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PubMed1992

Coffee shops and clinics: the give and take of doing HIV/AIDS research with injecting drug users.

We discuss recruiting and interviewing injecting drug users and using research as health promotion in the context of collecting information related to human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) from a convenience sample of 200 injecting drug users, half in treatment and half not, in 1989 and 1990 in Perth, Western Australia. A variety of recruiting methods were used including advertising, referral by agency staff, 'snowballing' and approaches to personal contacts and others known to inject by the interviewer. Snowballing and personal contacts were the most successful means of recruiting those not in treatment, while advertising was comparatively unsuccessful with this group because of the importance of establishing the credibility of the study and the interviewer among injecting drug users before they will volunteer to be involved. The promotion of behavioural risk reduction among respondents during the interview is detailed. We argue that the traditionally rigid separation between research and intervention is inappropriate in the HIV/AIDS context. When lives are potentially at stake, any contact with injecting drug users, especially those not in treatment (where may receive HIV/AIDS education), must be used as an HIV/AIDS prevention opportunity, and the interview is an ideal opportunity. The employment of research as community intervention is also discussed.

HIV Infections↗

PubMed1985

Multi-section multi-echo pulse magnetic resonance techniques: optimization in a clinical setting.

The user-selectable magnetic resonance imaging parameters involved in a multi-section multi-echo pulse sequence are described and their interrelationships explained. These parameters include repetition time (TR), echo delay time (TE), the number of sections (S), the number of echoes (E'), the time from the center of the last echo to the end of data acquisition (15 msec on the authors' system), and the time for T1 recovery. A simple mathematical relationship among these quantities, permitting easy calculation of the remaining parameters once a sufficient number have been specified, is given. In addition, a nomogram that permits rapid visual estimation of these parameters is presented. The effects of these choices and others is explained with respect to imaging time, region covered, and image contrast. Finally, the inherent trade-offs are illustrated in a clinical example involving the pelvis.

Humans↗

PubMed1988

Vocal fatigue and dysphonia in the professional voice user: Bogart-Bacall syndrome.

Over the past 5 years, the authors have treated 67 adult professional voice users with a musculoskeletal tension disorder involving the larynx and supporting structures and leading to vocal dysfunction. Common clinical features in both sexes were muscle tension in the neck, poor control of the breath stream, and an abnormally low-pitched speaking voice. Most of the men sounded like Humphrey Bogart and the women like Lauren Bacall. These cases represent a discrete clinical vocal fatigue syndrome, the treatment of which is patient education and voice therapy.

Adult↗

PubMed1986

Endocarditis of a tricuspid prosthesis causing valvular stenosis and shunting through a patent foramen ovale.

A young intravenous drug user presented with Staphylococcus aureus endocarditis involving the tricuspid valve, which was replaced with a Hancock bioprosthesis. She presented again with fever and dyspnea five months later and was found to be cyanotic. Recurrent endocarditis involving the prosthesis with right-to-left shunting through a patent foramen ovale was documented by echo and confirmed at autopsy.

Adult↗

PubMed2005

[Reflections on stress and burnout and their relationship with nursing].

This bibliographic review aimed to differentiate between stress and Burnout and to establish their relationship with nursing work to support the understanding of psychical suffering at work. The study was based on the analysis and interpretation of articles, thesis and dissertations produced between 1990 and 2001. Although there is a consensus among the individuals on the existence of stress and burnout, there are several controversies surrounding these terms. These theories were created in the context of capitalist production increase. Stress refers to a personal tiring that interferes in the life of the person but not necessarily in his/her relationship with the work. Burnout is a syndrome involving negative attitudes and behaviors towards users, clients, organization and work. It is a gradual process of subjective experiences that result in practical and emotional problems to workers and organizations. Nursing work facilitates stress and burnout and causes suffering and illness among workers.

Burnout, Professional↗

PubMed2004

Tackling regional health inequalities in france by resource allocation : a case for complementary instrumental and process-based approaches?

This article aims to evaluate the results of two different approaches underlying the attempts to reduce health inequalities in France. In the 'instrumental' approach, resource allocation is based on an indicator to assess the well-being or the quality of life associated with healthcare provision, the argument being that additional resources would respond to needs that could then be treated quickly and efficiently. This governs the distribution of regional hospital budgets. In the second approach, health professionals and users in a given region are involved in a consensus process to define those priorities to be included in programme formulation. This 'procedural' approach is employed in the case of the regional health programmes. In this second approach, the evaluation of the results runs parallel with an analysis of the process using Rawlsian principles, whereas the first approach is based on the classical economic model.At this stage, a pragmatic analysis based on both the comparison of regional hospital budgets during the period 1992-2003 (calculated using a 'RAWP [resource allocation working party]-like' formula) and the evolution of regional health policies through the evaluation of programmes for the prevention of suicide, alcohol-related diseases and cancers provides a partial assessment of the impact of the two types of approaches, the second having a greater effect on the reduction of regional inequalities.

