Effects of electro-acupuncture on the expression of c-jun and c-fos in spared dorsal root ganglion and associated spinal laminae following removal of adjacent dorsal root ganglia in cats

This study evaluated the plastic changes of c-jun andc-fos in the right sixth lumbar dorsal root ganglion (L₆ DRG), Rexed’s lamina II in representative spinal segments L₃, L₅, and L₆ and in the nucleus dorsalis (ND) at L₃ segments after electro-acupuncture (EA) in cats subjected to removal of L₁–L₅ and L₇–S₂ DRG. Following dorsal root ganglionectomy, there was a significant increase in the density of c-jun immunoreactivity in the neurons and glia in spinal lamina II and in the ND; there was also marked elevation in the expression of c-fos in ND. In both cases there was no change in the c-jun and c-fos immunoreactivity in the DRG. After EA in the operated animals, there was an up-regulation in the expression of c-jun in the L₆ DRG and the associated spinal lamina II; however, increased c-fos expression was detected only in the L₆ DRG. Western blot and RT-PCR were also performed to quantitatively explore the mRNA and protein expression changes in the spinal dorsal horn and associated DRG. Following partial deafferentation, there was a significant increase in the protein level of both c-jun and c-fos in the dorsal horn, while, in both cases there was no change in c-jun and c-fos protein and mRNA in the DRG. After EA in the operated animals, both c-jun protein and its mRNA in the L₆ DRG as well as the associated dorsal horn of L6 spinal segment were upregulated, but increased c-fos protein and its mRNA was observed only in the L₆ DRG. These findings suggested that c-jun and c-fos might be related to the acupuncture promoted spinal cord plasticity as reported previously.     

Empowerment of patients and communication with health care professionals through an electronic health record

Objective: The aim of this project was to design and develop a personal electronic health record (EHR) in order to support patient empowerment and additionally to enhance their communication and information exchange with health professionals through this EHR. Method: The functionality of a personal Electronic Healthcare Record (EHR) may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals and even reminder based support for the empowered citizen, to actively take care of his health, based on relevant disease management programs. It is one means to support patient empowerment, additionally supported by tools for building a patient community. Since storage and communication of data in an EHR comprises sensible personal health data, each of those functions needs specific security and access management requirements to be considered and implemented. Result: Clinical pilot projects are already done or under development.     

Using n-gram method in the decomposition of compound medical diagnoses

Objective: Our goal in this study was to find an easy to implement method to detect compound medical diagnosis in Hungarian medical language and decompose them into expressions referring to a single disease. Methods: A corpus of clinical diagnoses extracted form discharge reports (3079 expressions, each of them referring to only one disease) was represented in an n-gram tree (a series of n consecutive word). A matching algorithm was implemented in a software, which is able to identify sensible n-grams existing both in test expressions and in the n-gram tree. A test sample of another 92 diagnoses was decomposed by two independent humans and by the software. The decompositions were compared with measure the recall and the precision of the method. Results: There was not full agreement between the decompositions of the humans, (which underlines the relevance of the problem). A consensus was arrived in all disagreed point by a third opinion and open discussion. The resulting decomposition was used as a gold standard and compared with the decomposition produced by the computer. The recall was 82.6% the precision 37.2%. After correction of spelling errors in the test sample the recall increased to 88.6% while the precision slightly decreased to 36.7%. Conclusion: The proposed method seems to be useful in decomposition of compound diagnostic expressions and can improve quality of diagnostic coding of clinical cases. Other statistical methods (like vector space methods or neural networks) usually offer a ranked list of candidate codes either for single or compound expressions, and do not warn the user how many codes should be chosen. We propose our method especially in a situation where formal NLP techniques are not available, as it is the case with scarcely spoken languages like Hungarian.     

