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PubMed2006

[The evolutionist fallacy of early visitors. Analogies between 'primitive peoples' and prehistoric man in medical historiography].

Accounts of 'prehistoric medicine' and 'ethnomedicine' have sometimes led to conclusions by analogy in medical historiography that are seen as highly problematic in modern cultural anthropology. However, this review of medical historical writings of the last three centuries shows that evolutionist identifications of early with foreign medicine were not a permanent trait of medical historiography. This approach flourished mainly in the climate of certain movements or periods that were characterised by fanatical belief in progress and by social utopias: the French Revolution, Darwinism and the period of industrial expansion in Germany, and National Socialism. Medical historiography shared this problematic approach with contemporary (social and cultural) anthropology, and - despite this methodological misuse - both acknowledged the legitimacy or even requirement of studying also similarities in the development of different periods and cultures.

Anthropology↗
PubMed2003

Freshwater as shared between society and ecosystems: from divided approaches to integrated challenges.

The paper has its focus on water's key functions behind ecosystem dynamics and the water-related balancing involved in a catchment-based ecosystem approach. A conceptual framework is being developed to address fundamental trade-offs between humans and ecosystems. This is done by paying attention to society's unavoidable landscape modifications and their unavoidable ecological effects mediated by water processes. Because the coevolution of societal and environmental processes indicates resonance rather than a cause-effect relationship, humanity will have to learn to live with change while securing ecosystem resilience. In view of the partial incompatibility of the social imperative of the millennium goals and its environmental sustainability goal, human activities and ecosystems have to be orchestrated for compatibility. To this end a catchment-based approach has to be taken by integrating water, land use and ecosystems. It is being suggested that ecosystem protection has to be thought of in two scales: site-specific biotic landscape components to be protected for their social value, and a catchment-based ecosystem approach to secure sustainable supply of crucial ecosystem goods and services on which social and economic development depends.

Conservation of Natural Resources↗
PubMed1999

Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke.

OBJECTIVE: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. DESIGN: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. SETTING: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. MAIN OUTCOME MEASURES: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. RESULTS: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003). CONCLUSIONS: A supervised home-based programme is as effective as outpatient or day hospital therapy.

Aged↗
PubMedDate not supplied

Congenital hemangiopericytoma/infantile myofibromatosis: radical surgery versus a conservative "wait and see" approach.

Infantile/congenital hemangiopericytoma, although sharing many similar histological features with adult hemangiopericytoma, has a much better prognosis. Nevertheless, most cases described in the literature were pursued by radical surgery with or without adjuvant chemotherapy. We describe a neonate who presented with a huge mass in the right gluteus, 6 x 5 x 4 cm, and a small ventral abdominal mass. The masses were confirmed on biopsy according to light microscopy, immunohistochemistry, and electron microscopy as congenital hemangiopericytoma. They shrank spontaneously within 2 weeks and vanished within 2 months. We present a hypothesis that masses appearing in the neonatal period with this histology and with no life-endangering pressure on vital organs should routinely be dealt with conservatively.

Adult↗
PubMed2005

The treatment of inguinal hernia in the elderly: open technique or laparoscopic approach?

Well defined and shared quality standards characterize the ideal treatment of inguinal hernia: it should be the least traumatic as regards both the requested type of anaesthesia and the operative technique and the least expensive; it should have the least per-and post-operative morbidity. The chosen technique should be also the easiest to learn and to perform; and his positive results should be the most reproducible. While there are a lot of studies about the comparison between open and laparoscopic surgery, the number of the studies about the specific evaluation of the problem in the aged is very limited. Aim of the paper is to aid in evaluation of the problem in a group of patients, on the basis of the reports and on an initial departmental experience. In conclusion the laparoscopic repair is a complementary choice and not an alternative to the open surgery in the elderly patients.

Adult↗
PubMedDate not supplied

New approaches of organizing care and work: giving way to participation, mobilization, and innovation.