Budgets↗

PubMed1995

Capitation.

As managed care increases its presence in the home care industry, providers need to take a good look at capitation, the reimbursement method that some managed care users. This article explores the issues involved in this new payment method.

Capitation Fee↗

PubMed1999

Non-steroidal anti-inflammatory drugs and gastrointestinal bleeding.

Non-steroidal anti-inflammatory drug use carries the risk of gastrointestinal complications (1% over 6 months) which is increased by a factor of 4 to 5, although strong differences are observed between different non-steroidal anti-inflammatory drugs. This risk is present in both the upper and lower gastrointestinal tract which indicates that non-steroidal anti-inflammatory drugs induces bleeding from both peptic ulcer and non-peptic ulcer sources. Symptoms are poor predictors of serious lesions and complications, which may occur without previous symptoms. At present, risk factors for non-steroidal anti-inflammatory drug-associated upper gastrointestinal bleeding are well defined and include ulcer or complication history, age, high non-steroidal anti-inflammatory drug dose, combination with corticosteroid and warfarin. Helicobacter pylori infection is not considered a risk factor for complications in non-steroidal anti-inflammatory drug users. There is a high prevalence of over-the-counter non-steroidal anti-inflammatory drug (especially aspirin) use among those presenting with gastrointestinal complications. Prophylactic aspirin regimens increase the risk of gastrointestinal bleeding. The potential beneficial effect of nitrate treatments (nitric oxide donors) in low dose aspirin users deserves further study. The mechanisms involved in the induction of gastrointestinal bleeding by non-steroidal anti-inflammatory drugs are poorly understood. Platelet activity inhibition associated with an abnormal, but reversible, prolongation of the bleeding time in susceptible individuals using aspirin might be a mechanism affecting no more than a third of patients with gastrointestinal bleeding.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2003

Rapid prototyping strategy for a surgical data warehouse.

OBJECTIVES: Healthcare processes typically generate an enormous volume of patient information. This information largely represents unexploited knowledge, since current hospital operational systems (e.g., HIS, RIS) are not suitable for knowledge exploitation. Data warehousing provides an attractive method for solving these problems, but the process is very complicated. This study presents a novel strategy for effectively implementing a healthcare data warehouse. METHODS: This study adopted the rapid prototyping (RP) method, which involves intensive interactions. System developers and users were closely linked throughout the life cycle of the system development. The presence of iterative RP loops meant that the system requirements were increasingly integrated and problems were gradually solved, such that the prototype system evolved into the final operational system. RESULTS: The results were analyzed by monitoring the series of iterative RP loops. First a definite workflow for ensuring data completeness was established, taking a patient-oriented viewpoint when collecting the data. Subsequently the system architecture was determined for data retrieval, storage, and manipulation. This architecture also clarifies the relationships among the novel system and legacy systems. Finally, a graphic user interface for data presentation was implemented. CONCLUSIONS: Our results clearly demonstrate the potential for adopting an RP strategy in the successful establishment of a healthcare data warehouse. The strategy can be modified and expanded to provide new services or support new application domains. The design patterns and modular architecture used in the framework will be useful in solving problems in different healthcare domains.

Colorectal Surgery↗

PubMed2002

Operating the European Drawer Rack on the ISS.

The Erasmus User Centre, located at ESTEC in Noordwijk, will have overall responsibility for the preparation and execution of operations for the European Drawer Rack (EDR) facility in the European Columbus laboratory on the International Space Station (ISS). Together with the national User Support and Operations Centres (USOCs) involved in the operation of experiments on the ISS, it will form the network conducting the decentralised payload operations baselined for the European elements of the ISS.

Biotechnology↗

PubMed2004

Surgical video systems.

A surgical video system (SVS) is an integration of components used to perform minimally invasive surgery (MIS). In the operating room, an SVS consists of an endoscope, an attached video camera, a light source, a video processor, and one or more video displays. A single SVS can generally be used in any type of MIS procedure (e.g., general, orthopedic, urologic), provided that it is equipped with the appropriate type of endoscope. In this Evaluation, we tested seven systems from six manufacturers. We found that, on average, three-chip systems provide better overall image quality than one-chip systems. Three systems were judged as providing image quality slightly superior to that of all the other systems; however, the level of subjectivity involved in judging performance suggests that users should perform in-house trials before purchase. All the evaluated systems performed relatively well in performance testing, but most systems were rated Fair or Poor in several human factors and safety tests. In fact, only two systems did not receive any Poor ratings in the Light Source Safety Features tests. Although users bear much of the responsibility for ensuring that light sources are used safely, most manufacturers have not made simple design changes that would make unintentional misuse less likely. We would be more likely to rate systems that still exhibit these safety issues in the future as Not Recommended or Unacceptable.

