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At least 1,531 records · Page 85Linked to original sources
PubMed1997

Quality improvement in Germany.

THE GERMAN HEALTH CARE SYSTEM: Recent law has provided for increased competition among public insurers ("sickness funds"). Hospitals are also finding increasing competition as lengths of stay shorten and excess capacity grows. THE EVOLUTION OF QUALITY IMPROVEMENT: Quality improvement in Germany, mostly as quality assurance, has progressed slowly since its beginnings in the 1970s. A majority of medical associations and societies now support quality improvement, by dint of the public's increasing demand for performance data, the potential threat posed by declining financial resources to the quality of medical care, competition among providers for payer purchases of health care, and financial concerns of third parties. INTERNAL QUALITY MANAGEMENT (QM) ACTIVITIES: In Germany quality improvement activities are conducted either as external quality assurance or as internal quality management (QM). Payers, who increasingly prefer to work with those hospitals that provide information on the quality of treatment offered, are interested not only in the structure and outcome dimensions of quality, but in the process dimension--as practice guidelines and clinical pathways. More than a few hospitals in Germany have implemented or have started to implement QM systems. Key processes in the hospital should all be described, examined, and considered by project groups (once referred to as quality circles) in terms of potential efficiencies to be gained through improvement. QUALITY ASSURANCE: Federal and state hospital associations and sickness fund associations agreed on a new contract in 1995 that included a provision to introduce new external quality assurance measures.

Economic Competition↗
PubMed2000

Effect of variations in operational definitions on performance estimates for screening mammography.

RATIONALE AND OBJECTIVES: The Mammography Quality Standards Act requires practices to measure limited aspects of their performance. The authors conducted this study to calculate the differences in measurements of sensitivity and specificity due only to differences in the definitions used in the analysis. This included definitions for case inclusion. MATERIALS AND METHODS: Data from the New Mexico Mammography Project for January 1991 to December 1995 on 136,540 women who underwent screening mammography were analyzed. A starting definition was created for each performance measure. The components of the definition were varied, and estimates of sensitivity and specificity for the different definitions were calculated. RESULTS: Sensitivity was lower and specificity was higher when assessed on the basis of the results of all imaging performed in the screening work-up rather than on the initial screening examination alone. Sensitivity was higher and specificity was lower in women who did not undergo rather than in women who did recently undergo a previous examination. When the definition of a positive examination included cases that were recommended for short-term follow-up, the work-up sensitivity was slightly higher and the work-up specificity was considerably lower. Longer follow-up times for determining the diagnosis of cancer were associated with decreasing sensitivity, particularly when the follow-up period extended beyond 12 months. CONCLUSION: Variations in the operational definitions for measures of mammographic performance affect these estimates. To facilitate valid comparisons, reports need to be explicit regarding the definitions and methods used.

Adult↗
PubMed2025

Genome-wide identification of potassium transporters and channels in Malus domestica genome.

Potassium (K+) is an essential nutrient for plants. It contributes to most physiological and biochemical pathways for plant metabolism, growth, and development. It is the most available plant nutrient, comprising 10–15% of plant weight. Plants have a sophisticated system of K+ transporters and channels for distribution in plant body. Apple is one of the most consumed fruits in the world. Its fruit quality and yield are positively affected by K+. However, limited information is available about K+ transport systems in Apple. In this study, 47 candidate genes (26 K+ transporters and 21 K+ channels) have been identified in Apple (Malus domestica) genome. The phylogenetic comparisons with other plants (Glycine max, Arabidopsis thaliana, and Oryza sativa) indicated that the K+ transport system is much conserved among different plants. The analysis of Gene structure showed the presence of specific introns and exon patterns for these gene families. Transcriptomic data analysis and RT-qPCR demonstrated significant variations in the transcript abundance of these genes in response to abiotic stresses. The current project represents the first report about the K+ transport system in Apple. Therefore, it may act as a starting point for further functional characterizations.

Malus↗
PubMed2006

The SUN cohort study (Seguimiento University of Navarra).

