Consecutive Requests Research Articles

Impact économique de la psychiatrie de liaison dans un CHU français

In times of fiscal restraint for health structures, apart from the clinical input, it seems important to discuss the economic impact of liaison psychiatry. There are only a few studies on the economic added value provided by a liaison psychiatry team. In addition to this, only a few psychiatric pathologies are coded as they should be, hence we make the assumption of an additional development provided by a specialised team. Over a short period of 4months, in three departments of the Toulouse University Hospital Centre, the added value to the general pricing system of liaison psychiatry was studied. The population was represented by all the consecutive requests for consultations from patients over 18years old, men and women, hospitalised at that time. These three departments frequently request consultations with the psychiatry liaison team. They set a diagnostic, and if this is associated with a higher Homogeneous Group of Patients (HGP), it provides added value. Fifty-two patients benefited from a psychiatric consultation over 4months. The results highlight a development of €8630.43 for the traumatology department, €3325.03 for the internal medicine department, and €513.61 for the haematology department over the study period. The overall development over this period was €12,469.07. To our knowledge, this approach is one of the first in France to highlight an economic impact of the intervention of liaison psychiatry in the claiming departments.

Different Human Behavior Patterns in Web Surfing

Recently, understanding and modeling human behavior have attracted increasing interests. In this paper, we provide some statistical research on human behavior in Web surfing during special stage called Flash Crowd (FC). Approximate entropy is used to find out the FC stage. We quantify behavior patterns by interval time between two consecutive request behaviors. Kolmogorov-Smirnov statistical test is used to estimate the appropriate probability distribution function of interval time. The results show that the request behavior patterns varied in different stages.

Competitive strategies for an online generalized assignment problem with a service consecution constraint

This work studies a variant of the online generalized assignment problem, where there are m⩾2 heterogeneous servers to process n requests which arrive one by one over time. Each request must either be assigned to one of the servers or be rejected upon its arrival, before knowing any information of future requests. There is a corresponding weight (or revenue) for assigning each request to a server, and the objective is to maximize the total weights obtained from all the requests. We study the above problem with a service consecution constraint, such that at any time each server is only allowed to process up to d consecutive requests.We investigate both deterministic and randomized online strategies for this problem. When the ratio ρ between the largest and smallest possible weights obtained from assigning a request to a server is known in advance, we present an optimal deterministic online strategy with competitive ratio ρ1d. For randomized strategies, we first prove a lower bound on the competitive ratio, then we present a randomized strategy with competitive ratio less than 2, which does not need to know the value of ρ or d. Computational tests show that our proposed strategies have very good practical performance.

PERTURBAÇÃO DISMÓRFICA CORPORAL - UM DESAFIO EM DERMATOLOGIA

Na sociedade actual, em que a beleza e juventude são sinónimos de sucesso, são cada vez mais fre- quentes as queixas “estéticas” centradas nas imperfeições da pele e do corpo. Os Dermatologistas são muitas vezes procurados para avaliação e tratamento dessas queixas. A Perturbação Dismórfica Corporal (PDC), inicialmente de- nominada “dismorfofobia”, é uma patologia psiquiátrica frequente e incapacitante, caracterizada pela preocupação excessiva com um determinado defeito físico, real ou inexistente, causando angústia e disfunção nos planos social, afectivo e laboral. A ansiedade associada ao “defeito” estético compele os indivíduos com PDC a comportamentos do tipo compulsivo com o objectivo de o camuflar, evidenciando-se comportamentos como a compra compulsiva de lenços e chapéus, utilização de produtos de maquilhagem, manipulação da pele (skin picking), verificação ao espelho e procura de intervenções correctivas em consultas de Dermatologia, Cirurgia Plástica e Medicina Dentária (“doctor shop”). Os doentes com PDC, não reconhecendo o defeito como mínimo ou inexistente, procuram trata- mentos estéticos para uma patologia de natureza psiquiátrica. A prevalência da PDC na população geral é de 1 a 2% e na população de doentes dermatológicos é de 2,9 a 29,4%. Considerando a alta prevalência de PDC naquela população, e tendo em conta que os tratamentos estéticos raramente melhoram os sintomas, a sensibilização e for- mação dos Dermatologistas para a investigação sistemática, diagnóstico e orientação para consulta de Psiquiatria torna-se fundamental.PALAVRAS-CHAVE – Perturbação Dismórfica Corporal; Imagem Corporal; Cirurgia Plástica.

