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  • 1
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, cardiovascular consortium and the progress made so far by this collaborative group. In 1997, a group of hospitals in the state Michigan agreed to create a regional collaborative consortium for the development of a quality improvement program in interventional cardiology. The project included the creation of a comprehensive database of PCIs to be used for risk assessment, feedback on absolute and risk-adjusted outcomes, and sharing of information. To date, information from nearly 20,000 PCIs have been collected. A risk prediction tool for death in the hospital and additional risk prediction tools for other outcomes have been developed from the data collected, and are currently used by the participating centers for risk assessment and for quality improvement. As the project enters into year 5, the participating centers are deeply engaged in the quality improvement phase, and expansion to a total of 17 hospitals with active PCI programs is in process. In conclusion, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium is an example of a regional collaborative effort to assess and improve quality of care and outcomes that overcome the barriers of traditional market and academic competition.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The technical challenges in the development of a quality-controlled registry of percutaneous coronary interventions (PCIs) are currently unknown. This article describes the authors' experience in the development of a regional, quality-controlled PCI registry. In 1996, 16 centers in Michigan were invited to participate in a multicenter PCI registry. Nine centers agreed to a pilot data collection and, as of July 2001, eight centers are still actively collecting data. An Oracle database was developed by the coordinating center. A common data collection form and a standard set of definitions were agreed on during several meetings. Data validity was insured through review of each form by a trained nurse, by automatic database diagnostic routines, and by site visits that included a review of the catheterization laboratory logs and a review of randomly selected charts. The average number of forms requiring query resolution was 33% in 1997 (range 7–76%), and it decreased to 5% in 1999 (range 1.4–10%). The most commonly queried variables were outcomes prior to discharge, lesion category, lesion complexity, date of birth, device used, gender, postprocedural percent stenosis, presence of left main disease, and MI date. Invalid dates, identification of the doctor, the presence of duplicate forms, and of duplicate outcomes were additional common queries generated by the internal diagnostic routines. In conclusion, the number of queries and diagnostic reports generated in the database suggests that the development of a quality-controlled PCI registry requires the institution of a careful diagnostic and data quality assessment system.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Journal of personality 70 (2002), S. 0 
    ISSN: 1467-6494
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: We hypothesized that semester goal attainmentprovides a route to short-term psychological growth. In an attempt to enhance this process, werandomly assigned participants to either a goal-training program or to a control condition.Although there were no main effects of program participation on later goal attainment, importantinteractions were found. Consistent with a “prepared to benefit” model,participants already high in goal-based measures of personality integration perceived the programas most useful and benefited the most from the program in terms of goal attainment. As a result,they became even more integrated and also increased in their levels of psychosocial well-being andvitality. Implications for theories of short-term growth and positive change are discussed, as is theunanswered question of how to help less-integrated persons grow.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Geophysical journal international 124 (1996), S. 0 
    ISSN: 1365-246X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Geosciences
    Notes: Accurate determination of the strength of the ancient geomagnetic field is limited by mineralogical alteration that may occur when samples are heated to produce a thermoremanent magnetization (Thellier & Thellier 1959; Shaw 1974). By using direct microwave excitation of the magnetic grains we have been able to form a thermoremanent magnetization without significantly heating the bulk sample, thus avoiding thermal alteration (Walton et al. 1993). Incorporation of this new microwave heating technique with the conventional Thellier palaeointensity method has dramatically reduced the scatter of archaeointensity results from Peruvian ceramics and clearly defined how the field strength has varied in Peru over the past 2000 years. The new microwave technique will therefore enhance the feasibility of archaeointensity dating and provide accurate field strength data for geomagnetic modelling.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Contact dermatitis 39 (1998), S. 0 
    ISSN: 1600-0536
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Metal release from 13 different gold-containing jewellery alloys stored for 1 and 3 weeks in artificial sweat was analysed. For chemical analysis, inductively-coupled plasma detection (ICP) and atomic absorption spectrophotometry (AA), with flame and with furnace, were used. No release of gold was detected. It is unlikely that skin contact with gold-containing metallic items such as jewellery is responsible for inducing contact allergy to gold or allergic contact dermatitis due to the gold. The patch-test reactivity to gold sodium thiosulfate needs to be explained by some other mechanism(s).
