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PubMed2006

Resident physicians' competencies and attitudes in delivering a postnatal diagnosis of Down syndrome.

OBJECTIVE: This study responded to the need expressed by physicians and parents alike for improved medical information and support to families upon the initial diagnosis of Down syndrome at birth. The purpose was to assess obstetrics and gynecology and pediatrics residents' cognitive knowledge about Down syndrome and comfort in counseling parents with a newborn child with Down syndrome before and after intervention (resident viewing and interaction with the educational material). METHODS: A team of physicians, parents, and educational specialists developed an interactive CD-ROM that asked resident physicians to read and view virtual patient-doctor sessions, and provide their own responses to critical situations related to Down syndrome diagnoses. The research tested both knowledge and attitude change, as well as the effectiveness of an interactive CD-ROM as a pedagogical tool. RESULTS: Our effectiveness study yielded positive and significant improvement in knowledge and level of comfort changes with both obstetrics and gynecology and pediatric physicians in residence at the University of Kentucky. Residents also found the technologically based interactive type of instruction to be usable and valuable. CONCLUSION: Teaching physicians to impart accurate and balanced information about Down syndrome at the initial point of diagnosis can be achieved, in part, through training with the CD-ROM. From a broader perspective, this effectiveness study suggests the potential applications of these communication strategies not only to families who have a child with Down syndrome, but also to those with other life-altering disabilities. LEVEL OF EVIDENCE: II-3.

Adult↗

PubMed2001

Sequence databases and microarrays as tools for identifying prostate cancer biomarkers.

Identification, acquisition, and assessment of molecular markers that could be adopted as surrogate endpoints for evaluating a response to prostate cancer intervention strategies is highly desirable. Recent advances in the fields of genomics and biotechnology have dramatically increased the quantity and accessibility of molecular information that is relevant to the study of prostate carcinogenesis. One major advance involves the construction of comprehensive databases that archive gene sequences and gene expression data. This information is in a format suitable for virtual queries designed to distinguish the molecular differences between normal and cancer cells. A second major advance uses robotic tools to construct microarrays comprising thousands of distinct genes expressed in prostate tissues. Such arrays offer a powerful approach for monitoring the expression of thousands of genes simultaneously and provide access for techniques designed to assess patterns or "fingerprints" of gene expression that may ultimately be used as signatures of response to therapeutic intervention.

Base Sequence↗

PubMed2006

Effectiveness of an incentive-based online physical activity intervention on employee health status.

OBJECTIVE: The objective of this study was to test whether a financial incentive integrated with health benefits for an online physical activity program was associated with increased employee participation and improved health status among participants compared with nonparticipants. METHODS: Participation in the Virtual Fitness Center (VFC), an online physical activity program associated with a 150 dollars cash rebate, was assessed. Risk status for 2004 VFC participants and nonparticipants was compared using a health risk appraisal. RESULTS: A total of 53.8% of total eligible employees were VFC participants and reduced their risk for physical inactivity (8.4% points), life dissatisfaction (2.1), low perception of health (1.9), high risk status (1.3), smoking (0.4), and high body weight (0.2). CONCLUSIONS: Providing a cash incentive is one strategy for encouraging VFC participation and eliciting improved health status in an employer-sponsored, web-based physical activity program.

Adult↗

PubMed2004

End-of-life after birth: death and dying in a neonatal intensive care unit.

OBJECTIVE: In canonical modern bioethics, withholding and withdrawing medical interventions for dying patients are considered morally equivalent. However, electing not to administer cardiopulmonary resuscitation (CPR) struck us as easily distinguishable from withdrawing mechanical ventilation. Moreover, withdrawing mechanical ventilation from a moribund infant "feels" different from withdrawing mechanical ventilation from a hemodynamically stable child with a severe neurologic insult. Most previous descriptions of withdrawing and withholding intervention in the neonatal intensive care unit (NICU) have blurred many of these distinctions. We hypothesized that clarifying them would more accurately portray the process of end-of-life decision-making in the NICU. METHODS: We reviewed the charts of all newborn infants who had birth weight >400 g and died in our hospital in 1988, 1993, and 1998 and extracted potential ethical issues (resuscitation, withdrawal, withholding, CPR, do-not-resuscitate orders, neurologic prognosis, ethics consult) surrounding each infant's death. RESULTS: Using traditional definitions, roughly half of all deaths in our NICU in 1993 and 1998 were associated with "withholding or withdrawing." In addition, by 1998, >40% of our NICU deaths could be labeled "active withdrawal," reflecting the extubation of infants regardless of their physiologic instability. This practice is growing over time. However, 2 important conclusions arise from our more richly elaborated descriptions of death in the NICU. First, when CPR was withheld, it most commonly occurred in the context of moribund infants who were already receiving ventilation and dopamine. Physiologically stable infants who were removed from mechanical ventilation for quality-of-life reasons accounted for only 3% of NICU deaths in 1988, 16% of NICU deaths in 1993, and 13% of NICU deaths in 1998. Moreover, virtually none of these active withdrawals took place in premature infants. Second, by 1998 infants, who died without CPR almost always had mechanical ventilation withdrawn. Finally, the median and average day of death for 100 nonsurvivors who received full intervention did not differ significantly from the 78 nonsurvivors for whom intervention was withheld. CONCLUSIONS: In our unit, a greater and greater percentage of doomed infants die without ever receiving chest compressions or epinephrine boluses. Rather, we have adopted a nuanced approach to withdrawing/withholding NICU intervention, providing what we hope is a humane approach to end-of-life decisions for doomed NICU infants. We suggest that ethical descriptions that reflect these nuances, distinguishing between withholding and withdrawing interventions from physiologically moribund infants or physiologically stable infants with morbid neurologic prognoses, provide a more accurate reflection of the circumstances of dying in the NICU.

Cause of Death↗

PubMed2026

Effectiveness of digital health technologies for post-discharge follow-up and management in older adults: a systematic review.

Older adults (≥65 years) are a rapidly growing population that are experiencing a higher number of hospitalisation admissions, longer hospital stays, and greater hospitalisation-related costs than younger adults. There is an important gap in post-discharge care for older adults, and digital technologies, such as video visits, mobile health apps, and remote patient monitoring, may support follow-up and management after hospital discharge. This systematic review examined the effectiveness, feasibility, acceptability, and impact (ie, effects on rehospitalisation, quality of life, mental health, adherence, and patient satisfaction) of technology-based interventions used for the follow-up and management of older adults after hospital discharge. MEDLINE (via PubMed), Scopus, and Web of Science were searched from database inception to January, 2026. The search identified 1972 records, of which 46 studies met the inclusion criteria: older adult populations (aged ≥65 years), a technology-based intervention, post-discharge follow-up or management, and empirical data. Overall, digital post-discharge interventions were reported to be feasible, with good engagement, adherence, compliance, and retention; low dropout rates; and positive patient satisfaction. However, mixed findings were reported regarding rehospitalisation rates and mental health outcomes for virtual care compared with those for traditional care. Digital health technologies might represent a promising step towards improving post-discharge health care and continuity of care for older adults.

Journal Article↗

PubMed1995

Lipopolysaccharide signal transduction, regulation of tumor necrosis factor biosynthesis, and signaling by tumor necrosis factor itself.

In recent years, the chain of events that connects introduction of bacterial endotoxin (lipopolysaccharide; LPS) into a mammalian host, and the syndrome of organ damage and vascular collapse that ensues, have come into sharper focus. Several of the molecules that engage LPS, and a rough outline of the signaling cascade that leads to cytokine release from mononuclear cells, have been elucidated. The principal cytokines that mediate the untoward effects of LPS have also been identified. The most important of these is tumor necrosis factor (TNF), which elicits biologic responses from virtually every type of cell to which it binds. Two distinct receptors transduce the TNF signal. Mechanisms of TNF receptor action are becoming increasing clear, and there is reason to hope that, through intervention at many distinct levels, the devastating effects of LPS might be attenuated or averted.

Animals↗

PubMedDate not supplied

Paediatric anaesthetic emergencies.

There is nowadays virtually no contraindication to anaesthesia for even small, sick neonates provided that adequate resuscitation is first carried out. Furthermore, apart from severe trauma and airway difficulties, very few paediatric surgical emergencies require immediate intervention. Most emergencies can be treated within a few hours, preferably when the full facilities of the hospital are available.

Adolescent↗

PubMed2004

Forest cover change, physiography, local economy, and institutions in a mountain watershed in Nepal.

This study assessed changes in forest cover in a mountain watershed in central Nepal between 1976 and 2000 by comparing classified satellite images coupled by GIS analyses, and examined the association of forest change with major physiographic, economic, and local forest governance parameters. The results showed an increase in forested area (forest plus shrublands) by 7.6% during 1976-2000. Forest dynamism (changes including improvement, deterioration, gain, and loss) was highest in low-elevation, south-facing and less-steep slopes that were closer to roads. Proportionately the highest net improvement and gain to forested area also took place in those locations. Forest degradation occurred at twice the rate of improvement in high elevation areas (> 2300 m). Forests located in urban and semiurban areas (i.e., a market-oriented economy) experienced a proportionately higher amount of net improvement and gain than forests in rural areas (i.e., a subsistence economy). Among the three governance arrangements, proportionately the highest net improvement and gain took place in semigovernment forests (forested area legally under the forest department but with de facto control and claim of ownership by local communities and/or municipality) followed by formalized community forests (including leasehold). Government forests, which were mostly found in the southern high mountains and had virtually open access, remained relatively stable during the study period. Over 50% of the watershed forests have not come under community-based management despite favorable policy and more than two decades of government intervention with continuous donor support. The findings indicate that the present "one size fits all" approach of community forest handover policy in Nepal needs rethinking to accommodate biophysical and socioeconomic variations across the country.

Altitude↗

PubMed2004

Reliability of maximal strength testing in older adults.

OBJECTIVES: To determine (1) the reliability of a maximal strength test (1 repetition maximum) [1-RM] in older adults and (2) the impact of differing periods of familiarization. DESIGN: Within-subject, repeated trials of maximal strength. SETTING: Community-based senior center. PARTICIPANTS: Forty-seven independently living men (n=16) and women (n=31), with a mean age of 75.4+/-4.7 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Systematic error (shift in mean) and random error (% coefficient of variation [%CV]) was assessed between consecutive pairs of 1-RM trials. RESULTS: For the bench press, systematic error was virtually eliminated for men between trials 2 and 3 (0.7%; 95% confidence interval [CI], -2.7% to 4.3%). The CV was stable (4.7%-7.3%) across all trials in both genders. For the leg press, a significant but clinically small systematic error (3.6%, P<.05; 95% CI, 0.8-6.6) was evident for women between trials 2 to 3. The CV was reduced across trial pairs by 3.3% for men and 0.9% for women. Three versus 6 or more sessions of familiarization produced small clinical differences in systematic error (< or =4.1%) and CV (< or =0.2%) between trials 2 and 3 for both lifts. CONCLUSIONS: Reliability is an indispensable requirement for valid test outcomes. Our results show that, in this group of older adults, 3 familiarization sessions and 2 to 3 test trials produced highly reliable 1-RM measures. Additional periods of familiarization added little to test reliability. Effective reliability testing for 1-RM is a practical and attainable goal for outcomes based practitioners.

Aged↗

PubMed2000

[Euthanasia in Europe--ten countries with special consideration of the Netherlands and Germany].

This article presents an overview of the current situation of euthanasia in Europe. Emphasis is given to the positions discussed in the Netherlands and in Germany. The current situation, the development of the legal positions, and the resulting debate are established by analysing English and German anesthesiological and medical-ethical journals. It has to be noted that many physicians are not satisfied with the terminology of euthanasia. The traditional concepts of euthanasia do not cover the aspect of accompanying terminally ill persons until they have died. The differentiation of active, passive, and indirect euthanasia does not correspond to the practical handling of the problem. Many physicians are in need of an open discussion of euthanasia-related issues. The way euthanasia is practiced in the Netherlands has strongly influenced the further development of the debate in Europe. Even though the Dutch model is rejected by the jurisdications of virtually all other countries, and official statements of medical corporations stick to the disapproval of active euthanasia, studies examining the attitudes towards euthanasia and the treatment of it in daily routine show that active interventions to shorten life are performed to different degrees outside of the Netherlands as well.

Europe↗

PubMed1996

Minimally invasive neurosurgery.

BACKGROUND: The philosophy and practice of minimally invasive surgery have fundamentally altered the practice of general and gynaecological surgery, and are currently transforming the practice of neurosurgery. The goal of minimally invasive surgery is to reduce tissue disruption and thus morbidity. This is a review of the development, applications, and benefits of minimally invasive neurosurgery, and its wider surgical implications. METHODS: A synthesis of the literature is presented. RESULTS: Interactive computer imaging with frame-based and frameless stereotaxy, ultrasonographic and endoscopic techniques are increasingly being used independently and in combination in order to execute minimally invasive approaches and to navigate a safe path within the cranium or spine. Interaction using an interlinking stereotactic instrument or robot between the surgeon, a graphic interface (such as a computer workstation) and the patient, enables precise planning and execution of surgery with exact correspondence of imaging data and the living pathology. The direct influence of virtual reality, cybernetics, robotics, and telepresence will further revolutionize the practice of neurosurgery and will impact increasingly on other surgical disciplines. Safety and precision are further enhanced by intra-operative physiological monitoring techniques. Interventional neuroradiology and stereotactic radiosurgery add further dimensions to the minimally invasive approach and may not only diminish the need for open surgery, but in selected cases obviate the need altogether. CONCLUSIONS: Minimally invasive neurosurgery is a major force in contemporary neurosurgery and many of the current neurosurgical applications will have far-reaching effects on the practice of surgery in general.

Brain↗

PubMed2005

Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study.

BACKGROUND AND PURPOSE: Virtual reality (VR) is a new promising computer-assisted technology to promote motor recovery in stroke patients. VR-induced neuroplasticity supporting locomotor recovery is not known. We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients. METHODS: Ten chronic stroke patients were assigned randomly to either the control group or the VR group. VR was designed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning. Laterality index (LI) in the regions of interests (ROIs) and locomotor recovery were measured before and after VR using functional MRI (fMRI) and standardized locomotor tests, respectively. The t test and nonparametric test were performed to compare the mean differences at P<0.05. RESULTS: There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex (SMC) between the groups (P<0.05), indicating that VR practice produced a greater increase in LI for the control group. However, the interval changes in the other ROIs were not significantly different (P>0.05). Motor function was significantly improved after VR (P<0.05). CONCLUSIONS: Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation. This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke. This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR.

Brain↗

PubMed2002

Psychiatric disorders in rescue workers after the Oklahoma City bombing.

OBJECTIVE: Psychiatric disorders were studied in a volunteer group of 181 firefighters who served as rescue/recovery workers after the Oklahoma City bombing. METHOD: Approximately 34 months after the disaster, the authors retrospectively assessed psychopathology both before and after the bombing with the Diagnostic Interview Schedule. Findings for male rescue workers were compared with those of male primary victims who had been in the direct path of the blast and who had been assessed with the same instrument. RESULTS: The prevalence of posttraumatic stress disorder related to the bombing was significantly lower in male rescue workers (13%) than in male primary victims (23%). High rates of alcohol disorders (postdisaster: 24%; lifetime: 47%) were seen among all rescue workers, with virtually no new cases occurring after the bombing. CONCLUSIONS: The resilience seen in firefighters may be related to their career selection, their preparedness and experience, the fewer injuries they suffered, and postdisaster mental health interventions. However, alcohol disorders were endemic before the disaster, indicating a need for ongoing programs targeting this problem.

Adult↗

PubMed2000

New developments in schizophrenia.

BACKGROUND: Over 2% of the population suffer from schizophrenia and related psychoses. Virtually all sufferers now live in the community, and go to see their general practitioners. OBJECTIVE: To overview recent developments in the presentation and causes of schizophrenia and its treatment with medication and psychosocial intervention. DISCUSSION: The diagnostic boundaries of schizophrenia have become less distinct as aetiological and therapeutic similarities between schizoaffective and affective psychoses have emerged. The importance of specific symptom groups (positive, negative, cognitive, manic, depressed) with respect to brain mechanisms and response to treatment has been recognised. It is now thought that recognition of early phase illness and vigorous treatment aimed at relapse prevention may improve long term prognosis. Availability of new medications has improved outcomes. Patients with schizophrenia living in the community need a range of services best delivered through collaborative care between GPs, community and specialist services.

Antipsychotic Agents↗

PubMed1991

[A descriptive study of 105 patients with cerebral metastasis].

BACKGROUND: To investigate the hospital frequency and natural history of patients with cerebral metastases (CM). METHODS: A retrospective study of patients seen because of CM from 1984 to 1989. They were identified from the discharge reports and the cancer registry (CR). Data of interest were taken from the clinical record and the CR. RESULTS: 105 patients were identified. Mean age was 60 years. There were 77 males. In 44 patients cancer past history was present, in 33 lung cancer was simultaneously diagnosed and in 28 there was no past cancer history and the primary neoplasm was not identified. CM were multiple in 49 patients. In 18 patients CM was single, with no extracerebral neoplasia. Craniotomy was carried out in 22 patients and 11 received postoperative radiotherapy. The probability of one-year survival in the operated and nonoperated group was 27% and 1.5%, respectively (27 +/- 20% and 1.5% +/- 1.5%; 95% confidence intervals). CONCLUSIONS: The frequency of the diagnosis of CM is not negligible and its occurrence virtually always represents a fatal prognosis. About one half are caused by a lung cancer that may have clinically presented with CM. Poor general condition, multiple CM or extracerebral neoplastic disease prevent radical therapeutic intervention in nearly 80% of these patients. Survival with palliative therapy is shorter than that with surgical treatment.

Adult↗

PubMedDate not supplied

Breast reconstruction using tissue expanders.

Breast reconstruction options are available to virtually all women undergoing mastectomy. Breast reconstruction may increase the woman's self-esteem and foster a more positive body image. Tissue expansion provides a means of developing breast symmetry with minimal surgical intervention. It can be used when the skin and soft tissue remaining after mastectomy are of good quality but inadequate quantity. The nurse's role encompasses physical and psychological support and patient education.

Breast↗

PubMed1979

Long duration subarachnoid anaesthesia with continuous epidural block.

UNLABELLED: A method of spinal anaesthesia with Dixidextracaine-70 (a mixture of xylocaine 40.0 mg + percaine, 10.0 mg+ Dextran-70, 60,0 mg+ distiled water ad 2.0 ml) with continuous epidural block has been tested in 150 patients. The advantages of this association are: the possibility of obtaining a high quality conduction anaesthesia, virtually unlimited in time, the ability to extend over several anatomical regions the surgical field, minimal toxicity, the absence of postoperative pulmonary complications, and the economy. Drawbacks are: the need for two vertebral punctures, the longer induction time of anaesthesia and some difficulty in finding the subarachnoid space after catheterisation of the epidural space. The indications of the method include subdiaphragmatic surgery, interventions on more than one anatomical region, surgery in aging patients, patients with full stomach, and those with anaesthetic and surgical risk, as well as socioeconomic factors which may prevent application of a differentiated and safe narcosis. CONTRAINDICATIONS: those of subarachnoid and epidural block. The incidents and accidents are minimal and specific to both techniques. The fear of producing total subarachnoid anaesthesia by injection of the anaesthetic solution in the epidural space after puncture of the subarachnoid space is virtually unfounded.

Adolescent↗

PubMed1992

Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop.

Idiopathic dilated cardiomyopathy (IDC) is the primary indication for cardiac transplantation, with associated costs of approximately $177 million per year. Recognizing the economic implications of IDC, the increasing incidence, and the limited information on pathogenesis and prognosis, the National Heart, Lung, and Blood Institute convened a workshop on the Prevalence and Etiology of Idiopathic Dilated Cardiomyopathy on June 13 to 14, 1991. The difficulties of studying the disease were reviewed, including its relatively low prevalence, its potentially pluricausal nature, and the fact that it is often a diagnosis of exclusion. Still, it presents significant challenges to the cardiovascular scientific community, since the mechanism of myocardial damage and related etiologic and prognostic factors are virtually unknown. The development of more reliable measures of immune-mediated damage and noninvasive measures of impaired cardiac function present new research opportunities in this disorder. Standardized diagnostic criteria for use in observational and interventional trials were developed, and priorities for future research were proposed. Population-based registries and nested case-control studies, where feasible, are appropriate study designs for tracking incidence and prevalence, and for identifying risk factors, respectively. Interventional studies should focus on secondary prevention, through modifying immune-mediated damage in clinically evident dilated cardiomyopathy, and through prevention of sudden death in patients with the disorder. Primary prevention trials must await the identification of modifiable risk factors and of appropriate and effective interventions.

Cardiomyopathy, Dilated↗