Note: This page contains sample records for the topic clinical radiobiological experience from Science.gov.
While these samples are representative of the content of Science.gov,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of Science.gov
to obtain the most current and comprehensive results.
Last update: November 12, 2013.
1

Studies in the radiobiology of osteoradionecrosis and their clinical significance  

Microsoft Academic Search

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

R. E. Marx; R. P. Johnson

1987-01-01

2

Radiobiological rationale and clinical implications of hypofractionated radiation therapy.  

PubMed

Recent clinical trials of hypofractionated radiation treatment have provided critical insights into the safety and efficacy of hypofractionation. However, there remains much controversy in the field, both at the level of clinical practice and in our understanding of the underlying radiobiological mechanisms. In this article, we review the clinical literature on hypofractionated radiation treatment for breast, prostate, and other malignancies. We highlight several ongoing clinical trials that compare outcomes of a hypofractionated approach versus those obtained with a conventional approach. Lastly, we outline some of the preclinical and clinical evidence that argue in favor of differential radiobiological mechanisms underlying hypofractionated radiation treatment. Emerging data from the ongoing studies will help to better define and guide the rational use of hypofractionation in future years. PMID:21514198

Ko, E C; Forsythe, K; Buckstein, M; Kao, J; Rosenstein, B S

2011-04-21

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

Radiobiological Experiments on Cosmos-110 Biosatellite.  

National Technical Information Service (NTIS)

The flight of the Cosmos-110 biosatellite substantially outlasted all preceding flights -- the effects of weightlessness in this experiment continued for about 22 days. The paper presents results of research in lysogenic bacteria E. coli K-12(lambda), mic...

V. V. Antipov N. L. Delone M. D. Nikitin G. P. Parfenov P. P. Saksonov

1968-01-01

5

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

6

Feasibility of BNCT radiobiological experiments at the HYTHOR facility  

Microsoft Academic Search

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

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

2008-01-01

7

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

8

Estimate of Radiobiologic Parameters From Clinical Data for Biologically Based Treatment Planning for Liver Irradiation  

SciTech Connect

Purpose: The Radiation Therapy Oncology Group (RTOG) is initiating a few new hypofractionation regimens (RTOG 0438) to treat liver cancer patients. To evaluate the radiobiologic equivalence between different regimens requires reliable radiobiologic parameters. The purpose of this work is to estimate a plausible set of such parameters for liver tumors and to design new optimized dose fractionation schemes to increase patient survival. Methods and Materials: A model was developed to fit clinical survival data from irradiation of a series of primary liver patients. The model consists of six parameters including radiosensitivity parameters {alpha} and {alpha}/{beta}, potential doubling time T{sub d}. Using this model together with the Lyman model for calculations of the normal tissue complication probability, we designed a series of hypofractionated treatment strategies for liver irradiation. Results: The radiobiologic parameters for liver tumors were estimated to be: {alpha}/{beta} = 15.0 {+-} 2.0 Gy, {alpha} = 0.010 {+-} 0.001 Gy {sup -1}, T{sub d} = 128 {+-} 12 day. By calculating the biologically effective dose using the obtained parameters, it is found that for liver patients with an effective liver volume of {approx}45% the dose fractionation regimens suggested in RTOG 0438 can be escalated to higher dose for improved patient survival ({approx}80% at 1 year) while keeping the normal tissue complication probability to less than 10%. Conclusions: A plausible set of radiobiologic parameters has been obtained based on clinical data. These parameters may be used for radiation treatment planning of liver tumors, in particular, for the design of new treatment regimens aimed at dose escalation.

Tai, An; Erickson, Beth; Khater, Kevin A. [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)], E-mail: ali@mcw.edu

2008-03-01

9

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

2007-05-15

10

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

11

The European Radiobiology Archives (ERA), present state and future developments.  

PubMed

The European Radiobiology Archives (ERA) aims to collect most of the information still available in Europe on long-term animal experiments--including some selected human studies suitable for comparison with animal data--and to make them available to the scientific community for further analysis. ERA cooperates with the US (National Radiobiology Archives, NRA) and Japan (Japanese Radiobiology Archives, JRA) in the International Radiobiology Archives (IRA). PMID:15623889

Gerber, G B; Wick, R R

2004-01-01

12

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 dUTP 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

13

Studies of UV-cured CR39 recording properties in view of its applicability in radiobiological experiments with alpha particles  

Microsoft Academic Search

In radiobiology, low doses of high-LET radiation correspond to a few particle traversals through the cell population. Therefore, for studies on cell monolayers irradiated with a low dose of ?-particles, it is extremely useful if the number and position of particle traversals can be determined. In this study we describe a new method, based on UV-curing, to obtain a 10?m

Sylvain Gaillard; Caroline J. Ross; Vincent Armbruster; Mark A. Hill; David L. Stevens; Tijani Gharbi; Michel Fromm

2005-01-01

14

Non-extensive radiobiology  

SciTech Connect

The expression of survival factors for radiation damaged cells is based on probabilistic assumptions and experimentally fitted for each tumor, radiation and conditions. Here we show how the simplest of these radiobiological models can be derived from the maximum entropy principle of the classical Boltzmann-Gibbs expression. We extend this derivation using the Tsallis entropy and a cutoff hypothesis, motivated by clinical observations. A generalization of the exponential, the logarithm and the product to a non-extensive framework, provides a simple formula for the survival fraction corresponding to the application of several radiation doses on a living tissue. The obtained expression shows a remarkable agreement with the experimental data found in the literature, also providing a new interpretation of some of the parameters introduced anew. It is also shown how the presented formalism may have direct application in radiotherapy treatment optimization through the definition of the potential effect difference, simply calculated between the tumour and the surrounding tissue.

Sotolongo-Grau, O.; Rodriguez-Perez, D. [UNED, Departamento de Fisica Matematica y de Fluidos (Spain); Antoranz, J. C. [UNED, Departamento de Fisica Matematica y de Fluidos (Spain); UH, Catedra de Sistemas Complejos Henri Poincare (Cuba); Sotolongo-Costa, O. [UH, Catedra de Sistemas Complejos Henri Poincare (Cuba)

2011-03-14

15

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

16

Rofecoxib: clinical pharmacology and clinical experience  

Microsoft Academic Search

Background: Rofecoxib is a member of a subgroup of nonsteroidal anti-inflammatory drugs (NSAIDs) known as cyclooxygenase-2 (COX-2)—selective inhibitors. It has been studied in adult and elderly patients in a number of painful conditions (primary dysmenorrhea, acute pain after dental and orthopedic surgery, osteoarthritis [OA], and rheumatoid arthritis).Objective: This review discusses the clinical pharmacology of and clinical experience with rofecoxib, and

Arthur L. Weaver

2001-01-01

17

Renin inhibitors, clinical experience  

Microsoft Academic Search

The inhibition of the renin–angiotensin system is one of the most commonly utilized ways to lower blood pressure in patients\\u000a with arterial hypertension. Up till now, angiotensin-converting enzyme inhibitors as well as angiotensin receptor blockers\\u000a are the established inhibitors of this system, and both classes are used in clinical routine. There is a wealth of information\\u000a about those classes, which

Dirk Westermann; Roland Schmieder; Heinz-Peter Schultheiss; Carsten Tschöpe

2008-01-01

18

The Janeway Lecture 1992. Nine decades of radiobiology: is radiation therapy any the better for it?  

PubMed

Nine decades have elapsed since Pierre Curie performed the first radiobiologic experiment when he used a radium tube to produce an ulcer on his arm and charted its progress and ultimate healing. A wide range of topics have been investigated in experimental radiation biology from chromosomal aberrations to fractionation effects in normal tissues to the use of neutrons and bioreductive drugs. Many of the strategies used in clinical radiation therapy, including hyperfractionation and accelerated treatment, are firmly based on laboratory experiments conducted in the past. Much current research is focused on understanding the molecular genetics of cancer to identify the genes that are activated or deleted in cells exposed to radiation. Radiobiology has played a key role in shaping radiation therapy into the vigorous, scientifically based, and highly quantitative branch of medicine that it is currently. In addition, research is preparing the field for the future when treatment protocols must be based on molecular rather than cellular biology. PMID:8490926

Hall, E J

1993-06-01

19

Beam-Port Design of a Radiobiological Dosimetry Experiment for {sup 10}B-Enhanced {sup 252}Cf Brachytherapy  

SciTech Connect

It has been previously suggested that the incorporation of {sup 10}B-labeled drugs into tumor cells might significantly increase the dose to the peripheral tumor cells in {sup 252}Cf brachytherapy. The dose enhancement comes from the thermal neutron capture reactions of {sup 10}B(n, {alpha}){sup 7}Li. As a new cancer treatment modality, this so-called {sup 10}{und B}-{und E}nhanced {sup 252}{und C}f {und B}rachy{und t}herapy (BECBT) is currently being commercialized by Isotron. One of the challenges for implementing BECBT has been to determine the maximum tolerable dose (MTD) to the normal tissue surrounding a tumor. Because the relative biological effectiveness for the {sup 10}B(n, {alpha}){sup 7}Li reaction products is greater than that for fission neutrons, the MTD should decrease as {sup 10}B concentration increases for BECBT. To more precisely determine the MTD for BECBT, we intend to conduct both in vitro (cell culture) and in vivo (rat) experiments with a 50-mg {sup 252}Cf source. We will use cell survival fraction and normal brain necrosis as the biological end points for the cell-culture experiments and rat experiments, respectively. To carry out these experiments, the neutron field to which the samples are exposed must contain a significant portion of thermal neutrons. The rat experiments further require the use of a very small and well-collimated neutron beam to effectively irradiate the rat brain while minimizing the dose to its whole body. This paper discusses the design criteria for the experimental neutron beam port and the computational work leading to its optimal configuration.

Carla White; C.-K. Chris Wang; David Halpern; Casey Moore

2000-11-12

20

Calculation of the radiobiological effects of heavy ions on eggs of Artemia salina flown in the Biostack experiments.  

PubMed

By factorizing fragmentation cross-sections of ions into a projectile and a target-depending part, their flux inside a space vehicle can be calculated. This factorization was found at Bevalac for high-energy oxygen and carbon ions. With some restrictions, an extension of the factorization law to heavier nuclei up to iron is indicated by cosmic-ray data. Using this factorization the known cross-sections for the fragmentation of heavy ions (Z=6-26) in collisions with protons were extrapolated to heavier target nuclei and the energy spectra of nuclei of different charges in the interior of' the Biostack were calculated. The theory of Katz was applied to estimate the heavy-ion-induced radiation damage in Artemia salina. The results are compared with experiment. PMID:11958210

Heinrich, W

1977-01-01

21

[Radiobiology and the lessons of Chernobyl].  

PubMed

The Chernobyl accident has marked the beginning of a new stage of radiobiology development and revealed scantiness of old concepts. One should (1) search for effective protectors against the long-term influence of low-level radiation and means of removal of radionuclides using criteria that differ principally from those used previously in selecting among nontoxic antioxidants, immunomodulators, and adaptogens; (2) study systematically the synergism of low doses of harmful agents and review the hygienic standardization system with due regard for the risk from their combinations; (3) consider comprehensively, on the basis of the experimental and clinical experience, the problem of "hot" particles and remote consequences of their influence on the respiratory and digestive systems; (4) study independently the problem of chronic stress as a combination of radiation effects and psycho-emotional consequences of the accident and living in the exposed areas; (5) consider it inadmissible to include in the B category the population of the districts influenced by the accident and to use the concept: "35 rads during the lifetime" in standardizing the radiation load; (6) organize a comprehensive analysis of the Chernobyl accident consequences for public health within the contaminated areas as well as for animals and plants using a single approved methodology and programme, the principle of "other equal conditions" being provided. PMID:2217733

Barabo?, V A

22

Cancer Research Campaign review of radiobiology research.  

PubMed

The meeting was reviewed and summarised by Professor Herman Suit. He judged that the potential clinical gains from research in radiobiology were very great and likely to translate to improved cancer treatment in the near future. He was highly complimentary about the contribution of UK research in radiobiology and he indicated that this viewpoint was held widely in the United States, Europe and Japan. Radiobiological research was the basis for major clinical trials in radiotherapy undertaken by trial groups in all these countries. He felt that major contributions to current practice in radiotherapy had been the definition of dose response, the rationale for the use of radiotherapy against slowly responding tumours, and the understanding of repair differentials and of clonal proliferation in the design of clinical fractionation trials, leading to clear demonstration of benefit for altered fractionation in the treatment of head and neck cancer and in the treatment of bladder cancer. An important goal of research should be the development of predictive testing for radiation response employing multiple predictive tests of radiation sensitivity (survival at 2 Gy), cellular proliferation (potential doubling time) and identification of hypoxic cells, together with physiological parameters such as blood flow intratumoral pressure, thiol metabolism and activation and status of repair genes. In terms of improving differential response between tumour and normal tissues, further refinement of dose fractionation patterns would be needed, but also research should continue on the modification of response using drug/radiation protocols, targeting techniques, growth factors and other biological response modifiers to support normal tissues, and modulation of DNA repair. Professor Suit felt that the pace of research in radiobiology was most encouraging for the field of radiotherapy. There was a consensus that support for radiobiology needed to be matched by support for academic radiotherapy if potential research gains were to be translated into advances in treatment. He shared the view expressed by the Committee of Cancer Experts of the EORTC that improvements in cancer cure over the next decade were likely to derive from improvements in radiotherapy. PMID:8094004

Horwich, A

1993-01-01

23

Clinical experience with water-heated interstitial hyperthermia system  

Microsoft Academic Search

An orignal circulating hot water hyperthermia system for interstitial treatment has been constructed at the University Cliic\\u000a for Radiotherapy and Radiobiology in Vienna, Austria. At the Institute of Oncology in Ljubljana, Slovenia, animal experiments\\u000a as well as a few human treatments were done. Results obtained with 44 metal needle implants on rabbits and\\/or pigs thigh\\u000a showed that a good temperature

H. Lesnicar; M. Budihna; L. Handl-Zeller; K. Schreider

1992-01-01

24

Experience of a seating clinic.  

PubMed

Patients who cannot walk, particularly those with orthopaedic deformities, need more than a simple wheelchair; they require a special seating system. Since the early 1970's many different systems have been introduced to the field of orthotics and prescribed through "Seating Clinics" in many centres in North America and around the world. Our experience in the Seating Clinic at the University of Kansas Medical centre is presented. Most patients were children (70%) with 69% male and 31% female. Various seating systems were prescribed, including the Safety Travel Chair, the Moulded Plastic Insert, the Orthopaedic Body Support (foam on plywood), the Spinal Support System, the Moulded Seat Total Contact Shell (sitting support orthosis) and the DESEMO support system. The majority of patients had cerebral palsy (58%) and muscular dystrophy (33%). Other conditions included spinal cord injury, spina bifida and multiple orthopaedic deformities. Sixty five percent of the custom made seating systems prescribed were the Orthopaedic Body Support. Unilateral dislocation of the hip presents a major problem in seating because of pelvic obliquity. PMID:3912340

Medhat, M A; Redford, J B

1985-01-01

25

Preceptorial students' view of their clinical experience.  

PubMed

A preceptorial is a one-on-one reality-based clinical experience in which the staff nurse supervises the learning experience. Many schools of nursing use preceptor clinicals for the last clinical experience, but no studies were found that examined how students viewed that experience. This qualitative study was undertaken to ascertain how undergraduate preceptorial students view their clinical experience. In addition, since the program studied also uses preceptorials for its students' first clinical experience, the study examined differences in perception about the preceptorial between first- and second-level students. The students were asked to complete an anonymous open-ended questionnaire about their clinical experience. Content analysis was performed on the answers using the whole response to the question as the unit of analysis. Indicators of reliability and validity were established. Two themes emerged from the analysis: what students desire from their clinical experience and the factors that influence the preceptorial clinical experience. In addition, differences were found between perceptions of students in the first and last preceptorial clinical experiences. The results were discussed in terms of clinical experiences and possible differences in perception of clinical between those who have preceptorial and traditional faculty-led clinical experiences. PMID:1649273

Peirce, A G

1991-06-01

26

In vivo radiobiology of heavy ions  

SciTech Connect

The radiobiology of heavy charged particles has been investigated with various animal systems in vivo at the Lawrence Berkeley Laboratory using the helium beam from the 184'' synchrocyclotron and the carbon, neon, and argon beams from the BEVALAC. Tumor experiments were carried out using the R/sub 1/ sarcoma in rats and the EMT6 mouse mammary carcinoma, comparing X rays, carbon ions, neon ions, and argon ions. In vivo normal tissue experiments have been carried out with a wide range of tissues including testis, bone marrow, intestinal crypt cells, lens of the eye, esophagus, lung, and the spinal cord. The induction of dominant lethal mutations after irradiation of the testis was assayed by in vivo embryo culture after in vivo irradiation. Experiments were also done with the Harderian gland tumor induction system.

Phillips, T.L. (Univ. of California, San Francisco); Ross, G.Y.; Goldstein, L.S.; Ainsworth, J.; Alpen, E.

1982-12-01

27

In vivo radiobiology of heavy ions  

SciTech Connect

The radiobiology of heavy charged particles has been investigated with various animal systems in vivo at the Lawrence Berkeley Laboratory using the helium beam from the 184'' synchrocyclotron and the carbon, neon, and argon beams from the BEVALAC. Tumor experiments were carried out using the R/sub 1/ sarcoma in rats and the EMT6 mouse mammary carcinoma, comparing X rays, carbon ions, neon ions, and argon ions. In vivo normal tissue experiments have been carried out with a wide range of tissues including testis, bone marrow, intestinal crypt cells, lens of the eye, esophagus, lung, and the spinal cord. The induction of dominant lethal mutations after irradiation of the testis was assayed by in vitro embryo culture after in vivo irradiation. Experiments were also done with the Harderian gland tumor induction system.

Phillips, T.L. (Univ. of California, San Francisco); Ross, G.Y.; Goldstein, L.S.; Ainsworth, J.; Alpen, E.

1982-12-01

28

Neutron facility for radiobiological studies  

NASA Astrophysics Data System (ADS)

A neutron facility suitable for radiobiological applications is described. The small chamber can house, either, solid targets or a gas target. Using this facility, absorbed doses ranging up to 7.2 Gy were delivered to Drosophila melanogaster larvae in order to study induced somatic mutation and mitiotic recombination. Some preliminary results concerning these effects, related to a mean neutron energy of 2.15 MeV provided by a d + Be source, are presented.

Policroniades, Rafael; Varela, A.; Guzman, J.; Graaf, U.

1997-02-01

29

Radiobiological Aspects of Brachytherapy in the Era of 3Dimensional Imaging  

Microsoft Academic Search

\\u000a Radiobiological principles are increasingly well understood for external beam radiotherapy (EBRT) for a variety of tumor histologies\\u000a and the associated normal tissue effects. Application of this knowledge in the daily use of brachytherapy is much more challenging,\\u000a although equally important. Brachytherapy was initially developed empirically with dose being determined predominantly by\\u000a clinical effect. In the modern era, radiobiological modeling is

Alexandra J. Stewart; Søren M. Bentzen

30

The Hallmarks of Cancer and the Radiation Oncologist: Updating the 5Rs of Radiobiology.  

PubMed

A comprehensive, mechanistic understanding of radiobiological phenomena that can be integrated within the broader context of cancer biology offers the prospect of transforming clinical practice in radiation oncology. In this review, we revisit the six established biological hallmarks of cancer and examine how they have provided insights into novel therapeutic strategies. In addition, we discuss the potential of two emerging hallmarks to continue to expand our understanding beyond the narrow confines of the traditional 5Rs of radiobiology. PMID:23850153

Good, J S; Harrington, K J

2013-07-10

31

The radiobiology of intravascular irradiation  

Microsoft Academic Search

Purpose: There is increasing interest in the use of vascular irradation, from an internally introduced radioactive source to control restenosis after balloon angioplasty. Both animal experiments and early clinical studies appear to show promising results in this regard. We consider various mechanistic interpretations of the experimental and clinical observations that doses of 12–20 Gy appear to be efficacious in preventing

David J. Brenner; Richard C. Miller; Eric J. Hall

1996-01-01

32

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

Microsoft Academic Search

A Clinician’s discrimination between radiation therapy treatment plans is traditionally a subjective process, based on experience\\u000a and existing protocols. A more objective and quantitative approach to distinguish between treatment plans is to use radiobiological\\u000a or dosimetric objective functions, based on radiobiological or dosimetric models. The efficacy of models is not well understood,\\u000a nor is the correlation of the rank of

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

2009-01-01

33

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

34

Monte Carlo Simulations for Radiobiology  

NASA Astrophysics Data System (ADS)

The relationship between tumor response and radiation is currently modeled as dose, quantified on the mm or cm scale through measurement or simulation. This does not take into account modern knowledge of cancer, including tissue heterogeneities and repair mechanisms. We perform Monte Carlo simulations utilizing Geant4 to model radiation treatment on a cellular scale. Biological measurements are correlated to simulated results, primarily the energy deposit in nuclear volumes. One application is modeling dose enhancement through the use of high-Z materials, such gold nanoparticles. The model matches in vitro data and predicts dose enhancement ratios for a variety of in vivo scenarios. This model shows promise for both treatment design and furthering our understanding of radiobiology.

Ackerman, Nicole; Bazalova, Magdalena; Chang, Kevin; Graves, Edward

2012-02-01

35

Clinical training experience in district general hospitals  

Microsoft Academic Search

AIMSTo estimate the nature and quantity of clinical experience available for trainees in paediatrics or general practice in acute general hospitals of differing sizes in the UK. To discuss implications for training and service configuration taking account of current Royal College recommendations (a minimum of 1800 acute contacts each year and ideally covering a population of 450 000 to 500

Roderick MacFaul; Stephen Jones; Ursula Werneke

2000-01-01

36

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

37

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

NASA Astrophysics Data System (ADS)

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 Cancerología 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; Yañez, Elvia; López, Jesús

2012-10-01

38

Therapeutic Radionuclides: Biophysical and Radiobiologic Principles  

PubMed Central

Although the general radiobiologic principles underlying external beam therapy and radionuclide therapy are the same, there are significant differences in the biophysical and radiobiologic effects from the two types of radiation. In addition to the emission of particulate radiation, targeted radionuclide therapy is characterized by (i) extended exposures and, usually, declining dose rates; (ii) nonuniformities in the distribution of radioactivity and, thus, absorbed dose; and (iii) particles of varying ionization density and, hence, quality. This chapter explores the special features that distinguish the biologic effects consequent to the traversal of charged particles through mammalian cells. It also highlights what has been learned when these radionuclides and radiotargeting pharmaceuticals are used to treat cancers.

Kassis, Amin I.

2008-01-01

39

A qualitative study of nursing student experiences of clinical practice  

Microsoft Academic Search

BACKGROUND: Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice. METHODS: Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of

Farkhondeh Sharif; Sara Masoumi

2005-01-01

40

National Radiobiology Archives Distributed Access user's manual  

SciTech Connect

This User's Manual describes installation and use of the National Radiobiology Archives (NRA) Distributed Access package. The package consists of a distributed subset of information representative of the NRA databases and database access software which provide an introduction to the scope and style of the NRA Information Systems.

