Proclets in healthcare.

Healthcare processes can be characterized as weakly-connected interacting light-weight workflows coping with different levels of granularity. Classical workflow notations fall short in supporting these kind of processes. Although these notations are able to describe the life-cycle of individual cases and allow for hierarchical decomposition, they primarily support monolithic processes. However, they are less suitable for healthcare processes. The Proclets framework is one formalism that provides a solution to this problem. Based on a large case study, describing the diagnostic process of the gynecological oncology care process at the Academic Medical Center (AMC), we identify the limitations of "monolithic workflows". Moreover, by using the same case study, we investigate whether healthcare processes can be described effectively using Proclets. In this way, we provide a comparison between the Proclet framework and existing workflow languages and identify research challenges.

Reduced femoral component subsidence with improved impaction grafting at revision hip arthroplasty.

BACKGROUND: Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem. QUESTIONS/PURPOSES: We used a sensitive technique to measure subsidence of a cemented polished collarless double-taper stem at each interface after femoral impaction grafting and compared subsidence, radiographic loosening, complications, and reoperations over three series of hips defined by technique developments. PATIENTS AND METHODS: Three series were defined: Series 1 (n = 23, irradiated allograft), Series 2 (n = 12, double-washed, size-profiled graft, nonirradiated bone, long stems as required), and Series 3 (n = 21, modular tamps). Stem subsidence was analyzed with Ein Bild Röntgen Analyse software. Radiographic loosening, complications, and reoperations were also determined. RESULTS: The median subsidence at 12 months for Series 1, 2, and 3 were 2.1, 0.5, and 0.7 mm at the prosthesis-cement interface and 1.3, 0.1, and 0.1 mm at the cement-bone interface. There were two postoperative Vancouver B periprosthetic fractures in Series 1, four hips were revised for loosening in Series 1, and there were no fractures or loosening in Series 2 and 3 at minimum 2 years' followup. There were no surviving hips radiographically classified as possibly or probably loose. CONCLUSIONS: Evolution in techniques of femoral impaction grafting in this study were associated with reduced subsidence of the stem at both the prosthesis-cement interface and cement-bone interface when compared to the original series. Concurrent with reduced stem subsidence was the absence of periprosthetic fracture, radiographic loosening, and complications requiring rerevision.

Not So Fast: Autistic traits and Anxious Apprehension in Real-World Visual Search Scenarios.

Autistic individuals have shown superior performance in simple, albeit difficult, visual search tasks. We compared eye movements and behavioral markers across two visual search tasks based on real-world scenes in young adults. Context-aided search increased speed and accuracy for all groups. Autistic adults (n = 29) were on average consistently slower and less accurate than a non-anxious neurotypical comparison group (n = 48), but similar to neurotypical adults with elevated anxious apprehension (n = 26). Dimensional analyses suggest that autism traits, not anxious apprehension, are most associated with search efficiency of naturalistic stimuli suggesting that autistic individuals can effectively integrate contextual information to aid visual search, but that advantages in less visually complex tasks, reported in previous studies, may not transfer to situations involving real-world scenes.

Factors affecting the prognosis of primary liver carcinoma.

Analysis of the clinical records of 163 patients with primary liver carcinoma was performed to identify factors affecting prognosis. The overall 3-year survival rate was 10%, and the median survival was 7.8 months. Survival was similar for patients with single or multiple tumor nodules. There was no significant association between nodule size of 3 cm or larger and survival. Patients who underwent resection had a longer survival. For patients without cirrhosis, location of the tumor in the left lobe regardless of whether it is resected appears to be a prognostic factor associated with prolonged survival. Female sex and the absence of cirrhosis were also associated with longer survival.

Schizophrenic performance on line bisection: no simple lateralization defects.

Many studies have assessed the possible lateralization deficits of schizophrenics, and the results usually suggest left hemisphere dysfunction. Nevertheless, they have been variable. This may have been due to cognitive demand of the different tasks, not to changes in brain lateralization itself. In order to circumvent this problem, the present study evaluates the performance of schizophrenics on a simple but lateralized task, line bisection. Subjects bisected a line using either visual or tactile information, with the left or right hand, when it was placed in their left or right hemispace or directly in front of them. Schizophrenic subjects were not more erroneous than normals (variable error), nor were they biased differently from normals in either direction with either modality of sensory input (constant error). There were only two significant effects of group on the tactile line bisection, one of position x length x group and one of position x hand x end x length x group, both on constant error (directional bias). The lack of main effects and presence of interactions on these basic tasks suggests that apparent lateralization differences found in schizophrenic subjects are due not to a simple defect of brain lateralization but may stem from task demands and attention allocation.

