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Better Quality (good + quality)
Selected AbstractsLaparoscopic surgery in neonates and infants weighing less than 5 kgPEDIATRICS INTERNATIONAL, Issue 6 2000Tadashi Iwanaka Background: Laparoscopic surgery in small infants is still an uncommon procedure in Japan. The present study was conducted to evaluate the advantages and disadvantages of laparoscopic surgery in neonates and infants weighing less than 5 kg. Methods: Between July 1997 and November 1999, 54 infants underwent laparoscopic surgery. They were evaluated for length of operation, intra- and postoperative complications, changes in intra-operative body temperature, time to postoperative feeding, length of hospital stay and changes in serum levels of C-reactive protein (CRP), creatinine phosphokinase (CPK) and interleukin (IL)-6 on days 0, 1 and 4. These parameters in the laparoscopic pyloromyotomy (LP) and laparoscopic fundoplication groups were compared with those in the open pyloromyotomy (OP) and open fundoplication groups, respectively, which were performed during the same period. Results: Three laparoscopy cases were converted to open procedures. One case of fundoplication had panperitonitis due to failed gastrostomy and required long-term parenteral nutrition. Time to postoperative feeding and length of hospital stay in the LP group were significantly shorter than in the OP group. In LP group, intra-operative body temperature did not markedly decrease during CO2 pneumoperitoneum. Although serum levels of CRP, CPK and IL-6 were elevated in all groups on postoperative day 1, there were no significant differences between the groups. Conclusions: Better quality of life after laparoscopy is a significant advantage over conventional surgical procedures. This advantage not only outweighs the incidence of intra- and postoperative complications in small infants, but further emphasizes the need to improve laparoscopic techniques to avoid complications. [source] Isotropic Remeshing with Fast and Exact Computation of Restricted Voronoi DiagramCOMPUTER GRAPHICS FORUM, Issue 5 2009Dong-Ming Yan Abstract We propose a new isotropic remeshing method, based on Centroidal Voronoi Tessellation (CVT). Constructing CVT requires to repeatedly compute Restricted Voronoi Diagram (RVD), defined as the intersection between a 3D Voronoi diagram and an input mesh surface. Existing methods use some approximations of RVD. In this paper, we introduce an efficient algorithm that computes RVD exactly and robustly. As a consequence, we achieve better remeshing quality than approximation-based approaches, without sacrificing efficiency. Our method for RVD computation uses a simple procedure and a kd -tree to quickly identify and compute the intersection of each triangle face with its incident Voronoi cells. Its time complexity is O(mlog n), where n is the number of seed points and m is the number of triangles of the input mesh. Fast convergence of CVT is achieved using a quasi-Newton method, which proved much faster than Lloyd's iteration. Examples are presented to demonstrate the better quality of remeshing results with our method than with the state-of-art approaches. [source] Comparison of cardiovascular function and quality of recovery in isoflurane-anaesthetised horses administered a constant rate infusion of lidocaine or lidocaine and medetomidine during elective surgeryEQUINE VETERINARY JOURNAL, Issue 3 2010A. VALVERDE Summary Reasons for performing study: The effects of lidocaine combined with medetomidine or lidocaine alone on cardiovascular function during anaesthesia and their effects on recovery have not been thoroughly investigated in isoflurane-anaesthetised horses. Objectives: To determine the effects of an intraoperative i.v. constant rate infusion of lidocaine combined with medetomidine (Group 1) or lidocaine (Group 2) alone on cardiovascular function and on the quality of recovery in 12 isoflurane-anaesthetised horses undergoing arthroscopy. Hypothesis: The combination would depress cardiovascular function but improve the quality of recovery when compared to lidocaine alone in isoflurane-anaesthetised horses. Methods: Lidocaine (2 mg/kg bwt i.v. bolus followed by 50 µg/kg bwt/min i.v.) or lidocaine (same dose) and medetomidine (5 µg/kg bwt/h i.v.) was started 30 min after induction of anaesthesia. Lidocaine administration was discontinued 30 min before the end of surgery in both groups, whereas medetomidine administration was continued until the end of surgery. Cardiovascular function and quality of recovery were assessed. Results: Horses in Group 1 had longer recoveries, which were of better quality due to better strength and overall attitude during the recovery phase than those in Group 2. Arterial blood pressure was significantly higher in Group 1 than in Group 2 and this effect was associated with medetomidine. No significant differences in cardiac output, arterial blood gases, electrolytes and acid-base status were detected between the 2 groups. Conclusions and potential relevance: The combination of an intraoperative constant rate infusion of lidocaine and medetomidine did not adversely affect cardiovascular function in isoflurane-anaesthetised horses and improved the quality of recovery when compared to an intraoperative infusion of lidocaine alone. [source] IPO Underpricing, Firm Quality, and Analyst ForecastsFINANCIAL MANAGEMENT, Issue 2 2007Steven X. Zheng We find that IPO underpricing is positively related to post-IPO growth in sales and EBITDA, but is not significantly related to growth in earnings. Our evidence suggests that accrual