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PubMed1995

[Problems when swallowing tablets. A questionnaire study from general practice].

Dysphagia, or difficulty in swallowing tablets, may greatly affect compliance. This report presents the results of our survey, which was undertaken to determine the proportion of a general practitioner's patient population who had difficulty in swallowing tablets, and to identify the reasons for the difficulty. 6,158 questionnaires were received from patients who consulted a general practitioner. More than 1/4 (26%) of the total patient population (or 1,576) said they had problems in swallowing tablets. A prominent complaint was the size of the tablet, followed by the surface, form and taste of the tablet. Twice as many women as men experienced swallowing problems. Elderly patients (> 70 years) had less difficulty than younger patients when taking tablets. To achieve good compliance and optimal pharmacotherapy, it is important for medical practitioners and pharmaceutical personnel to be aware of the general problems connected to swallowing tablets, to enable them to select the correctly formulated drug for their patients. New and novel oral drug formulations, such as tablets that dissolve in seconds on the tongue without water, may alleviate the problem of swallowing tablets. They offer substantial advantages over ordinary tablets, are more convenient to administer, and enhance the potential for improved compliance in patients who experience difficulty in taking tablets.

Adolescent↗
PubMed2000

Pharmacokinetics and anti-inflammatory activity in rabbits of a novel indomethacin ophthalmic solution.

The formulation of aqueous ophthalmic solutions containing indomethacin (IND) presents serious problems due to poor solubility and stability of the drug. The purpose of this study was to evaluate a novel 0.1% IND formulation containing a poly(oxyethylene)-poly(oxypropylene) block copolymer (poloxamer 407) as solubilizer. This formulation was evaluated for stability, bioavailability and anti-inflammatory activity in comparison with an ophthalmic IND solution currently on the market. The experimental solution, tested for IND stability at different temperatures, compared favorably with the commercial solution. In rabbits, it produced significantly higher IND levels in the aqueous humor and, in an immunogenic uveitis model, it induced a comparatively faster resolution of the symptoms, as determined by inflammation scores and by IOP measurements. The data indicate poloxamer 407 as a potentially valuable nonirritating, solubilizing and stabilizing agent for indomethacin.

Animals↗
PubMed1984

A chance-constrained multiobjective model for mental health services planning.

Mental health services planning, and particularly the planning for deinstitutionalization, is a very complex problem. This paper suggests a chance-constrained goal programming (CCGP) approach to mental health services planning. The CCGP approach is based on the sequential solution of a linear programming formulation, allowing efficient solution of large-scale planning problems using commercially available linear programming computer codes. The procedure is demonstrated with a case example and implementation of the approach is discussed.

Deinstitutionalization↗
PubMed1993

Formulating selection policies for assisted reproduction.

This paper addresses one of the most important problems in the area of assisted reproduction, namely the selection policies used by the providers of the services. Some of the difficulties involved in formulating policies in this area are outlined. The paper concludes that public involvement in decision making in this area is vital, and that to facilitate this the issues must be opened up to public scrutiny and debate. Such a debate would be a significant first step towards the implementation of policies which reflect the opinion of the entire community rather than just the professionals who provide the service, or sectional groups who manage to influence the professionals.

Advisory Committees↗
PubMed2005

Sentence completion test for depression (SCD): an idiographic measure of depressive thinking.

OBJECTIVES: This study set out to investigate the reliability and validity of the Sentence Completion Test for Depression (SCD) as a clinical measure. In contrast to questionnaire measures of depressive thinking, respondents finish incomplete sentences using their own words. This elicits idiographic information concurrent with measuring depressive thinking. METHOD: In Study 1, measures of negative thinking were tested between a depressed group and a non-depressed control group. A preliminary item analysis was conducted and replicated on separate samples in Study 2. Psychometric properties of the test were investigated. In Study 3, idiographic validity and sensitivity to change were explored in a sample of clinical cases with reference to cognitive-behavioural case-formulation. RESULTS: In Study 1, the depressed group produced more negatives and fewer positives, and the SCD demonstrated good content validity, internal consistency and inter-rater reliability. The preliminary short-form had comparable psychometric properties, and these were replicated on new samples in Study 2. Sensitivity and specificity values were above 90% in both studies. In Study 3, idiographic content generated hypotheses about target problems and dysfunctional beliefs within cognitive-behavioural case-formulation, and SCD scores were sensitive to clinical change. CONCLUSIONS: The SCD demonstrates good construct validity, internal consistency, inter-rater reliability, sensitivity, and specificity. It offers an idiographic assessment of depression that is complementary to questionnaire measures, particularly by generating hypotheses about target problems and dysfunctional beliefs within a cognitive-behavioural case-formulation. This is achieved without loss to reliability and validity at the nomothetic level.

