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PubMed2002

Establishing a standardized clinical assessment tool of pathologic and prosthetic hand function: normative data, reliability, and validity.

OBJECTIVE: To develop a new assessment procedure, the Southampton Hand Assessment Procedure (SHAP), that allows contextual results of hand function to be obtained readily in a clinical environment. DESIGN: Reliability (test-retest, interrater) and validity (criterion, content) of new assessment procedure against standard medical outcome measure techniques. SETTING: Normative data collected in a university laboratory. PARTICIPANTS: Twenty-four volunteers selected on the basis of optimum hand function using these criteria: age (range, 18-25 y), and no adverse hand trauma, neurologic condition, or disabling effects of the upper limb. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The normative control group was assessed for variability, and the procedure measured in terms of interrater and test-retest reliability. The absence of a direct comparison prevents a criterion standard from being established; however, content validity was shown by expert peer review. RESULTS: The control group data were shown to be multivariate gaussian; test-retest and interrater reliability were demonstrated at the 95% confidence level. The content validity was demonstrated by peer panel approval. CONCLUSIONS: Results of the control group established the statistical integrity of SHAP. Clinical trials are underway, although more extensive use of the procedure is advocated in primary care and rehabilitation centers where physiotherapy and occupational therapy are actively used in hand rehabilitation.

Activities of Daily Living↗

PubMed2000

Altered selectivity in an Arabidopsis metal transporter.

Plants require metals for essential functions ranging from respiration to photosynthesis. These metals also contribute to the nutritional value of plants for both humans and livestock. Additionally, plants have the ability to accumulate nonessential metals such as cadmium and lead, and this ability could be harnessed to remove pollutant metals from the environment. Designing a transporter that specifically accumulates certain cations while excluding others has exciting applications in all of these areas. The Arabidopsis root membrane protein IRT1 is likely to be responsible for uptake of iron from the soil. Like other Fe(II) transporters identified to date, IRT1 transports a variety of other cations, including the essential metals zinc and manganese as well as the toxic metal cadmium. By heterologous expression in yeast, we show here that the replacement of a glutamic acid residue at position 103 in wild-type IRT1 with alanine increases the substrate specificity of the transporter by selectively eliminating its ability to transport zinc. Two other mutations, replacing the aspartic acid residues at either positions 100 or 136 with alanine, also increase IRT1 metal selectivity by eliminating transport of both iron and manganese. A number of other conserved residues in or near transmembrane domains appear to be essential for all transport function. Therefore, this study identifies at least some of the residues important for substrate selection and transport in a protein belonging to the ZIP gene family, a large transporter family found in a wide variety of organisms.

Amino Acid Sequence↗

PubMed2002

Perception of risk information. Similarities and differences between Danish and Polish general practitioners.

OBJECTIVE: The objective of the study was to gain better insight into how general practitioners (GPs) perceive risk reduction and the way this perception may be influenced by healthcare environment. DESIGN: Questionnaires with clinical episodes were sent to Danish and Polish GPs, who were randomised into four groups, each receiving the same case story with differently phrased information about risk reduction achieved through medical treatment. The GPs were asked whether they would recommend medical treatment, knowing the case story and expected risk reduction. SUBJECTS: Danish and Polish GPs. RESULTS: A greater proportion of Polish GPs than Danish GPs would definitely or probably recommend treatment (93% versus 72%; p < 0.001). Both groups of doctors were more inclined to recommend treatment when the achievable benefits were presented in terms of relative risk reduction rather than absolute risk reduction or number needed to treat. CONCLUSION: Neither information on number needed to treat nor relative risk reduction alone provides doctors with all the information they need to recommend treatment or prevention to their patients. The present study showed that the professional handling of risk information is affected by differences produced by healthcare cultures.

Adult↗

PubMed2005

Organising a surgical skills centre.

The aim of this paper is to define a strategy for the development and organisation of a surgical skills centre. The areas of interest can be divided into decisions about who, what and where to teach, the importance of an approach which is competency-based, definition of staff to run the centre, and also the use of the centre for the purposes of assessment, as well as training. The efficient delivery of this service will be augmented by adopting a multi-disciplinary and multi-professional approach, and must also be malleable enough to adopt future developments, such as web-based learning. Simulation is now the preferred mode of practice for commencement of surgical training. Surgical skills centres must be able to supply users with tools in a suitably designed environment, which enables them to move along a curriculum which is delivered in a competency-based manner.

