bluuebunny/crossref_metadata_2025 huggingface dataset:
UK survey of the provision of multicompartment compliance aids and medicines reminder charts on discharge from hospital
Authors: Green Christopher F , McCloskey Sinead
Published: December 2005

Objective

To describe and characterise the provision of multicompartment compliance aids (MCAs) and medicine reminder charts (MRCs) in UK hospitals; to investigate the transfer of information about these items between secondary and primary care and to investigate methods of remuneration for MCA supply in primary care.

Method

A structured questionnaire was sent to the dispensary manager at each of the 217 acute hospitals in the UK with one reminder after four weeks. Questions covered whether the hospital provided MCAs and MRCs and, if so, the process for deciding which patients should receive one and the type of device to be used. The survey also explored local arrangements for continuing the use of MCAs and MRCs after the patient was discharged from hospital.

Key findings

The response rate was 73.7% (160) and one or more type of MCA and/or MRC were supplied by 134 hospitals to some patients on discharge. Medicines reminder charts were supplied by 106 (66.3%) hospitals. Reusable MCAs were supplied by 131 (81.9%) hospitals and sealed blister pack MCAs were supplied by 35 (21.9%) hospitals. Only 26 (16.3%) hospitals reported having formal methods of targeting which patients should receive a compliance aid. The most common method of funding for the filling of compliance aids by community pharmacists was reported to be the use of weekly repeat prescriptions in 38 (28.4%) primary care trusts (PCTs) and a specific fee for dispensing compliance aids in 12 (9%). Information about the compliance aid was communicated to the patient's community pharmacist by 66 (49.2%) hospitals. Information about the compliance aid was communicated to the patient's general practitioner by 77 (57.5%) hospitals.

Conclusion

MCAs are supplied by the majority of hospitals in the UK but only a minority said they had a formal system to target patients for their use. Arrangements for remuneration for supplying and filling MCAs were variable. Our results show that transfer of information between secondary and primary care about MCAs needs to be improved.
The role of the pharmacist in the prevention and management of HIV/AIDS: an exploratory study of the establishment of AIDS Resource Centres in pharmacies
Authors: Gilbert Leah
Published: December 2005

Objective

The magnitude of the HIV/AIDS epidemic in South Africa, particularly its rapid growth and the inability of existing health structures to respond to the rising needs for treatment, has had a profound impact on South African society. The epidemic has specifically affected the healthcare services, in that it calls for greater involvement of all health professionals, including pharmacists. There is undoubtedly potential for community pharmacists to be involved in the prevention and treatment of HIV/AIDS, and the fact that many community pharmacies already have private areas for consultation and a designated professional to offer advice renders them an ideal space for these activities. The objective of the study was to explore the role played by pharmacists in the prevention and management of the epidemic.

Methods

The paper synthesises data from three sources: documentary analysis of official reports; a telephone survey of 112 community pharmacies in Johannesburg; and interviews with three key informants from pharmaceutical organisations and pharmacists involved with the governmental anti-retroviral programme.

Key findings

The South African Pharmacy Council (SAPC) and the Pharmaceutical Society of South Africa (PSSA) embarked on the process of establishing AIDS Resource Centres in pharmacies. Six months later 55% of the pharmacists interviewed had heard about it and 33% of these knew very little about it. The SAPC and the PSSA have developed strict criteria for the accreditation of pharmacists and AIDS Resource Centres, so that the consumer can be assured of a high quality of service. At the time of the survey, 40% of pharmacists said they intended to apply for accreditation at this stage. Most pharmacists (82%) reported that they were already involved in some HIV/AIDS-related activities, without having acquired additional training and specific accreditation. This paper analyses pharmacists' readiness and ability to develop these services and discusses possible barriers to successful implementation of the programme.

Conclusion

The HIV/AIDS epidemic generally, and in South Africa in particular, poses challenges for all health professionals. This paper demonstrates the willingness of the professional pharmacy establishment in South Africa to co-operate with the government in order to confront the epidemic and respond to national needs; it also highlights the potential difficulties inherent in the process. Given the nature of the epidemic in South Africa, pharmacy is potentially in a position to rise to the challenges presented and place itself at the centre of the professional team. However the findings of this study show that achieving this will require substantial adjustments in pharmacists' practice, good communication skills between pharmacists and their customers, and considerable goodwill among pharmacists on the ground.
Identification of medication error through community pharmacies
Authors: Warner Bruce , Gerrett David
Published: December 2005

Objective

The objective of this study was to record medication error against specific categories identified through community pharmacies in Southern Derbyshire.

Method

A piloted diary-based reporting instrument was used with defined medication error incident type related to who identified the error and the stage in the process when the error was discovered.

Setting

Community pharmacies in Southern Derbyshire (UK) between October 2002 and October 2003.