Fuzzy Based Real Time Task Scheduling for Multiprocessor System

Scheduling real time systems involves allocation of resources and CPU-time to tasks in such a way that certain performance requirements are met. In real time systems scheduling plays a more critical role than non-real-time systems because in these systems having the right answer too late is as bad as not having it at all [1]. Such a system must react to the requests within a fixed amount of time which is called deadline. Real-time tasks can be classified as periodic or a periodic. A periodic task is a kind of task that occurs at regular intervals, and a periodic task occurs unpredictably. The length of the time interval between the arrivals of two consecutive requests in a periodic task is called period

070 Avoiding ANCAs becoming routine: the use of clinical guidelines for requesting anti-neutrophil cytoplasmic antibodies in neurology

BackgroundANCA is highly specific for a group of small vessel vasculitides known as the ANCA associated small vessel vasculitides (AASVs). Consensus clinical guidelines have identified specific conditions where ANCA testing...

Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 Years of clinical experience

PurposeOur aim is to describe the number and distribution of requests addressed to an Advanced Practice Nursing team for functional problems of totally implantable venous access devices (TIVADs) and to describe, in detail, the malfunction management by the type and number of additional investigations and treatment modalities. MethodThe Advanced Practice Nursing team recorded data about all requests for support as part of the standard care. A specific protocol, the Leuven Malfunction Management Protocol was used for troubleshooting. In this descriptive, retrospective study, data of 3950 consecutive requests for TIVAD-related functional problems in 2019 patients were analyzed. Data collection included (1) demographic information, (2) device-related details, and (3) malfunction and follow-up details. Results‘Easy injection, impossible aspiration’ was the most frequently documented functional problem (66.9%) for all requests for help. Of all malfunctions, catheter tip was in an optimal position in 73.4%, thrombolytics were administered in 59.0%, and a linogram was performed in 4.9%. TIVAD removal/exchange was advised in 4.4% of the requests. ConclusionsTIVAD malfunction—defined operationally in terms of injection and/or aspiration problems—reflect all functional complications encountered in practice. Adherence to the Leuven Malfunction Management Protocol can ensure that, in most cases, catheter patency can be fully restored without removing or replacing the TIVAD. The Advanced Practice Nursing team coordinates the following treatments, investigations, and procedures: radiological catheter tip verification; thrombolytic agent administration and, if necessary, subsequent injection of solutions to dissolve drug precipitates or lipid deposits; linogram; percutaneous sleeve stripping; and TIVAD removal/replacement.

Follow-up of pregnant women exposed to chicken pox: an audit of relationship between level of antibody and development of chicken pox

The purpose of this study was to validate through natural exposure a cut-off level of varicella zoster IgG as protective against infection with varicella zoster virus (VZV). Laboratory testing to determine VZV immune status of pregnant women exposed to varicella is recommended. Quantitative assays are now available which are sensitive and specific. More than 200 consecutive requests for screening in pregnant patients with recent varicella contacts were followed-up by questionnaire. DiaSorin LIAISON and VZV time resolved fluorescence immuno assay (VZV TRFIA) were used to measure VZV antibody level. One hundred fifty out of 209 (72%) questionnaires were returned; 14 patients developed varicella, 129 did not and seven were not known. Patients who had been given VZIG and developed varicella on follow-up had a mean antibody level before VZIG of 28 mIU/ml and 62 mIU/ml, by LIAISON and TRFIA, respectively. The mean IgG level of those that did not develop varicella was 885 and 866 mIU/ml by LIAISON and TRFIA, respectively. Those with levels <100 mIU/ml were more likely to develop chicken pox than those with levels >100 mIU/ml (relative risk of 10.4 for LIAISON and 8.8 for TRFIA). On the basis of the relatively small numbers in this study, quantitative assays, using a 100mIU/ml cut-off, can differentiate between those who are susceptible and those who are protected against exposure, however follow-up studies should include sampling for VZV DNA and IgM.