Journal Article↗

PubMed1983

A field evaluation of noise measuring instruments.

Five sound level measuring instrument responses were compared in four plant noise situations. A sound level meter (SLM), an integrating sound level meter (LOSHA), a 25 dB crest-80 dB threshold dosimeter, a 15 dB crest-80 dB threshold dosimeter, and a 15 dB crest-90 dB threshold dosimeter were used in the study. All instruments were calibrated and maintained as recommended by the manufacturers and were tested in constant noise environments at moderate and high levels, at moderate background levels with moderate impact noise, and at low background levels with high impact noise. Experimentation was conducted in a plant environment designed to encompass various types of noise exposure actually found in industry. The results showed varying differences depending on noise levels between dosimeters with matching crest factors but with differing thresholds. The results showed no appreciable differences among instrument precision, dosimeter response at 25 versus 15 crest in impact noise areas, LOSHA meter response with dosimeter response at matching thresholds, SLM readings with 80 threshold dosimeter response, and LOSHA meter response at 80 threshold with SLM data.

Noise↗

PubMed2004

Inverse modeling using multi-block PLS to determine the environmental conditions that provide optimal cellular function.

MOTIVATIONS: Tissue engineering constitutes an important field with its potential of addressing the current shortage in organ availability. To successfully develop tissue-engineered organs, it is crucial to understand how to maintain the cells under conditions that maximize their ability to perform their physiological roles, regardless of the environment, whether the cells are part of an extracorporeal system, such as the bioartificial liver assist device, or an implantable tissue-engineered device. Our goals are to (1) provide insight into how cells will behave when confronted with changes in its environment and (2) determine the optimal environmental factors to achieve a desired level of cellular function. RESULTS: Diverse sets of environmental factors were used to systematically perturb the metabolic behavior associated with pre-conditioning and plasma supplementation. To probe metabolic state of hepatocytes, metabolic flux analysis was used to obtain the metabolic profile. We applied a multi-block partial least square (MPLS) model to relate environmental factors and fluxes to levels of intracellular lipids and urea synthesis. The MPLS model identified: (1) the most influential environmental factors and (2) how the metabolic pathways are altered by these factors. Finally, we inverted the MPLS model to determine the concentrations and types of environmental factors required to obtain the most economical solution for achieving optimal levels of cellular function for practical situations.

Amino Acids↗

PubMed2002

Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger.

OBJECTIVE: The 1998 evaluation sought to assess the Quality Assurance Project (QAP) in Niger since 1993 and the degree of quality assurance institutionalization in the Tahoua Department, and to summarize lessons from introducing the Integrated Management of Childhood Illness (IMCI) guidelines in a quality management (QM) environment. DESIGN: This evaluation collected data from interviews with staff and managers, from focus groups conducted in the communities, and from medical records. The data were then compared with three sources of evaluation criteria. A pre-project assessment provided a baseline across certain impact indicators for tracking progress. Other measures were derived from the objectives and indicators from the QAP/Tahoua project plan, the joint QAP/BASICS (Basic Support for Institutionalizing Child Survival Project) project plan, and from an additional US Agency for International Development (USAID) objective that the joint project be a model for West Africa. SETTING: The evaluation took place in the two departments of Niger in which the joint project was carried out: Tahoua and Dosso. The QA Project launched a pilot program in Niger in 1993 to strengthen newly decentralized regional and district management, and to improve the quality of primary health care in Tahoua. The principal QA Project approach was QM. The BASICS Project became active in Niger in 1995, helping to improve child health services. In 1997, the projects merged in Niger to form the joint QAP/BASICS Project. The Ministry of Public Health (MPH) planned to implement IMCI in 1998, and wished to determine whether QM facilitated the introduction of IMCI. RESULTS: The evaluation team found that QM had been effectively implemented in Tahoua and that there were related improvements in health program indicators. The team also found that the joint project had met most of its objectives and that QM facilitated the introduction of IMCI. A follow-up evaluation 2 years later found continued practice of QM by Nigerien health care providers. CONCLUSION: Several factors contributed to the success of the Tahoua QA program and the joint project: teamwork, focus on patients, clarity of roles through standards, and synergy between the QA Project and the BASICS Project.

