The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey).

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

IT support for clinical pathways--lessons learned.

Clinical pathways are an effective instrument to decrease undesired practice variability and improve clinician performance. IT-applications embedded into clinical routine work can help to increase pathway compliance. Successfully implementing such applications requires both a responsive IT infrastructure and a participatory and iterative design process aimed at achieving user acceptance and usability. Experiences from the implementation and iterative improvement of an online surgical pathway at Marburg University Medical Centre have shown that pathway conformance actually could be improved by the use of IT. An analysis of the iterative design process has shown that future pathway projects can benefit from the lessons learned during this project. Based on these lessons recommendations for developing well adapted interaction mechanisms are presented, aimed at improving process alignment. Our goal is to build up a library of tested reusable components to reduce the number of iterations for pathway implementation.

Improving pathway compliance and clinician performance by using information technology.

To deliver patient-specific advice at the time and place of a consultation is an important contribution to improving clinician performance. Using computer-based decision support on the basis of clinical pathways is a promising strategy to achieve this goal. Thereby integration of IT applications into the clinical workflow is a core precondition for success. User acceptance and usability play a critical role: additional effort has to be balanced with enough benefit for the users and interaction design and evaluation should be handled as an intertwined, continuous process. Experiences from routine use of an online surgical pathway at Marburg University Medical Center show that it is possible to successfully address this issue by seamlessly integrating patient-specific pathway recommendations with documentation tasks which have to be done anyway, by substantially reusing entered data to accelerate routine tasks (e.g. by automatically generating orders and reports), and by continuously and systematically monitoring pathway conformance and documentation quality.

IT support for clinical pathways--lessons learned.

Clinical pathways are an effective instrument to decrease undesired practice variability and improve clinician performance. IT applications embedded into clinical routine work can help to increase pathway compliance. Successfully implementing such applications requires both a responsive IT infrastructure and a participatory and iterative design process aimed at achieving user acceptance and usability. Experiences from the implementation and iterative improvement of an online surgical pathway at Marburg University Medical Centre have shown that pathway conformance actually could be improved by the use of IT. An analysis of the iterative design process has shown that future pathway projects can benefit from the lessons learned during this project. Based on these lessons a method for developing well adapted interaction mechanisms is presented, which is aimed at improving process alignment. Our goal is to build up a library of tested reusable components to reduce the number of iterations for pathway implementation.

A case of Maffucci 's syndrome with pleural effusion: ten-year follow-up.

INTRODUCTION: Maffucci 's syndrome (MS) is a congenital non-hereditary mesodermal dysplasia characterised by numerous mesenchymal neoplasias in the form of enchondromas with secondary bone deformities and multiple soft tissue haemangiomas that may have phlebolitis. CLINICAL PICTURE: A 23-year-old male patient presented with non-productive cough, dyspnoea, chest pain and back pain. Chest X-ray showed unilateral pleural effusion and multiple enchondromas of the ribs. On physical examination, there were mobile, multiple, bluish-coloured lesions probably cavernous haemangiomas on bilateral chest walls. In addition, there were multiple nodular lesions on the extremities especially accumulated on the fingers. The patient was diagnosed as Maffucci 's syndrome according to computed tomography (CT) of the thorax, conventional radiography of the skeletal system, magnetic resonance (MR) imaging, Th4-Th11 intercostal and right upper extremity angiography and physical examination findings. TREATMENT: As the patient rejected any diagnostic intervention, he was monitored with CT. OUTCOME: During the last 6 years of follow-up, the lesion that was detected on the rib adjacent to the basal segments of the left lung showed significant progression and was accepted as chondrosarcoma. CONCLUSION: To our knowledge, this is the first case of Maffucci ' s syndrome with pleural effusion. In this case report, the probable mechanism of pleural effusion was discussed.

Mechanical vasoconstriction for a cerebral myogenic autoregulatory model.

This work presents the design of a mechanical vasoconstriction mechanism with application for cerebral autoregulation. The relationship between the applied voltage of a DC motor and the tension within a pressurized vessel wall was utilized for constricting an arteriole segment within an intracranial vascular model. Using current proportional to the string tension, options for closed loop feedback control are considered.

Use of pleural fluid C-reactive protein in diagnosis of pleural effusions.

