3D-QSARpy: Combining variable selection strategies and machine learning techniques to build QSAR models

Abstract Quantitative Structure-Activity Relationship (QSAR) is a computer-aided technology in the field of medicinal chemistry that seeks to clarify the relationships between molecular structures and their biological activities. Such technologies allow for the acceleration of the development of new compounds by reducing the costs of drug design. This work presents 3D-QSARpy, a flexible, user-friendly and robust tool, freely available without registration, to support the generation of QSAR 3D models in an automated way. The user only needs to provide aligned molecular structures and the respective dependent variable. The current version was developed using Python with packages such as scikit-learn and includes various techniques of machine learning for regression. The diverse techniques employed by the tool is a differential compared to known methodologies, such as CoMFA and CoMSIA, because it expands the search space of possible solutions, and in this way increases the chances of obtaining relevant models. Additionally, approaches for select variables (dimension reduction) were implemented in the tool. To evaluate its potentials, experiments were carried out to compare results obtained from the proposed 3D-QSARpy tool with the results from already published works. The results demonstrated that 3D-QSARpy is extremely useful in the field due to its expressive results.

Extração de recomendações farmacológicas para subsidiar o processo de adaptação de guias de prática clínica utilizados no tratamento da fibrilação atrial não valvar - uma revisão sistemática de guias de prática clínica / Extraction of pharmacological recommendations to support the process of adaptation of clinical practice guides used in the treatment of non-valvular atrial fibrillation a systematic review of clinical practice guidelines

A fibrilação atrial (FA) não valvar é a arritmia cardíaca mais comum em adultos, principalmente na população idosa. Para o tratamento da FA, recomenda-se a utilização de guias de prática clínica (GPCs), que são documentos que apresentam as melhores e mais atualizadas evidências para o tratamento dos pacientes acometidos por essa arritmia. Todavia, o processo de desenvolvimento dos GPCs requer recursos humanos, financeiros e tempo. Assim, a adaptação dos referidos documentos é uma opção para reduzir a duplicação de esforços e possibilitar sua adequação para uso local. O objetivo deste trabalho foi elaborar uma matriz de recomendações farmacológicas para subsidiar o processo de adaptação de GPCs utilizados no tratamento da fibrilação atrial não valvar. Para tanto, aplicou-se o método ADAPTE: revisão sistematizada de GPCs, avaliação e seleção dos GPCs de qualidade e elaboração da matriz. Foram considerados elegíveis 26 GPCs com recomendações farmacológicas para assistência primária da fibrilação atrial não valvar em adultos, publicados em inglês, espanhol ou português no período de abril de 2014 a abril de 2019 e indexados às bases de referência: MEDLINE, Embase, Cochrane Library e em 12 bases de dados específicas. A qualidade dos GPCs, foi avaliada pela aplicação do instrumento Appraisal of Guidelines for Research & Evaluarion II (AGREE II), sendo considerados de alta qualidade aqueles que apresentaram nota igual ou superior a 60 % no domínio Rigor de desenvolvimento. Todas as etapas foram realizadas por, pelo menos, 2 avaliadores e em caso de discrepância, um terceiro avaliador participou do processo. Dos 26 GPCs avaliados apenas 7 (26,9%) foram considerados de alta qualidade. A maioria dos GPCs utiliza o escore CHA2DS2-VASc, que indica a profilaxia tromboembólica em pacientes com FA não valvar a partir da pontuação 1 (fator de risco não sexual) e sugere a anticoagulação com anticoagulantes de ação direta. Houve pouca ênfase à complexidade da profilaxia de eventos tromboembólicos em idosos. Esta matriz visa contribuir para que sejam realizadas discussões e adaptações de GPCs destinado ao tratamento da FA não valvar com ênfase nas demandas e necessidades locais

Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, especially in the elderly population. For the treatment of AF, the use of clinical practice guidelines (CPGs) is recommended, which are documents that present the best and most up-to-date evidence for the treatment of patients who are affected by this arrhythmia. However, the CPGs development process requires human, financial and time resources. However, the adaptation of documents is an option to reduce the duplication of efforts and make it possible to adapt them for any local use. The objective of this work was to elaborate a matrix of pharmacological treatment to support the process of adaptation of CPGs used in the treatment of non-valvular atrial fibrillation. Therefore, the ADAPTE method was applied: systematic review of CPGs, evaluation and selection of quality CPGs and matrix definition. Twenty-six CPGs were considered eligible with pharmacological recommendations for primary care of non-valvular atrial fibrillation valid in adults, published in English, Spanish or Portuguese from April 2014 to April 2019 and indexed to the following reference databases: MEDLINE, Embase, Cochrane Library and in 12 specific databases. The quality of the CPGs was assessed by applying the Assessment of Guidelines for Research and Assessment II (AGREE II) instrument, being considered of high those who had a grade equal to or greater than 60% in the domain Rigour of development. All steps were performed by a least 2 evaluators and in case of discrepancy, a third evaluator participated in the process. Of the 26 CPGs evaluated, only 7 (26.9%) were considered to be of high quality. Most CPGs use the CHA2DS2-VASc score, which indicates thromboembolic prophylaxis in patients with non-valvular AF from score 1 (non-sexual risk factor), and suggest anticoagulation with direct-acting anticoagulants. There was little emphasis on the complexity of prophylaxis for thromboembolic events in the elderly. This matrix aims to contribute to discussion and adaptations of CPGs for the treatment of non-valvar AF with the emphasis on local demands and needs

Novel biopharmaceutical development investigations towards drug and formulation performance optimization

For a drug to excerpt pharmacological action after oral intake, it first needs to be released from the formulation, get into solution (dissolve), be absorbed, and reach the systemic circulation. Since only solubilized drugs can be absorbed, and thus have therapeutic effect, the understanding of the dissolution and drug release processes of a drug product is of primary importance. Such understanding allows a robust formulation development with an ideal in vivo performance. In order to meet set standards, the performance assessment of oral drug products, such as dissolution testing, often applies conditions that are not reflective of the in vivo environment. The use of non-physiologically relevant dissolution method during the drug product development phase can be misleading and give poor mechanistic understanding of the in vivo dissolution process. Hence, we hypothesized that applying physiologically relevant conditions to the dissolution test would result in more accurate in vivo predictability for a robust and precise development process. Since the buffering system in the intestinal lumen operates at low molarity values, phosphate buffer at low buffer capacity was used as a first approach to an in vivo relevant parameter. Furthermore, a biphasic system was used, that is, the low buffer capacity medium was paired with an organic layer (n-octanol) to mimic the concurrent drug absorption that happens with the in vivo dissolution. Both poorly and highly soluble drugs in immediate release formulations (ibuprofen and metronidazole, respectively) were tested in this set-up to assess the dissolution in the aqueous medium and the partitioning to the organic phase. Additionally, enteric coated formulations were tested in bicarbonate buffer at the in vivo reported molarities values to assess the impact of buffer species on drug dissolution. The evaluated parameters were the buffer system (bicarbonate buffer vs. phosphate buffer), buffer capacity and medium pH. In all approaches, dissolution was also carried out in compendial buffer for comparison purposes. Our results demonstrate that the USP-recommended dissolution method greatly lacked discriminatory power, whereas low buffer capacity media discriminated between manufacturing methods. The use of an absorptive phase in the biphasic dissolution test assisted in controlling the medium pH due to the drug removal from the aqueous medium. Hence, the applied noncompendial methods were more discriminative to drug formulation differences and manufacturing methods than conventional dissolution conditions. In this study, it was demonstrated how biphasic dissolution and a low buffer capacity can be used to assess drug product performance differences. This can be a valuable approach during the early stages of drug product development for investigating drug release with improved physiological relevance. Similarly, all the enteric coated formulations displayed a fast release in phosphate buffer and complied with the compendial performance specifications. On the other hand, they all had a much slower drug release in bicarbonate buffer and failed the USP acceptance criteria. Also, the nature of the drug (acid vs base) impacted the dissolution behavior in bicarbonate buffer. This study indicates that compendial dissolution test for enteric coated tablets lacks physiological relevance and it needs to be reevaluated. Thus, an in vivo relevant performance method for EC products is needed. Overall, the findings of this thesis comprehensively demonstrates that meaningful differences in performance and accordance to clinical reports were only obtained when physiological relevant conditions were applied. Hence, our results indicate that the central hypothesis was answered positively