In-advance path reservation for file transfers in e-science applications

We develop several multipath reservation algorithms for in-advance scheduling of single and multiple file transfers in connection-oriented optical networks. These algorithms consider the jobs one at a time or in a batch. The latter can be potentially useful to minimize the resource conflict between multiple consecutive requests. Extensive simulations using both real world networks and random topologies show that the greedy strategy, which process requests one at a time, can perform comparable to batch scheduling and is significantly better in terms of computational time requirement. Further, this strategy can be extended to reduce the path switching overheads.

A Graphics Parallel Memory Organization Exploiting Request Correlations

Real-time graphics applications require memory organizations featuring parallel pixel access and low-cost implementation. This work bases on a nonlinear skew mapping scheme and exploits the correlation between consecutive requests for pixels to design an efficient parallel memory organization. The mapping achieves parallel access, of mn pixels in various shapes, to the memory organized with mn banks. The proposed design technique combines the mapping properties and the spatial correlations among pixel requests to eliminate conflicts by spending at most one extra cycle every mn consecutive parallel pixel accesses. Consequently, the technique ensures that any pixel pattern-among these commonly used in graphics-can be accessed in a single cycle from any image location. The address computations become straightforward as the numbers of the requested pixels and the banks-apart from equal-can be powers of 2.

Integration and acceleration of virtual microscopy as the key to successful implementation into the routine diagnostic process

BackgroundThe virtual microscopy is widely accepted in Pathology for educational purposes and teleconsultation but is far from the routine use in surgical pathology due to the technical requirements and some limitations. A technical problem is the limited bandwidth of a usual network and the delayed transmission rate and presentation time on the screen.MethodsIn this study the process of secondary diagnostic was evaluated using the "T.Konsult Pathologie" service of the Professional Association of German Pathologists within the German breast cancer screening program. The characteristics of the access to the WSI (Whole Slide Images) have been analyzed to explore the possibilities of prefetching and caching to reduce the presentation and transfer time with the goal to increase user acceptance. The log files of the web server were analyzed to reconstruct the movements of the pathologist on the WSI and to create the observation path. Using a specialized tool the observation paths were extracted automatically from the log files. The attributes linearity, 3-point-linearity, changes per request, and number of consecutive requests were calculated to design, develop and evaluate different caching and prefetching strategies.ResultsThe analysis of the observation paths showed that a complete accordance of two image requests is a very rare event. But more frequently a partial covering of two requested image areas can be found. In total 257 diagnostic paths from 131 WSI have been extracted and analysed. On average a diagnostic path consists of 16 image requests and takes 189 seconds between first and last image request. The mean linearity was 0,41 and the mean 3-point-linearity 0,85. Three different caching algorithms have been compared with respect to hit rate and additional image requests on the WSI server. Tests demonstrated that 95% of the diagnostic paths could be loaded without any deletion of entries in the cache (cache size 12,2 Megapixel). If the image parts are stored after JPEG compression this complies with less than 2 MB.DiscussionWSI telepathology is a technology which offers the possibility to break the limitations of conventional static telepathology. The complete histological slide may be investigated instead of sets of images of lesions sampled by the presenting pathologist. The benefit is demonstrated by the high diagnostic security of 95% accordance between first and second diagnosis.

