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[Adverse effects and medication errors: incidence and role of the organization of drug distribution].

The true incidence of adverse drug events is controversial and there are few data concerning the percentage of potentially preventable adverse drug events. Over 2 months, in two internal medicine units, we asked the staff to report adverse drug events. All incidents were evaluated: adverse drug events (preventable and non-preventable) and potential adverse drug events (non-intercepted potential adverse drug events and intercepted potential adverse drug events). The severity, the stage in the process at which the error occurred and the type of error were evaluated by a physician reviewer. Over the 240 admissions, the incidence of adverse drug events is 18 per 1000 patient-days. The system design caused 77 per cent of the incidents. The medication errors occurred at all stages from ordering to administration. Adverse drug events resulting in medication errors (n = 22) were more serious than non-preventable adverse drug events (n = 26) (p = 0.003). A prevention strategy by pharmacovigilance centres (Centres Régionaux de Pharmacovigilance) should target all stages of the drug delivery process.

Drug-Related Side Effects and Adverse Reactions↗

New electrochemiluminescent immunoassay for the determination of CYFRA 21-1: analytical evaluation and clinical diagnostic performance in urine samples of patients with bladder cancer.

BACKGROUND: A new electrochemiluminescent immunoassay (ECLIA) has been developed for the determination of cytokeratin 19 (CYFRA 21-1) in the Elecsys 2010 immunoassay system. Urinary CYFRA 21-1 might have a role in the diagnosis of bladder cancer. METHODS: We performed an analytical evaluation of the CYFRA 21-1 ECLIA for serum and urine samples. The clinical value of urinary CYFRA 21-1 for the detection of bladder cancer was evaluated through its measurement in 226 urine samples from symptomatic and asymptomatic controls. RESULTS: At concentrations of 2-30 microg/L, within-assay imprecision (CV) was below 2.1% for sera and 3.3% for urines, with interassay CVs below 3.3% for sera and 4.9% for urines. The day-to-day CV was <20% at concentrations >0.2 microg/L (functional sensitivity). Measurement of diluted samples showed that the assay estimated CYFRA 21-1 between 98% and 103% for sera and 98% and 105% for urines. Recovery of added CYFRA 21-1 was 99-105% for sera and 96-115% for urines. We separately compared serum and urine CYFRA 21-1 ECLIA results with those obtained with an IRMA (CIS bio international). Regression analysis for sera was: CYFRA 21-1 (ECLIA) = 0.520 + 1.018 CYFRA 21-1 (IRMA); [95% confidence interval (CI) (y-intercept), -0.260 to 1.309]; 95% CI (slope), 0.978-1.060; n = 100; S(y|x) = 3.242; r(2) = 0.987. For urine samples it was: CYFRA 21-1 (ECLIA) = 0.716 + 0.966 CYFRA 21-1 (IRMA); 95% CI (y-intercept), 0.009-1.422; 95% CI (slope), 0.956-0.976; n = 100; S(y|x) = 4.136; r(2) = 0.986. In urine samples voided by patients with and without bladder cancer, the best ROC analysis discrimination provided 81.0% (95% CI, 72.7-87.7%) sensitivity and 97.2% (95% CI, 90.2-99.6%) specificity at a threshold value of 5.7 microg/L. CONCLUSIONS: Our initial evaluation showed reliable analytical performance for urinary CYFRA 21-1, which might assist urologists in the detection of bladder cancer as a noninvasive adjunct to cystoscopy.

Adult↗

Nuclear volume in type I gastric intestinal metaplasia.

