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Medical Systems (medical + system)
Selected AbstractsDIAGNOSIS OF COLONIC ADENOMAS BY NEW AUTOFLUORESCENCE IMAGING SYSTEM: A PILOT STUDYDIGESTIVE ENDOSCOPY, Issue 2007Noriya Uedo Detection and removal of adenoma by colonoscopy is an important means of preventing cancer. Autofluorescence endoscopy can visualize flat or isochromatic tumor that was not detectable by white light endoscopy by the difference in tissue fluorescence properties. Recently, a new autofluorescence imaging system (AFI, Olympus Medical Systems) using a combination of autofluorescence and reflection imaging has been developed. The purpose of the present paper was to investigate its feasibility in detection of colonic adenoma in a clinical setting. A total of 64 patients were randomly assigned to AFI or white light groups, and the distal sigmoid colon and the rectum was observed under autofluorescence or white light followed by the other mode of observation by a different endoscopist. The diagnostic ability of each method for detection of neoplasms was compared in relation to the histology as a reference standard. Sensitivity and specificity of AFI for detection of neoplastic polyps was 84% and 60%, respectively, and were similar to those of white light colonoscopy: 90% and 64%. Conventional colonoscopy overlooked more flat lesions including one adenocarcinoma. AFI has the potential to detect more flat lesions but efficacy was unable to be demonstrated in the restricted population. Further investigations are needed to determine optimum usage. [source] Low bone mineral density in children and adolescents with inflammatory bowel disease: A population-based study from Western SwedenINFLAMMATORY BOWEL DISEASES, Issue 12 2009Susanne Schmidt MD Abstract Background: Low bone mineral density (BMD) has been recognized as a potential problem in children with inflammatory bowel disease (IBD). The aim of the study was to investigate BMD in Swedish children and adolescents with IBD and to evaluate possible factors affecting BMD. Methods: To evaluate BMD, all patients (n = 144) underwent a dual-energy X-ray absorptiometry (DXA) of the whole body and the spine. BMD values were expressed as Z-scores using normative pediatric data from Lunar (GE Medical Systems). Results: In this population-based study, the lowest BMD values were found in the lumbar spine. The entire IBD group showed significantly lower BMD Z-scores of the lumbar spine (L2,L4) in comparison to healthy references (,0.8 standard deviation [SD], range ,5.9 to 3.7 SD, P < 0.001). Decreased BMD with a Z-score < ,1 SD occurred in 46.7% of the individuals with Crohn's disease (CD) and in 47.0% of those with ulcerative colitis (UC). Low BMD with a Z-score , ,2 SD was present in 26.7% of the patients with CD and in 24.1% of the UC patients. In a multiple regression model with BMD lumbar spine as the depending variable, possible factors associated with lower BMD were male gender, low body mass index (BMI), and treatment with azathioprine. Conclusions: Low BMD is prevalent in Swedish pediatric patients with IBD. Possible risk factors for lower BMD are male gender, low BMI, and treatment with azathioprine, as a probable marker of disease course severity. (Inflamm Bowel Dis 2009) [source] Reforms And Performance of the Medical Systems in the Transition States of the Former Soviet Union and Eastern EuropeINTERNATIONAL SOCIAL SECURITY REVIEW, Issue 2-3 2001Christopher Davis The States of the former Soviet Union and eastern Europe inherited acute health problems and introduced numerous reforms in their health sectors in the 1990s. In the initial years of transition most countries experienced increases in morbidity and mortality that were caused by deterioration in health conditions (demographic, consumption, social, environmental) and deficiencies in medical systems. The latter were the result of malfunctioning economies, continued low priority status of health, and ineffective health reforms. Although health trends in the East have become more positive in recent years, they are unlikely to converge rapidly with those in western Europe unless health sector institutions in transition countries are allocated more resources and improve their efficiency and effectiveness. [source] Light-chain-restricted plasmacellular infiltrates in necrobiosis lipoidica , a clue to an underlying monoclonal gammopathyJOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2005Adina M. Cioc Background:, Necrobiosis lipoidica (NL) is a member of the palisading granulomatous dermatitides that is associated, in most cases, with diabetes mellitus. However, there are an increasing number of cases of NL associated with other forms of systemic disease. We describe a novel case of NL associated with a light-chain-restricted plasmacellular infiltrate; subsequent investigations established an underlying monoclonal gammopathy. Methods:, Skin biopsy material was obtained and was processed in the usual fashion for hematoxylin and eosin (H&E) examination. Immunohistochemical staining was performed by utilizing kappa and lambda monoclonal antibodies (Dako Corporation, Carpentiera, CA, USA). Kappa and lambda in situ hybridization was also performed (Ventana Medical Systems, Tucson, AZ, USA). Results:, A 55-year-old woman with a 5-year history of bilateral thigh subcutaneous nodules underwent a skin biopsy, showing typical changes of NL; there was a concomitant prominent perivascular plasmacellular infiltrate. Kappa light chain restriction was observed amid the plasmacellular infiltrate. Bone