Use of thoracic computed tomography by general practitioners

To audit requests for computed tomography (CT) examination of the chest emanating from general practitioners and assess the appropriateness and usefulness of these requests. We reviewed 50 consecutive requests for CT examination received by two private radiology practices in Cairns between August 2004 and March 2005. Clinical details were abstracted from request forms and clarified by telephone if necessary. A subjective assessment of the appropriateness of the investigation was made by the authors. The study was performed in a large regional centre. Indications for requesting a CT scan; appropriateness of CT scan for indication specified. Fifteen patients had had recent normal chest x-rays, all of whom proved to have normal CTs; eight had not had a recent chest x-ray performed. The CT scan was considered appropriate in 16 cases (32%), but 10 of these patients required referral to specialists anyway. Thirty-four CT scans (68%) were felt to be inappropriate and, of these, 10 were subsequently referred to specialists. In only six cases did the CT scan resolve the GP's clinical problem. In six cases the wrong type of CT scan was performed (five were conventional CT scans instead of high-resolution scans; one was a high-resolution instead of low-resolution scan). Many CT examinations of the chest requested by GPs could be avoided or replaced by simpler, cheaper tests with lower radiation exposure. Assuming a fatal cancer risk of 1 in 3000, the radiation exposure involved in unnecessary chest CT scans could be responsible for about 40 fatal cancers a year in Australia.

Considering User Behavior and Multiple QoS Supports in Multimedia Streaming Caching

With the prevalence of video-on-demand (VOD) services as well as the diffusion of various multimedia devices, caching in a multimedia streaming server is becoming increasingly important. However, due to some peculiar characteristics of multimedia objects and user activities in streaming services, design of an efficient caching system becomes a more challenging problem compared to the traditional caching systems. This paper discusses some important issues that are of interest in the domain of multimedia streaming caching and presents a new cache management scheme for multimedia streaming servers. Our new scheme considers different streaming rates of multimedia objects as well as the inter-arrival time between two consecutive requests on an identical object. It also considers user activities in requesting and playing multimedia contents. Trace-driven simulations with real world VOD traces show that the proposed scheme improves the performance of multimedia streaming systems significantly.

Application of a combined protocol for rational request and utilization of antibody assays improves clinical diagnostic efficacy in autoimmune rheumatic disease.

Abstract Context.—Because of a marked increase in the number of requests for antinuclear antibodies, anti–extractable nuclear antigen antibodies, and anti–double-stranded DNA antibodies for the diagnosis of autoimmune rheumatic disease, guidelines have been proposed for their appropriate use. Objective.—To evaluate in terms of clinical efficacy and cost-benefit ratio the outcome of applying a protocol for the diagnosis of autoimmune rheumatic disease. Design.—A diagnostic protocol for the rational utilization of second-level tests (anti–extractable nuclear antigen antibodies and anti–double-stranded DNA antibodies) was applied at Hospital Polyclinic beginning January 2004. The appropriateness of 685 consecutive requests received at the clinical pathology laboratory from January to June 2004 was assessed. Patients who underwent these laboratory tests were followed up for 12 months after blood sample drawing. Results.—Introduction of the protocol led to a significant reduction in the number of second-level ...

Application of a Combined Protocol for Rational Request and Utilization of Antibody Assays Improves Clinical Diagnostic Efficacy in Autoimmune Rheumatic Disease

Because of a marked increase in the number of requests for antinuclear antibodies, anti-extractable nuclear antigen antibodies, and anti-double-stranded DNA antibodies for the diagnosis of autoimmune rheumatic disease, guidelines have been proposed for their appropriate use. To evaluate in terms of clinical efficacy and cost-benefit ratio the outcome of applying a protocol for the diagnosis of autoimmune rheumatic disease. A diagnostic protocol for the rational utilization of second-level tests (anti-extractable nuclear antigen antibodies and anti-double-stranded DNA antibodies) was applied at Hospital Polyclinic beginning January 2004. The appropriateness of 685 consecutive requests received at the clinical pathology laboratory from January to June 2004 was assessed. Patients who underwent these laboratory tests were followed up for 12 months after blood sample drawing. Introduction of the protocol led to a significant reduction in the number of second-level tests prescribed (27.9% vs 49.5% for anti-extractable nuclear antigen antibodies; 27.5% vs 56.6% for anti-double-stranded DNA antibodies). After the period of observation, none of the 163 patients who had negative results on the first-level test and were asymptomatic, for whom second-level tests had not therefore been performed, were found to have autoimmune rheumatic disease. In 90.5% (77/85) of patients positive for the second-level tests, clinical confirmation of autoimmune rheumatic disease was obtained. Not only did application of the diagnostic protocol reduce the number of second-level tests performed but it also increased their specificity. Our data thus indicate that the use of shared guidelines by clinical and laboratory specialists yields satisfactory results.

