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PubMed1996

Evaluation of physician intervention letters.

OBJECTIVES: The Omnibus Budget Reconciliation Act of 1990 requires that Medicaid Agencies perform drug utilization review (DUR). The Texas Medicaid Agency, in cooperation with the Texas DUR Board, have chosen to mail intervention letters to physicians with patient profiles that indicate possible inappropriate use of medications. The objective of this study was to assess the effect of intervention letters indicating duplicative anti-ulcer medications. METHODS: Analysis of Medicaid prescription claims produced 335 patient profiles involving concurrent therapy. Physicians for 174 patients were selected randomly to receive an intervention letter, a response form, and a stamped envelope. The remaining patients served as a control group. RESULTS: A 71.2% response rate was obtained. Of these responses, 48.9% agreed with the letter and 19.1% disagreed with the letter. Profiles generated 6 months after the letters were sent indicated that 47.7% of the patients in the experimental group were still on concurrent therapy compared with 64.4% of patients in the control group (P = 0.007). CONCLUSIONS: The high response rate to the letter, the moderately high agreement with the letters, and the statistically significant reduction of duplicative therapy in the experimental group indicate that intervention letters can be an effective way to change prescribing. Future research is needed to assess the effects of educational intervention letters for other drug categories, for other populations, and for longer periods of time; and the effect these changes may have on true patient outcomes.

Anti-Ulcer Agents↗

PubMed2002

Surveying physicians: do components of the "Total Design Approach" to optimizing survey response rates apply to physicians?

BACKGROUND: Surveys serve essential roles in clinical epidemiology and health services research. However, physician surveys frequently encounter problems achieving adequate response rates. Research on enhancing response rates to surveys of the general public has led to the development of Dillman's "Total Design Approach" to the design and conduct of surveys. The impact of this approach on response rates among physicians is uncertain. OBJECTIVE: To determine the extent to which the components of the total design approach have been found to be effective in physician surveys. DESIGN: A systematic review. RESULTS: The effectiveness of prepaid financial incentives, special contacts, and personalization to enhance response rates in surveys of physicians have been confirmed by the existing research. There is suggestive evidence supporting the use of first class stamps on return envelopes and multiple contacts. The optimum amount for incentives and the number of contacts necessary have not been established. Details of questionnaire design and their impact on response rates have received almost no attention from researchers. Few studies have assessed the usefulness of combinations of components of the total design approach. CONCLUSIONS: Despite the number of surveys conducted among physicians, their cost, the level of interest in their findings, and in spite of inadequate response rates, there have been few randomized trials conducted on important aspects of enhancing response in this population. Until this gap has been filled, researchers conducting surveys of physicians should consider including all components of the total design approach whenever feasible.

Attitude of Health Personnel↗

PubMedDate not supplied

"Definite lines of influence": Catholic sisters and nurse training schools, 1890-1920.

BACKGROUND: Standard histories of the nurse training school movement have focused on national leaders and organizations and have generally not included Catholic sisters, even though nuns had established approximately 220 nursing schools by 1915. OBJECTIVES: This study asks how Catholic sisters used their distinct understanding of nursing to shape their nursing schools and the nurse training movement in the United States between 1890 and 1920. METHOD: Historical methodology draws upon primary sources in archives of three women's religious congregations, the Catholic Health Association, and the University of Notre Dame. These include nuns' constitutions and letters, hospital chronicles, journals, minutes of meetings, training school records, annual reports, yearbooks, census records, and educational reports. Secondary sources include nursing, hospital, religious, and labor histories. RESULTS: Catholic sisters adapted their nursing to bring it into line with modern society by establishing nurse training schools for both religious and secular women. This legitimized their nursing practice and enhanced their influence with students, physicians, and hospital groups. As nuns admitted laywomen into their schools and worked toward accepted standards of professionalization, they stamped their distinct understanding of nursing onto secular society. DISCUSSION: The development of professionalized nursing drew Catholic sisters' schools toward common goals with non-Catholic programs. On the other hand, the sisters' historical construction of nursing in the 19th century, their unique relationship with physicians, and the obstacles they faced later, such as the Roman Catholic clergy's attempt to control evaluation processes, indicate a distinct approach to Catholic nursing. Questions remain as to whether nuns could hold onto their authority later in the 20th century.