marrow biopsy and immunophenotyping studies revealed a clonal plasmacytosis with kappa light chain restriction. Conclusions:, Granulomatous inflammation, including NL, may be a cutaneous paraneoplastic expression of low-grade B-cell lymphoproliferative disease in the context of an underlying plasma cell dyscrasia. [source] Automated radiosynthesis of [18F]SPA-RQ for imaging human brain NK1 receptors with PETJOURNAL OF LABELLED COMPOUNDS AND RADIOPHARMACEUTICALS, Issue 1 2006Frederick T. Chin Abstract [18F]SPA-RQ is an effective radioligand for imaging brain neurokinin type-1 (NK1) receptors in clinical research and drug discovery with positron emission tomography. For the automated regular production of [18F]SPA-RQ for clinical use in the USA under an IND we chose to use a modified commercial synthesis module (TRACERlab FXF-N; GE Medical Systems) with an auxiliary custom-made robotic cooling,heating reactor, after evaluating several alternative radiosynthesis conditions. The automated radiosynthesis and its quality control are described here. [18F]SPA-RQ was regularly obtained within 150 min from the start of radiosynthesis in high radiochemical purity (>99%) and chemical purity and with an overall decay-corrected radiochemical yield of 15±2% (mean±S.D.; n=10) from cyclotron-produced [18F]fluoride ion. The specific radioactivity of [18F]SPA-RQ at the end of synthesis ranged from 644 to 2140 mCi/µmol (23.8,79.2 GBq/µmol). Copyright © 2005 John Wiley & Sons, Ltd. [source] Splitting a large software repository for easing future software evolution,an industrial experience report,JOURNAL OF SOFTWARE MAINTENANCE AND EVOLUTION: RESEARCH AND PRACTICE, Issue 2 2009Marco Glorie Abstract Philips Medical Systems produces medical diagnostic imaging products, such as magnetic resonance, X-ray and computed tomography systems. The software of these devices is complex, has been evolving for several decades and is currently a multi-MLOC monolithic software repository. In this paper we report on splitting a single software repository into multiple smaller repositories so that these can be developed independently, easing the software's evolution. For splitting the single software repository, we set up two experiments that involve well-known analysis techniques, namely formal concept analysis and clustering. Because of the sheer size of the monolithic software repository, we also propose to use a ,leveled approach', which implies that the analysis technique is applied in several iterations, whereby in some iterations only part of the application is subjected to the analysis technique. Unfortunately, both analysis techniques failed to produce an acceptable partitioning of the monolithic software repository, even if they are combined with our newly proposed leveled approach. We provide a number of valuable lessons learned, which might prevent others from falling into the same pitfalls. Copyright © 2009 John Wiley & Sons, Ltd. [source] Absence of explicit and implicit memory in unconscious patients using a TCI of propofolACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2003P. Y. Lequeux Background:, ,Episodes of implicit memory have been described during propofol anaesthesia. It remains unclear whether implicit memory is caused by short periods of awareness or occurs in an unconscious subject. Methods:, Sixty patients were randomized in an experimental group (EG), a control group (CG) and a reference group (RG). Loss of consciousness (LOC) was obtained by progressive stepwise increases of propofol using a target-controlled infusion device (Diprifusor, Alaris Medical Systems, San Diego, CA). A tape containing 20 words was played to the patients in the CG before the start of anaesthesia and to the patients in the EG at a constant calculated concentration of propofol associated with LOC. The tape was not played to the patients in the RG. Three memory tests were performed postoperatively. Results:, Explicit and implicit memories were evidenced in the CG but not in the EG. Conclusion:, In our group of young ASA I/II patients, in the absence of any noxious stimulus, no implicit or explicit memory was found when the calculated concentration of propofol using a Diprifusor was maintained at the level associated with LOC. [source] The first trimester ,combined test' for the detection of Down syndrome pregnancies in 4939 unselected pregnanciesPRENATAL DIAGNOSIS, Issue 3 2002K. Schuchter Abstract The high detection rate (DR) for Down syndrome (DS) pregnancies which can be achieved by measuring fetal nuchal translucency (NT) early in pregnancy can be improved by combining it with placental hormones [pregnancy-associated plasma protein A (PAPP-A) and free ,-human chorionic gonadotrophin (f,-hCG)] and maternal age (,combined test'). In this study we wanted to assess the DR using the ,combined test' in an unselected population of self-referred pregnant women at a false-positive rate (FPR) of about 5%. NT, PAPP-A, f,-hCG and maternal age were measured in all women with singleton pregnancies who booked for delivery in our hospital from 1 December 1997 to 31 April 2000 and who were between 10 and 13 completed weeks of gestation [crown,rump length (CRL) 35,70,mm]. The specific DS risk was calculated using the computer program Alpha Version 5aa (Logical Medical Systems, London, UK). A total of 4939 women were tested. Out of 14 DS pregnancies that occurred during this period of time, 12 were detected with the test. A total of 246 women had a false-positive test result in a non-DS pregnancy (FPR 5.0%). This makes the ,combined test' by far the best