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PubMed2000

Measurement: the key to success for providers, payors, and patients in long-term care.

The complex financing structure that supports home and community-based long-term care services has resulted in the application of different quality assurance requirements to similar services. Goals for home and community-based care are viewed differently by providers, payors, and customers. This raises the issue of how goals can be harmonized and what should be used to measure goals. Current quality assurance strategies are judge insufficient to assure the delivery of high-quality services; in part due to the state of health programs and lack of unified outcome measurement. The need for multidimensional assessment to adopt a baseline measure of health status to support allocation of services and enhance successful client outcomes has become the aim for health care providers.

Aged↗
PubMed2000

Non-contrast second harmonic imaging improves interobserver agreement and accuracy of dobutamine stress echocardiography in patients with impaired image quality.

OBJECTIVE: To examine the influence of second harmonic imaging during dobutamine echocardiography on regional endocardial visibility, interobserver agreement in the interpretation of wall motion abnormalities, and diagnostic accuracy in patients with reduced image quality. DESIGN: Blinded comparison. SETTING: Tertiary care centre. PATIENTS: 103 consecutive patients with suspected coronary artery disease and impaired transthoracic image quality (>/= 2 segments with poor endocardial delineation). METHODS: Fundamental and second harmonic imaging were performed at each stage of a dobutamine stress echocardiography. Coronary angiography was undertaken within three weeks of dobutamine echocardiography in 75 patients. MAIN OUTCOME MEASURES: Evaluation of regional endocardial visibility (scoring from 0 = poor to 2 = good) and of segmental wall motion abnormalities for both modalities separately. A second blinded examiner analysed 70 studies to determine interobserver agreement. RESULTS: Mean (SD) visibility score for all segments was 1.2 (0.4) using fundamental imaging and 1.7 (0.2) using second harmonic imaging at rest (p < 0.001), and 1.1 (0.4) v 1.6 (0.3), respectively, at peak dobutamine dose (p < 0.001). The average number of segments with poor endocardial visibility was lower for second harmonic than for fundamental imaging (0.6 (1.1) v 3.8 (2.6) at rest, p < 0.001; 0.9 (1.3) v 4.3 (2.9) at peak dose, p < 0.001). Improvement was most pronounced in all lateral and anterior segments. The kappa value for identical study interpretation increased from 0. 40 to 0.69 (p < 0.05). Sensitivity for the diagnosis of coronary artery disease was 64% using fundamental imaging versus 92% using harmonic imaging (p < 0.001), while specificity remained unchanged at 75% for both imaging modalities. CONCLUSIONS: Second harmonic imaging enhances endocardial visibility during dobutamine echocardiography. Consequently, interobserver agreement on stress echocardiography interpretation and diagnostic accuracy are significantly improved compared to fundamental imaging. Thus, in difficult to image patients, dobutamine echocardiography should be performed using second harmonic imaging.

Cardiotonic Agents↗
PubMed1987

The influence of anterior coupling on mandibular movement.

The need for and use of anterior coupling in occlusal rehabilitation has been discussed. The anterior teeth can often be coupled to the posterior controls by modifying contours with selective grinding, full or partial coverage restorations, or composite. When anterior guidance is provided, the anterior teeth should harmonize with the TMJs so that the posterior teeth will disclude in excursive mandibular movements. Significant functional, esthetic, and phonetic alterations that change the anterior guidance must be carefully planned because the anterior guidance affects all excursive tooth contacts. Anterior coupling, as described, is often an overlooked entity in restorative dentistry. Evidence of its role in separating the posterior teeth, reducing parafunctional activity, and harmonizing the temporomandibular complex has been presented.

Cuspid↗
PubMedDate not supplied

[AIDS: challenge to liaison psychiatry. Various expectations by clinicians concerning liaison psychiatry].

Interdisciplinary group work could be conceived as shared common abilities in order to provide a global management of diseases. In this regard, psychologists should assumed several tasks: to advise on patient's psychological resources to keep them less anxious or more cooperative, to humanize hospital and death, to prevent burn-out. This does not mean a management of the illness, but a careful listening to help patients to find a meaning to what they are living. The aim should not to harmonize different skills but to define each other place (physician, social worker, nurse, psychologist...) concerning queries that involve us and that wonder us about life, health, sexuality, love, the way we take risks.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Harmonizing European medical education, continuing and postgraduate education].

