Physicians’ attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators

Scand J Caring Sci; 2013; 27; 303–310 Physicians’ attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators Aims and objectives: Interprofessional collaboration is the process in which different professional groups work together to positively impact health care. We aimed to explore physicians’ attitudes toward interprofessional collaboration in the context of chronic pain management with the implication that if attitudes are not positive, appropriate interventions could be developed. Design: A quantitative attitudes study. Ethical issues: The ethical committee approved the study. Methods: A web‐based survey about interprofessional treatment of chronic pain was administered to physicians. Outcome measures were as follows: physicians’ demographic and workplace information, previous experience of working within an interprofessional team, and attitudes towards interprofessional collaboration in chronic pain management. Results: There were 90 physicians who responded to the survey. Physicians had positive attitudes towards team work in the context of chronic pain, but they were undecided about sharing their role within an interprofessional team. The family physician was singled out as the most important as well as the most common collaborator in chronic pain treatment. Interprofessional educational seminars and workshops were suggested as methods for improving interprofessional collaboration. Conclusions: Interprofessional collaboration may be enhanced with continuing medical education that will bring together different healthcare professionals, enable them to exchange experiences and learn about their potential roles within a team.     

Hematopoetic stem cell bank at Zagreb University Hospital Center, Zagreb, Croatia

At Zagreb University Hospital Center, the first cryopreservation of hematopoietic stem cells (HSC) was performed in 1989 at Department of Hematology. Since that time, more than 1000 products of HSC have been stored for autologous and related homologous use. In 2000, HSC Bank became organizational unit of the Department of Transfusion Medicine. The purpose of the Bank is to ensure quality in procurement, testing, processing, preservation, storage and distribution of HSC as well as transplantation traceability. Today, it serves as a central storage unit for two transplantation centers. At the moment, there are 587 HSC units on stock for 262 patients. In the future, we are planning to establish a public umbilical cord bank and laboratory for cell therapy.     

Urates in exhaled breath condensate as a biomarker of control in childhood asthma

Objective: The aim of this study was to (1) investigate the possibility to use urates in exhaled breath condensate (EBC) as a biomarker of airway inflammation and control in childhood asthma and (2) explore their association with other biomarkers of airway inflammation and clinical indices of asthma control (Asthma Control Test [ACT], quality of life [PAQLQ], lung function, prn beta-agonist use, time from last exacerbation [TLE]. Methods: This cross-sectional study comprised 103 consecutive patients (age 6–18 years) divided in groups of uncontrolled ([NC], n?=?53) and controlled asthma ([C], n?=?50). Measured lung function and biomarkers included: spirometry, eosinophilic cationic protein (ECP), high-sensitivity C-reactive protein (hs-CRP), exhaled NO (F_ENO), pH and urates in EBC and exhaled breath temperature (EBT). Results: Statistically significant differences were found between groups for EBC urates, EBC pH and EBT (NC versus C: EBC urates, median [IQR], µmol/L; 10 [6] versus 45 [29], p?<?0.001; EBC pH, mean [SD], 7.2 [0.17] versus 7.33 [0.16], p?=?0.002; EBT mean [SD], °C; 34.26 [0.83], versus 33.90 [0.60], p?=?0.014). EBC urates showed significant association with TLE and F_ENO (r?=?0.518, p?<?0.001; r?=?0.369, p?=?0.007, respectively) in NC, and EBC pH (r?=?0.351, p?<?0.001), FEV₁ (r?=?0.222, p?=?0.024), ACT (r?=?0.654, p?<?0.001), PAQLQ (r?=?0.686, p?<?0.001) and prn salbutamol use (r?=??0.527, p?<?0.001) in all asthmatics. Conclusion: In our study, EBC urates were found to be the best single predictor of asthma control and underlying airway inflammation. Our results provide evidence supporting the potential utility to use EBC urates as an additional non-invasive biomarker of control in childhood asthma.     

Image quality of mammography in Croatian nationwide screening program: comparison between various types of facilities

Purpose

The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality.

Materials and methods

A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified.

Results

Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts.

Conclusions

Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.     

Radiography and Angiography

Purpose

   We introduce a new hierarchical approach for elastic medical image registration using approximating splines. In order to obtain the dense deformation field, we employ Gaussian elastic body splines (GEBS) that incorporate anisotropic landmark errors and rotation information. Since the GEBS approach is based on a physical model in form of analytical solutions of the Navier equation, it can very well cope with the local as well as global deformations present in the images by varying the standard deviation of the Gaussian forces.

Methods

   The proposed GEBS approximating model is integrated into the elastic hierarchical image registration framework, which decomposes a nonrigid registration problem into numerous local rigid transformations. The approximating GEBS registration scheme incorporates anisotropic landmark errors as well as rotation information. The anisotropic landmark localization uncertainties can be estimated directly from the image data, and in this case, they represent the minimal stochastic localization error, i.e., the Cramér-Rao bound. The rotation information of each landmark obtained from the hierarchical procedure is transposed in an additional angular landmark, doubling the number of landmarks in the GEBS model.

Results

   The modified hierarchical registration using the approximating GEBS model is applied to register 161 image pairs from a digital mammogram database. The obtained results are very encouraging, and the proposed approach significantly improved all registrations comparing the mean-square error in relation to approximating TPS with the rotation information. On artificially deformed breast images, the newly proposed method performed better than the state-of-the-art registration algorithm introduced by Rueckert et al. (IEEE Trans Med Imaging 18:712–721, 1999). The average error per breast tissue pixel was less than 2.23 pixels compared to 2.46 pixels for Rueckert’s method.

Conclusion

   The proposed hierarchical elastic image registration approach incorporates the GEBS approximation scheme extended with anisotropic landmark localization uncertainties as well as rotation information. Our experimental results show that the proposed scheme improved the registration result significantly.     

A placebo controlled, dose-ranging, safety study of allogenic mesenchymal stem cells injected by endomyocardial delivery after an acute myocardial infarction.

AIMS: Although mesenchymal stem cells (MSCs) show promising signs in reducing myocardial infarct (MI) size, the safety of endomyocardial delivery and the most efficacious dose is unknown. METHODS AND RESULTS: Three days after MI, female Yorkshire swine (25-32 kg, age 2 months, n = 32) were randomized to endomyocardial delivery of one of three MSC doses (2.4 x 10(7), 2.4 x 10(8), 4.4 x 10(8) cells) or vehicle control. Animals were sacrificed at 12 weeks. There were no safety issues related to cell delivery and all animals tolerated the procedure. By magnetic resonance imaging infarct size (g) was decreased in the experimental groups and increased in the control group; 2.4 x 10(7): Delta -2.5 +/- 2.5 g, 2.4 x 10(8): -0.9 +/- 2.71 g, 4.4 x 10(8): -1.6 +/- 5.8 g, and control +3.6 +/- 3.4 g (P = 0.002, P = 0.016, and P = 0.055 compared with control, respectively). There was no effect on ejection fraction or left ventricular volumes. By histology there were no toxic effects of MSC delivery, however, few engrafted MSCs were observed. CONCLUSION: Direct MSC delivery into infarcted myocardium was safe and produced a local but not a functional effect. There was no dose-dependent effect. The effect of MSCs on infarct reduction may result from transient residence and subsequent paracrine effects.