Collaborative environment for clinical reasoning and distance learning sessions

Background: The medical curriculum has changed with the adoption of the student-centered learning paradigm. Clinical reasoning learning (CRL) is used in order to develop and improve students’ clinical reasoning and problem-solving skills. Purpose: We have observed that, in complement to traditional CRL sessions, students commonly consult resources available on the internet. Based on this observation, our objective is to create computer tools to coordinate CRL sessions at distance, integrating these electronic resources at every step of the reasoning process. Material and methods: In order to create the system, we elaborated an object-oriented model of a computer-supported collaborative learning environment. The proposed system includes a local web-server to store electronic resources and a relational database to store their electronic addresses (urls). was used as the programming language. Results: We developed a set of cooperative platform-independent tools. This environment includes a communication tool. Multimedia data exchange is possible. Information is shared thanks to an electronic notepad and whiteboard tools. Perspectives: This learning environment will be integrated in the French Virtual Medical University project, and is intended to be used for undergraduate, internships, residency or continuing medical education.     

Prevalence of disability and associated social and health-related factors among the elderly in Spain: a population-based study

Objectives: To estimate the prevalence of disability and its association with morbidity and other social and health-related factors among Spain’s non-institutionalized elderly population. Methods: Cross-sectional survey, by home-based personal interview, covering a sample of 4000 subjects representative of the non-institutionalized Spanish population aged 60 years and over. The relationship between disability and social and health-related study variables was studied using logistic regression. Results: A total of 72.9% of subjects reported some type of disability: 59.1% in agility, 51.6% in mobility, 40.1% in instrumental activities and 19.1% in activities of daily living. After adjusting for all relevant variables, disability showed to be significantly more frequent for: female gender (OR=1.83; 1.53–2.19); more advanced age (OR=4.54; 3.27–6.32); low/no educational level (OR=2.01; 1.67–2.42); deteriorated cognitive status (OR=1.67; 1.24–2.23); at least two chronic diseases (OR=2.54; 2.01–3.20); poor perceived health status (OR=3.02; 2.48–3.69); little physical activity (OR=2.57; 1.94–3.42); and greater use of hospital care (OR=1.34; 1.10–1.64). Conclusions: Prevalence of disability among Spain’s non-institutionalized elderly population is very high. This might be explained by a greater number of chronic diseases, a higher percentage of subjects with low educational level and a higher proportion of community-dwelling elderly persons than in Anglo-Saxon countries.     

Development and evaluation of a phenotypic assay monitoring resistance formation to protease inhibitors in HIV-1-infected patients

Several aspects of enzyme-linked immunosorbent assay (ELISA) procedures and data analysis have been examined in an attempt to find a rapid and reliable method for discriminating between ‘positive’ and ‘negative’ results when testing a large number of samples. A layout of ELISA plates was designed to reduce uncontrolled variation and to optimize the number of negative and positive controls. A transformation using the fourth root (A^1/4) of the optical density readings corrected for the blank (A) stabilized the variance of most ELISA data examined. Transformed A values were used to calculate the true limits, at a set protection level, for false positive (C) and false negative (D). Methods are discussed to reduce the number of undifferentiated samples, i.e. the samples with response falling between C and D. The whole procedure was set up for use with an electronic spreadsheet. With the addition of few instructions of the type ‘if…then…else’ in the spreadsheet, the ELISA results were obtained in the simple trichotomous form ‘negative/undefined/positive’. This allowed rapid analysis of more than 1100 maize samples testing for the presence of seven aphid-borne viruses—in fact almost 8000 ELISA samples.     

Depression, partnership, social support, and parenting: interaction of maternal factors with behavioral problems of the child

Background: Children of depressed mothers are at elevated risk to develop behavioral problems. Besides maternal depression, other risk factors like interpersonal functioning, are discussed. The object of this study was to investigate the predictive value of the maternal variables depression, partnership, social support, and parenting for internal and external behavioral problems of the children. Methods: A total of 100 mothers and their children who participated in a German mother–child rehabilitation program were interviewed by questionnaire. Structural equation modeling was conducted in order to determine the predictive value of the mentioned maternal variables on behavioral problems of the children. Results: Behavioral problems of the children can be predicted by the parenting and the partnership of the mothers. Mothers with more parenting difficulties and with less containment with partnership report more behavioral problems of their children. Depression and social support do indirectly predict the child’s problems. Limitations: The data is from a cross-sectional sample. Therefore, path models do not demonstrate causation. All information is based upon maternal report. Conclusions: These findings suggest the need for intervention programs which focus on the parenting and the partnership of the mothers. More research with independent assessment is needed.     