The harmonization of medical education, specialist training and continuing medical education (CME) in Europe progresses at different levels. University exchange programmes like ERASMUS and SOKRATES try to realize the European idea on the student and academic level. Specialist training is complicated by differences in responsibilities. The UEMS, based on various agreements, coordinates the harmonization process. Surgical training is represented by the European Board of Surgery (EBS). Its basic care and subspecialties have been described and European qualifications are being prepared. The content of education as well as log books, trainee qualification and training centers are regulated by position papers. Continued medical education is described in the Charter of Continued Medical Education of Specialists in which the content of training and requirements are defined.

Curriculum↗
PubMed1994

Caught in the crossfire: children, guns, and trauma.

Violence, especially that related to the use of firearms, has become a leading cause of death in children in the United States. Providing physical and psychosocial care for the child with a gunshot wound is a nursing challenge. Nurses can and must play a major role in helping to prevent this public health problem.

Adolescent↗
PubMed2006

Structures, electron affinities, and harmonic vibrational frequencies of C6H5X/C6H5X- (X = N, S, NH, PH, CH2, and SiH2).

The molecular structures and electron affinities of the C6H5X/C6H5X- (X = N, S, NH, PH, CH2, and SiH2) species have been determined using seven different density functional or hybrid Hartree-Fock density functional methods. The basis set used in this work is of double-zeta plus polarization quality with additional diffuse s- and p-type functions, denoted DZP++. These methods have been carefully calibrated (Chem. Rev. 2002, 102, 231). The geometries are fully optimized with each density functional theory (DFT) method, and discussed. Harmonic vibrational frequencies were found to be within 3.2% of available experimental values for most functionals. Three different types of the neutral-anion energy separations reported in this work are the adiabatic electron affinity (EA(ad)), the vertical electron affinity (EA(vert)), and the vertical detachment energy (VDE). The most reliable adiabatic electron affinities, obtained at the DZP++ BPW91 level of theory, are 1.45 (C6H5N), 2.29 (C6H5S), 1.57 (C6H5NH), 1.51 (C6H5PH), 0.91 (C6H5CH2), and 1.48 eV (C6H5SiH2), respectively. Compared with the experimental values, the average absolute error of the BPW91 method is 0.04 eV. The B3LYP and B3PW91 functionals also gave excellent predictions, with average absolute errors of 0.06 and 0.07 eV, respectively.

Journal Article↗
PubMed2002

The influence of new technologies on laparoscopic adrenalectomy: our personal experience with 91 patients.

BACKGROUND: Laparoscopic adrenalectomy has proved to be the technique of choice for managing benign pathologies of the adrenals and isolated adrenal metastases, especially those arising from lung tumor, but the procedure should not be performed for primitive adrenal carcinoma. The Authors wanted to test the advantages of the Harmonic Scalpel in laparoscopic adrenalectomy. METHODS: From April 1995 to April 2001, the authors investigated their series of laparoscopic adrenalectomies performed at the Careggi General Hospital, Division of General and Vascular Surgery, Florence, Italy. This study enrolled 91 patients with various adrenal pathologies. The transperitoneal approach was used, with the patient in a lateral position, as suggested by Gagner. Special care was taken to improve the surgical approach to the adrenals by the use of new technological devices such as the Harmonic Scalpel. The operative time required by the surgical procedure was computed by dividing the study into three periods: 1995-1997, 1998-1999, 2000-2001. The first period was necessary to complete the learning curve. In the second period, a steady state in surgical time was reached. During the third period, the Harmonic Scalpel was introduced. The differences between the three periods were tested using a nonparametric analysis (Mann-Whitney U test or Kruskal-Wallis test) as appropriate. A two-tailed p value of 0.05 or less was considered statistically significant. The authors investigated the cost of the operation performed in each of the two groups using, respectively, the conventional laparoscopic device (1998-1999) and the Harmonic Scalpel (2000-2001). The following expenses were considered: Harmonic Scalpel impulse generator and disposable shears, operating room cost per hour, and endoclip applier. RESULTS: The 91 laparoscopic adrenalectomies were performed with these indications: 31 incidentalomas (26 adenomas and 5 cysts), 25 cases of Conn's disease, 18 cases of Cushing's disease, 9 pheochromocytomas, 2 myelolipomas, 5 metastases (from lung, kidney, and breast) and 1 primitive carcinoma diagnosed preoperatively. Considering the whole series (1995-2001), there was a significant trend of reduction in operative time (p = 0.0001). Moreover looking at the first period (1995-1997), in which the learning curve was completed, the mean surgical time was 148 min, as compared with 125 mm. For the second period (1998-1999) (p = 0.0002). This represents a significant reduction in operative time. The authors noted a further reduction in the operative time when surgery was performed with the Harmonic Scalpel (2000-2001) (92 min; p = 0.001). The reduction in operative time attributable to the Harmonic Scalpel was confirmed also by a multivariate analysis of covariance general linear models procedure (GLM), which accounts for several confounders: age, gender, site and size of tumors, and histology (p = 0.0001). The rate was 3.3% for morbidity, 1.1% for mortality, and 2.2% for conversion. There was no difference in complications between patients treated with conventional devices and those treated with the Harmonic Scalpel. CONCLUSIONS: The laparoscopic approach has proved to be an extremely reliable procedure for benign pathologies and isolated metastases. There may yet be doubts about its use for the treatment of adrenal carcinomas preoperatively diagnosed. When surgery is performed using Harmonic Scalpel, operative time is significantly reduced and surgery is easier and less expensive. Infact use of the Harmonic Scalpel allowed the cost per operation to be reduced $70. Moreover, if surgery is performed using the nondisposable clip applier, the expenses are reduced $105.

