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At least 631 records · Page 35Linked to original sources

PubMed1992

Prevention of bicycle accidents.

OBJECTIVE: To elucidate the way of reducing the number of bicycle accidents. A prospective study of all casualties from bicycle accidents attending an accident unit for a 29-month period was performed (1831 patients). A more detailed questionnaire on the causes of accidents was used for the last 12 months of the study (818 patients). RESULTS: In the 0-7 and 8-12 years age groups, 87.5 per cent and 66.2 per cent, respectively, were due to cyclist error. The 8-12-year-old cyclists were twice as likely to have caused the accident if they had not had formal training (risk ratio = 2.0). Over the age of 18 years, 41.4 per cent were due to another road user. A motor vehicle was involved in 633 of the 1831 accidents. CONCLUSIONS: Children under the age of 8 years should not be allowed on public roads. Older children should only be allowed on the roads after formal training. This should become part of the school curriculum. A campaign to increase the awareness of motorists would be expected to reduce the number of cycle accidents. It would be beneficial to dedicate more roads and tracks to cycle use. Cyclists should be encouraged to wear more protective gear.

Accidents, Traffic↗

PubMed2006

Spontaneous pneumothorax as a complication of septic pulmonary embolism in an intravenous drug user: a case report.

Infective endocarditis has been the major cause of morbidity and mortality among intravenous drug users (IDUs) with infections, mostly involving the tricuspid valve and presenting multiple septic pulmonary embolisms. Numerous pulmonary complications of septic pulmonary embolism have been described, but only a few have reported spontaneous pneumothorax. Our patient, a 23-year-old heroin addict, was hospitalized for tricuspid endocarditis and septic pulmonary embolism. Acute onset of respiratory distress occurred on his seventh hospital day and rapidly resulted in hypoxemia. Immediate bedside chest radiograph demonstrated left pneumothorax. It was thought to be a spontaneous pneumothorax, because he had not undergone any invasive procedure before the occurrence of pneumothorax. His clinical condition improved after the insertion of an intercostal chest tube. He later underwent surgery to replace the tricuspid valve as a result of the large size of the vegetation and poor control of infection. He ultimately survived. Pneumothorax is a possible lethal complication of septic pulmonary embolism in IDUs with right-sided endocarditis and should be considered in such patients when respiratory distress occurs acutely during their hospitalization.

Adult↗

PubMed1996

An audit of the cochlear implant service in Manchester.

The adult cochlear implant programme in Manchester was established in 1988 and the evaluation of the cochlear implant service involved the first 58 implants users (mean age = 51.65 years, range 19-75 years). Questionnaires were sent to implant users and their partners to evaluate the service with regard to provision of information, clinical care during in-patient assessments, waiting times, operation for cochlear implant and post-operative rehabilitation. The results show that the majority of patients (78 per cent) felt that the implant gave them as much or more benefit than expected. Areas identified for improvements include provision of more written information about cochlear implants; reduction in waiting times for first appointments; more information about the surgical risks and more instruction about home auditory training exercises for family and friends. As a consequence of the audit results the clinical practice and service provision for cochlear implantation in Manchester has been modified.

Adult↗

PubMed2000

American association of tissue banks: a historical reflection upon entering the 21st century.

The American Association of Tissue Banks (AATB) is a scientific, not-for-profit, peer-group organization founded in 1976 to facilitate the provision of transplantable tissues of uniform high quality in quantities sufficient to meet national needs. The Association was created well before there was governmental oversight of tissue banking. The organization consists of individuals involved in tissue banking, medical users, and scientists in the field. Current structure consists of a 13-member Board of Governors with specific subgroups including Musculoskeletal, Reproductive, Skin, Tissue Bank Councils and Council of Accredited Tissue Banks. A historical review shows the evolution from development of guidelines to publication of standards, and from an inspection conducted by peers to one conducted by an independent, trained professional inspector. Association growth and historical accomplishments are highlighted.

Journal Article↗

PubMed2002

The intra- and inter-examiner reliability of quantitative light-induced fluorescence (QLF) analyses.

