Identification of patient's requirements in quality management system in health care institutions

AimTo present the solutions implemented in health care institution in the context of identification of patient's requirements, and evaluation of the level of patients’ satisfaction in accordance with the requirements of ISO norm 9001:2008 based on the experience of GPCC.BackgroundThe fundamental mechanisms behind the free market, such as competition, start applying also to the public health sector. Health service providers are gradually realising that patients are actual clients of health care institutions, with physicians, nurses, supporting personnel, registration officers and other staff responding to patients demand for medical and auxiliary services (e.g. exam registration, provision of information).Material and methodsPN-EN ISO 9001:2009 “Quality Management Systems. Requirements”, relevant literature and documentation of quality management system from the GPCC.The review of relevant literature and legal requirements; interpretation of provisions in relation to the functioning of health care institutions.ResultsModel of identification of patient's requirements and satisfaction in accordance with the requirements of ISO 9001:2008 has been elaborated and implemented in the GPCC.ConclusionThe identification of patient's requirements is much more complicated than evaluating the same parameters in manufacturing companies. In the context of medical services one should be aware of the subjectivity of patient's feelings, the psycho-social status and the general state of health during his or her treatment. Therefore, the identification of patient's requirements and satisfaction must be carefully thought out, implemented and regularly improved.     

Cohesin-dockerin code in cellulosomal dual binding modes and its allosteric regulation by proline isomerization

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Down's syndrome: a pathology involving the lack of balance of reactive oxygen species

Mongolism, or Down's syndrome (DS) is an inborn pathology due to trisomy 21. Apart from mental deficiency and anatomical abnormalities, premature aging is characteristic for this disease. This paper mainly reviews data on the generation of reactive oxygen species (ROS) and antioxidative defense mechanisms in DS, and on the sensitivity of DS cells to model sources of ROS. Changes in the antioxidative defense of DS cells are due mainly to the location of the gene for (Cu,Zn)-superoxide dismutase on chromosome 21. It is suggested that a disturbance of balance of ROS may be a key point in the pathogenesis of DS.     

Mutagenesis and Functional Analysis of Ion Channels Heterologously Expressed in Mammalian Cells

We will demonstrate how to study the functional effects of introducing a point mutation in an ion channel. We study G protein-gated inwardly rectifying potassium (referred to as GIRK) channels, which are important for regulating the excitability of neurons. There are four different mammalian GIRK channel subunits (GIRK1-GIRK4) - we focus on GIRK2 because it forms a homotetramer. Stimulation of different types of G protein-coupled receptors (GPCRs), such as the muscarinic receptor (M2R), leads to activation of GIRK channels. Alcohol also directly activates GIRK channels. We will show how to mutate one amino acid by specifically changing one or more nucleotides in the cDNA for the GIRK channel. This mutated cDNA sequence will be amplified in bacteria, purified, and the presence of the point mutation will be confirmed by DNA sequencing. The cDNAs for the mutated and wild-type GIRK channels will be transfected into human embryonic kidney HEK293T cells cultured in vitro. Lastly, whole-cell patch-clamp electrophysiology will be used to study the macroscopic potassium currents through the ectopically expressed wild-type or mutated GIRK channels. In this experiment, we will examine the effect of a L257W mutation in GIRK2 channels on M2R-dependent and alcohol-dependent activation.Download video file.^{(94M, mov)}     

Brain Potentials of Conflict and Error-Likelihood Following Errorful and Errorless Learning in Obsessive-Compulsive Disorder

Background

The anterior cingulate cortex (ACC) is thought to be overacting in patients with Obsessive Compulsive Disorder (OCD) reflecting an enhanced action monitoring system. However, influences of conflict and error-likelihood have not been explored. Here, the error-related negativity (ERN) originating in ACC served as a measure of conflict and error-likelihood during memory recognition following different learning modes. Errorless learning prevents the generation of false memory candidates and has been shown to be superior to trial-and-error-learning. The latter, errorful learning, introduces false memory candidates which interfere with correct information in later recognition leading to enhanced conflict processing.