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

1991-11-01

41

Transhiatal Esophagectomy: Clinical Experience and Refinements  

PubMed Central

Objective To review the authors’ clinical experience with transhiatal esophagectomy (THE) and the refinements in this procedure that have evolved. Background Increased use of THE during the past two decades has generated controversy about the merits and safety of this approach compared with transthoracic esophageal resection. The authors’ large THE experience provides a valuable basis for benchmarking data regarding the procedure. Methods The results of THE were analyzed retrospectively using the authors’ prospectively established esophageal resection database and follow-up information on these patients. Results From 1976 to 1998, THE was performed in 1085 patients, 26% with benign disease and 74% with cancer. The procedure was possible in 98.6% of cases. Stomach was the esophageal substitute in 96%. The hospital mortality rate was 4%. Blood loss averaged 689 cc. Major complications were anastomotic leak (13%), atelectasis/pneumonia (2%), intrathoracic hemorrhage, recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration (<1% each). Actuarial survival of patients with carcinoma equaled or exceeded that reported after transthoracic esophagectomy. Late functional results were good or excellent in 70%. With preoperative pulmonary and physical conditioning, a side-to-side stapled cervical esophagogastric anastomosis (<3% incidence of leak), and postoperative epidural anesthesia, the need for an intensive care unit stay has been eliminated and the length of stay reduced to 7 days. Conclusion THE is possible in most patients requiring esophageal resection and can be performed with greater safety and fewer complications than the traditional transthoracic approaches.

Orringer, Mark B.; Marshall, Becky; Iannettoni, Mark D.

1999-01-01

42

[The comet assay application in radiobiological investigations].  

PubMed

The analysis of the literature data on application of the gel electrophoresis of individual cells ("comet assay") in radiobiological investigations was carried out. The descriptions of various variants of the method are presented; its alkaline version is in more detail considered. The works concerning to induction and DNA damage repair of single stranded and double stranded DNA breaks, DNA alkali labile sites, crosslinks, DNA bases damage, cellular radiosensitivity and revealing of apoptotic cells were analyzed. The application of the method at biomonitoring of DNA damage level in cells of the person and the animals exposed to genotoxic agents, including ionizing radiation is described. The analysis of the literary data testifies to perceptivity of development and further uses of this method in radiobiological researches. PMID:20734806

Sirota, N P; Kuznetsova, E A

43

[Clinical experiences with extracorporeal shockwave lithotripsy].  

PubMed

Clinical experience with 2738 patients treated by extracorporeal shock wave lithotripsy between March 1985 and December 1988 is reported. All treatments were performed with the Dornier HM-3 lithotriptor. 34% of the patients needed auxiliary measures, consisting primarily of urological manipulation to improve urinary drainage or for better localization and/or focussing of the stones. Severe complications were rare; urosepticemia occurred in 0.3%, 2 patients had to undergo nephrectomy because of abscessing pyelonephritis, and there was one death due to recurrent pulmonary embolism in a patient with polycythemia vera. ESWL was used for stones in the entire upper urinary tract. The stone free rate for pelvic calculi smaller than 2 cm was 79% three months after treatment; a further 16% showed desintegrated material smaller than 5 mm, augmenting the success rate to 95%. The success rate dropped to 74% for very large renal stones of more than 4 cm. A stone free rate of 84-96% was ascertained for ureteral calculi 3 months after ESWL. Absolute contraindications for ESWL are acute pyelonephritis, coagulation disorders and pregnancy. The patients must tolerate anesthesia, as most treatments with this lithotriptor must be carried out under peridural or general anesthesia and only in a few exceptional cases is treatment in sedoanalgesia possible. ESWL is now generally accepted in view of its negligible invasiveness, low morbidity and the high success rate. Modern treatment of urinary calculi is inconceivable without considering ESWL. PMID:2799324

Ackermann, D; Merz, V; Marth, D; Zehntner, C

1989-07-01

44

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

45

Overview of Cancer Molecular Radiobiology  

Microsoft Academic Search

The first recorded use of X-rays for the treatment of cancer occurred within about 1 year of their discovery in the late 1800s\\u000a by Roentgen. The study of X-rays and other ionizing radiations, and their clinical application to cancer treatment, has become\\u000a increasingly sophisticated. This chapter will provide an overview of the molecular responses induced in cells by ionizing\\u000a radiation

Jann N. Sarkaria; Robert G. Bristow

46

Introductory Laboratory Exercises in Radiobiology  

ERIC Educational Resources Information Center

Describes experiments suitable for introducing use of radioisotopes in biology. Includes demonstrations of tracing food chains, uptake of ions by plants, concentration of elements by insects, tracing photosynthetic reactions, activation analysis of copper, and somatic and genetic effects. Uses autoradiographic and counting techniques. (AL)

Williams, J. R. Parry; Servant, D. M.

1970-01-01

47

Providing early clinical experience in primary care  

Microsoft Academic Search

SUMMARY Undergraduate courses in British medical schools are changing following recommendations from the General Medical Council. Increasing emphasis has been placed on teaching in the community. Nottingham Medical School has pioneered the teaching of basic clinical skills in primary care during the pre-clinical course to help produce an integrated curriculum. This qualitative study evaluated the first two years of the

A J Hampshire

1998-01-01

48

Compensation of Missed Fractions Without Knowledge of Radiobiological Parameters  

SciTech Connect

The purpose of this work was to develop simple formulas that can be used to estimate the biologic effect of missed radiotherapy fractions independently of radiobiological parameters. This is achieved by expressing the limits in biologically effective dose for very low or very high radiobiological parameter ratios. Worked examples are given.

Carlone, Marco, E-mail: marco.carlone@rmp.uhn.on.ca

2011-01-01

49

Operation and Maintenance of the National Radiobiology Archives  

SciTech Connect

The National Radiobiology Archives (NRA) are an archival program, started in 1989, to collect, organize and maintain data, laboratory notebooks, and animal tissue specimens from government (Department of Energy and its predecessor agencies) sponsored radiobiology life-span animal studies. These unique records, histopathology slides and paraffin embedded tissue blocks are maintained in a central facility and are available for further research study. The materials include electronic and paper records for each of more than 6,000 life-span-observations on dogs as well as details of major studies involving nearly 30,000 mice. Although these studies were performed over many years and at different laboratories with differing data management systems, the NRA has translated them into a standardized set of relational database tables. These can be distributed to interested individuals on written request. Specific Aims are: (1) To Maintain the Archive of Written Records from the Animal Experiments - The USTUR continued to maintain the NRA archives which consist of approximately 175 storage boxes containing laboratory notebooks, animal exposure records, animal pathologic records, and radiographs. These were stored in a 6,000 square foot leased facility in Richland, WA. Additionally, through a collaboration with Pacific Northwest National Laboratory's (PNNL) Low Dose Program, many of these records were scanned into digital files. These totaled 34 GB of data, which are saved in 2,407 separate PDF files that are organized by box number and animal identification number. (2) To Maintain the Archive of Animal Tissues at Washington State University - The USTUR continued to house the NRA dog tissue collection in the leased facility. The NRA tissue collection consisted of pathology slides and tissue blocks. Approximately 25% of the laboratory facility was dedicated to the storage of the NRA materials. (3) To Organize the Datasets of These Animals in the Context of Other Datasets so That They Can be Used by the Scientific Community at Large - As was reported in the FY2009 NRA progress report, Dr. Chuck Watson (NRA Database Consultant) completed his service as the US representative on the European Radiobiological Archives (ERA) Advisory Board during FY2009. Unfortunately, due to the lack of financial support during FY2010, the NRA was not able to make further contributions to the ERA's efforts.

Dr. Anthony C. James; Stacey L. McCord

2012-03-07

50

New challenges in radiobiology research with microbeams.  

PubMed

There is a continuing interest in the use of microbeam systems designed to deliver ionizing radiation (both photons and particles) with a resolution of a few micrometers or less in biological targets. With more than 30 facilities currently in operation, several new research topics can be explored. In the 9th International Microbeam Workshop held in Darmstadt, Germany, in July 2010, several new ideas and results have been presented, indicating that microbeams will be increasingly important in radiobiology. Subnuclear targeting of single cells for DNA repair studies and microirradiation of 3D or small animal models are among the most promising new research perspectives. PMID:21667289

Durante, Marco; Friedl, Anna A

2011-06-12

51

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

52

Eosinophilic gastroenteritis: Clinical experience with 15 patients  

Microsoft Academic Search

AIM: To evaluate the clinic features of eosinophilic gastroenteritis and examine the diagnosis, treatment, long- term outcome of this disease. METHODS: Charts with a diagnosis of eosinophilic gastroenteritis from 1984 to 2002 at Mackay Memorial Hospital were reviewed retrospectively. There were 15 patients diagnosed with eosinophilic gastroenteritis. The diagnosis was established in 13 by histologic evaluation of endoscopic biopsy or

Ming-Jen Chen; Cheng-Hsin Chu; Shee-Chan Lin; Shou-Chuan Shih; Tsang-En Wang

53

Clinical experience with an elemental diet1  

Microsoft Academic Search

An elemental diet of defined composition and simple chemical form was nutritionally tested in a variety of surgical patients. Complete absorption in the upper gastrointestinal tract and minimal fecal residue proved especially advantageous in patients undergoing abdominal surgery, and the diet also showed usefulness in patients with feeding problems. The patients responded well clinically, although some of them showed taste

Joseph M Miller; Juanito C Taboada

54

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

55

Impact of the comet assay in radiobiology.  

PubMed

Until the development of single cell gel electrophoresis methods in the 1980s, measurement of radiation-induced DNA strand breaks in individual cells was limited to detection of micronuclei or chromosome breaks that measured the combined effects of exposure and repair. Development of methods to measure the extent of migration of DNA from single cells permitted detection of initial radiation-induced DNA breaks present in each cell. As cells need not be radiolabeled, there were new opportunities for analysis of radiation effects on cells from virtually any tissue, provided a single cell suspension could be prepared. The comet assay (as this method was subsequently named) was able to measure, for the first time, the fraction of radiobiologically hypoxic cells in mouse and human tumors. It was used to determine that the rate of rejoining of DNA breaks was relatively homogenous within an irradiated population of cells. Because individual cells were analyzed, heavily damaged or apoptotic cells could be identified and eliminated from analysis to determine "true" DNA strand break rejoining rates. Other examples of applications of the comet assay in radiobiology research include analysis of the inter-individual differences in response to radiation, effect of hypoxia modifying agents on tumor hypoxic fraction, the role of cell cycle position during DNA break induction and rejoining, non-targeted effects on bystander cells, and effects of charged particles on DNA fragmentation patterns. PMID:18083062

Olive, Peggy L

2007-11-12

56

Citrullinemia. Clinical experience with 23 cases.  

PubMed

A retrospective study was performed on the clinical outcome of 23 patients with citrullinemia diagnosed during the last 20 years in our clinic. The study group consisted of 13 patients with the neonatal form of the disease, four patients with the subacute form, five patients with the late-onset form and one with the asymptomatic form. All patients were treated with natural protein restriction, sodium benzoate and arginine administration. Almost all of the neonatal-onset patients were treated with exchange transfusions and/or peritoneal dialysis. Fourteen patients died: 11 with the neonatal form, one with the subacute form, and two with the late-onset form. The general neurological outcome of the patients who were alive was not satisfactory. Despite these results, it was concluded that the prognosis and quality of life of patients with citrullinemia might be improved with early diagnosis and appropriate therapy. PMID:9677723

Tokatli, A; Co?kun, T; Ozalp, I

57

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

58

Experience with an obstetric perineal clinic  

Microsoft Academic Search

Objective: To review the characteristics of patients attending a dedicated perineal clinic in a maternity hospital. Methods: Case-note review of all new referrals over 2 years 1998 and 1999. Results: A total of 399 women were referred with mean age of 34 years (range 18–77), parity of 1.7 (range 1–13) and duration of symptoms of 14 (range 1–156) months. A

Myra Fitzpatrick; Mary Cassidy; P. Ronan O’Connell; Colm O’Herlihy

2002-01-01

59

Mesenchymal stem cells: from experiment to clinic  

PubMed Central

There is currently much interest in adult mesenchymal stem cells (MSCs) and their ability to differentiate into other cell types, and to partake in the anatomy and physiology of remote organs. It is now clear these cells may be purified from several organs in the body besides bone marrow. MSCs take part in wound healing by contributing to myofibroblast and possibly fibroblast populations, and may be involved in epithelial tissue regeneration in certain organs, although this remains more controversial. In this review, we examine the ability of MSCs to modulate liver, kidney, heart and intestinal repair, and we update their opposing qualities of being less immunogenic and therefore tolerated in a transplant situation, yet being able to contribute to xenograft models of human tumour formation in other contexts. However, such observations have not been replicated in the clinic. Recent studies showing the clinical safety of MSC in several pathologies are discussed. The possible opposing powers of MSC need careful understanding and control if their clinical potential is to be realised with long-term safety for patients.

2011-01-01

60

Clinical experience with antiangiogenic therapy in leukemia.  

PubMed

The pathological role of bone marrow angiogenesis in human leukemias has been clearly established. Bone marrow neoangiogenesis is mediated by several growth factors, such as VEGF-A, VEGF-C, angiopoietin-1 and -2, FGF, HGF, TGF-? and others secreted by leukemic cells. The prognostic relevance of microvessel density, and expression of VEGF-A and -C has been demonstrated especially in acute myeloid leukemia. In the last years, several classes of angiogenesis inhibitors have been developed blocking several angiogenic pathways. These include drugs that inhibit the VEGF (with or without blockade of FLT3) and the mTor signalling cascade. Besides, thalidomide and lenalidomide although possessing a pleiotrophic mode of action including antiangiogenic properities have been evaluated in the treatment of human leukemias. In the current review we analyze the results of clinical trials employing these antiangiogenic drugs. Since the clinical efficacy of these compounds used as monotherapy is often limited, confined to certain subgroups of patients and frequently short lived, several trials combining standard chemotherapy with these agents have been initiated in order to demonstrate an additional benefit to standard therapy. Furthermore the introduction of new antiangiogenic drugs such as inhibitors of the angiopoietin and HGF/cMET pathway is on the horizon. Utilizing cocktails of inhibitors of several angiogenic pathways may represent a new possibility to augment the efficacy of antiangiogenic therapy in the future. PMID:21999626

Wellbrock, J; Fiedler, W

2011-11-01

61

Clinical experience in invasive fungal infections.  

PubMed

Lung infections caused by invasive filamentous fungi are very rare conditions in AIDS, but must be considered in patients with profound immune suppression especially in the presence of additional risk factors, such as hematologic malignancies, corticosteroid therapy, neutropenia, and chemotherapy. The authors report a case of dual lung infection caused by Aspergillus and Mucor, which occurred in a 34-year-old AIDS patient who was treated with chemotherapy for oral plasmablastic lymphoma. The case presented clinically with low grade fever and pulmonary cavitation, which suggested tuberculosis. After extensive investigation the diagnosis of mucormycosis was established and the patient was treated sequentially with liposomal amphotericin B and posaconazole. Despite a reduction in the size of the pulmonary cavitation, improvement of the lung interstitial infiltrates and clinical recovery, the patient was submitted to cardiothoracic surgery given the aggressive behavior of this invasive fungus. Histology of the surgical specimen showed numerous hyphae with a morphologic pattern compatible with Aspergillus as well as hyphae that were suggestive of Mucor. PMID:23381980

Pacheco, Patrícia; Ventura, Ana Sofia; Branco, Teresa; Gonçalves, Lucília; Carvalho, Célia

2013-02-01

62

Aripiprazole in children and adolescents: clinical experience.  

PubMed

Despite few supportive data, aripiprazole was being administered to children and adolescents for management of mood instability, aggression, and psychosis. Using a retrospective review (n = 11) and prospective recruitment (n = 6), 17 children and adolescents received aripiprazole 5 to 20 mg/day. Only 4 of 16 bipolar and autistic subjects (25%) demonstrated reduced aggression without adverse events, and the symptoms of 2 of 4 psychotic subjects improved. Coadministration of sedative medications (particularly guanfacine or clonidine) and weight < 58 kg increased the risk of adverse events, such as increased lability and aggression. All three children < 8.6 years old, all four children < 34 kg, and all five children receiving alpha2-agonists developed adverse events prior to clinical efficacy. Age > 11 years, weight > 58 kg, and absence of sedative medications were associated with a 56% (five of nine) success rate. Until larger, prospective studies are completed, caution is advised when considering aripiprazole for smaller children and children receiving sedative medications. PMID:16159529

Rugino, Thomas A; Janvier, Yvette M

2005-07-01

63

Clinical experience with inactivated, virosomal influenza vaccine.  

PubMed

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 younger subjects. Several approaches are currently being pursued in order to improve the efficacy of influenza vaccines in elderly individuals and others who have impaired immune responses to conventional influenza vaccines. A novel antigen-presenting strategy to overcome impaired immune responses is the use of virosomes. Previously, data on safety and reactogenicity have been published regarding the use of virosomal influenza vaccines. Data from three recent clinical trials are presented here. The first of these was a comparative study of a virosomal vaccine and a conventional subunit vaccine in "at-risk" adults with underlying chronic illness. The virosomal vaccine demonstrated comparable tolerability to the subunit vaccine, with about 98% of patients reporting tolerability to be good or very good. The vast majority of adverse events reported were mild to moderate in severity. With both vaccine types, mean HI titres decreased with age for both the A-H1N1 and B influenza virus strains, but for the A-H3N2 strain (the most virulent of the three strains), mean HI titres did not decrease with age, suggesting a better response with the virosomal vaccine when compared to the subunit vaccine. All three studies explored the long-term persistence of antibodies after vaccination with virosomal influenza vaccines. Immunogenicity declined over time but remained high at 4, 6 and 12 months post-vaccination compared to baseline, indicating that adequate seroprotection is achievable for the duration of the influenza season. Virosomal vaccines may induce better immunity in elderly subjects and may be more effective in reducing morbidity and mortality in this age group. PMID:16005120

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

2005-07-01

64

The good clinical nursing educator and the baccalaureate nursing clinical experience: attributes and praxis.  

PubMed

Clinical education accounts for a significant portion of baccalaureate nursing (BSN) education. This study examined recent BSN program graduates' views about clinical nursing educator attributes that enhance the ability of the graduates to provide safe, effective patient care. In this descriptive study, 6 participants were interviewed using grounded theory techniques. The study framework blended the elements of cognitive field theory, the humanistic philosophy of teaching and learning, the gestalt theory of learning, and Hergenhahn's behavioral change model. Participants identified three attributes of a good clinical nursing educator: knowledge, interpersonal presentation, and teaching strategies. Analysis revealed that educator attributes and phases of the clinical experience process together form the foundation for clinical experience praxis. Educators can improve the clinical education experience by developing teaching strategies and evaluation tools that build on the positive attributes and phases of the clinical experience identified in this study. PMID:18232614

Hanson, Karla J; Stenvig, Thomas E

2008-01-01

65

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

66

Clinical experience in T cell deficient patients  

PubMed Central

T cell disorders have been poorly understood until recently. Lack of knowledge of underlying molecular mechanisms together with incomplete data on long term outcome have made it difficult to assess prognosis and give the most effective treatment. Rapid progress in defining molecular defects, improved supportive care and much improved results from hematopoietic stem cell transplantation (HSCT) now mean that curative treatment is possible for many patients. However, this depends on prompt recognition, accurate diagnosis and careful treatment planning. This review will discuss recent progress in our clinical and molecular understanding of a variety of disorders including: severe combined immunodeficiency, specific T cell immunodeficiencies, signaling defects, DNA repair defects, immune-osseous dysplasias, thymic disorders and abnormalities of apoptosis. There is still much to discover in this area and some conditions which are as yet very poorly understood. However, with increased knowledge about how these disorders can present and the particular problems each group may face it is hoped that these patients can be recognized early and managed appropriately, so providing them with the best possible outcome.

2010-01-01

67

BNL accelerator-based radiobiology facilities.  

PubMed

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 40-3000 MeV/nucleon with maximum beam intensities of 10(10) to 10(11) ions per pulse. The BAF Project will be described and the future AGS and BAF operation plans will be presented. PMID:11770532

Lowenstein, D I

2001-01-01

68

Effect of Malpractice Experience on Physicians' Clinical Decision-Making.  

National Technical Information Service (NTIS)

In a cross sectional study of internists, cardiologists, general surgeons and obstetricians, the authors tested by using clinical scenarios, whether personal malpractice experience was associated with resource use, defined by management and test ordering ...

P. A. Glassman L. P. Petersen M. A. Bradley J. E. Rolph

1994-01-01

69

Enhancing nursing students' clinical experiences using aesthetics.  

PubMed

Traditional nursing education is based strongly in empiric knowledge. However, just as important as empiric knowledge is aesthetic knowledge. Nursing involves multiple ways of knowing, and as such, educational institutions have a responsibility to assist students in gaining knowledge in nontraditonal ways. This article describes an assignment implemented in a pediatric course in a baccalaureate nursing program. Books and movies were used in a an undergraduate nursing course to help students gain insight into illness and disability from the client and family perspective. The students in the course were required to reflect on the meaning of the movie/book and the influence the book/movie had on the student. Based on student responses, this assignment was successful in meeting the objectives originally proposed. The books and movies provided a beginning introduction to, and an appreciation for, client and family experiences. Students were helped to understand illness, abuse, disability, and/or death from the client and/or family perspective. PMID:15682163

Northington, Ladonna; Wilkerson, Robin; Fisher, Wanda; Schenk, Laura

70

Amchitka Radiobiological Program Progress Report, January 1976--December 1976.  

National Technical Information Service (NTIS)

The Amchitka Radiobiological Program is a continuing program to collect biological and environmental samples for radiometric analyses. Results of analyses for samples collected during 1976 include gamma-emitting radionuclides in air filters, freshwater, b...

V. A. Nelson A. H. Seymour

1977-01-01

71

Amchitka Radiobiological Program Progress Report, January 1975--December 1975.  

National Technical Information Service (NTIS)

Begun in 1970, the Amchitka Radiobiological Program is a continuing program to collect biological and environmental samples for radiometric analyses. This report is an account of the program for Calendar Year 1975. Results of analyses for samples collecte...

V. A. Nelson A. H. Seymour

1976-01-01

72

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

73

The European Radiobiology Archives (ERA)--content, structure and use illustrated by an example.  