Catholicism↗

PubMed1993

The anatomic data sheet in plastic surgery: graphic and accurate documentation for standardized evaluation of results.

A graphic and written anatomic data sheet (ADS) for facial aesthetic surgery and body contour surgery is presented as a tool for: (1) analyzing surgical maneuvers and their effect on final outcome; (2) recording individual anatomic variations; (3) communicating data between office personnel and colleagues; (4) aiding in the treatment of the postsurgical patient; (5) use as a worksheet for the surgeon; and (6) standardizing, evaluating, and comparing surgical techniques. The ADS takes account of the common aesthetic facial and body contour procedures performed in plastic surgery. A supplemental rubber stamp for use on the office chart, with graphics identical to those of the ADS, identifies areas of treatment concern before and after surgery.

Anatomy, Artistic↗

PubMed2002

The changing face of the genetics of corneal dystrophies.

Modern molecular genetics has had a profound effect on our understanding of corneal dystrophies. Mutations in the BIGH3 gene are responsible for four autosomal dominant corneal dystrophies. The mutation spectrum reveals the phenotypically diverse possibilities stemming from mutations of a single gene. Dystrophies have been grouped together in a "stamp-collector" fashion. Classification has been based on clinical description of disease. With better appreciation of molecular genetics, classifications can be based on underlying genetic cause. In fact, classification schema based on the gene or molecular defect responsible for the dystrophy have been introduced. Different phenotypes are determined by different genotypes. Clinicians must become more adept at understanding the molecular genetics of corneal dystrophies as genetics is increasingly important in the long-term diagnostic and therapeutic approach to dystrophies.

Corneal Dystrophies, Hereditary↗

PubMedDate not supplied

Low-fat milk and high-fiber bread availability in food stores in urban and rural communities.

As part of the Albany Prevention Research Center's Core Project to understand environmental influences on a healthy lifestyle, all food stores in downtown Albany (N=79) and rural Columbia and Greene counties (N=177) in New York State were visited and surveyed for their availability of low-fat milk and high-fiber bread. Stores in the rural community were significantly (P < .01) more likely to stock low-fat milk (71%) and high-fiber bread (55%) than stores in Albany (40% and 33%, respectively). The rural community also had a significantly higher population ratio of "healthy milk & bread (M&B) stores" (carrying both items) than Albany (7.6 vs 3.9 per 10,000 residents). Urban healthy M&B stores were more likely to be a convenience store and accept food stamps, whereas rural healthy M&B stores were more likely to be a gas station store and offer off-street parking. Multiple logistic regression analysis found that healthy M&B stores were inversely associated with proportions of ethnic/racial minorities in the census block group (CBG). More than 80 percent of minorities in Albany resided in a CBG without a healthy M&B store. Urban residents in predominantly minority neighborhoods were most likely to encounter environmental barriers to obtain healthy staple food, and intervention should be tailored to aid this population.

Animals↗

PubMed2006

The objective determination of compliance in treatment of adolescent idiopathic scoliosis with spinal orthoses.

STUDY DESIGN: Prospective study using a specifically developed microelectronic technology. OBJECTIVE: To establish new technical methods for the objective measurement of brace use without patient involvement. SUMMARY OF BACKGROUND DATA: Effectiveness of spinal bracing clearly depends on the compliance of the patient. For further improvement of spinal bracing, reliable data are needed concerning the brace use. Questionnaires or clinical judgment usually estimates subjectively the compliance, which ranges from 20% to 90%. So far, only 1 study with 10 patients has investigated the compliance by objective time-stamped logging in a daily life environment, showing an average brace use of 65%. METHODS: There were 9 female patients (age 14.2 years, standard deviation 1.5) with adolescent idiopathic scoliosis who took part in the study. Their thoracolumbosacral orthoses (Chêneau braces OT-Kiel, Kiel, Germany) were equipped with a specifically developed discrete data logger to record temperature at the skin-brace interface over a period of 5.4 weeks (standard deviation 3.1), at 2-minute date/time-stamped intervals. RESULTS: Brace use ranged from 4.2 to 22.4 hours per day (average 15.4 hours). Underlying the recommended bracing time of 23 hours, average compliance rate was 67.5% (range 19.0% to 97.1%). No patient reached a complete 23-hour bracing. Patients with poor compliance usually removed the brace during the daytime. The individual bracing pattern did not change over the course of an evaluation period, and the compliance can be estimated after 2 weeks. CONCLUSIONS: Long-term logging of temperature within a spinal orthosis is a reliable and simple way to measure objectively the compliance. Thus, comparison of full-time and part-time bracing is made possible on an objective basis. Furthermore, knowing the bracing pattern provides a better focus on other variables of spinal bracing, such as the force distribution within the brace. This knowledge may help to improve further the shape and effectiveness of bracing.

