bluuebunny/crossref_metadata_2025 huggingface dataset:
Topical ketoprofen TDS patch versus diclofenac gel: efficacy and tolerability in benign sport related soft-tissue injuries
Authors: Esparza Francisco , Cobián César , Jiménez José Fernando , García-Cota Juan José , Sánchez Carlos , Maestro Antonio ,   the working group for the acute pain study of SETRADE (coordinated by Josep Borrell)
Published: December 2006

Objective:To compare the ketoprofen TDS patch with diclofenac gel in the treatment of traumatic acute pain in benign sport-related soft-tissue injuries.

Design:7–14 treatment days, prospective, randomised, open study.

Patients:Outpatients aged 18–70 years diagnosed for painful benign sport-related soft-tissue injury (sprains, strains and contusions within the prior 48 h), randomised to either ketoprofen patch 100 mg once daily (n = 114) or diclofenac gel 2–4 g three times daily (n = 109).

Intervention:7–14 days of topical non-steroidal anti-inflammatory drugs treatment to assess the pain intensity changes (daily activities and spontaneous at rest) in a daily diary (100-mm Visual Analogue Scale (VAS)).

Main outcome measurement:Pain intensity (VAS).

Results:The ketoprofen patch was not inferior to diclofenac gel in reducing the baseline pain during daily activities (difference of –1.17 mm in favour of ketoprofen patch, 95% CI (–5.86 to 3.52), reducing to the baseline VAS 79%. Ketoprofen patch presented also a higher cure rate (64%) than diclofenac gel (46%) at day 7 (p = 0.004). Patient opinions about the treatment comfort (pharmaceutical shape, application and dosage) were also statistically higher for the ketoprofen patch (>80% of the patients rated as good or excellent the patch removal and skin adherence).

Conclusion:Ketoprofen patches are effective and safe pain relievers for the treatment of sports injury pain with advantages compared with diclofenac gel.
Effect of maximal exercise on the short-term kinetics of zinc metabolism in sedentary men
Authors: Volpe Stella Lucia , Lowe Nicola M , Woodhouse Leslie R , King Janet C
Published: December 2006

Objective:To examine the effect of acute exhaustive exercise versus rest on short-term zinc kinetics in men.

Design:Crossover design, wherein all subjects were their own control.

Setting:University setting, where subjects were free living.

Participants:12 healthy, sedentary men, 25–35 years of age.

Interventions:70Zn was infused 10 min after exercise or at rest. Plasma zinc concentrations were measured at baseline and 2, 5, 10, 15, 30, 45, 60, 75, 90 and 120 min after exercise or rest. Haematocrit was measured before and after exercise to assess changes in plasma volume.

Main outcome measurements:Plasma zinc (primary), serum creatine kinase and serum cortisol concentrations (secondary).

Results:Plasma zinc concentrations decreased (p<0.05) after exercise, with a mean (SD) nadir of 13.9% (4.1%) observed at 70 min after exercise. There were increases in the size of the rapidly exchangeable plasma zinc pool (Qa; from 3.1 (0.2) to 3.6 (0.2) mg; p<0.05) and the liver zinc pool (Qb; from 10.2 (0.6) to 11.4 (0.8) mg; p = 0.12).

Conclusion:Exercise seems to cause a shift of plasma zinc into the interstitial fluid and liver after exercise, which may reflect the acute stress response of strenuous exercise.
A study on tinea gladiatorum in young wrestlers and dermatophyte contamination of wrestling mats from Sari, Iran
Authors: Hedayati Mohammad T , Afshar Parvaneh , Shokohi Tahereh , Aghili Reza
Published: December 2006

Objective:To study the prevalence of tinea gladiatorum among young wrestlers and dermatophyte contamination of wrestling mats from Sari city, the capital of Mazandaran, a northern province of Iran.

Design:324 wrestlers (aged 9–20 years) from 7 active clubs in Sari city were examined, and skin scrapings were obtained from 135 wrestlers suspected of having tinea gladiatorum. The scraped skin samples were evaluated with potassium hydroxide. Pleated carpet sterile fragments (5×5 cm) were used for to survey of wrestling mat contamination. Sabouraud’s dextrose agar with and without chloramphenicole and cyclohexamide was used to culture scrapings and wrestling mat samples. The dermatophytes were identified by routine laboratory techniques.

Results:Our study showed that of the 324 wrestlers, 65 (20.1%) had tinea gladiatorum. Most lesions were on the trunk and head. All the wrestling mat samples were positive for dermatophytes.Trichophyton tonsuranswas isolated from all the scrapings and wrestling mat samples.

Conclusion:Considering that several colonies ofT tonsuranswere isolated from all the wrestling mats and from wrestlers with tinea gladiatorum (as the only dermatophyte species) we think that the contamination of wrestling mats withT tonsuranshas a crucial role in the injection of wrestlers.
Difference in plantar pressure between the preferred and non-preferred feet in four soccer-related movements
Authors: Wong Pui-lam , Chamari Karim , Chaouachi Anis , Mao De Wei , Wisløff Ulrik , Hong Youlian
Published: December 2006

Objective and participants:The present study measured the difference in plantar pressure between the preferred and non-preferred foot in four soccer-related movements in 15 male university soccer players (mean (SD) age 20.9 (1.3) years, mean (SD) height 173 (4) cm and mean (SD) weight 61.7 (3.6) kg).

