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At least 235 records · Page 13Linked to original sources

PubMed2004

[Development of guidelines for rehabilitation of patients with stroke: analysis of therapeutic procedures].

The Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte) in Berlin took the initiative to develop evidence-based guidelines for rehabilitation including stroke rehabilitation. In the present study we performed a systematic survey of the scientific literature on stroke rehabilitation and deduced 8 evidence-based therapeutic modules. They were supplemented by 5 practice-based modules to cover the full range of interventions currently applied in stroke rehabilitation. Modules are clusters of various interventions which were aggregated according to the rehabilitative goal they have in common. Data were analysed from 8,876 BfA patients, the total population of "neuro"-patients in 2001 and 2002 with 142,951 interventions and 1,071,885 appointments. Stroke diagnoses covered ICD-10 codes I60, I61, I62, I63, I64 or were coded by G45, G81 and one of these I-codes. Stroke rehabilitation as provided in daily practice was found to be a complex multimodal treatment programme in all hospitals which were studied. On average, patients receive treatments from 7.3 therapeutic modules. A dominating role is played by "motor modules". Obviously, they play a major role in acute stroke rehabilitation in all hospitals compared to cognitive retraining, language therapy and especially improvement of psychic functions, which were significantly less applied. A dramatic variation could be shown to exist between the rehabilitation hospitals (1) with respect to the number of patients who were treated with a given module (e. g., some modules showed variations between 18 % and 100 %), and (2) with respect to treatment intensity and treatment duration per week. Several factors can be taken into account for interpretation of this high variance. Intrinsically, the high variation in symptomatology after stroke can play a major role, as both the deficit profile and the level of severity of a given deficit and the combined severity level can vary from patient to patient. On the other hand, extrinsic factors such as lack of staff may also account for some of the differences. In any case, the results show the necessity to optimize stroke rehabilitation by development and implementation of guidelines. Yet, they also point to a need for further research into rehabilitation interventions and procedures to yield evidence for the approximately 30 % of "only" practice-based interventions.

Adult↗

PubMed2006

The anatomy of the stigma and style from Cyclamen persicum (Mill.) cv. "pure white" and its relation to pollination success.

Old flowers of Cyclamen generate few or no seeds. To understand the pollination problems of Cyclamen we investigate the general anatomy of the stigma and the style of Cyclamen persicum by scanning electron microscopy at different stages of floral maturity. Our investigations confirm that there is a hollow style. Against data commonly found in the literature, we present evidence of pollen germination and tube growth that show the stigma is not outside the style but inside it. Furthermore the maturation process of the style during the flowering time indicates a mechanism by which the stigma becomes shut off through closure at the terminal aperture of the style. At 3 to 5 days after anthesis there was the beginning closure of the style which was nearly completed at 21 days. The substance which leads to the closure is still unknown. The closure of the hollow style is a probable cause for failure of seed set in flowers not pollinated early in anthesis.

Cyclamen↗

PubMed1998

[Schizophrenia and violence: epidemiological, forensic and clinical aspects].

Recent studies confirm a significantly (several times, in fact) increased risk for schizophrenics to commit severely violent acts compared to the general population. Violent acts of minor degree and threats not followed by forensic detention are even much more common. Data on prevalence depend on study conditions, sample selection, and outcome definitions of violence. In psychiatric hospitals, too, violent and threatening behaviour seems to occur most frequently in schizophrenic patients. However, in this respect findings are inconsistent and display considerable variations across different countries and times (with increasing rates reported within the last decade). Additional risk indicators beside the diagnosis of schizophrenia are male gender, comorbidity with personality disorders, substance abuse, lack of adequate treatment and increasing social disintegration due to an unfavourable course of the illness. The violence risk does not seem to decrease with increasing age in contrast to the general population. Beyond these sociodemographic data and variables related to treatment and course of illness, psychopathological causes of violence are less evident. Even imperative hallucinations are not clearly associated with violence: systematic delusions are associated with severe violent acts, but not with the much more frequent violent acts of minor degree. Most probably, the total of psychopathological symptomatology is associated with the proneness to aggressive behaviour. Neuropsychological and biological findings are also inconsistent.

