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PubMedDate not supplied

Breast cancer screening controversies.

BACKGROUND: The Cochrane Collaborative, a respected independent review body, recently published a meta-analysis of the effectiveness of screening mammography in decreasing breast cancer mortality. Based on the results of two controlled trials they judged to be of medium validity, they concluded that screening mammography was unjustified. In contrast, the US Preventive Services Task Force recently updated their screening recommendations, and based on a meta-analysis of the same randomized controlled trials, they recommended screening mammography for all women starting at age 40 years. Additionally the Canadian Task Force on Preventive Health Care no longer recommends breast self-examination (BSE). This article reviews the controversies regarding breast cancer screening. METHODS: We performed a systematic review of the literature using keywords and cross-referencing articles. We also used automated data from the Breast Cancer Screening Program at Group Health Cooperative to determine the sensitivity of the clinical breast examination (CBE) at our institution. For the latter we included all cancers diagnosed within 1 year of a screening examination and then determined which of those had been found by CBE. RESULTS: Although most screening studies have shown that mammography decreases breast cancer death, there are controversies about the validity of some of the randomized controlled screening mammography trials. These controversies have led to different conclusions about the efficacy of screening mammography. Evidence is limited about the optimal interval for screening mammography. No studies have directly tested the efficacy of the CBE in decreasing breast cancer mortality. At Group Health Cooperative, 8% of all diagnosed breast cancers were found by the CBE alone (negative mammogram). Whether this 8% incremental increase in case finding leads to decreased breast cancer deaths is unknown. There is good evidence that training women to perform BSE does not increase breast cancer diagnoses or decrease breast cancer deaths. CONCLUSION: There are limitations to randomized controlled trials and meta-analyses. The balance of the evidence still favors screening mammography in women aged 40 years and older at least every 2 years. The independent incremental benefit of the CBE, when added to mammography, in decreasing breast cancer mortality is unknown. Population-based education and training to do BSE are unlikely to lead to decreased breast cancer deaths. Many women find their own breast cancers, so women need to pay attention to symptoms or changes in their breasts.

Breast Neoplasms↗

PubMed1999

Independent living centres: an innovation with mental health implications?

The findings of a national study of Independent Living Centres (ILCs) in Canada suggest that the ILCs are a potentially powerful innovation for the consumer/survivor movement. Independent Living Centres are non-profit, cross-disability, consumer-driven, community-based centres which promote both individual empowerment and community change. The IL and mental health reform paradigms share in the development of empowerment theory, acknowledge the importance of consumer driven organizations, and utilize a socio-political analysis of disability which goes beyond the person and recognizes the environment as problematic. Accordingly, the reform paradigm seeks innovative services which are separate from the traditional mental health system. Before this can fully become a reality, mental health professionals need to increase their knowledge of the IL philosophy and ILC practice. Similarly, ILCs need to increase their knowledge of consumer/survivor empowerment and recovery and carefully assess any barriers that exist in terms of consumers/survivors accessing the ILCs. Collaboration between the IL movement and mental health will increase the likelihood of ILCs becoming a stronger resource for consumers/survivors.

Activities of Daily Living↗

PubMed1993

Prevalence of infections and use of antibiotics among hospitalized patients in Mauritius. A nationwide survey for the planning of a national infection control programme.

As part of a programme for improving hospital infection control in Mauritius a nationwide survey, including a prevalence study, was carried out in order to identify characteristics of the hospitals, the population, and the infections. Community-acquired infections were three times more prevalent than nosocomial infections: 15.0% and 4.9%, respectively. Surgical wound infection was by far the most common nosocomial infection, with a prevalence rate of 8.2 per 100 operations, followed by urinary tract infection with a low rate of 0.8 per 100 admissions. The survey showed that these hospitals in Mauritius housed mainly a young population (mean of 36.8 years for females and 39.4 years for males) with few risk factors for acquiring nosocomial infection. Although diabetes mellitus is prevalent in Mauritius the diagnosis of diabetes was not associated with nosocomial infection. The spectrum of operations offered was limited, and Caesarean section was the most prevalent operation. The amount and types of antibiotics used in hospitalized patients were recorded. More than one third of the patients received antibiotic treatment at the time of the survey, which is comparable to figures reported from large teaching hospitals in Western Europe. The information gathered from the survey, the interviews and the inspection were used to establish priorities for a collaborative programme for improved infection control. It included the draft of a set of custom-made guidelines, which were eventually studied by staff members from hospitals in Mauritius during a training period in Denmark. We believe that a prevalence survey is useful for initiating infection control programmes in hospitals in developing countries.