Quebec's health network has undertaken large-scale organizational changes to ensure the continuity, accessibility, and quality of health care and services for the population. This article describes the optimal approach for making changes to the organization of care and work for patients, health care workers, and organizations. This participative action research was carried out by means of interviews and document analysis. One hundred participants were involved, describing a total of 34 projects for significant organizational change. Results include an optimal approach broken down into 4 phases, each of which includes steps, facilitating factors, and potential difficulties. The phases of this approach are: (1) sharing the vision, mission, and values of the organization and identifying the purpose and need underlying the change; (2) building alliances and validating the involvement of the various players; (3) conceptualizing and planning the project; and (4) implementing changes and continuing evaluation. It is possible to rise to the challenge of finding new approaches to organize care and work by giving way to participation, mobilization, and innovation.

Cooperative Behavior↗
PubMed2001

Transumbilical breast augmentation (TUBA): patient selection, technique, and clinical experience.

The TUBA procedure offers another approach to placing inflatable breast implants in the subglandular or submuscular position. It is an easy procedure to learn and to perform, using only a few relatively inexpensive specialized instruments. It also can be modified to use preexisting scars on the abdomen as the access point. The authors believe that complications seem to occur less with TUBA patients than with patients having breast augmentation by other approaches, an observation shared by other plastic surgeons offering the TUBA procedure. Limitations include the fact that only inflatable implants can be used. Also, with increasing distance from the breast, there is less control over manipulation of the pocket. Fortunately, the authors have not found this to be a problem in achieving symmetry. Furthermore, bleeding tends to be minimal with this approach. Nevertheless, should technical difficulties arise, conversion to a standard breast incision is an easy back-up option and should be discussed with the patient before surgery. Interest in the TUBA approach to breast augmentation continues to grow. Patients appreciate the lack of scarring on the breast and the short recovery that allows them to resume their normal lifestyle quickly. The authors' caseload has increased considerably over the past 8 years through word-of-mouth advertising from satisfied patients. Other plastic surgeons who offer this approach agree that patient demand for this operation continues to grow dramatically in their practices.

Breast Implants↗
PubMed2004

Use of selected reaction monitoring mass spectrometry for the detection of specific MHC class I peptide antigens on A3 supertype family members.

The development of peptide-based vaccines that are useful in the therapeutic treatment of melanoma and other cancers ultimately requires the identification of a sufficient number of antigenic peptides so that most individuals, regardless of their major histocompatibility complex (MHC)-encoded class I molecule phenotype, can develop a cytotoxic T lymphocyte (CTL) response against one or more peptide components of the vaccine. While it is relatively easy to identify antigenic peptides that are presented by the most prevalent MHC class I molecules in the population, it is problematic to identify antigenic peptides that are presented by MHC class I molecules that have less frequent expression in the population. One manner in which this problem can be overcome is by taking advantage of known MHC class I supertypes, which are groupings of MHC class I molecules that bind peptides sharing a common motif. We have developed a mass spectrometric approach which can be used to determine if an antigenic peptide is naturally processed and presented by any given MHC class I molecule. This approach has been applied to the A3 supertype, and the results demonstrate that some, but not all, A3 supertype family-associated peptides can associate with all A3 supertype family members. The approach also demonstrates the shared nature of several newly identified peptide antigens. The use of this technology negates the need to test peptides for their ability to stimulate CTL responses in those cases where the peptide is not naturally processed and bound to the target MHC class I molecule of interest, thus allowing resources to be focused on the most promising vaccine candidates.

Antibodies, Monoclonal↗
PubMed2004

Using multilevel, multisource needs assessment data for planning community interventions.

African Americans and Latinos share higher rates of cardiovascular disease (CVD) and diabetes compared with Whites. These diseases have common risk factors that are amenable to primary and secondary prevention. The goal of the Chicago REACH 2010-Lawndale Health Promotion Project is to eliminate disparities related to CVD and diabetes experienced by African Americans and Latinos in two contiguous Chicago neighborhoods using a community-based prevention approach. This article shares findings from the Phase 1 participatory planning process and discusses the implications these findings and lessons learned may have for programs aiming to reduce health disparities in multiethnic communities. The triangulation of data sources from the planning phase enriched interpretation and led to more creative and feasible suggestions for programmatic interventions across the four levels of the ecological framework. Multisource data yielded useful information for program planning and a better understanding of the cultural differences and similarities between African Americans and Latinos.

Adult↗
PubMed1998

Empowerment of dying patients: the strategies and barriers to patient autonomy.

