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1

Postoperative radiotherapy in DBCG during 30 years. Techniques, indications and clinical radiobiological experience.  

PubMed

During the time period 1977-2007 postoperative radiotherapy in DBCG has varied considerably with regard to techniques and indications together with changes in the extent of surgery and adjuvant systemic therapy. The radiation treatment has been developed on the basis of clinical, radiophysical and radiobiological principles, encompassing also practical problems such as available equipment in the different centres and at times lack of sufficient machine capacity. The paper focus especially on the comprehensive work done prior to the DBCG 82 b&c studies, in order to optimize radiotherapy in all aspects prior to the evaluation of the efficacy of this treatment modality. The results from these trials did succeed in clear evidence that radiotherapy has an important role in the multidisciplinary treatment of early breast cancer. In parallel to these studies a new and challenging use of radiotherapy after breast conserving surgery was evaluated in the DBCG TM 82 protocol. The experience obtained with different techniques in this study formed the basis for the current principles of radiotherapy after lumpectomy. Reduction of radiation related morbidity has been a major issue for the DBCG radiotherapy group, and in this aspect several studies, including quality control visits, have been carried out to make the relevant modifications and to evaluate deviations from the guidelines between the centres. The background for the changes in radiotherapy is described for each of the programme periods as well as future perspectives which will include further refinements of the target and adjustments of dose and fractionation in selected patients. PMID:18465332

Overgaard, Marie; Christensen, Jens Juul

2008-01-01

2

Hypofractionation in Prostate Cancer: Radiobiological Basis and Clinical Appliance  

PubMed Central

External beam radiation therapy with conventional fractionation to a total dose of 76–80 Gy represents the most adopted treatment modality for prostate cancer. Dose escalation in this setting has been demonstrated to improve biochemical control with acceptable toxicity using contemporary radiotherapy techniques. Hypofractionated radiotherapy and stereotactic body radiation therapy have gained an increasing interest in recent years and they have the potential to become the standard of care even if long-term data about their efficacy and safety are not well established. Strong radiobiological basis supports the use of high dose for fraction in prostate cancer, due to the demonstrated exceptionally low values of ?/?. Clinical experiences with hypofractionated and stereotactic radiotherapy (with an adequate biologically equivalent dose) demonstrated good tolerance, a PSA control comparable to conventional fractionation, and the advantage of shorter time period of treatment. This paper reviews the radiobiological findings that have led to the increasing use of hypofractionation in the management of prostate cancer and briefly analyzes the clinical experience in this setting.

Mangoni, M.; Desideri, I.; Detti, B.; Bonomo, P.; Greto, D.; Paiar, F.; Simontacchi, G.; Meattini, I.; Scoccianti, S.; Masoni, T.; Ciabatti, C.; Turkaj, A.; Serni, S.; Minervini, A.; Gacci, M.; Carini, M.; Livi, L.

2014-01-01

3

In vitro irradiation station for broad beam radiobiological experiments  

NASA Astrophysics Data System (ADS)

The study of the interaction of charged particles with living matter is of prime importance to the fields of radiotherapy, radioprotection and space radiobiology. Particle accelerators and their associated equipment are proven to be helpful tools in performing basic science in all these fields. Indeed, they can accelerate virtually any ions to a given energy and flux and let them interact with living matter either in vivo or in vitro. In this context, the University of Namur has developed a broad beam in vitro irradiation station for use in radiobiological experiments. Cells are handled in GLP conditions and can be irradiated at various fluxes with ions ranging from hydrogen to carbon. The station is mounted on a 2 MV tandem accelerator, and the energy range can be set up in the linear energy transfer (LET) ranges that are useful for radiobiological experiments. This paper describes the current status of the hardware that has been developed, and presents results related to its performance in term of dose-rate, energy range and beam uniformity for protons, alpha particles and carbon ions. The results of clonogenic assays of A549 lung adenocarcinoma cells irradiated with protons and alpha particles are also presented and compared with literature.

Wéra, A.-C.; Riquier, H.; Heuskin, A.-C.; Michiels, C.; Lucas, S.

2011-12-01

4

Studies in the radiobiology of osteoradionecrosis and their clinical significance  

SciTech Connect

The radiobiology of osteoradionecrosis is a complex of cellular death and cellular functional impairments from radiation energy transfers. Four studies of irradiated patients and a data base from 536 patients with osteoradionecrosis revealed separate pathophysiologic conditions for osteoradionecrosis induced by early trauma, osteoradionecrosis induced by late trauma, and spontaneous osteoradionecrosis. A large body of data suggested useful clinical guidelines for the management of irradiated patients. The guidelines, in part, include a recommendation for deferring radiation treatment for 21 days after tissue wounding, if possible; a relative contraindication to wounding tissue during a radiation course; a recommendation for the use of hyperbaric oxygen before wounding; and a strong recommendation to provide comprehensive dental care to the irradiated patient.

Marx, R.E.; Johnson, R.P.

1987-10-01

5

Feasibility of BNCT radiobiological experiments at the HYTHOR facility  

NASA Astrophysics Data System (ADS)

HYTHOR (HYbrid Thermal spectrum sHifter tapirO Reactor) is a new thermal-neutron irradiation facility, which was installed and became operative in mid 2005 at the TAPIRO (TAratura PIla Rapida potenza 0) fast reactor, in the Casaccia research centre (near Rome) of ENEA (Ente per le Nuove tecnologie Energia ed Ambiente). The facility has been designed for in vivo radiobiological studies. In HYTHOR irradiation cavity, 1-6 mice can be simultaneously irradiated to study skin melanoma treatments with the BNCT (boron neutron capture therapy). The therapeutic effects of HYTHOR radiation field on mouse melanoma has been studied as a preliminary investigation before studying the tumour local control due to boron neutron capture effect after boronated molecule injection. The method to properly irradiate small animals has been precisely defined. Results show that HYTHOR radiation field is by itself effective in reducing the tumour-growth rate. This finding has to be taken into account in studying the effectiveness of new 10B carriers. A method to properly measure the reduction of the tumour-growth rate is reported and discussed.

Esposito, J.; Ceballos, C.; Soncin, M.; Fabris, C.; Friso, E.; Moro, D.; Colautti, P.; Jori, G.; Rosi, G.; Nava, E.

2008-06-01

6

Preliminary analysis of a radiobiological experiment for LifeSat  

NASA Technical Reports Server (NTRS)

With the possibility of performing radiation life science experiments on a dedicated satellite (LifeSat) in space, a combined effort in radiation physics and radiation dosimetry, in addition to radiation biology, is clearly required to ensure that meaningful biological experiments can be performed. To better understand the relationship of these disciplines, some possible LifeSat missions are examined. As a trial biological system, tumorigenesis is considered in the Harderian gland of mice, a system of sufficient radiosensitivity for which relative biological effectiveness (RBE) is well defined by laboratory experiments.

Wilson, John W.; Townsend, Lawrence W.; Nealy, John E.; Hardy, Alva C.; Atwell, William; Schimmerling, Walter

1991-01-01

7

Radiobiological experiments with plant seeds aboard the biosatellite Kosmos 1887.  

PubMed

The effects of spaceflight factors on the seeds of Arabidopsis thaliana and Crepis capillaris were studied provided with various protective measures: the seeds were located inside the satellite and in open space, protected with aluminium foil and also exposed without the foil cover. When the seeds were in open space without any protection, their viability was found to be suppressed; the survival rate and fertility of plants grown from these seeds were also diminished. An increase in the frequency of chromosome aberrations (CA) and in the number of multiple injuries was registered in this case. Experiments with the aluminium foil shielding showed a decrease in the suppression of the seeds' viability, but mutational changes were found to be even more increased, while the survival and fertility of the plants decreased. An increase in the thickness of shielding resulted in a decrease in the effects up to the level of the control, except for the effects connected with CA and fertility of the plants. Analysis of the results shows that these impairments can be ascribed to the action of single heavy charged particles (HCP). The seeds can be thus regarded as an integral biological 'dosimeter' which allows estimation of the total effects of radiation, ecological and biological factors. PMID:11537516

Anikeeva, I D; Akatov YuA; Vaulina, E N; Kostina, L N; Marenny, A M; Portman, A I; Rusin, S V; Benton, E V

1990-01-01

8

Radiobiological experiments with plant seeds aboard the biosatellite Cosmos 1887  

NASA Technical Reports Server (NTRS)

The effects of spaceflight factors on the seeds of Arabidopsis thaliana and Crepis capillaris were studied. The seeds were located inside the satellite in an open space, protected with aluminum foil and also exposed without the foil cover. When the seeds were in open space without any protection, their viability was found to be suppressed; the survival rate and fertility of plants grown from these seeds were also diminished. An increase in the frequency of chromosome aberrations (CA) and in the number of multiple injuries was registered in this case. Experiments with the aluminum foil shielding showed a decrease in the suppression of the seeds' viability, but mutational changes were found to be even more increased, while the survival rate and fertility of the plants decreased. An increase in the thickness of shielding resulted in a decrease in the effects up to the level of the control, except for the effects connected with CA and fertility of the plants. Analysis of the results shows that these impairments can be ascribed to the action of single heavy charged particles (HCP). The seeds can thus be regarded as an integral biological 'dosimeter' which allows estimation of the total effects of radiation, ecological and biological factors.

Benton, E. V.; Anikeeva, I. D.; Akatov, Yu. A.; Vaulina, E. N.; Kostina, L. N.; Marenny, A.; Portman, A. I.; Rusin, S. V.

1995-01-01

9

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context  

PubMed Central

Radiotherapy for the treatment of cancer is undergoing an evolution, shifting to the use of heavier ion species. For a plethora of malignancies, current radiotherapy using photons or protons yields marginal benefits in local control and survival. One hypothesis is that these malignancies have acquired, or are inherently radioresistant to low LET radiation. In the last decade, carbon ion radiotherapy facilities have slowly been constructed in Europe and Asia, demonstrating favorable results for many of the malignancies that do poorly with conventional radiotherapy. However, from a radiobiological perspective, much of how this modality works in overcoming radioresistance, and extending local control and survival are not yet fully understood. In this review, we will explain from a radiobiological perspective how carbon ion radiotherapy can overcome the classical and recently postulated contributors of radioresistance (?/? ratio, hypoxia, cell proliferation, the tumor microenvironment and metabolism, and cancer stem cells). Furthermore, we will make recommendations on the important factors to consider, such as anatomical location, in the future design and implementation of clinical trials. With the existing data available we believe that the expansion of carbon ion facilities into the United States is warranted.

2014-01-01

10

Bringing the heavy: carbon ion therapy in the radiobiological and clinical context.  

PubMed

Radiotherapy for the treatment of cancer is undergoing an evolution, shifting to the use of heavier ion species. For a plethora of malignancies, current radiotherapy using photons or protons yields marginal benefits in local control and survival. One hypothesis is that these malignancies have acquired, or are inherently radioresistant to low LET radiation. In the last decade, carbon ion radiotherapy facilities have slowly been constructed in Europe and Asia, demonstrating favorable results for many of the malignancies that do poorly with conventional radiotherapy. However, from a radiobiological perspective, much of how this modality works in overcoming radioresistance, and extending local control and survival are not yet fully understood. In this review, we will explain from a radiobiological perspective how carbon ion radiotherapy can overcome the classical and recently postulated contributors of radioresistance (?/? ratio, hypoxia, cell proliferation, the tumor microenvironment and metabolism, and cancer stem cells). Furthermore, we will make recommendations on the important factors to consider, such as anatomical location, in the future design and implementation of clinical trials. With the existing data available we believe that the expansion of carbon ion facilities into the United States is warranted. PMID:24679134

Schlaff, Cody D; Krauze, Andra; Belard, Arnaud; O'Connell, John J; Camphausen, Kevin A

2014-01-01

11

Dosimetry and spectral analysis of a radiobiological experiment using laser-driven proton beams.  

PubMed

Laser-driven proton and ion acceleration is an area of increasing research interest given the recent development of short pulse-high intensity lasers. Several groups have reported experiments to understand whether a laser-driven beam can be applied for radiobiological purposes and in each of these, the method to obtain dose and spectral analysis was slightly different. The difficulty with these studies is that the very large instantaneous dose rate is a challenge for commonly used dosimetry techniques, so that other more sophisticated procedures need to be explored. This paper aims to explain a method for obtaining the energetic spectrum and the dose of a laser-driven proton beam irradiating a cell dish used for radiobiology studies. The procedure includes the use of a magnet to have charge and energy separation of the laser-driven beam, Gafchromic films to have information on dose and partially on energy, and a Monte Carlo code to expand the measured data in order to obtain specific details of the proton spectrum on the cells. Two specific correction factors have to be calculated: one to take into account the variation of the dose response of the films as a function of the proton energy and the other to obtain the dose to the cell layer starting from the dose measured on the films. This method, particularly suited to irradiation delivered in a single laser shot, can be applied in any other radiobiological experiment performed with laser-driven proton beams, with the only condition that the initial proton spectrum has to be at least roughly known. The method was tested in an experiment conducted at Queen’s University of Belfast using the TARANIS laser, where the mean energy of the protons crossing the cells was between 0.9 and 5 MeV, the instantaneous dose rate was estimated to be close to 109 Gy s?1 and doses between 0.8 and 5 Gy were delivered to the cells in a single laser shot. The combination of the applied corrections modified the initial estimate of dose by up to 40%. PMID:22008825

Fiorini, F; Kirby, D; Borghesi, M; Doria, D; Jeynes, J C G; Kakolee, K F; Kar, S; Kaur, S; Kirby, K J; Merchant, M J; Green, S

2011-11-01

12

Radiobiology in radiotherapy  

SciTech Connect

This book is designed to provide a synthesis of current radiobiological knowledge as it related to modern radiotherapy practice. A radiobiologist working in a specific area provides the biological background and a clinician then reviews the up-to-date practical implications of this scientific basis. All topical aspects of radiobiology as applied to radiotherapy are covered, including the effects of radiation on cells, normal tissue and tumor, the important features of fractionation, and dose rate. Alternative treatment modalities, such as particle therapy hyperthermia radiation sensitizers and other oxygen modifiers and the interaction with chemotherapeutic agents, are discussed from both the clinical and radiobiological points of view.

Bleehen, N.M.

1988-01-01

13

The biological effect of cosmic radiation and the standardization of a permissible dose level (on conducting radiobiological experiments in outer space)  

NASA Technical Reports Server (NTRS)

Radiobiological effects of cosmic radiation are investigated by animal experimentation. Prolonged radiation effects on humans are evaluated clinically. Methods for standardizing permissible radiation levels for spacecraft crews are discussed.

1973-01-01

14

The new hybrid thermal neutron facility at TAPIRO reactor for BNCT radiobiological experiments.  

PubMed

A new thermal neutron irradiation facility, devoted to carry out both dosimetric and radiobiological studies on boron carriers, which are being developed in the framework of INFN BNCT project, has been installed at the ENEA Casaccia TAPIRO research fast reactor. The thermal column, based on an original, hybrid, neutron spectrum shifter configuration, has been recently become operative. In spite of its low power (5 kW), the new facility is able to provide a high thermal neutron flux level, uniformly distributed inside the irradiation cavity, with a quite low gamma background. The main features and preliminary benchmark measurements of the Beam-shaping assembly are here presented and discussed. PMID:17504745

Esposito, J; Rosi, G; Agosteo, S

2007-01-01

15

Real-Time Dosimetry for Radiobiology Experiments Using 25 MeV LINAC  

SciTech Connect

The next generation of radiobiology research requires increasingly more complex radiation sources to address questions ranging from the effects of space-based radiation to the influence of dose rate on biological systems. The Idaho Accelerator Center (IAC) has developed a radiobiology research facility to address some of these questions. The irradiation challenge is to deliver stable and reproducible conditions of high dose rate with well-controlled beam uniformity, dose, and dose rate under controlled temperature. In this work, we used a 25 MeV modified medical grade linear accelerator (LINAC) to obtain a high and adjustable electron dose rate. To overcome electron beam drift we used a collimator that both assisted the LINAC operator to steer the beam and ensured that regardless of beam drift, only the fixed collimated beam would irradiate the specimens. In addition, we utilized a beam flattener to keep the beam variation as low as 3% at 2.5 cm from the beam's center, and 1% variation between the simultaneously irradiated sample tubes. We also demonstrated that a segmented Faraday 'cup'(FC) array provides a useful real-time beam scanning and monitoring system, and is promising for implementing real-time dosimetry and control.

Mestari, Mohammed A.; Naeem, Syed F. [Department of Physics, Idaho State University, 921 S. 8th St., MS 8106, Pocatello, ID 83209 (United States); Wells, Douglas P.; Hunt, Alan [Idaho Accelerator Center, Idaho State University, 921 S. 8th St., MS 8263, Pocatello, ID 83209 (United States); Department of Physics, Idaho State University, 921 S. 8th St., MS 8106, Pocatello, ID 83209 (United States); DeVeaux, Linda C. [Idaho Accelerator Center, Idaho State University, 921 S. 8th St., MS 8263, Pocatello, ID 83209 (United States); Department of Biological Sciences, Idaho State University, 921 S. 8th St., MS 8007, Pocatello, ID 83209 (United States)

2009-03-10

16

Real-Time Dosimetry for Radiobiology Experiments Using 25 MeV LINAC  

NASA Astrophysics Data System (ADS)

The next generation of radiobiology research requires increasingly more complex radiation sources to address questions ranging from the effects of space-based radiation to the influence of dose rate on biological systems. The Idaho Accelerator Center (IAC) has developed a radiobiology research facility to address some of these questions. The irradiation challenge is to deliver stable and reproducible conditions of high dose rate with well-controlled beam uniformity, dose, and dose rate under controlled temperature. In this work, we used a 25 MeV modified medical grade linear accelerator (LINAC) to obtain a high and adjustable electron dose rate. To overcome electron beam drift we used a collimator that both assisted the LINAC operator to steer the beam and ensured that regardless of beam drift, only the fixed collimated beam would irradiate the specimens. In addition, we utilized a beam flattener to keep the beam variation as low as 3% at 2.5 cm from the beam's center, and 1% variation between the simultaneously irradiated sample tubes. We also demonstrated that a segmented Faraday ``cup'' (FC) array provides a useful real-time beam scanning and monitoring system, and is promising for implementing real-time dosimetry and control.

Mestari, Mohammed A.; Wells, Douglas P.; Deveaux, Linda C.; Hunt, Alan; Naeem, Syed F.

2009-03-01

17

Feasibility study on the use of polyallyldiglycol-carbonate cell dishes in TUNEL assay for alpha particle radiobiological experiments  

NASA Astrophysics Data System (ADS)

In the present work, we have studied the feasibility of a method based on polyallyldiglycol-carbonate (PADC) films to investigate the effects of alpha particles on HeLa cervix cancer cells. Thin PADC films with thickness of about 20 ?m were prepared from commercially available CR-39 films by chemical etching to fabricate custom-made petri dishes for cell culture, which could accurately record alpha particle hit positions. A special method involving "base tracks" for aligning the images of cell nuclei and alpha particle hits has been proposed, so that alpha particle transversals of cell nuclei can be visually counted. Radiobiological experiments were carried out to induce DNA damages, with the TdT-mediated d UTP Nick- End Labeling (TUNEL) fluorescence method employed to detect DNA strand breaks. The staining results were investigated by flow cytometer. The preliminary results showed that more strand breaks occurred in cells hit by alpha particles with lower energies. Moreover, large TUNEL positive signals were obtained even with small percentages of cells irradiated and TUNEL signals were also obtained from non-targeted cells. These provided evidence for the bystander effect.

Chan, K. F.; Yum, E. H. W.; Wan, C. K.; Fong, W. F.; Yu, K. N.

2007-08-01

18

Update on clinical radiobiology  

PubMed Central

Radiation therapy is an important local cytotoxic modality for cancer treatment whose aim is to control the disease while minimising damage to normal tissue. The combination of different treatment modalities offers a more effective cure and reduction in normal tissue toxicity. However, the differences in genetic profiles can cause diverse treatment outcomes. Multidisciplinary research, where technologies and knowledge from different areas are integrated, is necessary to design the optimal regimen for individualised cancer treatment. This paper offers an overview of some new cancer treatment strategies; the impact of molecular imaging on radiation oncology; and a computer simulation model to optimise treatment planning based on patient information. It briefly discusses molecular targeted therapy, tumour microenvironment and bioreductive agents, and evidence for making individualised medicine a reality. Using DNA microarrays and proteomic technologies, information on defined molecular targets and genetic profiling for individual patients can be obtained and new algorithms for radiation oncology-related diagnosis, treatment response and prognosis can be developed.

2006-01-01

19

Radiobiology challenges for ELIMED  

NASA Astrophysics Data System (ADS)

Laser driven accelerators have been proposed for possible clinical applications facilities with the clear aim to reduce the facilities overall cost and complexity of at least one order of magnitude compared to currently employed accelerators. While significant efforts is on-going in the physics community to achieve the required ion beam parameters for medical applications and design suitable radiotherapy facilities, radiobiological investigations of the effects of such beams is also mandatory in order to validate their future therapeutic use. The main aim of these investigations has been initially to establish a procedure for cell handling, irradiation and dosimetry compatible with the mixed beam, continuous energy spread and ultra-high dose rate of the pulsed particle beams produced by high power lasers. Moreover, ions are emitted in bursts of picosecond duration at the source and their therapeutic use may result in dose rates exceeding 109 Gy/sec and the biological effects at these ultra-high dose rates are virtually unknown.

Schettino, G.

2013-07-01

20

A TCP-NTCP estimation module using DVHs and known radiobiological models and parameter sets.  

PubMed

Radiotherapy treatment plan evaluation relies on an implicit estimation of the tumor control probability (TCP) and normal tissue complication probability (NTCP) arising from a given dose distribution. A potential application of radiobiological modeling to radiotherapy is the ranking of treatment plans via a more explicit determination of TCP and NTCP values. Although the limited predictive capabilities of current radiobiological models prevent their use as a primary evaluative tool, radiobiological modeling predictions may still be a valuable complement to clinical experience. A convenient computational module has been developed for estimating the TCP and the NTCP arising from a dose distribution calculated by a treatment planning system, and characterized by differential (frequency) dose-volume histograms (DDVHs). The radiobiological models included in the module are sigmoidal dose response and Critical Volume NTCP models, a Poisson TCP model, and a TCP model incorporating radiobiological parameters describing linear-quadratic cell kill and repopulation. A number of sets of parameter values for the different models have been gathered in databases. The estimated parameters characterize the radiation response of several different normal tissues and tumor types. The system also allows input and storage of parameters by the user, which is particularly useful because of the rapidly increasing number of parameter estimates available in the literature. Potential applications of the system include the following: comparing radiobiological predictions of outcome for different treatment plans or types of treatment; comparing the number of observed outcomes for a cohort of patient DVHs to the predicted number of outcomes based on different models/parameter sets; and testing of the sensitivity of model predictions to uncertainties in the parameter values. The module thus helps to amalgamate and make more accessible current radiobiological modeling knowledge, and may serve as a useful aid in the prospective and retrospective analysis of radiotherapy treatment plans. PMID:15753933

Warkentin, Brad; Stavrev, Pavel; Stavreva, Nadia; Field, Colin; Fallone, B Gino

2004-01-01

21

The significance of the choice of radiobiological (NTCP) models in treatment plan objective functions.  

PubMed

A Clinician's discrimination between radiation therapy treatment plans is traditionally a subjective process, based on experience and existing protocols. A more objective and quantitative approach to distinguish between treatment plans is to use radiobiological or dosimetric objective functions, based on radiobiological or dosimetric models. The efficacy of models is not well understood, nor is the correlation of the rank of plans resulting from the use of models compared to the traditional subjective approach. One such radiobiological model is the Normal Tissue Complication Probability (NTCP). Dosimetric models or indicators are more accepted in clinical practice. In this study, three radiobiological models, Lyman NTCP, critical volume NTCP and relative seriality NTCP, and three dosimetric models, Mean Lung Dose (MLD) and the Lung volumes irradiated at 10Gy (V10) and 20Gy (V20), were used to rank a series of treatment plans using, harm to normal (Lung) tissue as the objective criterion. None of the models considered in this study showed consistent correlation with the Radiation Oncologists plan ranking. If radiobiological or dosimetric models are to be used in objective functions for lung treatments, based on this study it is recommended that the Lyman NTCP model be used because it will provide most consistency with traditional clinician ranking. PMID:19623858

Miller, J; Fuller, M; Vinod, S; Suchowerska, N; Holloway, L

2009-06-01

22

[Clinical experiences with noxiptilin].  

PubMed

Noxiptilin (Elronon) proved to be a good bipolar thymoleptic agent in the clinical test at 3 special clinics. Its stimulating effect on the psychomotor function is more pronounced than its sedative action. Therefore, in cases with the anxious, agitated depressive syndrome the additional therapy with a neuroleptic agent or a sedative tranquilizer may be favourable. N. is well tolerated even at a higher age. The side effects are the same as those of other known thymoleptics. PMID:947276

König, L; Lange, E; Rossner, M; Liefke, T; Uhlig, B; Kursawe, H K; Lungwitz, J

1976-04-01

23

[Recent developments in radiation oncology-integrating radiation physics and molecular radiobiology advances into clinical radiotherapy practice and beyond].  

PubMed

Significant developments in radiation oncology have taken place in recent years as a result of advances in radiation physics and molecular radiobiology. From the conventional 2-dimensional (2D) radiotherapy to 3-dimensional (3D) conformal radiotherapy, we have now entered the era of intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT). IMRT/IGRT allows conformal treatment of tumor and conformal avoidance of normal tissues leading to possible improvement of tumor control and decrease in treatment-related toxicity. Frameless stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) have now become a reality, offering more treatment options in radiation oncology. With technological advances in image guidance, brachytherapy especially in early stage prostate cancer has progressed and shown excellent long-term outcome data. Charged particle therapy including proton therapy is a promising area for new development. Combining radiotherapy with the more traditional chemotherapy and hormonal therapy to novel targeted therapy and gene therapy is aimed to overcome radio-resistance, improve the radio-therapeutic index and provide better loco-regional and systemic control of cancer. A recent randomized trial in head and neck cancer has shown improved survival data when comparing combined radiotherapy and targeted therapy with radiotherapy alone. Recent advances in functional or molecular imaging offer new opportunity to improve targeting of tumor, for example, hypoxic region, and possibly to perform radiation dose painting with IMRT. Integrating PET/CT in radiotherapy has shown promise in assisting target delineation during treatment planning and assessing radiation treatment response. Cancer stem cell, gene expression profiling and nanotechnology with the implications on radio-resistance are new exciting areas requiring more research in future as we move toward personalized medicine. PMID:18710628

Teh, Bin S; Paulino, Arnold; Butler, E Brian

2008-08-01

24

Radiobiology challenges for ELIMED  

SciTech Connect

Laser driven accelerators have been proposed for possible clinical applications facilities with the clear aim to reduce the facilities overall cost and complexity of at least one order of magnitude compared to currently employed accelerators. While significant efforts is on-going in the physics community to achieve the required ion beam parameters for medical applications and design suitable radiotherapy facilities, radiobiological investigations of the effects of such beams is also mandatory in order to validate their future therapeutic use. The main aim of these investigations has been initially to establish a procedure for cell handling, irradiation and dosimetry compatible with the mixed beam, continuous energy spread and ultra-high dose rate of the pulsed particle beams produced by high power lasers. Moreover, ions are emitted in bursts of picosecond duration at the source and their therapeutic use may result in dose rates exceeding 10{sup 9} Gy/sec and the biological effects at these ultra-high dose rates are virtually unknown.

Schettino, G. [CCRCB, Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL and NPL, Hampton Road, Teddington, TW11 0LW (United Kingdom)] [CCRCB, Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL and NPL, Hampton Road, Teddington, TW11 0LW (United Kingdom)

2013-07-26

25

CRC handbook of radiobiology  

Microsoft Academic Search

The author presents Development of Radiobiology. A Review. Basic Cell Biology. Physics of Radiation Biology. Cellular Radiation Damage. Modifications of Cellular Radiation Damage. Repair of Radiation Damage. Molecular Radiation Biology. Radiation Syndromes and their Modifications. Radiation Damage of Skin and Mucous Membrane. Radiation Damage of Nervous Tissue. Radiation Damage of Reproductive Organs. Radiation Damage of Other Organ Systems. Radiation Immunology.

Prasad

1984-01-01

26

A Monte Carlo study for the calculation of the average linear energy transfer (LET) distributions for a clinical proton beam line and a radiobiological carbon ion beam line  

NASA Astrophysics Data System (ADS)

Fluence, depth absorbed dose and linear energy transfer (LET) distributions of proton and carbon ion beams have been investigated using the Monte Carlo code Geant4 (GEometry ANd Tracking). An open source application was developed with the aim to simulate two typical transport beam lines, one used for ocular therapy and cell irradiations with protons and the other for cell irradiations with carbon ions. This tool allows evaluation of the primary and total dose averaged LET and predict their spatial distribution in voxelized or sliced geometries. In order to reproduce the LET distributions in a realistic way, and also the secondary particles’ contributions due to nuclear interactions were considered in the computations. Pristine and spread-out Bragg peaks were taken into account both for proton and carbon ion beams, with the maximum energy of 62 MeV/n. Depth dose distributions were compared with experimental data, showing good agreement. Primary and total LET distributions were analysed in order to study the influence of contributions of secondary particles in regions at different depths. A non-negligible influence of high-LET components was found in the entrance channel for proton beams, determining the total dose averaged LET by the factor 3 higher than the primary one. A completely different situation was obtained for carbon ions. In this case, secondary particles mainly contributed in the tail that is after the peak. The results showed how the weight of light and heavy secondary ions can considerably influence the computation of LET depth distributions. This has an important role in the interpretation of results coming from radiobiological experiments and, therefore, in hadron treatment planning procedures.

Romano, F.; Cirrone, G. A. P.; Cuttone, G.; Di Rosa, F.; Mazzaglia, S. E.; Petrovic, I.; Ristic Fira, A.; Varisano, A.

2014-06-01

27

A Monte Carlo study for the calculation of the average linear energy transfer (LET) distributions for a clinical proton beam line and a radiobiological carbon ion beam line.  

PubMed

Fluence, depth absorbed dose and linear energy transfer (LET) distributions of proton and carbon ion beams have been investigated using the Monte Carlo code Geant4 (GEometry ANd Tracking). An open source application was developed with the aim to simulate two typical transport beam lines, one used for ocular therapy and cell irradiations with protons and the other for cell irradiations with carbon ions. This tool allows evaluation of the primary and total dose averaged LET and predict their spatial distribution in voxelized or sliced geometries. In order to reproduce the LET distributions in a realistic way, and also the secondary particles' contributions due to nuclear interactions were considered in the computations. Pristine and spread-out Bragg peaks were taken into account both for proton and carbon ion beams, with the maximum energy of 62 MeV/n. Depth dose distributions were compared with experimental data, showing good agreement. Primary and total LET distributions were analysed in order to study the influence of contributions of secondary particles in regions at different depths. A non-negligible influence of high-LET components was found in the entrance channel for proton beams, determining the total dose averaged LET by the factor 3 higher than the primary one. A completely different situation was obtained for carbon ions. In this case, secondary particles mainly contributed in the tail that is after the peak. The results showed how the weight of light and heavy secondary ions can considerably influence the computation of LET depth distributions. This has an important role in the interpretation of results coming from radiobiological experiments and, therefore, in hadron treatment planning procedures. PMID:24828462

Romano, F; Cirrone, G A P; Cuttone, G; Rosa, F Di; Mazzaglia, S E; Petrovic, I; Fira, A Ristic; Varisano, A

2014-06-21

28

Microdosimetry study of radiobiological facilities at RSV-Tapiro reactor.  

National Technical Information Service (NTIS)

The irradiation facility existing at the RSV-TAPIRO fast reactor of the ENEA (Italian Agency for Energy, New Technologies and the Environment) Casaccia Center is routinely employed by ENEA laboratories and associated groups for radiobiological experiments...

P. Pihet M. Coppola V. Di Majo T. Loncol

1992-01-01

29

The Cleveland Clinic's magnet experience.  

PubMed

The awarding of Magnet Status by the Magnet Nursing Services Recognition Program of the American Nursing Credentialing Center is acknowledged as the achievement of Excellence in Nursing. In this article, The Cleveland Clinic shares insights from its experience in becoming the 72nd Magnet hospital. Questions to ponder when conducting a readiness assessment before embarking on the Magnet journey, techniques to engage the staff in the application process, and writing and organizing tips are shared. PMID:15682881

Kuhar, Peggy A; Lewicki, Linda J; Modic, Mary Beth; Schaab, Debbie; Rump, Colleen; Bixler, Sarah

2004-01-01

30

Monte Carlo role in radiobiological modelling of radiotherapy outcomes.  

PubMed

Radiobiological models are essential components of modern radiotherapy. They are increasingly applied to optimize and evaluate the quality of different treatment planning modalities. They are frequently used in designing new radiotherapy clinical trials by estimating the expected therapeutic ratio of new protocols. In radiobiology, the therapeutic ratio is estimated from the expected gain in tumour control probability (TCP) to the risk of normal tissue complication probability (NTCP). However, estimates of TCP/NTCP are currently based on the deterministic and simplistic linear-quadratic formalism with limited prediction power when applied prospectively. Given the complex and stochastic nature of the physical, chemical and biological interactions associated with spatial and temporal radiation induced effects in living tissues, it is conjectured that methods based on Monte Carlo (MC) analysis may provide better estimates of TCP/NTCP for radiotherapy treatment planning and trial design. Indeed, over the past few decades, methods based on MC have demonstrated superior performance for accurate simulation of radiation transport, tumour growth and particle track structures; however, successful application of modelling radiobiological response and outcomes in radiotherapy is still hampered with several challenges. In this review, we provide an overview of some of the main techniques used in radiobiological modelling for radiotherapy, with focus on the MC role as a promising computational vehicle. We highlight the current challenges, issues and future potentials of the MC approach towards a comprehensive systems-based framework in radiobiological modelling for radiotherapy. PMID:22571871

El Naqa, Issam; Pater, Piotr; Seuntjens, Jan

2012-06-01

31

Monte Carlo role in radiobiological modelling of radiotherapy outcomes  

NASA Astrophysics Data System (ADS)

Radiobiological models are essential components of modern radiotherapy. They are increasingly applied to optimize and evaluate the quality of different treatment planning modalities. They are frequently used in designing new radiotherapy clinical trials by estimating the expected therapeutic ratio of new protocols. In radiobiology, the therapeutic ratio is estimated from the expected gain in tumour control probability (TCP) to the risk of normal tissue complication probability (NTCP). However, estimates of TCP/NTCP are currently based on the deterministic and simplistic linear-quadratic formalism with limited prediction power when applied prospectively. Given the complex and stochastic nature of the physical, chemical and biological interactions associated with spatial and temporal radiation induced effects in living tissues, it is conjectured that methods based on Monte Carlo (MC) analysis may provide better estimates of TCP/NTCP for radiotherapy treatment planning and trial design. Indeed, over the past few decades, methods based on MC have demonstrated superior performance for accurate simulation of radiation transport, tumour growth and particle track structures; however, successful application of modelling radiobiological response and outcomes in radiotherapy is still hampered with several challenges. In this review, we provide an overview of some of the main techniques used in radiobiological modelling for radiotherapy, with focus on the MC role as a promising computational vehicle. We highlight the current challenges, issues and future potentials of the MC approach towards a comprehensive systems-based framework in radiobiological modelling for radiotherapy.

El Naqa, Issam; Pater, Piotr; Seuntjens, Jan

2012-06-01

32

[Continuous dopaminergic stimulation - clinical experience].  

PubMed

Both disease progression and pulsatile stimulation of dopaminergic receptors are responsible for development of fluctuations and dyskinesia in about 50% of patients with Parkinson disease (PD) after 4-6 years of therapy with levodopa. In order to prevent motor complications, the ideal therapy should secure continuous dopaminergic stimulation (CDS). The concept of CDS is supported by the results of both experimental and clinical studies. Several treatment options are available to achieve CDS. Dopamine agonists have a longer half-life than levodopa and the development of dyskinesia is delayed when they are used as monotherapy in early PD. Continuous delivery of agonists can be improved with prolonged-release oral preparations, a transdermal delivery system or continuous subcutaneous infusion. Continuous enteral infusion of levodopa is another way to achieve CDS and it is very effective in reducing motor complications in advanced PD. PMID:20827612

Bogucki, Andrzej; S?awek, Jaros?aw

2010-01-01

33

Decontamination and Decorporation: The Clinical Experience.  

National Technical Information Service (NTIS)

Decontamination and decorporation are quite interrelated when dealing with a contaminated person. Some clinical experiences from a transuranium production facility are offered. Skin decontamination is accomplished by washing with detergent and water. Stub...

G. A. Poda

1979-01-01

34

Clinical experience with CT colonography  

NASA Astrophysics Data System (ADS)

Since the introduction of Computed Tomographic Colonography (CTC) in 1995, many advances in computer equipment and software have become available. Despite these advances, the promise of colon cancer prevention has not been realized. A colorectal screening tool that performs at a high level, is acceptable to patients, and can be performed safely and at low cost holds promise of saving lives in the future. Our institution has performed over two hundred seventy five clinical CTC examinations. These scans, which each entail a supine and a prone acquisition, only differ from our research protocol in the necessity of an expeditious interpretation. Patients arrive for their CTC examination early in the morning following a period of fasting and bowel preparation. If a CTC examination has a positive finding, the patient is scheduled for colonoscopic polypectomy that same morning. To facilitate this, the patients are required to continue fasting until the CTC examination has been interpreted. It is therefore necessary to process the CTC examination very quickly to minimize patient discomfort. A positive CTC result occurred in fifteen percent of examinations. Among these positive results, the specificity has been in excess of ninety five percent. Additionally, life threatening extra-colonic lesions were discovered in two percent of the screened population.

Reed, Judd E.; Garry, John L.; Wilson, Lynn A.; Johnson, C. Daniel

2000-04-01

35

Gender variations in clinical pain experience  

Microsoft Academic Search

This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate

Anita M. Unruh

1996-01-01

36

Implementing a Clinical Experience for Student Trainers.  

ERIC Educational Resources Information Center

Clinical experiences offered to students preparing to become athletic trainers at East Carolina University (North Carolina) are diverse and multiple. The program acquaints students with actual medical practices in sports medicine by allowing them to observe experienced trainers and doctors at work as well as providing opportunities for practical…

Compton, Rod

37

The ethics of simulated nursing clinical experiences  

Microsoft Academic Search

Simulation has the capacity to alleviate many of the problems facing associate degree nursing education today. As the use of simulation increases, nurse educators must examine the ethical aspects of simulated clinical experience. The purpose of this article was to explore the ethical issues surrounding simulation in associate degree nursing education. Current literature supports simulation as an adjunct to traditional

Janeen Berndt

2010-01-01

38

Clinical impact of dosimetry quality assurance programmes assessed by radiobiological modelling of data from the thermoluminescent dosimetry study of the European Organization for Research and Treatment of Cancer  

Microsoft Academic Search

The European Organization for Research and Treatment of Cancer (EORTC) Radiotherapy Group initiated its mailed thermoluminescence dosimetry (TLD) programme in 1986. The aim of the present study was to evaluate the clinical relevance of variations in beam output detected in the period 1993 to 1996. A total of 140 beam outputs were checked (26 for cobalt-60 units and 114 for

S. M Bentzen; J Bernier; J. B Davis; J. C Horiot; G Garavaglia; J Chavaudra; K. A Johansson; M Bolla

2000-01-01

39

Fundamental space radiobiology  

NASA Technical Reports Server (NTRS)

The unique feature of the space radiation environment is the dominance of high-energy charged particles (HZE or high LET radiation) emitted by the Sun and galactic sources, or trapped in the Van Allen radiation belts. These charged particles present a significant hazard to space flight crews, and accelerator-based experiments are underway to quantify the health risks due to unavoidable radiation exposure. There are three principal properties of charged particles that distinguish them from conventional radiation, i.e. gamma rays and x-rays. First, they have a defined range in matter rather than an exponential absorption profile. Second, they undergo nuclear reactions to produce secondary particles. Third, and most important, they deposit their energy along well-defined linear paths or tracks rather than diffuse fields. The structured energy deposition pattern interacts on multiple scales with the biological structures of DNA, cells and tissues to produce correlated patterns of damage that evade repair systems. Traditional concepts of dose and its associated normalization parameter, RBE (relative biological effectiveness), break down under experimental scrutiny, and probabilistic models of risk based on the number of particle traversals per cell may be more appropriate. Unique patterns of DNA damage, gene expression, mobilization of repair proteins, activation of cytokines and remodeling of cellular microenvironment are observed following exposure to high LET radiation. At low levels of exposure the communication of bioactive substances from irradiated to unirradiated "bystander" cells can amplify the damage and cause a significant deviation from linearity in dose vs. response relations. Under some circumstances, there is even a multigenerational delay in the expression of radiation-induced genetic damage (genomic instability) which is not strictly dose dependent. These issues and the experimental evidence derived from ground based experiments at particle accelerators are presented along with speculation about how modified inertial conditions might perturb homeostatic responses to radiation to further complicate risk assessment for space flight.

Nelson, Gregory A.

2003-01-01

40

Target fragmentation in radiobiology  

NASA Technical Reports Server (NTRS)

Nuclear reactions in biological systems produce low-energy fragments of the target nuclei seen as local high events of linear energy transfer (LET). A nuclear-reaction formalism is used to evaluate the nuclear-induced fields within biosystems and their effects within several biological models. On the basis of direct ionization interaction, one anticipates high-energy protons to have a quality factor and relative biological effectiveness (RBE) of unity. Target fragmentation contributions raise the effective quality factor of 10 GeV protons to 3.3 in reasonable agreement with RBE values for induced micronuclei in bean sprouts. Application of the Katz model indicates that the relative increase in RBE with decreasing exposure observed in cell survival experiments with 160 MeV protons is related solely to target fragmentation events. Target fragment contributions to lens opacity given an RBE of 1.4 for 2 GeV protons in agreement with the work of Lett and Cox. Predictions are made for the effective RBE for Harderian gland tumors induced by high-energy protons. An exposure model for lifetime cancer risk is derived from NCRP 98 risk tables, and protraction effects are examined for proton and helium ion exposures. The implications of dose rate enhancement effects on space radiation protection are considered.

Wilson, John W.; Cucinotta, Francis A.; Shinn, Judy L.; Townsend, Lawrence W.

1993-01-01

41

Radiobiological concerns in radiopharmaceutical development  

SciTech Connect

Radiobiological considerations are a vital part of research and development of radiopharmaceutical procedures. More effort is needed to raise the general level of sophistication in the assessment of radiobiological risk of nuclear medicine studies that are planned for the future or are being performed at present. Simple dosimetry calculations of single administrations of radiopharmaceuticals to normal adults is insufficient for a rigorous scientific assessment of procedures. The specific areas explored in this paper includes: cellular uptake and microdosimetry considerations with Auger electron emitters such as In-111 and Cr-51; dosimetry in pathological states, such as for I-123-hippuran in diseased kidneys; dose commitments and limitations in the use of labeled antibodies for diagnosis and treatment when target/non-target ratios are low; risk/benefit decisions in pediatrics and during pregnancy; drug interactions that alter radiopharmaceutical biodistribution and clearance; and the importance of obtaining more extensive biodistribution and kinetic data and a means by which such data may be easily accessed, such as with a computer data bank service.

Marcus, C.S.

1985-05-01

42

Planning a study abroad clinical experience.  

PubMed

Not only is globalization expanding areas of human activity, it is also influencing the variety of educational offerings in universities. Therefore, globalization must be considered by nurse educators as they reevaluate ways of preparing nursing students to meet the health care needs of populations they currently serve and will care for in the future. Study abroad programs have been encouraged to be part of the college experience in the United States for more than 30 years; however, these programs have been relatively lacking in nursing education. Most of the study abroad programs described in the nursing literature are research-based or first-person accounts of an experience and provide little information about planning a study abroad program. This article describes a study abroad learning experience for senior nursing students and discusses the issues such as student selection, student safety, and available clinical experiences that need to be considered before undertaking such an endeavor. PMID:20143756

Wright, Dolores J

2010-05-01

43

Practicum and clinical experiences: postpracticum students' views.  

PubMed

The clinical or practicum component of preservice undergraduate education across all disciplines typically is rated by prebaccalaureate students as the most important phase of their entire professional preparation. This study collected e-mail survey responses from 63 post-practicum nursing students who had just completed their culminating fourth-year clinical course. Students identified the most positive and the most negative aspects of that final practicum experience. These responses were compared with those reported by postpracticum students from the disciplines of engineering and teacher education. The cross-disciplinary similarity of these data related to postpracticum students' perceptions of this experiential learning phase of their preservice professional training was noted. The student voice provides a critical dimension to the program-enhancement process for all professional disciplines, and practicum organizers across the disciplines should value such student input and collaborate to improve the clinical phase of preservice education for all professions. PMID:19681532

Ralph, Edwin; Walker, Keith; Wimmer, Randolph

2009-08-01

44

Radiobiology.  

National Technical Information Service (NTIS)

This bibliography contains unclassified-unlimited citations on the effects of radiation on living organisms; the effect of artificial and natural radiation on the heart, lungs, nervous system, and other physiological systems are included. The four compute...

1977-01-01

45

Invaluable Experience in a Specialty Clinic During Psychiatry Residency Training: My Cleveland Pride Clinic Experience  

Microsoft Academic Search

This article is a personal account of the author's experiences with a lesbian, gay, bisexual, transgender, questioning (LGBTQ) specialty care system during his psychiatry residency. The experience of his own resolution of his identity, LGBTQ health education and clinical exposures affected his resolve to provide more competent and respectful mental health care. This work has inspired the author to learn

Howard R. Hernandez

2012-01-01

46

Pulsed radiobiology with laser-driven plasma accelerators  

NASA Astrophysics Data System (ADS)

Recently, a high efficiency regime of acceleration in laser plasmas has been discovered, allowing table top equipment to deliver doses of interest for radiotherapy with electron bunches of suitable kinetic energy. In view of an R&D program aimed to the realization of an innovative class of accelerators for medical uses, a radiobiological validation is needed. At the present time, the biological effects of electron bunches from the laser-driven electron accelerator are largely unknown. In radiobiology and radiotherapy, it is known that the early spatial distribution of energy deposition following ionizing radiation interactions with DNA molecule is crucial for the prediction of damages at cellular or tissue levels and during the clinical responses to this irradiation. The purpose of the present study is to evaluate the radio-biological effects obtained with electron bunches from a laser-driven electron accelerator compared with bunches coming from a IORT-dedicated medical Radio-frequency based linac's on human cells by the cytokinesis block micronucleus assay (CBMN). To this purpose a multidisciplinary team including radiotherapists, biologists, medical physicists, laser and plasma physicists is working at CNR Campus and University of Pisa. Dose on samples is delivered alternatively by the "laser-linac" operating at ILIL lab of Istituto Nazionale di Ottica and an RF-linac operating for IORT at Pisa S. Chiara Hospital. Experimental data are analyzed on the basis of suitable radiobiological models as well as with numerical simulation based on Monte Carlo codes. Possible collective effects are also considered in the case of ultrashort, ultradense bunches of ionizing radiation.

Giulietti, Antonio; Grazia Andreassi, Maria; Greco, Carlo

2011-05-01

47

Clinical experience in temporomandibular joint arthroscopy.  

PubMed

Clinical experience of arthroscopy in 12 temporomandibular joints with a clinical diagnosis of closed lock was described. There were 10 patients and all were females with a mean age of 31.2 years (range 20 to 59 years). The antero-lateral approach was used for entry into 11 joints. The clinical findings were adhesions (64%), fibrillation (64%), anterior displacement of disc (36%) and scuffing of the articular surface of the glenoid fossa (9%). Two of the joints that had arthrocentesis prior to arthroscopy did not show any different findings from the rest. Of the 8 patients who had pre-arthroscopy pain, 7 patients (88%) had reduction of the symptom. Three patients (38%) had complete resolution of pain. The range of mouth opening (measured as maximal incisor opening) increased in all patients two weeks following arthroscopy. The average change in maximal incisor opening was 40.3% with a range of 22% to 85%. The mean follow-up was 34 months (range 4 to 68 months). PMID:8924004

Go, W S; Teh, L Y; Peck, R H; Chew, S C; Chua, E K

1996-09-01

48

A Curriculum Model for an Integrated Senior Year Clinical Experience.  

ERIC Educational Resources Information Center

A flexible clinical experience for nursing seniors integrates pediatrics, public health, and nursing leadership. Experiences in hospital units, schools, nurse-directed clinics, and home visits expose students to a wide range of settings and issues. (SK)

Wukasch, Ruth N.; Blue, Carolyn L.; Overbay, Jane

2000-01-01

49

Johnson Space Center Flight Medicine Clinic Experience  

NASA Technical Reports Server (NTRS)

Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

Landry, Trela

2006-01-01

50

Radiobiological compensation: A case study of uterine cervix cancer with concurrent chemotherapy  

SciTech Connect

The case of a patient diagnosed with uterine cervix cancer is presented as an example of the clinical application of the radiobiological compensation method implemented at Centro Estatal de Cancerologia de Durango. Radiotherapy treatment was initially modified to compensate for the chemotherapy component and, as medical complications arose during treatment delivery resulting in an 18 days gap, new compensation followed. All physical and radiobiological assumptions to calculate the Biologically Effective Dose in the external beam and brachytherapy parts of the treatment are presented. Good local control of the tumor was achieved, the theoretical tolerance limits for the organs at risk were not surpassed and the patient manifested no extensive morbidity.