OBJECTIVE: To retrospectively compare nuclear size of epithelial cells in type I intestinal metaplasia (IM) from various pathologic lesions of gastric mucosa. STUDY DESIGN: Endoscopic mucosal biopsies with type I IM from intestinal type gastric carcinoma (n = 25), chronic gastritis (n = 40) and benign ulcer (n = 32) cases were analyzed. After standard fixation, embedding, sectioning, routine hematoxylin and eosin and alcian blue--periodic acid--Schiff reaction (pH 1.0 and 2.5) staining were used for identification of IM. The mean point sampled nuclear intercept was estimated by the original test system and 100x objective at a total magnification of 1,200x. To obtain the mean nuclear volume, the cubed nuclear intercept was multiplied by pi/3. In each case 100 epithelial cell nuclei were analyzed. RESULTS: In type I IM in gastric carcinoma cases there was significantly greater nuclear volume (118.34 +/- 10.32 micron 3) than in type I IM in other pathologic states of gastric mucosa (77.72 +/- 8.58 micron 3). CONCLUSION: The karyometric findings of the present study suggest a difference between type I IM found in benign pathologic states and type I IM found in gastric mucosa surrounding carcinoma, despite morphologic and histochemical similarities. Nuclear volume may be used in early detection of precancerous states of gastric mucosa.

Adenocarcinoma↗

Noninvasive measurement of brain temperature after stroke.

BACKGROUND AND PURPOSE: Brain temperature may be an important factor governing the extent of neuronal injury associated with stroke. The goal of this study was to develop a noninvasive method for measuring brain temperature, both to characterize the extent to which temperature changes after stroke and to test protocols designed to reduce brain temperature. We used an animal model to test the ability of 1H MR spectroscopy to measure temperature from infarcted brain tissue at 24 hours after insult. METHODS: Unilateral permanent focal ischemia in the middle cerebral artery territory was induced in adult dogs by intravascular delivery of microfibrillar collagen. MR imaging performed at 24 hours after insult was used to guide the implantation of temperature probes into the basal ganglia infarct and into the same anatomic location on the contralateral side. Serial non-water-suppressed 1H MR spectra were obtained from 1.3-cm3 voxels using an echo time of 136 and 272 ms, alternately, from the infarcted and contralateral non-infarcted tissue during a period when brain temperature was raised and lowered by whole-body heating and cooling. RESULTS: The chemical shift difference between the 1H MR spectroscopy signal of water and N-acetylaspartate or water and trimethylamines was plotted against brain temperature for two voxel locations. The slope and intercept of the plots obtained for infarcted and non-infarcted brain were not significantly different (P < .05, t test), and there was no difference between the slope and intercept of plots made from data collected with an echo time of 136 or 272 ms. CONCLUSION: The results of this study indicate that brain temperature can be measured from regions of brain containing infarcted tissue, at least up to 24 hours after ischemia. It should be possible to apply the 1H MR spectroscopy method used in the present study to measure brain temperature after stroke.

Animals↗

Modelling the influence of age, body size and sex on maximum oxygen uptake in older humans.

The purpose of this study was to describe the influence of body size and sex on the decline in maximum oxygen uptake (O2,max) in older men and women. A stratified random sample of 152 men and 146 women, aged 55-86 years, was drawn from the study population. Influence of age on O2,max, independent of differences in body mass (BM) or fat-free mass (FFM), was investigated using the following allometric model: O2,max = BMb (or FFMb) exp(a + (c ' age) + (d ' sex)) [epsilon]. The model was linearised and parameters identified using standard multiple regression. The BM model explained 68.8 % of the variance in O2,max. The parameters (+/- s.e.e., standard error of the estimate) for lnBM (0.563 +/- 0.070), age (-0.0154 +/- 0.0012), sex (0.242 +/- 0.024) and the intercept (-1.09 +/- 0.32) were all significant (P < 0.001). The FFM model explained 69.3 % of the variance in O2,max, and the parameters (+/- s.e.e) lnFFM (0.772 +/- 0.090), age (-0.0159 +/- 0.0012) and the intercept (-1.57 +/- 0.36) were significant (P < 0.001), while sex (0.077 +/- 0.038) was significant at P = 0.0497. Regardless of the model used, the age-associated decline was similar, with a relative decline of 15 % per decade (0.984 exp(age)) in O2,max in older humans being estimated. The study has demonstrated that, for a randomly drawn sample, the age-related loss in O2,max is determined, in part, by the loss of fat-free body mass. When this factor is accounted for, the loss of O2,max across age is similar in older men and women.

