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At least 1,711 records · Page 95Linked to original sources
PubMed2002

Detection of vascular access stenosis by measurement of access blood flow from ionic dialysance.

BACKGROUND/AIM: The measurement of the vascular access blood flow rate (Q(a)) in chronic hemodialyzed patients was proposed to predict access thrombosis. We have recently presented a new method based on the measurements of ionic dialysance at normal and reversed positions of the blood lines. We evaluate the reliability of the measurement of Q(a) by this method in detecting significant access stenoses. METHODS: Twenty-five patients on chronic hemodialysis and having a vascular access cannulated with two needles were studied. The Q(a) was evaluated by the Diascan ionic dialysance (Q(a-id)) method and by the ultrasound dilution technique (Q(a-us); Transonic) during the same dialysis session. The measurements were available for 23 patients. In addition, the patients had ultrasonography of their fistula followed by angiography, if a stenosis was detected. RESULTS: Q(a-id) and Q(a-us) were not significantly different, showing a difference in Q(a) at 32 +/- 469 ml/min. Q(a-id) was significantly different between patients with or without stenosis (508 +/- 241 vs. 1,125 +/- 652 ml/min, p < 0.05). Among patients with a Q(a) <500 ml/min by Q(a-id), 5 had a stenosis detected by ultrasonography (sensitivity 83%), and 3 had no stenosis (false-positive rate 18%). Of these 3 patients, 2 had a thrombotic event at 1 and 3 months, suggesting that a more sensitive detection of stenosis for this range of Q(a) is needed and that a Q(a) <500 ml/min has a higher power to predict thromboses than a stenosis by ultrasonography. CONCLUSIONS: The measurement of the access flow rate by the Q(a-id) method has a clinical relevance to the detection of vascular access stenosis. An intervention program based on the Q(a-id) has to be evaluated.

Arterio-Arterial Fistula↗
PubMed1997

International documentation system for pancreatic cancer (IDS). The future in pancreatic cancer evaluation.

Different classification systems for pancreatic cancer have evolved in western countries as compared to Japan. While the UICC classification which is focused on tumour size and distant metastasis has achieved widespread acceptance, the more complicated Japanese system seems to be superior in the estimation of local growth. The major drawback of the JPS system, however, is the complex structure and difficult handling. To overcome both the international barriers in classification systems and to achieve a universal prospective data acquisition, a uniform international Documentation System for Exocrine Pancreatic Cancer (IDS for EPC) has been developed by an international group of pancreatologists. The present form of IDS is supported by a software program (based on Microsoft Access) which allows simplified data acquisition and statistical analysis as well as automated stage grouping for the UICC and JPS classifications. From the first contact with the patient, through all diagnostic and therapeutic measures including follow-up, IDS enables a compact and easy-to-use tool for prospective data acquisition and exchange on an international basis.

Documentation↗
PubMed1984

The impact of third-party payment cutbacks on the private practice of psychiatry: three surveys.

Recent cutbacks in private insurance benefits and publicly funded health programs are threatening the access of Americans, particularly the poor and the disabled, to private psychiatric care. The authors present the findings of three surveys that assessed the impact of threatened or actual cuts in third-party payments on the treatment provided by private practitioners. One survey indicated that, contrary to popular opinion, more than half of the psychiatrists in Northern California see severely disturbed Medicaid patients and that they provide outpatient psychiatric services to them for less cost than would public clinics. Two surveys conducted in the Washington, D.C., area indicated that both patients and psychiatrists have suffered from insurance cutbacks, with fewer patients being able to afford intensive private treatment and psychiatrists using reduced fees and less optimal treatment modalities. The fiscal and ethical dilemma posed by the cutbacks and further research needs are also explored.

Affective Disorders, Psychotic↗
PubMed1993

Health care utilization and costs after entry into an outreach program for homeless mentally ill veterans.

OBJECTIVE: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. METHODS: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of clinical need and to participation in the outreach program. RESULTS: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. CONCLUSIONS: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.

Adult↗
PubMed2004

Using civil representation to reduce delinquency among troubled youth.

Team Child is designed to provide civil legal representation for very troubled delinquent youth to improve their access to needed education programs, mental health services, and family services. Better provision of these services is intended to reduce delinquency and potentially avoid the long-term incarceration of these youth. This article uses an incidental truncation model to evaluate two Team Child programs in Florida. The authors find the programs not to be effective in reducing recidivism among the youth but to be effective in reducing the arrest rate of the recidivating juveniles. The results indicate a reduction of 11% to 23% of arrests after treatment for the Team Child group.