Key findings

Seventeen pharmacies over 104 months supplied 485 940 prescribed items and provided data on 987 medication errors. A large variation in error reporting between pharmacies was noted. Pharmacists identified 72% of reported errors. This has implications for system change, clinical governance and the evolving role of the pharmacy technician. Critically, 23% of reported errors were identified after medicines were issued to patients or carers. This begs a question as to the effectiveness of current practice in identifying error early in the process. Of 968 recorded errors for which full data were available, 70% were classed as dispensing errors. This compared with 24.1% of recorded errors being prescribing and 6.0% as ‘other’ types of error. While 25.2% of identified errors concerned the wrong strength or form of medication, more worryingly, 11.0% of identified errors involved the wrong drug being potentially or actually dispensed.

Conclusions

We conclude that medication error will occur in current practice. There are identifiable deficiencies in practice that leave patients potentially exposed. This study provides benchmark figures on reported error and concludes that there are specific areas of concern for future research.
Effectiveness and acceptability of community pharmacy-based interventions in type 2 diabetes: a critical review of intervention design, pharmacist and patient perspectives
Authors: Blenkinsopp Alison , Hassey Alan
Published: December 2005

Objective

It is generally accepted that greater use could be made of community pharmacy-based interventions. Diabetes care has been proposed as an area for enhanced community pharmacy involvement. However there is no published structured review of available evidence of either effectiveness or acceptability. This review aims to identify and assess such evidence and to synthesise findings to inform the design and delivery of future community pharmacy-based interventions in diabetes care.

Method

A systematic search of published literature was conducted using a defined search strategy, electronic databases and targeted hand searching of non Index Medicus journals. The search dates were 1990–2003. The scope was international and we included only articles in the English language. Key findings Seven experimental studies which tested community pharmacy-based interventions were reviewed. Four different primary outcomes were studied: diabetes control (three studies), adherence (two studies), medication problems (one study) and patient knowledge (one study). Six studies showed positive outcomes, and the findings were statistically significant in two. The theoretical basis of the interventions was unclear. Only one study included a cost-effectiveness analysis, and the interventions were provided free of charge to patients in all seven studies. Nine attitudinal studies were included, five involving pharmacists and four with patients. Members of the public do not currently expect community pharmacists to become involved in discussions about diabetes treatment and its monitoring, but when such services are offered they are well used by patients. Pharmacists were positive about the provision of services for people with diabetes. Patients' experiences indicated that community pharmacists overestimate their current provision of information and advice to people with diabetes.

Conclusions

There is limited evidence of effectiveness of community pharmacy-based interventions in diabetes care. Components of pharmacy-based intervention which appear to contribute to effectiveness include: elicitation and discussion of patient beliefs about their diabetes and its treatment; discussion of how patients are using their medicines; review of haemoglobin A1c (HbA1c) levels; and assessing and supporting necessary lifestyle changes. Further research is needed and future interventions need to incorporate evidence from the literature on patient and pharmacist perspectives on diabetes. The findings of this review will be useful to researchers and service planners involved in developing community pharmacy-based diabetes care.
Community pharmacy provision of allergic rhinitis treatments: a longitudinal study of patient reported outcome
Authors: Sinclair Hazel , Bond Christine , Largue Gordon , Price David , Hannaford Philip
Published: December 2005

Objective

To monitor and compare the symptoms, and reported quality of life, of two groups of people who obtained treatment for allergic rhinitis from community pharmacies (prescribed or purchased).

Method

Subjects were recruited by 64 community pharmacies in 2001 and followed up by postal questionnaire at four time points: five days, four weeks, eight weeks and 26 weeks. Setting Primary care: community pharmacies in Grampian, Scotland.

Results

Response rates: five days — 84%; four weeks — 63%; eight weeks — 59%; 26 weeks — 56%. Three hundred and twenty-four subjects completed the five-day questionnaire (138 prescribed, 186 purchased). There were no important differences between groups in socio-economic variables monitored. The commonest treatments provided were antihistamines (non-sedating: 63% prescribed, 59% purchased; sedating: 3% prescribed, 16% purchased). Despite treatment, symptoms and quality-of-life impairments remained high; the prescribed group reported higher levels of many symptoms (including asthma), and lower quality of life at early time points. Most were satisfied with their treatment and few reported unmet need for pharmacy advice (11% prescribed, 3% purchased group).

Conclusion

Despite high levels of patient satisfaction with allergic rhinitis treatment, symptoms and quality-of-life impairments remained high in both groups. Widespread implementation of ‘allergic rhinitis and its impact on asthma’ (ARIA) guidelines for physicians and for pharmacists might improve management of symptoms and quality of life of patients.
Maximum aerobic performance in lines ofMusselected for high wheel-running activity: effects of selection, oxygen availability and the mini-muscle phenotype
Authors: Rezende Enrico L. , Garland Theodore , Chappell Mark A. , Malisch Jessica L. , Gomes Fernando R.
Published: December 2005