Adult↗

PubMed1990

An interactive treatment planning system for ophthalmic plaque radiotherapy.

Brachytherapy using removable episcleral plaques containing sealed radioisotope sources is being studied as an alternative to enucleation in the treatment of choroidal melanoma and other tumors of the eye. Encouraging early results have been reported, but late complications which lead to loss of vision continue to be a problem. A randomized national study, the Collaborative Ocular Melanoma Study (COMS) is currently in progress to evaluate the procedure. The COMS specified isotope is 125I. Precise dosimetric calculations near the plaque may correlate strongly with complications and could also be used to optimize isotope loading patterns in the plaques. A microcomputer based treatment planning system has been developed for ophthalmic plaque brachytherapy. The program incorporates an interactive, 3-dimensional, solid-surface, color-graphic interface. The program currently supports 125I and 192Ir seeds which are treated as anisotropic line sources. Collimation effects related to plaque structure are accounted for, permitting detailed study of shielding effectiveness near the lip of a plaque. A dose distribution matrix may be calculated in any subregion of a transverse, sagittal, or coronal planar cross section of the eye, in any plane transecting the plaque and crossing the eye diametrically, or on a spherical surface within or surrounding the eye. Spherical surfaces may be displayed as 3-dimensional perspective projections or as funduscopic diagrams. Isodose contours are interpolated from the dose matrix. A pointer is also available to explicitly calculate and display dose at any location on the dosimetry surface. An interactive editing capability allows new plaque designs to be rapidly added to the system.

Brachytherapy↗

PubMedDate not supplied

Improving public health nursing education: recommendations of local public health nurses.

OBJECTIVES: This paper reports recommendations for improving public health nursing (PHN) undergraduate, graduate, and continuing education (CE) made by staff-level public health nurses working in local health departments (LHDs). Implications for academia and practice are discussed. DESIGN: A cross-sectional written survey was used to collect data from 424 public health nurses in 76 LHDs in Wisconsin (68% response rate) in 2003. Recommendations for improving undergraduate, graduate, and CE were made through responses to open-ended survey questions. Content analysis was conducted to identify major themes among responses. RESULTS: Major themes emerging from the recommendations for undergraduate education included the need for more clinical public health experiences and population-focused practice content. Graduate education improvement recommendations included addressing access barriers and increasing organizational incentives. Improved access and more public health content were the major recommendations for improving CE. CONCLUSIONS: Implications for academia focus on increasing opportunities for students to experience population-focused PHN and to learn organizational and collaborative practice skills, supporting PHN preceptors and building evidence for PHN intervention through research. Implications for practice include the need to expand opportunities for students with LHDs and to collaborate with academic partners for education and research.

Adult↗

PubMed1992

Advancing mission in the marketplace. Integrated strategic planning and budgeting helps a system remain accountable.

In the late 1980s Holy Cross Health System (HCHS), South Bend, IN, began to implement a revised strategic planning and budgeting process to effectively link the system's mission with its day-to-day operations. Leaders wanted a process that would help system employees internalize and act on the four major elements articulated in the HCHS mission statement: fidelity, excellence, empowerment, and stewardship. Representatives from mission, strategic planning, and finance from the corporate office and subsidiaries examined planning and budgeting methods. From the beginning, HCHS leaders decided that the process should be implemented gradually, with each step focusing on refining methodology and improving mission integration. As the process evolved. HCHS developed a sequence in which planning preceded budgeting. The system also developed a variety of educational and collaborative initiatives to help system employees adapt to the organization's change of direction. One critical aspect of HCHS's ongoing education is an ethical reflection process that helps participants balance ethical considerations by viewing an issue from three perspectives: social vision, multiple responsibility, and self-interest.