Adolescent↗

PubMed2003

Pathogenic role of interleukin-6 in the development of sepsis. Part I: Study in a standardized contact burn murine model.

OBJECTIVE: To establish a representative model for the evaluation of interleukin (IL)-6 and IL-6 receptor for pathogenicity and lethality in the postburn period. DESIGN: Ten-week-old C 57 BL/6J mice received a 20% body surface area contact burn and/or lipopolysaccharide (LPS) 48 hrs later. Standardized burns were created with a metal stamp of 150 degrees C of defined pressure and surface area (2.4525 Newton/0.00166 m2) over a period of 11 secs. The depth of dermal injury was verified histologically. The following groups were formed: I: no burn, no LPS (n = 35); II: burn, no LPS (n = 140); III, no burn, LPS (n = 56); and IV, burn, LPS (n = 80), to study the effect of burn alone, sepsis alone, or the combination. Lethal LPS dose (LD100) was determined by application of LPS in increasing doses (200, 300, 400, and 500 microg, n = 32) after burns. MEASUREMENTS: Concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma), and leukocytes, platelets and organ pathology were evaluated. SETTING: Research laboratory. RESULTS: Burn and LPS showed an additive effect on the release of IL-6 but not of TNF-alpha and IFN-gamma. Leukocyte and platelet numbers decreased significantly (group IV) compared with the other groups (I-III). The maximal levels of IL-6 in group IV were reached earlier than those of TNF-alpha. The contact burn model has a mortality rate of 30%, which is close to clinical outcome. We found the model of contact burn superior to scald or flame burn models. A dose of 400-microg LPS was found to be the lethal LPS dose (LD100). CONCLUSIONS: Our data suggest that preexisting burn injury increases the response to endotoxin. TNF-alpha is not involved in priming. IL-6 on the other hand is a very representative parameter for priming. Because TNF-alpha was obviously not the causative factor, it was concluded that the application of anti-IL-6-mAb should be of great value. Therefore, a therapeutic application was designed, see part II.

Animals↗

PubMed2003

Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system.

UNLABELLED: OBJECTIVE To determine the percentage of time that intensive care unit (ICU) nurses spend on documentation and other nursing activities before and after installation of a third-generation ICU information system. DESIGN: Prospective data collection using real-time time-motion analysis, before and after installation of the ICU information system. SETTING: A ten-bed surgical ICU at a Veterans Affairs medical center. SUBJECTS: ICU nurses. INTERVENTIONS: Installation of a third-generation ICU information system. MEASUREMENTS AND MAIN RESULTS: Ten ICU nurses were studied before and after installation of the ICU information system. Each ICU nurse's activities and tasks, during 4-hr observation periods, were categorized in real-time by a nurse observer and recorded in a laptop computer. Each recorded task was automatically time-stamped and logged into a data file. The percentage of time spent on documentation decreased from 35.1 +/- 8.3% to 24.2 +/- 7.6% (p =.025) after the ICU information system was installed. The percentage of time providing direct patient care increased from 31.3 +/- 9.2% to 40.1 +/- 11.7% (p =.085). The percentage of time doing patient assessment, a direct patient care task, increased from 4.0 +/- 4.7% to 9.4 +/- 4.4% (p =.001). CONCLUSIONS: Installation of a third-generation ICU information system decreased the percentage of time ICU nurses spent on documentation by >30%. Almost half of the time saved on documentation was spent on patient assessment, a direct patient care task.