Design:To record plantar pressure distribution, players randomly wore three types of soccer shoes (classical 6-stud and 12-stud, and specially designed 12-stud) embedded with an insole pressure recorder device with 99 sensors, divided into 10 areas for analysis. Plantar pressure was recorded in five successful trials in each of the four soccer-related movements: running (at 3.3 m/s), sideward cutting, 45° cutting and landing from a vertical jump.

Results:Plantar pressures of the preferred and non-preferred foot were different in 115 of 120 comparisons. The overall plantar pressure of the preferred foot was higher than that of the non-preferred foot. Specifically, in each of the four movements, higher pressure was found in the preferred foot during the take-off phase, whereas this was found in the non-preferred foot during the landing phase. This would suggest a tendency of the preferred foot for higher motion force and of the non-preferred foot for a greater role in body stabilisation.

Conclusions:The data indicate that the preferred and non-preferred foot should be treated independently with regard to strength/power training to avoid unnecessary injuries. Different shoes/insoles and different muscular strengthening programmes are thus suggested for each of the soccer player’s feet.
Intermittent KoldBlue cryotherapy of 3×10 min changes mid-portion Achilles tendon microcirculation
Authors: Knobloch Karsten , Grasemann Ruth , Spies Marcus , Vogt Peter M
Published: December 2006

Background:Neovascularisation and microcirculatory changes have been reported in Achilles tendinopathy. Cryotherapy and compression, as part of a rest, ice, compression and elevation regimen, are shown to decrease pain and improve function. However, the microcirculatory changes following a given dosage of cryotherapy on mid-portion Achilles tendon remain unclear.

Study design:Prospective clinical cohort study, level of evidence 2.

Methods:30 people (12 males, 33 (SD 12) years, body mass index 25.6 (5.3) kg/m2) were included in the cohort. 3×10 min KoldBlue ankle-cooling bandages were applied and microcirculation of Achilles tendon mid-portion was real-time and continuously assessed using a laser-Doppler-spectrophotometry system (O2C, Germany).

Results:Superficial capillary blood flow was reduced from 42 to 6, 5 and 3 relative units (rU) in the first, second and third cryotherapy periods, respectively (−65%, p = 0.001), with no significant capillary hyperaemia. Deep capillary tendon blood flow was reduced from 180 to 82, 53 and 52 rU (−71%, p = 0.001) within 6–9 min of application without hyperaemia. Superficial tendon oxygen saturation dropped significantly from 43% to 26%, 18% and 11% (p = 0.001) after repetitive cryotherapy, with persisting increase of tendon oxygenation during rewarming (51%, 49% and 54%, p = 0.077) up to 27% of the baseline level. At 8 mm tendon depth, cryotherapy preserved local oxygenation. Relative postcapillary venous tendon filling pressures were favourably reduced from 41 (11) to 31, 28 and 26 rU (−36%, p = 0.001) superficially and from 56 (11) to 45, 46 and 48 rU (−18%, p = 0.001) in deep capillary blood flow during cryotherapy, facilitating capillary venous clearance.

Conclusion:Intermittent cryotherapy of 3×10 min significantly decreases local Achilles tendon mid-portion capillary blood flow by 71%. Within 2 min of rewarming, tendon oxygen saturation is re-established following cryotherapy. Postcapillary venous filling pressures are reduced during cryotherapy, favouring capillary venous outflow of the healthy Achilles tendon.
Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment
Authors: Lempainen Lasse , Sarimo Janne , Mattila Kimmo , Heikkilä Jouni , Orava Sakari
Published: December 2006

Background:Hamstring strains are among the most frequent injuries in sports, especially in events requiring sprinting and running. Distal tears of the hamstring muscles requiring surgical treatment are scarcely reported in the literature.

Objective:To evaluate the results of surgical treatment for distal hamstring tears.

Design:A case series of 18 operatively treated distal hamstring muscle tears combined with a review of previously published cases in the English literature. Retrospective study; level of evidence 4.

Setting:Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland.

Patients:Between 1992 and 2005, a total of 18 athletes with a distal hamstring tear were operated at our centre.

Main outcome measurements:At follow-up, the patients were asked about possible symptoms (pain, weakness, stiffness) and their return to the pre-injury level of sport.

Results:The final results were rated excellent in 13 cases, good in 1 case, fair in 3 cases and poor in 1 case. 14 of the 18 patients were able to return to their former level of sport after an average of 4 months (range 2–6 months).

Conclusions:Surgical treatment seems to be beneficial in distal hamstring tears in selected cases.
Influence of vibration on delayed onset of muscle soreness following eccentric exercise
Authors: Bakhtiary Amir H , Safavi-Farokhi Ziaeddin , Aminian-Far Atefeh
Published: December 2006

Delayed onset muscle soreness (DOMS), which may occur after eccentric exercise, may cause some reduction in ability in sport activities. For this reason, several studies have been designed on preventing and controlling DOMS. As vibration training (VT) may improve muscle performance, we designed this study to investigate the effect of VT on controlling and preventing DOMS after eccentric exercise.