Serum Free Light Chains: An Alternative to the Urine Bence Jones Proteins Screening Test for Monoclonal Gammopathies

Retrospective analyses have established the role of quantitative serum free light chains (FLCs) in the diagnosis of monoclonal light chain disorders. The aims of this study were to assess (a) whether the addition of serum FLCs to serum protein electrophoresis (SPEP) identified additional patients with monoclonal gammopathies; (b) whether serum FLC measurements could replace urinalysis for Bence Jones protein (BJP); and (c) the cost/quality implications of routinely measuring serum FLCs. Serum FLCs were added to consecutive requests for SPEP from August to November 2004 and measured by automated immunoassay. Seventy-one of 923 patients had abnormal serum FLC ratios. Seven patients with monoclonal gammopathies and 1 patient with malignant lymphoma (but no monoclonal band) were detected among 43 patients with negative SPEP but positive serum FLC ratios. Thirty-five patients with negative SPEP had false-positive serum FLC ratios. The false-positive rate for a ratio >1.65 was higher than previously described and associated with polyclonal increases in immunoglobulins and renal impairment. Serum FLC ratios were normal in 2 of 13 patients with low-level persistent urine BJP. However, no significant pathology would have been missed by replacing BJP with serum FLCs. Revenue and manpower savings offset 60% of the costs of serum FLCs. Additional diagnostic information is gained by adding serum FLCs to SPEP as first-line tests for investigating possible B-cell disorders. The quality of the diagnostic service is enhanced by more confident exclusion of light chain disorders and improved interpretive assessment of SPEP and immunofixation electrophoresis.

Buffer management for heterogeneous resolution display in home VOD services

This paper presents an efficient buffer management scheme to support heterogeneous resolution display in home VOD services. The proposed scheme provides different quality services for various home appliances such as digital TV, home theater, and personal digital assistants (PDAs). Specifically, the proposed scheme exploits the reference popularity of video objects as well as the inter-arrival time between two consecutive requests on the same object. The scheme also considers the different streaming rate of video objects to provide QoS adaptive VOD service for heterogeneous appliances. Experiments with real world VOD traces show that the proposed scheme improves the performance of home VOD systems significantly

Serum Free Light Chain Measurement Can Replace Urine Electrophoresis in the Detection of B Cell Proliferative Disorders.

Retrospective studies have established the high sensitivity of quantitative serum free light chain (SFLC) measurement in the detection of patients with light chain myeloma, nonsecretory myeloma and primary amyloidosis. These disorders account for 15–20% of new diagnoses of B cell proliferative disorders and cannot be confidently excluded by current protocols without electrophoresis of both serum and urine. This prospective study evaluated whether the addition of SFLC to our first line investigations for B cell proliferative disorders detected additional patients with monoclonal gammopathies and if SFLC could replace the requirement for urine for Bence Jones Protein (BJP) analysis. SFLC were added to consecutive requests for serum electrophoresis (SPE) received to investigate patients for possible B-cell proliferative disorders over a 4 month period. SFLC was measured by immunoturbidimetry (The Binding Site, Birmingham, UK) in 923 patients. Subjects with known B-cell disorders were excluded. Concurrent urine samples were received from 370 patients for BJP(40%). The Hydrasis system was used for SPE, urine electrophoresis (UEP) and urine and serum immunofixation (Sebia, Issy-Les-Moulineaux, France.) Kappa/Lambda FLC ratio was abnormal in 71 (7.7%) patients. In 28 of these cases the SPE showed a possible monoclonal band or hypoglobulinaemia and subsequent serum immunofixation confirmed a monoclonal band in 19. In the remaining 43 with negative SPE but abnormal SFLC ratios, lymphoma was diagnosed in 1, multiple myeloma in 2 and monoclonal gammopathy of undetermined significance in 3. Follow-up is continuing in 3 further patients. Of 15 patients with positive urine BJP, 4 patients had normal SFLC ratios but did not have lymphoproliferative disorders requiring treatment. Additional diagnostic information was gained by adding SFLC to SPE for first line investigation of possible B cell disorders. 6 additional patients were identified by abnormal SFLC ratios. Replacing BJP with SFLC ratio would not have missed any significant pathology. In the light of this study we have adopted SPE and SFLC as our first line tests for the investigation of possible B cell disorders. The quality of our diagnostic service has improved; urine samples were received from only 40% of patients being screened and SFLC analysis allows the more confident exclusion of light chain disorders in the absence of a urine sample. The availability of SFLC results when viewing SPE gels assists in the interpretive process and highlights samples requiring serum immunofixation to identify monoclonal bands in the alph-2 or beta globulin regions or light chain monoclonal bands too small for reliable detection by SPE.