Forensic Psychiatry↗

PubMed1994

Degenerative joint disease. Part II: Symptoms and examination findings.

From a pool of 1,279 consecutive patients referred to the Parker E. Mahan Facial Pain Center for complaints of head/neck pain, a subset of 215 patients with the diagnosis of osteoarthrosis of the temporomandibular joint (TMJ-DJD) have been identified. Data regarding patient age and sex, reported symptoms and examination results are presented from this subset of TMJ-DJD patients. From this data, common signs and symptoms of TMJ-DJD are proposed.

Adolescent↗

PubMed2003

HIV-testing and newly-diagnosed malignant lymphomas. The SAKK 96/90 registration study.

The association of Non-Hodgkin Lymphoma (NHL) and HIV-infection was soon recognized and the Center of Disease Control (CDC) has classified some types of NHL as AIDS-defining illnesses (ADI). Hodgkin's disease (HD) represents the most common type of non ADI malignancy in HIV-infected cases. Commonly, data on malignant lymphoma in this population is collected in known HIV-positive patients or in autopsy-series. This registration study was designed to estimate the incidence of HIV-positivity in patients with newly diagnosed malignant lymphoma. A registration of all patients with newly diagnosed malignant lymphoma and their HIV-status was performed in every center of the Swiss Group for Clinical Cancer research (SAKK) from January 1, 1991 to July 31, 1993. Among 474 eligible patients, HIV-status was evaluated in 400 and 52 were tested positive (13%), 42 (81%) of them males. Three of them were newly detected cases (after lymphoma-diagnosis). Three hundred and forty patients (72%) presented with NHL, 42 (12.4%) of them HIV-positive; 33 out of these had aggressive lymphoma. B-symptoms were significantly more frequent in HIV-positive patients. In the 134 patients with HD, 10 (7.5%) tested HIV-positive, mostly presenting with stage IV disease (7), B-symptoms (9) and extranodal disease (7). In conclusion, 13% out of 400 evaluated patients with newly diagnosed malignant lymphoma tested HIV-positive. The study confirms the predominance of aggressive lymphoma histologies and frequent presentation with B-symptoms in HIV-positive patients with NHL. Male gender, young age (26-35 years) and B-symptoms are prognostic factors for HIV-positivity in NHL.

Adolescent↗

PubMed1983

Dosimetry with tissue-equivalent ionisation chambers in fast neutron fields for biomedical applications.

The use of calibrated tissue-equivalent (TE) ionisation chambers is commonly considered to be the most practical method for total absorbed dose determinations in mixed neutron-photon fields for biomedical applications. The total absorbed dose can be derived from the charge produced within the cavity of an ionisation chamber employing a number of physical parameters. To arrive at the charge produced in the cavity several correction factors have to be introduced which are related to the operational characteristics of the chambers. Information on the operational characteristics of four TE ionisation chambers is presented in relation to ion collection, density and composition of gas in the cavity, wall thickness and effective point of measurement. In addition, some recent results from an ionisation chamber operated at high gas pressures (up to 8 MPa(80 bar)) are presented. The total absorbed doses derived from TE ionisation chambers show agreement within the uncertainty limits with results from other independent dosimetry methods, i.e., differential fluence measurements and a TE calorimeter. Conscientious experimentation and a common data base can provide dosimetry results with TE ionisation chambers with variations of less than +/- 2%.

Calibration↗

PubMed2006

Assessing the reliability of standardized performance indicators.

OBJECTIVE: . To investigate the reliability of self-reported standardized performance indicators introduced by the Joint Commission on Accreditation of Healthcare Organizations in July 2002 and implemented in approximately 3400 accredited US hospitals. The study sought to identify the most common data quality problems and determine causes and possible strategies for resolution. DESIGN: Data were independently reabstracted from a random sample of 30 hospitals. Reabstracted data were compared with data originally abstracted, and discrepancies were adjudicated with hospital staff. Structured interviews were used to probe possible reasons for abstraction discrepancies. RESULTS: The mean data element agreement rate for the 61 data elements evaluated was 91.9%, and the mean kappa statistic for binary data elements was 0.68. The rate of agreement for individual data elements ranged from 100 to 62.4%. The mean difference between calculated indicator rates was 4.88% (absolute value) and the range of differences was 0.0-13.3%. Symmetry of disagreement among original abstractors and reabstractors identified eight indicators whose differences in calculated rates were statistically unlikely to have occurred through random chance (P < 0.05). CONCLUSION: Although improvement in the accuracy and completeness of the self-reported data is possible and desirable, the baseline level of data reliability appears to be acceptable for indicators used to assess and improve hospital performance on selected clinical topics.

