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Biomedical subjects

C Ramponi

Publications and source records attributed to C Ramponi.

At least 19 recordsLinked to original sources

[Glossary of terms of management and quality].

The implementation of a quality management system (QMS) in the health-care world is nowadays mandatory. This is a specific request not only of local laws but also of the World Health Organization which recently said that "By the year 2000, there should be structures and processes in all member States to ensure a continuous improvement in the quality of health care". In addition, we are bombarded by demands from patients, physicians, employers and the administration. However a QMS is something new for the medical doctor. We think that the first step to divulge the culture of quality in our field is to have a good knowledge of the specific terminology used in the QMS. This glossary explains the meaning of more than 80 terms related to the QMS.

Quality Control↗

Epidemiologic study of use of resources in patients with unstable angina: the EARISA registry. On behalf on the EARISA Investigators (Epidemiologia dell'Assorbimento di Risorse nell'Ischemia, Scompenso e Angina).

AIM: The EARISA Registry was designed to describe diagnostic and therapeutic resources used in Italian cardiology centers for patients with the epidemiologically most relevant cardiac diseases. This article focuses on patients with unstable angina; characteristics associated with invasive procedures were specifically analyzed. METHODS AND RESULTS: Information was collected over a 2-week period on 1420 patients with unstable angina discharged from 308 cardiology centers. The mean length of stay was 9 +/- 6 days; 51% of patients were admitted to a coronary care unit (mean length of stay, 4 +/- 3 days). Noninvasive procedures included echocardiography (64%), Holter monitoring (25%), exercise stress testing (24%), and echocardiographic stress testing or nuclear imaging (7%). Invasive procedures were coronary angiography (39%) and percutaneous transluminal coronary angioplasty or coronary artery bypass grafting (13%). Unstable angina had a greater impact on invasive procedures than acute myocardial infarction. Variables independently associated with a higher rate of coronary angiographic procedures were younger age, higher technologic level of the hospital, and need for intravenous therapy. CONCLUSION: In Italy, approximately half the patients with unstable angina are admitted to hospitals without catheterization laboratories or cardiac surgery facilities. This fact supports the concept that treatments that can be administered in all types of hospitals are more likely to affect the outcome of patients with unstable angina. Overall, the rates of coronary angiography and revascularization procedures appeared low, and the setting where cardiologists practice, rather than patient characteristics, is the major determinant of the care given to patients with unstable angina.

Aged↗

[The appropriateness of hospital admissions: reflections for a global approach].

In accordance with a recent definition, appropriateness of medical care is a diagnostic-therapeutic intervention with a correct use of resources and competency, and a procedure that satisfies the request of patients. This definition considers not only the risk/benefit relationship but also the interaction between costs and benefits. In this light, the concept of appropriateness needs a global approach. The identification of the Mission and Vision of the structure, the use of medical guidelines, the distribution of documents which inform patients on the procedures carried out in the hospital and the modalities of access to the structure, the implementation of procedures which define hospital admission and finally the random check of medical records could represent important steps to implement a quality system aimed at guaranteeing the appropriateness of hospital admissions in accordance with the international standards for total quality management ISO 9000.

Guidelines as Topic↗

Response deadline and subjective awareness in recognition memory.

Level of processing and generation effects were replicated in separate experiments in which recognition memory was tested using either short (500 ms) or long (1500 ms) response deadlines. These effects were similar at each deadline. Moreover, at each deadline these effects were associated with subsequent reports of remembering, not of knowing. And reports of both knowing and remembering increased following the longer deadline. These results imply that knowing does not index an automatic familiarity process, as conceived in some dual-process models of recognition, and that both remembering and knowing increase with the slower, more controlled processing permitted by the longer response time.

Humans↗

Experiences of remembering, knowing, and guessing.

This article presents and discusses transcripts of some 270 explanations subjects provided subsequently for recognition memory decisions that had been associated with remember, know, or guess responses at the time the recognition decisions were made. Only transcripts for remember responses included reports of recollective experiences, which seemed mostly to reflect either effortful elaborative encoding or involuntary reminding at study, especially in relation to the self. Transcripts for know responses included claims of just knowing, and of feelings of familiarity. These transcripts indicated that subjects were often quite confident of the accuracy of their decisions, compared with those for guess responses. Transcripts for decisions associated with guess responses also expressed feelings of familiarity but additionally revealed various strategies and inferences that did not directly reflect memory for studied items. The article concludes with a historical and theoretical overview of some interpretations of the states of awareness measured by these responses.

Association Learning↗

[Long term treatment of moderate to severe hypercholesterolemia with low dose statin. Comparison of simvastatin and pravastatin].