Adult↗
PubMedDate not supplied

Ciclosporin microemulsion preconcentrate treatment of patients with Behçet's disease.

PURPOSE: The new microemulsion preconcentrate (MEPC) formulation of ciclosporin has been developed to reduce problems in intestinal absorption and to stabilize fluctuations in blood levels. A multicenter, open-label clinical trial of MEPC was conducted to assess its efficacy and safety in Behçet's disease patients with ocular involvement. METHODS: The patient population comprised 17 de novo patients (patients not previously treated with ciclosporin in the currently available formulation) and 30 patients whose ciclosporin formulation was switched from the conventional formulation to MEPC. The patients were treated with the test formulation for 16 weeks in the former (de novo) group and for 12 weeks in the latter (switched) group. RESULTS: In the de novo group, ocular attacks decreased significantly as compared to the pretreatment incidence in 11 of the 14 patients (78.6%) evaluated after MEPC therapy. Ocular attacks also decreased significantly in the switched group. In the de novo group, visual acuity improved with MEPC therapy in 20 of the 28 eyes (71.4%) examined, and the overall efficacy evaluation was "improved" or "markedly improved" in 13 of the 16 patients evaluated (81.3%). The one case each of onset of neuro-Behçet's disease and intestinal Behçet's disease observed in the de novo group were regarded as adverse reactions. CONCLUSION: It was concluded that ciclosporin MEPC is useful for controlling the ocular symptoms of Behçet's disease, and that it can be used as effectively and safely as the conventional formulation.

Adult↗
PubMed1999

Markov chain Monte Carlo linkage analysis of a complex qualitative phenotype.

We tested a new computer program, LOKI, that implements a reversible jump Markov chain Monte Carlo (MCMC) technique for segregation and linkage analysis. Our objective was to determine whether this software, designed for use with continuously distributed phenotypes, has any efficacy when applied to the discrete disease states of the simulated data from the Mordor data from GAW Problem 1. Although we were able to identify the genomic location for two of the three quantitative trait loci by repeated application of the software, the MCMC sampler experienced significant mixing problems indicating that the method, as currently formulated in LOKI, was not suitable for the discrete phenotypes in this data set.

Chromosome Mapping↗
PubMed1993

MRI gradient waveform design by numerical optimization.

This manuscript describes a method of gradient waveform design by nonlinear constrained optimization. Methods of formulation and solution of the waveform optimization problem are briefly described for minimization of root mean squared current and minimization of waveform moments. Waveforms generated using these objectives are presented and compared with those obtained with other objectives. The method uses waveforms which are defined as a set of discrete amplitudes in order to remove artificial constraints on waveform shape imposed by "multilobe" designs. These point-to-point amplitudes are the parameters determined in the optimization procedure which includes knowledge of the specific imaging conditions and the specific gradient hardware system. Some beneficial results of this design approach are: a) physically realizable waveforms which optimally achieve specific imaging and motion artifact reduction goals, b) waveforms which are guaranteed to be optimal with respect to one of several possible objective, c) less reliance on the experience of the designer, and d) a potential reduction in waveform design time.

Humans↗
PubMedDate not supplied

Estimating the causal effects of smoking.

An important application of statistics in recent years has been to address the causal effects of smoking. There is little doubt that there are health risks associated with smoking. However, more general issues concern the causal effects due to the alleged misconduct of the tobacco industry or due to programmes designed to curtail tobacco use. To address any such causal question, assumptions must be made. Although some of the issues are well known in the statistical and epidemiological literature, there does not appear to be a unified treatment that provides prescriptive guidance on the estimation of these causal effects with explication of the needed assumptions. A 'conduct attributable fraction' is derived, which allows for arbitrary changes in smoking and non-smoking health care expenditure related factors in a counterfactual world without the alleged misconduct, and therefore generalizes the traditional 'smoking attributable fraction'. The formulation presented here, although described for the problem of estimating excess health care expenditures due to the alleged misconduct of the tobacco industry, is more general. It can be applied to any outcome, such as mortality, morbidity, or income from excise taxes, as well as to any situation in which consequences due to alleged misconduct (for example, of two entities, such as the tobacco and the asbestos industries) or due to hypothetical programmes (for example, extra smoking reduction initiatives) are to be estimated.

Delivery of Health Care↗
PubMed2001

The NMR reciprocity theorem for arbitrary probe geometry.