Adolescent↗
PubMed1995

[Health evaluation and promotion. State of the art across the international literature].

UNLABELLED: Ten years after its emergence on the international scene, Health Promotion remains a marginal concept, even it its diffusion continues in practice. Resting on an ecological model of health that stresses the importance of interactions between the individual or group and the physical and social environment, health promotion aims to reduce the inequalities concerning health and access to care. The evaluation of health promotion actions suffers from a double handicap (or benefits from a double advantage?): the newness of the concept of health promotion and the relative novelty of using systematic evaluation practices for health actions. To carry out the inquiry of evaluation and health promotion, several public health data bases were consulted, both French and foreign, crossing evaluation and health promotion. It was noted that a degree of assimilation had occurred between health promotion and health education, and thus the research was enlarged by crossing evaluation with health education, community health and prevention. Only one article made specific reference to any of the five strategies delineated in the Ottawa Charter, and it appeared from the existing literature that health promotion in real life seems to have a meaning-confirmed by general practice--somehow reduced compared with the ambitions of the text to reduce inequalities in health and to allow the mastery and control by the population of the determinants of health. FINDINGS: The lack of available materials, particularly in francophone Europe, with the majority of references describing actions or experiments in Canada, and only rarely actions on the determinants of health.(ABSTRACT TRUNCATED AT 250 WORDS)

Diffusion of Innovation↗
PubMed2006

Teaching cultural competence to reduce health disparities.

As part of the Genesee County, Michigan, REACH 2010 initiative, a new course, Cultural Competence in Health Care, was developed at the University of Michigan-Flint. The objective of this course is to improve the cultural competence of future health and human service providers and to reduce persistent racial and ethnic health disparities. This article describes the course and the important role that REACH 2010 partners played in its development and implementation. Course materials, methods, and student feedback are summarized, along with lessons learned.

Community Health Services↗
PubMed2002

The comparative RNA web (CRW) site: an online database of comparative sequence and structure information for ribosomal, intron, and other RNAs.

BACKGROUND: Comparative analysis of RNA sequences is the basis for the detailed and accurate predictions of RNA structure and the determination of phylogenetic relationships for organisms that span the entire phylogenetic tree. Underlying these accomplishments are very large, well-organized, and processed collections of RNA sequences. This data, starting with the sequences organized into a database management system and aligned to reveal their higher-order structure, and patterns of conservation and variation for organisms that span the phylogenetic tree, has been collected and analyzed. This type of information can be fundamental for and have an influence on the study of phylogenetic relationships, RNA structure, and the melding of these two fields. RESULTS: We have prepared a large web site that disseminates our comparative sequence and structure models and data. The four major types of comparative information and systems available for the three ribosomal RNAs (5S, 16S, and 23S rRNA), transfer RNA (tRNA), and two of the catalytic intron RNAs (group I and group II) are: (1) Current Comparative Structure Models; (2) Nucleotide Frequency and Conservation Information; (3) Sequence and Structure Data; and (4) Data Access Systems. CONCLUSIONS: This online RNA sequence and structure information, the result of extensive analysis, interpretation, data collection, and computer program and web development, is accessible at our Comparative RNA Web (CRW) Site http://www.rna.icmb.utexas.edu. In the future, more data and information will be added to these existing categories, new categories will be developed, and additional RNAs will be studied and presented at the CRW Site.

Base Sequence↗
PubMed2006

Automated external defibrillator program does not impair cardiopulmonary resuscitation initiation in the public access defibrillation trial.

