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PubMed1971

An approach to the design of wheelchairs for young users.

Sixty six physically handicapped children between the ages of 5 and 16 took part in an anthropometric study of young wheelchair users. All those involved had at one time used a wheelchair regularly, and only 9 in the study habitually walked. Using a standard body measuring instrument, 13 measurements of bodily dimensions were taken with the children sitting in their usual chairs. An assessment was also made of the degree of support afforded by the backrest. Five dimensions normally used in prescribing wheelchairs to patients were used as a basis for working out the sizes of the various sections of a wheelchair, such as seat, backrest, armrest and frame size. The raw data indicated that appreciable inconsistencies in body shape existed which were not allowed for in present wheelchair design. A new approach is proposed in which wheelchairs would be assembled from interlocking sections of variable size . This arrangement would allow wheelchairs to be fitted more completely to the individual.

Journal Article↗

PubMed1995

Selection of needlestick prevention devices: a conceptual framework for approaching product evaluation.

Needlestick injuries have been associated with blood-borne disease transmission to health care workers. A demand for a safer work environment has contributed to a proliferation of "safety" products. The selection and evaluation of these devices differs from traditional product evaluation in that it considers not only effectiveness in patient care but also health care worker safety and cost-effectiveness in terms of prevention gained. In addition, multiple devices associated with injuries and choices between passive, active, and accessory safety options require that institutions establish priorities for focusing intervention efforts. Selection of products must involve the primary users. Unless new devices are found acceptable for patient care, health care workers are likely to reject them, despite any apparent safety advantages. Five project steps help define a systematic approach for this process: (1) creation of a multidisciplinary team, (2) defining prevention priorities on the basis of collection and analysis of an institution's injury data, (3) development of design and performance criteria for product selection according to needs for patient care and health care worker safety, (4) planning and implementing an evaluation of products in clinical settings, and (5) analyzing product performance and cost-effectiveness to choose the product. Several methodologic issues raise questions for future research in the area of product evaluation, including the selection of study populations, methods of product distribution and data collection, and influence of institutional culture. In addition, there is a need to develop product-specific design and performance criteria by which evaluation teams can measure various technologies under consideration. Standardization of the product evaluation process for needlestick prevention technology should lead to the collection of information that can be compared across institutions. Infection control professionals have an important opportunity to assume a leadership role in this process.

Consumer Product Safety↗

PubMed2006

Modernising chronic obstructive pulmonary disease admissions to improve patient care: Local outcomes from implementing the Ideal Design of Emergency Access project.

This project illustrates how benefits to patients, carers, staff and NHS trusts can result from service redesign that is targeted at improving services for patients with chronic obstructive pulmonary disease. Using a Continuous Quality Improvement methodology and 'plan-do-study-act' cycles, this project established key local measures for service redesign based on the national Ideal Design of Emergency Care project. These were to improve patients' experiences of care, by: decreasing patient journey time, improving patient, carer and staff experiences and reducing process variability. The result was a reduction in the average length of stay for patients and an increase in the numbers of patients admitted directly to the emergency medical unit and transferred to the respiratory department. Service users were actively involved in developing the changes. Although not generalizable, this project provides useful insights for consideration by others facing similar issues in their own organisations: we conclude that the methodology used in this study has been instrumental in improving key aspects of patient care, and that a similar methodological approach could be effective for other organisations.

Attitude of Health Personnel↗

PubMed2026

Utility of hearing aid use on neurocognitive functions and auditory processing: A systematic review.