We compared maximum aerobic capacity during forced exercise(V̇O2max) in hypoxia (PO2=14% O2), normoxia (21%) and hyperoxia (30%) of lines of house mice selectively bred for high voluntary wheel running (S lines) with their four unselected control (C) lines. We also tested for pleiotropic effects of the `mighty mini-muscle' allele, a Mendelian recessive that causes a 50% reduction in hind limb muscle but a doubling of mass-specific aerobic enzyme activity, among other pleiotropic effects. V̇O2max of female mice was measured during forced exercise on a motorized treadmill enclosed in a metabolic chamber that allowed altered PO2. Individual variation in V̇O2max was highly repeatable within each PO2, and values were also significantly correlated across PO2. Analysis of covariance showed that S mice had higher body-mass-adjusted V̇O2max than C at all PO2, ranging from +10.7% in hypoxia to +20.8% in hyperoxia. V̇O2maxof S lines increased practically linearly with PO2,whereas that of C lines plateaued from normoxia to hyperoxia, and respiratory exchange ratio (=CO2production/V̇O2max)was lower for S lines. These results suggest that the physiological underpinnings of V̇O2max differ between the S and C lines. Apparently, at least in S lines, peripheral tissues may sustain higher rates of oxidative metabolism if central organs provide more O2. Although the existence of central limitations in S lines cannot be excluded based solely on the present data, we have previously reported that both S and C lines can attain considerably higher V̇O2max during cold exposure in a He-O2 atmosphere, suggesting that limitations on V̇O2max depend on interactions between the central and peripheral organs involved. In addition,mini-muscle individuals had higher V̇O2max than did those with normal muscles, suggesting that the former might have higher hypoxia tolerance. This would imply that the mini-muscle phenotype could be a good model to test how exercise performance and hypoxia tolerance could evolve in a correlated fashion, as previous researchers have suggested.
Dietary choice behavior inCaenorhabditis elegans
Authors: Shtonda Boris Borisovich , Avery Leon
Published: December 2005

Animals have evolved diverse behaviors that serve the purpose of finding food in the environment. We investigated the food seeking strategy of the soil bacteria-eating nematode Caenorhabditis elegans. C. elegans bacterial food varies in quality: some species are easy to eat and support worm growth well, while others do not. We show that worms exhibit dietary choice: they hunt for high quality food and leave hard-to-eat bacteria. This food seeking behavior is enhanced in animals that have already experienced good food. When hunting for good food, worms alternate between two modes of locomotion, known as dwelling: movement with frequent stops and reversals; and roaming: straight rapid movement. On good food, roaming is very rare, while on bad food it is common. Using laser ablations and mutant analysis, we show that the AIY neurons serve to extend roaming periods, and are essential for efficient food seeking.
Pupil shapes and lens optics in the eyes of terrestrial vertebrates
Authors: Malmström Tim , Kröger Ronald H. H.
Published: December 2005

Animal eyes that are primarily used under low-light conditions usually have optical systems of short depth of focus, such that chromatic defocus may lead to considerable blurring of the images. In some vertebrates, the problem is solved by multifocal lenses having concentric zones of different focal lengths, each of which focuses a different relevant spectral range onto the retina. A partially constricted circular pupil would shade the peripheral zones of the lens, leading to the loss of well-focused images at relevant wavelengths. The slit pupil, however, allows for use of the full diameter of the lens even in bright light. We studied species of terrestrial vertebrates from a variety of phylogenetic groups to establish how widespread multifocal lenses are and how pupil shapes are adapted to the optical systems. We found that multifocal lenses are common from amphibians to mammals, including primates. Slit pupils were only present in animals having multifocal optical systems. Among the felids, small species have multifocal lenses and slit pupils, while large species have monofocal lenses and round pupils. The Eurasian lynx, a cat of intermediate size, has an intermediate eye design. The functional significance of the absence of multifocal optical systems in large felids remains mysterious, because such systems are present in other large-eyed terrestrial vertebrates. Multifocal optical systems in nocturnal prosimians suggest that those animals have colour vision despite being described as cone monochromats.
On the importance of radiative heat exchange during nocturnal flight in birds
Authors: Léger Jérôme , Larochelle Jacques
Published: December 2005

Many migratory flights take place during cloudless nights, thus under conditions where the sky temperature can commonly be 20°C below local air temperature. The sky then acts as a radiative sink, leading objects exposed to it to have a lower surface temperature than unexposed ones because less infrared energy is received from the sky than from the surfaces that are isothermic to air. To investigate the significance of this effect for heat dissipation during nocturnal flight in birds, we built a wind tunnel with the facility to control wall temperature (TASK) and air temperature (TAIR) independently at air speeds(UWIN) comparable to flying speeds. We used it to measure the influence of TASK, TAIR and UWIN on plumage and skin temperatures in pigeons having to dissipate a thermal load while constrained at rest in a flight posture.

Our results show that the temperature of the flight and insulation plumages exposed to a radiative sink can be accurately described by multiple regression models (r2>0.96) based only on TAIR, TASK and UWIN. Predictions based on these models indicate that while convection dominates heat loss for a plumage exposed to air moving at flight speed in a thermally uniform environment, radiation may dominate in the presence of a radiative sink comparable to a clear sky.

