Aneurysmal growth in type-B aortic dissection: assessing the impact of patient-specific inlet conditions on key haemodynamic indices.

Type-B aortic dissection is a cardiovascular disease in which a tear develops in the intimal layer of the descending aorta, allowing pressurized blood to delaminate the layers of the vessel wall. In medically managed patients, long-term aneurysmal dilatation of the false lumen (FL) is considered virtually inevitable and is associated with poorer disease outcomes. While the pathophysiological mechanisms driving FL dilatation are not yet understood, haemodynamic factors are believed to play a key role. Computational fluid dynamics (CFD) and 4D-flow MRI (4DMR) analyses have revealed correlations between flow helicity, oscillatory wall shear stress and aneurysmal dilatation of the FL. In this study, we compare CFD simulations using a patient-specific, three-dimensional, three-component inlet velocity profile (4D IVP) extracted from 4DMR data against simulations with flow rate-matched uniform and axial velocity profiles that remain widely used in the absence of 4DMR. We also evaluate the influence of measurement errors in 4DMR data by scaling the 4D IVP to the degree of imaging error detected in prior studies. We observe that oscillatory shear and helicity are highly sensitive to inlet velocity distribution and flow volume throughout the FL and conclude that the choice of IVP may greatly affect the future clinical value of simulations.

Trust, feasibility, and priorities influence Swedish dairy farmers' adherence and nonadherence to veterinary advice.

The problem of nonadherence to advice is recognized in several professional relationships, including the veterinarian-client relationship. A better understanding of farmer perspectives may help to improve efficiency in veterinary herd health management. This study aimed to qualitatively and quantitatively describe farmers' reasons for adherence and nonadherence with veterinary recommendations regarding preventive herd health measures. We carried out structured telephone interviews about implementation of preventive measures with owners or staff of 163 dairy farms and 6 beef farms. The farms had received an advisory visit by their veterinarian (n = 36), who had documented the preventive measures they had recommended. The interviewer noted verbatim responses to reasons for implementing preventive measures fully, partially, or not at all, and we analyzed these responses thematically. We also conducted a quantitative analysis, in which we calculated descriptive statistics of the proportions of different categories of reasons stated by the farmers. Altogether, 726 preventive measures (range per farm 1 to 17; median 3; interquartile range 2 to 6) were documented. We identified 3 organizing themes related to adherence or nonadherence with veterinary advice: trust, feasibility, and priorities. Overall, the most commonly stated reasons related to trust (in the veterinarian, in the advisory process, or in individual preventive measures). The most common reasons not to follow the recommended advice were related to feasibility. Based on the results, we recommend that, to improve adherence to their advice, veterinarians pay increased attention to farmers' needs, priorities, goals, and motives, as well as to farmers' perceptions of the effectiveness of individual preventive measures. We also recommend that veterinarians need to increase their focus on recommending preventive measures that are practically feasible to implement on farms.

[Clinical pathways in psychiatry and psychotherapy]. / Behandlungspfade in Psychiatrie und Psychotherapie.

BACKGROUND: Implementing evidence-based clinical guidelines by means of clinical pathways is one of the key elements of continuous quality management at the University Hospital of Marburg. This paper explains how clinical pathways for suicidal ideation and suicide attempts were developed. METHODS: Based upon a review of existing guidelines and literature, optimal standards of care were defined. Step-by-step analysis of the process of care and results of a questionnaire were used to describe the actual processes. A problem-orientated comparison of the actual and the optimal process of care was the basis for developing these pathways. A consensus was achieved with all persons involved in the respective process of care taking into consideration local resources as well as barriers. The most important decisions and interventions were defined and presented as a patient-oriented process. RESULTS: The lack of explicit "how to do it"-recommendations of the guidelines for the entire care processes required specific, locally tailored adaptations. Potentials for improvement were identified in the following areas: transfer of patients, consultation, information and coordination within the team, and diagnosis of suicide risk. The pathways include care-oriented algorithms, checklists and assignments of responsibility. CONCLUSIONS: The development of clinical pathways as part of quality management and transsectoral integrated care in psychiatry and psychotherapy is feasible. The concept presented incorporates the potential of increasing transparency, efficiency and efficacy of care, and of improving satisfaction of those involved. It offers psychiatric hospitals the chance to guarantee optimal quality of care in face of increasing workload and costs.