PURPOSE: Hearing loss not only affects the peripheral auditory system but also leads to changes in central auditory pathways and neurocognitive skills. The use of hearing aids has shown potential benefits in mitigating the adverse effects of hearing loss. Earlier literature showed various studies assessing the impact of hearing aid use on cognitive functions and auditory processing, a comprehensive review of the existing literature is warranted. Existing literature showed heterogeneous outcomes among studies investigated the effect of Hearing aid use in combating the adverse effects of hearing loss on neurocognitive functions and auditory processing. METHOD: Databases including PubMed, SciELO, Cochrane Library, PsycINFO, Web of Science, and Index Copernicus were searched (2005-2025) using English keywords on hearing aid effects on neurocognition and auditory processing in individuals with hearing loss. Studies on effect of hearing aid use on neurocognition and auditory processing were included, while those involving cochlear implant users or other neurological disorders unrelated to hearing loss were excluded. Titles, authors and publication years were examined, and duplicates were removed. RESULTS: Total of 61 research papers were found on specific area and were included in the present review. Findings of these 61 articles have been analysed and are reported in this article. The outcome of the present study showed usefulness of hearing aid use on neurocognitive functions and auditory processing. CONCLUSION: The present literature review emphasized the importance of early rehabilitation through hearing aid use to alleviate the adverse effects of hearing loss on neurocognitive function and auditory processing.

Humans↗

PubMed2006

Decrease in Epstein-Barr virus-positive AIDS-related lymphoma in the era of highly active antiretroviral therapy.

Recent introduction of highly active antiretroviral therapy (HAART) is reported to have reduced the incidence of lymphoma among HIV-infected individuals. A clinicopathological study was performed on 86 AIDS-related lymphoma patients who were treated in Tokyo area from 1987 to 2005. The incidence of lymphoma detected by autopsy was 27% (53 cases/198 autopsies). Diffuse large B cell lymphoma was the most predominant histological subtype throughout the period (78%). Burkitt's lymphoma (BL) increased from 2% in the pre-HAART era (before end-1997) to 13% in the HAART era, whereas incidence of BL did not vary between HAART users and non-users. Epstein-Barr virus (EBV)-positive lymphoma decreased from 88% in the pre-HAART era to 58% in the HAART era, but did not differ significantly between HAART users (73%) and non-users (74%). Nodal involvement of lymphoma increased from 14% in the pre-HAART era to 50% in the HAART era; however, central nervous system involvement decreased from 62 to 38%. Kaposi's sarcoma-associated herpesvirus infection was rare (4%) among all cases. These data suggest that HAART might play a partial role in these changes, and the alteration in immunological backgrounds, such as EBV prevalence, is suggested as another leading cause of these changes in Japanese AIDS-related lymphoma.

Adolescent↗

PubMed2005

Application of three-dimensional magnetic resonance image registration for monitoring hip joint diseases.

The purpose of this study was to estimate the accuracy of a method in which three-dimensional (3D) magnetic resonance (MR) volume registration is used for monitoring hip joint disease. Data were analyzed using a normalized cross-correlation (NCC) algorithm involving a user-selected 3D box including the proximal femur. Most of the femoral head was not included in the 3D box because it can become deformed during the course of disease. The accuracy of registration around the femoral head was evaluated using five phantoms and clinical MR data of 17 patients with hip joint disease. In the phantom experiment, registration accuracy was evaluated using four fiducial markers attached to the femoral head. In the experiment using clinical data, registration accuracy was evaluated using a landmark in the femoral head. The registration accuracy in the phantom and clinical experiment was 0.43+/-0.18 mm (S.D.) and 1.12+/-0.46 mm (S.D.), respectively. The former is a value less than half the minimum dimension of a voxel (1.25 x 1.25 x 1.0 mm). Although the latter is slightly larger than the minimum dimension of a voxel, actual errors would be smaller because of the uncertainty in landmark localization. In conclusion, the present method based on an NCC algorithm can be used to accurately register serial MR images of the femoral heads with an error on the order of a voxel. We believe that this method is sufficiently accurate for monitoring hip joint diseases.

Algorithms↗

PubMed2005

Neural responses to acute cocaine administration in the human brain detected by fMRI.

An improved functional MRI (fMRI) method for the reduction of susceptibility artifacts has been utilized to measure blood oxygen level-dependent (BOLD) responses to acute cocaine administration in the human brain of cocaine users. Intravenous administration of cocaine (20 mg/70 kg) activated mesolimbic and mesocortical dopaminergic projection regions and showed temporal positive or negative BOLD responses. These results obtained from human cocaine users supported the involvement of the dopaminergic pathway in cocaine addiction from animal models. In addition, the cocaine administration also induced activations in the hierarchical brain networks in the anterior prefrontal cortex (aPFC) of the Brodmann area 10 (BA10) and orbitofrontal cortex (OFC). It is suggested that the dopaminergic pathways and the hierarchical brain networks may participate in mediating cocaine reward processes, associative learning, motivation, and memory in cocaine addiction in the human brain.

