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PubMed2004

Feasibility of using the TOSCA telescreening procedures for diabetic retinopathy.

AIMS: The TOSCA project was set up to establish a tele-ophthalmology service to screen for diabetic retinopathy (DR) in Europe. The aim of this study was to determine the feasibility of establishing telemedicine-based digital screening for detecting DR and to evaluate the satisfaction of both patients and healthcare professionals with the screening procedures used within the TOSCA project. METHODS: The study was a non-randomized, multicentre study carried out in four different countries over a period of 3 months. Patients (n = 390) with diabetes aged > 12 years were included. Two digital retinal images per eye (macular and nasal) were taken and exported to a central server. Patients were asked to complete a questionnaire to assess satisfaction. Accredited graders carried out grading remotely and the results were reported back to the referring centre. Previously graded patient data chosen randomly to represent examples of both DR and no DR were also sent anonymously to the grading centre at a frequency of approximately every 10 patients. RESULTS: Most (99%) of the images were assessable enabling a retinopathy grade to be assigned to the patient. Patients found the retinal photography procedures acceptable; only 6% in one centre would not recommend the procedure. Healthcare professionals (photographers and graders) were also satisfied with the overall procedures. The average time taken to grade each patient was approximately 5 min. CONCLUSIONS: This study demonstrated that it is feasible to electronically transmit and grade retinal images remotely using the TOSCA process. Built-in quality assurance procedures proved acceptable.

Adolescent↗
PubMed1997

READS: a radiology-oriented electronic analysis and display station.

READS is a picture archiving and communications system (PACS) display program that is tailored to allow a radiologist to efficiently perform image review tasks. In this study, the image review process was observed and functional patterns were identified. These were used to define a design that was considered to represent the optimal balance of compromises for a low-cost review station that also allowed easy addition of new functionality. As a result, a program was designed and implemented that has been found to be acceptable for image review and for special image processing function development.

Data Display↗
PubMed1997

Measuring quality of care in neurology.

Neurologists are being asked to incorporate methods into daily practice that measure quality of care. Standards of care are increasingly being defined using evidence-based assessments of neurological literature. To evaluate quality of care, a widely accepted and useful model considers the structure, process, and outcomes of care. Outcomes, the impact of care on patients' health, should include measures of mortality, morbidity, disability, patient functioning and well-being (health-related quality of life), and patient satisfaction with care. A variety of private organizations and government programs exist to encourage documentation and promotion of high quality of care. This explosion in quality information is not yet standardized, so that much confusion exists about appropriate data elements to be measured. The challenge is to collect, summarize, and disseminate practical data useful to neurologists and the purchasers and consumers of our services.

Evidence-Based Medicine↗
PubMed1975

Labeling effects in psychiatric hospitalization. A study of diverging patterns of inpatient self-labeling processes.

This report explores two theoretical positions regarding psychiatric inpatient self-labeling processes over time. One position suggests that acceptance of the deviant label "mentally ill" is benign; the other suggests that such label acceptance may be harmful to patients. Employing empirical, longitudinal data from a sample of 43 inpatients, three complex, but discernible, patterns of "acceptance," "rejection," or "denial" of the "deviant" label of mental patient emerged over time within a short-term hospital setting. The three patient groups varied on Minnesota Multiphasic Personality Inventory scales, staff behavioral ratings over time, involvement in approved ward activities, and length of hospitalization. Results were discussed in terms of patient-staff interaction and its possible relation to patient self-labeling.

Adult↗
PubMed1998

Prospective individual matching: covariate balance and power in a comparative study.

In phase II to phase IV studies, randomization has gained widespread acceptance as a methodologic tool for the allocation of patients to treatment. However, randomization is not always feasible. At times, the treatment intervention occurs universally throughout one or more units (for example, a hospital unit), while the control therapy is the only intervention provided in other units. Patients may arrive randomly at a unit, based solely on availability of the unit to accept new subjects. Thus, the treatment assignment process is out of the investigator's control and not subject to selection bias. We describe a prospective individual matching procedure through which one can achieve balanced allocation of subjects to treatment groups in this comparative study setting. In this paper, we compare balance of baseline covariates and power for this design, in which the subject is selected at random and assigned to a treatment group, and the traditional randomized block design, in which the treatment is chosen at random and assigned to a subject. We show that the prospective individual matching procedure compares favourably to the traditional randomized blocked design with respect to both baseline covariate comparability and statistical power.

