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PubMed1986

Components of occupational health information systems.

Occupational health information systems continue to evolve and mature. Consistent throughout this evolution is the linkage of four data bases: job history, work site exposure, environmental agents, and health and safety. A review of the literature cites common elements within these data bases and characteristics of successful systems. Among the factors of successful systems is the role of key staff members. The medical record practitioner can be a significant contributor in the design of such systems. The profession should explore further the opportunities that exist in the occupational health setting.

Environmental Pollutants↗

PubMed2000

[From the great clinical studies to the management of the single patient. Medical therapy in the pre- and post-fibrinolytic era].

Medical therapy of myocardial infarction has changed over the last 30 years. The "lag phenomenon", i.e. the time lapsing from the appraisal of a new, relevant scientific evidence and its practical adoption, has been variable, and different from one treatment to another. It has been very short for GP IIb/IIIa receptor inhibitors in candidates for urgent coronary angioplasty after myocardial infarction, short for ACE inhibitors, and it has been also short for the decrease in the prescription of calcium channel inhibitors after controversial scientific evidence. This time lapse has been long for beta-blockers, that only now are used quite extensively in Italy: from less than 10% of hospitalized patients during the early '80s, to over 60% nowadays. This evolution of medical therapy has been progressive and continuous, has not been divided into two eras, and thrombolysis seems to have little to do with it. The extensive introduction of thrombolysis has simply divided patients with acute myocardial infarction into two subgroups, very different for clinical characteristics: candidates for this therapy, and "others". Candidates for thrombolysis have a much better prognosis, but for a "paradox effect" they have been studied much more than the others. Now, the bulk of publications concerning patients undergoing thrombolysis carries the risk of spreading the concept that myocardial infarction has changed. We do not think that this corresponds to reality. Probably, the concepts that have guided medical therapy have been very similar and unchanged over the years, and both medical and surgical plus coronary angioplasty therapies are today much more appropriately used than yesterday.

Adrenergic beta-Antagonists↗

PubMed2000

Towards evidence-based health administration education: the tasks ahead.

The vision of a more objective, patient-oriented and quantitative evaluation of medicine motivates much current activity in health care, and has come to be called "evidence-based" medicine (Atkins, Kamerow and Eisenberg 1998). A similar vision underlies this special issue. It derives from the 1998 AUPHA annual meeting theme of teaching management technology and the work of an AUPHA task force. The task force is seeking support for a collaborative program to develop measures of educational outcomes and use them in the systematic improvement of member programs (Stephen F. Loebs, PhD, Chair. Members include Ray Davis, PhD; Jeptha W. Dalston, PhD; Gary Filerman, PhD; Barry Greene, PhD; the author; and Douglas Wakefield, PhD.) The task force calls this effort "evidence-based health administration education." It intends a systematic, outcomes-oriented, evaluation and improvement of the educational process, as the evidence-based medicine movement does of medical care. Evolution of member programs using measured performance and continuous improvement is implied, rather than dramatic change (Griffith 1998). Just as evidence-based medicine relies on a disease-oriented taxonomy, evidence-based education must rely on an agreed-upon set of specific skills, knowledge, and abilities (SKAs) that can be learned by students and tested in graduates. This paper discusses what lessons can be learned from the papers reported in the issue, identifies the components necessary to implement the vision, and suggests how AUPHA can proceed in the near future to implement evidence-based education.

Education, Professional↗

PubMed2002

[Surgery for rectal cancer: function rather than organ preservation surgery].

Rectal surgery continues to progress during the last ten years. This technical and treatment evolution give the possibility to increase survival, with local recurrence decrease, all associated with more digestive, urinary and sexual function preservation. These progressive and continues modifications make that today the surgeon was a major prognosis factor of success. Whatever the technical solution used, the function preservation that we reported here, was more and more associated with better oncological result, for the patient benefit. These improvements required mixed teams, medical and surgical, implicated in this specific cancer giving the possibility to use all the technical solutions described here.

Anal Canal↗

PubMedDate not supplied

[Apparatus for hourly determination of diuresis].

