Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002-2012.

BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson's χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson's χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years. CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).

Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study.

BACKGROUND: Tinnitus is an often disabling condition for which there is no effective therapy. Current research suggests that tinnitus may develop due to maladaptive plastic changes and altered activity in the auditory and prefrontal cortex. Transcranial direct current stimulation (tDCS) modulates brain activity and has been shown to transiently suppress tinnitus in trials. OBJECTIVE: To investigate the efficacy and safety of tDCS in the treatment of chronic subjective tinnitus. METHODS: In a randomized, parallel, double-blind, sham-controlled study, the efficacy and safety of cathodal tDCS to the auditory cortex with anode over the prefrontal cortex was investigated in five sessions over five consecutive days. Tinnitus was assessed after the last session on day 5, and at follow-up visits 1 and 3 months post stimulation using the Tinnitus Handicap Inventory (THI, primary outcome measure), Subjective Tinnitus Severity Scale, Hospital Anxiety and Depression scale, Visual Analogue Scale, and Clinical Global Impression scale. RESULTS: 42 patients were investigated, 21 received tDCS and 21 sham stimulation. There were no beneficial effects of tDCS on tinnitus as assessed by primary and secondary outcome measures. Effect size assessed with Cohen's d amounted to 0.08 (95% CI: -0.52 to 0.69) at 1 month and 0.18 (95% CI: -0.43 to 0.78) at 3 months for the THI. CONCLUSION: tDCS of the auditory and prefrontal cortices is safe, but does not improve tinnitus. Different tDCS protocols might be beneficial.

Chronic disease management programmes for adults with asthma (intervention Review)

BACKGROUND: The burden of asthma on patients and healthcare systems is substantial. Interventions have been developed to overcome difficulties in asthma management. These include chronic disease management programmes, which are more than simple patient education, encompassing a set of coherent interventions that centre on the patients' needs, encouraging the co-ordination and integration of health services provided by a variety of healthcare professionals, and emphasising patient self-management as well as patient education. OBJECTIVES: To evaluate the effectiveness of chronic disease management programmes for adults with asthma. SEARCH METHODS: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, MEDLINE (MEDLINE In-Process and Other Non-Indexed Citations), EMBASE, CINAHL, and PsycINFO were searched up to June 2014. We also handsearched selected journals from 2000 to 2012 and scanned reference lists of relevant reviews. SELECTION CRITERIA: We included individual or cluster-randomised controlled trials, non-randomised controlled trials, and controlled before-after studies comparing chronic disease management programmes with usual care in adults over 16 years of age with a diagnosis of asthma. The chronic disease management programmes had to satisfy at least the following five criteria: an organisational component targeting patients; an organisational component targeting healthcare professionals or the healthcare system, or both; patient education or self-management support, or both; active involvement of two or more healthcare professionals in patient care; a minimum duration of three months. DATA COLLECTION AND ANALYSIS: After an initial screen of the titles, two review authors working independently assessed the studies for eligibility and study quality; they also extracted the data. We contacted authors to obtain missing information and additional data, where necessary. We pooled results using the random-effects model and reported the pooled mean or standardised mean differences (SMDs). MAIN RESULTS: A total of 20 studies including 81,746 patients (median 129.5) were included in this review, with a follow-up ranging from 3 to more than 12 months. Patients' mean age was 42.5 years, 60% were female, and their asthma was mostly rated as moderate to severe. Overall the studies were of moderate to low methodological quality, because of limitations in their design and the wide confidence intervals for certain results.Compared with usual care, chronic disease management programmes resulted in improvements in asthma-specific quality of life (SMD 0.22, 95% confidence interval (CI) 0.08 to 0.37), asthma severity scores (SMD 0.18, 95% CI 0.05 to 0.30), and lung function tests (SMD 0.19, 95% CI 0.09 to 0.30). The data for improvement in self-efficacy scores were inconclusive (SMD 0.51, 95% CI -0.08 to 1.11). Results on hospitalisations and emergency department or unscheduled visits could not be combined in a meta-analysis because the data were too heterogeneous; results from the individual studies were inconclusive overall. Only a few studies reported results on asthma exacerbations, days off work or school, use of an action plan, and patient satisfaction. Meta-analyses could not be performed for these outcomes. AUTHORS' CONCLUSIONS: There is moderate to low quality evidence that chronic disease management programmes for adults with asthma can improve asthma-specific quality of life, asthma severity, and lung function tests. Overall, these results provide encouraging evidence of the potential effectiveness of these programmes in adults with asthma when compared with usual care. However, the optimal composition of asthma chronic disease management programmes and their added value, compared with education or self-management alone that is usually offered to patients with asthma, need further investigation.

