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20860058 | Zebrafish: A tool for chemical screens. | The zebrafish has proven to be an invaluable vertebrate animal model for developmental biology. Recent technological advances have added an arsenal of tools to expand its use into the realm of drug discovery. This includes methodology to generate transgenic reporter lines that allow for the direct visualization of fluorescent markers in live embryos. With the addition of automated imaging and analysis of embryos treated with small molecules, these innovations have expanded its utility into high throughput chemical screens. This review will highlight some of these advances that have propelled zebrafish as a tool for drug discovery. |
20860060 | Mechanobiology of embryonic skeletal development: Insights from animal models. | A range of clinical conditions in which fetal movement is reduced or prevented can have a severe effect on skeletal development. Animal models have been instrumental to our understanding of the interplay between mechanical forces and skeletal development, particularly the mouse and the chick model systems. In the chick, the monly used means of altering the mechanical environment is by pharmaceutical agents which induce paralysis, whereas genetically modified mice with nonfunctional or absent skeletal muscle offer a valuable tool for examining the interplay between muscle forces and skeletogenesis in mammals. This article reviews the body of research on animal models of bone or joint formation in vivo in the presence of an altered or abnormal mechanical environment. In both immobilized chicks and "muscleless limb" mice, a range of effects are seen, such as shorter rudiments with less bone formation, changes in rudiment and joint shape, and abnormal joint cavitation. However, although all bones and synovial joints are affected in immobilized chicks, some rudiments and joints are unaffected in muscleless mice. We propose that extrinsic mechanical forces from movements of the mother or littermates impact on skeletogenesis in mammals, whereas the chick embryo is reliant on intrinsic movement for mechanical stimulation. The insights gained from animal models into the mechanobiology of embryonic skeletal development could provide valuable cues to prospective tissue engineers of cartilage and bone and contribute to new or improved treatments to minimize the impact on skeletal development of reduced movement in utero. |
20860064 | Influence of neurexin 1 (NRXN1) polymorphisms in clozapine response. | Schizophrenia patients show alterations in the synaptic connectivity. However, it remains unknown whether antipsychotic response may be altered depending on the synaptic connectivity. We tested this association using polymorphisms in the neurexin 1 gene (NRXN1). Large NRXN1 deletions have also been associated with schizophrenia. We genotyped four variants in 140 schizophrenia patients assessed prospectively for clozapine response after 6 months. We observed a trend toward association of clozapine response with the rs12467557 (permuted p = 0.051). These results should be read with caution before independent replication. |
20860059 | The mechanics of development: Models and methods for tissue morphogenesis. | Embryonic development is a physical process during which groups of cells are sculpted into functional organs. The mechanical properties of tissues and the forces exerted on them serve as epigenetic regulators of morphogenesis. Understanding these mechanobiological effects in the embryo requires new experimental approaches. Here we focus on branching of the lung airways and bending of the heart tube to describe examples of mechanical and physical cues that guide cell fate decisions and organogenesis. We highlight recent technological advances to measure tissue elasticity and endogenous mechanical stresses in real time during organ development. We also discuss recent progress in manipulating forces in intact embryos. |
20860065 | An algorithm for the design of group sequential triangular tests for single-arm clinical trials with a binary endpoint. | Consider the problem of testing H(0):p ≤ p(0) vs H(1):p > p(0), where p could, for example, represent the response rate to a new drug. The group sequential TT is an efficient alternative to a single-stage test as it can provide a substantial reduction in the expected number of test subjects. Whitehead provides formulas for determining stopping boundaries for this test. Existing research shows that test designs based on these formulas (WTTs) may not meet Type I error and/or power specifications, or may be over-powered at the expense of requiring more test subjects than are necessary. We present a search algorithm, with program available from the author, which provides an alternative approach to triangular test design. The primary advantage of the algorithm is that it generates test designs that consistently meet error specifications. In tests on nearly 1000 binations of n (group size), p(0), p(1), α, and β the algorithm-determined triangular test (ATT) design met specified Type I error and power constraints in every case considered, whereas WTT designs met constraints in only 10 cases. Actual Type I error and power values for the ATTs tend to be close to specified values, leading to test designs with favorable average sample number performance. For cases where the WTT designs did meet Type I error and power constraints, the corresponding ATT designs also had the advantage of providing, on average, a modest reduction in average sample numbers calculated at p(0), p(1), and (p(0) + p(1))/2. |
20860066 | The analysis of very small samples of repeated measurements II: a modified Box correction. | There is a need for appropriate methods for the analysis of very small samples of continuous repeated measurements. A key feature of such analyses is the role played by the covariance matrix of the repeated observations. When subjects are few it can be difficult to assess the fit of parsimonious structures for this matrix, while the use of an unstructured form may lead to a serious lack of power. The Kenward-Roger adjustment is now widely adopted as a means of providing an appropriate inferences in small samples, but does not perform adequately in very small samples. Adjusted tests based on the empirical sandwich estimator can be constructed that have good nominal properties, but are seriously underpowered. Further, when such data are plete, or unbalanced, or non-saturated mean models are used, exact distributional results do not exist that justify analyses with any sample size. In this paper, a modification of Box's correction applied to a linear model-based F-statistic is developed for such small sample settings and is shown to have both the required nominal properties and acceptable power across a range of settings for repeated measurements. |
20860067 | Differences in clinical effect and tolerance between fluvoxamine and paroxetine: a switching study in patients with depression. | We examined whether discontinuation and the responses to fluvoxamine (FLV) administration could predict the subsequent discontinuation and the responses to paroxetine (PRX) in patients with depression. |
20860061 | Extending the family table: Insights from beyond vertebrates into the regulation of embryonic development by FGFs. | Since the discovery of fibroblast growth factors (FGFs) much focus has been placed on elucidating the roles for each vertebrate FGF ligand, receptor, and regulating molecules in the context of vertebrate development, human disorders and cancer. Studies in human, mouse, frog, chick, and zebrafish have made great contributions to our understanding of the role of FGFs in specific processes. However, in recent years, as more genomes are sequenced, information is ing available from many non-vertebrate models and a plete picture of the FGF superfamily as a whole is emerging. In some cases, less redundancy in these FGF signaling systems may allow for more mechanistic insights. Studies in sea anemones have highlighted how ancient FGF signaling is and helped provide insight into the evolution of the FGF gene family. Work in nematodes has shown that different splice forms can be used for functional specificity in invertebrate FGF signaling. Comparing FGFs between urochordates and vertebrates as well as between different insect species reveals important clues into the process of gene loss, duplication and subfunctionalization of FGFs throughout evolution. paring all members of the FGF ligand superfamily reveals variability in many properties, which may point to a feature of FGFs as being highly adaptable with regards to protein structure and signaling mechanism. Further studies on FGF signaling outside of vertebrates is likely to continue plement work in vertebrates by contributing additional insights to the FGF field and providing unexpected information that could be used for medical applications. |