Herrera, Higmar; Yanez, Elvia; Lopez, Jesus [Centro Estatal de Cancerologia de Durango, Victoria de Durango, Durango (Mexico); ISSSTE General Hospital Dr. Santiago Ramon y Cajal, Victoria de Durango, Durango (Mexico)

2012-10-23

51

National Radiobiology Archives distributed access programmer's guide  

SciTech Connect

The National Radiobiology Archives is a comprehensive effort to gather, organize, and catalog original data, representative specimens, and supporting materials related to significant radiobiology studies. This provides researchers with information for analyses which compare or combine results of these and other studies and with materials for analysis by advanced molecular biology techniques. This Programmer's Guide document describes the database access software, NRADEMO, and the subset loading script NRADEMO/MAINT/MAINTAIN, which comprise the National Laboratory Archives Distributed Access Package. The guide is intended for use by an experienced database management specialist. It contains information about the physical and logical organization of the software and data files. It also contains printouts of all the scripts and associated batch processing files. It is part of a suite of documents published by the National Radiobiology Archives.

Prather, J. C. [Linfield Coll., McMinnville, OR (United States); Smith, S. K.; Watson, C. R. [Pacific Northwest Lab., Richland, WA (United States)

1991-12-01

52

Clinical environment as a learning environment: student nurses’ perceptions concerning clinical learning experiences  

Microsoft Academic Search

The aim of this study is to describe student nurses’ perceptions of clinical learning experiences in the context of the clinical learning environment. We use the phenomenological approach by Colaizzi. The data was collected by unstructured interviews. Altogether 16 student nurses were asked to describe the significance of clinical learning experiences and good and bad learning experiences. Four elements sum

Mikaela von Bonsdorff

2003-01-01

53

Heavy charged particle radiobiology: Using enhanced biological effectiveness and improved beam focusing to advance cancer therapy  

Microsoft Academic Search

Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and ?-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce

Christopher Allen; Thomas B. Borak; Hirohiko Tsujii; Jac A. Nickoloff

2011-01-01

54

Cooperative Digoxin Experiment I - Summary Report, Clinical Chemistry Division, 1977.  

National Technical Information Service (NTIS)

Numerous clinical laboratories and manufacturers of diagnostic products were invited to participate in an experiment to assess the present status of assays for the quantitation of digoxin. The response was excellent, and a cooperative digoxin experiment w...

W. H. Hannon D. M. Fast

1978-01-01

55

The Importance of Early Experiences: Clinical, Research, and Policy Perspectives  

Microsoft Academic Search

The degree to which early adverse experiences exert long term effects on development and how much early adversity may be overcome through subsequent experiences are important mental health questions. The clinical, research and policy perspectives on these questions lead to different answers. From a clinical perspective, change is always possible, and it is never too late. From a research perspective,

Charles H. Zeanah

2009-01-01

56

The Importance of Early Experiences: Clinical, Research, and Policy Perspectives  

ERIC Educational Resources Information Center

The degree to which early adverse experiences exert long term effects on development and how much early adversity may be overcome through subsequent experiences are important mental health questions. The clinical, research and policy perspectives on these questions lead to different answers. From a clinical perspective, change is always possible,…

Zeanah, Charles H.

2009-01-01

57

Clinical experience with trisomies 18 and 13  

Microsoft Academic Search

The clinical, cytogenetic, dermatoglyphic, and postmortem observations of the 29 cases of trisomy 18 and 19 cases of trisomy 13 seen in the Department of Medical Genetics from 1963-76 are summarised. Chromosomes were studied in all and 30 were banded. One patient had tertiary trisomy 18 and 8 had translocations of chromosome 13. The features of these patients are described

M E Hodes; J Cole; C G Palmer; T Reed

1978-01-01

58

Clinical experience with inactivated, virosomal influenza vaccine  

Microsoft Academic Search

Current available influenza vaccines are safe and effective in preventing influenza. Nevertheless, there is a need for influenza vaccines with improved efficacy in the elderly. This need is underscored by both the observation that influenza has a major clinical and economic impact in the elderly and the fact that currently available vaccines are generally less effective in elderly than in

I. A. de Bruijn; J. Nauta; W. C. M. Cramer; L. Gerez; A. M. Palache

2005-01-01

59

Collaborative Clinical Practice: An Alternate Field Experience  

ERIC Educational Resources Information Center

Teacher education in the 21st century is encountering increased scrutiny, added pressure, and escalating external regulations but does not have practical and immediate solutions for improving programs. While reforms in teacher education call for additional and improved clinical practice for candidates, through strengthened partnerships with local…

Dee, Amy Lynn

2012-01-01

60

A Simulated Interprofessional Rounding Experience in a Clinical Assessment Course  

PubMed Central

Objective To implement a simulated interprofessional rounding experience using human patient simulators as a required activity for third-year pharmacy students in a clinical assessment course. Design Interprofessional student teams consisting of pharmacy, medical, and physician assistant students participated in a simulated interprofessional rounding experience in which they provided comprehensive medical care for a simulated patient in an inpatient setting. Assessment Students completed a survey instrument to assess interprofessional attitudes and satisfaction before and after participation in the simulated interprofessional rounding experience. Overall student attitudes regarding interprofessional teamwork and communication significantly improved; student satisfaction with the experience was high and students’ self-perceived clinical confidence improved after participation. The mean team clinical performance scores were 65% and 75% for each simulated interprofessional rounding experience. Conclusion Incorporating a simulated interprofessional rounding experience into a required clinical assessment course improved student attitudes regarding interprofessional teamwork and was associated with high student satisfaction.

Shrader, Sarah; McRae, Lacy; King, William M.; Kern, Donna

2011-01-01

61

Long-term clinical experience with zofenopril.  

PubMed

Angiotensin-converting enzyme inhibitors are extensively used to improve clinical outcome of patients with several cardiovascular diseases. Zofenopril proved to be very effective in patients with coronary artery disease and myocardial infarction, thanks to its unique effective mechanism of action for improving blood pressure control, left ventricular function and myocardial ischemia burden, as well as angiotensin-converting enzyme inhibition. The SMILE project involved more than 3500 patients with coronary artery disease and demonstrated that zofenopril treatment may reduce mortality and morbidity in patients with myocardial infarction, also when combined with acetyl salicylic acid and to a greater extent than lisinopril and ramipril. In addition, the results of the SMILE-ISCHEMIA study have demonstrated an interesting anti-ischemic effect of zofenopril, and these properties largely contribute to the overall clinical benefit of the drug. The effects of zofenopril on blood pressure control and cardiovascular protection clearly support its primary role for prevention and treatment of cardiovascular diseases. PMID:23030285

Borghi, Claudio; Bacchelli, Stefano; Degli Esposti, Daniela

2012-08-01

62

Clinical experiences with local microwave hyperthermia  

SciTech Connect

At the Claire Zellerbach Saroni Tumor Institute, Mount Zion Hospital and Medical Center, 38 patients who failed definitive radiotherapy and chemotherapy were treated with 915 megahertz and 2450 megahertz microwave hyperthermia to observe normal tissue tolerance and therapeutic responses. When hyperthermia was combined with radiation, complete clinical regression occurred in 41% of patients and partial regression in 37%, however with hyperthermia alone, complete regression occurred in 18% of patients and partial regression in 18%. Thus, moderate local tumor hyperthermia (42.5/sup 0/C) following low dose irradiation (1800 to 2700 rad) has resulted in significant responses in recurrent tumors in previously irradiated areas. Thermal dosimetry remained an outstanding problem for clinical hyperthermia, in part because of inadequacy of heat delivery and measurement systems, and in part because of patient variations in terms of tolerance to heat and tumor physiological changes with fractions of hyperthermia. Side effects of thermal blistering and burns were correlated with maximum temperatures attained during heat treatments.

Luk, K.H.; Purser, P.R.; Castro, J.R.; Meyler, T.S.; Phillips, T.L.

1981-05-01

63

Tocilizumab in pediatric rheumatology: the clinical experience.  

PubMed

During the last two decades, clinical use of novel biological therapy has led to increased mechanistic understanding of complex rheumatological diseases. Conversely, basic and translational studies have led to development of new and varied therapeutic agents. These new medications which "target" specific steps in one or more immune pathways have the potential to control disease symptoms, improve quality of life and long-term prognosis, and perhaps in some, restore immunological tolerance. Use of these agents in clinical trials, combined with post-marketing surveillance, has revealed both the benefits and the undesirable side-effects of biological disease-modifying anti-rheumatic drugs (DMARDs). In this review we focus on the use of tocilizumab, a monoclonal antibody directed against the IL6 receptor (IL6R), which potently inhibits IL-6/IL6R signaling. PMID:23715975

Gurion, Reut; Singer, Nora G

2013-07-01

64

Workshop on radiobiological effectiveness of neutrons  

SciTech Connect

The radiobiological effectiveness (RBE) of neutrons has become the subject of some heated discussions in both scientific and radiation-protection oriented communities. This has become especially so since the realization that neutron exposures of A-bomb survivors in Hiroshima were considerably lower than previously assumed, thus ''devaluating'' the importance of what we thought was a solid human data base. At the same time, more recent data from radiobiological research appeared to indicate that, at least for some biological endpoints, the RBE of neutrons at low doses and low dose rates was increased dramatically compared to the RBE at higher dose and dose rates. As a consequence, the protection of health against neutrons became a subject of some urgency. The objective of this workshop was to evaluate the existing data base in order to determine the need for additional research in this field. 22 refs., 3 figs., 6 tabs.

Stapleton, G.E.; Thomas, R.G.; Thiessen, J.W.

1985-09-01

65

Korean Supervisors' Experiences in Clinical Supervision  

ERIC Educational Resources Information Center

The demand for mental health services in Korea is increasing, and a corresponding rise in the number of trainees in counseling psychology results in a need for effective supervision. Using a grounded theory approach, this study explored Korean supervisors' experiences in supervision to better understand the current status of supervision practice…

Bang, Keeyeon; Park, Jeeseon

2009-01-01

66

Clinical Experience with Treatment of Angioleiomyoma  

PubMed Central

Background Angioleiomyoma, a vascular leiomyoma, is a rare, benign smooth-muscle tumor that originates in the tunica media of vessels. It occurs anywhere in the body, most frequently in the lower extremities. Methods We reviewed the medical records of 16 patients who were treated for angioleiomyoma between 2000 and 2012. The clinical features of angioleiomyoma and the correlation between symptoms and pathological subtypes were investigated. Results There were 9 males and 6 females. Ages of the patients ranged from 21 to 61. Pain was the primary symptom in 44% of the patients. Tumors were smaller than 2.0 cm in all dimensions and were located in the face in 4 patients, whereas 5 lesions occurred in the upper extremities and the remaining 7 in the lower extremities. Three histologic subtypes were identified: solid, venous, and cavernous. The subtypes did not correlate with the clinical symptoms. Conclusions Angioleiomyoma appears to be a rare tumor that occurs in the face and the extremities. The tumor usually occurs in middle age. A differential diagnosis of this tumor is difficult, but the tumor should be considered in the diagnosis of painful subcutaneous masses. Ultrasonography and magnetic resonance imaging can be helpful in the diagnosis of angioleiomyoma. These tumors can be successfully treated with simple excision, with a low recurrence rate.

Woo, Kyoung Sik; Kim, Sang Hun; Kim, Han Seong

2014-01-01

67

Clinical intestinal transplantation: Experience in Miami  

Microsoft Academic Search

Intestinal transplantation can be a life-saving procedure for patients with intestinal failure and life-threatening complications of the underlying disease or total parenteral nutrition (TPN). The transplantation techniques at the University of Miami were based on our Pittsburgh experience and the organs were separated as needed following Starzl's cluster principle. According to the latter all intra-abdominal organs are like a grape

T. Karatzas; F. Khan; A. G. Tzakis

1997-01-01

68

[Somatostatin and the digestive system. Clinical experiences].  

PubMed

The effect of somatostatin on the gastrointestinal tract is complex; it inhibits the release of gastrointestinal hormones, the exocrine function of the stomach, pancreas and bile, decreases motility and influences absorption as well. Based on these diverse effects there was an increased expectation towards the success of somatostatin therapy in various gastrointestinal disorders. The preconditions for somatostatin treatment was created by the development of long acting somatostatin analogues (octreotide, lanreotide). During the last twenty-five years large trials clarified the role of somatostatin analogues in the treatment of various gastrointestinal diseases. This study summarizes shortly these results. Somatostatin analogue treatment could be effective in various pathological conditions of the gastrointestinal tract, however, this therapeutic modality became a part of the clinical routine only in neuroendocrine tumours and adjuvant treatment of oesophageal variceal bleeding and pancreatic fistulas. PMID:24058098

Herszényi, László; Mihály, Emese; Tulassay, Zsolt

2013-09-29

69

Clinical evaluation of terconazole. European experience.  

PubMed

Terconazole is a new topical antifungal agent that differs structurally and functionally from the imidazoles. European clinical trials were conducted to determine (1) the lowest effective dose for a given treatment period, (2) which formulation should be tested further, and (3) how terconazole compares with other topical antifungal agents in terms of safety and efficacy. The results of dose-response studies demonstrated that 80- and 240-mg suppositories and 0.4% cream were the most effective formulations. Data from multicenter studies of pregnant and nonpregnant women in Belgium and Luxembourg indicate that the efficacy of terconazole cream is superior to that of miconazole nitrate cream and clotrimazole cream. Terconazole cream is also more effective than clotrimazole cream in terms of lower relapse rates. PMID:2677364

Hirsch, H A

1989-08-01

70

Educational Preparation and Experiences in the Clinical Setting: Entry-Level Clinical Athletic Trainers' Perspectives  

ERIC Educational Resources Information Center

Context: The clinical job setting: (Outpatient/Ambulatory/Rehabilitation Clinic) should no longer be referred to as a nontraditional setting as it employs the greatest percentage of certified members. Understanding the experiences, knowledge, and skills necessary to be successful in the clinical setting as entry-level certified athletic trainers…

Schilling, Jim

2011-01-01

71

Hypersensitivity reactions to ethylene oxide: clinical experience.  

PubMed

A hypersensitivity reaction occurring in the first minute of the dialysis procedure was observed in seven haemodialysis patients in one day. Hollow-fibre dialysers were used, five made of saponified cellulose ester (SCE) and two of cuprammonium cellulose (CC). All were sterilised with ethylene oxide (ETO) and used for the first time. The severity of the reactions was grade 2. The whole series of dialysers was examined for the presence of ETO concentration. A significantly higher concentration of ETO was found in the polyurethane potting than in the capillaries. The ETO concentrations were 122, 185, 440, 274, 342, and 280 p.p.m. in the following dialysers: Cordis Dow (cellulose acetate CA), Cordis Dow-Plivadial (SCE), Fresenius C-1.3 (CC), Fresenius E-2 (CC), Fresenius E-3 (CC), and Travenol-Medial S 11 flate plate (CC) respectively. According to the clinical signs, ETO concentrations in the dialysers and the lack of reaction when extensive rinsing was used, it can be presumed that these reactions are related to ETO although other mechanisms cannot be excluded. PMID:1775268

Masin, G; Polenakovi?, M; Ivanovski, N; Atanasov, N; Olivera, S; Cakalaroski, K

1991-01-01

72

Cancer therapy with bispecific antibodies: Clinical experience  

PubMed Central

The binding of at least two molecular targets simultaneously with a single bispecific antibody is an attractive concept. The use of bispecific antibodies as possible therapeutic agents for cancer treatment was proposed in the mid-1980s. The design and production of bispecific antibodies using antibody- and/or receptor-based platform technology has improved significantly with advances in the knowledge of molecular manipulations, protein engineering techniques, and the expression of antigens and receptors on healthy and malignant cells. The common strategy for making bispecific antibodies involves combining the variable domains of the desired mAbs into a single bispecific structure. Many different formats of bispecific antibodies have been generated within the research field of bispecific immunotherapeutics, including the chemical heteroconjugation of two complete molecules or fragments of mAbs, quadromas, F(ab’)2, diabodies, tandem diabodies and single-chain antibodies. This review describes key modifications in the development of bispecific antibodies that can improve their efficacy and stability, and provides a clinical perspective on the application of bispecific antibodies for the treatment of solid and liquid tumors, including the promises and research limitations of this approach.

Thakur, Archana; Lum, Lawrence G

2013-01-01

73

Space radiobiology on the Moon  

NASA Astrophysics Data System (ADS)

Most of the uncertainty on space radiation risk is due to poor knowledge of the biological response to heavy ions. Large experimental programs are under way to study biological effects at accelerators both in USA and Europe. These studies will have to be benchmarked in spaceflight experiments, and the Moon may represent an ideal experimental base.

Durante, M.

2012-12-01

74

Rhinocerebral and systemic mucormycosis. Clinical experience with 36 cases  

Microsoft Academic Search

We analysed retrospectively our clinical experience with 36 cases of mucormycosis. They were seen during the last 15 years. The diagnosis suspected on clinical grounds, was confirmed in 31 cases by finding the hyphae in hematoxylin-eosin stained material obtained from aspirated or tissue biopsy or by isolation of the fungus in culture. Rhinocerebral mucormycosis was diagnosed in 22 patients. Diabetes

Ricardo A Rangel-Guerra; Héctor R Martínez; Corando Sáenz; Francisco Bosques-Padilla; Ingrid Estrada-Bellmann

1996-01-01

75

ECG devices interoperability in hospital environment: clinical experience  

Microsoft Academic Search

The clinical use of information systems is now widely accepted in hospital departments. Among diagnostic instrumental examinations the electrocardiogram is the most popular diagnostic procedure in hospitals and out- patient points of care and its integration in Hospital Information System (HIS) is mandatory. We report our experience in integrating ECG devices in the clinical HIS of an advanced Health Care

C. Carpeggiani; F. Conforti; S. Dalmiani; M. Emdin; A. Macerata

2004-01-01

76

THREE YEARS CLINICAL EXPERIENCE WITH INTESTINAL TRANSPLANTATION  

PubMed Central

BACKGROUND After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal transplantation worldwide were discouraging because of unsatisfactory graft and patient survival. The experimental and clinical demonstration of the superior therapeutic efficacy of FK 506, a new immunosuppressive drug, ushered in the current era of small bowel and multivisceral transplantation with initial promising results. STUDY DESIGN Forty-three consecutive patients with short bowel syndrome, intestinal insufficiency, or malignant tumors with or without associated liver disease, were given intestinal (n=15), hepatic and intestinal (n=21), or multivisceral allografts that contained four or more organs (n=7). Treatment was with FK 506 based immunosuppression. The ascending and right transverse colon were included with the small intestine in 13 of the 43 grafts, almost evenly distributed between the three groups. RESULTS After six to 39 months, 30 of the 43 patients are alive, 29 bearing grafts. The most rapid convalescence and resumption of diet, as well as the highest three month patient survival (100 percent) and graft survival (88 percent) were with the isolated intestinal procedure. However, this advantage was slowly eroded during the first two postoperative years, in part because the isolated intestine was more prone to rejection. By the end of this time, the best survival rate (86 percent) was with the multivisceral procedure. With all three operations, most of the patients were able to resume diet and discontinue parenteral alimentation, and in the best instances, the quality of life approached normal. However, the surveillance and intensity of care required for these patients for the first year, and in most instances thereafter, was very high, being far more than required for patients having transplants of the liver, kidney or heart. CONCLUSIONS Although intestinal transplantation has gone through the feasibility phase, strategies will be required to increase its practicality. One possibility is to combine intestinal transplantation with contemporaneous autologous bone marrow transplantation.

Abu-Elmagd, Kareem; Todo, Satoru; Tzakis, Andreas; Reyes, Jorge; Nour, Bakr; Furukawa, Hiroyuki; Fung, John J.; Demetris, Anthony; Starzl, Thomas E.

2009-01-01

77

Enhancing nursing students' clinical placement experiences: a quality improvement project.  

PubMed

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students' clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians' perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues. Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates' readiness for practice. Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made. PMID:17083320

Levett-Jones, Tracy; Fahy, Kathleen; Parsons, Kimberly; Mitchell, Amanda

2006-10-01

78

Radiobiological studies using gamma and x rays.  

SciTech Connect

There are approximately 500 self-shielded research irradiators used in various facilities throughout the U.S. These facilities use radioactive sources containing either 137Cs or 60Co for a variety of biological investigations. A report from the National Academy of Sciences[1] described the issues with security of particular radiation sources and the desire for their replacement. The participants in this effort prepared two peer-reviewed publications to document the results of radiobiological studies performed using photons from 320-kV x rays and 137Cs on cell cultures and mice. The effectiveness of X rays was shown to vary with cell type.

Potter, Charles Augustus; Longley, Susan W.; Scott, Bobby R. [Lovelace Respiratory Research Institute, Albuquerque, NM; Lin, Yong [Lovelace Respiratory Research Institute, Albuquerque, NM; Wilder, Julie [Lovelace Respiratory Research Institute, Albuquerque, NM; Hutt, Julie A. [Lovelace Respiratory Research Institute, Albuquerque, NM; Padilla, Mabel T. [Lovelace Respiratory Research Institute, Albuquerque, NM; Gott, Katherine M. [Lovelace Respiratory Research Institute, Albuquerque, NM

2013-02-01

79

Female genital mutilation: Experience in a West London clinic.  

PubMed

In 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously. PMID:17654198

Gordon, H; Comerasamy, H; Morris, N H

2007-05-01

80

Rural clinical experiences for emergency medicine residents: a curriculum template.  

PubMed

Rural emergency departments (EDs) in the United States are less likely to be staffed with emergency medicine (EM) residency-trained and American Board of Emergency Medicine (ABEM)-certified physicians than urban EDs. Rural EM clinical experiences during residency training have been suggested as a strategy to encourage future rural practice, but past Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine program requirements and a lack of familiarity with rural rotations in the EM graduate medical education (GME) community have limited their availability. To provide a template for the development and implementation of a rural EM clinical experience, Kern's six-step approach was followed. PMID:23167861

Wadman, Michael C; Clark, Ted R; Kupas, Douglas F; Macht, Marlow; McLaughlin, Steve; Mize, Terry; Casaletto, Jennifer; Muelleman, Robert L

2012-11-01

81

Our clinical experience in low-energy laser medical treatments  

NASA Astrophysics Data System (ADS)

In clinical research the efficiency of low-energy laser (LEL) therapy remains controversial. We present here some of the most important results of our clinical experience in this field. We summarize our opinions about the LEL effects in rheumatic diseases, in chronic pelvic inflammatory disorders, in the treatment of some dermatological disorders, and in the recovery of the distal forearm nerve from traumatic lesion after surgical suture. We conclude that these results may be important evidence for the real clinical efficiency of the LEL.

Antipa, Ciprian; Bruckner, Ion I.; Crangulescu, Nicolae; Moldovan, Corneliu I.; Podoleanu, Adrian G.; Stanciulescu, Viorica; Ionescu, Elena

1996-05-01

82

Providing premedical students with quality clinical and research experience  

PubMed Central

Undergraduate premedical students face a prodigious decision as they work to determine whether to pursue a profession in medicine. Experience in clinical medicine and research is essential to inform students what it might be like to be a physician. Undergraduates, however, face a number of obstacles to obtaining the kind of quality clinical and research experience needed to best inform them on this decision. Growing regulations designed to protect patient confidentiality, though undeniably important, pose a barrier to students seeking patient contact. Traditional passive physician shadowing often does not provide ample opportunities for one-on-one patient interaction or problem solving. Finally, research opportunities available to students typically are not associated with clinical work and therefore do not provide an experiential model of how empirical evidence informs medical practice. This report provides a description of the University of Wisconsin Tobacco Science Scholars Program, a pilot program designed to grapple with some of these barriers. The program provides supervision for students so that they might fulfill institutional requirements required for patient contact, provides an active model of clinical patient interaction and problem solving, and provides access to research that is integrated into the student’s clinical experience so the student might better understand the nature of research-based evidence in medicine. Program details and limitations are discussed.

Davis, James; Anderson, Maggie; Stankevitz, Kristen

2014-01-01

83

Designing Nursing Simulation Clinical Experiences to Promote Critical Inquiry  

ERIC Educational Resources Information Center

The use of high fidelity simulation (HFS) learning opportunities in nursing education has received increased attention in the literature. This article describes the design of a systematic framework used to promote critical inquiry and provide meaningful simulation clinical experiences for second year nursing students. Critical inquiry, as defined…

Beattie, Bev; Koroll, Donna; Price, Susan

2010-01-01

84

Vertebroplasty: clinical experience and follow-up results  

Microsoft Academic Search

This study was undertaken to report the clinical experience with percutaneous minimal invasive vertebroplasty using polymethyl-methacrylcate (PMMA) for a consecutive group of patients. Over the period of the last 4 years, 40 patients were treated at 68 vertebral segment levels with the intention to relieve pain related to vertebral body lesions. Reduced vertebral body height and destruction of the posterior

J. B Martin; B Jean; K Sugiu; D San Millán Ruíz; M Piotin; K Murphy; B Rüfenacht; M Muster; D. A Rüfenacht

1999-01-01

85

Teachers' Clinical Experiences and Attitudes toward Technology Inclusion  

ERIC Educational Resources Information Center

The purpose of this qualitative multisite case study is to examine participants' attitudes toward technology, types of technology available for participant use, and the extent to which technology is used by preservice and mentor teachers during clinical experiences. Research supports the benefit of improved attitudes toward technology integration…

Paganelli, Andrea Lynch

2010-01-01

86

Molecular and cellular radiobiological effects of Auger emitting radionuclides  

PubMed Central

Although the general radiobiologic principles underlying external beam therapy and radionuclide therapy are similar, significant differences in the biophysical and radiobiologic effects from the two types of radiation continue to accumulate. Here, I will address the unique features that distinguish the molecular and cellular radiobiological effects of Auger electron-emitting radionuclides consequent to (1) the physical characteristics of the decaying atom and its subcellular localisation, (2) DNA topology and (3) the bystander effect. Based on these experimental findings, I postulate that the ability of track structural simulations as primary tools in modelling DNA damage and cellular survival at the molecular level would be greatly enhanced when these contributions are factored in.

Kassis, Amin I.

2011-01-01

87

Ambulance clinical placements - A pilot study of students' experience  

PubMed Central

Background Undergraduate paramedic students undertake clinical placements in a variety of locations. These placements are considered an essential element for paramedic pre-employment education. However, anecdotal evidence suggests some students have not had positive experiences on their emergency ambulance placements. The objective of this study was to identify the type of experiences had by students during ambulance clinical placements and to provide feedback to the ambulance services. Methods In this pilot study we employed a cross-sectional study methodology, using a convenience sample of undergraduate paramedic students available in semester one of 2007 to ascertain the students' views on their reception by on-road paramedics and their overall experience on emergency ambulance clinical placements. Ethics approval was granted. Results There were 77 students who participated in the survey, 64% were females, with 92% of students < 25 years of age and 55% < 65 Kg in weight. There was a statistically significant difference in average height between the genders (Male 179 cm vs Female 168 cm, p < 0.001). Clinical instructors were available to 44% of students with 30% of students excluded from patient management. Thirty percent of students felt there was a lot of unproductive down time during the placement. Paramedics remarked to 40% of students that they doubted their ability to perform the physical role of a paramedic, of this group 36% were advised this more than once. Conclusion This study demonstrates that for a small group of students, emergency ambulance clinical placements were not a positive experience clinically or educationally. Some qualified paramedics doubt if a number of female students can perform the physical role of a paramedic.

Boyle, Malcolm J; Williams, Brett; Cooper, Jennifer; Adams, Bridget; Alford, Kassie

2008-01-01

88

BNL ACCELERATOR-BASED RADIOBIOLOGY FACILITIES  

SciTech Connect

For the past several years, the Alternating Gradient Synchrotron (AGS) at Brookhaven National Laboratory (USA) has provided ions of iron, silicon and gold, at energies from 600 MeV/nucleon to 10 GeV/nucleon, for the US National Aeronautics and Space Administration (NASA) radiobiology research program. NASA has recently funded the construction of a new dedicated ion facility, the Booster Applications Facility (BAF). The Booster synchrotron will supply ion beams ranging from protons to gold, in an energy range from 40--3,000 MeV/nucleon with maximum beam intensities of 10{sup 10} to 10{sup 11} ions per pulse. The BAF Project is described and the future AGS and BAF operation plans are presented.

LOWENSTEIN,D.I.

2000-05-28

89

Clinical Diagnostic Clues in Crohn's Disease: A 41-Year Experience  

PubMed Central

Determining the diagnosis of Crohn's disease has been highly difficult mainly during the first years of this study carried out at the Pontificia Universidad Catolica (PUC) Clinical Hospital. For instance, it has been frequently confused with Irritable bowel syndrome and sometimes misdiagnosed as ulcerative colitis, infectious colitis or enterocolitis, intestinal lymphoma, or coeliac disease. Consequently, it seems advisable to characterize what the most relevant clinical features are, in order to establish a clear concept of Crohn's disease. This difficulty may still be a problem at other medical centers in developing countries. Thus, sharing this information may contribute to a better understanding of this disease. Based on the clinical experience gained between 1963 and 2004 and reported herein, the main clinical characteristics of the disease are long-lasting day and night abdominal pain, which becomes more intense after eating and diarrhoea, sometimes associated to a mass in the abdomen, anal lesions, and other additional digestive and nondigestive clinical features. Nevertheless, the main aim of this work has been the following: is it possible to make, in an early stage, the diagnosis of Crohn's disease with a high degree of certainty exclusively with clinical data?

Quintana, C.; Galleguillos, L.; Benavides, E.; Quintana, J. C.; Zuniga, A.; Duarte, I.; Klaassen, J.; Kolbach, M.; Soto, R. M.; Iacobelli, S.; Alvarez, M.; O'Brien, A.

2012-01-01

90

Clinical diagnostic clues in Crohn's disease: a 41-year experience.  

PubMed

Determining the diagnosis of Crohn's disease has been highly difficult mainly during the first years of this study carried out at the Pontificia Universidad Catolica (PUC) Clinical Hospital. For instance, it has been frequently confused with Irritable bowel syndrome and sometimes misdiagnosed as ulcerative colitis, infectious colitis or enterocolitis, intestinal lymphoma, or coeliac disease. Consequently, it seems advisable to characterize what the most relevant clinical features are, in order to establish a clear concept of Crohn's disease. This difficulty may still be a problem at other medical centers in developing countries. Thus, sharing this information may contribute to a better understanding of this disease. Based on the clinical experience gained between 1963 and 2004 and reported herein, the main clinical characteristics of the disease are long-lasting day and night abdominal pain, which becomes more intense after eating and diarrhoea, sometimes associated to a mass in the abdomen, anal lesions, and other additional digestive and nondigestive clinical features. Nevertheless, the main aim of this work has been the following: is it possible to make, in an early stage, the diagnosis of Crohn's disease with a high degree of certainty exclusively with clinical data? PMID:23213555

Quintana, C; Galleguillos, L; Benavides, E; Quintana, J C; Zúñiga, A; Duarte, I; Klaassen, J; Kolbach, M; Soto, R M; Iacobelli, S; Alvarez, M; O'Brien, A

2012-01-01

91

National Radiobiology Archives (NRA) at the United States Transuranium and Uranium Registries (USTUR)  

DOE Data Explorer

The U.S. National Radiobiology Archives (NRA) is an archival program that was started in 1989 and whose original mission was to collect, organize, and catalog data, laboratory notebooks, and animal tissue specimens from government (i.e. DOE and its predecessor agencies) sponsored radiobiology life-span studies performed at various National Laboratories and universities since the 1940's. The NRA is part of a greater international program that includes the European Radiobiology Archives and the Japanese Radiobiology Archives (Gerber, Watson, Sugahara and Okada 1996). The major thrust of the early studies was to determine the level, rate, and extent of the radiological and toxicological effects induced by ingested or inhaled radionuclides, including plutonium and other transuranics. Over several decades, a variety of life-span studies using beagle dogs were initiated at the Argonne National Laboratory, University of California at Davis, Pacific Northwest National Laboratory, Inhalation Toxicology Research Institute, and the University of Utah. The results and many microscope slides from these life-span studies, totaling some 6000 dogs, have been transferred to the NRA and are now available to researchers. A seminal work included in the Archive is The Atlas of Experimentally-Induced Neoplasia in the Beagle Dog (Watson et al, 1997). The NRA also holds the results and materials from some 30,000 mice studies comparing various strains have been transferred from Oak Ridge National Laboratory and Brookhaven National Laboratory. In addition, records, data, and many microscope slides from life-span studies on some 4,000 rats that were used for plutonium inhalation studies at Pacific Northwest National Laboratory and biokinetic and pathological data from experiments on more than 300 nonhuman primates have been added to the archive collection.

Watson, Charles R.

92

National Radiobiology Archives (NRA) at the United States Transuranium and Uranium Registries (USTUR)  

DOE Data Explorer

The U.S. National Radiobiology Archives (NRA) is an archival program that was started in 1989 and whose original mission was to collect, organize, and catalog data, laboratory notebooks, and animal tissue specimens from government (i.e. DOE and its predecessor agencies) sponsored radiobiology life-span studies performed at various National Laboratories and universities since the 1940's. The NRA is part of a greater international program that includes the European Radiobiology Archives and the Japanese Radiobiology Archives (Gerber, Watson, Sugahara and Okada 1996). The major thrust of the early studies was to determine the level, rate, and extent of the radiological and toxicological effects induced by ingested or inhaled radionuclides, including plutonium and other transuranics. Over several decades, a variety of life-span studies using beagle dogs were initiated at the Argonne National Laboratory, University of California at Davis, Pacific Northwest National Laboratory, Inhalation Toxicology Research Institute, and the University of Utah. The results and many microscope slides from these life-span studies, totaling some 6000 dogs, have been transferred to the NRA and are now available to researchers. A seminal work included in the Archive is The Atlas of Experimentally-Induced Neoplasia in the Beagle Dog (Watson et al, 1997). The NRA also holds the results and materials from some 30,000 mice studies comparing various strains have been transferred from Oak Ridge National Laboratory and Brookhaven National Laboratory. In addition, records, data, and many microscope slides from life-span studies on some 4,000 rats that were used for plutonium inhalation studies at Pacific Northwest National Laboratory and biokinetic and pathological data from experiments on more than 300 nonhuman primates have been added to the archive collection.

Watson, Charles R.

93

Histone deacetylase inhibitors in glioblastoma: pre-clinical and clinical experience.  

PubMed

Epigenetic mechanisms are increasingly recognized as a major factor contributing to pathogenesis of cancer including glioblastoma, the most common and most malignant primary brain tumour in adults. Enzymatic modifications of histone proteins regulating gene expression are being exploited for therapeutic drug targeting. Over the last decade, numerous studies have shown promising results with histone deacetylase (HDAC) inhibitors in various malignancies. This article provides a brief overview of mechanism of anti-cancer effect and pharmacology of HDAC inhibitors and summarizes results from pre-clinical and clinical studies in glioblastoma. It analyses experience with HDAC inhibitors as single agents as well as in combination with targeted agents, cytotoxic chemotherapy and radiotherapy. Hallmark features of glioblastoma, such as uncontrolled cellular proliferation, invasion, angiogenesis and resistance to apoptosis, have been shown to be targeted by HDAC inhibitors in experiments with glioblastoma cell lines. Vorinostat is the most advanced HDAC inhibitor that entered clinical trials in glioblastoma, showing activity in recurrent disease. Multiple phase II trials with vorinostat in combination with targeted agents, temozolomide and radiotherapy are currently recruiting. While the results from pre-clinical studies are encouraging, early clinical trials showed only modest benefit and the value of HDAC inhibitors for clinical practice will need to be confirmed in larger prospective trials. Further research in epigenetic mechanisms driving glioblastoma pathogenesis and identification of molecular subtypes of glioblastoma is needed. This will hopefully lead to better selection of patients who will benefit from treatment with HDAC inhibitors. PMID:24838514

Bezecny, Pavel

2014-06-01

94

Links between Innate Immunity and Normal Tissue Radiobiology  

PubMed Central

The body senses “danger” from “damaged self” molecules through members of the same receptor superfamily it uses for microbial “non-self”, triggering canonical signaling pathways that lead to the generation of acute inflammatory responses. For this reason, the biology of normal tissue responses to moderate and clinically relevant doses of radiation is inextricably connected to innate immunity. The complex sequence of inflammatory events that ensues causes further cell and tissue damage to eliminate potential invaders but also leads to cytoprotective responses that limit the spread of damage and to wound healing through tissue regeneration or replacement. These sequential processes are orchestrated through multiple feedback control mechanisms involving cyclical production of free radicals and cytokines that are common to both radiation and immune signaling. This requires a concerted effort by resident tissue and inflammatory cell types, with macrophages apparently leading the way. The initial response to moderate doses of radiation therefore feeds into a pro-inflammatory paradigm whose eventual outcome is critically dependent upon the properties of the immune cells that are involved in tissue damage, regeneration and repair and that are in part under genetic influence. Importantly, these canonical pathways provide targets for interventions aimed at modifying normal tissue radiation responses. In this review, we examine areas of intersection between innate immunity and normal tissue radiobiology.

Schaue, Dorthe; McBride, William H.

2010-01-01

95

Clinical encounter experiences of patients with nasopharyngeal carcinoma.  

PubMed

Nasopharyngeal carcinoma (NPC) is a commonly occurring cancer among Hong Kong Chinese, especially in the relatively young population group. Since the disease carries a favorable prognosis, sequelae following treatment have become an important concern for patients suffering from NPC, particularly because of the strong interplay of psychological, social, and biological issues during their rehabilitation. In this qualitative study, in-depth, semistructured audiotaped interviews were undertaken with 32 patients receiving rehabilitation at the physiotherapy department of a regional teaching hospital in Hong Kong. The objective of the study was to examine the rehabilitation experiences of NPC survivors to identify factors that contributed to a satisfying clinical encounter experience. During the study, data collection and analysis using a grounded theory approach were concurrently conducted. The 3 main themes that shaped the rehabilitation experiences of NPC survivors were the patient-clinician relationship, participation in therapeutic alliance, and quality rehabilitation service provision. These, together with the identified needs of the participants, contributed to the participants' perceived health-related quality of life. A constructive clinical experience was perceived when their needs were met. The findings highlight the importance of patient-centeredness in the treatment delivery and a multifaceted role of clinicians in meeting the needs of this group of cancer survivors. PMID:18292592

Lee, Edwin W C; Twinn, Sheila; Moore, Ann P; Jones, Mark P; Leung, S F

2008-03-01

96

Hot particle dosimetry and radiobiology--past and present.  

PubMed

Small high-activity radioactive particles of nominal diameter ranging from approximately 1 mm down to several microm have been a radiological concern over the last 30 years in and around European and American nuclear reactor facilities. These particles have often been referred to as 'hot particles'. The 'hot particle problem' came into prominent concern in the late 1960s. The potential carcinogenic effects in lungs as the result of irradiation by discrete small particles containing alpha-emitting radionuclides, particularly (239)Pu, were claimed by some to be several orders of magnitude greater than those produced by uniform irradiation to the same mean dose. The phrase 'hot particle problem' was subsequently used to refer to the difficulty of predicting health effects for all microscopic radioactive sources. The difficulty arose because of the paucity of comparative human, animal or cell studies using radioactive particles, and the lack of validated measurement or calculational techniques for dose estimation for non-uniform exposures. Experience was largely restricted to uniform, large-area/volume exposures. The concern regarding cancer induction was extended to deterministic effects when the ICRP in 1977 failed to give adequate dose limits for dealing with 'hot particle' exposures of the skin. Since 1980, considerable efforts have been made to clarify and solve the dosimetric and radiobiological issues related to the health effects of 'hot particle' exposures. The general recommendations of the ICRP in 1991 used the latest radiobiological data to provide skin dose limits which are applicable to 'hot particle' exposures. More recently the NCRP has extended considerations to other organs. This progress is reviewed and applied to the specific case of the recent evaluation of potential health effects of Dounreay fuel fragments commissioned by the Scottish Environment Protection Agency (SEPA). Analyses of possible doses and risks in this case indicate that the principal concern following skin contact, ingestion or inhalation is the possibility of localised ulceration of skin or of the mucosal lining of the colon or extra-thoracic airways. PMID:17768323

Charles, M W; Harrison, J D

2007-09-01

97

Three-Dimensional Radiobiologic Dosimetry: Application of Radiobiologic Modeling to Patient-Specific 3-Dimensional Imaging-Based Internal Dosimetry  

PubMed Central

Phantom-based and patient-specific imaging-based dosimetry methodologies have traditionally yielded mean organ-absorbed doses or spatial dose distributions over tumors and normal organs. In this work, radiobiologic modeling is introduced to convert the spatial distribution of absorbed dose into biologically effective dose and equivalent uniform dose parameters. The methodology is illustrated using data from a thyroid cancer patient treated with radioiodine. Methods Three registered SPECT/CT scans were used to generate 3-dimensional images of radionuclide kinetics (clearance rate) and cumulated activity. The cumulated activity image and corresponding CT scan were provided as input into an EGSnrc-based Monte Carlo calculation: The cumulated activity image was used to define the distribution of decays, and an attenuation image derived from CT was used to define the corresponding spatial tissue density and composition distribution. The rate images were used to convert the spatial absorbed dose distribution to a biologically effective dose distribution, which was then used to estimate a single equivalent uniform dose for segmented volumes of interest. Equivalent uniform dose was also calculated from the absorbed dose distribution directly. Results We validate the method using simple models; compare the dose-volume histogram with a previously analyzed clinical case; and give the mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for an illustrative case of a pediatric thyroid cancer patient with diffuse lung metastases. The mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for the tumor were 57.7, 58.5, and 25.0 Gy, respectively. Corresponding values for normal lung tissue were 9.5, 9.8, and 8.3 Gy, respectively. Conclusion The analysis demonstrates the impact of radiobiologic modeling on response prediction. The 57% reduction in the equivalent dose value for the tumor reflects a high level of dose nonuniformity in the tumor and a corresponding reduced likelihood of achieving a tumor response. Such analyses are expected to be useful in treatment planning for radionuclide therapy.

Prideaux, Andrew R.; Song, Hong; Hobbs, Robert F.; He, Bin; Frey, Eric C.; Ladenson, Paul W.; Wahl, Richard L.; Sgouros, George

2010-01-01

98

Heavy-ion tumor therapy: Physical and radiobiological benefits  

SciTech Connect

High-energy beams of charged nuclear particles (protons and heavier ions) offer significant advantages for the treatment of deep-seated local tumors in comparison to conventional megavolt photon therapy. Their physical depth-dose distribution in tissue is characterized by a small entrance dose and a distinct maximum (Bragg peak) near the end of range with a sharp fall-off at the distal edge. Taking full advantage of the well-defined range and the small lateral beam spread, modern scanning beam systems allow delivery of the dose with millimeter precision. In addition, projectiles heavier than protons such as carbon ions exhibit an enhanced biological effectiveness in the Bragg peak region caused by the dense ionization of individual particle tracks resulting in reduced cellular repair. This makes them particularly attractive for the treatment of radio-resistant tumors localized near organs at risk. While tumor therapy with protons is a well-established treatment modality with more than 60 000 patients treated worldwide, the application of heavy ions is so far restricted to a few facilities only. Nevertheless, results of clinical phase I-II trials provide evidence that carbon-ion radiotherapy might be beneficial in several tumor entities. This article reviews the progress in heavy-ion therapy, including physical and technical developments, radiobiological studies and models, as well as radiooncological studies. As a result of the promising clinical results obtained with carbon-ion beams in the past ten years at the Heavy Ion Medical Accelerator facility (Japan) and in a pilot project at GSI Darmstadt (Germany), the plans for new clinical centers for heavy-ion or combined proton and heavy-ion therapy have recently received a substantial boost.

Schardt, Dieter; Elsaesser, Thilo; Schulz-Ertner, Daniela [GSI Helmholtzzentrum fuer Schwerionenforschung mbH (GSI), D-64291 Darmstadt (Germany); Markus-Krankenhaus, MVZ Radiologisches Institut, D-60431 Frankfurt/M. (Germany)

2010-01-15

99

Systematic review of new medics' clinical task experience by country  

PubMed Central

Objectives There is a need for research which informs on the overall size and significance of clinical skills deficits among new medics, globally. There is also the need for a meta-review of the similarities and differences between countries in the clinical skills deficits of new medics. Design A systematic review of published literature produced 68 articles from Google/Google Scholar, of which nine met the inclusion criteria (quantitative clinical skills data about new medical doctors). Participants One thousand three hundred twenty-nine new medical doctors (e.g. foundation year-1s, interns, postgraduate year-1 doctors). Setting Ten countries/regions. Main outcome measures One hundred twenty-three data points and representation of a broad range of clinical procedures. Results The average rate of inexperience with a wide range of clinical procedures was 35.92% (lower confidence interval [CI] 30.84, upper CI 40.99). The preliminary meta-analysis showed that the overall deficit in experience is significantly different from 0 in all countries. Focusing on a smaller selection of clinical skills such as catheterisation, IV cannulation, nasogastric tubing and venepuncture, the average rate of inexperience was 26.75% (lower CI 18.55, upper CI 35.54) and also significant. England presented the lowest average deficit (9.15%), followed by New Zealand (18.33%), then South Africa (19.53%), Egypt, Kuwait, Gulf Cooperation Council countries and Ireland (21.07%), after which was Nigeria (37.99%), then USA (38.5%) and Iran (44.75%). Conclusion A meta-analysis is needed to include data not yet in the public domain from more countries. These results provide some support for the UK General Medical Council’s clear, detailed curriculum, which has been heralded by other countries as good practice.

2014-01-01

100

The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved?  

PubMed

Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiation therapy (SABR), are rapidly becoming accepted practice for the radiation therapy of certain tumors. Typically, SRS and SBRT involve the delivery of 1 or a few large-dose fractions of 8 to 30 Gy per fraction: a major paradigm shift from radiation therapy practice over the past 90 years, when, with relatively large amounts of normal tissues receiving high doses, the goal was to maximize tumor response for an acceptable level of normal tissue injury. The development of SRS and SBRT have come about because of technologic advances in image guidance and treatment delivery techniques that enable the delivery of large doses to tumors with reduced margins and high gradients outside the target, thereby minimizing doses to surrounding normal tissues. Because the results obtained with SRS and SBRT have been impressive, they have raised the question whether classic radiobiological modeling, and the linear-quadratic (LQ) model, are appropriate for large doses per fraction. In addition to objections to the LQ model, the possibility of additional biological effects resulting from endothelial cell damage, enhanced tumor immunity, or both have been raised to account for the success of SRS and SBRT. In this review, we conclude that the available preclinical and clinical data do not support a need to change the LQ model or to invoke phenomena over and above the classic 5 Rs of radiobiology and radiation therapy, with the likely exception that for some tumors high doses of irradiation may produce enhanced antitumor immunity. Thus, we suggest that for most tumors, the standard radiobiology concepts of the 5 Rs are sufficient to explain the clinical data, and the excellent results obtained from clinical studies are the result of the much larger biologically effective doses that are delivered with SRS and SBRT. PMID:24411596

Brown, J Martin; Carlson, David J; Brenner, David J

2014-02-01

101

Clinical experience with adolescent diabetes in a Nigerian teaching hospital.  

PubMed Central

Diabetes mellitus presenting in adolescents age 10 to 20 years accounts for less than 5% of all diabetes in tropical African countries. Consequently, inadequate attention is paid to the medical and psychosocial problems attendant on adolescent diabetes in those countries. This article highlights our clinical experience in the management of 30 adolescent diabetic subjects who presented consecutively in the diabetic clinic of a major Nigerian teaching hospital. In these patients, adolescent diabetes appeared heterogeneous, comprising classical insulin-dependent diabetes mellitus (IDDM) in approximately 80%; the remaining fraction (20%) was contributed variably by malnutrition-related diabetes (MRDM) and an "atypical" form of IDDM. The most common medical complications were recurrent hypoglycemia, ketoacidosis, and infections. About 80% of the patients were poor, and up to two thirds had to withdraw from school or trade because of recurrent illness. One third of the girls had a history of unwanted pregnancies. Almost all (93%) had a history of general rebelliousness and clinic truancy. Therefore, the high prevalence of acute metabolic decompensation may be related to the increased frequency of psychosocial problems, especially poverty, in these patients. It is suggested that agencies in tropical Africa increase welfare facilities for adolescent chronic disease, and also establish and encourage clinics dedicated to adolescent diabetes care.

Akanji, A. O.

1996-01-01

102

Radiation Resistance of Cancer Stem Cells: The 4 R's of Radiobiology Revisited  

PubMed Central

There is compelling evidence that many solid cancers are organized hierarchically and contain a small population of cancer stem cells (CSCs). It seems reasonable to suggest that a cancer cure can be achieved only if this population is eliminated. Unfortunately, there is growing evidence that CSCs are inherently resistant to radiation, and perhaps other cancer therapies. In general, success or failure of standard clinical radiation treatment is determined by the 4 R’s of radiobiology: repair of DNA damage, redistribution of cells in the cell cycle, repopulation, and reoxygenation of hypoxic tumor areas. We relate recent findings on CSCs to these four phenomena and discuss possible consequences.

Pajonk, Frank; Vlashi, Erina; McBride, William H.

2010-01-01

103

Druy ureteral stent set: clinical experience in 25 patients.  

PubMed

Clinical experience with a new universal-length silicone ureteral stent set is described. The technique for placing the stent is discussed in detail. The softness and universal length of the stent are important advantages over rigid stents. The set includes a peel-away sheath-introducing system, which allows for easy and rapid placement of a soft stent in most cases. Thirty-one stents have been placed since July 1985, with a mean follow-up of 17 weeks for 21 patients. There have been no stent malfunctions, and no significant complications have been encountered. PMID:3737912

Rozenblit, G; Tarasov, E; Srur, M F; Neithamer, C D; Sumers, E H; Sos, T A

1986-09-01

104

[Professor OUYANG Qun's clinical experience on application of single point].  