PubMed

The European Radiobiology Archives (ERA), supported by the European Commission and the European Late Effect Project Group (EULEP), together with the US National Radiobiology Archives (NRA) and the Japanese Radiobiology Archives (JRA) have collected all information still available on long-term animal experiments, including some selected human studies. The archives consist of a database in Microsoft Access, a website, databases of references and information on the use of the database. At present, the archives contain a description of the exposure conditions, animal strains, etc. from approximately 350,000 individuals; data on survival and pathology are available from approximately 200,000 individuals. Care has been taken to render pathological diagnoses compatible among different studies and to allow the lumping of pathological diagnoses into more general classes. 'Forms' in Access with an underlying computer code facilitate the use of the database. This paper describes the structure and content of the archives and illustrates an example for a possible analysis of such data. PMID:16244098

Gerber, G B; Wick, R R; Kellerer, A M; Hopewell, J W; Di Majo, V; Dudoignon, N; Gössner, W; Stather, J

2005-10-21

74

The Microcomputer in Clinical Psychiatric Research, a Personal Experience  

PubMed Central

This paper will describe a personal experience with the microcomputer in clinical psychiatric research, and the creation of MITISTAT, a data analytic software system that was developed on a TRS-80 microcomputer. The value of the microcomputer in clinical research is found primarily in its ability to handle, organize and analyse clinical data. In essence, the microcomputer is an affordable “tool” that allows clinicians to participate in clinical research and to undertake projects that in the past would have required large computing facilities necessitating extensive financial or institutional support.

Rosen, Arnold

1982-01-01

75

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

76

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

2007-08-24

77

Osteoradionecrosis: clinical experience and a proposal for classification  

SciTech Connect

Osteoradionecrosis is a severe complication of radiation therapy for cancer. Prevention of osteoradionecrosis is most important as the condition may be chronic, progressive and lead to pathologic fracture. The clinical experience at the Cancer Control Agency of British Columbia with 26 cases in approximately 1000 patients treated with radical radiation therapy to the head and neck region is presented and discussed. A clinical classification system is proposed to provide a guide for treatment selection, and to allow classification for research purposes.

Epstein, J.B.; Wong, F.L.; Stevenson-Moore, P.

1987-02-01

78

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

79

Biophysical and biomathematical adventures in radiobiology  

SciTech Connect

Highlights of my biophysical and biomathematical adventures in radiobiology is presented. Early adventures involved developing state-vector models'' for specific harmful effects (cell killing, life shortening) of exposure to radiation. More recent adventures led to developing hazard-function models'' for predicting biological effects (e.g., cell killing, mutations, tumor induction) of combined exposure to different toxicants. Hazard-function models were also developed for predicting harm to man from exposure to large radiation doses. Major conclusions derived from the modeling adventures are as follows: (1) synergistic effects of different genotoxic agents should not occur at low doses; (2) for exposure of the lung or bone marrow to large doses of photon radiation, low rates of exposure should be better tolerated than high rates; and (3) for some types of radiation (e.g., alpha particles and fission neutrons), moderate doses delivered at a low rate may be more harmful than the same dose given at a high rate. 53 refs., 7 figs.

Scott, B.R.

1991-01-01

80

Heavy-ion tumor therapy: Physical and radiobiological benefits  

NASA Astrophysics Data System (ADS)

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; Elsässer, Thilo; Schulz-Ertner, Daniela

2010-01-01

81

Radiobiological model-based bio-anatomical quality assurance in intensity-modulated radiation therapy for prostate cancer.  

PubMed

A bio-anatomical quality assurance (QA) method employing tumor control probability (TCP) and normal tissue complication probability (NTCP) is described that can integrate radiobiological effects into intensity-modulated radiation therapy (IMRT). We evaluated the variations in the radiobiological effects caused by random errors (r-errors) and systematic errors (s-errors) by evaluating TCP and NTCP in two groups: patients with an intact prostate (G(intact)) and those who have undergone prostatectomy (G(tectomy)). The r-errors were generated using an isocenter shift of ±1 mm to simulate a misaligned patient set-up. The s-errors were generated using individual leaves that were displaced inwardly and outwardly by 1 mm on multileaf collimator field files. Subvolume-based TCP and NTCP were visualized on computed tomography (CT) images to determine the radiobiological effects on the principal structures. The bio-anatomical QA using the TCP and NTCP maps differentiated the critical radiobiological effects on specific volumes, particularly at the anterior rectal walls and planning target volumes. The s-errors showed a TCP variation of -40-25% in G(tectomy) and -30-10% in G(intact), while the r-errors were less than 1.5% in both groups. The r-errors for the rectum and bladder showed higher NTCP variations at ±20% and ±10%, respectively, and the s-errors were greater than ±65% for both. This bio-anatomical method, as a patient-specific IMRT QA, can provide distinct indications of clinically significant radiobiological effects beyond the minimization of probable physical dose errors in phantoms. PMID:22915778

Park, Ji-Yeon; Lee, Jeong-Woo; Chung, Jin-Beom; Choi, Kyoung-Sik; Kim, Yon-Lae; Park, Byung-Moon; Kim, Youhyun; Kim, Jungmin; Choi, Jonghak; Kim, Jae-Sung; Hong, Semie; Suh, Tae-Suk

2012-08-21

82

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

PubMed

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 up these clinical learning experiences: the appreciation and support the students received, the quality of mentoring and patient care, and students' self-directedness. Student nurses valued clinical practice and the possibilities it offered in the process of growing to become a nurse and a professional. A good clinical learning environment was established through good co-operation between the school and the clinical staff. It was concluded that the school should be able to provide a suitable clinical learning environment at the right time, so that theory and practice would complement each other. The teacher was the expert on nursing education, the aims set for each practice, as well as student nurses and their skills, but then again the nurse mentor knew the ward on which students were practicing. This was why collaboration between nurse mentors and nurse teachers was considered very necessary. PMID:12727093

Papp, Inkeri; Markkanen, Marjatta; von Bonsdorff, Mikaela

2003-05-01

83

Radiation resistance of cancer stem cells: the 4 R's of radiobiology revisited.  

PubMed

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. PMID:20135685

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

2010-04-01

84

Osteoradionecrosis: clinical experience and a proposal for classification  

Microsoft Academic Search

Osteoradionecrosis is a severe complication of radiation therapy for cancer. Prevention of osteoradionecrosis is most important as the condition may be chronic, progressive and lead to pathologic fracture. The clinical experience at the Cancer Control Agency of British Columbia with 26 cases in approximately 1000 patients treated with radical radiation therapy to the head and neck region is presented and

J. B. Epstein; F. L. Wong; P. Stevenson-Moore

1987-01-01

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

Preservice Clinical Experiences: A Bridge for Teachers and Students.  

ERIC Educational Resources Information Center

This article describes a university teacher training program for preservice teachers of students with mental retardation that emphasizes adult learning theory, case method teaching, communication, and clinical experiences to bridge research and practice. A review of the literature examines adult learning theory, Bloom's Taxonomy of Educational…

Ruediger, Greg; Lorance, Anne

87

Improving Associate Degree Nursing Students' Perioperative Clinical Observation Experiences  

Microsoft Academic Search

For associate degree nursing students at Eastern Kentucky University, Richmond, the perioperative nursing clinical experience typically included a one-day observation of a surgical procedure, with students entering the OR suite after the surgery started and having to leave before the surgery was completed. An associate professor of nursing and a perioperative staff education coordinator partnered to address this lack of

Donna L. Ricketts; Susan E. Gray

2010-01-01

88

Clinical Application of Fast Neutrons. The Amsterdam Experience.  

National Technical Information Service (NTIS)

The results of treatments and clinical experiments with neutrons (from a medical d+T neutron generator with an output of 10 exp 12 neutrons per second) are reported and discussed. Data on RBE values are presented after single doses and multiple fractions ...

J. J. Battermann

1981-01-01

89

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

90

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

91

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

92

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

93

Radiobiological restrictions and tolerance doses of repeated single-fraction hdr-irradiation of intersecting small liver volumes for recurrent hepatic metastases  

Microsoft Academic Search

BACKGROUND: To assess radiobiological restrictions and tolerance doses as well as other toxic effects derived from repeated applications of single-fraction high dose rate irradiation of small liver volumes in clinical practice. METHODS: Twenty patients with liver metastases were treated repeatedly (2 - 4 times) at identical or intersecting locations by CT-guided interstitial brachytherapy with varying time intervals. Magnetic resonance imaging

Ricarda Rühl; Lutz Lüdemann; Anna Czarnecka; Florian Streitparth; Max Seidensticker; Konrad Mohnike; Maciej Pech; Peter Wust; Jens Ricke

2010-01-01

94

A review of clinical experience with newer antifungals in children.  

PubMed

Fungal infections are a significant cause of morbidity and mortality in immunocompromised children. Since the beginning of the 21st century, many new antifungals including the echinocandins (i.e., caspofungin, micafungin, anidulafungin) and the newer generation triazoles (i.e., voriconazole and posaconazole) have received Food and Drug Administration approval. Unfortunately, despite making great strides in the adult arena, these agents are not currently approved in the pediatric population. However, pharmacokinetic data and clinical experiences with these agents in infants, children, and adolescents are mounting. As such, this review will discuss key concepts in pediatric pharmacology and clinical use of these newer antifungal agents. PMID:23055874

Fallon, Renee M; Girotto, Jennifer E

2008-07-01

95

A Review of Clinical Experience with Newer Antifungals in Children  

PubMed Central

Fungal infections are a significant cause of morbidity and mortality in immunocompromised children. Since the beginning of the 21st century, many new antifungals including the echinocandins (i.e., caspofungin, micafungin, anidulafungin) and the newer generation triazoles (i.e., voriconazole and posaconazole) have received Food and Drug Administration approval. Unfortunately, despite making great strides in the adult arena, these agents are not currently approved in the pediatric population. However, pharmacokinetic data and clinical experiences with these agents in infants, children, and adolescents are mounting. As such, this review will discuss key concepts in pediatric pharmacology and clinical use of these newer antifungal agents.

Fallon, Renee M.; Girotto, Jennifer E.

2008-01-01

96

Experience of 2 dental clinics registered to ISO 9002.  

PubMed

This paper describes the 3-year experience of managing 2 hospital-based dental clinics registered to ISO 9002:1994; it also examines the revision of previous quality management standards in 2 separate institutions to prepare for registration under the new ISO 9001:2000 standard. Daily equipment and process checks, combined with internal audits, were the backbone of the quality system at both locations. Corrective and protective actions had been underused, because of the partial duplication produced by 2 different institutionally mandated risk management and incident reporting systems. ISO 9002 registration provided both dental clinics with responsive quality systems, emphasizing patient satisfaction and providing measurable continuous quality improvement. PMID:12662459

Casas, Michael J; Kenny, David J; Johnston, Douglas H

2003-04-01

97

Quality of hallucinatory experiences: differences between a clinical and a non-clinical sample  

PubMed Central

In this study, we asked people from two samples (a clinical one, consisting of patients with schizophrenia, and a non-clinical one, including university students) to complete the Revised Hallucination Scale (RHS) as a self-questionnaire. When the participants responded positively to an item, they were encouraged to provide further detailed descriptions (i.e., examples of their own experiences) concerning that item. We found that the kinds of descriptions provided by the two groups were very different. We suggest that it is not advisable to explore the presence of hallucinations in non-clinical samples using research protocols based exclusively on yes-or-no answers to questionnaires like the RHS. Hallucinatory or hallucinatory-like experiences cannot be reliably and validly assessed without a precise characterization of the phenomenal quality of the experience.

STANGHELLINI, GIOVANNI; LANGER, ALVARO I.; AMBROSINI, ALESSANDRA; CANGAS, ADOLFO J.

2012-01-01

98

Management of oral anticoagulant therapy. Experience with an anticoagulation clinic.  

PubMed

The experience acquired in an anticoagulation clinic during 4 1/2 years is reviewed to demonstrate the effectiveness of such a clinic and to provide the practicing physician with guidelines for managing outpatient oral anticoagulation therapy. The experience is based on anticoagulant therapy in 141 patients during 1,264 patient-months. The patient population is characterized and aspects of management are explored, such as the incidence of major and minor complications (5% and 18% per treatment course, respectively), failure rate, and adequacy of therapy control. Guidelines concerning patient education, prothrombin time control, and other management suggestions are also given. This study, which compares favorably with others, is intended to aid the practicing physician and improve management of outpatient anticoagulation therapy. PMID:6435556

Errichetti, A M; Holden, A; Ansell, J

1984-10-01

99

Clinical experience with a fiberoptic intracranial pressure monitor  

Microsoft Academic Search

Retrospective clinical experience with our first 46 patients monitored with a fiberoptic intracranial pressure device is described.\\u000a In 43 of 46 patients, the transducer was introduced into brain parenchyma. A ventriculostomy system was used in 3 of 46 patients.\\u000a The monitoring system was generally characterized by ease of placement and system maintenance and by technical simplicity.\\u000a Several problems were encountered,

Jeffrey S. Yablon; Howard J. Lantner; Thomas M. McCormack; Somnath Nair; Ellen Barker; Perry Black

1993-01-01

100

Understanding clinical expertise: nurse education, experience, and the hospital context.  

PubMed

Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise. PMID:20645420

McHugh, Matthew D; Lake, Eileen T

2010-08-01

101

Low LET protons focused to submicrometer shows enhanced radiobiological effectiveness  

NASA Astrophysics Data System (ADS)

This study shows that enhanced radiobiological effectiveness (RBE) values can be generated focusing low linear energy transfer (LET) radiation and thus changing the microdose distribution. 20 MeV protons (LET = 2.65 keV µm-1) are focused to submicrometer diameter at the ion microprobe superconducting nanoprobe for applied nuclear (Kern) physics experiments of the Munich tandem accelerator. The RBE values, as determined by measuring micronuclei (RBEMN = 1.48 ± 0.07) and dicentrics (RBED = 1.92 ± 0.15), in human-hamster hybrid (AL) cells are significantly higher when 117 protons were focused to a submicrometer irradiation field within a 5.4 × 5.4 µm2 matrix compared to quasi homogeneous in a 1 × 1 µm2 matrix applied protons (RBEMN = 1.28 ± 0.07; RBED = 1.41 ± 0.14) at the same average dose of 1.7 Gy. The RBE values are normalized to standard 70 kV (dicentrics) or 200 kV (micronuclei) x-ray irradiation. The 117 protons applied per point deposit the same amount of energy like a 12C ion with 55 MeV total energy (4.48 MeV u-1). The enhancements are about half of that obtained for 12C ions (RBEMN = 2.20 ± 0.06 and RBED = 3.21 ± 0.10) and they are attributed to intertrack interactions of the induced damages. The measured RBE values show differences from predictions of the local effect model (LEM III) that is used to calculate RBE values for irradiation plans to treat tumors with high LET particles.

Schmid, T. E.; Greubel, C.; Hable, V.; Zlobinskaya, O.; Michalski, D.; Girst, S.; Siebenwirth, C.; Schmid, E.; Molls, M.; Multhoff, G.; Dollinger, G.

2012-10-01

102

Low LET protons focused to submicrometer shows enhanced radiobiological effectiveness.  

PubMed

This study shows that enhanced radiobiological effectiveness (RBE) values can be generated focusing low linear energy transfer (LET) radiation and thus changing the microdose distribution. 20 MeV protons (LET = 2.65 keV µm(-1)) are focused to submicrometer diameter at the ion microprobe superconducting nanoprobe for applied nuclear (Kern) physics experiments of the Munich tandem accelerator. The RBE values, as determined by measuring micronuclei (RBE(MN) = 1.48 ± 0.07) and dicentrics (RBE(D) = 1.92 ± 0.15), in human-hamster hybrid (A(L)) cells are significantly higher when 117 protons were focused to a submicrometer irradiation field within a 5.4 × 5.4 µm(2) matrix compared to quasi homogeneous in a 1 × 1 µm(2) matrix applied protons (RBE(MN) = 1.28 ± 0.07; RBE(D) = 1.41 ± 0.14) at the same average dose of 1.7 Gy. The RBE values are normalized to standard 70 kV (dicentrics) or 200 kV (micronuclei) x-ray irradiation. The 117 protons applied per point deposit the same amount of energy like a (12)C ion with 55 MeV total energy (4.48 MeV u(-1)). The enhancements are about half of that obtained for (12)C ions (RBE(MN) = 2.20 ± 0.06 and RBE(D) = 3.21 ± 0.10) and they are attributed to intertrack interactions of the induced damages. The measured RBE values show differences from predictions of the local effect model (LEM III) that is used to calculate RBE values for irradiation plans to treat tumors with high LET particles. PMID:22955045

Schmid, T E; Greubel, C; Hable, V; Zlobinskaya, O; Michalski, D; Girst, S; Siebenwirth, C; Schmid, E; Molls, M; Multhoff, G; Dollinger, G

2012-09-07

103

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

104

Radiobiological compensation for unintended treatment interruptions during palliative radiotherapy  

Microsoft Academic Search

Unlike radical treatment protocols, in which radiobiological methods have been used in an attempt to overcome the risk of reduced tumour control, the problem of compensation for unintended treatment interruptions during palliative radiotherapy has received little attention. For palliative radiotherapy, unnecessarily extended treatment times could theoretically reduce the duration of tumour regression and symptomatic relief. It can be shown, using

B Jones; J W Hopewell; R G Dale

2007-01-01

105

Research in radiobiology. Annual report, Internal Irradiation Program  

SciTech Connect

The annual progress report for the Radiobiology Division of the University of Utah College of Medicine is presented. Summaries of twenty-four projects concerning the metabolism, dosimetry and toxicity of a variety of actinide elements in beagles or rats are given. Individual papers within this report have been separately indexed and abstracted for the data base.

Miller, S.C.; Buster, D.S. (eds.)

1985-12-31

106

Clinical education experiences: perceptions of student registered nurse anesthetists.  

PubMed

The purpose of this study was to describe the experiences and attitudes of student registered nurse anesthetists (SRNAs) related to clinical instruction. This descriptive study used a cross-sectional survey method with a regionally stratified randomly selected sample of SRNA members from the American Association of Nurse Anesthetists data bank. A total of 2,673 SRNAs were invited by email to respond to an online, 54-item questionnaire; 696 SRNAs participated. Verbal abuse was reported by almost 70% of SRNA participants, but fewer experienced sexual harassment (13%), physical abuse (14%), or racial discrimination (72%). However, SRNAs reported that their Certified Registered Nurse Anesthetist (CRNA) preceptors most often served as positive role models. These SRNAs found CRNA preceptors, unique cases, reading, and clinical lectures more helpful to their clinical learning compared with grand rounds, surgeons, and anesthesiology residents. The SRNAs' perceptions of the ideal behavioral characteristics for CRNA preceptors included calmness during stressful events, use of nonthreatening communication, clear communication, and encouraging independent decision making. The educational process for nurse anesthetists is continually evolving and improving. Study findings offer insights that may assist in improvements in the clinical component of SRNA education. PMID:22403965

Elisha, Sass; Rutledge, Dana N

2011-08-01

107

Review of clinical experience with digoxin immune Fab (ovine).  

PubMed

Following the development of methods for eliciting and purifying digoxin-specific Fab fragments with high affinity and specificity for cardiac glycosides, clinical studies were undertaken as a multicenter, open-label trial to test safety and efficacy in patients with advanced and potentially life-threatening digitalis toxicity that failed to respond to conventional therapeutic measures. One-hundred fifty such patients were treated with digoxin-specific antibody fragments purified from immunoglobulin G (IgG) produced in sheep. Doses of Fab were equivalent to the amount of digoxin or digitoxin in the patient's body, as estimated from the medical history or serum concentration measurements. Of 150 patients included in this trial, detailed information is available on 148. One-hundred nineteen (80%) had resolution of all signs and symptoms of digitalis toxicity following specific Fab fragment infusions, 14 (10%) improved, and 15 (10%) showed no response. Among 14 patients with adverse events possibly or probably caused by Fab, the most common events were development of hypokalemia and exacerbation of congestive heart failure. Analysis of the available clinical data indicates that a treatment response was observed in at least 90% of patients with convincing evidence of advanced and potentially life-threatening digitalis toxicity. The data from this multicenter trial have been augmented by findings from an observational surveillance study conducted to monitor the safety and effectiveness of treatment with digoxin immune Fab (ovine) following commercial availability. In this experience, 74% of patients were judged to have a complete or partial response to treatment, and 12% no response. The response for the remaining 14% was not reported or reported as uncertain. In this clinical experience, digoxin-specific Fab was generally well tolerated and clinically effective in patients with potentially life-threatening digitalis toxicity. PMID:1997014

Smith, T W

1991-03-01

108

The radiobiology of radiosurgery: Rationale for different treatment regimes for AVMs and malignancies  

SciTech Connect

Based on basic radiobiological principles, we suggest that the radiosurgery technique of delivering a radiation dose in a single fraction, whilst appropriate for benign brain lesions such as arteriovenous malformations (AVM), is not optimal for treating malignant tumors. Radiosurgery was originally developed to treat benign lesions in the brain, such as AVMs, and has been successfully used for this purpose for over four decades. Recently, the technique has been adopted for treating small primary malignant brain tumors or single metastases. We argue, and derive radiobiological data to support the view that, treating malignant tumors with a single fraction will result in a suboptimal therapeutic ratio between tumor control and late effects, even for small tumors; and that improved therapeutic ratios would be expected if the treatment were divided into a small number of fractions. On the other hand, no therapeutic gain is to be expected from fractionating treatment of AVMs. A new generation of noninvasive relocatable stereotactic head frames makes feasible the use of fractionated stereotactic external-beam radiotherapy, and may allow significant benefits over single, radiosurgical, treatments for malignant brain tumors. As stereotactic fractionation/protraction regimes become more widespread, a uniform approach for determining equivalent fractionation schemes become important for intercomparing clinical results, and such calculations can be reliably carried out using the linear-quadratic formalism.

Hall, E.J.; Brenner, D.J. (Columbia Univ., New York, NY (United States))

1993-01-15

109

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

110

Past and Future Work on Radiobiology Mega Studies: A Case Study at Argonne National Laboratory  

PubMed Central

Between 1952 and 1992 more than 200 large radiobiology studies were conducted in research institutes throughout Europe, North America and Japan to determine the effects of external irradiation and internal emitters on the life span and tissue toxicity development in animals. At Argonne National Laboratory, 22 external beam studies were conducted on nearly 700 beagle dogs and 50,000 mice between 1969 and 1992. These studies helped to characterize the effects of neutron and gamma irradiation on lifespan, tumorigenesis, and mutagenesis across a range of doses and dosing patterns. The records and tissues collected at Argonne during that time period have been carefully preserved and redisseminated. Using these archived data ongoing statistical work has been done and continues to characterize quality of radiation, dose, dose rate, tissue, and gender specific differences in the radiation responses of exposed animals. The ongoing application of newly developed molecular biology techniques to the archived tissues has revealed gene specific mutation rates following exposure to ionizing irradiation. The original and ongoing work with this tissue archive is presented here as a case study of a more general trend in the radiobiology mega studies. These experiments helped form the modern understanding of radiation responses in animals, and continue to inform development of new radiation models. Recent archival efforts have facilitated open access to the data and materials produced by these studies and so a unique opportunity exists to expand this continued research.

Haley, Benjamin; Wang, Qiong; Wanzer, Beau; Vogt, Stefan; Finney, Lydia; Yang, Ping Liu; Paunesku, Tatjana; Woloschak, Gayle

2013-01-01

111

Past and future work on radiobiology mega-studies: a case study at Argonne National Laboratory.  

