169,967 research outputs found
Models d'integració entre cardiologia i atenció primària per millorar la pràctica clínica en els pacients amb cardiopaties cròniques
No full textL'atenció ambulatòria al pacient amb malalties cardiovasculars ha consistit tradicionalment en l’assistència fragmentada per cardiòlegs i metges de família amb poca comunicació ni coordinació. La integració entre nivells assistencials és una resposta organitzativa que pretén connectar els diferents participants en l'assistència sanitària evitant la fragmentació en la cura dels pacients i fomentant la coordinació i continuïtat assistencial. Per millorar l’atenció als pacients amb cardiopatia crònica s’han proposat nous models, com la integració entre nivells assistencials o el desenvolupament de nous dispositius d’assistència ambulatòria, com les consultes d’alta resolució.
En la present tesi s’analitzen dos experiències d’integració entre cardiologia i atenció primària en el context del sistema sanitari públic de Catalunya: La integració entre atenció primària i cardiologia a Barcelona-Esquerra i la consulta d'alta resolució en cardiologia a Vic (Osona).
Hipòtesi de treball: 1/ Un model d'integració entre atenció primària i cardiologia, format per un cardiòleg hospitalari en cada centre de primària, historia clínica compartida, guies clíniques consensuades, sessions de consultoria i altres eines de coordinació, ha de conduir a una millora en el control i tractament crònic de la població atesa per les patologies cardiovasculars més prevalents. 2/ Un model de consulta d'alta resolució en cardiologia, per donar resposta ràpida als pacients amb la realització de la visita especialitzada i les proves complementàries el mateix dia, és aplicable en la pràctica real, sostenible en el seguiment i pot permetre reduir visites successives i col•laborar a reduir ingressos hospitalaris.
La metodologia, antecedents, resultats i discussió es troben reflectits en els articles publicats:
• C. Falces, R. Andrea, M. Heras, C. Vehí, M. Sorribes, L. Sanchis, J. Cevallos, I. Menacho, S. Porcar, D. Font, M. Sabaté, J. Brugada. Integración entre cardiología y atención primaria: impacto sobre la practica clínica / Integration between cardiology and primary care: impact on clinical practice. Rev Esp Cardiol, 2011;.64(7):564-71
• C. Falces, J. Sadurní, J. Monell, R. Andrea, M. Ylla, A. Moleiro, J. Cantillo. Consulta inmediata ambulatoria de alta resolución en cardiología: 10 años de experiencia / One-Stop outpatient cardiology clinics: 10 years' experience. Rev Esp Cardiol 2008; 61:530-3.
Conclusions: La tesi avalua dos models organitzatius que han permès augmentar la integració entre atenció primària i cardiologia en dos territoris de característiques diferents (urbà i comarcal), adaptats a les característiques de cada àrea. Ambdós models han demostrat millorar la pràctica clínica en els indicadors estudiats:
Integració entre cardiologia i atenció primària: La instauració d'un model d'integració entre cardiologia i atenció primària va conduir a una milloria del control i tractament dels pacients amb cardiopatia isquèmica, insuficiència cardíaca i fibril•lació auricular en els paràmetres estudiats. L’atenció integrada va permetre redistribuir els pacients crònics entre atenció primària i cardiologia, amb augment del control dels pacients de major gravetat pel cardiòleg i el control dels pacients estables pel metge de família, amb el cardiòleg com a consultor. La satisfacció dels metges de família va augmentar amb la integració, especialment per la major comunicació i coordinació amb el cardiòleg. La integració no va implicar un increment en l'ús de recursos.
Consulta d'alta resolució en cardiologia: La consulta d'alta resolució en cardiologia és factible en la pràctica clínica real i sostenible durant 10 anys. Aquest model va permetre reduir el temps d'espera per les visites i eliminar la demora per les exploracions. El model va resultar satisfactori per l’atenció primària, va disminuir les visites successives i els contactes pacient-hospital i va contribuir a la reducció d'ingressos hospitalaris.INTEGRATION MODELS BETWEEN PRIMARY CARE AND CARDIOLOGY TO IMPROVE CLINICAL PRACTICE IN PATIENTS WITH CHRONIC HEART DISEASES
Outpatient care of patients with heart disease has traditionally been based on a model of three separate levels of care. For years, communication between these levels has been limited and not very fluid. New models have been proposed in search of greater efficiency in the management of outpatients, such as one-stop consultations or models that try to integrate primary and specialist health care. Integration between levels of care is an organizational response that aims to connect the different players in health care to avoid fragmentation and encourage continuity. To assess the impact of a program integrating cardiology and primary care in clinical practice, compared with usual care. The integrated care consists of a hospital cardiologist in each primary care clinic, shared clinical history, joint practice guidelines, consultation sessions, and other coordinating tools.
The existence of waiting lists in the public health system has led to a search for new health care models. The aim of the “one-stop” outpatient clinic is to perform the examinations needed for diagnosis and treatment at a single visit. The purpose of our study was to assess the results of 10 years’ experience in this health care model.