Costs and Cost Analysis↗

PubMed2004

Clinical practice guidelines' development and use in New Zealand: an evolving process.

AIMS: This study explores the use of evidence-based guidelines by New Zealand general practitioners, and describes strategies developed to overcome identified barriers in the New Zealand setting. METHODS: In-depth, semi-structured interviews with a purposeful sample of New Zealand guideline stakeholders including policy makers and general practitioners. Data were analysed using inductive thematic analysis. Feedback of emergent themes to the New Zealand Guidelines Group (NZGG) and further collaboration resulted in strategies to overcome barriers to use, some of which have now been implemented. RESULTS: At the time of the research (2000/2001), general practitioners reported that they did not regularly use guidelines to support decision-making regarding patient care. Reasons given included guidelines formats not being recognisable or user-friendly, lack of general practitioner involvement in prioritisation and development processes, influence of stakeholders, and recommendations not being accessible or relevant. Policy and other interviewed stakeholders reported general acceptance of guidelines, however there were minimal interfaces between the NZGG and these organisations. CONCLUSIONS: Effective implementation of guidelines requires more than guidelines endorsement by policy stakeholders and passive dissemination strategies, but rather an understanding of the issues facing general practitioners and their attitudes to guideline use.

Attitude of Health Personnel↗

PubMed2005

The case for alcohol research as a focus of study by nurse researchers.

Sixty percent of the U.S. population drinks alcohol. Although numerous investigators have shown that low-volume alcohol intake has positive influences on cardiovascular health, bone density, and cognition, there is a fine line between positive, neutral, and negative ramifications of alcohol consumption on health. Alcohol accounts for 7% of the global burden of disease and injury from all causes and for 10% to 11% of all illnesses and death each year worldwide. So alcohol use is a two-edged sword. Psychiatric nurses have a long history of involvement with alcoholic patients, and alcohol users, misusers, and abusers comprise a significant percentage of the patient load in every specialty and subspecialty of nursing. Yet nursing education has neglected this important area of content in general nursing curricula, staff development has not trained mainstream nurses to routinely assess for alcohol problems among hospital patients, and primary care providers have failed to do case finding. During the past 25 years, the federal government has funded curricular and faculty development programs to bring alcohol information into the core of health provider training. The process has been halting and minimally successful at best. One ramification of the inattention to alcohol-related education is the dearth of nurse-scientists engaged in programs of research in the field of alcohol abuse. A federally funded faculty development program in the 1990s focused attention on this issue, and a small cadre of nurses were trained to do related research. Several of the authors in this volume are members of that group. A brief overview of the focus of each of the remaining chapters in this volume is presented. A rationale is provided for the importance of this area of research for nursing knowledge and quality patient care in essentially all areas of nursing practice. Finally, several burning research questions are posed that would most appropriately be answered through nursing research.

Alcohol Drinking↗

PubMed2005

A "true" polymicrobial endocarditis: Candida tropicalis and Staphylococcus aureus--to a drug user. Case presentation and literature review.

Polymicrobial endocarditis is more frequent in intravenous drug user (IVDU). Combined therapy--medical and surgical--represents the standard of care, but long-term suppressive therapy duration in fungal endocarditis is still debated. The polymicrobial endocarditis is rare: 1-3%. It is being observed with increasing frequency among drug users; a predominance of tricuspid valve involvement exists. We report a case of dual etiology infective endocarditis (IE) - Candida tropicalis and Staphylococcus aureus - in a IVDU; the treatment was combined, medical and surgical, and was followed by a suppressive antifungal therapy. We review the other published Candida tropicalis endocarditis cases and discuss their optimal management.

Adult↗

PubMed1995

Electrodographic analysis and field evaluation of the Speak coding strategy.

