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Biomedical subjects

J March

Publications and source records attributed to J March.

23 records · Page 2Linked to original sources
PubMed1974

Absence of REM rebound after barbiturate withdrawal.

Administration of three different barbiturates reduced rapid eye movement (REM) sleep. Drug withdrawal led to a return to baseline REM] values without significant overshoot. Similar results are observed with administration of benzodiazepines in pharmacologically equivalent dosages; therefore, a distinction between these two drug classes on the basis of withdrawal effects on the sleep electroencephalogram appears unwarranted. Further investigation is required determine why high REM levels are sometimes associated with the withdrawal of sedative-hypnotic agents.

Amobarbital↗
PubMedDate not supplied

[Problems and proposals for improvement in the health care of economic immigrants].

OBJECTIVES: To analyse existing problems in health care to economic immigrants from the point of view of health and social professionals, health authorities and economic immigrants and to know which will be their proposals and priorities to improve economic immigrants's health assistance. METHODS: Qualitative approach study made in Majorca island. (Spain). Three focus groups and three nominal groups with health and social workers from primary health care and hospital services were carried out as well as two partially structured interviews to health authorities, one Autonomic Authority and one Governmental Authority, and twelve partially structured interviews to economic immigrants identified trough key informants. RESULTS: Health and social workers perceive the increase in the number of economic immigrants as a massive arrival. The main problems identified are: access restrictions to public health services for economic immigrants, the follow-up of these patients and diagnostic difficulties because lack of training in tropical medicine. Health and social workers's first proposal for improving this situation is their own training in tropical medicine. Autonomic Authority priorities are to guarantee access to public health services for all immigrants and to look actively for health problems in these population. Governmental Authority, instead, holds the legalization for all. In fact, economic immigrants are not concerned on health care because legalization and housing problems. CONCLUSIONS: The main barriers identified by health and social workers in health care to economic immigrants are: access restrictions, follow-up and lack of training in tropical medicine. Health and social first proposal to improve this situation is their own training in tropical medicine while Autonomic and Central Authorities's priorities are not the same. For economic immigrants, health assistance is not their biggest concern.

Delivery of Health Care↗
PubMedDate not supplied

[Application of artificial neural networks for risk stratification of hospital mortality].

OBJECTIVE: To compare the ability of an artificial neural network (ANN) to predict hospital mortality with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) system and multiple logistic regression (LR). A secondary objective was to compare the allocation of individual probability among the models. METHOD: The variables required for calculating the APACHE II were prospectively collected. A total of 1146 patients were divided (randomly 70% and 30%) into the Development (800) and the Validation (346) sets. With the same variables an LR model and an ANN were carried out (a 3-layer perceptron trained by algorithm backpropagation with bootstrap resampling and with 9 nodes in the hidden layer) in the Development set. The models developed were contrasted with the Validation set and their discrimination properties were evaluated using the area under the ROC curve (AUC [95% CI]) and calibration with the Hosmer-Lemeshow C (HLC) test. Differences between the probabilities were evaluated using the Bland-Altman test. RESULTS: The Validation set showed an APACHE II with an AUC = 0.79 (0.75-0.84) and HLC = 11 (p = 0.329); LR model AUC = 0.81 (0.76-0.85) and HLC = 29 (p = 0.0001) and an ANN AUC = 0.82 (0.77-0.86) and HLC = 10 (p = 0.404). The patients with the most important differences in the allocation of probability between LR and ANN (8% of the total) were neurological. The worst results were found in trauma patients with an AUC of not greater than 0.75 in all the models. In respiratory patients, the ANN achieved the best AUC = 0.87 (0.78-0.91). CONCLUSIONS: The ANN was able to stratify hospital mortality risk by using the APACHE II system variables. The ANN tended to achieve better results than LR, since, in order to work, it does not require lineal restrictions or independent variables. Allocation of individual probability differed in each model.

Female↗