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At least 1,675 records · Page 93Linked to original sources
PubMed1999

[Modern hearing-aids at the cutting edge of microelectronics. Increased possibilities for individual customization].

The development of modern hearing aids has been so great that they now represent the cutting edge of micro-electronics. Flexibility has been enhanced by computer-aided programming of the devices, and particularly by digital signal processing, developments which enable improved customization. Increased knowledge of the pathophysiology of the auditory system, fundamental processes in central auditory pathways, and cognitive function enable technological developments to be exploited, thus enhancing our ability to cope with an increasingly broad spectrum of hearing impairment, ranging from mild high-frequency loss to severe loss across the entire frequency range.

Auditory Pathways↗
PubMed1999

[Clinico-laboratory effectiveness of modern ointments with a polyethylene glycol base in the treatment of purulent wounds].

The 25-year experience with the underbandage treatment of soft tissue purulent wounds of various location and genesis with modern ointments with polyethylene glycol as the basis was analyzed. Levocin, levomecole, dioxycole, 5-percent dioxydinic, 1-percent iodopyronic, 0.5-percent quinifuryl and furagel ointments proved to preserve their high activity against aerobic grampositive and gramnegative flora. 10-percent mafenide acetate ointment had a high selective effect on Pseudomonas aeruginosa. The new ointments nitacid and streptonitole containing nitazole and white streptocide were highly active against both aerobic and anaerobic infections. The use of the ointments with the polyethylene glycol as the basis made it possible to decrease 2 times the period of the patient hospitalization in surgical units and to shorten the terms of the systemic antibacterial therapy. The marked therapeutic effect of such ointments due to their high dehydrating capacity and broad antibacterial spectrum enabled to consider them as the drugs of choice in the local treatment of purulent wounds during the 1st phase of the wound process, trophic and decubic ulcers, infected burns, diabetic and atherosclerotic gangrene, furuncles, carbuncles, mastitis, etc. The ointments in the water soluble vehicle can be as well used with success for the prophylactic treatment of infected wounds after the suture. The multitarget effect of the ointments in the water soluble vehicle and their ability to prevent severe purulent complications permitted to consider them as the 1st order drugs in cases of emergency.

Anti-Bacterial Agents↗
PubMed1999

[Bar-Valtrac--a modern alternative to conventional intestinal anastomosis?].

The authors describe a modern method of intestinal anastomoses without suture after resections of the gastrointestinal tract, by means of a biofragmentable ring used in 62 patients where the continuity of the digestive tract was restored by means of BAR-Valtrac (Davis Geck Co, USA). The perspective alternative of the common manual and stapler technique BAR anastomosis is evaluated on the basis of data from the literature and the authors own clinical exoerience with regard to the main parameters of healing of the anastomosis and immediate postoperative complications, among which dehiscence of the anastomosis is, no doubt, most important.

Adult↗
PubMed1999

[The physician-patient relationship in post-modernism].

The doctor-patient relationship represents a particular link that goes beyond formality and it is projected in time, space and emotionalism. It takes place in the midst of a cultural, social, physiological, scientific and technical context which at the same time is conditioned by local, regional, national and foreign influences as a consequence of globalization. Different ethnical groups, social stratification, economic structures, philosophical concepts, religious beliefs and moral values play a pivotal role. The technological advances have shown an exponential increase during the last forty years. This phenomenon was accompanied by deep changes that varied from philosophical to strictly technical aspects which were significatively intensified during the post Second World War period. The consequences have been unfortunate for physicians and particularly for patients. Those consequences came out by philosophical reviews, the economical liberalism and neoliberalism development, a new concept for science, the priorization of technique development together with changes in both ethical value scales and economic & politic power hegemonies. The great reports of philosophy have tried to justify these social changes. The end of modern meta discourses such as Iluminism, Idealism, and Marxism, incited the liberal and neoliberal discourse. Knowledge has been affected not only in the research field but in the teaching field as well. Today, the discourse in vogue is the performance. The "organic conjugation" of technique and profit precedes its union with science. The State disengagement in managing the great social problems in many countries, the globalization and the concentration of the capital has redefined the power. Neither the patient nor the medicine escapes from this reality. The final results are generations of physicians quite right informed but unable to solve or even face the minimum problems of a patient, and what is worst, they run the risk of feeling frustrated and resentful. Everything is thought and done through technique, and there is a fact that appears to justify this action "The malpractice judgement industry". The economical monopoly of private or sindical Healthcare Providers and self-managed Hospitals projects are rapidly and notoriously modifying the medical labour market. There seems to exist only one element that the doctor and the patient have in common in this new culture: loneliness. There is also a human communication failure that separates them: the patient is in more need of human comprehension than ever before and the doctor has a cultural inability to offer it. To sum up, the relationship between the doctor and the patient is still a theme of deep preoccupation, even more nowadays when everything seems to indicate that this relationship has suffered a significant impairment.