Our data also indicate that reducing TASK to a temperature 20°C below TAIR can increase the temperature difference across the exposed plumage by at least 13% and thus facilitate heat flow through the main thermal resistance to the loss of internally produced heat in birds. While extrapolation from our experimentally constrained conditions to free flight in the atmosphere is difficult, our results suggest that the sky temperature has been a neglected factor in determining the range of TAIR over which prolonged flight is possible.
Interpolation of animal tracking data in a fluid environment
Authors: Tremblay Yann , Shaffer Scott A. , Fowler Shannon L. , Kuhn Carey E. , McDonald Birgitte I. , Weise Michael J. , Bost Charle-André , Weimerskirch Henri , Crocker Daniel E. , Goebel Michael E. , Costa Daniel P.
Published: December 2005

Interpolation of geolocation or Argos tracking data is a necessity for habitat use analyses of marine vertebrates. In a fluid marine environment,characterized by curvilinear structures, linearly interpolated track data are not realistic. Based on these two facts, we interpolated tracking data from albatrosses, penguins, boobies, sea lions, fur seals and elephant seals using six mathematical algorithms. Given their popularity in mathematical computing,we chose Bézier, hermite and cubic splines, in addition to a commonly used linear algorithm to interpolate data. Performance of interpolation methods was compared with different temporal resolutions representative of the less-precise geolocation and the more-precise Argos tracking techniques. Parameters from interpolated sub-sampled tracks were compared with those obtained from intact tracks. Average accuracy of the interpolated location was not affected by the interpolation method and was always within the precision of the tracking technique used. However, depending on the species tested, some curvilinear interpolation algorithms produced greater occurrences of more accurate locations, compared with the linear interpolation method. Total track lengths were consistently underestimated but were always more accurate using curvilinear interpolation than linear interpolation. Curvilinear algorithms are safe to use because accuracy, shape and length of the tracks are either not different or are slightly enhanced and because analyses always remain conservative. The choice of the curvilinear algorithm does not affect the resulting track dramatically so it should not preclude their use. We thus recommend using curvilinear interpolation techniques because of the more realistic fluid movements of animals. We also provide some guidelines for choosing an algorithm that is most likely to maximize track quality for different types of marine vertebrates.
Ant navigation: resetting the path integrator
Authors: Knaden Markus , Wehner Rüdiger
Published: December 2005

Desert ants use path integration as their predominant system of long-distance navigation, but they also make use of route-defining and nest-defining visual landmarks. Such landmark-gained information might override the information provided by the path integrator, but nevertheless the path integrator keeps running. Here we show that only cues that are associated with the ant being inside the nest are able to reset the path integrator to zero state. Ants were captured at a feeder, i.e. without having run off their home vector, and were forced to enter the nest. On their next outbound run their walking direction differed by 180° from that of ants that had also been captured at the feeder but instead of having been forced to enter the interior of the nest were released at its entrance. Whereas these latter ants still ran off their home vector pointing in the feeder-nest direction (and by this departed from the nest in a direction opposite to the feeder direction)the former ants had reset their home vector to zero state, and had therefore been able to reload their learned feeder vector, and consequently departed from the nest in the feeder direction.

Owing to its egocentric nature the path-integrator is error prone. Hence,it is a suitable strategy to reset the path integrator if the ant has appeared at its final goal, the nest. Otherwise during consecutive foraging runs navigational errors would steadily increase.
Molecular cloning and mRNA expression analysis of carp embryonic, slow and cardiac myosin heavy chain isoforms
Authors: Nihei Yoshiaki , Kobiyama Atsushi , Ikeda Daisuke , Ono Yosuke , Ohara Satoshi , Cole Nicholas J. , Johnston Ian A. , Watabe Shugo
Published: December 2005