test for the detection of DS pregnancies in a low-risk population. The constant increase in maternal age at the time of delivery can also lead to an improved DR if a simple age-dependant protocol for DS detection is used, but only at the price of a much higher number of amniocenteses and subsequent abortions. The DR for DS can be increased much more markedly using the ,combined test' with a FPR that still remains at the level as it was in the early 1970s. Copyright © 2002 John Wiley & Sons, Ltd. [source] Suburethral slingplasty evaluation study in North Queensland, Australia: The SUSPEND trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2005Yik Nyok LIM Abstract Objective:, To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence. Methods:, Following ethics approval, 195 (3 × 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. Main outcome measures were:, (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings. Results:, There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11). Conclusions:, All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out. [source] Intermediate-term results, up to 4 years, of a bone-anchored male perineal sling for treating male stress urinary incontinence after prostate surgeryBJU INTERNATIONAL, Issue 4 2009Miguel Guimarăes OBJECTIVE To examine the intermediate-term outcome (up to 4 years) of a bone-anchored perineal sling (InVanceTM, American Medical Systems, Minnetonka, MN, USA) in men with stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS In all, 62 men with SUI were implanted with the InVance sling. SUI was diagnosed after radical prostatectomy in 58 patients and after benign prostatic hyperplasia (BPH) prostatectomy in four patients. Implantation of the InVance bone-anchored bulbourethral sling was conducted primarily under spinal anaesthesia. Patients were considered cured, if they stopped wearing continence pads and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire and a simple verbal question about patient satisfaction with the surgery were also used and complications were measured. RESULTS In all, 40 patients (65%) were cured and 14 (23%) were improved after a mean follow-up of 28 months. The UI cure rates at 3 and 4 years follow-up were 70% and 66%, respectively. The most common side-effect was transient scrotal or perineal pain or numbness, which affected 12 patients (19%). There was a prolonged postvoid residual urine volume of >100 mL in six patients (10%), which resolved within 2 weeks of indwelling catheterization. Explantation of the sling was required in two cases (3%) because of infection. In one patient (2%), revision was required for bone-anchor dislodgement. CONCLUSION The InVance sling offers good intermediate-term cure and improvement rates for SUI after prostatectomy. The procedure has an acceptably low rate of minor complications, and should be considered for treating men with less severe forms (,5 pads per day) of SUI. [source] Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysisBJU INTERNATIONAL, Issue 1 2009Athanasios N. Argyropoulos OBJECTIVE To identify the effect of the presence of a ureteric stent on the outcome of extracorporeal shockwave lithotripsy (ESWL), by comparing patients with ureteric stones with matched-pair analysis. PATIENTS AND METHODS Patients undergoing ESWL with the Sonolith Vision lithotripter (Technomed Medical Systems, Vaulx-en-Velin, France) were identified from our prospectively maintained database. Only adult patients with a solitary, radio-opaque, previously untreated ureteric stone were considered for further analysis. A follow-up of ,3 months with a plain abdominal film was used to identify residual fragments. Patients were exactly matched for gender, side, location in the ureter and size (in two dimensions, within ±2 mm). If both diameters could not be matched exactly, the size was extended to ±1 mm and then to ±2 mm of both diameters. An effort was finally made to match patients by age. The treatment outcome in terms of stone-free rates was assessed and compared using McNemar's test. RESULTS In all, 45 patients with a ureteric stent in place during ESWL were identified. The only patient who could not be adequately matched was a 40-year-old man with an 8 × 3 mm stone in the upper ureter. The best/closest match for age was selected. Most stones were in the upper ureter (77%); the mean stone size was 8.5 and 8.6 mm, respectively, with no statistical differences between the groups for age and size of stones (P = 0.41 and 0.86, Student's t -test). In 12 pairs, only patients with no stent were stone-free, compared to two pairs where the patient with a stent was stone-free. Using McNemar's test, the odds ratio was 6.0 (95% confidence interval 1.3,55.2) and the difference between the groups was statistically significant (P = 0.016). CONCLUSION These results show that the presence of a stent is associated with a worse outcome after ESWL for ureteric stones. Ureteric stents should still be used in cases of obstruction, when there is a risk of sepsis, and in patients with intolerable pain or deteriorating renal function. However, their use in patients offered ESWL for ureteric stones should be considered with caution. [source] Outcomes using a fourth-generation lithotripter: a new benchmark for comparison?BJU INTERNATIONAL, Issue 6 2007Michael S. Nomikos OBJECTIVE To evaluate the efficacy of a fourth-generation lithotripter, the Sonolith Vision (Technomed Medical Systems, Vaulx-en-Velin, France) for treating single previously untreated renal calculi, and to compare the results with the reference