20860068 | Venlafaxine versus methylphenidate in pediatric outpatients with attention deficit hyperactivity disorder: a randomized, double-blind comparison trial. | The present report aimed to investigate the efficacy and tolerability of pared to methylphenidate in children and adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). |
20860069 | The duration of the use of imatinib mesylate is only weakly related to elevated BNP levels in chronic myeloid leukaemia patients. | Cardiotoxicity has been feared as a potential side effect of imatinib therapy. Studies with short-term follow-up failed to identify an excess of cardiac events, but longer-term observations are needed to more definitely exclude this adverse effect. This study was designed to assess the cardiac effects of imatinib in patients under long-term treatment. We included 90 chronic myeloid leukaemia (CML) patients under imatinib therapy for a median treatment time of 3.3 years (mean age 48.9 ± 15.1 years). Patients underwent clinical evaluation, electrocardiography, echocardiography (two-dimensional, colour flow, tissue Doppler and strain imaging), brain natiuretic peptide (BNP) and troponin I measurements. Twenty healthy volunteers were included as a control group for strain measurements. The mean ejection fraction was 68 ± 7% and the median BNP level was 9.6 pg/ml (interquartile range [IQR] 5.7-17.0 pg/ml). Two patients had either an elevated BNP or a depressed ejection fraction (2.2%; 90%CI 0.9-6.8%). Most of troponin I measurements were lower than the detection limit, except for two patients. Longitudinal strain was similar to measurements in healthy controls. A weak relation was observed between log BNP and imatinib treatment duration and dose. There was no relation between these variables and left ventricle ejection fraction. In conclusion, matinib-related cardiotoxicity is an mon event in CML patients, even during long-term treatment. Therefore, its use should not be cause of great concern, and the usefulness of regular cardiac monitoring all patients while on imatinib therapy is questionable. |
20860070 | Deletion and duplication of 15q24: molecular mechanisms and potential modification by additional copy number variants. | To investigate the potential influence of additional copy number variants in patients with 15q24 rearrangements and the possible underlying mechanisms for these rearrangements. |
20860071 | Findings from a community education needs assessment to facilitate the integration of genomic medicine into primary care. | To assess the lay public's knowledge of, and beliefs about, genetics and genetic testing to create an educational initiative that promotes acceptance and utilization of genomic medicine in primary health care. |
20860085 | Demonstration of the effective performance of a combined enrichment/real-time PCR method targeting the prfA gene of Listeria monocytogenes by testing fresh naturally contaminated acid curd cheese. | A rapid real-time PCR-based method for the detection of Listeria monocytogenes was applied to the examination of 44 Quargel cheese samples from a recent outbreak in Austria pared to the standard method according to ISO-16140. |
20860087 | A path from predation to mutualism. | Luminescent bacteria and nematodes associate in a strategy where the bacteria act as virulent pathogens of insects, used as their food supply, while the nematodes graze on them. Upon reaching high density, the bacteria produce light and metabolites that turn the nematodes into hosts permitting them to be carried over to further nematode preys. In this issue of Molecular Microbiology, Lango and Clarke show that the corresponding shift in lifestyle is triggered by a metabolic switch closely linked to the tricarboxylic acid cycle, but apparently not by the well-known acetate switch that monitors entry of bacteria into the stationary phase of growth. |
20860089 | Mobile units of DNA in phytoplasma genomes. | Phytoplasmas are obligate symbionts of plants and insects that are responsible for significant yield losses in diverse crops. Genome sequencing has revealed that many phytoplasma genomes appear to contain repeated genes organized in units of approximately 20 kb. These 'potential mobile units' (PMUs) posite replicative transposons. PMUs contain several genes for bination and some also contain putative 'virulence genes'. Genome alignments suggest that PMUs are involved in phytoplasma genome instability and bination. In this edition of Molecular Microbiology, Hogenhout and colleagues report that one PMU from the aster yellows phytoplasma strain Witches' Broom (AY-WB) can exist as both a linear PMU within the chromosome and as an extrachromosomal circular form. The copy number of the circular form is much higher in the insect pared with the plant, and expression levels of genes present on the PMU are also higher in the insect. These observations suggest not only that this PMU could be a mobile element, but that it could also be involved in a phase-variation mechanism that allows the phytoplasma to adapt to its different hosts. |
20860090 | Upregulation of thymidine kinase activity compensates for loss of thymidylate synthase activity in Mycoplasma pneumoniae. | Thymidylate, an essential building block of DNA, is synthesized either from deoxyuridylate by thymidylate synthase (TS) or thymidine (dT) by thymidine kinase (TK). Thymidylate kinase (TMPK) phosphorylates dTMP to dTTP. Thymidine phosphorylase (TP) catalyses reversible phosphorolysis of dT. Using transposon mutagenesis M. pneumoniae TS gene (thyA/MPN320) was interrupted and requirement of these enzymes was studied. We found that TK activity and transcript levels and TP activity, but not TMPK or TS activity, are growth-phase-regulated, with induction at the exponential growth phase and a decline after the stationary phase. Inactivation of thyA results in upregulation of TK transcript and a 10-fold increase in TK activity, reduced TMPK level and it had no effect on TP activity. The level of [3H]-dT uptake and incorporation into DNA in the thyA mutant correlates with increases in TK activity, suggesting that dT uptake and metabolism is TK-dependent and that upregulation of TK activity in the thyA pensates for the lack of ThyA activity. [3H]-dU uptake was pared with dT, and incorporation of radioactivity into DNA in the thyA mutant indicates the presence of an alternative TS. Our results suggest that TK and TMPK are potential targets for the development of Mycoplasma-specific antibiotics. |
20860091 | Adaptation of Staphylococcus aureus to ruminant and equine hosts involves SaPI-carried variants of von Willebrand factor-binding protein. | Staphylococci adapt specifically to various animal hosts by genetically determined mechanisms that are not well understood. One such adaptation involves the ability to coagulate host plasma, by which strains isolated from ruminants or horses can be differentiated from closely related human strains. Here, we report first that this differential coagulation activity is due to animal-specific alleles of the von Willebrand factor-binding protein (vWbp) gene, vwb, and second that these vwb alleles are carried by highly mobile pathogenicity islands, SaPIs. Although all Staphylococcus aureus possess chromosomal vwb as well as coagulase (coa) genes, neither confers species-specific coagulation activity; however, the SaPI-coded vWbps possess a unique N-terminal region specific for the activation of ruminant and equine prothrombin. vWbp-encoding SaPIs are widely distributed among S. aureus strains infecting ruminant or equine hosts, and we have identified and characterized four of these, SaPIbov4, SaPIbov5, SaPIeq1 and SaPIov2, which encode vWbp Sbo4, vWbp Sbo5, vWbp Seq1 and vWbp Sov2 respectively. Moreover, the SaPI-carried vwb genes are regulated differently from the chromosomal vwb genes of the same strains. We suggest that the SaPI-encoded vWbps may represent an important host adaptation mechanism for S. aureus pathogenicity, and therefore that acquisition of vWbp-encoding SaPIs may be determinative for animal specificity. |
20860092 | Diagnostic accuracy of computed tomography coronary angiography in a high risk symptomatic population. | To evaluate the diagnostic accuracy of puted tomography (CT) coronary angiography (CA) for the detection of significant coronary artery stenosis (> or = 50% lumen reduction) pared to invasive coronary angiography (ICA) in a population of patients with chest pain and high risk. |
20860102 | Obesity and diabetes: two growing epidemics in California. | The prevalence of both diabetes and obesity has grown significantly in California. Six million adults are obese and an additional 9.3 million are overweight. Obesity is a significant risk factor for diabetes; more than two million adults have been diagnosed with diabetes in California. Obesity and diabetes disproportionately affect people of color, the poor and those with the least education in California. Policy and environmental changes that promote and encourage physical activity and healthy eating will likely prove most effective bating obesity and related conditions |