Adult↗

PubMed2000

[Consensus on care for the users of the Maintenance Program with Methadone at the health centers of the province of Cádiz].

OBJECTIVES: To reach a consensus on primary care actions concerning transmissible illnesses in users of the methadone maintenance programme. To promote coordination between levels. To find the needs of primary care professionals. DESIGN: Qualitative study based on the nominal group technique. SETTING: Cádiz province, including primary care districts, NHS hospitals and county drug-dependency centres. PARTICIPANTS: 76 health professionals: two doctors and a nurse from each health centre, selected for their experience and motivation; hospital specialists in preventive medicine and internal medicine also with experience and motivation, and with knowledge of primary care; a doctor from each county drug-dependency centre, chosen by the Provincial Drug-Dependency Management. INTERVENTIONS: The study had two phases: a) nominal group technique with homogeneous groups for each professional environment; b) modified nominal group with heterogeneous groups of professionals from all environments by hospital areas. MEASUREMENTS AND MAIN RESULTS: The final result of the study was the overall consensus in the four areas. The prioritized activities focused on "recruitment and study of patients and contacts", "educational and health promotion interventions", "immunisation programme", "monitoring therapy compliance", and "unified record of actions". What was needed to put into practice the interventions was agreed by consensus. CONCLUSIONS: Consensus techniques are a useful tool for planning primary care activities. A high degree of reproducibility can be reached if the participants are properly selected. Restrictions in being able to introduce some of the agreed interventions could be avoided with user participation and involvement of the health authorities.

Humans↗

PubMed2002

Cerebellum segmentation employing texture properties and knowledge based image processing: applied to normal adult controls and patients.

A semi-automated method is described for segmenting the cerebellum from T(1)-weighted 3-dimensional magnetic resonance imaging scans of adult controls and patients. The method relies on prior knowledge involving a user-defined template as a guide to aid the segmentation of the cerebellum. As the gray and white matter intensity distribution in the cerebellum has a complex pattern, texture information that identified the "graininess" was employed to capture the intensity distribution of voxels. The textural information was used to group voxels in a small circular structuring element as belonging to the cerebellum region. The cerebella from scans of 15 of the 20 subjects were segmented both manually and using the semi-automated procedure; the results were strongly correlated (r = 0.985, n = 15, p < 0.0001), and the volumes obtained from the two methods differed by 2.3%. The cerebellar volumes in 10 normal subjects and 10 age- and sex-matched patients with a neuropsychiatric disorder (schizophrenia) did not differ significantly (p = 0.18). The whole cerebellum was segmented in approximately 30 min using the semi-automated procedure. The method described is robust, easy-to-use, fairly fast and gives objective measurements.

Cerebellum↗

PubMedDate not supplied

Impact of HIV risk and infection and the role of prevention services.

Blood-borne infection associated with injection drug use is a significant cause of morbidity and mortality. Over the last decade, HIV infection and its clinical sequelae have had a significant impact on research and interventions involving injecting drug users (IDUs) in the United States and elsewhere. Discussed are some of the major intervention options for reducing blood-borne infections in general and HIV in particular. The use of multiple interventions is considered within the community context in which both IDUs and service providers operate. Intervention options discussed include treatment for drug dependence; voluntary and confidential HIV testing and counseling; community health outreach; bleach distribution; and easy, legal access to needles and syringes through pharmacy sales and needle exchange programs. Many surveillance and evaluative studies have examined multiple intervention efforts that include all or some of these program components and suggest positive outcomes. However, these studies tend to be limited by experimental designs that restrict attribution of causal inference. Examples of such programs in the United States and abroad are examined in terms of their potential for reducing HIV risk behaviors and averting new infections. The article concludes that diversity among AIDS prevention programs, rapid deployment (at earlier stages of epidemics), and effective coordination (minimization of interagency conflicts) are important factors in successful AIDS prevention programming and attaining disease prevention objectives.