standard HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the same population originally studied by the USA Cooperative Study Group in 1986. PATIENTS AND METHODS The Sonolith Vision uses an innovative electroconductive shock-wave generator with an elliptical reflector specially designed to give the maximum concentration of energy on the stone. We reviewed the treatment sessions from our prospectively maintained database of the first 1000 consecutive patients with urinary stone disease who were treated with the Sonolith Vision between September 2004 and March 2006. Patients with previously untreated solitary renal calculi in anatomically normal kidneys were included. The outcome was assessed by plain films for radio-opaque stones, and renal ultrasonography for radiolucent stones, at 1 and 3 months after lithotripsy; the results were analysed according to stone size and location. RESULTS Data from 309 patients who had a complete follow-up and with 373 renal calculi that matched the above criteria were analysed. The initial fragmentation rate was 94%. The stone-free rate for stones of <10 mm was 77%, for 11,20 mm was 69% and for >20 mm was 50%. The overall stone-free rate 3 months after lithotripsy was 75%. Within a month of lithotripsy, 221 patients (59%) became stone-free. Additional procedures to render patients stone-free after lithotripsy were needed in only 22 cases (7%). The overall efficiency quotient was 62%. The stone-free rates for lower, upper, middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%, respectively. There were no serious complications. CONCLUSIONS When similar populations of stone formers were assessed the Sonolith Vision achieved a high success rate, comparable with that using the HM-3 machine but with lower analgesia requirements and very low re-treatment rates. This method of comparison belies the commonly held view that newer lithotripters are less effective than the original spark-gap machines. [source] Characteristics of Medical Surge Capacity Demand for Sudden-impact DisastersACADEMIC EMERGENCY MEDICINE, Issue 11 2006Samuel J. Stratton MD Objectives To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. Methods Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points. Results The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances. Conclusions As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses. [source] Maximizing help for dissonant smokersADDICTION, Issue 1s1 2000Michael Kunze 'Consonant' smokers know and accept the risks associated with tobacco consumption, and do not wish to change their smoking, whereas 'dissonant' smokers are tobacco consumers whose attitudes differ from their behaviour. Dissonant smokers have several options: to quit smoking (the optimal solution), reduce their smoking, switch products or brands, or do nothing. To date, nicotine replacement therapy (NRT) is the best-established medical aid to smoking cessation, but several important factors impact on NRT use. As smokers constitute a diverse group there is a need for various different formulations, some of which will suit certain smokers better than others. Smokers should be allowed to select their preferred products in order to increase compliance, and should also be permitted to combine various products if desired. Adequate dosage regimens should be stressed in order to avoid under-dosing, which is common with NRT. It is also essential that the medical system focuses increasingly on the diagnosis and treatment of those smokers who are unable or unwilling to quit smoking. High nicotine dependence correlates with a high risk of pulmonary and cardiovascular disease; because these smokers cannot quit, cessation efforts have little impact on the incidence of tobacco-related diseases in this population. Additional smoking control interventions, such as smoking reduction therapy, are therefore required to treat this group. Our experience in Vienna shows that these smokers can be targeted through approaches that utilize new messages offering alternatives to cessation. [source] The challenge of using the low back pain guidelines: a qualitative researchJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2007Rachel Dahan MD MClSc Abstract Purpose, Current low back pain (LBP) clinical guidelines have helped to summarize the scientific evidence and research, but have failed to provide tools and guide family physicians (FPs). The purpose of this study is to identify barriers and facilitators for the implementation of LBP guidelines from family FPs' perspective. Methods, A qualitative focus group study of FPs in the north of Israel. Purposeful sampling was used to recruit participants, all of them board-certified FPs. Four focus groups were created, and discussions were taped, transcribed and analysed for major themes. Results, Focus groups findings have expanded the understanding of the intellectual and mental challenges faced by Israeli FPs caring for LBP patients and highlighted the many obstacles to implementing LBP guidelines. Physicians' decision-making, pertaining to LBP, functions on three levels simultaneously: the physicians' agenda based on familiarity with the guidelines; their need to remain grounded in the context of the specific patient,doctor relationship; and the constraints and demands of the physician's workplace, medical system and environment. Conclusions, Despite an overall positive attitude towards LBP guideline implementation, FPs found it hard to come to terms with the conflicting dimensions of LBP patient care. The patient,doctor interaction determined the outcome