Hospitals↗

PubMed1997

IMGT, the international ImMunoGeneTics database.

IMGT, the international ImMunoGeneTics database, is an integrated database specializing in immunoglobulins, T-cell receptors (TcR) and major histocompatibility complex (MHC) of all vertebrate species, initiated and co-ordinated by Marie-Paule Lefranc, CNRS, Montpellier II University, Montpellier, France (lefranc@ligm.crbm.cnrs-mop.fr). IMGT includes two databases: LIGM-DB (for immunoglobulins and TcR) and MHC/HLA-DB. IMGT comprises expertly annotated sequences and alignment tables. LIGM-DB contains more than 19 000 immunoglobulin and TcR sequences from 78 species. MHC/HLA-DB contains class I and class II human leukocyte antigen alignment tables. An IMGT tool, DNAPLOT, developed for immunoglobulins, TcR and MHC sequence alignments, is also available. IMGT works in close collaboration with the EMBL database. IMGT goals are to establish a common data access to all immunogenetics data, including sequences, oligonucleotide primers, gene maps and other genetic data of immunoglobulins, TcR and MHC molecules, and to provide a graphical user-friendly data access. IMGT will have important implications in medical research (repertoire in autoimmune diseases, AIDS, leukemias, lymphomas), therapeutical approaches (antibody engineering), genome diversity and genome evolution studies. IMGT can be accessed at http://imgt.cnusc.fr:8104 and http://www.ebi.ac.uk/IMGT

Amino Acid Sequence↗

PubMed1998

IMGT, the International ImMunoGeneTics database.

IMGT, the international ImMunoGeneTics database, is an integrated database specialising in Immunoglobulins (Ig), T cell Receptors (TcR) and Major Histocompatibility Complex (MHC) of all vertebrate species, created by Marie-Paule Lefranc, CNRS, Montpellier II University, Montpellier, France (lefranc@ligm.crbm.cnrs-mop.fr). IMGT includes three databases: LIGM-DB (for Ig and TcR), MHC/HLA-DB and PRIMER-DB (the last two in development). IMGT comprises expertly annotated sequences and alignment tables. LIGM-DB contains more than 23 000 Immunoglobulin and T cell Receptor sequences from 78 species. MHC/HLA-DB contains Class I and Class II Human Leucocyte Antigen alignment tables. An IMGT tool, DNAPLOT, developed for Ig, TcR and MHC sequence alignments, is also available. IMGT works in close collaboration with the EMBL database. IMGT goals are to establish a common data access to all immunogenetics data, including nucleotide and protein sequences, oligonucleotide primers, gene maps and other genetic data of Ig, TcR and MHC molecules, and to provide a graphical user friendly data access. IMGT has important implications in medical research (repertoire in autoimmune diseases, AIDS, leukemias, lymphomas), therapeutical approaches (antibody engineering), genome diversity and genome evolution studies. IMGT is freely available at http://imgt.cnusc.fr:8104

Amino Acid Sequence↗

PubMed2001

The distribution of BOLD susceptibility effects in the brain is non-Gaussian.

A key assumption underlying fMRI analysis in the general linear model is that the underlying distribution of BOLD Susceptibility is gaussian. Analysis of several common data sets and experimental paradigms shows that the underlying distribution for the BOLD signal is non-Gaussian. Further identification shows that the distribution is probably Gamma and implications for hemodynamic modeling are discussed as well as recommendations concerning inferential testing in heavy-tailed environments.

Brain↗

PubMed2000

Automated computerized intensive care unit severity of illness measure in the Department of Veterans Affairs: preliminary results. SISVistA Investigators. Scrutiny of ICU Severity Veterans Health Sysyems Technology Architecture.

