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PubMed1989

Improvement in the occupational health program in a Finnish construction company by means of systematic workplace investigation of job load and hazard analysis.

The aim of the present study was to improve an occupational health program by means of systematic workplace investigations. The 8-month study was done at three building sites of one construction firm. The method for workplace investigations was a simple job hazard analysis of chemical hazards, physical hazards, physical work load, mental stress, and risk of injury, each factor being rated on a three-point scale. Information was gathered by observations, interviews, and a worker questionnaire. Occupational health and safety personnel and worker representatives dealt with problems cooperatively. Together they assessed occupational loads and hazards, whereafter the occupational health and safety personnel devised an occupational health care program and proposed preventive measures. The workplace investigation method proved to function well. It improved the occupational health care program, produced an overall analysis of occupational hazards, and dramatically increased the number and quality of proposed preventive measures. The new method was evaluated to be clearly superior to previous practices and was implemented at moderate cost. The study showed that attention to issues of environmental and occupational health can effectively prevent health impairment even in difficult setting such as construction work. More research is needed for effective utilization of information accumulated by systematic workplace investigations.

Finland↗

PubMed2004

Coherence-induced artifacts in large-flip-angle steady-state spin-echo imaging.

High-resolution imaging of trabecular bone aimed at analyzing the bone's microarchitecture is preferably performed with spin-echo-type pulse sequences. Unlike gradient echoes, spin-echoes are immune to artifactual broadening of trabeculae caused by local static field gradients near the bone-bone marrow interface and signal loss from chemical shift dephasing at k-space center. However, the previously practiced 3D fast large-angle spin-echo (FLASE) pulse sequence was found to be prone to a low-frequency modulation artifact in both the readout and slice direction. The artifact is caused by deviations in the effective flip angle of the nonselective 180 degrees pulse, which converts a fraction of the phase-encoded transverse magnetization to longitudinal magnetization. The latter recurs as transverse magnetization in the subsequent pulse sequence cycle forming a spurious stimulated echo. The objective of this work was to perform a k-space analysis of this steady-state artifact and propose two modifications of the original 3D FLASE that effectively remove it. The results of the simulations were in exact agreement with the experiments and the proposed remedy was found to eliminate the artifact.

Artifacts↗

PubMed2006

Predicting G-protein coupled receptors-G-protein coupling specificity based on autocross-covariance transform.

Determining G-protein coupled receptors (GPCRs) coupling specificity is very important for further understanding the functions of receptors. A successful method in this area will benefit both basic research and drug discovery practice. Previously published methods rely on the transmembrane topology prediction at training step, even at prediction step. However, the transmembrane topology predicted by even the best algorithm is not of high accuracy. In this study, we developed a new method, autocross-covariance (ACC) transform based support vector machine (SVM), to predict coupling specificity between GPCRs and G-proteins. The primary amino acid sequences are translated into vectors based on the principal physicochemical properties of the amino acids and the data are transformed into a uniform matrix by applying ACC transform. SVMs for nonpromiscuous coupled GPCRs and promiscuous coupled GPCRs were trained and validated by jackknife test and the results thus obtained are very promising. All classifiers were also evaluated by the test datasets with good performance. Besides the high prediction accuracy, the most important feature of this method is that it does not require any transmembrane topology prediction at either training or prediction step but only the primary sequences of proteins. The results indicate that this relatively simple method is applicable. Academic users can freely download the prediction program at http://www.scucic.net/group/database/Service.asp.

Algorithms↗

PubMed1999

Using the Internet to calculate clinical action thresholds.

