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Biomedical subjects

G Weil

Publications and source records attributed to G Weil.

At least 19 recordsLinked to original sources
PubMed1998

Quality assessment of discharge letters in a French university hospital.

The quality of discharge letters has been evaluated in order to initiate a process of improved communications between the hospital and general practitioners. From each of 37 volunteer clinical departments of the hospital, a random sample of 30 stays was selected among the hospitalisations for one year. The quality of discharge letters was assessed according to recipients' needs and to French legislation. In total, 1,024 medical records were relevant and were analysed. This study showed deficiencies in management of discharge letters in the hospital. It constitutes the first step of a quality improvement process based on the awareness of concerned actors through information feedback and the follow-up of specific indicators.

Communication↗
PubMed1998

Debriefing with brief group psychotherapy in a homogenous group of non-injured victims of a terrorist attack: a prospective study.

This study describes a follow-up of 15 non-injured women, all from the same socio-economic background, who were exposed to a terrorist attack in Israel. All of the women participated in group debriefing with brief group psychotherapy, involving six meetings during the first 2 months following the event. Two days after the attack, and 2 months and 6 months after the event, the women were administered a post-traumatic stress disorder (PTSD) diagnostic scale, the Impact of Event Scale (IES) and the SCL-90. At 6 months, four subjects (27%) were diagnosed with full PTSD. The IES showed significantly higher scores at the first measure than at the other two measures. Furthermore, the phobic anxiety subscale score immediately after the event was significantly associated with the General Severity Index of the SCL-90 and the severity of PTSD symptomatology at 6 months. The present paper discusses the effectiveness of psychological intervention following trauma, and raises questions concerning the need to invest public resources in this kind of intensive intervention. Suggestions are proposed regarding the desired emphasis of the psychological treatment in order to improve its benefits to victims.

Cost-Benefit Analysis↗
PubMed1998

The nurse scheduling problem: a combinatorial problem, solved by the combination of constraint programming and real users heuristics.

Nurse scheduling consists of assigning shifts and rest to nurses for each day, on a time schedule, taking in account legal and collective constraints, and individual wishes. The Nurse Scheduling Problem (NSP) is a highly difficult and complicated problem that has already be explored using several operational research methods. Nevertheless, those methods are not flexible enough to match the individual requests from nursing staff and they don't allow for effective management of unforeseen absences. This paper explores the use of a Constraint Programming (CP) to build Gymnaste, which is since June 1997 a available package, after five years of a slow research and development process. We describe the way the problem is modeled, the constraints typology, and the interface. In fact, the NSP is also an ill defined problem, making the man computer interface critical to let the user chose the best heuristics. Gymnaste is currently beta-tested on several pilot sites. Schedules have been generated very quickly, typically in less than a minute for 20-30 persons over 4 weeks. An evaluation process is running, which preliminary results also show some interesting sociological and organizational aspects.

Nursing Staff↗
PubMed1997

Implementation of a documentation management system for quality assurance in a university hospital.

Development and implementation of guidelines constitutes the basis of quality management systems for any organization. The authors have studied the internal documentation produced by professionals on 88 functional units of a university hospital. Reveals the existence of many documents concerning quality of care with an average of 102 available procedures or protocols per unit. However, this documentation is badly organized, making it difficult to consult and to put into practice. The results of this study were provided to other professionals at our hospital in order to make them aware of the necessity of rigorous document management. We have also written and sent recommendations for drawing up procedures and implementing an efficient documentary management system. This effort complements development of the hospital quality assurance plan.

Clinical Protocols↗
PubMed1997

[Effects of the improvement in the quality of care in a university hospital].

In charge with the development of quality assurance in a university hospital, the authors have recorded actions realised in medical departments to improve quality. A first questionnaire was sent to every physician (340) and every chief nurse (170). The 126 answers allowed to pick 467 actions out and to identify 72 professionals who were involved in quality actions. These last ones have been asked during semi-directive interviews in view to describe those actions, their results and difficulties encountered. The main actions consisted in writing procedures (197), animating working groups (84) or department reunions (54), realising studies (54) or measuring indicators (33). This study shows the professionals' dynamism who spontaneously develop actions to improve the quality of care. It also shows the limits of these actions because of a lack of specific resources and methods.