Aged↗

Evaluation of four automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications.

BACKGROUND: C-reactive protein (CRP) can provide prognostic information about the risk of developing atherosclerotic complications in apparently healthy patients. This new clinical application requires quantification of CRP concentrations below those traditionally measured in the clinical laboratory. METHODS: The Dade Behring BN II, the Abbott IMx, the Diagnostic Products Corporation IMMULITE, and the Beckman Coulter IMMAGE are four automated analyzers with high-sensitivity CRP (hs-CRP) methods. We evaluated these assays for precision, linearity, and comparability with samples from 322 apparently healthy blood donors. RESULTS: The imprecision (CV) of the BN II, IMx, IMMULITE, and IMMAGE methods was < or = 7.6%, < or = 12%, < or = 9.8%, and < or = 9.7% at 3.5 mg/L, respectively. The BN II, IMx, IMMULITE, and IMMAGE methods were linear down to < or = 0.30, < or = 0.32, < or = 0.85, and 2.26 mg/L, respectively. CRP concentrations demarcating each quartile in a healthy population were method dependent. The IMx method gave results comparable to the BN II method for values in the reference interval. The IMMULITE method had a positive intercept compared with the BN II method. The IMMAGE method demonstrated more scatter and a positive intercept compared with the BN II method, which may reflect the fact that it is a less sensitive assay. CONCLUSIONS: The four hs-CRP methods exhibited differences in results for a healthy population. Additional standardization efforts are required to ensure that hs-CRP results can be related to large-scale epidemiologic studies.

Adolescent↗

Task dependent processing of visual information about target acceleration.

The objective of this study was to investigate the sensitivity of the perceptual and motor systems to target acceleration information using verbal magnitude estimations of target acceleration and manual interception of these targets. The results showed that in the perceptual task the participants were responding mainly to acceleration threshold values, which is acceleration as a function of initial, final, and average velocities, rather then to the absolute accelerations. When manually intercepting the targets the participants responded mainly to the absolute acceleration value and target initial velocity. Thus, these results suggest that target motion can be processed in the ventral (perception) and dorsal (action) visual streams however different motion characteristics are processed in these streams depending on the required output.

Adult↗

Gender differences in the patterns of coronary angiography and PTCA use in a university hospital in Taiwan.

BACKGROUND AND PURPOSE: Coronary artery angiography (CAG) and percutaneous transluminal coronary angioplasty (PTCA) are important procedures for the diagnosis and treatment of patients with coronary artery disease. However, long-term trends in the frequency of CAG and PTCA use and their relation to gender have not been clearly determined in the Asian population. The purpose of this study was to investigate gender differences in the patterns of CAG and PTCA use in a university hospital in Taiwan during the period of 1983 through 1996. METHODS: We studied the monthly data of all patients who underwent CAG or PTCA in a university hospital in Taipei from 1983 through 1996. A time series analysis was used to estimate gender differences in the patterns of CAG and PTCA use. RESULTS: The frequency of CAG and PTCA increased significantly during this period. Before 1990, only a small number of patients underwent PTCA. However, this number increased steadily after 1990. Men were more likely to undergo CAG and PTCA than women. A time series analysis with fitted models was used to create an integrated moving average model. For CAG, the value of the estimated intercept for men was 2.5 times greater than that for women. In the PTCA series, the value of the intercept in men was 4.4 times greater than that in women. The patterns of trend change showed greater increases in men than in women, and a greater increase in the PTCA than in the CAG series. By transfer function modeling and intervention analysis, we found that the effect of CAG on the frequency of PTCA in men was 1.8 times greater than its effect in women. The estimated influence of the use of a new catheterization room (added in 1993) was 2.8 times greater in men than in women. The fitted model correlated well with the observed values in the next 12 months for both genders. CONCLUSIONS: We concluded that women had fewer CAG and PTCA procedures than men, and the influence of CAG on the PTCA series was significantly higher in men than in women.

Angioplasty, Balloon, Coronary↗

A comparison study of house entering and exiting behavior of Anopheles vestitipennis (Diptera: Culicidae) using experimental huts sprayed with DDT or deltamethrin in the southern district of Toledo, Belize, C.A.

