Evaluating the use of an online gaming community in a pediatric hemodialysis center

Children that suffer from chronic illnesses are at risk of developing behavioral disorders stemming from a lack of self esteem,frequent removal from their peer support networks, and feeling a sense of injustice with regards to their medical condition and the health of their peers.Furthermore, the process of hemodialysis can be a socially isolating experience by way of being tied to a machine that restricts freedom of movement and social activity amongst concomitant users.

[Rheumatologic treatment in the G-DRG system]

On June 27 2000, the German Self-Administration and lately the German Ministry of Health set the general conditions for a new reimbursement system for the inpatient hospital sector which is based nearly exclusively on lump-sum payments. The Association of Acute Rheumatology Hospitals (VRA) and the DRG-Research-Group, Münster University Hospital, conducted a multi-center trial which included 7266 cases from 22 different hospitals. The data were used to analyze how well the not yet German healthcare adjusted G-DRG system (version 1.0) accounts for rheumatologic diagnostics and treatment as well as problems of specialized hospitals. 7 Adjacent-DRGs covered 91% of all cases, 68% of all cases were grouped into only two different Adjacent-DRGs (169 Bone Diseases and Specific Arthropathies and 166 Other Connective Tissue Disorders). Groups with different complexity which are not appropriately covered by the existing G-DRG system could be identified. The data further revealed a systematically longer length of stay in rheumatology clinics opposed to the average length of stay in the data used for calculating the G-DRGs, due to different structures and procedures of the complex rheumatologic treatment. The results strongly supported the assumption that an accurate reimbursement of rheumatologic cases in the current G-DRG system 1.0 would not have been possible. Adaptations made in the new G-DRG Version 2004 can only partly solve these problems, despite an improved construction of the DRGs. In order to guarantee an appropriate reimbursement of rheumatology clinics from 2005 on, the G-DRG system must be adapted to specific rheumatological pathways and/or alternative or additional reimbursement systems have to be found.

Die Beurteilung der Struktur-, Konzept- und Prozessqualit�t von Pr�vention und Gesundheitsf�rderung

The effectiveness of health promotion is determined by the foundation of evidence, the targeting of health problems, and the adaptation of interventions to specific social and organizational contexts. Methods for the implementation of these objectives must be able to balance interacting intervention goals, to account for the suitability of interventions for specific target groups and settings, and to integrate complex and divergent data. The core methodology underlying these conditions is peer review assessment. A quality assurance system based on this approach is presented: Two inventories elicit detailed self-descriptions characterizing either actors or activities within health promotion and education. Two assessment instruments instruct experts in reviewing these data according to primary and partial dimensions of quality. Thus, systematically structured and quantifiable quality profiles of organizational units or specific activities are produced. On this basis, comparative indicators for benchmarking purposes can be calculated. Quality profiles containing the strengths and weaknesses of organizations or activities, including indicators, benchmarks, and reviewers' recommendations, are communicated to participating organizations in order to stimulate continuous quality improvement by feedback. Moreover, the system offers a database of comparative indicators for monitoring and optimizing health promotion and education.

Method to correct for the effects of limited spatial resolution in phase-contrast flow MRI measurements

Phase-contrast (PC) magnetic resonance imaging (MRI) flow measurements suffer from the effect of the point spread function (PSF) due to the limited sampling of k-space. The PSF, which in this case is a sinc function, deforms the flow profile and forms a ringing pattern around the vessel. In this work, an empirical method is presented that corrects for errors due to the deformation of the flow profile. The ringing pattern is used to obtain a well-defined vessel segmentation, which after correction provides more accurate vessel radius and volume flow rate (VFR). The correction method was developed from phantom measurements at constant flow and applied on phantom measurements at moderately pulsatile flow. After correction, the error of the estimated tube radius and the VFR was less than 10% and 5%, respectively. Corresponding errors without correction overestimated the radius by 60% and the VFR by 35%. Preliminary results indicate that the method is also valid in vivo. The variation in the estimated radius and VFR for different spatial resolution decreased when the method was applied. The presented method gives a more accurate estimation of the radius and VFR in vessels of the size of a few pixels without prior knowledge about the true vessel radius.

Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylactic platelet transfusions

The purpose of this study was to determine which clinical and laboratory features correlate with serious hemorrhage in thrombocytopenic oncology patients. A retrospective review was conducted of all thrombocytopenic adult patients admitted to the Johns Hopkins Oncology Center, Baltimore, MD, over the last 10 years. We performed multiple logistic regression analysis on 2942 patients looking at the frequency of serious bleeding as a function of platelet count and numerous features that may correlate with hemorrhage. Multivariate analyses showed no relationship between either the first morning platelet count or the lowest platelet count of the day and the risk of hemorrhage. Of the other features we examined, several correlated independently with bleeding, including uremia (odds ratio [OR] 1.64; 95% confidence interval [CI], 1.40 to 1.92), hypoalbuminemia (OR 1.54; 95% CI, 1.33 to 1.79), recent bone marrow transplantation (OR 1.32; 95% CI, 1.22 to 1.43), and recent hemorrhage (OR 6.72; 95% CI, 5.53 to 8.18). Leukopenia was associated with a decreased risk of bleeding (OR 0.70; 95% CI, 0.60 to 0.82). Although this large study identified a number of clinical and laboratory features that correlated significantly with bleeding, the ORs of these factors were not large and all were much less than previous bleeding. These findings suggest that the major goal of transfusion support should be the aggressive therapeutic use of blood products rather than prophylactic use based on such weak clinical correlates and on the platelet count, which was not a correlate at all in multivariate analysis.

A UML-based meta-framework for system design in public health informatics

The National Agenda for Public Health Informatics calls for standards in data and knowledge representation within public health, which requires a multi-level framework that links all aspects of public health.

METHOD

The literature of public health informatics and public health informatics application were reviewed. A UML-based systems analysis was performed. Face validity of results was evaluated in analyzing the public health domain of lead poisoning.

RESULTS

The core class of the UML-based system of public health is the Public Health Domain, which is associated with multiple Problems, for which Actors provide Perspectives. Actors take Actions that define, generate, utilize and/or evaluate Data Sources. The life cycle of the domain is a sequence of activities attributed to its problems that spirals through multiple iterations and realizations within a domain.

CONCLUSION

The proposed Public Health Informatics Meta-Framework broadens efforts in applying informatics principles to the field of public health

Clinical decision support systems for the practice of evidence-based medicine

BACKGROUND

The use of clinical decision support systems to facilitate the practice of evidence-based medicine promises to substantially improve health care quality.

OBJECTIVE

To describe, on the basis of the proceedings of the Evidence and Decision Support track at the 2000 AMIA Spring Symposium, the research and policy challenges for capturing research and practice-based evidence in machine-interpretable repositories, and to present recommendations for accelerating the development and adoption of clinical decision support systems for evidence-based medicine.

RESULTS

The recommendations fall into five broad areas--capture literature-based and practice-based evidence in machine--interpretable knowledge bases; develop maintainable technical and methodological foundations for computer-based decision support; evaluate the clinical effects and costs of clinical decision support systems and the ways clinical decision support systems affect and are affected by professional and organizational practices; identify and disseminate best practices for work flow-sensitive implementations of clinical decision support systems; and establish public policies that provide incentives for implementing clinical decision support systems to improve health care quality.

CONCLUSIONS

Although the promise of clinical decision support system-facilitated evidence-based medicine is strong, substantial work remains to be done to realize the potential benefits.

Analytical electron microscopical investigations on the apoplastic pathways of lanthanum transport in barley roots

In transmission electron microscopy studies, lanthanum ions have been used as electron-opaque tracers to delineate the apoplastic pathways for ion transport in barley (Hordeum vulgare L.) roots. To localize La3+ on the subcellular level, e.g. in cell walls and on the surface of membranes, electron-energy-loss spectroscopy and electron-spectroscopic imaging were used. Seminal and nodal roots were exposed for 30 min to 1 mM LaCl3 and 10 mM LaCl3, respectively. In seminal roots, possessing no exodermis, La3+ diffusion through the apoplast was stopped by the Casparian bands of the endodermis. In nodal roots with an exodermis, however, La3+ diffusion through the cortical apoplast had already stopped at the tight junctions of the exodermal cell walls resembling the Casparian bands of the endodermis. Therefore, we conclude that in some specialized roots such as the nodal roots of barley, the physiological role of the endodermis is largely performed by the exodermis.

