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PubMed2002

Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps.

In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, "flaps") now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with (99m)Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that (99m)Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis.

Adult↗

PubMed1983

A washbasin for washing when seated. An example of a user-oriented development project: a study in systematic design based on ergonomics principles.

This article describes an example of innovative product development. The development process possesses features which we believe are essential for encouraging innovation which is user oriented. One aim of this article is to show and discuss the multitude of activities required if the aim is not only to carry out ergonomic research but also to create innovations based on ergonomics principles. A further aim is to focus attention on some 'ergonomic' aspects of the innovation process itself. The description in the paper follows the sequential steps of the development model used. For each step a brief factual description is given. There is also a general discussion of methodological points. The project has resulted in a new and different product which is now successfully in commercial production. The concluding discussion contains a summary of the main methodological experiences and points. These are: A development project started from, and oriented towards, use and user problems can result in a product which is different from and functionally superior to those developed in more traditional ways. An ability to extract, handle and transform user experiences in systematic ways needs to be developed. Much user knowledge is now discarded as being unmanageable. Methods for the practical evaluation of prototypes at an early stage in development are missing and the potential of such work is neglected. Methods to describe the costs and benefits of ergonomics development can, and should be, used to supply arguments in favour of the product at hand.

Journal Article↗

PubMed1990

Effect of diarrhoeal disease control on infant and childhood mortality in Egypt. Report from the National Control of Diarrheal Diseases Project.

The effect of the National Control of Diarrheal Diseases Project, started in 1983, on infant and childhood mortality in Egypt was assessed by means of national civil registration data, nationwide cluster sample surveys of households, and local area studies. Packets of oral rehydration salts are now widely accessible; oral rehydration therapy is used correctly in most episodes of diarrhoea; most mothers continue to feed infants and children during the child's illness; and most physicians prescribe oral rehydration therapy. These changes in the management of acute diarrhoea are associated with a sharp decrease in mortality from diarrhoea, while death from other causes remains nearly constant.

Cause of Death↗

PubMed1991

Spatial visualization of DNA in solution.

An image analysis method is presented which allows for the reconstruction of the three-dimensional path of filamentous objects from two of their projections. Starting with stereo pairs, this method is used to trace the trajectory of DNA molecules embedded in vitreous ice and leads to a faithful representation of their three-dimensional shape in solution. This computer-aided reconstruction is superior to the subjective three-dimensional impression generated by observation of stereo pairs of micrographs because it enables one to look at the reconstructed molecules from any chosen direction and distance and allows quantitative analysis such as determination of distances, curvature, persistence length, and writhe of DNA molecules in solution.

DNA, Bacterial↗

PubMed2004

[Standards, options and recommendations for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy-update 2003].

CONTEXT: "The Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the twenty French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To update the Standards, Options and Recommendations clinical practice guidelines for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy. METHODS: The working group identified the questions requiring up-dating from the previous guideline. Medline and Embase were searched using specific search strategies from January 1999 to October 2002. Literature monitoring was performed to identify randomised clinical trials published between October 2002 to November 2003. In addition several Internet sites were searched in October 2002. RESULTS: There is no standard attitude for use of rHuEPO in patients undergoing radiotherapy. There is no evidence to support use of rHuEPO in patients with ENT cancer receiving radiotherapy alone. In patients undergoing curative radiotherapy, it is recommended to correct anaemia under I Og/dL using transfusion rather than rHuEPO. When the haemoglobin concentration is between 12g/dL and 14g/dL initial use of rHuEPO can be an option under certain conditions for radiochemotherapy if the risk of anaemia is high with the chemotherapy regimen used. Anaemic patients should be included in clinical trials to clarify the impact of rHuEPO in terms of local control of the tumour and survival.

Anemia↗

PubMed2004

[Clinical practice guidelines: 2004 Standards, Options and Recommendations for the management of patient with adenocarcinoma of the stomach--radiotherapy].

