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At least 451 records · Page 25Linked to original sources
PubMed1996

Periodic health examination, 1996 update: 1. Prenatal screening for and diagnosis of Down syndrome. Canadian Task Force on the Periodic Health Examination.

OBJECTIVE: To make recommendations to physicians providing prenatal care on (1) whether prenatal screening for and diagnosis of Down syndrome (DS) is advisable and (2) alternative screening and diagnosis manoeuvres. OPTIONS: "Triple-marker" screening of maternal serum levels of alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol; fetal ultrasonographic examination; amniocentesis; and chorionic villus sampling (CVS). OUTCOMES: Accuracy of detection of DS in fetuses, and risks to the mother, including psychologic distress, and to the fetus from the screening and diagnostic interventions. EVIDENCE: A MEDLINE search for relevant articles published from Jan. 1, 1966, to Mar. 31, 1994, with the use of MeSH terms "Down syndrome," "prenatal diagnosis," "screening," "prevention," "amniocentesis," "chorionic villus sampling," "ultrasonography," "anxiety," "depression" and "psychological stress" and a manual search of bibliographies, recent issues of key journals and Current Contents. VALUES: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. A high value was placed on providing pregnant women with the opportunity to determine whether they are carrying a fetus with DS and to make choices concerning the termination of the pregnancy. The economic issues involved are complex and were not considered. BENEFITS, HARMS AND COSTS: Triple-marker screening identifies an estimated 58% of fetuses with DS, but it has an estimated rate of true-positive results of 0.1% and of false-positive results of 3.7% (given a risk cut-off of one chance in 190 of DS). These rates vary with maternal age and the risk cut-off chosen. Women with a known risk of having a fetus with DS (e.g., those who have had a previous child with DS) may benefit from a reduction in anxiety after confirmation that their fetus does not have DS. Screening allows women at low risk of having a child with DS to detect fetuses with the syndrome, but may cause psychologic distress if there is a false-positive screening test result. Up to 20% of women with positive results of screening tests may decline to undergo a subsequent amniocentesis. Amniocentesis and CVS are very accurate in diagnosing DS in fetuses and have a very low rate of serious complications for the mother. Amniocentesis is associated with a 1.7% rate of fetal loss when it is performed after 16 weeks' gestation, whereas the rate among controls is 0.7% (for a difference of 1%, 95% confidence interval 0.3% to 1.5%). CVS entails a greater risk of fetal loss than amniocentesis (odds ratio 1.32, 95% confidence interval 1.11 to 1.57). There is little evidence from controlled trials of significant associations between amniocentesis or CVS and neonatal morbidity or malformations; however, samples have been too small to show differences in rare outcomes. Results from some case-control studies suggest that CVS increases the risk of transverse limb deficiency. Costs were not considered because they are beyond the scope of this review. RECOMMENDATIONS: There is fair evidence to offer triple-marker screening through a comprehensive program to pregnant women under 35 years of age (grade B recommendation). Women given detailed information about serum-marker screening show more satisfaction with the screening than those not given this information. There is fair evidence to offer amniocentesis or CVS to pregnant women 35 years of age and older and to women with a history of a fetus with DS or of a chromosome 21 anomaly (grade B recommendation). Information on the limitations and advantages of each procedure should be offered. Triple-marker screening may be offered as an alternative to CVS or amniocentesis to pregnant women over 35. VALIDATION: Recommendations concerning prenatal diagnosis are similar to those of the US Preventive Services Task Force, the Society of Obstetricians and Gynaecologists of Canada, the Canadian College of Medical Geneticists and the Cochrane Pregnancy and Childbirth Group. No previous specific recommendations concerning triple-maker screening exist. SPONSORS: These guidelines were developed and endorsed by the Canadian Task Force on the Periodic Health Examination, which is funded by Health Canada and the National Health Research and Development Program.

Abortion, Eugenic↗
PubMed1996

Latex allergy: a new threat to patients and health professionals.

