Medical errors-what and when: what do patients want to know?

Objectives: 1) To determine how and when emergency department (ED) patients and their families wish to learn of health care errors. 2) To assess the error threshold this population believes should trigger reporting to government agencies, state medical boards, and hospital patient safety committees. 3) To evaluate the role patients and families believe medical educators should play in this process.

Implant angulation: a measurement technique, implant overdenture maintenance, and the influence of surgical experience.

Purpose: The purposes of this study were to develop a technique to measure the angulation between two implants and between each implant and reference planes, to analyze the relationship between the maintenance (adjustments and repairs) of ball-attachment mandibular implant overdentures and implant angulation, and to see if there is any correlation between surgeon experience and implant orientation.

Materials And Methods: Final casts of 41 patients who had received two-implant ball-attachment mandibular overdentures were used to measure implant angulations using digital photographs and plane geometry. The measured angles were compared with the number of adjustments and repairs of the prostheses and analyzed by surgeon experience for any trends.

Mass properties of the human mandible.

Computer simulation of human masticatory dynamics requires specification of the jaw's mass properties. These are difficult to estimate, especially in living subjects. Here, we used calibrated computed tomography (CT) to determine the properties of eight osseous jaw specimens with adult dentitions.

Forces resisting jaw displacement in relaxed humans: a predominantly viscous phenomenon.

Forces opening the relaxed human jaw are resisted by intrinsic restraints, including passive tensions in the jaw-closing muscles. These muscle tensions have been modelled as viscoelastic elements, and static measurements suggest their elastic portions contribute approximately a total of 5 N resistance at wide gape. As the viscous damping properties of muscles which affect the jaw's dynamic behaviour are unknown, we measured the jaw opening force required to reach maximum gape during fast and slow opening in six relaxed subjects.

Comparison of carotid endarterectomy at high- and low-volume hospitals.

Background: Population-based studies have demonstrated better outcomes for carotid endarterectomies at high-volume hospitals.

Methods: This is a 2-year retrospective review of carotid procedures at two low-volume hospitals (n = 156) and one high-volume hospital (n = 404) in the metropolitan area of Portland, Oregon.

Results: There were no significant differences in 30-day mortality and stroke rates for carotid endarterectomies when comparing low- and high-volume hospitals (P = 0.

Assessing health system provision of well-child care: The Promoting Healthy Development Survey.

Background: Preventive care guidelines for children include parent education and counseling, developmental assessment, and screening for psychosocial and safety risks. Health care providers are in a unique position to identify and follow up on potential problems and to influence parenting knowledge, attitudes, and behavior to ensure the healthy development of young children. Few quality measures are available to assess health care system performance in this important area.

Assessing health system provision of adolescent preventive services: the Young Adult Health Care Survey.

Background: Adolescents often do not receive recommended preventive counseling and screening services. Few measures are available to assess health care system performance in this area.

Objective: Develop a reliable, valid, and feasible method for measuring adherence to consensus guidelines for adolescent preventive counseling and screening services.

Prediction of the outcome of a phase 3 clinical trial of an antischizophrenic agent (quetiapine fumarate) by simulation with a population pharmacokinetic and pharmacodynamic model.

A completed phase 3 trial result was simulated 100 times on the basis of a simulation model of quetiapine fumarate (Seroquel), an antischizophrenic agent. The simulation was executed by analysts who were completely blinded from results of the actual trial until after the simulations were submitted to the holder of the trial results. Data from two clinical investigations of quetiapine in patients with schizophrenia were analyzed by use of nonlinear mixed effects modeling to derive a population pharmacokinetic- and pharmacodynamic-based simulation model.

The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis.

Background: The accuracy of noncontrast helical computed tomography (CT) for appendicitis has recently been demonstrated. What is its clinical utility?

Methods: This was a retrospective review of 443 consecutive community hospital patients evaluated for acute appendicitis over an 18-month period using limited pelvic CT scan or clinical acumen alone.

Results: Appendicitis was pathologically proven in 158 patients.

Dynamic simulation of muscle and articular properties during human wide jaw opening.

Human mandibular function is determined in part by masticatory muscle tensions and morphological restraints within the craniomandibular system. As only limited information about their interactions can be obtained in vivo, mathematical modeling is a useful alternative. It allows simulation of causal relations between structure and function and the demonstration of hypothetical events in functional or dysfunctional systems.

A pharmacodynamic Markov mixed-effects model for the effect of temazepam on sleep.

Background: A hypnogram shows how sleep travels through its various stages in the course of a night. The sleep stage changes can be quantified to study sedative drug effects.

Methods: Hypnograms from 21 patients with primary insomnia were collected during a randomized, placebo-controlled crossover study of 20 mg temazepam.

Optimizing the science of drug development: opportunities for better candidate selection and accelerated evaluation in humans.

Two international meetings were convened in 1998 to review the current science of drug development and the potential opportunities to optimize the evaluation of new drugs in humans. This report represents a synopsis of these meetings, and focuses on the current state of knowledge pertaining to drug development, future scientific and technical needs, and the relative merits of various strategies intended to accelerate the clinical development of drugs.

Simulation of clinical trials.

Computer simulation of clinical trials has evolved over the past two decades from a simple instructive game to "full" simulation models yielding pharmacologically sound, realistic trial outcomes. The need to make drug development more efficient and informative and the awareness that many industries make extensive use of simulation in product development have advanced considerably the use of simulation of clinical trials in pharmaceutical product development over the past decade. The structural and stochastic components of trial simulation models are explained as a prelude to a listing of representative simulation projects, reflecting investigative applications of statistical methods, trial design comparisons, and full simulation of new drugs being developed.

Conformational changes in the human estrogen receptor observed by (19)F NMR.

The (19)F NMR spectra of the 5F-Trp labeled glutathione-S-transferase fusion protein with residues 282-595 of the human estrogen receptor show that there is a distinct conformational change in the protein when estradiol is added to the unliganded protein. Our studies show the empty receptor to have more conformational flexibility than the liganded form. This study shows the applicability of (19)F NMR to study conformational change in large protein systems.

To be or not to be? How hospitals and doctors should decide whether to reinvest in or divest of their group practices.

Do you have a physician-hospital partnership that's bleeding red ink? How do you decide whether to divest or reinvest in it? Here are some guidelines and considerations to help you choose.

Trajectories of condylar points during nonworking side and protrusive movements of the mandible.

Statement Of Problem: During lateral excursive and protrusive jaw movements, condylar points are distant from any instantaneous rotational center. Therefore, it is likely that different condylar points would follow similar trajectories during these movements.

Purpose: This study evaluated the effect of changes in condylar point location on trajectories of condylar points on the nonworking side and during a protrusive jaw movement and compared these changes with the effects described for open-close and working-side condylar movements in the same group of subjects.

Occupational back disability in U.S. Army personnel.

Musculoskeletal disorders represent a prevalent source of outpatient visits, lost work time, hospitalization, and disability in the military. Recent research has identified patterns among military occupations, gender, and musculoskeletal disability. Although back disorders accounted for a high percentage of all cases, little is known about the relationship between job type and disability in soldiers.