Blood-Borne Pathogens↗

PubMed1998

Exposures at work to ionising radiation due to the use of naturally occurring radioactive materials in industrial processes.

In its role as specialist radiation protection adviser to industries in the United Kingdom, the National Radiological Protection Board has had extensive involvement with industrial users of raw materials with low activity concentrations of naturally occurring radionuclides. The magnitude of the exposure to ionising radiation in these establishments has been investigated. This paper reviews the pathways of exposure and gives estimates of worker dose in the light of revised dose coefficients. It concludes that doses are lower than previously reported and are generally in the order of a few millisieverts per year or less.

Background Radiation↗

PubMed2001

SANE (Structure Assisted NOE Evaluation): an automated model-based approach for NOE assignment.

A reliable automated approach for assignment of NOESY spectra would allow more rapid determination of protein structures by NMR. In this paper we describe a semi-automated procedure for complete NOESY assignment (SANE, Structure Assisted NOE Evaluation), coupled to an iterative procedure for NMR structure determination where the user is directly involved. Our method is similar to ARIA [Nilges et al. (1997) J. Mol. Biol., 269, 408-422], but is compatible with the molecular dynamics suites AMBER and DYANA. The method is ideal for systems where an initial model or crystal structure is available, but has also been used successfully for ab initio structure determination. Use of this semi-automated iterative approach assists in the identification of errors in the NOE assignments to short-cut the path to an NMR solution structure.

Automation↗

PubMed2003

The effects of aspirin and warfarin therapy on haemorrhage in vitreoretinal surgery.

BACKGROUND: No substantial recommendations exist regarding the management of anticoagulant drugs prior to ocular surgery. Stopping anticoagulation can cause fatal emboli, but sight-threatening bleeds may occur if anticoagulation is continued. We examined the effects of anticoagulation on vitreoretinal surgery. METHODS: Clinical details were prospectively entered on a database. The anticoagulant status of 541 consecutive patients undergoing vitreoretinal surgery was recorded. RESULTS: Sixty patients in the study were taking aspirin and seven were taking warfarin. There were 11 cases of choroidal haemorrhage, one of which involved a warfarin user. Of 325 retinal detachment repairs, 21 (6.5%) had preoperative vitreous haemorrhages. Two of these patients were on aspirin and two were on warfarin. Sixty-six vitrectomies were performed for diabetic vitreous haemorrhages, of which nine re-bled postoperatively. One of these patients was taking warfarin. The association of warfarin with bleeding was statistically significant (relative risk 6.185). CONCLUSION: Anticoagulation had no effect on the number of significant perioperative (choroidal) haemorrhages. Aspirin had little effect on bleeding during vitreoretinal surgery. Warfarin, however, was associated with bleeding complications. We suggest that aspirin should not be stopped prior to surgery. Warfarin may be stopped if the patient's thromboembolic risk is low.

Adolescent↗

PubMed1992

Diagnosing specific language impairment in adults for the purpose of pedigree analysis.

Two sets of diagnostic measures were administered to a group of 35 adults with well-documented histories of specific language impairment and to a control group of 35 normal language users. These measures involved the comprehension and production of words and sentences in formal and spontaneous speaking activities as well as measures of verbal memory and auditory temporal perceptual ability. One set of tasks was administered in a standard face-to-face setting and the other set was given over the telephone. Multivariate and univariate tests indicated that the adults with a history of specific language impairment performed more poorly on all tasks administered. A discriminant analysis of the two sets of measures indicated that four measures in each set identified language-impaired individuals with 97% accuracy for the face-to-face battery and 95% accuracy for the telephone battery. These results suggest that it should be possible to diagnose specific language impairment in the adult family members of children with specific language impairment and therefore permit accurate construction of pedigrees for specific language impairment.

Adult↗

PubMed1999

Dimensions of choice in the assessment and care management process: the views of older people, carers and care managers.

The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from whom (i.e. which provider organization and which individual care worker). Drawing on interviews with 28 older service users, 20 informal carers and 22 care managers across four local authority areas in England, the paper goes on to describe the extent to which such choices - both at the strategic/macro and operation/micro level - have increased or decreased in practice. The evidence confirms that of other recent studies that the gap between the 'ideal' of user and carer involvement and the 'reality' of everyday practice is still considerable.