OBJECTIVES: To evaluate whether automated external defibrillator (AED) training and AED availability affected the response of volunteer rescuers and performance of cardiopulmonary resuscitation (CPR) in presumed out-of-hospital cardiac arrest (OOH-CA) during the multicenter Public Access Defibrillation Trial. METHODS: The Public Access Defibrillation Trial recruited 1,260 facilities in 24 North American regional sites to participate in a trial addressing survival from OOH-CA when AED training and availability were added to a volunteer-based emergency response team. Volunteers at each facility were trained to perform either CPR alone (CPR) or CPR in conjunction with AED use (CPR+AED) according to randomized assignments. This study reports the frequency of response and initiation of CPR actions (chest compressions and/or ventilations) by volunteers in the CPR and CPR+AED study groups. RESULTS: A total of 314 presumed OOH-CA episodes occurred in CPR facilities, and 308 occurred in CPR+AED facilities. The volunteers were matched well for age, gender, and other features. Overall, ventilations (23.1% vs. 13.1%), chest compressions (24.4% vs. 12.1%), and both actions (19.8% vs. 10.5%; all p < 0.05) were more commonly performed in OOH-CA cases in the CPR+AED group. However, when only OOH-CA cases with volunteers responding were analyzed, the rates of CPR actions were similar. In the subgroup of CPR+AED cases with a responding volunteer, the AED was turned on for only 47% of cases. Volunteers initiated a CPR action more commonly when the AED was turned on (60.7% vs. 39.3%; p = 0.003). CONCLUSIONS: In the Public Access Defibrillation Trial, rates of CPR actions for presumed OOH-CA victims were low but similar for CPR and CPR+AED responding volunteer rescuers. Factors associated with volunteer response, CPR action initiation, and AED activation warrant further investigation.

Adult↗
PubMed2000

Cognitive intervention in unemployed individuals with reading and writing disabilities.

Sixty native-born Swedish unemployed participants with reading and writing disabilities (R&WD) participated in a 20-week educational program aimed at improving reading and writing, verbal memory, self-confidence, and flexibility of perspectives. They were tested with a comprehensive battery (interviews, questionnaires, neuropsychological tests, and tests of academic achievement) before and after the intervention. Sixteen controls, matched for sex, age, education, and nonverbal IQ, participated in the pre- and posttest sessions but received only standard unemployment interventions. The educational program participants' performance in tests assessing spelling, decoding of letters, self-confidence, and flexibility improved significantly in comparison with the controls after the intervention. A significantly larger number of the participants had obtained work or started a regular education than expected. A substantial proportion of unemployed participants have R&WD and it appears that an intensive but fairly short educational program can improve their accessibility to the labor market and their motivation for study.

Aged↗
PubMed2005

TarBase: A comprehensive database of experimentally supported animal microRNA targets.

MicroRNAs (miRNAs) are approximately 22-nt RNA segments that are involved in the regulation of protein expression primarily by binding to one or more target sites on an mRNA transcript and inhibiting translation. MicroRNAs are likely to factor into multiple developmental pathways, multiple mechanisms of gene regulation, and underlie an array of inherited disease processes and phenotypic determinants. Several computational programs exist to predict miRNA targets in mammals, fruit flies, worms, and plants. However, to date, there is no systematic collection and description of miRNA targets with experimental support. We describe a database, TarBase, which houses a manually curated collection of experimentally tested miRNA targets, in human/mouse, fruit fly, worm, and zebrafish, distinguishing between those that tested positive and those that tested negative. Each positive target site is described by the miRNA that binds it, the gene in which it occurs, the nature of the experiments that were conducted to test it, the sufficiency of the site to induce translational repression and/or cleavage, and the paper from which all these data were extracted. Additionally, the database is functionally linked to several other useful databases such as Gene Ontology (GO) and UCSC Genome Browser. TarBase reveals significantly more experimentally supported targets than even recent reviews claim, thereby providing a comprehensive data set from which to assess features of miRNA targeting that will be useful for the next generation of target prediction programs. TarBase can be accessed at http://www.diana.pcbi.upenn.edu/tarbase.

3' Untranslated Regions↗
PubMed2004

Pediatric emergency department outreach: solving medical problems or revealing community solutions?

Low-acuity (LA) use of emergency departments (EDs) is often viewed as misuse or abuse. We designed a program to help users access services more efficiently. Community health workers (CHWs) functioned as health educators, screeners, and liaisons to care. A participatory curriculum emphasized medical problems. Qualitative ethnographic methods were used for formative evaluation. Ninety families received regular visits from CHWs. Original system-oriented objectives and methods did not fit community needs. Instead, information was gathered regarding service utilization patterns: (1) families mistrusted primary and preventive care, reporting frequent discrimination and humiliation; (2) a primarily biomedical prioritization did not match families' need hierarchies; (3) complex demands of poverty made other uses of the system challenging; (4) primary care services were frequently avoided; and (5) the ED was often preferred. Intangible psychosocial factors and practical complexities of poverty were powerful promoters of LA visits. Families were creative strategists, viewing LA visits as rational use, not misuse, of a challenging system.