Scalp recordings of mid-latency AEP and auditory gating in the Göttingen minipig: a new animal model in information processing research.

Early central information processing, measured in humans by the gating of the middle latency auditory evoked potential (AEP) P50 and the effect of attention on AEP N100, is affected in schizophrenia. Exploring the possibility of using miniature pigs in longitudinal studies of chronic neuropsychiatric disorders, we present a method for recording seven channel surface middle latency AEP in the awake animal. The AEP and the AEP gating measured in a paired stimulus paradigm similar to the P50 gating paradigm used in humans, were recorded in six adult male minipigs in two sessions. The AEP had a stable N40/P60/N120/P200 configuration and in the gating paradigm the difference between stimulus one (S1) and two (S2) P60 and N120 amplitudes were significant. Mean AEP P60 gating ratio (S2/S1) at the posterior central electrode was 0.66 (std 0.29) range 0.21-1.08 and corresponding N120 was 0.60 (std 0.19) range 0.28-0.76. The method presented is feasible for scalp recordings of middle latency evoked potentials in the awake animal, but further studies of interval sensitivity and the effect of arousal manipulation are needed to assess the equivalence of the pig components to those of the human at similar latencies.

Policy goals for health and safety.

Health management and safety regulation are separate disciplines but share the aim to extend expectancy of life in good health. The need to improve cost-effectiveness calls for their co-ordinated management according to a unified rationale. Three guiding principles of accountability, demonstrable net benefit and a uniform measure of performance, have been laid out in Canada by the Joint Committee on Health and Safety. They call for open accounting in terms of (health-related quality-adjusted) life expectancy. The principles are utilitarian in format but, it is argued, inequity is naturally diminished in the process of optimizing cost-effectiveness through maximum marginal returns. Comments are made on practical implementation. The need for public consent in practice calls for two additional principles reflecting fair procedure and sovereignty of the citizens. It is concluded that public health and safety measures should be surveyed, documented for cost-effectiveness and prioritized for improvement.

Partnership in education: central service prepares students for materiel management duties.

Partnership in education looks at one technical college's approach to meeting the demand for trained workers in central service and materiel management. This article examines the partnership formed between a college, area health care facilities, and industry to design, develop, and implement a central service materiel management program.

Central service in Siberia.

In 1992, eight healthcare professionals from United Hospital in Grand Forks, North Dakota spent six weeks in Ishim, in the Siberian region of Russia, on a medical information exchange to observe the methods of healthcare delivery, assess the needs of medical facilities and share technical advice where applicable. Ishim's CS workers were anxious to learn how to better utilize the resources they had--which were few. Supplies were so limited that CS workers were provided little personal protective equipment; there were not even gloves available for handling contaminated instruments in the washing and decontamination areas. Ishim's facility reprocessed virtually everything, including tongue depressors and surgeons' gloves. The CS department cleaned, assembled and sterilized instruments for Ishim City Hospital's OR and for the city's 28 clinics. When United's representatives returned to the U.S., they formed a supply committee to procure instruments and other needed materials for the Russian hospital and clinics.

Alternatives to psychiatric hospitalization for children.

The impetus for the dramatic increase in the number of treatment alternatives for children has come from changes in the theoretical conceptualization of treatment, social and political pressures, and financial considerations. This article reviews the literature on alternatives to hospitalization, appraising the available data on the effectiveness of psychiatric hospitalization and its alternatives and considers future research needs and the development of services in this area.