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Results for “Continuous Evolution”

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At least 433 records · Page 24Linked to original sources

PubMed2005

Laparoscopic splenectomy for non-traumatic diseases.

At present, laparoscopic splenectomy (LS) is mostly indicated in hematologic benign diseases, and in case of normal size spleen it is considered the gold standard. The technique is under a continuous evolution and several studies have demonstrated feasibility and safety of laparoscopic approach also in case of massive splenomegaly, malignant diseases and even in the treatment of selected cases traumatic lesions. LS is an advanced surgical procedure that requires a management of a full trained team involved in the preoperative preparation, surgical strategy and postoperative care. A fully comprehension of the impact of the surgical strategy is needed to plan the treatment of diseases that often are managed in a multidisciplinary setting. Indications and contraindications to surgery does not differ significantly from open traditional splenectomy, but the nature of the disease and the volume of the spleen can greatly influence the operation. A preoperative study with definition of these parameters along with a standard preparation to surgery is required. Over the years the technique has been developed and adapted to respond to emergent necessities related to those parameters. Anterior, semilateral, later and hand assisted approaches offer advantages and drawbacks that should be weighed in each case. They depend on surgeons preferences but most of the time are related to the preoperative studies, even when new surgical tools (i.e. harmonic scalpel and radiofrequency). No randomized, prospective trials have been conducted, however several studies with strong evidence have shown that less surgical trauma, intraoperative blood loss, early hospital discharge, rapid return to normal activities and better cosmesis can be obtained with a laparoscopic approach.

Adolescent↗

PubMedDate not supplied

Modern surgical and interventional options for the management of heart failure.

Current standard drug therapy provides only palliative and symptomatic relief for patients with severe heart failure, but there is now a wide array of device applications that holds great promise for reducing the mortality and disability that result from heart failure. Patients with severe chronic and refractory heart failure should be considered for heart transplantation or mechanical circulatory supportwith a ventricular assist device. Newer surgical and interventional treatments are in continuous evolution.

Cardiac Pacing, Artificial↗

PubMedDate not supplied

A proposed human needs conceptual model for dental hygiene: part I.

To date, research and theory development in dental hygiene have been largely sporadic and lacking in focus. Dental hygiene has begun to develop its body of knowledge by adopting a definition of the discipline and a structural hierarchy of knowledge that includes a global paradigm, conceptual model(s), and theory. By identifying major concepts and linking theory to an expanding knowledge base, dental hygiene can begin to evolve as a scientific discipline. Conceptual models and theories will characterize the uniqueness of dental hygiene and move it into collegiality with other professional disciplines. In the future, practitioners, educators, and researchers may adopt an organizational framework for dental hygiene. Doing so will enhance dental hygiene research, teaching, and client care. Most importantly, it will enhance dental hygiene's view of itself. This in turn will facilitate dental hygiene's continuing evolution toward professionalization.

Dental Care↗

PubMed1992

Ig V kappa family repertoire of plasma cells derived from autoimmune MRL mice.

V kappa gene family usage was determined in the resident in vivo-activated plasma cells of individual diseased MRL mice by using in situ hybridization. In this way, the entire autoimmune repertoire could be analyzed. Autoantibody levels and extent of glomerulonephritis were also measured, so that the severity of disease could be assessed. It was found that V kappa expression was highly variable from mouse to mouse. Some animals displayed a V kappa family repertoire similar to mitogen-stimulated cells and consistent with the size of the families. These animals tended to have lower disease indices. Other animals, which had higher disease indices, displayed considerable over- or underutilization of individual V kappa families. However, no particular V kappa families were repeatedly biased in their expression, as was found at the VH level with J558. Importantly, in the 10% of animals that expressed VH J558 exclusively, four or more V kappa families were expressed and multiple antiself specificities were produced. The data are most consistent with a number of J558 genes being expanded in a variety of self-specificities. However, because only VH J558 is expressed in these sicker animals, nonspecific polyclonal activation is highly unlikely. These results underscore the continuing evolution of the autoimmune repertoire, with considerable diversity at early stages followed by a highly selected repertoire in which a potential role for nonspecific polyclonal activation is virtually excluded.

Animals↗

PubMed1991

Surgical myocardial revascularization for the 1990s.