OBJECTIVE: To evaluate the feasibility of an automated intensive care unit (ICU) risk adjustment tool (acronym: SISVistA) developed by selecting a subset of predictor variables from the Acute Physiology and Chronic Health Evaluation (APACHE) III available in the existing computerized database of the Department of Veterans Affairs (VA) healthcare system and modifying the APACHE diagnostic and comorbidity approach. DESIGN: Retrospective cohort study. SETTING: Six ICUs in three Ohio Veterans Affairs hospitals. PATIENT SELECTION: The first ICU admission of all patients from February 1996 through July 1997. OUTCOME MEASURE: Mortality at hospital discharge. METHODS: The predictor variables, including age, comorbidity, diagnosis, admission source (direct or transfer), and laboratory results (from the +/- 24-hr period surrounding admission), were extracted from computerized VA databases, and APACHE III weights were applied using customized software. The weights of all laboratory variables were added and treated as a single variable in the model. A logistic regression model was fitted to predict the outcome and the model was validated using a boot-strapping technique (1,000 repetitions). MAIN RESULTS: The analysis included all 4,651 eligible cases (442 deaths). The cohort was predominantly male (97.5%) and elderly (63.6 +/- 12.0 yrs). In multivariate analysis, significant predictors of hospital mortality included age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.04-1.09), comorbidity (OR, 1.11; 95% CI, 1.08-1.15), total laboratory score (OR, 1.07; 95% CI, 1.06-1.08), direct ICU admission (OR, 0.39; 95% CI, 0.31-0.49), and several broad ICU diagnostic categories. The SISVistA model had excellent discrimination and calibration (C statistic = 0.86, goodness-of-fit statistics; p > .20). The area under the receiver operating characteristic curve of the validated model was 0.86. CONCLUSIONS: Using common data elements often found in hospital computer systems, SISVistA predicts hospital mortality among patients in Ohio VA ICUs. This preliminary study supports the development of an automated ICU risk prediction system on a more diverse population.

APACHE↗

PubMedDate not supplied

Managing hospital length of stay reduction: a multihospital approach.

Major financial constraints on health care payors are increasing pressure on hospitals to become more efficient. This study described the use of common data formats and specific interventions with physicians and nursing homes to reduce inpatient lengths of stay by four hospitals in Syracuse, New York. These initiatives saved over 28,000 patient days and an average daily census of 96.0 over a 3.5-year period.

Efficiency, Organizational↗

PubMed1994

Deliberations on the dissemination of PORT products: translating research findings into improved patient outcomes.

This report outlines the activities undertaken by the Inter-PORT Dissemination work group during its first 2 years of operation. The work group's initial purpose was to assist the individual PORTs in developing their plans for both disseminating research findings and evaluating the effectiveness of these strategies. However, it became quickly apparent that in a discipline little more than a decade old, a commonly understood vocabulary had yet to be adopted. Even the term "dissemination" held different meaning for different constituencies. Consequently, the work group has tried to encourage the development of both a definitional framework and a set of common data elements of importance to all dissemination programs. The work group has analogously attempted to agree on minimum standards of methodologic rigor as a starting point for coordination of evaluations across PORTs. To help determine the potential for further coordination, a matrix of each individual PORT's target audiences, intervention strategies, and evaluation designs has been constructed. Much remains to be learned before we can know with any certainty how best to translate research findings into useful behavior change and improved patient outcomes. Our goal is that the efforts of the work group will serve to catalyze this process.

Health Services Research↗

PubMed1987

Reporting the visual acuity of groups: the relation among alternate measures.

There are often large disparities in the way in which visual acuities are reported for groups. A survey of 156 reports published within the last 5 years shows that some researchers report binocular acuity, others best eye, monocular, or mean monocular acuities. Some of these measures may be confounded further with accommodation distance. To ascertain the relation among the various measures of acuity reported commonly, data were obtained from 702 observers. The results indicate that there is a high degree of concordance among the various measures used to report the visual acuity of groups, with many of the correlations in the 0.9 range. It is further shown that a composite measure, based upon mean binocular or best eye acuity, may be a useful means of conveying group differences in visual resolution.

Adolescent↗

PubMed1999

Spinous process osteotomies to facilitate lumbar decompressive surgery.