CONTEXT: "The Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French regional cancer centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To elaborate clinical practice guidelines for patients with stomach adenocarcinoma. These recommendations cover the diagnosis, treatment and follow-up of these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. The Standards, Options and Recommendations are thus based on the best available evidence and expert agreement. RESULTS: Adjuvant radiation therapy alone is not a standard treatment for patients with stomach adenocarcinoma. Adjuvant concomitant chemoradiotherapy is not a standard treatment for patients with stage II or III stomach adenocarcinoma R0, with Dl or D2 lymphadenectomy who have undergone surgery. Following surgical resection, adjuvant concomitant chemoradiotherapy should be proposed to patients without denutrition with a lymphadenectomy < Dl (fewer than 15 lymph nodes examined) and those with T3 and/or N+ tumours following the protocol used in the MacDonald trials (SWOG-9008) (Level of evidence B1). Adjuvant concomitant chemoradiotherapy can be administered to patients without denutrition with DI or D2 lymphadenectomy and with involvement of regional lymph nodes (N2 or N3).

Adenocarcinoma↗

PubMed2005

[Standards and Options for the use of radiation therapy in the management of patients with osteosarcoma. Update 2004].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French regional cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVE: To update the SOR recommendations for the use of radiation therapy in the management of patients with osteosarcoma. This work was performed in collaboration with the French society against cancers in children and adolescent (SFCE). METHODS: Data have been identified by literature search using Medline (from January 1992 to October 2003). In addition several Internet sites were searched in October 2003. RESULTS: The 3 mains standards are: 1) local and exclusive curative irradiation is not indicated as primary treatment for osteosarcoma or for local and operable recurrence, except for lesion in inaccessible sites or if the patient refuses surgery; 2) local and prophylactic adjuvant irradiation is not indicated for the treatment of osteosarcoma after chemotherapy (neoadjuvant and/or adjuvant) and complete macro or microscopic surgery, except for non-operable R1 or R2 surgical resection; 3) whole-lung prophylactic irradiation is not indicated in non-metastatic osteosarcoma. Systemic metabolic radiotherapy for pain treatment, using samarium-153 ethylenediaminetetramethylene phosphonic acid (Sm-153-EDTMP) can be offered to patients with painful metastatic osteosarcoma or in case of recurrent bone sites inaccessible to local therapies (surgery, external irradiation).

Adolescent↗

PubMed2004

Electromechanical delay estimated by using electromyography during cycling at different pedaling frequencies.

The purpose of this study was to propose a new method that can be used to calculate electromechanical delay (EMD) without the measurement of forces. A secondary purpose, as an example of the importance of measuring EMD, was to predict muscle force development events based on the EMG activity of selected muscles during cycling at different pedaling frequencies. EMD was estimated using newly derived equations based on activation dynamics hypothesis. Tibialis anterior (TA) and soleus (SL) muscles of 16 male participants were studied while subjects pedaled at targeted cadences of 60, 80, and 100 revolutions per minute. The estimated EMDs of TA and SL were significantly different from each other with means of 68.1 and 88.7 ms, respectively. The average crank angle for the initiation and time to peak TA contraction was estimated at 75 +/- 35 degrees and 26 +/- 15 degrees before the crank reached top-dead-center (TDC), while the contraction ended at 31 +/- 19 degrees after the TDC on average. The projected starting, peak and end angles of SL contraction activity were 45 +/- 18 degrees , 123 +/- 13 degrees, and 218 +/- 35 degrees after the TDC, respectively. There was no difference among different pedaling cadences observed for these mechanical events. The proposed method was proven to be effective in studying EMD and estimate muscle contraction patterns during cycling.

Adult↗

PubMed2002

Recent situation of schistosomiasis in Indonesia.

