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The Department of Radiology at the University of Utah Health Sciences Center has made the transition from a traditional film-based department to a near filmless operation. The University of Utah is a large teaching hospital and the transition from film in an educational facility will be discussed. This transition has had its difficulties and its success is dependent on the support of departmental leadership and hospital administration. We have had more than 100 years of experience with film, and current procedures were efficient given the limitations of the medium. While motivated by the traditional reasons for moving to a picture archival and communications system (PACS), such as film savings, unavailable films, and faster reports, we found the intangibles to be the larger issue, as well as a source for the largest benefits. This report will discuss the implementation process and the affect it had on all areas of the hospital, including its impact on hospital physicians, radiologists, file room personnel, and technologists. Procedure changes to the flow of patients, film, and electronic images will also be described. This process cannot be viewed as a onetime change, but must be viewed as a continuous process as areas of improvement are identified and new and improved technologies are developed. 相似文献
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Bernhard T. Baune p hd md mph Jordan McAfoose ba Geraldine Leach ba Frances Quirk p hd David Mitchell p hd 《Psychiatry and clinical neurosciences》2009,63(3):392-400
Aim: The aim of the present study was to investigate the association between cognitive performance and psychiatric and medical comorbidity in major depression.
Methods: The present study evaluated the cognitive performance of patients ( n = 96) diagnosed with a major depressive episode in relation to the presence of medical and/or psychiatric comorbidity. Participants were assessed clinically and cognitively using the Mini International Neuropsychiatric Interview and Repeatable Battery for the Assessment of Neuropsychological Status. Four groups of comorbidity were categorized: (i) no comorbidity, (ii) medical comorbidity; (iii) psychiatric comorbidity; and (iv) both medical and psychiatric comorbidity, and subsequently analyzed for differences across six cognitive domains: immediate memory, visuospatial, language, attention, delayed memory, and total score.
Results: Only 20.8% of the participants did not have a comorbidity of any kind, while psychiatric comorbidities (67.7%) were more frequent than medical comorbidities (39.6%). Education and severity of depressive symptoms negatively influenced cognitive performance. Psychiatric comorbidity alone significantly decreased cognitive performance in the visuospatial/constructional and the language domains and the total score. In addition, increasing numbers of psychiatric comorbidities were related to worse cognitive performance. In contrast, medical illnesses alone had no negative impact on any of the domains of cognitive performance. Evidence was found for additive effects of medical and psychiatric comorbidities in depression on visuospatial/constructional cognitive abilities.
Conclusion: The strongest predictor of poor cognitive performance in depression was psychiatric comorbidity. The assessment and treatment of cognitive dysfunction in depression should consider the relative impact of psychiatric comorbidity. 相似文献
Methods: The present study evaluated the cognitive performance of patients ( n = 96) diagnosed with a major depressive episode in relation to the presence of medical and/or psychiatric comorbidity. Participants were assessed clinically and cognitively using the Mini International Neuropsychiatric Interview and Repeatable Battery for the Assessment of Neuropsychological Status. Four groups of comorbidity were categorized: (i) no comorbidity, (ii) medical comorbidity; (iii) psychiatric comorbidity; and (iv) both medical and psychiatric comorbidity, and subsequently analyzed for differences across six cognitive domains: immediate memory, visuospatial, language, attention, delayed memory, and total score.
Results: Only 20.8% of the participants did not have a comorbidity of any kind, while psychiatric comorbidities (67.7%) were more frequent than medical comorbidities (39.6%). Education and severity of depressive symptoms negatively influenced cognitive performance. Psychiatric comorbidity alone significantly decreased cognitive performance in the visuospatial/constructional and the language domains and the total score. In addition, increasing numbers of psychiatric comorbidities were related to worse cognitive performance. In contrast, medical illnesses alone had no negative impact on any of the domains of cognitive performance. Evidence was found for additive effects of medical and psychiatric comorbidities in depression on visuospatial/constructional cognitive abilities.
Conclusion: The strongest predictor of poor cognitive performance in depression was psychiatric comorbidity. The assessment and treatment of cognitive dysfunction in depression should consider the relative impact of psychiatric comorbidity. 相似文献
26.
