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At least 667 records · Page 37Linked to original sources

PubMed2004

Development of an applied cognition scale to measure rehabilitation outcomes.

OBJECTIVE: To examine the structure and content coverage of an item pool of new items based on the Activity categories from the International Classification of Functioning, Disability and Health and items from existing instruments to measure the applied cognition dimension of function. DESIGN: Prospective study. SETTING: Four postacute care rehabilitation settings (inpatient, transitional care, home care, outpatient) in an urban-suburban area of northeast United States. PARTICIPANTS: Convenience sample of 477 patients (mean age, 62.7 y) receiving rehabilitation services for neurologic, orthopedic, or complex medical conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were administered applied cognition items from the new Activity Measure for Post-Acute Care, the Medical Outcomes Study 8-Item Short-Form Health Survey, and an additional setting-specific measure: the FIM instrument (inpatient rehabilitation); the Minimum Data Set (skilled nursing facility); the Minimum Data Set-Post Acute Care (postacute settings); or the Outcome Assessment and Information Set (home care). Rasch (partial-credit model) analyses were conducted to examine item fit, item coverage, scale unidimensionality, and category difficulty estimates. RESULTS: The majority of items (46/59) could be located along a single continuum. Relatively few people were performing at the lower end of the difficulty scale, and about 25% were at ceiling. CONCLUSIONS: The proposed definition of applied cognition dimension provides a useful guide for item development to measure this dimension. Further work is needed to determine how best to measure function in this domain for people at the upper and lower ends of the continuum.

Adult↗

PubMedDate not supplied

Determining sources for formal nursing terminology systems.

OBJECTIVE: The purpose of this study is to assess the relative merits of aspects--labels or informal definitions--of traditional nursing terminology systems as the foundational sources for target formal nursing terminology systems. DESIGN: This study builds upon and compares the findings of two previous experiments in which formal terminology systems, one based on informal definitions, the other based on labels, were developed under the GALEN approach and used to generate hierarchies of nursing interventions drawn from the Nursing Interventions Classification. MEASUREMENTS: The two generated hierarchies were compared to see whether, and to what extent, they captured a test set of hierarchical relationships implicit within and derived from the Nursing Interventions Classification. An analysis of the relevant conceptual representations was carried out in those cases where a hierarchical relationship from the test set was absent from either of the generated hierarchies. RESULTS: The hierarchy generated from the formal terminology system based on informal definitions contained none of the test set of hierarchical relationships. Reasons included structural differences between conceptual representations; different levels of specificity; and deficiencies within the formal terminology system itself. The hierarchy generated from the formal terminology system based on labels contained all but one of the test set. The reason for the one absence was inconsistent usage within source and target. CONCLUSIONS: While it may be possible to derive formal terminology systems from informal definitions for nursing interventions, the inherent complexity within those informal definitions brings into question the utility of such systems. This study demonstrates that it may be more productive to base formal nursing terminology systems on labels, simpler sources with limited discursive content and a higher degree of consistency.

Computational Biology↗

PubMed2026

High-Fat Diet and a High Amyloid Load Interact to Induce PKC-α Dependent Synaptic Insulin Resistance.

A plethora of studies suggest that a high-fat diet in combination with a high amyloid load causes synaptic insulin resistance and is a risk factor for Alzheimer's disease. Our understanding of the underlying mechanisms is still fragmented. To gain new insights, we conducted integrated proteomic and phosphoproteomic profiling of hippocampal synaptosomes from WT and a transgenic mouse line with a high amyloid load (heterozygous TBA2.1 mice) that show no overt signs of neurodegeneration and dementia. Mice were fed with a regular or high-fat diet. Data-independent acquisition quantified over 5400 proteins, revealing a stable synaptic proteome across conditions. However, the combination of high amyloid load and high-fat diet triggered coordinated remodeling of lipid metabolism pathways, particularly mitochondrial and peroxisomal fatty acid catabolism. Phosphoproteomic analysis showed pronounced activation of lipid- and stress-responsive kinases, including protein kinase C-α, along with increased inhibitory phosphorylation of insulin receptor substrates (IRS1/2). In vitro experiments indicate that blocking protein kinase C-α indeed prevents synaptic insulin resistance in primary neurons. The findings suggest that this proteomic workflow, combined with kinase pathway analysis, can reveal nodal points for interventions in a complex disease state with a trajectory to Alzheimer's disease.