Schistosomiasis in Indonesia is limited to two very isolated areas, the Napu and Lindu valleys, in the province of Central Sulawesi. The disease was initially found in 1937 in the village of Tomado. In 1940, a study on schistosomiasis in the Lake Lindu area was initiated and an infection rate of 56% among the people in the three villages of Anca, Tomado and Langko was found. Before a comprehensive control programme was initiated, the infection rate among the population of approximately 4000 people in the Napu valley was very high, e.g. 72% in the village of Winowanga. In 1982, more coordinated and intensive schistosomiasis control measures in the Napu and Lindu valleys were initiated. The average infection rate after control measures were greatly decreased-in Napu valley it was 1.83%, while in Lindu valley it was 0.46%, in 1999. The control approaches can be described over five phases, from 1982 to 1986, up to 1998 to present. In 1998, an agreement between the Government of Indonesia and the Asian Development Bank was signed to develop the schistosomiasis endemic areas of Central Sulawesi into a better socio-economic condition. The objectives of the project are not only to control schistosomiasis, but mainly to protect the National Park which is located between the Lindu and Napu valleys. It is an integrated project named 'Central Sulawesi Integrated Area Development and Conservation Project' and many relevant sectors have been involved in the implementation of this project for the development of the area, including control of schistosomiasis. The implementation of the integrated project started in 1999.

Adolescent↗

PubMed1999

The Consumer Assessment of Health Plan Study (CAHPS) survey of children's health care.

BACKGROUND: Little is known about the experience of children and families with pediatric care. Asking parents about their experiences and the treatment of their children in health care plans can yield important information about selected aspects of medical care quality. Such data can be used to motivate, focus, and evaluate quality improvement efforts. METHODS: Development of the Child Core Survey followed the survey development principles of the Consumer Assessment of Health Plan Study (CAHPS) project, starting with assembly of existing instruments, consultation with experts, focus groups, and cognitive testing. A field test of the survey was conducted by mail among members enrolled in 1 of 25 plans originally identified as providing health care services to the public employees of the state of Washington (response rate, 52%). RESULTS: The 3,083 respondents rated personal doctors most highly, with overall care and specialty care rated nearly as well, and plan administration rated lowest. Parent-clinician and child-clinician communication, as well as spending sufficient time with the child were the strongest correlates of assessments of overall care and of personal doctors. Plans differed significantly in their performance along all the dimensions of child health care assessed in the survey except for aspects of access ("getting the care you need"). IMPLICATIONS: The Child Core Survey from the CAHPS provides a readily accessible method to assess the interpersonal care of children. Such data could be used to make plans accountable to the needs of children, to focus specific improvement initiatives, or both.

Adolescent↗

PubMedDate not supplied

[Concomitant radiochemotherapy for cancer of the cervix: critical analysis based on the Standards, Options and Recommendations methodology].

INTRODUCTION: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the National Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres (CRLCC) and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To update, according to the methodology of SOR, the Standards, Options and Recommendations for the management of patients with cancer of the cervix, and in particular, the place of concomitant radiochemotherapy. METHODS: Data have been identified by a literature search using Medline (to April 1999) and the personal reference lists of experts. Once the guidelines were defined, the document was submitted for review to independent national and international reviewers and to the medical committees of the CRCC. RESULTS: The principle recommendations concerning the place of radiochemotherapy in the treatment of cancer of the cervix are 1/ the available data shows a significant increase in local control (level of evidence A) and of overall survival (level of evidence B1) following concomitant radiochemotherapy as compared to radiotherapy alone or the combination of radiotherapy-hydroxyurea. For stages IB, IIA, proximal IIB with bad prognostic factors (tumour size greater than 4 cm and/or invasion of pelvic nodes and/or microscopic invasion of the parametrium) and without lumbo-aortic nodal invasion, concomitant radiochemotherapy can be considered as standard treatment. This benefit is less clear for stages distal IIB, III and IVA without para-aortic nodal invasion (level of evidence C) and must be confirmed (expert agreement). 2/ the toxicity of radiochemotherapy is essentially haematologic and gastrointestinal (level of evidence B1) and is greater than that of radiotherapy alone (level of evidence B1). 3/ these results have been obtained by the combination of chemotherapy based oncisplatin alone, or in combination with 5-FU. Although of equal benefit, the toxicity of the cisplatin/5-FU/ hydroxyurea combination was greater than that of cisplatin alone in a trial comparing the two protocols. A significantly longer survival have also been obtained by the combination of chemoradiation and adjuvant chemotherapy with epirubicin (level of evidence C). These results must be confirmed. 4/ the exact means of delivering the chemotherapy has not been clearly established. In fact, in these trials, some protocols use cisplatin weekly at a dose of 40 mg/m2 and others every three or four weeks at doses ranging from 50 to 75 mg/m2. Subsequent randomised studies are likely to establish optimal schema for the delivery of chemotherapy when combined with external radiotherapy and brachytherapy.

