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At least 1,711 records · Page 95Linked to original sources
PubMed1996

Rapid opiate detoxification.

We report on clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD). The goal is to induce rapid narcotic withdrawal in a controlled environment using narcotic antagonists while suppressing withdrawal symptoms with sedative drugs, thus effecting a dramatic abbreviation of the traditional withdrawal schedule. Twenty-five consecutive heroin-addicted patients presenting for detoxification were treated at a university hospital. There were 14 women and 11 men, with a mean age 32.6 years (range, 24-48). They underwent 29 separate detoxifications over a 4-month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, ranging from intramuscular and oral sedation to intravenous sedation, paralysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO prior to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusions from this early clinical experience: First, ROD appears to be a valuable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is probably most suited to designated outpatient centers.

Adult↗
PubMed2003

Accurate determination of a joint rotation center based on the minimal amplitude point method.

In many computer-assisted surgery procedures in the field of joint replacement a joint rotation center must be located. To this end, joints such as the hip or the shoulder are approximated as spherical joints, and the most commonly used numerical method is the sphere-fitting algorithm. However, this method has a numerical instability where there is a limited range of motion caused by, for example, joint impingement. The aim of the present study was to develop an alternative kinematic method called the minimal amplitude point method. This method estimates the localization of the rotation center and can easily be integrated into program codes of computer-assisted surgery modules. It mainly consists of identifying the point of a mobile segment that moves least in the reference coordinate system of an immobile segment using an optimization procedure (genetic algorithm). The point determined can then be assumed to be the rotation center of the joint. To compare results of the two methods, an experimental set-up of two rigid solids linked by a spherical joint with known geometry was used to compute the rotation center. In contrast to the sphere-fitting method, the minimal amplitude point method permits the evaluation of the rotation center with an error of less than 4.1 mm, having a range of motion (ROM) of 5 degrees. An equivalent accuracy for the sphere-fitting method requires an ROM of 45 degrees.

Algorithms↗
PubMed2005

Quality of life and stress factors for veterinary medical students.

Psychological distress has been shown to affect the academic success, health, emotional well-being, and dropout rates of medical students. Although it can be assumed that stress has similar effects on veterinary students, there is a paucity of research pertaining to the psychological stressors and coping strategies of this group. This article focuses on selected non-academic areas (as identified through a survey of currently enrolled students) that can create significant stressors for veterinary students. Also assessed and discussed here are poor coping strategies (e.g., substance abuse) and gender differences in perceived stressors and coping strategies that emerged from the survey. Results suggest the need for veterinary programs to integrate academic and professional skills instruction with personal life balance training and access to psychological services.

Adult↗
PubMed1994

Chemicals used by the poultry industry.

The safe and effective use of chemicals within the live production phases of the poultry industry requires the implementation of integrated health programs. Chemical programs will vary with regard to phase, intended usage, and method and frequency of application. The term "chemicals" herein presented excludes drugs and non-nutritive feed additives, with primary emphasis on sanitation products (i.e., detergents, disinfectants, sanitizers, deodorizers, descalers, and possible combinations), pesticides (i.e., insecticides and rodenticides), and brief mention of soil litter treatments for environmental management of air quality at the farm level. Chemical usage by phase, location, and frequency of application are summarized. Products that are effective, environmentally and user friendly, and applied within label specification will provide for safe, economical, and long-term success of poultry health programs. Such programs must be supported by management and maintained through education and product stewardship administered cooperatively with chemical suppliers, technical consultants, and end users.

Agrochemicals↗
PubMed2006

ECA39 is a novel distant metastasis-related biomarker in colorectal cancer.

AIM: To investigate the possible role of polysaccharide-K (PSK) -related markers in predicting distant metastasis and in the clinical outcome of colorectal cancer (CRC). METHODS: Firstly, we used protein microarrays to analyze the in vitro expression profiles of potential PSK-related markers in the human colorectal adenocarcinoma cell line SW480, which carries a mutant p53 gene. Then, we investigated the clinical implications of these markers in the prognosis of CRC patients. RESULTS: ECA39, a direct target of c-Myc, was identified as a candidate protein affected by the anti-metastatic effects of PSK. Immunohistochemistry revealed that ECA39 was expressed at significantly higher levels in tumor tissues with distant metastases compared to those without (P<0.00001). Positive ECA39 expression was shown to be highly reliable for the prediction of distant metastases (sensitivity: 86.7%, specificity: 90%, positive predictive value: 86.7%, negative predictive value: 90%). A significantly higher cumulative 5-yr disease free survival rate was observed in the ECA39-negative patient group (77.3%) compared with the ECA39-positive patient group (25.8%) (P<0.05). CONCLUSION: Our results suggest that ECA39 is a dominant predictive factor for distant metastasis in patients with advanced CRC and that its suppression by PSK might represent a useful application of immunotherapy as part of a program of integrated medicine.

Adenocarcinoma↗
PubMed1987

Tenure and promotion: an update on university nursing faculty.