OBJECTIVE: Cohort study (the SUN project) to identify dietary determinants of hypertension, diabetes, obesity and coronary heart disease (CHD), among other conditions. DESIGN: The SUN project is a Mediterranean dynamic prospective follow-up (cohort) study assessing participants every 2 years. The recruitment started in 2000 and it is permanently open (this is a dynamic cohort). A preliminary case-control study of myocardial infarction was also conducted, selecting incident cases of myocardial infarction and matched hospital controls. SETTING: The SUN study is conducted in Spain with university graduates, most of them being former students of the University of Navarra. The case-control study was conducted in three tertiary hospitals in the city of Pamplona (Spain). SUBJECTS: The case-control study included 171 cases and 171 controls. We have currently enrolled more than 17,500 participants in the SUN cohort. Approximately 7500 of them were enrolled less than 2 years ago, and have not received yet the invitation to complete the 2-year follow-up assessment. The follow-up rate for the first 10,000 participants approaches 90%. RESULTS: The case-control study found inverse associations between olive oil (or adherence to a Mediterranean food pattern) and myocardial infarction. In the SUN cohort, after 28.5 months of follow-up a higher adherence to a Mediterranean food pattern rich in olive oil was associated with a reduced risk of hypertension, though the results were statistically significant only among men. CONCLUSIONS: The SUN study and the accompanying case-control study support the benefits of a Mediterranean diet and olive oil against CHD and hypertension.

Case-Control Studies↗
PubMed2001

Management of hypertension in the elderly using home blood pressures.

OBJECTIVE: To evaluate whether patient-measured home blood pressures alone can be used to manage hypertension in adults 65 years and older. METHODS: 40 hypertensive men and women, average age 73 +/- 6 years, were randomly assigned to one of two treatment decision groups. The 'home' group (N = 20) had blood pressure managed and medication changed according to measurements taken by the patient at home with the Omron HEM-702 semi-automatic oscillometric digital blood pressure monitor and the 'clinic' group (N = 20) had medication adjusted based upon readings taken by the project nurse in the clinic. In both groups, treated hypertensives had medications adjusted downward, while untreated hypertensives were started on a diuretic and/or ACE inhibitor and adjustments were made upward. To assess the efficacy of the home measurements as a means of hypertension management, 24-hour ambulatory blood pressure averages, quality of life (From the QOL SF-36), and dosage of antihypertensive medications were compared between the home and clinic groups over a three-month period. RESULTS: At baseline, the 'home' group had slightly higher ambulatory awake and sleep blood pressure than the 'clinic' group. At 3 months, the average awake and sleep ambulatory blood pressure for the 'home' group decreased to the level of the 'clinic' group. Values of the 'clinic' group did not change. In both groups, pressures of previously treated patients increased over the 3 months, while those that were previously untreated declined. However, this difference, to some extent, might be expected because the acceptable limit of pressure control (150 / 90 mmHg) was higher than many of the patients on medications; thus, their pressures could increase and still be considered controlled. Those patients who were previously untreated had their pressures decreased only to this level. The nurse-measured clinic blood pressures for the 'home' group began higher than that of the 'clinic' group and remained higher at the end of the study. Average home pressures of the 'home' group were consistently lower than nurse-measured clinic pressures over the 3-month study period, indicating a persistent 'white coat' effect. Both groups had similar changes in total quality of life scores. Decrease/discontinuance of antihypertensive medication was also achieved equally in both groups at the end of 3 months. CONCLUSION: Home blood pressure monitoring alone may be as useful as clinic measurements for making treatment decisions in the elderly.

Aged↗
PubMed2005

Developmental stages in public health partnerships: a practical perspective.

Health education practitioners often form and provide support to partnerships directed toward public health goals. The authors viewed the start-up of a state health department/multiuniversity partnership for the evaluation of the state's tobacco settlement pilot project using the lens of the Tuckman four-stage model of group development. The four stages--forming, storming, norming, and performing--occurred in sequence but with pronounced overlap. Two types of performing--institutional and group performing--were observed. An awareness of group developmental stages can allow leaders and members to improve the ways their partnership works together. Applying Tuckman's model also can allow expectations about the group's progress and members' interactions to be managed so that tasks are aligned with the appropriate stage of development. Finally, for partnerships that have a long life span, understanding that the stages may occur several times throughout the group's existence can acclimate members to shifting responsibilities and relationships over time.