Disruption of saccade production during oculomotor tracking in schizophrenia and the use of its changes across target velocity as a discriminator of the disorder.

A clear measure of eye movement disorder (EMD) that reliably separated schizophrenic individuals from others would both give insight into the brain control of the disorder and provide an aid in diagnosis. In the present study, a detailed analysis was carried out of the interactions between the pursuit and saccadic components of eye movements at different target velocities. The subjects comprised schizophrenic patients, unipolar depressed patients, and normal controls. The speed of the slow pursuit component did not differ among the groups, but schizophrenic subjects made more saccadic movements at low target velocities, though they started further away from the target at high target velocities. On the basis of these differences, a slope was computed of the linear function that related the number of saccadic eye movements to the velocity of a ramp visual target. Slope direction was negative for schizophrenic subjects but positive for unipolar depressive and normal subjects, and the correct classification rate for subjects was 84%.

Coley toxins immunotherapy: a retrospective review.

OBJECTIVE: Coley toxins are administered to cancer patients worldwide, though clinical studies assessing efficacy either alone or in combination with conventional cancer therapy are limited. This article provides an overview of Coley toxins immunotherapy and compares the survival experience of cancer patients who received Coley toxins for renal, ovarian, breast cancer, or soft-tissue sarcomas with patients who received conventional treatment other than radiation. DATA SOURCES: Cases were compiled from 5 of 18 monographs by Helen Coley Nauts. STUDY SELECTION: Using a retrospective cohort design with external controls, 128 Coley cases treated in New York from 1890 to 1960 were compared with 1675 controls from the Surveillance Epidemiology End Result (SEER) population-based cancer registry who received a cancer diagnosis in 1983. DATA EXTRACTION: Groups were matched on age, sex, ethnicity, site, stage, and treatment status (i.e., no radiotherapy). DATA SYNTHESIS: The Cox proportional hazards model controlled for stage and menopausal status (when applicable) and the hazard ratio and 95% CI defined the odds of site-specific survival from date of diagnosis to last follow-up. Compared to the SEER population, risk of death within 10 years was not significantly different in Coley patients treated for renal, ovarian, breast cancer, or soft-tissue sarcomas. CONCLUSIONS: This study suggests that patients treated with surgery and Coley toxins between 1890 and 1960 experienced survival rates comparable to those of patients diagnosed in 1983 and treated with nonradiotherapeutic conventional approaches. The study is limited by small sample sizes, possibly inaccurate technology for staging during Coley time, and potential selection bias with Coley patients.

Assessment of outcomes at alternative medicine cancer clinics: a feasibility study.

OBJECTIVE: This pilot study tested the feasibility of performing outcomes and more advanced research regarding cancer patients at two complementary and alternative (CAM) clinics. The primary objectives were to determine the feasibility of (1) obtaining and collecting data from medical records, (2) determining 5-year survival, and (3) comparing 5-year survival to that of conventional treatment. In addition, in this paper we present the barriers and recommend strategies to facilitate high-quality research. SETTINGS/LOCATION: The Bio-Medical Center in Tijuana, Mexico, and the Livingston Foundation Medical Center in San Diego, California. SUBJECTS: New patients who were treated for cancer during 1992 at the Livingston Foundation Medical Center and during the first quarter of 1992 at the Bio-Medical Center. RESULTS: Charts were available for 89.6% of the 307 new patients treated at the Bio-Medical Center; 149 (54%) patients were treated for cancer and 65 (43.6%) cases were confirmed by pathology reports. In contrast, all records were available for 193 new patients treated for cancer at the Livingston Clinic; 152 (78.8%) cases had pathology confirmation. At both clinics, patients were equally divided by gender and were predominantly Caucasian, were married, and were U.S. residents. On average, patients were 51-54 years old and within 1 year of diagnosis for breast, colorectal, lung, or male genital cancer. Most patients (61.1%-63.7%) arrived with distant or regional disease after conventional surgery and/or chemotherapy/radiotherapy. Survival at 5 years was determined for 57.0% at the Bio-Medical Center (11.4% were alive and 45.6% were deceased) and 94.8% at Livingston (14.5% were alive and 80.3% were deceased). The limited number of cases by cancer site prevented comparison to conventional treatment. CONCLUSIONS: Historical, widespread use of clinics such as these with anecdotal reports of extraordinary survival merit prospective, systematic monitoring of patient outcomes. For data to be meaningful, however, disease status must be pathologically confirmed and patient follow-up improved.