Dannlowski U Ohrmann P Konrad C Domschke K Bauer J Kugel H Hohoff C Schöning S Kersting A Baune BT Mortensen LS Arolt V Zwitserlood P Deckert J Heindel W Suslow T 《The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP)》2009,12(1):11-22
The amygdala plays a pivotal role in a cortico-limbic circuitry implicated in emotion processing and regulation. In the present study, functional connectivity of the amygdala with prefrontal areas involved in emotion regulation was investigated during a facial expression processing task in a sample of 34 depressed inpatients and 31 healthy controls. All patients were genotyped for a common functional variable number tandem repeat (VNTR) polymorphism in the promoter region of the monoamine oxidase A gene (MAOA u-VNTR) which has been previously associated with major depression as well as reduced cortico-limbic connectivity in healthy subjects. In our control group, we observed tight coupling of the amygdala and dorsal prefrontal areas comprising the dorsolateral prefrontal cortex (DLPFC), dorsal parts of the anterior cingulate cortex (dACC), and lateral orbitofrontal cortex. Amygdala-prefrontal connectivity was significantly reduced in depressed patients and carriers of the higher active MAOA risk alleles (MAOA-H). Hence, depressed MAOA-H carriers showed the weakest amygdala-prefrontal coupling of the investigated subgroups. Furthermore, reduced coupling of this circuitry predicted more than 40% variance of clinical variables characterizing a longer and more severe course of disease. We conclude that genetic variation in the MAOA gene may affect the course of major depression by disrupting cortico-limbic connectivity. 相似文献
27.
Z Luo Y Chen S Chen WJ Welch BT Andresen PA Jose CS Wilcox 《British journal of pharmacology》2009,157(6):935-943
Background and purpose:
We compared the dose-dependent reductions in cellular superoxide anion (O2−) by catalytic agents: superoxide dismutase (SOD), polyethylene glycol (PEG)-SOD and the nitroxide 4-hydroxy-2,2,6,6,-tetramethylpiperidine-1-oxyl (tempol) with uncharacterized antioxidants: 5,10,15,20-tetrakis (4-sulphonatophenyl) porphyrinate iron (III)(Fe-TTPS), (-)-cis-3,3′,4′,5,7-pentahydroxyflavane (2R,3R)-2-(3,4-dihydroxyphenyl)-3,4-dihydro-1(2H)-benzopyran-3,5,7-triol (-epicatechin), 2-phenyl-1,2-benzisoselenazol-3(2H)-one (ebselen) and N-acetyl-L-cysteine (NAC) with the spin trap nitroblue tetrazolium (NBT) and with the vitamins or their analogues: ascorbate, α-tocopherol and 6-hydroxy-2,5,7,8-tetramethylkroman-2-carboxy acid (trolox).Experimental approach:
O2− was generated in primary cultures of angiotensin II-stimulated preglomerular vascular smooth muscle cells from spontaneously hypertensive rats and detected by lucigenin-enhanced chemiluminescence.Key results:
SOD, PEG-SOD, NAC and tempol produced a similar maximum inhibition of O2− of 80–90%. -Epicatechin, NBT, ebselen and Fe-TTPS were significantly (P < 0.0125) less effective (50–70%), whereas trolox, α-tocopherol and ascorbate had little action even over 24 h of incubation (<31%). Effectiveness in disrupted and intact cells was similar for the permeable agents, PEG-SOD and tempol, but was enhanced for SOD. Generation of O2− was increased by NAC and NBT at low concentrations but reduced at high concentrations.Conclusions and implications:
Maximum effectiveness against cellular production of O2− requires cell membrane permeability and catalytic action as exemplified by PEG-SOD or tempol. NAC and NBT have biphasic effects on O2− production. Vitamins C and E or analogues have low efficacy. 相似文献28.
Rudge C Johnson RJ Fuggle SV Forsythe JL;Kidney Pancreas Advisory Group UK Transplant NHS BT 《Transplantation》2007,83(9):1169-1173
BACKGROUND: To investigate any differences in access to transplant and post-transplant outcomes for ethnic minority patients in the United Kingdom, national data on ethnicity of patients on the waiting list, those receiving a transplant, and deceased donors were analyzed. METHODS: Adult patients and donors were included. Ethnic origin was classified as white, Asian, black, or "other." National data were analyzed, and 2001 U.K. National census data were used for comparative purposes. Median waiting times to transplant were obtained from Kaplan-Meier estimates for patients registered 1998-2000. Transplant survival was estimated for patients transplanted from 1998 to 2003. RESULTS: A total of 92% of the U.K. population was white, compared with 77% of waiting list patients, 88% of transplant recipients, and 97% of deceased donors. Median waiting time to transplantation for white patients was 719 days (95% confidence interval 680-758) compared with 1368 (1131-1605) days for Asian patients and 1419 (1165-1673) days for black patients. The degree of human leukocyte antigen matching achieved was inferior for Asian and black patients. There is some evidence of inferior 3-year transplant survival for black patients compared with white and Asian patients (P=0.03). CONCLUSIONS: There are imbalances in the ethnic make up of the waiting list, the donor pool, and renal transplant recipients. There are significant differences in both post-transplant outcomes and time to transplantation between patients of different ethnic origin. Waiting times are influenced by allocation schemes, and the 2006 U.K. National Kidney Allocation Scheme is designed to achieve greater equity of access to transplant for all patients, regardless of geography, blood group, or ethnicity. 相似文献
29.