Communication↗
PubMed1994

[Evaluation of the quality of management of urinary infections in children in ambulatory care].

The objective of this study was to describe the conditions in which urinary tract infections in children are managed by ambulatory medical services and compare the results with recommendations of experts in the field. For a period of one month, we focused on the methods of urine sample collection by observing 149 urinalyses for children under 15 in 13 private medical laboratories. Secondly, we investigated cases involving 26 prescribing physicians in order to assess treatment and additional testing on 28 children whose urine cultures showed significant bacterial growth. Urine samples were collected at home by parents in 72% of the cases, often with defective procedures: improper antisepsis for pre-collection cleansing in 65% of the cases, in 51% of the cases the maximum time lapse between the moment a collection-bag was applied and the moment the filled bag was removed was overrun. Compared with standard techniques, the quality of the samples was deemed questionable in 33% of cases and unacceptable in 41%. Attending physicians diagnosed urinary infections in 22 children. The antibiotic treatment prescribed to these children was apparently insufficient in 40% of the cases. Less than a third of the infected children benefited from a radiologic examination of the urinary tract. This study demonstrates that adherence to rules inherent in managing pediatric urinary infections is less than satisfactory in ambulatory medicine. It appears necessary to improve the quality of urinalysis by inciting laboratories to collect urine samples in laboratory. Physicians should also be better informed of the results of consensus conferences.

Adolescent↗
PubMed1994

Evidence supporting the presence of Borrelia burgdorferi in Missouri.

Although Lyme disease is commonly seen in the southcentral United States, the epidemiology of the disease is poorly defined there. The purpose of this study was to document the presence of Borrelia burgdorferi in ticks collected in southeastern Missouri and around the city of St. Louis. Spirochetes were detected and identified as B. burgdorferi by immunofluorescent antibody (IFA) tests using the monoclonal antibody H5332 in 1.9% of Amblyomma americanum and 2.0% of Dermacentor variabilis ticks collected. The identity of IFA-positive organisms was verified by polymerase chain reactions (PCRs) with two different sets of B. burgdorferi-specific primers followed by Southern blotting. The DNA sequences of amplified 371-basepair PCR products from two positive Missouri ticks showed 97-98% identity with that obtained by the same method for the B31 strain of B. burgdorferi. These results confirm that B. burgdorferi is present in questing D. variabilis and A. americanum ticks in areas of Missouri where Lyme disease occurs. Additional studies are needed to determine the role of these ticks in the epidemiology of Lyme disease in Missouri and neighboring states.

Animals↗
PubMed1993

Comparison of single-dose diethylcarbamazine and ivermectin for treatment of bancroftian filariasis in Papua New Guinea.

This double-blind study compared the clinical safety and parasitologic efficacy of single-dose regimens of diethylcarbamazine (DEC) and ivermectin for treatment of bancroftian filariasis in Papua New Guinea. Five groups of 10 men each with mean levels of parasitemia ranging from 2,985 to 5,185 microfilariae (mf)/ml were given DEC (6 mg/kg of body weight one time or 1 mg/kg, then 6 mg/kg four days later) or ivermectin (220 micrograms/kg; 20 micrograms/kg, then 200 micrograms/kg four days later or 20 micrograms/kg, then 400 micrograms/kg four days later). No significant side effects (e.g., acute adenolymphangitis, fever lasting more than eight hours, hypotension) were observed in any of the five treatment groups. The magnitude of reduction in microfilaremia was greater (P < 0.01) for the three ivermectin groups versus the two DEC groups in the first 30 days after drug administration (mf levels < 1% of pretreatment values versus 22.6-41.5%, respectively). At 90 and 180 days, mf levels continued to decrease in the DEC groups whereas they increased in the ivermectin groups given a total dose of 220 micrograms/kg. Eighteen months after drug administration, individuals given DEC or 420 micrograms/kg of ivermectin had the greatest degree of reduction in microfilaremia (86-90% compared with the pretreatment values). Decreases in parasite antigenemia measured by enzyme-linked immunosorbent assay for a secreted 200-kD adult worm antigen were greatest for the single-dose DEC group (39.7% decrease relative to the pretreatment level versus 7.8-15.7% for the ivermectin groups). These results indicate that single-dose DEC and ivermectin are well-tolerated by Wuchereria bancrofti-infected individuals with high levels of microfilaremia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[The median functional slope of the tibia. Principle. Technique of measurement. Value. Interest].