Three embryonic class II myosin heavy chains (MYHs) were cloned from the common carp (Cyprinus carpio L.), MYHemb1,MYHemb2 and MYHemb3. MYH DNA clones were also isolated from the slow muscle of adult carp acclimated to 10°C (MYHS10)and 30°C (MYHS30). Phylogenetic analysis demonstrated that MYHemb1 and MYHemb2 belonged to the fast skeletal muscle MYH clade. By contrast, the sequence of MYHemb3 was similar to the adult slow muscle isoforms, MYHS10 and MYHS30. MYHemb1 and MYHemb2 transcripts were first detected by northern blot analysis in embryos 61 h post-fertilization (h.p.f.) at the heartbeat stage, with peak expression occurring in 1-month-old juveniles. MYHemb1 continued to be expressed at low levels in 7-month-old juveniles when MYHemb2 was not detectable. MYHemb3transcripts appeared at almost the same stage as MYHemb1transcripts did (61 h.p.f.), and these genes showed a similar pattern of expression. Whole mount in situ hybridization analysis revealed that the transcripts of MYHemb1 and MYHemb2 were expressed in the inner part of myotome, whereas MYHemb3 was expressed in the superficial compartment. MYHS10 and MYHS30 mRNAs were first detected at hatching. In adult stages, the expression of slow muscle MYH mRNAs was dependent on acclimation temperature. MYHS10 mRNA was expressed at an acclimation temperature of 10 and 20°C, but not at 30°C. In contrast, MYHS30 mRNA was strongly expressed at all acclimation temperatures. The predominant MYH transcripts found in adult slow muscle and in embryos at hatching were expressed in adult fast muscle at some acclimation temperatures but not others. A MYH DNA clone was isolated from the cardiac muscle of 10°C-acclimated adult fish (MYHcard). MYHcard mRNA was first detected at 61 h.p.f., but strong signals were only observed in the adult myocardium. The present study has therefore revealed a complex pattern of expression of MYH genes in relation to developmental stage, muscle type and acclimation temperature. None of the skeletal muscle MYHs identified so far was strongly expressed during the late juvenile stage, indicating further developmentally regulated members of the MYH II gene family remain to be discovered.
Hunting archer fish match their take-off speed to distance from the future point of catch
Authors: Wöhl Saskia , Schuster Stefan
Published: December 2005

Archer fish can shoot down insect prey with a sharp jet of water. Fish usually fire from positions that are not directly below their target so that a dislodged insect falls ballistically with a horizontal velocity component. Only 100 ms after the insect is on its path both the shooter and other school members can initiate a rapid turn and then head straight in the direction of the later point of impact of their falling prey. The quick turn and subsequent take-off are performed `open-loop', based on the initial values of the falling insect's motion. We report here that archer fish can not only take off in the direction of the later point of impact but also predict its distance. Distance information allows the fish to adjust their take-off speed so that they would arrive within a narrow time slot slightly (about 50 ms) after their prey's impact, despite large differences in the size of the aligning turn and in the distance to be covered. Selecting a constant speed program with matched speed and catching the insect on the move minimizes frictional losses. The initial speed of starting fish is slightly but systematically too slow and is increased later so that the fish arrive 20 ms earlier than expected and often make the catch on a higher than take-off speed. The variability of later speed changes suggests a systematic `error' in the take-off, as if the fish underestimated distance. However, this apparent deficiency seems well adapted to the fish catching their prey at a high speed: if later the fish had no possibility to correct an initial error then it is better to start slightly too slow in order to minimize the risk of overshooting the point of catch.
Ultrasonic Cavitational Activation: A Simple and Feasible Route for the Direct Conversion of Zinc Acetate to Highly Monodispersed ZnO
Authors: Sivakumar Manickam , Towata Atsuya , Yasui Kyuichi , Tuziuti Toru , Iida Yasuo
Published: December 2005

Highly monodispersed submicron structures of ZnO were successfully fabricated by a simple ultrasonic cavitational activation, which assists a direct conversion of zinc acetate to ZnO, without using any additives.
Yellow-green Fluorescence of 5,11- and 5,12-Bis(diisopropylsilyl)naphthacenes
Authors: Kyushin Soichiro , Ishikita Yoshihito , Matsumoto Hideyuki , Horiuchi Hiroaki , Hiratsuka Hiroshi
Published: December 2005

5,11- and 5,12-Bis(diisopropylsilyl)naphthacenes (2a and 2b) were synthesized, and their electronic properties were studied. In UV–visible spectra, the lowest energy absorption bands of 2a and 2b are more intense than that of naphthacene. Compounds 2a and 2b show intense yellow-green fluorescence, and the fluorescence quantum yields are almost two times higher than that of naphthacene.
Fast Synthesis of Si- and Ce-MCM-48 Mesoporous Molecular Sieve with Hydrothermal Stability
Authors: Wang Lingzhi , Shao Yaofeng , Zhang Jinlong , Anpo Masakazu
Published: December 2005

A novel route for reducing crystallization times of Si- and Ce-MCM-48 mesoporous molecular sieves and simultaneously endowing them with hydrothermal stability has been developed.
Ester Condensation from a Stoichiometric Mixture of a Carboxylic Acid and an Alcohol at 313 K Assisted by Pervaporation via Zeolite Membranes
Authors: Inoue Tomoya , Nagase Takako , Hasegawa Yasuhisa , Kiyozumi Yoshimichi , Sato Koichi , Kobayashi Kiyoshi , Nishioka Masateru , Hamakawa Satoshi , Mizukami Fujio
Published: December 2005

Ester condensation was conducted from stoichiometric mixture of a carboxylic acid and an alcohol (acetic acid and ethanol was used as a test reaction) at nearly room temperature (313 K), assisted by pervaporation via zeolite membrane with hydrophilic character. We succeeded preparing the hydrophilic zeolite membrane tolerant against acidic environment, and the membrane worked stably to shift equilibrium.
Twenty years’ experience of a telehealth service in the UK
Authors: Mansfield Peter
Published: December 2005