It is shown that the NMR reciprocity theorem is a variant of a problem considered by Lorentz in 1895. This formulation is quite general and applies to electric-dipole-based as well as coil-based or resonator-based magnetic resonance probes. The reasoning is related to, but different from, the proof of the reciprocity theorem for radiofrequency networks and for transmit/receive antenna systems in telecommunications. The signal-to-noise ratio of the NMR experiment is also discussed in very general terms.

Journal Article↗
PubMed2005

Simultaneous registration and segmentation of anatomical structures from brain MRI.

In this paper, we present a novel variational formulation of the registration assisted image segmentation problem which leads to solving a coupled set of nonlinear PDEs that are solved using efficient numerical schemes. Our work is a departure from earlier methods in that we have a unified variational principle wherein non-rigid registration and segmentation are simultaneously achieved; unlike previous methods of solution for this problem, our algorithm can accommodate for image pairs having very distinct intensity distributions. We present examples of performance of our algorithm on synthetic and real data sets along with quantitative accuracy estimates of the registration.

Algorithms↗
PubMed2005

Prevention and treatment of postoperative pain with particular reference to children.

Pain therapy is an important aspect of medical practice for patients of all ages, to optimize care, to obtain an adequate quality of life and to improve their general conditions. Pain is among the most prevalent symptoms experienced by patients undergoing surgery. The success of postoperative pain therapy depends on the ability of the clinician to assess the presenting problems, identify and evaluate pain syndromes and formulate a plan for comprehensive continuing care. The prevalence of acute pain has led to the need to develop techniques for the assessment and management of this symptom in order to focus the attention on an interdisciplinary therapeutic approach (including pharmacologic, cognitive-behavioral, psychologic and physical treatment) and on the timing of different interventions (pre and postoperative). In this chapter we describe the principal therapeutic approaches to control pain in post-operative patients, such as non-opioid, opioid and adjuvant analgesics with particular attention in paediatric age. Moreover we report the principal scales to assess the pain intensity in the post-operative period. The need of a multidisciplinatory team and of a pre and postoperative pain management program represents an important goal in order to obtain effective pain relief and optimize pediatric care and rapid recovery. The introduction of a perioperative team service will improve the approach to pain management programs and it is considered the most important challenge for future.

Analgesics↗
PubMed1990

Threshold and stability results for an age-structured epidemic model.

We study a mathematical model for an epidemic spreading in an age-structured population with age-dependent transmission coefficient. We formulate the model as an abstract Cauchy problem on a Banach space and show the existence and uniqueness of solutions. Next we derive some conditions which guarantee the existence and uniqueness for non-trivial steady states of the model. Finally the local and global stability for the steady states are examined.

Age Factors↗
PubMed1992

Standardized nursing language for healthcare information systems.

Since a substantial component of health care delivery is reflected in nursing's work, it is imperative that nursing expedites implementation of a standardized language that reflects nursing's work and ultimately allows outcome evaluation. This paper will summarize the state of development and related issues of standardized language in nursing, including: Nursing Minimum Data Set, Taxonomies of Nursing Diagnoses, Nursing Interventions, Outcomes, and the Nursing Management Minimum Data Set. The Nursing Minimum Data Set, including nursing care, patient or client demographic, and service elements, reflects a standardized collection of essential nursing data used by multiple data users in the health care delivery system across all types of settings. The nursing care elements include nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care. Currently, more than 100 nursing diagnoses have been accepted for clinical testing by the North American Nursing Diagnosis Association (NANDA) and have been incorporated into a taxonomy of nursing diagnoses that reflects patient responses to actual or potential health problems that nursing can address. A current formulation of a taxonomy of nursing interventions for the treatment of the nursing diagnoses yielded 336 nursing intervention labels organized at three or four levels of abstraction. Concomitant with these endeavors is the necessity for identifying outcomes associated with each diagnosis and its treatment. Concepts and a classification for indicators of these outcomes are being reviewed. Last, to address the contextual covariates of patient outcomes, a collection of core variables needed by nurse managers to make management decisions and compare nursing effectiveness across institutions and geographic regions is under development. In summary, standardized measures to determine cost effective, high quality, appropriate outcomes of nursing care delivered across settings and sites are being developed.

Classification↗
PubMed1989

A ready-to-use activated charcoal mixture. Adsorption studies in vitro and in dogs: its influence on the intestinal secretion of theophylline in a rat model.