The aims of the study were to assess whether C-reactive protein (CRP) is a sensitive marker for discriminating between transudative and exudative and pleural effusions to evaluate whether it can be used to distinguish inflammatory pleural effusions from other types of effusion. Pleural fluid and serum CRP levels were obtained in 97 patients with pleural effusion, using an immunoturbidimetric method (Olympus AU-600 autoanalyser). We compared CRP levels between transudates and exudates, inflammatory effusions and other types of effusion. According to the criteria used, 16 patients were included in the transudate group and 81 patients in the exudate group. Pleural fluid CRP levels were significantly lower in the transudate group (P<0.04; 14.9 +/- 4.9 mg l(-1) and 35.5 +/- 4.9 mg l(-1) respectively). Also, the ratio of pleural fluid to serum was significantly lower in the transudate group (P<0.009; 0.8 +/- 0.5 mg l(-1) and 2.8 +/- 0.7 mg l(-1), respectively). In the exudate group, 35 patients had neoplastic effusions, 10 chronic non-specific pleurisy, 19 tuberculous pleurisy, 16 parapneumonic effusion and one Dressler Syndrome. When these sub-groups were compared, the parapneumonic effusion subgroup CRP levels (mean 89 +/- 16.3 mg l(-1)) were significantly higher than those in the other subgroups, other exudate of neoplastic effusion, tuberculous pleurisy and chronic non-specific effusion and the transudate group (P<0.0001; P<0.0001; P<0.0004 and P<0.0001, respectively). The ratio between pleural fluid and serum CRP was significantly higher in the parapneumonic effusion subgroup than in the neoplastic subgroup (P<0.0002; 6.6 +/- 2.7 mg l(-1) and 1 +/- 0.2 mg l(-1), respectively). Pleural fluid CRP levels > 30 mg l(-1) had a high sensitivity (93.7%) and specificity (76.5%) and a positive predictive value of 98.4%. In the differential diagnosis of pleural effusions, higher CRP levels may prove to be a rapid, practical and accurate method of differentiating parapneumonic effusions from other exudate types. Although the high level of CRP obtained in the exudate group may be due to the number of patients with parapneumonic effusion who were included, the pleural CRP level may also be helpful in discriminating between exudative and transudative pleural effusions.

A study of sex differences in presentation for care of HIV.

The current study examines sex differences in 183 male and 141 female patients presenting for care of HIV disease at an inner city hospital infectious disease clinic. Females (43%) were found to be less likely to have a history of illicit drug use (relative risk = .77, p < .01) and more likely to have become infected heterosexually (relative risk = 2.38, p < .01). However, a significant number of women reported both intravenous drug use (IVDU) and heterosexual exposure to an IVDU partner which complicates the analysis of the risk factors. Women sought testing because they knew that their sexual partners were HIV-positive (relative risk = 2.88, p < .01) Median CD4 counts at entry were significantly different (females = 340, males = 246; p < .01). Women were less likely to contract tuberculosis, the only infection which presented with a sex difference (relative risk = .38, p < .01) and to have previously had an AIDS defining infection (relative risk = .37, p < .01). Women took longer to progress to AIDS (42 vs. 19 months; p < .05). Survival of patients with AIDS was 51 months for females and 54 for males (p > 0.9). It did appear that the effect of a lower CD4 cell count on risk for death was magnified in patients who acquired their disease through heterosexual transmission. Women presented with higher CD4 counts, were more aware of their risk factors and fared better, with respect to progression to AIDS, than the men. The study underscored the impact of heterosexual transmission of the virus in women as well as the affect of this risk factor on disease progression. Hopefully, this information will initiate further studies on sex differences which will guide interventions and policy development.

Serum angiotensin converting enzyme activity in pulmonary diseases: correlation with lung function parameters.

Serum angiotensin converting enzyme activity (ACE), plasma renin activity (PRA), blood pressure (BP), blood pH, blood gases and lung function parameters were measured in patients with emphysema, extrinsic and intrinsic asthma, malignant pulmonary neoplasms, active sarcoidosis and healthy adults. Serum ACE activity was significantly higher in sarcoidosis (250.22+/-34.18 U/L); in small cell carcinoma of lung (155.10+/-38.25 U/L); emphysema (149.82+/-18.31 U/L); extrinsic asthma (141.22+/-25.30 U/L) and lower in intrinsic asthma (98.12+/-15.11 U/L) and squamous cell carcinoma of lung (97.294+/-18.85 U/L) when compared with that of control subjects (108.20+/-13.15 U/L). PRA and BP values of the patients with sarcoidosis, emphysema and small cell carcinoma were markedly elevated and sACE activity was found to be correlated with PRA and mean BP in the same diagnostic groups. sACE activity, PRA and BP of smokers were higher than those of non-smokers in control subjects and in patients with emphysema, extrinsic asthma and small cell carcinoma of lung. Oxygen tensions of the patients with emphysema , extrinsic asthma and small cell carcinoma of lung were found to be significantly decreased. Negative correlations between the sACE activity and oxygen tension (r= -0.68) and between the sACE activity and lung function parameters (r= -0.69 ) were found in these diagnostic groups suggesting that increased sACE level might appeared as a response to chronic hypoxia in the patients with emphysema, extrinsic asthma and small cell carcinoma of lung.

Application of electrical impedance tomography in diagnosis of emphysema--a clinical study.