Baltimore↗
PubMed2003

Rising role of obesity surgery caused by increase of morbid obesity, failure of conventional treatments and unrealistic expectations: trends from 1997 to 2001.

BACKGROUND: The authors analyzed the trends in anthropometric and behavioral characteristics among patients seeking weight loss and the trends in choice of treatments, between 1997 and 2001 in an outpatient obesity clinic. PATIENTS AND METHODS: 138 and 128 consecutive patients attending the out-patient obesity clinic at University Hospital of Lausanne were screened in 1997 and in 2001 respectively. Eating habits, body composition and treatment used were assessed. RESULTS: Median BMI was 35 kg/m2 in 1997 and 38 kg/m2 in 2001 (P <0.001) and waist circumference was 99 cm and 111 cm respectively (P <0.001). This increase in the average body weight involved especially patients <30 years old (P <0.01). Morbid obesity increased by 16% (P <0.01), and prevalence of abdominal obesity by 13% (P < 0.05). The median desired weight loss increased significantly from 25% to 29% (P <0.05). 64% of the patients in 1997 and 83% in 2001 (P <0.01) hoped for a weight loss of 20% of their baseline weight. Motivation to lose weight for esthetic reasons was found in 81% of the women and 55% of the men in 1997 (P <0.01), while in 2001 the percentage was 89 and 43 respectively (P <0.001). CONCLUSION: In spite of the increasing access to weight loss programs, we found that the patients are more severely obese, especially those <30 years old, and have more unrealistic expectations of weight loss. This may explain the doubling of the patients treated by surgery.

Adult↗
PubMed2006

Characterization and mapping of a shattering mutant in rice that corresponds to a block of domestication genes.

Easy shattering reduces yield due to grain loss during harvest in cereals. Shattering is also a hindrance in breeding programs that use wild accessions because the shattering habit is often linked to desirable traits. We characterized a shattering mutant line of rice, Hsh, which was derived from a nonshattering japonica variety, Hwacheong, by N-methyl-N-nitrosourea (MNU) treatment. The breaking tensile strength (BTS) of the grain pedicel was measured using a digital force gauge to evaluate the degree of shattering of rice varieties at 5, 10, 15, 20, 25, 30, 35, and 40 days after heading (DAH). The BTS of Hwacheong did not decrease with increasing DAH, maintaining a level of 180-240 gf, while that of Hsh decreased greatly during 10-20 DAH and finally stabilized at 50 gf. Optical microscopy revealed that Hsh had a well-developed abscission layer similar to the wild rice Oryza nivara (accession IRGC105706), while Hwacheong did not produce an abscission layer, indicating that the shattering of Hsh was caused by differentiation of the abscission layer. On the basis of the BTS value and morphology of the abscission layer of F(1) plants and segregation data in F(2) populations, it was concluded that the easy shattering of Hsh was controlled by the single recessive gene sh-h. The gene sh-h was determined to be located on rice chromosome 7 by bulked segregant analysis. Using 14 SSR markers on rice chromosome 7, the gene sh-h was mapped between the flanking markers RM8262 and RM7161 at distances of 1.6 and 2.0 cM, respectively. An SSR marker Rc17 cosegregated with the gene sh-h. The locus sh-h for shattering was tightly linked to the Rc locus conferring red pericarp, as well as a QTL qSD(s)-7-1 for seed dormancy, implying that this region might represent a domestication block in the evolutionary pathway of rice.

Agriculture↗
PubMed2004

[Evaluation of comprehensiveness: ascribing meaning to agreements on goals for local health systems].

As a policy guideline, ideal, or objective, comprehensiveness is a relevant attribute in the evaluation of quality of care and health systems. The article discusses the meaning of the concept of comprehensiveness in practice in some health services and systems, analyzing various methodologies to implement the concept. In Brazil, what prevails is an expanded perception emphasizing the complete, continuous, and coordinated nature of health care and management. The article highlights the importance of combining the evaluation of comprehensiveness with measures of access, suggesting the selection of indicators pertaining to agreements on goals for local health systems and their monitoring. This initiative could enhance the validity of existing evaluation instruments, from a communications perspective.

Brazil↗