After two decades, coronary artery surgery remains a reliable mainstay in the treatment of select patients suffering from ischemic heart disease. However, surgical myocardial revascularization has undergone continuous evolution. Several trends have emerged, including increased use of autogenous artery for bypass conduit, extending indications to include patients with poor ventricular function or following recent myocardial infarction and new techniques, such as surgical angioplasty of the left main coronary artery.

Humans↗

PubMed1991

Education and credentialing of the gynecologic laser surgeon.

Gynecologic laser surgery involves the use and understanding of a number of different wavelengths (lasers) and their delivery systems. The educated laser surgeon understands the pros and cons of all the practical wavelengths, their tissue reactions, and their safety features. The laser surgeon may use a colposcope, hysteroscope, laparoscope, or laser handpiece in surgery. Few gynecologists have acquired the necessary expertise to perform laser surgery during residency training. For this reason, attendance at courses that include hands-on laboratory experience has been mandatory. Hospitals, not course directors, credential surgeons to perform laser operations in their operating rooms. The credentialing committee of the hospital must decide which surgeons have been properly trained for laser surgery. Objective criteria have been offered in this chapter in the effort to make the task easier and more fair. As the number of laser surgeons grows, the need for training courses may decrease, because if laser surgery is learned during the residency years, the demand for postgraduate training will decrease. On the other hand, since surgical laser evolution continues, the training center will continue to offer a valuable educational experience.

Credentialing↗

PubMed1990

Cutaneous laser surgery. An update.

New laser technologies alone cannot provide a solution to every medical problem or condition. However, the benefits associated with new wavelengths of light, different types of delivery systems, and innovative therapeutic regimens all have helped to create more effective forms of therapy for many patients who could not have been successfully managed otherwise. Continued evolution in this exciting area of medicine is certain to provide even greater refinement and better results in an ever-enlarging number of cutaneous disorders.

Humans↗

PubMed1990

Industry's voluntary program: Community Awareness and Emergency Response Program and the Emergency Planning and Community Right-to-Know Act.

This paper describes the chemical industry's Community Awareness and Emergency Response (CAER) Program, and voluntary and mandatory actions by the chemical industry to comply with the major environmental legislation. The chemical industry started the voluntary CAER Program soon after the Bhopal Disaster in 1984; it is coordinated through the Chemical Manufacturer's Association. This program, which began in March 1985, is a long-term industry commitment to develop a community outreach program and to improve local emergency response planning. The Congress of the United States began, in 1985, to consider proposals for mandatory programs. This led to enactment of the Superfund Amendments and Reauthorization Act of 1986, known as SARA. A portion of this Act, entitled Title III is also known as the Emergency Planning and Community Right-to-Know Act. Although this legislation has many mandatory requirements, it should be emphasized that a significant degree of voluntary industrial participation is needed if the purposes of the statute are to be achieved. Title III has created an intricate and still evolving system that ties together the EPA, industrial plant managers, state emergency response commissions, local emergency planning committees and fire departments with jurisdiction over the facility. Each of these groups has a different role and responsibilities but must work cooperatively with other participants. Because of the intricate network of participants, the magnitude of the information flow, and the continuing evolution of the system, unique public relations problems exist in order to comply with Title III.(ABSTRACT TRUNCATED AT 250 WORDS)

Awareness↗

PubMed1989

[Double heart prosthesis in a patient with rheumatoid arthritis].

The incidence of rheumatoid valvular disease is among 2.5% to 30% of necropsy patients with rheumatoid arthritis. The valves may be affected by a granulomatous form patognomonic, or by unspecific inflammatory changes (the most frequent 90-99%). We present a patient affected by a classical seropositive rheumatoid arthritis accompanied by mixed stenosis and incompetence of both mitral and aortic valves. The patient underwent replacement of both valves, and typical unspecific inflammatory changes were detected histologically in the valvular tissues. Replacement of the valves by a prosthesis is the choice treatment despite severe joint disease. The echocardiography is the ideal method for detection of cases with subclinic lesions and to continue evolution.

Adult↗

PubMedDate not supplied

[Total cystectomy in the treatment of infiltrative bladder tumors. The conclusions of an analysis of postoperative results in a series of 269 nonselected patients at late follow-up].