What are older peoples' experiences of taking antidepressants?

Background: Antidepressants are prescribed widely to older people but little is known about older peoples’ own reported experiences of taking them in routine practice. Methods: A doctor interviewed 92 people, aged over 65, with a hospital diagnosis of depression, who had been prescribed an antidepressant in the past year. Results: Most of the subjects were prescribed a selective serotonin reuptake inhibitor (SSRI), at a standard dose, for at least 8 weeks. Most people felt the antidepressants were helpful, although a third felt they made no difference. Two thirds of older people reported having adverse effects of which most were moderate or severe. The most common adverse effects were headache and dry mouth. Only a third said that they always took their tablets. Limitations: The sample was restricted to older people seen by hospital services. Interviews were carried out by a doctor and patients may not have been entirely truthful. Conclusions: Older people have important views about their treatment that they are prepared to tell a doctor. A lot of older people do not think their antidepressants are helpful, and the majority experience adverse effects. Many do not always take their medication. Doctors should routinely ask older people about their experiences of taking antidepressants.     

e-meducation.org: an open access medical education web portal

Background

Internet can serve in opening the door to a brand new world of high quality medical information. However, the chaotic size of data available in the WWW is often misleading. We sought to provide the world medical community with a web portal that may be used as a clearinghouse providing the outlet for dissemination of high quality WWW educational products.

Methods

Directories of the relevant WWW resources have been compiled and others are being currently under development to cover most medical fields. A custom-built medical search engine was created. Really Simple Syndication (RSS) feeds and video sharing services were reviewed for their quality and were presented along with case-based educational presentations through a user-friendly web portal interface. A directory of guidelines database is currently under development.

Results

The educational portal "e-meducation" available at http://www.e-meducation.org/ has been launched in December 2006 and at the moment, provides links to more than 800 educational web-pages, more than 2100 clinical practice guidelines, 32 news feeds, and 14 educational videos. The web site also hosts 40 case-based presentations and a custom medical search engine.

Conclusion

Based on the incorporation of simple and tested educational strategies such as case based instruction and interactive learning, e-meducation.org aims to become a prototype platform that offers a more convenient interface to existing products, resources and medical contents.     

MCP-1, RANTES, and SDF-1 polymorphisms in Mexican patients with systemic lupus erythematosus

Chemokines and cytokines play an important role in the inflammatory development and progression of autoimmune diseases. The aim of the present study was to evaluate the role of MCP-1, SDF-1, and RANTES polymorphisms as susceptibility markers for systemic lupus erythematosus (SLE) in a group of Mexican patients. MCP-1-2518, SDF-1 G801A, and RANTES-28 polymorphisms were determined in 242 patients with SLE and 220 ethnically matched healthy controls by the polymerase chain reaction–restriction fragment length polymorphism technique. The differences between patients and healthy controls were evaluated by χ², Fisher’s exact test, and Woolf method for odds ratio. A moderately increased frequency of MCP-1-2518 A allele (p = 0.033, pC = NS) and AA genotype (p = 0.017, pC = NS) existed in SLE patients compared with healthy controls. There was a relationship between polymorphisms and some clinical and laboratory characteristics. SLE patients with and without antiphospholipid syndrome demonstrated different distribution of SDF-1 G801A genotype frequencies. On the other hand, patients with leukopenia, anti-dsDNA, and antiphospholipid autoantibodies demonstrated different MCP-1-2518 genotype distribution compared with patients without these features. Our results suggest that MCP-1 polymorphism is moderately associated with the genetic susceptibility to SLE in Mexican individuals. The polymorphisms could be related to specific clinical and laboratory characteristics in these patients.     

Can evaluation studies benefit from triangulation? A case study

Background: Information and communication technologies (ICTs) are increasingly being used in health care. Rigorous evaluations of ICT applications during both introduction and routine use are of great importance for decision makers and users. Within evaluation research, two main (and often rather distinct) traditions can be found: the objectivistic and the subjectivistic tradition. Methods: The theory of triangulation deals with the integration of methods and approaches as to conduct better evaluation studies. In evaluation research, triangulation in general means the multiple employment of various sources of data, observers, methods, and/or theories in investigations of the same phenomenon. We applied triangulation aspects in the analysis of the effects of a computer-based nursing documentation system. Results: We discuss, based on this case study, what benefits can be obtained from applying triangulation in an evaluation study. We show how both the validation of results and the completeness of results can be supported by triangulation. Discussion: The decision whether triangulation may be useful for a given research question, and how it may be correctly applied, requires—like other evaluation methods—intensive training and methodological experience. Medical informatics evaluation research may profit from this well-established theory.     

