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At least 1,693 records · Page 94Linked to original sources
PubMed2003

Incidence of intraoperative hypothermia. Adopting protocol for its prevention.

OBJECTIVE: To determine the incidence of hypothermia during surgical procedures when adequate methods of preserving normothermia are applied. METHODS: A prospective study in which patients ASA I-IV presented for surgery at the Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia during the period from July 2000 until February 2003, in whom body core temperature was between 35-37 degree, were included. Ambient temperature of the operating room was thermostatically adjusted to record 26 degree and 24 degree if patients were less than 10 year-old or above. Depending on type of surgery; the patients were provided with space blankets and were lying on warm mattresses. Fluid or blood warmers and forced-air surface warming were used when needed. RESULTS: There were 3886 surgical patients operated upon during the period of the study. Their average age was 34.5 years (range 15 days to 104 years). Sixty patients (1.54%) developed intraoperative hypothermia (core temperature <35 C) and were admitted to the intensive care unit for monitoring and gradual rewarming. There was no mortality amongst them. Out of those 60 patients, 17 (28.3%) expressed dissatisfaction on this part of the service, but the overall patient's satisfaction scored 99.6%. CONCLUSION: Aggressive measures must be adopted to preserve normothermia as prevention of intraoperative hypothermia improves patient's outcome. All patients should have their core body temperature monitored during surgery. However, application of available methods of keeping normothermia reduces the incidence of intraoperative hypothermia but does not abolish it completely. Hypothermic patients should be closely monitored during gradual rewarming, preferably in the intensive care setting. A protocol for prevention of intraoperative hypothermia must be adopted by all operating theaters.

Adolescent↗
PubMed2003

[Limitations of occupational exposure to electromagnetic fields adopted by Polish law from the perspectives of international documents with particular reference to fields of low and medium frequencies].

Following the provisions of the decree on maximum admissible strength (MAS) values, issued by the Minister of Labour and Social Policy, comprehensive and homogeneous principles of workers' protection against excessive exposure to 0-300 GHz electromagnetic fields have been in force since 2001. Different mechanisms responsible for interactions between electromagnetic field and human body, as well as the need to limit their harmful effects were taken into account while setting permissible exposure conditions. Owing to the fact that both the strength of electric and magnetic fields and exposure duration have been considered, Polish regulations facilitate a parallel harmonisation of the prohibited exposure levels with so-called "basic restriction" values adopted as a minimum protection level in many international guidelines and to implement a significantly higher level of workers' protection in case of long-duration per shift exposure (equivalent of "precautionary principle" applied in the evaluation of general public exposure). The approaches adopted in Polish regulations coincide in many points with a drafted EU directive. Amendments being introduced into Polish legal regulations on the environmental protection should maintain cohesion principle with legal regulations on occupational exposure to electromagnetic fields, and should take into account additional restrictions concerning the protection of residential areas, as practiced in many European countries.

Dose-Response Relationship, Radiation↗
PubMed2003

Stretching water--Queensland's water use efficiency cotton and grains adoption program.

The Cotton and Grains Adoption Program of the Queensland Rural Water Use Efficiency Initiative is targeting five major irrigation regions in the state with the objective to develop better irrigation water use efficiency (WUE) through the adoption of best management practices in irrigation. The major beneficiaries of the program will be industries, irrigators and local communities. The benefits will flow via two avenues: increased production and profit resulting from improved WUE and improved environmental health as a consequence of greatly reduced runoff of irrigation tailwater into rivers and streams. This in turn will reduce the risk of nutrient and pesticide contamination of waterways. As a side effect, the work is likely to contribute to an improved public image of the cotton and grain industries. In each of the five regions, WUE officers have established grower groups to assist in providing local input into the specific objectives of extension and demonstration activities. The groups also assist in developing growers' perceptions of ownership of the work. Activities are based around four on-farm demonstration sites in each region where irrigation management techniques and hardware are showcased. A key theme of the program is monitoring water use. This is applied both to on-farm storage and distribution as well as to application methods and in-field management. This paper describes the project, its activities and successes.

Agriculture↗
PubMed2003

Warsaw Declaration on HIV/AIDS and injection drug use adopted.