20860105 | Older adults need twice the federal poverty level to make ends meet in California. | New calculations using the Elder Economic Security Standard (TM) Index (Elder Index) for California show that both singles and couples age 65 or older who rent need more than twice the amount established by the Federal Poverty Level (FPL) Guideline to meet basic living expenses. The gap is greater for elders who own their home and are paying a mortgage than for renters. The gap between basic expenses and the FPL is smaller for owners without a mortgage, but still exists. Housing and health care are the primary drivers of the high costs. This policy brief documents that the Elder Index provides a better measure of e adequacy than the FPL for older adults because it accounts for those costs at the county level. The growing number of public and nonprofit organizations using the Elder Index will aid the quality of planning and programs that improve e security for California's rapidly growing older population. |
20860118 | An aggressive "double-hit" lymphoma occurring in a 42-year-old male with both MYC and t(14;18) translocations. | We describe a 42-year-old male who was in good health until he presented with a high grade B-cell non-Hodgkin lymphoma/leukemia that had both MYC and t(14;18) translocations. This process has now been classified as "B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma," according to the 2008 World Health Organization Classification of Tumours of Haematopoitic and Lymphoid Tissues. The clinical presentation, pathologic work-up including examination of the peripheral blood, lymph node biopsy, bone marrow aspiration and biopsy are included. Treatment consisted of seven cycles of chemotherapy following the CALGB protocol 9251. Prognosis is generally reported as poor in these aggressive "double-hit" lymphomas. However, this patient's disease has now been in remission for two years. |
20860127 | [Comparative study of two operation methods on complicated fractures of the distal radius and ulna]. | pare the differences between external fixator and volar T-shaped plate in the treatment plicated fractures of the distal radius and ulna, and evaluate the appropriate operation method for the fractures. |
20860128 | [Comparison study of small splint fixation and plaster slab fixation for the treatment of distal radius fractures]. | To study the advantage of fir bark splint for the treatmet of distal radius fracture. |
20860129 | [The causes and strategies for the postoperative shortening in distal radius fractures]. | To analyze the cause of the postoperative shortening in distal radius fractures and to find treatment strategies to enhance the reduction effect of distal radius fracture and long-term efficacy. |
20860131 | [MRI finding of the lumbar foraminal stenosis and its clinical significance]. | To observe morphological changes of lumbar intervertebral foramen and pathologic changes around the nerve root and to explore the main evaluation index for lumbar foraminal stenosis (LPS) in parasaggital MRI finding. |
20860132 | [Clinical observation of the treatment of cervical vertebral instability with kinesitherapy]. | To ovserved the treatment of cervical vertebral instability with bined with occipitomandibular traction. |
20860134 | [Effective analysis of the posterior vertebral pedicle screw fixation, vertebral body removal, decompression and titanium mesh reconstruction for the treatment of the lower lumbar fractures]. | To evaluate the effect of the treatment of the lower lumbar fractures by posterior vertebral pedicle screw fixation, vertebral canal pression,bone graft and titanium mesh reconstruction. |
20860133 | [Clinical effects of the treatment of gastrointestinal dysfunction after stable thoracolumbar fractures with Simo decoction oral liquid]. | To evaluate the clinical effects of Simo Decoction Oral Liquid for the treatment of gastrointestinal dysfunction after stable thoracolumbar fractures. |
20860135 | [Biomechanical comparison of three methods of internal fixation for distal femoral fractures]. | pare the biomechanics of three internal fixations for distal femoral fractures,and to choose suitable clinical internal fixation according to experimental date. |
20860137 | [Experimental study of directional differentiation of bone mesenchymal stem cells (BMSCs) to osteoblasts guided by serum containing cistanche deserticola]. | To study directional differentiation of BMSCs guided by Desert living Cistanche (Herba Cistanches) which invigorates the kidney. |
20860138 | [Pathological observation of femoral refracture after removal of plates]. | To discuss the reasons and the treatments for the femoral refracture. |
20860141 | [Small needle-knife for the treatment of heel pain according to its classification]. | To treat heel pain with small needle-knife according to its classification,so as to improve the therapeutic effects. |
20860140 | [Analysis of the vacuum sealing drainage technique combined with sural neurovascular pedicle fascio-cutaneous flap to repair deep wounds in the foot near the ankle joint with exposed bone and tendons]. | To evaluate the practical method of vacuum sealing drainage (VSD) bined with sural neurovascular pedicle fasciocutaneous flap to repair deep wounds in the foot near the ankle joint with exposed bone and tendons. |
20860143 | [Application of elastic intramedullary nail in treating bilateral femoral shaft fractures in children]. | To explore the curative effects plications of elastic intramedullary nail in treating children's bilateral femoral shaft fractures. |
20860144 | [Clinical observation on the modified external fixation with splints for double fractures of forearm in children]. | To explore the advantages of conservative treatment for trauma of children,and evaluate effect of external fixation for the treatment of double fractures of forearm. |
20860145 | [Clinical observation of frog shape four-step pulling method for the treatment of 92 patients with sacroiliac joint subluxation]. | To study the clinical efficacy of the frog shape four-step pulling method for the treatment of sacroiliac joint subluxation, and to explore the rationality of the method. |
20860146 | [Diagnosis and treatment of osteoid osteoma]. | To study the clinical features and surgical treatment of osteoid osteoma and improve the diagnostic therapeutic level. |
20860151 | [Research advancement of the distal radius fracture]. | Distal radius fracture is one of the mon injuries of human beings, particularly in young males and elderly females. There are various classifications among which classification by author' names and the AO fracture classification system are most frequently used. Although the latter one is overall and consummate, a precise classification system plete description of the fracture remains to be raised. Recently, with the development of wrist biomechanics and microscope anatomy, more and more studies were made to treat distal radius fracture. Good reduction and fixation are the key points for treatment. In tenns uf treatment, several options exist. Nonoperative management consists of closed ent and external fixation. Operative treatments includes intrafocal pinning ,non-bridging and bridging external fixation , various methods of open reduction internal fixation and hone or bone substitute transplantation. Besides, arthroscopic-assisted external fixation and artificial joint for wrist e a new hot spot. However,any single therapy could not treat all sorts of distal radius fractures. Therefore, it is better to institute individualized therapy according to different fracture characteristics of each patient in order to achieve the best curative effect. This review aims to make a conclusion about advancement in distal radius fractures, in aspects of epidemiology, classification and treatment. |
20860155 | [Cerebral protection in aortic arch surgery]. | In recent decades, the e of patients after thoracic aortic surgery has improved considerably. However, surgery of the thoracic aorta and, in particular, of the aortic arch is still associated with significant high mortality and morbidity caused by plications resulting from temporary suspension of cerebral circulation. Cerebrovascular injuries in thoracic aortic surgery can be caused by inadequate cerebral protection, cerebral embolism and, in case of acute type A aortic dissection, cerebral malperfusion. The neurological e of these patients depends on the quality of central nervous system protection during the critical period of interruption of cerebral circulation. Various techniques have been proposed as a means of protecting the brain from ischemic injury, such as deep hypothermic circulatory arrest, retrograde cerebral perfusion, and antegrade selective cerebral perfusion. This review analyzes these three methods and the strategies of cerebral protection focusing on the advantages and disadvantages of each one. |