Para que um medicamento exerça a ação farmacológica após a ingestão oral, ele primeiro precisa ser liberado da formulação, dissolver, ser absorvido e atingir a circulação sistêmica. Uma vez que apenas medicamentos solubilizados podem ser absorvidos e, assim, ter efeito terapêutico, a compreensão dos processos de dissolução e liberação de um medicamento é de extrema importância. Tal compreensão permite o desenvolvimento de uma formulação robusta com o desempenho in vivo ideal. Para atender aos padrões regulatórios previamente estabelecidos, a avaliação da performance de formulações orais, como por exemplo, o teste de dissolução, frequentemente aplica condições que não refletem o ambiente fisiológico. O uso de métodos de dissolução não fisiologicamente relevante durante a fase de desenvolvimento do medicamento pode gerar resultados equivocados sem uma compreensão mecanistica do processo de dissolução in vivo. Portanto, a hipótese desse trabalho é que a aplicação de condições fisiologicamente relevantes no teste de dissolução resultaria em uma predição mais precisa da dissolução in vivo para um processo de desenvolvimento robusto e preciso. Uma vez que o sistema tampão no lúmen intestinal possui baixa molaridade, o tampão fosfato com baixa capacidade tamponante foi usado como uma primeira abordagem como um meio de dissolução fisiologicamente relevante. Além disso, foi utilizado um sistema bifásico, ou seja, o meio de baixa capacidade tamponante combinado a uma fase orgânica (n-octanol) para imitar a absorção in vivo. Formulações de liberação imediata contendo fármacos de baixa e de alta solubilidade (ibuprofeno e metronidazol, respectivamente) foram testadas no sistema bifásico para avaliar a dissolução no meio aquoso e a partição para a fase orgânica. Ademais, formulações com revestimento entérico foram testadas em tampão bicarbonato nos valores de molaridades fisiológicos para avaliar o impacto da espécie tamponante na dissolução do fármaco. Os parâmetros avaliados foram o sistema tampão (tampão bicarbonato vs. tampão fosfato), capacidade tamponante e pH médio. Em todas as abordagens, a dissolução também foi realizada em tampão farmacopeico para fins de comparação. Nossos resultados demonstraram que o método de dissolução farmacopeico não foi discriminativo, enquanto o meio com menor capacidade tamponante diferenciou entre as formulações obtidas via granulação úmida ou compressão direta. Ademais, a utilização da fase orgânica no teste de dissolução bifásica auxiliou no controle do pH do meio aquoso. Portanto, os métodos não compendiais aplicados foram mais discriminativos do que as condições de dissolução convencionais. Neste estudo, foi demonstrado como a dissolução bifásica e uma baixa capacidade tamponante podem ser usadas para avaliar as diferenças na performance de formulações. Esta pode ser uma abordagem valiosa durante os estágios iniciais do desenvolvimento de medicamentos para investigar a liberação destes sob condições fisiologicamente relevantes. Da mesma forma, todas as formulações com revestimento entérico exibiram uma liberação rápida em tampão de fosfato e atenderam às especificações farmacopeicas. Entretanto, a liberação do fármaco foi muito mais lenta em tampão de bicarbonato e consequentemente não cumpriram com as especificações farmacopeicas. Além disso, a natureza do fármaco (ácido vs. base) impactou o comportamento de dissolução no tampão de bicarbonato. Este estudo indica que o teste de dissolução convencional para comprimidos de liberação retardada não possui relevância fisiológica e precisa ser reavaliado. Portanto, os resultados desta tese demonstram de forma abrangente que diferenças significativas na performance condizentes com relatórios clínicos foram obtidas apenas quando as condições fisiológicas relevantes foram aplicadas. Esses resultados indicam que a hipótese central foi respondida positivamente