Morphological changes of dorsal root ganglion cells in the process-forming period

Rat DRG cells at early stages of development were observed to clarify the forming process from bipolar to pseudounipolar cells.

Dissociated DRG cells in vivo and in vitro were observed by light and scanning electron microscopy. The percentage of cell types in the 13th prenatal to the 1-day postnatal DRG in vivo were investigated. It is noteworthy that about 5% of ganglion cells were still bipolar in the 1-day postnatal rat. When dissociated DRG cells were seen in long-term culture, completely unipolarized DRG cells were revealed by silverimpregnation. But when fibroblast growth was suppressed in long-term culture, no pseudounipolar cells were observed.

Dorsal root ganglia on day 14 of gestation were organ cultured. The incidence of pseudounipolar cell appearance was estimated time-sequentially by silver-impregnations (Table 2). Unipolar cells increased to about 80% at the 22nd day of culture.

Cultured DRG cells were examined by transmission electron microscopy and the morphological change from bipolar cells to pseudounipolar cells was investigated. No evidence was obtained which showed that the processes of bipolar cells fuse to make a stem process.

In conclusion, observations of developing DRG cells by light and electron microscopy revealed that the stem process of the pseudounipolar DRG cells is derived from the elongated cytoplasm of the cell body and is not derived from the fusion of the opposite two processes.     

Opinion survey towards hormone replacement therapy in the prevention of coronary heart disease

Background: Observational and experimental data underscore the cardioprotective effects of hormone replacement therapy (HRT). On the other hand, the randomised trial available, the ‘Heart and Estrogen/Progestin Replacement Study (HERS)’, showed no reduced risk of coronary heart disease (CHD), using HRT. Aim: Opinion survey on the effect of HRT on CHD risk. Setting: Identification of articles on the related topic using a Medline search. Written survey of the authors’ opinion towards HRT in relation to CHD. Results: Thirty-seven of the 108 principal authors responded. Among them, respectively, 16 (43%) and seven (19%) found that HRT has favourable effects on primary and secondary prevention, two (5%) and five (14%) that it had no effect, none (0%) and four ( 11%) that it had an unfavourable effect, seven (19%) and nine (25%) that it had both favourable and unfavourable effects, and nine (25%) and ten (27%), thought that there are not enough data. Considering a risk modification superior to 20% as clinically relevant, then 57% thought that HRT has a beneficial effect of on primary prevention and 30% on secondary prevention, while none of the responders considered that HRT has unfavourable effects on primary prevention and only 2% on secondary prevention of CHD. Conclusion: Despite the negative results of the HERS study, about one-half of the responders still think that HRT has a beneficial effect on primary prevention of CHD and almost one-third on secondary prevention.     

Five-year compliance with hormone replacement therapy in postmenopausal Chinese women in Hong Kong

Objectives: To assess 5-year compliance with hormone replacement therapy (HRT) in Hong Kong Chinese women and the reasons for long-term compliance or non-compliance. Methods: A telephone survey using a standardized questionnaire was conducted in 187 postmenopausal women who had commenced HRT in a referral-only specialist clinic of a university teaching hospital 5 years previously. Over this 5-year period, the cohort had been referred out to primary care doctors once they had become stabilized on treatment. Results: The 5-year compliance rate was 71.1%. The overall compliance rates were nearly the same from 2 and 5 years. ‘Doctors’ advice’ was the most important reason for maintenance of long-term compliance, accounting for 88.0% of all compliant cases. The most frequent reason for non-compliance was that of the experience of side effects. Other important reasons were fear of cancer, fear of other side effects, and discouragement from other doctors. Overall, 16.0% of women expressed concern regarding potential side effects or risk of breast cancer. Younger age at menopause and at time of initial consultation, shorter duration of menopause at presentation and previous history of hysterectomy were associated with a higher degree of compliance at 5 years. Presence or absence of menopausal symptoms, on the other hand, was not a significant factor. Conclusions: The 5-year compliance rate in this cohort of Hong Kong Chinese women was comparable to that reported from predominantly Caucasian populations. The physicians’ role in encouraging postmenopausal women to achieve long-term HRT compliance was observed.     

