Laminin, laminin-entactin and extracellular matrix are equally appropriate adhesive substrates for isolated adult rat cardiomyocyte culture and experimentation.

Although techniques for isolating and culturing adult cardiomyocytes were developed four decades ago, it still remains a challenge to isolate high yields of healthy viable cardiomyocytes, to maintain them in culture, and to use them successfully in experiments. This is due to the difficulty in deciding which adhesive substrate and buffer composition to use. Therefore this study aimed to (1) identify a robust experimental buffer to sustain survival of cultured adult rat cardiomyocytes (ARCMs) during control normoxic conditions, and (2) to identify an adhesive substrate that provides optimal cell adherence, not only during normoxia, but especially during simulated ischemia-reperfusion (SIR) experiments. Adhesion and viability of ARCMs were evaluated on laminin, laminin-entactin (LE), and extracellular matrix (ECM) at concentrations between 25-200 ug/ml, in three different normoxic experimental buffers and under SIR conditions. Differences in normoxic buffer composition had no effect on the adherence of ARCMs, but had a significant effect on mitochondrial function and thus cell viability. HEPES buffered PBS supplemented with 10 mM glucose was not sufficient to sustain cell viability unless 2 mM pyruvate was added, yet a cocktail of PBS and M199 provided an even greater viability. Finally, laminin, LE, and ECM retained similar numbers of ARCMs per concentration, but only provided efficient adhesion at concentrations ≥ 100 ug/ml.

Health care procedures.

BACKGROUND: ICD is used for coding medical diagnoses across the world, but there is no globally accepted coding system for health care procedures. The need for the introduction of a common international medical procedure classification has been addressed by the Australian NCCH, which proposed the International Classification of Health Interventions (ICHI) as the basis of an international procedure classification. In parallel, the French multiaxial Classification Commune des Actes Médicaux (CCAM) has been established. OBJECTIVES: The aim is to compare ICHI to the CCAM architecture and to assess their appropriateness for supporting international comparability of procedure data and give a recommendation for the further development of international procedure classifications. METHODS: The architecture of both ICHI and CCAM was thoroughly analyzed. ICHI classes were mapped to the classes of the multiaxial CCAM basic coding tables. This was done manually by domain experts, which analyzed the exact wording of each ICHI title. The result was assessed in terms of representability and granularity. RESULTS: 78.4% of ICHI classes could be mapped directly to CCAM. The anatomical site could be represented in 99.3%. Numerous ICHI classes combined anatomical sites requiring more than one CCAM code. Problems arouse due to imprecise ICHI descriptions. CONCLUSIONS: CCAM appeared as the more elaborate and mature system whereas ICHI had some drawback regarding ambiguity and varying granularity. It is recommended to improve the structure of ICHI by the beneficial aspects of the CCAM and to avoid semantic ambiguities by applying ontological principles and logic-based representation languages.

[The French Common Classification of Procedures CCAM. An option for Germany]. / Die französische Prozedurenklassifikation CCAM. Eine Option für Deutschland.

A working group of the National Board for Classification in Health Care at the Federal Ministry for Health (KKG) concerned itself between 1996 and 2003 with the topic of a possible follow-up procedure classification system for the actually used "Operation and Procedure Coding System" (OPS-301), which was introduced to Germany in the mid 1990's. In the context of a feasibility study the American "Procedure Coding system" (PCS) and the French "Classification commune des actes médicaux "(CCAM) were examined and evaluated as possible follow-up classifications. In this study it could be shown that the CCAM has great advantages over the pure multiaxial PCS. The strength for that is its medical content, its construction, the methods used and in particular the usability by physicians, the ease of statistic evaluations and the support to maintain the CCAM. In this article the CCAM is presented in detail with its basic principles and its classification methods together with some of the most important coding rules. It is discussed whether the CCAM can be a follow-up classifications system for the German OPS as it is, or if it would make more sense to reconstruct the existing medical content of the OPS with the architecture and methodology of the CCAM.

The semantics of procedures and diseases in SNOMED CT.

OBJECTIVES: SNOMED CT is emerging as a reference terminology for the entire health care process. It claims to be founded on logic-based modelling principles. In this article, we analyze a special encoding scheme for diseases and procedures in SNOMED CT, the so-called relationship groups (RGs), which had been devised to avoid ambiguities in definitions. METHODS: We reformulate SNOMED CT's relationship groups in the format of description logics in order to check whether RGs serve the needs they were designed for. RESULTS: We show that a considerable proportion of relationship groups represent hidden mereological relations. We also report discrepancies encountered between the defined semantics of many SNOMED CT terms and their intuitive meaning, as well as inconsistencies detected between the definition of various complex composed terms and the definition of their top-level parents. CONCLUSIONS: We formulate recommendations for improving SNOMED CT by replacing most occurrences of relation groups by formally more adequate "part-of" relations.