PubMed

The clinical experience of Professor OUYANG Qun in using single acupoint includes treatment of Meniere's syndrome with Baihui (GV 20), optic neuritis with "Fengyan" (Extra point), painful heel with Xiaguan (ST 7), lymphoid tuberculosis with Quchi (LI 11), acute sore throat with Kongzui (LU 6), painful diseases with "Luolingwu" (Extra point), chest distress with "Kuanxiong" (Extra point), hordeolum with Feishu (BL 13), headache in menstrual period with Xuehai (SP 10), frozen shoulder with Tiaokou (ST 38), toothache with Waihuaijian (Extra point), occipital pain with Chengshan (BL 57) and vomiting with Yongquan (KI 1). PMID:18085152

Huang, Yong; Chen, Jun-Qi

2007-11-01

105

Clinical trial participants' experiences of completing questionnaires: a qualitative study  

PubMed Central

Objectives To improve clinical study developments for elderly populations, we aim to understand how they transfer their experiences into validated, standardised self-completed study measurement instruments. We analysed how women (mean 78±8?years of age) participating in a randomised controlled trial (RCT) cognised study instruments used to evaluate outcomes of the intervention. Setting The interview study was nested in an RCT on chronic neck pain using common measurement instruments situated in an elderly community in Berlin, Germany, which comprised of units for independent and assisted-living options. Participants The sample (n=20 women) was selected from the RCT sample (n=117, 95% women, mean age 76 (SD±8)?years). Interview participants were selected using a purposive sampling list based on the RCT outcomes. Outcomes We asked participants about their experiences completing the RCT questionnaires. Interviews were analysed thematically, then compared with the questionnaires. Results Interviewees had difficulties in translating complex experiences into a single value on a scale and understanding the relationship of the questionnaires to study aims. Interviewees considered important for the trial that their actual experiences were understood by trial organisers. This information was not transferrable by means of the questionnaires. To rectify these difficulties, interviewees used strategies such as adding notes, adding response categories or skipping an item. Conclusions Elderly interview participants understood the importance of completing questionnaires for trial success. This led to strategies of completing the questionnaires that resulted in ‘missing’ or ambiguous data. To improve data collection in elderly populations, educational materials addressing the differential logics should be developed and tested. Pilot testing validated instruments using cognitive interviews may be particularly important in such populations. Finally, when the target of an intervention is a subjective experience, it seems important to create a method by which participants can convey their personal experiences. These could be nested qualitative studies. Trial registration number ISRCTN77108101807.

Holmberg, Christine; Karner, Julia J; Rappenecker, Julia; Witt, Claudia M

2014-01-01

106

Mutuality: clinical and metapsychological potentials of a failed experiment.  

PubMed

Ferenczi's experiments with mutual analysis are often dismissed, without acknowledging the results obtained from them and his own cautionary remarks about their limits. Though ultimately failed, Ferenczi's experiments with mutual analysis were a source of clinical and metapsychological knowledge, despite the fact that he was unable to elaborate them in his lifetime. In this paper I connect mutuality to the development of the psyche, especially to the constitutive core of the intrapsychic. To understand the latter, it is necessary to take into account, among others, issues such as the common attribute, the mutual flux between the unconsciouses, the dialogue of unconsciouses, the maternal profundity, the primal relationship with the mother, and, above all, the primal unity between mother and child, which are fundamental for the emergence and development of the primary psychic forces. Incidences of rupture, distortion of the core of mutuality in the psychic life, its loss and disadjustment, by means of external traumatizing forces, and some clinical implications are described. PMID:22398886

Castillo Mendoza, Carlos Alberto

2012-03-01

107

Trichomycosis (Trichobacteriosis): Clinical and Microbiological Experience with 56 Cases  

PubMed Central

Background: Trichomycosis is asymptomatic bacterial infection of the axillary hairs caused by Corynebacterium sp. Objective: to bring a series of cases of trichomycosis, its clinical and microbiological experience. Materials and Methods: This report consists in a linear and observational retrospective study of 15 years of cases of trichomycosis confirmed clinically and microbiologically. Results: Fifty six confirmed cases of trichomycosis were included in this report. The majority were men 53/56 (94.6%), mean age was 32.5 years. The most commonly affected area was the axilla (92%), trichomycosis flava was the principal variant 55/56 (98.2%) and signs and symptoms associated were hyperhidrosis (87.5%), hairs’ texture change (57.1%) and odor (35.7%). Bacterial concretions were observed in all cases, and the predominant causative agent in 89.3% of all cases was Corynebacterium sp. Thirty patients were included in therapeutic portion of the study, and 28 (93.3%) of them experienced a clinical and microbiological cure. Conclusion: Trichomycosis is asymptomatic, superficial infection, which primarily affects axillary hairs.

Bonifaz, Alexandro; Vaquez-Gonzalez, Denisse; Fierro, Leonel; Araiza, Javier; Ponce, Rosa Maria

2013-01-01

108

Stereotactic Body Radiation Therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience  

PubMed Central

Background Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer. Methods Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database. Treatment was delivered using the CyberKnife® with doses of 35 Gy or 36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were recorded and scored using the CTCAE v.3. Quality of life was assessed before and after treatment using the Short Form-12 Health Survey (SF-12), the American Urological Association Symptom Score (AUA) and Sexual Health Inventory for Men (SHIM) questionnaires. Late urinary symptom flare was defined as an AUA score???15 with an increase of???5 points above baseline six months after the completion of SBRT. Results One hundred patients (37 low-, 55 intermediate- and 8 high-risk according to the D’Amico classification) at a median age of 69 years (range, 48–90 years) received SBRT, with 11 patients receiving ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.2 ng/ml (range, 1.9-31.6 ng/ml) and the median follow-up was 2.3 years (range, 1.4-3.5 years). At 2 years, median PSA decreased to 0.49 ng/ml (range, 0.1-1.9 ng/ml). Benign PSA bounce occurred in 31% of patients. There was one biochemical failure in a high-risk patient, yielding a two-year actuarial biochemical relapse free survival of 99%. The 2-year actuarial incidence rates of GI and GU toxicity???grade 2 were 1% and 31%, respectively. A median baseline AUA symptom score of 8 significantly increased to 11 at 1 month (p?=?0.001), however returned to baseline at 3 months (p?=?0.60). Twenty one percent of patients experienced a late transient urinary symptom flare in the first two years following treatment. Of patients who were sexually potent prior to treatment, 79% maintained potency at 2 years post-treatment. Conclusions SBRT for clinically localized prostate cancer was well tolerated, with an early biochemical response similar to other radiation therapy treatments. Benign PSA bounces were common. Late GI and GU toxicity rates were comparable to conventionally fractionated radiation therapy and brachytherapy. Late urinary symptom flares were observed but the majority resolved with conservative management. A high percentage of men who were potent prior to treatment remained potent two years following treatment.

2013-01-01

109

Radiobiological evaluation of low dose-rate prostate brachytherapy implants  

NASA Astrophysics Data System (ADS)

Low dose-rate brachytherapy is a radiation therapy treatment for men with prostate cancer. While this treatment is common, the use of isotopes with varying dosimetric characteristics means that the prescription level and normal organ tolerances vary. Additionally, factors such as prostate edema, seed loss and seed migration may alter the dose distribution within the prostate. The goal of this work is to develop a radiobiological response tool based on spatial dose information which may be used to aid in treatment planning, post-implant evaluation and determination of the effects of prostate edema and seed migration. Aim 1: Evaluation of post-implant prostate edema and its dosimetric and biological effects. Aim 2: Incorporation of biological response to simplify post-implant evaluation. Aim 3: Incorporation of biological response to simplify treatment plan comparison. Aim 4: Radiobiologically based comparison of single and dual-isotope implants. Aim 5: Determine the dosimetric and radiobiological effects of seed disappearance and migration.

Knaup, Courtney James

110

Clinicians' experiences of becoming a clinical manager: a qualitative study  

PubMed Central

Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.

2012-01-01

111

A laser-driven nanosecond proton source for radiobiological studies  

NASA Astrophysics Data System (ADS)

Ion beams are relevant for radiobiological studies and for tumor therapy. In contrast to conventional accelerators, laser-driven ion acceleration offers a potentially more compact and cost-effective means of delivering ions for radiotherapy. Here, we show that by combining advanced acceleration using nanometer thin targets and beam transport, truly nanosecond quasi-monoenergetic proton bunches can be generated with a table-top laser system, delivering single shot doses up to 7 Gy to living cells. Although in their infancy, laser-ion accelerators allow studying fast radiobiological processes as demonstrated here by measurements of the relative biological effectiveness of nanosecond proton bunches in human tumor cells.

Bin, Jianhui; Allinger, Klaus; Assmann, Walter; Dollinger, Günther; Drexler, Guido A.; Friedl, Anna A.; Habs, Dieter; Hilz, Peter; Hoerlein, Rainer; Humble, Nicole; Karsch, Stefan; Khrennikov, Konstantin; Kiefer, Daniel; Krausz, Ferenc; Ma, Wenjun; Michalski, Dörte; Molls, Michael; Raith, Sebastian; Reinhardt, Sabine; Röper, Barbara; Schmid, Thomas E.; Tajima, Toshiki; Wenz, Johannes; Zlobinskaya, Olga; Schreiber, Joerg; Wilkens, Jan J.

2012-12-01

112

The Meta-Analysis of Clinical Judgment Project: Effects of Experience on Judgment Accuracy  

ERIC Educational Resources Information Center

Clinical and educational experience is one of the most commonly studied variables in clinical judgment research. Contrary to clinicians' perceptions, clinical judgment researchers have generally concluded that accuracy does not improve with increased education, training, or clinical experience. In this meta-analysis, the authors synthesized…

Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.; Anderson, Linda A.; Cook, Robert S.; Nichols, Cassandra N.; Lampropoulos, Georgios K.; Walker, Blain S.; Cohen, Genna R.; Rush, Jeffrey D.

2009-01-01

113

[Use of Valtrac in digestive surgery. Initial clinical experience].  

PubMed

Stapling instruments are being currently used for digestive or colorectal anastomoses with definite advantages. The authors report their initial clinical experience about BAR utilization to restore intestinal continuity after upper digestive and colorectal resections. The authors have been carried out 20 anastomoses on 18 patients: 11 males and 7 females. Eleven (61.1%) of them were affected with malignant neoplasms and in 9 cases were performed an urgency procedure. The colorectal and jejunal-jejunal anastomoses were performed, respectively, in 8 cases; gastric-jejunal and ileo-colic anastomoses, respectively, in 2. The satisfactory results obtained seem to demonstrate that the biofragmentable anastomotic ring constitutes a "safe" method of bowel junction of the whole digestive apparatus. PMID:9324675

Monaco, A; Moncelli, G; Gastaldi, L; Verna, C; Scifo, M; Nizia, R; Maio, C; Governato, L; Deirino, A; Mangione, F; Volterrani, P

1997-06-01

114

Pedicled Thoracodorsal Artery Perforator Flap in Breast Reconstruction: Clinical Experience  

PubMed Central

Background: The thoracodorsal artery perforator (TDAP) flap has been described for reconstruction of the head and neck, trunk and extremities. Yet, its use as a pedicled flap in breast reconstruction has not gained wide popularity and has not been widely documented, especially not for complete breast reconstruction or in combination with expanders or permanent implants. The authors present their clinical experience with the thoracodorsal artery perforator flap in breast reconstruction. Methods: From February 2007 to February 2009, eighteen patients had breast reconstruction utilizing a TDAP flap. Retrospective analyzes of patient characteristics, breast history, clinical indications, complications and outcomes were performed. The follow-up period ranged from 1 to 17 months. Results: Eleven patients had complete breast reconstruction using a TDAP flap with simultaneous insertion of an expander or implant. Four cases were partial reconstruction to gain additional volume after previous breast reconstruction and the 3 other cases were reconstruction after lumpectomy. All flaps survived. Two case required evacuation of hematoma. One case had late extrusion of the expander after expansion in the previously irradiated tissue, requiring expander removal. There were no donor site complications. Conclusions: The TDAP flap has proven to be a reliable flap with minimal donor site morbidity. Patients who had radiation treatment prior to reconstruction with pronounced radiated chest skin changes might still benefit from additional tissue from the LD muscle.

Adler, Neta; Seitz, Iris A.; Song, David H.

2009-01-01

115

Medical academia clinical experiences of Ward Round Teaching curriculum  

PubMed Central

Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

2014-01-01

116

Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital  

PubMed Central

Purpose Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. Methods We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. Results The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. Conclusion Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Jung, Soo Jung; Kim, Jun Hyun; Kong, Pil Sung; Kim, Kyung Ha; Bae, Sung Woo

2012-01-01

117

Amchitka Radiobiological Program. Progress report, January-December 1978  

Microsoft Academic Search

The Amchitka Radiobiological Program began in 1970 and is a continuing program to collect biological and environmental samples for radiometric analyses. This report is an account of the program for calendar year 1978. Results of analyses for samples collected in August 1978 have been added to the tables of Seymour and Johnson (1978) which summarize the Amchitka program from 1970

L. D. Tornberg; R. E. Nakatani

1979-01-01

118

Tritium radiobiology research in the US DOE program  

SciTech Connect

The history of the original US Atomic Energy Commission, its replacement, the Energy Research and Development Administration, and the present Department of Energy's interest and sponsorship of tritium radiobiology is reviewed beginning in 1971 and continuing through 1986. In particular, the four remaining US Department of Energy, Division of Health and Environmental Research programs are described in some detail.

Carsten, A.L.

1986-01-01

119

Initial Clinical Experience with Contrast-Enhanced Digital Breast Tomosynthesis  

PubMed Central

RATIONALE and OBJECTIVES Contrast-enhanced digital mammography and digital breast tomosynthesis are 2 imaging techniques that attempt to increase malignant breast lesion conspicuity. The combination of these into a single technique, contrast-enhanced digital breast tomosynthesis (CE-DBT), could potentially integrate the strengths of both. The objectives of this study were to assess the clinical feasibility of CE-DBT as an adjunct to digital mammography, and to correlate lesion enhancement characteristics and morphology obtained with CE-DBT to digital mammography, ultrasound, and magnetic resonance (MR). MATERIALS and METHODS CE-DBT (GE Senographe 2000D, Milwaukee, WI) was performed as a pilot study in an ongoing NCI-funded grant (P01 CA85484) studying multimodality breast imaging. 13 patients with ACR BI-RADS category 4 or 5 breast lesions underwent imaging with digital mammography, ultrasound, MR, and CE-DBT. CE-DBT was performed at 45-49 kVp with a rhodium target and a 0.27 mm copper (Alfa Aesar, Ward Hill, MA) filter. Pre- and post-injection DBT image sets were acquired in the MLO projection with slight compression. Each image set consists of 9 images acquired over a 50° arc and was obtained with a mean glandular x-ray dose comparable to two conventional mammographic views. Between the pre- and post-contrast DBT image sets, a single bolus of iodinated contrast agent (1 ml/kg at 2 ml/s; Omnipaque-300, Amersham Health Inc., Princeton, NJ) was administered. Images were reconstructed using filtered-backprojection in 1 mm increments, and transmitted to a clinical PACS workstation. RESULTS Initial experience suggests that CE-DBT provides morphologic and vascular characteristics of breast lesions qualitatively concordant with that of digital mammography and MR. CONCLUSION As an adjunct to digital mammography, CE-DBT may be a potential alternative tool for breast lesion morphologic and vascular characterization.

Chen, Sara C.; Carton, Ann-Katherine; Albert, Michael; Conant, Emily F.; Schnall, Mitchell D.; Maidment, Andrew D. A.

2007-01-01

120

Long-term experience with pravastatin in clinical research trials.  

PubMed

Pravastatin is a new lipid-lowering drug belonging to the class of 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase inhibitors. Since 1986, more than 15,000 patients have received pravastatin in sponsored clinical research trials with more than 21,000 cumulative patient-years of exposure to the drug. Analysis of long-term follow-up data from 1142 patients participating between 1986 and 1990 in six core randomized clinical trials in the United States confirms the favorable safety profile of pravastatin. Rash, gastrointestinal complaints, musculoskeletal pain, and elevations in liver transaminase levels, whether or not attributed to treatment, were the most common reasons for patients withdrawing from these trials. Ophthalmologic monitoring revealed no adverse effects on the crystalline lens. Safety assessments continue for two core trials in more than 400 patients with up to 7 years of continuous follow-up. The effects of pravastatin on serum cholesterol levels are not influenced by the age, sex, weight, or initial cholesterol level of the patient. Vitamin E, A, and D metabolism remain normal during treatment. Combination therapy with pravastatin and bile-acid-binding resins or niacin is well tolerated, with additive effects on low-density lipoprotein cholesterol. There is limited experience with the combination of pravastatin and gemfibrozil or cyclosporine. An ongoing arteriosclerosis research program with more than 21,000 patients enrolled will further define the long-term safety of pravastatin and its effects on atherosclerosis progression, as well as its role in the primary and secondary prevention of coronary heart disease. PMID:8458055

McGovern, M E; Mellies, M J

1993-01-01

121

Clinical and laboratory experience of chorionic villous sampling in Nigeria.  

PubMed

Background: Chorionic villous sampling is a first trimester invasive diagnosis procedure that was introduced in Nigeria < 2 decades ago. Objective: The objective of the following study is to review experience with chorionic villous sampling in relation to clinical and laboratory procedures, including general characteristics of women, indications and outcome, complications, laboratory analysis and learning curve. Materials and Methods: Descriptive study of chorionic villous samplings between 2005 and 2012. Clinical and laboratory data were extracted from records. The women had trans-abdominal or trans-cervical procedure after counseling. Deoxyribonucleic acid extraction was by boiling method and molecular diagnosis by restriction fragment length polymorphism or quantitative fluorescence polymerase chain reaction. Analyzed data were presented using simple frequency tables. Results: A total of 426 women were analyzed. The major indications were Sickle cell anemia (97.2%), gender determination (1.9%) and aneuploidy (0.7%) respectively. Most procedures (71.2%) were done between 11 +0 and 13 +6 weeks by trans-abdominal approach (88.7%). Overall success at the first sampling was 98.8%. Error in laboratory diagnosis recorded in 3 (0.7%) pregnancies, while 5 (1.2%) were reanalyzed due to maternal decidua/inadequate fetal sample (0.7%) or failure of amplification (0.5%) respectively. Primary sex ratio was 5 (XY): 3 (XX). Down syndrome was the most common aneuploidy diagnosed with a detection rate of 66.7%. Learning curve was evident from reducing the incidence of abortion, number of aspirations and increasing success at the first attempt and villi yield. Conclusion: The present study shows acceptance and utilization of chorionic villus sampling and also demonstrates its safety and reliability. PMID:24909479

Oloyede, O A; Olaide, A; Onyinye, N

2014-01-01

122

Telephotography in trauma: a 2-year clinical experience.  

PubMed

Abstract Introduction: Smartphones can be used to record and transmit high-quality clinical photographs. The aim of this study was to describe our experience with smartphone telephotography in the care of trauma patients. We hypothesized that smartphone telephotography can be safely and effectively implemented on a trauma service. Subjects and Methods: We performed a 2-year (January 2011-December 2012) prospective analysis of all patient photographs recorded by members of our trauma team at our Level I trauma center. All members of the trauma team recorded patient photographs and e-mailed them to a secure e-mail account. An administrative assistant uploaded a copy of each photgrapho into the patient's electronic medical record. We assessed the number of photographs collected and uploaded, as well as the success, failure, and complication rates. Results: Our trauma team sent 7,200 photographs to a secure e-mail account. Of those, 6,120 (85%) were considered, after an initial review, to be of good quality. Of these, 3,320 photographs (54%) were successfully uploaded into a patient's electronic medical record; the remaining 2,800 photographs lacked adequate labeling and could not be uploaded. The average interval to uploading was 3 months. In total, 10 photographs were uploaded into the wrong patient's electronic medical record, for an error rate of 0.003%. We received only three complaints during the study period. Conclusions: Telephotography can be safely and effectively implemented in trauma clinical practice. Fears of Health Insurance Portability and Accountability Act violations are not valid, as the incidence of patient complaints is minimal when telephotography is implemented under strict guidelines and rules. Dedicated administrative personnel are essential for effective implementation of smartphone photography. PMID:24443926

Joseph, Bellal; Pandit, Viraj; Wynne, Julie; Aziz, Hassan; Tang, Andrew; Kulvatunyou, Narong; Webster, Arvie; O'Keeffe, Terence; Ziemba, Michelle; Friese, Randall S; Weinstein, Ronald S; Rhee, Peter

2014-04-01

123

Prospective clinical experience with research biopsies in breast cancer patients.  

PubMed

There are ethical concerns regarding the performance of biopsies in patients for research purposes. We examined our single-institution experience regarding acceptance, safety, and success rate with research biopsies in patients with breast cancer. Among patients with data from paired samples, receptor status agreement between primary and metastatic samples was examined, either on first recurrence or after progression on one or more lines of therapy. An IRB-approved prospective study at the Dana-Farber Cancer Institute collects research biopsies as additional passes at the time of a clinical biopsy (AB, additional biopsy) or as a separate procedure for banking purposes (RPOB, research purposes only biopsy). Biopsies are not linked to a specific therapeutic or correlative trial. Grade 2-5 adverse events are prospectively collected. 151 patients were included in the analytic cohort (total procedures = 161); 80.8 % underwent AB, 17.2 % underwent RPOB, and 2.0 % underwent both AB and RPOB. Most patients were white (88.7 %) with a performance status of 0-1 (94.0 %). 96.0 % of patients underwent a biopsy in the setting of known or suspected metastatic disease. Receptor status between primary cancer and recurrent research biopsies differed in 43.2 % of patients with available data (18.8 % among patients who underwent the research biopsy before any systemic treatment, 48.1 % after treatment). Tissue was successfully collected in 92.3 % of patients undergoing AB and 100 % patients undergoing RPOB. Only three (2.0 %) patients had adverse events ? grade-2: one grade-2 pain; one grade-2 pneumothorax; and one grade-3 pain. Our experience suggests research biopsies can be performed safely with a high rate of successful tissue collection. Consistent with previous reports we found a high rate of discordance between primary and metastatic samples, which was even higher among treated patients. This supports continued efforts to study tissue samples at multiple points in a patient's disease course. PMID:24113744

Vaz-Luis, Ines; Zeghibe, Catherine A; Frank, Elizabeth S; Sohl, Jessica; Washington, Kimberly E; Silverman, Stuart G; Fonte, Joseph M; Mayer, Erica L; Overmoyer, Beth A; Richardson, Andrea L; Krop, Ian E; Winer, Eric P; Lin, Nancy U

2013-11-01

124

Students' experiences of learning manual clinical skills through simulation.  

PubMed

Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students' experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten third-year undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision™, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in three themes: what the students learn, how the students learn, and the simulator's contribution to the students' learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection. PMID:22395307

Johannesson, Eva; Silén, Charlotte; Kvist, Joanna; Hult, Håkan

2013-03-01

125

Development of a novel experimental model to investigate radiobiological implications of respiratory motion in advanced radiotherapy  

NASA Astrophysics Data System (ADS)

Respiratory motion introduces complex spatio-temporal variations in the dosimetry of radiotherapy. There is a paucity of literature investigating the radiobiological consequences of intrafraction motion and concerns regarding the impact of movement when applied to cancer cell lines in vitro exist. We have addressed this by developing a novel model which accurately replicates respiratory motion under experimental conditions to allow clinically relevant irradiation of cell lines. A bespoke phantom and motor driven moving platform was adapted to accommodate flasks containing medium and cells in order to replicate respiratory motion using varying frequencies and amplitude settings. To study this effect on cell survival in vitro, dose response curves were determined for human lung cancer cell lines H1299 and H460 exposed to a uniform 6 MV radiation field under moving or stationary conditions. Cell survival curves showed no significant difference between irradiation at different dose points for these cell lines in the presence or absence of motion. These data indicate that motion of unshielded cells in vitro does not affect cell survival in the presence of uniform irradiation. This model provides a novel research platform to investigate the radiobiological consequences of respiratory motion in radiotherapy.

Cole, Aidan J.; McGarry, Conor K.; Butterworth, Karl T.; Prise, Kevin M.; O'Sullivan, Joe M.; Hounsell, Alan R.

2012-11-01

126

Biological wound dressings sterilized with gamma radiation: Mexican clinical experience  

NASA Astrophysics Data System (ADS)

Biological wound dressings sterilized with gamma radiation, such as amnion and pig skin, are a reality in Mexico. These tissues are currently processed in the tissue bank and sterilized in the Gamma Industrial Irradiation Plant; both facilities belong to the Instituto Nacional de Investigaciones Nucleares (ININ) (National Institute of Nuclear Research). With the strong support of the International Atomic Energy Agency, the bank was established at the ININ and the Mexican Ministry of Health issued its sanitary license on July 7, 1999. The Quality Management System of the bank was certified by ISO 9001:2000 on August 1, 2003; the scope of the system is "Research, Development and Processing of Biological Tissues Sterilized with Gamma Radiation". At present, more than 150 patients from 16 hospitals have been successfully treated with these tissues. This paper presents a brief description of the tissue processing, as well as the present Mexican clinical experience with children and adult patients who underwent medical treatment with radiosterilized amnion and pig skin, used as biological wound dressings on burns and ocular surface disorders.

Martínez-Pardo, M. E.; Ley-Chávez, E.; Reyes-Frías, M. L.; Rodríguez-Ferreyra, P.; Vázquez-Maya, L.; Salazar, M. A.

2007-11-01

127

Mobile Computed Tomography : Three Year Clinical Experience in Korea  

PubMed Central

Objective Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. Methods A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. Results Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. Conclusion mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency.

Jeon, Jin Sue; Son, Young-Je; Yang, Hee-Jin; Chung, Young Seob; Jung, Hee-Won

2013-01-01

128

The Effects of an Institutional Clinical Experience on Pharmacy Student Professional Status Perceptions  

ERIC Educational Resources Information Center

Senior pharmacy students' perceptions prior to and after clinical experience were examined as they rated the occupations of BS pharmacist, PharmD pharmacist, physician, and nurse in one of three teaching hospitals in which the clinical course was conducted. The clinical experience did not significantly change students' previous perceptions. (LBH)

McCook, William M.; Speranza, Kenneth A., Sr.

1978-01-01

129

An Eight-Year Clinic Experience with Clozapine Use in a Parkinson's Disease Clinic Setting  

PubMed Central

Background To examine our eight year clinic-based experience in a Parkinson’s disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). Methods The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. Results There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45–87 years (mean 68.3±10.15), disease duration of 17–240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r?=??0.36, p<0.01) and H&Y score (r?=??0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r?=?0.21, p>0.05). Conclusions This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

Hack, Nawaz; Fayad, Sarah M.; Monari, Erin H.; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L.; Malaty, Irene A.; Romrell, Janet; Shukla, Aparna A. Wagle.; McFarland, Nikolaus; Ward, Herbert E.; Okun, Michael S.

2014-01-01

130

[Nursing students' perceptions of the factors in the field of general clinical experience which facilitate learning].  

PubMed

Learning through clinical experience forms an integral part of student nurses' academic and professional foundation. The extent to which learning is facilitated for student nurses is determined by the structuring of the field of clinical experience as well as by student nurses' perception of the field of clinical experience. The purpose of this study is to determine student nurses' perception of factors in the field of general clinical experience which facilitate learning. Literature pertaining to factors in the field of general clinical experience which impact on the learning by students was studied. A descriptive, exploratory survey was done through the medium of a questionnaire completed by B.Cur-students. The results of this study indicate, despite the fact that student nurses experience some aspects pertaining to learning in the general clinical field negatively, their overall impression is positive and favourable. Factors restraining learning were identified. Recommendations are made to counter the restraining factors. PMID:9791346

van Velden, C E; van Wyk, N C; van Niekerk, S E

1998-03-01

131

Clinical governance development: learning from the New Zealand experience.  

PubMed

The development of clinical governance in New Zealand has been pivotal to the country's health policy since 2009. Some of the key findings from one component of a national assessment project, which involved interviews with health professionals and managers at 19 of the country's 20 district health boards, are reviewed here. Key lessons for clinical governance are that: clinical governance needs to be clearly defined; it requires robust management-clinical partnerships along with a multi-layered developmental strategy and investment in training; and it also requires organisational arrangements such as a clinical board. The New Zealand emphasis on clinical governance has been positive for health professionals but, at this stage, it is not possible to assess its broader impact. PMID:24198340

Gauld, Robin

2014-01-01

132

Learning to Practice: The Design of Clinical Experience in Teacher Preparation  

NSDL National Science Digital Library

Few would disagree that clinical experience is critical for teacher development. Teaching is, after all, a demanding clinical practice, requiring teachers to orchestrate complex classroom interactions designed to help children learn. While clinical practice rests on a body of professional knowledge, ultimately teachers need to be able to put this knowledge to use in practice. Clinical experiences during professional education provide opportunities for teachers to develop and hone their craft.

Grossman, Pam

2012-01-25

133

Ultrashort Pulse Laser Accelerated Proton Beams for First Radiobiological Applications  

SciTech Connect

We report on the generation of proton pulses with maximum energies exceeding 15 MeV by means of the irradiation of few micron thick metal foils by ultrashort (30 fs) laser pulses at a power level of 100 TW. In contrast to the well known situation for longer laser pulses, here, a near linear scaling of the maximum proton energy with laser power can be found. Aiming for radiobiological applications the long and short term stability of the laser plasma accelerator as well as a compact energy selection and dosimetry system is presented. The first irradiation of in vitro tumour cells showing dose dependent biological damage is demonstrated paving the way for systematic radiobiological studies.

Schramm, U.; Zeil, K.; Beyreuther, E.; Bussmann, M.; Cowan, T. E.; Kluge, T.; Kraft, S.; Metzkes, J.; Sauerbrey, R. [Forschungszentrum Dresden-Rossendorf (FZD), Bautzner Landstrasse 400, 01328 Dresden (Germany); Richter, C.; Enghardt, W.; Pawelke, J. [OncoRay- Center for Radiation Research in Oncology, TU Dresden, Fetscherstr. 74, 01307 Dresden (Germany); Forschungszentrum Dresden-Rossendorf (FZD), Bautzner Landstrasse 400, 01328 Dresden (Germany); Karsch, L.; Laschinsky, L.; Naumburger, D. [OncoRay- Center for Radiation Research in Oncology, TU Dresden, Fetscherstr. 74, 01307 Dresden (Germany)

2010-11-04

134

Clinical Interdisciplinary Health Team Care: An Educational Experiment.  

ERIC Educational Resources Information Center

Patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting are described. Questions are raised concerning the effect of clinical teams on the quality of patient care, cost-effectiveness, etc. (Author/MLW)

And Others; Mazur, Harold

1979-01-01

135

Managing Medical Images and Clinical Information: InCor's Experience  

Microsoft Academic Search

Patients usually get medical assistance in several clinics and hospitals during their lifetime, archiving vital information in a dispersed way. Clearly, a proper patient care should take into account that information in order to check for incompatibilities, avoid unnecessary exams, and get relevant clinical history. The Heart Institute (InCor) of Satildeo Paulo, Brazil, has been committed to the goal of

Sérgio Shiguemi Furuie; Marina S. Rebelo; Ramon Alfredo Moreno; Marcelo Santos; Nivaldo Bertozzo; Gustavo H. M. B. Motta; Fabio A. Pires; Marco Antonio A. Gutierrez

2007-01-01

136

Femtosecond laser eye surgery: the first clinical experience  

NASA Astrophysics Data System (ADS)

A brief review of commercial applications of femtosecond lasers in a clinical setting with emphasis on applications to corneal surgery is presented. The first clinical results of 208 procedures conducted from June to November 2000 is reported. The results show that femtosecond lasers may be safely used as keratome for use in LASIK procedures.

Juhasz, Tibor; Kurtz, Ron M.; Horvath, Christopher; Suarez, Carlos G.; Nordan, Lee; Slade, Steven

2002-04-01

137

Experience with a Family-Practice-Resident-Directed Obstetrical Clinic.  

ERIC Educational Resources Information Center

At Toledo Hospital, family practice residents have assumed responsibility for the normal obstetrics clinic. Specialty consultations are provided by the hospital's obstetrics residency program. A medical audit of the clinic indicates that the family practice residents obtained consultations and made referrals at the appropriate times. (JMD)

Hunter, Jerry L.; Snyder, Frank

1980-01-01

138

Dosimetry for radiobiological studies of the human hematopoietic system  

NASA Technical Reports Server (NTRS)

A system for estimating individual bone marrow doses in therapeutic radiation exposures of leukemia patients was studied. These measurements are used to make dose response correlations and to study the effect of dose protraction on peripheral blood cell levels. Three irradiators designed to produce a uniform field of high energy gamma radiation for total body exposures of large animals and man are also used for radiobiological studies.

Beck, W. L.; Stokes, T. R.; Lushbaugh, C. C.

1972-01-01

139

[Radiobiological research at the Joint Institute for Nuclear Research (JINR)].  

PubMed

The Joint Institute for Nuclear Research has the unique sources of ionizing radiation. The different radiobiological researches have been carried out at the JINR accelerators for more than forty years. They are connected not only to the solution of fundamental problems of radiation genetics but also with applied tasks of great social importance. These tasks are concerned with the improvement of targeted therapy methods for treatment of cancer diseases. PMID:11721347

Krasavin, E A

2001-01-01

140

The application of charged-particle microbeams in radiobiology  

NASA Astrophysics Data System (ADS)

For radiobiological applications, the strength of the microirradiation technique lies in its ability to deliver precise doses of radiation to selected individual cells (or sub-cellular targets) in vitro. There is particular interest in studying the risks associated with environmental exposures to ?-particle emitting isotopes (which are predominantly due to single-particle effects) and for investigating the so-called `bystander effect' where non-irradiated cells are seen to respond to signals from nearby irradiated cells. The Gray Cancer Institute charged particle microbeam is one of only two facilities currently in routine use for radiobiology; although a number other facilities are at various stages of development. To be useful in a radiobiological study, a microbeam facility is required to reliably deliver an exact number of particles to a pre-selected sub-cellular target. Furthermore, the low incidence of some biological endpoints means that a large number of cells may have to be individually irradiated (>100,000 cells), therefore some form of automation is essential. Our microbeam uses a 1 ?m diameter bore glass capillary to vertically collimate protons, or helium ions accelerated by a 4 MV Van de Graaff. Using 3He 2+ ions, 99% of cells are targeted with an accuracy of ±2 ?m, and with a particle counting accuracy >99%. Using automated cell finding and irradiation procedures, up to 10,000 cells per hour can be individually irradiated.

Folkard, Melvyn; Vojnovic, Boris; Prise, Kevin M.; Michael, Barry D.

2002-04-01

141

Quantitative modeling of chronic myeloid leukemia: insights from radiobiology.  

PubMed

Mathematical models of chronic myeloid leukemia (CML) cell population dynamics are being developed to improve CML understanding and treatment. We review such models in light of relevant findings from radiobiology, emphasizing 3 points. First, the CML models almost all assert that the latency time, from CML initiation to diagnosis, is at most ?10 years. Meanwhile, current radiobiologic estimates, based on Japanese atomic bomb survivor data, indicate a substantially higher maximum, suggesting longer-term relapses and extra resistance mutations. Second, different CML models assume different numbers, between 400 and 10(6), of normal HSCs. Radiobiologic estimates favor values>10(6) for the number of normal cells (often assumed to be the HSCs) that are at risk for a CML-initiating BCR-ABL translocation. Moreover, there is some evidence for an HSC dead-band hypothesis, consistent with HSC numbers being very different across different healthy adults. Third, radiobiologists have found that sporadic (background, age-driven) chromosome translocation incidence increases with age during adulthood. BCR-ABL translocation incidence increasing with age would provide a hitherto underanalyzed contribution to observed background adult-onset CML incidence acceleration with age, and would cast some doubt on stage-number inferences from multistage carcinogenesis models in general. PMID:22353999

Radivoyevitch, Tomas; Hlatky, Lynn; Landaw, Julian; Sachs, Rainer K

2012-05-10

142

(Radio)Biological Optimization of External-Beam Radiotherapy  

PubMed Central

“Biological optimization” (BIOP) means planning treatments using (radio)biological criteria and models, that is, tumour control probability and normal-tissue complication probability. Four different levels of BIOP are identified: Level I is “isotoxic” individualization of prescription dose Dpresc at fixed fraction number. Dpresc is varied to keep the NTCP of the organ at risk constant. Significant improvements in local control are expected for non-small-cell lung tumours. Level II involves the determination of an individualized isotoxic combination of Dpresc and fractionation scheme. This approach is appropriate for “parallel” OARs (lung, parotids). Examples are given using our BioSuite software. Hypofractionated SABR for early-stage NSCLC is effectively Level-II BIOP. Level-III BIOP uses radiobiological functions as part of the inverse planning of IMRT, for example, maximizing TCP whilst not exceeding a given NTCP. This results in non-uniform target doses. The NTCP model parameters (reflecting tissue “architecture”) drive the optimizer to emphasize different regions of the DVH, for example, penalising high doses for quasi-serial OARs such as rectum. Level-IV BIOP adds functional imaging information, for example, hypoxia or clonogen location, to Level III; examples are given of our prostate “dose painting” protocol, BioProp. The limitations of and uncertainties inherent in the radiobiological models are emphasized.

Nahum, Alan E.; Uzan, Julien

2012-01-01

143

Experience with validation of clinical trial materials: an inspector's viewpoint.  

PubMed

The new EU directive now states quite clearly that GMP applies to Clinical Trials Manufacturers and implicit in this is process validation. Although it is generally accepted that full process validation may not be possible at Clinical Trails, there are many areas which can and should be validated, and certainly when a product is administered to patients. It is also noteworthy that Annex 13 is currently being revised and this has implications with regard to validation, especially of equipment and facilities. PMID:14620849

Wolfe, L

2003-01-01

144

Clinical and Field-based Experiences To Prepare Teachers for Wholistic Practice.  

ERIC Educational Resources Information Center

Care must be taken to ensure that students in teacher preparation programs are prepared to benefit maximally from field experiences. A curriculum that provides prerequisite knowledge, contrived teaching experiences on campus, proper sequencing of experiences, and balance between formal instruction and field experience is needed. Clinical and…

Clarken, Rodney H.

145

A detailed radiobiological and dosimetric analysis of biochemical outcomes in a case-control study of permanent prostate brachytherapy patients  

SciTech Connect

The purpose of this study is to determine dosimetric and radiobiological predictors of biochemical control after recalculation of prostate implant dosimetry using updated AAPM Task Group 43 (TG-43) parameters and the radiobiological parameters recommended by TG-137. All biochemical failures among patients implanted with {sup 125}I or {sup 103}Pd sources between 1994 and March 2006 were matched 2:1 with nonfailure controls. The individual matching was by risk group, radionuclide, prescribed dose, and time of implant (one match before and one after the failed patient) resulting in a median follow-up of 10.9 years. Complete dose volume histogram (DVH) data were recalculated for all 55 cases and 110 controls after updating the original source strength by the retrospectively determined ratios of TG-43. Differential DVH data were acquired in 179 increments of prostate volume versus percentage prescribed dose. At each incremental dose level i, the biologically equivalent dose BED{sub i}, equivalent uniform dose EUD{sub i}, and tumor control probability TCP{sub i} were calculated from the implant dose plus any external beam delivered to the patient. Total BED, EUD, and TCP were then derived from the incremental values for comparison with single point dosimetric quality parameters and DVH-based averages. There was no significant difference between failures and controls in terms of total BED (143 vs 142 Gy), EUD (95 vs 94 Gy), or TCP (0.87 vs 0.89). Conditional logistic regression analysis factored out the matching variables and stratified the cohort into each case and its controls, but no radiobiological parameter was predictive of biochemical failure. However, there was a significant difference between radiobiological parameters of {sup 125}I and {sup 103}Pd due to less complete coverage of the target volume by the former isotope. The implant BED and TCP were highly correlated with the D{sub 90} and natural prescription doses and a series of mean DVH-based doses such as the harmonic mean and expressions of the generalized EUD. In this case-control study of prostate brachytherapy biochemical failures and nonfailures, there were no radiobiological parameters derived from detailed DVH-based analysis that predicted for biochemical control. This may indicate that in our approach, implant dosimetry is at or near the limits of clinically effective dose escalation.

Butler, Wayne M.; Stewart, Renee R.; Merrick, Gregory S. [Schiffler Cancer Center, Wheeling Hospital, 1 Medical Park, Wheeling, West Virginia 26003-6300 and Wheeling Jesuit University, 316 Washington Avenue, Wheeling, West Virginia 26003 (United States)

2009-03-15

146

Integrating Clinical Experiences in a TESOL Teacher Education Program: Curriculum Mapping as Process  

ERIC Educational Resources Information Center

Across all certification areas, teacher education is being challenged to better integrate clinical experiences with coursework. This article describes the process of curriculum mapping and its impact on the organization of clinical experiences in a master's TESOL program over a 1-year redesign process. Although curriculum mapping has been…

Baecher, Laura

2012-01-01

147

Second Life ® as a Clinical Conference Environment: Experience of Students and Faculty  

Microsoft Academic Search

The purpose of this article is to discuss the students’ and faculty members’ experience of using Second Life® during a psychiatric mental health clinical conference. The clinical conference is explained, as well as the process in which students were oriented to the use of Second Life. The students’ and faculty members’ experience, obstacles encountered, and lessons learned are also presented.

Melinda Hermanns; Carol Kilmon

148

Our Experience in a Psychodermatology Liaison Clinic at Manipal, India  

PubMed Central

Psychodermatology is an emerging specialty in dermatology which deals with the interactions between mind and skin. Psychocutaneous diseases can be either primary psychiatric or primary cutaneous, with various degrees of associations between psyche and skin. Unless the dermatologist cultivates a special interest in this field, many an invisible mental disorder may be missed leading to sub optimal treatment of the visible skin condition. Though Dermatology Psychiatry liaison clinics are common in Europe and other western countries, it is just an emerging concept in India. Here we describe the working pattern of psychodermatology liaison clinic established in Manipal in August 2010 and describe briefly the type of cases attended to.

Shenoi, Shrutakirthi D; Prabhu, Smitha; Nirmal, B; Petrolwala, Shailee

2013-01-01

149

Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores  

PubMed Central

Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2??=??0.01, P??=??.96, patients per hour: r2??=??0.00, P??=??.76), or between teaching scores and total clinical hours with residents (r2??=??0.07, P??=??.19). There was a significant negative relationship between years of experience and teaching scores (r2??=??0.27, P?clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators.

Clyne, Brian; Smith, Jessica L.; Napoli, Anthony M.

2012-01-01

150

Clinical experience and acceptability of the etonogestrel subdermal contraceptive implant  

Microsoft Academic Search

Objective: To evaluate efficacy, adverse effects, and user continuation rate of an etonogestrel subdermal single-rod contraceptive implant. Methods: A total of 417 healthy volunteers of childbearing age were included in this multicenter trial. After implant insertion, the women were followed up during the 3 years of contraceptive action. At each visit, clinical findings, side effects, and bleeding patterns were recorded.

J. B. Otero Flores; M. Lozano Balderas; M. Cortés Bonilla; L. Vázquez-Estrada

2005-01-01

151

Geriatric hip fracture clinical pathway: the Hong Kong experience  

PubMed Central

Geriatric hip fracture is one of the commonest fractures in orthopaedic trauma. There is a trend of further increase in its incidence in the coming decades. Besides the development of techniques and implants to overcome the difficulties in fixation of osteoporosis bone, the general management of the hip fracture is also very challenging in terms of the preparation of the generally poorer pre-morbid state and complicate social problems associated with this group of patients. In order to cope with the increasing demand, our hospital started a geriatric hip fracture clinical pathway in 2007. The aim of this pathway is to provide better care for this group of patients through multidisciplinary approach. From year 2007 to 2009, we had managed 964 hip fracture patients. After the implementation of the pathway, the pre-operative and the total length of stay in acute hospital were shortened by over 5 days. Other clinical outcomes including surgical site infection, 30 days mortality and also incidence of pressure sore improved when compared to the data before the pathway. The rate of surgical site infection was 0.98%, and the 30 days mortality was 1.67% in 2009. The active participation of physiotherapists, occupational therapists as well as medical social workers also helped to formulate the discharge plan as early as the patient is admitted. In conclusion, a well-planned and executed clinical pathway for hip fracture can improve the clinical outcomes of the geriatric hip fractures.

Leung, F.; Siu, D.; Wong, G.; Luk, K. D. K.

2010-01-01

152

Antenatal noninvasive DNA testing: clinical experience and impact.  

PubMed

Background?Nearly two decades ago, the discovery of circulating cell-free fetal DNA in maternal blood created a paradigm shift in prenatal testing. Recent advances in DNA sequencing technology have facilitated the rapid translation of DNA-based testing into clinical antenatal care. Content?In this review, we summarize the technical approaches and current clinical applications of noninvasive testing using cell-free DNA in maternal plasma. We discuss the impact of these tests on clinical care, outline proposed integration models, and suggest future directions for the field. Summary?The use of cell-free DNA in maternal blood for the detection of fetal rhesus D antigen status, fetal sex, and common whole chromosomal aneuploidies is now well established, although testing for aneuploidy is still considered screening and not diagnostic. Further advances in technology and bioinformatics may see future clinical applications extend to the noninvasive detection of fetal subchromosomal aneuploidy, single gene disorders, and the entire fetal genome. PMID:24683075

Ferres, Millie A; Hui, Lisa; Bianchi, Diana W

2014-08-01

153

rHuEPO and Treatment Outcomes: the Clinical Experience  

Microsoft Academic Search

Increasingly, anemia is being recognized as a negative prognostic and predictive factor for patients undergoing chemotherapy, radiation therapy, or a combination of these treatment modalities. The results of clinical studies have shown correlations between anemia and shorter survival times in patients with a wide variety of solid tumors and hematologic malignancies, including lung, ovarian, breast, and head\\/neck cancers, non-Hodgkin's lymphoma,

CLIFFORD A. HUDIS; SIMON VAN BELLE; JOSE CHANG; KARSTEN MUENSTEDT

154

Sick Sinus Syndrome: Experience of a Cardiac Pacemaker Clinic  

Microsoft Academic Search

Out of a pacemaker clinic population of 182 patients 21 (11·5%) were found to have the sick sinus syndrome. Their ages ranged from 30 to 80 years and averaged 62. Ischaemic heart disease was more commonly an aetiological factor than in patients with chronic atrioventricular heart block. Other aetiologies were familial cardiomyopathy, postcardiac surgery, and dystrophia myotonica.Cardioversion before pacemaker insertion

Dorothy J. Radford; D. G. Julian

1974-01-01

155

The Clinical/Practicum Experience in Professional Preparation: Preliminary Findings  

ERIC Educational Resources Information Center

The authors synthesize preliminary findings from an interdisciplinary study of the practicum/clinical phase of undergraduate pre-service education in the professions. Early data analysis identified similarities and differences across disciplines in terms of: (a) the terminology describing each practicum program, (b) the programs' key…

Ralph, Edwin George; Walker, Keith; Wimmer, Randy

2008-01-01

156

Clinical gait analysis by neural networks: issues and experiences  

Microsoft Academic Search

Clinical gait analysis is an area aiming at the provision of support for diagnoses and therapyconsiderations, the development of bio-feedback systems to train patients, and the recognition ofeffects of multiple diseases and still active compensation. The data recorded with ground reactionforce measurement platforms is a convenient starting point for gait analysis. We argue in favor ofusing the raw data from

Monika Köhle; Dieter Merkl; Josef Kastner

1997-01-01

157

Review of cleveland clinic experience with penile fracture  

Microsoft Academic Search

Objectives. Fracture of the penis is an uncommon injury that results from trauma to the erect penis, usually during sexual intercourse. In some cases, the urethra is injured as well. To determine the outcome of immediate surgical management, we reviewed the cases of 8 patients with fracture of the penis who presented to the Cleveland Clinic from 1992 to 1998.Methods.

Amr F Fergany; Kenneth W Angermeier; Drogo K Montague

1999-01-01

158

Radiobiological studies with the nematode Caenorhabditis elegans. Genetic and developmental effects of high LET radiation  

NASA Technical Reports Server (NTRS)

The biological effects of heavy charged particle (HZE) radiation are of particular interest to travellers and planners for long-duration space flights where exposure levels represent a potential health hazard. The unique feature of HZE radiation is the structured pattern of its energy deposition in targets. There are many consequences of this feature to biological endpoints when compared with effects of ionizing photons. Dose vs response and dose-rate kinetics may be modified, DNA and cellular repair systems may be altered in their abilities to cope with damage, and the qualitative features of damage may be unique for different ions. The nematode Caenorhabditis elegans is being used to address these and related questions associated with exposure to radiation. HZE-induced mutation, chromosome aberration, cell inactivation and altered organogenesis are discussed along with plans for radiobiological experiments in space.

Nelson, G. A.; Schubert, W. W.; Marshall, T. M.

1992-01-01

159

Heavy charged particle radiobiology: using enhanced biological effectiveness and improved beam focusing to advance cancer therapy.  

PubMed

Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and ?-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce high energy charged particle beams are more costly than photon facilities, particle therapy has shown improved cancer survival rates, reflecting more highly focused dose distributions and more severe DNA damage to tumor cells. Despite early successes of charged particle radiotherapy, there is room for further improvement, and much remains to be learned about normal and cancer cell responses to charged particle radiation. PMID:21376738

Allen, Christopher; Borak, Thomas B; Tsujii, Hirohiko; Nickoloff, Jac A

2011-06-01

160

Heavy Charged Particle Radiobiology: Using Enhanced Biological Effectiveness and Improved Beam Focusing to Advance Cancer Therapy  

PubMed Central

Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and ?-rays, are the most widely used type of ionizing radiation in radiobiology experiments, and in radiation cancer therapy. Charged particles, including protons and carbon ions, are seeing increased use as an alternative therapeutic modality. Although the facilities needed to produce high energy charged particle beams are more costly than photon facilities, particle therapy has shown improved cancer survival rates, reflecting more highly focused dose distributions and more severe DNA damage to tumor cells. Despite early successes of charged particle radiotherapy, there is room for further improvement, and much remains to be learned about normal and cancer cell responses to charged particle radiation.

Allen, Christopher; Borak, Thomas B.; Tsujii, Hirohiko; Nickoloff, Jac A.