20860157 | [Clinical and genetic features of left ventricular noncompaction: a continuum in cardiomyopathies]. | Isolated left ventricular paction (LVNC) is a rare genetic form of cardiomyopathy (CM) characterized by prominent left ventricular wall trabeculation and intertrabecular municating with the ventricular cavity. Clinical signs are variable, ranging from lack of symptoms to severe manifestations including heart failure, sustained ventricular arrhythmias, cardioembolism and sudden death. The diagnosis of LVNC is frequently missed, due to limited awareness in the munity. Contemporary diagnostic sensitivity has been enhanced by the introduction of specific morphologic criteria by high resolution echocardiography and cardiac magnetic resonance. As a consequence, LVNC has been diagnosed more frequently in association with other disorders such as congenital heart disease or genetic CM. The clinical relevance of regional paction in the context of other cardiac diseases is still uncertain. Recent evidence points to an overlapping genetic background passing LVNC, hypertrophic and dilated CM, suggesting a continuum of disease associated with ere protein gene mutations. This concept may prove relevant to the understanding mon pathogenetic mechanisms of CM and offer novel research opportunities. |
20860156 | [Vulnerable plaque imaging: is it time for its application in clinical practice?]. | Atherosclerosis is a slowly progressive degenerative disease occasionally characterized by a sudden shift in its natural history with a rupture of the atherosclerotic plaque and consequent acute thrombosis and clinical events. In recent years, biological and morphological factors responsible for the instability of coronary plaques have been identified. According to the most frequent pathophysiological sequence the fibrous cap that separates the lipid core of the atherosclerotic plaque from the circulation, ruptures thus exposing the highly thrombogenic biochemical elements and resulting in acute thrombosis and possible vessel occlusion. In this scenario, plaque morphology plays a crucial role along with systemic responses, such as activation of inflammation and coagulation cascade, in the definition of the patients at risk of acute myocardial infarction. Recent advances in intracoronary imaging techniques capable of defining the morphological characteristics of vulnerable plaques with high resolution, have given us the reasonable expectation that, in the immediate future, critical information on the pathophysiology of atherosclerosis and the direct causes of myocardial infarction can be obtained. It is conceivable that in the next few years these new high-resolution imaging techniques will be able to identify the crucial characteristics that define a vulnerable plaque that is likely to rupture. A scoring system designed to assess the specific risk of instability for any given atherosclerotic plaque could be generated with the purpose of identifying prospectively acute coronary events. In this perspective, optical coherence tomography is certainly the most promising imaging technique. Thus, the association of specific morphological information with systemic markers of vulnerability may allow in the near future to predict the true risk of acute myocardial infarction for each individual patient. |
20860158 | [Door-to-balloon time and in-hospital mortality in patients with ST-evaluation myocardial infarction: a network experience in a province in northwest Tuscany, Italy]. | A network system for ST-elevation myocardial infarction (STEMI) patients offers a quick diagnosis and a rapid transfer to a specialized center for primary percutaneous coronary intervention. The aim of our study was to evaluate the relationship between door-to-balloon time and in-hospital mortality in our network of STEMI patients. |
20860159 | [Management of ST-elevation myocardial infarction in the Umbria region: results from the observational prospective Umbria-STEMI registry]. | In the last few years, advances have been made in the diagnosis and management of ST-segment elevation myocardial infarction (STEMI). Recent guidelines have been developed to improve e of STEMI patients by implementation of the mendations into clinical practice. In order to assess the disease burden, the treatment modalities and the mid-term e of STEMI in the Umbria region, Italy, we performed a prospective observational study of all patients hospitalized with a diagnosis of STEMI from October 14, 2006 to April 14, 2008 (Umbria-STEMI registry). |
20860160 | [Echocardiographic alterations suggestive of pulmonary hypertension in the Italian ultrasonography laboratories. Epidemiological data from the INCIPIT study (INCidence of Pulmonary Hypertension in Italian ulTrasonography laboratories)]. | Pulmonary hypertension is characterized by an increase in pulmonary vascular resistance and premature death. Echocardiography is useful in the screening of patients with suspected pulmonary hypertension by estimation of the systolic regurgitant tricuspid flow velocity according to the simplified Bernoulli equation. On this basis, the survey INCIPIT was created aiming at evaluating the frequency of suspected pulmonary hypertension among Italian patients. |
20860162 | [Italian nursing survey of cardiological intensive care units]. | The recent evolution of nursing management of cardiovascular disease has led to significant changes in specific healthcare processes. The aim of this study is to present the first nursing survey of Italian intensive cardiac care units (ICCUs). |
20860167 | [New-onset left bundle branch block as an early electrocardiographic feature of takotsubo cardiomyopathy]. | Takotsubo cardiomyopathy is a recently described syndrome characterized by reversible left ventricular dysfunction, chest pain, ST-segment elevation, and minor elevation in serum levels of cardiac enzymes, in the absence of significant coronary artery disease. ST-segment elevation is the mon electrocardiographic finding on the admission ECG of patients, followed by evolutionary T-wave inversions. We report a case of takotsubo cardiomyopathy characterized by the unusual feature of a new onset transient left bundle branch block as first electrocardiographic manifestation. New left bundle branch block increases heterogeneity in the broad spectrum of electrocardiographic findings of takotsubo syndrome, contributing to ambiguity in the early recognition and affecting potential management strategies. |
20860168 | [Laboratory-based evaluation of loop-mediated isothermal amplification (LAMP) to detect Cryptosporidium oocyst and Giardia lamblia cyst in stool specimens]. | To establish an alternative and more sensitive test method to detect oocyst of Cryptosporidium parvum and cyst of Giardia lamblia in clinical stool specimens, loop-mediated isothermal amplification (LAMP) was evaluated. Minimum cell concentrations at which LAMP assay could detect C. parvum oocyst and G. lamblia cyst were determined as 6.25 x 10(-1) and 3.12 x 10(-1) cells/assay when the stool specimens were spiked with the respective parasites. The results indicated 400 times higher sensitivities or more pared to the microscopic readings. Twenty and nineteen diarrhea stool specimens spiked with C. parvum oocyst or G. lamblia cyst were assayed by LAMP. The results indicated that 14 (70%) and 16 (84%) samples successfully resulted in positive readings. But the remaining 6 and 3 samples were read as negative probably due to residual stool color. However, further dilutions of DNA extraction samples and addition of bovine serum albumin to LAMP reaction mixture showed positive effects on the occurrence of false-negative readings. With these results, we can conclude that the LAMP assay provides us an accurate and highly sensitive test method to detect C. parvum oocyst and cyst of G. lamblia, in place of labor-intensive and experience-dependent microscopic examination, in clinical laboratories. |
20860169 | [Assembly and secretion of mutant fibrinogens with variant gamma-chain C terminal region (gamma313-gamma345)]. | It has been reported that the structure of the fibrinogen gamma-chain C terminal (D) region (140-411 residues) has important functions in fibrinogen assembly and/or secretion. Variant fibrinogens, gamma313S>N, gamma336M>I, gamma341A>D, and gamma345N>D have been reported as hypofibrinogenemias or dysfibrinogenemias. To study the assembly and secretion of the variant fibrinogens containing aberrant D regions, we established CHO cells producing these four fibrinogens. |