Articles published:
• C. Falces, R. Andrea, M. Heras, C. Vehí, M. Sorribes, L. Sanchis, et al. Integration between cardiology and primary care: impact on clinical practice. Rev Esp Cardiol, 2011;.64(7):564-71
• C. Falces, J. Sadurní, J. Monell, R. Andrea, M. Ylla, A. Moleiro, et al. One-Stop outpatient cardiology clinics: 10 years' experience. Rev Esp Cardiol 2008; 61:530-3
After applying the integrated care model to cardiology, improved long- term monitoring and treatment of patients with ischemic heart disease, heart failure, and atrial fibrillation were observed for the variables studied. Integration allows a redistribution of the chronic patients between primary care and cardiology, with increased follow-up of the patients with most serious disease by the cardiologist while follow-up of stable patients is performed by the family physicians. The satisfaction of the family physicians increased after integration, particularly in view of the better communication and coordination with the cardiologist. Integration was not accompanied by an increase in resource usage.
The one-stop clinic proved feasible in clinical practice and proved robust during the follow-up period. This model has reduced the waiting time for visits and eliminated the delay for examinations. Moreover, it was satisfactory for primary care physicians, reduced the number of follow-up visits and the need for patients to contact the hospital, and helped reduce hospital admissions
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Mitomycin C in highly myopic eyes - Author reply
No full textOphthalmology. 2005 Feb;112(2):208-18; discussion 219.
Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes.
Gambato C, Ghirlando A, Moretto E, Busato F, Midena E.
SourceRefractive Surgery Service and Antimetabolite Therapy Research Unit, Department of Ophthalmology, University of Padova, Padova, Italy.
Abstract
PURPOSE: To evaluate the role of topical mitomycin C in corneal wound healing (CWH) after photorefractive keratectomy (PRK) in highly myopic eyes.
DESIGN: Prospective, double-masked, randomized clinical trial.
PARTICIPANTS: Seventy-two eyes of 36 patients affected by high (>7 diopters) myopia.
METHODS: In each patient, one eye was randomly assigned to PRK with intraoperative topical 0.02% mitomycin C application, and the fellow eye was treated with a placebo. Postoperatively, mitomycin C-treated eyes received artificial tears (3 times daily, tapered in 3 months), whereas the fellow eye was treated with fluorometholone sodium 2% and artificial tears (3 times daily, tapered in 3 months).
MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity, manifest refraction, and biomicroscopy. Contrast sensitivity was determined using the Pelli-Robson chart. Corneal confocal microscopy documented CWH.
RESULTS: Mean follow-up was 18 months (range, 12-36). No side effects or toxic effects were documented. At 12-month follow-up examination, UCVAs (logarithm of the minimum angle of resolution) were 0.4+/-0.48 and 0.5+/-0.53 (P = .03) in mitomycin C-treated eyes and corticosteroid-treated eyes, respectively. At 1 year, corneal haze developed in 20% of corticosteroid-treated eyes, versus 0% of mitomycin C-treated eyes. At 12, 24, and 36 months, corneal confocal microscopy showed activated keratocytes and extracellular matrix significantly more evident in untreated eyes (Ps = 0.004, 0.024, and 0.046, respectively).
CONCLUSION: Topical intraoperative application of 0.02% mitomycin C can reduce haze formation in highly myopic eyes undergoing PRK.
Comment in
Ophthalmology. 2006 Feb;113(2):357; author reply 357-8
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Spatial distribution of surface action potentials generated by individual motor units in the human biceps brachii muscle
No full textThis study analyses the spatial distribution of individual motor unit potentials (MUPs) over the skin surface and the influence of motor unit depth and recording configuration on this distribution. Multichannel surface (13 x 5 electrode grid) and intramuscular (wire electrodes inserted with needles of lengths 15 and 25 mm) electromyographic (EMG) signals were concurrently recorded with monopolar derivations from the biceps brachii muscle of 10 healthy subjects during 60-s isometric contractions at 20% of the maximum torque. Multichannel monopolar MUPs of the target motor unit were obtained by spike-triggered averaging of the surface EMG. Amplitude and frequency characteristics of monopolar and bipolar MUPs were calculated for locations along the fibers' direction (longitudinal), and along the direction perpendicular (transverse) to the fibers. In the longitudinal direction, monopolar and bipolar MUPs exhibited marked amplitude changes that extended for 16-32 mm and 16-24 mm over the innervation and tendon zones, respectively. The variation of monopolar and bipolar MUP characteristics was not symmetrical about the innervation zone. Motor unit depth had a considerable influence on the relative longitudinal variation of amplitude for monopolar MUPs, but not for bipolar MUPs. The transverse extension of bipolar MUPs ranged between 24 and 32 mm, whereas that of monopolar MUPs ranged between 72 and 96 mm. The mean power spectral frequency of surface MUPs was highly dependent on the transverse electrode location but not on depth. This study provides a basis for the interpretation of the contribution of individual motor units to the interference surface EMG signal. (C) 2013 Elsevier Ltd. All rights reserved
A Multi-Language Comparison of Influences on Author Verification using Character N-Grams
No full textWe create a new multi-language corpus for author verification based on Wikipedia talkpages, and evaluate the influence that differences in topic and time have on character n-gram author profiles. Topic alignment between two texts is found to increase author verification precision, and an authors writing style is found to change over time, but not more significantly after 3 years than after 1 year.Information ArchitectureWISElectrical Engineering, Mathematics and Computer Scienc
A 0.12mm<sup>2</sup> Wien-Bridge Temperature Sensor with 0.1°C (3σ) Inaccuracy from -40°C to 180°C