Budgets↗

PubMed1999

Development of a Web-based clinical information system for surveillance of multiresistant organisms and nosocomial infections.

To optimize the surveillance and control of infections at our hospital, we have developed a clinical information system (CIS) linked to a server providing three kinds of patient-oriented data reports: 1/an automated alert for multiresistant bacteria from a data-driven mechanism; 2/the relevant data for surveillance of hospital-acquired infections; 3/some clinical and educational data for antibiotic prescribing. The new CIS is a Web-based one and now integrated to the Hospital Information System (HIS). In a close collaboration with the experts, we have, first, specified the relevant information for each report. Then, we have linked the system to those HIS DBs containing this information. Finally we have developed a well-secured intranet Web site, on which the concerned practitioners can instantaneously review the latest alerts and/or the summarized/detailed reports. The preliminary results shows that the system is reliable in medical practice and the response time is satisfying.

Algorithms↗

PubMed1984

A collaborative study on larval excretory/secretory antigens of Toxocara canis for the immunodiagnosis of human toxocariasis with ELISA.

Two batches of excretory/secretory (E/S) antigens from second stage larvae of Toxocara canis maintained in vitro were prepared independently in two different laboratories (Zürich and Basel) and analysed in order to obtain information for future efforts to standardize the enzyme-linked immunosorbent assay (ELISA) used for the serodiagnosis of human toxocariasis. SDS-PAGE and "Western-blotting" revealed at least 10 different antigenic components common to the two antigen preparations. However, distinct qualitative and quantitative differences among the two E/S-antigens were observed, since one antigen had a more complex composition than the other. Despite these differences, an accordance of serodiagnosis was obtained in 80% of 25 sera from patients with suspected Toxocara infection tested independently in two different ELISA systems (Basel and Zürich) with the corresponding E/S-antigens. The specificity was 93% as determined (BS-antigen, BS-ELISA) by testing 46 out of 3396 sera from patients with parasitologically proven extra-intestinal helminthic infections. Cross-reactions occurred mainly with sera from patients infected with filariae (5 from 13 cases) exhibiting very high extinction values in their homologous ELISA-system. The reproducibility (intra- and inter-test variations) of two ELISA systems using the corresponding E/S-antigens varied from 5-15%. The results demonstrate that T. canis E/S-antigens may well be applicable for standardization of the ELISA used for the serodiagnosis of human toxocariasis.

Animals↗

PubMedDate not supplied

Clostridium difficile-associated disease. Implications for midwifery practice.

Clostridium difficile-associated disease (CDAD), a gastrointestinal infection with a wide range of manifestations whose primary symptom is diarrhea, occurs when antibiotic medications, or rarely other drugs or conditions, disrupt the normal colonic microflora, making it susceptible to the growth of toxigenic C difficile. It is a significant nosocomial infection and an increased incidence has been noted in recent years. Although infrequently seen in midwifery practices, it does occur and may increase with the growing usage of intrapartal antibiotics. Midwives may evaluate and treat a client with an initial episode of mild to moderate CDAD; they also may manage collaboratively or refer for medical management those clients with recurrent or severe disease. This article reviews the epidemiology, pathogenesis, clinical presentation, prevention, and midwifery management of initial and recurrent CDAD. The limitation in the use of oral vancomycin due to the emergence of vancomycin-resistant enterococcus, resulting in metronidazole becoming the primary agent for treatment of CDAD, and the implications of this in the treatment of CDAD during pregnancy and lactation are addressed.

Adult↗

PubMed1981

The 5936 Ig-idiotype(s): genetic linkage to Ig-Ch Loci, T-cell dependence of synthesis and possible specificities.