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Astrophysics and space science 231 (1995), S. 127-130 
    ISSN: 1572-946X
    Keywords: Gamma-ray bursts ; Counterparts ; Instrumentation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract The BATSE and OSSE instrument teams have modified flight software to promptly (within 2 min of trigger) slew the OSSE detectors to burst locations determined on-board by BATSE. This enables OSSE to make sensitive searches for prompt and delayed post-burst line and continuum emission above 50 keV. In the best cases our sensitivity will be more than an order of magnitude better than any other search in this energy range. We expect to slew to 1–2 bursts per month, based on the OSSE FOV and BATSE event rate. Detections or limits from continued operation of this system may provide significant constraints on burst models. As an example of the observations made using this system, we present preliminary limits for post-burst emission from GRB 950223 on several time scales.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric radiology 30 (2000), S. 3-6 
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Children are better served by radiologists and technical personnel trained in the care of pediatric patients. However, a variety of obstacles may limit the access of children to dedicated pediatric imaging facilities.¶Objective. We designed and implemented two models for providing community-based imaging by academic pediatric radiologists.¶Materials and methods. The first site was an outpatient clinic staffed by physicians from the university-affiliated children's hospital. Imaging services included radiography, fluoroscopy, and ultrasound. The second site was a full-service community hospital radiology department staffed by a group practice, with pediatric imaging covered by the children's hospital radiologists. Facility, equipment, and protocol modifications were required to maintain quality standards. Success of these models was determined by volume statistics, referring physician/patient satisfaction surveys, and quality-assurance (QA) programs.¶Results. The outpatient satellite had a 48 % increase in total examinations from the first year to the second year and 87 % the third year. Pediatric examinations in the community hospital increased over 1000 % the first 7 months. Referring physicians reported increased diagnostic information and patient satisfaction compared to previous service. QA efforts revealed improved image quality when pediatric radiologists were present, but some continuing difficulties off-hours.¶Conclusion. We successfully implemented pediatric imaging programs in previously underserved communities. This resulted in increased pediatric radiologist supervision and interpretation of examinations performed on children and improved referring physician and patient satisfaction.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective. We reviewed the contrast enema examinations and medical records of six patients with small intestinal obstruction due to omphalomesenteric duct remnant to evaluate for characteristic imaging findings. Results. In five out of the six patients the point of obstruction was demonstrated on the enema; in three patients, the characteristic “beak” of a volvulus was seen, either in the terminal ileum or cecum. In three patients, there was medial deviation of the cecum. Conclusion. The characteristic radiographic features of volvulus at the cecum or terminal ileum and medial deviation of the cecum should suggest persistence of an omphalomesenteric duct remnant as the etiology of obstruction in a child less than 2 years of age. The appearance of omphalomesenteric duct remnant obstruction on enema examination, though not specific, is characteristic and should be familiar to pediatric radiologists.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric radiology 26 (1996), S. 528-530 
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Five cases of hydrocele of the spermatic cord are presented. All five patients had a firm inguinal mass, and ultrasonography, performed to exclude adenopathy, incarcerated hernia, and paratesticular tumor, showed an avascular cystic mass superior to and separate from the testicle. A testicular hydrocele did not coexist. This typical appearance should lead to a confident diagnosis of this benign but rare anomaly. Elective surgery may prevent the development of an acquired indirect hernia.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-198X
    Keywords: Key words: Streptokinase   ;   Pulmonary thromboembolism   ;   Nephrotic syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A child with nephrotic syndrome presenting with right heart failure and severe pulmonary hypertension due to pulmonary artery thrombus was treated with locally administered streptokinase infusion. Streptokinase infusion was continued for 8 days, eventually leading to complete dissolution of thrombus.
    Type of Medium: Electronic Resource
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