Analysis of Variance↗
PubMed2005

Molecular pathogenesis of colorectal cancer: implications for molecular diagnosis.

Colorectal cancer is the third leading cause of cancer-related death in both men and woman in industrialized countries. Major advances have been made in our understanding of molecular events leading to formation of adenomatous polyps and cancer. Most colorectal cancers are sporadic, but a significant proportion (5-6%) has a clear genetic background. It is now widely accepted that colorectal carcinogenesis is a multistep process involving the inactivation of a variety of tumor-suppressor and DNA-repair genes and simultaneous activation of certain oncogenes. In addition, epigenetic alterations through aberrant promoter methylation and histone modification have been found to play a major role in the evolution and progression of a large proportion of sporadic colon cancers. Consequently, it is now apparent that individual colorectal cancers may evolve through diverse molecular pathways. In this article, the authors have summarized the current knowledge of molecular pathogenesis in common hereditary syndromes and sporadic forms of colorectal cancer. Novel molecular diagnostic tools for the early diagnosis and prevention of colorectal cancer that have emerged from these insights are discussed.

Colorectal Neoplasms↗
PubMedDate not supplied

Management of laryngeal radionecrosis: animal and clinical experience.

Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

Animals↗
PubMed1992

Chemoprevention strategies for prostate cancer: the role of 5 alpha-reductase inhibitors.

Prostate cancer is a major health problem for the aging male population. Despite hormonal dependence, the inevitable emergence of androgen insensitive tumors, which have a dismal prognosis, highlights the need to develop prevention strategies such as chemoprevention. An acceptable agent must interfere with either the process of carcinogenesis or tumor growth, and have minimal toxicity. In clinical studies, 5 alpha-reductase inhibitors have been shown to suppress serum and intraprostatic levels of dihydrotestosterone, an important promoter of prostate cancer, leading to reduction in prostate size and suppression of glandular cell activity as measured by prostate specific antigen secretion. In addition, 5 alpha-reductase inhibitors have demonstrated an excellent safety profile and tolerability in 12 month controlled clinical trials. No significant metabolic effects have been observed in gonadotropin secretion, spermatogenesis, serum lipids or glucose tolerance. The efficacy and safety of 5 alpha-reductase inhibitors in studies to date, combined with the androgen dependence of tumor production, strongly supports investigating their use for chemoprevention of prostate cancer.

5-alpha Reductase Inhibitors↗
PubMed1976

Development of a stable sublingual nitroglycerin tablet II: formulation and evaluation of tablets containing povidone.

Stable and pharmaceutically elegant sublingual nitroglycerin tablets were formulated using povidone to retard volatilization of the drug. Formulation and processing variables were investigated to produce an acceptable product. A blend of two grades of povidone, of different degrees of cross-linkage and water solubility, provided stable tablets which exhibited rapid disintegration. Directly compressed sublingual tablets made in this study retained over 80% of the initial nitroglycerin when exposed to the atmosphere at room temperature for 2 months. The direct compression tablets are of good appearance and low friability, and the formulation is readily compressed without problems. An interesting relationship among the hardness, disintegration time, and compaction pressure is described.

Drug Compounding↗
PubMed1995

Laparoscopic-assisted colectomy. The learning curve.

One hundred fifty consecutive laparoscopic-assisted colectomies performed by a surgical team were analyzed in an attempt to define a learning curve. These colectomies performed by the Norfolk Surgical Group over a 24-month period, were divided chronologically into six groups of 25 patients each. The groups were then compared to determine if any improvement in length of procedure, complication rate, conversion rate, or length of stay developed as experience increased. Colon cancer and diverticular disease were the most common indications for surgery in all groups. Right hemicolectomy, left colectomy, and low anterior resection accounted for the majority of procedures in all groups. A significant decrease in mean operative time, from 250 min to 156 min over the first 35-50 cases was observed before leveling off at approximately 140 min for the remaining group. Intraoperative complications were low in all groups (range zero to two) and did not show any trend. There was no statistically significant difference in the conversion rate (23.3% overall) among the six groups. Length of stay decreased from 6 days in the first two groups to 5 days in the last four groups, although the difference was not statistically significant. The learning curve for laparoscopic-assisted colectomies is longer than appreciated by many surgeons, requiring as many as 35-50 procedures to decrease operative time to baseline. Complications can be kept at an acceptably low level while on the curve if a cautious approach is taken and the surgeon realizes that a prolonged operative time is not only acceptable, but appropriate during this long learning process. A conversion rate of 20-25% at any phase of the learning process may in fact represent a limitation of current technology. When combined with a low complication rate it may be the sign of a careful surgeon.