Because latex products are essential in preventing the transmission of blood-borne diseases, reports of severe, immediate allergic reactions to latex exposure have become a major public health concern. In recent years, immunoglobulin E (IgE)-mediated reactions to latex have been reported with increasing frequency and have been associated with anaphylaxis and death. The most severe reactions have been reported in the health care setting. Three groups appear to be at highest risk: children with spina bifida or with a history of multiple surgeries, workers with industrial exposure to latex and health care workers. This review presents the scope of this problem in the various risk groups, the different techniques available for diagnosis and the consensus on principles of management. Because latex is a component of many commonly used medical devices, including surgical and examination gloves, it behooves us to identify latex-sensitive patients and be prepared to treat allergic reactions promptly.

Anaphylaxis↗
PubMed1995

Somatic cell mutation in workers occupationally exposed to mercury vapors.

Somatic cell mutation in human peripheral lymphocytes is one of the tools used recently in the biological monitoring of the work environment. The scope of this review was to test whether biomonitoring methods are sensitive to the presence of mercury (Hg) in the body. We used the following techniques: micronucleus frequency (MN), sister chromatid exchanges (SCE), and hypoxanthine guanine phosphoribosyl transferase (HGPRT) assay in human lymphocytes. A total number of 30 male workers exposed to Hg vapors in chloralkali industry had been selected and compared with 30 control subjects. The concentration of mercury in urine (HgU) was used as a biological index of exposure. The exposed group showed higher levels of MN (32.0 +/- 1.7), SCE (7.3 +/- 0.2),and HGPRT mutations (0.94 +/- 0.01) then the nonexposed controls. We recommend the introduction of somatic cell mutation analysis in the periodic medical examination of workers exposed to Hg vapors.

Adult↗
PubMed1997

Specialized imaging techniques.

The foregoing discussion has presented a summary of many of the optical microscopic methods in use by researchers and clinicians. Along with emerging technologies, such as laser tweezers and scissors, which are outside the scope of this review, the methodologies discussed here ensure that the optical microscope will remain a central tool for biomedical research.

Diagnostic Imaging↗
PubMed1997

Some developments in brain ageing and dementia.

The aetiology of the common dementias of old age remains incompletely understood. Here we describe some of the biological, neurophysiological and psychological changes associated with ageing of the human brain, in terms of those that occur throughout life and those that are characteristic of senescence. Age-dependent diseases, such as Alzheimer's disease (AD), idiopathic Parkinson's disease (IPD) and dementia with Lewy bodies (DLB), are considered from these viewpoints, and risk factors described. Vascular dementia (VaD) is related to hypertension and atherosclerosis and detailed description of its pathogenesis is outside the scope of this review. The importance of age as the main risk factor raises basic questions about the relationship of these diseases to the ageing process itself. Similarities and differences between ageing and disease may be important for a rational approach to prevention and treatment of cognitive decline and dementia in later life.

Aging↗
PubMed1994

Oral rehydration therapy: a simple, effective solution.

Nurses assess severity of dehydration as well as prescribe and supervise oral rehydration therapy to treat the following nursing diagnosis: fluid imbalance, less than body requirements, related to diarrhea. Published literature is reviewed to address the scope of the problem in the United States, provide a historical perspective, and review the components of oral rehydration solution. The nursing management of dehydration is outlined using the nursing process. The need for further nursing research, especially related to homemade oral rehydration solution, is discussed.

Child↗
PubMed2003

A scope-of-practice survey leading to the development of standards of practice for health promotion in higher education.

To review and analyze the scope of practice of health promotion services and draft standards of quality indicators for higher education communities, the American College Health Association (ACHA) initiated a Task Force on Health Promotion in Higher Education in May 1996. Members of the task force developed a National Survey on Health Promotion and Education in Institutions of Higher Education and mailed the survey to a stratified random sample of 600 ACHA member institutions, as well as to 97 key "best-practice health promotion leaders". The larger sample produced a 75.3% response rate, and 90.7% of the key informants returned usable surveys. The authors report selected findings from both groups that chronicle the state of health promotion practice in higher education at the close of the 20th century. The task force used the findings to establish a data-driven framework for the Year 2001 Standards of Practice for Health Promotion in Higher Education.

Health Promotion↗
PubMed2003

Review article: test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

A 'test and treat' strategy is advocated for patients with dyspepsia under the age of 45 years, with endoscopy reserved for those with alarm symptoms or aged over 45 years. One of the consequences of this strategy will be a reduction in population infection rates of Helicobacter pylori. It is now clear that H. pylori is one of the prime initiators of gastric cancer with up to 70% of gastric cancers attributable to H. pylori. What remains unclear is if H. pylori reduction will lead to a reduction in gastric cancer.