2011-01-01

161

PACS archive upgrade and data migration: clinical experiences  

NASA Astrophysics Data System (ADS)

Saint John's Health Center PACS data volumes have increased dramatically since the hospital became filmless in April of 1999. This is due in part of continuous image accumulation, and the integration of a new multi-slice detector CT scanner into PACS. The original PACS archive would not be able to handle the distribution and archiving load and capacity in the near future. Furthermore, there is no secondary copy backup of all the archived PACS image data for disaster recovery purposes. The purpose of this paper is to present a clinical and technical process template to upgrade and expand the PACS archive, migrate existing PACs image data to the new archive, and provide a back-up and disaster recovery function not currently available. Discussion of the technical and clinical pitfalls and challenges involved in this process will be presented as well. The server hardware configuration was upgraded and a secondary backup implemented for disaster recovery. The upgrade includes new software versions, database reconfiguration, and installation of a new tape jukebox to replace the current MOD jukebox. Upon completion, all PACS image data from the original MOD jukebox was migrated to the new tape jukebox and verified. The migration was performed during clinical operation continuously in the background. Once the data migration was completed the MOD jukebox was removed. All newly acquired PACS exams are now archived to the new tape jukebox. All PACs image data residing on the original MOD jukebox have been successfully migrated into the new archive. In addition, a secondary backup of all PACS image data has been implemented for disaster recovery and has been verified using disaster scenario testing. No PACS image data was lost during the entire process and there was very little clinical impact during the entire upgrade and data migration. Some of the pitfalls and challenges during this upgrade process included hardware reconfiguration for the original archive server, clinical downtime involved with the upgrade, and data migration planning to minimize impact on clinical workflow. The impact was minimized with a downtime contingency plan.

Liu, Brent J.; Documet, Luis; Sarti, Dennis A.; Huang, H. K.; Donnelly, John

2002-05-01

162

Clinical experience in cell-based therapeutics: intervention and outcome  

Microsoft Academic Search

Disc herniation treated by discectomy results in a significant loss of nucleus material and disc height. Biological restoration\\u000a through the use of autologous disc chondrocyte transplantation (ADCT) offers a potential to achieve functional integration\\u000a of disc metabolism and mechanics. Nucleus regeneration using autologous cultured disc-derived chondrocytes has been demonstrated\\u000a in a canine model and in clinical pilot studies. In 2002

Hans Joerg Meisel; Timothy Ganey; William C. Hutton; Jeanette Libera; Yvonne Minkus; Olivera Alasevic

2006-01-01

163

Nursing process documentation systems in clinical routine - prerequisites and experiences  

Microsoft Academic Search

Documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality and high writing efforts, are reported. However, it is still unclear if computer-based documentation systems can reduce these problems. At the Heidelberg University Medical Center, computer-based nursing process

Elske Ammenwerth; Ulrike Kutscha; Ansgar Kutscha; Cornelia Mahler; Ronald Eichstädter; Reinhold Haux

2001-01-01

164

ART in Clinic of Infertility INTERMEDICA: 2 years experience  

Microsoft Academic Search

Materials and methods: Data from 381 fresh embryo transfers have been collected: IVF—207 transfers, ICSI—151, mixed ones—23. Female patients who underwent reproductive technology were between 21 and 47 years of age. Results: For the IVF-derived embryos, a pregnancy rate per transfer was 38.9%, and a clinical pregnancy rate—24.4%, while for ICSI, respectively 33.8% and 23.3%. Mixed-derived embryos provided respective values

Anna Kaczmarek-Sroka; ?ukasz Sroka; Maciej Kurpisz

2004-01-01

165

Clinical experience with monoclonal antibodies to epidermal growth factor receptor  

Microsoft Academic Search

Recent knowledge about the intermediate steps and final consequences of ligand-dependent epidermal growth factor receptor\\u000a (EGFR) activation has clearly supported the notion that EGFR plays a fundamental role in regulating the proliferation and\\u000a survival of malignant neoplasms. Among the rationally designed target-based therapeutics that are being assessed, those targeting\\u000a EGFR appear to be some of the most clinically relevant. The

Emiliano Calvo; Eric K. Rowinsky

2005-01-01

166

Laboratory and clinical experience with neodymium:YAG laser prostatectomy  

NASA Astrophysics Data System (ADS)

Since 1991, we have undertaken extensive laboratory and clinical studies of the Neodymium:YAG (Nd:YAG) laser for surgical treatment of bladder outlet obstruction due to prostatic enlargement or benign prostatic hyperplasia (BPH). Side-firing optical fibers which emit a divergent, relatively low energy density Nd:YAG laser beam produce coagulation necrosis of obstructing periurethral prostate tissue, followed by gradual dissolution and slough in the urinary stream. Laser-tissue interactions and Nd:YAG laser dosimetry for prostatectomy have been studied in canine and human prostate model systems, enhancing clinical application. Ongoing studies examine comparative Nd:YAG laser dosimetry for various beam configurations produced by available side-firing optical fibers and continue to refine operative technique. We have documented clinical outcomes of Nd:YAG laser prostatectomy in 230 consecutive patients treated with the UrolaseTM side-firing optical fiber. Nd:YAG laser coagulation the prostate produces a remarkably low acute morbidity profile, with no significant bleeding or fluid absorption. No postoperative incontinence has been produced. Serial assessments of voiding outcomes over more than 3 years of followup show objective and symptomatic improvement following Nd:YAG laser prostatectomy which is comparable to older but more morbid electrosurgical approaches. Nd:YAG laser prostatectomy is a safe, efficacious, durable and cost-effective treatment for BPH.

Kabalin, John N.

1996-05-01

167

Navigating a guide wire through total occlusions: clinical experience  

NASA Astrophysics Data System (ADS)

One of the last remaining frontiers in angioplasty interventions is successfully recanalizing arteries containing total occlusions. The primary limiting condition is the inability to pass a guide wire safely across the total occlusion to facilitate therapeutic interventions. The operator has to perform the intervention without the assistance of x-ray imaging to define the vessel's path since the contrast media flow is blocked by the occlusion. To overcome this limitation, a guide wire system has been developed that transmits low coherence near-infrared light through an optical fiber internal to the guide wire and illuminates the tissue adjacent the distal end. Differences in the scattering of near-infrared light by the normal arterial wall and occluding tissues are detected by optical coherence reflectometry (OCR) techniques. Through a real-time monitoring system and display, the physician is warned if the guide wire approaches the normal arterial wall, allowing the guide wire to be redirected to prevent perforating the vessel. The system has been used in clinical coronary angioplasty cases demonstrating the ability to cross 10 out of 11 total occlusions without any perforations or dissections. The OCR guide wire system has demonstrated clinical potential and will require additional testing for clinical efficacy claims.

Neet, John M.; Winston, Thomas R.; Hedrick, Allan D.; Koolen, Jaques J.; Bonnier, Hans

2000-05-01

168

Laparoscopic aortofemoral bypass grafting: Human cadaveric and initial clinical experiences  

Microsoft Academic Search

Purpose: Postoperative complications are mainly related to the surgical trauma derived from the extensive abdominal incision and dissection after a conventional aortofemoral bypass grafting procedure. In an attempt to reduce postoperative complications, a concept of video-endoscopic vascular surgery on the infrarenal aortoiliac artery has been developed. On the basis of our experience with the practicability of video-endoscopic vascular surgery in

Samir Said; Julian Mall; Frank Peter; Joachim M. Müller

1999-01-01

169

Medical students' emotional development in early clinical experience: a model.  

PubMed

Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development. PMID:23949724

Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

2014-08-01

170

Transapical Transcatheter Aortic Valve Implantation in Humans Initial Clinical Experience  

Microsoft Academic Search

Background—Aortic valve replacement with cardiopulmonary bypass is currently the treatment of choice for symptomatic aortic stenosis but carries a significant risk of morbidity and mortality, particularly in patients with comorbidities. Recently, percutaneous transfemoral aortic valve implantation has been proposed as a viable alternative in selected patients. We describe our experience with a new, minimally invasive, catheter-based approach to aortic valve

Samuel V. Lichtenstein; Anson Cheung; Jian Ye; Christopher R. Thompson; Ronald G. Carere; Sanjeevan Pasupati; John G. Webb

2010-01-01

171

Students' Experiences of Learning Manual Clinical Skills through Simulation  

ERIC Educational Resources Information Center

Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students' experiences and…

Johannesson, Eva; Silen, Charlotte; Kvist, Joanna; Hult, Hakan

2013-01-01

172

An in vitro study of the radiobiological effects of flattening filter free radiotherapy treatments  

NASA Astrophysics Data System (ADS)

Flattening filter free (FFF) linear accelerators allow for an increase in instantaneous dose-rate of the x-ray pulses by a factor of 2-6 over the conventional flattened output. As a result, radiobiological investigations are being carried out to determine the effect of these higher dose-rates on cell response. The studies reported thus far have presented conflicting results, highlighting the need for further investigation. To determine the radiobiological impact of the increased dose-rates from FFF exposures a Varian Truebeam medical linear accelerator was used to irradiate two human cancer cell lines in vitro, DU-145 prostate and H460 non-small cell lung, with both flattened and FFF 6 MV beams. The fluence profile of the FFF beam was modified using a custom-designed Nylon compensator to produce a similar dose profile to the flattened beam (6X) at the cell surface but at a higher instantaneous dose-rate. For both cell lines there appeared to be no significant change in cell survival. Curve fitting coefficients for DU145 cells irradiated with constant average dose-rates were 6X: ? = 0.09 ± 0.03, ? = 0.03 ± 0.01 and 6FFF: ? = 0.14 ± 0.13, ? = 0.03 ± 0.02 with a significance of p = 0.75. For H460 cells irradiated with the same instantaneous dose-rate but different average dose-rate the fit coefficients were 6FFF (low dose-rate): ? = 0.21 ± 0.11, 0.07 ± 0.02 and 6FFF (high dose-rate): ? = 0.21 ± 0.16, 0.07 ± 0.03, with p = 0.79. The results indicate that collective damage behaviour does not occur at the instantaneous dose-rates investigated here and that the use of either modality should result in the same clinical outcome, however this will require further validation in vivo.

King, R. B.; Hyland, W. B.; Cole, A. J.; Butterworth, K. T.; McMahon, S. J.; Redmond, K. M.; Trainer, C.; Prise, K. M.; McGarry, C. K.; Hounsell, A. R.

2013-03-01

173

Clinical experience with Zarzio® in Europe: what have we learned?  

PubMed

Biosimilars are similar, but non-identical, versions of existing biological drugs for which patents have expired. Despite the rigorous approval process for biosimilars, concerns have been expressed about the efficacy and safety of these products in clinical practice. Biosimilars of filgrastim, based on the originator product Neupogen®, have been available since 2008 and are now in widespread clinical use in Europe and elsewhere. Three biosimilar G-CSFs have been approved based on a combination of physicochemical and biological protein characterisation, pharmacokinetic and pharmacodynamic assessment in healthy volunteers and efficacy and safety data in patients with cancer. To assess whether biosimilars are effective in the real-world clinical practice setting, a pooled analysis of five post-approval studies of biosimilar G-CSF (Zarzio®) that included 1,302 adult patients who received at least one cycle of chemotherapy with G-CSF support for the prevention of neutropenia was conducted. A total of 36 % of patients had a febrile neutropenia risk of >20 %, while 39.6 % had a risk of 10-20 % based on chemotherapy regimen. The occurrence of severe or febrile neutropenia was within the range of that observed in previous studies of originator G-CSF. In addition, the safety profile of Zarzio® was consistent with that reported for originator G-CSF and the known safety profile of G-CSF. Initial concerns about the use of biosimilars, at least with regard to biosimilar G-CSFs, appear to be unfounded. Adoption of cost-effective biosimilars should help reduce healthcare costs and improve patient access to biological treatments. PMID:23903799

Gascón, Pere; Tesch, Hans; Verpoort, Karl; Rosati, Maria Sofia; Salesi, Nello; Agrawal, Samir; Wilking, Nils; Barker, Helen; Muenzberg, Michael; Turner, Matthew

2013-10-01

174

Experience of a Clinic for Afghan Refugees in Pakistan  

PubMed Central

Since the Soviets invaded Afghanistan in 1979, 3.5 to 4 million refugees have moved into Pakistan and Iran. Even before the war, the health status of the Afghans was extremely poor and the medical personnel limited. Various international efforts are attempting to cope with the health care needs of the refugees. Economic, language, and cultural problems hamper the projects. One clinic found the most common problems were of the gastrointestinal tract, then the respiratory tract, with a problem ranking similar to that of pre-war Afghanistan. Many of the health problems are linked to deficiencies in sanitation and nutrition.

Morgan, Walter A.

1988-01-01

175

Madreporique stemmed total hip replacement: five years' clinical experience1  

PubMed Central

Between February 1975 and December 1980, 1214 total hip arthroplasties were performed with a new type of rough surface implant. The results, pitfalls and complications are presented with special reference to the first 173 cases which have had a complete clinical and radiological follow up for at least five years. The indications for operations in both primary and revision arthroplasties are defined. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 9.Figure 10.Figure 11.Figure 12. AFigure 12. BFigure 13. AFigure 13. B

Lord, Gerald A

1982-01-01

176

Initial Clinical Experience Using the Amplatzer Vascular Plug  

Microsoft Academic Search

Background and purpose  The Amplatzer Vascular Plug (AVP) is a self-expanding nitinol wire mesh vascular embolization device derived from the Amplatz\\u000a septal occluder. We assessed the results of vascular embolization obtained using the AVP.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective review was carried out of 23 consecutive cases of vascular embolization using the AVP in a variety of different\\u000a clinical settings. The AVP was chosen

David J. Tuite; David O. Kessel; Anthony A. Nicholson; Jai V. Patel; Simon J. McPherson; David R. Shaw

2007-01-01

177

Radiosurgery for epilepsy: clinical experience and potential antiepileptic mechanisms  

PubMed Central

Summary Stereotactic radiosurgery, well established in the noninvasive treatment of focal lesions that are otherwise difficult to access through open surgery, is an emerging technology in the treatment of focal epileptic lesions. Recent studies suggest that seizures from hypothalamic hamartomas and mesial temporal lobe epilepsy remit at clinically significant rates with radiosurgery, but large variations among different studies have raised questions about appropriate treatment protocols and mechanisms. Proposed anticonvulsant mechanisms include neuromodulatory effects or ischemic necrosis of epileptic tissue. An ongoing trial that directly compares efficacy, morbidities, and cost of radiosurgery versus open surgery for mesial temporal lobe epilepsy is underway.

Quigg, Mark; Rolston, John; Barbaro, Nicholas M.

2012-01-01

178

Lessons learned during 15 years of clinical information system experience.  

PubMed

This article describes lessons learned during an initial intensive care unit point-of-care clinical information system implementation and subsequent expansions to other units and hospitals in a multihospital healthcare delivery system. Although the implementation and expansions were primarily successful, lessons learned include developing a broad base of support, making decisions through consensus, addressing conflict when it occurs, keeping user expectations realistic, preparing for the change process, implementing the computer information system in stages, challenging existing work processes, viewing the implementation as a process, and choosing a project leader with outstanding communication and group process skills in addition to technical skills. PMID:11477738

Miranda, D; Fields, W; Lund, K

2001-01-01

179

First clinical experiences with perampanel--the Kork experience in 74 patients.  

PubMed

Perampanel (PER) has been approved for adjunctive treatment of partial-onset seizures in patients age 12 years and older. In Germany, PER was licensed and marketed in September of 2012. At our tertiary referral epilepsy center, a couple of difficult-to-treat patients were awaiting this introduction of PER; therefore, we were able to initiate treatment in many patients within a short period of time. For this report we collected and analyzed the data of the first patients who had been started on add-on PER between September and December of 2012, so that we were able to evaluate at least 6 months of treatment when we made this analysis. At cutoff in June of 2013, 74 patients could be analyzed. Mean age was 38.4 years (range 15-71 years). PER doses ranged from 4 to 14 mg (mean 8.8 mg). All patients took PER once daily at bedtime. Seventy-one patients had focal epileptic seizures; the remaining four patients had Lennox-Gastaut syndrome. Considering the last 3 months of observation compared with baseline, 34 patients (46%) were responders with a reduction of seizure frequency of at least 50%. Ten patients of these (14% of all) were seizure-free. Adverse events were reported in 40 patients (54%). Leading side effects were somnolence (n = 31, 42%) and dizziness (n = 13, 18%), followed by ataxia, irritability, falls, cognitive slowing, and depression in single cases. Six-month retention rate was 70%. Our first clinical experiences with add-on PER in a highly selected group of difficult-to-treat epilepsies are promising. PMID:24400693

Steinhoff, Bernhard J; Bacher, Matthias; Bast, Thomas; Kornmeier, Reinhold; Kurth, Christoph; Scholly, Julia; Staack, Anke M; Wisniewski, Ilona

2014-01-01

180

Clinical experience with microdialysis catheters in pediatric liver transplants.  

PubMed

Ischemic vascular complications and rejection occur more frequently with pediatric liver transplants versus adult liver transplants. Using intrahepatic microdialysis catheters, we measured lactate, pyruvate, glucose, and glycerol values at the bedside for a median of 10 days in 20 pediatric liver grafts. Ischemia (n = 6), which was defined as a lactate level > 3.0 mM and a lactate/pyruvate ratio > 20, was detected without a measurable time delay with 100% sensitivity and 86% specificity. Rejection (n = 8), which was defined as a lactate level > 2.0 mM and a lactate/pyruvate ratio < 20 lasting for 6 or more hours, was detected with 88% sensitivity and 45% specificity. With additional clinical criteria, the specificity was 83% without a decrease in the sensitivity. Rejection was detected at a median of 4 days (range = 1-7 days) before alanine aminotransferase increased (n = 5, P = 0.11), at a median of 4 days (range = 2-9 days) before total bilirubin increased 25% or more (n = 7, P = 0.04), and at a median of 6 days (range = 4-11 days) before biopsy was performed (n = 8, P = 0.05). In conclusion, microdialysis catheters can be used to detect episodes of ischemia and rejection before current standard methods in pediatric liver transplants with clinically acceptable levels of sensitivity and specificity. The catheters were well tolerated by the children, and no major complications related to the catheters were observed. PMID:23193034

Haugaa, Håkon; Almaas, Runar; Thorgersen, Ebbe Billmann; Foss, Aksel; Line, Pål Dag; Sanengen, Truls; Bergmann, Gísli Björn; Ohlin, Per; Waelgaard, Lars; Grindheim, Guro; Pischke, Soeren Erik; Mollnes, Tom Eirik; Tønnessen, Tor Inge

2013-03-01

181

Clinical experience with thalidomide and lenalidomide in multiple myeloma.  

PubMed

Thal has antiangiogenic and immunomodulatory activity. Clinical research provided clear evidence that Thal belongs to the most active drugs for the treatment of multiple myeloma e.g. leading to decrease of monoclonal protein of at least 50 % in 30 % of patients with relapsed or refractory multiple myeloma. Randomized trials that were designed based on a large body of evidence from phase II trials determined that Thal significantly increases total response rate, progression-free and in some studies overall survival in combination regimens (dexamethason and or chemotherapy) for relapsed as well as newly diagnosed patients and was therefore approved for first-line treatment of Multiple Myeloma. Strict guidelines apply due to the teratogenic effects of Thal and to monitor and prevent other potential adverse events as neuropathy and thrombosis has been recognized by leading organizations as part of the treatment concept for patients with relapsed or refractory disease. The success of Thal has sparked the development of Thal analogues with Lenalidomide (Len) the most advanced compound which was approved for relapsed multiple myeloma. As Len has a lower incidence of polyneuropathy, constipation and somnolence compared to Thalidomid but at least equal if not higher efficacy Len is meanwhile used more frequently in clinical routine and has advantages in combination therapies with Bortezomib. Additional randomized studies will now define the status of Thal and Len for maintenance therapy and their optimal integration in multi-agent treatment regimen. PMID:22229246

Moehler, T

2012-05-01

182

Clinical experiences in fungal keratitis caused by Acremonium  

PubMed Central

Purpose To report the predisposing risk factors, clinical presentation, management, and therapeutic outcomes of fungal keratitis caused by Acremonium. Methods This is a retrospective study of cases with Acremonium fungal keratitis that presented to our tertiary referral center between January 2006 and August 2012. Patient demographic and clinical details were determined and reported. Results Five cases of fungal keratitis from Acremonium species were identified in five patients (three males, two females). The mean age of the patients was of 73.4±5.46 years, with a mean follow-up time of 124±72 days. All patients had a history of corneal trauma with vegetable matter. Four cases were unresponsive to initial treatment (0.2% fluconazole, 0.15% amphotericin B) and required topical 5% natamycin, and, in two out of five cases, topical 1% voriconazole. Conclusion The most common risk factors for Acremonium fungal keratitis was ocular trauma. When a corneal lesion is found to be unresponsive to the initial treatment, we should consider adding or substituting topical natamycin or voriconazole for treatment.

Kim, Seong-Jae; Cho, Yong-Wun; Seo, Seong-Wook; Kim, Sun-Joo; Yoo, Ji-Myong

2014-01-01

183

Differential diagnoses to MS: experiences from an optic neuritis clinic.  

PubMed

Optic neuritis (ON) is closely linked to multiple sclerosis (MS). It may, however, also be associated to a range of autoimmune or infectious diseases. The purpose of this study was to assess the differential diagnoses in patients with suspected ON. In this retrospective study, we reviewed the files of all patients referred to the Clinic of Optic Neuritis, Glostrup Hospital, University of Copenhagen, Denmark, between January 2000 and November 2011. All patients were referred by ophthalmologists with possible ON. Patients diagnosed with MS prior to referral were excluded from the study. A total of 643 patients were included in the study. Apart from ON, the most frequent diagnoses were tumors (n = 15), ischemic or hypertensive neuropathies (n = 13), and retinal or choroid disorders (n = 9). Six patients were diagnosed with neuromyelitis optica. Rarer causes of visual loss were infections (n = 5), giant cell arteritis (n = 4), sarcoidosis (n = 3), thyrotoxicosis (n = 2), and hereditary or toxic neuropathies (n = 2). Nine percent of patients referred to the Clinic of Optic Neuritis had symptoms caused by medical, neurosurgical or ophthalmic disorders, and 0.9 % of our patients had NMO. Though most of these conditions are rare, it is of importance to keep them in mind upon encountering patients with symptoms of ON. PMID:24158275

Horwitz, Henrik; Friis, Tina; Modvig, Signe; Roed, Hanne; Tsakiri, Anna; Laursen, Bjarne; Frederiksen, Jette Lautrup

2014-01-01

184

[Clinical experiences of interval treatment with dermatologic agents containing urea].  

PubMed

Topical vehicles containing urea are increasingly used in dermatology because of their favorable pharmacological properties, which are due to the following capacities of urea: (1) its beneficial influence on the structure and physiology of the skin, and (2) its therapeutic effect in combination with other topically active agents in various skin diseases, such as psoriasis, ichthyosis, and chronic eczema. Our own experiences presented here are in accordance with these statements. PMID:2284833

Petres, J; Antal, I; Füzesi, S

1990-08-01

185

Fat emulsion for intravenous administration: clinical experience with intralipid 10%.  

PubMed Central

A 10% soybean oil emulsion (Intralipid 10%), used extensively in Europe for intravenous alimentation, has now been clinically evaluated in the United States. Controlled studies have shown that the soybean oil emulsion can be substituted for glucose to supply one-third to two-thirds of the total calories, and can be administered peripherally without significant vein irritation. Essential fatty acid deficiencies, frequently encountered in patients dependent on parenteral alimentation with fat-free solutions, are prevented and corrected by use of this preparation. Data on long-term tolerance to Intralipid 10% infusions are presented for 292 patients treated for more than 6,000 patient days. The soybean oil emulsion was usually well tolerated. Side effects were reported in two of 133 adults and 12 of 159 pediatric patients.

Hansen, L M; Hardie, B S; Hidalgo, J

1976-01-01

186

Twelve years of clinical experience with lithium pulse generators.  

PubMed

The clinical performance of 9,651 lithium pulse generators, which were implanted at our registry hospitals since 1973, was assessed by analysis of actuarial survival data and information obtained at the time of pacemaker failure. Cumulative survival estimates for all units were: 5 years, 94 percent, 7 years, 81 percent, 10 years, 62 percent. Discriminant actuarial analysis revealed no differences between lithium iodine and lithium cupric sulfide longevity. Battery depletion was found in 49.1 percent of 277 units subjected to detailed explant analysis, while 31 percent and 8.7 percent had component and hermetic seal defects, respectively. Of the pulse generators with battery depletion, all but two units exhibited normal end-of-battery life behavior. We conclude that the lithium iodine and lithium cupric sulfide batteries are safe, long-term energy sources; however, the impact of reduced battery size and dual chamber pacing on these performance parameters is unknown. PMID:2432547

Hauser, R G; Wimer, E A; Timmis, G C; Gordon, S; Staller, B; Klodnycky, M; Eisenhauer, A; Goren, C; Moran, J F; Davis, A A

1986-11-01

187

Japanese experience with clinical trials of fast neutrons  

SciTech Connect

Between November, 1975 and November, 1981, 825 patients were treated with 30 MeV (d-Be) neutrons at the National Institute of Radiological Sciences, Chiba. At the Institute of Medical Science, Tokyo, 302 patients were referred to the Radiation Therapy department and were treated with 16 MeV (d-Be) neutrons. The emphasis of these clinical trials with fast neutrons was placed on the estimation of the effect of fast neutrons for locally advanced cancers or radioresistant cancers, and on evaluation of the rate of complication of normal tissues following irradiation with fast neutrons. Results were evaluated for patients with previously untreated cancer; local control of the tumor was observed in 59.1%. Complications requiring medical care developed in only 32 patients. Late reaction of soft tissue seemed to be more severe than that observed with photon beams. The results also suggest that for carcinoma of the larynx, esophagus, uterine cervix, Pancoast's tumor of the lung and osteosarcoma, fast neutrons were considered to be effectively applied in this randomized clinical trial. For carcinoma of the larynx, a fast neutron boost was effectively delivered, although an interstitial implant was necessarily combined with fast neutrons for carcinoma of the tongue. The cumulative survival rate of the patients with carcinoma of the esophagus treated with fast neutrons of 26% compared to the survival rate of 10.5% obtained using photons. The results also indicate that local control and relief of the symptom related to Pancoast's tumor of the lung seemed to be better with neutrons than with photons. For patients suffering from osteosarcoma, the surgical procedures preserving the function of the leg and arm were studied according to the better local control rate of the tumor following fast neutron beam therapy.

Tsunemoto, H.; Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.

1982-12-01

188

Japanese experience with clinical trails of fast neutrons  

SciTech Connect

Between November, 1975 and November, 1981, 825 patients were treated with 30 MeV (d-Be) neutrons at the National Institute of Radiological Sciences, Chiba. At the Institute of Medical Science, Tokyo, 302 patients were referred to the Radiation Therapy department and were treated with 16 MeV (d-Be) neutrons. The emphasis of these clinical trials with fast neutrons was placed on the estimation of the effect of fast neutrons for locally advanced cancers or radioresistant cancers, and on evaluation of the rate of complication of normal tissues following irradiaton with fast neutrons. Results were evaluated for patients with previously untreated cancer; local control of the tumor was observed in 59.1%. Complications requiring medical care developed in only 32 patients. Patients who had received pre- or postoperative irradiation were excluded from this evaluation. Late reaction of soft tissue seemed to be more severe than that observed with photon beams. The results also suggest that for carcinoma of the larynx, esophagus, uterine cervix, Pancoasts's tumor of the lung and osteosarcoma, fast neutrons were considered to be effectively applied in this randomized clinical trial. For carcinoma of the larynx, a fast nuetron boost was effectively delivered, although an interstitial implant was necessarily combined with fast neutrons for carcinoma of the tongue. The cumulative survival rate of the patients with carcinoma of the esophagus treated with fast neutrons was 26% compared to the survival rate of 10.5% obtained using photons. This was supported by evidence from the pathological studies that showed that the tumor cells which had deeply invaded into the esophagus were effectively destroyed when fast neutrons were applied.

Tsunemoto, H. (National Inst. of Radiological Sciences, Chiba-shi, Japan); Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.

1982-12-01

189

The clinical presentation of celiac disease: experiences from northeastern iran.  

PubMed

BACKGROUND This study aimed to explore demographic characteristics and clinical presentations of celiac disease (CD) in Northeastern Iran. METHODS This was a cross-sectional retrospective study of 193 adults with CD who presented to Mashhad University Gastroenterology Clinic between 2008 and 2013. Patient data that included mode of presentation and the presence of any concomitant illnesses were collected. Intestinal biopsy and serum anti-tissue transglutaminase (anti-tTG) were used for diagnosis. Mucosal lesions were classified according to modified Marsh classification. RESULTS Overall, 132 females and 61 males, with a mean age at diagnosis of 32.6 ± 13.2 years were included. The patient's chief complaints in order of decreasing frequency were dyspepsia (24.6%), diarrhea (20%), anemia (12.8%), and flatulence (7.2%). Bone disease was seen (osteopenia, osteoporosis) in 30% of patients. A positive family history of CD was found in 17.9% of cases. There were 64% who had serum anti-tTG >200 units/ml and 78% had a Marsh classification grade 3 on duodenal biopsy. The histology grade (Marsh) did not show any correlation with anti-tTG serum levels, age, body mass index (BMI) or hemoglobin levels. CONCLUSION In Northeastern Iran, CD was seen more commonly in females and with non-diarrheal presentations. Abdominal discomfort, anemia and bone disease were most common primary presentations in this area. Histology grade showed no significant correlation with level of anti-tTG, BMI or hemoglobin levels. We suggest screening for CD in unexplained abdominal discomfort, bone disease and anemia. PMID:24872868

Ganji, Azita; Esmaielzadeh, Abbas; Aafzal Aghayee, Mehdi; Goshayeshi, Ladan; Ghaffarzadegan, Kamran

2014-04-01

190

The Clinical Presentation of Celiac Disease: Experiences from Northeastern Iran  

PubMed Central

BACKGROUND This study aimed to explore demographic characteristics and clinical presentations of celiac disease (CD) in Northeastern Iran. METHODS This was a cross-sectional retrospective study of 193 adults with CD who presented to Mashhad University Gastroenterology Clinic between 2008 and 2013. Patient data that included mode of presentation and the presence of any concomitant illnesses were collected. Intestinal biopsy and serum anti-tissue transglutaminase (anti-tTG) were used for diagnosis. Mucosal lesions were classified according to modified Marsh classification. RESULTS Overall, 132 females and 61 males, with a mean age at diagnosis of 32.6 ± 13.2 years were included. The patient’s chief complaints in order of decreasing frequency were dyspepsia (24.6%), diarrhea (20%), anemia (12.8%), and flatulence (7.2%). Bone disease was seen (osteopenia, osteoporosis) in 30% of patients. A positive family history of CD was found in 17.9% of cases. There were 64% who had serum anti-tTG >200 units/ml and 78% had a Marsh classification grade 3 on duodenal biopsy. The histology grade (Marsh) did not show any correlation with anti-tTG serum levels, age, body mass index (BMI) or hemoglobin levels. CONCLUSION In Northeastern Iran, CD was seen more commonly in females and with non-diarrheal presentations. Abdominal discomfort, anemia and bone disease were most common primary presentations in this area. Histology grade showed no significant correlation with level of anti-tTG, BMI or hemoglobin levels. We suggest screening for CD in unexplained abdominal discomfort, bone disease and anemia.

Ganji, Azita; Esmaielzadeh, Abbas; Aafzal Aghayee, Mehdi; Goshayeshi, Ladan; Ghaffarzadegan, Kamran

2014-01-01

191

Assessing Research Participants' Perceptions of their Clinical Research Experiences  

PubMed Central

Introduction Participants’ perceptions of their research experiences provide valuable measures of ethical treatment, yet no validated instruments exist to measure these experiences. We conducted focus groups of research participants and professionals as the initial step in developing a validated instrument. Methods Research participants enrolled in twelve focus groups, consisting of: 1) individuals with disorders undergoing interventions or 2) in natural history studies; or 3) healthy volunteers. Research professionals participated in six separate groups of 1) IRB members, ethicists, Research Subject Advocates, 2) research nurses/coordinators, or 3) investigators. Focus groups used standard methodologies. Results 85 participants and 29 professionals enrolled at 8 academic centers. Altruism and personal relevance of the research were commonly identified motivators; financial compensation was less commonly mentioned. Participants were satisfied with informed consent processes but disappointed if not provided test results, or study outcomes. Positive relationships with research teams were valued highly. Research professionals were concerned about risks, undue influence, and informed consent. Conclusions Participants join studies for varied, complex reasons, notably altruism and personal relevance. They value staff relationships, health gains, new knowledge, and compensation, and expect professionalism and good organization. Based on these insights, we propose specific actions to enhance participant recruitment, retention and satisfaction.

Kost, Rhonda G.; Lee, Laura M.; Yessis, Jennifer; Coller, Barry S.; Henderson, David K.

2013-01-01

192

Clinical Experience with the Bentall Procedure: 28 Years  

PubMed Central

Purpose We retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease. Materials and Methods Between March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%). Results The early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0±81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively. Conclusion In our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients.

Joo, Hyun-Chel; Chang, Byung-Chul; Youn, Young-Nam; Yoo, Kyung-Jong

2012-01-01

193

Experiences of infertility: liminality and the role of the fertility clinic.  

PubMed

This paper explores the experiences of infertile women who occupy a liminal space in society, and argues that the fertility clinic served as a space to tolerate women's experiences of liminality. It provided not only rituals aimed at transition to pregnancy, but also a space where women's liminal experiences, which are caused by the existential chaos of infertility, could be tolerated. The British experience seemed to differ from the American one identified in the literature, where self-management and peer group support are described as strategies used by infertile women to manage infertility. The British women in this study did not appear to draw so much on self-management or peer group support to deal with their experiences of infertility. They appeared to be isolated in their experience. The clinic thus provided a space in which recognition was given to their intensely private experiences of difference from those in the outside fertile world and allowed them to manage these socially unacceptable, culturally taboo and invisible experiences. However, because of its very limited success rate in enabling women to become pregnant, rather than facilitating the transition of status from infertile to fertile woman, the clinic also served to reinforce the liminal experiences of those women who remained infertile. Inadvertently, the clinic offered a way of being in limbo while at the same time reinforcing the liminal experiences of women. PMID:17518825

Allan, Helen

2007-06-01

194

Clinical Experience of an Iontophoresis Based Glucose Measuring System  

PubMed Central

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45±52.99 mg/dL with a mean absolute relative error of 20±15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p<0.05)) and this correlation was independent of time of data collection. However, after excluding confounding variables this correlation coefficient exhibited a tendency to increase. 98.9% of the results were clinically acceptable by Clarke error grid analysis. We concluded that RIGMD does not have the reliability and accuracy required to wholly replace conventional methods. However, further technical advancements that reduce its shortcomings would make this device useful for the management of diabetes.

Rhee, Sang Youl; Chon, Suk; Koh, Gwanpyo; Paeng, Jeong Ryung; Oh, Seungjoon; Woo, Jeong-taek; Kim, Sung Woon; Kim, Jin-Woo

2007-01-01

195

Clinical experience with psychoanalytic post-termination meetings.  

PubMed

The authors describe post-termination meetings in order to examine the controversial issue of the proper relationship between analyst and patient at this stage. In the first case the meetings facilitated the patient's re-entering treatment, leading to significant further growth. In the second and third cases, the meetings re-ignited mourning for the analyst and furthered analytic gains. The authors' overall impression was that the post-termination contacts were helpful for all three patients. Their limited data contradicted the long-standing assumption that all post-termination contact, unless specified as a course of further treatment, is harmful to the patient. The authors suggest that such meetings stabilise analytic gains, provide a joint assessment of analytic outcome from a useful later perspective and provide an opportunity for further analytic work. The consideration of any post-termination changes in the patient allows for a more inclusive evaluation of the analysis than was possible earlier. While acknowledging the need to consider such meetings thoughtfully in order to avoid any harmful enactment of wishes by the patient or the analyst, the authors encourage analysts to explore and report such meetings to replace unexamined assumptions and develop a body of clinical data about the effects of post-termination contacts. PMID:9513017

Schachter, J; Martin, G C; Gundle, M J; O'Neil, M K

1997-12-01

196

A telepsychiatry transition clinic: the first 12 months experience.  

PubMed

To improve the management of soldiers with combat-related mental health problems, an interdisciplinary telepsychiatry service was established between a clinic at the Fort Bragg army base and the Veterans Affairs (VA) Medical Center in Salem. In the first 12 months of operation, 120 soldiers (105 males) were seen in a total of 394 telepsychiatry sessions. The time spent on telepsychiatry by the six VA psychiatrists increased from 13 hours in the first month to 41 hours in the twelfth month. The number of telepsychiatry sessions increased from nine in the first month to 56 in the twelfth month. The mean global assessment of function score (GAF) in the soldiers increased significantly (P < 0.001) from 58.0 at intake to 62.3 at the last visit. Soldiers received VA telepsychiatry on average 22 days after the initial consultation with a primary care provider, a reduction of at least eight days compared to the previous delay. The majority of soldiers (89%) who were treated by VA psychiatrists enrolled in the VA within about six months of discharge. Similar VA-US Military collaborations may prove beneficial for other military bases that have returning combat soldiers. PMID:21844181

Detweiler, Mark B; Arif, Saira; Candelario, Joseph; Altman, Joanne; Murphy, Pamela F; Halling, Mary H; Detweiler, Jonna G; Vasudeva, Sachinder

2011-01-01

197

Paradoxical vocal cord dysfunction: clinical experience and personal considerations  

PubMed Central

Summary Paradoxical vocal cord dysfunction is a nosographic entity that remains to be fully elucidated as far as concerns criteria required for diagnosis and underlying aetiopathogenesis. The disorder manifests with repeated episodes of acute dyspnoea associated with a series of symptoms that may include hoarseness, globus, chest pain and “shortness of breath”. A retrospective analysis of cases with acute dyspnoea referred to our Department between June 2004 and June 2005 revealed 3 patients with paradoxical vocal cord dysfunction. In 2 of these 3 cases, concomitant psychiatric morbidity was observed and the third also presented gastro-oesophageal reflux. In one patient, the episodes of dyspnoea were triggered by inspiration of irritating substances. Diagnosis of the condition requires a high level of suspicion, which is confirmed by a laryngoscopic investigation that demonstrates hyperadduction of the true vocal cords and a reduction of at least 50% in the breathing space. From a therapeutic point of view, patients with paradoxical vocal cord dysfunction require, in our opinion, a multidisciplinary approach; in fact, only a team comprising otorhinolaryngologists, phoniatricians, pulmonologists, neurologists, allergologists, psychotherapists and speech therapists is capable of defining the appropriate treatment according to the clinical and psychological characteristics of each individual patient. Our results with speech therapy, focused on respiratory and speech retraining, are reported.

Nacci, A; Fattori, B; Ursino, F; Rocchi, V; Matteucci, F; Citi, C; Bruschini, L; Rognini, F; La Vela, R; Dallan, I

2007-01-01

198

Paradoxical vocal cord dysfunction: clinical experience and personal considerations.  

PubMed

Paradoxical vocal cord dysfunction is a nosographic entity that remains to be fully elucidated as far as concerns criteria required for diagnosis and underlying aetiopathogenesis. The disorder manifests with repeated episodes of acute dyspnoea associated with a series of symptoms that may include hoarseness, globus, chest pain and "shortness of breath". A retrospective analysis of cases with acute dyspnoea referred to our Department between June 2004 and June 2005 revealed 3 patients with paradoxical vocal cord dysfunction. In 2 of these 3 cases, concomitant psychiatric morbidity was observed and the third also presented gastro-oesophageal reflux. In one patient, the episodes of dyspnoea were triggered by inspiration of irritating substances. Diagnosis of the condition requires a high level of suspicion, which is confirmed by a laryngoscopic investigation that demonstrates hyperadduction of the true vocal cords and a reduction of at least 50% in the breathing space. From a therapeutic point of view, patients with paradoxical vocal cord dysfunction require, in our opinion, a multidisciplinary approach; in fact, only a team comprising otorhinolaryngologists, phoniatricians, pulmonologists, neurologists, allergologists, psychotherapists and speech therapists is capable of defining the appropriate treatment according to the clinical and psychological characteristics of each individual patient. Our results with speech therapy, focused on respiratory and speech retraining, are reported. PMID:18198755

Nacci, A; Fattori, B; Ursino, F; Rocchi, V; Matteucci, F; Citi, C; Bruschini, L; Rognini, F; La Vela, R; Dallan, I

2007-10-01

199

Clinical experience with continuous glucose monitoring in adults.  

PubMed

Despite recent advances in therapy, achieving adequate glycemic control may be difficult for a large number of patients with diabetes. Real-time (RT)-continuous glucose monitoring (CGM) has the potential to improve glycemic control through immediate feedback to the properly trained patient. However, limitations exist both in interpreting the results of published randomized clinical trials on CGM use and in extrapolating the results to the diabetes population at large. This review summarizes the evidence for use, identifies suitable candidates, describes optimal implementation, and employs case scenarios in order to emphasize practical aspects of RT-CGM use in adults. Establishment of expectations and comprehensive education in intensive insulin therapy and RT-CGM use are necessary for successful implementation. Because the technology has been shown to be most useful in patients who are actively viewing and responding to RT data, patients should receive explicit instructions for active self-adjustment of insulin and lifestyle elements. While the technology is improving, false alarms remain a significant barrier to optimal use. The utility of RT-CGM for patients with severe hypoglycemia or hypoglycemia unawareness has not been established. Finally, studies are needed to determine the sustainability of improvements in glycemic control, as well as cost-effectiveness and practicality of implementation into busy real-world practice. PMID:19469683

Fabiato, Kristin; Buse, John; Duclos, Michelle; Largay, Joseph; Izlar, Camille; O'Connell, Thomas; Stallings, Jennifer; Dungan, Kathleen

2009-06-01

200

Surgical management of coracoid fractures: technical tricks and clinical experience.  

PubMed

The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures; surgical management may be warranted to avoid functional compromise or impingement. A direct approach through Langer's lines allows for easy exposure and direct visualization for an anatomic reduction of simple fractures through the shaft or base of the coracoid. An anterior approach for fractures that extend into the superior glenoid fossa allows for direct exposure to obtain an anatomic articular reduction and indirect reduction of the coracoid fracture. In cases where a complex glenoid or scapula neck/body fracture is being addressed simultaneously either a posterior Judet approach can be used with an indirect reduction method or a separate anterior approach must be combined to address it if not in continuity with the superior scapular segment. Implant selection, primarily interfragmentary screws or a buttress plate, should be based on the size of the fragment, the degree of comminution, and the degree of articular involvement to ensure adequate stabilization. The purpose of this manuscript was to describe a stepwise approach to the surgical management of displaced coracoid fractures, describe surgical tips and techniques, and to present the clinical outcomes in 22 patients after surgical treatment with this approach. PMID:24751608

Hill, Brian W; Jacobson, Aaron R; Anavian, Jack; Cole, Peter A

2014-05-01

201

Surgical treatment of colon cancer: Colentina surgical clinic experience.  

PubMed

Most patients with colon cancer are surgically treated, with postoperative association of chemotherapy and possibly immunotherapy in advanced cases. Surgical treatment is chosen depending on the evolution stage, tumor topography and the existence of complications, colonic surgery being dictated by colonic vascularization. The radical character of the surgical intervention can be assured only in the early stages of the tumor. Colostomy is rarely necessary in patients with colon cancer. In the period of the last 5 years (2007-2011), 307 patients with colon cancer were operated in "Colentina" Surgical Clinic, radical intervention being possible only in 219 cases. 48 cases were emergency interventions for occlusion or perforation with peritonitis. Every time the mechanical preparation of the bowel was not possible, the intraoperative washout technique was used. Postoperative complications were met in 27 cases, being represented by bleeding (3 cases), peritoneal abscess (5 cases), anastomotic fistula (7 cases), abdominal wound infection (12 cases). In 5 cases the operation was done laparoscopically. Preoperative mortality was of 13 cases. Postoperative chemotherapy was done in the great majority of cases. PMID:23144667

Mastalier, B; Tihon, C; Ghi??, B; Botezatu, C; Deaconescu, V; Mandisodza, P; Dr?ghici, C; Simion, S

2012-09-15

202

Initial Clinical Experience Using the Amplatzer Vascular Plug  

SciTech Connect

Background and purpose. The Amplatzer Vascular Plug (AVP) is a self-expanding nitinol wire mesh vascular embolization device derived from the Amplatz septal occluder. We assessed the results of vascular embolization obtained using the AVP. Methods. A retrospective review was carried out of 23 consecutive cases of vascular embolization using the AVP in a variety of different clinical settings. The AVP was chosen to have a diameter approximately 30-50% greater than the target vessel. The device was delivered via an appropriately sized guide catheter and was released when satisfactorily positioned. Additional embolic agents were used in some cases. Results. All target vessels were successfully occluded with no device malpositioning or malfunction. In 14 (61%) patients the AVP was the sole embolic material. In the remaining patients additional agents were used, particularly in preoperative embolization of highly vascular renal tumors. The AVP does not cause instantaneous thrombosis and in high-flow situations thrombosis typically takes up to 15 min. Conclusion. The AVP is a safe, effective embolization device that provides a useful adjunct to the therapeutic armamentarium. It is particularly suited to the treatment of short high-flow vessels where coil migration and catheter dislodgment might occur. In the majority of cases no additional embolic agents are necessary but it may take up to 15 min for complete thrombosis to occur.

Tuite, David J.; Kessel, David O., E-mail: david.kessel@leedsth.nhs.uk; Nicholson, Anthony A.; Patel, Jai V.; McPherson, Simon J.; Shaw, David R. [Leeds Teaching Hospitals NHS Trust, St. James University Hospital, Department of Vascular and Interventional Radiology (United Kingdom)

2007-07-15

203

[Clinical experience with BCG immune prevention in superficial bladder cancer].  

PubMed

Previous randomized studies have shown that in cases of superficial urothelial carcinoma or carcinoma in situ of the urinary bladder, complete and long-lasting remission can be obtained by immunotherapy with bacillus Calmette-Guérin (BCG). Such studies have shown that BCG reduces the recurrence rate significantly compared with transurethral resection alone. Our 6-year experience with BCG Pasteur strain (and Connaught strain, respectively) in tumour stages pTis, pTa and pT1 (G I-II) shows lasting remission in 88.5% (73%) of 78 (26) patients after transurethral resection of the tumour. A complete remission was found in 92% of patients with carcinoma in situ (12 patients). The local and the rare systemic side effects were all of limited duration, tolerable, easily treated and fully reversible. PMID:1302409

Bach, D; Romics, I; Rüssel, C

1992-09-01

204

Clinical experience with automatic midline echoencephalography: cooperative study of three neurosurgical clinics  

Microsoft Academic Search

Computerized midline echoencephalography was developed in order to make the determination of the midline more objective. In a group study involving the neurosurgical clinics in Berlin, Erlangen, and Munich, a total of 1,889 patients with various intracranial diseases was examined by this method. An exact analysis of the results obtained is presented: 18 percent were unsatisfactory.

M Klinger; E Kazner; T Grumme; V Amtenbrink; G Graef; K H Hartmann; H Hopman; W Meese; B Vogel

1975-01-01

205

Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)  

ERIC Educational Resources Information Center

A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

2009-01-01

206

Cooperating Teacher Evaluation of Candidates in Clinical Practice and Field Experiences  

ERIC Educational Resources Information Center

The Investigators hypothesized cooperating teachers' evaluations of candidates in clinical practice and field experiences would possess higher scores than those provided by clinical and education division faculty. However, the reasons for the higher scores proved to be much more complex than originally thought. While it was assumed that teachers…

Moffett, David W.; Zhou, Yunfang

2009-01-01

207

Undergraduate Nursing Students' Clinical Experiences in Rural and Remote Areas: Recruitment Implications.  

ERIC Educational Resources Information Center

Two urban Australian nursing students' stories of their experiences in clinical placements in rural and Aboriginal communities indicate their interest in and enthusiasm for returning to rural nursing after graduation. Unfortunately, many urban students are disadvantaged financially by the added expense of their rural clinical rotation. Assisting…

Neill, Jane; Taylor, Kerry

2002-01-01

208

Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward  

ERIC Educational Resources Information Center

Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

2013-01-01

209

Learning on clinical placement:the experience of six Australian student nurses  

Microsoft Academic Search

Concerns about the adequacy of clinical education in nursing courses in Australia have escalatedsince the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their

Carol A. Nolan

1998-01-01

210

Microwave imaging for neoadjuvant chemotherapy monitoring: initial clinical experience  

PubMed Central

Introduction Microwave tomography recovers images of tissue dielectric properties, which appear to be specific for breast cancer, with low-cost technology that does not present an exposure risk, suggesting the modality may be a good candidate for monitoring neoadjuvant chemotherapy. Methods Eight patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer were imaged longitudinally five to eight times during the course of treatment. At the start of therapy, regions of interest (ROIs) were identified from contrast-enhanced magnetic resonance imaging studies. During subsequent microwave examinations, subjects were positioned with their breasts pendant in a coupling fluid and surrounded by an immersed antenna array. Microwave property values were extracted from the ROIs through an automated procedure and statistical analyses were performed to assess short term (30 days) and longer term (four to six months) dielectric property changes. Results Two patient cases (one complete and one partial response) are presented in detail and demonstrate changes in microwave properties commensurate with the degree of treatment response observed pathologically. Normalized mean conductivity in ROIs from patients with complete pathological responses was significantly different from that of partial responders (P value = 0.004). In addition, the normalized conductivity measure also correlated well with complete pathological response at 30 days (P value = 0.002). Conclusions These preliminary findings suggest that both early and late conductivity property changes correlate well with overall treatment response to neoadjuvant therapy in locally advanced breast cancer. This result is consistent with earlier clinical outcomes that lesion conductivity is specific to differentiating breast cancer from benign lesions and normal tissue.

2013-01-01

211

Clinical review: The Israeli experience: conventional terrorism and critical care  

PubMed Central

Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.