The tibial slope is an important datum in knee surgery; the levelling by a uni- or bicompartmental prosthesis preserving both cruciate ligaments requires to maintain this slope. The postoperative rehabilitation of the A.C.L. plasties, especially those performed with a patellar tendon and the surgical cure of a genu recurvatum, must integrate this notion. Even if the anatomical slopes are usable in prosthetic surgery, they do not seem precise enough in the field of A.C.L. and tibia recurvatum surgery. In these indications, the authors propose to determine the functional tibial slope defined as being the complement of the angle formed by the tangent to the tibial medial plateau and the lateral mechanical axis of the leg. Measured to an average of 7 degrees on 238 knees, the average median functional slope cannot be deduced from anatomical slopes; it must be measured on a lateral teleradiographic view of the lower limb, the knee being in full extension and X-rayed in true posterior and inferior lateral view.

Adult↗
PubMed1992

Differential roles of Fc gamma RII and Fc gamma RIII in immune complex stimulation of human neutrophils.

Insoluble immune complexes (IIC) stimulate human neutrophils through Fc gamma receptors. Freshly isolated human neutrophils express two FcR subclasses, FcRII and FcRIII. We explored the role of FcRII and FcRIII in this activation process by selectively binding each FcR subclass with the Fab fragments of the respective anti-FcR monoclonal antibodies (MFab) before exposure to IIC. Correlation among liganded FcR subclass, IIC binding, and ensuant IIC stimulation was achieved with multiparameter flow cytometry. We utilized rhodamine-labeled anti-FcRIII and fluorescein-labeled IIC to study binding and observed the change in [Ca2+]i in the same cell with a Ca2+ indicator, Indo-1. Treatment with either anti-FcRII (IV.3) or anti-FcRIII (3G8) MFab decreased both the fraction of cells exhibiting a Ca2+ transient and the magnitude of that transient, although only anti-FcRIII but not anti-FcRII significantly inhibited the subsequent IIC binding. In addition, cells treated with anti-FcRII and then stimulated with IIC exhibited a decrease in both the intracellular Ca2+ transient and the later Ca2+ influx, whereas anti-FcRIII totally abolished the mobilization of intracellular Ca2+ without affecting the Ca2+ influx. Treatment with either anti-FcR MFab decreased the IIC-stimulated transmembrane potential change, oxidative burst, and elastase release. These studies indicate that freshly isolated neutrophils' Fc receptor subclasses have unique roles in the IIC-initiated stimulation and that full activation can only be achieved when both FcR subclasses are available.

Antibodies, Monoclonal↗
PubMed1991

Calcium changes in immune complex-stimulated human neutrophils. Simultaneous measurement of receptor occupancy and activation reveals full population stimulus binding but subpopulation activation.

Immune complexes (ICs) induce an initial transient increase in cytosolic intracellular calcium [( Ca2+]in) levels in human neutrophils (PMN). Changes in PMN [Ca2+]in were measured with the fluorescent calcium indicator Indo-1 ( [1-[2-amino-5-(6-carboxylindol-2-yl]-phenoxyl]-2-(2'-amino-5 '- methylphenoxy]ethane-N,N,N'N'-tetraacetic acid), at the level of individual cells by flow cytometry. Two kinds of immune complexes (ICs) were used in this study: an insoluble (IIC) and a more soluble less valent immune complex (SIC) with fewer available Fc receptor binding ends per molecule of SIC than IIC. Simultaneous binding and activation studies performed on the flow cytometer with fluoresceinated IIC or SIC demonstrated that a majority of the cells bound each stimulus uniformly. However, only an IC dose-dependent proportion of those IC-bound cells responded with an increase in [Ca2+]in. Analysis of Indo-1 fluorescence signals from neutrophils exposed to IIC, corrected for the contribution of the nonresponding population, indicated that every dose of IIC elicited a similar maximum [Ca+2]in within the responding population. In contrast, the magnitude of the increase in [Ca2+]in elicited by low doses of SIC did become dependent on dose. Cells treated with pertussis toxin and exposed to IIC exhibited a normal [Ca2+]in response both in magnitude and expression. Therefore, [Ca2+]in responses induced by immune complexes are expressed by subpopulations of PMN, in a response which is dependent on the valency of the stimulus. In addition, pertussis toxin sensitive G protein(s) appear not to have a major role in IIC-induced [Ca2+]in changes, membrane potential changes, production of superoxide anions, and elastase release.