Monitoring spontaneous adherence to therapeutic guidelines in 500 cancer patients

6055 Background: Our institution adheres to recognized guidelines for cancer treatment (GCT) as those from NCI (USA) or NICE (UK). These are essential tools to our understanding, for monitoring quality of medical care. In a previous study, over 90% of physicians complied with these guidelines when they were included in a monitored program, however an evaluation of spontaneous (non monitored) adherence to GCT by practicing oncologists in our country is lacking and it was the purpose of the study. Methods: We retrieved from our database 500 consecutive requests for cancer treatment received from 1997 to 2004 from outside non monitored institutions. Results: The treatment received by 389 patients (78%) was according to GCT, whereas 111 (22.6%) were treated without any compliance of existing GCT’s. Major deviations from GCT were detected in this cohort, such as investigational treatments in 43 (8.6%), inadequate treatment for the actual stage of the disease 43 (8.6%), inadequate dosage: 13 (2.6%), lack of correlation between diagnosis and treatment prescribed 5 (1%) and delayed treatment 7 (1.4%). Compared to our historical series of monitored prescriptions, the likelihood of receiving an inadequate therapy significantly increased when practicing oncologists were not monitored (p=0.0001). Conclusions: When treatment was not monitored, one every five patients received an inadequate therapy either because of inaccurate treatment for stage, incorrect dosing or by utilizing investigational treatments instead of a proven one. No significant financial relationships to disclose.

Request form history, clinical indication, and yield of brain magnetic resonance studies.

To investigate whether improved clinical history allows the radiologist to better predict the pretest probability of obtaining a positive or negative result from a magnetic resonance (MR) examination. Six neuroradiologists prospectively reviewed 100 consecutive requests for brain MR examinations and sequentially assessed 1) quality of written history, 2) degree of indication for requested study, and 3) any pertinent new information found during chart review that may have altered the degree of indication. MR yield was correlated with the degree of indication assessed before and after chart review. Most request form histories were judged as poor (63%), and chart review reduced the overall indications for MR examinations, as there was a tendency for high-indication requests to migrate to the low-indication category. Based on request form history alone, the yields for low- and high-indication studies were 13% and 37%, respectively. Correlations between MR yield and indication after chart review improved significantly (P < 0.05) with 2% and 61% for low and high indications, respectively. Sensitivity and specificity for a positive MR yield were 71% and 62%, respectively, for the indication judged by the request history alone, and 96% and 80%, respectively, after chart review. Positive and negative prediction rates were 37% and 87%, respectively, for the indication judged by the request history alone, and 61% and 98%, respectively, for the indication judged after chart review. Based on our limited data, most request form histories were inadequate, and essential information available in the chart before MR examinations was frequently missing from the request forms. When adequate information was provided, the indication for the studies as judged by the radiologists predicted the MR yield more accurately, particularly for those requests with low indication. Therefore, our study suggests that MR imaging (MRI) may be used more effectively when pertinent clinical history is available. However, our study is limited and further studies are needed to confirm our results.