Methods:Fifty healthy non-athletic volunteers were assigned randomly into two experimental, VT (n = 25) and non-VT (n = 25) groups. A vibrator was used to apply 50 Hz vibration on the left and right quadriceps, hamstring and calf muscles for 1 min in the VT group, while no vibration was applied in the non-VT group. Then, both groups walked downhill on a 10° declined treadmill at a speed of 4 km/hour. The measurements included the isometric maximum voluntary contraction force (IMVC) of left and right quadriceps muscles, pressure pain threshold (PPT) 5, 10 and 15 cm above the patella and mid-line of the calf muscles of both lower limbs before and the day after treadmill walking. After 24 hours, the serum levels of creatine-kinase (CK), and DOMS level by visual analogue scale were measured.

Results:The results showed decreased IMVC force (P = 0.006), reduced PPT (P = 0.0001) and significantly increased mean of DOMS and CK levels in the non-VT group, compared to the VT group (P = 0.001).

Conclusion:A comparison by experimental groups indicates that VT before eccentric exercise may prevent and control DOMS. Further studies should be undertaken to ascertain the stability and effectiveness of VT in athletics.
Effect of off-road competitive motocross race on plasma oxidative stress and damage markers
Authors: Ascensão António , Ferreira Rita , Marques Franklim , Oliveira Eduardo , Azevedo Victor , Soares José , Magalhães José
Published: December 2006

Aim:To analyse the effect of an off-road motocross heat on plasma levels of oxidative stress and damage, blood leucocyte counts and urine catecholamine concentration.

Methods:Plasma contents of total, reduced and oxidised (GSSG) glutathione, %GSSG, malondialdehyde (MDA), protein carbonyl and sulphydryl groups, total antioxidant status (TAS), uric acid, and blood neutrophil and lymphocyte counts were evaluated in 10 male top-level riders before, immediately after (0 h) and 1 h after a simulated competitive motocross race. 24-h urine adrenaline, noradrenaline and dopamine concentrations were also measured.

Results:The motocross heat resulted in an increase in plasma oxidative stress and damage (p<0.05). This was shown by a significant increase in %GSSG, TAS, MDA and carbonyls, and by a decrease in sulphydryl groups after the race. There was a significant increase in both plasma uric acid and urine catecholamine concentration after the race (p<0.05). Blood neutrophil counts increased at 0 and 1 h after exercise (p<0.05). Lymphocyte count increased from baseline to 0 h, although it decreased from baseline and 0 to 1 h after exercise (p<0.05).

Conclusion:The data reinforce the marked metabolic and hormonal demands imposed by motocross, resulting in a condition of enhanced plasma oxidative stress and damage.
Time–motion analysis and physiological data of elite under-19-year-old basketball players during competition
Authors: Ben Abdelkrim Nidhal , El Fazaa Saloua , El Ati Jalila
Published: December 2006

The physical demands of modern basketball were assessed by investigating 38 elite under-19-year-old basketball players during competition. Computerised time–motion analyses were performed on 18 players of various positions. Heart rate was recorded continuously for all subjects. Blood was sampled before the start of each match, at half time and at full time to determine lactate concentration. Players spent 8.8% (1%), 5.3% (0.8%) and 2.1% (0.3%) of live time in high “specific movements”, sprinting and jumping, respectively. Centres spent significantly lower live time competing in high-intensity activities than guards (14.7% (1%)v17.1% (1.2%); p<0.01) and forwards (16.6% (0.8%); p<0.05). The mean (SD) heart rate during total time was 171 (4) beats/min, with a significant difference (p<0.01) between guards and centres. Mean (SD) plasma lactate concentration was 5.49 (1.24) mmol/l, with concentrations at half time (6.05 (1.27) mmol/l) being significantly (p<0.001) higher than those at full time (4.94 (1.46) mmol/l). The changes to the rules of basketball have slightly increased the cardiac efforts involved during competition. The game intensity may differ according to the playing position, being greatest in guards.
The “bench-presser’s shoulder”: an overuse insertional tendinopathy of the pectoralis minor muscle
Authors: Bhatia Deepak N , de Beer Joe F , van Rooyen Karin S , Lam Francis , du Toit Donald F
Published: December 2006

Background:Tendinopathies of the rotator cuff muscles, biceps tendon and pectoralis major muscle are common causes of shoulder pain in athletes. Overuse insertional tendinopathy of pectoralis minor is a previously undescribed cause of shoulder pain in weightlifters/sportsmen.

Objectives:To describe the clinical features, diagnostic tests and results of an overuse insertional tendinopathy of the pectoralis minor muscle. To also present a new technique of ultrasonographic evaluation and injection of the pectoralis minor muscle/tendon based on use of standard anatomical landmarks (subscapularis, coracoid process and axillary artery) as stepwise reference points for ultrasonographic orientation.

Methods:Between 2005 and 2006, seven sportsmen presenting with this condition were diagnosed and treated at the Cape Shoulder Institute, Cape Town, South Africa.