An investigation of the house entering and exiting behavior of Anopheles vestitipennis Dyar and Knab was undertaken in the Toledo District of Belize, Central America, between March and December of 1998. Three untreated experimental huts were either fitted with exit or entrance interception traps or used as a control for human landing collections. Human landing collections showed that An. vestitipennis exhibited a high level of biting activity shortly after sunset and continued biting at high levels throughout the night. Under unsprayed conditions, the use of exit and entrance interception traps demonstrated that doors, windows, and eaves were the primary mode of entry; whereas, cracks in the walls served a secondary role. The peak entrance time for An. vestitipennis occurred between 6:45 P.M. and 9:45 P.M. and a peak exit time occurred between 11:45 P.M. and 4:45 A.M. Additional trials were conducted after spraying one of the huts with DDT and another with deltamethrin. The excito-repellent properties of deltamethrin did not affect entrance times but did result in a peak exiting behavior that was five hours earlier than under pre-spray conditions. Deltamethrin also exhibited a repellency effect, showing 66% fewer An. vestitipennis entering the hut two weeks post-spray. DDT had an even more powerful repellency effect resulting in a 97% post-spray reduction of An. vestitipennis females entering the hut up to two weeks post-spray. The control hut showed only a 37% reduction in An. vestitipennis as compared to pre-spray conditions.

Animals↗

A simple method for measuring severely reduced glomerular filtration rate.

OBJECTIVE: The purpose of this study was to develop a simpler method to measure severely reduced glomerular filtration rate (GFR) for patients with a GFR below 30 mL/min. METHOD: The GFR was measured in 24 patients using both the 51Cr EDTA slope-intercept method (the conventional method) and 99mTc-DTPA with our proposed simpler GFRn method. RESULTS: The correlation coefficient was 0.92 between the 2 methods, with a slope of 0.97 and an intercept of 2 mL/min. CONCLUSION: Our simplified method for measuring GFR is accurate for most patients with severely reduced GFR. Errors are acceptably small in patients with severely reduced GFR when edema or dehydration are present. If extrarenal (liver) clearance is significant, however, a urine sampling method is required for an accurate GFR measurement.

Algorithms↗

Nuclear volume estimates in prostatic atypical adenomatous hyperplasia.

OBJECTIVE: To investigate nuclear volume estimates by the point-sampled intercepts method in atypical adenomatous hyperplasia (AAH) as compared with nodular hyperplasia and well-differentiated prostatic adenocarcinoma. STUDY DESIGN: The study group consisted of 27 formalin-fixed, paraffin-embedded, whole-mounted radical prostatectomy specimens that contained foci of nodular hyperplasia, atypical adenomatous hyperplasia and well-differentiated adenocarcinoma (Gleason pattern 1 and 2). Representative sections were selected for stereologic estimation of volume-weighted mean nuclear volume by the point-sampled intercepts method. On each focus, an average of five fields of vision were systematically chosen. RESULTS: The quantitative results indicate an increase in nuclear volume from nodular hyperplasia (209 +/- 65 micron 3) to AAH (237 +/- 85 micron 3) and prostate adenocarcinoma (436 +/- 106 micron 3). Significant differences were found (F = 39.0, P < .001) with two group comparisons (Scheffe's procedure) between prostate cancer and AAH (P < .001) or nodular hyperplasia (P < .001). The difference between AAH and benign hyperplasia was not signifcant. CONCLUSION: The results indicate that three-dimensional estimates of the nuclear size discriminate AAH and nodular hyperplasia from well-differentiated prostate adenocarcinoma. These findings suggest that AAH is probably a histologic variant of benign prostatic hyperplasia the exact relationship of which to prostatic adenocarcinoma remains to be determined.

Adenocarcinoma↗

Modelling working and reference memory in rats: effects of scopolamine on delayed matching-to-position(1,2).