of the encounter, whether it complied with the guidelines and whether the encounter leads to a healing process or to a vicious circle of unnecessary utilization of services. [source] The Sociopolitical Status of U.S. Naturopathy at the Dawn of the 21st CenturyMEDICAL ANTHROPOLOGY QUARTERLY, Issue 3 2001Hans A. Baer Naturopathic medicine in the United States had its inception around the turn of the 20th century. Subsequently, it underwent a process of relatively rapid growth until around the 1930s, followed by a period of gradual decline almost to the point of extinction due to biomedical opposition and the advent of "miracle drugs." Because its therapeutic eclecticism had preadapted it to fit into the holistic health movement that emerged in the 1970s, it was able to undergo a process of organizational rejuvenation during the last two decades of the century. Nevertheless, U.S. naturopathy as a professionalized heterodox medical system faces several dilemmas as it enters the new millennium. These include (1) the fact that it has succeeded in obtaining licensure in only two sections of the country, namely, the Far West and New England; (2) increasing competition from partially professionalized and lay naturopaths, many of whom are graduates of correspondence schools; and (3) the danger of cooptation as many biomedical practitioners adopt natural therapies, [naturopathy, alternative medicine, medical pluralism] [source] Decisional needs assessment regarding Down syndrome prenatal testing: a systematic review of the perceptions of women, their partners and health professionalsPRENATAL DIAGNOSIS, Issue 13 2008Sylvie St-Jacques Abstract Objective To identify decisional needs of women, their partners and health professionals regarding prenatal testing for Down syndrome through a systematic review. Methods Articles reporting original data from real clinical situations on sources of difficulty and/or ease in making decisions regarding prenatal testing for Down syndrome were selected. Data were extracted using a taxonomy adapted from the Ottawa Decision-Support Framework and the quality of the studies was assessed using Qualsyst validated tools. Results In all 40 publications covering 32 unique studies were included. The majority concerned women. The most often reported sources of difficulty for decision-making in women were pressure from others, emotions and lack of information; in partners, emotion; in health professionals, lack of information, length of consultation, and personal values. The most important sources of ease were, in women, personal values, understanding and confidence in the medical system; in partners, personal values, information from external sources, and income; in health professionals, peer support and scientific meetings. Conclusion Interventions regarding a decision about prenatal testing for Down syndrome should address many decisional needs, which may indeed vary among the parties involved, whether women, their partners or health professionals. Very little is known about the decisional needs of partners and health professionals. Copyright © 2008 John Wiley & Sons, Ltd. [source] The relationship of military imposed marital separations on maternal acceptance of pregnancy,,§RESEARCH IN NURSING & HEALTH, Issue 3 2008Karen L. Weis Abstract The effect of military deployment and perceived availability and source of community support on women's acceptance of pregnancy were examined in each trimester of pregnancy at four military bases. The sample was 503 primigravida or multigravida women eligible for care in the military medical system. Military deployment and community support had a statistically significant effect on pregnancy acceptance. Gravidas with deployed husbands had higher conflict for accepting pregnancy than gravidas without deployed spouses. Community support had a significant positive effect on pregnancy acceptance. Women perceiving support predominantly from off-base versus on-base communities had significantly higher conflict with acceptance of pregnancy. Findings point to improved maternal acceptance of pregnancy with paternal presence and community support in the event of military deployment. Published 2008 Wiley Periodicals, Inc. Res Nurs Health 31:196,207, 2008 [source] The Australian Dominative Medical System: A Reflection of Social Relations in the Larger SocietyTHE AUSTRALIAN JOURNAL OF ANTHROPOLOGY, Issue 3 2008Hans Baer This paper posits a working or tentative model of medical pluralism, a pattern in which multiple medical sub-systems co-exist, or what I term the Australian dominative medical system. I argue that whereas the Australian medical system with its various medical sub-systems was pluralistic, that is more or less on an equal footing, in the nineteenth century, by the early twentieth century it became a plural or dominative one in the sense that biomedicine came to clearly dominate other medical sub-systems. This paper also explores the growing interest of biomedicine and the Australian Government in complementary medicine to which Australians have increasingly turned over the course of the past three decades or so. [source] Attitudes of the American Public toward Organ Donation after Uncontrolled (Sudden) Cardiac DeathAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010M. L. Volk Concerns about public support for organ donation after cardiac death have hindered expansion of this practice, particularly rapid organ recovery in the context of uncontrolled (sudden) cardiac death (uDCD). A nationally representative Internet-based panel was provided scenarios