Since 1996 a small call centre has been operated to provide instant self-help, non-medical advice to members. Non-clinical advisers work under a medical director. The scheme grew to 1200 member-families from a regional catchment area, peaking at 2500 across the country. About 30–50 telephone calls are received each day and up to 1000 Web visits per day; about 20–50 postal items are sent out daily to members. In a telephone poll during 2001, half of our current members said that they used the National Health Service about 70% less than before they joined, but a third said that they used complementary and alternative medicines 80% more. Half had gained in confidence by about 50% in managing their own health. Members most often join for alternative medical help with a specific problem, but stay if they begin to appreciate the help we can give them in regaining and keeping health in the round. Our retention of new members for a second year is only 10–20%. The ‘barefoot’ profession of telehealth adviser appears to meet a community need.
Electronic patient record systems and the general practitioner: An evaluation study
Authors: Mäkelä K , Virjo I , Aho J , Kalliola P , Koivukoski A-M , Kurunmäki H , Kähärä M , Uusitalo L , Valli M , Vuotari V , Ylinen S
Published: December 2005

We studied how well electronic patient record (EPR) systems meet the needs of general practitioners (GPs) and other healthcare professionals for specific information. GPs in eight health centres in the South-Ostrobothnia region of Finland were invited to participate. They used three types of EPR system. They were asked to access EPRs to obtain 20 types of information for patients receiving anticoagulant treatment. In total 2389 patient cases were studied. All of the information requested was available for 73% of the cases (range 55–93%). There was a significant difference between the type of EPR system and the percentage of patients for whom information was available through the EPR. However, further analysis showed that differences in performance between EPR systems probably reflected differences in the way EPRs were used by different organizations. Great care should be taken in attempts to rank EPR systems based on their performance.
Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic
Authors: Hailey D , Foerster V , Nakagawa B , Wapshall T M , Murtagh J A , Smitten J , Steblecki J A , Wong G
Published: December 2005

We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.
Successes and failures: What are we measuring?
Authors: Whetton Sue
Published: December 2005

In telemedicine and telehealth, the perception of success is complex, varies according to time and context, and depends on the perspective of the observer. Several reviews of the evaluation literature have been undertaken in recent years. These reviews identify common methodological shortcomings. Telehealth services continue to be funded as short-term projects. While it is essential to address methodology issues, it is important to understand that studies of pilot projects provide only interim findings about the feasibility of such applications, not how well they operate as mature applications. This represents something of a conundrum: evaluation is expected to establish the long-term value of telehealth using criteria which are specific to short-term projects. A useful approach would be to develop frameworks enabling all similar studies (e.g. diabetic home care) to be examined in order to extract commonalities and differences. This would enable us to draw conclusions about where telehealth is effective, as well as what variables demonstrate ‘success’
A tele-ultrasound needs analysis in Queensland
Authors: Lewis Chris
Published: December 2005

A tele-ultrasound survey was distributed to clinicians and sonographers in regional and rural sites throughout Queensland. In all, 28 centres were invited to complete a profile questionnaire, and 27 centres were invited to complete a case-log. Twenty-five of the 28 questionnaires were returned (89% response rate). Twenty-two of the 27 case-logs were returned (81 % response rate). Obstetric ultrasound was the most frequently performed ultrasound examination, accounting for 846 (35%) of the 2410 recorded during the two-week survey period. The respondents considered that 182 cases would have benefited from further consultation: 79% for diagnostic advice, 1 3% for patient management advice and 8% for advice on examination technique. Six hospitals appeared to have the greatest need for a tele-ultrasound service. There was a strong preference for the store-and-forward transmission of static images: 70% preferred this modality, in comparison with 19% who preferred realtime transmission and 11 % who preferred store-and-forward transmission of video clips.
Supporting community carers via videoconferencing
Authors: Van Ast Penny
Published: December 2005

We provided support, practical advice and networking opportunities for carers in rural and remote areas of Western Australia through the use of videoconferencing. The first videoconference for carers occurred in June 2004. In the next 12 months there were 11 videoconferences with 11 rural towns. Some sessions were point-to-point and some were multipoint. Over 90 carers participated in the sessions. A facilitator with expertise on stress in carers delivered the sessions from Perth. The acceptance of videoconferencing as a support medium by the carers attending was positive and there were requests for the sessions to be continued. The skills of the facilitator to connect in a very personal way with each person were important to the success of the programme.
Striving for evidence in e-health evaluation: Lessons from health technology assessment
Authors: Gagnon Marie-Pierre , Scott Richard E
Published: December 2005