5936-idiotype(s) are defined by a rabbit antiserum which was obtained by immunizing a mouse-immunoglobulin(MIg)-tolerant rabbit 5936 with B6 anti-CBA Ig from a single B6 mouse. These idiotypes were found on IgG1 molecules in sera from B6 mice immunized with cells carrying the IAk alloantigen, and they were associated with B6 Ig allotypes (Igh-1b). The particular interest of this idiotypic system is that antiserum 5936 also detects idiotypes (Id) on B6-T cells immunized in vitro with IAk alloantigen, and such T-cell Id were found to be associated with Ig allotypes. We attempted to show that the 5936-Id on Ig molecules were linked to Igh-1b allotypes by backcross analysis. In addition, it was investigated whether the 5936-Id response was a T-cell dependent response, and, if so whether there was any restriction in this T-B cell collaboration. Finally, we continued our studies on the specificity of 5936-Id+ Ig molecules. The present experiments show that 5936-Id are linked to Igh-1b allotypes and that the quantity of 5936-Id produced appears to be regulated by Ir genes in the H-2 complex. The synthesis of 5936-Id is T-cell dependent, and only Igh-1b allotype compatible T cells would collaborate with 5936-Id+ B-cell precursors. 5936-Id+ Ig molecules appeared not to have specificity against eco- and xeno-tropic viruses. However, monoclonal antibodies produced from B6-T-cell-reconstituted B6 nude mice may carry 5936-Id and have specificity for B6-T-cell membrane molecules. The relevance of these findings to the question of whether or not T and B cells display identical idiotypes are discussed.

Animals↗

PubMed1992

Risk factors for Alzheimer's disease: the EURODEM collaborative re-analysis of case-control studies.

Case-control studies of risk factors for Alzheimer's disease have been hampered by low statistical power. Here, we present a collaborative analysis of 11 case-control studies of Alzheimer's disease. The original data of these studies were pooled and re-analyzed. The risk factors considered in this analysis were family history of dementia and related disorders, maternal age at index birth, head trauma, medical and psychiatric history and environmental exposures. This paper gives a brief overview of the findings of the re-analysis.

Age Factors↗

PubMedDate not supplied

Infection surveillance scheme: collaborative working practices.

This article describes the development of the Nosocomial infection National Surveillance Scheme. Doctors and nurses are expected to collaborate and work together in order to improve patient care. Guidelines on infection control in hospitals include the need for infection control teams to carry out surveillance and feed back the results to doctors so that they can make the necessary changes. The relationship between doctors and nurses has long been debated, and this could hinder the success of doctors cooperating and sharing ownership of the scheme. Interpersonal skills, group dynamics, organizational controls and professional standards are discussed.

Causality↗

PubMedDate not supplied

Developing a European Internet and kiosk-based health information system.

A consortium of partner organisations (universities, health care organisations and information technology companies) from Northern Ireland, Germany, Portugal and Italy have collaborated to develop a multi-lingual, multi-media Internet and kiosk-based health information system in cardiology and skin cancer. The project, CATCH II (Citizens Advisory System based on Telematics for Communication and Health), has been funded by the European Commission under the Fourth Framework Research and Development TELEMATICS Applications Program (TAP), Health Care Sector. In this paper we provide an overview of the system and the methodological approach adopted. Key characteristics with respect to the technical architecture and flexible customisation of different web and kiosk-based versions will be presented. In particular, the development of dedicated software for the procurement, structuring and management of the information knowledge-base is illustrated. Some of the most interesting findings from a cross-national study of health information needs on the internet are presented along with information on the validation of the system by the general public, content providers and health care authorities.

European Union↗

PubMed1980

WHO collaborative study: assessment of depressive disorders.

In the context of an ongoing WHO research programme in depression, a total of 573 patients consulting psychiatrists in Canada, Iran, Japan and Switzerland were assessed with the WHO/SADD schedule which proved to be a simple and reliable instrument for standardized recording of clinical data. The results indicated that the "average" depressive patients seeking care in culturally different settings have many clinical features in common. A screening instrument, developed in the same study, has been shown to be effective in selecting depressive patients among in- and out-patient populations.

Cross-Cultural Comparison↗

PubMed2002

Role of Sp1 in insulin regulation of gene expression.

Sp1 is a ubiquitous nuclear factor that plays a key role in maintaining basal transcription of 'house-keeping' genes. However, recent evidence points to a more important function for Sp1 in mediating 'cross-talk' between selected signaling cascades to regulate the target genes that respond to these pathways. The role of Sp1 in mediating the actions of the peptide hormone insulin is of specific interest and serves as a model for detailing effects of intracellular signaling on Sp1 activity. This review summarizes studies suggesting that changes in Sp1 phosphorylation provide one potential mechanism for manipulating activity of this protein. A growing body of evidence reveals that the DNA binding and transcription activity of Sp1 may increase or decrease in response to changes in phosphorylation. This enables 'fine-tuning' of Sp1 activity for regulation of gene transcription. Several mechanisms exist by which Sp1 alters gene activity in response to insulin. These include independent Sp1 activity as well as collaboration or competition with others factors. This review points to an ever-increasing role for Sp1 in regulating the transcription of genes in response to extracellular signals such as insulin.

Animals↗

PubMed1994

[Future directions of antimycotic therapy].

There are presently numerous developments in the field of antifungal armamentarium. Amphotericin B has been considered as the standard treatment since the fifties for most invasive fungal infections. However, emergence of resistant strains and failures despite adequate treatment with amphotericin B are numerous and toxicity as well as side effects are limiting factors in many patients. Alternative modalities to administer amphotericin B using liposomal or lipid formulations are presently evaluated. Tremendous research has been performed in the development of new azoles including ketoconazole, fluconazole and itraconazole. The emergence of resistant strains of yeasts in patients treated with fluconazole requires attention. The problem of possible cross resistance for all azoles should be a matter of further investigation. Itraconazole is a new broad-spectrum antifungal agent. But due to its pharmacokinetic properties monitoring of serum concentrations is recommended in life-threatening situations. New formulations of itraconazole are currently under development and may be extremely useful. The role of azole antifungals for prophylactical administration or therapeutic purposes must be balanced carefully. Studies designed to evaluate adjuvant antifungal treatment based on G-CSF, M-CSF or GM-CSF in combination to antifungals would be useful. Future directions of antifungal treatments should include evaluation of combination of antifungal agents to each other. There is a tremendous need for pivotal clinical studies in the field of antifungal treatments which need international collaboration in order to collect rapidly significant numbers of data. Such comprehensive approaches are initiated by the EORTC Invasive Fungal Infections Cooperative Group, and all European clinicians taking care of mycosis patients are invited to cooperate.

Antifungal Agents↗

PubMed2005

Cholesterol and sphingolipids as lipid organizers of the immune cells' plasma membrane: their impact on the functions of MHC molecules, effector T-lymphocytes and T-cell death.

The possible regulatory mechanisms by which glycosphingolipid- and cholesterol-rich membrane microdomains, caveolar and non-caveolar lipid rafts, control the immune response are continuously expanding. In the present overview we will focus on how these membrane-organizing lipids are involved, in collaboration with tetraspanin proteins, in the formation of distinct MHC-I and MHC-II microdomains at the cell surface and will analyze the possible roles of MHC compartmentation in the processes of antigen presentation and regulation of various stages of the cellular immune response. Some basic, lipid raft- and tetraspan mediated mechanisms involved in the formation and function of immunological synapses between various APCs and T-cells will also be discussed. Finally, a new aspect of immune regulation by sphingolipids will be briefly described, namely how can the death or stress signals, leading to ceramide accumulation, result in raft-associated regulatory platforms controlling cell death or antigen-induced, TCRmediated signaling of T-lymphocytes. The influence of these signals and their cross-talk on the fate (death or survival) of T-cells and the outcome of T-cell response will also be discussed.

Animals↗

PubMed1996

An analysis of the concept facilitation.

This paper is an analysis of the concept facilitation. The analysis is based on a model suggested by Wilson (1969) cited in Walker & Avent (1988). The literature review shows the term used in physiological, educational, counselling/psychotherapy, social and theological contexts. The analysis leads to the compilation of the defining attributes of the concept facilitation which are: a process of enabling change; a climate for learning (mutual trust, acceptance and respect); and factors which relate to the nature of the process (student-centred, negotiated and collaborative). The antecedents relate to the facilitator qualities (realness, caring and empathy), access to a learning situation and the effects of motivation and social influences; the consequences of effective facilitation being reciprocal change (learning and understanding), reciprocal feedback and increased independence. To a limited extent the empirical referents have been discussed. Cases have been constructed to provide examples of the term facilitation used in a model, borderline, related and contrary situations. The analysis will be of particular interest to those in nurse education.

Concept Formation↗