Aged↗
PubMed1986

Mechanism of peptide chain initiation in animal cells: a reevaluation.

Despite numerous reports from several laboratories, the precise mechanism of peptide chain initiation in animal cells and the roles of different factors involved in this process are not clear. The most widely accepted mechanism for peptide chain initiation is that proposed several years ago by Staehelin, Anderson, Hersey and coworkers. However, results reported from several laboratories differ significantly from the results on which the above mechanism is based. In this article, we have analyzed these different reports and their significance on the proposed mechanism of peptide chain initiation. Also, we have proposed an alternative mechanism based on the results reported from our laboratory.

Animals↗
PubMed1997

A clinical perspective of accelerated statistical reconstruction.

Although the potential benefits of maximum likelihood reconstruction have been recognised for many years, the technique has only recently found widespread popularity in clinical practice. Factors which have contributed to the wider acceptance include improved models for the emission process, better understanding of the properties of the algorithm and, not least, the practicality of application with the development of acceleration schemes and the improved speed of computers. The objective in this article is to present a framework for applying maximum likelihood reconstruction for a wide range of clinically based problems. The article draws particularly on the experience of the three authors in applying an acceleration scheme involving use of ordered subsets to a range of applications. The potential advantages of statistical reconstruction techniques include: (a) the ability to better model the emission and detection process, in order to make the reconstruction converge to a quantitative image, (b) the inclusion of a statistical noise model which results in better noise characteristics, and (c) the possibility to incorporate prior knowledge about the distribution being imaged. The great flexibility in adapting the reconstruction for a specific model results in these techniques having wide applicability to problems in clinical nuclear medicine.

Algorithms↗
PubMed2004

[Shared decision making. The perspective of practicing physicians].

BACKGROUND AND PURPOSE: More and more, patients want to participate in medical decision making. They expect a patient-centered communication as well as adequate information. However, little is known about the physicians' perspective and skills regarding shared decision making (SDM). This paper presents data about the physicians' perspective and allows focused comparison with the patients' views. METHODS: Standardized survey of 502 physicians from ambulatory care practices and of 1,512 German-speaking people, aged 18-79 years. Patient data were collected from a population-based random sample of an access panel. The following topics were included in this survey: medical decision making in daily practice, communication skills and behavior of physicians from the perspectives of physicians and patients. RESULTS: A majority of physicians approve the concept of SDM. Especially younger physicians favor the concept of SDM. Overall, physicians underestimate their patients' preference to participate in medical decision making. Physicians also tend to overestimate their information and communication skills. CONCLUSION: Not only in the general public, but also among physicians, a model of SDM is widely accepted. The communication skills necessary for this process appear to exist. However, they need to be promoted and extended. Learning to communicate adequately should receive a greater focus in medical education and postgraduate training.

Adolescent↗
PubMed2004

Toxicity and estrogenic activity of a wastewater treatment plant in Northern Italy.

Many xenobiotics, widely diffused in the environment, have the potential to disrupt the delicate endocrine system balance of wildlife and humans. Substances showing hormone-like actions in living organisms are defined endocrine-disruptor chemicals and they may mimic, block, or interfere with the synthesis, release, transport, elimination, and binding of natural hormones. Different ecotoxicologic studies were applied to screen for the discharge of estrogenic and toxic substances into the aquatic environment from a small industrial wastewater treatment plant based in Northern Italy. Samples of wastewater (3 L) were taken at three different periods during the year from different points of the plant's process: three phases of treatment, and effluent. Untreated samples (1 L) were assayed with two toxicity tests: Microtox and Daphnia magna. A simplified proliferation test using human estrogen receptor-positive MCF-7 breast cancer cells (E-screen assay) was performed on 2-L samples after solid-phase extraction for the determination of total estrogenic activity; the presence of estrogenic substances was evaluated by measuring the proliferation rate in cells exposed to samples. The results of the Microtox assay employing the marine bacterium Vibrio fischeri were compared with data obtained from whole-effluent toxicity testing methods employing D. magna. Toxicity was found only for the influent point. The proliferative effect of the five points, relative to the positive control 17beta-estradiol (relative proliferation effect), was between 2.4% and 39%, and the 17beta-estradiol equivalent concentrations were between 0.06 and 3.94 ng/L. A first comparison between results from toxicity load and estrogenic activity was performed. At all process points, the effluent samples were considered acceptable (taking only toxicity into account), but we demonstrated that they had estrogenic activity in the river water indicating an input of estrogenic substances by way of the treatment plant.