Methodology/Principal Findings

Sixteen OCD patients according to DSM-IV criteria and 16 closely matched healthy controls participated voluntarily in the event-related potential study. Both, OCD- and control group showed enhanced memory performance following errorless compared to errorful learning. Nevertheless, response-locked data showed clear modulations of the ERN amplitude. OCD patients compared to controls showed an increased error-likelihood effect after errorless learning. However, with increased conflict after errorful learning, OCD patients showed a reduced error-likelihood effect in contrast to controls who showed an increase.

Conclusion/Significance

The increase of the errorlikelihood effect for OCD patients within low conflict situations (recognition after errorless learning) might be conceptualized as a hyperactive monitoring system. However, within high conflict situations (recognition after EF-learning) the opposite effect was observed: whereas the control group showed an increased error-likelihood effect, the OCD group showed a reduction of the error-likelihood effect based on altered ACC learning rates in response to errors. These findings support theoretical frameworks explaining differences in ACC activity on the basis of conflict and perceived error-likelihood as influenced by individual error learning rate.     

Diel Changes in Phytoplankton Composition and Abundance in the Surface and Sub‐Surface Strata from a Shallow Eutrophic Pond

Representative phytoplankton assemblages were identified in a eutrophic pond over a 24 hour period. One assemblage characterized species in the surface (neuston) layer and another consisted of algae from 2, 5, and 20 cm sub‐surface depths. The surface layer (0 cm) included a similar, but less diverse assemblage of species, and a lower abundance of cells per unit volume, than those at the lower depths. At each of the sub‐surface depths (2–20 cm), the major phytoplankton components initially followed similar patterns of abundance in reference to the time and depth of sample collections then later differed in their abundance levels. The dominant algae were chlorophytes, cryptophytes, diatoms, and cyanobacteria. Mean concentrations of total phytoplankton, over the 24 hours for the surface, were 3.3 × 10³ cells ml^–1, compared to 36.9 × 10³ cells ml^–1 for depths 2–20 cm. The autotrophic picoplankton abundance was recorded separately from the phytoplankton with mean concentrations of 472.9 × 10³ cells ml^–1 in the surface layer and 623.0 × 10³ cells ml^–1 for the three sub‐surface depths. Photos of representative species from these surface layers are presented. (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Diterpenoids and triterpenoids in hairy roots of Salvia sclarea

Hairy root culture of Salvia sclarea L. was established following infection with Agrobacterium rhizogenes LBA 9402. The culture was grown in growth regulator-free half-strength B5 Gamborg medium with 30 g l⁻¹ sucrose and was investigated with respect to its capability of producing diterpenoids and triterpenoids. Four diterpenoids (ferruginol, salvipisone, aethiopinone and 1-oxoaethiopinone) and two ursene-type triterpenoids (2α,3α-dihydroxy-urs-12-en-28-oic acid and 2α,3α,24-trihydroxy-urs-12-en-28-oic acid) were isolated from the hairy roots. The presence of three sterols (β-sitosterol, stigmasterol and campesterol), as well as oleanolic and ursolic acids was also shown by GC–MS analysis. The quantitative and qualitative differences in diterpenoid and triterpenoid production patterns between hairy roots grown in the light and in the dark were described.     

Assessment of late results in surgical treatment of lower limb ischemia in obliterative atheromatosis of the femoral-popliteal region]

The results of treatment of arterial incompetence localized in femoro-popliteal region in the selected 14 centres have been assessed after 24 and 60 months. Eight hundred fifty five patients were operated in the selected centres during 12 months i.e. 50% of all patients operated for obliterative atheromatosis of the lower limbs. Perioperative mortality rate was 4%. During a 5-year follow up, 30% of patients died, and 15% did not return supplied questionnaire, and their fate is unknown. The limb was preserved in 70% of patients operated with any technique except the primary amputation. Markedly worse results were noted in patients operated for necrosis or resting pain and in patients who underwent surgery which did not directly improve blood flow in the affected limb. The authors conclude that the most favourable results are produced by the implantation of vascular prosthesis during the period of intermittent claudication distance shortening before the development of resting pain or necrosis. Such operation are loaded with the lowest rate of failures and complications.