PubMed

Between 1952 and 1992, more than 200 large radiobiology studies were conducted in research institutes throughout Europe, North America, and Japan to determine the effects of external irradiation and internal emitters on the lifespan and tissue toxicity development in animals. At Argonne National Laboratory, 22 external beam studies were conducted on nearly 700 beagle dogs and 50,000 mice between 1969 and 1992. These studies helped to characterize the effects of neutron and gamma irradiation on lifespan, tumorigenesis, and mutagenesis across a range of doses and dosing patterns. The records and tissues collected at Argonne during that time period have been carefully preserved and redisseminated. Using these archived data, ongoing statistical work has been done and continues to characterize quality of radiation, dose, dose rate, tissue, and gender-specific differences in the radiation responses of exposed animals. The ongoing application of newly-developed molecular biology techniques to the archived tissues has revealed gene-specific mutation rates following exposure to ionizing irradiation. The original and ongoing work with this tissue archive is presented here as a case study of a more general trend in the radiobiology megastudies. These experiments helped form the modern understanding of radiation responses in animals and continue to inform development of new radiation models. Recent archival efforts have facilitated open access to the data and materials produced by these studies, and so a unique opportunity exists to expand this continued research. PMID:22004930

Haley, Benjamin; Wang, Qiong; Wanzer, Beau; Vogt, Stefan; Finney, Lydia; Yang, Ping Liu; Paunesku, Tatjana; Woloschak, Gayle

2011-06-01

112

Past and Future Work on Radiobiology Mega-Studies: A Case Study At Argonne National Laboratory  

SciTech Connect

Between 1952 and 1992, more than 200 large radiobiology studies were conducted in research institutes throughout Europe, North America, and Japan to determine the effects of external irradiation and internal emitters on the lifespan and tissue toxicity development in animals. At Argonne National Laboratory, 22 external beam studies were conducted on nearly 700 beagle dogs and 50,000 mice between 1969 and 1992. These studies helped to characterize the effects of neutron and gamma irradiation on lifespan, tumorigenesis, and mutagenesis across a range of doses and dosing patterns. The records and tissues collected at Argonne during that time period have been carefully preserved and redisseminated. Using these archived data, ongoing statistical work has been done and continues to characterize quality of radiation, dose, dose rate, tissue, and gender-specific differences in the radiation responses of exposed animals. The ongoing application of newly-developed molecular biology techniques to the archived tissues has revealed gene-specific mutation rates following exposure to ionizing irradiation. The original and ongoing work with this tissue archive is presented here as a case study of a more general trend in the radiobiology megastudies. These experiments helped form the modern understanding of radiation responses in animals and continue to inform development of new radiation models. Recent archival efforts have facilitated open access to the data and materials produced by these studies, and so a unique opportunity exists to expand this continued research.

Haley, Benjamin; Wang, Qiong; Wanzer, Beau; Vogt, Stefan; Finney, Lydia; Yang, Ping Liu; Paunesku, Tatjana; Woloschak, Gayle

2011-09-06

113

Radiobiological Experiments with Plant Seeds Aboard the Biosatellite Cosmos 1887.  

National Technical Information Service (NTIS)

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 ...

E. V. Benton I. D. Anikeeva Y. A. Akatov E. N. Vaulina L. N. Kostina

1995-01-01

114

Marjolin Ulcer: Clinical Experience with 34 Patients over 15 Years.  

PubMed

Background:Malignancies that arise from scars are referred to as Marjolin ulcers. The association between chronic ulcers and squamous cell carcinomas is well established. There are many case reports in the literature regarding Marjolin ulcer; however, randomized controlled clinical series that describe a thorough evaluation of these patients are rarely encountered.Objective:We present our clinic's 15 years of experience with 34 Marjolin ulcer patients and their treatment modalities.Methods:A retrospective analysis of 302 squamous cell carcinoma patients who were treated in the plastic surgery department between 1997 and 2011 was performed. Thirty-four (10.3%) histopathologically confirmed Marjolin ulcer patients were further analyzed.Results:Although burn scars represented 77% of the patients in the present study, unstable scars that formed following traffic accidents and fistula tracts are also among the commonly encountered etiologies. Based on our observations, squamous cell carcinoma, in addition to malignant melanoma and verrucous carcinoma, is frequently observed in cases of Marjolin ulcers.Conclusion:If the goal is to eradicate this clinical entity, all of the chronic ulcers that fail to heal require biopsies at regular intervals. Large excisional margins, lymphadenectomies in cases of palpable lymph nodes, and a well-defined oncology protocol are all essential in treating Marjolin ulcer. PMID:24138977

Karasoy Yesilada, Aysin; Zeynep Sevim, Kamuran; Ozgur Sucu, Deniz; Akçal, Arzu; Kar?ida?, Semra; Kilinc, Leyla; Orhan Kizilkaya, Hazim

115

Initial clinical experience with the Baylor-Nikkiso centrifugal pump.  

PubMed

Recently, a newly developed centrifugal pump, the Baylor-Nikkiso pump, was approved for clinical use in the United States. This pump is the most compact centrifugal pump with a priming volume of only 25 ml. Although it is small, this pump can provide a flow of 4 L/min against a total pressure head of 300 mm Hg at 3,000 rpm. In vitro and in vivo validation of the Baylor-Nikkiso pump has proved that this pump could effectively reduce blood trauma even under high total head pressure. In addition, 48-h durability tests with biventricular bypass using calves verified the reliability of shaft sealing and antithrombogenicity. Clinical trials of the Baylor-Nikkiso pumps have been initiated in our department. This pump provides flows of 60-70 ml/kg/min with stable hemodynamic conditions. No leakage of thrombus formation was observed. The results of the initial clinical experience of the Baylor-Nikkiso pump suggest that it is suitable for cardiopulmonary bypass surgery. PMID:8572993

Ohtsubo, S; Naito, K; Matsuura, M; Kawahito, K; Shimono, T; Makinouchi, K; Tasai, K; Ohara, Y; Damm, G; Glueck, J

1995-07-01

116

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

117

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

118

Toward a consensus on radiobiology teaching to radiation oncology residents.  

PubMed

There are approximately 82 radiation oncology residency programs in the United States, which provide training opportunities for about 400 residents. All accredited radiation oncology residency programs must have at least one basic scientist on the faculty, and it is these individuals who often assume, wholly or in part, the responsibility of teaching radiation and cancer biology to radiation oncology residents in preparation for the American College of Radiology (ACR) In-Training Examination in Radiation Oncology and the American Board of Radiology (ABR) written examinations. In response to a perceived lack of uniformity in radiation and cancer biology curricula currently being taught to residents and a perceived lack of guidance for instructors in formulating course content for this population, a special session was presented at the Forty-eighth Annual Radiation Research Society meeting on April 23, 2001. The session, entitled "Toward a Consensus on Radiobiology Teaching to Radiation Oncology Residents", was focused on issues related to teaching radiobiology to radiation oncology residents and targeted for individuals who actively teach radiation and cancer biology as well as coordinators of residency training programs. The speakers addressed current challenges and future problems facing instructors and programs. Among these were lack of feedback on resident performance on ABR and ACR written examinations and on course content, uncertainty about what topics residents must know to pass the ABR examination, and, in the near future, a reduction (due to retirement) of instructors qualified to teach radiobiology. This article provides a synopsis of the information that was presented during that session, offers a glimpse into how the ABR and ACR examinations are prepared and details of the content of past and future examinations, and summarizes the activities of the Joint Working Group on Radiobiology Teaching which was formed to educate instructors, to establish a consensus for course curricula, and to improve the overall quality of resident teaching. PMID:11966327

Dynlacht, Joseph R; Dewhirst, Mark W; Hall, Eric J; Rosenstein, Barry S; Zeman, Elaine M

2002-05-01

119

Evaluation of the Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment. Volume I: Description of the Experiment.  

National Technical Information Service (NTIS)

The Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment tested two alterations in the Medicare Program: (1) decreasing the copayment rate for outpatient mental health services from 50% to 20%, and (2) recognizing clinical psychologists...

N. McCall

1981-01-01

120

Equivalence testing of traditional and simulated clinical experiences: undergraduate nursing students' knowledge acquisition.  

PubMed

Although simulated clinical experience is being used increasingly in nursing education, vital evidence related to knowledge acquisition associated with simulated clinical experience does not exist. This intervention study used a 2×2 crossover design and equivalence testing to explore the effects of simulated clinical experiences on undergraduate students' (n = 74) knowledge acquisition in a fundamentals of nursing course. Following random assignment, students participated in laboratory-based simulated clinical experiences with high-fidelity human patient simulators and traditional clinical experiences and completed knowledge pretests and posttests. Analysis identified significant knowledge gain associated with both simulated and traditional clinical experiences, with the groups' knowledge scores being statistically significantly equivalent. A priori equivalence bounds around the difference between the groups were set at ± 5 points. Simulated clinical experience was found to be as effective as traditional clinical experience in promoting students' knowledge acquisition. PMID:19810668

Schlairet, Maura C; Pollock, Jane W

2010-01-04

121

Questioning Skills Demonstrated by Approved Clinical Instructors During Clinical Field Experiences  

PubMed Central

Context: The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies. Objective: To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs. Design: Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions. Setting: The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education. Patients or Other Participants: The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores. Data Collection and Analysis: Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework. Results: The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other. Conclusions: Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs sequenced questions (their questioning pattern) appeared to be more important than the number of specific cognitive-level questions posed. Nonstrategic questioning appears to support knowledge and comprehension, whereas strategic questioning appears to support critical thinking.

Barnum, Mary G

2008-01-01

122

Quantitative modeling of chronic myeloid leukemia: insights from radiobiology  

PubMed Central

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 106, of normal HSCs. Radiobiologic estimates favor values > 106 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.

Radivoyevitch, Tomas; Hlatky, Lynn; Landaw, Julian

2012-01-01

123

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

2012-02-21

124

Radiobiological aspects of low dose rates in radioimmunotherapy  

SciTech Connect

It is assumed that initial dose rates of 10-20 cGy/hour and total doses of 1500-2000 cGy, delivered with effective half-lives of a few days, are reasonable starting points for assessing the radiobiological effects of such low and declining dose rates. Such doses might kill 2 or 3 logs of cells out of the 9 or 10 required for tumor eradication. The emphasis in this paper is on the change of effectiveness with change in dose rate. Biological effectiveness, in terms of log cell kill per Gy, will be less than that of higher dose rates because there is more time for repair of sublethal radiation injury. This loss in Relative Effectiveness is unlikely to exceed 20% in most types of tumor cell, compared with conventional external beam radiation schedules. Therefore, a tumor or metastatic deposit that would require 60-70 Gy to sterilize it using conventional radiotherapy with 2 Gy fractions (or traditional radioactive implants at 50 cGy/hr) would require 70-84 Gy at the lower dose rates available from radioimmunotherapy. This is the major dose rate effect and so far we have ignored proliferation. In the dose-rate range of 10-300 cGy/hr in vitro, highly variable depending on type of cell, division might be prevented but not progression through the cell cycle. Additional cell kill is observed because cells accumulate in the radiosensitive G2 phase; this is the inverse dose-rate effect. However, that range of dose rates comes from in vitro experiments where cells are doubling in number every 0.5 to 1 day. In vivo they double more slowly so it is possible that the unpredictable benefit of G2 accumulation, or partial synchrony, could occur at lower dose rates than 10 cGy/hr in human tumors. The dose rates necessary to kill cells at exactly the rate they are proliferating can be calculated, if values are assumed for intrinsic radiosensitivity and doubling rate of cells.

Fowler, J.F. (Univ. of Wisconsin Medical School, Madison (USA))

1990-05-01

125

Clinical experience with computer navigation in revision total hip arthroplasty.  

PubMed

The biomechanically and anatomically correct placement of hip prostheses components is the main challenge in revision hip arthroplasty. The orientation of the cup and stem with the restoration of leg length, offset and hip centre is hampered by the defect situations frequently present. In primary hip arthroplasty, it has been demonstrated that the components can be accurately positioned using computer-navigated procedures. However, such procedures could also be of considerable benefit in revision hip arthroplasty. Systems that not only detect anatomical landmarks using pointers but also use image data for referencing may provide a possible solution for the defect situation. Literature about navigation in revision arthroplasty is very rare. This article comprises general considerations on this subject and presents our experience and possible clinical applications. PMID:23636955

Franke, Jochen; Zheng, Guoyan; Wendl, Klaus; Grützner, Paul A; von Recum, Jan

2012-08-21

126

Junior nursing students' experiences of vertical violence during clinical rotations.  

PubMed

Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students. PMID:19631065

Thomas, Sandra P; Burk, Renee

127

Clinical Experience with the Cervista HPV HR Assay  

PubMed Central

Testing for high-risk (HR) human papillomavirus (HPV) is a key component of current recommendations for cervical cancer screening. Herein is described our clinical experience using Cervista HPV HR, a testing platform recently approved by the US Food and Drug Administration for clinical use. Using data from a high-volume commercial laboratory, a retrospective analysis of cytologic and Cervista HPV HR test results from 56,501 samples was performed, and an indirect comparison was made with previous experience with 53,008 samples tested using the Hybrid Capture 2 platform. Of samples analyzed using Cervista HPV HR, 1.5% were of insufficient volume for testing and 1.1% yielded an insufficient signal from the internal control to be reported. In samples with a cytological interpretation of atypical squamous cells of undetermined significance, 48.5% (95% confidence interval [CI], 47.5 to 49.5) tested positive using Cervista HPV HR, compared with 59.4% (95% CI, 58.3 to 60.5) of samples using Hybrid Capture 2. Of samples from women aged 30 years or older with a negative cytological interpretation, 5.8% (95% CI, 5.6 to 6.1) tested positive using Cervista HPV HR, compared with 5.5% (95% CI, 5.3 to 5.7) of samples using Hybrid Capture 2. When stratified by five-year age groups between 30 and 65 years, positivity rates for high-risk human papillomavirus were similar in the Cervista HPV HR and Hybrid Capture 2 populations, and were consistent with expectations established by the literature.

Youens, Kenneth E.; Hosler, Gregory A.; Washington, Paula J.; Jenevein, E. Patrick; Murphy, Kathleen M.

2011-01-01

128

Antioxidant vitamins in atherosclerosis--animal experiments and clinical studies.  

PubMed

Atherosclerotic heart diseases are universal problems in modern society. Oxidative damage to lipids is a primary cause of atherosclerosis. There are many choices for treatment, but no definite recommendations to prevent the occurrence of the disease. There is a relationship between atherosclerotic risk factors and increased vascular production of reactive oxygen species (ROS). Oxidized low-density lipoproteins (LDL) and ROS may directly cause endothelial dysfunction by reducing endothelial nitric oxide (NO) bioavailability. Vitamin E can to some degree prevent the consequences of oxidized LDL, and vitamin C provides NO synthase activity. Although prolonged use of vitamin A, C, and E supplementation in pharmaceutical forms has been proven to be effective in preventing atherosclerosis in animal experiments, this has not yet been demonstrated in clinical trials with human beings. It should be taken into account that the evidence has been gathered from young/adult experimental animals with early stages of arthrosclerosis and from in-vitro studies, while most of the clinical trials have involved older patients with late stages of the disease. Prolonged use of vitamins in the diet has not yet been recommended in human beings. There is some indication that a diet rich in antioxidant fruit and vegetables may be beneficial in the prevention of cardiovascular events. PMID:23214308

Ozkanlar, Seckin; Akcay, Fatih

129

Treatment plan comparison between helical tomotherapy and MLC-based IMRT using radiobiological measures  

NASA Astrophysics Data System (ADS)

The rapid implementation of advanced treatment planning and delivery technologies for radiation therapy has brought new challenges in evaluating the most effective treatment modality. Intensity-modulated radiotherapy (IMRT) using multi-leaf collimators (MLC) and helical tomotherapy (HT) are becoming popular modes of treatment delivery and their application and effectiveness continues to be investigated. Presently, there are several treatment planning systems (TPS) that can generate and optimize IMRT plans based on user-defined objective functions for the internal target volume (ITV) and organs at risk (OAR). However, the radiobiological parameters of the different tumours and normal tissues are typically not taken into account during dose prescription and optimization of a treatment plan or during plan evaluation. The suitability of a treatment plan is typically decided based on dosimetric criteria such as dose-volume histograms (DVH), maximum, minimum, mean and standard deviation of the dose distribution. For a more comprehensive treatment plan evaluation, the biologically effective uniform dose ({\\bar{\\bar{D}}}) is applied together with the complication-free tumour control probability (P+). Its utilization is demonstrated using three clinical cases that were planned with two different forms of IMRT. In this study, three different cancer types at different anatomical sites were investigated: head and neck, lung and prostate cancers. For each cancer type, a linac MLC-based step-and-shoot IMRT plan and a HT plan were developed. The MLC-based IMRT treatment plans were developed on the Philips treatment-planning platform, using the Pinnacle 7.6 software release. For the tomotherapy HiArt plans, the dedicated tomotherapy treatment planning station was used, running version 2.1.2. By using {\\bar{\\bar{D}}} as the common prescription point of the treatment plans and plotting the tissue response probabilities versus {\\bar{\\bar{D}}} for a range of prescription doses, a number of plan trials can be compared based on radiobiological measures. The applied plan evaluation method shows that in the head and neck cancer case the HT treatment gives better results than MLC-based IMRT in terms of expected clinical outcome (P+ of 62.2% and 46.0%, {\\bar{\\bar{D}}} to the ITV of 72.3 Gy and 70.7 Gy, respectively). In the lung cancer and prostate cancer cases, the MLC-based IMRT plans are better over the clinically useful dose prescription range. For the lung cancer case, the HT and MLC-based IMRT plans give a P+ of 66.9% and 72.9%, {\\bar{\\bar{D}}} to the ITV of 64.0 Gy and 66.9 Gy, respectively. Similarly, for the prostate cancer case, the two radiation modalities give a P+ of 68.7% and 72.2%, {\\bar{\\bar{D}}} to the ITV of 86.0 Gy and 85.9 Gy, respectively. If a higher risk of complications (higher than 5%) could be allowed, the complication-free tumour control could increase by over 40%, 2% and 30% compared to the initial dose prescription for the three cancer cases, respectively. Both MLC-based IMRT and HT can encompass the often-large ITV required while they minimize the volume of the organs at risk receiving high doses. Radiobiological evaluation of treatment plans may provide an improved correlation of the delivered treatment with the clinical outcome by taking into account the dose-response characteristics of the irradiated targets and normal tissues. There may exist clinical cases, which may look dosimetrically similar but in radiobiological terms may be quite different. In such situations, traditional dose-based evaluation tools can be complemented by the use of P_ +{-}{\\bar{\\bar{D}}} diagrams to effectively evaluate and compare treatment plans.

Mavroidis, Panayiotis; Costa Ferreira, Brigida; Shi, Chengyu; Lind, Bengt K.; Papanikolaou, Nikos

2007-07-01

130

Traumatic effects of political repression in Chile: a clinical experience.  

PubMed

The author examines psychic trauma resulting from human rights violations in Chile. Starting from trauma theories developed by authors such as Ferenczi, Winnicott and Stolorow, she posits the relevance of the subject's emotionally significant environment in the production of the traumatic experience. She describes the characteristics of the therapeutic process on the basis of a clinical case. She emphasizes the need to recognize the damage that may be produced within the reliable link between patient and analyst, pointing out the risk of retraumatization if analysts distance themselves and apply 'technique' rigorously, leaving out their own subjective assessments. Therapists must maintain their focus on the conjunction of the patient's intersubjective context and inner psychic world both when exploring the origin of the trauma and when insight is produced. The author posits repetition in the transference as an attempt at reparation, at finding the expected response from the analyst that will help patients assemble the fragments of their history and achieve, as Winnicott would put it, a feeling of continuity in the experience of being. PMID:16174610

Cordal, Margarita Díaz

2005-10-01

131

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

132

Clinical magnetocardiography. 10 years experience at the Catholic University.  

PubMed

Since the introduction, in 1982, of a Biomagnetic facility in the clinical environment, efforts were concentrated to investigate whether magnetocardiography could really provide new information of potential diagnostic use, even avoiding electromagnetic shielding to facilitate simultaneous biomagnetic and conventional cardiac investigations, including cardiac catheterization for invasive electrophysiological procedures. More than 350 patients have been magnetically investigated using a single-channel second-order gradiometer. Results of 281 MCG studies, whose data have been extensively analyzed with updated software programs, are reported. Magnetocardiographic (MCG) mapping during endocardial pacing was performed to quantify the accuracy of MCG localization of intracardiac dipolar sources. MCG classification of ventricular preexcitation has been attempted in 70 patients with overt preexcitation. MCG localization of the ventricular preexcited area was accurate and reproducible, provided that during mapping a sufficient degree of ventricular preexcitation was present. MCG mapping during orthodromic A-V re-entry tachycardia has been also employed to attempt the localization of retrograde atrial preexcitation as well as the site of origin of atrial and ventricular tachyarrhythmias. For validation, the results of catheter and epicardial mappings have been used. Other applications of clinical magnetocardiography are under evaluation. The use of the Relative smoothness index needs, in our opinion, a larger experience to define its reliability as a predictor of risk for sudden death. MCG follow-up study of patients with transplanted hearts seems to be a promising application, for early detection of acute graft rejection reaction. Our reported case strongly supports this potentiality. Present work is also addressed to develop an integrated system allowing easy MCG mapping during cardiac catheterization, as a new method to guide diagnostic and therapeutic procedures as close as possible to the arrhythmogenic substrate. PMID:1820397

Fenici, R R; Melillo, G; Masselli, M

1991-01-01

133

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

2012-03-01

134

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

135

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

2011-03-03

136

Clinical utility of noninvasive fetal trisomy (NIFTY) test - early experience  

PubMed Central

Objective: To report the initial experience of noninvasive prenatal diagnosis of fetal Down syndrome (The NIFTY test) in a clinical setting. Methods: The NIFTY test was offered as a screening test for fetal Down syndrome to pregnant women with a singleton pregnancy at 12 weeks of gestation or beyond. A satisfaction questionnaire was sent to the first 400 patients. Results: During a 6-month period, 567 NIFTY tests were performed. Over 90% of those studied were ethnic Chinese, and the mean age of the women studied was 36 years. The test was performed at 12–13 weeks of gestation in 49.21%. The median reporting time was 9 days. The test was positive for trisomy 21 in eight cases, and for trisomy 18 in 1 case; all were confirmed by fetal karyotyping. There was no false-positive result. Of the questionnaires, 182 completed responses were received. Over 95% had complete or almost complete resolution of anxiety. Except for one, all were satisfied with the NIFTY test, and all indicated that they would recommend the test to their friends. Conclusion: The NIFTY test was a highly specific test. Unnecessary invasive tests and associated fetal losses could be avoided in almost all women who have a normal fetus.