Aschkenasy-Steuer, Gabriella; Shamir, Micha; Rivkind, Avraham; Mosheiff, Rami; Shushan, Yigal; Rosenthal, Guy; Mintz, Yoav; Weissman, Charles; Sprung, Charles L; Weiss, Yoram G

2005-01-01

212

Clinical management of cocaine body packers: the Hillingdon experience  

PubMed Central

Background International smuggling of cocaine by internal concealment is a serious and growing problem. People who engage in this practice are commonly referred to as body packers or mules. The most serious risks associated with body packing include intestinal obstruction and death from cocaine intoxication. These patients were previously managed primarily by surgical retrieval. This was associated with significant mortality due to rupture of poorly constructed cocaine packages. More recently, conservative management using whole bowel irrigation with polyethylene-glycol (Klean-prep Norgine) has been shown to be safe for most patients. To date, however, a consistent approach for the management of these patients has not been established. Methods We retrospectively reviewed the case notes, prescription charts and radiological investigations of all body packers admitted to our unit between 2000 and 2005, concentrating on initial management, complications and outcome. Results We identified 61 patients for inclusion. Of these, 56 were managed conservatively with a selection of aperients and laxatives. Six patients were treated successfully for cocaine toxicity and 5 required surgical retrieval of cocaine packets. Conclusion Our results confirm the safety of a conservative approach. Based on our experience and a review of the literature, we have devised a treatment protocol to reduce the risk of complications and the length of stay in hospital.

Beckley, Ian; Ansari, Nabeel A.A.; Khwaja, Haris A.; Mohsen, Yasser

2009-01-01

213

"Drop in" gastroscopy outpatient clinic - experience after 9 months  

PubMed Central

Background Logistics handling referrals for gastroscopy may be more time consuming than the examination itself. For the patient, "drop in" gastroscopy may reduce uncertainty, inadequate therapy and time off work. Methods After an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with "drop in" gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated. Results 112 patients had "drop in" gastroscopy and 101 gastroscopy by appointment. The number of "drop in" patients varied between 3 and 12 per day (mean 6.5). Mean time from first GP consultation to gastroscopy was 3.6 weeks in the "drop in" group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing "drop in" to 1022 after (47% increase) and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with "drop in". Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff. Conclusions "Drop in" gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise "drop in" outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented.

2012-01-01

214

Work Experience Program at a Metropolitan Paediatric Hospital: Assisting Rural and Metropolitan Allied Health Professionals Exchange Clinical Skills.  

ERIC Educational Resources Information Center

A clinical experience program provided 29 rural Australian allied health professionals with experience in pediatric clinical areas and opportunities to share clinical knowledge and develop networks with metropolitan peers. Questionnaires and focus groups indicated that networking, clinical skills, knowledge, confidence, and awareness of rural…

Parkin, Ann E.; McMahon, Sandra; Upfield, Nancy; Copley, Jodie; Hollands, Karen

2001-01-01

215

A Clinical Experience for Pharmacy Students in a Skilled Nursing Facility.  

ERIC Educational Resources Information Center

At the University of California-San Francisco, a multidisciplinary teaching group from dentistry, medicine, nursing, pharmacy, and social/behavioral sciences leads a multidisciplinary student team in a clinical experience in a nursing home. The program provides specialized experience in geriatric care and encourages teamwork. (MSE)

Leeds, Andrew L.

1993-01-01

216

Experiences of clinical teaching for dental core trainees working in hospital.  

PubMed

There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching. PMID:25012332

Mannion, C J; Brotherton, P

2014-07-11

217

Clinical experience with exenatide in a routine secondary care diabetes clinic  

Microsoft Academic Search

Exenatide use in type 2 diabetes is limited in routine clinical practice. We examined a cross-section of 90 patients. Mean weight and HBA1c were 114.9±20.6kg, 10.3±2.1% at initiation; 108.0±15.3kg (p<0.0001), 9.0±2.1% (p<0.001) at 3 months; 109.2±18.2kg (p<0.0001), 9.5±2.3% (p=0.08) at 6 months. Exenatide appears effective in reducing HBA1c and weight.

B. Natarajan; M. Edavalath; J. Davies; L. Jenkins; N. Marshall-Richards; D. Evans; D. E. Price; S. C. Bain; J. W. Stephens

2010-01-01

218

In utero Repair of Myelomeningocele: Rationale, Initial Clinical Experience and a Randomized Controlled Prospective Clinical Trial  

PubMed Central

Myelomeningocele (MMC), one of the most common congenital malformations, can result in severe lifelong disabilities, including paraplegia, hydrocephalus, Arnold-Chiari II malformation, incontinence, sexual dysfunction, skeletal deformations, and mental impairment. MMC was the first nonlethal anomaly to be treated by fetal surgery. Studies in animals provide compelling evidence that the primary cause of the neurological deficit associated with MMC is not simply incomplete neurulation but rather chronic mechanical injury and amniotic-fluid-induced chemical trauma that progressively damage the exposed neural tissue during gestation. Initial results suggest that the surgical repair of MMC before 25 weeks of gestation may preserve neurological function, reverse the hindbrain herniation of the Arnold-Chiari II malformation, and obviate the need for postnatal placement of a ventriculoperitoneal shunt. As it is currently unknown whether fetal surgery for MMC is truly beneficial compared to standard postnatal care, a randomized, controlled clinical trial has been initiated within the United States.

Danzer, Enrico; Flake, Alan W.

2008-01-01

219

The radiobiology/radiation protection interface in healthcare.  

PubMed

The current knowledge of radiation effects is reviewed and implications for its application in healthcare considered. The 21st L H Gray conference gathered leading experts in radiobiology, radiation epidemiology, radiation effect modelling, and the application of radiation in medicine to provide an overview of the subject. The latest radiobiology research in non-targeted effects such as genomic instability and the bystander effect challenge the old models, but the implications for health effects on humans are uncertain. Adaptive responses to external stresses, of which radiation is one, have been demonstrated in cells and animal models, but it is not known how these might modify human dose-effect relationships. Epidemiological evidence from the Japanese A-bomb survivors provides strong evidence that there is a linear relationship between the excess risk of cancer and organ dose that extends from about 50 mSv up to 2.5 Sv, and results from pooled data for multiple epidemiological studies indicate that risks extend down to doses of 20 mSv. Thus linear extrapolation of the A-bomb dose-effect data provides an appropriate basis for radiological protection standards at the present time. Risks from higher dose diagnostic procedures fall within the range in which health effects can be demonstrated. There is therefore reason for concern about the rise in the number of computed tomography (CT) scans performed in many countries, and in particular the use of CT for screening of asymptomatic individuals. New radiotherapy techniques allow high dose radiation fields to be conformed more effectively to target volumes, and reduce doses to critical organs, but they tend to give a higher and more uniform dose to the whole body which may increase the risk of second cancer. It is important that radiation protection practitioners keep abreast of developments in understanding of radiation effects and advise the medical community about the implications of fundamental research when planning medical applications for the future. PMID:19454808

Martin, C J; Sutton, D G; West, C M; Wright, E G

2009-06-01

220

A study of the radiobiological modeling of the conformal radiation therapy in cancer treatment  

NASA Astrophysics Data System (ADS)

Cancer is one of the leading causes of mortalities in the world. The precise diagnosis of the disease helps the patients to select the appropriate modality of the treatments such as surgery, chemotherapy and radiation therapy. The physics of X-radiation and the advanced imaging technologies such as positron emission tomography (PET) and computed tomography (CT) plays an important role in the efficient diagnosis and therapeutic treatments in cancer. However, the accuracy of the measurements of the metabolic target volumes (MTVs) in the PET/CT dual-imaging modality is always limited. Similarly the external beam radiation therapy (XRT) such as 3D conformal radiotherapy (3DCRT) and intensity modulated radiation therapy (IMRT) is the most common modality in the radiotherapy treatment. These treatments are simulated and evaluated using the XRT plans and the standard methodologies in the commercial planning system. However, the normal organs are always susceptible to the radiation toxicity in these treatments due to lack of knowledge of the appropriate radiobiological models to estimate the clinical outcomes. We explored several methodologies to estimate MTVs by reviewing various techniques of the target volume delineation using the static phantoms in the PET scans. The review suggests that the more precise and practical method of delineating PET MTV should be an intermediate volume between the volume coverage for the standardized uptake value (SUV; 2.5) of glucose and the 50% (40%) threshold of the maximum SUV for the smaller (larger) volume delineations in the radiotherapy applications. Similarly various types of optimal XRT plans were designed using the CT and PET/CT scans for the treatment of various types of cancer patients. The qualities of these plans were assessed using the universal plan-indices. The dose-volume criteria were also examined in the targets and organs by analyzing the conventional dose-volume histograms (DVHs). The biological models such as tumor control probability based on Poisson statistics model, and normal tissue complication probabilities based on Lyman-Kutcher-Burman model, were efficient to estimate the radiobiological outcomes of the treatments by taking into account of the dose-volume effects in the organs. Furthermore, a novel technique of spatial DVH analysis was also found to be useful to determine the primary cause of the complications in the critical organs in the treatments. The study also showed that the 3DCRT and IMRT techniques offer the promising results in the XRT treatment of the left-breast and the prostate cancer patients respectively. Unfortunately, several organs such as salivary glands and larynx, and esophagus, were found to be significantly vulnerable to the radiation toxicity in the treatment of the head and neck (HN), and left-lung cancer patients respectively. The radiobiological outcomes were also found to be consistent with the clinical results of the IMRT based treatments of a significant number of the HN cancer patients.

Pyakuryal, Anil Prasad

221

[Calcium blockers in the therapy of vertebrobasilar insufficiency. Results of animal experiments and clinical studies].  

PubMed

Vertebrobasilar insufficiency (VBI) is a clinical syndrome which includes different transient brain stem symptoms. In addition to anamnesis and clinical study electronystagmography (ENG) is regarded as the most important method for testing the labyrinthine and brain stem system. Typical findings, not only in patients with VBI, but also in animal experiments (occlusion of one vertebral artery) are an increase in nystagmus frequency and decrease in nystagmus amplitude. The present study concerns two calcium antagonists: flunarizine and nimodipine. During tests on patients the caloric and the rotatory nystagmus and during animal experiments the rotatory nystagmus was investigated. Patient tests as well as animal experiments showed, that flunarizine and nimodipine have a depressant influence on the pathologically increased nystagmus frequency. With both substances there was also a trend to normalization of nystagmus amplitude as well as an improvement of clinical symptoms. PMID:6383990

Hofferberth, B

1984-07-26

222

Clinical Outcome and Safety of Multilevel Vertebroplasty: Clinical Experience and Results  

SciTech Connect

To compare safety and efficacy of percutaneous vertebroplasty (PVP) when treating up to three vertebrae or more than three vertebrae per session. We prospectively compared two groups of patients with symptomatic vertebral fractures who had no significant response to conservative therapy. Pathologic substrate included osteoporosis (n = 77), metastasis (n = 24), multiple myeloma (n = 13), hemangioma (n = 15), and lymphoma (n = 1). Group A patients (n = 94) underwent PVP of up to three treated vertebrae (n = 188). Group B patients (n = 36) underwent PVP with more than three treated vertebrae per session (n = 220). Decreased pain and improved mobility were recorded the day after surgery and at 12 and 24 months after surgery per clinical evaluation and the use of numeric visual scales (NVS): the Greek Brief Pain Inventory, a linear analogue self-assessment questionnaire, and a World Health Organization questionnaire. Group A presented with a mean pain score of 7.9 {+-} 1.1 NVS units before PVP, which decreased to 2.1 {+-} 1.6, 2.0 {+-} 1.5 and 2.0 {+-} 1.5 NVS units the day after surgery and at 12 and 24 months after surgery, respectively. Group B presented with a mean pain score of 8.1 {+-} 1.3 NVS units before PVP, which decreased to 2.2 {+-} 1.3, 2.0 {+-} 1.5, and 2.1 {+-} 1.6 NVS units the day after surgery and at 12 and 24 months after surgery, respectively. Overall pain decrease and mobility improvement throughout the follow-up period presented no statistical significance neither between the two groups nor between different underlying aetiology. Reported cement leakages presented no statistical significance between the two groups (p = 0.365). PVP is an efficient and safe technique for symptomatic vertebral fractures independently of the vertebrae number treated per session.

Mailli, Leto, E-mail: lmailli@hotmail.com; Filippiadis, Dimitrios K.; Brountzos, Elias N.; Alexopoulou, Efthymia; Kelekis, Nikolaos; Kelekis, Alexios [Attikon University Hospital, Second Department of Radiology, Athens University School of Medicine (Greece)] [Attikon University Hospital, Second Department of Radiology, Athens University School of Medicine (Greece)

2013-02-15

223

The role of technological progress vs. accidental discoveries and clinical experience in the evolution of dialysis  

PubMed Central

The 50th anniversary of dialysotherapy celebrated by nephrologists around the world in 2012 provided an opportunity for discussion on the role of clinical experience in relation to technological progress in the evolution of dialysis, especially of recently observed inadequate decrease in mortality/morbidity rates of patients on chronic dialysis. My report, based on almost 50 years of career in nephrology, refers the evolution of dialysis, from catharsis to modern dialysotherapy with special attention devoted to nowadays gravely underestimated role of clinical experience and personalized professional care for patients.

Wankowicz, Zofia

2013-01-01

224

Radiograaff, a proton irradiation facility for radiobiological studies at a 4 MV Van de Graaff accelerator  

NASA Astrophysics Data System (ADS)

A horizontal beam facility for radiobiological experiments with low-energy protons has been set up at the 4 MV Van de Graaff accelerator of the Institut de Physique Nucléaire de Lyon. A homogeneous irradiation field with a suitable proton flux is obtained by means of two collimators and two Au-scattering foils. A monitoring chamber contains a movable Faraday cup, a movable quartz beam viewer for controlling the intensity and the position of the initial incident beam and four scintillating fibers for beam monitoring during the irradiation of the cell samples. The beam line is ended by a thin aluminized Mylar window (12 ?m thick) for the beam extraction in air. The set-up was simulated by the GATE v6.1 Monte-Carlo platform. The measurement of the proton energy distribution, the evaluation of the fluence-homogeneity over the sample and the calibration of the monitoring system were performed using a silicon PIPS detector, placed in air in the same position as the biological samples to be irradiated. The irradiation proton fluence was found to be homogeneous to within ±2% over a circular field of 20 mm diameter. As preliminary biological experiment, two Human Head and Neck Squamous Carcinoma Cell lines (with different radiosensitivities) were irradiated with 2.9 MeV protons. The measured survival curves are compared to those obtained after X-ray irradiation, giving a Relative Biological Efficiency between 1.3 and 1.4.

Constanzo, J.; Fallavier, M.; Alphonse, G.; Bernard, C.; Battiston-Montagne, P.; Rodriguez-Lafrasse, C.; Dauvergne, D.; Beuve, M.

2014-09-01

225

Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting.  

PubMed

Successful interprofessional teams are essential when caring for older adults with multiple complex medical conditions that require ongoing management from a variety of disciplines across healthcare settings. To successfully integrate interprofessional education into the healthcare professions curriculum, the most effective learning experiences should utilize adult learning principles, reflect real-life practice, and allow for interaction among trainees representing a variety of health professions. Interprofessional clinical experiences are essential to prepare future healthcare professionals to provide quality patient care and understand the best methods for utilizing members of the healthcare team to provide that care. To meet this need, the University of Alabama at Birmingham Geriatric Education Center has developed an Interprofessional Clinical Experience (ICE) to expose future healthcare providers to an applied training experience with older adults in the nursing home setting. This paper outlines how this program was developed, methods used for program evaluation, and how the outcome data influenced program revisions. PMID:23631410

Ford, Channing R; Foley, Kathleen T; Ritchie, Christine S; Sheppard, Kendra; Sawyer, Patricia; Swanson, Mark; Harada, Caroline N; Brown, Cynthia J

2013-07-01

226

A comparative analysis of radiobiological models for cell surviving fractions at high doses.  

PubMed

For many years the linear-quadratic (LQ) model has been widely used to describe the effects of total dose and dose per fraction at low-to-intermediate doses in conventional fractionated radiotherapy. Recent advances in stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have increased the interest in finding a reliable cell survival model, which will be accurate at high doses, as well. Different models have been proposed for improving descriptions of high dose survival responses, such as the Universal Survival Curve (USC), the Kavanagh-Newman (KN) and several generalizations of the LQ model, e.g. the Linear-Quadratic-Linear (LQL) model and the Pade Linear Quadratic (PLQ) model. The purpose of the present study is to compare a number of models in order to find the best option(s) which could successfully be used as a fractionation correction method in SRT. In this work, six independent experimental data sets were used: CHOAA8 (Chinese hamster fibroblast), H460 (non-small cell lung cancer, NSLC), NCI-H841 (small cell lung cancer, SCLC), CP3 and DU145 (human prostate carcinoma cell lines) and U1690 (SCLC). By detailed comparisons with these measurements, the performance of nine different radiobiological models was examined for the entire dose range, including high doses beyond the shoulder of the survival curves. Using the computed and measured cell surviving fractions, comparison of the goodness-of-fit for all the models was performed by means of the reduced ? (2)-test with a 95% confidence interval. The obtained results indicate that models with dose-independent final slopes and extrapolation numbers generally represent better choices for SRT. This is especially important at high doses where the final slope and extrapolation numbers are presently found to play a major role. The PLQ, USC and LQL models have the least number of shortcomings at all doses. The extrapolation numbers and final slopes of these models do not depend on dose. Their asymptotes for the cell surviving fractions are exponentials at low as well as high doses, and this is in agreement with the behaviour of the corresponding experimental data. This is an important improvement over the LQ model which predicts a Gaussian at high doses. Overall and for the highlighted reasons, it was concluded that the PLQ, USC and LQL models are theoretically well-founded. They could prove useful compared to the other proposed radiobiological models in clinical applications for obtaining uniformly accurate cell surviving fractions encountered in stereotactic high-dose radiotherapy as well as at medium and low doses. PMID:23098282

Andisheh, B; Edgren, M; Belki?, Dž; Mavroidis, P; Brahme, A; Lind, B K

2013-04-01

227

An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.  

PubMed

Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research evidence are crucial to realising clinical practice for nurse educators. Alternative interpretations of what may constitute the clinical role such as joint research projects and supporting and supervising students are offered, which need to be assessed against clear, specific and realistic aims for the clinical role of the nurse educator. PMID:18586358

Williams, Angela; Taylor, Cathy

2008-11-01

228

Radiobiological modeling of interplay between accelerated repopulation and altered fractionation schedules in head and neck cancer.  

PubMed

Head and neck cancer represents a challenge for radiation oncologists due to accelerated repopulation of cancer cells during treatment. This study aims to simulate, using Monte Carlo methods, the response of a virtual head and neck tumor to both conventional and altered fractionation schedules in radiotherapy when accelerated repopulation is considered. Although clinical trials are indispensable for evaluation of novel therapeutic techniques, they are time-consuming processes which involve many complex and variable factors for success. Models can overcome some of the limitations encountered by trials as they are able to simulate in less complex environment tumor cell kinetics and dynamics, interaction processes between cells and ionizing radiation and their outcome. Conventional, hyperfractionated and accelerated treatment schedules have been implemented in a previously developed tumor growth model which also incorporates tumor repopulation during treatment. This study focuses on the influence of three main treatment-related parameters, dose per fraction, inter fraction interval and length of treatment gap and gap timing based on RTOG trial data on head and neck cancer, on tumor control. The model has shown that conventionally fractionated radiotherapy is not able to eradicate the stem population of the tumor. Therefore, new techniques such as hyperfractionated/ accelerated radiotherapy schedules should be employed. Furthermore, the correct selection of schedule-related parameters (dose per fraction, time between fractions, treatment gap scheduling) is crucial in overcoming accelerated repopulation. Modeling of treatment regimens and their input parameters can offer better understanding of the radiobiological interactions and also treatment outcome. PMID:20098550

Marcu, Loredana G; Bezak, Eva

2009-10-01

229

Introductory and Advanced Pharmacy Practice Experiences Within Campus-based Influenza Clinics  

PubMed Central

Objective. To describe the development, implementation, and assessment of an introductory and an advanced pharmacy practice experience (IPPE and APPE) integrated within campus-based influenza clinics. Design. The influenza clinics were designed to incorporate the learning objectives for the IPPE and APPE, and included preparatory sessions, online learning, and direct patient interactions tailored to the appropriate education level of the learner. Assessment. The clinics provided influenza vaccinations to 2,292 and 2,877 individuals in 2010 and 2011, respectively. The clinics allowed for experiential education of 39 students earning a total of 467 IPPE and APPE hours in 2010 and 58 students earning a total of 656 IPPE and APPE hours in 2011. Third-year students were assessed before and after completing the IPPE, and improvement was seen in knowledge and self-ratings of perceptions and attitudes toward administering immunizations. Conclusions. Integrating pharmacy practice experiences within campus-based influenza clinics was an effective way to provide students with direct patient care experience and preventive health services knowledge.

Johnson, Eric J.; Hagemann, Tracy M.

2013-01-01

230

Animal experiments and clinical application of olfactory ensheathing cell transplantation for treatment of spinal cord injury  

Microsoft Academic Search

BACKGROUND: The olfactory epithelium can still generate new neurons after arresting its growth and development in the human body. Axons can still be generated and pass through peripheral tissue to reach the olfactory bulb. Thus, olfactory cells have been widely used in the repair of spinal cord injury. OBJECTIVE: Using animal experiments in conjunction with a clinical study of olfactory

Nan Liu; Wei Liu; Baiyu Zhou; Jing Wang; Bing Li

231

Clinical Experience with Transdermal and Orally Administered Opioids in Palliative Care Patients—A Retrospective Study  

Microsoft Academic Search

Background: Transdermal fentanyl is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, based on our clinical experience, transdermal fentanyl is often not efficacious in terminally ill palliative care patients. We thus retrospectively examined the pain management and need for opioid switching in cancer

Katri Elina Clemens; Eberhard Klaschik

2007-01-01

232

Nursing students'experience of care planning activities in clinical education  

Microsoft Academic Search

This paper summarises a research studyinquiring into the experiences of nursing students of their practice of individualised care planning as a learning activity. The survey was conducted in the final stage of the students' education and concerned three groups of students in the years 1990, 1992 and 1993 who were asked to evaluate their main clinical placements in surgical, medical

Ingrid Thorell-Ekstrand; Hjördis Bjorvell

1995-01-01

233

Second Year Associate Degree Nursing Students and Nursing Faculty Attitudes towards Clinical Educational Experiences  

ERIC Educational Resources Information Center

Professional registered nursing is an essential part of the health care system and student nurses need experimental learning with actual patients to learn to practice as a nurse. The health care system has changed dramatically and nursing schools have decreasing access to the health care agencies. The clinical educational experience develops…

LaFauci, Frances F.

2009-01-01

234

A Tool To Evaluate How to Learn from Experience in Clinical Settings.  

ERIC Educational Resources Information Center

An evaluation tool for the process of learning from experience in a clinical practicum at baccalaureate nursing level was developed and validated. This reflective type of process evaluation helps students link theory to practice and think critically. (Contains 50 references.) (JOW)

Dumas, Louise; Villeneuve, Jean; Chevrier, Jacques

2000-01-01

235

The Working Practices and Clinical Experiences of Paediatric Speech and Language Therapists: A National UK Survey  

ERIC Educational Resources Information Center

Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and…

Pring, Tim; Flood, Emma; Dodd, Barbara; Joffe, Victoria

2012-01-01

236

Personal Experiences of Taking Part in Clinical Trials - A Qualitative Study | accrualnet.cancer.gov  

Cancer.gov

A key finding of this broad examination of participants’ trial experiences is that written materials for clinical trials are usually too detailed and difficult to comprehend. Participants preferred brief brochures with an opportunity to ask questions rather than being left alone with a complex document that contains medical jargon. They also tended to be interested in receiving feedback on research results.

237

The Safe use of Radioactive Isotopes in Teaching Experiments  

ERIC Educational Resources Information Center

This article briefly discusses some of the dangers involved in the use of radioisotopes and includes a comprehensive list of precautions and laboratory rules for use during radiobiology experiments. (Author)

Hawcroft, D. M.; Stewart, J. C.

1974-01-01

238

Role and function of a paediatric clinical ethics service: experiences at the Royal Children's Hospital, Melbourne.  

PubMed

This article explores and analyses the role and functions of a clinical ethics service in paediatrics. It is based on the experiences of developing ethics capacity at the Royal Children's Hospital, Melbourne, which has evolved since 2002 from a multidisciplinary advisory panel into Australia's first dedicated paediatric Children's Bioethics Centre, which opened in 2008. The ultimate goal is building ethics capacity and literacy across the hospital and continuing to support clinical staff managing patients and their families in ethically problematic cases. This is achieved through current case consultation, education and training, research and institutional policy, and guideline development. The experience of building a clinical ethics service has led to many changes to its structure over the years, with issues like timeliness of meeting, constitution of the group and referral and reporting structures arising as key elements of evolution. Challenges include resourcing and structure, institutional support, and family involvement in ethics consultations. PMID:21951448

Gold, Hugo; Hall, Georgina; Gillam, Lynn

2011-09-01

239

Radiobiological study by using laser-driven proton beams  

SciTech Connect

Particle acceleration driven by high-intensity laser systems is widely attracting interest as a potential alternative to conventional ion acceleration, including ion accelerator applications to tumor therapy. Recent works have shown that a high intensity laser pulse can produce single proton bunches of a high current and a short pulse duration. This unique feature of laser-ion acceleration can lead to progress in the development of novel ion sources. However, there has been no experimental study of the biological effects of laser-driven ion beams. We describe in this report the first demonstrated irradiation effect of laser-accelerated protons on human lung cancer cells. In-vitro A549 cells are irradiated with a proton dose of 20 Gy, resulting in a distinct formation of gamma-H2AX foci as an indicator of DNA double-strand breaks. This is a pioneering result that points to future investigations of the radiobiological effects of laser-driven ion beams. The laser-driven ion beam is apotential excitation source for time-resolved determination of hydroxyl (OH) radical yield, which will explore relationship between the fundamental chemical reactions of radiation effects and consequent biological processes.

Yogo, A.; Nishikino, M.; Mori, M.; Ogura, K.; Sagisaka, A.; Orimo, S.; Nishiuchi, M.; Pirozhkov, A. S.; Ikegami, M.; Tampo, M.; Sakaki, H.; Suzuki, M.; Daito, I.; Kiriyama, H.; Okada, H.; Kanazawa, S.; Kondo, S.; Shimomura, T.; Nakai, Y.; Kawachi, T. [Photo-Medical Research Center and Advanced Photon Research Center, Japan Atomic Eenrgy Agency, Kyoto 619-0215 (Japan)

2009-07-25

240

Amchitka Radiobiological Program progress report, January 1979-December 1979  

SciTech Connect

The objective of the Amchitka Radiobiological Program for the period 1970-1979 was to determine the extent of radionuclide contamination from world-wide atmospheric fallout and from the detonation of three underground nuclear blasts on Amchitka Island. The objective is achieved, by the collection and radiological analyses of biological and environmental samples and by background radiation measurements. Leakage of radionuclides from the underground sites of the Amchitka nuclear detonations would be suspected if the contamination was significntly greater than would be expected from world fallout. An account of the program from July 1970 to December 1978 has been given in nine previous reports from the Laboratory of Radiation Ecology to the Nevada Operations Office of the US Department of Energy. This report is an account of the program for calendar year 1979. The results of analyses of the samples collected in 1979 lead to the same conclusions as in previous years; i.e., there is no evidence that the radionuclide contamination at Amchitka Island is greater than would be expected from world fallout except for a slight contamination of the Long Shot Mud Pits with tritium.

Thornberg, L.D.; Sibley, T.H.; Nakatani, R.E.

1980-07-01

241

Stochastic, weighted hit size theory of cellular radiobiological action  

SciTech Connect

A stochastic theory that appears to account well for the observed responses of cell populations exposed in radiation fields of different qualities and for different durations of exposure is described. The theory appears to explain well most cellular radiobiological phenomena observed in at least autonomous cell systems, argues for the use of fluence rate (phi) instead of absorbed dose for quantification of the amount of radiation involved in low level radiation exposure. With or without invoking the cell sensitivity function, the conceptual improvement would be substantial. The approach suggested also shows that the absorbed dose-cell response functions currently employed do not reflect the spectrum of cell sensitivities to increasing cell doses of a single agent, nor can RBE represent the potency ratio for different agents that can produce similar quantal responses. Thus, for accurate comparison of cell sensitivities among different cells in the same individual, or between the cells in different kinds of individuals, it is necessary to quantify cell sensitivity in terms of the hit size weighting or cell sensitivity function introduced here. Similarly, this function should be employed to evaluate the relative potency of radiation and other radiomimetic chemical or physical agents.

Bond, V.P.; Varma, M.N.

1982-01-01

242

Two-dimensional inverse planning and delivery for precision preclinical radiobiological investigations  

NASA Astrophysics Data System (ADS)

Advances in preclinical radiotherapy systems have provided the technical foundations for delivering highly heterogeneous dose distributions for unique radiobiological experiments, but methods to deliver arbitrary dose distributions are in their infancy. This study developed a method to optimize and automatically deliver planar dose distributions on a recently developed preclinical radiotherapy platform. The method was based on empirically determined dose kernel distributions from radiochromic film measurements. These kernels were used to determine optimal animal stage positions and beam weights to deliver a desired dose distribution at a given depth using a sequential quadratic programming optimization algorithm. The method was validated by end-to-end delivery of two dosimetric challenges designed to quantify targeting and dosimetric accuracy. The results revelead an overall targeting accuracy of 112 ?m and a dosimetric delivery error, calculated along four line profiles in radiochromic film measurements, of 6.8%. Mean absolute delivery error across a linear dose gradient between 0 and 1 Gy over 7.5 mm was 0.03 Gy. These results confirm the optimization framework is an effective platform for delivery of millimetre scale heterogeneous dose distributions with sub-millimetre accuracy.

Stewart, J. M. P.; Lindsay, P. E.; Jaffray, D. A.

2014-03-01

243

Estimation of a Self-Consistent Set of Radiobiological Parameters From Hypofractionated Versus Standard Radiation Therapy of Prostate Cancer  

SciTech Connect

Purpose: To determine a self-consistent set of radiobiological parameters in prostate cancer. Methods and Materials: A method to estimate intrinsic radiosensitivity (?), fractionation sensitivity (?/?), repopulation doubling time, number of clonogens, and kick-off time for accelerated repopulation of prostate cancer has been developed. Based on the generalized linear-quadratic model and without assuming the isoeffective hypothesis, the potential applications of the method were investigated using the clinical outcome of biochemical relapse-free survival recently reviewed in the literature. The strengths and limitations of the method, regarding the fitted parameters and 95% confidence intervals (CIs), are also discussed. Results: Our best estimate of ?/? is 2.96 Gy (95% CI 2.41-3.53 Gy). The corresponding ? value is 0.16 Gy{sup ?1} (95% CI 0.14-0.18 Gy{sup ?1}), which is compatible with a realistic number of clonogens: 6.5 × 10{sup 6} (95% CI 1.5 × 10{sup 6}-2.1 × 10{sup 7}). The estimated cell doubling time is 5.1 days (95% CI 4.2-7.2 days), very low if compared with that reported in the literature. This corresponds to the dose required to offset the repopulation occurring in 1 day of 0.52 Gy/d (95% CI 0.32-0.68 Gy/d). However, a long kick-off time of 31 days (95% CI 22-41 days) from the start of radiation therapy was found. Conclusion: The proposed analytic/graphic method has allowed the fitting of clinical data, providing a self-consistent set of radiobiological parameters for prostate cancer. With our analysis we confirm a low value for ?/? with a correspondingly high value of intrinsic radiosensitivity, a realistic average number of clonogens, a long kick-off time for accelerated repopulation, and a surprisingly fast repopulation that suggests the involvement of subpopulations of specifically tumorigenic stem cells during continuing radiation therapy.

Pedicini, Piernicola, E-mail: ppiern@libero.it [Service of Medical Physics, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Italy)] [Service of Medical Physics, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Italy); Strigari, Lidia [Laboratory of Medical Physics and Expert Systems, Istituto Nazionale Tumori Regina Elena, Rome (Italy)] [Laboratory of Medical Physics and Expert Systems, Istituto Nazionale Tumori Regina Elena, Rome (Italy); Benassi, Marcello [Service of Medical Physics, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Italy)] [Service of Medical Physics, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (Italy)

2013-04-01

244

The association between demographic factors, user reported experiences and user satisfaction: results from three casualty clinics in Norway  

PubMed Central

Background User reported experiences and satisfaction are increasingly used as basis for quality indicators in the health sector. However, there is limited understanding of factors associated with user reported experiences and satisfaction with casualty clinics. Methods A random sample of 542 patients that had contacted any of three casualty clinics from mid April to mid May 2008 was mailed a questionnaire. A reminder was sent to non-respondents after six weeks. Descriptive statistics for four user reported experiences scales and 20 single items are presented. Multivariate regression analysis was used to assess associations between background variables and user reported experiences, and between user reported experiences and user satisfaction. Results 225 (41.5%) patients, carers and guardians returned a completed questionnaire. Users reported most positive experiences with the doctor services and the nursing services at the casualty clinics; on a scale from 0 to 100, where 100 is the best possible experience the doctor scale was 82 and the nursing scale 81. Users reported least positive experiences with the organization of the casualty clinic, with a scale score of 65. Self perceived health was associated with user satisfaction, while self perceived health and age were associated with user reported experiences with organization of the clinics. A range of user reported experience domains were related to user satisfaction, after controlling for socio-demographic variables, including experiences with doctor services at the clinics, organization of the clinics, information and self perceived incorrect treatment. Conclusions Users report positive experiences with the three casualty clinics, with organization as the aspect with largest improvement potential. The importance of age and health status for users' experiences and satisfaction with casualty clinics was shown, but a range of user reported experiences with the clinics were the most important predictors for user satisfaction.

2010-01-01

245

Neural and cognitive basis of spiritual experience: biopsychosocial and ethical implications for clinical medicine.  

PubMed

The role of patient spirituality and spiritual/liminal experience(s; SE) in the clinical setting has generated considerable equivocality within the medical community. Spiritual experience(s), characterized by circumstance, manifestation, and interpretation, reflect patients' explanatory models. We seek to demonstrate the importance of SE to clinical medicine by illustrating biological, cognitive, and psychosocial domains of effect. Specifically, we address where in the brain these events are processed and what types of neural events may be occurring. We posit that existing evidence suggests that SE can induce both intermediate level processing (ILP) to generate attentional awareness (ie, "consciousness of") effects and perhaps nonintermediate level processing to generate nonattentive, subliminal (ie, "state of") consciousness effects. Recognition of neural and cognitive mechanisms is important to clinicians' understanding of the biological basis of noetic, salutogenic, and putative physiologic effects. We posit that neurocognitive mechanisms, fortified by anthropologic and social contexts, led to the incorporation of SE-evoked behaviors into health-based ritual(s) and religious practice(s). Thus, these experiences not only exert biological effects but may provide important means for enhancing patients' locus of control. By recognizing these variables, we advocate clinicians to act within an ethical scope of practice as therapeutic and moral agents to afford patients resources to accommodate their specific desire(s) and/or need(s) for spiritual experiences, in acknowledgement of the underlying mechanisms and potential outcomes that may be health promotional. PMID:16781644

Giordano, James; Engebretson, Joan

2006-05-01

246

Clinical education guideline creation by residents for junior learners in emergency medicine: a novel educational experience.  

PubMed

ABSTRACTClinical practice guidelines are an important vehicle for knowledge translation and improving patient care. For most learners, these documents can be daunting and confusing. We describe a novel educational experience that clarified the guideline generation process for learners while at the same time creating clinical educational guidelines (simplified learning aids) for junior learners in the emergency department (ED). We devised a system using near-peer mentors to generate a series of clinical education guideline learning materials created by residents and junior learners for the evaluation of undifferentiated chest pain in the ED. This process assisted in teaching residents and junior learners and generated an endurable educational product. PMID:24742792

Baw, Bandar; Chan, Teresa; Upadhye, Suneel

2014-04-01

247

Systematic reviews of animal experiments demonstrate poor human clinical and toxicological utility.  

PubMed

The assumption that animal models are reasonably predictive of human outcomes provides the basis for their widespread use in toxicity testing and in biomedical research aimed at developing cures for human diseases. To investigate the validity of this assumption, the comprehensive Scopus biomedical bibliographic databases were searched for published systematic reviews of the human clinical or toxicological utility of animal experiments. In 20 reviews in which clinical utility was examined, the authors concluded that animal models were either significantly useful in contributing to the development of clinical interventions, or were substantially consistent with clinical outcomes, in only two cases, one of which was contentious. These included reviews of the clinical utility of experiments expected by ethics committees to lead to medical advances, of highly-cited experiments published in major journals, and of chimpanzee experiments--those involving the species considered most likely to be predictive of human outcomes. Seven additional reviews failed to clearly demonstrate utility in predicting human toxicological outcomes, such as carcinogenicity and teratogenicity. Consequently, animal data may not generally be assumed to be substantially useful for these purposes. Possible causes include interspecies differences, the distortion of outcomes arising from experimental environments and protocols, and the poor methodological quality of many animal experiments, which was evident in at least 11 reviews. No reviews existed in which the majority of animal experiments were of good methodological quality. Whilst the effects of some of these problems might be minimised with concerted effort (given their widespread prevalence), the limitations resulting from interspecies differences are likely to be technically and theoretically impossible to overcome. Non-animal models are generally required to pass formal scientific validation prior to their regulatory acceptance. In contrast, animal models are simply assumed to be predictive of human outcomes. These results demonstrate the invalidity of such assumptions. The consistent application of formal validation studies to all test models is clearly warranted, regardless of their animal, non-animal, historical, contemporary or possible future status. Likely benefits would include, the greater selection of models truly predictive of human outcomes, increased safety of people exposed to chemicals that have passed toxicity tests, increased efficiency during the development of human pharmaceuticals and other therapeutic interventions, and decreased wastage of animal, personnel and financial resources. The poor human clinical and toxicological utility of most animal models for which data exists, in conjunction with their generally substantial animal welfare and economic costs, justify a ban on animal models lacking scientific data clearly establishing their human predictivity or utility. PMID:18186670

Knight, Andrew

2007-12-01

248

How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital  

PubMed Central

A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40?kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart.

Lindstedt, Sandra; Eyjolfsson, Atli; Koul, Bansi; Wierup, Per; Pierre, Leif; Gustafsson, Ronny; Ingemansson, Richard

2011-01-01

249

Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences  

Microsoft Academic Search

Background  Victimisation in childhood may be associated with adult psychosis. The current study examined this association in the crucial\\u000a developmental period of early adolescence and investigated whether (1) unwanted sexual experiences, and (2) being bullied,\\u000a were associated with non-clinical delusional ideation and hallucinatory experiences in a general population sample of 14 year\\u000a olds.\\u000a \\u000a \\u000a \\u000a Methods  Data were derived from standard health screenings of the

Tineke Lataster; Jim van Os; Marjan Drukker; Cécile Henquet; Frans Feron; Nicole Gunther; Inez Myin-Germeys

2006-01-01

250

The clinical nurse leader in the perioperative setting: a preceptor experience.  

PubMed

The US Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. PMID:24973183

Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

2014-07-01

251

Anxious and non-anxious adolescents' experiences of non-clinical magnetic resonance imaging research.  

PubMed

Magnetic resonance imaging (MRI) has become a ubiquitous research tool for developmental neuroscientists interested in brain structure and function in children and adolescents. However, ethical concerns are sometimes raised about using MRI with children and adolescents, especially when participants have anxiety. We asked 17 clinically/sub-clinically anxious and 19 non-anxious adolescents about their experiences of taking part in MRI for research purposes. Although the anxious group reported experiencing more anxiety during the scan, these differences had attenuated by the time participants got home. We found no evidence that anxious adolescents would be less likely to choose to have another scan or would feel more nervous during another scan. There was some evidence that more trait anxious adolescents found the MRI study enjoyable. These findings should give ethics committees, clinicians, and parents confidence that so long as researchers exercise appropriate care, MRI research is acceptable to adolescents, including those with clinical anxiety. PMID:23232793

Haddad, Anneke D M; Platt, Belinda; James, Anthony C; Lau, Jennifer Y F

2013-08-01

252

Clinical Experience in Late Antiquity: Alexander of Tralles and the Therapy of Epilepsy  

PubMed Central

Alexander of Tralles, writing in the late sixth century, combined his wide-ranging practical knowledge with earlier medical theories. This article shows how clinical experience is used in Alexander’s works by concentrating on his therapeutic advice on epilepsy and, in particular, on pharmacology and the group of so-called natural remedies. I argue that clinical testing is used not only for the introduction of new medicines but also as an instrument for checking the therapeutic effect of popular healing practices. On another level, this article discusses Alexander’s role as the author of a medical compendium; it suggests that by marking the cases of clinical testing with a set of recurrent expressions, Alexander leads his audience to reflect on his medical authority and personal contribution.

Bouras-vallianatos, Petros

2014-01-01

253

Experiences and barriers to implementation of clinical practice guideline for depression in Korea  

PubMed Central

Background Clinical guidelines can improve health-care delivery, but there are a number of challenges in adopting and implementing the current practice guidelines for depression. The aim of this study was to determine clinical experiences and perceived barriers to the implementation of these guidelines in psychiatric care. Methods A web-based survey was conducted with 386 psychiatric specialists to inquire about experiences and attitudes related to the depression guidelines and barriers influencing the use of the guidelines. Quantitative data were analyzed, and qualitative data were transcribed and coded manually. Results Almost three quarters of the psychiatrists (74.6%) were aware of the clinical guidelines for depression, and over half of participants (55.7%) had had clinical experiences with the guidelines in practice. The main reported advantages of the guidelines were that they helped in clinical decision making and provided informative resources for the patients and their caregivers. Despite this, some psychiatrists were making treatment decisions that were not in accordance with the depression guidelines. Lack of knowledge was the main obstacle to the implementation of guidelines assessed by the psychiatrists. Other complaints addressed difficulties in accessing the guidelines, lack of support for mental health services, and general attitudes toward guideline necessity. Overall, the responses suggested that adding a summary booklet, providing teaching sessions, and improving guidance delivery systems could be effective tools for increasing depression guideline usage. Conclusion Individual barriers, such as lack of awareness and lack of familiarity, and external barriers, such as the supplying system, can affect whether physicians’ implement the guidelines for the treatment of depression in Korea. These findings suggest that further medical education to disseminate guidelines contents could improve public health for depression.

2013-01-01

254

Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy  

Microsoft Academic Search

BACKGROUND: To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology. METHODS: Forty-five patients with a median age of 72 ± 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0

Gianfranco A Pesce; Alessandro Clivio; Luca Cozzi; Giorgia Nicolini; Antonella Richetti; Emanuela Salati; Mariacarla Valli; Eugenio Vanetti; Antonella Fogliata

2010-01-01

255

Initial clinical experience with a video-based patient positioning system  

Microsoft Academic Search

Purpose: To report initial clinical experience with an interactive, video-based patient positioning system that is inexpensive, quick, accurate, and easy to use.Methods and Materials: System hardware includes two black-and-white CCD cameras, zoom lenses, and a PC equipped with a frame grabber. Custom software is used to acquire and archive video images, as well as to display real-time subtraction images revealing

L. S. Johnson; B. D. Milliken; S. W. Hadley; C. A. Pelizzari; D. J. Haraf; G. T. Y. Chen

1999-01-01

256

Clinical trials in traumatic brain injury: Past experience and current developments  

Microsoft Academic Search

Summary  In this article, we review past and current experience in clinical trials of traumatic brain injuries (TBIs), we discuss limitations\\u000a and challenges, and we summarize current directions. The focus is on severe and moderate TBIs. A systematic literature search\\u000a of the years from 1980 to 2009 revealed 27 large phase III trials in TBI; we were aware of a further

Andrew I. R. Maas; Bob Roozenbeek; Geoffrey T. Manley

2010-01-01

257

Tegress(TM) Urethral Implant Phase III Clinical Experience and Product Uniqueness  

PubMed Central

Advances in materials technology, coupled with a heightened understanding of wound healing and tissue-materials interactions in the lower urinary tract, have led to the development of a variety of new urethral bulking agents that are expected to be available in the near future. Experience with such bulking agents continues to grow and study results are disseminated as more clinical trials are initiated and completed. The intention of this report is to review the characteristics and initial clinical results for one of these new agents: Tegress™ Urethral Implant (C. R. Bard, Inc., Murray Hill, NJ). This material, with unique phase-change properties upon exposure to body temperature fluids, offers ease of injection and requires less volume for clinical effect than bovine collagen. Additionally, Tegress Urethral Implant performance in clinical trials has suggested improved durability and correspondingly higher continence and improvement rates versus bovine collagen. As these materials evolve, an understanding of preferential implant techniques is being gained also. Delivery method and implant site may prove to substantially alter the biologic activity of these compounds. As outlined in this review, experience with Tegress Implant resulted in changes in delivery technique that translated into improved materials and tissue interaction.

Dmochowski, Roger R

2005-01-01

258

BLAST model: an innovative approach to prepare second-degree accelerated BSN students for inpatient psychiatric clinical experiences.  

PubMed

This article describes the design, development, and implementation of an innovative teaching/learning model involving integration of classroom teaching, clinical simulation, and debriefing/critical thinking to prepare accelerated baccalaureate nursing students for clinical practice experiences in the inpatient psychiatric setting. Lessons learned and future directions for simulation experiences involving standardized patient scenarios in undergraduate psychiatric nursing education are shared. PMID:23394963

Lang, Carol S; Hahn, Joyce A

2013-03-01

259

Confirmatory Factor Analysis of Scores on the Clinical Experience Rubric: A Measure of Dispositions for Preservice Teachers  

ERIC Educational Resources Information Center

This study examines the underlying structure of the Clinical Experience Rubric (CER), which is designed to assess preservice teachers' dispositions during the clinical experiences. Dispositions were conceptualized as being a multidimensional construct with three related factors: (a) professionalism, (b) teaching quality, and (c) relationship with…

Flowers, Claudia

2006-01-01

260

Evaluating Quality in Clinical Cancer Research: The M.D. Anderson Cancer Center Experience  

PubMed Central

Background Despite the unquestionable importance of clinically oriented research designed to test the safety and efficacy of new therapies in patients with malignant disease, there is limited information regarding strategies to evaluate the quality of such efforts at academic institutions. Methods To address this issue, a committee of senior faculty at the University of Texas M.D. Anderson Cancer Center established specific criteria by which investigators from all departments engaged in clinical research could be formally evaluated. Scoring criteria were established and revised based on the results of a pilot study. Beginning in January 2004, the committee evaluated all faculty involved in clinical research within 35 departments. Scores for individual faculty members were assigned on a scale of 1 (outstanding) to 5; a score of 3 was set as the standard for the institution. Each department also received a score. The results of the evaluation were shared with departmental chairs and the Chief Academic Officer. Results 392 faculty were evaluated. The median score was 3. Full professors more frequently received a score of 1, but all faculty ranks received scores of 4 and 5. As a group, tenure/tenure track faculty achieved superior scores compared to nontenure track faculty. Conclusions Based on our experience, we believe it is possible to conduct a rigorous consensus-based evaluation of the quality of clinical cancer research being conducted at an academic medical center. It is reasonable to suggest such evaluations can be used as a management tool and may lead to higher-quality clinical research.

Cox, James D.; Giralt, Sergio A.; Veazie, Mary L.; Ajani, Jaffer A.; Bruner, Janet M.; Chan, Ka Wah; Hittelman, Walter N.; Hunt, Kelly K.; Iyer, Revathy B.; Karp, Daniel D.; Kuban, Deborah A.; Lippman, Scott M.; Raad, Issam I.; Rodriguez-Bigas, Miguel A.; Zwelling, Leonard A.; Markman, Maurie

2009-01-01

261

Student pharmacists' clinical interventions in advanced pharmacy practice experiences at a community nonteaching hospital.  

PubMed

Objective. To assess student pharmacists' clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used. Methods. Clinical interventions of 120 fourth-year (P4) student pharmacists in advanced institutional, medication safety, or internal medicine APPEs were collected over a 3½-year period. Clinical interventions were analyzed for cost savings, intervention type, and acceptance rates. A secondary analysis of paper-based vs electronic-based documentation of completed interventions was performed. Results. There were 2,170 clinical interventions attempted with an acceptance rate of 97%. The estimated cost savings was $280,297. A comparable number of interventions and cost savings per student was observed between paper-based and electronic-based documentation methods. Conclusion. Student pharmacists at a community nonteaching hospital have many opportunities for participation in patient-centered activities, and for interaction and collaboration with other healthcare professionals. They can significantly benefit patient care through clinical interventions, while also contributing to cost savings for the institution. PMID:24761011

Shogbon, Angela O; Lundquist, Lisa M

2014-04-17

262

Student Pharmacists' Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital  

PubMed Central

Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used. Methods. Clinical interventions of 120 fourth-year (P4) student pharmacists in advanced institutional, medication safety, or internal medicine APPEs were collected over a 3½-year period. Clinical interventions were analyzed for cost savings, intervention type, and acceptance rates. A secondary analysis of paper-based vs electronic-based documentation of completed interventions was performed. Results. There were 2,170 clinical interventions attempted with an acceptance rate of 97%. The estimated cost savings was $280,297. A comparable number of interventions and cost savings per student was observed between paper-based and electronic-based documentation methods. Conclusion. Student pharmacists at a community nonteaching hospital have many opportunities for participation in patient-centered activities, and for interaction and collaboration with other healthcare professionals. They can significantly benefit patient care through clinical interventions, while also contributing to cost savings for the institution.

Lundquist, Lisa M.

2014-01-01

263

Early experiences in establishing a regional quantitative imaging network for PET/CT clinical trials.  

