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Last news: January 7, 2008 09:34:29

The studys purpose was to investigate the item-level psychometric properties of the Communicative Effectiveness Survey (CES) using Rasch analysis, an item response theory model. The CES (8-item 7-category rating scale) was designed to elicit ratings of communicative effectiveness in everyday situations from individuals with dysarthria. A speech-language pathologist (SLP) blind to the studys purpose administered the CES to 95 individuals (58% male), mean age 62.5 (SD = 14.0, range 18-87), with neurodegenerative diseases and a wide range of speech competency. Rasch analysis showed three of the seven rating scale categories were used with such low statistical probability that they... (Source: Journal of Medical Speech - Language Pathology) - [Read more]

As a hospitalist, Dr. John Nelson belongs to the fastest-growing medical specialty in the country -- even if the average person doesn't know a hospitalist from a hospital gown. (Source: bizjournals.com Health Care:Physician Practices headlines) - [Read more]

Erie County Medical Center and Kaleida Health officials are no more certain about the shared future of their facilities than they were a year ago when the merger of the public and private hospital systems was mandated by the state. (Source: bizjournals.com Health Care:Hospitals headlines) - [Read more]

Dublin Methodist Hospital opens Jan. 8 not only as the latest competitor in the Central Ohio medical market, but as a testing ground for the latest theories in hospital construction. (Source: bizjournals.com Health Care:Hospitals headlines) - [Read more]

Health care reform, education policy and improving the state's transportation system are among the big Statehouse issues weighing heavily on Colorado businesses and the state's economy. (Source: bizjournals.com Health Care:Health Insurance headlines) - [Read more]

In 2004, Bradley Roberts was rushed to Miami Valley Hospital after being shot four times by a Springfield police officer. (Source: bizjournals.com Health Care:Hospitals headlines) - [Read more]

Steve Anderson, CEO of Overland Park Regional Medical Center, arrived at the hospital in September 2006. But his reputation as a spreadsheet fanatic preceded him. (Source: bizjournals.com Health Care:Hospitals headlines) - [Read more]

Alta Bates Summit Medical Center in Oakland and Berkeley snuffed out cigarette smoking on its campuses as of Jan. 1, one in a growing list of hospitals that are going smoking free. (Source: bizjournals.com Health Care:Hospitals headlines) - [Read more]

THEN Date: June 22, 2007 Headline: "Litigation lingers as doctors leave the building" THE STORY Doctors vacating a medical office building owned by Memorial Hermann Healthcare System have filed two lawsuits against the hospital giant as part of their departure. (Source: bizjournals.com Health Care:Physician Practices headlines) - [Read more]

Columbia St. Mary's Inc. and the Medical College of Wisconsin have combined efforts to use a Milwaukee food pantry as a clinic site aimed at assisting low-income adults who may be at risk of developing chronic diseases. (Source: bizjournals.com Health Care:Health Insurance headlines) - [Read more]

Journal of the American Geriatrics Society, Volume 0, Issue 0, Page ???, OnlineEarly Articles. OBJECTIVES: To compare the use of guideline-recommended medical and interventional therapies in older and younger patients with acute coronary syndromes (ACSs). DESIGN: Prospective cohort study. SETTING: Fifty-five hospitals in Switzerland. ... (Source: Journal of the American Geriatr) - [Read more]

Amer J PerinatolDOI: 10.1055/s-2007-1004831ABSTRACTOur patient was a 24-year-old gravida 2 para 0 woman. After delivery, placenta percreta was noticed. There was no postpartum hemorrhage, and the patient desired future pregnancies. Although placenta percreta is rare, its sequelae include potentially lethal hemorrhage and loss of reproduction function. Placenta percreta was confirmed histologically and with ultrasonography and magnetic resonance imaging (MRI). Placenta percreta was treated conservatively with methotrexate. On follow-up, MRI showed a small calcified transmural extension of the placenta throughout the uterus in the right fundal area. Color Doppler ultrasonography showed no blood flow in the corresponding area, and maternal serum human chorionic gonadotropin (hCG) was undetectable. Use of MRI is a new method to detect abnormal placentation, and it could be used on follow-up in selective cases with other follow-up modalities. However, it seems likely that conservative management to preserve future fertility remains a secured and reasonable alternative when a patient has no active bleeding.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology) - [Read more]