Lau, Tze Kin; Chan, Mei Ki; Lo, Pui Shan Salome; Chan, Hon Yee Connie; Chan, Wai Sze Kim; Koo, Tik Yee; Ng, Hoi Yan Joyce; Pooh, Ritsuko K.

2012-01-01

137

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

138

Limitations of a convolution method for modeling geometric uncertainties in radiation therapy: the radiobiological dose-per-fraction effect  

SciTech Connect

The convolution method can be used to model the effect of random geometric uncertainties into planned dose distributions used in radiation treatment planning. This is effectively done by linearly adding infinitesimally small doses, each with a particular geometric offset, over an assumed infinite number of fractions. However, this process inherently ignores the radiobiological dose-per-fraction effect since only the summed physical dose distribution is generated. The resultant potential error on predicted radiobiological outcome [quantified in this work with tumor control probability (TCP), equivalent uniform dose (EUD), normal tissue complication probability (NTCP), and generalized equivalent uniform dose (gEUD)] has yet to be thoroughly quantified. In this work, the results of a Monte Carlo simulation of geometric displacements are compared to those of the convolution method for random geometric uncertainties of 0, 1, 2, 3, 4, and 5 mm (standard deviation). The {alpha}/{beta}{sub CTV} ratios of 0.8, 1.5, 3, 5, and 10 Gy are used to represent the range of radiation responses for different tumors, whereas a single {alpha}/{beta}{sub OAR} ratio of 3 Gy is used to represent all the organs at risk (OAR). The analysis is performed on a four-field prostate treatment plan of 18 MV x rays. The fraction numbers are varied from 1-50, with isoeffective adjustments of the corresponding dose-per-fractions to maintain a constant tumor control, using the linear-quadratic cell survival model. The average differences in TCP and EUD of the target, and in NTCP and gEUD of the OAR calculated from the convolution and Monte Carlo methods reduced asymptotically as the total fraction number increased, with the differences reaching negligible levels beyond the treatment fraction number of {>=}20. The convolution method generally overestimates the radiobiological indices, as compared to the Monte Carlo method, for the target volume, and underestimates those for the OAR. These effects are interconnected and attributed to assuming an infinite number of fractions inherent in the implementation of the convolution technique, irrespective of the uniqueness of each treatment schedule. Based on the fraction numbers analyzed (1-50), and the range of fraction numbers normally used clinically ({>=}20), the convolution method can be used safely to estimate the effects of random geometric uncertainties on prostate treatment radiobiological outcomes, for both the target and the OAR. Although the results of this study is likely to apply to other clinical sites and treatment techniques other than the four-field, further validation similar to those done in this study may be necessary prior to clinical implementation.

Song, William; Battista, Jerry; Van Dyk, Jake [London Regional Cancer Program, London Health Sciences Centre and Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); London Regional Cancer Program, London Health Sciences Centre and Departments of Medical Biophysics and Oncology, University of Western Ontario, London, Ontario (Canada)

2004-11-01

139

A Memory of an Aesthetic Experience Transferred to Clinical Practice  

Microsoft Academic Search

Purpose: To examine the usefulness of writing about a memory of an aesthetic experience, and then transfer the aesthetic experience to a health care situation. Methods: The study was accomplished at two university colleges of health sciences in Sweden. It started with student nurses (N=291) writing about a memory of an aesthetic experience. Then they transferred the aesthetic experience to

BRITT-MAJ WIKSTROM

2003-01-01

140

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

141

The Cleveland Clinic Experience With Primary Central Nervous System Lymphoma.  

PubMed

BACKGROUND:: The rarity and difficulty of conducting large trials limit the evaluation of various treatment options for primary central nervous system lymphoma (PCNSL). In this study, we sought to describe the demographics, diagnoses, management, and outcomes of patients with PCNSL at a single institution. METHODS:: This is a retrospective study of 153 patients with PCNSL between 1986 and 2010. Prognostic factors identified by univariate and multivariable survival analyses were used by recursive partitioning analysis to generate a prognostic model. RESULTS:: The median age was 61 and Karnofsky performance status (KPS) was 70. The progression-free survival was 9.3 months; the overall survival was 27 months. The diagnosis of PCNSL was established mainly by stereotactic brain biopsy (80%), cerebrospinal fluid analysis (7.2%), and vitrectomy (2.6%). Methotrexate-based chemotherapy with or without consolidation whole-brain radiation therapy offered better response rate and survival in the initial treatment than whole-brain radiation therapy alone. However, this observation was not present in the subsequent salvage treatments. Multivariable Cox proportional hazards regression identified age and KPS as the only prognostic indicators. Recursive partitioning analysis categorized the patients into 3 groups. Patients with KPS >70 had a favorable outcome compared with patients with KPS ?70. This held true especially for patients age 60 and younger. CONCLUSIONS:: The Cleveland Clinic experience with management of PCNSL demonstrated successful disease control with methotrexate-based regimens. The survival and prognostic indicators approximate those reported previously and provide independent validation for a simple yet powerful prognostic model using age and KPS to predict survival. PMID:23608829

Xie, Hao; Ahluwalia, Manmeet S; Peereboom, David M

2013-04-19

142

Clinical Experiences Are Not Predictive of Outcomes on the NATABOC Examination.  

ERIC Educational Resources Information Center

|Examined the efficacy of the National Athletic Trainers' Association Board of Certification (NATABOC) clinical experience requirements and individual student characteristics to predict candidate outcomes on the examination. Student surveys and exam scores indicated that neither number of clinical experience hours nor sports experiences influenced…

Turocy, Paula Sammarone; Comfort, Ronald E.; Perrin, David H.; Gieck, Joe H.

2000-01-01

143

Radiobiological speculations on therapeutic total body irradiation  

SciTech Connect

Unexpected total body irradiation (TBI) of human beings, involved in nuclear warfare or in accidents in nuclear reactors can be lethal. In the 1950s, bone marrow transplantation was discovered as a potentially life saving procedure after TBI in the dose range of 5.0 to 12.0 Gy. Since that time, deliberate or therapeutic TBI has been used to condition patients with a lethal bone marrow disorder for bone marrow replacement. The therapeutic ratio of TBI followed by bone marrow transplantation is small. Many potentially lethal complications can occur, such as acute TBI side effects, late TBI side effects or immunological complications of bone marrow transplantation such as graft versus host disease or graft rejection. The benefits of TBI and bone marrow transplantation are that they offer a chance for cure of previously lethal bone marrow disorders. The optimal parameters for TBI remain to be defined. The review discusses the current clinical and experimental animal data, as they relate to the future definition of less toxic TBI procedures with a better therapeutic ratio. Different TBI procedures are required for patients with malignant vs. non-malignant disorders or for patients with histoincompatible vs. histocompatible bone marrow donors.77 references.

Vriesendorp, H.M. (Johns Hopkins Hospital, Baltimore, MD (USA))

1990-01-01

144

Evaluation of the Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment. Executive Summary.  

National Technical Information Service (NTIS)

The Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment tested two alterations in the Medicare Program: (1) decreasing the copayment rate for outpatient mental health services from 50% to 20%, and (2) recognizing clinical psychologists...

N. McCall T. Rice B. Steinhardt

1981-01-01

145

Evaluation of the Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment. Volume II: Process Evaluation.  

National Technical Information Service (NTIS)

The Colorado Clinical Psychology/Expanded Mental Health Benefits Experiment tested two alterations in the Medicare Program: (1) decreasing the copayment rate for outpatient mental health services from 50% to 20%, and (2) recognizing clinical psychologists...

N. McCall T. Rice M. Swenson

1981-01-01

146

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

147

Therapeutics in Clinical Cardiovascular Practice. Experiences and Evidence  

Microsoft Academic Search

The quality of evidence in Cardiology has been intensified in the last years. By exceeding classic pharmachological and biological foundation, evidence-based methods of classic medicine, particu- larly randomized clinical assay, were applied to clinical scenario, allowing for discriminating among efficient, inert and injurious the- rapies. Classic studies, such as the one that demonstrated the inefficiency of mammary artery ligature surgery

Flávio Danni Fuchs

2005-01-01

148

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

149

Differences in Clinical Experiences of ADN and BSN Students.  

ERIC Educational Resources Information Center

|In a study of 211 associate degree (AD) and 204 baccalaureate nursing students, AD students reported significantly higher stress in clinical practice. Stress for both groups increased as they progressed. Instructors were the predominant source of stress. Students had the most difficulty coping with the demands of patient care and the clinical

Oermann, Marilyn H.

1998-01-01

150

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

151

Robot-assisted Laparoscopic Aortobifemoral Bypass for Aortoiliac Occlusive Disease: Early Clinical Experience  

Microsoft Academic Search

BackgroundRobotic technology may facilitate laparoscopic aortic reconstruction. We present our early clinical experience with laparoscopic aortobifemoral bypass, aided by two different robotic surgical systems.

D. Nio; J. Diks; M. A. M. Linsen; M. A. Cuesta; C. Gracia; J. A. Rauwerda; W. Wisselink

2005-01-01

152

Radiobiological modelling of dose-gradient effects in low dose rate, high dose rate and pulsed brachytherapy  

NASA Astrophysics Data System (ADS)

This paper presents a generalization of a previously published methodology which quantified the radiobiological consequences of dose-gradient effects in brachytherapy applications. The methodology uses the linear-quadratic (LQ) formulation to identify an equivalent biologically effective dose (BEDeq) which, if applied uniformly to a specified tissue volume, would produce the same net cell survival as that achieved by a given non-uniform brachytherapy application. Multiplying factors (MFs), which enable the equivalent BED for an enclosed volume to be estimated from the BED calculated at the dose reference surface, have been calculated and tabulated for both spherical and cylindrical geometries. The main types of brachytherapy (high dose rate (HDR), low dose rate (LDR) and pulsed (PB)) have been examined for a range of radiobiological parameters/dimensions. Equivalent BEDs are consistently higher than the BEDs calculated at the reference surface by an amount which depends on the treatment prescription (magnitude of the prescribed dose) at the reference point. MFs are closely related to the numerical BED values, irrespective of how the original BED was attained (e.g., via HDR, LDR or PB). Thus, an average MF can be used for a given prescribed BED as it will be largely independent of the assumed radiobiological parameters (radiosensitivity and ?/?) and standardized look-up tables may be applicable to all types of brachytherapy treatment. This analysis opens the way to more systematic approaches for correlating physical and biological effects in several types of brachytherapy and for the improved quantitative assessment and ranking of clinical treatments which involve a brachytherapy component.

Armpilia, C.; Dale, R. G.; Sandilos, P.; Vlachos, L.

2006-09-01

153

Clinical experience with sorbinil--an aldose reductase inhibitor.  

PubMed

A considerable volume of animal pharmacologic data support the view that increased flux through the polyol pathway provides a unifying hypothesis for the major complications of diabetes. An extensive clinical program has been established to verify the extrapolation of the animal pharmacologic findings to man. Clinical data accumulated to date confirm the biochemical and electrophysiologic effects, and encouraging evidence of a drug effect in diabetic neuropathy and retinopathy has already been observed. In the large, controlled safety data base already available, the long-term clinical use of sorbinil is devoid of significant adverse effects in terms of both subjective side effects and laboratory parameters. The only clinically important adverse reaction reported to date has been a hypersensitivity reaction in the early weeks of therapy, which is similar to that seen with other hydantoins. PMID:3083213

Pitts, N E; Vreeland, F; Shaw, G L; Peterson, M J; Mehta, D J; Collier, J; Gundersen, K

1986-04-01

154

eCTD: A Clinical Reviewer's Experience Disclaimer  

Center for Drug Evaluation (CDER)

Text Version... s) 6.1.6 Other Endpoints 6.1.7 Subpopulations 6.1.8 Analysis of Clinical ... Hyperlinks: Narratives • Helpful: Link directly with Subject Narrative ... More results from www.fda.gov/downloads/drugs/developmentapprovalprocess

155

Baccalaureate nursing students' experiences of anxiety producing situations in the clinical setting.  

PubMed

The purpose of this study was to identify the clinical experiences of nursing students that were anxiety provoking and examine the relationship between the level of trait anxiety and the clinical experience that produced anxiety in nursing students. A descriptive correlational design collected data from 61 nursing students in their last semester of the baccalaureate nursing program using survey questionnaires that captured demographic data and included the Trait Anxiety Scale and the Clinical Experience Assessment form. Analyses of data indicate that 36% of the students experienced a moderate level of anxiety. Clinical experiences related to arriving late, being observed by instructors, responding to initial experiences, having a fear of making mistakes, and talking to physicians were the most anxiety producing for these students. A significantly positive relationship (r = .40, p < .05) was found between the trait anxiety and clinical experience that was anxiety producing. A higher level of perceived anxiety accompanied the following clinical experiences; being observed by instructors (F = 3.44, p = .04), doing beforehand in-hospital preparation (F = 4.46, p < .02), asking questions of faculty (F = 4.38, p < .02), being evaluated by faculty (F = 3.37, p < .04), and reporting to team leader (F = 3.60, p < .05). The most anxiety producing clinical experiences in nursing students before graduation are evaluated with descriptive data. Results would provide useful insights for faculty and senior nursing students involved in clinical practice, and have implications for education, further research, and clinical support. PMID:12785605

Kim, Kimberly H

2003-04-01

156

Review of clinical experience with ion beam radiotherapy  

PubMed Central

The article describes both the early development of oncology as a core discipline at the University of Heidelberg Hospital and the first steps towards ion beam treatment, from the pilot project carried out in co-operation with the Gesellschaft für Schwerionenforschung Darmstadt to the initial start-up of clinical service at the Heidelberg Heavy Ion Centre (HIT). We present an overview, based on data published in the literature, of the available clinical evidence relating the use of ion beam therapy to treat major indications in active particle centres. A rationale for the use of particle therapy in each of these indications is given. In view of the limited availability of data, we discuss the necessity to conduct clinical trials. We also look forward towards the next activities to be undertaken at the HIT.

Jensen, A D; Munter, M W; Debus, J

2011-01-01

157

The Effects of Clinical Experiences on the Understanding of Classroom Management Techniques  

Microsoft Academic Search

For teacher educators, classroom management education is one of the least researched aspects of the profession. The purpose of this study was to determine if classroom management was most effective learned through textbook analysis coupled with classroom discussion, or the experience of observing and practicing classroom management in the clinical experience. The results of this study suggest that the clinical

Carey Anne Cushmann; Andrew T. Kemp

2012-01-01

158

An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques  

ERIC Educational Resources Information Center

|An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

Duxbury, Mark

2004-01-01

159

Necrotizing Craniocervical Soft Tissue Infections: Clinical Experience and Personal Considerations  

PubMed Central

Necrotizing cervical soft tissue infections (NCSTIs) are devastating uncommon clinical entities that are often life threatening. We report two patients suffering from NCSTI and treated at our institution. Diagnosis of NCSTI has been confirmed histologically and surgically. Both patients were managed with very aggressive treatment (medical and surgical) and survived with minimal morbidity. Early diagnosis and aggressive, multimodality treatment can reduce mortality and morbidity rates. Thoracic and mediastinal involvement requires appropriate management. A strong clinical suspicion remains one of the most important aspects of the management of such shattering conditions.

Lenzi, Riccardo; Castelnuovo, Paolo; Dallan, Iacopo

2012-01-01

160

Our experience in a psychodermatology liaison clinic at manipal, India.  

PubMed

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. PMID:23372214

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

2013-01-01

161

Preliminary clinical experience of a contracture correction device  

Microsoft Academic Search

Joint contractures which do not respond to conventional physiotherapy can be difficult to treat. Serial plastering has been used effectively but is expensive, inconvenient to the patient and does not permit daily hygiene or clinical inspection. A mechanical device has been developed consisting a hinged orthosis which spans the affected joint to which is attached a gas strut to provide

P. CHARLTON; D. FERGUSON; C. PEACOCK; J. STALLARD

1999-01-01

162

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 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

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

2007-01-01

163

Managing University Clinical Partnership: Learning from International Experience  

ERIC Educational Resources Information Center

Dialogue between the leaders of academic clinical organisations in different countries has revealed that the core elements of the partnership between universities and health care systems are remarkably consistent across national boundaries. There is now an impetus to move beyond analysis of common challenges and towards strategies for success that…

Davies, Stephen; Smith, Tom

2004-01-01

164

Electrochemotherapy with Cisplatin: Clinical Experience in Malignant Melanoma Patients1  

Microsoft Academic Search

Electrochemotherapy consists of chemotherapy fol- lowed by local application of electric pulses to the tumor to increase drug delivery into the cells. The aim of this Phase II clinical study was to evaluate the antitumor effectiveness of electrochemotherapy using intratumoral cisplatin adminis- tration on cutaneous tumor nodules in malignant melanoma patients. In 10 patients, 133 tumor nodules of different sizes

Gregor Sers; Borut Stabuc; Maja C; Damijan Miklavc; Zvonimir Rudolf

165

Trazodone, a Review of Clinical Literature and Personal Experience  

Microsoft Academic Search

The authors summarize the international clinical research performed on trazodone, underlying some pharmacodynamic and therapeutic features of the activity of the drug, the originality of its pharmacodynamic profile and the possibility of using trazodone in a wide range of primary or secondary depression subtypes. Available data also suggest that trazodone is safer than traditional antidepressants even when taken in overdose,

A. Agnoli; M. de Gregorio; A. Dionisio

1984-01-01

166

Thymosin alpha 1: past clinical experience and future promise.  

PubMed

Thymosin alpha 1, originally isolated as the compound responsible for reconstitution of immune function in thymectomized animal models, has enjoyed a wide-ranging clinical development program over the past decades, extending across multiple companies, indications, countries, and continents. This paper provides an overview of this complex picture. The extensive clinical studies began with small studies conducted with an impure mixture of peptides under the aegis of physician-sponsored INDs submitted to the US FDA, in subjects with primary immune deficiency such as DiGeorge syndrome. Subsequent studies ranged all the way to large phase-3 trials conducted with synthetically produced thymosin alpha 1 and hundreds of patients, in many countries including the United States, Italy, and China. PMID:20536460

Tuthill, Cynthia; Rios, Israel; McBeath, Randy

2010-04-01

167

Agalsidase Beta Clinical Trials and Long Term Experience  

Microsoft Academic Search

\\u000a There have been phase I\\/II and III clinical trials of agalsidase beta infusions for treatment of Fabry disease. The phase\\u000a I\\/II trial demonstrated that agalsidase beta infusions were well tolerated, and that globotriaocylceramide (GL-3) clearance\\u000a was dose dependent. A phase III trials demonstrated clearance of GL-3 on a tissue level. A separate study demonstrated decreased\\u000a risk of renal progression with

Carlos E. Prada; Robert J. Hopkin

168

PATIENTS WITH GALL BLADDER CANCER: A CLINICAL EXPERIENCE  

Microsoft Academic Search

Objective: To see the clinical profile of patients with gallbladder cancer. Methodology: In this multicentre retrospective study records of all patients with gallbladder cancer, who presented at Patel Hospital, Karachi Adventist Hospital and Bilquis Naz Hospital Karachi, during January 2002 to December 2005, were reviewed. Result: Out of sixty-six, forty-nine were females (74.2%) and seventeen were males (25.8%), showing female

Abdul Qayyum

169

Twenty-year clinical experience with the Greenfield filter  

Microsoft Academic Search

The purpose of this study was to characterize the long-term safety and efficacy of the stainless-steel Greenfield filter. All patients who underwent Greenfield filter placement at three institutions during tenure of the senior author (L.J.G.) were entered prospectively into a filter registry and followed on an annual basis. Follow-up consisted of clinical examination to evaluate the status of venous disease

L. J. Greenfield; M. C. Proctor

1995-01-01

170

Chest wall tuberculosis - A clinical and imaging experience  

PubMed Central

Aims: Tuberculous infection of the thoracic cage is rare and is difficult to discern clinically or on radiographs. This study aims to describe the common sites and the imaging appearances of chest wall tuberculosis. Materials and Methods: A retrospective review of the clinical and imaging records of 12 confirmed cases of thoracic cage tuberculosis (excluding that of the spine), seen over the last 7 years, was performed. Imaging studies available included radiographs, ultrasonographies (USGs), and computed tomography (CT) scans. Pathological confirmation was obtained in all cases. Results: All patients had clinical signs and symptoms localized to the site of involvement, whether it was the sternum, sternoclavicular joints, or ribs. CT scan revealed sternal destruction in three patients and osteolytic lesions with sclerosis of the articular surfaces of the sternoclavicular joints in two patients. In five patients with rib lesions, USG elegantly demonstrated the bone destruction underlying the cold abscess. All cases were confirmed to be of tuberculous origin by pathology studies of the aspirated/curetted material, obtained by CT / USG guidance. Conclusions: Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation. CT scan plays an important role in the evaluation of these patients. However, the use of USG for demonstrating rib destruction in a chest wall cold abscess has so far been under-emphasized, as has been the role of CT and USG guided aspiration in confirming the aetiology.

Grover, Shabnam Bhandari; Jain, Meghna; Dumeer, Shifali; Sirari, Nanda; Bansal, Manish; Badgujar, Deepak

2011-01-01

171

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

172

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

173

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

174

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

Microsoft Academic Search

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

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

2005-01-01

175

Problems of Space Biology. Volume 27: Radiobiology and Genetics of Arabidopsis.  

National Technical Information Service (NTIS)

Arabidopsis thaliana is discussed as an optimum object of aerospace research on radiobiology, radiation genetics and general botanical research. Varied aspects of plant research are considered: survival, growth, development, fertility, effects of irradiat...

V. I. Ivanov

1974-01-01

176

Feasibility Assessment and Applications Development of a Radiobiological Dosimeter for Space Applications, Phase 2.  

National Technical Information Service (NTIS)

Radiobiological dosimeters were developed and evaluated for space applications. Basic properties and sensitivities of metal oxide semiconductor (MOS) dosimeters were studied and a flexible MOS dosimeter 12 cm long and 3 mm wide was developed for radiobiol...

G. Macray

1991-01-01

177

Clinical management of prolactinomas: A ten-year experience  

Microsoft Academic Search

A ten-year experience on 36 patients bearing macroprolactinomas (MP) and 86 others bearing microprolactinomas (mP) is reported\\u000a in this study. Different therapeutical approaches were used: 1) trans-sphenoidal surgery in 24 patients with MP and in 25\\u000a with mP; 2) medical therapy with the oral form of bromocriptine (BRC) in all the 24 patients with MP previously subjected\\u000a to surgery, in

Bartolomeo Merola; Annamaria Colao; Nicola Panza; Enzo Caruso; Renato Spaziante; Gennaro Schettini; Enrico De DIVITIIS; Giovanni Pacilio; Gaetano Lombardi

1992-01-01

178

Clinical experience: studies with HMG-CoA reductase inhibitors  

Microsoft Academic Search

\\u000a Before the hydroxy-methyl glutaryl CoA (HMG-CoA) reductase inhibitor (statin) era, it was known from animal experiments and\\u000a from human angiographic studies that lowering of serum total and LDL cholesterol levels is followed by regression of atherosclerotic\\u000a lesions in arteries [1]. It was also shown in humans that with extensive dietary and lifestyle changes it was possible to reduce the most

Helena K. Gyllingl; Tatu A. Miettinen

179

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

180

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

181

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

182

Gene therapy for liver cancer: clinical experience and future prospects.  