Music therapy research and applications in pediatric oncology treatment.

Music therapy is a profession which meets multiple physical, social, and psychological needs. Music therapists can facilitate health objectives by reducing the intensity or duration of pain, alleviating anxiety, and decreasing the amount of analgesic medication needed. Rehabilitative objectives can include activities which incorporate exercise, range of motion therapy, or gait training. Reduction of fear, anxiety, stress, or grief are common psychological objectives. Music therapy is particularly effective in promoting social objectives such as increased interaction, verbalization, independence, and cooperation; enhanced relationships with health care personnel and family members; and increased stimulation during long-term hospitalization or isolation. Counseling techniques are often paired with music to achieve emotional objectives such as expression, adjustment, stability, or locus of control. The purpose of this article is to synthesize the extant music/medical research literature and clarify how music therapy can provide a quintessential combination of physical, social, and psychological benefits to enhance the health care of pediatric oncology patients.

Effects of a music therapy strategy on depressed older adults.

A music-facilitated psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety. Thirty older adults who had been diagnosed with major or minor depressive disorder were randomly assigned to one of three 8-week conditions: (1) a home-based program where participants learned music listening stress reduction techniques at weekly home visits by a music therapist; (2) a self-administered program where participants applied these same techniques with moderate therapist intervention (a weekly telephone call); or (3) a wait list control. Participants in both music conditions performed significantly better than the controls on standardized tests of depression, distress, self-esteem, and mood. These improvements were clinically significant and maintained over a 9-month follow-up period. The potential for this type of intervention with homebound elders and others who have limited access to services is discussed.

Maternal distress and discrepancy in reports of psychopathology in chronically ill children.

This article focuses on the relation between maternal distress and mother-child discrepancy in reports of child psychopathology, as assessed by a standardized structured interview. The sample includes 92 chronically ill children (mean age +/- SD = 12.5 +/- 2.7 years). Agreement between mother and child on the presence of any child psychiatric diagnosis was low. Maternal distress was correlated with the number of disorders identified by the mother but not with those identified by the child. Maternal distress was significantly higher in the mothers who identified a disorder but whose children did not. Choice of informant and maternal distress are significant factors in the evaluation of psychopathology.

Mental disorders in chronically ill children: parent-child discrepancy and physician identification.

Mental disorders affect 18% to 20% of children and adolescents. The rate in children with chronic illness is probably higher. This study of chronically ill children addresses the discrepancy between parent and child reports of child psychiatric disorders and the extent to which pediatricians agree with reports by children and parents regarding such problems. Eighty-three subjects, aged 9 to 18 (mean = 12.6), were recruited; they had the following diagnoses: cystic fibrosis, diabetes, inflammatory bowel disease, and cancer. Subjects and one parent were interviewed separately, using the Diagnostic Interview Schedule for Children (DISC-2.1). The subject's physician completed a questionnaire asking about the presence of a range of mental disorders. Forty-one (49%) subjects reached threshold criteria for a psychiatric diagnosis, using both parent and child as informants. Psychiatric disorders were identified in only 22 subjects (54%) by the child and in 28 (68%) by parent alone. Thus, reliance on one informant resulted in failure to identify one third to one half of psychiatric disorders. Physicians' ratings agreed significantly with children's reports but not with parental reports, suggesting that physicians are sensitive to children's concerns but may underestimate the value and importance of parents' reports. Clinical and research evaluations of chronically ill children, as well as clinician identification of mental health problems, will be influenced by the choice of informant.

Batter up! Relapse prevention for homeless veteran substance abusers via softball team participation.

Thirty-four veterans of a residential rehabilitation program for homelessness and substance abuse participated on a community-based softball team. Compared to nonparticipants, participants stayed in treatment longer and were more likely to complete all aspects of the program (inpatient and outpatient). They also were more likely to be abstinent from drugs/alcohol, employed, and housed 3 months postdischarge. Participation appeared to enhance outcomes by providing in vivo opportunities for practicing coping skills and developing supportive relationships. A softball program may be a viable adjunct treatment in which formally taught cognitive-behavioral skills can be applied in a natural, but semistructured setting.