20860170 | [Accuracy and reliability of international normalized ratio (INR) in monitoring of warfarin--comparison in the sensitivity to extrinsic coagulation factors between PT (INR) and TT (INR)]. | Prothrombin time (PT) is widely used as the monitor of oral anticoagulant therapy using ISI/NR system which WHO mended. However, a main clinical usefulness of an bined reagent (TT) also remains in the monitoring of warfarin in Europe and Japan. Recently, a TT reagent utilizing a binant bovine tissue factor (TF) expressed by silkworm-baculovirus system has been developed. The purpose of this study is to investigate the sensitivity to coagulation factors (FII, FV, FVII, FX) of PT (rabbit brain and binant human) and TT (bovine brain and binant bovine) in INR, and the correlation among those reagents using 53 plasma samples from patients treated with warfarin. The INR results were calculated using a certified INR calibrator, "AK-CALIBRANT", according to the method of "Direct" INR determination. The sensitivity to FII, FVII and FX of those reagents results similar behavior in INR, but the sensitivity to FV of PT reagents were generally higher than that of TT reagents. The correlation coefficient between binant PT and binant TT was 0.979. There were a good agreement between two TT reagents (bovine brain and binant bovine) in INR (r = 0.998). It was apparent that a variance between PT and TT was dependent on the sensitivity to FV level during the course of warfarin treatment in a clinical case. In conclusion, PT and TT reagents gave generally acceptable correlation in INR, and our results indicate that the Owren-type TT reagent is also well suited for monitoring warfarin using local INR calibration according to WHO mendation. |
20860171 | [Autopsy case of corticosteroid-induced invasive pulmonary aspergillosis with cavity-formation]. | Invasive pulmonary aspergillosis (IPA) is an important and plication in the patients with neutropenic or immunosuppressed condition. In spite of intensive treatment with anti-fungal drugs, the prognosis of the patients who have been suffered from IPA is extremely poor. This case was an 85-year-old Japanese man who was diagnosed as idiopathic thrombocytopenic purpura (ITP). He underwent high-dose corticosteroids and gamma-globulin therapy. During the hospitalization, plained respiratory symptoms, and the abnormal shadow suggesting pulmonary infiltration and cavitation was pointed out on chest imaging. He was diagnosed as IPA because of high level of serum beta-D-glucan and positive for aspergillus antigen. Although he underwent intensive care with anti-fungal drug administration and artificial respiration, he died of respiratory distress on the 68th hospitalization. Postmortem examination disclosed severe bronchopneumonia, cavitation and pulmonary arterial thrombi in both lungs. Histological examination showed widely distributed epitheloid cell granulomata with central necrosis containing aspergillus hyphae, and vasodestructive growth of fungus with occasional organized thrombi. |
20860172 | [Predictive significance of evaluation of left ventricular diastolic function in patients with heart failure]. | Pulsed-Doppler derived transmitral flow (TMF) has been widely used for evaluating left ventricular (LV) diastolic function. The grading of LV diastolic dysfunction is feasible by the ratio of early to late diastolic inflow velocities (E/A): normal: E/A > 1, grade I: E/A < 1 (abnormal relaxation pattern), grade II: E/A > 1 (pseudonormal pattern), grade III: E/A > > 1 (restrictive pattern), and grade IV: E/A > > 1 (irreversible restrictive pattern). Pulmonary venous flow pattern is also used for evaluation of LV diastolic dysfunction, especially to differentiate a normal from pseudonormal TMF pattern. The ratio of systolic to diastolic pulmonary venous flow (S/D) >1 is normal and S/D < 1 is regarded as pseudonormal. Recently, tissue Doppler imaging (TDI) has been introduced as a new diagnostic tool for LV diastolic dysfunction. The mitral annular velocity obtained by TDI is used for a preload-independent index of LV diastolic function. The ratio of early transmitral inflow to mitral annular velocity (E/Ea) related well to pulmonary capillary wedge pressure. In particular, E/Ea > 15 strongly suggested elevated PCWP and LV filling pressure. Therefore, analysis of TMF and PVF patterns by pulsed Doppler and Ea by TDI is useful for diagnosing the pensated state of heart failure. Furthermore, the TMF pattern is utilized to predict the prognosis of patients with heart failure. Patients with an irreversible restrictive filling pattern have high mortality, whereas those with, reversible restrictive filling have a high probability of improvement of heart failure. |
20860173 | [Clinical applications of strain rate imaging for evaluation of left atrial function]. | Left atrial (LA) function plays an important role in patients with left ventricular dysfunction and atrial fibrillation, and has been assessed using several noninvasive methods. However, there are a number of limitations regarding clinical application, including the dependence of altered left ventricular hemodynamics, image quality, single plane assessment, and the tethering effect. Strain rate (SR) imaging is a novel echocardiographic technique for assessing LA function, which enables the quantification of LA function in patients with atrial fibrillation, hypertension, diabetes mellitus, obesity, atrial septal defect, dilated cardiomyopathy, and cardiac amyloidosis. Furthermore, SR imaging can identify LA dysfunction in patients with hypertension or diabetes mellitus, even in the absence of LA dilation or functional LA impairment assessed by conventional Doppler echocardiography and tissue Doppler imaging. LA deformation assessed by SR imaging is a predictor of the maintenance of a sinus rhythm after either electrical cardioversion or catheter ablation for atrial fibrillation. Recently, two-dimensional speckle tracking echocardiography has been used as a noninvasive, simple, and reproducible technique for assessing LA function in patients with either physiological or pathological left ventricular hypertrophy. LA dysfunction detected by either SR imaging or two-dimensional speckle tracking echocardiography may be associated with the development of heart failure, thromboembolism, and atrial fibrillation, and should undergo further investigations. In this review, the clinical applications of SR imaging for LA function evaluation are summarized. |
20860174 | [Investigation of atherosclerosis using carotid ultrasonography]. | Carotid ultrasonography is useful for patients in the early stage of atherosclerosis or with manifest vascular disease. We can assess the intima-media thickness (IMT), stenosis, and also elasticity of the carotid artery noninvasively. IMT is well-known as a strong predictor of future vascular events and a surrogate marker of atherosclerosis. We examined 353 consecutive subjects (coronary artery disease: n=92, cerebral vascular disease: n=62, peripheral arterial disease: n=104), regarding whether the accumulation of vascular diseases affects the IMT. The maximum IMT of mon carotid artery expanded with increasing numbers of vascular diseases (no vascular disease, 1.10 +/- 0.51; one vascular disease, 1.38 +/- 0.63; two vascular diseases, 1.69 +/- 0.65; three vascular diseases, 2.01 +/- 0.67 mm; p < 0.01, no vs. one vascular disease, one vs. two vascular diseases). The accumulation of vascular diseases, independent of the types of vascular lesion, accelerated carotid atherosclerosis. The stiffness parameter beta of the carotid artery was related to the brachial-to-ankle pulse wave velocity(baPWV) (n=38, r = 0.81, p < 0.0001). Stiffness parameter beta (10.95 +/- 2.8) and baPWV (1,549 +/- 179 cm/s) in the metabolic syndrome (MetS) group (n=18) was higher than in the preliminary MetS (n=12, 8.82 +/- 1.69, 1417 +/- 148 cm/s) and control (n=8, 7.90 +/- 1.78, 1357 +/- 171 cm/s) groups. The mean IMT of mon carotid artery was not different between the MetS and preliminary MetS groups. Morphological and functional changes in atherosclerosis can be evaluated employing carotid ultrasonography. |
20860176 | [Adipocytokines and assay method in metabolic syndrome]. | Adipocytokines, such as adiponectin, TNF-alpha, and leptin, are cytokines secreted by visceral adipocytes, and they are associated with metabolic syndrome. Adiponectin is one of the adipocytokines, and is a prised of 244 amino acids. It is known as ACRP30, GBP28, and AdipoQ. Adiponectin is secreted by adipocytes, has three different isoforms, including trimers (low-molecular weight: LMW), hexamers (middle-molecular-weight: MMW), and higher-order oligomeric (high-molecular-weight: HMW) structures, and affects the biological activity. Adiponectin is a clinically relevant parameter measured routinely in subjects at risk of type 2 diabetes and metabolic syndrome. We investigated the adiponectin levels using a number of ELISA assay kits. |
20860175 | [Evaluation of kidney circulation using duplex Doppler ultrasonography]. | Chronic kidney disease (CKD) is increasingly being recognized as a leading public health issue. CKD is associated with an increased risk of cardiovascular disease (CVD), and the convalescence of patients with CVD is greatly influenced by the renal function. CVD and CKD are closely related, and diagnosis/treatment of CVD while considering renal function are mended. Renal duplex Doppler ultrasonography is a tool which can evaluate the renal hemodynamics and renal function noninvasively and is an important screening examination for renal disease. Renal artery stenosis is important as one of the renal diseases clinically related to arteriosclerosis. Using an increase in the renal artery peak systolic velocity (PSV) and the ratio of the PSV in the renal artery to the abdominal aorta, duplex scanning is able to predict significant renal arterial stenosis. On the other hand, the intrarenal resistive index (RI), which is a function of the blood velocity waveform of the artery in the kidney, is an index of the kidney's peripheral arterial resistance. It has been reported that the RI value is related to the aggravation of renal function disorder, and a renal insufficiency above 0.8 is related to an increase in peripheral arterial resistance. |