Helicobacter Infections↗
PubMed2006

Clinical applications of high-density surface EMG: a systematic review.

High density-surface EMG (HD-sEMG) is a non-invasive technique to measure electrical muscle activity with multiple (more than two) closely spaced electrodes overlying a restricted area of the skin. Besides temporal activity HD-sEMG also allows spatial EMG activity to be recorded, thus expanding the possibilities to detect new muscle characteristics. Especially muscle fiber conduction velocity (MFCV) measurements and the evaluation of single motor unit (MU) characteristics come into view. This systematic review of the literature evaluates the clinical applications of HD-sEMG. Although beyond the scope of the present review, the search yielded a large number of "non-clinical" papers demonstrating that a considerable amount of work has been done and that significant technical progress has been made concerning the feasibility and optimization of HD-sEMG techniques. Twenty-nine clinical studies and four reviews of clinical applications of HD-sEMG were considered. The clinical studies concerned muscle fatigue, motor neuron diseases (MND), neuropathies, myopathies (mainly in patients with channelopathies), spontaneous muscle activity and MU firing rates. In principle, HD-sEMG allows pathological changes at the MU level to be detected, especially changes in neurogenic disorders and channelopathies. We additionally discuss several bioengineering aspects and future clinical applications of the technique and provide recommendations for further development and implementation of HD-sEMG as a clinical diagnostic tool.

Electromyography↗
PubMed2000

Teamwork in multi-person systems: a review and analysis.

As the scope and complexity of modern task demands exceed the capability of individuals to perform, teams are emerging to shoulder the burgeoning requirements. Accordingly, researchers have striven to understand and enhance human performance in team settings. The purpose of this review is to summarize that research, from the theoretical underpinnings that drive it, to the identification of team-level elements of success, to the methodologies and instruments that capture and measure those characteristics. Further specified are three important avenues to creating successful teams: team selection, task design and team training. In other words, one can select the right people, provide them with a task engineered for superior performance and train them in the appropriate skills to accomplish that task. Under task design, new technologies and automation are examined that both support and impede team functioning. Finally, throughout are provided critical remarks about what is known about teamwork and what is needed to be known to move the science and practice of team performance forward. The paper concludes with the identification of team issues that require further investigation.

Efficiency↗
PubMed2006

Identifying nursing hazards in the emergency department: a new approach to nursing job hazard analysis.

INTRODUCTION: It is widely acknowledged that nurses are crucial components in healthcare system. In their roles, nurses are regularly confronted with a variety of biological, physical, and chemical hazards during the course of performing their duties. The safety of nurses themselves, and subsequently that of their patients, depends directly upon the degree to which nurses have knowledge of occupational hazards specific to their jobs and managerial mechanisms for mitigating those hazards. The level of occupational safety and health training resources available to nurses, as well as management support, are critical factors in preventing adverse outcomes from routine job-related hazards. This study will identify gaps in self protective safety education for registered nurses working in emergency departments as well as for nursing students. Furthermore, this study reviews the nature and scope of occupational nursing hazards, and the degree to which current nursing education and position descriptions (or functional statements) equip nurses to recognize and address the hazards inherent in their jobs. METHOD: This study has three parts. First, a literature review was performed to summarize the nature and scope of occupational nursing hazards. Second, the safety components of position descriptions from 29 Veterans Affairs (VA) hospitals across the United States were obtained and evaluated by an expert panel of occupational health nurses. Finally, an expert panel of occupational health nurses evaluated the degree to which nursing accreditation standards are integrated with OSHA's list of known emergency department hazards; and a separate expert panel of occupational health nurses evaluated the degree to which current VA emergency department nursing position descriptions incorporated hazard recognition and control strategies. CONCLUSION: Ultimately, prevention of job-related injuries for nurses, and subsequently their patients, will depend directly on the degree to which nurses can identify and control the varied occupational hazards specific to jobs. Neither accreditation standards nor position descriptions adequately integrate common occupational hazard recognition and control strategies, nor do they adequately prepare nurses to identify and control hazards specific to nursing. A research approach that specifically addresses the current lack of formal on-the-job training for nurses regarding job-related hazard recognition and avoidance strategies is presented.