An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry.

Squeaking arising from a ceramic-on-ceramic (CoC) total hip replacement (THR) may cause patient concern and in some cases causes patients to seek revision surgery. We performed a meta-analysis to determine the incidence of squeaking and the incidence of revision surgery for squeaking. A total of 43 studies including 16,828 CoC THR that reported squeaking, or revision for squeaking, were entered into the analysis. The incidence of squeaking was 4.2% and the incidence of revision for squeaking was 0.2%. The incidence of squeaking in patients receiving the Accolade femoral stem was 8.3%, and the incidence of revision for squeaking in these patients was 1.3%.

Release of saccades in schizophrenics: inattention or inefficiency?

This paper attempts to distinguish between inattention and inefficiency as the cause of the eye movement problems of schizophrenic subjects. It focuses on their release of fast saccadic eye movements in four different situations: interrupting smooth tracking, as double-jumps in refixation, and as inadvertent departures from steady fixation or too-early prediction moves. If an attention deficit causes saccades during tracking, they should be reduced only for schizophrenic subjects in the dark, when there is no contrasting background. Instead the reduction was present for all groups. If double-jumps in saccadic refixations were caused by inattentional instability, they should increase in schizophrenic subjects when the target is a temporary flash of light. Instead, they were reduced in all groups to almost none, suggesting a perceptual processing cause for the excess double jumps. If a global attentional problem of schizophrenia caused saccade release, saccade number should be correlated across the four situations. Instead, there were significant correlations only between departures and predictions in paranoid schizophrenic subjects (r = 0.728) and between predictions and looking in nonparanoid schizophrenic subjects (r = -0.855). This lack of over-all correlations suggests that a common inattentional problem does not produce these eye movement deficiencies. Instead, the perceptual influence on tracking and looking suggests that processing inefficiency is responsible for at least part of the deficit.

Medroxyprogesterone acetate, nocturnal penile tumescence, laboratory arousal, and sexual acting out in a male with schizophrenia.

This study reports the effects of the antilibidinal drug, medroxyprogesterone acetate (MPA) on nocturnal penile tumescence (NPT) during sleep, tumescence responses to provocative audiotapes during wakefulness in the laboratory, and sexual behaviors in the hospital environment, in a conduct-disordered sexually aggressive male, who had not responded to previous treatment. NPT, laboratory tumescence, and sexual behaviors in the hospital environment were all decreased. Testosterone levels declined by 73% within 2 weeks of starting the drug and prolactin levels increased by 300% across the treatment period. The effects on NPT and laboratory arousal were still partially in evidence 2 months after the drug had been stopped, although testosterone levels had returned to predrug levels. Some differences between the NPT and daytime test data are discussed in terms of the probable importance of testosterone to erotic fantasy. NPT may be a useful addition to present methods for examining the effects of drugs used to suppress socially unacceptable sexual behaviors.

Questionable relationship between cholecystectomy and colon cancer.

The relationship between prior cholecystectomy and right-sided colon cancer was evaluated in a case-control study. The study population comprised 267 women with right-sided colon cancer (cases) and 268 women with left-sided colon cancer (controls). All patients were white females, aged between 40 and 69 years, and registered at The University of Texas M.D. Anderson Hospital and Tumor Institute between 1970 and 1982. Thirty cases (11.2%) and 21 controls (7.8%) had documented prior cholecystectomy (odds ratio 1.49, 95% confidence limits 0.83, 2.67). The temporal relationship between cholecystectomy and colon cancer and the presence of diabetes were also evaluated. The authors conclude that there is no significant relationship between prior cholecystectomy and the development of right-sided colon cancer.