The status of tenure and promotion practices in nursing schools in university settings was studied. Forty nursing administrators from nursing programs around the country responded to a questionnaire regarding requirements to achieve tenure and/or promotion in the areas of teaching, research and scholarly activities, clinical competence, and community service. Findings revealed that while a growing number of nursing programs were more integrated into the academic community, many programs continued to struggle with the need for more faculty prepared at the doctoral level and for increased research activities.

Adult↗
PubMed2003

Complementary and alternative medicine: core competencies for family nurse practitioners.

Recent surveys demonstrate substantial use of complementary and alternative medicine. This growth presents a challenge for family nurse practitioner programs that already have dense curricula due to the explosion of biomedical knowledge. Significant barriers exist to incorporating complementary and alternative medicine into educational programs, such as differing philosophies about health and lack of research on many complementary and alternative medicine therapies. This study used a mailed questionnaire in which family nurse practitioner program directors described the current status of complementary and alternative medicine teaching in family nurse practitioner programs and identified core competencies for family nurse practitioners. Most programs reported integrating some content on complementary and alternative medicine into advanced practice courses, such as health promotion. Competencies related to interviewing, critical thinking, evidence-based medicine, knowledge of laws, ethics, and spiritual and cultural beliefs were rated the highest. The findings are useful in helping family nurse practitioner faculty incorporate complementary and alternative medicine content into their curricula with the goal of preparing family nurse practitioners for safe practice.

Clinical Competence↗
PubMed1991

Traditional and modern medicine working in tandem.

Because of the many problems relating to health care delivery in Africa, it is becoming apparent that neither the exclusive/monopolistic nor the tolerant legislative systems should be tolerated any longer. Especially since the Alma Ata Conference held by the WHO/UNICEF there has been growing impetus towards either inclusive/parallel (the beneficial co-existence of traditional and modern medical systems), or integrated systems. Although the idea of making traditional and modern medicine work in tandem in a united treatment context has its merits, it is also plagued by issues such as the nature of the products of an integrated training, resistance by stubborn protagonists of either of the two systems, or that only lip-service is paid to the idea of co-operation. Nevertheless, it is believed that all interest groups--the authorities responsible for health care delivery, the Western-trained health care workers, the traditional healers and the users of these services--stand to gain from such liaison.

Delivery of Health Care↗
PubMed1994

Community participation in vector control: lessons from Chagas' disease.

As applied to vector-borne disease control, the term community participation has been broadly interpreted. Community-based vector control projects have been described as having both active and passive components. Recently, community participation in organized efforts to control Chagas' disease has become more dynamic, with increasingly active involvement by local community members. Chagas' disease is a particularly significant vector-borne disease problem in the South American countries of Brazil, Venezuela, and Bolivia, and health officials there are beginning to emphasize horizontal or decentralized approaches to control of triatomine vectors. Experience suggests that vector control programs using community participation have significant and sustainable impact on vector density, appear to be more cost-effective than purely vertically structured programs, are readily integrated with other health or development programs, promote an enduring sense of pride in home and community, and are politically viable vector control strategies. Community participation per se has inherent value because of its positive effect on social relationships and community solidarity. Moreover, it is a dynamic process that results in accrued benefits for public health that exceed most vector control program goals and persist well beyond program termination.

Animals↗
PubMed1994

The role of biological control of mosquitoes in integrated vector control.

An integrated approach for the control of mosquitoes and the diseases they transmit will better enable sustainable control while helping to circumvent some of the problems associated with the use of conventional insecticides. Environmental methods and biological control are alternatives to chemical control and are key components of the integrated strategy. The use of vertebrate and invertebrate predators and entomopathogens as biological control agents and their role in integrated control programs is reviewed with emphasis on fish, Toxorhynchites mosquitoes, Notonecta species, predatory copepods, entomopathogenic bacteria, and the fungus Lagenidium giganteum. The successful implementation of these organisms will depend on an in-depth understanding of the ecology of both the targeted species and the biological control agents to be used. Thorough geographic reconnaissance will also be essential for the successful abatement of pest and vector mosquitoes. The success and sustainability of future programs, especially in developing countries, will rely not only on the use of the most appropriate technologies but also on the direct participation of the affected communities. Possible undesirable effects of biological control are also reviewed.

Animals↗
PubMed2000

The potential impact of integrated malaria transmission control on entomologic inoculation rate in highly endemic areas.

We have used a relatively simple but accurate model for predicting the impact of integrated transmission control on the malaria entomologic inoculation rate (EIR) at four endemic sites from across sub-Saharan Africa and the southwest Pacific. The simulated campaign incorporated modestly effective vaccine coverage, bed net use, and larval control. The results indicate that such campaigns would reduce EIRs at all four sites by 30- to 50-fold. Even without the vaccine, 15- to 25-fold reductions of EIR were predicted, implying that integrated control with a few modestly effective tools can meaningfully reduce malaria transmission in a range of endemic settings. The model accurately predicts the effects of bed nets and indoor spraying and demonstrates that they are the most effective tools available for reducing EIR. However, the impact of domestic adult vector control is amplified by measures for reducing the rate of emergence of vectors or the level of infectiousness of the human reservoir. We conclude that available tools, including currently neglected methods for larval control, can reduce malaria transmission intensity enough to alleviate mortality. Integrated control programs should be implemented to the fullest extent possible, even in areas of intense transmission, using simple models as decision-making tools. However, we also conclude that to eliminate malaria in many areas of intense transmission is beyond the scope of methods which developing nations can currently afford. New, cost-effective, practical tools are needed if malaria is ever to be eliminated from highly endemic areas.