Understanding the risks and benefits of available treatments represents an essential element of clinical practice. Previous work has demonstrated that knowledge of net benefits and net risks can relate to our decisions on whether or not to administer a particular treatment or order a diagnostic test. A wider application of this model has been difficult because data on net benefits and net risks are not directly reported. We used more frequently reported data on treatment efficacy (E) and risks (Rrx) to obtain an equation for the treatment threshold probability above which treatment should be given and below which it should be withheld. The diagnostic test should only be performed if the probability of a disease is between the testing threshold and the treatment threshold. We first described a theoretical background for these calculations. We then used a JavaScript programming language to write a computer program which physicians can use to calculate these threshold probabilities effortlessly through the Internet. In most clinical situations we do not have to achieve maximum diagnostic certainty in order to act. However, we should never treat or order a diagnostic test if the risk of the treatment is greater than its efficacy. The minimally required E/R ratio of a particular treatment is equal to the reciprocal value of the mortality/morbidity of untreated disease. Similarly, the lowest number of patients needed to be treated (NNT) for therapy to be worth administering is equal to the reciprocal of the treatment risk. We show how evidence-based summary measures of therapeutic effects, such as the treatment efficacy, harms, and NNT, can successfully be integrated within a decision analytic model. This in turn will facilitate wider use of the quantitative benefit-risk analysis. Accessing the Internet for direct and immediate approach to the formulas described here should make this task even easier in everyday clinical decision making.

Adult↗

PubMed1975

[The use of the "anti-G-suit" during operations in the sitting position as a treatment of postural hypotension.(author's transl)].

The use of the "Anti-G-Suit" in patients with postural hypotension is described. Acute falls in the blood pressure during operations in the sitting position can be successfully treated with the aid of an external counterpressure garment reaching from ankles to xiphoid process. The mean increase in systolic blood pressure was about 60% in hypotensive and 17% in normotensive control patients. A reciprocal relation between pre-treatment blood pressure and its increase after use of the "G-Suit" was noticed. In contrast to previous practice, we were able to operate on all hypotensive patients in poor condition. The effect of external counterpressure on the lower part of the body can be explained by increase of peripheral resistance and decrease of vascular flow, resulting in better venous return, displacement of the circulating blood above the diaphragm and augmentation of systolic blood pressure.

Gravity Suits↗

PubMedDate not supplied

Pattern-onset visual evoked potentials: more useful than reversal for patients with nystagmus.

PURPOSE: The visual evoked potential is often used to assess visual function in neurologically impaired patients, a group in whom nystagmus is a common feature. Pattern-reversal stimuli are commonly used to produce visual evoked potentials in clinical practice. Previous reports have shown that this stimulus is not optimal when subjects have nystagmus. The present study aimed to compare the efficacy of pattern-onset and reversal stimuli when used to measure visual evoked potentials from subjects with idiopathic nystagmus. METHODS: In five adults with congenital nystagmus and 10 visually normal adults, VEPs were recorded and reproduced for checkerboard stimuli of two sizes (120' and 60'). Each size was presented as both pattern-onset and reversal check. RESULTS: Visually normal adults demonstrated similar visual evoked potential amplitudes and quality in response to pattern-reversal and pattern-onset. However, in the presence of nystagmus, visual evoked potentials recorded to pattern-reversal stimuli were significantly smaller and of poorer quality than those obtained to pattern-onset stimuli (analysis of variance p<0.05; Kendall's tau, p<0.05). CONCLUSIONS: Pattern-onset stimuli produce larger and clearer visual evoked potentials in patients with nystagmus compared with those produced to pattern-reversal stimuli.

Adult↗

PubMed1993

Problem-oriented management of laboratory work through dynamic test scheduling.

This paper gives an overview of problems inherent in dynamic test scheduling together with some model solutions. Dynamic test schedules are decision tree-like protocols for cost-efficient management of analytical production in a clinical laboratory. The present analysis is based on previous practical experience and concludes that it is not feasible to introduce dynamic test scheduling on a large scale without computer-based support, because of the increase in complexity of the laboratory work processes. Further, our experience is that it is extremely complex to incorporate the dynamic test scheduling functionality into an existing Laboratory Information System (LIS). The approach pursued in the OpenLabs (A2028) AIM Project for implementing dynamic test scheduling is to provide the necessary functionality as a stand-alone module interconnected with a LIS in an open systems solution.