Explosive epidemics of HIV among injection drug users are occurring in both developing and developed countries. Globally, it is estimated that 10 percent of HIV infections are attributable to injection drug use, but this proportion is increasing, and is much higher in many countries. Effective interventions exist to prevent the spread of HIV among injection drug users, but in most countries they are being adopted too slowly, or not at all. On 14 November 2003, the Warsaw Declaration: A Framework for Effective Action on HIV/ADS and Injection Drug Use, was adopted at the 2nd International Policy Dialogue on HIV/AIDS. Its purpose is to provide a framework for--finally--"mounting an effective response that will slow and eventually stop the HIV/AIDS epidemic among injecting drug users worldwide."

Global Health↗
PubMed2004

An analysis of a health professions appeal board--should a mediational style of hearing matters be adopted?

The Ontario Health Professions Board is a statutory Board that carries out a supervisory function and review function of certain matters arising from twenty-three health professions in the province. This paper examines the board, how it functions, and the nature and type of disputes, which come before it. Having regard to key concepts in the areas of conflict analysis and process design, the paper critically discusses whether the Board ought to adopt a mediational style of hearing matters. The conclusions are that there are very real dangers that the current practices of the Board may contribute to conflict rather than resolve it, that there is no legal impediment to the Board adopting a mediational style of hearing matters, and that such an approach would contribute to the Board effectively carrying out its statutory functions.

Governing Board↗
PubMed2004

Translating research into practice: speeding the adoption of innovative health care programs.

For this study, the authors conducted case studies of four varied clinical programs to learn key factors influencing the diffusion and adoption of evidence-based innovations in health care. They found that the success and speed of the adoption/diffusion process depend on: the roles of senior management and clinical leadership; the generation of credible supportive data; an infrastructure dedicated to translating the innovation from research into practice; the extent to which changes in organizational culture are required; and the amount of coordination needed across departments or disciplines. The translation process also depends on the characteristics and resources of the adopting organization, and on the degree to which people believe that the innovation responds to immediate and significant pressures in their environment.

Decision Making, Organizational↗
PubMed2004

An adoption study of a clinical reminder system in ambulatory care using a developmental trajectory approach.

In this study, we assess 41 medical residents' acceptance and adoption of a clinical reminder system for chronic disease and preventive care management in the ambulatory care environment using a novel developmental trajectory approach. This group-based, semi-parametric statistical modeling method identifies distinct groups, following distinct usage trajectories, among those who recorded use of the reminder system within an evaluation period of 10 months. We trace system use within these groups over time using computer-generated logs and user satisfaction surveys. Our preliminary analysis of this small sample of users delineates three categories of users. Feedback from these categories of users is being used to re-engineer the application and adapt it better to their workflow and functionality requirements. Despite the small sample size in this particular study, we conclude that this methodology has considerable promise to provide new insights into system usability and adoption issues that may benefit clinical decision support systems as well as information systems more generally.

Ambulatory Care↗
PubMed2004

[The new German general threshold limit value for dust--pro and contra the adoption in Austria].

Since it has been realised that inhalation of inert dust is one of the important confounding variables for the development of chronic bronchitis, the threshold values for occupational exposure to these dusts needs to be further decreased. The German Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area (MAK-Commission) has set a new threshold (MAK-Value) for inert dusts (4 mg/m3 for inhalable dust, 1.5 mg/m3 for respirable dust) in 1997. This value is much lower than the threshold values currently used world-wide. The aim of the present article is to assess the scientific plausibility of the methodology (databases and statistics) used to set these new German MAK-Values, regarding their adoption in Austria. Although we believe that it is substantial to lower the MAK-Value for inert dust in order to prevent the development of chronic bronchitis as a consequence of occupational exposure to inert dusts, the applied methodology used by the German MAK-Commission in 1997 to set the new MAK-Values does not justify the reduction of the threshold limit value. A carefully designed study to establish an appropriate scientific basis for setting a new threshold value for inert dusts in the workplace should be carried out. Meanwhile, at least the currently internationally applied threshold values should be adopted in Austria.

Air Pollutants, Occupational↗
PubMed2005

A national study of the relationship of care site HIV specialization to early adoption of highly active antiretroviral therapy.

BACKGROUND: Little is known about characteristics of organizations that predict early adoption of highly active antiretroviral therapy (HAART) for persons with HIV infection. OBJECTIVES: To describe characteristics of sites where HIV care is provided and to assess site characteristics that predict early adoption of HAART. DESIGN: Cross-sectional analysis of survey data from patients, HIV physicians, and medical directors. PATIENTS AND SETTING: Participants in the HIV Cost and Services Utilization Study, a national probability sample of persons with HIV who received outpatient care in the continental United States during 1996. MAIN OUTCOME MEASURE: Rates of exposure to HAART by December 1996. RESULTS: Nationally, 79% of patients were treated at sites specializing in HIV care (HIV sites). Over 90% of patients were cared for by physicians who were experts in HIV care, either infectious disease specialists (46%) or general medicine experts (45%). Adjusted rates of exposure to HAART by December 1996 varied from 0.02 to 0.79 across sites (mean rate, 0.33). In multivariable models, HIV specialization (odds ratio [OR], 3.6; P < 0.001), total patient volume of more than 20,000 visits a year (OR, 2.1; P < 0.01), and educational level of the zip code in which the site was located (OR, 1.2 for each 10% increase in college education) were associated with higher rates of exposure to HAART. These effects persisted after adjustment for physician HIV expertise. Site effects were more important than physician effects in explaining rates of exposure to HAART. CONCLUSION: In 1996 there were wide variations in rates of HAART use by site of care. Low-volume sites that do not specialize in HIV care should take measures to ensure that HIV expertise is available to their patients.

Adult↗
PubMed2005

TRICARE; sub-acute care program; uniform skilled nursing facility benefit; home health care benefit; adopting Medicare payment methods for skilled nursing facilities and home health care providers. Final rule.

This rule partially implements the TRICARE "sub-acute and long-term care program reform" enacted by Congress in the National Defense Authorization Act for Fiscal Year 2002, specifically: Establishment of "an effective, efficient, and integrated sub-acute care benefits program," with skilled nursing facility (SNF) and home health care benefits modeled after those of the Medicare program; adoption of Medicare payment methods for skilled nursing facility, home health care, and certain other institutional health care providers; adoption of Medicare rules on balance billing of beneficiaries, prohibiting it by institutional providers and limiting it by non-institutional providers; and change in the statutory exclusion of coverage for custodial and domiciliary care.

Ambulatory Care↗
PubMed2005

Adopting an electronic health record. Keys to success.

Stratis Health, through its capacity as Minnesota's Medicare Quality Improvement Organization, is working to promote successful implementation of electronic health records (EHRs) in primary care clinics in the state. This article focuses on lessons learned while helping primary care clinics adopt EHRs. It also includes observations on the current status of EHR adoption in Minnesota clinics. Sixty-eight percent of 341 clinics responding to a survey have implemented, are in the process of implementing, or plan to implement electronic health record systems during the next 2 years.

Humans↗
PubMed2006

The California Clinical Data Project: a case study in the adoption of clinical data standards for quality improvement.

The California Clinical Data Project is a statewide initiative to remove barriers to the widespread and effective use of information technology to improve chronic disease care. The project is a case study in the development and widespread adoption of clinical data standards by varied and often competing stakeholders. As an initial step, the project defined precise data standards for the batch reporting of pharmacy claims data and laboratory results data. These uniform standards facilitate the flow of existing electronic clinical information into disease registries and electronic health record systems. Pharmacy and lab results data now are being exchanged electronically with this standard among the largest health plans, medical groups, and clinical laboratories participating in California's pay-for-performance programs. Lessons from this project may apply to the development and adoption of data standards for other states and locales and for the emerging national health information infrastructure.

California↗
PubMed2006

Case report: Taiwan's experience in adopting IHE technical framework to integrate systems.

Though more and more hospitals adopt PACS in Taiwan, they all meet the same problem of system integration. The Integrating the Healthcare Enterprise (IHE) association proposes an integrated technical framework and process profiles to solve problems of heterogeneous system integration in medical environment for information sharing. Therefore, this paper reports the experience of a case hospital that successfully applied IHE framework to integrate its HIS, RIS and PACS in Taiwan. This paper indicates that using the IHE can help evaluate the integration ability of PACS vendors, enhance staff's ability, shorten the PACS implementation time, reduce the cost, and reserve system's expansibility. The case hospital was able to successfully implement it's PACS because of executive's full support, using the standard, and providing complete training to reduce user's resistance. This paper not only shares the experiences of IHE adoption of a case hospital but also summarizes key factors to implement PACS successfully. Again, this paper confirms that standard is helpful to integrate heterogeneous system.