Towards a PropeR combination of patient records and protocols

Problem: The combination of a computer-based patient record and a decision-support system (DSS) may give physicians the decisive push they need to accept such systems. In the PropeR-project we determine the requirements for a generic interface between both these systems and evaluate its potential impact on patient care. This article reports results from the first year in one of the domains under study. It also provides background information about the project, including design considerations and experimental approach of forthcoming years. Purpose: The objectives of the first year were to determine bottlenecks of the current situation and to determine expected improvements and conditions for implementation of a future situation with computer support. Methods: These topics were investigated in general by literature review and in the local situation by a requirements analysis. For the analysis we used a combination of observation, interviews, and patient record study. For the literature survey we searched for reviews, meta-analyses and original studies concerning experiences with computer-based patient records and DSSs in conventional settings and in integrated care. Results: Main bottleneck was the poor use of shared patient record and paper guidelines. Expected improvements were better protocol adherence and communication. Conditions for implementation of computer support were a proper system interface and adoption by the user. Conclusion: Our main conclusion was that the aspect of cooperation needs more decision support than the clinical work itself.     

Severity of bipolarity in hospitalized manic adolescents with history of stimulant or antidepressant treatment

Background: Childhood bipolarity (BP) and ADHD frequently co-occur, these children often receive stimulants. Method: We retrospectively evaluated 80 adolescents hospitalized with BP, manic or mixed, assessed severity of hospital course, and compared groups according to current/past stimulant or antidepressant treatment. Results: Lifetime ADHD rate was 49%; 35% of patients had exposure to stimulants and 44% to antidepressants. Stimulant-exposed patients were younger than non-exposed (mean±S.D.=13.7±2 vs. 15.1±2 years, Z=−3.1, P=0.002). Only stimulant exposure was associated with worse hospitalization course (MANCOVA, Wilks’ Lambda=0.87, F=3.4; df=70; P=0.02). Conclusion: Stimulant-exposed BP-adolescents may have more severe illness course not fully explained by ADHD comorbidity. Limitations: Retrospective methodology and lack of structured interviewing make it difficult to quantify exposure to stimulants and antidepressants.     

Copability,coping, and learning as focal concepts in the evaluation of computerised diabetes disease management

Introduction: Within diabetes care, the majority of health decisions are in the hands of the patient. Therefore, the concepts of disease management and self-care represent inescapable challenges for both patient and healthcare professionals, entailing a considerable amount of learning. Thus, a computerised diabetes disease management systems (CDDM) is to be seen not merely as tools for the medical treatment, but also as pedagogical tools to enhance patient competence. Hypothesis: The unfortunate lack of success for most knowledge-based systems might be related to the problem of finding an adequate way of evaluating the systems from their development through the implementation phase to the daily clinical practice. The following presents the initial methodological considerations for evaluating the usefulness of a CDDM system called DiasNet, which is being implemented as a learning tool for patients. The evaluation of usefulness of a CDDM, we claim, entails clinical assessment taking into account the challenges and pitfalls in diabetes disease management. Results: Drawing on activity theory, we suggest the concept of copability as a supplement to ‘usability’ and ‘utility’ when determining ‘usefulness’. We maintain that it is necessary to ask how well the user copes with the new situation using the system. As ways to measure copability of DiasNet the concepts of coping and learning are discussed, as well as ways this methodology might inform systems development, implementation, and daily clinical practice.     

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: A mixed methods approach

BackgroundPharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption.ObjectivesThe study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers.MethodsUsing a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae^® to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, ‘Infobutton^®’ and ‘Evidence’ icons provided participants with clinical knowledge resources to aid decision-making.ResultsNine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an ‘Infobutton’ or ‘Evidence’ icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants’ median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree).ConclusionsUsability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways.