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At least 127 records · Page 7Linked to original sources
PubMed2004

Hand hygiene among physicians: performance, beliefs, and perceptions.

BACKGROUND: Physician adherence to hand hygiene remains low in most hospitals. OBJECTIVES: To identify risk factors for nonadherence and assess beliefs and perceptions associated with hand hygiene among physicians. DESIGN: Cross-sectional survey of physician practices, beliefs, and attitudes toward hand hygiene. SETTING: Large university hospital. PARTICIPANTS: 163 physicians. MEASUREMENTS: Individual observation of physician hand hygiene practices during routine patient care with documentation of relevant risk factors; self-report questionnaire to measure beliefs and perceptions. Logistic regression identified variables independently associated with adherence. RESULTS: Adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for nonadherence. LIMITATIONS: Direct observation of physicians may have influenced both adherence to hand hygiene and responses to the self-report questionnaire. Generalizability of study results requires additional testing in other health care settings and physician populations. CONCLUSION: Physician adherence to hand hygiene is associated with work and system constraints, as well as knowledge and cognitive factors. At the individual level, strengthening a positive attitude toward hand hygiene and reinforcing the conviction that each individual can influence the group behavior may improve adherence among physicians. Physicians who work in technical specialties should also be targeted for improvement.

Adult↗
PubMed1995

[Disposable versus reusable instruments in laparoscopic surgery--a controlled study].

The instruments for laparoscopic surgery are usually available in a disposable and in a reusable type. We performed a prospective, randomized study, based on the most frequent laparoscopic operation, the cholecystectomy, in order to directly quantify and compare the advantages and disadvantages of both types of instruments. 158 patients, who planned to undergo a cholecystectomy, were randomly distributed into two groups. 80 patients (group A) underwent surgery with reusable instruments and 78 patients (group B) with disposable instruments. We investigated the following parameters and compared them for both groups: length of operation, complications, conversion rate to open surgery, subjective postoperative pain, length of inability to work, technical problems during operation, postoperative hospitalization time, satisfaction of operating room personnel. The analysis of the results demonstrates no difference in the postoperative hospitalization time, in the postoperative complication rate, subjective pain sensation and postoperative inability to work. Differences in favour for the group of patients, operated with disposable instruments, were found in the conversion rate, in the length of operation and, statistically significant, in the amount of intraoperative problems, caused by instrument-technical reasons. Even if considering the greater expenses in time and personnel costs, operations with reusable instruments are in average 1015 DM cheaper.

Adolescent↗
PubMed2006

Future prospects for fMRI in the clinic.

Functional MRI (fMRI) has tremendous clinical potential that is as yet unrealized. There are tremendous unmet medical needs that fMRI could address with significant benefit to human health. However, both medical and technical barriers prevent this benefit from accruing today. Technical barriers may be the reflexive focus of the current practitioners of fMRI, a technically savvy group. However, the real challenge lies in the medical realm, and this will require multidisciplinary and interdisciplinary work since the technical aspects of fMRI are ahead of the medical aspects. This can be seen in a range of diseases from Alzheimer's disease to schizophrenia to ischemic stroke: in each case our ability to image changes with fMRI outstrips our ability to do anything useful for the patient with them. Diagnostic imaging will always be linked in the clinic to therapeutic choices, and therefore the most powerful approach to link fMRI more directly to the clinic will be to tie fMRI to therapy development and implementation.

Brain Mapping↗
PubMed2004

When redundant on-screen text in multimedia technical instruction can interfere with learning.

It is frequently assumed that presenting the same material in written and spoken form benefits learning and understanding. The present work provides a theoretical justification based on cognitive load theory, and empirical evidence based on controlled experiments, that this assumption can be incorrect. From a theoretical perspective, it is suggested that if learners are required to coordinate and simultaneously process redundant material such as written and spoken text, an excessive working memory load is generated. Three experiments involving a group of 25 technical apprentices compared the effects of simultaneously presenting the same written and auditory textual information as opposed to either temporally separating the two modes or eliminating one of the modes. The first two experiments demonstrated that nonconcurrent presentation of auditory and visual explanations of a diagram proved superior, in terms of ratings of mental load and test scores, to a concurrent presentation of the same explanations when instruction time was constrained. The 3rd experiment demonstrated that a concurrent presentation of identical auditory and visual technical text (without the presence of diagrams) was significantly less efficient in comparison with an auditory-only text. Actual or potential applications of this research include the design and evaluation of multimedia instructional systems and audiovisual displays.

Adolescent↗
PubMed2001

[Data protection--an obstacle for prospective studies? Solutions exemplified by a cohort study].