History, 19th Century↗
PubMedDate not supplied

Time to abandon electroconvulsion as a treatment in modern psychiatry.

This review examines the evidence for the current use of electroconvulsive therapy (ECT) in psychiatry. The history of ECT is discussed because ECT emerged with no scientific evidence, and the absence of other suitable therapy for psychiatric illness was decisive in its adoption as a treatment. Evidence for the current recommendation of ECT in psychiatry is reconsidered. We suggest that ECT is an unscientific treatment and a symbol of authority of the old psychiatry. ECT is not necessary as a treatment modality in the modern practice of psychiatry.

Decision Making↗
PubMed1999

Food and Drug Administration Modernization Act of 1997; list of documents issued by the Food and Drug Administration that apply to medical devices regulated by the Center for Biologics Evaluation and Research. Food and Drug Administration, HHS. Notice.

The Food and Drug Administration (FDA) is publishing a list of documents issued in response to the Food and Drug Administration Modernization Act of 1997 (FDAMA), and clarifying their applicability to medical devices regulated by the Center for Biologics Evaluation and Research (CBER). This notice is intended to inform the public of the availability of these documents, clarify their scope of applicability, and to provide instructions on ways to access them.

Equipment and Supplies↗
PubMed1999

Integrating a modern knowledge-based system architecture with a legacy VA database: the ATHENA and EON projects at Stanford.

We present a methodology and database mediator tool for integrating modern knowledge-based systems, such as the Stanford EON architecture for automated guideline-based decision-support, with legacy databases, such as the Veterans Health Information Systems & Technology Architecture (VISTA) systems, which are used nation-wide. Specifically, we discuss designs for database integration in ATHENA, a system for hypertension care based on EON, at the VA Palo Alto Health Care System. We describe a new database mediator that affords the EON system both physical and logical data independence from the legacy VA database. We found that to achieve our design goals, the mediator requires two separate mapping levels and must itself involve a knowledge-based component.

Artificial Intelligence↗
PubMed1999

[Mental training--does it also help the modern surgeon?].

The demands on the modern surgeon are extremely complex. Especially in endoscopic surgery he must be able to carry out most complicated finemotoric motions which are not part of the natural action repertoire, sometimes under extreme conditions of stress. Such demands can be compared to those of top athletes. Within a cooperative project between the second chair of surgery of the University of Cologne and the sport psychologic working unit of the Heidelberg University department of sport and sports science the empirically sound Mental Practice (MP) which has been successfully applied in worldclass sports for a long time was modified so that an application of this training method is now possible for the training and continuing education of young surgeons. The following four types of surgery were emphasized: laparoscopic cholecystectomy, laparoscopic appendectomy, thyroidectomy and inguinal hernia. The article will focus on the detailed description of MP in surgery. At first, however, we are going to delineate MP in sports and will then turn to how it is modified and applied in the field of surgery. Besides the arrangement and exact description of surgeries, MP in this field requires the formulation of instructions which are summarized in instructional handbooks. These handbooks serve as target values for instrumental and cognitive simulation techniques which are applied in MP. The surgeon is thus provided with a foundation for the construction of functional mental representations of the surgery types which enables him to optimize the quality of his actions during the above mentioned surgeries.

Endoscopy↗
PubMedDate not supplied

Innovative techniques in modern radiation oncology: the economic and organizational impact.

An overview of the impact of innovative techniques in modern radiotherapy on economic and organizational issues is proposed. The analyzed innovative procedures are: intraoperative radiotherapy, stereotactic radiosurgery, conformal radiotherapy and high dose rate brachytherapy. They are approached separately in terms of cost-benefit analysis, optimized management and estimated productivity. The introduction of these innovative techniques in the daily practice of radiation oncology departments is vital in the quest for excellence. The strictly monetary implications of programs for the implementation of innovative radiotherapy techniques are hindered by the present planned containment of public health care expenditure in western European countries.

Cost-Benefit Analysis↗
PubMedDate not supplied

Hypofractionated radiation therapy in the modern era.