PubMed

In contrast to the large quantity of preclinical evidence for efficacy, few gene therapy agents have reached clinical development for the treatment of primary and secondary liver cancer. This review discusses the published clinical trials that have explored the feasibility, safety and efficacy of gene therapy strategies for the treatment of liver cancer. Strategies include restoration of tumor suppressor genes, genetic prodrug-activating therapy, genetic immunotherapy and oncolytic virotherapy. In these trials, transgene expression of varying degrees has been detected. Globally, gene therapy has proven to be safe, with none of the agents tested reaching the MTD. Although none of the phase II trials provided significant response rates, objective remissions have occasionally been observed and proof-of-concept for the ability of gene therapy to produce significant tumor cell killing has been determined. Insufficient delivery following intravascular administration and short-lived transgene expression are likely to be the cause of this limited antitumor efficacy. The development of new gene therapy vectors with improved characteristics will increase the probability of success of gene therapy for the treatment of liver cancer. PMID:20886388

Sangro, Bruno; Prieto, Jesus

2010-10-01

183

Clinical experience with intravenous radiosensitizers in unresectable sarcomas  

SciTech Connect

Traditionally, adult bone and soft tissue sarcomas have been considered to be ''radioresistant.'' Because of this philosophy, patients who present with locally advanced, unresectable sarcomas often are treated in a palliative fashion, usually with low-dose radiotherapy. Over the last 6 years, 29 patients with unresectable primary or metastatic sarcomas were treated using a combination of intravenous chemical radiosensitizers and high-dose irradiation. Twenty-two of 29 patients achieved clinical local control, with six patients having a complete clinical response. The time to tumor response is often several months or longer, which is in contrast to other tumor histologies (carcinomas, lymphomas), where tumor response usually occurs over several weeks. Several large tumors have shown only a minimal tumor response, yet were found to be sterilized in posttreatment biopsy or autopsy examination. Of 15 patients with primary sarcomas without metastases, 11 patients (73%) remain free of local tumor progression from 12 to 83 months. Adult high-grade sarcomas can be controlled with high-dose radiotherapy and intravenous radiosensitizers, although the precise role of these agents is unclear.

Kinsella, T.J.; Glatstein, E.

1987-03-01

184

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

185

Dideoxycytidine: current clinical experience and future prospects. A summary.  

PubMed

The reverse transcriptase inhibitor 2',3'-dideoxycytidine (ddC) is capable of mediating virologic and immunologic improvements in some patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. However, severe peripheral neuropathy often develops as a dose-limiting toxicity in ddC-treated patients. Lower doses of ddC may avoid this side effect, while retaining antiviral activity associated with this drug. A series of clinical trials is currently examining regimens employing simultaneous or alternating administration of ddC and 3'-azido-3'-deoxythymidine (zidovudine). Concurrent therapy with more than one drug may allow the use of decreased drug doses and thus reduce dose-dependent toxicities, whereas alternating schedules would provide rest periods from each drug without interrupting therapy. Since zidovudine and ddC possess different toxicity profiles and zidovudine-resistant strains remain susceptible to ddC in vitro, such regimens could theoretically provide additional benefits and reduced toxicity, compared with either agent administered alone. It is hoped that these ongoing and future studies will uncover new and better ways to exploit the therapeutic potential of ddC. However, at present, ddC is an experimental drug and should not be used outside the setting of an approved clinical protocol. PMID:2159708

Broder, S; Yarchoan, R

1990-05-21

186

Clinical experience of PDT in Brazil: a 300 patient overview  

NASA Astrophysics Data System (ADS)

Clinical application of Photodynamic Therapy (PDT) in Brazil is a result of a pioneering work in a collaborative program involving the Physics Institute and the Medical School of the University of Sao Paulo and the Amaral Carvalho Cancer Hospital in the city of Jau, Sao Paulo. This work began in 1997 with the first patient treated in 1999. Up to the end of 2003 this program has treated over 300 patients and the ones with correct follow up had their lesions included in this report. The majority of the lesions were of non-melanoma skin cancer located on the head and neck region, but the group has also treated Esophagus, Bladder, Gynecological, chest wall recurrence of breast cancer, among others. The results have shown to be compatible with internationally reported data, and we have modified some application procedures towards to a better benefit for the patient and an optimization of the results. We present the overall results observed after 5 year of experimental clinical treatment.

Kurachi, Cristina; Ferreira, Juliana; Marcassa, Luis G.; Cestari Filho, Guilherme A.; Souza, Cacilda S.; Bagnato, Vanderlei S.

2005-04-01

187

A comparison of a traditional clinical experience to a precepted clinical experience for baccalaureate-seeking nursing students in their second semester.  

PubMed

The shortage of nursing faculty has contributed greatly to the nursing workforce shortage, with many schools turning away qualified applicants because there are not enough faculty to teach. Despite the faculty shortage, schools are required to admit more students to alleviate the nursing shortage. Clinical groups in which preceptors are responsible for student learning extend faculty resources. Purpose. To determine the effectiveness of an alternative clinical experience (preceptorship). Methods. quasi-experimental, randomized, longitudinal design. Students were randomized to either the traditional or precepted clinical group. The clinical experience was a total of 12 weeks. Groups were compared according to several variables including second semester exam scores, HESI scores, and quality and timeliness of clinical paperwork. Sample. Over a two-year period, seventy-one undergraduate nursing students in the second semester medical-surgical nursing course participated. 36 were randomized to the experimental group. The preceptors were baccalaureate-prepared nurses who have been practicing for at least one year. Setting. Two hospitals located in the Texas Medical Center. Statistical Analysis. Descriptive statistics and independent t-test. Results. There was no difference between the groups on the variables of interest. Conclusion. Students in the precepted clinical group perform as well as those in a traditional clinical group. PMID:22577535

Ownby, Kristin; Schumann, Renae; Dune, Linda; Kohne, David

2012-04-22

188

Clinical Experiences Are Not Predictive of Outcomes on the NATABOC Examination  

PubMed Central

Objective: To determine the efficacy of the National Athletic Trainers' Association Board of Certification (NATABOC) clinical experience requirements and individual student characteristics to predict candidate outcomes on the NATABOC certification examination. Design and Setting: For all subjects, we gathered survey information and examination scores. The survey information included age, sex, route to certification, previous athletic training and allied health experience, and clinical education experiences. Subjects: A total of 269 subjects, 22.25% of all first-time candidates for the June and November 1993 NATABOC examinations, were included in this study. Measurements: Data were analyzed for standard descriptive statistics and parametric linear regression and correlational relationships. Results: Total clinical hours, high-risk sport experiences, and previous athletic training experience were not predictive of examination outcomes. Although our results indicated a relationship between previous allied health experience and both outcome on the written section of the examination and age and outcome on the oral/practical section, these characteristics also were not predictive of examination outcomes. Conclusions: Gaining clinical experience hours in excess of 400 hours beyond the 800-or 1500-hour requirement may yield no greater benefit for an entry-level professional than less time. The quality, rather than the quantity, of clinical experiences should be evaluated. More emphasis should be placed on the achievement of an entry level of clinical competency, rather than on total hour collection. Also, because high-risk sport experiences did not predict outcomes on the NATABOC examination, the emphasis of clinical education should be on students' receiving a more structured clinical experience, in which they are progressively required to assume greater responsibilities integrating both cognitive and psychomotor skills, while working under the supervision of a certified athletic trainer.

Turocy, Paula Sammarone; Comfort, Ronald E.; Perrin, David H.; Gieck, Joe H.

2000-01-01

189

Anti-CD40 agonist antibodies: preclinical and clinical experience  

PubMed Central

The cell-surface molecule CD40, a member of the tumor necrosis factor receptor superfamily, broadly regulates immune activation and mediates tumor apoptosis. CD40 is expressed by antigen-presenting cells (APC) and engagement of its natural ligand on T cells activates APC including dendritic cells and B cells. Agonistic CD40 antibodies have been shown to substitute for T cell help provided by CD4+ lymphocytes in murine models of T cell-mediated immunity. In tumor-bearing hosts, CD40 agonists trigger effective immune responses against tumor-associated antigens. In contrast, CD40 is also expressed on many tumor cells and its ligation in this setting mediates a direct cytotoxic effect. Engagement of CD40 on tumor cells results in apoptosis in vitro and impaired tumor growth in vivo. These observations have prompted efforts to use agonistic CD40 antibodies for the treatment of cancer patients and initial clinical results have been promising.

Khalil, Magi; Vonderheide, Robert H.

2009-01-01

190

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

191

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

192

Understanding the experience of noninclusive occupational therapy clinics: lesbians' perspectives.  

PubMed

This article presents understandings about how noninclusive occupational therapy environments are developed and maintained. The data are drawn from a study that, in part, explored the experiences of lesbian or bisexual occupational therapists working in a health care system. Ten participants each engaged in two to five in-depth audiotaped interviews. The narrative data were analyzed with a modified form of grounded theory. The data provide insight into how heterosexist occupational therapy work climates are created and maintained through four processes: heterosexual discourse, homophobic comments, assumed heterosexuality, and perceived stereotypes. The way in which heterosexist occupational therapy work climates may impede the professional growth of therapists also is presented. The knowledge gained from this study can help practitioners, professors, and students in their attempts to sustain an inclusive environment with respect to persons who are lesbian, gay, and bisexual. PMID:10686624

Jackson, J

193

Experience in international clinical research: the HIV Prevention Trials Network  

PubMed Central

The HIV Prevention Trials Network (HPTN) is supported by the NIH to conduct randomized clinical trials to assess the efficacy of HIV prevention strategies and technologies to reduce HIV transmission between adults. A special focus of attention is on the use of antiretroviral drugs to prevent HIV transmission, both by reducing infectiousness among HIV-infected persons taking combination antiretroviral therapy (cART) and also by reducing susceptibility among HIV-uninfected persons taking antiretrovirals for pre-exposure prophylaxis. Studies may be developmental in nature to assess novel ideas for interventions or for assessing trial feasibility. However, pivotal efficacy trials to test HIV-specific prevention strategies and technologies are the main HPTN priority. Examples include a major protocol investigating the impact of expanded testing and linkage to care on HIV surveillance indicators in the USA (HPTN 065). Another protocol is addressing similar issues while also investigating how combinations of prevention approaches are best deployed to make a community-level impact in southern Africa (HPTN 071). HPTN 068 is evaluating a novel conditional cash transfer structural intervention to increase school completion rates in young girls and thereby reduce their HIV risk. Studies outside the US address the epidemic in most at-risk populations and include an assessment of opiate agonist therapy to reduce risk of HIV seroconversion among injection drug users (HTPN 058), methods to increase HIV testing rates (HTPN 043), as well as methods for reducing high-risk behaviors, and increasing adherence to cART in HIV-infected individuals (HPTN 062 and HPTN 063, respectively). The recent HPTN 052 study demonstrated that a 96% reduction in HIV transmission could be achieved between serodiscordant sexual partners by providing the infected partners with cART at a CD4+ cell count (350–550/µl) above the level that would usually qualify them for therapy in low- and middle-income countries. The immediate relevance to public health policy showcased in these trials is a paradigm for the HPTN: design and conduct of clinical trials using available licensed tools that can be rapidly translated for implementation (‘Prevention NOW!’).

Sista, Nirupama Deshmane; Abdool Karim, Quarraisha; Hinson, Kathy; Donnell, Deborah; Eshleman, Susan H; Vermund, Sten H

2012-01-01

194

Comparison of primary care experiences among adults in general outpatient clinics and private general practice clinics in Hong Kong  

Microsoft Academic Search

BACKGROUND: The main goal of Hong Kong's publicly-funded general outpatient clinics (GOPCs) is to provide primary medical services for the financially vulnerable. The objective of the current study was to compare the primary care experiences of GOPC users and the users of care provided by private general practitioners (GPs) in Hong Kong via a territory-wide telephone survey. METHODS: One thousand

Samuel YS Wong; Kenny Kung; Sian M Griffiths; Tanya Carthy; Martin CS Wong; Su V Lo; Vincent CH Chung; William B Goggins; Barbara Starfield

2010-01-01

195

MIBG in the evaluation of suspected pheochromocytoma: Mayo Clinic experience  

SciTech Connect

Work done at the University of Michigan has shown that I-131 metaiodobenzylguanidine (MIBG) is an effective agent for the diagnosis and localization of pheochromocytoma. A recent report questioned the sensitivity of this test. In 1983, 40 patients at Mayo Clinic had 42 scans during the workup of suspected spontaneous pheochromocytoma or metastatic pheochromocytoma. All patients were given 500 ..mu..Ci I-131 MIBG supplied by the University of Michigan. The final diagnosis of pheochromocytoma (true positive (TP) and false negative (FN) and false positive (FP)) was made by surgery and pathology. True negative (TN) diagnosis was made by normal plasma and urinary catecholamines, and in many patients CT. There were 15 TP studies (six spontaneous pheochrocytoma, nine metastatic or recurrent pheochromoctyoma), and 22 TN studies. There was one FP study of recurrent paraganglioma near the bladder (CT was also FP) and four FN studies (two spontaneous and two metastatic) where one CT was also FN. This results in a sensitivity of 79%, specificity of 96%, and accuracy of 88%. MIBG is very useful in the workup of patients with known or suspected recurrent or metastatic pheochromocytoma and is helpful in the evaluation of the patient suspected of having a spontaneous pheochromocytoma when CT is normal.

Brown, M.L.; Sheps, S.G.; Sizemore, G.; Swensen, S.J.; Gharib, H.; Grant, C.S.; van Heerden, J.A.

1984-01-01

196

[Clinical experience with gemcitabine treatment for metastatic breast cancer].  

PubMed

It is difficult to cure recurrent or metastatic breast cancer(MBC). Therefore, it is important to continue treatment for MBC with maintenance of quality of life(QOL). Gemcitabine has been approved for MBC since February 2010. We administered gemcitabine to 39 patients with MBC between February 1, 2010 and March 31, 2012. Depending on the case, taxane or trastuzumab was added. Almost all patients had received prior chemotherapy or hormonal therapy. The median age of patients was 61 years(range, 33-82 years), and the median number of previous treatment regimens was 3(range, 0-6). The response rate was 15.4%, the disease control rate was 56.4%, and the clinical benefit rate was 33.3%. The main hematological adverse event was neutropenia, and the main non-hematological adverse event was fatigue. Neutropenia could be managed by reducing the gemcitabine dose or withdrawing treatment. Adverse events requiring hospitalization were not observed. These findings suggest that gemcitabine-based regimens are feasible in terms of efficacy and maintenance of QOL for patients with MBC. PMID:24105058

Watanabe, Mototsugu; Hara, Fumitaka; Kiyoto, Sachiko; Takahashi, Mina; Takabatake, Daiten; Takashima, Seiki; Aogi, Kenjiro; Ohsumi, Shozo

2013-10-01

197

Clinical Experience of Rigid Bronchoscopy in Single Center  

PubMed Central

Background The aim of this study was to analyze clinical situations requiring rigid bronchoscopy and evaluate usefulness of rigid bronchoscopic intervention in benign or malignant airway disorders. Methods We retrospectively reviewed 29 patients who underwent rigid bronchoscopy from November 2007 to February 2011 at St. Paul's Hospital, The Catholic University of Korea School of Medicine. Results Of the 29 patients, the most frequent underlying etiology was benign stenosis of trachea (n=20). Of those 20 patients, 16 had post-intubation tracheal stenosis (PITS), 2 had tracheal stenosis due to inhalation burn (IBTS) and other 2 had obstructive fibrinous tracheal pseudomembrane (OFTP). Other etiologies were airway malignancy (n=6), endobronchial stenosis due to tuberculosis (n=2), and foreign body (n=1). For treatment, silicone stent insertion was done in 16 cases of PITS and IBTS and mechanical removal was performed in 2 cases of OFTP. In 6 cases of malignant airway obstruction mechanical debulking was performed and silicone stents were inserted additionally in 2 cases. Balloon dilatation and electrocautery were used in 2 cases of endobronchial stenosis due to tuberculosis. In all cases of stent, airway obstructive symptom improved immediately. Granulation tissue formation was the most common complication. Conclusion Tracheal stenosis was most common indication and silicone stenting was most common procedure of rigid bronchoscopy in our center. Rigid bronchoscopic procedures, at least tracheal silicone stenting, should be included in pulmonary medicine fellowship programs because it is a very effective and indispensable method to relieve critical airway obstruction which needs training to learn.

Kim, Hyun Jin; Kim, Sei Won; Lee, Hye Yeon; Kang, Hyeon Hui; Kang, Ji Young; Kim, Ju Sang; Kim, Myung Sook; Kim, Seung Soo; Kim, Jin Woo; Yun, Hyeong Gyu; Kim, Chi Hong; Kim, Kwan Hyoung; Moon, Hwa Sik; Cho, Kwang Jae; Moon, Seok Hwan

2012-01-01

198

Immediate and Long-Term Changes in Simulated Clinical Performance Following Didactic Instruction and Preceptorship Experiences.  

National Technical Information Service (NTIS)

Changes in levels of simulated clinical performance as a result of didactic instruction and preceptorship experience in the Primex Program offered by the University of California at Los Angeles to train family nurse practitioners were investigated. Eleven...

W. R. Crawford D. V. Steeg

1976-01-01

199

42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...  

Code of Federal Regulations, 2010 CFR

...requirements for initial approval of transplant centers. 482.80 Section 482...Requirements for Specialty Hospitals Transplant Center Data Submission, Clinical Experience...requirements for initial approval of transplant centers. Except as specified in...

2009-10-01

200

42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...  

Code of Federal Regulations, 2010 CFR

...requirements for initial approval of transplant centers. 482.80 Section 482...Requirements for Specialty Hospitals Transplant Center Data Submission, Clinical Experience...requirements for initial approval of transplant centers. Except as specified in...

2010-10-01

201

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

202

Stereotactic Radiosurgery for Single Brainstem Metastases: The Cleveland Clinic Experience  

SciTech Connect

Purpose: To assess the imaging and clinical outcomes of patients with single brainstem metastases treated with stereotactic radiosurgery (SRS). Materials and Methods: We retrospectively reviewed the data from patients with single brainstem metastases treated with SRS. Locoregional control and survival were calculated using the Kaplan-Meier method. Prognostic factors were assessed using a Cox proportional hazards model. Results: Between 1997 and 2007, 43 patients with single brainstem metastases were treated with SRS. The median age at treatment was 59 years, the median Karnofsky performance status was 80, and the median follow-up was 5.3 months. The median dose was 15 Gy (range, 9.6-24), and the median conformality and heterogeneity index was 1.7 and 1.9, respectively. The median survival was 5.8 months from the procedure date. Of the 33 patient with post-treatment imaging available, a complete radiographic response was achieved in 2 (4.7%), a partial response in 8 (18.6%), and stable disease in 23 (53.5%). The 1-year actuarial rate of local control, distant brain control, and overall survival was 85%, 38.3%, and 31.5%, respectively. Of the 43 patients, 8 (19%) died within 2 months of undergoing SRS, and 15 (36%) died within 3 months. On multivariate analysis, greater performance status (hazard ratio [HR], 0.95, p = .004), score index for radiosurgery (HR, 0.7; p = .004), graded prognostic assessment score (HR, 0.48; p = .003), and smaller tumor volume (HR, 1.23, p = .002) were associated with improved survival. No Grade 3 or 4 toxicities were observed. Conclusion: The results of our study have shown that SRS is a safe and effective local therapy for patients with brainstem metastases.

Koyfman, Shlomo A.; Tendulkar, Rahul D.; Chao, Samuel T. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH (United States)

2010-10-01

203

Early Clinical Experience with the Mobi-C Disc Prosthesis  

PubMed Central

Purpose We have experienced 23 patients who had underwent cervical disc replacement with Mobi-C disc prosthesis and analyzed their radiological results to evaluate its efficacy. Patients and Methods This study was performed on 23 patients with degenerative cervical disc disease who underwent CDR with Mobi-C disc prosthesis from March 2006 to June 2006. Results The age of the study population ranged from 31 to 62 years with mean of 43 years, and 16 male and 7 female cases. Regarding axial pain, the average preoperative VAS score was 6.47 ± 1.4, while at final follow-up it was 1.4 ± 0.7 (p < 0.001). The preoperatively VAS score for radiculopathy was 6.7 ± 0.7 compared with an average score of 0 ± 0 at the final follow-up (p < 0.001). At postoperative 6th month, Odom's criteria were excellent, good, or fair for all 23 patients (100%). 7 patients (30.4%) were classified as excellent, 15 patients (65.2%) as good, and 1 patients (4.4%) as fair. Prolo economic and functional rating scale was average 8.9 ± 0.7 at postoperative 6th month. ROM in C2-7, ROM of FSU, and ROM in upper adjacent level were well preserved after CDR. Conclusion This report would be the first document about the CDR with Mobi-C disc prosthesis in the treatment of degenerative cervical disc disease. CDR with Mobi-C disc prosthesis provided a favorable clinical and radiological outcome in this study. However, Long-term follow-up studies are required to prove its efficacy and ability to prevent adjacent segment disease.

Kim, Sang Hyun; Shin, Hyun Chul; Shin, Dong Ah; Kim, Keung Nyun

2007-01-01

204

Clinical experience with Ex-press Mini Glaucoma Shunt implantation.  

PubMed

In this prospective study we wanted to report our experience and to evaluate the efficacy and safety of Ex-press Mini-Glaucoma Shunt implantation under a superficial scleral flap, as a newly and improved surgical technology in a treatment of POAG (Primary open-angle glaucoma) and refractory glaucoma. 44 eyes (35 patients) underwent an implantation of Ex-Press Mini Glaucoma Shunt. We had 21 patients with POAG (60%) and 14 patients with PEXG-pseudoexfoliation glaucoma (40%). The follow-up period was 8.62 + 7.48 months (range 2-22 months). Main outcome measures included postoperative IOP control, postoperative medications and early postoperative complications. The IOP was measured in the following postoperative time-points of 1 day, 1 week, 1, 3, 6, 9 and 12 months. The mean IOP values 1 year postoperatively were reduced for 52.8% compared to preoperative values and the use of medications were reduced for 77%. We had complications like postoperative hypotony (3.5%), choroidal ablation (7%), intraocular hemorrhage (3.5%) and postoperative shunt closure (3.5%). The Ex PRESS Mini Glaucoma Shunt implanted under a superficial scleral flap is relatively safe and effective surgical procedure and provides satisfactory IOP control and medication reduction. However, device related complications remain still a problem. PMID:22220401

Gavri?, Morena; Gabri?, Nikica; Jagi?, Jurica; Covi?, Ana

2011-09-01

205

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

206

Clinical experience treating Paecilomyces lilacinus keratitis in four patients  

PubMed Central

Background Paecilomyces lilacinus is a saprobic fungus that occasionally causes keratitis in infected patients. Voriconazole, a triazole antifungal agent, is often administered to treat P. lilacinus keratitis, because it is resistant to many antifungal agents. However, some patients may not require voriconazole. Here, we report our experience of treating this infection and compare outcomes between patients treated with or without voriconazole. Subjects We retrospectively reviewed four cases of infectious keratitis caused by P. lilacinus and compared treatment course and outcomes among the four cases. Observations P. lilacinus was isolated from corneal cultures in all four cases. Three cases developed corneal perforation and underwent keratoplasty. Voriconazole was given in two cases with severe and refractory infection. Both required long-term treatment despite the effectiveness of voriconazole. They also had a medical history of diabetes and corticosteroid therapy. In two cases that were not treated with voriconazole, the eye conditions improved with a short treatment period (2–3 weeks). Neither of these cases had a medical history of diabetes, nor had they used corticosteroids. Conclusion Although voriconazole is the most useful antifungal agent for treating P. lilacinus keratitis, this infection can be resolved by other treatments. Voriconazole should be offered to patients with diabetes and/or prior corticosteroid use.