Results:In five patients, the initiating and aggravating factor was performance of the bench-press exercise (hence the term “bench-presser’s shoulder”). Medial juxta-coracoid tenderness, a painful active-contraction test and bench-press manoeuvre, and decrease in pain after ultrasound-guided injection of a local anaesthetic agent into the enthesis, in the absence of any other clinically/radiologically apparent pathology, were diagnostic of pectoralis minor insertional tendinopathy. All seven patients were successfully treated with a single ultrasound-guided injection of a corticosteroid into the enthesis of pectoralis minor followed by a period of rest and stretching exercises.

Conclusions:This study describes the clinical features and management of pectoralis minor insertional tendinopathy, secondary to the bench-press type of weightlifting. A new pain site-based classification of shoulder pathology in weightlifters is suggested.
A stress fracture of the lumbar spine in a professional rugby player
Authors: Castinel Bernard H , Adam Philippe , Prat Christophe
Published: December 2006

In modern rugby, the spine is subjected to great physical pressure, with an increased number of impacts, on both the cervical and the lumbar spine. This case report illustrates overuse injuries of the lumbar spine in international professional rugby players. A 32-year-old sportsman had been practising rugby for 24 years and was playing for a championship level French team when he started suffering from a right lateral pain in the lumbosacral spine. A CT scan showed a unilateral isthmolysis and a coronal irregular fracture of the right pars interarticularis of L5. This led to discussion of (1) the importance of the decision on the date of return to playing rugby and (2) the future of professional rugby players with chronic spinal injuries.
A 6-month prospective study of injury in Gaelic football
Authors: Wilson F , Caffrey S , King E , Casey K , Gissane C
Published: December 2006

Objective:To describe the injury incidence in Gaelic football.

Methods:A total of 83 players from three counties were interviewed monthly about their injury experience, during the 6 months of the playing season.

Results:The injury rate was 13.5/1000 h exposure to Gaelic football (95% CI, 10.9 to 16.6). There were nearly twice as many injuries during matches (64.4%, 95% CI, 54.1 to 73.6) as in training (35.6%, 95% CI, 26.4 to 49.5). The ankle was found to be the most commonly injured site (13.3%, 95% CI, 7.8 to 21.9). The musculotendinous unit accounted for nearly 1/3 of all injuries (31.1%). The tackle accounted for 27.8% of the injuries sustained (tackler 10%, 95% CI, 5.4 to 17.9; player being tackled 17.9%, 95% CI, 11.2 to 26.9). Of total match injuries, 56.9% (95% CI, 46.1 to 67.1) were experienced in the second half as opposed to 39.7% (95% CI, 29.8 to 50.5) in the first half.

Conclusions:Gaelic footballers are under considerable risk of injury. Greater efforts must be made to reduce this risk so that players miss less time from sport due to injury. Risk factors for injury in Gaelic football must now be investigated so that specific interventions may be established to reduce them.
Epithelioid trophoblastic tumour: a case report and review of the literature
Authors: Vencken P M L H , Ewing P C , Zweemer R P
Published: December 2006

Epithelioid trophoblastic tumour (ETT) is an unusual type of trophoblastic tumour, which can cause difficulties in diagnosis and (as a consequence) in treatment. The literature suggests that surgery should be the treatment of choice for ETT as it is not responsive to chemotherapeutic agents, used in the treatment of other types of gestational trophoblastic diseases. This case report describes an ETT, which was initially diagnosed as a carcinoma of the cervix. Surgical management was chosen based on the literature. 6 months later the patient also developed a plasmacytoma and was treated with radiotherapy. The occurrence of ETT and plasmacytoma in combination has never been described before. This case report describes a rare case of an atypical trophoblastic tumour, with problematic differential diagnosis. Treatment of carcinoma of the cervix would have necessitated postoperative radiotherapy, but on diagnosis of ETT, surgical management was considered sufficient. Hence, it is important to consider the occurrence of ETTs, although rare, in patients with atypical cervical or endometrial cancer, and in patients diagnosed with a gestational trophoblastic tumour, who do not respond to appropriate chemotherapy.
Three coexisting lymphomas in one patient: genetically related or only a coincidence?
Authors: Steinhoff M , Assaf C , Anagnostopoulos I , Geilen C C , Stein H , Hummel M
Published: December 2006

The simultaneous manifestation of different lymphomas in the same patient or even in the same tissue, defined as composite lymphoma, is very rare. The exceptional case of a patient who, presented with simultaneous manifestation of three different lymphomas after 30 years of successful treatment of a nodal T cell lymphoma is reported here. The three lymphomas were: (1) primary cutaneous marginal zone B cell lymphoma (MZBL); (2) nodal Epstein–Barr virus (EBV)-associated classic Hodgkin’s lymphoma (cHL) of the B cell type; and (3) peripheral T cell lymphoma coexisting in the skin and cervical lymph node. Immunohistochemical and molecular analyses showed different clonal origins of EBV-negative cutaneous MZBL and EBV-positive B cell cHL and, in addition, the presence of the same clonal T cell population in the skin and lymph node. The simultaneous occurrence of three different, clonally unrelated lymphomas in one patient at the same time has not been reported yet.
Russell body gastritis associated withHelicobacter pyloriinfection: a case report
Authors: Paik S , Kim S-H , Kim J-H , Yang W I , Lee Y C
Published: December 2006