Journal Article↗

PubMed2005

Characteristics of treatment provided for amphetamine use in New South Wales, Australia.

The purpose of this study was to examine the types of treatment services provided for amphetamine use, the characteristics of amphetamine treatment clients and the geographic areas most affected by amphetamine treatment provision within New South Wales (NSW), Australia. Data on completed amphetamine treatment episodes were extracted from the NSW Minimum Data Set for Alcohol and Other Drug Treatment Services for the year 2002/03 (n = 4,337). The geographic area of treatment presentations was based on the location of the treatment service, and was categorized as metropolitan, regional or rural. Treatment disproportionately affected regional and rural NSW, and treatment clients often presented with concurrent cannabis and/or alcohol problems. Clients were overwhelmingly injecting drug users with poor socio-demographic characteristics. Counselling was the most common treatment service provided, followed by detoxification and residential rehabilitation. Detoxification was usually provided in an in-patient setting, particularly within metropolitan NSW. Compliance with residential rehabilitation was notably poor. In conclusion, the development of appropriate interventions for amphetamine use needs to consider that the majority of treatment recipients will be based in a regional or rural setting, and treating amphetamine users will often involve treatment of concurrent cannabis and alcohol problems. The nature and appropriateness of treatment services provided for amphetamine use needs to be reviewed in detail, and further research is needed into the nature of problematic amphetamine use and factors affecting treatment demand in regional and rural NSW.

Adult↗

PubMed2006

Systematic development of a self-help and motivational enhancement intervention to promote sexual health in HIV-positive men who have sex with men.

The objective of this study was to describe the application of a systematic process-Intervention Mapping-to developing a theory- and evidence-based intervention to promote sexual health in HIV-positive men who have sex with men (MSM). Intervention Mapping provides a framework that gives program planners a systematic method for decision-making in each phase of intervention development. In Step 1, we focused on the improvement of two health-promoting behaviors: satisfactory sexual functioning and safer sexual behavior. These behaviors were then linked with selected personal and external determinants, such as attitudes and social support, to produce a set of proximal program objectives. In Step 2, theoretical methods were identified to influence the proximal program objectives and were translated into practical strategies. Although theoretical methods were derived from various theories, self-regulation theory and a cognitive model of behavior change provided the main framework for selecting the intervention methods. The main strategies chosen were bibliotherapy (i.e., the use of written material to help people solve problems or change behavior) and motivational interviewing. In Step 3, the theoretical methods and practical strategies were applied in a program that comprised a self-help guide, a motivational interviewing session and a motivational interviewing telephone call, both delivered by specialist nurses in HIV treatment centers. In Step 4, implementation was anticipated by developing a linkage group to ensure involvement of program users in the planning process and conducting additional research to understand how to implement our program better. In Step 5, program evaluation was anticipated based on the planning process from the previous Intervention Mapping steps.

Condoms↗

PubMed2005

A review of family donor constructs: current research and future directions.

This review addresses research on gamete donors, recipients, and offspring and demonstrates that the foci on all three within the triad are largely directed at disclosure or anonymity; and each in turn centers on the perceived importance of the genetic link. The importance attached to genetics has led some countries to review the ethics of anonymous gamete donation (e.g. New Zealand's 'open system' of information sharing) and has led other countries (Sweden, Austria, Victoria, Australia; the Netherlands, the UK) to change their laws allowing donor gamete offspring the right to obtain identifying information about their genetic parent. This review demonstrates that genealogical inconsistencies between and within members of the triad are common regardless of legislation. A discussion of future trends and concerns, relating to the use of gamete donation and the effects legislation is likely to have on the donor triads in the UK following 2005, is provided. The review also addresses the importance of testing theoretical models within future research, and argues this would lead to a better understanding of the underlying problems encountered at a psychosocial level, such as continued preference for anonymity in donors and denial in large numbers of users of the involvement of a donor in conception. Lack of disclosure effectively prevents true implementation of legislation; if a child is not informed, it is the result of donated gametes, it cannot take up the legally available option of finding out identifiable information about their genetic parent(s).

Biomedical Research↗