Emergency Service, Hospital↗
PubMed1999

Assessment of Healthy Start Fetal and Infant Mortality Review recommendations.

OBJECTIVES: We examine the scope and nature of the recommendations that emerged from the Healthy Start Fetal and Infant Mortality Review (FIMR) projects and explore their use to promote systems change. METHODS: The FIMR process of 16 of the 22 federal Healthy Start projects was reviewed. We analyzed data from a June 1996 survey developed and administered by the MCH Bureau which gathered information about recommendations produced by the FIMRs. We supplemented these data with information gathered through follow-up telephone interviews and by abstracting information from grant documents. RESULTS: The 16 Healthy Start FIMRs reviewed approximately 1300 cases between 1991 and 1996. A total of 303 specific action strategies were recommended, reflecting eighteen specific substantive areas of concern. Overall, 65% of recommendations fell under the rubric of "program" functions, 31% under "practice," and 4% under "policy." Healthy Start itself was most commonly targeted for action. The second most frequent target for action were public and private provider institutions. Public policymaking entities were rarely targeted. CONCLUSIONS: In the first several years of implementation, with few exceptions these FIMRs sought limited change. They worked almost exclusively within their own span of control to effect important, but limited changes in systems serving women and their infants. As public health professionals seek to monitor population health, the field must strengthen any and all vehicles that draw upon collaborative structures at the community level to not only uncover problems, but to address them as well.

Fetal Death↗
PubMed2003

Primer on medical genomics part V: bioinformatics.

Bioinformatics is the discipline that develops and applies informatics to the field of molecular biology. Although a comprehensive review of the entire field of bioinformatics is beyond the scope of this article, I review the basic tenets of the field and provide a topical sampling of the popular technologies available to clinicians and researchers. These technologies include tools and methods for sequence analysis (nucleotide and protein sequences), rendering of secondary and tertiary structures for these molecules, and protein fold prediction that can lead to rational drug design. I then discuss signaling pathways, new standards for data representation of genes and proteins, and finally the promise of merging these molecular data with the clinical world (the new science of phenomics).

Computational Biology↗
PubMedDate not supplied

The need for specialist nurses to work with older people.

This article is based on a comprehensive literature review undertaken by the Royal College of Nursing gerontological nursing programme on the development of specialist gerontological nursing practice (Schofield et al, 1998). The scope of the original review covered the development of specialist nursing, frameworks for practice, accreditation and regulation, role components and competencies, methods of evaluating the specialist role and fields of practice. The literature review's purpose was to inform work on the development of a specialist gerontological nursing BSc (Hons) degree by distance learning. This article focuses on the key findings of the literature review, setting out the potential for the introduction of specialist gerontological nurses in the UK.

Aged↗
PubMed1994

[The federal emission control law/monitoring practice of applications by health offices].

In accordance with a directive of the office of the Regional Government in Darmstadt, magistrates and county boards are to be involved in approval proceedings under the Pollution Control Act. In these proceedings, the health offices review and comment on the individual projects. In many cases the scope of the health office review overlaps with that of other public authorities, since a precise definition of the public health tasks has been lacking to date. In consultation with concerned parties and the approval authority, the Task Force of Hessian Health Offices (Arbeitsgemeinschaft hessischer Gesundheitsämter) has addressed this issue in principle, and has discussed and established testing criteria. In this article, we use two examples of health office reviews to present our results. We hope that the article will stimulate an exchange of experience with other health offices.

Environmental Pollution↗
PubMed2006

Risk assessment scales for pressure ulcers: a methodological review.

Much is written about risk-assessment scales (RASs) for pressure ulcers (PU) and their properties demonstrating that they are of limited value. Less is known about the reasons for these limitations and the scope for improvement. This review examines issues such as structure and scoring for the Norton, Waterlow and Braden scales, showing that the equal-weighting technique behind the current RASs is too simplistic and leads to limitations. It concludes that properly trained, experienced nurses should conduct PU risk assessments, whilst more robust data-driven RASs should be developed using the differential weighting scoring method together with advanced statistical techniques.

Data Interpretation, Statistical↗