Monden, Yu; Sugita, Minoru; Yamakawa, Ryoji; Nishimura, Kazuko

2012-01-01

207

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

208

Gaucher disease and the clinical experience with substrate reduction therapy.  

PubMed Central

Gaucher disease is caused by an enzymatic defect with consequent accumulation of glucocerebroside. Type I, the non-neuronopathic form, is rather common and panethnic. Patients may present with hepatosplenomegaly, anaemia, thrombocytopenia and skeletal or lung involvement. Enzyme replacement therapy ameliorates disease symptoms and signs; however, it involves lifelong intravenous therapy, is costly and is incapable of crossing the blood-brain barrier. Substrate reduction with N-butyldeoxynojirimycin (OGT 918) is a harbinger of oral iminosugars for glycolipid storage disorders. Long-term data in the seminal trial (100 mg three times per day), demonstrate safety and efficacy in adult type I patients naive to enzyme therapy, and suggest its application in patients unwilling or unable to receive enzyme replacement and tolerating side effects, including diarrhoea, weight loss, tremor and peripheral neuropathy (mostly reversible with dose reduction or withdrawal). Dose dependency was demonstrated with 50 mg three times per day. In patients stabilized on enzyme therapy switched from or in combination with enzyme, no deterioration in disease parameters was seen but side effects were as above. Although efficacy is less dramatic than enzyme treatment, it may be that plateaux are achieved asymptotically so therapeutic outcomes with OGT 918 may ultimately be comparable. Yet, given the above side effects and the lack of long-term experience, patients with very mild manifestations would probably not be appropriate candidates.

Zimran, Ari; Elstein, Deborah

2003-01-01

209

The Bridge to Practice Model: a collaborative program designed for clinical experiences in baccalaureate nursing.  

PubMed

The Bridge to Practice Model provides undergraduate nursing students with continuity in medical-surgical education through placement in the same hospital for all medical-surgical clinical rotations. Hospitals that participate in the bridge model provide senior clinical nurse preceptors whose time is paid for by the university. The university provides an on-site nurse faculty member who works with nursing education to coordinate all clinical groups. Institutional continuity and university/hospital collaboration result in less orientation time for students and faculty, more involvement with clinical support services and care management, and more informed employment choices by senior students. Challenges include recruitment of interested senior clinical nurses, retention of clinical liaison faculty, and management of the trade-off between institutional stability offered by clinical site continuity and the variety of experiences offered by rotation across several clinical settings. PMID:18979693

Paterson, Mary; Grandjean, Cindy

210

Comparison of treatment effects between animal experiments and clinical trials: systematic review  

Microsoft Academic Search

Objective To examine concordance between treatment effects in animal experiments and clinical trials. Study design Systematic review. Data sources Medline, Embase, SIGLE, NTIS, Science Citation Index, CAB, BIOSIS. Study selection Animal studies for interventions with unambiguous evidence of a treatment effect (benefit or harm) in clinical trials: head injury, antifibrinolytics in haemorrhage, thrombolysis in acute ischaemic stroke, tirilazad in acute

Pablo Perel; Ian Roberts; Emily Sena; Philipa Wheble; Catherine Briscoe; Peter Sandercock; Malcolm Macleod; Luciano E Mignini; Pradeep Jayaram; Khalid S Khan

2006-01-01

211

Children's Views Matter Too! A Pilot Project Assessing Children's and Adolescents' Experiences of Clinical Psychology Services  

ERIC Educational Resources Information Center

|This pilot study explored the experiences and understanding of clinical psychology practices and services of children and adolescents attending clinical psychology outpatient appointments. Fifteen young participants took part in the study. A content analysis indicated that young children and adolescents have an appropriate understanding of the…

Gordon, Michael; Russo, Kate

2009-01-01

212

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

213

Students' Experiences of Clinic-Based Learning during a Final Year Veterinary Internship Programme  

ERIC Educational Resources Information Center

This study investigated veterinary students' experiences of clinic-based learning (CBL) during a comprehensive final year internship programme. Open-ended surveys (n = 93) were used to gather qualitative data about students' conceptions of what is learned during CBL and their approaches to learning in clinics. Phenomenography was used for detailed…

Matthew, Susan M.; Taylor, Rosanne M.; Ellis, Robert A.

2010-01-01

214

Children's Views Matter Too! A Pilot Project Assessing Children's and Adolescents' Experiences of Clinical Psychology Services  

ERIC Educational Resources Information Center

This pilot study explored the experiences and understanding of clinical psychology practices and services of children and adolescents attending clinical psychology outpatient appointments. Fifteen young participants took part in the study. A content analysis indicated that young children and adolescents have an appropriate understanding of the…

Gordon, Michael; Russo, Kate

2009-01-01

215

Comparison of treatment effects between animal experiments and clinical trials: systematic review  

Microsoft Academic Search

Objective To examine concordance between treatment effects in animal experiments and clinical trials. Study design Systematic review. Data sources Medline, Embase, SIGLE, NTIS, Science Citation Index, CAB, BIOSIS. Study selection Animal studies for interventions with unambiguous evidence of a treatment effect (benefit or harm) in clinical trials: head injury, antifibrinolytics in haemorrhage, thrombolysis in acute ischaemic stroke, tirilazad in acute

Pablo Perel; Ian Roberts; Emily Sena; Philipa Wheble; Catherine Briscoe; Peter Sandercock; Malcolm Macleod; Luciano E Mignini; Pradeep Jayaram; Khalid S Khan

2007-01-01

216

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

217

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

218

Simulating clinical experience: Exploring Second Life as a learning tool for nurse education  

Microsoft Academic Search

Healthcare professionals have established that experience gained through simulation is a fundamental learning activity in developing competent nurses. An emerging technology that has, up to now, had little consideration as a clinical simulation platform is three- dimensional multi-user virtual environments. The purpose of this study was to explore Second Life as a clinical simulation platform, based on the attitudes and

Luke Rogers

219

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

220

Clinical Hypnosis with a Little League Baseball Population: Performance Enhancement and Resolving Traumatic Experiences  

Microsoft Academic Search

A model for the use of clinical hypnosis with a Little League population was proposed and outlined with dual emphasis: performance enhancement and resolving traumatic experiences. The Performance Enhancement Training Model was developed to enhance performance with this non-patient population. It employed clinical hypnosis to bring to fruition recommendations made by coaches to enhance players' batting proficiency. The second emphasis

Alex Iglesias; Adam Iglesias

2011-01-01

221

Iatrogenic Paresthesia in the Third Division of the Trigeminal Nerve: 12 Years of Clinical Experience  

Microsoft Academic Search

Background: Iatrogenic paresthesia in the third division of the trigeminal nerve remains a complex clinical problem with major medicolegal implications. However, most lawsuits can be prevented through better planning of procedures and by obtaining informed consent. The purpose of this article is to present the authors' clinical experience over the past 12 years, to review the principles of prevention and

René Caissie; Jacques Goulet; Michel Fortin; Domenic Morielli

2005-01-01

222

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

223

Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity?  

Microsoft Academic Search

In a recent article, Weisz, Weiss, and Donenberg (1992) compared the effects of child and adolescent psychotherapy in experimental studies and in studies of clinic practice. Here we update that report with new information and we explore 10 possible reasons why, to date, therapy in experiments appears to have shown larger effect sizes than therapy in clinics. We find that

John R. Weisz; Geri R. Doneffberg; Susan S. Han; Danika Kauneckis I

1995-01-01

224

Clinical experience with Sandostatin LAR in patients with acromegaly.  

PubMed

Patients with acromegaly, who are not cured after transsphenoidal adenomectomy, may be treated with external irradiation and/or octreotide injections. Recently, a long-acting formulation of octreotide (Sandostatin LAR has become available in clinical practice. We assessed the effects of treatment with this long-acting octreotide in 18 consecutive patients with acromegaly treated in our center, who had persistent signs and symptoms of acromegaly despite transsphenoidal surgery with (n=7) or without irradiation (n=11). Twelve had already been treated with regular Sandostatin for a period of 0.5-8 years in dosages of 3 x 50 to 3 x 300 mcg s.c. (median daily dose 300 mcg). All patients started with i.m. injections of 20 mg Sandostatin LAR every 4 weeks. In the patients who started treatment with octreotide for the first time, mean serum IGF-1 levels (measured by IRMA, Nichols Diagnostics) decreased from 634+/-229 to 255+/-88 ng/ml after 3 months, 271+/-81 ng/ml after 1 year and 263+/-97 ng/ml after 2 years (all P<0.05), while random GH levels (DELFIA, Wallac) decreased from 6.6 (range 3.1-67.0) to 2.1 (0.5-3.1) mU/l after 2 years (P<0.05). In the 12 patients who had already been treated with octreotide, mean IGF-1 also fell, from 367+/-193 to 331+/-195 ng/ml (P=0.023) after 3 months, to 342+/-191 ng/ml after 1 year and 277+/-169 ng/ml (P=0.002) after 2 years, while random GH levels decreased from 4.5 (1.1-46) mU/l at baseline to 2.1 (0.4-23.0) after 2 years (P=0.003). Therefore, the average decrease of IGF-1 was 10% after 3 months and 25% after 2 years. One patient had a decrease of less than 5% (but her IGF-1 was normal, 193 ng/ml), and one patient showed no response to both regular and long-acting Sandostatin (ave. IGF-1, 755 ng/ml). No specific side-effects occurred. One patient chose to return to t.i.d. injection of regular octreotide because of slight worsening of her complaints of headache despite normal IGF-1 levels. All other patients favoured continuation of the monthly injections. In six patients, the dose had to be increased to 30-40 mg monthly because the IGF-1 levels still remained elevated. Sandostatin LAR may be considered a great improvement for the treatment of patients with (symptomatic) acromegaly. PMID:11744180

Heijckmann, C A; Menheere, P P; Sels, J P; Beuls, E A; Wolffenbuttel, B H

2001-12-01

225

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

226

Amchitka Radiobiological Program. Final report, July 1970-December 1979  

SciTech Connect

The Amchitka Radiobiological Program, to collect biological and environmental samples for radiological analyses, began in 1970 and continued through 1979. The principal objective was to determine the extent of radionuclide contamination from worldwide atmospheric fallout and from the detonation of three underground nuclear tests on Amchitka. Leakage of radionuclides from the underground test sites would be suspected if the amount of contamination was significantly greater than could be attributed to worldwide fallout or if an unexpected assemblage of radionuclides was detected. No radionuclides from the underground sites were detected, except for tritium from the Long Shot test (1965) which produced increased tritium concentrations in surface water and freshwater plants near the test site. This final report compiles all previous data into one report and considers the temporal trends in these data. Two naturally occurring radionuclides, /sup 40/K and /sup 7/Be, were the most abundantly occurring radionuclides in most samples; in lichen samples either /sup 137/Cs or /sup 144/Ce had the highest activity. All samples were below applicable Radiation Protection Guides and by 1979 most samples were near or below the statistical detection limits. Increased concentrations of short-lived fallout radionuclides following the Chinese atmospheric tests were found in freshwater and seawater samples and in most indicator organisms.

Sibley, T.H.; Tornberg, L.D.

1982-11-01

227

Radiobiological study by using laser-driven proton beams  

NASA Astrophysics Data System (ADS)

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 ?-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.; Sato, K.; Nishikino, M.; Mori, M.; Teshima, T.; Numasaki, H.; Murakami, M.; Demizu, Y.; Akagi, S.; Nagayama, S.; Ogura, K.; Sagisaka, A.; Orimo, S.; Nishiuchi, M.; Pirozhkov, A. S.; Ikegami, M.; Tampo, M.; Sakaki, H.; Suzuki, M.; Daito, I.; Oishi, Y.; Sugiyama, H.; Kiriyama, H.; Okada, H.; Kanazawa, S.; Kondo, S.; Shimomura, T.; Nakai, Y.; Tanoue, M.; Sugiyama, H.; Sasao, H.; Wakai, D.; Kawachi, T.; Nishimura, H.; Bolton, P. R.; Daido, H.

2009-07-01

228

[Exposure to ionizing radiation: radiobiological effects and pathogenesis. 1].  

PubMed

The present paper describes the radiobiological effects induced by an exposure to ionizing radiation and their pathogenesis. The different skin reactions are described in detail because of their importance and frequency. Thus the acute skin lesions after high doses and the late effects resulting, either from high doses, or from accumulation of chronic irradiation, are studied. The main early syndromes are then characterized: neurological, gastro-intestinal, bone-marrow and prodromic. As far as the complex problem of radiocarcinogenesis is concerned, the main results derived from studies by international organizations such as the ICRP and the UNSCEAR are reported: risk coefficient of 5% per gray, for lethal radio-induced cancer, after total body irradiation, at low dose of low-LET radiation. The effects of irradiation in utero are then considered: risk of malformation after irradiation during the two first months of pregnancy and risk of mental retardation after irradiation during the third and the fourth months. Finally, the genetic risk is presented as being equal to one fourth of the risk of carcinogenesis at low-doses. The effects of irradiation on the gonads are also described. PMID:8720971

Wambersie, A; Smeesters, P; Frühling, J

1996-02-01

229

[Exposure to ionizing radiation: radiobiological and pathogenic effects (2)].  

PubMed

The present paper describes the radiobiological effects induced by an exposure to ionizing radiation and their pathogenesis. The different skin reactions are described in detail because of their importance and frequency. Thus the acute skin lesions after high doses and the late effects resulting, either from high doses, or from accumulation of chronic irradiation, are studied. The main early syndromes are then characterized: neurological, gastro-intestinal, bone-marrow and prodromic. As far as the complex problem of radiocarcinogenesis is concerned, the main results derived from studies by international organizations such as the ICRP and the UNSCEAR are reported: risk coefficient of 5% per gray, for lethal radioinduced cancer, after total body irradiation, at low dose of low-LET radiation. The effects of irradiation in utero are then considered: risk of malformation after irradiation during the two first months of pregnancy and risk of mental retardation after irradiation during the third and the fourth months. Finally, the genetic risk is presented as being equal to one fourth of the risk of carcinogenesis at low doses. The effects of irradiation on the gonads are also described. PMID:8685552

Wambersie, A; Smeesters, P; Frühling, J

1996-04-01

230

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

231

The radiobiological basis for tissue reactions in the oral cavity following therapeutic x-irradiation. A review  

SciTech Connect

The radiobiological basis for the response of tissues in the oral cavity following therapeutic doses of ionizing radiation has been reviewed. Clinical manifestations of radiation response occur when the functional compartment of the tissue, the parenchymal cells, is depleted to some minimal value. The time course and severity of the response depend on the sensitivity of cellular compartments, the vegetative intermitotic compartment being the most sensitive and the fixed postmitotic cells being the least sensitive. Early responses are therefore seen in rapid cell renewal systems while the chronic effects are closely correlated with damage to the terminal vascular bed, a multipotential connective tissue compartment. Osteonecrosis of bone following irradiation involves a series of events, including a decreased salivary gland function, devitalization of bone, and infection. Carcinogenesis in oral cavity tissues is a very rare late sequela of therapeutic radiation.

Baker, D.G.

1982-01-01

232

A systematic review of evidence on the links between patient experience and clinical safety and effectiveness  

PubMed Central

Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.

Doyle, Cathal; Lennox, Laura; Bell, Derek

2013-01-01

233

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

234

Peroral small-intestinal biopsy: experience with the hydraulic multiple biopsy instrument in routine clinical practice  

Microsoft Academic Search

Experience of the peroral, hydraulic, multiple, small-bowel biopsy instrument is recorded and compared with reported experience of other peroral biopsy instruments. It is concluded that, in routine clinical practice, there is no particular danger associated with this instrument despite warnings to the contrary. Furthermore, biopsies are obtained at least as quickly as with other instruments and with great reliability. Since

B B Scott; M S Losowsky

1976-01-01

235

The use of therapist self-disclosure: Clinical psychology trainees' experiences  

Microsoft Academic Search

This qualitative study examined clinical psychology trainees' experiences of using, or not using, therapist self-disclosure and their experience of training and supervision on this issue. Fourteen trainees were interviewed and their accounts analyzed using interpretative phenomenological analysis, yielding nine themes organized into two domains. The first domain (“the decision in the moment”) concerned participants' struggle with decision making about disclosure;

Samantha Bottrill; Nancy Pistrang; Chris Barker; Michael Worrell

2010-01-01

236

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

237

Effectiveness of simulation-based orientation of baccalaureate nursing students preparing for their first clinical experience.  

PubMed

This study evaluated the effectiveness of a 2-day, simulation-based orientation for baccalaureate nursing students preparing to begin their first clinical experience. Students were recruited for participation in the study from a clinical foundation course. Actors (standardized patients) provided students with the chance to engage with simulated real patients in realistic clinical situations prior to entering the clinical setting. Students' perceived stress, knowledge acquisition, anxiety, self-confidence, and satisfaction with the orientation process were assessed. Findings indicated a statistically significant increase in knowledge of and confidence in skills needed when first entering the clinical setting and a decrease in anxiety following the orientation activity. Students had a positive attitude about interaction with real patients, faculty, and other students during the experience. Improved self-confidence and satisfaction were reported as a result of participation in simulation-based orientation. PMID:23230885

Dearmon, Valorie; Graves, Rebecca J; Hayden, Sue; Mulekar, Madhuri S; Lawrence, Sherry M; Jones, Loretta; Smith, Kandy K; Farmer, Joseph E

2012-12-12

238

Clinical needs finding: developing the virtual experience-a case study.  

PubMed

We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as "virtual" clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but also increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

Mittal, Vaishali; Thompson, Megan; Altman, Stuart M; Taylor, Peter; Summers, Alexander; Goodwin, Kelsey; Louie, Angelique Y

2013-03-13

239

Clinical experience of residents with RPD treatment in U.S. graduate prosthodontics programs.  

PubMed

This cross-sectional study was conducted to quantify the clinical experience of prosthodontic residents with cast metal removable partial denture (RPD) treatment based on their year of training, geographic location of the program, and nature of the program. A web-based survey consisting of five questions was e-mailed to program directors from forty-two programs across the United States. A 62 percent response rate was obtained (26/42). Thirteen of the programs (50 percent of respondents) stipulated a specific number of RPDs to be done prior to completion of the program. Clinical experience of residents varied vastly based on year of training, geographic location of the program, and nature of the program. Prosthodontic residents from southern states, university-based programs, and public school programs had more clinical experience than residents from other programs. The average clinical experience for a prosthodontic resident during three years of training was eight traditional RPDs and two implant-supported RPDs. This is the first study done exploring this topic and provides baseline information on residents' clinical experience in RPD treatment. Future studies will determine educational trends and reassess this portion of the curriculum in graduate prosthodontics. PMID:20145065

Bidra, Avinash S; Agar, John R

2010-02-01

240

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

241

Sensitivity Analysis of Parameters in Linear-Quadratic Radiobiologic Modeling  

SciTech Connect

Purpose: Radiobiologic modeling is increasingly used to estimate the effects of altered treatment plans, especially for dose escalation. The present article shows how much the linear-quadratic (LQ) (calculated biologically equivalent dose [BED] varies when individual parameters of the LQ formula are varied by {+-}20% and by 1%. Methods: Equivalent total doses (EQD2 = normalized total doses (NTD) in 2-Gy fractions for tumor control, acute mucosal reactions, and late complications were calculated using the linear- quadratic formula with overall time: BED = nd (1 + d/ [{alpha}/{beta}]) - log{sub e}2 (T - Tk) / {alpha}Tp, where BED is BED = total dose x relative effectiveness (RE = nd (1 + d/ [{alpha}/{beta}]). Each of the five biologic parameters in turn was altered by {+-}10%, and the altered EQD2s tabulated; the difference was finally divided by 20. EQD2 or NTD is obtained by dividing BED by the RE for 2-Gy fractions, using the appropriate {alpha}/{beta} ratio. Results: Variations in tumor and acute mucosal EQD ranged from 0.1% to 0.45% per 1% change in each parameter for conventional schedules, the largest variation being caused by overall time. Variations in 'late' EQD were 0.4% to 0.6% per 1% change in the only biologic parameter, the {alpha}/{beta} ratio. For stereotactic body radiotherapy schedules, variations were larger, up to 0.6 to 0.9 for tumor and 1.6% to 1.9% for late, per 1% change in parameter. Conclusions: Robustness occurs similar to that of equivalent uniform dose (EUD), for the same reasons. Total dose, dose per fraction, and dose-rate cause their major effects, as well known.

Fowler, Jack F. [Departments of Human Oncology and Medical Physics, School of Medicine, University of Wisconsin, Madison, WI (United States)], E-mail: jackfowlersbox@gmail.com

2009-04-01

242

Sebaceous carcinoma in the clinical setting of non-Hodgkin lymphoma: the Mayo Clinic experience.  

PubMed

Objectives  Non-Hodgkin lymphoma is a hematologic malignancy associated with the more aggressive behavior of some forms of skin cancer. An association between sebaceous carcinoma and immunosuppression has been identified, but the behavior of sebaceous carcinoma in the setting of non-Hodgkin lymphoma has not been studied. This study aimed to increase understanding of the behavior of sebaceous carcinoma in patients with concomitant non-Hodgkin lymphoma. Methods  Six patients diagnosed with sebaceous carcinoma and non-Hodgkin lymphoma from 1976 to 2008 were identified at the Mayo Clinic in Rochester, Minnesota. Their charts were reviewed retrospectively. Results  All six patients were male and White and presented with sebaceous carcinoma on non-eyelid regions of the head and neck. Two patients had Muir-Torre syndrome; four had secondary cancers that included colon, prostate, transitional cell, and urothelial cancers. Skin cancers other than sebaceous carcinoma included basal cell carcinoma and squamous cell carcinoma. Three patients died of causes unrelated to sebaceous carcinoma; one died of an unknown cause and two were alive at the time of the study. Conclusions  Sebaceous carcinoma does not appear to behave more aggressively in the setting of non-Hodgkin lymphoma. Larger studies are needed to definitively understand how sebaceous carcinoma behaves in patients with lymphoma. PMID:23675639

Chang, Timothy W; Weaver, Amy L; Brewer, Jerry D

2013-05-15

243

Health care students' personal experiences and coping with bullying in clinical training.  