The authors report their experience with 341 radical cystectomies, and 61 anterior pelvectomies for infiltrating urinary bladder tumours, of which 269 were followed at long periods of time after surgery. In 56% of the patients there was tumoural involvement of lymph nodes at the time when cystectomy was performed. In 88% of the cases the tumours were of G3 stage. Fifty-one percent of the patients had had one previous surgical procedure, and in 75% of the cases surgery was performed when the upper urinary apparatus was already dilated by tumoural obstruction, or when high serum nitrogen was present. Planned radical cystectomy was possible in only 26% of the patients. The technical procedure implies a significant change consisting in the exclusive use of the urethropelvic drainage, and this had excellent results. The urinary derivation used was adapted to the stage of development of the tumour, and after consideration of the condition of the upper urinary apparatus. In 130 cases cutaneous urethrostomy was performed, in 95 patients urethrocolic derivation, in 23 cases cutaneous transurethral ureterostomy, and in 6 patients substitution bladder was achieved. The global postoperative mortality of 16.6% was mainly due to the advanced age of patients, the advanced stages of the tumours, to high serum nitrogen, infections, and to operatory indications that were not always justified but were determined by clinical complications and the extreme discomfort of patients. The most frequent early postoperative complications included an association of toxic shock and high serum nitrogen. In the authors' experience preoperative radiotherapy did not have satisfactory results, and chemotherapy only resulted in inconstant improvement of the patients' condition The late results were not satisfactory, the deaths in the first two years after surgery being the result, almost in exclusivity, to a continued evolution of the neoplastic tissue remaining in the pelvic cavity, and that was due to the fact that the patients had been operated at a very advanced stage of the disease. Total cystectomy has an elective indication in urinary bladder tumours of the T2, T2a, or T3b type, with N0 and M0. It should be carried out as planned surgical intervention and presumes a mandatory urinary derivation that should provide a maximal renal protection.

Female↗

PubMed1989

Assurance of quality vision care in alternative health care delivery systems.

The continuing evolution of competitive arrangements in the marketing and delivery of health care services can have an adverse effect upon the quality of care. Traditional modes of health care delivery are being replaced by the more competitive alternative delivery and managed care systems. Practitioners, consumers, administrators and legislators are finding it increasingly difficult to balance the various issues that surround the desire for quality and the necessity of cost containment. Optometry must be able to establish its own standards and methods of evaluation for the assurance of quality eye care within the alternative delivery and managed care systems.

Delivery of Health Care↗

PubMed1987

The major histocompatibility complex of the rat.

Immunogenetic studies in the rat began with the investigation of blood group antigens (1-7) and evolved into the investigation of histocompatibility antigens and transplantation phenomena (8-17). In the course of this work, several nomenclature systems evolved that were eventually reconciled in a series of comparison studies (18-24). The biennial Workshops on Alloantigenic Systems in the Rat held under the aegis of the Transplantation Society (24) have provided the forum for the continued evolution of this field. In addition, several reviews (24-31) and books (32-35) have provided periodic summaries of different aspects of rat immunogenetics. This review will focus on the structure of the major histocompatibility complex (MHC) of the rat from the serological, biochemical, and molecular points of view.

Amino Acid Sequence↗

PubMed1987

Families and mental illness: current interpersonal and biological approaches (Part 1). Contributions by the Society for Life History Research on Psychopathology: epidemiology, life course development, and family research.

FAMILY research in mental health has until recently been largely confined within specific disciplines or fairly narrow perspectives, with little interdisciplinary integration. While sociologists, geneticists, psychologists, psychiatrists and scholars in related disciplines all have developed explanations regarding the familial origins or transmission of psychopathology and mental disorders, their work has largely remained isolated in the separate fields and is usually published in separate journals. We believe that the importance of Psychiatry: Interpersonal and Biological Processes lies in its mission to promote the integration of such work, not only in regard to family research but in the broad arena of research in mental health and illness. The Society for Life History Research on Psychopathology has always been concerned with interdisciplinary longitudinal investigation. Its 1984 meeting focused upon new opportunities in methods and in theory building in family research. This set of five papers and the papers to be published in the next issue were first presented at that meeting, hosted in Baltimore by the Department of Mental Hygiene, The Johns Hopkins School of Hygiene and Public Health. They reflect continuing evolution toward a multidisciplinary family research perspective.