PubMed

The Seattle Cancer Care Alliance (SCCA) is a Pacific Northwest regional network that enables patients from community cancer centers to participate in multicenter oncology clinical trials where patients can receive some trial-related procedures at their local center. Results of positron emission tomography (PET) scans performed at community cancer centers are not currently used in SCCA Network trials since clinical trials customarily accept results from only trial-accredited PET imaging centers located at academic and large hospitals. Oncologists would prefer the option of using standard clinical PET scans from Network sites in multicenter clinical trials to increase accrual of patients for whom additional travel requirements for imaging are a barrier to recruitment. In an effort to increase accrual of rural and other underserved populations to Network trials, researchers and clinicians at the University of Washington, SCCA and its Network are assessing the feasibility of using PET scans from all Network sites in their oncology clinical trials. A feasibility study is required because the reproducibility of multicenter PET measurements ranges from approximately 3% to 40% at national academic centers. Early experiences from both national and local PET phantom imaging trials are discussed, and next steps are proposed for including patient PET scans from the emerging regional quantitative imaging network in clinical trials. There are feasible methods to determine and characterize PET quantitation errors and improve data quality by either prospective scanner calibration or retrospective post hoc corrections. These methods should be developed and implemented in multicenter clinical trials employing quantitative PET imaging of patients. PMID:22795929

Doot, Robert K; Thompson, Tove; Greer, Benjamin E; Allberg, Keith C; Linden, Hannah M; Mankoff, David A; Kinahan, Paul E

2012-11-01

264

Effects of Clinical Field-Experience Setting on Athletic Training Students' Perceived Percentage of Time Spent on Active Learning.  

PubMed

OBJECTIVE: Our purpose was to examine undergraduate athletic training students' perceptions of how time is utilized during clinical field experiences while enrolled in Commission on Accreditation of Allied Health Education Program (CAAHEP)-accredited athletic training programs and to determine the effects of clinical field-experience length and setting, academic standing, sex, clinical assignment, and National Collegiate Athletic Association level on active learning. DESIGN AND SETTING: Using the Athletic Training-Clinical Education Time Framework (AT-CETF) and Utilizing Time and Active Learning Survey, subjects completed a 1-day, self-reported observation of how their clinical field-experience time was utilized. SUBJECTS: Program directors at 131 CAAHEP-accredited athletic training programs were sent survey packages. Seventy-two (41%) male subjects and 105 (59%) female subjects from 25 institutions completed the survey packages. Eight of the 10 National Athletic Trainers' Association districts were represented in the study. MEASUREMENTS: The AT-CETF is a behavioral time-profiling framework that measures athletic training students' perceptions of utilization of clinical field-experience time based on the performance domains associated with the 1999 National Athletic Trainers' Association Board of Certification Role Delineation Study and literature related to time and learning. RESULTS: Subjects spent 51% of their clinical field-experience time engaged in active learning, 9% in managerial activities, 17% in unengaged activities, and 23% in waiting activities. Multiple 2 x 2 x 3 analyses of variance (length of clinical field experience x academic standing x clinical field-experience setting) revealed a significant difference between the levels of clinical field-experience setting and the dependent variables of perceived percentage of active learning time and waiting time. A 2 x 3 analysis of variance (sex x clinical assignment) revealed a significant difference between the levels of clinical assignment and the dependent variable of perceived percentage of active learning time. CONCLUSIONS: The type of clinical field-experience setting and clinical assignment affects the amount of time spent in active learning. Therefore, profiling students' use of time may allow educators to identify clinical field-experience settings that maximize active learning time, expose students to their own unique learning situations, and offer students access to clinical field-experience settings aligned with their professional goals. PMID:15173870

Berry, David C.; Miller, Michael G.; Berry, Leisha M.

2004-06-01

265

DoD's Medical Radiobiology Advisory Team: experts on the ground.  

PubMed

The Medical Radiobiology Advisory Team (MRAT) is the operations arm of the Armed Forces Radiobiology Research Institute (AFRRI), located at Naval Support Activity in Bethesda, MD. AFRRI is internationally recognized as expert in the biological effects of ionizing radiation research, training, and mitigation. During the U.S. Department of Defense's (DoD) response to the Fukushima Daiichi reactor incident, Operation Tomodachi, the MRAT provided guidance and advice to the U.S. Military leaders in Japan. This support helped ensure the safety of U.S. service members, family members, and civilians and supported the humanitarian relief in a coordinated effort with the Government of Japan (GOJ). PMID:22469928

VanHorne-Sealy, Jama; Livingston, Brian; Alleman, Lee

2012-05-01

266

Preliminary Experience with Small Animal SPECT Imaging on Clinical Gamma Cameras  

PubMed Central

The traditional lack of techniques suitable for in vivo imaging has induced a great interest in molecular imaging for preclinical research. Nevertheless, its use spreads slowly due to the difficulties in justifying the high cost of the current dedicated preclinical scanners. An alternative for lowering the costs is to repurpose old clinical gamma cameras to be used for preclinical imaging. In this paper we assess the performance of a portable device, that is, working coupled to a single-head clinical gamma camera, and we present our preliminary experience in several small animal applications. Our findings, based on phantom experiments and animal studies, provided an image quality, in terms of contrast-noise trade-off, comparable to dedicated preclinical pinhole-based scanners. We feel that our portable device offers an opportunity for recycling the widespread availability of clinical gamma cameras in nuclear medicine departments to be used in small animal SPECT imaging and we hope that it can contribute to spreading the use of preclinical imaging within institutions on tight budgets.

Aguiar, P.; Silva-Rodriguez, J.; Herranz, M.; Ruibal, A.

2014-01-01

267

What Factors Facilitate Good Learning Experiences in Clinical Studies in Nursing: Bachelor Students' Perceptions  

PubMed Central

Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students' opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students' in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: “being in a vulnerable and exposed position characterized by conflicting needs.” Four categories were found: “aspects related to the clinical setting”, “aspects related to the nurse supervisor,” “aspects related to the student,” and “aspects related to the student-supervisor relationship”. The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect.

Leland, Arne; Dale, Jan Gunnar

2013-01-01

268

Initial Clinical Experience with Microwave Breast Imaging in Women with Normal Mammography  

PubMed Central

We have developed a microwave tomography system for experimental breast imaging. In this paper we illustrate a strategy for optimizing the coupling liquid for the antenna array based on in vivo measurement data. We present representative phantom experiments to illustrate the imaging system’s ability to recover accurate property distributions over the range of dielectric properties expected to be encountered clinically. To demonstrate clinical feasibility and assess the microwave properties of the normal breast in vivo, we summarize our initial experience with microwave breast exams of 43 women categorized as BIRADS 1. The clinical results show a high degree of bilateral symmetry in the whole breast average microwave properties. Focal assessments of microwave properties are associated with breast tissue composition evaluated through radiographic density categorization verified through MR image correlation in selected cases. Specifically, both whole breast average and local microwave properties increase with increasing radiographic density where the latter exhibits a more substantial rise. These findings support our hypothesis that water content variations in the breast play an influential role in dictating the overall dielectric property distributions and indicate that the microwave properties in the breast are more heterogeneous than previously believed based on ex vivo property measurements reported in the literature.

Meaney, Paul M.; Fanning, Margaret W.; Raynolds, Timothy; Fox, Colleen J.; Fang, Qianqian; Kogel, Christine A.; Poplack, Steven P.; Paulsen, Keith D.

2007-01-01

269

Preliminary Experience with Small Animal SPECT Imaging on Clinical Gamma Cameras.  

PubMed

The traditional lack of techniques suitable for in vivo imaging has induced a great interest in molecular imaging for preclinical research. Nevertheless, its use spreads slowly due to the difficulties in justifying the high cost of the current dedicated preclinical scanners. An alternative for lowering the costs is to repurpose old clinical gamma cameras to be used for preclinical imaging. In this paper we assess the performance of a portable device, that is, working coupled to a single-head clinical gamma camera, and we present our preliminary experience in several small animal applications. Our findings, based on phantom experiments and animal studies, provided an image quality, in terms of contrast-noise trade-off, comparable to dedicated preclinical pinhole-based scanners. We feel that our portable device offers an opportunity for recycling the widespread availability of clinical gamma cameras in nuclear medicine departments to be used in small animal SPECT imaging and we hope that it can contribute to spreading the use of preclinical imaging within institutions on tight budgets. PMID:24963478

Aguiar, P; Silva-Rodríguez, J; Herranz, M; Ruibal, A

2014-01-01

270

Posttraumatic stress disorder in women--experiences form the Psychiatric Clinic, University Hospital Center Zagreb, Croatia.  

PubMed

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops after a severe traumatic event or experience. Lifetime prevalence rate in the European population is 1.9 % and it is higher for women (2.9%) then for men (0.9 %). The aim of this study was to examine rates and sociodemographic and clinical characteristics of women with PTSD who were hospitalized at the Psychiatric clinic of University Hospital Center in Croatia over the years 1990-2007. Data were gathered retrospectively from the medical charts. We found that 67 women were diagnosed with PTSD which is 0.58% of all admissions over these years. Majority suffered from comorbid depression (N = 51) and various somatic conditions, especially malignant gynecological tumors (N = 23). No significant differences were found in distribution of PTSD symptoms in relation to the combat vs. civilian trauma. We found that patients with combat trauma often suffer from comorbid depression, while those with civilian traumas more often reported somatic conditions, especially malignant gynecological tumors. Our institution is a speciality clinic at a tertiary care medical center which tends to accumulate patients with serious forms of the disorder, and therefore our results can not be generalized to other settings involved in working with women with PTSD. Our results indicate that psychiatrists' assessment of female patients should inevitably include lifetime traumatic experiences, and among those with PTSD, special attention should be paid to comorbid depression and malignant tumors. PMID:19408636

Jovanovi?, Nikolina; Kuzman, Martina Rojni?; Medved, Vesna; Saboli?, Andelina Boki?; Grubisin, Jasmina; Hotujac, Ljubomir

2009-03-01

271

Clinical experiences with an ASP model backup archive for PACS images  

NASA Astrophysics Data System (ADS)

Last year we presented a Fault-Tolerant Backup Archive using an Application Service Provider (ASP) model for disaster recovery. The purpose of this paper is to update and provide clinical experiences related towards implementing the ASP model archive solution for short-term backup of clinical PACS image data as well as possible applications other than disaster recovery. The ASP backup archive provides instantaneous, automatic backup of acquired PACS image data and instantaneous recovery of stored PACS image data all at a low operational cost and with little human intervention. This solution can be used for a variety of scheduled and unscheduled downtimes that occur on the main PACS archive. A backup archive server with hierarchical storage was implemented offsite from the main PACS archive location. Clinical data from a hospital PACS is sent to this ASP storage server in parallel to the exams being archived in the main server. Initially, connectivity between the main archive and the ASP storage server is established via a T-1 connection. In the future, other more cost-effective means of connectivity will be researched such as the Internet 2. We have integrated the ASP model backup archive with a clinical PACS at Saint JohnÕs Health Center and has been operational for over 6 months. Pitfalls encountered during integration with a live clinical PACS and the impact to clinical workflow will be discussed. In addition, estimations of the cost of establishing such a solution as well as the cost charged to the users will be included. Clinical downtime scenarios, such as a scheduled mandatory downtime and an unscheduled downtime due to a disaster event to the main archive, were simulated and the PACS exams were sent successfully from the offsite ASP storage server back to the hospital PACS in less than 1 day. The ASP backup archive was able to recover PACS image data for comparison studies with no complex operational procedures. Furthermore, no image data loss was encountered during the recovery. During any clinical downtime scenario, the ASP backup archive server can repopulate a clinical PACS quickly with the majority of studies available for comparison during the interim until the main PACS archive is fully recovered.

Liu, Brent J.; Cao, Fei; Documet, Luis; Huang, H. K.; Muldoon, Jean

2003-05-01

272

Phenotypic Information in Genomic Variant Databases Enhances Clinical Care and Research: The ISCA Consortium Experience  

PubMed Central

Whole genome analysis, now including whole genome sequencing, is moving rapidly into the clinical setting, leading to detection of human variation on a broader scale than ever before. Interpreting this information will depend on the availability of thorough and accurate phenotype information, and the ability to curate, store, and access data on genotype-phenotype relationships. This idea has already been demonstrated within the context of chromosome microarray (CMA) testing. The International Standards for Cytogenomic Arrays (ISCA) Consortium promotes standardization of variant interpretation for this technology through its initiatives, including the formation of a publicly available database housing clinical CMA data. Recognizing that phenotypic data is essential for the interpretation of genomic variants, the ISCA Consortium has developed tools to facilitate the collection of this data and its deposition in a standardized, structured format within the ISCA Consortium database. This rich source of phenotypic data can also be used within broader applications, such as developing phenotypic profiles of emerging genomic disorders, the identification of candidate regions for particular phenotypes, or the creation of tools for use in clinical practice. We summarize the ISCA experience as a model for ongoing efforts incorporating phenotype data with genotype data to improve the quality of research and clinical care in human genetics.

Riggs, Erin Rooney; Jackson, Laird; Miller, David T.; Van Vooren, Steven

2012-01-01

273

Clinical Experience With Gene Therapy for the Treatment of Prostate Cancer  

PubMed Central

Localized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients.

Stanizzi, Matthew A; Hall, Simon J

2007-01-01

274

The lived experience of seeking tenure while practicing clinically: finding balance in academia.  

PubMed

The purpose of this hermeneutic phenomenological research study was to assess the lived experience of seeking tenure while teaching and practicing at the bedside and to identify how a sense of balance was maintained throughout the process. Six nursing faculty were interviewed while actively seeking tenure or within 2 years after seeking tenure. Four themes were identified and will be discussed. The process of tenure is a stressful time for faculty and even more stressful when the faculty try to balance the demands for academe with clinical scholarship. These participants felt that their clinical practice was recognized or valued only when it was of benefit to the academic institution. In many institutions, creativity must be utilized to enhance the tenure portfolio. PMID:23222230

Beck, Julie; Ruth-Sahd, Lisa

2013-01-01

275

Focal Laser Ablation for Localized Prostate Cancer: Principles, Clinical Trials, and Our Initial Experience  

PubMed Central

Focal therapy of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility. This review presents the principles of laser ablation, the role of multiparametric MRI for delineating the site of significant prostate cancer, a summary of published clinical studies, and our initial experience with 23 patients, criteria for selecting candidates for focal prostate ablation, and speculation regarding future directions.

Lee, Ted; Mendhiratta, Neil; Sperling, Dan; Lepor, Herbert

2014-01-01

276

Clinical experience with In-Ceram Spinell crowns: 5-year follow-up.  

PubMed

Prompted by increased patient requests for esthetic treatment, restorative clinicians have evaluated a variety of new materials and procedures. This study reports on 5 years' experience with In-Ceram Spinell all-ceramic crowns. A total of 40 anterior crowns were positioned in 13 patients from October 1995 to December 1998. The clinical examination was made following modified California Dental Association/Ryge criteria. Final evaluation was carried out in October 2000, for an observation period of 22 to 60 months (mean 50 months). Only one failure was recorded, and the fractured crown needed to be replaced; according to Kaplan-Meier analysis, the estimated success rate was 97.5%. A thorough description of the clinical procedures through which anterior teeth can be successfully treated with all-ceramic Spinell crowns is described. PMID:12516824

Fradeani, Mauro; Aquilano, Augusto; Corrado, Marcantonio

2002-12-01

277

Increasing minority participation in cancer clinical trials: the Minority-Based Community Clinical Oncology Program experience. | accrualnet.cancer.gov  

Cancer.gov

The National Cancer Institute’s (NCI) Minority-Based Community Clinical Oncology Program (MBCCOP) seeks to enhance minority participation in cancer clinical trials by building clinical trials outreach and management capacity in healthcare institutions serving large numbers of minority cancer patients.

278

Risk communication in clinical trials: A cognitive experiment and a survey  

PubMed Central

Background A Royal Statistical Society Working Party recently recommended that "Greater use should be made of numerical, as opposed to verbal, descriptions of risk" in first-in-man clinical trials. This echoed the view of many clinicians and psychologists about risk communication. As the clinical trial industry expands rapidly across the globe, it is important to understand risk communication in Asian countries. Methods We conducted a cognitive experiment about participation in a hypothetical clinical trial of a pain relief medication and a survey in cancer and arthritis patients in Singapore. In part 1 of the experiment, the patients received information about the risk of side effects in one of three formats (frequency, percentage and verbal descriptor) and in one of two sequences (from least to most severe and from most to least severe), and were asked about their willingness to participate. In part 2, the patients received information about the risk in all three formats, in the same sequence, and were again asked about their willingness to participate. A survey of preference for risk presentation methods and usage of verbal descriptors immediately followed. Results Willingness to participate and the likelihood of changing one's decision were not affected by the risk presentation methods. Most patients indicated a preference for the frequency format, but patients with primary school or no formal education were indifferent. While the patients used the verbal descriptors "very common", "common" and "very rare" in ways similar to the European Commission's Guidelines, their usage of the descriptors "uncommon" and "rare" was substantially different from the EU's. Conclusion In this sample of Asian cancer and arthritis patients, risk presentation format had no impact on willingness to participate in a clinical trial. However, there is a clear preference for the frequency format. The lay use of verbal descriptors was substantially different from the EU's.

2010-01-01

279

A cross-sectional study investigating clinical predictors and physical experiences of pain in Parkinson's disease  

PubMed Central

Summary Pain is a non-motor symptom of Parkinson’s disease (PD) that is often neglected due to its high prevalence in both the PD and the normal elderly population. The aims of this cross-sectional study were to establish the prevalence of pain, investigate its clinical predictors and analyze physical experiences of pain as described by PD patients. A total of 121 patients diagnosed with PD were included. The patients underwent a neurological examination and a structured interview and completed questionnaires focusing on clinical types and physical experiences of pain. Logistic regressions were used to analyze possible predictors. Pain was reported by 80 (66%) patients with a mean age at PD diagnosis of 67.26±11.43 years. The most common clinical types of pain experienced by the patients were dystonic pain (48%), paresthesia/neuropathic pain (36%) and musculoskeletal pain (28%). The PD patients described their physical experience of pain as aching (46%), a feeling of tension (18%), sharp pain (12%), deep pain (12%) and dull pain (11%). Patients with PD affecting the right side of the body were four times more likely to report pain on the right side of the body; however, no such relation was found for the left side of the body. A higher UPDRS-III scale score and longer PD duration reduced the likelihood of patients reporting dull pain. The presence of paresthesia/neuropathic pain was shown to decrease the likelihood of patients reporting sharp pain. No significant relationships were found between the magnitude of pain and gender, age at PD diagnosis, PD duration, UPDRS-III score, or Hoehn and Yahr stage of PD. Although 40% of the PD patients felt that medication had a (direct) effect on their pain, no relationship could be found between pain severity and PD medication.

Rana, Abdul Qayyum; Saeed, Usman; Masroor, Mohamed Sufian; Yousuf, Muhammad Saad; Siddiqui, Ishraq

2013-01-01

280

Serum 25-Hydroxyvitamin D3 and D2 and Non-Clinical Psychotic Experiences in Childhood  

PubMed Central

Objective Non-clinical psychotic experiences are common and distressing. It has been hypothesized that early life vitamin D deficiency may be a risk factor for psychosis-related outcomes, but it is not known if circulating concentrations of 25-hydroxyvitamin D (25(OH)D) during childhood are associated with psychosis-related outcomes or whether the two different forms of 25(OH)D, (25(OH)D3 and 25(OH)D2, have similar associations with psychosis-related outcomes. Methods We investigated the association between serum 25(OH)D3 and 25(OH)D2 concentrations and psychotic experiences in a prospective birth cohort study. Serum 25(OH)D3 and 25(OH)D2 concentrations were measured at mean age 9.8 years and psychotic experiences assessed at mean age 12.8 years by a psychologist (N?=?3182). Results Higher 25(OH)D3 concentrations were associated with lower risk of definite psychotic experiences (adjusted odds ratio: OR (95% confidence interval: CI) 0.85 (0.75–0.95)). Higher concentrations of 25(OH)D2 were associated with higher risk of suspected and definite psychotic experiences (adjusted odds ratio: OR (95% confidence interval: CI) 1.26 (1.11, 1.43)). Higher 25(OD)D2 concentrations were also weakly associated with definite psychotic experiences (adjusted OR (95% CI) 1.17 (0.96, 1.43), though with wide confidence intervals including the null value. Conclusions Our findings of an inverse association of 25(OH)D3 with definite psychotic experiences is consistent with the hypothesis that vitamin D may protect against psychosis-related outcomes.

Tolppanen, Anna-Maija; Sayers, Adrian; Fraser, William D.; Lewis, Glyn; Zammit, Stanley; McGrath, John; Lawlor, Debbie A.

2012-01-01

281

Discrepancies between measured changes of radiobiological hypoxic fraction and oxygen tension monitoring using two assay systems  

SciTech Connect

This study was conducted to assess the ability of computerized pO{sub 2} histography to measure changes in tumor oxygenation produced by low oxygen breathing. Female syngeneic C3H/Km mice bearing SCC VII/St carcinomas were used in these experiments. Changes in tumor oxygenation produced by the mice breathing 10% oxygen were assessed with computerized pO2 histography, {sup 3}H-misonidazole binding, and the paired survival curve assay of radiosensitivity. The hypoxic cell fraction of the tumors in mice breathing 10% oxygen was 3.1 times higher than that of tumors in mice breathing normal air determined by an in vivo-in vitro clonogenic assay. Binding of radiolabeled misonidazole to the tumors in mice breathing 10% oxygen was also significantly higher than that to tumors in mice breathing normal air (p < 0.05). In addition, oxygen tension histograms for normal tissue showed a dramatic shift to a lower oxygen tension when the mice were breathing 10% oxygen. However, under identical conditions, there was only a minimal shift in the oxygen tension of tumor tissue. Although the number of oxygen tension readings in the relatively oxic class in tumor tissue was lower when the mice were breathing 10% oxygen than when breathing normal air, there was not a significant decrease in the median pO{sub 2} value for the tumor. The number of pO{sub 2} readings lower than 5 mmHg in the tumor was not affected by the 10% oxygen breathing. These findings indicate that increases in radiobiological hypoxic fraction produced by lower blood oxygen levels may not correlate well with the results of polarographic measurements of tumor pO{sub 2} levels. 29 refs., 4 figs., 1 tab.

Sasai, K.; Brown, J.M. [Stanford Univ. School of Medicine, CA (United States)

1994-09-30

282

Vas deferens occlusion by percutaneous injection of polyurethane elastomer plugs: clinical experience and reversibility.  

PubMed

A non-incision method of vas occlusion based on the percutaneous injection of polyurethane elastomer solution to form plugs is described. The results are based on clinical experience in 12,000 men in which only 56 cases of minor complications were recorded. Follow-up of 500 men for up to 3 years demonstrated an azoospermia rate of 98%. Plugs have been removed from 86 men and, to date, 51 have made their wives pregnant. In those from which the plugs have been removed for more than 1 year (n = 31), the pregnancy rate is 100%. PMID:2347193

Zhao, S C

1990-05-01

283

Radiobiologic research for head and neck cancer therapy. Therapeutic implications  

SciTech Connect

Hypoxic cell sensitizers, particle therapy, hyperthermia, and combinations of chemotherapy and radiotherapy have potential to increase the therapeutic ratio in future clinical radiotherapy treatment regimens. The biologic bases of these investigations are beginning to appear as avenues of clinical investigation.

Weichselbaum, R.R.; Rose, C.M.; Ervin, T.J.; Miller, D.

1983-12-01

284

Participants' Experiences of Being Debriefed to Placebo Allocation in a Clinical Trial  

PubMed Central

Participants in placebo-controlled clinical trials give informed consent to be randomized to verum or placebo. However, researchers rarely tell participants which treatment they actually received. We interviewed four participants in a trial of acupuncture for irritable bowel syndrome, before, during, and after they received a course of placebo treatments over six weeks. During the final interview, we informed participants that they had received a course of placebo treatments. We used an idiographic phenomenological approach based on the Sheffield School to describe each participant’s experiences of being blinded to and then debriefed to placebo allocation. Our participants’ experiences of blinding and debriefing were embodied, related to their goals in undertaking the study, and social (e.g., embedded in trusting and valued relationships with acupuncturists). We suggest ways in which debriefing to placebo allocation can be managed sensitively to facilitate positive outcomes for participants.

Bishop, Felicity L.; Jacobsen, Eric E.; Shaw, Jessica; Kaptchuk, Ted J.

2013-01-01

285

Radiobiologically guided optimisation of the prescription dose and fractionation scheme in radiotherapy using BioSuite  

PubMed Central

Objective Radiobiological models provide a means of evaluating treatment plans. Keeping in mind their inherent limitations, they can also be used prospectively to design new treatment strategies which maximise therapeutic ratio. We propose here a new method to customise fractionation and prescription dose. Methods To illustrate our new approach, two non-small cell lung cancer treatment plans and one prostate plan from our archive are analysed using the in-house software tool BioSuite. BioSuite computes normal tissue complication probability and tumour control probability using various radiobiological models and can suggest radiobiologically optimal prescription doses and fractionation schemes with limited toxicity. Results Dose–response curves present varied aspects depending on the nature of each case. The optimisation process suggests doses and fractionation schemes differing from the original ones. Patterns of optimisation depend on the degree of conformality, the behaviour of the normal tissue (i.e. “serial” or “parallel”), the volume of the tumour and the parameters of clonogen proliferation. Conclusion Individualising the prescription dose and number of fractions with the help of BioSuite results in improved therapeutic ratios as evaluated by radiobiological models.

Uzan, J; Nahum, A E

2012-01-01

286

The impact of modeling nuclear fragmentation on delivered dose and radiobiology in ion therapy  

Microsoft Academic Search

The importance of nuclear interactions for ion therapy arises from the influence of the particle spectrum on, first, radiobiology and therefore also on treatment planning, second, the accuracy of measuring dose and, third, the delivered dose distribution. This study tries to determine the qualitative as well as the quantitative influence of the modeling of inelastic nuclear interactions on ion therapy.

Armin Lühr; David C Hansen; Ricky Teiwes; Nikolai Sobolevsky; Oliver Jäkel; Niels Bassler

2012-01-01

287

Fluctuations in energy loss and their implications for dosimetry and radiobiology  

NASA Technical Reports Server (NTRS)

Serious consideration of the physics of energy deposition indicates that a fundamental change in the interpretation of absorbed dose is required at least for considerations of effects in biological systems. In addition, theoretical approaches to radiobiology and microdosimetry seem to require statistical considerations incorporating frequency distributions of the magnitude of the event sizes within the volume of interest.

Baily, N. A.; Steigerwalt, J. E.

1972-01-01

288

Clinical experience with a bioartificial liver in the treatment of severe liver failure. A phase I clinical trial.  

PubMed Central

OBJECTIVE: The purpose of this study was to develop a bioartificial liver (BAL) to treat patients with severe liver failure until they can be either transplanted or recover spontaneously. SUMMARY BACKGROUND DATA: Severe acute liver failure is associated with high mortality. Liver transplantation has emerged as an effective therapy for patients who did not respond to standard management. However, because of the donor organ shortage and urgent need for transplantation, many patients die before they can be transplanted and others do not survive after transplantation, primarily because of intracranial hypertension. METHODS: Three groups of patients with severe acute liver failure were treated with the BAL. In group 1 (n = 18) were patients with fulminant hepatic failure (FHF), in group 2 (n = 3) were patients with primary nonfunction (PNF) of a transplanted liver, and in group 3 (n = 10) were patients with acute exacerbation of chronic liver disease. Patients in groups 1 and 2 were candidates for transplantation at the time they entered the study, whereas patients in group 3 were not. RESULTS: In group 1, 16 patients were "bridged" successfully to transplantation, 1 patient was bridged to recovery without a transplant, and 1 patient died because of concomitant severe pancreatitis. In group 2, all patients were bridged successfully to retransplantation. In group 3, two patients were supported to recovery and successful transplants at later dates; the other eight patients, although supported temporarily with the BAL, later died because they were not candidates for transplantation. CONCLUSIONS: The authors' clinical experience with the BAL has yielded encouraging results. A randomized, controlled, prospective trial (phase II-III) is being initiated to determine the efficacy of the system. Images Figure 1.

Watanabe, F D; Mullon, C J; Hewitt, W R; Arkadopoulos, N; Kahaku, E; Eguchi, S; Khalili, T; Arnaout, W; Shackleton, C R; Rozga, J; Solomon, B; Demetriou, A A

1997-01-01

289

From forgetfulness to dementia: clinical and commissioning implications of diagnostic experiences  

PubMed Central

Background The National Dementia Strategy in England stressed the importance of earlier diagnosis of dementia. In-depth knowledge of the experiences of patients using such services remains an evidence gap. Aim To increase understanding of the experiences of people developing dementia and of their carers, to inform practice and decision making. Design and setting A retrospective and prospective qualitative interview study of participants recruited from four memory clinics in London, the north-west and the north-east of England. Method Purposive sampling was used to recruit 27 individuals with memory problems and 26 supporters and carers. Interviews explored referral pathways, assessment processes, disclosure of the diagnosis, experiences of being prescribed medication to help with symptoms, and issues of risk and decision making. Results Few participants experienced the process of memory assessment as patient centred. Where assessment processes were lengthy and drawn out, participants experienced considerable uncertainty. Many experienced tests and assessments as distressing, sometimes in settings that were perceived as alarming or potentially stigmatising by association. Information provision and communication were variable and practitioners were not always thought to help people to make sense of their experiences. Conclusion The transition from the early stages of cognitive impairment is not straightforward. There is potentially much uncertainty and waiting. Primary care practitioners may be better able to provide tailored support to individuals and their carers during this time if they are aware of what patients are anticipating and are informed about the diagnostic ‘journey’ by the insights of those who have experienced it.

Manthorpe, Jill; Samsi, Kritika; Campbell, Sarah; Abley, Clare; Keady, John; Bond, John; Watts, Sue; Robinson, Louise; Warner, James; Iliffe, Steve

2012-01-01

290

Three clinical experiences with SNP array results consistent with parental incest: a narrative with lessons learned.  

PubMed

Single nucleotide polymorphism microarrays have the ability to reveal parental consanguinity which may or may not be known to healthcare providers. Consanguinity can have significant implications for the health of patients and for individual and family psychosocial well-being. These results often present ethical and legal dilemmas that can have important ramifications. Unexpected consanguinity can be confounding to healthcare professionals who may be unprepared to handle these results or to communicate them to families or other appropriate representatives. There are few published accounts of experiences with consanguinity and SNP arrays. In this paper we discuss three cases where molecular evidence of parental incest was identified by SNP microarray. We hope to further highlight consanguinity as a potential incidental finding, how the cases were handled by the clinical team, and what resources were found to be most helpful. This paper aims to contribute further to professional discourse on incidental findings with genomic technology and how they were addressed clinically. These experiences may provide some guidance on how others can prepare for these findings and help improve practice. As genetic and genomic testing is utilized more by non-genetics providers, we also hope to inform about the importance of engaging with geneticists and genetic counselors when addressing these findings. PMID:24222483

Helm, Benjamin M; Langley, Katherine; Spangler, Brooke; Vergano, Samantha

2014-08-01

291

The logic of turmoil: some epistemological and clinical considerations on emotional experience and the infinite.  

PubMed

The idea of the infinite has its origins in the very beginnings of western philosophy and was developed significantly by modern philosophers such as Galileo and Leibniz. Freud discovered the Unconscious which does not respect the laws of classical logic, flouting its fundamental principle of non-contradiction. This opened the way to a new epistemology in which classical logic coexists with an aberrant logic of infinite affects. Matte Blanco reorganized this Freudian revolution in logic and introduced the concept of bi-logic, which is an intermingling of symmetric and Aristotelic logics. The authors explore some epistemological and clinical aspects of the functioning of the deep unconscious where the emergence of infinity threatens to overwhelm the containing function of thought, connecting this topic to some of Bion's propositions. They then suggest that bodily experiences can be considered a prime source of the logic of turmoil, and link a psychoanalytic consideration of the infinite to the mind-body relation. Emotional catastrophe is seen both as a defect-a breakdown of the unfolding function which translates unconscious material into conscious experience-and as the consequence of affective bodily pressures. These pressures function in turn as symmetrizing or infinitizing operators. Two clinical vignettes are presented to exemplify the hypotheses. PMID:18816337

Bria, Pietro; Lombardi, Riccardo

2008-08-01

292

Clinical experience and psychometric properties of the Children's Dermatology Life Quality Index (CDLQI), 1995-2012.  

PubMed

The Children's Dermatology Life Quality Index (CDLQI) is a widely used questionnaire to measure the quality of life of children aged from 4 to 16 years. The purpose of this review is to summarize all published data regarding the clinical experience of the CDLQI and its psychometric properties as a single reference source for potential users. A literature search was carried out to identify all articles describing the use of the CDLQI from 1995 to November 2012. One hundred and six articles were identified, with four excluded. The CDLQI has been used in 28 countries in 102 clinical studies and is available in 44 languages, including six cultural adaptations; a cartoon version is available in 10 languages. It has been used in 14 skin conditions and used in the assessment of 11 topical drugs, nine systemic drugs, 13 therapeutic interventions and two epidemiological and other studies. There is evidence of high internal consistency, test-retest reliability, responsiveness to change, and significant correlation with other subjective and objective measures. Rasch analysis has not been carried out and more information is needed concerning minimal clinically important difference; these are areas requiring further study. PMID:23679682

Salek, M S; Jung, S; Brincat-Ruffini, L A; MacFarlane, L; Lewis-Jones, M S; Basra, M K A; Finlay, A Y

2013-10-01

293

Eight years' experience of regional audit: an assessment of its value as a clinical governance tool.  

PubMed

Strengthening clinical audit is crucial for improving the quality of healthcare provision. The West Midlands Rheumatology Service and Training Committee coordinates an innovative programme of regional audits and the experience of rheumatology healthcare professionals involved was surveyed. This was a questionnaire-based study in which respondents rated statements relating to regional audit on Likert scales. Out of 105 staff, 70 replied. There was consensus that results of regional audit have been robust, valid and reliable; regional audits benefit patients and units; provide educational opportunities for specialist registrars (SpRs); and are more efficient than local audit by allowing comparison between units. Opinion was divided about how well informed respondents were and how effective they are at closing the audit loop. Many units reported changes in practice. Regional audit is widely perceived to be a valuable clinical governance tool supporting significant changes to clinical practice, and an excellent training opportunity for SpRs. Recommendations for a successful regional audit scheme are described in this article. PMID:20408300

John, H; Paskins, Z; Hassell, A; Rowe, I F

2010-02-01

294

Care of Pediatric Neurosurgical Patients in Iraq in 2007: Clinical and Ethical Experience of a Field Hospital.  

National Technical Information Service (NTIS)

Object. Care for host-nation pediatric casualties and disease or nonbattle injuries is an essential mission of deployed military medical assets. Clinical experience with pediatric patients at field hospitals has been increasingly reported since 2001, with...

J. E. Martin P. C. Spinella R. J. Teff

2010-01-01

295

Three-dimensional radiobiological dosimetry of kidneys for treatment planning in peptide receptor radionuclide therapy  

PubMed Central

Purpose: Peptide receptor radionuclide therapy (PRRT) delivers high absorbed doses to kidneys and may lead to permanent nephropathy. Reliable dosimetry of kidneys is thus critical for safe and effective PRRT. The aim of this work was to assess the feasibility of planning PRRT based on 3D radiobiological dosimetry (3D-RD) in order to optimize both the amount of activity to administer and the fractionation scheme, while limiting the absorbed dose and the biological effective dose (BED) to the renal cortex. Methods: Planar and SPECT data were available for a patient examined with 111In-DTPA-octreotide at 0.5 (planar only), 4, 24, and 48 h post-injection. Absorbed dose and BED distributions were calculated for common therapeutic radionuclides, i.e., 111In, 90Y and 177Lu, using the 3D-RD methodology. Dose-volume histograms were computed and mean absorbed doses to kidneys, renal cortices, and medullae were compared with results obtained using the MIRD schema (S-values) with the multiregion kidney dosimetry model. Two different treatment planning approaches based on (1) the fixed absorbed dose to the cortex and (2) the fixed BED to the cortex were then considered to optimize the activity to administer by varying the number of fractions. Results: Mean absorbed doses calculated with 3D-RD were in good agreement with those obtained with S-value-based SPECT dosimetry for 90Y and 177Lu. Nevertheless, for 111In, differences of 14% and 22% were found for the whole kidneys and the cortex, respectively. Moreover, the authors found that planar-based dosimetry systematically underestimates the absorbed dose in comparison with SPECT-based methods, up to 32%. Regarding the 3D-RD-based treatment planning using a fixed BED constraint to the renal cortex, the optimal number of fractions was found to be 3 or 4, depending on the radionuclide administered and the value of the fixed BED. Cumulative activities obtained using the proposed simulated treatment planning are compatible with real activities administered to patients in PRRT. Conclusions: The 3D-RD treatment planning approach based on the fixed BED was found to be the method of choice for clinical implementation in PRRT by providing realistic activity to administer and number of cycles. While dividing the activity in several cycles is important to reduce renal toxicity, the clinical outcome of fractionated PRRT should be investigated in the future.

Baechler, Sebastien; Hobbs, Robert F.; Boubaker, Ariane; Buchegger, Franz; He, Bin; Frey, Eric C.; Sgouros, George

2012-01-01

296

Experiences of women with a diagnosis of breast cancer: a clinical pathway approach.  

PubMed

The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide age range and different stages of illness. The transcribed accounts of the women were analysed by means of Qualitative Solutions and Research, Non-Numerical Unstructured Data Indexing Searching and Theorising (QSR*NUDIST). The study examined the individual experiences of women with a diagnosis of breast cancer and its aftermath as they passed through different stages related to it. The women's experiences are presented within the conceptual framework of the clinical pathway and their accounts represent their journey along the pathway. Various significant points in this journey are portrayed representing the women's reactions to diagnosis, treatment, femininity and body image, support, family and friends, information and after care. PMID:12849036

Lindop, E; Cannon, S

2001-06-01

297

Nurse practitioners' knowledge, experience, and intention to use health literacy strategies in clinical practice.  

PubMed

Nurse practitioners' (NPs) knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework. NPs who work in outpatient settings were recruited at a national NP conference. Participants were administered 3 self-report instruments: Health Literacy Knowledge and Experience Survey, Parts I and II; and the Health Literacy Strategies Behavioral Intention Questionnaire. Overall knowledge of health literacy and health literacy strategies was found to be low. Screening patients for low health literacy and evaluating patient education materials were found to be areas of knowledge deficit. Most NP participants used written patient education materials with alternate formats for patient education, such as audiotapes, videotapes, or computer software rarely used. Statistically significant differences were found in mean experience scores between NP level of educational preparation and NP practice settings. The intention to use health literacy strategies in practice was found to be strong. The findings of this investigation offer implications for enhancing NP curriculum and for continuing education opportunities. Increasing NPs' knowledge of health literacy and facilitating the use of health literacy strategies has the potential to change clinical practice and support improved patient outcomes. PMID:24093347

Cafiero, Madeline

2013-01-01

298

Nurse Practitioners' Knowledge, Experience, and Intention to Use Health Literacy Strategies in Clinical Practice  

PubMed Central

Nurse practitioners' (NPs) knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework. NPs who work in outpatient settings were recruited at a national NP conference. Participants were administered 3 self-report instruments: Health Literacy Knowledge and Experience Survey, Parts I and II; and the Health Literacy Strategies Behavioral Intention Questionnaire. Overall knowledge of health literacy and health literacy strategies was found to be low. Screening patients for low health literacy and evaluating patient education materials were found to be areas of knowledge deficit. Most NP participants used written patient education materials with alternate formats for patient education, such as audiotapes, videotapes, or computer software rarely used. Statistically significant differences were found in mean experience scores between NP level of educational preparation and NP practice settings. The intention to use health literacy strategies in practice was found to be strong. The findings of this investigation offer implications for enhancing NP curriculum and for continuing education opportunities. Increasing NPs' knowledge of health literacy and facilitating the use of health literacy strategies has the potential to change clinical practice and support improved patient outcomes.

Cafiero, Madeline

2013-01-01

299

Dissociative experiences in obsessive-compulsive disorder and trichotillomania: clinical and genetic findings.  

PubMed

A link between dissociation proneness in adulthood and self-reports of childhood traumatic events (including familial loss in childhood, sexual/physical abuse and neglect) has been documented. Several studies have also provided evidence for an association between dissociative experiences and trauma in patients with various psychiatric disorders, including post-traumatic stress disorder, borderline personality, dissociative identity and eating disorders. Based on the relative paucity of data on dissociation and trauma in obsessive-compulsive disorder (OCD) and trichotillomania (TTM), the primary objective of this study was to examine the relationship between trauma and dissociative experiences (DE) in these two diagnostic groups. Furthermore, the availability of clinical and genetic data on this sample allowed us to explore clinical and genetic factors relevant to this association. A total of 110 OCD and 32 TTM patients were compared with respect to the degree of dissociation (using the Dissociative Experiences Scale [DES]) and childhood trauma (using the Childhood Trauma Questionnaire [CTQ]). Patients were classified on the DES as either "high" (mean DES score >/= 30) or "low" (mean DES score < 30) dissociators. Additional clinical and genetic factors were also explored with chi-square and t tests as appropriate. A total of 15.8% of OCD patients and 18.8% of TTM patients were high dissociators. OCD and TTM groups were comparable on DES and CTQ total scores, and in both OCD and TTM groups, significant positive correlations were found between mean DES scores and mean CTQ subscores of emotional abuse, physical abuse, sexual abuse, and physical neglect. In the OCD group, high dissociators were significantly younger than low dissociators, and significantly more high dissociators than low dissociators reported a lifetime (current and past) history of tics (P <.001), Tourette's syndrome (P =.019), bulimia nervosa (P =.003), and borderline personality disorder (P =.027). In the TTM group, significantly more high dissociators than low dissociators reported (lifetime) kleptomania (P =.005) and depersonalisation disorder (P =.005). In the Caucasian OCD patients (n = 114), investigation of genetic polymorphisms involved in monoamine function revealed no significant differences between high and low dissociator groups. This study demonstrates a link between childhood trauma and DE in patients with OCD and TTM. High dissociative symptomatology may be present in a substantial proportion of patients diagnosed with these disorders. High dissociators may also be differentiated from low dissociators on some demographic features (e.g., lower age) and comorbidity profile (e.g., increased incidence of impulse dyscontrol disorders). Additional work is necessary before conclusions about the role of monoaminergic systems in mediating such dissociation can be drawn. PMID:15332202

Lochner, Christine; Seedat, Soraya; Hemmings, Sian M J; Kinnear, Craig J; Corfield, Valerie A; Niehaus, Dana J H; Moolman-Smook, Johanna C; Stein, Dan J

2004-01-01

300

Tradeoffs for Assuming Rigid Target Motion in Mlc-Based Real Time Target Tracking Radiotherapy: A Dosimetric and Radiobiological Analysis  

PubMed Central

We report on our assessment of two types of real time target tracking modalities for lung cancer radiotherapy namely (1) single phase propagation (SPP) where motion compensation assumes a rigid target and (2) multi-phase propagation (MPP) where motion compensation considers a deformable target. In a retrospective study involving 4DCT volumes from six (n=6) previously treated lung cancer patients, four-dimensional treatment plans representative of the delivery scenarios were generated per modality and the corresponding dose distributions were derived. The modalities were then evaluated (a) Dosimetrically for target coverage adequacy and normal tissue sparing by computing the mean GTV dose, relative conformity gradient index (CGI), mean lung dose (MLD) and lung V20; (b) Radiobiologically by calculating the biological effective uniform dose (D?) for the target and organs at risk (OAR) and the complication free tumor control probability (P+). As a reference for the comparative study, we included a 4D Static modality, which was a conventional approach to account for organ motion and involved the use of individualized motion margins. With reference to the 4D Static modality, the average percent decrease in lung V20 and MLD were respectively (13.1±6.9) % and (11.4±5.6) % for the MPP modality, whereas for the SPP modality they were (9.4±6.2) % and (7.2±4.7) %. On the other hand, the CGI was observed to improve by 15.3±13.2 and 9.6±10.0 points for the MPP and SPP modalities, respectively while the mean GTV dose agreed to better than 3% difference across all the modalities. A similar trend was observed in the radiobiological analysis where the P+ improved on average by (6.7±4.9) % and (4.1±3.6) % for the MPP and SPP modalities, respectively while the D? computed for the OAR decreased on average by (6.2±3.6) % and (3.8±3.5) % for the MPP and SPP tracking modalities, respectively. The D? calculated for the GTV for all the modalities was in agreement to better than 2% difference. In general, respiratory motion induces target displacement and deformation and therefore the complex MPP real time target tracking modality is the preferred. On the other hand, the SPP approach affords simplicity in implementation at the expense of failing to account for target deformation. Radiobiological and dosimetric analyses enabled us to investigate the consequences of failing to compensate for deformation and assess the impact if any on the clinical outcome. While it is not possible to draw any general conclusions on a small patient cohort, our study suggests that the two tracking modalities can lead to comparable clinical outcomes and as expected are advantageous when compared with the static conventional modality.

Roland, Teboh; Shi, Chengyu; Liu, Yaxi; Crownover, R.; Mavroidis, Panayiotis; Papanikolaou, Nikos

2010-01-01

301

An exploration of the experience of compassion fatigue in clinical oncology nurses.  

PubMed

Compassion fatigue (CF) is "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers' stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided. PMID:21661623

Perry, Beth; Toffner, Greg; Merrick, Trish; Dalton, Janice

2011-01-01

302

New minimal immunosuppression strategies for composite tissue allograft transplantation: the cleveland clinic experience.  

PubMed

Clinical application of composite tissue allografts requires the introduction of new minimal immunosuppressive or tolerance-inducing protocols. We have established a protocol for tolerance induction under ?/? selective blocking antibody T-cell receptor combined with interleukin-2 blocker cyclosporin A therapy. Application of this therapy resulted in induction of tolerance in fully allogenic and semiallogenic limb allograft transplants. Based on this experience we have found that the bone marrow component of the allograft is essential for tolerance induction and have confirmed that injection of bone marrow of donor origin directly into the bone marrow compartment of allograft recipients resulted in higher chimerism levels. In addition, we have developed a system for isolation of chimeric cells, which are specific for both the donor and recipient, by using magnetic activated cell sorting technique and flow cytometry. These new, experimental approaches confirm that introducing minimal suppression to patients undergoing hand or face transplantation will likely be achieved in the near future. PMID:21304046

Siemionow, Maria

2011-01-01

303

Portaclamp in video-assisted minimally invasive cardiac surgery: surgical technique and preliminary clinical experience.  

PubMed

Video-assisted minimally invasive cardiac surgery (VAMICS) is currently performed with various indications. However, despite the increasing evidence of its effectiveness, new approaches have to be defined to simplify this procedure, minimize its potential complications and limit its costs, for a wider use in the surgical community. The limited access to the aorta is a key point in VAMICS and mandates specific clamping modalities with their own limitations, costs and drawbacks. The Portaclamp (Cardio Life Research SA, Louvain la Neuve, Belgium), a new autoguided extravascular aortic cross-clamping system, has been recently proposed to facilitate VAMICS. Herein, we describe the Portaclamp approach and report our indications and preliminary clinical experience so to define its role in VAMICS. PMID:15896633

Marchetto, Giovanni; D'Armini, Andrea M; Rinaldi, Mauro; Viganò, Mario

2005-06-01

304

Clinical experience results with clindamycin 1% benzoyl peroxide 5% gel (Duac) as monotherapy and in combination.  

PubMed

This article will examine various clinical experiences with acne patients successfully treated with topical clindamycin 1% benzoyl peroxide 5% gel (Duac) alone and in combination with other acne treatments. Clindamycin 1% benzoyl peroxide 5%, the only once-daily prescription topical aqueous gel combining a benzoyl peroxide and an antibiotic, has demonstrated excellent tolerability and efficacy and is stable when used concomitantly with other therapies. A regimen of topical clindamycin 1% benzoyl peroxide 5% gel, oral doxycycline hyclate (Doryx), and adapalene gel (Differin) seems especially advantageous from a theoretical and practical perspective. Improvement is noted by means of photographic, physician, and/or patient assessments at baseline and follow-up visits. PMID:15776773

Bikowski, Joseph B

2005-01-01

305

Clinical experience with stem cells and other cell therapies in neurological diseases.  

PubMed

To overcome the limited capacity of the CNS for regeneration, the theoretical alternative would be to use stem cells for more effective management of chronic degenerative and inflammatory neurological conditions, and also of acute neuronal damage from injuries or cerebrovascular diseases. Although the adult brain contains small numbers of stem cells in restricted areas, this intrinsic stem cell repertoire is small and does not measurably contribute to functional recovery. Embryonic cells carrying pluripotent and self-renewal properties represent the stem cell prototype, but there are additional somatic stem cells that may be harvested and expanded from various tissues during adult life. Stem cell transplantation is based on the assumption that such cells may have the potential to regenerate or support the survival of the existing, partially damaged cells. This review summarizes the state-of-the-art and the clinical worldwide experience with the use of various types of stem cells in neurological diseases. PMID:23107343

Karussis, Dimitrios; Petrou, Panayiota; Kassis, Ibrahim

2013-01-15

306

Bringing Buprenorphine-Naloxone Detoxification to Community Treatment Providers: The NIDA Clinical Trials Network Field Experience  

PubMed Central

In October 2002, the U.S. Food and Drug Administration approved buprenorphine-naloxone (Suboxone®) sublingual tablets as an opioid dependence treatment available for use outside traditionally licensed opioid treatment programs. The NIDA Center for Clinical Trials Network (CTN) sponsored two clinical trials assessing buprenorphine-naloxone for short-term opioid detoxification. These trials provided an unprecedented field test of its use in twelve diverse community-based treatment programs. Opioid-dependent men and women were randomized to a thirteen-day buprenorphine-naloxone taper regimen for short-term opioid detoxification. The 234 buprenorphine-naloxone patients averaged 37 years old and used mostly intravenous heroin. Direct and rapid induction onto buprenorphine-naloxone was safe and well tolerated. Most patients (83%) received 8 mg buprenorphine-2 mg naloxone on the first day and 90% successfully completed induction and reached a target dose of 16mg buprenorphine-4 mg naloxone in three days. Medication compliance and treatment engagement was high. An average of 81% of available doses was ingested, and 68% of patients completed the detoxification. Most (80.3%) patients received some ancillary medications with an average of 2.3 withdrawal symptoms treated. The safety profile of buprenorphine-naloxone was excellent. Of eighteen serious adverse events reported, only one was possibly related to buprenorphine-naloxone. All providers successfully integrated buprenorphine-naloxone into their existing treatment milieus. Overall, data from the CTN field experience suggest that buprenorphine-naloxone is practical and safe for use in diverse community treatment settings, including those with minimal experience providing opioid-based pharmacotherapy and/or medical detoxification for opioid dependence.