Clinical Laboratory Information Systems↗

PubMed1993

Detection of airborne cocaine and heroin by high-throughput liquid-absorption preconcentration and liquid chromatography-electrochemical detection.

A high-throughput liquid-absorption preconcentrator (HTLAP) for rapid and/or ultrasensitive detection and analysis of trace contaminants samples air at a rate of 600-700 l/min and collects analytes from vapors or aerosols at an efficiency of 40-60% into a small volume of liquid absorbent dripping at a rate of 0.1-2 ml/min. These features combine to reduce the lower detection limit (LDL) of available analytical instrumentation by a factor of > 1000 and/or to permit faster sampling and far more rapid on-site air monitoring than were previously practicable. LDLs of ca. 1:10(13) (v/v) of alkaloids have been achieved with LC and electrochemical detection. The HTLAP is directly adaptable to most liquid-phase analyzers. The small rate of liquid collection is also compatible with available interfaces to mass spectrometers. Moreover, the HTLAP permits detection and quantitation of polar or highly reactive compounds that cannot be readily analyzed by conventional preconcentration and GC.

Air Pollutants↗

PubMed1993

The practice of consultation-liaison psychiatry in Japan.

Consultation-liaison (C-L) psychiatry has been developing for the past 10 years as a new clinical service field in Japan. Although this kind of service had been practiced previously, it was not recognized as an independent clinical field. Still in the developing phase, clinical research in C-L psychiatry has been reported, although its quality has been variable. The authors describe the development and a typology of C-L psychiatry (seven types) in Japan. This article reports time spent on C-L psychiatry activity in a general hospital. Although C-L psychiatry requires much time and labor, hardly any of the C-L psychiatry services are reimbursed in the Japanese insurance system. The authors propose a "new department" as one option to continue providing C-L psychiatry service to general hospital patients and for further development of C-L psychiatry in Japan.

Ambulatory Care↗

PubMed1989

Listeria monocytogenes in foods. Isolation, characterization and control.

The intent for examining foods for Listeria monocytogenes, i.e. for surveying, for epidemiological purposes, or to inspect consignments of foods for microbiological safety, determines which analytical method is to be used. For instance resuscitation of debilitated cells may be required, and the degree of accuracy and precision necessary should be considered. Moreover, in the case of acceptance-or-rejection monitoring target values for 'absence' of the pathogen have been amply but not always effectively discussed. Recommendations are given for assessing adequate repair of sublethally damaged populations of L. monocytogenes and for performance testing of selective enrichment and isolation media to be used for the isolation and enumeration of L. monocytogenes. An approach to the empirical assessment of reference values for L. monocytogenes in foods processed for safety is also presented. This relies on a data base of results obtained when examining foods manufactured and distributed according to practices previously validated by longitudinally integrated ('holistic') quantitative risk analysis.

Culture Media↗

PubMed2004

Error-free pathology: applying lean production methods to anatomic pathology.

The current state of our health care system calls for dramatic changes. In their pathology department, the authors believe these changes may be accomplished by accepting the long-term commitment of applying a lean production system. The ideal state of zero pathology errors is one that should be pursued by consistently asking, "Why can't we?" The philosophy of lean production systems began in the manufacturing industry: "All we are doing is looking at the time from the moment the customer gives us an order to the point when we collect the cash. And we are reducing that time line by removing non-value added wastes". The ultimate goals in pathology and overall health care are not so different. The authors' intention is to provide the patient (customer) with the most accurate diagnostic information in a timely and efficient manner. Their lead histotechnologist recently summarized this philosophy: she indicated that she felt she could sleep better at night knowing she truly did the best job she could. Her chances of making an error (in cutting or labeling) were dramatically decreased in the one-by-one continuous flow work process compared with previous practices. By designing a system that enables employees to be successful in meeting customer demand, and by empowering the frontline staff in the development and problem solving processes, one can meet the challenges of eliminating waste and build an improved, efficient system.

