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PubMed1997

Injecting nation: achieving control of hepatitis C in Australia.

Since Australia banned heroin in 1953 consumption of illicit drugs, deaths, crime and corruption related to drugs have steadily increased. Injecting drug use (IDU) in Australia is now a significant public health problem linked each year to approximately 500 overdose deaths and more than 6000 hepatitis C infections. At least 85% of prevalent and incident hepatitis C cases in Australia are injecting drug users (IDUs) with annual incidence estimated at 15%. Although poorly documented, increasing numbers of patients with end-stage liver disease from hepatitis C now appear to present in Australia. This reflects a heroin-injecting epidemic commencing a quarter of a century ago, the close association between drug injecting and hepatitis C and the long delay between hepatitis C infection and complications. The overall health and economic burden of hepatitis C may soon exceed HIV. Control is far more difficult to achieve for hepatitis C than HIV because of much higher baseline prevalence levels and far greater infectiousness by blood to blood spread. Transmission appears to follow minimal breaches of infection control guidelines. Hepatitis C has not yet become a priority public health issue in Australia. No national prevention strategy has been proposed. Prevention strategies (such as needle exchange or methadone) which controlled HIV among IDUs should be expanded, with the expectation of some useful reduction of spread but without achieving control of hepatitis C. Other options for control must be considered. Eradicating illicit drug use in Australia is unachievable. Virtually eradicating injecting drug use by facilitating a switch to non-injecting routes of administration (NIROA) is achievable (although difficult) and this could control hepatitis C. NIROA will have the probable additional benefit of reducing drug overdose deaths. NIROA has begun recently to replace injecting in several countries without government intervention. Powerful cultural, pharmacological and economic factors strongly reinforce drug injecting. Economic impediments to NIROA could be reduced by drug policy reform. Facilitating a switch to NIROA carries some risk of increased discrimination directed against an already marginalized population. A major obstacle to harm reduction is the common assumption that any relaxation of drug policy invariably leads to increased consumption. Switching the predominant route of administration of illicit drugs from IDU to NIROA should be the major focus of national efforts to control hepatitis C and overdose deaths in Australia.

Journal Article↗
PubMed2005

Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model.

OBJECTIVES: To compare the safety and efficiency of standard multiplanar fluoroscopy (StdFluoro) and virtual fluoroscopy (VirtualFluoro) for use in the percutaneous insertion of iliosacral screws. DESIGN: : Human cadaver study comparing 2 imaging modalities during iliosacral screw insertion; imaging randomized from side to side. SETTING: Bioskills laboratory in a medical school. PARTICIPANTS: Twenty-nine embalmed whole human cadavers without prior hip or pelvic surgery. INTERVENTION: Iliosacral screws were inserted into the S1 bodies using a percutaneous insertion technique. Screws were inserted on one side using StdFluoro, and on the other side, screws were placed using VirtualFluoro. MAIN OUTCOME MEASUREMENTS: Time necessary for imaging preparation, screw insertion, and actual fluoroscopy were recorded. Accuracy and safety of screw placement was assessed using computed tomography and an anatomic dissection of the pelvis. RESULTS: : Fifty-six of 58 iliosacral screws were placed within the desired bony corridor of the posterior pelvis. One screw placed using each method was inserted erroneously, but both were relatively minor deviations. There were no obvious injuries to major vessels or nerve roots. The total surgical time required for preparation of imaging and screw insertion averaged 7.3 minutes using StdFluoro and 6.7 minutes using VirtualFluoro (P = 0.4). Although the time necessary for screw insertion using VirtualFluoro averaged only 3.5 minutes, compared to 7.0 minutes for StdFluoro (P < 0.05), this time savings was offset by that required for application and calibration of tracking devices when using VirtualFluoro. The average fluoroscopy time using StdFluoro method was 26 seconds, whereas that for the VirtualFluoro was only 6 seconds (P < 0.01). CONCLUSIONS: Most of the percutaneous iliosacral screws were safely inserted using StdFluoro and VirtualFluoro, and total surgical times were similar using both methods. As VirtualFluoro continues to evolve, improved efficiency in operative times may be expected. Currently, the most beneficial aspect of using VirtualFluoro during the insertion of percutaneous iliosacral screws appears to be significantly decreased use of fluoroscopy when compared to StdFluoro.