Combined Modality Therapy↗

PubMed2003

PropeR: a multi disciplinary EPR system.

This article describes the architecture of an EPR system developed for the PropeR project. This EPR system not only aims at supporting home care of stroke patients, but is also designed in such a way that it can be ported to other medical services without much effort. We will briefly describe the Stroke Service and the related PropeR project. Starting from a list of requirements to construct a generic EPR system we will outline the architecture and describe the standards and methods used. Subsequently we describe the implementation and the problems encountered. In the discussion, we will go into the advantages and disadvantages of the tools and techniques we have used.

Computer Systems↗

PubMed2003

Electronic healthcare record; a way to empower the patient.

BACKGROUND: Patients are demanding a bigger role in the management of their own health and health care. METHODS: The Dutch Federation of Patient and Consumer Organizations (NPCF) has initiated several projects in this area. One project started in 2001 and aims at contributing to the development of a nation-wide EPR system. RESULTS: the NPCF participates in the National Institute for the Care Sector (NICTIZ). The NPCF plays an important role in defining the requirements regarding authorization and security of the EPR as well as for the legal framework in which optimal use can be made of the EPR. NPCF strongly promotes an active role of NICTIZ in developing a master plan for the EPR and an active role in its implementation. CONCLUSION: Patients and their organizations have to play an active role in designing and implementation of an ICT infrastructure for health care and in particular of the EPR.

Humans↗

PubMed1988

Evidence against linkage of schizophrenia to markers on chromosome 5 in a northern Swedish pedigree.

Schizophrenia is a severe mental illness with a typically chronic course affecting nearly 1% of the human population. It is generally accepted that genetic factors have an important pathogenic role in a substantial portion of schizophrenia cases; however, despite decades of family studies, there is no agreed-upon mode of inheritance. The discovery of genetic aetiologic factors and resolution of the inheritance pattern(s) will undoubtably emerge from genetic linkage studies. With these objectives in mind, we undertook a linkage project, starting in 1985, in a previously well-documented kindred from north Sweden. Multipoint linkage analyses were used to screen the proximal long arm of chromosome 5 using restriction fragment length polymorphism (RFLP) markers at five loci and the distal long arm using RFLPs at two loci, one of which was the locus for the glucocorticoid receptor. We found strong evidence against linkage between schizophrenia and the seven loci. These results, together with the positive evidence for linkage of schizophrenia with markers in the proximal long arm of chromosome 5 lead us to conclude that the genetic factors underlying schizophrenia are heterogeneous.

Chromosomes, Human, Pair 5↗

PubMedDate not supplied

A student-directed community project to support sexually abused women veterans suffering from post-traumatic stress disorder.

While awareness of post-traumatic stress disorder (PTSD) and sexual abuse continues to grow, it has only been during the past few years that the military has realized the prevalence and impact of sexual abuse inflicted upon women while on active military duty. Though Veteran Administration (VA) agencies throughout the United States have given concerted attention to this problem, published resources specific to PTSD and military sexual abuse have been limited. In this article the authors present the results of a 2(1/2)-year endeavor to address the problem of PTSD and military sexual abuse at the Tulsa VA Outpatient Clinic. The project started with a research study and the subsequent initiation of a PTSD women veterans support group, and culminated in the development of resource manuals for both professional staff and women veterans.

Education, Nursing↗

PubMed2004

The Aristotle score for congenital heart surgery.