A model of working and reference memory in rats is described, based on a discrete-trial operant procedure with concurrent components of spatial matching (for working memory) and nonspatial discrimination (for reference memory). On each trial in the matching component, rats received food for pressing one of two retractable levers after a delay if that lever had been presented in the prior sample phase of the trial. On each trial in the discrimination component, food was delivered if the rat pressed a lever illuminated by a cue light after the delay interval. The model was tested with scopolamine (0.10 to 0.56 mg/kg, ip), which reduced matching accuracy in a dose-related manner. Linear slope and intercept estimates of retention gradients showed that intercepts declined and slopes remained unchanged with increasing scopolamine dose. In contrast, scopolamine had no significant effect on nonspatial discrimination accuracy, indicating a relative insensitivity of reference memory to cholinergic blockade. Because the matching component involved spatial cues and the discrimination component did not, a second group of rats was trained to discriminate between the spatial locations of two levers, to compare the effects of scopolamine on spatial and nonspatial discriminations. Scopolamine at the same doses caused a small, consistent decrease in spatial discrimination accuracy, suggesting that spatial discrimination was more sensitive to disruption by scopolamine than was nonspatial discrimination. The combined delayed matching-to-position/nonspatial discrimination procedure appears to provide a useful technique for characterizing mnemonic effects of drugs and toxicants in rats.

Journal Article↗

Nutrition and the Aging Process: A Population Study.

Highly significant correlations exist in the age range 35 to 84 years between log mortality from all causes and age, obtained from 33 countries (mean r equals 0.999 in men and 0.997 in women). Populations with a high life expectancy are characterized by a low intercept and a high slope of the equation between log mortality and age. The slope and intercept of the equation obtained from different countries are highly intercorrelated, pointing to a maximum life expectancy at the population level of about 104 years in men and 108 years in women. The slope of the equation between log mortality and age can be considered as an expression of the resistance against aging of a given population. Significant positive correlations exist between the level of saturated fat intake and the determinants of mortality at the population level. These correlations are more evident in men compared with women. The results offer evidence for a detrimental influence of saturated fat on the aging process in populations.

Journal Article↗

Reporting of CAHPS quality information to medicare beneficiaries.

OBJECTIVES: To assess which Consumer Assessment of Health Plans (CAHPS) survey measures Medicare beneficiaries find the most meaningful, how beneficiaries and information intermediaries interpret different formats for presenting CAHPS information, and how beneficiaries have reacted to the CAHPS information included in the annual mailing to beneficiaries called Medicare & You 2000. DATA SOURCES: Fourteen focus groups of beneficiaries and State Health Insurance Assistance Program counselors, more than 200 cognitive interviews, and 122 mall-intercept interviews with beneficiaries were conducted from spring 1998 through winter 2000. STUDY DESIGN: In 1998 focus groups and cognitive interviews were conducted with Medicare beneficiaries and State Health Insurance Assistance Program counselors to determine which CAHPS measures to report to Medicare beneficiaries and how to report this information. In 1999 additional focus groups and mall-intercept interviews were conducted to determine which measures to include in Medicare & You 2000. To obtain feedback on the CAHPS information in Medicare & You 2000 additional focus groups were conducted in winter 2000. PRINCIPAL FINDINGS: Focus group participants indicated that getting the care they need quickly, having access to specialists, and communicating well with doctors were more important to them than nonmedical characteristics of plans. Most beneficiaries had problems interpreting quality information. Many misinterpreted star charts, and while bar charts appear easier to read, many beneficiaries still had trouble interpreting the information on these charts. Most beneficiaries did not consider quality information important to them and most were unaware of the availability of CAHPS information. CONCLUSIONS: Many challenges lie ahead in making quality information meaningful to Medicare beneficiaries. These challenges include increasing awareness of the existence of this information, educating beneficiaries about how this information can help in choosing a health plan, continuing to simplify reporting formats, assuring beneficiaries that this information comes from a credible source, and providing guidance to beneficiaries about how quality information can help with health care decisions.

Aged↗

Fractal geometry of bean root systems: correlations between spatial and fractal dimension.