Animals↗
PubMed1991

Toy Control Program evaluation.

The Toy Control Program for the Apple IIe microcomputer is a software and hardware package developed for the training of single-switch scanning skills. The specially designed scanning programs provide on screen visual feedback and activate a battery-powered toy to reinforce performance. This study examined whether the training of preschool subjects in single-switch scanning skills with the Toy Control Program would result in increased task completion scores and increased levels of attention to task, as compared with conditions of toy activation only and microcomputer programs with screen reinforcement only. The results showed that the subjects paid significantly more attention to the toys as reinforcers (p less than .01). No significant difference was found for the performance results of the three conditions. These findings support the use of a program like the Toy Control Program, which integrates the instructional capabilities of a computer with the reinforcement potential of a toy and the creativity of a therapist.

Cerebral Palsy↗
PubMedDate not supplied

Developments in surgical oncology--past, present, and future trends.

The historical development of integrated treatment programs for locally advanced or aggressive cancers, for which the results of surgical excision or radiotherapy are unsatisfactory, is reviewed. Chemotherapy should be used first (induction chemotherapy), while tumour vasculature is intact; intra-arterial infusion gives a greater regional effect. Central residual tumour may be eradicated by subsequent radiotherapy and/or surgery. Regional induction chemotherapy is particularly useful in treating locally advanced stage III breast cancer, locally advanced head and neck cancer, gastric cancer, and locally advanced sarcomas and melanomas of the limbs. A team approach, involving surgical and medical oncologists, radiotherapists, immunologists, and others should improve the results in these patients.

Combined Modality Therapy↗
PubMed2003

Meeting the challenge of chronic illness in general practice.

Seven of every 10 general practice encounters are for chronic conditions. Three common chronic conditions managed by GPs are depression, diabetes and asthma. Two of these are National Health Priority Areas (NHPAs), while depression is the focus of the mental health NHPA. General practice care for people with depression is being strengthened by the "Better outcomes in mental health care initiative", which includes a 3 Step Mental Health Process - assessment, mental health plan, and review. GPs have the opportunity to screen patients for diabetes and manage their condition. For those with risk factors who screen negative, GPs are well placed to encourage lifestyle interventions. Two of the four components of the National Integrated Diabetes Program focus on general practice. The Asthma 3+ Visit Plan, which incorporates diagnosis and assessment of asthma, development of a written asthma plan, and review of asthma management, has been shown to improve GPs' management of asthma. These initiatives to improve general practice interventions for chronic illness, although welcomed, put further pressure on already overstretched GPs coping with multiple changes in the primary-care sector.

Asthma↗
PubMed1994

Integrating leprosy control into primary health care: the experience in Ghana.

Integration of leprosy control into primary health care is the most comprehensive and permanent system of delivering care to leprosy patients. But so far only a few countries have adopted this approach, largely on account of a fear of failure. Over the past decade Ghana has developed a model approach towards the transition from a vertical to an integrated programme. The highlights of our approach included the development of the leprosy service as part of the overall development of the health service, increasing capacity building for leprosy control at the district and subdistrict levels as well as the establishment of a regular and effective monitoring to identify and correct operational problems early. This paper describes the principles behind the integration, the strategies adopted and how they were implemented. It also includes the achievements made as well as the problems that were encountered and how they were solved.

Ghana↗
PubMed1991

A novel comprehensive DUE program--five years of experience.

A comprehensive program has been developed to evaluate prescribing practices in diverse drug therapy categories and in all areas of the institution. Input for topic selection comes not only from the pharmacy department, but also from QA, medical staff, and nursing. The development of monitoring criteria and review of the results by the P&T Committee, Medical Executive Committee, and other key medical staff members, promotes ownership of the program by the medical staff. The benefit of this ownership is active support for the program and participation in peer review. Overall, the results of this cost-effective program include limited use of broad spectrum antibiotics, select prescribing of high-risk drugs, and focused educational efforts to improve quality of patient care. The primary goal for the future of the program is to develop criteria and documentation mechanisms for reporting measurable clinical outcomes. In making the transition, it is important to use the success and impact of the current program as the foundation. This is particularly true for the concurrent monitoring program and its immediate feedback mechanism. The major challenge will be evaluating negative clinical outcomes and developing corrective actions as well as documenting the positive outcomes and the avoidance of negative outcomes of the current program. To meet this challenge, the DUE program must be integrated with all other institutional QA programs. Although a difficult task, this is a significant yet necessary step in the right direction for assuring optimal patient care.

Anti-Bacterial Agents↗