A practical, ready-to-use preparation of activated charcoal (AZU mixture) for application in toxicology has been formulated. To establish its efficacy, the formulation was tested in vitro and in dogs. The in vitro adsorption capacity was compared to that of freshly prepared charcoal suspension in water (CW) and to Carbomix. Langmuir adsorption coefficients demonstrated small but clinically insignificant differences in adsorption capacity between the preparations. The laxative sodium sulfate did not reduce the adsorption capacity of charcoal in vitro. Dogs were given 60 mg of paracetamol per kg as an oral solution followed by 5 g of activated charcoal preparation. The area under the plasma concentration versus time curve (control 2955 +/- 353 mg.min-1.l-1) was significantly reduced following CW (921 +/- 453) and AZU (786 +/- 270). The premixed AZU charcoal formulation is efficacious, inexpensive and overcomes the problems of bed-side preparation. An isolated vascularly perfused rat small intestine can be used to describe the effect of activated charcoal on the intestinal secretion of theophylline.

Acetaminophen↗
PubMed2005

Household demand for waste recycling services.

Municipalities everywhere are coping with increasing amounts of solid waste and need urgently to formulate efficient and sustainable solutions to the problem. This study examines the use of economic incentives in municipal waste management. Specifically, we address the issue of recycling, if and when this waste management option is-on social welfare grounds-a preferred solution.A number of studies have recently assessed the monetary value of the externalities of alternative solid waste management options. In the present context, these subsidies could be interpreted as the implicit value of the benefits from reducing environmental externalities associated with landfilling as perceived by local government authorities. We surmise that the difference between mean households' willingness to pay (WTP) for recycling services, via the purchase of a subsidized waste disposal facility, and the above (proxy) value of externalities reflects the difference between private and public perception regarding the negative externality associated with landfilling. We believe that this information is useful in determining the level of subsidization needed (if at all) to sustain any recycling program.The study is unique in the sense that its conclusions are based on revealed household behavior when faced with increased disposal costs, as well as information on WTP responses in hypothetical but related (and, therefore, familiar) scenarios. The article also explores the influence of the subsidization schemes on recycling rates. It was found that with low levels of effort needed to participate in a curbside recycling program, households' participation rates are mainly influenced by economic variables and age, and households are willing to pay a higher price for the recycling scheme. When the required effort level is relatively high, however, households would pay a lower price, and the rate is influenced mainly by their environmental commitment and by economic considerations. We found that in both cases a subsidy would be required in order to achieve an efficient level of recycling. The median price that households are willing to pay for recycling devices is found to be about NIS 370 (New Israeli Shekel, approximately 90 dollars).

Conservation of Natural Resources↗
PubMed2003

Psychopathological dimensions in first-episode psychoses. From the trunk to the branches and leaves.

BACKGROUND: Dimensional frameworks for structuring psychopathology have been formulated in recent years to overcome classification problems of categorical approaches. However, few studies have addressed the dilemma of hierarchy within symptoms or dimensions in psychosis. METHODS: This study was designed to examine the hierarchical structure of psychopathological dimensions in first episode psychosis. The sample consisted of 94 first-episode patients psychosis. An exhaustive psychopathological assessment was carried out using the AMDP-system. Consecutive principal component analyses of AMDP symptoms, determining 'a priori' the number of factors to be extracted, were carried out. RESULTS: Following the track of the resulting factor analyses, a 'vertical hierarchical' framework was achieved. Our schema organized dimensions in a series of echelons in which lower tiers are subsumed as subsets of those assigned to higher ranks. In addition, a final model comprising 10 dimensions provided an 'horizontal' and multidimensional structure comprising all relevant psychopathological dimensions in first-episode psychosis. CONCLUSIONS: This study confirmed to a great extent the existence of a hierarchical organization within psychopathological dimensions in 'first-episode' psychosis. The present 'hierarchical and multidimensional' model of psychopathological dimensions allows for selection of the level of complexity of 'candidate phenotypes' to use in neurobiological research of psychosis.

Adult↗
PubMed2006

Toward a science of transdisciplinary action research.

This paper offers a conceptual framework for establishing a science of transdisciplinary action research. Lewin's (1951) concept of action research highlights the scientific and societal value of translating psychological research into community problem-solving strategies. Implicit in Lewin's formulation is the importance of achieving effective collaboration among behavioral researchers, community members and policy makers. The present analysis builds on Lewin's analysis by outlining programmatic directions for the scientific study of transdisciplinary research and community action. Three types of collaboration, and the contextual circumstances that facilitate or hinder them, are examined: (1) collaboration among scholars representing different disciplines; (2) collaboration among researchers from multiple fields and community practitioners representing diverse professional and lay perspectives; and (3) collaboration among community organizations across local, state, national, and international levels. In the present analysis, transdisciplinary action research is viewed as a topic of scientific study in its own right to achieve a more complete understanding of prior collaborations and to identify strategies for refining and sustaining future collaborations (and their intended outcomes) among researchers, community members and organizations.

Community Participation↗