Design of the Dutch prevention of influenza,surveillance and management (PRISMA) study

Rationale and design of a study on the cost-effectiveness of the Dutch influenza vaccination campaign are described. During two influenza epidemics, about 75,000 primary care patients recommended for influenza vaccination are included. Cases have fatal or non-fatal influenza, pneumonia, otitis media, acute respiratory disease (ARD), heart failure, myocardial infarction, depression or diabetes dysregulation. Per case four controls are sampled, frequency matched on age and high-risk co-morbidity (<18 years, 18-64, >/=65 healthy, >/=65 with co-morbidity). Baseline and outcome data are retrieved from patient records. During the 1999-2000 influenza A epidemic 5891 (7.9%) high-risk children, 24,848 (33.2%) high-risk adults aged 18-64 years, 18,484 (24.7%) elderly with co-morbidity and 25,527 (34.1%) healthy elderly had been included. The mortality rate was 5.2 per 1000 and 2035 non-fatal outcome events were recorded (incidence rate 27.2/1000).     

Decision support system for the operating room rescheduling problem

Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other involved departments, and therefore, the OR schedule has to be adjusted. In this paper, we develop a decision support system (DSS) which assists the OR manager in this decision by providing the three best adjusted OR schedules. The system considers the preferences of all involved stakeholders and only evaluates the OR schedules that satisfy the imposed resource constraints. The decision rules used for this system are based on a thorough analysis of the OR rescheduling problem. We model this problem as an Integer Linear Program (ILP) which objective is to minimize the deviation from the preferences of the considered stakeholders. By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries. By using these changes in the DSS, the performed simulation study shows that less surgeries are canceled and patients and wards are more satisfied, but also that the perceived workload of several departments increases to compensate this. The system can also be used to judge the acceptability of a proposed initial OR schedule.     

Cancer Patients' and their Physicians' Perceptions of the Formers' need for Occupational Therapy

To support occupations outside the home for older people with functional limitations it is important to understand how the person, environment, and occupations influence performance. Therefore the purpose of this study was to describe how very old people experience occupational performance outside the home. Twenty-one single-living, very old persons, above 80 years, were strategically selected and interviewed. A phenomenographic approach was used for this study and the interviews were analyzed using contextual analysis. The findings showed a variation in the experience of occupational performance described in three referential aspects: keeping on doing as before, drawing on available resources, and living in constrained circumstances. Referring to everyday occupations the participants described how they continued to do what they had done before, but decline in functional capacity made it more difficult to overcome environmental barriers. They also described how they sometimes could put functional limitations aside and use their utmost capacity to reach their goals. When they could not do that any more, they had to find possibilities for occupations close to home. In order to support very old people's occupational performance outside the home, outdoor mobility has to be facilitated, including the design of the physical environment as well as possibilities for social interaction.     

Successful long-term control of idiopathic hypereosinophilic syndrome with etoposide.

A 38-year-old man with idiopathic hypereosinophilic syndrome had an inadequate response to steroids and severe side effects from hydroxyurea treatment, which necessitated withdrawal of the treatment. Successful control of clinical symptoms and eosinophil counts was obtained with etoposide (VP16-213) for 18 months. VP16-213 may be valuable in idiopathic hypereosinophilic syndrome treatment.     

The projections from striate cortex (V1) to areas V2 and V3 in the macaque monkey: asymmetries, areal boundaries, and patchy connections

The organization of projections from V1 to areas V2 and V3 in the macaque monkey was studied with a combination of anatomical techniques, including lesions and tracer injections made in different portions of V1 and V2 in 20 experimental hemispheres. Our results indicate that dorsal V1 (representing the inferior contralateral visual quadrant) consistently projects in topographically organized fashion to V3 in the lunate and parietooccipital sulci as well as to the middle temporal area (MT) and dorsal V2. In contrast, ventral V1 (representing the superior contralateral quadrant) projects only to MT and ventral V2. A corresponding dorsoventral asymmetry in myeloarchitecture supports the idea that V3 is an area that is restricted to dorsal extrastriate cortex and lacks a complete representation of the visual field. The average surface area of myeloarchitectonically identified V3 was 89 mm2. Additional information was obtained concerning the laminar distribution of connections from V1 to V2 and V3, the patchiness of these projections, and the consistency of projections to other extrastriate areas, including V4 and V3A.     

Besteht ein Zusammenhang Zwischen Ver-Langsamung der Blutsenkungsgeschwin-Digkeit und Funktionellen Neurosen?

Zusammenfassung An Hand der Senkungsreaktionen von 157 Personen mit funktionellen nervösen Störungen und 100 normalen Individuen wurde die Frage diskutiert, ob eine Verlangsamung der Senkungsreaktion bis zu 3,5 mm in einer Stunde ein bedeutsames Stigma eines neuropathischen Zustandes ist. Auf Grund statistischer Auswertung konnte der Beweis erbracht werden, daß Neuropathen mit größerer Wahrscheinlichkeit verlangsamt senkten als Normale. Die ver-langsamte Senkung darf aber nicht als Stigma der Neuropathen überwertet werden, da sie auch häufig bei Gesunden vorkommt, sondern sie hat ihre Bedeutung mir im Rahmen anderer vegetativer Zeichen.     

Target organ directed drug delivery: evaluation of renal infusion of chromium-51 ethylenediaminetetraacetate and sodium o-[125I]iodohippurate in the Wistar Kyoto rat

To evaluate the merits of intrarenal drug delivery, the disposition of chromium-51 ethylenediaminetetraacetate (51Cr EDTA) and sodium o-[125I]iodohippurate (125I OIH) was studied following their constant-rate infusion into either the jugular vein or the left or right renal artery of Wistar Kyoto rats. The contralateral kidney was removed. Renal blood flow through the lateral kidney was measured during the experiment via an electromagnetic flow probe. Urine and systemic arterial blood samples were taken at steady state. The clearance and extraction of both substances by the right kidney were independent of the route of administration. Nonlinear kinetics were observed during infusion of 125I OIH at the highest infusion rate in the left kidney. At steady state the advantage of intrarenal over systemic delivery was limited because of the relative high blood flow of the kidney. Only a small reduction (30%) in systemic concentration was achieved by infusion of 51Cr EDTA. Intrarenal infusion of the lower dose (10 nCi/min) of 125I OIH reduced the systemic concentration by greater than 80% when compared with systemic infusion. Intrarenal infusion of the higher dose (40 nCi/min) saturated elimination processes in parts of the left kidney because of nonhomogeneous flow distribution.