Animals↗

PubMed2002

Amplification and expression of genes from the 17q11 approximately q12 amplicon in breast cancer cells.

Amplification of a portion of 17q11 approximately q12 involving the human epidermal growth factor receptor-2 (HER-2/neu) gene is common in solid tumors. HER-2/neu amplification in breast cancer is associated with a poor prognosis and may predict response to therapeutic interventions. The molecular complexity and informative content of the 17q11 approximately q12 amplified DNA remain largely unknown. Study of available sequence information in public database allowed us to construct a contig in bacterial artificial chromosome that covers this region. We have identified a several hundred kilobase core segment from this region that is amplified in three out of three breast cancer cell lines with HER-2/neu amplification. There is striking correlation between amplification and overexpression of genes from this region. Amplified and overexpressed genes, in addition to HER-2/neu, may play functional roles in the pathogenesis of breast cancer and may serve as additional targets for therapy. Published by Elsevier Science Inc.

Breast Neoplasms↗

PubMed1999

Changes in renal function with percutaneous transluminal coronary angioplasty.

There is concern about adverse effects on renal function in patients with prolonged cardiac intervention procedures, when contrast media is used. To investigate this further we studied changes in renal function in 104 patients (79 male, 25 female; mean age 59.2, SD 9.8) undergoing routine elective percutaneous transluminal coronary angioplasty (PTCA), where 28 (27%) patients had concomitant stent implantation. There was associated diabetes in 15 patients (14%) and previous hypertension in 44 (blood pressure >160/90 mmHg, 44%). None of the patients were known to have congestive heart failure at the time of procedure or chronic renal failure (defined as serum creatinine >200 pmol/l). There was no significant change in mean serum urea pre- and post-PTCA (mean change -0.04 mmol/l, paired t-test P=0.90). However, there was a small rise in serum creatinine pre- and post-PTCA of borderline significance (mean change +5.8 micromol/l, P=0.051). Of the whole cohort, 65 patients (63%) had a rise in mean serum creatinine, whilst 45 (43%) showed a rise in serum urea levels. This deterioration in renal function was related to a difference in the procedure duration, but there were no statistically significant differences in mean age or volume of contrast media (Iopamide 340) between patients with or without deterioration in renal function. Patients with a rise in serum creatinine had lower baseline (pre-PTCA) serum urea and serum creatinine levels. In patients undergoing stent implantation, there was a higher quantity of contrast media, screening time and procedure duration. There were no significant differences in age, pre-PTCA serum urea and creatinine levels, and mean change in serum urea or creatinine levels in patients with and without stent usage. Whilst severe renal dysfunction following PTCA is uncommon, we suggest that some caution is necessary during PTCA or other cardiac interventions where more complex or prolonged procedures necessitating large volumes of contrast media use.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

[Pharmacological and molecular aspects of the regulation of eating behavior. With special reference to the role of catecholamines and effects of amphetamine].

Among the numerous endogenous substances involved in the regulation of feeding behaviours, the catecholamines are in the front rank. The numerous studies devoted to this aspect of catecholamines emphasize the importance and complexity of their intervention. Depending on the cerebral structures on which they act and on whether noradrenaline or dopamine are concerned, orexigenic or anorexigenic effects have been described. Alpha-2 and beta adrenergic receptors as well as D1 and D2 dopaminergic receptors participate in these effects. Amphetamine, which is an indirect catecholaminergic agonist, mobilizes neuronal catecholamines and fosters their various effects. Moreover, it exercises direct effects by its association with sites borne by glycaemia-sensitive neurons. This target seems to be common to a wide variety of anorectic agents. They are thought to reproduce on this hypothalamic "glucostat" the effect of a high blood glucose level, thus triggering off signals of satiety. In this unifying hypothesis, the diverse pharmacological profiles these agents are known to possess would result from associated properties.