Diffusion of Innovation↗
PubMed1991

Successful treatment of paralytic relapses in adoptive experimental autoimmune encephalomyelitis via neuroantigen-specific tolerance.

We have previously demonstrated that Ag-specific tolerance induced by the i.v. administration of splenocytes coupled with neuroantigens, such as mouse spinal cord homogenate, myelin basic protein (MBP), and proteolipid protein, and their encephalitogenic peptides, results in dramatic inhibition of clinical and histologic signs of both actively induced and adoptively transferred relapsing experimental autoimmune encephalomyelitis (R-EAE). We report here that the administration of splenocytes coupled with mouse spinal cord homogenate (i.e., a mixture of neuroantigens), after the first paralytic episode of adoptive R-EAE triggered by MBP-specific T cells but before the appearance of the first relapse, effectively reduced the onset and severity of all subsequent relapses, as determined by both clinical and pathologic criteria. In contrast, the i.v. administration of splenocytes coupled with MBP (i.e., the specificity of the initiating T cell response), under similar conditions, effectively inhibited the initial clinical relapse, but subsequent relapses occurred with the same incidence rate and severity as those in control animals. Collectively, these results demonstrate that neuroantigen-specific tolerance is effective at specifically down-regulating an ongoing autoimmune response. This may have potential clinical applicability for treatment of autoimmune diseases. The results also support the hypothesis that the neuroantigen specificity of later relapses of R-EAE may be due to effector T cells with specificities different from those that triggered the initial clinical episode. Thus, potential therapy for the advanced stages of R-EAE, and perhaps other autoimmune diseases, may have to be directed not simply against the effector cells initiating the disease but also against effector cells with differing specificities recruited as a result of tissue damage occurring in the initial acute disease.

Animals↗
PubMed1991

Assessing environmental carcinogens: review of an approach adopted by the expert groups of the World Health Organization Regional Office for Europe.

The World Health Organization Regional Office for Europe has adopted the viewpoint that it is necessary to attempt to evaluate potential human carcinogens in such a way so that the risk they present can be compared and used in general consideration of protecting the public from toxic substances found in various environments. In order to demonstrate this process, the evaluations for a number of criteria air pollutants as presented in the volume Air Quality Guidelines for Europe are summarized and reviewed. The basic method used is that involving the estimation of risk based on lifetime exposures to airborne carcinogens by a linear extrapolation from known data using no threshold, with the carcinogenic potency expressed as the incremental unit risk estimate. This unit risk is defined as the average expected for a hypothetical population exposed for a lifetime to a concentration of one microgram per cubic meter of the agent in the air they breathe. The advantages and disadvantages of the method are reviewed, and background information for actual environmental conditions and risks leading up to the consensus guidelines adopted are presented for those 17 of the initial 28 criteria air pollutants treated which have IARC classifications of carcinogenicity.

Air Pollutants↗
PubMed1991

Specific adoptive immunotherapy mediated by tumor-draining lymph node cells sequentially activated with anti-CD3 and IL-2.