20860177 | [Risk management in laboratory medicine]. | Risk management is essential for providing patients with safe medical services. In the United States, the Institute for Healthcare Improvement (IHI) launched a 1.5-year national campaign to save 100,000 lives by improving the quality of medical care (100 K campaign) in 2004. They successfully prevented more than 100,000 deaths during this period. In Japan, the "National Joint Action of Risk Management" started as a 2 year program in May 2008. They listed 8 action goals for improving medical care. The Japanese Society of Laboratory Medicine is one of the organizations participating in this project. The purpose of this symposium is to promote and encourage investigations of incidents in clinical laboratories, collect data on this issue, and mend effective procedures for improving patient safety. |
20860178 | [To reduce the risk of blood collection problems]. | Obtaining blood specimens is routine; however, it is one of the riskiest procedures medical technologists perform. At the Fujita Health University Hospital, there were 182,000 blood collections in 2008, and 31 safety management reports on blood collection, accounting for 12% of all safety management reports. To reduce the risk of blood collection problems, our suggestions are as follows: (1) medical technologists should understand that venipuncture may induce nerve injury; (2) they should make efforts to improve their technical procedures; (3) they should develop procedural knowledge, an explanatory manner, and patient service; (4) they should make efforts to establish the safety of the blood collection system; and (5) they should recognize the need to provide high-quality medical services to patients and reduce problems associated with blood collection. Finally, when problems occur, medical technologists should collect accurate information and analyze it to promote blood collection safety. |
20860180 | [Current status of medical accident prevention in our pathology section]. | Preventive measures against medical accident should be addressed in the pathology section. Medical accidents occur while preparing tissue specimens and making pathological diagnoses. For the preparation of tissue specimens, we have developed a work manual in consultation with past incident reports and update this manual regularly. We can reduce medical accidents by including a check system for each task. For pathological diagnosis, we perform some of the same checks as for tissue specimen preparation and can make more correct diagnoses by conferring with other departments. It is also important to check each other's work to prevent medical accidents. |
20860179 | [Approach for prevention of medical test malpractice using ISO 15189]. | With the increasing need for medical laboratory data, the importance of the medical laboratory in medical care has grown exponentially. Therefore, it is necessary that the medical laboratory provide the doctor and the patient receiving medical care with accurate, precise, and reliable medical laboratory data. Quality assurance and safety management in the medical laboratory are necessary to prevent medical test malpractice, which would lead to a medical accident, and to manage the overall processes required to provide high quality medical laboratory data. ISO 15189 is an international standard known as an organizational management tool for medical laboratories. Our medical laboratory acquired this ISO in March 2005 and we utilized PDCA cycle as required by the international standard in order to establish appropriate safety management and crisis control. We introduced practices for quality improvement and prevention of medical test malpractice proposed by the mittee of our medical laboratory and describe these practices in this report. |
20860182 | The medium is the message or is the message in the medium? | Our conversation was interrupted with a woman shouting at her husband, 'I told you that you had selective deafness, you only hear what you want to and when you want to'. The innocent remark was bellowed across the hospital restaurant as I sat discussing practice issues with four perioperative colleagues. Interestingly, the message immediately changed our discussion to story telling about how some of us have municating with deaf patients challenging. |
20860187 | Promoting the dignity of patients in perioperative practice. | UK health policy has increasingly recognised that the quality of patients' experiences is important and there is a clear expectation that patients' dignity should be promoted in healthcare. Patients undergoing surgery are particularly vulnerable to their dignity being diminished. Operating department staff should ensure that dignity is promoted through attention to patients' privacy and through interactions that help patients to fortable, in control and valued. They should also challenge colleagues whose promises patients' dignity. |
20860188 | Perioperative blood transfusion: the role of allogenous and autologous transfusions, and pharmacological agents. | The decision to transfuse patients perioperatively is made on an individual basis and should consider factors such as duration and severity of anaemia, symptoms, physiological parameters orbidities. Autologous blood transfusion has the benefit of avoiding some of the immunological and plications associated with allogenic blood transfusion. Pharmacological agents as well as anaesthetic and surgical techniques have a role in avoiding the need for blood transfusion. |
20860189 | Regional anaesthesia: back to basics. | Regional anaesthesia has e more popular in recent years with an emphasis on cost effectiveness, bed occupancy, and reduction in hospital acquired infections (HAls). Anaesthesia is a worrying time for any patient, but now the emphasis is to encourage patient empowerment by involving patients in their own care throughout their holistic journey. This article explores patient selection for regional anaesthesia, and the different types of central and peripheral blocks in line with national policies. The equipment required, pharmacology, toxicity of local anaesthetics, and their physiological effects on the cardiovascular, respiratory, and gastrointestinal systems of the body will also be discussed. |
20860191 | Chlorhexidine's complications. | Chlorhexidine is an effective cleansing skin-preparation agent and has many user benefits. It has, however, been associated with a number plications which are highlighted in this paper. All users of chlorhexidine must be aware of these risks and employ insightful use of this chemical. |
20860190 | The obese patient. Anaesthetic issues: airway and positioning. | The authors bined experience of over forty years working within the NHS and private hospitals as registered operating department practitioners. It is widely accepted that obesity is a growing problem in the populations of all developed and, increasingly, developing countries. It is also agreed that this sector of the population present specific challenges when required to undergo general anaesthesia. What is not so evident is a universal approach to assessing, predicting and ing these challenges. Furthermore, where there is the presentation of a clearly high risk patient, there can be limitations in optimizing the environment for reasons such as saving time, a lack of resources or sheer apathy. This article reviews the challenges, assessment and solutions available to the clinician faced with a high BMI patient with particular reference to the technique of ramping. |
20860192 | The early days of anaesthesia. | If you should ask me to name the most important date in the whole history of surgery, I would reply, without a moment's hesitation, Friday October 16th 1846. The operation was a simple, almost trivial procedure, the removal of a small benign lump in the neck, but it marked the watershed between the past agonies of surgery and the modern era, where our patients enjoy the blissful oblivion of anaesthesia. |
20860196 | Asthma-how does it impact academic achievement and school budgets? | There are many more students with asthma attending public schools than previously known and documented. The challenge to identify and educate students remains largely with local school districts. A student's academic success is impacted by thorough planning and provision for the student's needs. Collecting and measuring asthma-related absence data can help drive program planning and impact school budgets. |