Child Health Services↗

PubMed1986

PROPHET, a national computing resource for life science research.

PROPHET is a national computing resource tailored to meet the data management and analysis needs of life scientists working in a wide variety of disciplines, ranging from pharmacology to molecular biology. The PROPHET system offers a fully integrated graphics-oriented environment designed to aid research scientists in the manipulation and analysis of scientific spreadsheets of data, graphs, molecular structures, biological simulation models, and protein and nucleic acid sequences, and it includes access to a range of molecular structure and sequence databases. This paper briefly describes the PROPHET system, some of its current capabilities, and plans for a new fully distributed version of the system now under development.

Amino Acid Sequence↗

PubMed1988

PROPHET--a national computing resource for life science research.

Computer Communication Networks↗

PubMed1999

Validation of the premature infant pain profile in the clinical setting.

OBJECTIVE: The Premature Infant Pain Profile (PIPP) is a 7-indicator composite measure developed to assess acute pain in preterm and term neonates. It has been validated in studies using synchronized videotaping of infants undergoing procedures. The purpose of this study was to establish (a) construct validity of the PIPP and (b) inter- and intrarater reliability of the PIPP prospectively in the clinical environment. DESIGN: A randomized, crossover design was used. SETTING: The study was conducted in a Level III outborn neonatal intensive care unit. PARTICIPANTS: A convenience sample of 43 neonates, stratified by gestational age, was studied. INTERVENTIONS: Each infant experienced three separate, randomly ordered events: baseline, a painful event, and a nonpain event. Infants were videotaped and scored at the bedside using the PIPP by the nurse caring for the infant and the clinical nurse specialist who bad expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique. RESULTS: Repeated-measures analysis of the main effects and interactions yielded a statistically significant main effect for event (pain, nonpain, baseline), thus differentiating pain from nonpain and baseline events (F = 48, p = 0.0001) and establishing construct validity. Interrater reliability analysis of individual event scores of the PIPP yielded reliability coefficients of 0.93-0.96. Intrarater reliability coefficients analysis for individual events were equally high at 0.94-0.98. CONCLUSIONS: This study demonstrates that the PIPP is a pain measure with good construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical settings.

Cross-Over Studies↗

PubMed1999

The financial environment of aesthetic surgery: results of a survey of plastic surgeons.

To gather information about aesthetic surgery's current practice structures, competitive environment, patient price sensitivity, and marketing and practice development requirements, a two-page survey was developed and mailed to all 1180 members of the American Society for Aesthetic Plastic Surgery. A total of 632 surveys were returned (response rate of 54.5 percent). Most aesthetic plastic surgeons said they were in solo practice (63.3 percent). More than two-thirds described the marketplace as "very competitive," with 59 percent reporting 25 or more surgeons offering aesthetic surgery in their area. They estimated their patients' average income at $62,800. Nearly all plastic surgeons labeled their patients as "moderately price sensitive" (62.3 percent) or "very price sensitive" (30.6 percent). Similarly, 23.2 percent estimated that they had lost 20 or more patients within the last year for reasons of price. Practice development and marketing efforts represented an average of 7.3 percent of plastic surgeons' working time. Parameters associated with a high percentage of time devoted to these activities were solo practice, percentage of revenue from aesthetic surgery greater than 50 percent, a practice environment designation of moderately or very competitive, and ten or more area surgeons offering aesthetic surgery (p < 0.05). High patient income led to only slight decreases in price sensitivity and did not significantly reduce the amount of time spent on marketing and practice development. Although the rest of the healthcare industry has undergone a period of consolidation, aesthetic surgeons have been able to resist these changes. The results of this survey suggest that the fragmented nature of the aesthetic surgery industry is associated with additional burdens on plastic surgeons. As the aesthetic surgery market becomes more competitive, plastic surgeons may benefit from consolidation to reduce costs and maximize efficiency.

Fees and Charges↗

PubMed2001

Can HIV-1-contaminated syringes be disinfected? Implications for transmission among injection drug users.