Community-Institutional Relations↗
PubMed2005

The science centre movement in India: a conspectus.

The present article is about the development of the science museum net in India started in 1956, when the government of that country created the Industry and Technology Museum in Calcutta. In the 1960's and 1970's, due to the need of simple programs for rural communities and small villages, the idea of Mobile Science Exhibits (MSE) started. In order to take universal scientific concepts to those who could not visit museums, the Museobus was projected. At that time, the educational focus in museums changes from exhibiting artifacts to encouraging learning through "doing". The Exploratorium in San Francisco influenced the approach of museums in India. While the first Science Centre was built in Mumbai, the Planning COmmission of the Indian government created a task force to study the development of Sciences Museums. In 1978, the National Council of Science Museums (NCSM) was created as an independent institution, which later became part of the Ministry of Education and Social Welfare. Twenty-five years after the creation of the Council, the movement for informal science teaching had acquired a solid background. In 1978, their priority was to expand the net of science Centres and Museums. Now, the priority is to achieve better quality and more efficient communication. Nowadays, Indian Science Centres evaluate the impact their activities have on individual, social and economic reality. With new technologies and approaches, they try to emphasize their relevance in a society that is characterized by having a great number of languages and poor education in science.

Education↗
PubMed2006

A fresh look at growth assessment of infants and young children in the Czech Republic in context of international developments.

The growth charts of basic body measurements are an important aid for the daily routine practice of paediatricians. Charts for children from birth to 2 years of age form an integral component of a set of such tools for the age spectrum from birth to 18 years of age. The interpretation of growth charts is highly dependent on the data on basis of which the charts were constructed. In the Czech Republic, the growth reference data have been regularly updated since 1951, in 10-year intervals. These updates are based on data from nation-wide anthropological surveys of children and adolescents. Countries, which do not have their own reference data, have been using for growth assessment the 1977 World Health Organization (WHO) and the National Center for Health Statistics (NCHS) international reference growth charts. These charts, developed for height for age, weight for age, and weight for height, were based for children younger than 2 years on a longitudinal study of North American children. Over the years, use in practice showed that because of the original criteria used to select the child population studied, these reference growth charts were not suitable for assessing growth of breastfed children. The 1977 reference is based on predominantly artificially, that is formula-fed, child population. The evidence shows that breastfed and artificially fed infants grow differently and that the growth pattern of breastfed children most likely better reflects physiological growth. In 1994, based on the accumulated evidence, the WHO started working on new international standards which would be based on a sample of healthy breastfed children. The project, the WHO Multicentre Growth Reference Study (MGRS), was carried out from 1997-2003. It focused on collection of growth and development data of 8440 children from different ethnic and cultural groups. The underlying assumption of the project was that in favourable socio-economic conditions and with a recommended level of nutrition and lack of maternal smoking, children's growth is very similar, regardless of their ethnic origin and geographic location. The new growth standard for children 0-5 years of age will be available early in 2006. In the Czech Republic, we plan to analyse our national reference against this standard. If considered necessary, a process will be put in place for replacing the Czech reference with the WHO standard. The objective of this article is to alert health professionals that growth charts currently used in their country may not represent an optimal tool, especially with regard to the assessment of nutritional status for 0 to 2-year-old children, unless already based on data of breastfed children. Generally, the lack of awareness of the difference between the two growth patterns--the breastfed versus artificially fed child--poses a serious problem since a strict interpretation of the growth charts may lead to early supplementation of breastmilk with infant formula and/or premature introduction of complementary foods. Both of these practices tend to lead to premature cessation of breastfeeding, one of the key strategies to improve child health and development.

Anthropometry↗
PubMedDate not supplied

Moving branches.

Clinical experience is identified in this comparative study as the most influential factor in student transfer between the Project 2000 specialist branches. Expecting prospective students to have exposure to branch-specific client groups prior to starting their pre-registration education and improving flexibility of transfer between the branches could help to reduce student wastage from the profession as a whole.