20860209 | A change of scenery. Interview by Louise Hunt. | Enhancing environments brings health benefits to patients but can also improve the quality of care given. |
20860211 | Teenagers uncovered. | There is mon belief that peer pressure and alcohol are instrumental in teenagers having sex, but new research reveals a different story. |
20860210 | Push for change. | municable diseases should e the next focus of the United Nations' aims to reduce poverty in developing countries. |
20860214 | Vascular access devices: securement and dressings. | Many patients admitted to hospital will require a vascular access device (VAD). Insertion of VADs is often viewed as a routine procedure, with little attention given to the importance of appropriate securement and dressing and how these factors can affect patient es. This article discusses the types of VAD available and the rationale for VAD securement and appropriate dressings to plications. |
20860215 | Extravasation: prevention, recognition and management. | This article provides readers with an overview of extravasation, including risk factors and management strategies. The importance of accurate reporting and documentation is also highlighted, particularly as patients will often require follow-up care and may take legal action as a result of extravasation injury. |
20860213 | Importance of sexual needs assessment in palliative care. | Sexuality is a fundamental aspect of being human. Guidance states that to support and improve the lives of adults with life-limiting illness, health professionals must address care in the social, psychological, spiritual and physical domains, yet no mention is made of the sexual domain. Palliative care aims to be holistic yet evidence suggests that sexuality is often overlooked when assessing care needs. This literature review will identify the issues that prevent sexual needs assessment in palliative care. |
20860221 | Upper gastrointestinal submucosal lesions--clinical and endosonographic evaluation and management. | Submucosal lesions (SML) include a diverse array of benign, potentially malignant, andmalignant lesions. The majority of SML's are asymptomatic and found incidentally. Endosonography (EUS) is the key investigation for these lesions. Although, the morphologic appearance of a SML as seen on EUS is rarely diagnostic, the differential diagnosis can be narrowed down. Obtaining a tissue diagnosis is often necessary, and EUS-FNA and EUS-guided trucut biopsy of a SML can be carried out. Information about the malignant potential, layer or origin, size, and extramural extension of an SML is also provided by EUS. EUS is strongly indicated before endoscopic or surgical resection of any SML. The monly encountered SML's in the upper gastrointestinal tract are GIST's, leiomyoma's, neuroendocrine tumors, lipomas, granular cell tumors, varices, duplication cysts, heterotopic pancreas, Brunner's gland hamartoma, lymphangiomas. A large number of rare lesions are also seen. This review describes the histological, clinical, endoscopic, and endosonographic appearance of the different SML. |
20860223 | The assessment of probable relationship between lung cancer and Helicobacter pylori infection. | Many sero-epidemiological and case-control studies suggest that H. pylori infection may be associated with the development of lung cancer. |
20860224 | Intrarectal application of formalin for chronic radiation proctitis: a simple, cheap and effective treatment. | Chronic radiation proctitis is known to be a difficult to treat condition. Argon Plasma Coagulation (APC) though being effective requires prolonged sessions and has limited availability. Formalin, by virtue of its chemical cauterizing effects, has been found to be effective in patients with bleeding radiation cystitis and hemorrhagic proctitis. Our goal was to study the effectiveness of 4% formalin instillation in resistant patients of chronic hemorrhagic radiation proctitis. |
20860222 | Cytokine gene polymorphisms in irritable bowel syndrome in Indian population--a pilot case control study. | This study aimed at evaluating the single nucleotide polymorphisms (SNPs) in five cytokine genes regulating inflammation at altogether 8 different loci pared their frequencies in patients with Irritable bowel syndrome (IBS) versus healthy age and sex matched controls. |
20860239 | Diffusing aviation innovations in a hospital in The Netherlands. | Many authors have advocated the diffusion of innovations from other high-risk industries into health care to improve safety. The aviation industry parable to health care because of its similarities in (a) the use of technology, (b) the requirement of highly specialized professional teams, and (c) the existence of risk and uncertainties. For almost 20 years, The Rotterdam Eye Hospital (Rotterdam, the Netherlands) has been engaged in diffusing several innovations adapted from aviation. |
20860240 | Risk assessing risk assessment. | If done well, proactive risk assessment methods can be effective in identifying and managing risks and still be efficient and rewarding for the participants. However, they can also fail, which suggests the potential usefulness of risk assessing the risk assessment process. |
20860241 | A practical guide to failure mode and effects analysis in health care: making the most of the team and its meetings. | Failure Mode and Effects Analysis (FMEA) is a proactive risk assessment tool used to identify potential vulnerabilities plex, high-risk processes and to generate remedial actions before the processes result in adverse events. FMEA is increasingly used to proactively assess and improve the safety plex health care processes such as drug administration and blood transfusion. A central feature of FMEA is that it is undertaken by a multidisciplinary team, and because it entails numerous analytical steps, it takes a series of several meetings. Composing a team of busy health care professionals with the appropriate knowledge, skill mix, and logistical availability for regular meetings is, however, a serious challenge. Despite this, information and advice on FMEA team assembly and meetings scheduling are scarce and diffuse and often presented without the panying rationale. |
20860237 | Transanal excision of anorectal lesions--a single centre experience. | Transanal excision monly used to treat lesions of the anorectum. It avoids the morbidity of radical pelvic surgery, while allowing plete histopathological examination of the lesion. |
20860242 | Reducing errors during patient-controlled analgesia therapy through failure mode and effects analysis. | Despite the technologic advances in design, resulting in the development of "smart" pumps to help deliver analgesia more safely, patient-controlled analgesia (PCA) is still involved in a significant proportion of the medication errors ascribed to intravenous (IV) drug administration, many of which have harmed patients. In 2003, Failure Mode and Effects Analysis (FMEA) was used to assess the PCA process at a 695-bed teaching and research tertiary hospital. IDENTIFYING AND ADDRESSING FAILURE MODES: For the three processes with hazard scores > 8--patient selection, prescribing, and medication administration-the potential cause(s) were identified, allowing the process to be redesigned to eliminate the potential cause(s). |
20860243 | Three kinds of proactive risk analyses for health care. | In health care, proactive risk assessment usually takes the form of Failure Mode and Effects Analysis (FMEA). An applied research firm, munity hospitals, and munity health care alliance in south-central Washington State--as members of the Tri-Cities Patient Safety Coalition (TCPSC)--used proactive risk assessment methods such as event tree analysis (ETA) and hazard identification to assess the risk of adverse events associated with a process or system. |
20860244 | Involving intensive care unit nurses in a proactive risk assessment of the medication management process. | Vulnerabilities in the medication manage ment process can lead to serious patient harm. In intensive care units (ICUs), nurses represent the last line of defense against medication errors. Proactive risk assessment (PRA) offers methods for determining how processes can break down and how people involved in such processes can contribute to or recover from a breakdown. Such methods can also be used to identify ICU nurses' contribution to the quality and safety of medication management. |
20860238 | Unilateral versus bilateral lateral internal sphincterotomy: a randomized controlled trial for chronic fissure in ano. | Standard treatment for Chronic Anal Fissure (CAF) is unilateral Internal Sphincterotomy (UIS). Still there is recurrence and the risk of of incontinence. Bilateral Internal Sphincterotomy (BIS) as a treatment for CAF has not been adequately evaluated. |