Hospitals, Veterans↗

PubMed2004

High-dose chemotherapy and autologous stem cell transplant in women with de novo chemosensitive metastatic breast cancer.

The prognosis of patients with de novo stage IV breast cancer seems to be similar to that of patients with metastatic disease. Because these patients have not been exposed to prior therapy, the use of high dose chemotherapy (HDCT) may be beneficial. Twenty-four newly diagnosed (median age 42) responding metastatic breast cancer patients underwent HDCT (Stamp V) and stem cell support as their initial treatment. The predominant sites of metastatic disease were bone (12), lung (5), liver (2), lymph nodes (6), marrow (4), and soft-tissue (1). Estrogen/progesterone receptors were positive in 35%, negative in 45%, and unknown in 20%. Before transplantation, 10 patients were in complete remission (CR), 6 were in partial remission (PR), and 8 were inevaluable. Radiotherapy was administered to sites of documented metastatic disease. Tamoxifen was given to patients with receptor positive and unknown tumor status. After a median follow-up of 60 months from diagnosis (range 42 to 96 months), 15 patients have relapsed and 10 died. Mean and median progression free survival from transplant are 53 (SE 6.6, CI 40-66) and 60 (SE 18, CI 25-96) months, respectively. The median survival has not yet been achieved (>6 years). There was no treatment-related mortality. The use of HDCT in patients with chemosensitive, de novo metastatic breast cancer is safe and well tolerated. Overall clinical outcome is good; however, this study cannot determine whether this was due to treatment or selection bias.

Adult↗

PubMed2004

Personal digital assistants used to document compliance of bacterial vaginosis treatment.

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.

Administration, Intravaginal↗

PubMed2004

Pattern formation in binary fluids confined between rough, chemically heterogeneous surfaces.

Using a mesoscale model for hydrodynamics, we simulate driven flow of AB binary fluids past surfaces that contain well-defined roughness or asperities. The geometry and wetting properties of the asperities are found to have a dramatic effect on the flow patterns. We isolate conditions where the A fluid forms vertical bands that bridge the asperities and an imposed shear (or pressure gradient) drives the system to form monodisperse droplets of A within the B fluid. The size of the droplets can be tailored by varying the morphology of the asperities. The surfaces needed to create this rich dynamical behavior are used as the stamps in microcontact printing; thus, the parameter space can readily be accessed experimentally, and the predictions suggest an efficient method for forming emulsions with well-controlled morphologies.

Journal Article↗

PubMed2006

Localized chemical wave emission and mode switching in a patterned excitable medium.

Chemical waves are initiated from complex geometries in the excitable Belosouv-Zhabotinsky medium using a wet stamping technique. Because of the coupling between the system's chemical kinetics and geometry, waves are emitted only from selected locations. By varying the nature of the wave-triggering reagent (here formaldehyde or methanol), it is possible to switch between two spatially distinct modes of wave emission. The system's dynamics is studied numerically, and the results of modeling agree with experimental observations.

Animals↗

PubMed2004

Phasing in the presence of severe site-specific radiation damage through dose-dependent modelling of heavy atoms.

The case of a brominated RNA crystal structure determination in which standard three-wavelength MAD phasing was unsuccessful because of fast X-ray-induced debromination was reinvestigated [Ennifar et al. (2002), Acta Cryst. D58, 1262-1268]. It was found that if the data are kept unmerged and if a dose-stamp is associated with each reflection measurement, dose-dependent occupancies can be refined for the Br atoms. Such a parametrization has been implemented in the macromolecular phasing program SHARP. Refining such dose-dependent occupancies on an unmerged data set gave a dramatic improvement, even for SAD phases from only the first wavelength (peak), and resulted in a good electron-density map after solvent flattening. The adverse effect of radiation damage has been turned into a beneficial one. The crucial difference is made by the use of unmerged data: phasing power is generated through the intensity differences of symmetry-related reflections recorded at different doses, i.e. corresponding to different states of the X-ray-induced debromination. This approach should prove useful in all situations of experimental phasing where site-specific radiation damage occurs unavoidably and undesirably and not only in cases in which radiation damage is purposely being created in order to demonstrate its potential usefulness.