Amphetamine↗

PubMed2002

Simultaneous open and closed dislocations of adjacent metacarpophalangeal joints: a case report.

Metacarpophalangeal joint (MCP) dislocations are uncommon, and when open are often complex, requiring surgical intervention for reduction. A 38-year-old man presented to the Emergency Department (ED) with simultaneous open and closed dorsal dislocations of adjacent MCP joints of the index and long fingers that were successfully treated by closed reduction in the ED. Injuries to the MCP joint can severely affect hand function when treatment is delayed and, thus, it is an accepted principle that definitive treatment should be achieved as quickly as possible for optimal functional outcome. In the case of dorsal dislocations of the MCP joints, aggressive ED intervention followed by brief immobilization and early hand therapy referral may result in dramatic clinical improvement for the patient without the need for surgery.

Adult↗

PubMed1999

Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: An ex vivo analysis.

OBJECTIVE: Although percutaneous angioplasty and stenting (PTAS) of carotid bifurcation lesions is feasible and appropriate for surgically inaccessible lesions, its general role and comparative value remain unclarified. Moreover, the acceptance of carotid PTAS has been limited by its potential for producing embolic debris. This study used an ex vivo model to evaluate the efficacy of a novel filter device to entrap emboli during PTAS of human carotid plaques. METHODS: Eight carotid bifurcation plaques were obtained from patients who underwent carotid endarterectomy for high-grade atherosclerotic stenosis (>90%). The mean age of the patients was 63 years, and six patients were symptomatic. Each plaque was encased with polytetrafluoroethylene material to simulate adventitia and was connected to a perfusion circuit, which provided continuous flow through the plaque. The filter device consisted of an expandable polymeric membrane with multiple micro pores that was attached to the distal end of a 0.014-in wire with a shapeable tip. This filter was encased in a delivery catheter. With fluoroscopic guidance, the filter wire was passed through the stenosis and the delivery catheter was then retracted to open the filter to capture particles released into the distal internal carotid artery. PTAS with a self-expandable stent then was carried out over the filter wire. The particles released during the initial filter passage, those captured in the filter, and those that flowed through or around the filter (missed) were collected and analyzed with light microscopy. RESULTS: Filter deployment, PTAS, and filter retrieval were achieved successfully with each lesion. Because the filter has a low crossing profile, it passed through the stenoses smoothly and only produced occasional small particles. PTAS improved the angiographic stenosis from 96.2% +/- 3.7% to 1.3% +/- 1.6%. The mean number and the maximum size of the particles that were released during initial filter passage, missed, and captured by the filter device were 3.1 and 500 microm, 2.8 and 360 microm, 20.1 and 1100 microm, respectively. Most of the particles and those of large size were released during PTAS. The filter captured 88% of these particles. CONCLUSION: These study results show that this filter device, at least in this model, did not add complexity to the interventional procedure itself. Furthermore, the filter may markedly decrease embolic events during carotid PTAS and expand the indications for this procedure.

Aged↗

PubMed2005

[Role of surgery in the treatment of pulmonary aspergillosis].