Prospective studies require the storage of the participants' personal data for follow-up. This demands special precautions for the protection of these data. Additional to the informed consent of the participant which enables the researchers to collect the prospective study data, the participant's right of informal self-determination should be protected. In the EPIC (European Prospective Investigation into Cancer and Nutrition) Potsdam study, therefore, an internal trustee was established that collects follow-up information from participants, physicians, clinics, health offices, tumour and population registries with the aim to obtain valid information on vital status and diseases of the participants. The internal trustee is a spatial and organizational separated working group. The isolated electronic data processing network, the alarm system which controls the rooms of the working group, the access control for employees are special security arrangements. During follow-up the individual identification number of the study data base is replaced by a specific identification number solely for the follow-up. Further, unique identification numbers are allocated to every single action and every single document such as inquiry forms which are sent to physicians, health offices, or population registries, that allow anonymous mailing and processing of the collected information. On copies of important documents, the name is erased and replaced by a specific record number. The inquiry forms for the physicians, for instance, contain the name of the participant at the head which has to be cut off before returning the form to the internal trustee. The identification number is also printed as bar code on each document facilitating its processing with technical aids such as scanners. If checkbacks are necessary, only certain work group members are able to reconnect the document number with the name. Depending on the task, the computer programmes confine automatically the details presented to the assistant. All arrangements to protect personal data do not interfere with research interests; on the contrary they lead to an efficient work routine and guarantee follow-up according to international rules.

Cohort Studies↗
PubMed2006

Improving the use of research evidence in guideline development: 3. Group composition and consultation process.

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the third of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVE: In this review we address the composition of guideline development groups and consultation processes during guideline development. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: What should be the composition of a WHO-panel that is set up to develop recommendations? The existing empirical evidence suggests that panel composition has an impact on the content of the recommendations that are made. There is limited research evidence to guide the exact composition of a panel. Based on logical arguments and the experience of other organisations we recommend the following: Groups that develop guidelines or recommendations should be broadly composed and include important stakeholders such as consumers, health professionals that work within the relevant area, and managers or policy makers. Groups should include or have access to individuals with the necessary technical skills, including information retrieval, systematic reviewing, health economics, group facilitation, project management, writing and editing. Groups should include or have access to content experts. To work well a group needs an effective leader, capable of guiding the group in terms of the task and process, and capable of facilitating collaboration and balanced contribution from all of the group members. Because many group members will not be familiar with the methods and processes that are used in developing recommendations, groups should be offered training and support to help ensure understanding and facilitate active participation.What groups should be consulted when a panel is being set up?We did not identify methodological research that addressed this question, but based on logical arguments and the experience of other organisations we recommend that as many relevant stakeholder groups as practical should be consulted to identify suitable candidates with an appropriate mix of perspectives, technical skills and expertise, as well as to obtain a balanced representation with respect to regions and gender. What methods should WHO use to ensure appropriate consultations? We did not find any references that addressed issues related to this question. Based on logical arguments and the experience of other organisations we believe that consultations may be desirable at several stages in the process of developing guidelines or recommendations, including: Identifying and setting priorities for guidelines and recommendations, commenting on the scope of the guidelines or recommendations, commenting on the evidence that is used to inform guidelines or recommendations, commenting on drafts of the guidelines or recommendations, commenting on plans for disseminating and supporting the adaptation and implementation of the guidelines or recommendations, key stakeholder organisations should be contacted directly whenever possible, consultation processes should be transparent and should encourage feedback from interested parties.

Journal Article↗
PubMed1998

Development of standard methods with special reference to Europe.

For a long time, many different microbiological methods were used around the world in order to enumerate or detect contaminants in foods. The development of commercial, but also scientific and technical exchanges between countries has stimulated new developments and a desire to harmonize methods. The example of AFNOR (French Association for Standardization) is first presented. Then, the new developments under CEN (European Committee for Standardization) are described, emphasizing a Measurements and Testing project. The MicroVal project, now integrated as a task force within CEN Technical Committee 275/Working Group 6 is described. Finally, the possibility of working towards an international consensus through the Codex Alimentarius is discussed.

Food Microbiology↗
PubMedDate not supplied

The time required to perform pediatric transthoracic echocardiographic studies.

The purpose of this study was to determine the time required to perform and evaluate transthoracic pediatric echocardiographic procedures by two groups of pediatric cardiologists; one group was university based and the other group was based in a private practice. Methods consisted of measuring five periods including technician preparation time, technician procedure time, physician imaging time, physician review and reporting time, and physician time in interpretation of the results of the study to the parent or patient. The study evaluated data for 200 studies for the university-based group (all of which were complete studies) and 193 studies for the private practice group (84% of which were complete studies and the remainder were partial studies). Eleven pediatric cardiologists participated in the study. Although some variations in physician imaging and review time were encountered, data demonstrated that mean total physician time for a complete echocardiographic study was 31.9 minutes for both groups. Mean total technical time for complete studies was 42.4 minutes for the private group and 40.9 minutes for the university group. These are the first data evaluating the technical and physician work durations for pediatric echocardiography.

Academic Medical Centers↗
PubMed1977

Experimental intracranial aneurysms.

Methods and results of creation of an experimental intracranial aneurysm on the canine basilar artery using an autogenous vein graft are presented. Aneurysms were produced either on the wall of the basilar artery or at a lingual-basilar artery anastomosis site. Postoperative angiography revealed no success in the first group and 55% success in the second group, with better results occurring later in the series. Mortality was higher in the first group. Hemodynamic and technical factors are discussed and compared with earlier work on experimental aneurysms in the rat. Construction of an aneurysm at the site of a lingual-basilar artery anastomosis seems to provide a satisfactory model for biophysical and catheter embolization experimentation, although at present it is unsuitable for studies of acute subarachnoid hemorrhage.

Animals↗
PubMed2005

[The tobacco problem in French-speaking Africa and regional perspectives of the French-speaking African tobacco observatory].

The tobacco problem is one which is both global and political. The epidemic and the growing smoking crisis in Africa is a menace to the health of our continent, with significant socio-economic repercussions to follow in the coming years. Approximately 1.1 billion people around the world smoke, and between now and the year 2025, this number will most likely increase to 1.6 billion. By 2030, 10 million tobacco-related deaths will have occurred, and for the most part those deaths will be concentrated in developing countries. The tobacco industry clearly lies at the heart of the development of the tobacco pandemic in the 20th century. Specifically, cigarettes have made tobacco a massively consumed product, constantly expanding and opening up new markets; the day before yesterday it was men, yesterday it was women and youth, and today it is the developing world. The strategy is identical: increase sales, and do goat a price which puts a heavy burden on the population's health. The industries turn themselves towards developing countries, and namely Africa, in order to compensate for their losses in the markets of the Northern Hemisphere at a time when the demand in these countries is decreasing. The industry's cynical strategy targets Africa as its strongest potential market for development, counting on an estimated increase in consumption of 16% over the next decade, according to WHO's recent World Tobacco Atlas. The illegal importation of cigarettes is a practice which is growing more and more within African countries, with a well-structured African network for smuggling. Smuggled cigarettes are even more toxic with very elevated levels of nicotine and tar. Sponsorship as well as direct and indirect advertising are rapidly developing in all kinds of formats, with a proliferation of aggressive advertising messages targeting African populations with cynicism, manipulation, the complicity of smuggling in broad daylight, and disrespect for the law, while exploiting all of the themes which promote tobacco use to the target audiences (youth, women, the poorest groups). Everyday the tobacco industry recruits new African smokers to replace those who die. The future of the industry is represented by about 8 out of 10 people who began smoking before the age of 18 years old. It was imperative to establish a Tobacco Observatory in Francophone Africa (OTAF) in order to resituate the African tobacco situation, contribute to the development of the French-speaking nations in Africa, and to make known and increase awareness of its needs, its initiatives, and its actions across the world, and finally to effectively fight against tobacco and the industry's practices. One year after OTAF was established in Bamako thanks to the consolidated efforts of all its members and support of the French League against Cancer and the International Union against Cancer, OTAF OTAF is an independent entity whose mission is to gather, analyse and disseminate information on all aspects of tobacco with the objective of soliciting and supporting public health activities and interventions. It is a reference centre for Francophone Africa and a technical advisory group for the public authorities on tobacco issues. OTAF's work is counted upon to inform the public authorities on the most effective measures to use in the fight against tobacco. OTAF's duty is to promote activities which protect the health of young people and non-smokers, and communicate on the harmful effects of tobacco and the tobacco industry's practices. The goal is to organise a fight against tobacco based on solid, scientific data of the highest level of quality. OTAF is the only Francophone African surveillance organisation for monitoring the tobacco epidemic, and the practices, schemes and methods of the tobacco industry which are known to be dishonest Today, OTAF is a unique reference centre as far as the fight against tobacco is concerned in Francophone Africa. It is a partner in a number of projects with the French League against Cancer, the International Union against Cancer, and the International Union for Health Promotion and Education, among others. The success of OTAF has been crowned by a trophee having been awarded by WHO and an honorary degree signed by WHO's Director General.

Africa, Northern↗
PubMed1988

Variation in hospital morbidity in the male workforce of Western Australia.

The associations of hospital morbidity with occupation were studied in Western Australian men of working age in 1981-2. Data on hospital morbidity were derived from a population based system that covered all short stays in hospitals in the state. Occupations were grouped into 12 major categories and conditions were coded using the International Classification of Diseases. Armed services personnel had the highest overall rate of hospital admissions, followed by transport and communications workers and by administrative and managerial workers. Injuries were the most common cause of referral to hospital. Four occupational groups, farmers and allied workers, miners and quarrymen, transport and communications workers, and craftsmen, production workers, and labourers were often associated with injury. Diseases of the musculoskeletal system and connective tissue were the second most common cause for referral and were increased in transport and communications workers, and in craftsmen, production workers, and labourers. Several other associations between causes of hospital admission and major occupational groups were observed, including associations of circulatory system diseases with professional and technical work and with administrative and managerial work. The excess of hospital admissions due to factors associated with occupation was estimated to be 12,665 admissions a year or 24.9% of the total in working men.

Adolescent↗
PubMedDate not supplied

[Adaptation times of flight-technical personnel to work in subtropical climate conditions].

The results of studying the process and time of adaptation of two groups of the flying personnel who arrived from moderate climate to the subtropic climate show that the early stage of acclimatization lasts from two to four weeks, depending on the season. From the physiological point of view the best season is spring-summer. During this period the time of acclimatization is two times shorter than in winter.

Acclimatization↗
PubMed1999

Relation between indicators for quality of occupational rehabilitation of employees with low back pain.

OBJECTIVES: To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables--a set of objective criteria for technical performance and continuity of care--led to a better outcome in clinical and return to work variables. METHODS: The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain. Univariate analyses as well as multiple logistic regression and Cox's regression analyses were performed to assess the relation between quality of care and outcome. RESULTS: Process indicators for technical competence, continuity of care, and total performance were all significantly related to satisfaction of employees. Continuity of care and total performance were significantly related to working status at 3 months, and time to return to work. None of the process indicators was related to pain or disability after 3 months follow up. Satisfaction was not related to any of the other outcome variables. This indicates that if guidelines for occupational rehabilitation are met, outcome is better. CONCLUSION: Quality of the process of care was related to outcome. Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians. The effectiveness of an improved intervention should be studied in a subsequent randomised clinical trial.

Adult↗
PubMed1994

Quinsy tonsillectomy or interval tonsillectomy--a prospective randomised trial.

Fifty-one patients with peritonsillar abscesses were randomised to undergo either quinsy tonsillectomy (QT) or interval tonsillectomy (IT), and the two groups were compared. The QT group lost fewer (10.3 v. 17.9) working days and less blood during the operation (158.6 ml v. 205.7 ml); haemostasis was easier and the operation was technically simpler in this group. There was no significant difference in length of hospital stay and neither group had intra- or postoperative complications. Only 64% of the IT group returned for tonsillectomy. In this study QT had distinct advantages over drainage and IT in the management of peritonsillar abscesses.

Absenteeism↗
PubMed2005

[Mortality from malignant melanoma: epidemiological trends in Switzerland].

The skin doesn't forget damage by sun exposure (sunburn, ultraviolet radiation). Indeed, melanoma mortality increases quite linearly with rising age. For Swiss nationals the sex ratio of mortality rates is 1.7, i.e. risks for male foreigners and Swiss females are of similar size. However, in younger Swiss men (35 to 44 years) mortality rates between 1979/83 and 1997/2001 diminished by 66% (p < 0.02). Analyses of mortality by occupational groups revealed that indoor working males like graduates and employees with commercial or technical education have an increased risk. The results support the association between melanoma risk and intermittent sun exposure, outdoor workers with chronic sunlight exposure being slightly protected. Further declines in mortality may be expected with skin cancer prevention campaigns improving sun exposure behaviour.

Adult↗
PubMed2006

Agents in bioinformatics, computational and systems biology.

The adoption of agent technologies and multi-agent systems constitutes an emerging area in bioinformatics. In this article, we report on the activity of the Working Group on Agents in Bioinformatics (BIOAGENTS) founded during the first AgentLink III Technical Forum meeting on the 2nd of July, 2004, in Rome. The meeting provided an opportunity for seeding collaborations between the agent and bioinformatics communities to develop a different (agent-based) approach of computational frameworks both for data analysis and management in bioinformatics and for systems modelling and simulation in computational and systems biology. The collaborations gave rise to applications and integrated tools that we summarize and discuss in context of the state of the art in this area. We investigate on future challenges and argue that the field should still be explored from many perspectives ranging from bio-conceptual languages for agent-based simulation, to the definition of bio-ontology-based declarative languages to be used by information agents, and to the adoption of agents for computational grids.

Artificial Intelligence↗