New drugs registered in Brazil from 2003 to 2013: analysis from the perspective of child health

This study aims to analyze the new drugs registered in Brazil from 2003 to 2013 from the perspective of childcare needs, drug safety and considering the disease burden of the country. This is a retrospective cohort study including new drugs registered in Brazil between 2003 and 2013. Drug indications were related to the Disability-Adjusted Life Year (DALY) of the 2015 Global Burden of Disease Study. Association between the number of new drugs and DALY was determined by Spearman's coefficient. Post-marketing safety alerts specific to the pediatric population have been identified in the WHO Drug Information Bulletin and on websites of drug regulatory agencies. A total of 134 new drugs were included in the cohort and 46 (34.3%) had a pediatric indication. There was no evidence of an association between the disease burden in children in Brazil and the number of pediatric drugs. The safety alert data associated with the pediatric population published after registration of the new drugs were scarce. The number of new drugs launched in Brazil with a pediatric indication was small, reflecting the international challenges of developing effective and safe medicines for children. No association was found between the number of new drugs and the disease burden.

What Occupational Health Needs Arise in Workplaces Following Disasters? A Joint Analysis of Eight Cases of Disaster in Japan.

OBJECTIVE: To identify occupational health needs arising after disasters. METHODS: Using semistructured interviews with expert informants, we jointly analyzed the needs arising in eight disaster cases that threatened the lives or health of workers in Japan. RESULTS: Various types of health issues occurred in a wide range of employees. In total, we identified 100 needs in six phases after disasters and classified them across nine categories of worker characteristics. The proportion of health needs on the list that were applicable in each case varied from 13% to 49%. More needs arose when the companies were responsible for the disaster and when employee lives were lost. We also assessed the list as fairly comprehensive. CONCLUSIONS: The list developed in this study is expected to be effective for anticipating occupational health needs after disasters.

The need to improve health care in prisons.

OBJECTIVE: To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS: We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher's tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS: The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS: This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.

Necessidade de aprimoramento do atendimento à saúde no sistema carcerário / The need to improve health care in prisons

OBJETIVO Analisar a estrutura física, as condições de trabalho dos profissionais da saúde e o delineamento de processos estabelecidos em unidades prisionais. MÉTODOS Foram analisados 34 centros de detenção provisória e 69 unidades prisionais masculinas e seis femininas do Estado de São Paulo, Brasil, em 2009. Foi desenvolvido instrumento autoaplicativo para coleta de dados quantitativos sobre as características de estrutura, equipamento e pessoal para atendimento à saúde nas unidades prisionais. A análise de variância (ANOVA) ou equivalente não paramétrico e os testes de Qui-quadrado ou Fisher foram utilizados para comparação de variáveis contínuas ou categóricas, respectivamente, entre os grupos estudados. RESULTADOS Os principais problemas foram o retardo nos resultados de exames laboratoriais e de imagem. Quanto às equipes, grande maioria apresentou condições próximas da proposta pela Comissão InterGestores Bipartite 2013, mas sem que isso se refletisse em melhoria dos indicadores. Com relação ao processo, observou-se que mais de 60,0% das unidades prisionais estão localizadas em cidades pequenas, sem condições estruturais de saúde para garantir o atendimento secundário ou terciário para continuidade do processo de tratamento. CONCLUSÕES O perfil apresentado das unidades prisionais do País poderá ser utilizado para planejamento e acompanhamento de ações futuras para melhoria contínua das condições estruturais de saúde. .