Career Choice↗
PubMed2002

[Managing self determination and sexual violence in homes for young adults with mental handicap--report from an ongoing German model project].

This report is based upon a model project financially assisted by a grant from the German Federal Ministry for Families, Senior Citizens, Women and Youth, starting in 1999 and ending at the end of 2003. In cooperation with two disability care residential institutions, a conceptual approach and method to the questions of sexual self-determination and sexualized violence is being developed. Through qualitative methods of research e.g. focus groups, professional helpers of all hierarchies of the institution, including management, and the residents themselves, all had the chance to contribute their own opinions and experiences to the research topic. Specifically, to ensure their voice was heard, the people with mental retardation had an important impact on the questionnaire themselves. All aspects of sexuality were discussed--with notable difficulty arising in particular over the subject of sexual violence. It turned out that nonverbal communication and the interaction between the group members in the residents group were most indicative of their concerns. The staff at the nursing and living areas discussed the following topics: distance and closeness in the interaction between staff and residents, standards, reflections of their own professional attitudes, questions of legality as well as the tense topic of individual needs and tasks of the group. How those questioned described their solutions and ways of coping, and the impressions of the researchers forms the starting point for the compiled work. The initial ideas for the topics and the design of the concept are now laid out.

Adolescent↗
PubMed2003

[Science, communication and policy: sequencing the rice genome].

Nearly 4 years after launching the International Rice Genome Sequencing Project (IRGSP), the rice genome sequence is almost completed. This is the second plant genome after Arabidopsis thaliana and one expect that it is more representative of other cereal genomes. Indeed, no more than 4 sequences have been independently reported as a result of a tough competition between economy, politics and media. The efficiency and impact of this way of managing a large scale project is questionable. This paper reports the various phases in sequencing rice genome as well as what we start to learn.

Chromosomes, Plant↗
PubMed2006

From punched cards to computerized patient records: a personal journey.

OBJECTIVES: This paper presents the early history of the development of CPR in Sweden, the importance of international cooperation and standardisation and how this cooperation has been facilitated by IMIA, the European Union and the standards organisations. It ends with the lessons learned after 35 years of experience put together by the Swedish Institute for Health Services Development, SPRI, in a 5 year project initiated by the Swedish Government and with participation of most health care providers in the country. METHODS: Starting with the first attempts to use punched cards to store and use patient information for clinical use the author describes his troublesome and difficult road to a Computerized Patient Record that could be used both for the work with the patient and as a tool to follow up both the diagnostic and therapeutic processes and for clinical research. RESULTS: The most important results of the efforts to develop a computerized patient record in Sweden are published in many reports, among them three SPRI reports published in the late 1990s, and they are: Standardized information architecture, a common terminology, rules for communication, security and safety, electronic addresses to all units and users and an agreed upon patient and user identification. CONCLUSIONS: The future CPR must be problem oriented, capable of only adding new information instead of repeating already-known data and be available in real time regardless of geographic location. It must be possible to present the information in the CPR as 'views' where the healthcare provider has stated in advance the information needed for his patients. There can be a number of 'views' for different occasions.

European Union↗
PubMed1991

Selective effects of experimental glaucoma on axonal transport by retinal ganglion cells to the dorsal lateral geniculate nucleus.

Rapid-phase axonal transport to the dorsal lateral geniculate nucleus (dLGN) was determined autoradiographically in seven macaque monkey eyes with chronic intraocular pressure (IOP) elevation, in four eyes with an acute IOP elevation, and in three eyes with normal IOP. The monkeys with chronic IOP elevation showed a greater decrease in radioactive labeling of the magnocellular layers of the dLGN than the parvocellular layers by qualitative examination. Grain counts in selected specimens confirmed that transport to the magnocellular layers was less than to the parvocellular layers in monkeys with chronic IOP elevation. This selectivity was present in mildly damaged specimens and increased with greater ganglion cell loss. In monkeys with acute IOP elevation, qualitative evaluation suggested no consistent difference in transport among the dLGN layers; one animal in this group had less transport to the parvocellular than to the magnocellular layers by grain counts. Starting in early stages of the disease, chronic experimental glaucoma causes preferential damage to the ganglion cells that project to the magnocellular layers of the dLGN.