Evaluation is crucial to the integration of e-health applications into the health-care system and their ultimate sustainability. However, e-health evaluation is often criticized for the poor quality of research design, the lack of common outcome indicators and the absence of an agreed theory. Health technology assessment (HTA) could offer a sound methodological basis for e-health evaluation. However, there have been major concerns about the applicability of the HTA approach to the evaluation of e-health initiatives. Evaluators - and decision makers - must accept that telehealth evaluation may serve different purposes for different stakeholders, and therefore concede that no single evaluation framework or methodology, even the randomized controlled trial, is totally objective. To address the complex environment of telehealth evaluation, a participatory strategy is useful, whereby stakeholders are involved in the study design and definition of evaluation questions at each phase. This will also build confidence between the evaluation team and the stakeholders, facilitating informed decision making through an integrated knowledge mobilization activity.
Instant wireless transmission of radiological images using a personal digital assistant phone for emergency teleconsultation
Authors: Kim Dong-Keun , Yoo Sun K , Kim Sun H
Published: December 2005

The instant transmission of radiological images may be important for making rapid clinical decisions about emergency patients. We have examined an instant image transfer system based on a personal digital assistant (PDA) phone with a built-in camera. Images displayed on a picture archiving and communication systems (PACS) monitor can be captured by the camera in the PDA phone directly. Images can then be transmitted from an emergency centre to a remote physician via a wireless high-bandwidth network (CDMA 1 × EVDO). We reviewed the radiological lesions in 10 normal and 10 abnormal cases produced by modalities such as computerized tomography (CT), magnetic resonance (MR) and digital angiography. The images were of 24–bit depth and 1144 × 880, 1120 × 840, 1024 × 768, 800 × 600, 640 × 480 and 320 × 240 pixels. Three neurosurgeons found that for satisfactory remote consultation a minimum size of 640 × 480 pixels was required for CT and MR images and 1024 × 768 pixels for angiography images. Although higher resolution produced higher clinical satisfaction, it also required more transmission time. At the limited bandwidth employed, higher resolutions could not be justified.
Attitudes of breast cancer professionals to conventional and telemedicine-delivered multidisciplinary breast meetings
Authors: Fielding R G , Macnab M , Swann S , Kunkler I H , Brebner J , Prescott R J , Maclean J R , Chetty U , Neades G , Walls A , Bowman A , Dixon J M , Gardner T , Smith M , Lee M J , Lee R J
Published: December 2005

We surveyed the attitudes of breast cancer professionals to standard face-to-face and future telemedicine-delivered breast multidisciplinary team (MDT) meetings. Interviews, which included the Group Behaviour Inventory, were conducted face-to-face (n = 19) or by telephone (n = 26). The mean total score on the Group Behaviour Inventory was 96 (SD 19) for 33 respondents, which indicated satisfaction with standard MDT meetings, irrespective of role and base hospital. Positive attitudes to videoconferencing were more common among participants with previous experience of telemedicine (Spearman's rank correlation 0.26, P = 0.91). Common themes emerging from the interviews about telemedicine-delivered MDTs included group leadership, meeting efficiency, group interaction, group atmosphere and technical quality of communication. Most participants were satisfied with standard breast MDTs. Nurses and allied health professionals were least supportive of telemedicine.
Telemedicine by email in remote Cambodia
Authors: Heinzelmann Paul J , Jacques Gary , Kvedar Joseph C
Published: December 2005

An email-based telemedicine service was implemented in two remote village communities in Cambodia. Volunteer physicians at the Brigham and Women's Hospital, Massachusetts General Hospital and the Sihanouk Hospital Center of Hope in Phnom Penh provide monthly consultations to the local clinicians. Between February 2001 and May 2005, there were 469 tele-consultations. The 214 telemedicine cases involving new patients managed in the first 28 months were reviewed. The mean duration of the chief complaint at the initial patient visit was 37 months for the first six months and had dropped to eight months by the end of the study period. Of 63 adult patients surveyed, all were either satisfied (54%, n = 34) or very satisfied (46%, n = 29) with their experience in the telemedicine clinic. About 78% (n = 49) were willing to pay, on average, US$0.63 for their visits. The introduction of basic point-of-care laboratory testing in November 2004 was associated with a reduction in patients requiring off-site referral for completion of laboratory testing (69% before to 35% afterwards, P<0.001). The success of the pilot telemedicine programme confirms the value of email support for non-physician health-care workers in the developing world.
Development of a pilot telemedicine network for paediatric oncology in Brazil
Authors: De Mello André Nebel , Hira Adilson Yuuji , Faria Regis Rossi Alves , Zuffo Marcelo Knörich , Filho Vicente Odone
Published: December 2005

We established a pilot telemedicine network for paediatric oncology in Brazil, linking the School of Medicine at the University of Sao Paulo in Sao Paulo City to the ‘Hospital de Base’ in Porto Velho, Rondonia, located in the Amazon region, 3000 km away. The videoconferencing link used ISDN transmission at 384 kbit/s. The network was used for patient screening, follow-up, treatment monitoring and other activities. Between March 2000 and 2002, 69 videoconferences were held for 33 patients, 29 with cancer. During this period, 16 patients required transfer, 18 patients died and 11 achieved cancer remission. The main cause for patient mortality (infection) was not one that could be addressed directly by telemedicine. Using the School of Medicine as a benchmark, the average mortality rate for paediatric cancer patients in the pilot was higher. However, it was lower than previous levels observed at Rondonia (62% versus 80%).
An e-health needs assessment of medical residents in Cameroon
Authors: Scott Richard E , Ndumbe Peter , Wootton Richard
Published: December 2005