Aged↗
PubMed2006

Assessment of FFR-negative intermediate coronary artery stenoses by spectral analysis of the radiofrequency intravascular ultrasound signal.

BACKGROUND: Assessing the clinical importance of angiographically intermediate coronary artery stenoses at the time of cardiac catheterization remains a challenge. Spectral analysis of radiofrequency ultrasound backscatter signals, or virtual histology (VH), allows in vivo assessment of plaque composition. This study characterizes the VH composition of fractional flow reserve (FFR)-negative intermediate stenoses and adjacent vessel segments. METHODS: Intermediate coronary artery stenoses (> 40% and < 70% diameter stenosis) were assessed by pressure wire. If the FFR was > or = 0.75, percutaneous coronary intervention was deferred and VH was performed on the lesion and adjacent segments using a commercially available system. The primary clinical endpoint was any adverse cardiac event. RESULTS: Thirty-seven intermediate stenoses in 30 patients were studied. The reference vessel size was 3.02 +/- 0.71 mm, the QCA diameter stenosis was 52 +/- 6% and the FFR was 0.89 +/- 0.07. The target stenoses were characterized by VH as: thin-cap fibroatheroma (VH-TCFA; n = 22); fibrous cap atheroma (n = 5), fibrocalcific lesion (n = 7) and pathological intimal thickening (n = 3). The relative contribution of each stenosis plaque component was conserved across adjacent segments ("signature" plaque). Three patients, all with VH-TCFAs at index, had events in the clinical follow-up period of 12 +/- 2 months, but only 1 of these patients had an event related to the index stenosis. CONCLUSIONS: FFR-negative intermediate stenoses have heterogeneous plaque by VH, but are enriched in VH-TCFAs. Relative plaque composition is conserved along adjacent vessel segments. Although the specificity of VH-TCFA for index stenosis-related events appears low, larger trials are needed to assess the prognostic value of VH in this lesion subset.

Aged↗
PubMed1996

Reducing demand for physician visits through public education: a look at the pilot cold-and-flu campaign in London, Ontario.

OBJECTIVE: To estimate the effect of the Ontario Ministry of Health's pilot public-education campaign launched in London, Ont., on Jan. 15, 1994, to reduce the number of visits to physicians' offices because of cold and flu symptoms. DESIGN: Before-after comparison of claims to the Ontario Health Insurance Plan. OUTCOME MEASURES: Physician billings for visits because of cold and flu symptoms and total billings for all types of visits during the 2 months before and after the start of the campaign, and during the same two periods in the previous year, in London and in the rest of Ontario. RESULTS: By the time the campaign was started, much of the cold and flu season was already over for that winter. Still, the decrease in billings for visits because of cold and flu symptoms in the 2 months after the campaign was introduced was 6% greater in London than in the rest of Ontario. There was virtually no difference in total billings between London and the rest of the province during the same period. CONCLUSION: The modest relative reduction in physician billings for visits because of cold or flu symptoms in London following the introduction of the public-education campaign may have been due to the intervention as well as to other factors.

Accounting↗
PubMed1986

Legal intervention in civil commitment: the impact of broadened commitment criteria.

Recent legal changes in Washington State have broadened the grave-disability criterion for civil commitment of the mentally ill. Analysis of data from state mental hospitals and from records of commitment authorities in Washington's two largest counties revealed that, while there was an increase in the number of involuntary hospitalizations immediately before and after the changes in law, there was a virtual disappearance of voluntary patients in state hospitals. Moreover, expansion of the definition of "grave disability" resulted in a move toward a parens patriae-dominated civil commitment system. Analysis of the empirical consequences of the legal changes on commitment decisions is presented, along with the response of mental health officials and the public.

Commitment of Persons with Psychiatric Disorders↗
PubMed2000

A closed-loop model of the canine cardiovascular system that includes ventricular interaction.

A closed-loop model of cardiopulmonary circulation has been developed for the study of right-left ventricular interaction under physiologically normal and altered conditions. The core model provides insight into the effects of ventricular interaction and pericardial mechanics on hemodynamics. The complete model contains realistic descriptions of (a) the interacting ventricular free walls and septum, (b) the atria, (c) the pericardium, and (d) the systemic and pulmonary vascular loads. The current analysis extends previous work on ventricular interaction and pericardial influence under isolated heart conditions to loading conditions imposed by a closed-loop model of the circulation. A nonlinear least-squares parameter identification method (Levenberg-Marquardt algorithm) is used, together with parameter sensitivity analysis, to estimate the values of key parameters associated with the ventricular and circulation models. Pressure measurements taken at several anatomical locations in the circulation during open-chest experiments on dogs are used as data in the identification process. The complete circulatory model, including septal and pericardial coupling, serves as a virtual testbed for assessing the global affects of localized mechanical or hemodynamic alterations. Studies of both direct and series ventricular interaction, as well as the effect of the pericardium on cardiac performance, are accomplished with this model. Alterations in model parameter values are used to predict the impact of disease and/or clinical interventions on steady-state hemodynamic performance. Additionally, a software package titled CardioPV has been developed to integrate the complete model with data acquisition tools and a sophisticated graphical user interface. The complete software package enables users to collect experimental data, use the data to estimate model parameters, and view the model outputs in an online setting.

Animals↗
PubMed2005

Application of a virtual reality-enhanced exercise protocol in patients after coronary bypass.

OBJECTIVE: To determine whether, by using training enhanced by virtual reality (VR) displays, patients who had undergone coronary artery bypass graft (CABG) surgery could more effectively attain long-term cardiopulmonary results than those not using VR technology. DESIGN: Randomized controlled trial. SETTING: Exercise testing laboratory in a medical center. PARTICIPANTS: Consecutive sample of 32 patients who had undergone CABG surgery. INTERVENTIONS: All subjects were randomly assigned to 1 of 2 submaximal endurance programs, with or without simulated training. In all other respects, the 2 programs were identical. Each section lasted for 30 minutes and was conducted twice a week for about 3 months. Graded exercise tests, conducted before and after training, evaluated cardiorespiratory changes. MAIN OUTCOME MEASURES: The cardiorespiratory and hemodynamic parameters were evaluated at both peak and submaximal exertion. RESULTS: At the follow-up exercise tests (performed at 5.4 mo after surgical intervention), the VR group achieved significantly higher value in peak oxygen consumption (VO2peak), peak metabolic equivalents (METS), and amount of VO2 at anaerobic threshold than the non-VR group. Significant gain was attained in VO2peak and peak MET value accrued to those who participated in simulation-based aerobic training. CONCLUSIONS: Our study outcomes clearly support the perceived benefits of rehabilitation programs that incorporate VR to augment patients' recovery of their physical capacity.

Aged↗
PubMed2002

Structural biology in drug design: selective protein kinase inhibitors.

Protein kinases have a fundamental role in signal transduction pathways, and aberrant kinase activity has been observed in many diseases. In recent years, kinase inhibition has become a major area for therapeutic intervention and a variety of kinase inhibitor pharmacophores has been described. This review illustrates some of the efforts and results in the field of structure-based design of protein kinase inhibitors. The methods and results discussed here illustrate the power of structure-based design in lead discovery, for example via virtual screening and in guiding the optimization of the pharmacological properties of these molecules.

Adenosine Triphosphate↗
PubMed2005

Accuracy of virtual bronchoscopy for grading tracheobronchial stenosis: correlation with pulmonary function test and fiberoptic bronchoscopy.

STUDY OBJECTIVES: To compare the accuracy of virtual bronchoscopy (VB) with fiberoptic bronchoscopy (FOB) and pulmonary function testing (PFT) for the assessment of tracheal stenosis and bronchial anastomotic stenosis. DESIGN: Prospective case series. SETTING: Pulmonary institute of major tertiary university-affiliated center. PATIENTS: The study group included 10 lung transplant recipients and 13 patients with central airway stenosis. INTERVENTIONS: All patients underwent PFT, VB, and FOB. All cases were graded by each modality on a scale of 1 to 3, and the findings were compared between modalities. RESULTS: Mean +/- SD stenosis score was 2.0 +/- 0.79 for PFT, 1.62 +/- 0.73 for FOB, and 1.82 +/- 0.77 for VB. A statistically significant correlation was found between VB and FOB scores (p < 0.0001, r = 0.76) and between VB scores and PFT (p = 0.03, r = 0.45). There was no correlation between PFT and FOB. CONCLUSIONS: VB grading of tracheobronchial stenosis is well correlated with PFT. VB may be used to evaluate patients with known tracheobronchial stenosis after treatment and thereby reduce the frequency of repeated invasive FOB performed for that purpose. The correlation of VB with PFT may improve the reliability of this approach.

Adult↗
PubMed1984

The use of association data to identify family members at high risk for marker-linked diseases.

The study of genetic markers linked and associated with disease has provided important evidence of a genetic contribution to numerous diseases and has helped to establish their modes of inheritance. However, this information has not been fully utilized in counseling individuals at risk for these disorders. In the case of recessive, marker-linked diseases, such as idiopathic hemochromatosis linked to HLA in family studies and associated with specific HLA alleles in population surveys, the only current clinical application has been to identify siblings who share both HLA-marker haplotypes with the affected proband. They are considered to be presymptomatically affected, and more definitive invasive investigations are considered appropriate. All other relatives, including parents, offspring, and other siblings, who share only one marker with the proband, have been counseled only that their risk is equivalent to the gene frequency of the disease allele, for example, 3%-6% for hemochromatosis. We have developed a generally applicable method to utilize population association data to derive more specific and accurate risk figures for these other relatives of patients with marker-linked and associated diseases. We have applied this method to idiopathic hemochromatosis. If the offspring of a patient with hemochromatosis lacks A3, B7, and B14, the risk to that offspring for developing hemochromatosis is less than 2%. On the other hand, if they receive HLA A3 from their unaffected parent, their risk climbs to 9%-10%; if they receive an A3-B14 haplotype, their risk increases to virtually 100%. As demonstrated by our example, the application of association data to family members already at a basal increased risk for marker-linked disease can significantly refine the disease risk estimates given to those relatives. This information can be utilized to select individuals in whom invasive diagnostic testing or preventative intervention is indicated.

Alleles↗
PubMed1993

Post-traumatic myelopathy following flopping high jump: a pilot case of spinal manipulation.

OBJECTIVE: To present the first case of spinal cord injury from high jump and the first pilot case of spinal manipulation for post-traumatic myelopathy. CLINICAL FEATURES: An 11-yr-old tetraplegic boy was admitted to the hospital, where he had a thorough neurological examination, including myelogram, EEG and skull and spinal X rays, with normal findings. The author revealed subtle subluxations on plain X-ray films. Triceps hyperreflexia was detected bilaterally. Bilateral patella and ankle clonus with hyperreflexia, basic and excess spasticity, and bilateral extensor plantar responses were noted in the lower limbs. A clinical diagnosis of early post-traumatic incomplete spastic tetraplegia below C7 was made. INTERVENTION AND OUTCOME: He did not respond to 3 months of orthodox conservative hospital management, including steroid therapy. Spinal manipulation of the lower cervical and upper thoracic spine was performed in a private chiropractic clinic for 2 wk. He apparently recovered after 3 months of spinal manipulation. On recent examination, he has virtually completely recovered. He still suffers from hand muscle atrophy, hyperreflexia of the triceps and ankle reflex and bilateral positive Babinski reflex; ankle and patellar clonus are almost absent. CONCLUSIONS: The early response and long-term (9-yr follow-up) benefits of spinal manipulation to the early delayed traumatic myelopathy of this patient suggest spinal cord ischemia as its pathophysiology. Mechanisms of post-traumatic myelopathy are postulated. Biomechanical mechanisms of spinal manipulation for neurological recovery of post-traumatic myelopathy and/or radiculopathy are advanced. Further pilot spinal manipulation by experienced chiropractors after adequate anti-edematous (steroid) therapy is recommended for selected patients with post-traumatic myelopathy and/or radiculopathy, especially in a multidisciplinary spinal injury unit.