The aim of the Aristotle project was to develop a new method of evaluation of quality of care in congenital heart surgery based on the complexity of the surgical procedures. Involving a panel of expert surgeons, the project started in 1999 and included 50 pediatric surgeons from 23 countries representing International Scientific Societies. The complexity was based on the procedures as defined by the Society of Thoracic Surgeons (STS)/European Association for Cadiothoracic Surgery (EACTS) International Nomenclature and was undertaken in two steps: The first step was establishing the Basic Score, which adjusts only the complexity of the procedures and is based on three factors: the potential for mortality, the potential for morbidity, and the anticipated technical difficulty. The second step was the development of the Comprehensive Score, which further adjusts the complexity according to the specific patient characteristics. The Aristotle score allows precise scoring of the complexity for 145 congenital heart surgery procedures. One interesting concept coming out of this study is that complexity is a constant and precise value for a given patient regardless of the center where he is operated. The Aristotle method allows proposing the following equation of quality of care: Complexity FN Outcome = Performance. The Aristotle score, electronically available, was introduced in the EACTS and STS databases. A validation process, designed to evaluate its predictive value, is being developed.

Cardiac Surgical Procedures↗

PubMed1999

Screening of diabetic patients for microalbuminuria in primary care--The PROSIT-Project. Proteinuria Screening and Intervention.

The PROSIT (Proteinuria Screening and Intervention) Project started in 1993 in order to obtain data on the prevalence of micro- and macroalbuminuria in diabetic patients treated in primary care, to establish an easy screening programme for microalbuminuria, in which also diabetic patients can participate in self-responsibility, and to implement a specific intervention programme for incipient nephropathy. In 58 representative doctor's offices 647 diabetic patients were included, who performed at home self-tests for microalbuminuria on three days within one week using the early morning urine and a newly developed qualitative immunologic test-strip for microalbuminuria. After storage they returned the same urine samples to their doctors' offices for semiquantitative retesting with the immunologic test-strip Micral-Test II. In case of positive results the proteinuria dipstick Combur-9-Test was applied in order to exclude other causes of positive microalbuminuria (e.g. urinary tract infection). Data of 569 patients (6% Type 1, 88% Type 2 and 6% secondary diabetes) could be analysed. Both qualitative self-testing for microalbuminuria at home and semiquantitative retesting in doctors' offices were found to be feasible. Based on semiquantitative retesting the prevalences of microalbuminuria (macroalbuminuria) were 19.6% (0%) in Type 1 diabetes, 17.2% (10.8%) in Type 2 diabetes and 11.7% (7.8%) in secondary diabetes. Type 2 diabetic patients showed a clear correlation between albuminuria and diabetes duration, HbA1c, serum creatinine, triglycerides as well as micro- and macrovascular complications. 227 patients with micro- or macroalbuminuria were included into the ongoing PROSIT intervention programme.

Adult↗

PubMed2005

[Integrated sustainability-oriented reporting--key indicators for communities and cities. Results of a research and development project].

In our research project -- supported by the German Federal Ministry for Education and Research (BMBF) - 35 key indicators were developed in an ongoing process in co-operation with 10 East German cities, which are all members in the German cities healthy network. With these indicators the cities should take up integrated sustainability - oriented health reporting, from which actions and projects for health promotion and prevention can be derived. The conceptual background for the research project and the reports to be made by the project in co-operation with the cities, are the three policy programmes that to be realised on a county level: Healthy Cities, Local Agenda 21 and the German city development programme "Soziale Stadt (socially oriented city)". The common goal of these programmes is the sustainable improvement of the quality of life in the counties. The project is part of the BMBF-supported research field "problem - oriented regional reporting systems", in which other projects are involved which are mainly being conducted in the newly-formed East German "Lander". In this article we describe the co-operative process of the development of the indicators. A synopsis of already applied or proposed sets of indicators for municipal reporting was the basis for the development of the project's set of 35 key indicators. The set of indicators is presented according to its usefulness for planning and realisation of actions for health promotion on county level. For each of the 35 indicators a meta - data description was made to support the counties and cities in our project for health reporting. These indicator profiles are also helpful and supportive for all counties and citiesaiming at such health reporting. The project started in May 2002 and lasts till Mai 2005, so that most reports should be completed in the spring of 2005.

Community Health Services↗