indications that the hole size was nonuniform. The CB-CT reconstructions of data acquired with collimator showed no obvious signs of image artifact from the detection nonuniformities. However, low-noise simulated data with well-localized detection defects produced readily-apparent circular artifacts. The nonuniformity correction was accurate and easy to apply, and should be used whenever quantitative accuracy is required. The uniformity images acquired without collimator lacked the collimator-produced nonuniformities, but had decreased counts near the detector edge. The decrease was predictable, using simple geometric considerations. Uniform cylinder reconstructions of "without collimator" data showed a corresponding decrease in center density relative to the edge (edge-to-center ratio = 1.25), which was improved by the nonuniformity correction (ratio = 0.21). Accurate CB-CT without collimator will require further correction for photon scatter.

Gamma Cameras↗
PubMed2004

Implementation of an event reporting system in a transfusion medicine unit: a local experience.

Event reporting can provide data to study the failure points of an organization's work process. As part of the ongoing efforts to improve transfusion safety, a Medical Event Reporting System Transfusion Medicine, (MERS - TM) as designed by Kaplan et al was implemented in the Transfusion Medicine Unit of the University Malaya Medical Centre to provide a standardized means of organized data collection and analysis of transfusion errors, adverse events and near misses. An event reporting form was designed to detect, identify, classify and study the frequency and pattern of events occurring in the unit. Events detected were classified according to Eihdhoven Classification model (ECM) adopted for MERS - TM. Since our system reported all events, we called it Event Reporting System - Transfusion Medicine (ERS-TM). Data was collected and analyzed from the reporting forms for a period of five months from January 15th to June 15th 2002. The initial half of the period was a process of evaluation during which 118 events were reported, coded, analyzed and corrective measures adopted to prevent the recurrence of the same event. The latter half saw the reporting of 122 events following the adoption of corrective measures. There was a reduction in the occurrence of some events and an increase in others, which were mainly beyond the organization's control. A longer period of evaluation is necessary to identify the underlying contributory causes that can be useful to develop plans for corrective and preventive action and thereby reduce the rate of recurrence of errors through proper training and adoption of just culture.

Academic Medical Centers↗
PubMed2001

Mercury in feathers of Squacco Heron (Ardeola ralloides) chicks in relation to age, hatching order, growth, and sampling dates.

We studied the relationships between mercury content of Squacco Heron (Ardeola ralloides) chick body-feathers and nestling age, hatching order (seniors-juniors) and growth parameters, and the date of feather sampling in the Axios Delta, northern Greece, in 1993 (n = 75 chicks) and 1994 (n = 80). Mercury levels were not significantly correlated with chick age in either year of the study. Most of the variability in mercury (90%) was found among broods, attributable to differential prey selection and/or foraging habitat and patch utilization by parents. Within broods, juniors had significantly higher mercury loads than seniors in 1993, but there was no significant difference between the two in 1994. Correlations of nestling weight and linear measurements corrected for chick age and mercury concentrations were never significant and explained small amounts of variability in chick growth. However, linear measurements corrected for age were significantly higher among seniors in 1993, when those nestlings had lower mercury loads than their siblings. Mercury levels were unaffected by the date of feather collection in 1993, but exhibited a significant increase over time in 1994. This can be attributed to a shift towards more highly contaminated habitats and prey types by foraging parents, resulting from seasonal changes in water level and vegetation cover in important foraging habitats. Feather collection from Squacco Heron nestlings late in the breeding season seems to be an appropriate method for biomonitoring mercury pollution in the Axios Delta.

Animals↗
PubMed1984

Multidisciplinary quality assessment of a unit dose drug distribution system.

A two-part multidisciplinary study was performed at a 531-bed community hospital to evaluate the unit dose drug distribution system. The first study identified the relative incidence of medication discrepancies between nursing administration records and what actually was delivered for the patient. The second study revealed the incidence of scheduled medications which were returned to the pharmacy unused. In both studies, the reason for each disparity was noted and tabulated. The results of each study were reviewed and specific corrective measures were developed for each problem area detected. Follow-up programs were also recommended to determine the effectiveness of the corrective measures. Other hospitals with unit dose systems may find these study results revealing and useful in evaluating their own distribution services.

Hospital Bed Capacity, 500 and over↗