An unusual and rare gastric mucosal lesion histologically consisting of a localised accumulation of Russell bodies and Russell body-containing plasma cells, the so-called Mott cells, has been recognised only recently and termed as “Russell body gastritis”. This lesion, despite its densely monomorphous appearance is easily confirmed to be non-neoplastic by its polyclonal immunoreactive pattern to immunoglobulin light chains. However, the aetiology of Russell body gastritis is controversial and hence the optimal treatment for this disease has not been established. Two cases of Russell body gastritis associated withHelicobacter pyloriinfection are reported, and the possible role ofH pyloriinfection in the pathogenesis is discussed.
Squamous cell carcinoma with rhabdoid phenotype and osteoclast-like giant cells in a renal–pancreas transplant recipient
Authors: Aljerian K , Alsaad K O , Chetty R , Ghazarian D
Published: December 2006

Squamous cell carcinoma (SCC) is the commonest non-melanotic malignant skin tumour encountered after solid-organ transplantation. In this setting it is associated with a worse prognosis than sun-damage-induced SCC. Rhabdoid cells and osteoclastic giant cells are infrequently seen in SCC. This case highlights the unusual occurrence of rhabdoid cells and osteoclastic giant cells in a post-transplant SCC.
Hyperplastic polyps of the duodenum: an unusual histological finding
Authors: Roche H J , Carr N J , Laing H , Bateman A C
Published: December 2006

A 58-year-old man underwent upper gastrointestinal surveillance endoscopy for Barrett’s oesophagus. This showed a possible gastric ulcer, although histological examination was normal. Follow-up endoscopy showed white ridges in the distal duodenum and these were subjected to biopsy. Histological examination of the biopsy specimens showed polypoid duodenal mucosa showing features similar to those of a hyperplastic polyp of the colon. In addition, the mucosal surface was focally of gastric surface type. The features were interpreted overall as most likely to represent an unusual form of regenerative change in the setting of previous chronic inflammatory mucosal damage. The case is presented as an unusual histological phenomenon at this site; it would be important not to overdiagnose neoplasia in this situation.
Adenoid cystic/basal cell carcinoma of the prostate strongly expresses HER-2/neu
Authors: Iczkowski K A , Montironi R
Published: December 2006

Adenoid cystic/basal cell carcinoma (ACBCC) is a rare neoplasm in the prostate. Definitive treatment is warranted, as among 19 patients previously reported by us, 5 had extraprostatic extension and 4 were metastatic. TheHER-2/neu(c-erbB-2) gene has been reportedly overexpressed in adenoid cystic carcinomas in other organs, but its status in prostatic ACBCC was uncertain. Immunohistochemical staining and in situ hybridisation were carried out in 13 patients with ACBCC (11 from transurethral resection, 2 prostatectomy). One patient had metastasis to the lung. Citrate buffer and steam heat were used for antigen retrieval. Ten acinar adenocarcinomas of varying grades were also immunostained as controls. Protein and mRNA expression were 2+ to 3+ (of 3+) in all patients with ACBCC, compared to a breast cancer control with strong reactivity, whereas protein expression was noted in only one acinar carcinoma and mRNA expression was absent in all acinar carcinomas. Benign acini expressed HER-2/neu only in the basal layer. The finding of strong, consistent HER-2/neu expression in ACBCC suggests that treatment with Herceptin (trastuzumab) may be effective in patients with this rare tumour.
Work system design for patient safety: the SEIPS model
Authors: Carayon P , Schoofs Hundt A , Karsh B-T , Gurses A P , Alvarado C J , Smith M , Flatley Brennan P
Published: December 2006

Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.
Understanding the complexity of redesigning care around the clinical microsystem
Authors: Barach P , Johnson J K
Published: December 2006

The microsystem is an organizing design construct in which social systems cut across traditional discipline boundaries. Because of its interdisciplinary focus, the clinical microsystem provides a conceptual and practical framework for simplifying complex organizations that deliver care. It also provides an important opportunity for organizational learning. Process mapping and microworld simulation may be especially useful for redesigning care around the microsystem concept. Process mapping, in which the core processes of the microsystem are delineated and assessed from the perspective of how the individual interacts with the system, is an important element of the continuous learning cycle of the microsystem and the healthcare organization. Microworld simulations are interactive computer based models that can be used as an experimental platform to test basic questions about decision making misperceptions, cause-effect inferences, and learning within the clinical microsystem. Together these tools offer the user and organization the ability to understand the complexity of healthcare systems and to facilitate the redesign of optimal outcomes.
Design of high reliability organizations in health care:
Table 1
Authors: Carroll J S , Rudolph J W
Published: December 2006

To improve safety performance, many healthcare organizations have sought to emulate high reliability organizations from industries such as nuclear power, chemical processing, and military operations.We outline high reliability design principles for healthcare organizations including both the formal structures and the informal practices that complement those structures. A stage model of organizational structures and practices, moving from local autonomy to formal controls to open inquiry to deep self-understanding, is used to illustrate typical challenges and design possibilities at each stage. We suggest how organizations can use the concepts and examples presented to increase their capacity to self-design for safety and reliability.
Improving patient safety by instructional systems design
Authors: Battles J B
Published: December 2006

Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm.
A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional:
Figure 1
Authors: Karsh B-T , Holden R J , Alper S J , Or C K L
Published: December 2006

The goal of improving patient safety has led to a number of paradigms for directing improvement efforts. The main paradigms to date have focused on reducing injuries, reducing errors, or improving evidence based practice. In this paper a human factors engineering paradigm is proposed that focuses on designing systems to improve the performance of healthcare professionals and to reduce hazards. Both goals are necessary, but neither is sufficient to improve safety. We suggest that the road to patient and employee safety runs through the healthcare professional who delivers care. To that end, several arguments are provided to show that designing healthcare delivery systems to support healthcare professional performance and hazard reduction should yield significant patient safety benefits. The concepts of human performance and hazard reduction are explained.
Violations and migrations in health care: a framework for understanding and management:
Figure 1
Authors: Amalberti R , Vincent C , Auroy Y , de Saint Maurice G
Published: December 2006

Violations are deliberate deviations from standard procedure. The usual reaction is to attempt to eliminate them and reprimand those concerned. However, the situation is not that simple. Firstly, violations paradoxically may be markers of high levels of safety because they need constraints and defences to exist. They may even become more frequent than errors in ultrasafe systems. Secondly, violations have both positive and negative aspects. On the one hand they occur frequently, increase system performance and individual satisfaction, are mostly limited to practices with limited safety consequences, and therefore are often tolerated or even encouraged by the hierarchy. On the other hand, extreme violations can lead to real danger or actual harm. This paper proposes a three phase model derived from Rasmussen’s theory of migration to boundaries to explain the mechanism by which the deviance occurs, stabilizes, regresses, or progresses to harm. The model suggests that violations are unavoidable because system dynamics and deviances are markers of adaptation to this dynamicity. Violations cannot be eliminated but they can be managed. Solutions are specific to each step of the model, with a mix of relaxing constraints, increasing peer control (staff), and constraining dangerous individuals.
On the complexity of medical devices and systems
Authors: Senders J W
Published: December 2006

How does one design something that is complex? Or something that is simple? Why should one try to reduce or increase complexity? What is complexity? There are a large number of different uses of the word, including many in mathematics and physics. Most of these are not useful in attempting to fit the word to the problems of the design of systems and devices for medicine. In this paper the concept has been defined to apply to health care, which has led to some conclusions about the future development of medical systems and devices.
Issues in the design of training for quality and safety
Authors: Henriksen K , Dayton E
Published: December 2006

The US healthcare delivery system is in a state of change. Medical science and technology are advancing at an unprecedented rate, while cost containment and productivity pressures on clinicians make the clinical environment less than ideal for training. Training is one of the vehicles for addressing new knowledge requirements and for enhancing human and system based performance. Yet the theoretical underpinnings and design aspects of training have been largely unrecognized and unexamined in health care. This paper first explores changes in the practice of medicine and the healthcare delivery environment. It then describes how healthcare training and education can benefit from findings in the behavioral and cognitive sciences. It describes the systems approach to training and explores the extent to which a systems approach can be applied to the clinical environment. Finally, the paper examines innovative training and education techniques that are already gaining acceptance in health care.
An integrated framework for safety, quality and risk management: an information and incident management system based on a universal patient safety classification
Authors: Runciman W B , Williamson J A H , Deakin A , Benveniste K A , Bannon K , Hibbert P D
Published: December 2006

More needs to be done to improve safety and quality and to manage risks in health care. Existing processes are fragmented and there is no single comprehensive source of information about what goes wrong. An integrated framework for the management of safety, quality and risk is needed, with an information and incident management system based on a universal patient safety classification. The World Alliance for Patient Safety provides a platform for the development of a coherent approach; 43 desirable attributes for such an approach are discussed. An example of an incident management and information system serving a patient safety classification is presented, with a brief account of how and where it is currently used. Any such system is valueless unless it improves safety and quality. Quadruple-loop learning (personal, local, national and international) is proposed with examples of how an exemplar system has been successfully used at the various levels. There is currently an opportunity to “get it right” by international cooperation via the World Health Organization to develop an integrated framework incorporating systems that can accommodate information from all sources, manage and monitor things that go wrong, and allow the worldwide sharing of information and the dissemination of tools for the implementation of strategies which have been shown to work.
Accidents waiting to happen: the contribution of latent conditions to patient safety
Authors: Lowe C M
Published: December 2006

Poor design of elements in a healthcare system produce the latent conditions which result in patient safety incidents. A better understanding of these elements and specific healthcare design challenges will result in improved patient safety.
Safe design of healthcare facilities
Authors: Reiling J
Published: December 2006