Sixty-seven subjects with primary hypercholesterolemia were enrolled in an open study with "low dosages" of inhibitors of 3-hydroxy-3methylglutaril coenzyme A reductase. Patients were randomized in comparative and parallel study with simvastatin 10 mg (30 subjects) and pravastatin 20 mg (27 subjects) once in the evening for a treatment period of 12 months. At the end of the treatment the plasma concentrations of total and LDL cholesterol were reduced respectively by 21% (p < 0.001) and 29% (p < 0.001), plasma triglyceride concentration was reduced by 16%, high density lipoprotein (HDL) was increased by 2.9%. The efficacy of drugs was increasing during the study: at the third month 63% of subjects and at the twelfth month 89% of subjects showed a LDL < 160 mg/dL. In this study the drugs were well-tolerated, but 11 subjects showed a slight and transitory increase of CK. A treated group with simvastatin showed a similar decrease of the total cholesterol and LDL as that one treated with pravastatin. Pravastatin in comparison with simvastatin reduced significantly plasma triglycerides. There was no significant difference between the groups in the frequency of drug-related adverse effects. In conclusion "low dosages" of simvastatin and pravastatin in long term treatment were very efficacious in the reduction of total and LDL cholesterol. In our study, the decrease of total and LDL cholesterol was time-dependent, with the greatest reduction after sixth months. There were no significant differences between 10 mg of simvastatin and 20 mg of pravastatin on reduction of total and LDL cholesterol levels. Triglycerides decreased significantly only with pravastatin.

Aged↗

The therapeutic potential of moclobemide, a reversible selective monoamine oxidase A inhibitor in Parkinson's disease.

Dopamine is equally well deaminated oxidatively by monoamine oxidase (MAO) A and B types. Selegiline (L-deprenyl), a selective inhibitor of MAO-B, ameliorates the "wearing off" akinesia and delays the need for levodopa in mild, previously untreated Parkinson's disease. The therapeutic potential of selective inhibition of MAO-A in Parkinson's disease has not been examined in detail. MAO-A accounts for only about 20% of total MAO activity in the human basal ganglia, and it differs from MAO-B in distribution. In contrast to MAO-B, which is confined to the extraneuronal compartment, MAO-A is found both extraneuronally and within the presynaptic dopaminergic terminals. The inhibition of MAO-A might alter the intraneuronal handling of dopamine reuptaken from synaptic clefts and thereby prolong oral levodopa benefit. We have given moclobemide, a selective, reversible inhibitor of MAO-A, to nondepressed patients with Parkinson's disease receiving standard levodopa/peripheral decarboxylase inhibitor or levodopa with dopaminergic agonist (bromocriptine, pergolide). Selegiline was discontinued at least 8 weeks earlier. A standard oral levodopa challenge was performed at the patient's entry to the study and repeated on the 22nd day of moclobemide treatment (150 mg thrice daily). The overall time spent "on" and "off" before the onset of treatment and during the last week on the drug was estimated from the patients' diaries. Neuropsychological assessments were also made before and after 3 weeks of moclobemide to measure possible effects on cognitive performance and mood. In acute levodopa challenge, the latency of motor response was significantly shortened and its duration was prolonged during moclobemide treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[A computerized support system for the ambulatory treatment of patients with arterial hypertension].

AGAPE (Computer-based Outpatients' Clinic Programme) is a programme for IBM-compatible microcomputers realised by physicians for the management of hypertensive patients. The programme is planned to make the operators' work complete and expeditious while, at the same time, respecting the standard formulation of the clinical approach to the patient. The collection, organisation, recording and communication of data are handled on line by the programme under the operator's control. Special attention has been given to the control of the quality of the data collected as well as to their easy use for clinical, research and statistical purposes. This programme was used for 52 months in a hypertension clinic where physicians and nurses work jointly. Up to April 1989, 1924 new patient visits and 10,639 control visits together with 3,375 groups of lab tests were inserted. The mean training time for new operators was 3.2 hours; the mean data insertion time was 12.5 minutes for the first visit, 3 minutes for the subsequent visits and 2.5 minutes for lab tests. The drop-outs, evaluated at one-year follow-up on each 250 patients before and after the introduction of the computerized system, were 84/250 and 64/250 respectively (p less than 0.05), with a trend to wards the better control of hypertension (diastolic blood pressure less than 90 mmHg, 128/250 vs 143/250, n.s.).

Ambulatory Care↗

Variations in absorption of theophylline from two sustained-release products.

The intrasubject variability in the absorption of two sustained-release theophylline products was investigated in eight healthy volunteers, aged 27 to 38 years. Each subject randomly received 500 mg of Somophyllin-CRT on two days and 600 mg of Theo-Dur on two other days. At least one week separated each of the study days. Blood samples were collected at frequent intervals after each dose over a 24-hour period. Serum theophylline concentrations were assayed in duplicate by means of an enzyme immunoassay. The serum theophylline concentration-time curves were used to calculate the peak serum concentrations, the time to peak concentration, and the area under the curves for each subject. The intrasubject variability of these values was great with both drugs, but Theo-Dur demonstrated greater variability than did Somophyllin-CRT.

Adult↗

Ubiquinones: stereochemistry and biological implications.

Proton NMR and 13C-NMR studies on the configuration of CoQn homologues show that the polyisoprenoid side-chain is in the all-trans configuration and confers a higher degree of rigidity to the quinones with respect to the acyl-chains of the phospholipids within the membrane bilayer. The quinonoid ring appears to be specifically involved in the redox function of the coenzyme while the side-chain length only affects the lipophilicity of the molecule. LIS data show that the ring strongly interacts with metals as a consequence of the high pi-electron density on the carbonyls that is somewhat larger on the carbonyl oxygen to alpha to the isoprenoid chain.

Carbon Isotopes↗