describing donation in the context of brain death, controlled cardiac death and uncontrolled cardiac death. Participants were randomized to receive questions about trust in the medical system before or after the rapid organ recovery scenario. Among 1631 panelists, 1049 (64%) completed the survey. Participants expressed slightly more willingness to donate in the context of controlled and uncontrolled cardiac death than after brain death (70% and 69% vs. 66%, respectively, p < 0.01). Eighty percent of subjects (95% CI 77,84%) would support having a rapid organ recovery program in their community, though 83% would require family consent or a signed donor card prior to invasive procedures for organ preservation. The idea of uDCD slightly decreased trust in the medical system from 59% expressing trust to 51% (p = 0.02), but did not increase belief that a signed donor card would interfere with medical care (28% vs. 32%, p = 0.37). These findings provide support for the careful expansion of uDCD, albeit with formal consent prior to organ preservation. [source] On the invisibility of the emasculated (Respond to this article at http://www.therai.org.uk/at/debate)ANTHROPOLOGY TODAY, Issue 1 2010Richard Wassersug Castrating a male by destroying his testicles is a practice that most people assume ended a century or so ago with the collapse of the Chinese and Ottoman Empires and the death of the last castrato in the Vatican choir. However, because advanced prostate cancer is treated by either chemical or surgical castration, there are probably more castrated men alive today than ever before in history. Castration is also used in the western world as either a step in the sexual reassignment of male to female (MtF) transsexuals or rarely to treat recidivist sexual predators. In addition, some men desire emasculation who are neither cancer patients, MtF transsexuals, nor sexual predators. In this essay I argue that the public association of castration with sexual predators and deviant behaviour is so great that men, who require it as a medical treatment for cancer or who seek it for other reasons typically hide from public view. One consequence of the shame associated with castration is that those, who desire emasculation but do not have a diagnosis of cancer, too often subject themselves to risky and illegal amateur surgeries outside the medical system. I argue that for whatever reason a male seeks castration, the overall invisibility of the emasculated in modern society is a disservice. It minimizes the public's understanding of the magnitude of the impact of castration on cancer patients and it inhibits those in need of medical treatment from getting it in an appropriate and timely fashion. [source] Effect of an Integrated Public Health Curriculum in an Emergency Medicine ResidencyACADEMIC EMERGENCY MEDICINE, Issue 2009Marian Betz Background: Emergency departments (EDs) serve as a central point of interaction between the public and the medical system. Emergency physicians need education in public health in order to optimize their clinical care and their ability to evaluate potential public health interventions in the ED. Methods: As part of the Centers for Disease Control and Prevention (CDC) and the Association of American Medical College's (AAMC) national initiative for "Regional Medicine-Public Health Education Centers-Graduate Medical Education", we designed and implemented a new public health curriculum for the emergency medicine residents. Over four sessions during regular didactic time, we used a modular approach to link a basic public health principle, such as environmental hazard assessment, to a relevant clinical topic, such as violent patients and ED safety. Each session emphasized resident involvement, including small group work and role-plays. Journal clubs and quality assurance projects supplemented the curriculum. We sought resident feedback through focus groups and anonymous online pre- and post-tests for each session. Assessment: Both before and after the curriculum, 76% of responders felt it was important for physicians to receive training in public health. The program appeared to have a positive effect on residents' comfort level with various public health topics, and felt the residency program had taught them the skills necessary to implement public health principles in clinical practice (23.8%, versus 11.5% before; p<0.05). Conclusions: Integration of public health principles into existing clinical curricula in emergency medicine may increase resident interest and knowledge. Combining public health and emergency medicine topics in regular didactic conferences facilitates public health education for residents. [source] In vitro protective effect of Rhodiola rosea extract against hypochlorous acid-induced oxidative damage in human erythrocytesBIOFACTORS, Issue 3 2004Roberta De Sanctis Abstract Rhodiola rosea L. (Crassulaceae) is a plant living at high altitudes in Europe and Asia. Its roots have long been used in the traditional medical system of these geographical areas to increase the organism resistance to physical stress; today, it has become an important component of many dietary supplements. In this study we investigate the antioxidant capacity of the R. rosea aqueous extract evaluating its ability to counteract some of the main damages induced by hypochlorous acid (HOCl), a powerful oxidant generated by activated phagocytes, to human erythrocytes. Ascorbic acid was used as a reference substance because of its physiological HOCl-scavenging ability. Our study demonstrates that R. rosea is able to