Animals↗
PubMed2002

The influence of injected AC and DC currents on spontaneous otoacoustic emissions in the bobtail lizard.

Spontaneous otoacoustic emissions (SOAEs) are accepted as being indicators of an active process in the inner ear and have been observed in all groups of land vertebrates. Previous studies have indicated that there may be more than one cellular substrate driving the active processes in different groups of vertebrates. To investigate the cellular substrate in non-mammals and to relate the findings to studies in mammalian ears, we injected AC and DC currents of amplitudes generally below 5 microA into scala media of the bobtail skink Tiliqua rugosa and recorded their influences on SOAEs. Injected AC current has been shown previously to induce emissions [electrically induced otoacoustic emissions (EEOAEs)] in mammals and lizards. AC current in the appropriate frequency range entrained SOAEs but was relatively ineffective at increasing their magnitude compared with the dependence on current strength of EEOAEs generated at non-SOAE frequencies. The effects of DC current were polarity-dependent and changed over time with prolonged stimulation. Whereas positive current caused a small increase in SOAE frequency and a fall in magnitudes, negative DC current induced a decrease in SOAE frequency of more than 30%, accompanied by changes in level that were strongly time-dependent. All changes were slowly reversible. The effects observed in this species of lizard strongly resemble those observed in frogs and chinchillas. The similarity is interesting in view of the putatively different cellular mechanisms driving the active process in mammals and non-mammals.

Action Potentials↗
PubMed2001

Herbs and atherosclerosis.

It is now widely accepted that atherosclerosis is a complex multicellular process involving oxidation of cholesterol and the intracellular accumulation of oxidized cholesterol. This accumulation causes a cascade of inflammatory processes, resulting in an unstable atherosclerotic plaque that ultimately bursts, causing myocardial infarction. Botanical dietary supplements (herbs) can ameliorate this process and prevent cardiovascular disease at many steps in the process. Many herbs have antioxidant activity and can reduce low-density lipoprotein oxidation. Some phytosterols found in botanicals can inhibit cholesterol absorption. After a brief review of herbs being promoted for achieving and maintaining healthy cholesterol levels, the evidence and future prospects for Chinese red yeast rice, the main component of dietary supplements with HMG-CoA reductase inhibiting activity, are discussed in detail. Initial phase II clinical trials are highly encouraging. This herb is likely to be able to directly impact the process of atherosclerosis, but large-scale clinical trials are needed to assess the public health potential of this herbal supplement.

Arteriosclerosis↗
PubMed1984

Visuoperceptual and visuomotor abilities and locus of lesion.

Possible differential effects of laterality and caudality of cerebral lesions on simple visuoperceptual and visuomotor skills were examined. As expected, the right hemisphere lesion group was significantly more impaired than the left hemisphere lesion group. The effects of the caudality of lesion, however, yielded interesting results. While the right posterior group was worse than the right anterior lesion group, as expected, the left posterior lesion group was better than the left anterior lesion group. Our findings points to a possibility that the left hemisphere, especially the anterior region, might not be as silent in processing simple visual stimuli as has been accepted.

Brain Diseases↗
PubMed1994

Acquisition and use of calorimetric data for prediction of the thermodynamics of ligand-binding and folding reactions of proteins.

The commercialization of high-precision microcalorimeters has led to a sharp increase in the acquisition and utilization of calorimetric data on the binding and folding reactions of proteins. This thermodynamic database, together with high-resolution structures of proteins and their complexes with ligands, has facilitated the development, calibration, refinement and testing of empirically based and computational methods for predicting the thermodynamics of processes involving macromolecules. Even so, a generally accepted method for assigning structural parameters to the various energetic contributions of protein folding and ligand-binding reactions, much less a method for predicting the changes in thermodynamic parameters of these reactions, has not yet been firmly established.

Calorimetry↗