OBJECTIVE To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons. METHODS We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups. RESULTS The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment. CONCLUSIONS This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes. .

Sexual health and gynecological cancer: conceptualizing patient needs and overcoming barriers to seeking and accessing services.

OBJECTIVE: The current study explored the subjective experiences of women treated for a gynecological cancer, with a focus on filling gaps in the current literature. Topics explored were: (1) women's own definitions of healthy sexuality; (2) services desired to meet needs; and (3) barriers to participation in sexual health-related services. METHODS: Fifteen women participated in a one-on-one, semistructured interview. Data collection and analysis were based on guidelines of interpretive description. RESULTS: Definitions of healthy sexuality included emotional intimacy, body image, sexual self-schema, and sexual response. Unmet sexual needs were reported when women's current sexual experiences did not correspond with their subjective perceptions of healthy sexuality. Most women desired informational services, delivered one-on-one or through written material. Younger women often did not utilize services due to practical barriers and emotional avoidance, while older women reported that shyness and stigma discouraged them from discussing sexuality with their health care team. CONCLUSIONS: In order to understand patient needs and desire for help, health care providers should assess current sexual health and patient perceptions of healthy sexuality. To increase effectiveness of distress screening and treatment interventions, potential barriers must be evaluated and addressed.

Effectiveness of a discharge-planning program and home visits for meeting the physical care needs of children with cancer.

GOALS OF WORK: The purpose of this study was to investigate the effectiveness of a discharge-planning program on helping caregivers meet the physical care needs of children with cancer. PATIENTS AND METHODS: This research is a quasi-experimental type of study in a pediatric oncology clinic at a university hospital in Izmir/Turkey. The control group had 25 and the experimental group had 24 patients with their caregivers. For the experimental group, discharge planning, discharge teaching, home visits, and telephone consultation were provided and has been planned to investigate the effectiveness of a discharge-planning program on helping caregivers meet the physical care needs of children with cancer between 0-18 years of age. MAIN RESULTS: In the third assessment, the number of patients that needed physical care needs in the experimental and control groups was decreased, and children in the experimental group had a lower number of physical care needs. A decreased number of unplanned admissions to the hospital at the first and third follow-up times, a decrease in unplanned admissions, and higher satisfaction rate were seen in the experimental group caregivers. CONCLUSIONS: A discharge-planning program and a hospital-based home care model had a very significant effect on the care needs of children with cancer and their caregivers. Our findings indicate that a discharge-planning program and a hospital-based home care model had a very significant effect on the care needs of children with cancer and their caregivers.

The Pyhäjärvi Cataract Study. I. Study design, baseline characteristics and the demand for cataract surgery.

PURPOSE: The Pyhäjärvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland. METHODS: A random, population-based sample of 881 persons aged > or = 60 years were interviewed by telephone to obtain a Visual Function-14 (VF-14) score. A total of 294 persons were invited for an ophthalmic examination based on three categories of VF-14 score. Of these, 230 (78%) responded, 10 of whom were excluded as a result of prior bilateral surgery. The New Zealand Priority Criteria (NZPC) and the 15-Dimension Quality of Life (15-D) instruments were administered. In addition, another group of 96 patients waiting for cataract surgery were examined and scored using the VF-14, NZPC and 15-D instruments. A modified Lens Opacities Classification System (LOCS) III classification was used for grading the cataract. RESULTS: Only one (0.5%) of the 220 examined subjects was referred for cataract surgery. Many patients with relatively good visual acuity (VA), including six people with a 100-point VF-14 score suggesting no visual symptoms, were waiting for surgery. Demographic factors were not associated with access to cataract surgery. The patients examined from the waiting list for cataract surgery had more cataractous changes in the lens(es), poorer VA, were older, and scored higher on the NZPC instrument than the population sample examined. CONCLUSIONS: Practically no hidden demand for cataract surgery was found in the study population as defined by the national criteria for cataract surgery in Finland. This reflects the fact that the current Finnish health care system appears to recognize and treat cataract patients very well, even in rural areas. Although VA tests may not be sufficient for evaluating need for cataract surgery, the role of questionnaires is not clear either.