Amass, Leslie; Ling, Walter; Freese, Thomas E.; Reiber, Chris; Annon, Jeffrey J.; Cohen, Allan J.; M.F.T.; McCarty, Dennis; Reid, Malcolm S.; Brown, Lawrence S.; Clark, Cynthia; Ziedonis, Douglas M.; Krejci, Jonathan; Stine, Susan; Winhusen, Theresa; Brigham, Greg; Babcock, Dean; L.C.S.W.; Muir, Joan A.; Buchan, Betty J.; Horton, Terry

2005-01-01

307

Chromosomal microarray analysis as a first-tier clinical diagnostic test: Estonian experience  

PubMed Central

Chromosomal microarray analysis (CMA) is now established as the first-tier cytogenetic diagnostic test for fast and accurate detection of chromosomal abnormalities in patients with developmental delay/intellectual disability (DD/ID), multiple congenital anomalies (MCA), and autism spectrum disorders (ASD). We present our experience with using CMA for postnatal and prenatal diagnosis in Estonian patients during 2009–2012. Since 2011, CMA is on the official service list of the Estonian Health Insurance Fund and is performed as the first-tier cytogenetic test for patients with DD/ID, MCA or ASD. A total of 1191 patients were analyzed, including postnatal (1072 [90%] patients and 59 [5%] family members) and prenatal referrals (60 [5%] fetuses). Abnormal results were reported in 298 (25%) patients, with a total of 351 findings (1–3 per individual): 147 (42%) deletions, 106 (30%) duplications, 89 (25%) long contiguous stretches of homozygosity (LCSH) events (>5?Mb), and nine (3%) aneuploidies. Of all findings, 143 (41%) were defined as pathogenic or likely pathogenic; for another 143 findings (41%), most of which were LCSH, the clinical significance remained unknown, while 61 (18%) reported findings can now be reclassified as benign or likely benign. Clinically relevant findings were detected in 126 (11%) patients. However, the proportion of variants of unknown clinical significance was quite high (41% of all findings). It seems that our ability to detect chromosomal abnormalities has far outpaced our ability to understand their role in disease. Thus, the interpretation of CMA findings remains a rather difficult task requiring a close collaboration between clinicians and cytogeneticists.

Zilina, Olga; Teek, Rita; Tammur, Pille; Kuuse, Kati; Yakoreva, Maria; Vaidla, Eve; Molter-Vaar, Triin; Reimand, Tiia; Kurg, Ants; Ounap, Katrin

2014-01-01

308

Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator.  

PubMed

Seventy patients received the automatic implantable defibrillator, five original devices and 72 modified second-generation devices using only bipolar rate sensing and delivering an R wave synchronous cardioverting/defibrillating shock, for either ventricular tachycardia or fibrillation. The primary clinical arrhythmia was sustained ventricular tachycardia in 32 patients, ventricular fibrillation in 20 patients, and both ventricular tachycardia and fibrillation in 18 patients. Before implantation of the device the patients had survived 3.1 +/- 2.3 arrhythmic episodes, including 1.9 +/- 1.7 cardiac arrest, and had received 4.0 +/- 2.1 antiarrhythmic drugs without improvement. Sixty-eight patients ultimately received devices. After a follow-up period of 8.9 +/- 7.7 months (range 1 to 33), 37 patients received a total of 463 discharges. Inability to determine the precise reason for most discharges and the unpleasant nature of the discharges were the major clinical problems encountered. Complications included postoperative death (one patient), lead problems (six patients), inadequate energy requiring explanation (two patients), and pocket infection (one patient. Life-table analysis revealed 6 and 12 month cardiovascular survival of 95.0% and 89.9% and sudden death survival of 98.2%. In our experience, survival with the automatic implantable cardioverter/defibrillator exceeds that with other forms of therapy. PMID:3965173

Echt, D S; Armstrong, K; Schmidt, P; Oyer, P E; Stinson, E B; Winkle, R A

1985-02-01

309

Flagging clinical adverse experiences: reducing false discoveries without materially compromising power for detecting true signals.  

PubMed

Comparative analyses of safety/tolerability data from a typical phase III randomized clinical trial generate multiple p-values associated with adverse experiences (AEs) across several body systems. A common approach is to 'flag' any AE with a p-value less than or equal to 0.05, ignoring the multiplicity problem. Despite the fact that this approach can result in excessive false discoveries (false positives), many researchers avoid a multiplicity adjustment to curtail the risk of missing true safety signals. We propose a new flagging mechanism that significantly lowers the false discovery rate (FDR) without materially compromising the power for detecting true signals, relative to the common no-adjustment approach. Our simple two-step procedure is an enhancement of the Mehrotra-Heyse-Tukey approach that leverages the natural grouping of AEs by body systems. We use simulations to show that, on the basis of FDR and power, our procedure is an attractive alternative to the following: (i) the no-adjustment approach; (ii) a one-step FDR approach that ignores the grouping of AEs by body systems; and (iii) a recently proposed two-step FDR approach for much larger-scale settings such as genome-wide association studies. We use three clinical trial examples for illustration. PMID:22415725

Mehrotra, Devan V; Adewale, Adeniyi J

2012-08-15

310

Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients  

PubMed Central

Background To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology. Methods During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45Gy and 69.96Gy in 33 fractions (group A); 54.45Gy and 66Gy in 33 fractions (group B) and 55Gy in 25 fractions (group C). Results Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition. Conclusions These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities.

2010-01-01

311

Evaluation of Clinical Pharmacy Programs: The D.D. Eisenhower Army Medical Center Experience.  

National Technical Information Service (NTIS)

Although clinical pharmacy services have existed for a number of years, their cost effectiveness has not been adequately assessed. Clinical pharmacists are members of the patient care team. Besides providing direct patient counseling, clinical pharmacists...

K. H. Dexter

1996-01-01

312

Team-based learning, a learning strategy for clinical reasoning, in students with problem-based learning tutorial experiences.  

PubMed

Acquiring clinical reasoning skills in lectures may be difficult, but it can be learnt through problem-solving in the context of clinical practice. Problem finding and solving are skills required for clinical reasoning; however, students who underwent problem-based learning (PBL) still have difficulty in acquiring clinical reasoning skills. We hypothesized that team-based learning (TBL), a learning strategy that provides the opportunity to solve problems by repeatedly taking tests, can enhance the clinical reasoning ability in medical students with PBL experiences during the pre-clinical years. TBL courses were designed for 4(th) year students in a 6-year program in 2008, 2009, and 2010. TBL individual scores, consisting of a combination of individual and group tests, were compared with scores of several examinations including computer-based testing (CBT), an original examination assessing clinical reasoning ability (problem-solving ability test; P-SAT), term examinations, and Objective Structured Clinical Examination (OSCE). CBT, OSCE and P-SAT scores were compared with those of students who learned clinical reasoning only through PBL tutorials in 2005, 2006, and 2007 (non-TBL students). Individual TBL scores of students did not correlate with scores of any other examination. Assessments on clinical reasoning ability, such as CBT, OSCE, and P-SAT scores, were significantly higher in TBL students compared with non-TBL students. Students found TBL to be effective, particularly in areas of problem solving by both individuals and teams, and feedback from specialists. In conclusion, TBL for clinical reasoning is useful in improving clinical reasoning ability in students with PBL experiences with limited clinical exposure. PMID:22516766

Okubo, Yumiko; Ishiguro, Naoko; Suganuma, Taiyo; Nishikawa, Toshio; Takubo, Toshio; Kojimahara, Noriko; Yago, Rie; Nunoda, Shinichi; Sugihara, Shigetaka; Yoshioka, Toshimasa

2012-01-01

313

Effects of radiobiological uncertainty on shield design for a 60-day lunar mission  

NASA Technical Reports Server (NTRS)

Some consequences of uncertainties in radiobiological risk due to galactic cosmic ray exposure are analyzed to determine their effect on engineering designs for a first lunar outpost - a 60-day mission. Quantitative estimates of shield mass requirements as a function of a radiobiological uncertainty factor are given for a simplified vehicle structure. The additional shield mass required for compensation is calculated as a function of the uncertainty in galactic cosmic ray exposure, and this mass is found to be as large as a factor of 3 for a lunar transfer vehicle. The additional cost resulting from this mass is also calculated. These cost estimates are then used to exemplify the cost-effectiveness of research.

Wilson, John W.; Nealy, John E.; Schimmerling, Walter

1993-01-01

314

Laboratory x-ray irradiator for cellular radiobiology research studies: Dosimetry report. Technical report  

SciTech Connect

Dosimetry measurements were performed on a 50 kVp laboratory x-ray irradiator for cellular radiobiology research. The measurements were done with a parallel-plate ionization chamber, which had a thin aluminized-mylar window, and an extrapolation chamber. Intercomparison of dosimetry data from the two independent methods showed excellent agreement. Results are presented for radiation dose rate, uniformity, and beam quality for operation of the tungsten target, beryllium window x-ray tube at 50 kVp, 20 mA, and with filters either 0.012 mm, 0.180mm, or 0.633-mm thick, for arrays positioned at a range of distances from the x-ray tube. The data in this report establish a dosimetric link between the cellular radiobiology research to be performed at AFRRI with the 50 kVp laboratory x-ray irradiator and the landmark work performed by Elkind and Sutton (1960) with a similar device.

Mohaupt, T.H.; Zeman, G.H.; Blakely, W.F.; Elkind, M.M.

1989-04-01

315

Does recruitment lead to retention? - Rural Clinical School training experiences and subsequent intern choices  

Microsoft Academic Search

Introduction: The Australian Rural Clinical Schools, established nationally in 2000- 2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the

Diann Eley; Australia Peter Baker

316

Radiobiologic risk estimation from dental radiology. Part I. Absorbed doses to critical organs  

Microsoft Academic Search

The aim of the present study was to generate one consistent set of data for evaluating and comparing radiobiologic risks from different dental radiographic techniques. To accomplish this goal, absorbed doses were measured in fourteen anatomic sites from (1) five different panoramic machines with the use of rare-earth screens, (2) a twenty-film complete-mouth survey with E-speed film, long round cone,

T. E. Underhill; I. Chilvarquer; K. Kimura; R. P. Langlais; W. D. McDavid; J. W. Preece; G. Barnwell

1988-01-01

317

Clinical trials in cancer: the role of surrogate patients in defining what constitutes an ethically acceptable clinical experiment.  

PubMed Central

Doctors who treat lung cancer in Ontario were previously asked how they would wish to be managed if they developed non-small cell lung cancer and whether they would consent to participate in six clinical trials for which they might be eligible. The proportion of these expert surrogate patients who would consent to each clinical trial ranged from 11 to 64%. The results of this study were transmitted to the same group of doctors who were asked to comment on the ethical acceptability of each trial in the light of this information. The majority of physicians said that those trials to which less than 50% of expert surrogates consented should not have been opened to patients. Sixty-nine per cent of doctors thought that new trials should be evaluated in this way. We also present the results of a survey of 400 lay people in Ontario who were asked to imagine that they had lung cancer and whether they would consent to participate in two of these same clinical trials. Fifty per cent of lay people consented to a randomised trial of lobectomy versus segmentectomy in early, operable disease (LCSC-821) compared to 64% of expert surrogates, and 48% of lay people consented to a randomised trial of five different forms of chemotherapy in metastatic disease (SWOG-8241) compared to 19% of doctors. It was concluded that the lay people were unable to discern differences in the acceptability of clinical trials which were clear to experts in the field. Subsequently, respondents were told about the decisions which doctors would make in the same circumstances and asked if this information would modify their previous decisions. There is no net change in the proportion of patients consenting to the surgery trial but the proportion of people consenting to the chemotherapy trial decreased by 40%. The majority of lay people said that they would wish to have access to this type of information before consenting to participate in a clinical trial.

Mackillop, W. J.; Palmer, M. J.; O'Sullivan, B.; Ward, G. K.; Steele, R.; Dotsikas, G.

1989-01-01

318

21st L H Gray Conference: the radiobiology/radiation protection interface.  

PubMed

The 21st L H Gray Conference, organised by the L H Gray Trust with the Society for Radiological Protection, brought together international experts in radiobiology, epidemiology and risk assessment, and scientists involved in diagnostic and therapeutic radiation exposure. The meeting - held in Edinburgh, Scotland, on 4-6 June 2008 - aimed to raise awareness, educate and share knowledge of important issues in radiation protection. A distinguished group of speakers discussed topics that included (i) non-targeted effects of radiation, (ii) exposure to high natural background radiation, (iii) non-cancer effects in Japanese bomb survivors, (iv) lessons learnt from Chernobyl, (v) radiation in the workplace, (vi) biokinetic modelling, (vii) uncertainties in risk estimation, (viii) issues in diagnostic medical exposures, (ix) lessons leant from the polonium-210 incidence and (x) how the radiobiology/radiation oncology community is needed to help society prepare for potential future acts of radiation terrorism. The conference highlighted the importance, relevance and topicality of radiobiology today. PMID:19386958

West, C M L; Martin, C J; Sutton, D G; Wright, E G

2009-05-01

319

Accelerated partial-breast irradiation using proton beams: Initial clinical experience  

SciTech Connect

Purpose: We present our initial clinical experience with proton, three-dimensional, conformal, external beam, partial-breast irradiation (3D-CPBI). Methods and Materials: Twenty patients with Stage I breast cancer were treated with proton 3D-CPBI in a Phase I/II clinical trial. Patients were followed at 3 to 4 weeks, 6 to 8 weeks, 6 months, and every 6 months thereafter for recurrent disease, cosmetic outcome, toxicity, and patient satisfaction. Results: With a median follow-up of 12 months (range, 8-22 months), no recurrent disease has been detected. Global breast cosmesis was judged by physicians to be good or excellent in 89% and 100% of cases at 6 months and 12 months, respectively. Patients rated global breast cosmesis as good or excellent in 100% of cases at both 6 and 12 months. Proton 3D-CPBI produced significant acute skin toxicity with moderate to severe skin color changes in 79% of patients at 3 to 4 weeks and moderate to severe moist desquamation in 22% of patients at 6 to 8 weeks. Telangiectasia was noted in 3 patients. Three patients reported rib tenderness in the treated area, and one rib fracture was documented. At last follow-up, 95% of patients reported total satisfaction with proton 3D-CPBI. Conclusions: Based on our study results, proton 3D-CPBI offers good-to-excellent cosmetic outcomes in 89% to 100% of patients at 6-month and 12-month follow-up and nearly universal patient satisfaction. However, proton 3D-CPBI, as used in this study, does result in significant acute skin toxicity and may potentially be associated with late skin (telangiectasia) and rib toxicity. Because of the dosimetric advantages of proton 3D-CPBI, technique modifications are being explored to improve acute skin tolerance.

Kozak, Kevin R. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Smith, Barbara L. [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Adams, Judith C. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Kornmehl, Ellen [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Katz, Angela [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Gadd, Michele [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Specht, Michelle [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Hughes, Kevin [Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA (United States); Gioioso, Valeria [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Lu, H.-M. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Braaten, Kristina [Department of Pathology, Massachusetts General Hospital, Boston, MA (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Powell, Simon N. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Taghian, Alphonse G. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)]. E-mail: ataghian@partners.org

2006-11-01

320

A reappraisal of the clinical efficacy of nebulized flunisolide in pediatric asthma: the Italian experience.  

PubMed

Flunisolide (FLU) is a synthetic corticosteroid with potent topical anti-inflammatory activity. Its oral bioavailability is poor (6.7%). After gastrointestinal and lung absorption, the drug undergoes rapid and extensive first-pass metabolism by the liver to an inactive 6beta-hydroxylated metabolite. Plasma half-life is estimated to be 3.9 to 4.6 hours. FLU has a low volume of distribution at steady state and a short terminal half-life after inhalation (96 L and 1.6 hour, respectively). FLU, like budesonide, has a short pulmonary residence time and it is hypothesized that it may undergo esterification in the cell due to the presence of a free hydroxyl group at C21. Nebulization may offer important advantages over other inhalation methods. Nebulizers allow drug delivery in very young children through passive inhalation, depending less on patient coordination and cooperation. Comparative studies indicate that FLU is nebulized to a better advantage than beclomethasone dipropionate and budesonide. This is attributed to its elevated water solubility. The aim of this article is to outline the factors that influence drug nebulization and the pharmacokinetics-pharmacodynamics of FLU compared to other inhaled corticosteroids. In addition, we report a series of clinical data regarding the efficacy of nebulized FLU with focus on the Italian experience. Overall, the physicochemical characteristics and pharmacokinetic profile of FLU favor its use for nebulization. Clinical data indicate that nebulized FLU is effective in asthma treatment in infants and children. Side effects were not reported at the commonly used doses. PMID:17883883

Kantar, Ahmad; Mroueh, Salman; Fiocchi, Alessandro

2007-01-01

321

Initial clinical laboratory experience in noninvasive prenatal testing for fetal aneuploidy from maternal plasma DNA samples  

PubMed Central

Objective The aim of this study is to report the experience of noninvasive prenatal DNA testing using massively parallel sequencing in an accredited clinical laboratory. Methods Laboratory information was examined for blood samples received for testing between February and November 2012 for chromosome 21 (Chr21), Chr18, and Chr13. Monosomy X (MX) testing was available from July 2012 for cystic hygroma indication. Outcomes were collected from providers on samples with positive results. Results There were 5974 samples tested, and results were issued within an average of 5.1 business days. Aneuploidy was detected in 284 (4.8%) samples (155 Chr21, 66 Chr18, 19 Chr13, 40 MX, and four double aneuploidy). Follow-ups are available for 245/284 (86%), and 77/284 (27.1%) are confirmed, including one double-aneuploidy case concordant with cytogenetics from maternal malignancy. Fourteen (0.2%) discordant (putative false-positive) results (one Chr21, six Chr18, three Chr13, three MX, and one Chr21/13) have been identified. Five (0.08%) false-negative cases are reported (two trisomy 21, two trisomy 18, and one MX). In 170 (2.8%) cases, the result for a single chromosome was indefinite. Conclusions This report suggests that clinical testing of maternal cell-free DNA for fetal aneuploidy operates within performance parameters established in validation studies. Noninvasive prenatal testing is sensitive to biological contributions from placental and maternal sources. ©2013 Verinata Health, Inc. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

Futch, Tracy; Spinosa, John; Bhatt, Sucheta; de Feo, Eileen; Rava, Richard P; Sehnert, Amy J

2013-01-01

322

First clinical experience in carbon ion scanning beam therapy: retrospective analysis of patient positional accuracy  

PubMed Central

Our institute has constructed a new treatment facility for carbon ion scanning beam therapy. The first clinical trials were successfully completed at the end of November 2011. To evaluate patient setup accuracy, positional errors between the reference Computed Tomography (CT) scan and final patient setup images were calculated using 2D-3D registration software. Eleven patients with tumors of the head and neck, prostate and pelvis receiving carbon ion scanning beam treatment participated. The patient setup process takes orthogonal X-ray flat panel detector (FPD) images and the therapists adjust the patient table position in six degrees of freedom to register the reference position by manual or auto- (or both) registration functions. We calculated residual positional errors with the 2D-3D auto-registration function using the final patient setup orthogonal FPD images and treatment planning CT data. Residual error averaged over all patients in each fraction decreased from the initial to the last treatment fraction [1.09 mm/0.76° (averaged in the 1st and 2nd fractions) to 0.77 mm/0.61° (averaged in the 15th and 16th fractions)]. 2D-3D registration calculation time was 8.0 s on average throughout the treatment course. Residual errors in translation and rotation averaged over all patients as a function of date decreased with the passage of time (1.6 mm/1.2° in May 2011 to 0.4 mm/0.2° in December 2011). This retrospective residual positional error analysis shows that the accuracy of patient setup during the first clinical trials of carbon ion beam scanning therapy was good and improved with increasing therapist experience.

Mori, Shinichiro; Shibayama, Kouichi; Tanimoto, Katsuyuki; Kumagai, Motoki; Matsuzaki, Yuka; Furukawa, Takuji; Inaniwa, Taku; Shirai, Toshiyuki; Noda, Koji; Tsuji, Hiroshi; Kamada, Tadashi

2012-01-01

323

Rediscovering the essence of nursing: exploring the impact of in clinical experience in Thailand for undergraduate nursing students from Australia.  

PubMed

Cultural competence is now widely recognised as an essential characteristic for undergraduate nursing students. Clinical experience in foreign countries has become increasingly popular as a strategy to enhance cultural awareness and competence. However, published research articulating the experience and outcomes of these initiatives is relatively rare, particularly from an Australian perspective. This paper presents the findings of a qualitative, exploratory research project. Individual semi-structure interviews were conducted with eight undergraduate nursing students before, during and at the conclusion of a four week clinical placement in Surin, Thailand. Data analysis identified the following major themes: first interview - anticipation; second interview - making a difference; contrasting worlds; and part of the group; third interview - reality check and group dynamics. These findings suggest that international clinical experience has potential benefits beyond the development of cultural competence. The importance of caring in nursing and the importance of group dynamics were particularly valued by student participants. PMID:21256636

Reid-Searl, Kerry; Dwyer, Trudy; Moxham, Lorna; Happell, Brenda; Sander, Teresa

2011-11-01

324

V.A.C. Therapy in the management of paediatric wounds: clinical review and experience.  

PubMed

Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure (V.A.C. Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C. Therapy System. PMID:19614789

Baharestani, Mona; Amjad, Ibrahim; Bookout, Kim; Fleck, Tatjana; Gabriel, Allen; Kaufman, David; McCord, Shannon Stone; Moores, Donald C; Olutoye, Oluyinka O; Salazar, Jorge D; Song, David H; Teich, Steven; Gupta, Subhas

2009-08-01

325

The coordination of clinical and didactic learning experiences to improve critical-thinking skills and academic performance  

Microsoft Academic Search

Teaching strategies to improve critical-thinking skills and knowledge construction in associate degree (AD) nursing education are most effective when they actively engage the student. Faculty in an Illinois nursing program developed a schedule that correlated classroom content with clinical experiences for the predominant medical–surgical units. While planned didactic\\/clinical correlation yielded mixed results as a strategy to improve academic performance, providing

Cynthia L. Maskey

2008-01-01

326

Experiences and challenges in data monitoring for clinical trials within an international tropical disease research network  

PubMed Central

Background Models for the structure and procedures of data and safety monitoring boards (DSMBs) continue to evolve in response to issues of new and of old concern. Some authors have called for an open dialogue on these questions through publication of the experiences of DSMBs in addressing them. Purpose The goal of this paper is to add to the current discussion about acceptable models for establishing, serving on, and reporting to monitoring committees, particularly those that oversee multiple studies in less developed countries. The paper seeks to do so by describing the establishment and subsequent operation of one such multi-trial DSMB over a five-year period. This DSMB was formed to monitor trials conducted by members of the International Centers for Tropical Disease Research (ICTDR) network of the National Institute of Allergy and Infectious Diseases (NIAID). Methods The operational model and experiences are summarized by the authors, who had immediate responsibilities for directing the DSMB's activities. Results The board played an active, traditional role in assuring that patient safety was maintained and that current standards for clinical research were met. In addition, both NIAID and the board members viewed education of investigators to be an important role for the board to play in this particular setting. This affected the threshold for identifying which trials would be monitored, and it impacted several procedures adopted by the board. Limitations This report reflects the observations of those involved in managing the DSMB, including comments offered by the DSMB and by investigators, but not data gathered in a systematic way. Conclusions The operational model described here has allowed the DSMB to fulfill its role in the oversight of the trials. We hope that the ideas we present may help others facing similar situations and may stimulate further critical thinking about DSMB structure and function.

Chen-Mok, M; VanRaden, MJ; Higgs, ES; Dominik, R

2014-01-01

327

Work experience program at a metropolitan paediatric hospital: assisting rural and metropolitan allied health professionals exchange clinical skills.  

PubMed

The needs of rural allied health professionals (AHPs) have been widely documented. In particular, problems of professional isolation, lack of professional development opportunities and limited support systems have been highlighted as problems associated with working in rural and remote areas. This research aimed to provide rural and remote AHPs with an opportunity to gain experience in paediatric clinical areas of their choice, to provide rural/remote and metropolitan AHPs with an opportunity to share clinical knowledge and expertise, and to develop networks between rural/remote and metropolitan AHPs. A clinical experience program was developed to meet these aims. Twenty-nine AHPs from rural and remote areas of Queensland participated in the program. Participants completed questionnaires at the end of clinical experience program and 4-8 weeks after the visit. A focus group was also conducted. Analyses found the program met the majority of participants goals and expectations. Enhanced clinical skills in specialist paediatric areas, increased networking and access to resources were reported by rural/remote AHPs as benefits of the program. The role of a clinical consultant was found to be critical to the success of the program. PMID:11998265

Parkin, A E; McMahon, S; Upfield, N; Copley, J; Hollands, K

2001-12-01

328

Preliminary experience with a hospital blood pressure follow up clinic with nurse practitioner assessment and microprocessor based data retrieval.  

PubMed

Experience over two years with 376 hypertensive patients managed at a clinic where the primary observations are made by a trained nurse, clinical information is held on a microprocessor, and treatment follows a standard stepped care approach has been assessed. Blood pressure control after both one and two years was appreciably improved, with over 70% of patients having diastolic pressure below 90 mm Hg compared with 22% of patients when they first attended the new clinic. The non-attendance rate was half that of the conventional hospital outpatient clinic. A computer based record system with a nurse run hypertension clinic is acceptable to patients and offers the possibility of more effective long term control of blood pressure in large numbers of patients. PMID:6432180

Rubin, P C; Curzio, J L; Kelman, A; Elliott, H L; Reid, J L

1984-09-01

329

Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review.  

PubMed

Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation. PMID:15617960

Ewers, R; Schicho, K; Undt, G; Wanschitz, F; Truppe, M; Seemann, R; Wagner, A

2005-01-01

330

A multicenter survey of clinical experiences with perampanel in real life in Germany and Austria.  

PubMed

Perampanel (PER) has been approved by the European Medicines Agency (EMA) for adjunctive treatment of patients with partial-onset seizures from age 12 years on. It has been introduced to the market in Germany and Austria in 2012. This cross-sectional observational study summarizes the clinical experience of nine centers with adjunctive PER. Patients were consecutively followed from the initiation of PER on. Only patients with a minimum observational period of six months (in case of ongoing treatment) were recruited. Efficacy data reflect the preceding three months at last observation, tolerability data were assessed at the last observation carried forward. 281 patients were included. After six months 169 were still on PER so that a retention rate of 60% resulted. 43 patients were seizure-free for the preceding 3 months (15%). Overall incidence of adverse events was 52.0%. The leading adverse events were somnolence (24.6%) and dizziness (19.6%) followed by ataxia (3.9%), aggression (2.8%), nausea (2.5%) and irritability (2.1%). We conclude that adjunctive PER may lead to at least temporary freedom of seizures in some of these highly difficult-to-treat patients. Adverse events are not uncommon. PMID:24721197

Steinhoff, Bernhard J; Hamer, Hajo; Trinka, Eugen; Schulze-Bonhage, Andreas; Bien, Christian; Mayer, Thomas; Baumgartner, Christoph; Lerche, Holger; Noachtar, Soheyl

2014-07-01

331

Psychiatric outpatients report their experiences as participants in a randomized clinical trial.  

PubMed

We conducted exit interviews with 45 outpatients with severe and persistent mental illness (SPMI) who had participated in a randomized clinical trial. The interviews followed a semistructured format and were audiotaped for later transcription and rating by two independent raters. Content analyses of the interviews revealed that most participants evaluated their experiences quite favorably. For example, most noted that the assessment process was thought-provoking and motivational and that the intervention groups led to increased self-confidence and new friendships. Although a few participants noted that the assessment contained sensitive material, all appreciated the frequent reminders that information disclosed was strictly confidential. These results indicate that persons living with a SPMI often enjoy participating in behavioral research, which can yield immediate benefits to patient-participants. Exit interview research such as this can help investigators to understand reasons for consent and participation, to identify needs for protocol modifications, and to facilitate the integration of evidence-based interventions into the mental health care systems. PMID:11379973

Carey, M P; Morrison-Beedy, D; Carey, K B; Maisto, S A; Gordon, C M; Pedlow, C T

2001-05-01

332

A pilot experience with competency-based clinical skills assessment in a surgical clerkship.  

PubMed

This investigation examines a competency-based clinical skills assessment program for surgical clerks using checklists and rating forms for precise measurement of physical exam (PE) skills, physician-patient interaction (PPI) skills, and patient write-up (PW) skills. Analysis of variance demonstrated improvement in PW skills across the academic year when measured by the rating instrument, but this improvement was not detected on traditional subjective rating forms (SRF). PPI skills improved between first rotations across 2 academic years with the addition of orientation to expectations (mean, 79% versus 92%, P = 0.000). Poor correlation was noted between the National Board of Medical Examiners Surgery Subtest scores and PE skills (r = .19), PW skills (r = .20), and PPI skills (r = .15). While the overall ratings given by faculty on SRF correlated with the SRF ratings of PE skills (r = .77) and PPI skills (r = .58), these same faculty ratings correlated poorly with these skills as assessed by checklist (r = .16 and r = .14, respectively). This pilot experience demonstrates that PE skills, PW skills, and PPI skills (1) improve only with orientation to expectations and feedback, (2) correlate poorly with fund of knowledge assessment, and (3) are best assessed with precise measurement (eg, checklist, direct observation), which avoids the halo effect of overall evaluation that occurs with subjective rating forms. PMID:8209937

Dunnington, G L; Wright, K; Hoffman, K

1994-06-01

333

Trauma experience among homeless female veterans: correlates and impact on housing, clinical, and psychosocial outcomes.  

PubMed

This study examined lifetime exposure to traumatic events as reported by 581 homeless female veterans enrolled in a Homeless Women Veterans Program across 11 sites to characterize the types of trauma they experienced; their correlation with baseline characteristics; and their association with housing, clinical outcomes, and psychosocial functioning over a 1-year treatment period. Almost all participants endorsed multiple types and episodes of traumatic events. Among the most common were having someone close experience a serious or life-threatening illness (82%) and rape (67%). Exploratory factor analysis revealed 6 potential trauma categories: being robbed, experiencing accident or disasters, illness or death of others, combat, sexual assault, and physical assault. At baseline, trauma from sexual assault was associated with more days homeless (? = .18, p < .001), trauma from accidents or disasters was associated with poorer physical health (? = -.23, p < .001), and trauma from being robbed was related to greater use of drugs (? = .22, p < .001). Trauma reported at baseline, however, was not predictive of 1-year outcomes, suggesting type and frequency of trauma does not negatively affect the housing gains homeless women veterans can achieve through homeless services. PMID:23225030

Tsai, Jack; Rosenheck, Robert A; Decker, Suzanne E; Desai, Rani A; Harpaz-Rotem, Ilan

2012-12-01

334

Trauma Experience Among Homeless Female Veterans: Correlates and Impact on Housing, Clinical, and Psychosocial Outcomes.  

PubMed

This study examined lifetime exposure to traumatic events as reported by 581 homeless female veterans enrolled in a Homeless Women Veterans Program across 11 sites to characterize the types of trauma they experienced; their correlation with baseline characteristics; and their association with housing, clinical outcomes, and psychosocial functioning over a 1-year treatment period. Almost all participants endorsed multiple types and episodes of traumatic events. Among the most common were having someone close experience a serious or life-threatening illness (82%) and rape (67%). Exploratory factor analysis revealed 6 potential trauma categories: being robbed, experiencing accident or disasters, illness or death of others, combat, sexual assault, and physical assault. At baseline, trauma from sexual assault was associated with more days homeless (? = .18, p < .001), trauma from accidents or disasters was associated with poorer physical health (? = -.23, p < .001), and trauma from being robbed was related to greater use of drugs (? = .22, p < .001). Trauma reported at baseline, however, was not predictive of 1-year outcomes, suggesting type and frequency of trauma does not negatively affect the housing gains homeless women veterans can achieve through homeless services. PMID:23138863

Tsai, Jack; Rosenheck, Robert A; Decker, Suzanne E; Desai, Rani A; Harpaz-Rotem, Ilan

2012-11-01

335

CT Lesion Model-Based Structural Allografts: Custom Fabrication and Clinical Experience  

PubMed Central

Summary Background Patients requiring knee and hip revision arthroplasty often present with difficult anatomical situations that limit options for surgery. Customised mega-implants may be one of few remaining treatment options. However, extensive damage to residual bone stock may also be present, and in such cases even customised prosthetics may be difficult to implant. Small quantities of lost bone can be replaced with standard allografts or autologous bone. Larger defects may require structural macro-allografts, sometimes in combination with implants (allograft-prosthesis composites). Methods Herein, we describe a process for manufacturing lesion-specific large structural allografts according to a 3D, full-scale, lithographically generated defect model. These macro-allografts deliver the volume and the mechanical stability necessary for certain complex revisions. They are patient-and implant-matched, negate some requirements for additional implants and biomaterials and save time in the operating theatre by eliminating the requirement for intra-operative sizing and shaping of standard allografts. Conclusion While a robust data set from long-term follow-up of patients receiving customised macro-allografts is not yet available, initial clinical experience and results suggest that lesion-matched macro-allografts can be an important component of revision joint surgery.

Brune, Jan Claas; Hesselbarth, Uwe; Seifert, Philipp; Nowack, Dimitri; von Versen, Rudiger; Smith, Mark David; Seifert, Dirk

2012-01-01

336

Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study  

PubMed Central

Background There is limited evidence of the unmet needs and experiences of adults with Attention Deficit Hyperactivity Disorder (ADHD) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients diagnosed during adulthood and childhood. Methods In this qualitative study, 30 adults with ADHD were recruited through an ADHD charity (n?=?17) and two hospital outpatient clinics for adults with ADHD in England (n?=?13). Half of the participants were diagnosed with ADHD during childhood or adolescence and the remainder during adulthood. Semi-structured interviews were conducted and data was analysed using a thematic approach based on Grounded Theory principles. Results Analysis revealed five core themes: ‘An uphill struggle’: the challenge of accessing services, ‘Accumulated Psychosocial Burden and the Impact of ADHD’, ‘Weighing up Costs vs. Benefits of ADHD Pharmacological Treatment’, ‘Value of Non-pharmacological Treatment’ and ‘Barriers to Treatment Adherence’. Accessing services and the challenges associated with securing a definitive diagnosis of ADHD in adulthood was an ‘uphill struggle’, often due to sceptical and negative attitudes towards ADHD by healthcare professionals. ADHD-related impairment had an overwhelmingly chaotic impact on every aspect of patients’ lives and many felt ill equipped to cope. A persistent sense of failure and missed potential from living with the impact of ADHD impairment had led to an accumulated psychosocial burden, especially among those diagnosed from late adolescence onwards. In contrast, positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many felt strongly that by itself, it was inadequate. Additional support in the form of psychological therapies or psycho-education was strongly desired. However, few patients had access to non-pharmacological treatment. In some, medication use was often inadequately monitored with little or no follow-up by healthcare professionals, leading to poor adherence and a sense of abandonment from the healthcare system. Conclusion The findings suggest that the unmet needs of adults with ADHD are substantial and that there is a wide gap between policy and current practice in England.

2013-01-01

337

Building an Office of Clinical Research and Trials: The UC Irvine Experience. | accrualnet.cancer.gov  

Cancer.gov

The Office of Clinical Research and Trials (OCRT) was developed to assist investigators with the conduct of clinical trials, including assistance with preparing materials for submission to the Institutional Review Board (IRB), developing study budgets, and negotiating budgets and payment terms with external sponsors. It also provides clinical trial educational programs for faculty and staff.

338

Erlotinib and Concurrent Chemoradiation in Pretreated NSCLC Patients: Radiobiological Basis and Clinical Results  

PubMed Central

Aims. To establish feasibility of the combination of Erlotinib and concurrent chemoradiation in pre-treated patients with locally advanced or metastatic NSCLC. Materials and Methods. Data regarding 60 consecutive patients with NSCLC previously treated with chemotherapy alone were prospectically collected. All patients started Erlotinib concurrently with chemotherapy and radiation delivered to primary tumor. These data were retrospectively analyzed (observational study). Feasibility and toxicity were the primary endpoints, with response rate and progression being the secondary ones, while survival data are reported just as exploratory analysis. The EGFR mutational status was recorded in 32% of cases and it was always wild type. Results. Compliance to the combination protocol was good. Grade 3-4 esophagitis and acute lung toxicity occurred in 2% and 8% of patients, respectively. No progressive disease was recorded in the majority of cases (65%). Median OS and PFS were 23.3 and 4.7 months, respectively. Patients not responding to chemotherapy administered prior to chemoradiation achieved an objective response rate of 53.3% and complete response in 13.3% of cases. Conclusions. The addition of Erlotinib to chemoradiation in inoperable NSCLCs is feasible with interesting efficacy profile. These preliminary results warrant further investigation in patients with locally advanced nonmetastatic NSCLC with EGFR mutations.

Alberti, Antonio Maria; Cammilluzzi, Eugenio; Ippolito, Edy; Greco, Carlo; De Quarto, Angelo Luca; Ramponi, Sara; Apolone, Giovanni; Trodella, Lucio; Cesario, Alfredo; D'Angelillo, Rolando Maria

2013-01-01

339

Radiobiological intercomparison of clinical neutron beams for growth inhibition in Vicia faba bean roots  

SciTech Connect

Relative biological effectiveness (RBE) and oxygen enhancement ratio (OER) values of different neutron beams produced at the variable energy cyclotron Cyclone of Louvain-la-Neuve (Belgium) were determined. The neutrons were obtained by bombarding a beryllium target with 34-, 45-, 65-, or 75-MeV protons or with 50-MeV deuterons. The biological system was growth inhibition in Vicia faba bean roots. Taking the p(65) + Be neutron beam as a reference, RBE values were found equal to 1.36 +/- 0.2, 1.20 +/- 0.1, 1.00 (ref), 0.98 +/- 0.1, and 1.18 +/- 0.1, respectively; the doses corresponding to 50% growth inhibition were 0.39, 0.44, 0.53, 0.54, and 0.45 Gy. For the same beams, OER values were found equal to 1.55 +/- 0.1, 1.38 +/- 0.1, 1.29 +/- 0.1, 1.41 +/- 0.1, and 1.60 +/- 0.2, respectively.

Beauduin, M.; Gueulette, J.; Vynckier, S.; Wambersie, A.

1989-02-01

340

Further Radiobiologic Modeling of Palliative Radiotherapy: Use of Virtual Trials  

SciTech Connect

Purpose: To study duration of response in palliative radiotherapy in a population of tumors. Methods and Materials: Models of dynamic changes in cell number with time were used to develop a function for the remission time (T{sub rem}) after palliative radiotherapy: T{sub rem}=(BED)/K -t{sub 1}(1+({alpha}.K)/z ), where BED is the biologically effective dose, t{sub 1} the duration of symptoms (i.e., the time between the onset of symptoms and the initiation of radiotherapy), K the daily BED repopulation equivalent, {alpha} the linear radiosensitivity parameter in the linear-quadratic model, and z the tumor regression rate. Results: Simulations of clinical trials show marked variations in remission statistics depending on the tumor characteristics and are highly compatible with the results of clinical trials. Dose escalation produces both a higher proportion and extended duration of remissions, especially in tumors with high {alpha}/{beta} ratios and K values, but the predicted dose responses of acute and late side effects show that caution is necessary. The prospect of using particle beam therapy to reduce normal tissue radiation exposures or using hypoxic sensitizers to improve the tumor cell kill might significantly improve the results of palliative radiotherapy in carefully selected patients and could also be used for safer palliative re-treatments in patients with the potential for prolonged survival. The effect of tumor heterogeneity in determining palliative responses probably exceeds that in radical radiotherapy; as few as 100 patients in each treatment arm produce statistically unreliable results. Conclusions: Virtual trials of palliative radiotherapy can be useful to test the effects of competing schedules and better determine future strategies, including improved design of clinical trials as well as combinations of radiotherapy with other anticancer modalities.

Jones, Bleddyn [Department of Clinical Oncology, University Hospital Birmingham, Birmingham (United Kingdom)], E-mail: b.jones.1@bham.ac.uk; Dale, Roger G. [Department of Radiation Physics and Radiobiology, Charing Cross Hospital, London (United Kingdom)

2007-09-01

341

Magnetic resonance imaging (MRI): method and early clinical experiences in diseases of the central nervous system.  

PubMed

Magnetic resonance imaging (MRI) has undergone a rapid development which is still continuing. In this article a survey is given of the present status of this new diagnostic tool in the evaluation of diseases of the central nervous system. When atoms with uneven numbers of protons or neutrons in a homogeneous magnetic field are tilted against the main vector of this field by a radiofrequency pulse, nuclear magnetic resonance can be observed. During the relaxation of the little dipoles back to the direction of the underlying magnetic field, a resonance signal is generated. The superposition of variable field gradients enables the scanning of sectional images in the axial, frontal and sagittal plane. The variables of H+-magnetic resonance which can be utilized for imaging are: the proton density, the relaxation times T1 (spin-lattice) and T2 (spin-spin) and flow effects. While the proton density in organic tissue fluctuates only by some 10%, the relaxation times may vary by several hundred per cent. Tissue contrast, therefore, is mainly based on relaxation times differences. The image character can also be influenced by variations of imaging parameters (i.e. repetition rate, interpulse delay, read out or echo delay) in different imaging sequences, such as the spin-echo and the inversion recovery technique. Depending on these imaging parameters T1 and T2 will contribute to the signal to a varying degree. This fact is most important for the diagnostic information of MRI. In initial clinical experiences in the diagnosis of diseases of the central nervous system, MRI has demonstrated high sensitivity in the detection of lesions (such as oedema, neoplasms, demyelinating disease), but less significance in lesion discrimination. In spinal disease the direct sagittal imaging of MRI enables MRI-myelography without contrast medium, superior to conventional myelography in many cases. For detailed evaluation of disc disease, however, the spatial resolution still has to be improved. Promising results have been obtained from flow effects. Depending on the flow velocity of blood, vessels appear white with intensive signals (slow flow) or black due to low signal intensities (rapid flow). MRI-angiography including measurement of blood flow seems possible. MRI-contrast media are not yet available for routine clinical use. Promising results have been reported on the basis of rare-earth elements, such as gadolinium Gd3+. These substances decrease T1 and T2 with subsequent increase in signal intensity. Concerning harmful side-effects of MRI, three possible sources have to be considered: the static magnetic field, the changing magnetic field, and radiofrequency heating.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6397697

Huk, W J; Gademann, G

1984-01-01

342

Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy  

PubMed Central

Background To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology. Methods Forty-five patients with a median age of 72 ± 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0 ± 3.0 ng/mL, were treated with RapidArc in a feasibility study. All patients were treated with single arc using 6MV photons. Dose prescription ranged between 76 (7 patients) and 78 Gy (38 patients) in 2Gy/fraction. Plan quality was assessed by means of Dose Volume Histogram (DVH) analysis. Technical parameters of arcs and pre-treatment quality assurance results (Gamma Agreement Index, GAI) are reported to describe delivery features. Early toxicity was scored (according to the Common Terminology Criteria of Adverse Effects scale, CTCAE, scale) at the end of treatment together with biochemical outcome (PSA). Results From DVH data, target coverage was fulfilling planning objectives: V95% was in average higher than 98% and V107%~0.0% (D2%~104.0% in average). Homogeneity D5%-D95% ranged between 6.2 ± 1.0% to 6.7 ± 1.3%. For rectum, all planning objectives were largely met (e.g. V70Gy = 10.7 ± 5.5% against an objective of < 25%) similarly for bladder (e.g. D2% = 79.4 ± 1.2Gy against an objective of 80.0Gy). Maximum dose to femurs was D2% = 36.7 ± 5.4Gy against an objective of 47Gy. Monitor Units resulted: MU/Gy = 239 ± 37. Average beam on time was 1.24 ± 0.0 minutes. Pre-treatment GAI resulted in 98.1 ± 1.1%. Clinical data were recorded as PSA at 6 weeks after RT, with median values of 0.4 ± 0.4 ng/mL. Concerning acute toxicity, no patient showed grade 2-3 rectal toxicity; 5/42 (12%) patients experienced grade 2 dysuria; 18/41 (44%) patients preserved complete or partial erectile function. Conclusion RapidArc proved to be a safe, qualitative and advantageous treatment modality for prostate cancer.

2010-01-01

343

In search of specificity: "not just right experiences" and obsessive-compulsive symptoms in non-clinical and clinical Italian individuals.  

PubMed

The cognitive model of OCD proposes that certain beliefs may contribute to the development and maintenance of this disorder. To date, however, it is not yet clear which beliefs are more relevant for explaining OCD symptomatology; moreover, their causal status is yet to be clearly established. In the effort to identify other constructs and processes related to OCD, the phenomenon labeled "not just right experiences" (NJREs) has received increasing attention. In this study, measures of NJREs (the NJRE-Q-R), OCD symptoms, general distress (i.e., anxiety, and depression), and perfectionism were administered to a large sample of college students and a small sample of OCD and non-OCD patients. The clinical sample also completed a measure of OC beliefs. Results showed that NJREs could be reliably measured through a self-report format in non-clinical and clinical Italian individuals. A specific association between NJREs severity and OCD symptoms was found in the non-clinical sample, after controlling for anxiety, depression, and perfectionism. The NJRE-Q-R Severity scale clearly discriminated OCD patients from patients with other anxiety disorders or depression. Lastly, the NJREs measure differentiated the clinical groups when OC beliefs were controlled, whereas OC beliefs did not discriminate among the groups after NJREs severity was controlled. The concept of NJREs may contribute to improve current psychological and biological model of OCD. PMID:20627224

Ghisi, Marta; Chiri, Luigi Rocco; Marchetti, Igor; Sanavio, Ezio; Sica, Claudio

2010-12-01

344

The Intact porcine bioprosthesis: early world-wide clinical experience and analysis of a single institution's experience  

Microsoft Academic Search

The Intact porcine bioprosthesis is a new-generation valve fixed under stress-free conditions and subjected to a mineralization-inhibiting treatment. The valve is undergoing multi-centre prospective clinical evaluation sponsored by Medtronic, Inc., with 19 centres participating world wide. Since April 1986,1465 valves have been implanted in the aortic position (AVR, n = 965), mitral position (MVR, n = 438), or both (n

E Vermeulen; G. Rennink; S. Ernst; W. Jaarsma; P. A. Chevalier; D. V. Lutz

2009-01-01

345

Radiobiological evaluation of forward and inverse IMRT using different fractionations for head and neck tumours  

PubMed Central

Purpose To quantify the radiobiological advantages obtained by an Improved Forward Planning technique (IFP) and two IMRT techniques using different fractionation schemes for the irradiation of head and neck tumours. The conventional radiation therapy technique (CONVT) was used here as a benchmark. Methods Seven patients with head and neck tumours were selected for this retrospective planning study. The PTV1 included the primary tumour, PTV2 the high risk lymph nodes and PTV3 the low risk lymph nodes. Except for the conventional technique where a maximum dose of 64.8 Gy was prescribed to the PTV1, 70.2 Gy, 59.4 Gy and 50.4 Gy were prescribed respectively to PTV1, PTV2 and PTV3. Except for IMRT2, all techniques were delivered by three sequential phases. The IFP technique used five to seven directions with a total of 15 to 21 beams. The IMRT techniques used five to nine directions and around 80 segments. The first, IMRT1, was prescribed with the conventional fractionation scheme of 1.8 Gy per fraction delivered in 39 fractions by three treatment phases. The second, IMRT2, simultaneously irradiated the PTV2 and PTV3 with 59.4 Gy and 50.4 Gy in 28 fractions, respectively, while the PTV1 was boosted with six subsequent fractions of 1.8 Gy. Tissue response was calculated using the relative seriality model and the Poisson Linear-Quadratic-Time model to simulate repopulation in the primary tumour. Results The average probability of total tumour control increased from 38% with CONVT to 80% with IFP, to 85% with IMRT1 and 89% with IMRT2. The shorter treatment time and larger dose per fraction obtained with IMRT2 resulted in an 11% increase in the probability of control in the PTV1 with respect to IFP and 7% relatively to IMRT1 (p < 0.05). The average probability of total patient complications was reduced from 80% with CONVT to 61% with IFP and 31% with IMRT. The corresponding probability of complications in the ipsilateral parotid was 63%, 42% and 20%; in the contralateral parotid it was 50%, 20% and 9%; in the oral cavity it was 2%, 15% and 4% and in the mandible it was 1%, 5% and 3%, respectively. Conclusions A significant improvement in treatment outcome was obtained with IMRT compared to conventional radiation therapy. The practical and biological advantages of IMRT2, employing a shorter treatment time, may outweigh the small differences obtained in the organs at risk between the two IMRT techniques. This technique is therefore presently being used in the clinic for selected patients with head and neck tumours. A significant improvement in the quality of the dose distribution was obtained with IFP compared to CONVT. Thus, this beam arrangement is used in the clinical routine as an alternative to IMRT.