The physical environment has a significant impact on health and safety; however, hospitals have not been designed with the explicit goal of enhancing patient safety through facility design. In April 2002, St Joseph’s Community Hospital of West Bend, a member of SynergyHealth, brought together leaders in healthcare and systems engineering to develop a set of safety-driven facility design recommendations and principles that would guide the design of a new hospital facility focused on patient safety. By introducing safety-driven innovations into the facility design process, environmental designers and healthcare leaders will be able to make significant contributions to patient safety.
Quality and safety by design
Authors: Battles J B
Published: December 2006

Rather than continuing to try to measure the width and depths of the quality chasm, a legitimate question is how does one actually begin to close the quality chasm? One way to think about the problem is as a design challenge rather than as a quality improvement challenge. It is time to move from reactive measurement to a more proactive use of proven design methods, and to involve a number of professions outside health care so that we can design out system failure and design in quality of care. Is it possible to actually design in quality and design out failure? A three level conceptual framework design would use the six quality aims laid out in Crossing the quality chasm. The first or core level of the framework would be designing for patient centered care, with safety as the second level. The third design attributes would be efficiency, effectiveness, timeliness, and equity. Design methods and approaches are available that can be used for the design of healthcare organizations and facilities, learning systems to train and maintain competency of health professionals, clinical systems, clinical work, and information technology systems. In order to bring about major improvements in quality and safety, these design methods can and should be used to redesign healthcare delivery systems.
Synthesis and aldol cyclotrimerization of 4,7-di-tert-butylacenaphthenone
Authors: Amick Aaron W , Griswold Keith S , Scott Lawrence T
Published: December 2006

An efficient gram scale synthesis of the previously unknown 4,7-di-tert-butylacenaphthenone (3b) is reported. The facile isomerization of epoxide 9b to ketone 3b occurs simply on stirring a solution of 9b with silica gel at room temperature. Aldol cyclotrimerization of 3b with titanium tetrachloride gives 2,5,8,11,14,17-hexa-tert-butylde cacyclene (1b) in 58% isolated yield. X-ray crystal structures have been obtained for the synthetic intermediates 4,7-di-tert-butylacenaphthene (2b) and 4,7-di-tert-butylacenaphthylene (8b).Key words: aromatic, decacyclene, hydrocarbon, nonalternant, polycyclic.
Tetraazaoctaphyrin  A biimidazole-containing expanded porphyrin
Authors: Sessler Jonathan L , Rubin Bobbi L , Stępień Marcin , Köhler Thomas , Pantos G Dan , Roznyatovskiy Vladimir
Published: December 2006

A series of expanded porphyrins, incorporating biimidazoles and bipyrroles within their macrocyclic framework, has been synthesized. Insights into the complex conformational characteristics of these ems were obtained from two-dimensional NMR spectroscopic studies. The relative energy values for the various asymmetric structures inferred from these analyses were compared using DFT molecular modeling calculations.Key words: macrocycles, expanded porphyrins, imidazoles, pyrroles, biimidazoles, supramolecular chemistry, heterocycles.
Toward the total synthesis of lophotoxin — New methodologies and synthetic strategies
Authors: Wipf Peter , Grenon Michel
Published: December 2006

Our recent progress toward the synthesis of the furanocembranolide lophotoxin (1) is disclosed. Strategies for the stereoselective incorporation of the C13stereocenter by a catalytic desymmetrization of a cyclic meso-anhydride, as well as a novel 1,6-addition reaction of organocuprates to unsaturated [1,3]dioxin-4-ones are discussed. Preliminary results on the development of a rhodium-catalyzed asymmetric 1,6-addition reaction are also mentioned. Finally, modifications of a previously reported transition-metal-catalyzed cyclization reaction involving α-propargyl β-keto esters allow furan ring formation either under thermal conditions or by microwave irradiation.Key words: 1,6-addition, organocuprates, catalytic desymmetrization, furan cyclization, microwave.
Novel electrophilic ipso acylation - detosylation reaction of pyrroles
Authors: Pelkey Erin T , Gribble Gordon W
Published: December 2006

A pyrrole and two pyrroloindoles that are substituted with a p-toluenesulfonyl group undergo an ipso acylation – detosylation reaction with acid chlorides and aluminum chloride to afford the corresponding acyl-substituted pyrroles and pyrroloindoles.Key words: pyrrole, pyrroloindole, ipso acylation, detosylation, Friedel–Crafts reaction.
Catalysis with palladium colloids supported in poly(acrylic acid)-grafted polyethylene and polystyrene
Authors: Bergbreiter David E , Kippenberger Andrew , Zhong Zhenqi
Published: December 2006

Grafts of poly(acrylic acid) on polyethylene powder (PE-g-PAA) or polystyrene (PS-g-PAA) can be used to support Pd(0) crystallites that function like a homogeneous Pd(0) catalyst in some reactions. These Pd–PE-g-PAA catalysts were active in allylic substitution reactions in the presence of added phosphine ligand. A catalyst analogous to the Pd–PE-g-PAA powder catalyst on polystyrene (Pd–PS-g-PAA) was similarly active for allylic substitution and could also be used in Heck reactions at 80–100 °C in N,N-dimethylacetamide (DMA). Analysis of the product solutions for Pd leachate and a correlation of the Pd leaching with product formation in the allylic substitution chemistry for both types of catalysts suggests that the active catalysts in these reactions are leached from the support. In the case of the allylic substitution reaction, external triphenylphosphine and substrate together are required for the chemistry and Pd leaching.Key words: catalysis, palladium, allylic substitution, grafted polystyrene, supported catalysts.
A silyl-mediated [3+2] photochemical cycloaddition
Authors: Organ Michael G , Mallik Debasis
Published: December 2006