20860236 | Abdominal packing for surgically uncontrollable haemorrhage. | Using abdominal packs is often a life-saving technique for uncontrollable bleeding during operations. It prevents worsening of the hypothermia, coagulopathy and acidosis which usually panies massive bleeding till they may be corrected and the packs removed later. However, packing may be associated with a mortality of 56 to 82% due to continued bleeding, intra-abdominal abscesses and partment syndrome. We follow a policy of early abdominal packing (considering it after a 6 unit intraoperative blood loss) before the situation es irreversible. |
20860248 | Improving patient-centered medical-surgical nursing practice with quality-of-life assessment. | Measurement of quality of life can facilitate the delivery of patient-centered medical-surgical nursing care. The various types of quality-of-life instruments, important considerations when selecting an instrument, and helpful resources during the implementation process are reviewed. |
20860250 | Immune thrombocytopenia purpura. | Immune thrombocytopenic purpura (ITP), once known as idiopathic thrombocytopenic purpura, is an autoimmune disorder. ITP can occur acutely or chronically, and ranges in severity from mild to life-threatening. The signs and symptoms, treatment, and nursing care for patients with this disorder are discussed. |
20860249 | The wisdom of retaining experienced nurses at the bedside: a pilot study examining a minimal lift program and its impact on reducing patient movement related injuries of bedside nurses. | This Robert Wood Johnson Foundation grant-funded research examined nursing satisfaction with devices used in the target hospital's minimal lift program. It also investigated the possibility of maintaining or increasing retention of experienced nurses at the bedside by reducing potential patient movement-related injuries. |
20860251 | Staff nurses and students: the good, the bad, and the ugly. | Elements identified by student nurses as impacting learning in the clinical learning environment were explored. A significant element identified by participants was the staff nurse. Strategies for improvement and increasing learning opportunities are included in the discussion. |
20860247 | Experience with family activation of rapid response teams. | Condition H allows family activation of a rapid response team in a hospital setting. Systematic implementation of Condition H at a 500-bed munity hospital led to varied types of calls, all of which met the policy criteria. munication issues were discovered through this process. |
20860260 | Certified pediatric nurses' perceptions of job satisfaction. | The Pediatric Nursing Certification Board surveyed a national sample of 1354 hospital-based certified pediatric nurses (CPNs) to determine their perceptions of certification on job satisfaction and other factors. There is a substantial body of literature that demonstrates job satisfaction among nurses positively increases retention and reduces absenteeism and burnout. CPNs seek certification for a personal sense of achievement, professional recognition, and validation of petency. The certified nurse survey respondents had self-reported high levels of job satisfaction and indicated that relationships with colleagues and a supportive work environment were very important to their levels of job satisfaction. The results of this study highlight important factors for hospitals to consider as they plan strategies and cost-effective ways to positively affect patient care and retain qualified pediatric nurses at the bedside. |
20860257 | Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. | Health care professionals experience grief when caring for children with life-threatening conditions. Harriet Lane Compassionate Care, the pediatric palliative care program of the Johns Hopkins Children's Center, created an action plan to support health care professionals; one intervention-- the bereavement debriefing session - was specifically aimed at providing emotional support and increasing one's ability to manage grief. A structured format for conducting bereavement debriefing sessions was developed, and 113 sessions were held in a three-year period; data were collected to capture themes discussed. Bereavement debriefing sessions were conducted most frequently after unexpected deaths or deaths of long-term patients. Though attendance included all disciplines, nurses attended the sessions most often. Self-report evaluation forms revealed that health care professionals found the sessions helpful. Bereavement debriefing sessions can be one aspect of an effective approach to supporting health care professionals in managing their grief in caring for children with life-threatening conditions. |
20860258 | Seizure precautions for pediatric bedside nurses. | Seizures are mon neurologic disorder of childhood, and many pediatric nurses will care for children with epilepsy during their careers. The term "seizure precautions" is used frequently in nursing practice; however, its definition varies among institutions. Childhood epilepsy has many phenotypes, and while some children require airway clearance and ventilatory support in the event of a seizure, many will not. The bedside equipment for a child with seizures should reflect the patient's symptoms. To that end, an algorithm based on seizure classification and current practice in seizure precautions is presented to aid bedside nurses in safely caring for children with seizures. The algorithm may also be used to assist in educating parents about the safest way to care for their child at home, without sending contradictory messages about different needs for equipment in the hospital and in the home. |
20860263 | Good is not good enough: the culture of low expectations and the leader's challenge. | There are many examples of health care organizations that have morphed from the culture of low expectation to the culture of excellence. Ethically, to not drive to excellence means that we are settling from knowingly allowing harm to happen on our watch. The leader's obligation is to create that sonic boom that Black and Gregersen (2008) describe to break up the old mind maps, to create the movement, and to finish the cultural change in spite of change fatigue and other factors that could sabotage the process. Only then can the effective leader sleep well at night knowing that the infrastructure is being created that will provide a culture of excellence and safety for patients and their families. And it is being created on his/her watch. |
20860259 | Spirituality in children: understanding and developing interventions. | Children are born with petence," an inner quality or power for faith development. Traditions from early nursing practice address the care of those who are in distress, suffering, questioning the reason for illness or pain, or seeking meaning and purpose in their lives. Increased demands on time and rapidly plex medical cases allow less time and energy directed toward spiritual issues for the nurse, while at the same time increasing the possibility of spiritual needs of the child and family. The following discussion is a synthesis of faith development theory, effects of spirituality in children, spiritual assessment techniques, and intervention strategies for children. |
20860261 | The 'W.I.S.E. Up!' tool: empowering adopted children to cope with questions and comments about adoption. | Families of adopted children and the children themselves are not strangers to intrusive questions about private information, such as "Is that your real child (or mother)?" and "Why did your mother give you away?" While the questions may be benign, they can be fortable to handle and harmful to a child's self-esteem. To counteract this, The Center for Adoption Support and Education (C.A.S.E.) in Maryland has developed an empowering tool for adoptive children and their families. The "W.I.S.E. Up!" tool is based on the premise that adoptive children are wiser about adoption than peers who are not adopted. The tool uses the acronym W.I.S.E. to teach children four options for responding to fortable questions: W (walk away), I (ignore or change the subject), S (share what you fortable sharing), and E (educate about adoption in general). Nurses can assist adoptive families by introducing them to this empowering tool. |
20860275 | Outcome of adenotonsillectomy for obstructive sleep apnea syndrome in children. | We evaluated the e of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in children using polysomnography (PSG) data and a quality-of-life (QOL) instrument. |
20860276 | Management of complex cases of petrous bone cholesteatoma. | In a retrospective analysis of a quaternary referral neuro-otologic private practice, we plex cases of petrous bone cholesteatoma (i.e., cases with encasement of vital structures such as the internal carotid artery, jugular bulb, and sigmoid sinus, with further extension to the clivus, sphenoid sinus, or rhinopharynx), review surgical approaches and techniques of management of vital structures, and propose the ideal surgical management. |
20860274 | Multicenter evaluation of the digisonic SP cochlear implant fixation system with titanium screws in 156 patients. | We describe and evaluate the process of fixation of the Digisonic SP cochlear implant with two titanium screws. |