reversals or earnings management may cause this inconsistency. We interpret the growth rates of sales and EBITDA as measures of firm quality, and conclude that our evidence supports the notion that IPO firms with greater underpricing are of better quality. Our tests on analysts' earnings forecast errors show that analysts are less positively biased in their earnings forecasts for IPO firms that have greater underpricing. [source] Determination of essential oil quality index by using energy summation indices in an elite strain of Cymbopogon citratus (DC) Stapf [RRL(J)CCA12]FLAVOUR AND FRAGRANCE JOURNAL, Issue 2 2005Ashok Kumar Shahi Abstract Out of the several accessions of Cymbopogon citratus (DC) Stapf introduced from Central and West India, one accession coded as RRL(J)CCA12, selected through a mass selection technique, was found to have citral (,80%) as the major constituent in its essential oil. Citral has tremendous application in the ,avour and perfume industries. Plant adaptation was judged by quantifying the regression coef,cient (b) value, which was 1.0 using essential oil growth indices. For prediction of essential oil quality index (EOQI), a multiple regression equation was developed for the ,rst time by using essential oil yield/plant and energy summation indices as EOQI (citral %) = 61.6 + 1.09 × essential oil yield/plant (g) - 0.005 × heat use ef,ciency + 0.675 × phenothermal index. For obtaining a better quality of essential oil (citral ,78%), the optimal value of independent variable would be: X1 = 2.49; X2 = 0.018 and X3 = 20.47, where X1, X2 and X3 denote essential oil yield/plant, heat use ef,ciency and phenothermal index, respectively. The validation of the EOQI model is done by correlating the predicted and calculated values of citral (%) which exhibited signi,cant r value = 0.955 at 5% probability level. The thermal requirement of the selectant was ,5500 degree days to exhibit plant maturity in terms of qualitative and quantitative characteristics of its essential oil at 6.0 vegetative lea,ng stage, with attainment of plant height ,1.0 m from previous date of harvest (December 2001). Prediction of essential oil quality by using the mathematical model is helpful for integrating the growth processes and evaluating crop management strategies. Copyright © 2004 John Wiley & Sons, Ltd. [source] Psychological aspects and coping styles of parents with Haemophilic child undergoing a programme of counselling and psychological supportHAEMOPHILIA, Issue 3 2007A. M. BOTTOS Summary., Parents of children affected by haemophilia must face, often without prior knowledge, the difficult challenge imposed by such a pathology. To satisfy the need of information, guideline and psychological support for a better quality of life, 30 parents with haemophiliac children have participated in a programme of counselling and psychological support. Such a programme has the aim of guiding the group trough a process of discovery, comparison and personal growth and stimulating adaptive processes of problem,solving and decision,making. The aim of this paper was to verify how the programme influenced coping strategies and other psychological constructs such as depression and anxiety. Subjects of this study were administered the following psychological tests: COPE (coping, orientation to problems experienced), BDI (beck depression inventory), STAI-Y form (state,trait anxiety inventory) at the beginning and at the end of the programme. The results show that by the end of the programme subjects are characterized by a greater use of problem,focused coping strategies, typical of individuals who think that the situation is susceptible to change, and a minor use of emotion,focused coping strategies, related to individuals who regard the situation as immutable. The use of avoidance ,focused coping strategies seems to remain at the same level even if it was low. Also the other psychological aspects investigated, namely depression and anxiety, did receive a positive influence. The results show how significant such programme has been for parents. [source] Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in ThailandHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010R. Oupra RN MSc MNS PhD Abstract In Thailand, the crude death rate from stroke is 10.9/100 000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life. [source] Quality of private personal care for elderly people with a disability living at home: correlates and potential outcomesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2008Claudio Bilotta MD Abstract To investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the ,poor or fair care' group (n = 16), the ,intermediate care' group (n = 39) and the ,optimal care' group (n = 45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills (P = 0.002) and level of distress with life conditions (P = 0.020). A statistical analysis performed on elderly participants without an overt cognitive impairment (n = 59) and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group [mean ± standard deviation (SD) were, respectively, 45 ± 23.2, 63.7 ± 19.7 and 68.8 ± 21.6; P = 0.007], and a decrease in the Caregiver Burden Inventory score (mean ± SD were, respectively, 34.9 ± 25.3, 26 ± 17.7 and 17.6 ± 14.6; P = 0.020) across the three groups. We found no significant difference between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care. [source] Managed Care Quality of Care and Plan Choice in New York SCHIPHEALTH SERVICES RESEARCH, Issue 3 2009Hangsheng Liu Objective. To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources. 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design. Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings. There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions. Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. [source] Nocturnal Home Hemodialysis: Focus on the PartnerHEMODIALYSIS INTERNATIONAL, Issue 1 2003H Vos Background. Nocturnal home hemodialysis (NHD, 6 times weekly 6,8 hours) results in a better clinical and psychosocial condition of dialysis patients. However, this intensive therapy has important consequences for partners, who bear at least some responsibilities during the treatment. Methods. Since December 2001, we included 15 patients in a Dutch NHD project (,Nocturne'). All patients are assisted by their spouses. An aim of Nocturne is to study the effects of NHD on partners and other family members with questionnaires and interviews by a social worker. Results. NHD affects daily life of partners much more than conventional therapies. Partners feel very involved with the treatment. The invasion of the treatment in bed, the noise and light produced by the machine, the daily assisting of the patient, less freedom, and co-responsibility for the treatment are felt as a burden, specially during the first months of the treatment. However, the improved clinical condition of their spouse, resulting in less fatigue, less disability, less uremic symptoms, less complications, more attention for and contribution to family life, better quality of life and better mood are considered major improvements, with important positive effects for the quality of life of all family members. Additionally, partners consider the fact that they make an important positive contribution to their spouse's health valuable. All partners judged NHD, despite some negative consequences, as a major improvement of their life. Conclusion. The positive effects of NHD are more important than the negative consequences for partners of patients. However, partners need active support by nurses or social workers, specially during the first months of the treatment. [source] Perceived job stress of women workers in diverse manufacturing industriesHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 3 2005Jinky Leilanie Lu An investigation of the impact of organizational factors on perceived job stress among women workers in the IT-dominated garment and electronics industries in the Philippines was undertaken. The sample included 23 establishments with 630 women respondents. Questionnaires, walk-through surveys of the industries, and interviews were done. The workplace factors included the content of the job, the nature of tasks, job autonomy, hazard exposure, and management and supervisory styles. Chi-square analysis showed that there were interactions among the organizational factors (P = 0.05 and 0.10). These factors included the need for better quality and new products; tasks requiring intense concentration; exposure to radiation, chemical, noise, and vapor hazards; standing for prolonged periods of time; and highly monitored, repetitious work. Workers experienced job stress (P = .05) when they were subjected to low job autonomy, poor work quality, close monitoring, and hazardous work pressure. © 2005 Wiley Periodicals, Inc. Hum Factors Man 15: 275,291, 2005. [source] A systematic review of hand-assisted laparoscopic live donor nephrectomyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2004P. Dasgupta Summary We provide a systematic review of hand-assisted laparoscopic live donor nephrectomy (HALDN), a relatively new procedure. Medline search of HALDN between 1995 and 2002 was conducted. Published studies were scored by two independent assessors using a modified form of 11 generic questions. All questions required one of three responses: 0 , criterion not reported, 1 , criterion reported but inadequate, 2 , criterion reported and adequate. The studies were placed according to their scoRes in category A (score 20,22), category B (17,19) and category C (16 or less). Higher scores indicate better quality of studies. Where possible, statistical analysis of comparative data was performed. Most reports of HALDN are expert series, some comparative and a few prospective. There was good correlation between the assessors (r = 0.91), and of the seven published series on HALDN, two fell into category B and five into category C. At present, there is only one published randomised-controlled trial of HALDN vs. open donor nephrectomy; this is the only such trial in laparoscopic urology. HALDN allows kidneys to be harvested with short operating and warm ischaemia times and fewer ureteric complications. HALDN is a relatively new and effective technique, designed to make kidney donation more attractive and minimally invasive without affecting recipient outcomes. More prospective data of this technique is needed, and wide variation in reported outcome parameters need to be standardised to allow meaningful comparison. [source] A study of cross-border outshopping determinants: mediating effect of outshopping enjoymentINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 6 2009Chiquan Guo Abstract Outshopping has been studied in the marketing literature for years, and research has identified some compelling reasons for people to shop out of their home country. Outshoppers literally go extra miles to outshop for better quality and assortment of merchandise, higher quality of personal service, more pleasant shopping atmospherics, and more competitive prices. In this study, we propose that outshopping enjoyment is not only directly related to outshopping, as are the earlier outshopping determinants, but mediate the relationships between those cognitive determinants and outshopping behaviour. In addition, we explore how patriotism and terror would affect people's outshopping frequency. Managerial and research implications are also discussed. [source] The importance of understanding the shape of diverse ethnic female consumers for developing jeans sizing systemsINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 2 2007Su-Jeong Hwang Shin Abstract This study has been conducted to investigate the fit issues related to the current apparel pants and jeans sizing system for diverse consumers, identifying body shape differences among ethnic groups. A total of 1335 women in a certain size range (Misses figure type sizes 2,20) were selected in the study. A Misses figure type size category is commonly used for adult women of average proportion and height. First, the body dimension differences among ethnic groups were examined with a single factor analysis of variance. Second, the fit of pants and jeans for the diverse consumers within the same size category was examined with the current standard sizing system, ASTM D5585 for adult female Misses figure type sizes 2,20. Three cases were programmed within a database: When each consumer selects a size for a pair of jeans based on (1) waist size; (2) hip size; and (3) waist height (usually pants length). And last, the results were analysed with fit comparison plots. Current jean consumers are racially diversified in the US and globally as well. This study revealed that ethnic groups had different fit problems and significant body shape differences. Even within the same figure type size category, a variety of body dimensions existed in each ethnic group. According to the fit problem assessment in this study, consumers within the same body figure type size category could not find the right fit of the pants and jeans within the current sizing system. Half of the female consumers could not find a garment to fit based on waist height (pants length) because the current sizing systems overlooked the effect of diverse consumers. This study will be useful for standardizing organizations to modify current sizing systems for diverse ethnic consumer groups as a demographic factor so that apparel companies could provide better quality of fit for their consumers in the global and local market. [source] Implementation of oral health recommendations into two residential aged care facilities in a regional Australian cityINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2006Tony Fallon BAppSc(Hons) PhD Abstract Background, Residents of aged care facilities usually have a large number of oral health problems. Residents who suffer from dementia are at particular risk. A systematic review of the best available evidence with regard to maintaining the oral health of older people with dementia in residential aged care facilities provided a number of recommendations. Objectives, The aim of the implementation project was to introduce evidence-based oral hygiene practices for patients with dementia in two publicly funded residential aged care facilities and monitor for changes in nursing awareness, knowledge, documentation and practice to improve patient outcomes and ensure appropriate accreditation standards were met. An additional aim was to identify barriers and strategies to overcome barriers to implementation of evidence-based recommendations. Methods, Two facilities, a 40-bed facility and a 71-bed facility in the health service district of the regional Australian city of Toowoomba, provided the setting. A quality improvement approach was taken, using a number of strategies from the National Health and Medical Research Council guidelines for implementation studies. The implementation involved a number of stages, including project development, interactive oral health education, oral audits of residents, changes to oral hygiene practice via care plans and critical reflection. Results, The multidisciplinary approach to improving oral healthcare appeared to improve knowledge and awareness and move oral health practices in facilities closer to best practice. Specialised training in oral health was provided to a Clinical Nurse Consultant. Regular oral audits were introduced and facility staff were trained in the use of the oral audit tool. Care plans at one facility were of better quality and more comprehensive than before the intervention. Comments made during critical reflection suggested improvements in the oral health of residents, increased use of oral swabs and saliva substitutes, improved care of dentures and mention of the use of mouth props in resident care plans. There was also some evidence that changes brought about by the implementation are sustainable. Conclusion, The majority of recommendations provided in the systematic review of oral healthcare for dementia patients were applicable to the applied context. The importance of day-to-day leaders was highlighted by the apparently varied outcomes across target facilities. The quality improvement approach would appear to have considerable advantages when applied to improving practice in residential aged care. [source] Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumorINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2001ZIYA KIRKALI Abstract Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor. [source] Improvement of SAXS measurements on Kratky slit systems by Göbel mirrors and imaging-plate detectorsJOURNAL OF APPLIED CRYSTALLOGRAPHY, Issue 3-2 2000Alexander Bergmann Laboratory X-ray sources emit a highly divergent beam. The Kratky compact camera is constructed to maximize the intensity in the sample using a slit collimation system. The performance of this camera can be further increased if the primary beam is collimated from a divergent into a parallel beam. A recently developed device for this purpose is the so-called `Göbel mirror'. This mirror is made of parabolically bent multilayers, designed to collimate divergent X-rays from laboratory X-ray sources into a parallel and monochromatic beam of high brilliance. Modification of the block collimation system in combination with a Göbel mirror leads to a different beam geometry, resulting in an intensity increase by a factor of about 10. The gain in intensity implicates the use of imaging-plate detectors, which have a wide linear range in intensity and allow the full use of the increased intensity. Hence the quality of the SAXS data is improved by the higher intensity primary beam, the much lower background due to the exclusive use of Cu K, radiation, and a detection unit which is linear in the measured intensity regime. All these advantages, such as intensity gain, lower background, better quality of the data, are demonstrated with some selected experimental results. [source] Plant diversity and land use under organic and conventional agriculture: a whole-farm approachJOURNAL OF APPLIED ECOLOGY, Issue 4 2007R. H. GIBSON Summary 1Organic farming is thought to lead to increased biodiversity and greater sustainability than higher-yielding conventional farming systems. It is usually assumed that organic farms have both larger and higher quality areas of semi-natural habitats, although this assumption has not been unequivocally tested. 2Here we test the hypothesis that in comparison to conventional farms, organic farms have larger areas of semi-natural and boundary vegetation, and organic farms support higher levels of plant abundance, richness and diversity within cropped and semi-natural areas. 3Our study compared whole-farms: 10 organic farms were paired with 10 conventional farms in a complex landscape in the south-west of England. On average, organic farms were 7·3 years post conversion. Plant abundance, species richness and diversity were measured in all crop and non-crop landscape elements on each farm. 4Organic farms had greater total areas of semi-natural habitat (woodland, field margins and hedgerows combined). Woodland area on it's own was also significantly greater. Organic farms had more continuous blocks of woodland (with simpler perimeters than similarly sized patches on conventional farms), whereas woodland on conventional farms often consisted of more linear patches. 5Semi-natural habitats on organic farms did not have higher plant abundance, richness or diversity than their conventional counterparts. The only landscape element that showed a significant increase in plant abundance, richness or diversity was arable fields. 6Synthesis and applications. Even within a complex agricultural landscape differences do exist between organic and conventional farms, these differences being larger areas of semi-natural habitats on organic farms. However, with the exception of arable fields, no habitats on organic farms were yet of a better quality than their conventional counterparts in terms of plant abundance and diversity. Conventional farmers may be able to achieve an increase in plant diversity within arable fields by adopting some organic management practices at the field scale (e.g. exclusion of synthetic herbicides), and whole-farm conversion to organic practice might not be required. However, further work is needed to determine any biodiversity benefits of larger areas of semi-natural habitat on conventional farmland. [source] Musculoskeletal Rehabilitation in Osteoporosis: A Review,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 8 2004Michael Pfeifer Abstract Measures of musculoskeletal rehabilitation play an integral part in the management of patients with increased fracture risk because of osteoporosis or extraskeletal risk factors. This article delineates current scientific evidence concerning nonpharmacologic approaches that are used in conjunction with pharmacotherapy for prevention and management of osteoporosis. Fractures caused by osteoporotic fragility may be prevented with multidisciplinary intervention programs, including education, environmental modifications, aids, and implementation of individually tailored exercise programs, which are proved to reduce falls and fall-related injuries. In addition, strengthening of the paraspinal muscles may not only maintain BMD but also reduce the risk of vertebral fractures. Given the strong interaction between osteoporosis and falls, selection of patients for prevention of fracture should be based on bone-related factors and on risk factors for falls. Rehabilitation after vertebral fracture includes proprioceptive dynamic posture training, which decreases kyphotic posturing through recruitment of back extensors and thus reduces pain, improves mobility, and leads to a better quality of life. A newly developed orthosis increases back extensor strength and decreases body sway as a risk factor for falls and fall-related fractures. Hip fractures may be prevented by hip protectors, and exercise programs can improve strength and mobility in patients with hip fracture. So far, there is no conclusive evidence that coordinated multidisciplinary inpatient rehabilitation is more effective than conventional hospital care with no rehabilitation professionals involved for older patients with hip fracture. Further studies are needed to evaluate the effect of combined bone- and fall-directed strategies in patients with osteoporosis and an increased propensity to falls. [source] Patients' recovery after critical illness at early follow-upJOURNAL OF CLINICAL NURSING, Issue 5-6 2010Michelle A Kelly Aim., To determine the quality of life, particularly physical function, of intensive care survivors during the early recovery process. Background., Survivors of critical illness face ongoing challenges after discharge from the intensive care unit and on returning home. Knowledge about health issues during early phases of recovery after hospital discharge is emerging, yet still limited. Design., Descriptive study where the former critically ill patients completed instruments on general health and quality of life (SF-36) in the first six months of recovery. Methods., Participants responded to the SF-36 questionnaire and questions about problems, one to six months after intensive care, either face-to-face or by telephone. Results., Thirty-nine participants had a mean age of 60 years; of them, 59% were men and had been in intensive care for 1,69 days (median = 5). Most participants (69%) rated their health as good or fair, but 54% rated general health as worse than a year ago. Mean quality of life scores for all scales ranged from 25,65·5%, with particularly low scores for Role-Physical (25) and Pain (45·1). Half the participants reported difficulty with mobility, sleep and concentration, and 72% that their responsibilities at home had changed. No relationships were found between SF-36 scores and admission diagnosis, gender, age or length of intensive care stay. Conclusions., These survivors of critical illness and hospitalisation in an intensive care unit perceive their general health to be good despite experiencing significant physical limitations and disturbed sleep during recovery. Relevance to clinical practice., Knowledge of issues in these early phases of recovery and discussion and resolution of patient problems could normalise the experience for the patient and help to facilitate better quality of life. [source] Prospective evaluation of the time to peak effect of propofol to target the effect site in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009H. R. MUŃOZ Background: The plasma-effect site equilibration rate constant (ke0) of propofol has been determined in children with the use of the time to maximum effect (tpeak), however, it has not been validated. The objective was to measure the tpeak; of propofol with two depths of anesthesia monitors in children and to evaluate these measurements with a target-controlled infusion (TCI) system. Methods: Unpremedicated, ASA I children from 3 to 11 years were studied. In Part 1, children were monitored simultaneously with the bispectral index (BIS) and the A-Line ARX-index (AAI) from the Alaris A-Line auditory-evoked potential monitor/2. The tpeak after a bolus dose of propofol was measured. In Part 2, the tpeak measured was used to target the effect site with a TCI system. The median (MD) and the absolute median (MDA) difference between the predicted time of peak concentration at the effect site (Ce) and the measured time of peak effect in the index of depth of anesthesia (terror) was used to evaluate the performance of the system. Results: The BIS recordings were of a better quality than the AAI. The mean ± standard deviation tpeak was 65 ± 14 s with the BIS (n=25) and 201 ± 74 s with the AAI (n=10)(P<0.001). Validation was only performed with the BIS monitor in 40 children, yielding an MD terror of ,9.5 s and an MDA terror of 10.0 s. Conclusions: The small delay between the evolution of Ce of propofol and the observed effect suggests that this can be a useful model to target the effect site in children. [source] The dialogical self in psychotherapy for persons with schizophrenia: A case studyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 2 2007Paul H. Lysaker Schizophrenia often involves a profound experience of one's identity as diminished, which complicates adaptation to the demands of daily life. Within a backdrop of dialogical self-theory, we provide a report of an individual psychotherapy over the course of 4 years that assisted a patient suffering from schizophrenia to move from a state in which few aspects of self were available for internal or external conversation to one in which there was greater accessibility of multiple aspects of self, leading to richer dialogues, improved function, and a better quality of life. It is suggested a primary intervention of the therapist was continuously to offer the client a view of himself that invited him to experience himself in a plausible manner shared with and listened to by another. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 129,139, 2007. [source] Psychological aspects of hair diseaseJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2005Ramon Grimalt Summary Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self-image, depression resulting in increased introversion, and increased feelings of unattractiveness. Ours is a culture that places a premium on physical appearance. In this context, appearance-altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning. To date, little or no data have been available regarding the psychosocial and quality-of-life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self-esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA. A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti-alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder. [source] Evidence-based treatment and quality of life in heart failureJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2006Daniela Dobre MD MPH Abstract Objectives, To explore whether prescription of evidence-based drug therapy is associated with better quality of life (QoL) in patients with heart failure (HF). Methods, Patients (n = 62) were recruited in the outpatient clinic of Groningen University Hospital. Inclusion criteria were previous diagnosis of HF, age 40,80 years; ejection fraction of less than 45%, free from other serious disease (such as cancer) and psychiatric problems in the last year. QoL was assessed with the RAND 36-item health survey questionnaire, on five scales: physical functioning, mental health, social functioning, vitality and general health perception. Medication prescribed for 1 to 6 months before the QoL assessment was classified as either evidence-based treatment or under-treatment, according to the 2001 European guidelines on optimal HF treatment. The study had a cross-sectional design. Results, QoL did not differ significantly between evidence-based and under-treated patients, unadjusted or after adjustment for significant patient imbalances. Conclusions, Conventional step-up medication approach in HF may have a positive impact on survival or morbidity, but it seems not beneficial in relation to QoL. Other interventions should be designed to improve QoL of patients with HF. [source] EXPERIMENTAL AND NEURAL NETWORK PREDICTION OF THE PERFORMANCE OF A SOLAR TUNNEL DRIER FOR DRYING JACKFRUIT BULBS AND LEATHERJOURNAL OF FOOD PROCESS ENGINEERING, Issue 6 2005B.K. BALA ABSTRACT This article presents the field performance of a solar tunnel drier for drying jackfruit bulbs and leather. The drier consists of a transparent plastic-covered flat-plate collector and a drying tunnel connected in series to supply hot air directly into the drying tunnel using two direct-current fans operated by a photovoltaic module. The drier has a loading capacity of 120,150 kg of fruits. Sixteen experimental runs were conducted for drying jackfruit bulbs and leather (eight runs each). The use of a solar tunnel drier led to a considerable reduction in drying time and dried products of better quality in comparison to products dried under the sun. A multilayered neural network approach was used to predict the performance of the solar tunnel drier. Using solar drying data of jackfruit bulbs and leather, the model has been trained using backpropagation algorithm. The prediction of the performance of the drier was found to be excellent after it was adequately trained. It can be used to predict the potential of the drier for different locations, and can also be used in a predictive optimal control algorithm. [source] EFFECTS OF VARIETY AND GROWTH SEASON ON THE ORGANOLEPTIC AND NUTRITIONAL QUALITY OF HYDROPONICALLY GROWN TOMATOJOURNAL OF FOOD QUALITY, Issue 1 2006MIKEL ANZA ABSTRACT The effects of variety and season on several organoleptic and nutritional quality parameters (i.e., dry weight (dw), total sugars, soluble solid compounds, titratable acidity (TA), electrical conductivity (EC), juiciness, firmness, vitamin C (vit C), total phenolic compounds, hydrophilic antioxidant capacity and minerals) of five different varieties of tomatoes (i.e., Jack, Cabrales, Jaguar, Iker and Nevada) grown in two crop cycles (spring and autumn) were studied. Each variety presented its own specific characteristics regarding the chosen parameters. Firmness, TA and EC were season dependent, whereas soluble solids content did not change between cycles. In some varieties, the dw, juiciness and total sugars were affected by climatic conditions. The total phenolic compounds and the hydrophilic antioxidant capacity were variety dependent in both cycles. By contrast, the vit C content was variety dependent only in the autumn cycle. Similarly, these latter parameters (phenolic compounds, hydrophilic antioxidant capacity and vit C) were also season dependent, showing higher values in the spring than in the autumn cycle. The effect of tomato variety and season on mineral contents is also discussed. Those tomatoes grown in the spring cycle had better quality according to the organoleptic parameters studied here as well as to a higher antioxidant capacity. The percentages of the recommended dietary allowances supplied by the studied tomatoes were not significantly affected by variety or season, despite differences in their physicochemical compositions. [source] Quality Changes of Highbush Blueberries Fruit Stored in CA with Different CO2 LevelsJOURNAL OF FOOD SCIENCE, Issue 4 2009Carolina Duarte ABSTRACT:, Quality changes of blueberries (Vacccinium corymbosum L. cv Brigitta) were evaluated during CA storage (0 °C) with different concentrations of CO2 (5%, 10%, and 15%) combined with 5% O2, respectively. Atmospheric air (20.9% O2+ 0.03% CO2) was used as control. From samples taken at 0, 24, and 48 d of storage, unmarketable fruits and weight loss were recorded as well as color (h), firmness (g), soluble solid content (%), titratable acidity (% citric acid), ratio, and the monomeric anthocyanin content (ppm). At each sampling time, additional units were kept for 3 d at 10 °C to simulate retail holding conditions. Irrespective of gas concentration, 0.9% of the initial fresh weight was lost after 48 d at 0 °C. CA fruit had better quality than control at the 24 d sampling but due to the high number of unmarketable fruits, this advantage was not observed at 48 d at 0 °C. After 24 d of storage, fruits for CA treatments were more firm and had better color, with higher anthocyanin and acidity levels. Soluble solid content showed no significant differences throughout the cold storage period. Residual effect