Antigen-Antibody Complex↗
PubMed1991

[Non-aplastic N2 operated bronchial cancers. Multifactorial analysis of the prognosis].

The marked disparity of the published 5-year survival rates (0 to 3%) for non-anaplastic, operated N2 lung cancers would suggest the marked heterogeneity of the patients studied. We prospectively studies 97 N2 tumours for which "curative" resection was performed between 1983 and 1986. The overall survival rate was 28% at 3 years, 19% at 4 years and 12% at 5 years. Survival was studied on the basis of several parameters concerning the tumour: histological type and degree of differentiation, T (TNM), modality of invasion (circumscribed, infiltrating), the quality of the stroma (absent, fibrotic, cellular), the mitotic index, the necrosis rate, presence or absence of microscopic invasion of blood vessels; and concerning the nodes: site, number (solitary, multiple), size of the metastasis (massive, microscopic), macroscopic or microscopic invasion of the capsule. We know the outcome for all of our patients: 81 have died and 16 are still alive. Sixty-one have developed metastases, 5 have developed local and regional recurrences and 3 have both a recurrence and metastases. Univariate analysis demonstrated that a small number of parameters significantly influence survival: microscopic invasion of blood vessel (chi 2 = 5.24, p less than 0.02), macroscopic and microscopic invasion of the lymph node capsule. In order to more clearly define the prognostic factors, we used Cox's multidimensional model. This model was applied to the three significant parameters to which we added two other variables which non-significantly tended to be related to survival: tumour necrosis and number of lymph nodes involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1990

Simultaneous flow cytometric measurements of cytoplasmic Ca++ and membrane potential changes upon FMLP exposure as HL-60 cells mature into granulocytes: using [Ca++]in as an indicator of granulocyte maturity.

Treatment of human leukemic HL-60 cells with N,N-dimethylformamide (DMF) induces them to mature until they reach granulocytoid morphology 3-6 d later. We have reported a maturation-dependent ability of these cells to respond to phorbol myristate acetate (PMA), as evaluated by membrane depolarization and by oxidative burst product formation (Newburger et al.: J. Biol. Chem. 259,3771, 1984). More recently we have attempted to develop techniques for simultaneous evaluation of these parameters during HL-60 cell maturation. Here, we compare the cytoplasmic [Ca++] and membrane potential changes elicited by the chemotactic peptide fMLP via simultaneous measurement of individual cells in a fluorescence-activated cell sorter (FACS), as done previously for mature granulocytes (Lazzari et al.: J. Biol. Chem. 261,9710, 1986). The stimulus-induced [Ca++]in changes are detected with the fluorescent probe Indo-1 and reproducibly increase in magnitude for a subpopulation of cells as the cells mature into granulocytes. Ca++ responsiveness to formyl peptide is restricted to a subpopulation of HL-60 granulocytes which expresses receptors for chemotactic peptide and consistently increases in magnitude (in response to the same concentration of agonist) with maturation. In contrast, there is less consistency in the direction or magnitude of membrane potential changes elicited under the same circumstances from the same maturing HL-60 cells.

Calcium↗
PubMed1989

Defective control of cytoplasmic calcium concentration in T lymphocytes from old mice.