significantly protect, in a dose-dependent manner, human RBC from glutathione (GSH) depletion, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) inactivation and hemolysis induced by the oxidant. Furthermore, we demonstrate that R. rosea aqueous extract acts from the inside of the erythrocyte suggesting a probable involving of cell components. The protection on GSH afforded by the R. rosea extract with respect to ascorbic acid, occurred also if added 2 or 5 min. later than the oxidant, suggesting a more rapid or powerful effect. [source] Impaired psychosocial outcome of donors after living donor liver transplantation: a qualitative case studyCLINICAL TRANSPLANTATION, Issue 4 2006Marc Walter Abstract:, Adult-to-adult living donor liver transplantation (LDLT) of the right hepatic lobe has been developing into an established therapy for treating pre-terminal liver diseases. There is little experience available on the psychosocial outcome of living donors. The aim of this first qualitative case study was to investigate the patterns for impaired psychosocial outcome in donors after LDLT. Donor hepatectomies were performed in 30 donors at the Charité Berlin. Six months after surgery, the six of the 30 donors with negative moods and physical complaints in psychometric monitoring were examined. The post-operative interviews were transcribed and analysed using current qualitative research methods. These six donors (20%) reported various unspecific complaints and psychological conflicts. Sadness was expressed about organ rejection and death of the recipient. Anxieties about the recipient and their own health were verbalized. Disappointment and anger refer to the experience that they were not as fully appreciated by the medical system and their social environment as expected. The negative emotions of donors with impaired psychosocial outcome could be related to a decrease in self-esteem in the post-operative course. Adequate medical and psychological treatment opportunities for these donors should be provided. [source] Improving Surge Capacity for Biothreats: Experience from TaiwanACADEMIC EMERGENCY MEDICINE, Issue 11 2006Fuh-Yuan Shih MD This article discusses Taiwan's experience in managing surge needs based on recent events, including the 1999 earthquake, severe acute respiratory syndrome in 2003, airliner crashes in 1998 and 2001, and yearly typhoons and floods. Management techniques are compared and contrasted with U.S. approaches. The authors discuss Taiwan's practices of sending doctors to the scene of an event and immediately recalling off-duty hospital personnel, managing volunteers, designating specialty hospitals, and use of incident management systems. The key differences in bioevents, including the mathematical myths regarding individual versus population care, division of stockpiles, the Maginot line, and multi-jurisdictional responses, are highlighted. Several recent initiatives aimed at mitigating biothreats have begun in Taiwan, but their efficacy has not yet been tested. These include the integration of the emergency medical services and health-facility medical systems with other response systems; the use of the hospital emergency incident command system; crisis risk-communications approaches; and the use of practical, hands-on training programs. Other countries may gain valuable insights for mitigating and managing biothreats by studying Taiwan's experiences in augmenting surge capacity. [source] Emergency medicine in India: Why are we unable to ,walk the talk'?EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Suresh S David Abstract The largest democracy on earth, the second most populous country and one of the most progressive countries in the globe, India, has advanced tremendously in most conventional fields of Medicine. However, emergency medicine (EM) is a nascent specialty and is yet to receive an identity. Today, it is mostly practised by inadequately trained clinicians in poorly equipped emergency departments (EDs), with no networking. Multiple factors such as the size of the population, variation in standards of medical education, lack of pre-hospital medical systems and non-availability of health insurance schemes are some of the salient causes for this tardy response. The Indian medical system is governed by a central, regulatory body which is responsible for the introduction and monitoring of all specialties , the Medical Council of India (MCI). This organisation has not recognized EM as a distinct specialty, despite a decade of dogged attempts. Bright young clinicians who once demonstrated a keen interest in EM have eventually migrated to other conventional branches of medicine, due to the lack of MCI recognition and the lack of specialty status. The Government of India has launched a nationwide network of transport vehicles and first aid stations along the national highways to expedite the transfer of patients from a crash site. However, this system cannot be expected to decrease morbidity and mortality, unless there is a concurrent development of EDs. The present article intends to highlight factors that continue to challenge the handful of dedicated, full time emergency physicians who have tenaciously pursued the cause for the past decade. A three-pronged synchronous development strategy is recommended: (i) recognise the specialty of EM as a distinct and independent basic specialty; (ii) initiate postgraduate training in EM, thus enabling EDs in all hospitals to be staffed by trained Emergency physicians; and (iii) ensure that EMs are staffed by trained ambulance officers. The time is ripe for a paradigm shift, since the country is aware that emergency care is the felt need of the hour and it is the right of the citizen. [source] Reforms And Performance of the Medical Systems in the Transition States of the Former Soviet Union and Eastern EuropeINTERNATIONAL SOCIAL SECURITY REVIEW, Issue 2-3 2001Christopher Davis The States of the former Soviet Union and eastern Europe inherited acute health problems and introduced numerous reforms in their health sectors in the 1990s. In the initial years of transition most countries experienced increases in morbidity and mortality that were caused by deterioration in health conditions (demographic, consumption, social, environmental) and deficiencies in medical systems. The latter were the result of malfunctioning economies, continued low priority status of health, and ineffective health reforms. Although health trends in the East have become more positive in recent years, they are unlikely to converge rapidly with those in western Europe unless health sector institutions in transition countries are allocated more resources and improve their efficiency and effectiveness. [source] Emergency service systems: The use of the hypercube queueing model in the solution of probabilistic location problemsINTERNATIONAL TRANSACTIONS IN OPERATIONAL RESEARCH, Issue 5 2008Roberto D. Galvăo Abstract Probabilistic location problems are surveyed from the perspective of their use in the design of emergency service systems, with special emphasis on emergency medical systems. Pioneering probabilistic models were defined in the 1980s, as a natural extension of deterministic covering models (first generation models) and backup models (second generation). These probabilistic models, however, adopted simplifying assumptions that in many cases do not correspond to real-world situations, where servers usually cooperate and have specific individual workloads. Thus the idea of embedding the hypercube queueing model into these formulations is to make them more adherent to the real world. The hypercube model and its extensions are initially presented in some detail, which is followed by a brief review of exact and approximate methods for its solution. Probabilistic models for the design of emergency service systems are then reviewed. The pioneering models of Daskin and ReVelle and Hogan are extended by embedding the hypercube model into them. Solution methods for these models are surveyed next, with comments on specialized models for the design of emergency medical systems for urban areas and highways. [source] Integrated medical feedback systems for drug delivery,AICHE JOURNAL, Issue 4 2005Adam Heller Drugs are now administered at frequencies and doses based on averages optimized for large populations. Because the optimal frequency and dose for an individual differs, transiently or permanently, from that of a population's average, the dosing is necessarily suboptimal. Feedback loop-based individualized integrated medical systems, comprising an implanted sensor, battery, amplifier, processor, and actuator are now in use in cardiac pacemakers and defibrillators. Drug-delivering medical feedback loops, comprising miniature sensors and drug pumps, would individualize, and thereby improve the effectiveness and safety of drugs. Their sensor would continuously or frequently monitor the effect of the drug and adjust, through a medical control algorithm, its flow to the minimum necessary for effectiveness, reducing thereby side effects and improving the success rate of experimental drugs. The pace of integration of the drug delivering feedback loops depends on the availability of proven miniature components and of medical control algorithms. © 2005 American Institute of Chemical Engineers AIChE J, 2005 [source] A comparative study of knowledge about and attitudes toward the combined oral contraceptives among Korean and Japanese university students,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2004Hyun-Ja Lim RN Abstract Purpose To compare university students' knowledge about and attitudes toward the combined oral contraceptives (COC) in two countries with different pharmaceutical systems (Japan and Korea), and to explore the reasons limiting the use of the COC in these populations. Methods University students in Korea and Japan completed a questionnaire containing a total of 55 questions about the students' demographics (8 questions), knowledge about the COC (15 questions), attitudes toward the COC (24 questions) and the reasons for limited use of the COC among the population (8 questions). Results Male students' attitudes toward the COC were significantly more positive than those of female students in Korea, but not in Japan. Knowledge about and attitudes toward the COC did not differ significantly between the two countries. The age at which students desired to use the COC was significantly correlated with age in both countries. There were significant correlations between knowledge about and attitude towards the COC in both countries and between age and attitude towards the COC in Japan. In both countries, the most commonly cited reasons for limited use of the COC were concern about adverse side effects. Conclusions These results confirm the need to develop appropriate sex education programs in Korea and Japan. Cultural differences and differences in the pharmaceutical and medical systems between the two countries should be considered when designing sex education programs for young people in Korea and Japan. Copyright © 2004 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||