of CA storage was observed at the retail holding condition yielding better firmness, acidity, and ratio. However, the CO2 level tested increased the number of unmarketable fruit in long-term storage (48 d). Response of "Brigitta" blueberries to the different CO2 levels studied was moderate and could be related to the high storage potential of this cultivar. [source] A2. The carer's perception of dietitians' advice and its impact on the management of patients receiving haemodialysisJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2000M. A. Rezaie Background Patients with end stage renal disease and their carers suffer many changes in their daily life style as a result of haemodialysis (HD) treatment. Information and education concerning the management of dietary requirements and restrictions for renal patients should be aimed at both patients and their carers. Aim This study investigated the impact of dietitians' involvement and advice on the carers' ability to manage patients' dietary/fluid requirements. Method A total of 36 carers of renal patients receiving unit haemodialysis treatment were randomly recruited into this study from a hospital in Cardiff, Wales. All the carers completed the Haemodialysis carers questionnaire (HCQ), specifically designed for this study, delivered to them in the outpatient clinic by the dietitian. Results Of the 36 carers, 22 (61%) were female, six (16.7%) were male and eight (22%) did not report their gender. Thirteen (36%) of the carers were between the ages of 20,54 years and 23 (64%) were 55 years of age and older. Twenty-six (72%) of the carers involved in this study were spouses and 34 (94.4%) of the carers lived with the patient. The mean duration of haemodialysis treatment for the patient was found to be 20 months. The results indicated that although the majority of the carers were informed about patients' dietary and fluid restrictions, 45% had not received any dietary information. Dietitians' one-to,one interactions with the carer was the most effective way of providing information in enabling them to better manage the patient compared to other methods such as leaflet and information packs (P = 0.01). The majority of the carers knew how to contact the renal dietitian, however, many did not (P = 0.001). Almost all the carers considered receiving information about the purpose of HD, feed back on the patients' condition, fluid/dietary restriction and details of available community resources as very important. Those carers who had the benefit of a dietitian's involvement believed that their advice was very helpful and enabled them to cope better with the management and complications of patient fluid and dietary requirements (P < 0.02). Strong correlations were found (rs = 0.67; P < 0.01) between the amount of information received by the carers and the level of the carers satisfaction with this information. In contrast, there were no significant correlations between the amount of information received by the carers and different aspects of managing the patients' diet, because 45% of the carers received none or little information. Conclusions Dietitians should involve the carers in the management of HD patient's dietary/fluid requirements and restrictions in order to provide better quality of care and quality of life for both the patient and the carer. [source] Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatricsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009I. SAADAWY Background: Dexmedetomidine (DEX) is a highly selective ,2 -adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period. Methods: Sixty children (ASA status I) aged 1,6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n=30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 ,g/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted. Results: The end-tidal sevoflurane concentration and the incidence of agitation were significantly lower in the BD group (P<0.05). The duration of analgesia was significantly longer (P<0.001) and the total consumption of rescue analgesic was significantly lower in Group BD compared with Group B (P<0.01). There was no statistically significant difference in hemodynamics between both groups. However, group BD had better quality of sleep and a prolonged duration of sedation (P<0.05). Conclusion: Caudal DEX seems to be a promising adjunct to provide excellent analgesia without side effects over a 24-h period. It has the advantage of keeping the patients calm for a prolonged time. Implications statement: Caudally administered DEX (1 ,g/kg), combined with bupivacaine, was associated with an extended duration of post-operative pain relief. [source] Gender in the boss,subordinate relationship: a Nigerian studyJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 4 2004D. O. Adebayo The present study examines the interaction effect of gender of both subordinates and supervisors on subordinates' perception of differentiation of boss,subordinate relationship in an African setting. Data was collected from a total of 60 boss,subordinate dyads in four-sex combinations obtained through a survey of a large five-star hotel in Abuja, Nigeria. Results revealed that subordinates in opposite-sex dyads perceived better quality of exchange than those in same-sex dyads. The strongest quality of exchange was perceived in male boss,female subordinate dyad, while the weakest was perceived in female boss,female subordinate dyad. This emphasizes the importance of gender in the differentiation of boss,subordinate relationships in an African setting. Copyright © 2004 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||