Cytoplasmic calcium concentration ([Ca]i) rises within minutes of exposure of T lymphocytes to a mitogen. T cells from old mice are defective in this reaction, a defect that could reflect either altered signal transduction or instead a more general age-associated change in intracellular calcium regulation. We therefore tested the ability of T cells from old mice to regulate their [Ca]i concentration after exposure to low concentrations of ionomycin, an agent that raises [Ca]i but bypasses receptor-mediated signal transduction mechanisms. Exposure of T cells to ionomycin leads to an abrupt increase in [Ca]i followed by stabilization at a dose-dependent plateau level that is affected by extracellular EGTA, by calmodulin inhibitors, and by modulators of protein kinase C. Plateau levels of [Ca]i after ionomycin challenge were consistently lower in T cells from old mice than in T cells from young mice. Flow cytometric experiments showed that while essentially all T cells from both old and young mice responded to ionomycin, they did so to an extent that depended on donor age. The age-dependent increase in resistance to ionomycin-induced changes in [Ca]i cannot be attributed to diminished membrane permeability to the ionomycin-calcium complex. The data suggest that aging may lead, in T lymphocytes, to a relative resistance to increases in [Ca]i, a resistance that in turn prevents cell activation.

Aging↗
PubMed1989

The rheumatoid heel: its relationship to other disorders in the rheumatoid foot.

Four-hundred and eight rheumatoid feet are studied. The percentage of talalgia is 3.7%; for inferior exostosis it is 29.6%, and 30.8% for posterior exostosis. Posterior demineralisation is present in 12%, whereas for bony erosion it is 8.1%. Plantar spurs are very closely associated to flattened feet (p less than 0.0001). Likewise a very noticeable statistical association is noted between postero-superior calcaneitis and tarsal arthritis (p less than 0.0001), and calcaneitis was more frequent among marked valgus (p less than 0.001). These results are compared with findings of other works. Therapeutic consequences are evoked.

Achilles Tendon↗
PubMed1988

[Terminal constipation caused by abdominopelvic asynchrony: analysis of etiological, clinical, manometric data and therapeutic results after rehabilitation by biofeedback].

The aim of this study was to describe the etiological, clinical, rectoanal manometric findings as well as the results of biofeedback therapy in a series of 65 patients (34 males, 31 females, aged between 5 and 77 years) presenting with severe primary constipation due to pelvic abdominal asynchronism. Pelvic abdominal asynchronism was statistically more frequent in males during childhood and in female patients during adult life (p less than 0.005). This study disclosed a high frequency of psychogenic factors in the onset of pelvic abdominal asynchronism (26 p. 100) as well as a high frequency of soiling (46.2 p. 100) in constipated patients. In 36.2 p. 100 of cases, pelvic abdominal asynchronism was the only abnormality. In contrast, in most of the patients, asynchronism was associated with miscellaneous rectoanal disorders: increased anal closure pressure (43.3 p. 100), decreased anal closure pressure (11.8 p. 100), impaired rectal conscious sensitivity (11.7 p. 100), and increased rectal compliance (31 p. 100). This study demonstrated that when high-fiber diet and laxatives fail, biofeedback therapy is a very interesting alternative, providing 80 p. 100 of good results in selected cases. However, we were unable to find any clinical or manometric parameters predictive of results of treatment. Follow-up studies are needed to determine long-term results of biofeedback training.

Adolescent↗
PubMed1987

Diminished calcium influx in lectin-stimulated T cells from old mice.

T lymphocytes from aged donors function poorly, but the biochemical basis for the defect remains uncertain. We tested the hypothesis that T cells from old mice had a diminished ability to transmit extracellular signals into the cytoplasm, by measuring intracellular free calcium concentrations (Cai) in T cells stimulated by the polyclonal activator concanavalin A (Con A). Using the second-generation fluorochrome indo-1 as a reporter of Cai, we found that the Con A-induced elevation of Cai levels is reduced both in rate and extent in old T cells, as compared to T cells from young mice. Flow cytometric analysis showed that this age-sensitive change represents a decline, with age, in the number of T cells that can respond to Con A by increasing their Cai above resting baseline levels (100-120 nM). These results thus show that defects in activation are manifested by T cells from old donors within the first 5 minutes of the activation process, and suggest that aging may lead to alterations either in the surface molecules that receive extracellular signals, or in the sequence of coupled events by which these extracellular signals bring about alterations in the intracellular ionic milieu.

Aging↗