Athletic Injuries↗
PubMed1995

Essential concepts of inflammation and immunity.

Virtually all patients in acute or critical care settings experience some degree of immune system alteration, which places them at risk for serious potential complications, including sepsis and debilitation. Nurses need a good working knowledge of specific areas of immune function to provide a safe environment, adequate patient support, and appropriate early interventions to prevent complications. This article presents information about basic immune function and current and potential uses for new immunodulating agents, such as granulocyte macrophage--colony-stimulating factor.

Antibody Formation↗
PubMed2001

Surgeon-performed ultrasound imaging in acute surgical disorders.

As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound imaging will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, to narrow the differential diagnosis, or to initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients with an acute abdomen, especially those patients who are hypotensive. In the hands of the surgeon, this noninvasive, bedside tool can assess more accurately the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound imaging is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound imaging to detect a pleural effusion has virtually supplanted the lateral decubitus radiograph. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. As surgeons become more facile with ultrasound imaging, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.

Abdomen, Acute↗
PubMedDate not supplied

The German health care system: structure and changes.

The German health care system has often been viewed by American policy makers as a model for a system that controls costs and provides coverage to virtually all of its citizens, while maintaining a private market for the delivery of most services. Nevertheless, German policy makers are as concerned as their American counterparts about the increasing share of national income devoted to health care. To control rising health care costs, the German government, after two decades of cost control interventions, has enacted a major health care reform aimed at reducing structural deficits of the current system and enhancing competition within the system. We review the general structure of the German health care system and analyze its specific problems. We also discuss its accomplishments and present the recently enacted health care reform.

Ambulatory Care↗
PubMed2026

Effectiveness of artificial intelligence in nursing simulation education: A systematic review, meta-analysis and bibliometric visualization analysis.

OBJECTIVES: To synthesize the roles and core functions of AI in nursing simulation education for nursing students via systematic review, quantitatively evaluate its effects on students' knowledge and skill outcomes through meta-analysis, and map the research landscape and development trends of this field through bibliometric visualization analysis. DESIGN: Systematic review, meta-analysis and bibliometric visualization analysis. DATA SOURCES: Eight electronic databases: PubMed, Web of Science, MEDLINE, ERIC, Academic Search Complete, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Science and Technology Journal Database (VIP) were employed to search studies from the time of construction to 16 December 2025. REVIEW METHODS: Studies meeting the inclusion criteria were screened. The revised Cochrane Risk of Bias tool (ROB 2) and Joanna Briggs Institute (JBI) critical appraisal checklists were used for quality assessment. Meta-analysis was performed with Review Manager 5.4, and bibliometric visualization analysis was conducted using VOSviewer 1.6.20 and Bibliometrix (based on R4.4.3). RESULTS: A total of 61 studies were included. AI primarily played two roles in nursing simulation education: peer-type new subject (n&#xa0;=&#xa0;24) and direct mediator (n&#xa0;=&#xa0;22). Meta-analysis showed that AI interventions significantly improved nursing students' knowledge (SMD&#xa0;=&#xa0;1.49, 95% CI [0.55,2.43], p&#xa0;=&#xa0;0.002) and skills (SMD&#xa0;=&#xa0;0.66, 95% CI [0.02,1.31], p&#xa0;=&#xa0;0.04). Bibliometric analysis identified that the United States of America and China were the two main contributing countries in this field, and the key motor themes included generative artificial intelligence, virtual patients, and geriatric care. CONCLUSIONS: AI exerts positive effects on nursing students' knowledge acquisition and skill enhancement in simulation education, with peer-type new subject and direct mediator as the dominant roles. Future research should focus on expanding AI applications in multi-specialty simulation scenarios, activating the data-driven value of machine learning, and strengthening international collaboration and standardization construction, so as to promote the sustainable development of AI-integrated nursing simulation education.