No full text Resistor-based temperature sensors can achieve much higher resolution and energy efficiency than conventional BJT-based sensors [1], but they typically occupy more area (> 0.25 mm 2 ) and have lower operating temperatures (le 125 {circ} {C}) [2]-[4]. This work describes a 0.12mm 2 resistor-based sensor that uses a Wien-bridge (WB) filter to achieve 0.1 {circ} {C} (3 sigma) inaccuracy from - 40 {circ} {C} to 180 {circ} {C}. Compared to a state-of-the-art WB sensor [4], it occupies 6 × less area and achieves comparable relative accuracy over a 76% wider operating range. Session 10.3 Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Electronic InstrumentationMicroelectronic
A ±25A Versatile Shunt-Based Current Sensor with 10kHz Bandwidth and ±0.25% Gain Error from -40°C to 85°C Using 2-Current Calibration
No full textAccurate current sensing is critical in many industrial applications, such as battery management and motor control. Precise shunt-based current sensors have been reported with gain errors of less than 1% over the industrial temperature range (-40°C to 85°C) [1]–[4]. However, since they are intended for coulomb counting, their bandwidth is limited to a few tens of Hz, making them unsuitable for battery impedance or motor-current sensing. This paper presents a current sensor with a wide (10kHz) bandwidth and a tunable temperature compensation scheme (TCS), which allows it to be flexibly used with different types of shunts while maintaining high accuracy. A low-cost room-temperature calibration scheme is proposed to optimize gain flatness over temperature by exploiting the shunt's self-heating at large currents. Over the industrial temperature range and a ±25A current range, it achieves state-of-the-art gain error (±0.25%) with both low-cost PCB and stable metal-alloy shunts.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Electronic InstrumentationMicroelectronic
An Article About Albertus C. Van Raalte, Author Unknown, Except for Parts Taken from an Article by Anna C. Post
No full textAn article about Albertus C. Van Raalte, author unknown, except for parts taken from an article by Anna C. Post. The author knew first generation persons in the Holland settlement and therefore, the article has some value.https://digitalcommons.hope.edu/vrp_1890s/1012/thumbnail.jp
Archivist, Archaeologist, Author and the Tactile Window
No full textThe idea that the predominant way of engaging with architecture is through vision is not uncommon but also not always the most appropriate given that buildings are also experienced through tactile interventions. This consequence that emphasises visual aesthetics in order to appreciate and understand architecture probably has much to do with the assumed but rather vaguely defined role of the architect as designer in the practice of architectural design. A resulting misapprehension is that architects designing for visual appreciation think that they are actually designing physical space for embodied tactile engagement.
This prioritisation of vision in the way architects think about and approach design is questioned through the design project of the Tactile Window in which the position of the architect is redefined through inhabiting the roles of archivist, archaeologist and author during the design process.
A 16th century portrait of Queen Elizabeth I known as the Ditchley portrait, currently on display at the National Portrait Gallery is used as the source from which the design of the Tactile Window is derived from and refers back to. Questioning the validity of vision as the sole means of engaging with the work, information about the portrait and working methods gathered from the three carefully chosen positions mentioned above are drawn on and applied to the making of this Tactile Window that becomes an alternative Ditchley portrait. Through exploring the hidden historical and current narratives of and in the existing portrait, the presence of the portrait is alluded to on an alternative physical site. Key to this are the working methods of an invented archival system of design reasoning, the unearthing of archaeological texts and assuming of authorship within the individual frameworks of the roles of archivist, archaeologist and author.
The redefined role of the architect as archaeologist takes onboard the unearthing of associated drawings and writings as well as the methods of organising and applying the recovered information to the system set up by the archivist. This analysis of the graphic and text based information is used to formulate historical narratives that are woven into the design project. Whereas traditional archaeology stresses on the study of a site from a site with quantifiable limits to the physical context, the notion of archaeological sites in this instance refers to the places where the stored information is unearthed. Through the careful process of archiving and analysing this information, a new site that is located within both the physical and historical contexts of interest is discovered. The author then draws upon the elements in the archival system that includes the findings of the archaeologist to construct the alternative Ditchley portrait in this new site of the Echoing Cedar, the result of which bears no visual resemblance to the existing work.
The Tactile Window is a reading of the Ditchley portrait in which information about and in the painting is transformed into a design proposal for an inhabited structure. The intended method of interaction with this alternative portrait is not merely restricted to vision but relies on engagement with the other senses. This experience is enhanced by the interplay with certain site conditions such as wind and rain in order to allude to specific aspects of the Ditchley portrait that are not visually apparent in the existing work.
In the processes of excavating, finding and revealing the hidden information to create this alternative portrait, the effects of the visuals afforded by the existing portrait inadvertently begin to fade as the validity of a single means of visual expression is questioned
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