The Speak speech-coding strategy for the Nucleus Minisystem-22 cochlear implant continuously analyzes the speech signal using 20 digitally programmable band-pass filters and presents up to 10 spectral maxima to the implanted electrodes. To analyze the performance of this system for a variety of speech sounds in quiet and noise, the stimulation patterns of the implanted electrode array were reconstructed from the transmitted radio frequency signals by software as electrodograms and compared to electrodograms generated by other speech-coding strategies, as well as to the spectrograms of the input signals. The performance with the Speak strategy relative to that with the Multipeak (Mpeak) speech-processing strategy was also evaluated in a field trial study with 20 native German-speaking cochlear implant users from four European implant centers, involving a variety of auditory perceptual tasks in an ABAB paradigm over a 12-week period. Vowel, consonant, and monosyllable word tests, as well as sentence tests in quiet and noise, were conducted. Significant differences in group mean scores for most speech recognition subtests were obtained for the Speak versus the Mpeak strategy, with the largest overall improvements observed for the sentence tests in noisy conditions.

Adult↗

PubMedDate not supplied

[Cold retropharyngeal abscess associated with cervical vertebral tuberculosis].

A 38-year-old man, parenteral drug user affected by vertebral tuberculosis with involvement of the first, second and third cervical vertebrae associated with a cold retropharyngeal abscess is presented. Treatment and main clinical and histopathologic features of this very unusual location of tuberculosis are discussed.

Adult↗

PubMed1997

Analysis of human urine for pyridine-N-oxide metabolites of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, a tobacco-specific lung carcinogen.

4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is a potent pulmonary carcinogen in rodents and is believed to be a causative factor for lung cancer in smokers. NNK also may be involved in oral cancer etiology in users of smokeless tobacco products. Pyridine-N-oxidation of NNK and its major metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), produces NNK-N-oxide and NNAL-N-oxide, respectively, which are detoxification products of NNK metabolism and are excreted in the urine of rodents and primates. Our goal is to develop a panel of urinary biomarkers to assess the metabolic activation and detoxification of NNK in humans. In this study, we developed methodology to analyze human urine for NNK-N-oxide and NNAL-N-oxide. The key step in the method was conversion of the N-oxides to NNK and NNAL by treatment with Proteus mirabilis. The resulting samples were then analyzed essentially by methods that we have described previously. 4-(Methylnitrosamino)-4-(3-pyridyl-N-oxide)-1-butanol (iso-NNAL-N-oxide) was used as internal standard. Levels of NNAL-N-oxide in smokers' urine ranged from 0.06 to 1.4 pmol/mg creatinine, mean +/- SD 0.53 +/- 0.36 pmol/mg creatinine. Its presence was confirmed by high performance liquid chromatography-electrospray ionization-tandem mass spectrometry. NNK-N-oxide was not detected in smokers' urine. Levels of NNAL-N-oxide in the urine of smokeless tobacco users ranged from 0.02 to 1.2 pmol/mg creatinine, mean +/- SD 0.41 +/- 0.35 pmol/mg creatinine. The amounts of NNAL-N-oxide in urine were less than 20% of those of [4-(methylnitrosamino)-1-(3-pyridyl)but-1-yl]-beta-O-D-glucosiduronic acid (NNAL-Gluc) and were approximately 50% as great as those of free NNAL. These results demonstrate that pyridine-N-oxidation is a relatively minor detoxification pathway of NNK and NNAL in humans. The method was applied to analysis of urine from 11 smokers who consumed a diet containing watercress. In an earlier study (S.S. Hecht et al., Cancer Epidemiol., Biomarkers & Prev., 4: 877-884, 1995), we showed that consumption of watercress, a source of phenethyl isothiocyanate (PEITC), caused an increase in urinary excretion of NNAL plus NNAL-Gluc. This was attributed to inhibition of alpha-hydroxylation of NNK by PEITC, as seen in rodents in which PEITC also inhibits the pulmonary carcinogenicity of NNK. However, PEITC also could have inhibited pyridine-N-oxidation of NNK and NNAL. The urine of these smokers was analyzed for NNAL-N-oxide. The results demonstrated that watercress consumption had no effect on levels of NNAL-N-oxide in urine, supporting the conclusion that PEITC does inhibit the metabolic activation of NNK in humans.

Anticarcinogenic Agents↗

PubMed1997

Expanding the physician-substitute concept to oral health care practitioners.

This position paper proposes the development of an intermediate level practitioner to increase access to primary oral health care and to maximize cost benefit factors. The proposal is built upon research which has demonstrated the feasibility of preparing baccalaureate hygienists to serve as the counterpart to the physician assistant or nurse practitioner. The role of the primary oral health care practitioner would involve locating underserved or non-user groups, assessing oral health needs, referring to appropriate care providers, and providing primary care traditionally provided by dentists. Promotion of the intermediate oral practitioner would require policy to halt erosion of the infrastructure of university-based dental hygiene education, the allocation of nationally funded financial incentives, and specified modifications in the current health care system.

Cost-Benefit Analysis↗