Epidemiologic Methods↗

PubMed1986

Quality assurance in home laboratory testing.

In review, one is compelled to the notion that a variety of the aforementioned thoughts become pre-eminent in assuring quality. The selection of the tests available for home testing is crucial. They should be divided into categories of single encounter tests and multiple use tests. The single encounter implies a test that has an extremely high degree of reliability and is likely to achieve an answer to the question asked. This should relate to a disease or process for which potential favorable treatment can be achieved or which may have a major favorable impact on public health. In this category one thinks in terms of the worldwide prevalence of hepatitis B and other infectious diseases that are particularly common in third world countries. Yet, these are not "markets" likely to be able to afford this testing. Similarly, these societies are not currently sophisticated in terms of application of preventive measures. On the other hand, major benefits could be projected from the other category of testing, namely, therapeutic monitoring in the hands of individuals who will repetitively test for the same substance in the same manner. This includes not only diabetes but other conditions that are monitored for drug therapy, including seizure disorders and bronchospasm. Inherent in this aspect is the requirement for meaningful and ongoing instruction in proper testing methodology and recording of results. The incorporation of some type of memory device to enforce this aspect of testing appears extremely desirable, if not mandatory. Finally, we must consider the potential for misuse of the single test type of device. One suspects that it would be highly desirable that any test made available for self-testing should also be mandated as accessible through certified laboratories at the request of an individual, which would at least provide reliable performance of the test with a quality result. The development of the concept of quality assurance in home testing is in its infancy and will require continuing evolution.

Aged↗

PubMed1985

Economic regulation and hospital behavior: the effects on medical staff organization and hospital-physician relationships.

New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches.

Certificate of Need↗

PubMed1983

[Unfolding of the brain and secondary mandibular joint and face development in mammals: a synergetic and synchronous event].

The connection of phylogenesis and ontogenesis is discussed in terms of the interdependence of the development of face, secondary mandibular joint, and brain. The results show that phylogenesis can be explored from preadaptations which become functionally effective during ontogenesis. Therefore phylogenetically "old" functions will not be eliminated but functionally changed and then integrated into new ones. This is discussed as "synergetic events". Changes in the genetic material cannot be correlated with these functional changes, they are acausally connected. This is termed "synchronizition". Synergetic and synchronistic events together cause new functions thus forming archetypical organisms continuing evolution. It is further discussed that the essential role of ontogenesis during phylogenesis could be facilitated by an immaturity of the genome in the early embryological stages.

Adaptation, Physiological↗

PubMed1980

Control of microbial contamination in the use of laboratory rodents.

Historically, laboratory rodents have been used in preference to other animal species for biomedical research. Study disruptions and invalidations often have occurred due to microbial contaminants inherent to laboratory rodents. Today, many commercial suppliers and research institutions are controlling a variety of infectious diseases among laboratory rodents by careful design of animal facilities, by adaptation of managerial techniques employing precise operational policies coupled with careful supervision and attention to detail and the use of various diagnostic programs. The continued evolution of epidemiological practices, environment control systems, sophistication of barrier-sustained operations, preventative medicine and sanitation techniques, complemented by an improvement in veterinary diagnostic programs for disease surveillance further minimize microbial contamination of laboratory rodents. Such measures contribute to the fulfillment of various legislative requirements concerned with the quality of animals for biomedical research.

Animal Feed↗

PubMed1981

Contacts with a Canadian "street-level" Drug and Crisis Centre, 1975-1978.

This paper presents the work and functioning of the distress Centre/Drug Centre, an agency in Calgary, Alberta, Canada, which has evolved from a youth-oriented drug centre to a general crisis centre. It is staffed by volunteers who are supported by professional staff, and offers a 24-hour telephone service throughout the week. The paper reviews the continuing evolution of this service, the drugs most frequently noted in contacts involving crisis and suicide attempts, and the role of crisis centres that use volunteers as front-line workers. The years 1975-1978 were a period in which alcohol was the drug most frequently reported to be associated with crisis and attempted suicide.

Adolescent↗