Choice of the appropriate fractionation schedule in a modern radiation therapy department requires clear understanding of the radiobiologic principles that govern the tumor or normal tissue responses to radiation therapy as well as the goals and expected outcomes for the individual patient. Although the majority of patients will be most appropriately treated with conventional fractionated radiation therapy (dose per fraction less than 225 cGy), there may still be a role hypofractionated treatment for selected patients. Currently it is not feasible to taylor the fractionation regiment to the patient's individual and specific tumor cell survival characteristics. Thus, in malignant melanoma, despite the demonstration of "wide shoulders" on the cell survival curve, it has not been demonstrated clinically that large doses per fraction are clearly advantageous. Many patients may be well palliated with hypofractionated regimens. However, this requires the physicians to carefully select their patients and where resources allow, many patients will be better palliated with higher total doses and lower doses per fraction. This is especially true if they survive for longer than one year. Lastly, new technology that allows for the delivery of highly conformal radiation therapy needs further study relative to the optimal fractionation in its application.

Dose Fractionation, Radiation↗
PubMed1999

Thickness distribution of the occipital bone--a new approach based on CT-data of modern humans and OH 9 (H. ergaster).

A new approach for the analysis of cranial bone thickness is introduced. The study focuses on the occipital bone of modern humans and of a 1.25 Myr-old H. Ergaster/erectus specimen from Olduvai Gorge (OH 9). A semiautomatic algorithm detects a multitude of thicknesses from CT-data of the investigated bones. We find that every bone is characterized by its own distribution pattern of cranial thickness, which is then analyzed statistically. The results demonstrate that the thickness distribution of the occipital bone of OH 9 is within the normal range of the H. sapiens sample (which itself shows a remarkably high variance). This contributes to a further analysis of phyletic differences of hominid morphology by including distribution patterns of thickness combined with aspects of functional anatomy.

Algorithms↗
PubMedDate not supplied

The technological underpinnings of a modern clinical practice.

Information is the lifeblood of the modern clinical practice, and the information technology infrastructure is the vasculature that supports the flow of this information throughout the entire health care enterprise. Although the impact of information technology may not be obvious to the overworked clinician, information technology is the underpinning that makes virtually all knowledge-based work tenable. The increasing dependence of clinical medicine on this matrix of technologies is especially obvious when technology becomes the rate-limiting step in clinical process improvement and innovation.

Clinical Medicine↗
PubMed2000

The modern endoscopic approach to ureterocele.

PURPOSE: During the last 20 years the surgical approach to ureterocele has evolved from major open surgery to minimally invasive endoscopic puncture. We believe that the endoscopic approach decreases the need for open surgical procedures. We identified specific factors that predict the need for repeat surgery. MATERIALS AND METHODS: We reviewed the charts of 60 new patients with ureterocele treated with primary endoscopic incision between 1991 and 1995. Followup ranged from 4 to 62 months (mean 20). Mode of presentation, ureterocele location, associated vesicoureteral reflux and association of the ureterocele with a duplex system were evaluated. Ureterocele wall thickness was assessed subjectively via radiographic and cystoscopic methods, and categorized as thin, intermediate and thick. RESULTS: All 9 patients with a single system ureterocele had an intravesical ureterocele. No patient had associated reflux nor did any require a secondary open procedure. In 3 cases new onset ipsilateral reflux into the ureterocele spontaneously resolved. Of the 51 patients with a duplex system and associated ureterocele 19 (37%) required a secondary open procedure. The ureterocele was intravesical and ectopic in 22 (43%) and 29 (57%) cases, respectively. Reflux was associated with the ureterocele in 27 patients (53%), and 12 (44%) required a secondary open procedure. A total of 11 patients underwent ureteral reimplantation of 15 refluxing renal units and only 2 renal units required ureteral tapering. Reflux is no longer present in 14 of the 15 renal units (93%). Patients with a thick walled ureterocele required repeat puncture more frequently than those with a nonthick ureterocele. CONCLUSIONS: With the use of modern endoscopic techniques children with intravesical and single system ureteroceles require secondary open surgery less frequently than those with ectopic and duplex system ureteroceles. The mode of presentation does not predict the need for a repeat open procedure. Thick walled ureteroceles require repeat endoscopic puncture more frequently than thin and intermediate walled ureteroceles.

Female↗
PubMed2000

[Contribution of Berlin clinics and especially the Charité to the development of modern anesthesia in Germany].