Bleaching of syringes has been advocated to prevent HIV-1 transmission among injection drug users (IDUs). Bleach is frequently distributed by needle exchange, outreach, and educational programs targeting IDUs. We applied a sensitive HIV-1 microculture assay to determine the effectiveness of bleach in disinfecting syringes contaminated with HIV-1. This study demonstrates that in a laboratory environment designed to replicate injection behaviors, undiluted bleach is highly effective in reducing the viability of HIV-1 even after minimal contact time. However, it did not reduce the HIV-1 recovery to zero. Furthermore, three washes with water were nearly as effective as a single rinse with undiluted bleach in reducing the likelihood that contaminated syringes harbored viable HIV-1. Given the reality that IDUs share syringes and may not have access to a new, sterile syringe for each injection, the results suggest that they should be encouraged through harm reduction interventions to clean their syringes, preferably with undiluted bleach.

Disinfectants↗

PubMed2000

Risk-taking restraints in a bird with reduced egg-hatching success.

Risk taking, as is any other phenotypic and/or behavioural trait, is determined by proximate constraints related to time or resource availability and by evolutionary adaptive restraints related to the differences in the costs of risk taking and its benefits in terms of fitness. Because risk taking is influenced by many confounding variables related to experimental design, environment, parents and offspring, few field studies have been reported which unambiguously separate the effects of restraints from those of constraints. We compared parental risk taking in blue tits (Parus caeruleus) during brood defence towards a nest predator in broods with experimentally reduced and natural egg-hatching success leaving the original number of eggs in the nest. The experimentally reduced broods had more time or resources available and lower risk-taking benefits compared to the control broods. 'Constraint' would predict more risk taking in broods having experimentally reduced egg-hatching success, whereas 'restraint' would predict the opposite effect with more risk taking in broods with natural egg-hatching success. We report, to our knowledge, the first field study experimentally demonstrating a brood defence restraint in response to reduced egg-hatching success. This demonstration was only possible after controlling for more than 20 potential confounding variables showing once more how complicated it is to separate proximate from evolutionary levels of analyses in natural populations.

Adaptation, Physiological↗

PubMed2005

A randomised controlled trial of microwave endometrial ablation without endometrial preparation in the outpatient setting: patient acceptability, treatment outcome and costs.

OBJECTIVE: To compare outpatient microwave endometrial ablation (MEA) in the postmenstrual phase to standard MEA treatment after drug preparation in a day case theatre environment. DESIGN: A randomised controlled trial. SETTING: A large United Kingdom teaching hospital. POPULATION: Two hundred and ten women complaining of excessive menstrual loss. METHODS: Two hundred and ten women with excessive menstrual loss were randomised. Ninety-seven women were treated as outpatients in the immediate post-menstrual phase and 100 were treated in an operating theatre after hormonal preparation. All procedures were commenced under local anaesthesia with or without conscious sedation. Analysis was by modified intention to treat. MAIN OUTCOME MEASURES: Primary outcome measures were satisfaction with treatment (measured at one year) and acceptability of treatment (measured at two weeks). Secondary outcome measures were menstrual outcome and financial cost. RESULTS: Significantly more women found treatment post-menses acceptable; 86 (89.5%) versus 76 (76.0%) [difference in proportions 13.6%, 95% CI (3.0%, 23.9%)]. Similar numbers in each arm were totally or generally satisfied with the treatment, 86 (92.5%) versus 84 (88.4%) [difference in proportions 4.1%, 95% CI (-4.7%, 12.9%)] while amenorrhoea rates at one year were comparable, 52 (55.9%) versus 60 (61.9%). [difference in proportions -5.9%, 95% CI (-19.8%, 7.6%)]. The mean health service costs were 124 pounds (95% CI 86-194 pounds) lower for the patients in the post-menses group. CONCLUSION: MEA performed under local anaesthesia (with or without conscious sedation) in the post-menstrual phase achieves high levels of satisfaction is very acceptable to patients and results in significantly reduced health service costs. Importantly menstrual outcomes are not affected by omission of drug preparation. There is now good evidence to support the use of MEA, without drug endometrial preparation, in the outpatient setting.

Adult↗

PubMed2000

Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital.

BACKGROUND: Older persons frequently experience a decline in function following an acute medical illness and hospitalization. OBJECTIVE: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients. DESIGN: Randomized controlled trial. SETTING: Community teaching hospital. PATIENTS: A total of 1,531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997. INTERVENTION: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness. MEASUREMENTS: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction. RESULTS: Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P = .027) and during the year following hospitalization (P = .022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently (42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; P = .001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P < .05). CONCLUSIONS: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.