Diagnostic Errors↗

PubMed2005

Molecular evidence for progression of nephrogenic metaplasia of the urinary bladder to clear cell adenocarcinoma.

Nephrogenic metaplasia or nephrogenic adenoma of the urinary tract may present a diagnostic challenge in surgical pathology practice. Previous case reports suggest the possibility of nephrogenic metaplasia progressing to clear cell adenocarcinoma, but a malignant potential of nephrogenic metaplasia is generally not acknowledged. A case of a 70-year-old female patient with multiple recurrences of nephrogenic metaplasia of the urinary bladder and subsequent development of clear cell adenocarcinoma is described. Immunohistochemical studies help to differentiate the 2 entities. Results of molecular studies, particularly comparative genomic hybridization analysis, suggest clonal evolution of nephrogenic metaplasia to clear cell adenocarcinoma in this case.

Adenocarcinoma, Clear Cell↗

PubMedDate not supplied

Do anterior interbody cages have a potential value in comparison to autogenous rib graft in the surgical management of Scheuermann's kyphosis?

BACKGROUND CONTEXT: Previous studies have analyzed the outcome following posterior correction and combined anterior-posterior correction for Scheuermann's kyphosis. Traditionally interbody fusion has been obtained using morselized rib graft. Recently the use of titanium anterior cages has been suggested for interbody use. There are no long-term studies comparing these two techniques. PURPOSE: To investigate the potential value of titanium anterior interbody cages compared with morselized rib graft for anterior interbody fusion in combination with posterior instrumentation, correction, and fusion for Scheuermann's kyphosis. STUDY DESIGN: Nonrandomized comparison of two surgical techniques in matched subjects. PATIENT SAMPLE: Fifteen patients with identical preoperative radiographic and physical variables (age, gender, height, weight, body mass index) were managed with combined anterior release, interbody fusion, posterior instrumentation, correction, and fusion. Group A (n=8) had morselized rib graft inserted into each intervertebral disc space. Group B (n=7) had titanium interbody cages packed with bone graft inserted at each level. The posterior instrumentation extended from T2 to L2 in both groups. OUTCOME MEASURES: Preoperative and postoperative curve morphometry was studied on plain radiographs by two independent observers. The indices studied included Cobb angle, Ferguson's angle, Voutsinas index, sagittal vertical axis (SVA), sacral inclination (SI), and lumbar lordosis (LL). Interbody fusion was assessed at final follow-up. Each patient was reviewed at 3, 6, 12, 24, 48, and 60 months after surgery with standing radiographs. METHODS: Both surgical groups were compared in terms of radiological parameters and complications. Wilcoxon-matched pairs test and Mann-Whitney test were used. RESULTS: The average follow-up for Group A was 70 months and for Group B 66 months. For the whole group, the preoperative median Cobb angle for thoracic kyphosis was 86 degrees , the median Ferguson angle was 50 degrees , Voutsinas index was 28.7, SVA -3.5 centimeters, lumbar lordosis was 66 degrees , and the median sacral inclination angle was 40 degrees . The median postoperative Cobb angle was 42 degrees , Ferguson angle 28.4 degrees , Voutsinas index 13, SVA -4.0 centimeters, and the median sacral inclination angle was 34 degrees . There were significant differences between preoperative and postoperative measurements for all variables (p<.01), indicating that good correction was achieved. At 4-year follow-up, fusion criteria were satisfied in 12 of 15 cases (80%). Three patients had distal junctional kyphosis. There was no significant difference obtained in the final Cobb angle, Ferguson angle, and Voutsinas index when Group A (rib graft) was compared with Group B (titanium cage) Both Group A and B patients retained the postoperative correction achieved with respect to all the radiographic parameters studied. CONCLUSION: We were unable to demonstrate any significant advantage for the use of anterior titanium interbody cages over the use of morselized rib graft in the surgical management of Scheuermann's kyphosis. Given the not inconsiderable cost and the need for posterior chevron osteotomies when interbody cages are used, we have now reverted to our previous practice of using morselized rib graft at each intervertebral level.