The growing debate about the ability of the nurse to empower patients has featured frequently in the nursing journals over recent years. This paper seeks to address the issue around the need to empower dying patients by an examination of nurses' written reflections on critical incidents in their practice. Geertz's 'thick description' has been used to interpret the data. The issues of power and professionalism are central to the discussion. The results are tentative given the sample size but point towards a redefinition of the empathetic approach and the adoption of a 'facilitative' approach to the sharing of power. The paper recommends careful examination of the role of the nurse and the communication process to identify further barriers to patient empowerment.

Communication Barriers↗
PubMedDate not supplied

How managed care can be ethical.

The growth of managed care in the United States has been paralleled by a rising tide of anti-managed care sentiment. The "managed care problem" is understood generally as the need to protect individuals against large companies that care more about their bottom line than about people. The premise of the BEST (Best Ethical Strategies for Managed Care) project is that the "managed care problem" is best understood as an ethical problem--a conflict of values that arises as the country changes from a patient-centered to a population-centered approach to health care. The BEST project team worked with nine managed care organizations to identify their most intractable problems. The team redefined these problems in terms of ethical dilemmas, then studied each organization in search of innovative, exemplary approaches. These exemplary approaches are being shared publicly with the aim that they be adapted and adopted by other organizations facing similar difficulties and by regulators and legislators hoping to improve the health care system.

Benchmarking↗
PubMed1995

Communicating pharmaceutical outcomes to hospital administration.

The contributions of a pharmaceutical outcomes approach to therapeutic decision-making and the budgetary process are explored. In the new health care climate, pharmacists can no longer look at a pharmaceutical product or service strictly on the basis of clinical outcomes but must consider the economic and humanistic outcomes as well. Today, pharmacists as effective outcomes managers must ask, Will the drug therapy work? What will be the overall cost? What effect will the treatment have on the patient's quality of life? Some newly developed agents, while they may have a high acquisition cost, can reduce suffering and bottom-line costs by avoiding unnecessary hospitalizations. There needs to be a movement from individual departmental budgets to shared budgets. Another approach to the budgetary system is cost shifting among the various patient care settings. Reimbursement strategies should be in place to ensure recovery of costs. Hospital decision-makers should have a comprehensive knowledge of institutional payer mix, pharmaceutical, formulary decisions, financial planning, and the availability of indigent care programs. Pharmaceutical outcomes must become an important factor in therapeutic decisions. Pharmacy directors must present a strategic financial plan to hospital administration that positions the pharmacy as a solution to cost issues.

Communication↗
PubMed2002

Critical issues in bacterial phylogeny.

To understand bacterial phylogeny, it is essential that the following two critical issues be resolved: (i) development of well-defined (molecular) criteria for identifying the main groups within Bacteria, and (ii) to understand how the different main groups are related to each other and how they branched off from a common ancestor. These issues are not resolved at present. We have recently described a new approach, based on shared conserved inserts and deletions (indels or signature sequences) found in various proteins, that provides a reliable means for understanding these issues. A large number of conserved indels that are shared by different groups of bacteria have been identified. Using these indels, and based simply on their presence or absence, all of the main groups within Bacteria can be defined in clear molecular terms and new species could be assigned to them with minimal ambiguity. The analysis of these indels also permits one to logically deduce that the various main bacterial groups have branched off from a common ancestor in the following order: Low G+C Gram-positive ==> High G+C Gram-positive ==> Clostridium-Fusobacteria-Thermotoga ==> Deinococcus-Thermus-Green nonsulfur bacteria ==> Cyanobacteria ==> Spirochetes ==> Chlamydia-Cytophaga-Bacteroides-Green sulfur bacteria ==> Aquifex ==> Proteobacteria 1 (epsilon and delta) ==> Proteobacteria-2. (alpha) ==> Proteobacteria-3 (beta) and ==> Proteobacteria-4 (gamma). The validity of this approach was tested using sequence data from bacterial genomes. By making use of 18 conserved indels, species from all 60 completed bacterial genomes were assigned to different groups. The observed distribution of these indels in different species was then compared with that predicted by the model. Of the 936 observations concerning the placement of these indels in various species, all except one were in accordance with the model. The placement of bacteria into different groups using this approach also showed excellent correlation with the 16S rRNA phylogenies with nearly all of the species assigned to the same groups by both methods. These results provide strong evidence that the genes containing these indels have not been affected by factors such as lateral gene transfers. However, such events are readily detected by this means and some examples are provided. The approach described here thus provides a reliable and internally consistent means for understanding various critical and long outstanding issues in bacterial phylogeny.