Activities of Daily Living↗

PubMed2005

A comparative study of the use of four fall risk assessment tools on acute medical wards.

OBJECTIVES: To compare the effectiveness of four falls risk assessment tools (STRATIFY, Downton, Tullamore, and Tinetti) by using them simultaneously in the same environment. DESIGN: Prospective, open, observational study. SETTING: Two acute medical wards admitting predominantly older patients. PARTICIPANTS: One hundred thirty-five patients, 86 female, mean age+/-standard deviation 83.8+/-8.01 (range 56-100). MEASUREMENTS: A single clinician prospectively completed the four falls risk assessment tools. The extent of completion and time to complete each tool was recorded. Patients were followed until discharge, noting the occurrence of falls. The sensitivity, specificity, negative predictive accuracy, positive predictive accuracy, and total predictive accuracy were calculated. RESULTS: The number of patients that the STRATIFY correctly identified (n=90) was significantly higher than the Downton (n=46; P<.001), Tullamore (n=66; P=.005), or Tinetti (n=52; P<.001) tools, but the STRATIFY had the poorest sensitivity (68.2%). The STRATIFY was also the only tool that could be fully completed in all patients (n=135), compared with the Downton (n=130; P=.06), Tullamore (n=130; P=.06), and Tinetti (n=17; P<.001). The time required to complete the STRATIFY tool (average 3.85 minutes) was significantly less than for the Downton (6.34 minutes; P<.001), Tinetti (7.4 minutes; P<.001), and Tullamore (6.25 minutes; P<.001). The Kaplan-Meier test showed that the STRATIFY (log rank P=.001) and Tullamore tools (log rank P<.001) were effective at predicting falls over the first week of admission. The Downton (log rank P=.46) and Tinetti tools (log rank P=.41) did not demonstrate this characteristic. CONCLUSION: Significant differences were identified in the performance and complexity between the four risk assessment tools studied. The STRATIFY tool was the shortest and easiest to complete and had the highest predictive value but the lowest sensitivity.

Accidental Falls↗

PubMed2000

Quiet pride: the experience of chronic illness by rural older adults.

PURPOSES: To explore how chronic illness is experienced and managed by rural Hispanic and non-Hispanic older adults and their families, and to identify how the health care system and community facilitate or inhibit the ability to manage chronic illness in a changing health care environment. DESIGN: Descriptive ethnography with purposive sampling. METHODS: Data-generation methods included audiotaped interviews from 42 Hispanic and White, non-Hispanic participants, participant observations, examination of documents and artifacts, and photography in rural Colorado. Interpretive ethnographic methods were used to identify an overarching cultural theme. FINDINGS: Living with chronic illness was a proactive, reciprocal learning process shaped by interrelationships in the context of multiple, diverse communities. Participants expressed living with chronic illness as a quiet pride on the journey toward living a meaningful life. CONCLUSIONS: Findings provide an understanding of the webs of relationships that constitute the experience of elders living with chronic illness in rural communities. Viewing life as meaningful in the context of a broader understanding of health and well-being is important for nursing practice and future models of care.

Aged↗

PubMed2003

Experiences of pioneer nurse practitioners in establishing advanced practice roles.

PURPOSE: To describe pioneers' experience of establishing the nurse practitioner (NP) role, and their experiences in maintaining and building the NP role in the contemporary practice environment. DESIGN: The study sample included 50 middle-aged women currently practicing in Washington State as licensed advanced practice nurses, who began the NP role during 1965-1979. METHODS: This descriptive study included interviews and focus groups to gather data about the nurses' early experiences. Interpretative methods of grounded theory were used in data collection and analysis. FINDINGS: The central organizing theme, Advancing Autonomy to Make a Difference, was manifested through six broad themes: Breaking Free, Molding the Clay, Encountering Obstacles, Surviving the Proving Ground, Staying Committed, and Building the Eldership. CONCLUSIONS: Autonomy was requisite to practice to one's full potential and maintain commitment over time. The data findings show the evolution of advanced nursing practice in the United States and provide guidance for nurses who are working to establish advanced practice nursing in other countries.

Adaptation, Psychological↗