Childhood adversity alters the predisposition to psychiatric disorders later in life. Those with psychiatric conditions and a history of early adversity exhibit a higher incidence of treatment resistance compared with individuals with no such history. Modulation of the influence early stress exerts over neurobiology may help to prevent the development of psychiatric disorders in some cases, while attenuating the extent of treatment resistance in those with established psychiatric disorders. This review aims to critically evaluate the ability of behavioural, environmental and pharmacologic interventions to modulate neurobiological changes induced by early stress in animal models. Databases were systematically searched to locate literature relevant to this review. Early adversity was defined as stress that resulted from manipulation of the mother–infant relationship. Analysis was restricted to animal models to enable characterisation of how a given intervention altered specific neurobiological changes induced by early stress. A wide variety of changes in neurobiology due to early stress are amenable to intervention. Behavioural interventions in childhood, exercise in adolescence and administration of epigenetic-modifying drugs throughout life appear to best modulate cellar and behavioural alterations induced by childhood adversity. Other pharmacotherapies, such as endocannabinoid system modulators, anti-inflammatories and antidepressants can also influence these neurobiological and behavioural changes that result from early stress, although findings are less consistent at present and require further investigation. Further work is required to examine the influence that behavioural interventions, exercise and epigenetic-modifying drugs exert over alterations that occur following childhood stress in human studies, before possible translational into clinical practice is possible. 相似文献
30.
Biochemistry of the induction and prevention of lipoperoxidative damage in human spermatozoa 总被引:8,自引:1,他引:7
Lipid peroxidation occurs in human sperm cells with damage to the cell
plasma membrane, leading to loss of cytosolic components and hence to cell
'death'. The peroxidation may be induced at high rates in the presence of
Fe2+ and ascorbate. It occurs at slower rates under physiological
conditions as spontaneous lipid peroxidation, which has the following
characteristics. The rate is constant over the time required for complete
loss of motility in the cells of the sperm sample; one can thus use the
time to complete loss of motility (TLM) as a ready measure of the rate.
Loss of motility occurs at a characteristic extent of lipid peroxidation,
assayed in terms of production of the peroxidative breakdown product,
malonaldehyde (MA), that is independent of peroxidation rate. For human
sperm, this extent corresponds to 0.1 nmol MA/10(8) cells. Human
spermatozoa possess the anti-lipoperoxidative defence enzymes, superoxide
dismutase (SOD) and glutathione peroxidase plus glutathione reductase
(GPX/GRD). The SOD activity is highly variable between human sperm samples
while the activities of GPX and GRD are rather more constant. The rates of
production of superoxide anion, O2-, and hydrogen peroxide, H2O2, from
human spermatozoa are variable, but their sum calculated in O2- equivalents
as O2- + 2H2O2 is quite constant. The variability arises from the
variability in SOD activity: all H2O2 produced is from O2- due to the
action of SOD. The essential role of SOD as defence enzyme is inferred from
the observation that TLM of a given sperm sample is directly proportional
to the SOD activity of that sample. The essential role of GPX/GRD is
inferred from the observation that inhibition of GPX, either with
mercaptosuccinate or with complete oxidation of intracellular reduced
glutathione, results in a 20-fold increase in peroxidation rate. The
capacity of the GPX/GRD system appears to be limited by the
glucose-6-phosphate dehydrogenase-catalysed rate of production of NADPH,
the required reductive substrate for GRD. Human spermatozoa appear to have
enough anti-lipoperoxidative defensive capacity for lifetimes long enough
for fertilization but still short enough for ready removal from the female
reproductive tract in good time. Too low a defence capacity could lead to
male infertility.
相似文献