OBJECTIVE: To assess the reliability of the analysis stage of quantitative light-induced fluorescence (QLF). The QLF analysis involves subjective input from the user and this study examines the influence of this on the reproducibility of the QLF data. METHOD: QLF images were taken of 20 human molar teeth that had been previously subjected to a demineralizing solution (phosphoric acid 37%) to create artificial white spot lesions on their buccal surfaces. Following examination of the images, 16 were chosen to represent a range of lesion size and severity. Three copies were made of the images and each was allocated a different filename. 10 examiners in three centres were asked to analyse each of the 16 images on three occasions, with at least seven days between each attempt. Simple instructions describing the analysis procedure were supplied and examiners were asked to adhere to these directions. Examiners were asked to rate each of the 16 teeth on their first attempt both quantitatively (5 point scale) and qualitatively in terms of difficulty of analysis. Data reported were the delta Q at 5% threshold for each tooth on each of three attempts. RESULTS: Using ANOVA and paired t-tests to detect statistical differences, the three attempts of each examiner were used to determine intra-examiner reliability. Only one examiner (a novice at the technique) demonstrated differences between all three attempts and two demonstrated difference between one attempt. When the mean scores were compared to determine the inter-examiner reliability, only one examiner's results were statistically different when compared with two others. CONCLUSION: This study has demonstrated that the analysis stage of QLF is reliable between examiners and within multiple attempts by the same examiner, when analysing in vitro lesions. Novices at the technique should be trained before analysing experimental data.

Analysis of Variance↗

PubMed2002

Going home from hospital -- an appreciative inquiry study.

This paper reports on a project that involved a number of agencies and groups, including older people, working together to examine and develop practice in an area of shared concern -- going home from hospital. The project was stimulated by a 'whole-system event', and was based on appreciative inquiry (AI) methodology, which has roots in both action research and organisational development. In AI, the research is directed towards appreciating what it is about the social world that is positive, and exploring this. The study was planned around three workshops to streamline data collection and analysis. Group members were also required to carry out some activities between workshops. Invitations were sent out to groups and individuals previously identified as involved or interested in the discharge process across one health district (n = 71). Workshop one discussed the planned research schedule, and introduced the basic concepts of AI. This workshop also took participants through the interview process. Each participant was asked to undertake two interviews. Thirty-five individual interviews and one focus group were completed. At workshop two, interview data were analysed by the group using the nominal group technique. Subsequent group discussion produced 'provocative propositions'. At the third workshop, provocative propositions were developed into action plans. This paper gives an overview of the study, and explores some of the issues involved when working with service users and providers as co-researchers.

Aged↗

PubMed2002

An action research project in a night shelter for rough sleepers.

From October 1999 to June 2000, an action research project was undertaken in a homeless night shelter called Jimmy's. This project was grounded in user-consultation and sought the involvement of staff and management to institute tangible improvements in service delivery using the Power Audit. A brief overview of Jimmy's is given, then this research is placed in local and national context by describing policy development in homelessness. A brief description is given of the research methodology and a short description of the Power Audit. Following this, the lives and experiences of the guests (Jimmy's residents) are conveyed using ethnography. This tells of the development of relationships with guests, staff and management without which the project could not have succeeded. Finally, an overview is provided of the interview content and the practical changes made.

Female↗

PubMed1999

Viewpoint: management of malaria--working with the private sector.

Recent reviews have demonstrated that a substantial proportion of cases of malaria are managed in the private sector, and international policy initiatives routinely emphasize the need for malaria control programmes to collaborate with the private sector. However, information on how to develop successful partnerships between the public and private sectors remains limited. This paper reviews the current knowledge about the management of malaria by private providers, considers the potential of different strategies for influencing the quality of care provided, and identifies processes for facilitating public-private sector collaborations. We contend that public sector-led interventions, such as training of private providers or the distribution of prepackaged antimalarials through the private sector, are unlikely to scale up to sustainable national level programmes if they do not take into account a wide range of needs and concerns, represented by private provider organizations and other interest groups, including service users. These groups should be involved at key stages including the design and piloting of interventions, through to the dissemination and implementation of findings. Research priorities are outlined for the development of tools to facilitate public-private partnerships for improving the management of malaria.

Antimalarials↗

PubMed2002

The changing profile of bacterial endocarditis as seen at an australian provincial centre.

BACKGROUND: The clinical profile of endocarditis has changed over the past four decades with studies showing trends towards increasing age, more nosocomial and prosthetic valve infection and increasing rates of Staphylococcus aureus infection. However, these studies have been biased by referral patterns. METHODS: We reviewed data collected at three hospitals in the Barwon-South-West region in Victoria, Australia. All cases identified between 1994 and 1999 were reviewed according to the Duke criteria. RESULTS: During this period, 58 patients were diagnosed as having endocarditis. The incidence rate during this time was 3.0 per 100 000 with a rise in the rate of admissions from 0.15 to 0.26 per 1000 from 1995 to 1999. Sixteen (28%) were nosocomial with the majority from line-related sepsis. No intravenous drug users were identified. Eighteen (31%) involved endovascular prosthetic material. S. aureus was the causative pathogen in 23 (40%), with 'viridans' streptococci contributing 12 (21%) and other organisms accounting for 12 (21%). Attributable mortality in this series was 17%. CONCLUSIONS: We have seen a rise in the rate of endocarditis during this time. The proportions of endocarditis due to S. aureus and 'viridans' streptococci, as well as rates of nosocomial and prosthetic valve infection, are consistent with more recent series at referral hospitals and district hospitals, representing a change since studies performed in the 1960s and 1970s. Our findings confirm a trend towards a clinical profile seen at referral centres and reinforce the emerging importance of S. aureus, nosocomial bacteraemia and prosthetic valve endocarditis.

Journal Article↗

PubMed2005

Lessons from the history of tobacco harm reduction: The National Cancer Institute's Smoking and Health Program and the "less hazardous cigarette".

Scientists and public health practitioners are sharply divided today over the risks and benefits of tobacco harm-reduction strategies. At the same time, a range of novel tobacco products is being marketed with claims of reduced exposure or risk. Current scientific efforts to study tobacco products and harm reduction should be informed by past experience. During the 1960s and 1970s, there was substantial support within government and academia, as well as among voluntary health organizations, for efforts to modify tobacco products to reduce harm. This paper analyzes the former National Cancer Institute (NCI) Smoking and Health Program, which, between 1968 and 1980, pursued the development of "less hazardous" cigarettes as its primary goal. During this period, the program spent over dollar 50 million on contract research, of which 74% went toward biological and chemical analysis of modified cigarettes, 9.6% to epidemiological studies of risk factors, and only 1.4% to studies evaluating smoking cessation or prevention programs. NCI officials predicted during the mid-1970s that new "low-tar" cigarette brands would substantially reduce smoking-related mortality, but by 1978 the research agenda began to change in response to a reorganization of NCI research activities, modification of government antismoking efforts, and an emerging understanding of nicotine addiction that challenged key scientific assumptions. In retrospect, the program suffered from significant weaknesses that severely limited the likelihood that it would generate knowledge beneficial to public health, including a research agenda that failed to include surveillance and behavioral research, tobacco industry influence of the research agenda, and a lack of access to information about the characteristics of products on the market. There exists today a need for a public health-oriented research agenda on tobacco products and harm reduction, but current efforts should include input from a diverse range of disciplines, collect data on users' behavior, and limit the involvement of industry scientists.

Biomedical Research↗

PubMedDate not supplied

Sensitivity of the neuronal network biosensor to environmental threats.

It is widely acknowledged that there is a critical need for broad-spectrum environmental threat detection. While cells/tissue-based biosensors have been discussed for many years as a means of meeting this critical need, these kinds of systems have met with logistic concerns, in particular with regard to stability. Our group has been working with cultured neuronal networks, which have the capacity to respond to a wide range of neuroactive compounds and are sufficiently robust to be shipped to end users. The basis of operation involves extracellular recording using thin-film microelectrode arrays where spontaneous bioelectrical activity, that is, spike firing, can be monitored in a noninvasive manner conducive for potentially long-term measurements. This work describes the current status of our efforts for the fabrication of a portable biosensor that incorporates cultured neuronal networks grown over standardized microelectrode arrays. Based on our protocol for aqueous phase sample introduction under constant flow conditions, minimal variation in mean spike rate is observed, consistent with temporal stability, such that changes of > 10% are readily distinguished. To demonstrate the capability of this system, changes are reported in mean spike rate and network synchronization resulting from exposure to different model environmental threats, cadmium and strychnine. The sensitivity of this assay approach and implications of the experimental findings for environmental threat detection are discussed.

Animals↗

PubMedDate not supplied

Digitization of medical documents: an X-Windows application for fast scanning.

This paper deals with digitization, using a commercial scanner, of medical documents as still images for introduction into a computer-based Information System. Document management involves storing, editing and transmission. This task has usually been approached from the perspective of the difficulties posed by radiologic images because of their indisputable qualitative and quantitative significance. However, healthcare activities require the management of many other types of documents and involve the requirements of numerous users. One key to document management will be the availability of a digitizer to deal with the greatest possible number of different types of documents. This paper describes the relevant aspects of documents and the technical specifications that digitizers must fulfill. The concept of document type is introduced as the ideal set of digitizing parameters for a given document. The use of document type parameters can drastically reduce the time the user spends in scanning sessions. Presentation is made of an application based on Unix, X-Windows and OSF/Motif, with a GPIB interface, implemented around the document type concept. Finally, the results of the evaluation of the application are presented, focusing on the user interface, as well as on the viewing of color images in an X-Windows environment and the use of lossy algorithms in the compression of medical images.

Database Management Systems↗

PubMed2005

The integration of macromolecular diffraction data.

The objective of any modern data-processing program is to produce from a set of diffraction images a set of indices (hkls) with their associated intensities (and estimates of their uncertainties), together with an accurate estimate of the crystal unit-cell parameters. This procedure should not only be reliable, but should involve an absolute minimum of user intervention. The process can be conveniently divided into three stages. The first (autoindexing) determines the unit-cell parameters and the orientation of the crystal. The unit-cell parameters may indicate the likely Laue group of the crystal. The second step is to refine the initial estimate of the unit-cell parameters and also the crystal mosaicity using a procedure known as post-refinement. The third step is to integrate the images, which consists of predicting the positions of the Bragg reflections on each image and obtaining an estimate of the intensity of each reflection and its uncertainty. This is carried out while simultaneously refining various detector and crystal parameters. Basic features of the algorithms employed for each of these three separate steps are described, principally with reference to the program MOSFLM.

Algorithms↗

PubMed1999

Five laws for integrating medical and social services: lessons from the United States and the United Kingdom.

Because persons with disabilities (PWDs) use health and social services extensively, both the United States and the United Kingdom have begun to integrate care across systems. Initiatives in these two countries are examined within the context of the reality that personal needs and use of systems differ by age and by type and severity of disability. The lessons derived from this scrutiny are presented in the form of five "laws" of integration. These laws identify three levels of integration, point to alternative roles for physicians, outline resource requirements, highlight friction from differing medical and social paradigms, and urge policy makers and administrators to consider carefully who would be most appropriately selected to design, oversee, and administer integration initiatives. Both users and caregivers must be involved in planning to ensure that all three levels of integration are attended to and that the borders between medical and other systems are clarified.

Chronic Disease↗

PubMed2004

Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation--part I.

A range of psychosocial interventions (PSI) have developed as approaches to the treatment and support of people with enduring mental health problems and their carers. The impact of training mental health workers in PSI has also been subject to extensive research and evaluation for the past decade. Most previous research in the PSI and PSI training arenas have tended to adopt quasi-experimental designs and professionally defined outcomes-focused approaches to judging the success of training. This paper offers a critique of such approaches and presents a rationale for the methodology used in a qualitative study that evaluated five short PSI courses. The study emphasized a stakeholder approach to evaluation, involving collaborative activities between service users, carers, lecturers and mental health workers. These activities were intended to define what outcomes should be used to judge the success of training and how these should be examined during the research process. This paper details the processes and findings of these stakeholder activities that suggested, for service users particularly, process rather than outcome issues were the most important determinants of the success of PSI. Additionally, if outcomes were used to judge the success of interventions these should be highly individualized to reflect the aspirations of the person receiving the intervention. On the basis of the findings presented, discussion explores a proposal for a different methodological direction to the evaluation of PSI training. Part II of this paper presents and discusses the findings from the evaluation of the courses.

Cooperative Behavior↗

PubMed2005

The information needs and preferred roles in treatment decision-making of parents caring for infants with atopic dermatitis: a qualitative study.

BACKGROUND: Information needs and preferences in treatment decision-making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information-giving and involvement of health-care users in treatment decisions. OBJECTIVE: To explore information needs and decisional role-preferences of parents caring for infants with AD. METHODS: Qualitative study. Purposive sample: 31 parents caring for infants with AD. Tape-recorded focussed conversation-style interviews. Interview topic-guide literature-derived. Control Preferences Scale (5 sort-card vignettes 'very active' to 'very passive' role) adapted for use with parents; used to facilitate discussion. Thematic analysis of verbatim transcripts. RESULTS: Nine core information needs identified: AD-causation, role of diet, medication-use, medication-side-effects, exacerbating factors, new/alternative medication, nonpharmacological treatments, AD-prevention, AD and other atopic conditions. Parents desired verbal and written information. Many felt their baby's condition was not taken seriously, leading to delayed diagnosis and treatment. They had to be more active than they wished to obtain information/treatment. Parents preferred sharing decisions with their doctor. CONCLUSIONS: Parents caring for infants with AD have clearly defined, unmet information needs, forcing them into more active roles in the treatment decision-making process than they desire. The study-findings may inform the development of written information specifically for these parents and improve partnership during consultations.

Adult↗

PubMed2006

The development of an innovative education curriculum for 11-16 yr old children with type 1 diabetes mellitus (T1DM).

BACKGROUND: Evidence-based, structured education is recommended for all people with diabetes; tailored to meet their personal needs and learning styles. Adult courses exist in the UK but are of limited value for children. The aim of this study was to adapt the adult Dose Adjustment For Normal Eating (DAFNE) course to design a skills training course, for children aged 11-16 yr, focusing on self-management skills within an intensive insulin regime. To ensure that the course format meets the developmental, intellectual and social needs of children and adolescents and is delivered using educationally sound techniques. METHODS: Relevant professionals and potential users of the course were involved in curriculum design and content in the following ways: (i) The views of 95 pediatric diabetes specialist nurses were sought through a postal survey; (ii) Focus group discussions were conducted with children with type 1 diabetes mellitus (T1DM) and their families to contribute to content and design; and (iii) Secondary school teachers worked with experienced pediatric diabetes staff advising on educational content and teaching format. RESULTS: The developed curriculum uses a progressive modular-based structure to improve self-management in a variety of medical and social situations. It has clear learning objectives and is based on the format of UK schools curricula. Additional support is provided through dedicated parent sessions, involvement of friends and the provision of a school resource pack. CONCLUSION: Collaborative working between health professionals, school teachers and families has resulted in an age-appropriate curriculum, which employs validated educational techniques. This will be refined following pilot courses before formal evaluation in a multicentre randomized controlled trial.

Adolescent↗

PubMed1998

Nonsteroidal antiinflammatory drug use and gallstone disease prevalence: a case-control study.

OBJECTIVES: Conflicting results on the relationship between gallstone disease and the use of nonsteroidal antiinflammatory drugs (NSAIDs) have been reported, but studies on the effect of NSAID use in populations not selected on the basis of a high risk for gallstone development are still lacking. METHODS: We conducted a case-control study involving 216 patients, regular NSAID users (43 men and 173 women) consecutively admitted to a rheumatology department, suffering from rheumatoid arthritis (n = 147), osteoarthritis (n = 49), and ankylosing spondylitis (n = 20). Two-hundred sixteen patients who were not NSAID users, matched for gender, age, and body mass index, consecutively admitted to a medical department for various medical pathologies, acted as a control group. All patients underwent upper abdomen ultrasonography. RESULTS: The overall prevalence of gallstones was similar in the two groups: 24.0% in NSAID users (15.7% actual stones and 8.3% previous cholecystectomy) and 21.3% in controls (13.9% gallstones and 7.4% cholecystectomy). The prevalence of gallstone disease was significantly higher in women than in men, and the mean age was higher in gallstone patients than in gallstone-free patients, in both groups. No significant differences in type and duration of arthritis condition, type and dose of NSAID taken, and duration of treatment between gallstone patients and gallstone-free patients were found. On logistic regression analysis only female gender, aging, and family history of gallstone disease were significantly associated with the presence of gallstones, whereas no relationship between NSAID use and gallstone disease was found. CONCLUSIONS: Chronic NSAID ingestion does not seem to prevent gallstones in arthritis patients; in these patients gallstone disease is associated with classic risk factors (female gender and age).

Age Factors↗