INTRODUCTION: This article reviews the different forms of pulmonary disease caused by aspergillus and discusses the possible surgical treatments. The most well known is the classic aspergilloma which develops as a fungal ball in the centre of a pre-existing pulmonary cavity. STATE OF KNOWLEDGE: One can distinguish simple (few symptoms, thin walled cavity without immediate complications) and complex forms (patient generally unwell, thick cavity, complications). In the complex form, surgical intervention must be considered as a last resort. In the simple form, surgery is relatively benign and prevents disease progression. Pleural aspergillosis can occur, usually following the surgical removal of a cavity either in the short or medium term. Given the loss of lung parenchyma thoracoplasty is often the only option. OUTLINES: Two different scenarios occur in acute invasive aspergillosis where surgery may be indicated: firstly, surgery can be considered in the event of haemoptysis related to vascular erosion; secondly, resection of mycotic sequestrations before intensification or resumption of therapy may prevent a relapse. Semi-invasive aspergillosis usually occurs in territories of post-radiation fibrosis: after a phase of invasion equivalent to a lobar pneumonia, a secondary cavity appears containing a small fungal ball. Thoracoplasty is often the only surgical option. Ulcerating tracheobronchial aspergillosis has been observed following (cardio-) pulmonary transplant and this may progress to a characteristic invasive aspergillosis. CONCLUSIONS: Finally, rare observations of parietal aspergillosis could be treated by surgical resection and associated with systemic antifungal therapy. Optimum management of these patients requires a multidisciplinary approach.

Acute Disease↗

PubMed2002

Visualization and simulation techniques for surgical simulators using actual patient's data.

Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators.

Artificial Intelligence↗

PubMed2000

Direct graft puncture with use of a crossed catheter technique for thrombolysis of peripheral bypass grafts.

PURPOSE: To determine the efficacy and safety of direct graft puncture of peripheral arterial bypass grafts with placement of retrograde and antegrade catheters within the graft for thrombolytic therapy. This study also evaluated potential clinical benefit to patients. MATERIALS AND METHODS: A retrospective study was performed on 19 patients with 24 peripheral bypass grafts and lower extremity ischemia of less than 1 month duration. Thrombolysis was performed with a continuous high-dose infusion of urokinase. Successful lysis was defined as greater than 95% clot dissolution with antegrade flow within the graft. RESULTS: Technical success was achieved in 17 of 19 patients (89%). The complexity of operative intervention was diminished in 12 of 19 patients (63%). The major complication rate (16%) was significantly higher and, therefore, this technique has a role for patients in whom traditional access is not optimal, such as in those in whom access cannot be achieved or in those with long bypass grafts. CONCLUSION: Direct graft puncture with placement of catheters across the proximal and distal anastomoses of bypass grafts is a safe method of access, with a major complication rate similar to conventional access techniques. This mode of graft access demonstrates efficacious thrombolysis and acts as a conduit for ancillary procedures.

Aged↗

PubMed2001

Contact and nutrient caregiving effects on newborn infant pain responses.

To understand how the 'caregiving context' could affect responses to procedural pain, the authors sought to determine whether (1) the combined effects of sweet taste and holding (caregiving contact) were greater than the effects of either alone, (2) any combined effects were additive or interactive, and (3) the interventions had similar effects on behavioral (crying and facial activity) and physiological (heart rate, vagal tone) responses to the heel-stick procedure in newborn infants in a randomized two-factorial intervention trial. Eighty-five normally developing newborn infants were studied with a mean gestational age of 39.4 weeks on the 2nd or 3rd day of life. Infants were randomized in blocks of eight to receive (1) no holding and water taste (control participants), (2) no holding and sucrose taste (sucrose group), (3) holding and water taste (holding group), or (4) holding and sucrose taste (holding and sucrose group). Crying was reduced significantly by taste and holding, and the interventions combined additively. Facial activity was only significantly reduced by holding. For physiological measures, the interventions interacted with each other and preintervention levels to reduce heart rate and lower vagal tone more during the procedure in infants in whom heart rate and vagal tone were higher before intervention. Consequently, sweet taste and holding interventions combined in complex ways when acting on different behavioral and physiological response systems to modify stressful pain experiences. The results suggest that providing a caregiving context when painful procedures are performed may be a simple and practical method of reducing pain experience in infants, and that no one measure captures these effects.

Blood Specimen Collection↗

PubMed2005

Intraaortic balloon pump counterpulsation after implantation of infrarenal and thoracoabdominal aortic protheses.