Organizing automation maintenance business in Russia

The target of this thesis is to find out potential of automation maintenance services in Russian industry, especially in the region of St. Petersburg. At the beginning of this study the industrial maintainability and process efficiency are discussed from the point of view of process automation. A survey of the present technology and maintenance methods has been made during five visits to local plants. The results of the interviews are analyzed numerically to clarify the common needs and the potential of automation maintenance services. The most interesting services are evaluated by their required resources to find economically justified solutions for the needs of the industry. As results of this study, some service products that would interest interviewed companies have been introduced. These could be offered to the industry to enhance cost-efficiency and productivity of processes.

Health care utilization among immigrants and native-born populations in 11 European countries. Results from the Survey of Health, Ageing and Retirement in Europe

This study examines health care utilization of immigrants relative to the native-born populations aged 50 years and older in eleven European countries. Methods. We analyzed data from the Survey of Health Aging and Retirement in Europe (SHARE) from 2004 for a sample of 27,444 individuals in 11 European countries. Negative Binomial regression was conducted to examine the difference in number of doctor visits, visits to General Practitioners (GPs), and hospital stays between immigrants and the native-born individuals. Results: We find evidence those immigrants above age 50 use health services on average more than the native-born populations with the same characteristics. Our models show immigrants have between 6% and 27% more expected visits to the doctor, GP or hospital stays when compared to native-born populations in a number of European countries. Discussion: Elderly immigrant populations might be using health services more intensively due to cultural reasons.

Tuberous sclerosis complex with oral manifestations: A case report and literature review

Introduction: Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome produced by a number of genetic mutations. The disease is characterized by the development of benign tumors affecting different body systems. The most common oral manifestations of TSC are fibromas, gingival hyperplasia and enamel hypoplasia. Clinical Case: A 35-year-old woman diagnosed with TSC presented with a reactive fibroma of considerable size and rapid growth in the region of the right lower third molar. Discussion: In the present case the association of TSC with dental malpositioning gave rise to a rapidly evolving reactive fibroma of considerable diameter. Few similar cases can be found in the literature. Patients with TSC present mutations of the TSC1 and TSC2 genes, which intervene in cell cycle regulation and are important for avoiding neoplastic processes. No studies have been found associating TSC with an increased risk of oral cancer, though it has been shown that the over-expression of TSC2 could exert an antitumor effect. Careful oral and dental hygiene, together with regular visits to the dentist, are needed for the prevention and early detection of any type of oral lesion. The renal, pulmonary and cardiac alterations often seen in TSC must be taken into account for the correct management of these patients.

Projecte d'aplicació de dispositius mòbils Android : seguiment de pacients a distància

El projecte consisteix en una aplicació per a realitzar el seguiment de pacients a distància, evitant així desplaçaments innecessaris al centre de salut. Està format per una pàgina web, on el personal sanitari gestiona el sistema, i una aplicació Android, que és la que fa servir el pacient. El personal sanitari introdueix la medicació, les visites o les tasques periòdiques a fer pel pacient al sistema. El pacient consulta la informació en l’aplicació del seu mòbil, rebent avisos de recordatori i amb la possibilitat enviar respostes als formularis creats per el personal sanitari de manera periòdica.

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion

Cumulative Costs of Caries Prevention and Treatment in Children - with Special Reference to Work Division and Cohort Effect