Binding Sites↗

PubMed2005

A multiparameter wearable physiologic monitoring system for space and terrestrial applications.

A novel, unobtrusive and wearable, multiparameter ambulatory physiologic monitoring system for space and terrestrial applications, termed LifeGuard, is presented. The core element is a wearable monitor, the crew physiologic observation device (CPOD), that provides the capability to continuously record two standard electrocardiogram leads, respiration rate via impedance plethysmography, heart rate, hemoglobin oxygen saturation, ambient or body temperature, three axes of acceleration, and blood pressure. These parameters can be digitally recorded with high fidelity over a 9-h period with precise time stamps and user-defined event markers. Data can be continuously streamed to a base station using a built-in Bluetooth RF link or stored in 32 MB of on-board flash memory and downloaded to a personal computer using a serial port. The device is powered by two AAA batteries. The design, laboratory, and field testing of the wearable monitors are described.

Aerospace Medicine↗

PubMed2003

High-resolution, air-coupled ultrasonic imaging of thin materials.

This paper describes the use of a focused air-coupled capacitance transducer combined with pulse compression techniques to form high-resolution images of thin materials in air. The focusing of the device is achieved by using an off-axis parabolic mirror. The lateral resolution of the focused transducer, operating over a bandwidth of 1.2 MHz, was found to be less than 0.5 mm. A combination of the focused transducer as a source and a planar receiver in through-transmission mode has been developed for the measurement of different features in paper products, with a lateral resolution in through-transmission imaging of approximately 0.4 mm. Images in air of thin samples such as bank notes, high-quality writing paper, stamps, and sealed joints were obtained without contact to the sample.

Journal Article↗

PubMedDate not supplied

Summarizing dynamic bipolar conflict structures.

We present a method for visual summary of bilateral conflict structures embodied in event data. Such data consists of actors linked by time-stamped events, and may be extracted from various sources such as news reports and dossiers. When analyzing political events, it is of particular importance to be able to recognize conflicts and actors involved in them. By projecting actors into a conflict space, we are able to highlight the main opponents in a series of tens of thousands of events, and provide a graphic overview of the conflict structure. Moreover, our method allows for smooth animation of the dynamics of a conflict.

Algorithms↗

PubMed2004

Successful management of intractable epilepsy with lidocaine tapes and continuous subcutaneous lidocaine infusion.

PURPOSE: We report the successful management of a 10-year-old girl with intractable frontal lobe epilepsy by using lidocaine tapes and continuous subcutaneous lidocaine infusion. METHODS: This patient's seizures were refractory to conventional antiepileptic drugs (AEDs) and mexiletine, but they responded well to the intravenous infusion of lidocaine. The intravenous infusion of lidocaine was replaced by lidocaine tape therapy, and subsequently by continuous subcutaneous lidocaine infusion therapy. The lidocaine tape (Penles, Nihon Lederle, Tokyo Japan) used was a stamp-sized (30.5 x 50.0 mm) tape containing 18 mg of lidocaine. We used 25 lidocaine tapes every 12 h (50 tapes/day). Lidocaine hydrochloride (10%) was administered continuously at a dose of 1.5 mg/kg/h (0.3 ml/hour) through a 27-G needle that was inserted in the subcutaneous tissue. RESULTS: Lidocaine tape therapy showed good efficacy for 1 year. After that, six lidocaine tapes were added 6 h after the exchange of 25 lidocaine tapes [62 tapes/day (25,6,25,6)], because the seizures became frequent when the lidocaine tapes were being exchanged. The seizures were then well controlled, but dermatitis due to the lidocaine tapes grew serious, and lidocaine tape therapy had to be stopped. Continuous subcutaneous infusion of lidocaine applied in place of lidocaine tapes provided long-term seizure control without remarkable side effects. CONCLUSIONS: Lidocaine tape therapy and continuous subcutaneous lidocaine infusion therapy were considered to be useful for controlling this patient's seizures. This is the first report to describe the efficacy of continuous subcutaneous lidocaine infusion therapy for epilepsy.

Administration, Cutaneous↗