Highly complex vascular surgery interventions have nowadays become possible due to sophisticated operative techniques and modern intra- and postoperative anesthesiological strategies. Accordingly, the number of high risk vascular surgery interventions rises continuously and thus, the number of secondary complications after high risk interventions increases as well and requires likewise extraordinary treatment concepts. We report of a 68-year old patient who 6 months previously was operated on a ruptured abdominal aneurysm, before he was admitted to our institution for the treatment of a type IIIb (Crawford classification) thoracoabdominal aneurysm. Intraoperatively we implanted a 26 mm Dacron prosthesis which was anastomosed with the previously existing infrarenal graft. Postoperatively the patient suffered from a hemodynamically significant myocardial infarction and acute coronary catheter intervention was necessary. However, circulatory stability could not be reestablished by interventional measures and we therefore decided to implant the intraaortic balloon pump despite the presence of two synthetic aortic grafts. However, the chance of success of such a manoeuver as well as the effectiveness of intraprosthetic counterpulsation was unclear and our literature research undertaken to predict the risk of such a manouver was unsatisfactory. We therefore want to report this case and compile the literature dealing with perceptions and complications of intraaortic counterpulsation after the implantation of synthetic aortic prostheses, since such a treatment option comes to an increased clinical application in comparable constellations.

Aged↗

PubMed1998

An overview of the nature, causes, and consequences of abusive family relationships. Toward differentiating maltreatment and violence.

Despite gaps in research, this review argues for distinguishing family maltreatment from family violence, a differentiation between minimal or moderate abuse and serious endangerment, physical injury, or sexual violation. Most acts now defined as violent or abusive are moderate, and stressful life circumstances contribute to their development. Research suggests that abuse may develop through multiple pathways. The consequences of abuse appear to be general, but more commonalities may be found by examining more subtle and complex effects. Many interventions have attempted to prevent or treat family violence and its consequences, and several show promise. More systematic research is needed, but several changes in intervention seem warranted now. For instance, (a) mental health professionals should not be required to report maltreatment while a family is engaged in therapy; (b) the social service system needs to rediscover its roots in supporting families under stress, including in cases of moderate maltreatment; and (c) swift and decisive legal intervention is needed in cases of serious family violence.

Child↗

PubMed2006

Strategies for mitigating an influenza pandemic.

Development of strategies for mitigating the severity of a new influenza pandemic is now a top global public health priority. Influenza prevention and containment strategies can be considered under the broad categories of antiviral, vaccine and non-pharmaceutical (case isolation, household quarantine, school or workplace closure, restrictions on travel) measures. Mathematical models are powerful tools for exploring this complex landscape of intervention strategies and quantifying the potential costs and benefits of different options. Here we use a large-scale epidemic simulation to examine intervention options should initial containment of a novel influenza outbreak fail, using Great Britain and the United States as examples. We find that border restrictions and/or internal travel restrictions are unlikely to delay spread by more than 2-3 weeks unless more than 99% effective. School closure during the peak of a pandemic can reduce peak attack rates by up to 40%, but has little impact on overall attack rates, whereas case isolation or household quarantine could have a significant impact, if feasible. Treatment of clinical cases can reduce transmission, but only if antivirals are given within a day of symptoms starting. Given enough drugs for 50% of the population, household-based prophylaxis coupled with reactive school closure could reduce clinical attack rates by 40-50%. More widespread prophylaxis would be even more logistically challenging but might reduce attack rates by over 75%. Vaccine stockpiled in advance of a pandemic could significantly reduce attack rates even if of low efficacy. Estimates of policy effectiveness will change if the characteristics of a future pandemic strain differ substantially from those seen in past pandemics.

Antiviral Agents↗

PubMed2005

The Cochrane Collaboration.