Lapsen karieshoidon kustannuskertymän muutokset ja karieshoidon toimintakäytäntöjen yhteys kustannuksiin Tutkimuksen tavoitteena oli mitata terveyskeskuksessa hoidettavien lasten karieshoidon kumulatiivisia kustannuksia ja verrata niitä kahden erilaisen toimintatavan välillä. Lisäksi tarkasteltiin lasten hampaiden terveyttä. Tutkimus tehtiin julkisen palvelutuottajan näkökulmasta. Tutkimusaineisto kerättiin Kemin ja Tornion terveyskeskusten suun terveydenhuollon potilaskertomuksista. Kemin kohortit 1980, 1983 ja 1986 (n = 600) ja Tornion kohortit 1980 ja 1992 (n = 400) edustivat perinteistä ja Kemin kohortit 1989, 1992 ja 1995 (n = 600) uutta toimintatapaa työnjaon ja ehkäisyn ajoituksen suhteen. Kohortteja ja kaupunkeja verrattiin hampaiden terveyden (dmft/DMFT = 0 ja dmft ja DMFT keskiarvot 5 ja 12 vuoden iässä) ja voimavarojen käytön suhteen. Panoskäyttö johdettiin käyntimäärien avulla laskennallisen työajan kautta. Kustannuskertymät muodostettiin käyttämällä henkilöstömenoista laskettuja suorittajakohtaisia yksikkökustannuksia. Panoskäytön ja yksikkökustannusten kautta muodostettiin kustannuskertymät. Kustannusten ja terveysvaikutusten suhteita arvioitiin kustannus-vaikuttavuusanalyysissä. Suuhygienistien työpanosta hyödyntävällä varhaisen ehkäisyn toimintamallilla saavutettiin vähäisemmin kustannuksin alle kouluiässä parempi ja kouluiässä yhtä hyvä hammasterveys kuin perinteisellä, enemmän hammaslääkärien työpanokseen perustuvalla tavalla. Karieksen hoitoon liittyvien käyntien määrä oli nuorimmissa syntymävuosikohorteissa pienempi kuin vanhimmissa kohorteissa. Käynnit hammaslääkärissä vähenivät eniten. Toimintatavalla oli merkittävä vaikutus lapsen karieshoidon kokonaiskustannuksiin. Herkkyysanalyysin mukaan karieshoidon kustannukset olivat työnjakoa hyödyntämällä kolmanneksen pienemmät, kuin jos hoidon suorittajana olisi ollut ainoastaan hammaslääkäri-hoitaja työpari. Lasten karieshoidon kustannusvaikuttavuus kohentui molemmissa terveyskeskuksissa nuoremmissa kohorteissa vanhempiin verrattuna. Suun terveydenhuollon potilaskertomuksia olisi hyödynnettävä toiminnan kehittämisessä. Varhaisen ehkäisyn avulla voitaisiin kaikkien suun terveydenhuollon ammattihenkilöiden työpanos kohdentaa kustannustehokkaasti.

Product Data Managemet as a Key Success Factor in After Sales Business

The objective of this master’s thesis is to define Larox´s Product Data present state and future development needs from after sales point of view. In particular the object was to investigate after sales needs, which data related to products need to be managed by using Product Data Management. Empirical material of thesis was collected mainly through interviews, benchmark visits, and personal experience. Among the interviewees were internal stakeholders who are closely related to the product process, as well as external stakeholders. Interviews revealed that each stakeholder group has deviating needs for product data management and that at present all the needs are not met to take the best possible way. The main requirement was availability of up-to-date information, which plays a key role in after sales business. At the end of study is concentrated to find development targets at Larox, especially from after sales point of view. In addition, consideration of how the product data management advantages can utilized in making internal processes more efficient. Development needs are collected together as project descriptions, whose headings are shown at the end of the study.

Interpretación ambiental de INBioparque, La Finca (Costa Rica)

Este artículo es una síntesis del proyecto realizado en INBio (Instituto Nacional de Biodiversidad), Costa Rica, cuyo objetivo principal fue la mejora de la Interpretación Ambiental de INBioparque, un parque temático de biodiversidad dentro de la institución. INBioparque está situado en Santo Domingo de Heredia, provincia de Heredia, Costa Rica. Éste pretende hacer una pequeña representación de los principales ecosistemas que se encuentran en el país. El parque se divide en diferentes zonas: Bosque del Valle Central, Bosque Húmedo, Bosque Seco, Humedal y Finca. En esta última, la Finca (ecosistema basado en la biodiversidad domesticada) es dónde se ha centrado todo el proyecto, debido a que presentaba una mayor necesidad de mejora en su interpretación ambiental. La Interpretación ambiental traduce el lenguaje técnico de los profesionales a términos e ideas más entendedoras para todos los públicos. Pretende promover una nueva conciencia sobre el valor de la biodiversidad, lograr su conservación y mejorar la calidad de vida del ser humano. El proyecto propone la mejora de la interpretación ambiental a través de las fichas técnicas elaboradas de las diferentes especies vegetales de la Finca, así como la renovación o creación de rótulos explicativos. Se propone también un recorrido guiado y auto guiado para hacer más entendedora la visita, además de algunas actividades y talleres.