STUDY DESIGN: A technique for lumbar decompression using spinous process osteotomies is described, and the outcomes are studied prospectively. OBJECTIVE: To describe a technique that affords a wide exposure for decompression while minimizing damage to surrounding tissues, and to analyze the outcomes formally using the technique. SUMMARY OF BACKGROUND DATA: Commonly used techniques of lumbar decompression, which include bilateral takedown of paraspinal musculature and aggressive bony resection, can result in significant iatrogenic sequelae, whereas minimally invasive techniques often provide inadequate visualization and/or decompression. METHOD: Unilateral limited takedown of the multifidus is undertaken, followed by spinous process osteotomies at the involved levels. The spinous processes with the attached interspinous/supraspinous ligaments are then retracted. A complete "trumpeted" decompression is then undertaken. Fifty consecutive patients undergoing the procedure were analyzed prospectively and at follow-up by an independent observer using a validated functional outcome measure, a visual analog pain scale, and a patient satisfaction score. RESULTS: Functional outcome scores improved on average by 47%, pain levels were reduced by 66%, and high satisfaction rates were reported by 83% of patients. CONCLUSIONS: The technique affords excellent visualization and a wide area available for Kerrison use and angulation while minimizing destruction to tissues not directly involved in the pathologic process, including the paraspinal musculature as well as the interspinous/supraspinous ligament complex and facets. Additionally, it minimizes dead space and improves the cosmetic result.

Aged↗

PubMed1999

Microdecompression for lumbar spinal canal stenosis.

STUDY DESIGN: A description of the technique for lumbar microdecompression and a prospective study of the outcomes. OBJECTIVE: To describe and analyze a technique that affords an excellent decompression while minimizing damage to surrounding tissues. SUMMARY OF BACKGROUND DATA: Commonly used techniques of lumbar decompression that include bilateral takedown of paraspinal musculature and aggressive bony resection can result in significant iatrogenic sequelae. A less destructive alternative is needed. METHODS: Unilateral limited takedown of multifidus was undertaken, and ipsilateral decompression performed. The contralateral side then was addressed under the midline structures with microscopic visualization--thereby preserving the supra-/interspinous ligament complex and the contralateral musculature. Thirty consecutive patients undergoing the procedure were analyzed prospectively and after a follow-up period by independent observers using a modified validated functional outcome score and patient satisfaction measures. RESULTS: The technique affords an excellent decompression while minimizing destruction to tissues not directly involved in the pathologic process. Functional outcome scores doubled, and 87% of patients reported high satisfaction rates. CONCLUSIONS: Lumbar microdecompression is a minimally invasive technique that appears to provide excellent functional outcomes.

Adult↗

PubMed2003

Importance of input perturbations and stochastic gene expression in the reverse engineering of genetic regulatory networks: insights from an identifiability analysis of an in silico network.

Gene expression profiles are an increasingly common data source that can yield insights into the functions of cells at a system-wide level. The present work considers the limitations in information content of gene expression data for reverse engineering regulatory networks. An in silico genetic regulatory network was constructed for this purpose. Using the in silico network, a formal identifiability analysis was performed that considered the accuracy with which the parameters in the network could be estimated using gene expression data and prior structural knowledge (which transcription factors regulate which genes) as a function of the input perturbation and stochastic gene expression. The analysis yielded experimentally relevant results. It was observed that, in addition to prior structural knowledge, prior knowledge of kinetic parameters, particularly mRNA degradation rate constants, was necessary for the network to be identifiable. Also, with the exception of cases where the noise due to stochastic gene expression was high, complex perturbations were more favorable for identifying the network than simple ones. Although the results may be specific to the network considered, the present study provides a framework for posing similar questions in other systems.

Computational Biology↗

PubMed2004

Modeling and decoding motor cortical activity using a switching Kalman filter.

We present a switching Kalman filter model for the real-time inference of hand kinematics from a population of motor cortical neurons. Firing rates are modeled as a Gaussian mixture where the mean of each Gaussian component is a linear function of hand kinematics. A "hidden state" models the probability of each mixture component and evolves over time in a Markov chain. The model generalizes previous encoding and decoding methods, addresses the non-Gaussian nature of firing rates, and can cope with crudely sorted neural data common in on-line prosthetic applications.

Action Potentials↗