Semin Thromb Hemost 2007; 33: 821-828DOI: 10.1055/s-2007-1000371ABSTRACTVenous thromboembolism is a frequently occurring and potentially fatal disease characterized by short-term and long-term sequelae. Conventional treatment consists of heparin and vitamin K antagonists, but there is an ongoing controversy if more aggressive therapy, such as thrombolytic drugs, should be used in selected patients to achieve faster clot lysis in pursuit of better clinical outcome. A review of the literature shows that thrombolytic therapy is not recommended in the treatment of venous thrombosis. Although in deep vein thrombosis systemically administered and catheter-directed thrombolysis both offer advantages in improving vein patency and reducing the postthrombotic syndrome (PTS), prevention of severe PTS remains unproved while the bleeding risk is high. In pulmonary embolism (PE), thrombolytic therapy is generally recommended for patients with massive PE and hemodynamic instability, despite scarce and inconclusive evidence. There is no evidence that thrombolysis has a benefit over standard anticoagulant treatment in normotensive patients with acute PE, but more research is needed to better identify the subgroup of patients with nonmassive PE in whom the risk-benefit ratio is most favorable. Until this group is defined and the benefit of thrombolytic therapy is demonstrated, thrombolytic therapy should only be considered in patients with signs of massive PE and hemodynamic shock.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 727-744DOI: 10.1055/s-2007-1000364ABSTRACTvon Willebrand disease (VWD) is considered to be the most common inherited bleeding disorder. It is diagnosed after a clinical and physical review, with personal and familial evidence of (primarily mucocutaneous) bleeding, and confirmed by laboratory testing. The latter typically entails initial plasma testing of factor VIII coagulant (FVIII:C), von Willebrand factor (VWF) protein (antigen; VWF:Ag), and VWF function, which has classically been assessed using the ristocetin cofactor (VWF:RCo) assay. More recent attention has focused on another functional VWF assay, the collagen binding (VWF:CB) assay, as a possible replacement for the VWF:RCo assay or as a supplementary test of VWF adhesive “activity.” Additional laboratory testing can comprise a battery of confirmatory and VWD subtype assisting assays, including assessment of VWF:multimers. This review updates our knowledge of VWD diagnostics with a particular emphasis on the VWF:CB assay. There is good evidence now in place that an optimized VWF:CB assay can significantly reduce the diagnostic error rate otherwise arising from the use of a test panel restricted to including the VWF:RCo assay as the sole functional VWF assay. Nevertheless, the VWF:CB assay should not be used to wholly replace the VWF:RCo assay in phenotypic testing but rather as a supplementary assay. However, with some thought and justification, the VWF:CB assay can be used to partly replace the VWF:RCo assay in some “screening” applications and can also be used to abrogate the need to perform routine VWF:multimers in most test cases.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 810-815DOI: 10.1055/s-2007-1000370ABSTRACTPatients with severe bleeding are often treated with colloids as plasma replacement fluids, including dextrans, gelatin-based solutions, or starches. Many of these agents will affect the hemostatic system beyond their effect on hemodilution. Obviously, the ensuing impairment of coagulation is not desirable in patients with major blood loss. However, there is considerable controversy whether the anticoagulant effects of the various compounds will truly translate into clinically relevant effects, such as increased blood loss or, even more importantly, transfusion requirements, the need for surgical (re) exploration, organ dysfunction, or mortality. In this overview, we discuss the effects of various plasma replacement solutions on the coagulation system and review the controlled clinical studies with different plasma expanders on clinically significant end points. We conclude that most plasma expanders have indeed marked effects at various points in the hemostatic system and that there are significant differences between various plasma replacement fluids but that clinically relevant effects on bleeding are mostly present if large volumes (i.e., > 1.5 L) are infused or if the patient has a concomitant or preexistent hemostatic impairment.