The Cochrane Collaboration is an international, not-for-profit organisation that aims to help people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health-care interventions. Cochrane systematic reviews are prepared according to predefined, explicit methodology, and published in The Cochrane Library. The abstracts and plain English summaries of the reviews are freely available on the Internet. All reviews are prepared and maintained under the editorial control of 50 Cochrane Collaborative Review Groups that focus on (groups of) health problems. The work of Collaborative Review Groups is supported, among others, by people working in Cochrane Fields. Cochrane Fields focus on dimensions of health care other than health problems. To date, the issue of nutrition has not been addressed sufficiently in The Cochrane Collaboration. Nutrition issues are very important for day-to-day health care and the initiatives to establish a new Cochrane Diet and Nutrition (Sub)Field will help to promote the preparation of systematic reviews of nutritional interventions by the variety of Collaborative Review Groups to whom such interventions are relevant. Many issues regarding nutritional interventions, however, are complex, and methodological challenges will have to be overcome. A Cochrane Diet and Nutrition (Sub)Field with experts on nutritional research can help fill this gap and make those reviews more possible.

Clinical Trials as Topic↗

PubMed2006

Reactions of molybdenum(VI) with metal ion reductants.

The reactions of aqueous H2MoO4 at low pH with titanium(II), titanium(III), europium(II), vanadium(II), and germanium(II), as monitored at 430 nm, give biphasic profiles featuring a sharp rise in absorbance followed by a marked decrease (Fig. 1). The final product is the dimeric Mo(V) cation, [Mo2O4]2+, and the strongly absorbing intermediate is taken as a monomeric Mo(V) species. The molar absorbances of the transients from different reductants are not the same, nor are the rate laws governing the fadings. None of the decay curves exhibits evidence of a second order dependence on the transient. The kinetic behaviors of these systems are consistent with the intervention of successor complexes of the type [Chemical structure: see text], (formed by inner sphere reductions of Mo(VI)), which decompose, via first-order processes, to a monomeric Mo(V) species. The latter then experiences rapid dimerization, which is kinetically silent. The possibility that Ge(II) bypasses the unstable tripositive state by reducing Mo(VI) to Mo(IV) (which then undergoes rapid Mo(VI)-Mo(IV) comproportionation) is considered.

Journal Article↗

PubMed2002

Retracted: Considerations in patients undergoing implantation of a biventricular pacemaker.

OBJECTIVE: To compare hemodynamics and oxygenation in patients with congestive heart failure and broad QRS complexes before and with biventricular DDD pacing and to report experience with this new procedure. DESIGN: Prospective, observational study. SETTING: Major university-affiliated community hospital. PARTICIPANTS: Ten patients with congestive heart failure (New York Heart Association III to IV) and broad QRS complexes (>160 msec). INTERVENTIONS: Patients underwent implantation of a biventricular pacemaker (n = 4) or implantation of a combined biventricular pacemaker and cardioverter-defibrillator (n = 6). Anesthesia was performed using remifentanil (0.2 to 0.3 microg/kg/min) and propofol. Propofol was used as target-controlled infusion (plasma target concentration, 1.5 to 2.5 microg/mL). MEASUREMENTS AND MAIN RESULTS: Hemodynamics and oxygenation were measured before and with biventricular DDD pacing. Mean arterial pressure was significantly increased from 64.7 +/- 5.8 mmHg to 77.8 +/- 10.6 mmHg by biventricular pacing, whereas cardiac index (2.2 +/- 0.3 L/min/m(2) before and 2.3 +/- 0.3 L/min/m(2) with biventricular pacing) and pulmonary capillary wedge pressure (12.1 +/- 3.8 mmHg before and 14.2 +/- 3.6 mmHg with biventricular pacing) remained unchanged. Left ventricular stroke work index was increased >10% in 7 patients. Oxygen delivery, oxygen consumption, and difference in arteriovenous oxygen concentration were not affected. Anesthesia with remifentanil and propofol was safe and well-controllable and allowed immediate extubation at the end of the operation. CONCLUSION: There was no acute intraoperative improvement of hemodynamics except increased mean arterial pressure with biventricular pacing. Left ventricular performance seemed to improve with biventricular pacing in some patients. These results might be due to a nonoptimized atrioventricular delay. Postoperatively, atrioventricular delay was individually programmed for each patient by Doppler transmitral flow patterns.

Aged↗