2010-01-01

346

The breastfeeding experience of women with major difficulties who use the services of a breastfeeding clinic: a descriptive study  

PubMed Central

Background Many women experience breastfeeding difficulties. Sometimes these difficulties lead to breastfeeding cessation. Breastfeeding clinics provide support for women facing such problems. This study aims to describe the breastfeeding experience of women, particularly those who use the services of the breastfeeding clinic located in the Greater Quebec City area. Methods This is a descriptive study based on information gathered through telephone questionnaires that were administered in 2006 to a sample of 86 women and semi-structured interviews conducted with 12 of these women. Results Painful nipples/breasts, low milk supply and latching difficulties were the three most frequent major breastfeeding problems identified by women. Their personal characteristics as well as the moral and physical support provided by family and friends and by health professional and clinicians at the breastfeeding clinic were the factors identified most often as having a positive influence on the breastfeeding experience. Conclusion The results suggest that breastfeeding clinics have a critical role to play in improving the breastfeeding experience of women with major difficulties.

Lamontagne, Caroline; Hamelin, Anne-Marie; St-Pierre, Monik

2008-01-01

347

[Neuroendocrine tumors of a pancreas: 30 year's experience of clinic of faculty surgery of N.N. Burdenko].  

PubMed

N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times. PMID:23887317

Chernousov, A F; Egorov, A V; Musaev, G Kh; Fominykh, E V; Kondrashin, S A; Vasil'ev, I A; Parnova, V A; Anisimova, O V

2013-01-01

348

Experience with a physician-directed, clinic-based program for outpatient parenteral antibiotic therapy in the USA  

Microsoft Academic Search

The experience with 538 patients who received outpatient parenteral antibiotic therapy (OPAT) in 1993 in a private institute in Tacoma, Washington, USA, is reviewed here. Clinical outcomes suggested a successful resolution of infection in 99 % of cases. Bacteriological outcomes showed that eradication of the organism had occurred in 92 % of patients by the end of therapy. The success

A. D. Tice

1995-01-01

349

Robotic pancreatic surgery is no substitute for experience and clinical judgment: an initial experience and literature review  

PubMed Central

Robotic pancreatic surgery offers technical advantages, and has been applied across many surgical specialties. We report an initial experience of 12 distal pancreatic resections for benign tumors from an established pancreatic center with previous general and biliary laparoscopic experience. Of a total of 12 patients, 7 were women; the mean age was 55.5 years, and the lesions included 8 distal intraductal papillary mucinous tumors, 1 insulinoma and in 3 a non-functioning neuroendocrine tumor. All operations were performed in between 90 and 180 minutes, and blood loss and hospital stay were minimal.

2013-01-01

350

Clinical Experience With the Swiss Lithoclast Master in Treatment of Bladder Calculi.  

PubMed

Abstract Background and Purpose: Bladder calculi account for 5% of urinary tract calculi in the Western world, and many different treatment modalities have been presented throughout the decades. We report our clinical experience using the Swiss LithoClast® Master (SLM). Materials and Methods: The SLM is a rigid, hand-held endourologic probe including a pneumatic lithotriptor and an ultrasonic lithotriptor. Attached to the ultrasonic modality is a suction system. The two lithotriptor modalities are controlled by a footswitch and can be activated separately or simultaneously. The SLM is used via a rigid endoscope. Indications for treatment were medical complaints such as hematuria, lower urinary tract symptoms, pain, recurrent urinary tract infections, recurrent bursts of balloon in indwelling catheters, and difficulties performing clean intermittent self-catheterization. Results: From August 1, 2009, to August 1, 2011, 27 patients were treated for bladder calculi (24 men). Five had a neurogenic voiding dysfunction, 3 had prostate cancer, and 19 had benign prostatic enlargement or detrusor muscle insufficiency. Median age was 74 years (range 45-86 years). Stone clearance was obtained in 26 (96%) patients. Stone burden was one or multiple bladder calculi. Median stone size of the largest stone in each patient was 20 (5-40) mm. Under the same anesthesia, two patients underwent a transurethral resection of the prostate because of a very large prostate. Median lithotripsy time was 60 (range 20-144) minutes. All patients were discharged within 24 hours. Conclusion: The method described is a safe and quick method for endoscopic lithotripsy of bladder calculi rendering the patients stone free in the vast majority of cases. The procedure can be performed as day-case surgery. PMID:23384337

Kingo, Pernille S; Ryhammer, Allan M; Fuglsig, Sven

2013-04-01

351

Measurement of Subvisible Particulates in Lyophilised Erwinia chrysanthemi L-asparaginase and Relationship with Clinical Experience.  

PubMed

In order to generate further characterisation data for the lyophilised product Erwinia chrysanthemi L-asparaginase, reconstituted drug product (DP; marketed as Erwinase or Erwinaze) was analysed for subvisible (2-10 ?m) particulate content using both the light obscuration (LO) method and the newer flow-imaging microscopy (FIM) technique. No correlation of subvisible particulate counts exists between FIM and LO nor do the counts correlate with activity at both release and on stability. The subvisible particulate content of lyophilised Erwinia L-asparaginase appears to be consistent and stable over time and in line with other parenteral biopharmaceutical products. The majority (ca. 75%) of subvisible particulates in L-asparaginase DP were at the low end of the measurement range by FIM (2-4 ?m). In this size range, FIM was unable to definitively classify the particulates as either protein or non-protein. More sensitive measurement techniques would be needed to classify the particulates in lyophilised L-asparaginase into type (protein and non-protein), so the LO technique has been chosen for on-going DP analyses. E. chrysanthemi L-asparaginase has a lower rate of hypersensitivity compared with native Escherichia coli preparations, but a subset of patients develop hypersensitivity to the Erwinia enzyme. A DP lot that had subvisible particulate counts on the upper end of the measurement range by both LO and FIM had the same incidence of allergic hypersensitivity in clinical experience as lots at all levels of observed subvisible particulate content, suggesting that the presence of L-asparaginase subvisible particulates is not important with respect to allergic response. PMID:24854894

Gervais, David; Corn, Tim; Downer, Andrew; Smith, Stuart; Jennings, Alan

2014-07-01

352

Clinical encounters in tactical medicine: a mission-specific analysis of the Maryland state police experience.  

PubMed

Introduction: The Maryland State Police (MSP) Tactical Medical Unit (TMU) provides tactical emergency medical support (TEMS) through the deployment of specially trained state trooper tactical paramedics. The MSP TMU maintains an operational database of all mission related medical activity. This information constitutes a robust dataset derived from real world operational medicine experiences. Methods: A retrospective analysis of de-identified entries from the MSP TMU operational response database was performed for the 5-year period of 2007?2013. A summative analysis of missions, as well as a subgroup analysis of types of patients encountered, was performed to further characterize patient encounters based on the type of law enforcement tactical mission. Results: Analysis was performed on 1,042 tactical missions, of which there were 367 total patient encounters during the study period. The majority (67%; 246/367) of patients encountered were law enforcement tactical team personnel. The most frequently occurring mission, by type, was high-risk warrant service, accounting for 45% (470/1,042) of all missions in this series. Law enforcement training support missions comprised 25% (259/1,042), and 15% (157/1,042) of all missions in the database were medical standbys for law enforcement operations. The highest number of patient contacts were associated with training activities, resulting in 29% (108/367) of clinical encounters. The next most common mission associated with patient encounters was high-risk warrant service (24%; 88/367). Conclusion: The 5-year analysis conducted in this study represents the largest known retrospective assessment of a state police tactical medical program. Training activities resulted in the highest number of patient encounters by this program, with law enforcement/tactical team personnel comprising the majority of patient encounters. The majority of chief complaints encountered were non?life threatening and reinforce the need for expanded scope of practice training and enhanced treatment protocols for tactical medics. PMID:24952050

Levy, Matthew J; Smith, Rebecca; Gerold, Kevin B; Alves, Donald W; Tang, Nelson

2014-01-01

353

Early initial clinical experience with intravitreal aflibercept for wet age-related macular degeneration  

PubMed Central

Background Age-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular oedema (ME), and pigment epithelium detachments (PED). Purpose To evaluate the initial clinical experience of conversion from bevacizumab or ranibizumab to aflibercept in wet AMD patients. Methods Records of 250 consecutive wet AMD patients were retrospectively reviewed. Of 250 patients, 29 were naive (with no previous treatment), and 221 were previously treated with bevacizumab (1/3) or ranibizumab (2/3). On average, converted patients received 14 injections every 6?weeks on a treat-and-extend regimen with Avastin or Lucentis before being converted to aflibercept every 7?weeks on average (no loading dose) for three doses. For the purposes of this study, we concentrated on the patients converted to aflibercept since the number of naive patients was too small to draw any conclusion from. Snellen (as logMar) visual acuities, and optical coherence tomography (OCT) were compared predrug and postdrug conversion. Results Converted patients did not show a significant difference in visual acuity or average OCT thickness from preconversion values; however, small improvements in ME (p=0.0001), SRF (p=0.0001), and PED (p=0.008) grading were noted on average after conversion to aflibercept. Conclusions No significant difference in visual outcome or average OCT thickness was observed when switched from bevacizumab or ranibizumab q6?week to aflibercept 7-week dosing, on average. Mild anatomic improvements did occur in converted patients with regard to ME, SRF and PED improvement, on average, after conversion to aflibercept, and aflibercept was injected less frequently. No serious adverse reactions, including ocular infections or inflammation, as well as ocular and systemic effects were noted.

Ferrone, Philip J; Anwar, Farihah; Naysan, Jonathan; Chaudhary, Khurram; Fastenberg, David; Graham, Kenneth; Deramo, Vincent

2014-01-01

354

Added value of health-related quality of life measurement in cancer clinical trials: the experience of the NCIC CTG.  

PubMed

Health-related quality-of-life (HRQoL) data are often included in Phase III clinical trials. We evaluate and classify the value added to Phase III trials by HRQoL outcomes, through a review of the National Cancer Institute of Canada Clinical Trials Group clinical trials experience within various cancer patient populations. HRQoL may add value in a variety of ways, including the provision of data that may contrast with or may support the primary study outcome; or that assess a unique perspective or subgroup, not addressed by the primary outcome. Thus, HRQoL data may change the study's interpretation. Even in situations where HRQoL measurement does not alter the clinical interpretation of a trial, important methodologic advances can be made. A classification of the added value of HRQoL information is provided, which may assist in choosing trials for which measurement of HRQoL outcomes will be beneficial. PMID:20384559

Au, Heather-Jane; Ringash, Jolie; Brundage, Michael; Palmer, Michael; Richardson, Harriet; Meyer, Ralph M

2010-04-01

355

Five-year experience with setup and implementation of an integrated database system for clinical documentation and research.  

PubMed

In radiation oncology, where treatment concepts are elaborated in interdisciplinary collaborations, handling distributed, large heterogeneous amounts of data efficiently is very important, yet challenging, for an optimal treatment of the patient as well as for research itself. This becomes a strong focus, as we step into the era of modern personalized medicine, relying on various quantitative data information, thus involving the active contribution of multiple medical specialties. Hence, combining patient data from all involved information systems is inevitable for analyses. Therefore, we introduced a documentation and data management system integrated in the clinical environment for electronic data capture. We discuss our concept and five-year experience of a precise electronic documentation system, with special focus on the challenges we encountered. We specify how such a system can be designed and implemented to plan, tailor and conduct (multicenter) clinical trials, ultimately reaching the best clinical performance, and enhancing interdisciplinary and clinical research. PMID:24629596

Kessel, Kerstin A; Bohn, Christian; Engelmann, Uwe; Oetzel, Dieter; Bougatf, Nina; Bendl, Rolf; Debus, Jürgen; Combs, Stephanie E

2014-04-01

356

Initial Image Quality and Clinical Experience with New CR Digital Mammography System: A Phantom and Clinical Study  

SciTech Connect

The goal of the study was to evaluate the first CR digital mammography system ( registered Konica-Minolta) in Mexico in clinical routine for cancer detection in a screening population and to determine if high resolution CR digital imaging is equivalent to state-of-the-art screen-film imaging. The mammograms were evaluated by two observers with cytological or histological confirmation for BIRADS 3, 4 and 5. Contrast, exposure and artifacts of the images were evaluated. Different details like skin, retromamillary space and parenchymal structures were judged. The detectability of microcalcifications and lesions were compared and correlated to histology. The difference in sensitivity of CR Mammography (CRM) and Screen Film Mammography (SFM) was not statistically significant. However, CRM had a significantly lower recall rate, and the lesion detection was equal or superior to conventional images. There is no significant difference in the number of microcalcifications and highly suspicious calcifications were equally detected on both film-screen and digital images. Different anatomical regions were better detectable in digital than in conventional mammography.

Gaona, Enrique; Enriquez, Jesus Gabriel Franco [Universidad Autonoma Metropolitana-Xochimilco, Calz. del Hueso 1100, 04960 Mexico, D.F. (Mexico); Alfonso, Beatriz Y. Alvarez; Castellanos, Gustavo Casian [Hospital Juarez de Mexico, Av. Instituto Politecnico Nacional No. 5160, 07760 Mexico, D.F. (Mexico)

2008-08-11

357

Supportive relationship: Experiences of Iranian students and teachers concerning student-teacher relationship in clinical nursing education  

PubMed Central

Background: Student-teacher relationship is a salient issue in nursing education and has long-lasting implication in professional development of nursing students. Nowadays, this relationship in clinical settings is different from the past due to changing in nursing education paradigm. The purpose of this qualitative study was to explore the experiences of students and teachers about student-teacher relationship in the context of clinical nursing education in Iran. Materials and Methods: In this qualitative study that has been carried out adopting conventional qualitative content analysis approach, six bachelor nursing students and six clinical teachers in school of Nursing and Midwifery, were selected through purposive sampling. Semi-structured interview and participant observation were used for data collection. Interviews transcribed verbatim and analyzed using conventional content analysis through the process of data reduction and condensation, coding and also generating the categories and themes. Results: Results of the study showed the existence of a type of relationship in clinical education in which supportive actions of clinical teachers were prominent. These supportive actions appeared as three major categories including educational support, emotional support and social support which emerged from data. Conclusion: The results of this study explicit the ways that support could be provided for students in their relationship with clinical teachers. It also determines the teachers’ need to know more about the influence of their supportive relationship on students’ learning and the best possible outcomes of their education in clinical settings.

Heydari, Abbas; Yaghoubinia, Fariba; Roudsari, Robab Latifnejad

2013-01-01

358

Clinical Experience with Intraurethral Alprostadil (MUSE®) in the Treatment of Men with Erectile Dysfunction  

Microsoft Academic Search

Objective: The Food and Drug Administration (USA) approved the transurethral administration of prostaglandin (alprostadil in January 1997), which had an efficacy of approximately 50% in clinical trials. We studied its effectiveness in clinical practice.Methods: Patient and partner education was followed by an initial office trial of a medicated urethral system for erection (MUSE®) after other medical risk factors were corrected

André T. Guay; Jesús B. Perez; Ernesto Velásquez; Robert A. Newton; Jerilynn P. Jacobson

2000-01-01

359

Enrollment onto breast cancer therapeutic clinical trials: A tertiary cancer center experience | accrualnet.cancer.gov  

Cancer.gov

A retrospective chart review of newly diagnosed breast cancer patients showed high enrollment (58%). This is much higher than the reports that only 2-3% of patients enroll on clinical trials. However, the overall proportion of patients who were eligible for an trial was low (19%), primarily due to lack of a suitable clinical trials.

360

Initial Experience of an Objective Structured Clinical Examination in Evaluating Urology Residents  

Microsoft Academic Search

Objectives: Objective Structured Clinical Examination (OSCE) is now generally considered as the new gold standard for evaluating clinical competence. The objective of this study was to assess the feasibility of OSCE in evaluating urology residents.Material and Methods: 20 urology residents rotated through a circuit of five standardized patient–based OSCE stations of 10 min duration. The selection of problems was based

Louis Sibert; Paul Grand’Maison; Jean Doucet; Jacques Weber; Philippe Grise

2000-01-01

361

Experiences of clinical tutors with English as an additional language (EAL) students.  

PubMed

Clinical tutors, referred to in the international literature as clinical supervisors, facilitators, mentors or instructors, are responsible for providing and supervising workplace learning opportunities for groups of Bachelor of Nursing (BN) students. They also play a key role in assessing students. The role modeling and support provided by both clinical tutors and registered nurses (RN) or nurse preceptors helps students become familiar with the language in which nursing work is realised. As BN student cohorts in New Zealand have become more diverse in terms of cultures, ethnicities and language backgrounds, clinical tutors have to directly facilitate the development of context-specific and client-focused communication skills for students who speak English as an additional language. We undertook a study which looked at the perceptions of new nursing graduates with English as an additional language (EAL) on the development of spoken language skills for the clinical workplace. As well as interviewing graduates, we spoke to four clinical tutors in order to elicit their views on the language development of EAL students in previous cohorts. This article reports on the themes which emerged from the interviews with the tutors. These include goal setting for communication, integrating students into nursing work, making assessment less stressful, and endorsing independent learning strategies. Based on their observations and on other published research we make some suggestions about ways both clinical tutors and EAL students within their teaching groups could be supported in the development of communication skills for clinical practice. PMID:23421011

Lu, Hongyan; Maithus, Caroline

2012-11-01

362

Accelerator-based radiation sources for next-generation radiobiological research  

NASA Astrophysics Data System (ADS)

The Idaho Accelerator Center (IAC) of Idaho State University has developed a unique radiation research facility to answer next-generation radiobiological questions. The IAC has 10 operating research accelerators. These include continuously delivered radiation beams such as a 950 keV electron beam and a 2 MeV light-ion Van de Graaff. The IAC also has a number of pulsed electron linacs which range in energy from 4 to 40 MeV. The most intense amongst them deliver peak dose rates greater than 10 12 Gy/s. The operational flexibility of pulsed electron linacs allows control of peak and average dose rate, pulse separation and total dose over many orders of magnitude in these parameters. These high dose rates also allow delivery of large doses on time scales that are very small when compared to biological responses. The spectrum of particle beams that the IAC can deliver includes alphas, protons, neutrons, electrons (betas), and gammas (X-rays). Current radiobiological research at the IAC is focused upon radiation effects in unicellular organisms. The effectiveness of extremely high dose rate electron irradiation for the neutralization of microbes is being investigated. Concurrently, we are characterizing the survival mechanisms employed by microbes when exposed to these extremely high doses and dose rates. We have isolated strains from several diverse species that show increased radiation-resistance over normal populations. In addition, we were the first to demonstrate radiation-induced Bystander effects in unicellular organisms. Because of the numerous and diverse accelerators at the IAC, these and many other novel radiobiological investigations are readily attainable.

DeVeaux, Linda C.; Wells, Douglas P.; Hunt, Alan; Webb, Tim; Beezhold, Wendland; Harmon, J. Frank

2006-06-01

363

Using clinical risk management as a means of enhancing patient safety: the Irish experience.  

PubMed

This paper outlines the process and context in which the Clinical Risk Modification Project at Sligo Hospital, Ireland was established and focuses on the issues encountered from conception to implementation. The project is based in the emergency and orthopaedic departments and is of two years duration. The stated aim of this project is to design and test a framework incorporating the core components of a workable Clinical Risk Modification programme in the context of an Irish general hospital. This involved making an explicit commitment to the principles of a learning organisation including blame free risk reporting, providing education and awareness training to promote understanding of clinical risk management locally, and developing a clinical incident/near miss reporting system to address clinical risk in both a proactive and reactive way. PMID:12870248

McElhinney, John; Heffernan, Orla

2003-01-01

364

Nematode radiobiology and development in space. Results from IML-1  

NASA Technical Reports Server (NTRS)

The Radiat experiment was one of 17 investigations which used the ESA Biorack on IML-1 (International Microgravity Laboratory) and it had two objectives. The first objective was to isolate and characterize mutations induced by cosmic rays; the second was to assess the fidelity of development in 0-gravity over two consecutive generations. Two strategies were used to isolate mutations in a set of essential genes or a specific gene and to correlate the genetic events with the passage of charged particles. The results were isolation of 60 lethal mutations whose phenotypes are related to the local pattern of energy deposition. 12 mutations in the unc-22 gene include large deletions as characterized by DNA hybridization studies. Development of nematodes proceeded through two consecutive generations with no obvious defects. Cytoplasmic determinants in embryos, nuclear location and symmetry of cellular anatomy were normal as were Mendelian segregation and recombination of genetic markers.

Nelson, Gregory A.; Schubert, W. W.; Kazarians, G. A.; Richards, G. F.; Benton, E. V.; Benton, E. R.; Henke, R.

1994-01-01

365

National Radiobiology Archives Distributed Access User's Manual, Version 1. 1  

SciTech Connect

This supplement to the NRA Distributed Access User's manual (PNL-7877), November 1991, describes installation and use of Version 1.1 of the software package; this is not a replacement of the previous manual. Version 1.1 of the NRA Distributed Access Package is a maintenance release. It eliminates several bugs, and includes a few new features which are described in this manual. Although the appearance of some menu screens has changed, we are confident that the Version 1.0 User's Manual will provide an adequate introduction to the system. Users who are unfamiliar with Version 1.0 may wish to experiment with that version before moving on to Version 1.1.

Smith, S.K.; Prather, J.C.; Ligotke, E.K.; Watson, C.R.

1992-06-01

366

The impact of clinical experience with alcoholics on Brazilian nursing students' attitudes toward alcoholism and associated problems.  

PubMed

This quasiexperimental study assessed the impact of a clinical experience involving alcoholics on nursing students' attitudes. The study participants were 195 students at a large university-based nursing school in Brazil. They were divided into experimental and control groups. Individuals in the experimental group (n = 56) participated in 6 weeks of a clinical practicum at a specialized treatment service for addiction, during a course in psychiatric nursing. In the same period, the control group (n = 144) participated in a 6-week clinical practicum at a specialized mental health service that did not treat people with addiction. At the end of the theoretical course and clinical practica, both groups completed an attitude measurement scale. Data analysis, using analysis of variance, indicated a statistically significant difference in the overall score on the attitude scale between the experimental and control groups (p = .04), indicating that the experimental group participants' have more positive attitudes, perceptions, opinions, and feelings toward alcoholic individuals and working and relating to these patients. In conclusion, educational interventions that include clinical experience with alcoholics may be an effective teaching strategy that contributes to better skill preparation and more comfortable feelings for nurses intervening in problems related to the use and abuse of alcohol and other drugs. PMID:24621548

de Vargas, Divane

2013-01-01

367

Nuclear Physics and Radiobiology - Issues for Humans in Space and on Earth  

NASA Astrophysics Data System (ADS)

Nuclear physics is playing a vital role in human biological applications, specifically in planned space missions, in hadron radiotherapy, and in low dose radiobiology. While seemingly disparate, these and other areas share a common need for the understanding of nuclear interactions in biological systems. Radiobiology continues to provide valuable information that will help develop better methods for using radiation in the treatment of disease as well as provide a scientific basis for radiation protection standards. NASA is now focused on the agency's vision for space exploration encompassing a broad range of human and robotic missions including missions to the Moon, Mars and beyond. As a result, there is a focus on long duration space missions. Protection from hazards of space radiation has been identified as one of the five NASA critical areas for human space flight. The cost effective design of spacecraft demands a very stringent requirement on the optimization process. Exposures from the hazards of severe space radiation in deep space and/or long duration missions are very different from that of low earth orbit, and much needs to be done about their effects. However, it is clear that revolutionary technologies will need to be developed. Here on earth, particulate radiation treatment for cancer, such as proton radiotherapy, is playing an increasing important role, while the biological effectiveness remains less well understood than for x-rays and other forms of medical radiation treatments. Advanced imaging, dosimetric, Monte Carlo, and other techniques from nuclear physics are utilized to study the molecular basis of fractionation dependency and other tumor and normal tissue radiation responses, such as radiosensitivity. Moreover, advances developed by biological research efforts, such as the sequencing of the human genome, have opened new horizons for radiobiology. New techniques have made it possible to determine at the cellular / molecular level how living systems respond even to low doses of radiation. I will discuss the interplay between nuclear physics and human biological applications; Starting with high dose exposure in space applications, to controlled exposure in radiotherapy, and finally, low dose radiobiology. I will project how cellular level living system activities may provide the much needed impact of radiation exposure on living tissues in these applications.

Tripathi, Ram

2008-10-01

368

Research in radiobiology. Annual report of work in progress in the Internal Irradiation Program  

SciTech Connect

Survival data on 160 nonirradiated control beagles of the University of Utah's Radiobiology Laboratory were analyzed. The animals died during a period from 1958 into 1979. The average age at death of animals which died during the 1958 to 1965 interval was significantly less than that of those whose deaths occurred in the 1965 to 1979 interval. The best estimate for average age at death for Super-Selected nonirradiated control beagles of the colony is 4864 +- 901 days. The Super-Selected dogs excluded those dying because of epilepsy, lymphosarcoma, lymphoma or accidents, and also excluded all dogs dying before 1966.

Miller, S.C. (ed.)

1980-03-31

369

A Comparison of Students' Clinical Experience in Family Medicine and Traditional Clerkships.  

ERIC Educational Resources Information Center

Experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships was compared with the experience on a family medicine clerkship. The family medicine clerkship offered the most experience with circulatory, respiratory, digestive, neurological, musculoskeletal, and skin problems and with…

Parkerson, George R., Jr.; And Others

1984-01-01

370

[Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL].  

PubMed

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected. PMID:3177119

Tanda, H; Kato, S; Ohnishi, S; Nakajima, H; Mori, K

1988-05-01

371

Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning  

SciTech Connect

Purpose: To incorporate a quality control tool, according to previous planning experience and patient-specific anatomic information, into the intensity-modulated radiotherapy (IMRT) plan generation process and to determine whether the tool improved treatment plan quality. Methods and Materials: A retrospective study of 42 IMRT plans demonstrated a correlation between the fraction of organs at risk (OARs) overlapping the planning target volume and the mean dose. This yielded a model, predicted dose = prescription dose (0.2 + 0.8 [1 - exp(-3 overlapping planning target volume/volume of OAR)]), that predicted the achievable mean doses according to the planning target volume overlap/volume of OAR and the prescription dose. The model was incorporated into the planning process by way of a user-executable script that reported the predicted dose for any OAR. The script was introduced to clinicians engaged in IMRT planning and deployed thereafter. The script's effect was evaluated by tracking {delta} = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. Results: All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller {delta} and reduced variability after script implementation. These effects were substantial for the parotid glands, for which the previous {delta} = 0.28 {+-} 0.24 was reduced to {delta} = 0.13 {+-} 0.10. The clinical relevance was most evident in the subset of cases in which the parotid glands were potentially salvageable (predicted dose <30 Gy). Before script implementation, an average of 30.1 Gy was delivered to the salvageable cases, with an average predicted dose of 20.3 Gy. After implementation, an average of 18.7 Gy was delivered to salvageable cases, with an average predicted dose of 17.2 Gy. In the prostate cases, the rectum model excess was reduced from {delta} = 0.28 {+-} 0.20 to {delta} = 0.07 {+-} 0.15. On surveying dosimetrists at the end of the study, most reported that the script both improved their IMRT planning (8 of 10) and increased their efficiency (6 of 10). Conclusions: This tool proved successful in increasing normal tissue sparing and reducing interclinician variability, providing effective quality control of the IMRT plan development process.

Moore, Kevin L., E-mail: kmoore@radonc.wustl.edu [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Brame, R. Scott [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA (United States); Low, Daniel A.; Mutic, Sasa [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)

2011-10-01

372

Upgrading the genome facility for radiobiological experiments with heavy-ion beams  

NASA Astrophysics Data System (ADS)

The Genome-M facility for the automatic fast irradiation of thin biological samples with accelerated heavy ions at the U-400M cyclotron of the Flerov Laboratory of Nuclear Reactions, Joint Institute for Nuclear Research, is described. It allows a great deal of various samples to be irradiated within a few hours using radiation with preset and controlled characteristics. Methods for monitoring beam quality and calibrating the ionization chamber in absorbed dose units and the facility control software are also described.

Bezbakh, A. A.; Zager, V. B.; Kaminski, G.; Krylov, A. I.; Krylov, V. A.; Teterev, Yu. G.; Timoshenko, G. N.

2013-03-01

373

Use of accelerating clinical improvement in reorganization of care: the Dartmouth-Hitchcock Medical Center experience.  

PubMed

Accelerating clinical improvement is a unique strategic method for accelerating the rate and effectiveness of improvements in strategically important clinical services. It promotes real reduction in the cost of service while preserving the quality and value within the system. Based on the components of process, value, benchmarking, change, and learning, the method can be used in any system or setting to produce value-driven change. Accelerating clinical improvement is being used within the Obstetrical Department of Dartmouth-Hitchcock Medical Center to decrease postpartum length of stay for families with spontaneous vaginal delivery. Familiarity with the method led to additional and ongoing improvements in the system. This method is important for nurses because it is continuous, multidisciplinary, addresses values of concern to families and providers, and is easily incorporated by nurse providers in any clinical setting. PMID:9170598

Kobokovich, L J

1997-01-01

374

Recruitment experience in clinical trials: literature summary and annotated bibliography. | accrualnet.cancer.gov  

Cancer.gov

This article summarizes a literature review that was conducted to determine what problems exist in accruing patients for clinical trials. Delays in recruitment typically result in increased costs for recruitment and the entire trial.

375

Reflective Practice in Clinical Teaching: The Experience of Two Nurse Academics.  

ERIC Educational Resources Information Center

Two beginning nurse educators used reflective practice to shape ideas about clinical teaching. Techniques such as journal writing, audiotaped debriefing, and a "critical friend" helped support and inform their reflection and improve teaching and learning. (SK)

Stockhausen, Lynette

1995-01-01

376

Crossing over: The lived experiences of clinical laboratory science education teachers as they transition from traditional to online instruction  

NASA Astrophysics Data System (ADS)

A phenomenological study was undertaken to understand and describe the nature and meaning of the live experiences of faculty transition from traditional to teaching online clinical laboratory science courses. In order to gain insight into the lived experiences of faculty, in-depth interviews were conducted with 10 faculty members. The task of the researcher was to allow the participants to speak for themselves, and reveal the meaning of the experiences, rather than to discover causal connections or patterns of correlation. The key criterion in choosing purposeful sampling procedure was to obtain the deepest understanding possible of the lived experiences of faculty transitioning to online teaching, which were likely to be a rich source of the data of interest. Analyses of the interview text were based on three essential considerations. The three essential considerations were (a) the traditional role of the faculty, (b) factors affecting the changing role of the faculty, and (c) the effects of web-based technology on teaching role.

Veldkamp, Ruth B.

377

Radiobiological studies of plants orbited in Biosatellite II.  

PubMed

The Biosatellite II Tradescantia experiment probed the effects of the space environment on spontaneous and radiation-induced mutation rates and on cytological changes in Tradescantia clone 02. Thirty two young flowering plants arranged in a plastic housing with the roots immersed in nutrient solution were exposed to gamma radiation from an on-board 85 Strontium source during the two-day orbital flight. Unirradiated plants were flown in a package in the spacecraft behind a tungsten radiation shield and identical non-flight control packages (with and without irradiation) were maintained at the launch site. After retrieval of the spacecraft near Hawaii, samples of root tip, ovary and stamen tissues were collected. These and the intact plants were flown to the Brookhaven National Laboratory for observations on the following end points: somatic mutation, cell size, loss of reproductive integrity resulting in stunted stamen hairs, pollen grain mortality, frequency of micronuclei in pollen, disturbed mitotic spindle function and chromosome aberrations. Analysis of data on somatic mutation, cell size and chromosome aberration end points showed no significant differences between flight and non-flight samples. However, pollen abortion, frequency of micronuclei in pollen and loss of reproductive integrity (stamen hair stunting) showed increases associated with weightlessness in irradiated material. Root tip and microspore cells showed effects of disturbed mitotic spindle function in orbited plants both with and without irradiation. Clearly differences exist between flight and non-flight material and the significance and possible mechanisms for these effects are being studied in continuing non-flight tests. PMID:11822416

Schairer, L A; Sparrow, A H; Marimuthu, K M

1970-01-01

378

What to learn about sildenafil in the treatment of erectile dysfunction from 3-year clinical experience  

Microsoft Academic Search

We retrospectively assessed the clinical uses and results of sildenafil in the treatment of erectile dysfunction (ED) in daily clinical practice from a cohort of 1658 subjects at a multispeciality medical center from 1999 to 2001 through a chart review, mailed questionnaire and telephone interview. The overall follow-up rate was 77.8% (1290\\/1658). The mean age was 63.8 y and ED

B-P Jiann; C-C Yu; J-Y Tsai; TT Wu; Y-H Lee; J-K Huang

2003-01-01

379

Assessment and Development of Competency of Clinical Engineering Practitioners - South East Asian Experience  

Microsoft Academic Search

\\u000a Clinical Engineering was relatively unknown and remained an obscure engineering discipline in South East Asian countries until\\u000a the 1990s. Typically for most healthcare institutions, the management of medical equipment within the hospital environment\\u000a mainly focused on reactive breakdown maintenance management. Hospitals were unable to develop in-house clinical engineering\\u000a capabilities, since there was a severe shortage of skilled and competent technical

Ashok V. Shah; Azman Hamid

380

Holmium:YAG laser coronary angioplasty: quantitative angiography and clinical results in a large experience of a single medical center  

NASA Astrophysics Data System (ADS)

Clinical experience with the mid IR holmium:YAG laser in a single medical center (St. Paul Ramsey Medical Center, University of Minnesota Medical School, St. Paul, MN) includes 112 patients who underwent holmium laser coronary angioplasty. Utilizing a unique lasing technique; `pulse and retreat,' we applied this laser to thrombotic and nonthrombotic lesions in patients presenting with unstable angina, stable angina, and acute myocardial infarction. A very high clinical success and very low complication rates were achieved. Holmium:YAG laser is effective and safe therapy for patients with symptomatic coronary artery disease. Unlike excimer lasers, the clinical success, efficacy and safety of holmium laser angioplasty is not compromised when thrombus is present.

Topaz, On; Luxenberg, Michael; Schumacher, Audrey

1994-07-01

381

North American Clinical Experience with the EKOS MicroLysUS Infusion Catheter for the Treatment of Embolic Stroke  

Microsoft Academic Search

BACKGROUND AND PURPOSE: We present early experience with the EKOS MicroLysUS infusion catheter for acute embolic stroke treatment in North America. This study was designed to demonstrate the safety of the device and to determine if sonography accelerates thrombolysis and improves clinical outcomes. METHODS: Fourteen patients aged 40 -77 years with anterior- or posterior-circulation occlusion presented with cerebral ischemia 3-

Brian R. Mahon; Gary M. Nesbit; Stanley L. Barnwell; Wayne Clark; Thomas R. Marotta; Alain Weill; Phillip A. Teal; Adnan I. Qureshi

382

Radiobiological characterization of post-lumpectomy focal brachytherapy with lipid nanoparticle-carried radionuclides  

NASA Astrophysics Data System (ADS)

Post-operative radiotherapy has commonly been used for early stage breast cancer to treat residual disease. The primary objective of this work was to characterize, through dosimetric and radiobiological modeling, a novel focal brachytherapy technique which uses direct intracavitary infusion of ?-emitting radionuclides (186Re/188Re) carried by lipid nanoparticles (liposomes). Absorbed dose calculations were performed for a spherical lumpectomy cavity with a uniformly injected activity distribution using a dose point kernel convolution technique. Radiobiological indices were used to relate predicted therapy outcome and normal tissue complication of this technique with equivalent external beam radiotherapy treatment regimens. Modeled stromal damage was used as a measure of the inhibition of the stimulatory effect on tumor growth driven by the wound healing response. A sample treatment plan delivering 50 Gy at a therapeutic range of 2.0 mm for 186Re-liposomes and 5.0 mm for 188Re-liposomes takes advantage of the dose delivery characteristics of the ?-emissions, providing significant EUD (58.2 Gy and 72.5 Gy for 186Re and 188Re, respectively) with a minimal NTCP (0.046%) of the healthy ipsilateral breast. Modeling of kidney BED and ipsilateral breast NTCP showed that large injected activity concentrations of both radionuclides could be safely administered without significant complications.

Hrycushko, Brian A.; Gutierrez, Alonso N.; Goins, Beth; Yan, Weiqiang; Phillips, William T.; Otto, Pamela M.; Bao, Ande

2011-02-01

383

Heavy-ion radiobiology: new approaches to delineate mechanisms underlying enhanced biological effectiveness  

NASA Technical Reports Server (NTRS)

Shortly after the discovery of polonium and radium by Marie Curie and her husband and colleague, Pierre Curie, it was learned that exposure to these alpha-particle emitters produced deleterious biological effects. The mechanisms underlying the increased biological effectiveness of densely ionizing radiations, including alpha particles, neutrons and highly energetic heavy charged particles, remain an active area of investigation. In this paper, we review recent advances in several areas of the radiobiology of these densely ionizing radiations, also known as heavy ions. Advances are described in the areas of DNA damage and repair, chromosome aberrations, mutagenesis, neoplastic transformation in vitro, genomic instability, normal tissue radiobiology and carcinogenesis in vivo. We focus on technical innovations, including novel applications of pulsed-field gel electrophoresis, fluorescence in situ hybridization (FISH), linkage analysis, and studies of gene expression and protein expression. We also highlight the use of new cellular and animal systems, including those with defined DNA repair deficiencies, as well as epithelial cell model systems to assess neoplastic transformation both in vitro and in vivo. The studies reviewed herein have had a substantial impact on our understanding of the genotoxic effects of heavy ions as well as their distinct effects on tissue homeostasis. The use of these radiations in cancer therapy is also discussed. The use of both heavy-ion and proton therapy is on the upswing in several centers around the world, due to their unique energy deposition characteristics that enhance the therapeutic effect and help reduce damage to normal tissue.

Blakely, E. A.; Kronenberg, A.; Chatterjee, A. (Principal Investigator)

1998-01-01

384

Heavy-ion radiobiology: new approaches to delineate mechanisms underlying enhanced biological effectiveness.  

PubMed

Shortly after the discovery of polonium and radium by Marie Curie and her husband and colleague, Pierre Curie, it was learned that exposure to these alpha-particle emitters produced deleterious biological effects. The mechanisms underlying the increased biological effectiveness of densely ionizing radiations, including alpha particles, neutrons and highly energetic heavy charged particles, remain an active area of investigation. In this paper, we review recent advances in several areas of the radiobiology of these densely ionizing radiations, also known as heavy ions. Advances are described in the areas of DNA damage and repair, chromosome aberrations, mutagenesis, neoplastic transformation in vitro, genomic instability, normal tissue radiobiology and carcinogenesis in vivo. We focus on technical innovations, including novel applications of pulsed-field gel electrophoresis, fluorescence in situ hybridization (FISH), linkage analysis, and studies of gene expression and protein expression. We also highlight the use of new cellular and animal systems, including those with defined DNA repair deficiencies, as well as epithelial cell model systems to assess neoplastic transformation both in vitro and in vivo. The studies reviewed herein have had a substantial impact on our understanding of the genotoxic effects of heavy ions as well as their distinct effects on tissue homeostasis. The use of these radiations in cancer therapy is also discussed. The use of both heavy-ion and proton therapy is on the upswing in several centers around the world, due to their unique energy deposition characteristics that enhance the therapeutic effect and help reduce damage to normal tissue. PMID:9806616

Blakely, E A; Kronenberg, A

1998-11-01

385

Research in radiobiology: Annual report of work in progress in the internal irradiation program  

SciTech Connect

In the early 1950's the Atomic Energy Commission established at the University of Utah a large, long-term study designed to investigate the toxicity of internally deposited radionuclides in beagles. The first animals were injected on December 1, 1952 and thus began an odyssey unusual in modern science both for its duration and continued scientific interest and relevance. The original dogs were injected with /sup 239/Pu and /sup 226/Ra. Later, studies were initiated with /sup 241/Am, /sup 249/Cf, /sup 252/Cf, /sup 253/Es, /sup 224/Ra, /sup 228/Ra, /sup 90/Sr, and /sup 228/Th. These studies were unique and have and will continue to contribute valuable scientific information on the behavior and effects of these substances in biological systems. We feel that the data collected from these studies will be useful for many decades to come as we ask more demanding questions relative to radionuclides and environmental, biological and health issues. While this publication will be the last of our series Research in Radiobiology, the lifespan carcinogenesis studies are continuing under a collaborative arrangement with the I.T.R.I. Beginning in 1988, the colony status tables of dogs in the Utah studies and reports of research by the Radiobiology faculty will be included in the annual I.T.R.I. report. Under our new collaborative arrangements with the I.T.R.I. for the conduct of the lifespan carcinogenesis studies, we expect a continued high level of scientific productivity from our faculty.

Miller, S.C.; Buster, D.S. (eds.)

1987-12-31

386

Mental health pre-registration nursing students' experiences of group clinical supervision: a UK longitudinal qualitative study.  

PubMed

There is widespread international interest in the use of clinical supervision in nursing as well as recognition of the need to introduce nursing students to its concepts and value. This article reports on a three-year longitudinal qualitative focus group study which explored students' views and experiences of a group clinical supervision initiative. Students attended supervision groups facilitated by teaching staff over their three year pre-registration mental health nursing course, with a main aim of developing skills, knowledge and attitudes as supervisees. The findings showed that students derived benefit from the experience, gained greater awareness of the nature of supervision and became active supervisees within their groups. These benefits took time to emerge and were not universal however. While the findings support the value of exposing students to the experience of group clinical supervision educators wishing to implement such a programme need to address a host of issues. These include; the preparation of students, structural and resource concerns, and issues relating to group dynamics. PMID:24219985

Carver, Neil; Clibbens, Nicola; Ashmore, Russell; Sheldon, Julie

2014-03-01

387

A transdisciplinary approach to developing a web-based nursing experiential log system for advanced practice nursing clinical experiences.  

PubMed

This article describes a transdisciplinary project between the computer information systems department and the graduate nursing department of a higher education institution. The project is the planning, development, and implementation of a Web-based nursing experiential log system for advanced practice nursing clinical experiences, which was funded by a Nursing Education Practice and Retention grant from the Health Resources and Services Administration. The article explains the concept and benefits of the transdisciplinary nature of the project. The design team, project leadership, and roles within the team are reviewed, including the role of end-user faculty in the design process. The article describes the focus and scope of the Web-based experiential log system database that is used to document and track advanced practice nursing student clinical experiences, as well as a summary of the design process used to develop the log system and the specific functionality of the database system. The implementation process, including end-user training, pilot implementation, and modifications, lessons learned, and future directions of the project are addressed. The article concludes with the benefits to the clinical experience and graduate nursing program that have been noted since the implementation of the system. PMID:21697707

Olson, Brandon D; Fauchald, Sally K

2011-11-01

388

Natalizumab treatment in multiple sclerosis patients: a multicenter experience in clinical practice in Italy.  

PubMed

We evaluated efficacy of natalizumab in relapsing-remitting multiple sclerosis patients in a clinical practice setting. We report data on the first consecutive 343 patients receiving natalizumab in 12 multiple sclerosis (MS) Italian centers enrolled between April 2007 and November 2010. The main efficacy endpoints were the proportion of patients free from relapses, disease progression, combined clinical activity, defined as presence of relapse or disease progression, from MRI activity, and from any disease activity defined as the absence of any single or combined activity. At the end of follow-up, the cumulative proportion of patients free from relapses was 68%; the proportion of patients free from Expanded Disability Status Scale (EDSS) progression was 93%; the proportion of patients free from combined clinical activity was 65%; the proportion of patients free from MRI activity was 77%; and the proportion of patients free from any disease activity was 53%. Natalizumab was effective in reducing clinical and neuroradiological disease activity. Its effectiveness in clinical practice is higher than that reported in pivotal trials and was maintained over time. PMID:25004826

Totaro, R; Lugaresi, A; Bellantonio, P; Danni, M; Costantino, G; Gasperini, C; Florio, C; Pucci, E; Maddestra, M; Spitaleri, D; Lus, G; Ardito, B; Farina, D; Rossi, M; Di Carmine, C; Altobelli, E; Maccarone, B; Casalena, A; De Luca, G; Travaglini, D; Di Ioia, M; Di Tommaso, V; Fantozzi, R; Ruggieri, S; Provinciali, L; De Riso, S; Mundi, C; Fuiani, A; Galgani, S; Ruggieri, S; Maniscalco, G T; Giuliani, G; Cartechini, E; Petretta, V; Fratta, M; Alfieri, G; Gatto, M; Carolei, A

2014-01-01

389

Teaching style in clinical nursing education: a qualitative study of Iranian nursing teachers' experiences.  

PubMed

There are many studies about nursing clinical settings and their problems, but the teaching style as a whole has not been widely studied. Therefore, this study aimed to explore nursing teachers' perceptions about teaching style in the clinical settings in Iran. A grounded theory approach was used to conduct this study. Fifteen nursing teachers were interviewed individually, 2006-2007. The interviews were tape-recorded and later transcribed verbatim. The transcriptions were analyzed using Strauss and Corbin's method. Three main and 12 sub themes emerged from data and these could explain the nature of the teaching style in clinical education of the Mashhad Faculty of Nursing and probably others in Iran. The main themes included: multiplicity in teaching style, nature of clinical teaching, and control and adaptation in education atmosphere. Multiplicity in teaching style was the dominant concept in this study. Each educator had a personal and individualized style which was flexible according to the situation, type of the skill (course content), education environment and facilities, and level of the learner. This study can guide nurse educators to know more about teaching styles and use them appropriately in the clinical settings. Further research into the themes of this study are recommended. PMID:19251481

Hossein, Karimi Moonaghi; Fatemeh, Dabbaghi; Fatemeh, Oskouie Seid; Katri, Vehviläinen-Julkunen; Tahereh, Binaghi

2010-01-01

390

The Effects of Early Clinical Teaching Experiences on Pre-Service Teachers' Self-Efficacy  

ERIC Educational Resources Information Center

In-service teachers are often lack sufficient teaching experience (Block et al., 2010) that leads to being psychologically unprepared to confront many challenges in teaching. Providing ample experiences for Physical Education Teacher Education (PETE) students in a pedagogical setting parallel to that which they will one day teach (Kirk &…

Androzzi, Jared

2011-01-01

391

Diurnal variation in clinical depression and accessibility of memories of positive and negative experiences  

Microsoft Academic Search

Each of 12 depressed patients with diurnal mood variation was seen at 2 different times during the day. On one of these occasions they were substantially more depressed than on the other. On each occasion they recalled life experiences associated to stimulus words. At the end of the 2nd occasion they rated these experiences for happiness or unhappiness at the

David M. Clark; John D. Teasdale

1982-01-01

392

Parents' experiences of receiving their child's genetic diagnosis: A qualitative study to inform clinical genetics practice.  

PubMed

Little is currently known about how parents experience the medical genetics appointment at which their child receives a genetic diagnosis. We conducted semi-structured in-person interviews with 13 parents of 10 index children to explore their experience in the medical genetics appointment in which they received their child's genetic diagnosis. Guided by grounded theory, we used a constant comparative approach to data analysis. Transcribed interviews were coded and sorted, and thematic categories identified. Sixty-one and a half percent of parents experienced the diagnosis session as negative, 23% felt the experience was positive, and 15.5% were ambivalent. Receiving emotional support, an outline of the follow-up plans, and messages of hope and perspective during the session seemed to positively influence parents' experience, while feeling that their role was as a passive receiver of information and the use of difficult medical terminology negatively influenced parents' overall experience. Parental preparedness for the information, and the parents' emotional reaction to the diagnosis were also factors that influenced the parental experience. Few participants understood the role of the genetic counselor. Our results provide in-depth insight into the parental experience of the pediatric medical genetics diagnosis session. We propose a mechanism through which parental experience shapes their perception of the medical genetics session. © 2014 Wiley Periodicals, Inc. PMID:24706543

Ashtiani, Setareh; Makela, Nancy; Carrion, Prescilla; Austin, Jehannine

2014-06-01

393

Developing a clinical hypermedia corpus: experiences from the use of a practice-centered method.  

PubMed Central

This paper outlines a practice-centered method for creation of a hypermedia corpus. It also describes experiences with creating such a corpus of information to support interprofessional work at a Primary Healthcare Center. From these experiences, a number of basic issues regarding information systems development within medical informatics will be discussed.

Timpka, T.; Nyce, J. M.; Sjoberg, C.; Hedblom, P.; Lindblom, P.

1992-01-01

394

Locally enhanced chemotherapy by electroporation: clinical experiences and perspective of use of electrochemotherapy.  

PubMed

Electroporation is used to enhance drug diffusion and gene delivery into the cytosol. The combination of electroporation and cytotoxic drugs, electrochemotherapy (ECT), is used to treat metastatic tumor nodules located at the skin and subcutaneous tissue. The objective response rate following a single session of treatment exceeds 80%, with minimal toxicity for the patients. The efficacy of ECT in the bone and visceral metastasis is currently investigated, and Phase II studies have been completed. ECT has been used to treat skin primary tumors, except melanoma, and is under investigation for locally advanced pancreatic cancer. Early evidence suggests that treatment of tumor nodules with ECT recruits components of the immune system and eliciting a systemic immune response against cancer is a challenging clinical perspective. Considering the proven safety in several different clinical applications electroporation should be viewed as a clinical platform technology with wide perspectives for use in ECT, gene therapy and DNA vaccination. PMID:24799067

Cadossi, Ruggero; Ronchetti, Mattia; Cadossi, Matteo

2014-04-01

395

Experience and challenges from clinical trials with malaria vaccines in Africa  

PubMed Central

Malaria vaccines are considered amongst the most important modalities for potential elimination of malaria disease and transmission. Research and development in this field has been an area of intense effort by many groups over the last few decades. Despite this, there is currently no licensed malaria vaccine. Researchers, clinical trialists and vaccine developers have been working on many approached to make malaria vaccine available. African research institutions have developed and demonstrated a great capacity to undertake clinical trials in accordance to the International Conference on Harmonization-Good Clinical Practice (ICH-GCP) standards in the last decade; particularly in the field of malaria vaccines and anti-malarial drugs. This capacity is a result of networking among African scientists in collaboration with other partners; this has traversed both clinical trials and malaria control programmes as part of the Global Malaria Action Plan (GMAP). GMAP outlined and support global strategies toward the elimination and eradication of malaria in many areas, translating in reduction in public health burden, especially for African children. In the sub-Saharan region the capacity to undertake more clinical trials remains small in comparison to the actual need. H