Adolescent↗
PubMed2005

Radioactive iodine therapy for malignant and benign thyroid disease: a Canadian national survey of physician practice.

BACKGROUND: Radioactive iodine (as Na131I) has been used in the diagnosis and treatment of thyroid disease for more than 60 years, but the various treatment centres in Canada have different practice patterns. AIM: To determine whether there is a definable, nationwide pattern of practice which may be used to elucidate standards of practice and clarify some issues that arise when multiple care-givers are involved. METHODS: A survey questionnaire was mailed to all sites licensed by the Canadian Nuclear Safety Commission to administer Na131I for benign and malignant thyroid therapy. A second mailing was sent to non-responders. The questionnaire addressed the involvement of personnel: i.e., who prescribes, determines doses, obtains informed consent, counsels on radiation safety, administers the therapy, and follows the patient post-therapy. The survey also specifically addressed whether a nuclear medicine physician reviewed laboratory work or met with patients pre-therapy. RESULTS: The overall response rate was 60% (74/123) with representation from all Canadian provinces. The majority of respondents were physicians (78%). The data include 3447 benign thyroid therapies and 1202 malignant thyroid therapies. There are no significant regional differences in the average maximum dose administered for either benign or malignant thyroid therapies. The majority of therapies are administered in community and academic hospital settings. Endocrinologists most commonly prescribe Na131I for malignant thyroid therapies and nuclear medicine physicians for benign thyroid therapies. For all therapies nuclear medicine physicians most commonly obtain informed consent, determine the dose and provide radiation safety counselling. Nuclear medicine technologists most commonly administer the therapy and endocrinologists most commonly provide post-therapy follow-up. In the majority of centres, nuclear medicine physicians review the laboratory results for each patient's blood sample and meet with patients before therapy. CONCLUSIONS: Multiple health care specialists take part in Na131I therapy for both benign and malignant thyroid disease. In most centres, nuclear medicine physicians have major roles in the delivery of the treatments, including reviewing clinical and biochemical information. The findings of this study should provide reassurance to many centres and guidance to others to allow closer harmonization of practice.

Canada↗
PubMed2001

Dermabrasion.

This article provides an overview of the resurfacing technique of dermabrasion. Preoperative consultation, perioperative medications, postoperative management, common complications, and reasonable outcome expectations are all described in detail. A description of proper technique, intraoperative equipment, and an approach to full-face procedures is also described.

Cicatrix↗
PubMed2026

From Variability to Consensus: Rescoring Harmonizes Peptide Identification across Diverse Search Engines and Data Sets.

Peptide-spectrum match (PSM) rescoring has become standard in proteomics workflows, improving peptide identification accuracy across diverse search engines. Despite the availability of multiple rescoring strategies, systematic comparisons spanning several search engines, data sets, and database configurations remain limited. Here, we benchmarked seven publicly available search engines, evaluating standard target-decoy-based false discovery rate (FDR) estimation alongside Percolator, MS2Rescore, and Oktoberfest across four data sets acquired on different mass spectrometry platforms in data-dependent mode and searched against protein databases of varying size and composition. Rescoring substantially increased identification consensus and reduced variability between search engines, with prediction-based approaches yielding the largest gains. While database size had limited impact for human data sets, it significantly affected identification rates on a metaproteomic data set. Entrapment-based evaluation indicated generally adequate FDR control across methods, although prediction-based rescoring exhibited a higher tendency toward FDR underestimation in specific configurations. Overall, advanced rescoring strategies harmonize peptide identification outcomes across search engines, thereby enhancing robustness and comparability in proteomics analyses. However, careful feature selection and appropriate database choice remain essential to ensure reliable FDR control and optimal performance across diverse experimental settings.

Search Engine↗