Data mining and mall users profile

Marketing scholars have suggested a need for more empirical research on consumer response to malls, in order to have a better understanding of the variables that explain the behavior of the consumers. The segmentation methodology CHAID (Chi-square automatic interaction detection) was used in order to identify the profiles of consumers with regard to their activities at malls, on the basis of socio-demographic variables and behavioral variables (how and with whom they go to the malls). A sample of 790 subjects answered an online questionnaire. The CHAID analysis of the results was used to identify the profiles of consumers with regard to their activities at malls. In the set of variables analyzed the transport used in order to go shopping and the frequency of visits to centers are the main predictors of behavior in malls. The results provide guidelines for the development of effective strategies to attract consumers to malls and retain them there.

Gestió de la informació d'interès d'un treballador autònom

L’objectiu principal d’aquest treball és fer un programa que permeti portar la informació que un treballador autònom li interessa, d’acord amb les seves necessitats. En el nostre cas es tracta d’un centre d’estètica, que té més d’una seu, el qual li interessa portar tota la cartilla de clients, centres associats, proveïdors ... a més de poder fer les factures corresponents als centres associats, poder calcular en el moment que en el treballador li interessi, els ingressos realitzats durant un període de temps determinat i poder portar una agenda actualitzada dels dos centres, on es mostren totes les visites que hi ha en un dia. Per tal de realitzar el programa, s’han portat a terme mitjançant dos aplicacions, i connectant-los en una base de dades. Per una banda tenim una aplicació implementada amb C++, per l’altra, una pàgina web amb PHP, finalment com a sistema gestor de base de dades utilitzem el MySQL Server. El programa fet amb C++, consta de tota la part d’entrada i/o modificacions de dades, en aquesta part només hi pot accedir el treballador autònom, ja que és la única persona que pot fer aquesta feina. En la pàgina web, hi pot accedir qualsevol persona que tingui un nom d’usuari i una contrasenya. A través de la web es pot fer qualsevol tipus de consulta, fer tot el control de les agendes, portar a terme tot el tema de facturació i ingressos, i com a excepció l’entrada de dades de clients, ja que s’ha de poder realitzar en qualsevol moment i lloc. Per acabar, tenim la necessitat de tenir un servidor, aquest ha d’estar format, mínim, per la base de dades. Com que l’aplicació amb C++ i la base de dades han d’estar ubicades al mateix lloc. A més, necessitem un servidor web per tal de tenir la nostra pàgina a la xarxa, per aconseguir això, utilitzem un programa anomenat DynDNS, que es fa servir per a convertir una IP dinàmica en una IP estàtica i d’aquesta manera convertir un ordinador qualsevol amb un servidor web.

Desenvolupament d'una aplicació per a la creació de pressupostos on-line

En aquests moments, el mercat no es troba en una bona situació, per aquest motiu les empreses han de buscar noves maneres de créixer, expandir-se i noves formes d’interactuar amb els clients. La idea original d’aquest projecte sorgeix de la necessitat de disposar d’una manera diferent de promocionar-se i oferir nous serveis a través d’internet mitjançant una pàgina web. Degut a la situació actual, el preu és un aspecte molt important i influent a l’hora de realitzar una obra. Per aquest motiu es va pensar que seria molt interessant que el client pogués demanar de forma fàcil i ràpida un pressupost, i a l’instant tingués un preu orientatiu del que li pot costar la obra. D’aquesta manera l’interessat s’estalvia i agilitza molts passos previs abans de començar una obra. Després d’analitzar quina era la millor manera de portar a terme el projecte informàtic, s’ha determinat que la pàgina web es desenvoluparà utilitzant els llenguatges HTML i PHP combinant-lo amb el framework CodeIgniter. El disseny de la web es realitzarà mitjançant fulles d’estil CSS conjuntament amb el framework BootStrap. Per realitzar l’aplicació web que realitza els pressupostos s’utilitzarà AJAX i jQuery perquè d’aquesta manera el procés sigui dinàmic. L’entorn de desenvolupament escollit és el NetBeans i per provar el projecte s’utilitza el XAMPP. Un usuari només necessitarà un navegador i connexió a internet per fer servir totes les funcions de la web. Podrà realitzar pressupostos, concertar visites, contactar i per suposat veure tota la part informativa de la pàgina

A gestão de resíduos de laboratório na visão de alunos de um curso de graduação de quimica e áreas afins

This work presents the students´ profile before and after working in the course "Laboratory Chemical Waste Treatment" in the last ten years. The structure of the course is also described. Although students have shown an increasing previous experience on waste management, many fundamental aspects are missing, especially knowledge on the directives focusing environmental aspects. Visits to industrial plants are also essential to better understand the impact of wastes in environment. Most students nowadays consider waste management as an essential part of their professional formation. A good waste management program must consider several topics of extreme relevance.