The description is given of an apparatus with a clock-like mechanism imparting to a disk a 45 degrees rotation every 60 minutes in order to transfer the end of a vesical catheter from one graduate cylinder to another. This apparatus offers the possiblity of an hourly collection of urine for a continuous follow up of the clinical and therapeutical evolution, facilitating survey of the patient especially in acute renal insufficiency of varied etiology and in diabetic coma. The hourly diuresis diagram, including the qualitative data of the samples collected, furnishes basic information for research in intensive therapy. The apparatus built with local resources, is cheap and runs silently by means of intermittent electric impulses (220 V), is easily maintained in good conditions and guaranteed against corosion and clogging of the mechanisms.

Circadian Rhythm↗

PubMed2005

[Educational strategies to modify physician behaviours and health care outcomes].

The current evolution of medicine requires a sustained effort in continuing medical education to maintain an evidence-based practice. To support this process, several educational strategies are available, including guideline diffusion. Their critical analysis reveals that the dissemination of passive information by conferences or by unsolicited materials is generally ineffective to modify the behaviours in practice or patient outcomes. More effective interventions are practice- and community-based rather than didactic, include an evaluation of learning needs, and enhance active participation in multiple activities. Before investing time and money into an educational activity, one should consider the evidence of its efficacy and make an oriented choice, according to the goals aimed and the available resources.

Education, Medical, Continuing↗

PubMed1991

Reperfusion injury.

The paradigm of reperfusion is one that will test the skills of the critical care practitioner. This syndrome has been implicated in many of the disorders commonly encountered in the intensive care unit. As research continues and more knowledge is gained into the evolution of this process, many of the complications caused by this affliction will be eliminated. In the interim, understanding of the pathophysiology and the components of this syndrome will assist in providing quality care for the patient unfortunate enough to have encountered this potentially devastating malady.

Critical Care↗

PubMedDate not supplied

[Metastatic chorionepithelioma--a rare cause of digestive hemorrhage].

The authors present the case of a female patient aged 19 years with chorionepithelioma, multiple pulmonary metastases, and an unique intestinal metastasis, complicated by severe digestive haemorrhage and haemoperitoneum. Surgery was carried out in risky conditions and consisted in segmental enterectomy and subtotal hysterectomy, and bilateral adnexectomy. The postoperative evolution was unsatisfactory, and the patient died following continued digestive bleeding, probably due to coagulation disturbances induced by prolonged loss of blood. Although the disease is encountered and treated in ob-gyn departments, the general surgeon can be confronted by such complications of this affection which may take on extremely severe aspects, and where surgery, provided that is performed sufficiently early, can save the patient's life.

Adult↗

PubMedDate not supplied

[Buerger's disease. Clinical and therapeutic review. Apropos of a case].

In reference to a typical case of Buerger's disease, the clinical, arteriographic, histological signs as well as diagnostic criteria are restated. The pathogenesis is still unknown; a genetic predisposition and an auto-immune process could be involved. The treatment, presently symptomatic, cannot arrest the evolution which is often mutilating, when the patient continues to smoke. An early diagnosis is possible in the presence of superficial phlebitis or Raynaud's phenomenon.

Adult↗

PubMedDate not supplied

[Results of the use, for a period of 3 years (1974-1977), in pilot districts, of the complex program of measures for prevention of streptococcal infections and their complications].

Starting with the year 1974 a total 11 pilot units have been organized, in as many counties in which a complex program of surveillance of streptococcal infections was applied, that had the following objectives: 1. Prevention and fight against acute streptococcal infection ; 2. Prevention of severe complications of acute rheumatic fever of rheumatic carditis and acute glomerulonephritis ; 3. Prevention of relapses of acute rheumatic fever. The establishment and verification of methods for clinical and laboratory diagnosis was followed, as well as of therapeutic techniques and dispensarization. The analysis of results obtained after the application for a period of 3 years of the program in high-risk collectivities, and in the conditions of an intensive circulation of some epidemic strains of streptococcus has shown the decrease each year of the incidence of scarlet fever, the increased efficiency of detection of acute non-eruptive (non-rash) streptococcal infections, as well as a significant decrease in the number of cases that developed a first attack of acute rheumatic fever and acute glomerulonephritis. A significant decrease was also obtained in the number of relapses and of severe evolution of rheumatic carditis, due to active detection, continuous evidence, prophylaxis and periodic control of cases with acute rheumatic fever.