Amino Acid Sequence↗
PubMed1998

An analysis of hepatic retransplantation in children.

BACKGROUND: The limited supply of organ donors has led some groups to reconsider the role of retransplantation. Historically, except for children with malignancies, extrahepatic sources of sepsis, or severe irreversible neurologic injuries, our institution has offered all children with failing liver grafts the option of retransplantation regardless of their current severity of illness. The purpose of this study was to examine the outcome of hepatic retransplantation in children in an attempt to identify factors predictive of outcome and to assess the results of our approach to retransplantation. METHODS: Between October 1984 and December 1995, 314 children less than 15 years of age underwent a total of 441 liver transplants. Data were obtained retrospectively by review of hospital records. RESULTS: With a mean follow-up period of 5.3+/-2.7 years, the overall patient survival rates at 1 and 5 years were 77.1% and 67.1%, respectively. Primary allograft survival rates were 65.6% and 56.5%, respectively. Of the 137 patients who developed failure of their primary allograft, 92 underwent retransplantation (29.3% of all primary transplants). Both patient and allograft survival rates were significantly decreased after retransplantation (P<0.0001 versus primary transplants). Univariate and multivariate analysis of retransplanted patients revealed only two factors that were statistically related to patient and graft survival: age at the time of retransplantation (P<0.02 univariate and P<0.05 multivariate) and retransplantation with a reduced-size allograft (P<0.005 univariate and P<0.05 multivariate). In this series, the effect on patient survival of differences in medical condition as reflected by United Network for Organ Sharing (UNOS) status approached, but did not achieve, significance (P=0.08 for UNOS 1 versus UNOS 2 and 3). UNOS status did not affect graft survival. Neither the cause of primary allograft loss or the timing of retransplantation relative to the first transplant were related to outcome. CONCLUSIONS: These data demonstrate that the failure of primary hepatic allografts remains a major problem in pediatric liver transplantation and that the overall results of retransplantation were significantly worse than those associated with primary transplants. We have identified a group of children who experienced a significantly worse outcome after retransplantation. This group consisted of children less than 3 years of age retransplanted using reduced-size grafts. Based on this finding, we now attempt to avoid retransplanting young children with reduced-size grafts. By using this approach, we hope to be able to offer children the option of retransplantation with improved results and simultaneously minimize the negative impact on patients awaiting primary transplants.

Adolescent↗
PubMed2004

Conversion of brain SPECT images between different collimators and reconstruction processes for analysis using statistical parametric mapping.

To make it possible to share a normal database in single photon emission computed tomography (SPECT) studies, we developed a new method for converting a SPECT image in one physical condition to that in another condition for data acquisition and reconstruction. A Hoffman 3-dimensional brain phantom experiment was conducted to determine systematic differences between collimators and reconstruction processes. SPECT images for the brain phantom were obtained using fan-beam collimators with scatter and attenuation corrections and using parallel-hole collimators without any correction. Dividing these two phantom images after anatomical standardization by Statistical Parametric Mapping 99 (SPM99) created a 3-dimensional conversion map. This conversion map was applied to convert an anatomically standardized SPECT image using parallel-hole collimators without any correction to that using fan-beam collimators with scatter and attenuation corrections in eleven subjects who underwent sequential SPECT measurements using different collimators after injection of 99mTc ethyl cysteinate dimer. The SPM99 demonstrated adequate validity of this conversion in comparative analyses of these sequential SPECT images with different collimators. This may be a promising approach for further sharing of a normal database in SPECT imaging between different cameras.

Adult↗
PubMed2001

Dinuclear diazene iron and ruthenium complexes as models for studying nitrogenase activity.

The strength of hydrogen bonds has been investigated in various dinuclear diazene FeII, FeIII, and RuII complexes by use of the recently developed shared-electron number approach. Hydrogen bonding in these compounds plays an essential role in view of designing a model system for nitrogenase activity. The general conclusions for iron-sulfur complexes are: hydrogen bonds can stabilize diazene by at least 20% of the total coordination energy; the strength of the hydrogen bonds can be directly controlled through the hydrogen-sulfur bond length; reducing FeIII centers to FeII can double the hydrogen bond energy.

Hydrogen Bonding↗