Is the British National Health Service equitable? The evidence on socioeconomic differences in utilization.

Is the British National Health Service (NHS) equitable? This paper considers one part of the answer to this: the utilization of the NHS by different socioeconomic groups (SEGs). It reviews recent evidence from studies on NHS utilization as a whole based on household surveys (macro-studies) and from studies of the utilization of particular services in particular areas (micro-studies). The principal conclusion from the majority of these studies is that, while the distribution of use of general practitioners (GPs) is broadly equitable, that for specialist treatment is pro-rich. Recent micro-studies of cardiac surgery, elective surgery, cancer care, preventive care and chronic care support the findings of an earlier review that use of services was higher relative to need among higher SEGs.

Target delivery, service modernisation and system reform: reinventing planning in the English National Health Service.

PURPOSE: Aims to focus on the imperative to achieve national activity and performance targets in secondary care as set out in the NHS Plan. DESIGN/METHODOLOGY/APPROACH: The paper is in the form of "notes from the front line" that are based on the experience of the Royal Cornwall Hospitals NHS Trust (RCHT). FINDINGS: These include that planning needs to be understood as the means by which the NHS manages its future; that planning needs to become more technically and methodologically sophisticated; that planning is a process rather than a description of an organisational function; and that the NHS will only resolve the shortage of planning competencies once planning is seen as a management disciple. ORIGINALITY/VALUE: On the basis of the feedback received from drafts of this paper, it is suggested that the conclusions drawn are generally applicable across the English health service.

[Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures]. / Leitlinienentwicklung in der Rehabilitation bei Rückenschmerzpatienten--Phase 2: Ergebnisse einer Analyse von KTL-Daten.

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.

The MODEL project: a scoring system to manage demand for cataract and joint replacement surgery.

Cataract surgery and joint replacement are highly cost-effective procedures; however, their availability is inequitable and doctors lack guidance on whom to refer and treat. We investigated the feasibility of using a scoring system to assess patients' suitability for operation. Wefound acceptable correlations between the scores ofgeneral practitioners and surgeons for both procedures. Scoring systems can be used in a consistent way bygeneralpractitioners and surgeons, and can make a contribution towards matching patients' needs with available treatment capacity.

Health care needs of community-dwelling older adults.

OBJECTIVE: To identify, assess, and rank the importance of health care needs of community-dwelling older adults. METHOD: A structured telephone interview with 107 respondents (physicians, direct service providers and administrators) about the importance of a list of 31 health care needs of older adults. Respondents also identified the single most important health issue facing local older adults now and in the next 5 to 10 years. RESULTS: The five most important health care needs, in descending order, are: care-giver support services, community long-term care services, services for people with dementia/Alzheimer's disease, palliative/end-of-life care, and services for cancer patients and their families. Community long-term care services were identified as the single most important health issue both now and in the next 5 to 10 years. CONCLUSION: The study findings should be of value to health and social service researchers, planners, providers and administrators regarding the needs of community-dwelling older adults.

[Cardiac surgery in France (supply, service and needs response): a national survey]. / La chirurgie cardiaque en France (offre, activité et réponse aux besoins): une enquête nationale.

This paper describes the results of a national study of the 70 french cardiac surgery units. This study was required by the ministry of health in order to prepare the planning process of cardiac surgery in France. Results concerning the year 1994 show important regional variations of resources among the country. The number of interventions has increased three fold in 15 years (from 13,000 to 38,000 a year). The share of the different indications are constant (coronaropathy: 53%; valvulopathy: 36%; congenital: 8%). Patient flows across french regions represent 15% of the interventions. Regional intervention rates per capita range from 45 to more than 80 for 100,000 inhabitants. French cardiac surgery is, in fact, organized at a multiregional level and the regional intervention rates are not correlated with mortality or demographic rates.