Medical residents from Yaounde I University in Cameroon are required to spend periods of time in rural or remote locations to complete their training. To determine if e-health might lessen their isolation and enhance patient care, a needs assessment of the residents was performed using a brief questionnaire (five items) about the situation in which residents found themselves outside their medical school environment. We gave the questionnaires to 45 residents. Seventeen questionnaires had been returned at the time of the site visit, a response rate of 38%. Most residents indicated that the ability to contact a mentor would have either made them feel more confident (16, or 94%) or altered their handling of recent cases (15, or 88%). All residents had access to a mobile phone, and many (11, or 65%) had used it to contact a medical colleague for guidance. A low-cost and technologically simple telemedicine solution that maximized use of mobile phone capability, provided access to medical and health-care information, and permitted exchange of images would be an appropriate response to the identified needs.
Ziprasidone- and Lithium-Induced Neuroleptic Malignant Syndrome
Authors: Borovicka Mary C , Bond Linda C , Gaughan Kerri M
Published: December 2005

Objective:

To report a case of ziprasidone- and lithium-induced neuroleptic malignant syndrome (NMS).

Case Summary:

A 47-year-old white male with a history of schizoaffective disorder was admitted to the hospital due to an exacerbation of severe mania. He had been taking lithium 450 mg twice daily and divalproex sodium 750 mg/day. On hospital day 2, ziprasidone 80 mg twice daily was added, and as-needed doses of intramuscular ziprasidone 20 mg and lorazepam 2 mg were used for agitation. On day 6, the patient developed hyperthermia (39.4 °C), elevated creatine kinase 26 000 units/L and white blood cell (WBC) count (20.7 × 103/μL), myoglobinuria, hypotension (68/40 mm Hg), altered mental status, and tachypnea (28 breaths/min). This case is notable for the absence of muscle rigidity, which presents in greater than 90% of patients with NMS taking traditional antipsychotics.

Discussion:

This case of ziprasidone- and lithium-induced NMS is of probable cause, as determined by the Naranjo probability scale. The patient presented with symptoms consistent with NMS 4 days after initiation of ziprasidone and lithium. The majority of NMS cases present with the core features of hyperthermia, muscle rigidity, and elevated CK levels. Other frequently seen symptoms include altered mental status, tachypnea, tachycardia, elevated WBC count, hypotension, diaphoresis, and myoglobinuria. Our patient presented with 2 of the core symptoms, but did not develop muscle rigidity at any time. NMS criteria include muscle rigidity as one of the major presenting symptoms. Recent literature suggests that perhaps NMS due to novel antipsychotics presents with less muscle rigidity than is seen with traditional agents due to their lower affinity for the dopamine D2 receptor.

Conclusions:

This case illustrates that NMS due to the novel antipsychotic ziprasidone may present with many of the core symptoms of the syndrome, but possibly less muscle rigidity than is seen with traditional agents.
Mechanical Property Changes in Reactor Vessel Materials Thermally Aged for 209 000 H at 260°C
Authors: Gunawardane Heshan P. , Hall J. Brian , Rosinski Stan T.
Published: December 2005

Surveillance materials consisting of a SA-508 Class 2 forging, a Mn–Mo–Ni Linde 80 submerged-arc weld, and an SA-533, Grade B, Class 1, correlation monitor material were thermally aged on a commercial reactor pressure vessel. The materials were exposed to a thermal environment of 260°C for 209000h. This temperature is below the range (minimum of 370°C) where the effects of long-term thermal aging are typically considered relevant. Charpy impact, master curve transition temperature, upper-shelf fracture toughness, and tensile testing were conducted to evaluate the long-term thermal aging changes in material properties. Small changes in the impact properties were observed for all the materials, but were generally within the 95 % confidence bounds for typical Charpy data. Upper-shelf energy also showed small variations, but a general decrease for all materials was not seen. Fracture toughness testing at the upper shelf indicated that the upper-shelf toughness had increased, however the data is scattered. Master curve T0 testing in the transition region showed little change in the forging and plate results; however an improvement in the transition temperature of the weld metal was measured.
Radioactivity Inspections Applied to the Steelmaking Industry
Authors: Buoro S , Giurgevich M
Published: December 2005

The recycling of exhausted or end-of-life materials in industry is pursued worldwide to save natural resources and reduce pollution. The utilization of scrap as raw material in the steelmaking industry is a well-assessed technology. Nevertheless, recycled materials must be “free” from dangerous elements or compounds and particularly from hazardous levels of radioactivity. Typical problems to be faced in the electrical steelmaking industry relevant to radioactivity levels and measurements techniques are discussed in this paper.