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 745-758DOI: 10.1055/s-2007-1000367ABSTRACTPlasma-derived factor concentrates are important in the management of von Willebrand disease (VWD). We review the current literature regarding pharmacokinetic studies of von Willebrand factor (VWF) concentrates used to treat VWD. Using additional local experience of a crossover pharmacokinetic (PK) study comparing a currently licensed double virally inactivated concentrate, Biostate, with that of its single virally inactivated predecessor, AHF (High Purity), we propose that consideration now be given to the use of new and novel test parameters for future PK studies. In particular, we propose that an evaluation of VWF collagen binding (VWF:CB) using an assay confirmed to be sensitive to high-molecular-weight forms of VWF be used in all future studies in addition to standard parameters such as factor VIII coagulant (FVIII:C), VWF antigen (VWF:Ag), and ristocetin cofactor (VWF:RCo). We further propose the use of calculated ratios of VWF:RCo to VWF:Ag and VWF:CB capacity to VWF:Ag as a measure of delivered VWF “functionality.” We also report some new data regarding assessment of VWF:multimers using standard procedures together with densitometry and a novel scoring system to support our proposals. We suggest that these test parameters may be useful in future PK studies to better assess and compare the potential utility and clinical efficacy of VWF factor concentrates for use as therapy for VWD.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 780-786DOI: 10.1055/s-2007-1000368ABSTRACTPlatelet-type von Willebrand disease (PT-VWD, or pseudo-VWD) and type 2B VWD share a common bleeding phenotype with different etiologies. Both PT-VWD and type 2B VWD represent an enhanced binding between the plasma von Willebrand factor (VWF) to its platelet ligand, glycoprotein Ib α (). However, type 2B VWD results from a functionally abnormal VWF molecule, whereas PT-VWD is caused by hyperresponsive platelets due to defects in the platelet gene. The laboratory discrimination between the two disorders can be a challenge because simple phenotypic testing will not differentially identify the disorders, and the more complex testing approaches are often poorly applied. Definitive diagnosis is critical for treatment decisions and can be most definitively achieved by identifying the gene defect at either the or loci. A systematic international molecular genetic study would be helpful to address the question of whether PT-VWD is being misdiagnosed as type 2B VWD. Such a study can be facilitated by an international online database/disease registry to enhance international awareness about this otherwise long-recognized diagnostic dilemma.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 759-770DOI: 10.1055/s-2007-1000366ABSTRACTVenous thromboembolism is a major health care problem worldwide and is sustained by a multifactorial pathogenesis where both congenital and acquired causes contribute. It is increasingly being highlighted that a reliable approach based on genomics and proteomics might be effective to construct a rational personalized medicine framework that can be applied in the preclinical, clinical, and therapeutic settings of venous thrombosis. The aim of this review is to provide a concise description of the current and future applications of genomics and proteomics in this challenging pathology.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 798-809DOI: 10.1055/s-2007-1000372ABSTRACTWe review the association between disorders of endocrine function and hemostasis. The content of more than 570 review articles were appraised to provide the core of 81 key articles referenced in this chapter. The search method used MEDLINE and EMBASE electronic databases and the key words e and . Abnormalities of hemostasis, platelets, and endothelium and the presence of microparticles, abnormal expression of adhesion molecules, and elevated von Willebrand factor are all associated with cardiovascular disease and are also features of various endocrine disorders, including diabetes and its complications, insulin resistance, polycystic ovary syndrome, and various thyroid disorders. Related causes and associated factors, including obesity, alcohol, hyperlipidemia, omega fatty acids, vitamin D, serotonin, insulin-like growth factors, angiotensin-converting enzyme, and C-reactive protein, are also discussed in this review.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]

Semin Thromb Hemost 2007; 33: 771-779DOI: 10.1055/s-2007-1000369ABSTRACTMicroparticles are small, membrane-bound vesicles that are generated from cells of different origin. It now appears that all circulating blood cells as well as endothelial cells release membranous fragments ~1 μm in size or smaller bearing at least some characteristics of the parent cell. Elevated levels of microparticles have been described in cardiovascular states, thrombotic conditions, and cancer. Various methods of detection for microparticles include flow cytometry, enzyme-linked immunoassays, and functional assays. Flow cytometry has several advantages including its ability to quantitate and identify microparticles of different cellular origin. However, the standardization of preanalytical and analytical variables for enumeration of microparticles remains a significant challenge. Newer approaches are being investigated, and an international collaboration is working on standardization of detection as well as quantitation of microparticles by flow cytometry. Although it has evolved as an important vascular biology research tool, microparticle detection needs further evaluation and refinement before it becomes truly useful as a clinical tool.[...]© Thieme Medical PublishersGet connected:Table of contents  |  Abstract  |  Full text (Source: Seminars in Thrombosis and Hemostasis) - [Read more]