The generation of larger rings from intermediate cyclobutanes via a two-step [2+2] photocycloaddition – ring expansion, known as the de Mayo reaction, has been widely applied in synthesis. Herein a one-step synthesis of cyclopentanoids has been developed based on the photochemical irradiation of an enone in the presence of an allylsilane. The ability of the silyl moiety to stabilize the intermediate biradical is believed to be responsible for this unique transformation where one normally expects to see the [2+2] cyclobutane adduct.Key words: [2+2] photocycloaddition - ring expansion, allylsilanes, cyclopentanoids, photochemical.
Cyclotrimerization approach to unnatural structural modifications of pancratistatin and other amaryllidaceae constituents — Synthesis and biological evaluation
Authors: Hudlicky Tomas , Moser Michael , Banfield Scott C , Rinner Uwe , Chapuis Jean-Charles , Pettit George R
Published: December 2006

The phenanthridone core of pancratistatin lacking all aromatic oxygenation was prepared by cyclotrimerization of acetylene-containing scaffolds 30 and 41, reflecting the natural and the C-1 epi configuration, respectively, of the amino inositol moiety. The cobalt-catalyzed formation of the aromatic core led to bisTMS derivatives 39 and 48, as well as bisacetyl derivative 51. The effectiveness of cyclotrimerization of the natural or trans series was compared with that of the cis series. In addition, the yields of cyclotrimerization were compared for propargylic amines and propargylic amides. Eleven derivatives, including the fully hydroxylated phenantridone 39, were tested against seven cancer cell lines. Three of the compounds displayed activities only an order of magnitude less than those of 7-deoxypancratistatin. Full experimental and spectral details are provided for all key compounds and future projections for the preparation of unnatural analogs of Amaryllidaceae constituents are advanced, along with some new insight into the minimum pharmacophore of pancratistatin.Key words: cyclotrimerization, alkaloids, cobalt catalyst.
The regioselective α-alkylation of the benzophenone imine of glycinamide, alaninamide, and related derivatives
Authors: O'Donnell Martin J , Keeton Jeremy D , Khau Vien Van , Bollinger John C
Published: December 2006

The benzophenone imine of glycinamide was alkylated using ion pair extraction (RX, 10% aq. NaOH, Bu4NHSO4 (1 equiv.), CH2Cl2, rt) to give the α-monosubstituted products, which were then alkylated a second time using stronger basic conditions (KO-t-Bu, THF, 0 °C, RX). Crystal structures of the Schiff bases of glycinamide, an α-monosubstituted and an α,α-disubstituted product were reported.Key words: benzophenone imines, Schiff bases, alkylation, ion pair extraction (IPE), phase-transfer catalysis (PTC), anhydrous base, X-ray crystal structures.
Fabrication of patterned organic thin film by low-energy electron beam lithography and surface-initiated ring-opening metathesis polymerization
Authors: Ding Zhebo , Ganem Bruce
Published: December 2006

High densities of immobilized polymer brushes have been created on solid supports in a spatially addressable fashion. Octadecyltrichlorosilane was self-assembled on a silicon substrate to form an inert monolayer. The substrate was then patterned by low-energy electron beam lithography. Finally, the exposed region was back-filled with a second functionalized silane and the pattern was further amplified by surface-initiated ring-opening metathesis polymerization. The patterned substrate was imaged by scanning electron microscopy and atomic force microscopy.Key words: patterned thin film, e-beam lithography, ring-opening metathesis polymerization, polymer brushes.
1,4,8,11-Tetra[2-aryl-1-diazenyl]-1,4,8,11-tetraazacyclotetradecanes — Synthesis, characterization, and X-ray crystallography of the first tetrakistriazenes to be reported
Authors: Clarke Jeffery D , Vaughan Keith , Bertolasi Valerio
Published: December 2006

The reactions of a series of arene diazonium salts with 1,4,8,11-tetraazacyclotetradecane (cyclam) afford the novel compounds, the 1,4,8,11-tetra[2-aryl-1-diazenyl]-1,4,8,11-tetraazacyclotetradecanes (1a–1f), which are the first examples of tetrakistriazenes to be reported. The tetrakistriazenes were characterized by IR spectroscopy, proton and carbon NMR, elemental analysis, high resolution electrospray mass spectrometry, and X-ray crystallography. The analogous reaction of a diazonium salt with 1,4,7-triazacyclononane or 1,5,9-triazacyclododecane yields the tristriazenes 2, 3a, and 3b. The structures of compounds 1c and 1e were solved by X-ray crystallography at low temperature (150 K). Both molecules display a conformation where the four phenyltriazenyl groups point alternately upwards and downwards with respect to the mean macrocyclic plane.Key words: triazene, tetrakistriazene, cyclam, tetraazacyclotetradecane, X-ray, NMR, cyclic polyamines.