Adult↗

PubMed1982

Plasma gonadotropins, prolactin, and steroid hormone concentrations in female runners immediately after a long-distance run.

Six normally menstruating women who regularly run participated in a 10-mile race. Blood samples were collected within 20 minutes after the completion of the race (group 1). Samples were analyzed, and the results were compared with plasma hormonal concentrations in the same runners in samples collected between 12 and 24 hours after a previous practice run (group 2) and with our nonathletic female controls. Plasma concentrations of the following hormones in group 1 were significantly elevated when compared with group 2: dehydroepiandrosterone (DHA), androstenedione (delta 4A), testosterone (T), cortisol (F), luteinizing hormone (LH), and prolactin (PRL). Levels of 17 beta-estradiol (E2), 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHAS), and follicle-stimulating hormone (FSH) were comparable in groups 1 and 2. However, DHAS in group 1 was elevated when compared with controls, as were HDA, delta 4A,T,F,LH, and PRL. In group 1, but not in group 2, a significant correlation (P less than 0.05) was observed between plasma LH and PRL concentrations but not between FSH an PRL. We conclude that the immediate effect of running is reflected in increased levels of the adrenal androgens, F, LH, and PRL. However, concentrations of these hormones revert back to baseline within 12 to 24 hours after the race.

Adolescent↗

PubMed2002

Pediatric meralgia paresthetica.

Meralgia paresthetica is a focal peripheral neuropathy involving the lateral femoral cutaneous nerve and is rarely observed in pediatric practice. Previous reports have highlighted its occurrence within the context of a regional bony malignancy. We present here three patients less than 18 years of age with idiopathic meralgia paresthetica.

Adolescent↗

PubMed2003

A re-examination of levels and differential in fertility in South Africa from recent evidence.

The final estimate of South Africa's population as of October 1996 from the first post-apartheid census by Statistics South Africa was lower (40.6 million) than expected (42 million). The expectation of a total population of 42 million was largely based on results of apartheid projections of South Africa's population. The results of the last apartheid census in South Africa in 1991 had been adjusted such that it was consistent with results modelling the population size of South Africa. The discrepancy between the final estimate of the 1996 census and that expected from the modelling described above, and the departure by Statistics South Africa from previous practice of adjusting the census results to be consistent with demographic models, has generated controversies regarding the accuracy of the final results from the 1996 census. This study re-examines levels and differential in fertility in South Africa from recent evidence in order to assess whether or not the fertility inputs in projections of South Africa's population during the apartheid era overestimated fertility.

Adolescent↗

PubMed1992

Management of posterior mesotympanic cholesteatoma.

Contrary to previous practice, the eradication of posterior mesotympanic cholesteatoma can frequently be achieved using a transcanal approach and without the need for more major surgery. For success, certain specific steps are necessary. These are described and the results reported.

Cholesteatoma↗

PubMed1996

An audit of prophylactic antibiotic treatment following tonsillectomy in children.

A prospective audit study was undertaken to assess the effect of two different management policies following tonsillectomy in children in this hospital, one of which requires a prophylactic five-day course of oral antibiotics and the other doses not. A total of 95 children were entered into the trial: 54 received post-operative antibiotics and 41 did not. The post-operative recovery was assessed by completion of a parent questionnaire which included the following parameters: degree of patient distress, nausea and vomiting, otalgia, halitosis, pharyngeal bleeding, analgesic requirement, day of return to a regular diet and General Practitioner consultation. There was no significant reduction in any of the morbidity measures in patients treated with antibiotics. I fact, the analgesic requirement and the incidence of otalgia and irritability on Days 6 and 7 and secondary haemorrhage were significantly higher in the antibiotic-treated patients. Although the number of patients included in this study are small, the result suggest that post-operative antibiotics do not improve the outcome of uncomplicated tonsillectomy. Our previous practice of routinely administering antibiotics to post-tonsillectomy children has been discontinued as the consequence of this audit.

Adolescent↗