Humans↗
PubMed2006

Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.

BACKGROUND: Amiodarone (Cordarone; Wyeth, Ayerst, New York) is a potassium channel blocking antiarrythmal medication indicated for recurrent ventricular fibrillation and recurrent hemodynamically unstable ventricular tachycardia. Chemically, it is classified as an iodinated benzofuran derivate antiarrythmal drug not chemically related to any other available antiarrhythmic drug. Documented side effects of amiodarone include neurologic, gastrointestinal, dermatologic, cardiovascular, and ophthalmic. The ophthalmic abnormalities include optic neuropathy, optic neuritis, papilledema, corneal deposits, photosensitivity, lens opacities, and macular degeneration. Corneal microdeposits are seen in virtually all patients who receive amiodarone for more than 6 months. Corneal microdeposits result secondary to the secretion of amiodarone by the lacrimal gland with accumulation on, and absorption by, the corneal epithelium. Approximately 10% of these patients become symptomatic with glare and halos; however, that alone is usually not enough to precipitate intervention. CASE REPORT: A 69-year-old woman presented to our office with a 2-week history of halos and glare in both eyes (OU). Her ocular history was significant for occasional contact lens wear. Her systemic history was significant for atrial fibrillation, for which she was taking amiodarone daily for the last 6 years. Six weeks before the onset of her chief complaint, her daily amiodarone dosage was increased from 100 mg to 300 mg. Ophthalmic examination found decreased visual acuities OU, amiodarone keratopathy (subepithelial verticillata), and diffuse corneal epithelial edema with diffuse sodium fluorescein staining OU. The corneal compromise was treated in 2 ways: the source medication was discontinued, and the ocular signs were medicated with a prophylactic topical antibiotic along with supportive preparations (tears/lubricants) and monitored over 2 weeks until full elimination of the pathologic signs and their symptoms. Even after complete resolution of the acute keratitis, the infiltrative keratopathy persisted along with the initial complaints of halos and glare. The supportive treatments were maintained over the course of 2 months until full recovery. CONCLUSION: By exclusion, it was determined that the subepithelial depositions and cystic formations were secondary to an acute amiodarone dosage increase by a new practitioner. Prompt communication resulted in the physician discontinuing that medicine.

Aged↗
PubMed2003

Susceptibility of mice deficient in the MHC class II transactivator to infection with Mycobacterium tuberculosis.

Major histocompatibility complex (MHC) class II antigen presentation and subsequent CD4+ T-cell activation are critical for acquired immunity to Mycobacterium tuberculosis infection. MHC class II gene expression is primarily controlled by the master transactivator CIITA protein. Without functional CIITA protein, MHC class II expression is lost, impairing immune responses and increasing susceptibility to infection. In this study, we compared protective immune responses of CIITA-deficient mice and wild-type C57BL/6 controls with low dose aerosol M. tuberculosis infection. After aerogenic challenge, CIITA-/- mice failed to limit mycobacterial growth (2.5 and 2.0 log10 > WT lung and spleen CFUs, respectively, at day 58). Lung histopathology involved extensive necrosis, severe pneumonitis and overwhelming inflammation in the gene knockout mice. Mean survival time for CIITA-/- mice was significantly reduced (57 versus >300 days for WT). This extreme sensitivity to tuberculous infection was largely attributed to the absence of CD4+ cells. Flow cytometric studies detected virtually no CD4+ cells in CIITA-/- mouse spleens after infection versus elevated numbers in WT spleens. Failed CD4+ T-cell expansion markedly reduced interferon-gamma (IFN-gamma production in CIITA-/- mice versus WT controls. These results suggest the necessity of a functional CIITA pathway for controlling tuberculous infections and that interventions targeting CIITA expression may be useful antimycobacterial therapeutics.

Animals↗