Anti-Bacterial Agents↗

PubMed1984

[Effects of pretreatment with isoprenaline and conditions of perfusion on the specific radioactivity of ATP in rat heart].

14C adenine was supplied to isolated Rat heart retrograde perfused. The experiment was continued by aortic or atrial perfusion and the evolution of the specific radioactivity of ATP was estimated. Aortic perfusion did not reduce ATP content and the specific radioactivity decreased, expressing the turnover of adenine nucleotides. On the contrary, working heart perfusion provoked a breakdown of ATP and an increase of ATP specific radioactivity. When myocardial ATP was decreased prior to the perfusion with isoproterenol, the incorporation of 14C adenine was enhanced, a further aortic perfusion induced a greater decrease of ATP specific activity than in controls. Atrial perfusion did not change the concentration and the specific activity of ATP. These data seem to provide experimental evidences for a compartmentalization of myocardial ATP.

Adenosine Triphosphate↗

PubMedDate not supplied

[Rehabilitation and the pathology of dementia].

To recognize the influence of the social and physical environment on demential pathology has methodological and therapeutical implications. Since the beginning of the seventies, many works have demonstrated that senile deterioration is not a continuous nor insurmountable process. There is no ineluctable evolution, independent of environment. The different therapeutical strategies can be analysed in terms of behavior modification through an action upon the physical and social determinants of the environment. The authors present two complementary methods of revalidation: an individualised reeducation of necessary behaviors for a social autonomy (toilet, dressing, continence) and a program of physical and psychic activation, to maintain or reestablish social skills (management of the institutional environment, physical mobilisation, ergotherapy and sociotherapy). These methods are relevant to the functional analysis and behavior modification. They are in concordance with the goals of the contemporary gerontology.

Activities of Daily Living↗

PubMed1998

Senior executive behaviors for the Army Dental Care System of the 21st century.

Challenges will most likely confront the Army Dental Care System as it moves into the next century. Like any other learning organization, the Army dental care system must develop a continuous stream of dynamic leaders to direct its evolution if it wants to survive. Using the Delphi method, the investigators surveyed senior dental leaders to determine the attitudes and behaviors believed to be required to perform successfully as commanders, residency directors, and senior staff officers. The essential executive behaviors appear to be consistent: be honest, act with integrity, be accountable for your actions, be dedicated to mission accomplishment, and perform your duty with care and compassion. Relying solely on ratings assigned to the behaviors, discriminant function analyses could predict proper group membership with an accuracy of 79.4%. When demographic information was included, prediction accuracy improved to 96.7%.

Adult↗

PubMed1999

Phylogenetic analysis of a retroposon family in african great apes.

The SINE-R retroposon family has been identified by its relationship with the long terminal repeats (LTRs) of human endogenous retrovirus class K (HERV-K) as a mobile element that has evolved recently in the human genome. Here we examined the recent evolutionary history of this class of elements by a PCR approach to genomic DNA from the African great apes and by phylogenetic analysis including comparison with the HERV K10 parent sequence. With primers derived from a cDNA sequence from human brain, we identified 27 sequences from the chimpanzee and 16 from the gorilla. Phylogenetic comparisons with previously recognized sequences from the human and from the orangutan and gibbon revealed wide overlap of elements across species, suggesting multiple origins in the course of hominoid evolution. Two human elements SINE-R.C2 and HS307 were the furthest removed from the HERV-K10 sequence but these two elements were closely related to three elements from the chimpanzee and four elements from the gorilla. This group of elements (our clusters 14 and 15) appears to have transposed late in hominoid evolution. One element (Ch-M16) showed 99.1% sequence identity with the SINE-R.C2 element, which is human-specific. Thus the SINE-R family appears to have continued to be active in transposition throughout the course of primate evolution.