Animals↗
PubMed1988

[Fractures of the trapezium. Mechanisms. Anatomo-pathology and therapeutic indications].

Fractures of the trapezium are rare and often unrecognized lesions; their diagnosis can only be made by radiographs with specific projections that clearly separate the outline of the trapezium from the radial side of the carpal bony complex. Starting from a series of 88 cases collected from the world literature, 34 of which had been examined by the authors, a study was made of the different mechanisms of these fractures, their main fracture lines and displacements and the current indications for treatment. The physio-pathology of fractures of the trapezium was investigated by personal experiments conducted in the laboratory on 26 wrists and showed 3 main mechanisms: a fall on the hand with the wrist extended and radially deviated (Manon) and direct commissural trauma combined with various degrees of shearing described by Monsche. The fracture line is, in most cases, a vertical one and the lateral fragment which is connected to the first metacarpal is often subluxated proximally and radially. The treatment of these fractures can be conservative with immobilization in plaster either as the fracture lies or after reduction, or by continuous traction after reduction, or it can be operative. Direct internal fixation, completed, if necessary, by a stabilization of the thumb column using one of the various implants available today for the fixation of small fragments, should particularly be used for displaced and unstable fractures. Partial removal of the trapezium should be reserved for small fracture fragments that do not affect the joint surface or affect it very little. Proper treatment of this rare fracture is a key condition for the future function of the thumb column.

Adult↗
PubMed1993

[External and intracavitary afterloading radiotherapy of cervical cancer: a report of 110 cases].

Radiation therapy is one of the major methods among the multidisciplinary treatments for carcinoma of the uterine cervix. A series of 110 patients with carcinoma of uterine cervix treated from May 1987 to December 1987 by 3-channel (Cs-137) Buchler afterloading was presented. The youngest patients was 31 while the oldest was 78 years old with an average age of 56 years. Squamous cell carcinoma was found in 104 of the patients, while 6 had adenocarcinomas. There were 2 cases with Stage I, 17 Stage II and 91 Stage III lesions. Whole pelvis irradiation was delivered with two large parallel anterior-posterior opposite fields. The dose was 2.5-3Gy given in one field a day, three times a week, the total dose was 42-52Gy at the middle line plane of pelvis. Intracavitary irradiation was started a week following the external irradiation. The dose rate at point A was 0.1-0.26Gy/min. The project was designed to deliver 25-30 Gy to point A by 5-6 frequency. The over-all 5-year survival rate of the whole series was 70%, with 82% for Stage II and 67% for Stage III lesions. The frequency of late rectal and bladder reactions was 10.9% and 4.5%, respectively.

Adult↗
PubMedDate not supplied

A place called HOPE: group psychotherapy for adolescents of parents with HIV/AIDS.

Project HOPE is a psychosocial support program for noninfected children of HIV-positive parents. The challenges of starting and implementing the program's psychotherapy group for grieving adolescents, and clinical examples of group process and effective interventions in group leadership, are described. Four stages in group development are explicated--safety, dependency, counterdependency, and independence--paralleling the adolescent separation-individuation process.

Adaptation, Psychological↗
PubMed2003

A pilot telemedicine project in the Privolzhsky District, Russia.

The geography of Russia and the complex structure of the Russian health-care system make telemedicine systems especially appropriate. The telemedicine project described here deploys a telemedicine system in Nizhny Novgorod with further integration into the Privolzhsky District telemedicine network. It started with the creation of a telemedicine center with high-speed dedicated communication links to various medical institutions in Moscow, interregional telemedicine centers, and several district hospitals in rural areas of the Privolzhsky district. In addition to this specialized network, training by telemedicine specialists from the Space Biomedical Center at Moscow State University was provided along with teleconsultations with specialists from the most advanced medical institutions in Moscow. Consultations were carried out via the interregional telemedicine center on a contractual basis. The regional telemedicine network linked nearly 78 medical sites. This system provided approximately 500 teleconsultations and 100 educational sessions within the past 3 years.

Pilot Projects↗