Electron density separations in nonideal plasmas: structure of Thomas-Fermi-like bound states and the Mott transition

Starting from a general free energy functional, the chemical picture for nonideal plasmas arises from a certain separation of the electron density. Defining a bound state and its electrostatically screening plasma environment as a subsystem, a simple theory for plasma-correspondent bound state structure can be formulated. This provides the possibility to derive adjustable parameters for the interactions in the chemical picture. The Mott transition corresponds to the violation of the normalization condition due to plasma influences.

Amygdala lesions do not impair shock-probe avoidance retention performance

The present experiment used the shock-probe paradigm, a procedure usually used to assess anxiolytic processes, to assess memory in amygdala-lesioned rats. Rats were placed in a chamber that contained a probe protruding from 1 of 4 walls and were kept there for 15 min after they contacted the probe. For half the rats, the probe was electrified (2 mA). Four days later, sham or neurotoxic amygdala lesions were induced. Retention performance was assessed 8 days later by measuring the latency to contact the probe and the number of contact-induced shocks. The results indicated that, although shock-naive amygdala-lesioned rats were impaired on the 2nd shock-probe test, shock-experienced amygdala-lesioned rats were not. These data indicate that the memory of a shock experience, as indexed with a shock-probe avoidance response, is spared in rats with large amygdala lesions.

Experience with Bailey-Dubow rodding in children with osteogenesis imperfecta

AIM

The current report presents our experience with the use of Bailey-Dubow elongation rods in children with osteogenesis imperfecta.

MATERIAL AND METHODS

63 patients with osteogenesis imperfecta underwent a total of 186 primary intramedullary fixations with Bailey-Dubow rods during period 1984-1996. Most of them were inserted into the femur (54.3 %), followed by the tibia (38.2%) and the humerus (7.9%). Patients' age at operation ranged from 1-12 years and treatment-period varied from 1-10 years.

RESULTS

Insertion into the femur showed the lowest complication rate (21.0%). Patients either suffered from knee-joint migration of the distal nail (3.9%), proximal nail migration (7.9%), detached T-pieces from the sleeve (7.9%) or chronical nail infection (1.0%). Complication rate after tibia rodding was markedly higher (52.1%). Knee joint migration appeared in 8.5% and the distal piece of the rod migrated proximally in 38.0%, in 31.0% accompanied by recurrent antecurve deformity. Growth arrest and no elongation occurred in 5.6%. Results after humerus operation were by far least satisfying. None of the nails elongated adequately. 8 of the 14 Bailey-Dubow rods (57.1 %) required reoperation caused by migration and chronic nail infection, whereas reoperation rates amounted to 17.8% after femur and 29.6% after tibia insertion. However, just one refracture happened after adequate trauma (road accident), so that an extraordinary success of fracture prevention has to be scored.

CONCLUSIONS

We concluded that the use of Bailey-Dubow rods in early childhood can be recommended for the femur, whereas insertion into the tibia or humerus is associated with a considerable complication rate.

Amygdala lesions do not impair shock-probe avoidance retention performance

The present experiment used the shock-probe paradigm, a procedure usually used to assess anxiolytic processes, to assess memory in amygdala-lesioned rats. Rats were placed in a chamber that contained a probe protruding from 1 of 4 walls and were kept there for 15 min after they contacted the probe. For half the rats, the probe was electrified (2 mA). Four days later, sham or neurotoxic amygdala lesions were induced. Retention performance was assessed 8 days later by measuring the latency to contact the probe and the number of contact-induced shocks. The results indicated that, although shock-naive amygdala-lesioned rats were impaired on the 2nd shock-probe test, shock-experienced amygdala-lesioned rats were not. These data indicate that the memory of a shock experience, as indexed with a shock-probe avoidance response, is spared in rats with large amygdala lesions.

The GRID Technique: Current Status and New Trends

In the GRID technique one measures Doppler-broadened line profiles of γ transitions using the high resolution crystal spectrometers GAMS, which are installed at the high flux reactor of the ILL Grenoble. One of the essential applications of this technique is the measurement of nuclear state lifetimes. In the present contribution the precision and the principal limits of the technique are discussed.

GAMS5

The construction of the double-crystal γ-spectrometer GAMS5 was finished recently and the instrument is now operational. Measurements with double flat crystals were carried out and we will report here on the progress concerning the characteristics of the spectrometer.