Animals↗

PubMed2002

[Evolution and selection of reproduction].

The examination of the official records from Artas, Isère (North Dauphiné, France), provides nearly continuous information from 1540 to 1900. These allowed us to study the twinning during this period, to specify its importance, its evolution, and its links with diverse other characteristics of reproduction. The number of twins per 1000 births is on a general average very close to 11. It seems to decrease during the last four centuries. However, the variability is very high from one year to another or one decade to another, including the composition of twins (identical or different sex), with the result that no statistical argument allows us to reject the null hypothesis. Numerous data have been collected that support a partially genetic determinism in twinning. The number of children in families with twins is clearly higher that in other families. Age of death of the mother of twins is higher than that of the mother of single births. With the result that 'gemellity', fecundity and longevity are related. On the other hand, the perinatal and infant death rate is much higher for twins than for single births, so that the percentage of 'useful' children is very low for twins. There is therefore, at the same time, selection and counter-selection. The momentary importance of either could explain the extent of variation of the 'gemellity' rate. The compensations, at short or long time, between the two processes could explain the roughly constant rate of 'gemellity' during the last four centuries.

Biological Evolution↗

PubMed2006

Experimental evolution of resistance to an antimicrobial peptide.

A novel class of antibiotics based on the antimicrobial properties of immune peptides of multicellular organisms is attracting increasing interest as a major weapon against resistant microbes. It has been claimed that cationic antimicrobial peptides exploit fundamental features of the bacterial cell so that resistance is much less likely to evolve than in the case of conventional antibiotics. Population models of the evolutionary genetics of resistance have cast doubt on this claim. We document the experimental evolution of resistance to a cationic antimicrobial peptide through continued selection in the laboratory. In this selection experiment, 22/24 lineages of Escherichia coli and Pseudomonas fluorescens independently evolved heritable mechanisms of resistance to pexiganan, an analogue of magainin, when propagated in medium supplemented with this antimicrobial peptide for 600-700 generations.

Animals↗

PubMed2004

Reexamining organizational configurations: an update, validation, and expansion of the taxonomy of health networks and systems.

OBJECTIVES: To (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures. DATA SOURCES; 1994 and 1998 American Hospital Association (AHA) Annual Survey of Hospitals. STUDY DESIGN: As in the original taxonomy, separate cluster solutions are identified for health networks and health systems by applying three strategic/structural dimensions (differentiation, integration, and centralization) to three components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities). DATA EXTRACTION METHODS: Factor, cluster, and discriminant analyses are used to analyze the 1998 data. Descriptive and comparative methods are used to analyze the updated 1998 taxonomy relative to the original 1994 version. PRINCIPAL FINDINGS: The 1998 cluster categories are similar to the original taxonomy, however, they reveal some new organizational configurations. For the health networks, centralization of product/service lines is occurring more selectively than in the past. For the health systems, participation has grown in and dispersed across a more diverse set of decentralized organizational forms. For both networks and systems, the definition of centralization has changed over time. CONCLUSIONS: In its updated form, the taxonomy continues to provide policymakers and practitioners with a descriptive and contextual framework against which to assess organizational programs and policies. There is a need to continue to revisit the taxonomy from time to time because of the persistent evolution of the U.S. health care industry and the consequent shifting of organizational configurations in this arena. There is also value in continuing to move the taxonomy in the direction of refinement/expansion as new opportunities become available.

American Hospital Association↗

PubMed1999

RNA processing and the evolution of eukaryotes.

In eukaryotes, RNA processing events, including alternative splicing and RNA editing, can generate many different messages from a single gene. As a consequence, the RNA pool, which we refer to here as the 'ribotype', has a different information content from the genotype and can vary as circumstances change. The outcome of a single RNA processing event often regulates the outcome of another, giving rise to networks that affect the composition and expression of a particular ribotype. Successful ribotypes are determined by natural selection, and can be incorporated into the genome over time by reverse transcription. Eukaryotic evolution is therefore influenced by the alternate ways in which RNAs are processed and the continual interplay between RNA and DNA.

Animals↗