Lymph nodes (LN) draining progressively growing tumors contain tumor-sensitized but not fully functional preeffector lymphocytes. These cells could acquire therapeutic efficacy and be expanded upon sequential culture with anti-CD3 mAb for 2 days followed by incubation in IL-2 for 3 days. Using the weakly immunogenic MCA 106 and MCA 205 murine sarcomas, we have further defined conditions of this anti-CD3/IL-2 activation with which preeffector cells differentiated into immune effector cells. In vitro activation and expansion of effector cells required sequential but independent stimulation with anti-CD3 and IL-2 because the simultaneous presence of both anti-CD3 and IL-2 at either stage did not enhance the efficacy of activation. Generation of effector cells by this two-stage activation was critically dependent on the optimal concentrations of anti-CD3 (1.0 microgram/ml) and IL-2 (2-10 U/ml). However, these conditions were not optimal for inducing the greatest cellular proliferation. In adoptive immunotherapy experiments, although the transfer of anti-CD3/IL-2-activated cells alone could mediate the regression of established metastases, the concomitant administration of IL-2 enhanced the in vivo activity of these cells. More importantly, tumor regression mediated by the anti-CD3/IL-2-activated cells was found to be immunologically specific. The specificity was determined by the tumor that stimulated the preeffector cell response. In spite of their in vivo antitumor effects, the anti-CD3/IL-2-activated tumor-draining LN cells did not exhibit detectable in vitro cytotoxicity against the tumor target in the 4-h 51Cr-release assay. In mice bearing progressive tumor, draining LN contained most preeffector cells. Some preeffector cells were also detected in the spleen whereas mesenteric LN did not demonstrate any reactivity. In kinetics studies, sensitization of preeffector cells in the draining LN occurred between 4 to 6 days after tumor inoculation. As the tumor progressed, the presence of preeffector cells declined gradually suggesting a tumor-induced suppression. These results define the conditions whereby tumor-draining LN cells could be stimulated, in the absence of tumor Ag, to develop into specific therapeutic effector cells. Our findings also raise the possibility of using similar approaches for isolating immune effector cells from cancer patients for adoptive immunotherapy.

Animals↗
PubMed1990

Adoptive transfer of CD8+ T cells from immune animals does not transfer immunity to blood stage Plasmodium yoelii malaria.

The malaria parasite, Plasmodium yoelii 17X, causes a self-limited, nonlethal infection characterized, in the blood stage, by preferential invasion of reticulocytes. Previous studies have suggested that immunity to the blood stage infection may be related to enhanced levels of class I MHC Ag on the parasitized reticulocyte surface and can be adoptively transferred to immunodeficient mice by immune CD8+ T cells in the absence of CD4+ T cells. To further examine the mechanisms of CD8+ T cell involvement in immunity to blood stage P. yoelii infection, we performed in vivo CD8 depletion and adoptive transfer experiments. Depletion of CD8+ T cells during primary blood stage infection in BALB/c mice did not diminish the ability of the mice to resolve their infections. Spleen cells from immune BALB/c and C57BL/10 mice were transferred to BALB/c-nu/nu and C57BL/10-nu/nu mice, respectively. The recipient mice were CD4 depleted in vivo to kill any transferred CD4+ T cells. The mice failed to control the infection. Populations of CD4-, CD8+ T cells were transferred from immune CBA/CaJ donors to in vivo CD4-depleted CBA/CaJ recipients. The mice were unable to control the infection. Although immune unfractionated spleen cells transferred rapid protection in all three mouse strains and immune CD4+ T cells transferred immunity in the two mouse strains studied, CD8+ T cells by themselves were neither protective nor did they enhance immunity.

Animals↗
PubMed1990

Local adoptive immunotherapy of human head and neck cancer xenografts in nude mice with lymphokine-activated killer cells and interleukin 2.

The efficacy of local adoptive immunotherapy with human lymphokine-activated killer cells and recombinant interleukin 2 (rIL-2) in growth inhibition of established squamous cell carcinoma of the head and neck (SCCHN) was evaluated in a nude mouse model. The model of xenografted SCCHN was established by s.c. injections of in vitro maintained tumor cells (2-10 x 10(6) cells/mouse) into the flank of splenectomized animals pretreated with cyclophosphamide (200 mg/kg). The SCCHN line used was tumorigenic in 95% of the appropriately conditioned nude mice. Inhibition of tumor growth by locally administered effector cells was the end point of the study, since the tumors did not metastasize within 6 weeks of tumor challenge. Either i.p. or local administration of rIL-2 alone (1000 units/day) to the tumor site daily for 2 weeks resulted in a significant inhibition of tumor growth. In the absence of detectable natural killer activity in these mice, a modest dose of rIL-2 had a direct antitumor effect on SCCHN cells in vivo. In addition, complete inhibition of tumor growth was achieved with 3 times weekly injections of 5-10 x 10(6) lymphokine-activated killer cells delivered to the tumor site and 1000 units of rIL-2 administered locally every day for 2 weeks. Our data indicate that local or systemic immunotherapy with rIL-2 alone or local adoptive immunotherapy with an adequate dose of lymphokine-activated killer cells plus rIL-2 may be effective in preventing the growth of established SCCHN tumors in vivo.

Animals↗