An obstacle to the study of root architecture is the difficulty of measuring and quantifying the three-dimensional configuration of roots in soil. The objective of this work was to determine if fractal geometry might be useful in estimating the three-dimensional complexity of root architecture from more accessible measurements. A set of results called projection theorems predict that the fractal dimension (FD) of a projection of a root system should be identical to the FD of roots in three-dimensional space (three-dimensional FD). To test this prediction we employed SimRoot, an explicit geometric simulation model of root growth derived from empirical measurements of common bean (Phaseolus vulgaris L.). We computed the three-dimensional FD, FD of horizontal plane intercepts (planar FD), FD of vertical line intercepts (linear FD), and FD of orthogonal projections onto planes (projected FD). Three-dimensional FD was found to differ from corresponding projected FD, suggesting that the analysis of roots grown in a narrow space or excavated and flattened prior to analysis is problematic. A log-linear relationship was found between FD of roots and spatial dimension. This log-linear relationship suggests that the three-dimensional FD of root systems may be accurately estimated from excavations and tracing of root intersections on exposed planes.

Computer Simulation↗

Right and left ventricular volumes in vitro by a new nongeometric method.

We present an evaluation of a new nongeometric technique for calculating right and left ventricular volumes. This method calculates ventricular chamber volumes from multiple cross-sectional echocardiographic views taken from a single point as the echo beam is tilted progressively through the ventricle. Right and left ventricular volumes are calculated from both the approximate short axis and approximate apical position on 20 in vitro human hearts and compared with the actual chamber volumes. The results for both ventricles from both positions are excellent. Correlation coefficients are > 0.95 for all positions; the standard errors are in the range of 5 to 7 mL and the slopes and intercepts for the regression lines are not significantly different from 1 and 0, respectively (except for the left ventricular short-axis intercept). For all positions, approximately 6 to 8 views are needed for peak accuracy (7.5 degrees to 10 degrees separation). This approach offers several advantages. No geometric assumptions about ventricular shape are made. All images are acquired from a single point (or window), and the digitized points can be used to make a three-dimensional reconstruction of the ventricle. Also, during the calculations a volume distribution curve for the ventricle is produced. The shape of this curve can be characteristic for certain situations (ie, right ventricle, short axis) and can be used to make new simple equations for calculating volume. We conclude that this is an accurate nongeometric method for determining both right and left ventricular volumes in vitro.

Adult↗

Critical velocity of floatables in combined sewer overflow (CSO) chambers.

Although the efficiency of underflow baffles has never been clearly proven, these underflow baffles have gained in popularity over the last few years as a viable means to intercept floatables in Combined Sewer Overflows (CSOs). These pilot scale essays, performed in a 17.0 metres basin at various flowrates, show that a critical horizontal velocity (V(CR)) may develop in the overflow chamber. Whenever this critical velocity is exceeded, floatables that would normally rise to the surface are kept within the flow and never intercepted, thus rendering the underflow baffle ineffective. The equation relating the critical horizontal velocity to the vertical velocity is found to be: V(CR) = 16 w R(H) 1/6.

Models, Theoretical↗

Modulation of respiratory sinus arrhythmia by respiration rate and volume: stability across posture and volume variations.

We tested the assumption that the slope of the within-individual regression equation of respiratory sinus arrhythmia (RSA) normalized by tidal volume (V(T)) upon respiratory cycle length (T(TOT)) can characterize ventilatory RSA modulation independent of cardiac vagal tone, whereas the intercept is varying as a function of vagal tone. We also explored whether a variation of V(T) is necessary to estimate slopes reliably. Four 3-min sequences paced at 8-18 cycles/min were performed supine and standing. Participants also breathed the same sequences in supine posture with voluntarily varying V(T). The mean slope of RSA/V(T) upon T(TOT) was identical, and the mean intercept was lower for standing than supine (spontaneous V(T)) conditions. Stability of slopes was low between body postures, and was higher between spontaneous V(T) versus varying V(T) at the same body posture. The regression of RSA/V(T) upon T(TOT) allows for a valid estimation of ventilatory influences on RSA.

Adult↗