Soon after announcement of the first American ether anesthesias in 1846 one started to anesthetize with ether in Europe. The first ether anesthesia in Germany took place on January 24th, 1947, and was given by Johann Ferdinand Heyfelder in Erlangen. Two weeks later the first ether anesthesia in Berlin was given on February 6th, 1847, by the orthopaedic surgeon Heimann-Wolff Berend. On February 12th, 1847, the surgeon Johann Friedrich Dieffenbach used ether to anesthetize a patient in the Berlin university hospital. Still in 1847 he published his book "The Ether against Pain" which used to be the standard textbook of anesthesia in Germany for many years to come. On February 15th, 1847, Johann Christian Jüngken operated his first patient under ether anesthesia in the surgical department of the Charité hospital assisted by Rudolf Virchow. Since then several famous Berlin surgeons influenced the development of modern anesthesia until the middle of the 20th century. The nitrous oxide bottle was introduced into practice by the Barth company in cooperation with the dentist Carl Sauer and Kurt Schimmelbusch introduced his mask for ether anesthesia. Carl Ludwig Schleich reported at the German congress of surgery in 1894 about his first experience with infiltration anesthesia. Spinal anesthesia developed by August Bier in Kiel was improved during his time in Berlin.

Anesthesia↗
PubMed1999

[Creating an easier, more modern and more accessible health care system].

After superficially reviewing the advances which have occurred in the public health system over the past twenty years, the author speaks to us about the idea of how it is possible to facilitate improved information regarding health, sanity, and health services in order to help create a general public which is more responsible for their own actions while still accepting as a fact that each individual is a whole world with his/her own particular attitude toward health and illness. As a simple and accessible way to provide information, the author analyzes the method used in England to inform the general public by telephone contact, a method ideal to increase the self-care of the general public and to provide appropriate answers to their voiced concerns. The author concludes his article commenting that soon in Spain we should incorporate new information technologies and systems into the daily lives of our health system in order to make it more modern and accessible and to bring it into closer touch with the general public.

Attitude to Health↗
PubMed2000

[Biochemical control after external radiotherapy in localized prostatic cancer: results of a modern cohort].

PURPOSE: The present study reports biochemical outcomes of a modern series of patients with localised prostate cancer treated with external beam radiation therapy, and analyses the implications of the nadir PSA levels in monitoring outcome after treatment. METHODS: From March 1993 to March 1997, eighty three patients with clinical stages T1-T3 NxM0 prostate cancer received definitive external radiation therapy, median dose 66 Gy (range 60 to 68 Gy). Adjuvant androgen deprivation was associated in 53 high risk patients. Initial response to treatment was defined as a decrease of serum PSA to levels of < or = 1.5 ng/ml, and biochemical failure as three consecutive PSA rises over post-treatment nadir PSA value. RESULTS: The 3-year actuarial BDFS was 78% +/- 7 for the whole series, 74% +/- 12 for patients treated with radiotherapy alone, and 71% +/- 10 for high risk patients treated with combination therapy (p = 0.27). Only nPSA emerged as a potential indicator of biochemical control. The probability of BDFS at 3 years was 82%, 83% and 40% for nPSA of < or = 1 ng/ml, 1-2 ng/ml and > 2 ng/ml respectively (p = 0.0409). In multivariate analysis, this correlation was independent on the effect of other variables and persisted after adjusting for the effect of hormonal therapy (p = 0.0540). CONCLUSION: Radiation therapy is a potentially curative treatment for prostate carcinoma. Our data indicate that the nadir PSA value after radiation can be an excellent early determinant of outcome.

Adenocarcinoma↗
PubMed2000

[The modern surgery of face lift: indications and results].

In this retrospective study with a group of 55 patients aged 47.7 +/- 8.3 years, surveyed for a period of 16 months, the results of different face lift techniques--subcutaneous face lift combined with imbrication of the SMAS-Platysma complex versus sub-SMAS-dissection with transposition of the SMAS-Platysma complex--were compared in order to evaluate risks and complication rates of these two techniques. Various indications and different techniques including special features were discussed. A slightly higher complication rate is evident in the patient group treated with the sub-SMAS face lift technique, mainly referring to temporary asthenia of the nervus facialis, which regressed in all cases after 7 months. The post op bleeding rate was 2.3%, within the range given in the literature. Concludingly, the pure subcutaneous face lift with imbrication of the SMAS-Platysma complex still is an established method in modern rhytidectomy treatment.

Adult↗