In this paper, electrical impedance tomography (EIT) ventilation images from a group of 12 patients (11 patients with emphysema and one patient with only chronic obstructive pulmonary disease (COPD) (chronic bronchitis) and a group of 15 normal subjects were acquired using a Sheffield mark 1 EIT system, at the levels of second, fourth and sixth intercostal spaces. Patients were diagnosed based on CT scans of the thorax, pulmonary function tests and posteroanterior x-ray graphs. One of the patients with emphysema has also a malignant lung tumour. Ventilation-related conductivity changes at total lung capacity (TLC) relative to residual volume were measured quantitatively in EIT images. These quantitative values demonstrate marked differences compared to those values obtained from the EIT images of 15 normal subjects. The EIT images of the patients were also compared with the CT images. In addition to the visual examination of the EIT images a statistical confidence test is applied to compare the images of the patients with the images of the normal subjects. Prior to statistical analysis all images are normalized with TLC to minimize the effect of mismatch between the TLC of different subjects. A normal mean image is created by averaging the normalized images from the normal subjects, at each intercostal space level. Than a 95% confidence interval is defined for each normal mean image. For each image of the patients, a confidence test image, which represents the deviations from the 95% confidence interval of the normal mean image, is created. The regions with emphysematous bulla and parencyhma are detectable in the confidence test images as regions of positive and negative deviations from the confidence interval of the normal mean, respectively. In the test images, it is possible to differentiate emphysematous parenchyma from emphysematous bulla, tumour structure, and COPD. However, the emphysematous bulla, the tumour structure, and COPD result in the same type of defect in the test images and are therefore indistinguishable from each other. In some case, off-plane contributions in the EIT images may result in underestimation of the defects. EIT may be a useful screening device in detecting emphysema rather than a diagnostic tool.

Geriatric dentistry and the Alzheimer's patient: management techniques and service delivery.

A low-cost portable dental operatory system has been developed for the provision of removable prosthodontic services to the Alzheimer's patient. A light-cured denture base material is utilized for complete and partial denture fabrication, relines and repairs. The system is efficient, cost-effective and does not compromise the quality of care.

The geriatric patient: evaluation, treatment planning, affordable concepts.

The predicted growth of the geriatric population mandates the health professional to turn their attention to treatment modalities which are indicated for this particular cohort. The dentist must examine, evaluate and treatment plan these patients with a systematic approach. Guidelines are offered to expedite the care of the elderly both efficiently and cost effectively.

The geriatric patient: removable partial denture design, protecting the dentition.

The population of the United States is aging rapidly. By the year 2000, approximately 36 million Americans will be 65 years of age or older. With respect to dentistry, the oral health status of older adults is improving. In addition to retaining more of their teeth, the demand for dental care is increasing amongst the geriatric population. Because total edentulousness is expected to decline in the future, a greater demand for removable and fixed partial dentures is anticipated. This paper serves as an outline for quick reference when treatment planning the replacement of teeth in the partially edentulous arch.

The geriatric patient: controlling tooth contours, protecting the periodontium.

A significant number of geriatric patients are restored with the removable partial denture (RPD). Because the periodontal condition, as well as overall health, of this population is usually less than ideal, the recontouring of teeth prior to RPD construction must be executed precisely with special attention given to the biomechanics of RPD design. The philosophy and technique for the reshaping of abutment teeth is presented to clarify these procedures.

The geriatric patient: one- or two-visit complete denture construction technique. Part 1.

The next two articles will discuss the construction of quality complete dentures in one- or two-patient appointments. Material and techniques are presented for controlling costs by reducing laboratory expenses and dentist chair time. A block unit of 12 to 14 attached flat plane acrylic teeth, light cured denture base materials and modified techniques which incorporate multiple procedures are introduced. The procedure will be divided into two segments and described in two articles. The initial article will carry the technique through the completion of the maxillo-mandibular relations and articulation for the casts. The second section, described in the second article, will encompass the set-up of the teeth, try-in of the set-up, processing of the dentures and insertion of the case.

Is prosopagnosia more frequent in males than in females?

A case review of prosopagnosia was carried out and male-female incidence of the disorder compared to relative male-female incidence of cerebro-vascular disease in general. Prosopagnosia was found to occur significantly more frequently in males than in females. Possible implications of this finding vis-à-vis male-female differences in cerebral organization are discussed and topics for further investigation are suggested.

Comprehension strategies determining reference in aphasia: a study of reflexivization.

This study explored the comprehension of reference in aphasia as reflected in reflexivization. A total of 132 test sentences were used consisting of two basic syntactic frames varying in the minimal distance principle and in the type of cues available in the sentence (syntax, syntax and morphology, syntax and lexical, and syntax, morphology, and lexical) for determining pronominal reference. Fifteen patients, five Broca's, five Conduction, and five Wernicke's, were asked to point to the picture (of two) corresponding to the auditorily presented test sentence. Results indicated that aphasic patients as a whole comprehend reference; however, their performance varied depending on the nature of the cues available in the sentence. All groups were impaired when only syntactic cues were available and showed a significant decrement in performance when the test sentence violated the minimal distance principle. As additional cues other than syntactic structure were provided, performance level increased. All groups, including the Broca's aphasics, showed only slight improvement with the presence of morphological cues. Wernicke's aphasic's performance was particularly vulnerable when lexical cues were added to syntactic cues. These results suggest that evaluation of a patient's deficit in sentence comprehension requires analysis of those attributes of the sentence contributing to its overall semantic interpretation.