PubMed

Previous studies show that health care students have experienced bullying by nursing staff in clinical training. Although these studies provide plenty of information considering the manifestation and consequences of bullying on students, there is a gap of knowledge on how health care students' cope with bullying. In addition, previous studies seem to have focused only on the experiences of nursing and midwifery students. This paper presents the results of a qualitative study exploring the bullying experiences of Finnish health care students (n=41) representing two Universities of Applied Sciences. In order to provide information for faculties of health care on bullying intervention and prevention strategies, this study aimed at describing health care students' experiences and coping with bullying in clinical training. Based on previous study findings, an electronic semi-structured questionnaire was developed for the data collection. The qualitative data was analysed using inductive content analysis. The results show that the students experienced verbal and non-verbal bullying in clinical training. In addition to psychological and physical symptoms, bullying also decreased the students' learning, their studying motivation and their professional engagement. One reason why some students did not share their bullying experiences with their teachers and clinical instructors was their idea that sharing their experiences would be useless. On the other hand, students who did share their experiences with a teacher or a clinical instructor usually received emotional support, information, and help in the form of bullying intervention. The results of this study suggest that faculties of health care need to develop action plans against bullying in co-operation with clinical training sites in order to ensure students' learning and professional engagement. In the future, it is suggested that research is focused on factors preventing and contributing to bullying towards health care students. PMID:23021404

Hakojärvi, Henna-Riikka; Salminen, Leena; Suhonen, Riitta

2012-09-25

244

An alpha-particle irradiator for radiobiological research and its implementation for bystander effect studies.  

PubMed

An experimental system based on an improved version of an existing alpha-particle irradiator has been developed for radiobiological studies, in particular those investigating bystander effects. It consists of a 20-mm-diameter stainless steel chamber that can be equipped alternatively with 244Cm or 241Am sources of different activities. Mylar-based petri dishes 56 mm in diameter were specially designed to house adaptors for permeable membrane inserts that reproduce the geometry of commercial cell culture insert companion plates. Characterization of the radiation field at the cell level was performed by experimental measurements and calculations. The average incident LET was about 122 keV/microm for 244Cm and about 125 keV/microm for 241Am. Dose rates at the chosen source-sample distance were 2.8 and 88.6 mGy/min, respectively. These low dose rates are suitable for our planned experiments on low-dose effects. For both sources, the uniformity of the alpha-particle dose was better than +/-7%, and the photon dose calculated at the cell entrance was negligible compared to the alpha-particle dose. The irradiator is small enough to be inserted into a cell incubator for irradiation under physiological conditions or into a refrigerator to prevent metabolic processes during irradiation. Benchmark experiments using the 241Am source to examine DNA double-strand breaks in directly hit and bystander primary human fibroblasts have shown that the irradiator can be used successfully for bystander effect studies. PMID:19883232

Esposito, Giuseppe; Antonelli, Francesca; Belli, Mauro; Campa, Alessandro; Simone, Giustina; Sorrentino, Eugenio; Tabocchini, Maria Antonella

2009-11-01

245

Clinical experience with infliximab therapy in 100 patients with Crohn's disease  

Microsoft Academic Search

OBJECTIVE:The aim of this study was to assess our clinical experience with infliximab, a monoclonal antitumor necrosis factor antibody, following its approval for treatment of refractory Crohn's disease (CD).METHODS:We followed 100 consecutive patients with CD (53 women and 47 men; mean age, 41 yr) who received a total of 233 infliximab (5 mg\\/kg) infusions. Adverse events were noted and clinical

Richard J. Farrell; Samir A. Shah; Parag J. Lodhavia; Mazen Alsahli; Kenneth R. Falchuk; Pierre Michetti; Mark A. Peppercorn

2000-01-01

246

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

Microsoft Academic Search

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

Kevin R. Kozak; Barbara L. Smith; Judith C. Adams; Ellen Kornmehl; Angela Katz; Michele Gadd; Michelle Specht; Kevin Hughes; Valeria Gioioso; Hsiao-Ming Lu; Kristina Braaten; Abram Recht; Simon N. Powell; Thomas F. DeLaney; Alphonse G.. Taghian

2006-01-01

247

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

248

An exploration of the clinical learning experience of nursing students in nine European countries.  

PubMed

The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship. PMID:20409620

Warne, Tony; Johansson, Unn-Britt; Papastavrou, Evridiki; Tichelaar, Erna; Tomietto, Marco; Van den Bossche, Koen; Moreno, Maria Flores Vizcaya; Saarikoski, Mikko

2010-04-20

249

Discectomy combined with isolated facet joint fusion—as an alternative fusion technique. Our clinical experience  

Microsoft Academic Search

Objective  The purpose of the present study is to present our experience and clinical results with surgical technique of discectomy and\\u000a facet joint fusion. Our goal was to achieve pain free and stable back (segmental stability) after lumbar disc surgery and\\u000a to assess the status of fusion and its relationship with clinical results.\\u000a \\u000a \\u000a \\u000a Study design  The proposed study is a prospective clinical

Sudeep Jain; Devdatta Suhas Neogi; Baldeep Singh; Saurabh Singh; Ramesh Kumar; Sudhir K. Kapoor

2009-01-01

250

Management of genital herpes by genitourinary physicians: does experience or doctor's gender influence clinical management?  

Microsoft Academic Search

OBJECTIVE--To determine the variation in management of genital herpes by genitourinary physicians, and whether their duration of experience or gender influence their clinical management. METHODS--A postal questionnaire was sent to UK consultant genitourinary physicians with detailed questions about management of primary and recurrent herpes. The gender and duration of genitourinary medicine experience of the physicians were also recorded. RESULTS--One hundred

J M Russell; M Cracknell; S E Barton; J Catalan

1993-01-01

251

Asian Americans and Cancer Clinical Trials: A Mixed-Methods Approach to Understanding Awareness and Experience  

PubMed Central

Cancer clinical trials have been based on low accrual rates. Barriers to recruitment of minority populations affect the generalizability and impact of trial findings for those populations. The authors undertook a mixed-methods approach to understanding levels of awareness and experiences with cancer clinical trials. A survey was administered to new cancer patients and their caretakers (family, close friends, or other social support) at outpatient oncology clinics. Field observations of the trial accrual process also were conducted by employing the grounded theory approach in qualitative methods. Comparison of survey results for Asian-American respondents and non-Asian respondents indicated that Asians were less likely to have heard the term “clinical trial” and were more likely to define a clinical trial as “an experiment” or “a test procedure in a clinic” than non-Asians. Asians were more likely to have employer-based insurance and to report understanding issues related to cost reimbursement. Asians were less likely to have been involved in or to know someone in a trial and reported less willingness than white respondents to consider trial participation. Qualitative observations suggested that Asians who presented for a potential trial were interested in the availability of a novel cancer therapy but were not eligible for available trials. Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians, including richer understanding and increased involvement of Asians in cancer clinical trials and greater attention to the location and diversity of the Asian population in structuring study centers and evaluating trial results.

Paterniti, Debora A.; Chen, Moon S.; Chiechi, Christine; Beckett, Laurel A.; Horan, Nora; Turrell, Corinne; Smith, Ligaya; Morain, Claudia; Montell, Lisa; Gonzalez, Jose Luis; Davis, Sharon; Lara, Primo N.

2006-01-01

252

A Radiobiological Analysis of Multicenter Data for Postoperative Keloid Radiotherapy  

SciTech Connect

Purpose: To identify factors significantly affecting recurrence rates after postoperative external beam radiotherapy (XRT) of keloids, and to delineate any radiation dose response and effects of radiation dose per fraction. Methods and Materials: A comprehensive literature review was performed to compile a database of 2,515 resected keloids (36.9% earlobe). Postoperative XRT was 45- to 100-kV X-rays in 27.0% or 120- to 250-kV X-rays in 11.1%, Co-60 in 1.9%, Sr-90 in 4.7%, 1.5- to 9-MeV electrons in 26.5%, and no XRT in 28.8%. In the 1,791 irradiated patients, the median radiation parameters were as follows: total dose, 15 Gy (range, 6-30 Gy); dose per fraction, 5.0 Gy (range, 2-15 Gy); fractions, 3 (range, 1-10); and time, 7 days (range, 0-33 days). Results: Multivariate stepwise logistic regression correlated decreased keloid recurrence with earlobe location (p = 1.98E-10; odds ratio, 0.34), biologically effective dose (p = 1.01E-27), and treatment with electron beam or Co-60 vs. other techniques (p = 0.0014; odds ratio, 0.72). Different radiobiological models calculated values of {alpha}/{beta} = 1.12 to 2.86 (mean, 2.08) and time (repopulation) correction factors for biologically effective dose from 0.98 to 2.13 Gy per day (mean, 1.34) starting 10 days after surgery. Different models (with {alpha}/{beta} = 2.08) predicted that doses needed for 90% and 95% control with 3 fractions of postoperative electron beam were 16.0 to 16.2 Gy and 18.3 to 19.2 Gy, respectively, in less than 10 days for earlobe keloids and 21.5 to 22.2 Gy and 23.4 to 24.8 Gy, respectively, in less than 10 days for other sites. Conclusions: Postoperative keloid radiotherapy requires moderately high doses and optimal technique to be effective. The relatively low {alpha}/{beta} ratio indicates that radiotherapy with a limited number of fractions and high doses per fraction is the best strategy.

Flickinger, John C., E-mail: flickingerjc@upmc.ed [Departments of Radiation Oncology and Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA (United States)

2011-03-15

253

Introductory and advanced pharmacy practice experiences within campus-based influenza clinics.  

PubMed

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. PMID:23610479

Conway, Susan E; Johnson, Eric J; Hagemann, Tracy M

2013-04-12

254

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

255

The Use of Student Time Task Measures in Pre Student Teaching Clinical Experiences: A Panel Presentation.  

ERIC Educational Resources Information Center

|Illinois State University's teacher education program's professional sequence is organized around separate teaching skills, each of which relates to student outcomes in classrooms. Initially, a group of University High (U-High) Laboratory School supervisors was formed to develop clinical experiences which would enable prospective teachers to…

Waimon, Morton D.; And Others

256

Classification of Adults with Problematic Internet Experiences: Linking Internet and Conventional Problems from a Clinical Perspective  

Microsoft Academic Search

This article utilizes data from clinical reports of 929 adults to examine whether various prob- lematic Internet experiences are distinctly different from or extensions of conventional prob- lems. A TwoStep Cluster Analysis identified three mutually exclusive groups of adults, those with (1) online relationship problems and victimization; (2) online and offline problems; and (3) marital discord. Results suggest some initial

Kimberly J. Mitchell; David Finkelhor; Kathryn A. Becker-Blease

2007-01-01

257

‘Distally based dorsal hand flaps’: clinical experience, cadaveric studies and an update  

Microsoft Academic Search

Many developments have taken place in the area of distally based dorsal hand flaps since 1988. This paper reported these developments as well as our clinical experience and cadaveric studies. Thirty-three reverse dorsal metacarpal artery (RDMA) flaps, 11 reverse dorsal digital artery (RDDA) flaps and five extended RDMA flaps done in the Institute for Research and Rehabilitation of Hand, Stanley

Gunasekar Vuppalapati; C. Oberlin; G. Balakrishnan

2004-01-01

258

International Nursing Student Exchange: Rural and Remote Clinical Experiences in Australia  

Microsoft Academic Search

A rural and remote international clinical exchange permits the senior nursing student to experience another culture and to develop a feel for daily life and nursing practice abroad. In a student exchange between Australia and Canada, similarities exist with regard to life and work for nurses who live in these developed countries. Similarities extend to a growing population base of

Arlene Kent-Wilkinson; Linda Starr; Sandra Dumanski; Jennifer Fleck; Annette LeFebvre; Amanda Child

2010-01-01

259

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

260

Preservice Teachers' Reflection on Clinical Experiences: A Comparison of Blog and Final Paper Assignments  

ERIC Educational Resources Information Center

|This study focused on the depth of reflection in the writing of preservice teachers who completed end-of-the-semester reflective papers or reflective blogs for undergraduate education courses associated with clinical experiences. Coders rated the depth of reflection as one of four categories: non-reflection, understanding, reflection, or critical…

Harland, Darci J.; Wondra, Joshua D.

2011-01-01

261

Reliability of Objective Structured Clinical Examinations: Four Years of Experience in a Surgical Clerkship.  

ERIC Educational Resources Information Center

|Four years of experience with an objective structured clinical examination (OSCE) following an eight-week surgical clerkship (n=356 students) are reported, including data on mean student performance across years, reliability coefficients, and generalizability. Implications for improvement and development of OSCE are discussed. (Author/MSE)|

Mann, Karen V.; And Others

1990-01-01

262

Management Development in Health Care: Exploring the Experiences of Clinical Nurse Managers  

ERIC Educational Resources Information Center

|Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…

Purcell, Laura; Milner, Brigid

2005-01-01

263

Fetoscopic Endotracheal Occlusion for Severe Isolated Diaphragmatic Hernia: Initial Experience from a Single Clinic in Brazil  

Microsoft Academic Search

Objective: To report on the initial experience in a single Brazilian university clinic of the use of fetoscopic endotracheal occlusion (FETO) to treat severe isolated congenital diaphragmatic hernia (CDH). Methods: The inclusion criteria for FETO for this prospective study were isolated CDH and intrathoracic herniation of the liver, as well as the lung area to head circumference ratio (LHR) <1.0.

Cleisson Fábio Andrioli Peralta; Lourenço Sbragia; João Renato Bennini; Angélica de Fátima Assunção Braga; Monique Sampaio Rousselet; Izilda Rodrigues Machado Rosa; Ricardo Barini

2011-01-01

264

New Triple Therapy for Chronic Hepatitis C: Real Life Clinical Experience in a Community Setting  

PubMed Central

Recent advances in treatment of chronic hepatitis C virus have improved significantly due to the introduction of two new protease inhibitors—telaprevir and boceprevir. In combination with the previous standard of care, peginterferon and ribavirin, telaprevir and boceprevir have demonstrated improved sustained virologic response rates for HCV genotype 1 patients by approximately 30%. The purpose of this study was to assess the validity of large clinical trial data with respect to efficacy and side effects in a community setting in Honolulu, Hawai‘i. This retrospective study was performed by reviewing the charts of 59 chronic HCV patients who were started on triple therapy from July 1, 2011 to July 7, 2012. Sustained virologic response was attained by 73% of patients treated with telaprevir and 46% of patients treated with boceprevir respectively. Our clinical experience with telaprevir demonstrates that SVR rates are compatible with published literature values. Rates of SVR in our cohort were also similar to those reported in cirrhotic patients — about 50%. Due to small number of patients treated with a boceprevir-based regimen, it is difficult to compare our experience with pivotal trial experience. The side effect profiles for the two protease inhibitors were similar to the literature values except for more rectal irritation and a higher incidence and severity of anemia on telaprevir therapy in the clinical setting. While not intended to be conclusive, our study demonstrates that clinical trial data are largely compatible with the outcomes obtained in our community setting.

Akiyama, Matthew J; Piotrowski, Joy I; Roytman, Marina M; Chan, Siu MA; Hong, Leena K; Huddleston, Leslie; Trujillo, Ruby

2013-01-01

265

[Animal experiments in biomedical research. An evaluation of the clinical relevance of approved animal experimental projects].  

PubMed

According to the German Animal Welfare Act, scientists in Germany must provide an ethical and scientific justification for their application to the licensing authority prior to undertaking an animal experiment. Such justifications commonly include lack of knowledge on the development of human diseases or the need for better or new therapies for humans. The present literature research is based on applications to perform animal experiments from biomedical study groups of three universities in Bavaria (Germany) between 1991 and 1993. These applications were classified as successful in the animal model in the respective publications. We investigated the frequency of citations, the course of citations, and in which type of research the primary publications were cited: subsequent animal-based studies, in vitro studies, review articles or clinical studies. The criterion we applied was whether the scientists succeeded in reaching the goal they postulated in their applications, i.e. to contribute to new therapies or to gain results with direct clinical impact. The outcome was unambiguous: even though 97 clinically orientated publications containing citations of the above-mentioned publications were found (8% of all citations), only 4 publications evidenced a direct correlation between the results from animal experiments and observations in humans (0,3%). However, even in these 4 cases the hypotheses that had been verified successfully in the animal experiment failed in every respect. The implications of our findings may lead to demands concerning improvement of the licensing practice in Germany. PMID:16186990

Lindl, Toni; Voelkel, Manfred; Kolar, Roman

2005-01-01

266

Clinical experience in applying endoscopic Nd:YAG laser to treat 451 esophagostenotic cases  

NASA Astrophysics Data System (ADS)

This paper reports and analyzes clinical experience in applying endoscopic Nd:YAG laser to treat 451 esophagostenoses (1197 person times). Esophagostenosis was mainly characterized by having difficulties swallowing foods. Some of the esophagus were completely obstructed and patients could not drink even a drop of water. On the basis of experiments in animals and fresh organs of the body, all kinds of esophagostenosis were treated with endoscopic Nd:YAG laser in 1985. By the end of 1989, 451 patients had been treated. The results gained were satisfactory.

Wang, Rui-Zhong; Wang, Zhen-He; Lu, Kuang-Sheng; Yang, Xiao-Zhi; Lu, Bo-Kao

1991-07-01

267

Recruitment and Retention of Diverse Populations in Antiretroviral Clinical Trials: Practical Applications from the Gender, Race And Clinical Experience Study  

PubMed Central

Abstract Background Women, particularly women of color, remain underrepresented in antiretroviral (ARV) clinical trials. To evaluate sex-based differences in darunavir/ritonavir-based therapy, the Gender, Race And Clinical Experience (GRACE) study was designed to enroll and retain a high proportion of women representative of the racial/ethnic demographics of women with HIV/AIDS in the United States. The recruitment and retention strategies used in GRACE are described in this article. Methods Recruitment and retention strategies targeting women included selecting study sites that focused on women, involving community consultants, site-specific enrollment plans, access to other ARV drugs, study branding, site and patient toolkits, targeted public relations, site grants for patient support, and subsidized child care and transportation. Results The recruitment strategies were successful; 287 (67%) women were enrolled, primarily women of color (black, n=191 [67%], Hispanic, n=60 [21%]). Despite the focus on retention, a greater proportion of women (32.8%) discontinued compared with men (23.2%). Conclusions The successes of GRACE in enrolling a representative population of women were rooted in pretrial preparation, engagement of community advisors, enrollment quotas, choice of study sites and site support. Lessons learned from GRACE may be applied to future study design. Further focus on factors that influence discontinuation is warranted.

Bridge, Dawn Averitt; Currier, Judith; Squires, Kathleen; Hagins, Debbie; Schaible, Deborah; Ryan, Robert; Mrus, Joseph

2011-01-01

268

Initial clinical experience with the picosecond Nd:YLF laser for intraocular therapeutic applications  

Microsoft Academic Search

AIMS\\/BACKGROUNDCompared with nanosecond (ns) pulses of conventional Nd-YAG lasers, picosecond (ps) laser pulses allow intraocular surgery at considerably lower pulse energy. The authors report initial clinical experiences using a Nd:YLF ps laser for the treatment of various indications for photodisruption.METHODSA Nd:YLF laser system (ISL 2001, wavelength 1053 nm) was used to apply pulse series of 100–400 ?J single pulse energy

Gerd Geerling; Johann Roider; Ursula Schmidt-Erfurt; Kester Nahen; El-Sayed El-Hifnawi; Horst Laqua; Alfred Vogel

1998-01-01

269

Initial clinical experience with the picosecond Nd:YLF laser for intraocular therapeutic applications  

Microsoft Academic Search

Aims\\/background—Compared with nano- second (ns) pulses of conventional Nd- YAG lasers, picosecond (ps) laser pulses allow intraocular surgery at considerably lower pulse energy. The authors report initial clinical experiences using a Nd:YLF ps laser for the treatment of various indi- cations for photodisruption. Methods—A Nd:YLF laser system (ISL 2001, wavelength 1053 nm) was used to apply pulse series of 100-400

Gerd Geerling; Johann Roider; Ursula Schmidt-Erfurt; Kester Nahen; El-Sayed El-Hifnawi; Horst Laqua; Alfred Vogel

270

Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics  

Microsoft Academic Search

We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedica- lisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in- depth interview guide. While women appreciated the non-invasiveness

B. Ganatra; S. Kalyanwalab; B. Elul; S. Tewarie

271

Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics  

Microsoft Academic Search

We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical

B. Ganatra; S. Kalyanwala; B. Elul; K. Coyaji; S. Tewari

2010-01-01

272

Clinical Experience Using the Levitronix CentriMag System for Temporary Right Ventricular Mechanical Circulatory Support  

Microsoft Academic Search

Background: Short-term mechanical circulatory support may be lifesaving in patients with right ventricular (RV) failure related to post-cardiotomy cardiogenic shock (PCCS), cardiac transplantation (CTx), and long-term therapy with a left ventricular assist device (LVAD). This study evaluates our clinical experience using the CentriMag (Levitronix LLC, Waltham, Mass) system for temporary mechanical RV support. Methods: A retrospective review was performed of

Jay K. Bhama; Robert L. Kormos; Yoshiya Toyoda; Jeffrey J. Teuteberg; Kenneth R. McCurry; Michael P. Siegenthaler

2009-01-01

273

The influence of medical school clinical experiences on career preferences: A multidimensional perspective  

Microsoft Academic Search

This study examines the multiple influences of medical school clinical experiences on student career preferences. The analysis of responses to pre-clerkship and post-clerkship questionnaires administered to the 1983 graduating class of a well-established medical school in the Great Lakes region of the United States indicates significant changes in career plans: away from primary care practice towards the surgical specialties; away

Charles H. Brooks

1991-01-01

274

Clinical experience with titanium implants, especially with the limited contact dynamic compression plate system  

Microsoft Academic Search

AO\\/ASIF with its collaborating laboratories has developed cold worked pure titanium material for implants with an outstanding biocompatibility. The first prospectively controlled clinical series dates back to 1966 and was reported to be most successful. Pure titanium also became the material of choice for implants to be used in patients suffering from metal allergy. Today, a long-term and well-documented experience

P. Matter; H. B. Burch

1990-01-01

275

Procidentia of the rectum: Teflon sling repair of rectal prolapse, Lahey Clinic experience  

Microsoft Academic Search

Summary  The Teflon-sling method of repair of rectal prolapse in the Lahey Clinic experience has proved to be one of no mortality and\\u000a low morbidity, with a recurrence rate of 7.3 per cent over an average follow-up period of nearly four years. Bowel management\\u000a and incontinence are problems inherent in the pathogenesis of the problem and, though improved, necessitate longterm patient

H. Clement Jurgeleit; Marvin L. Corman; John A. Coller; Malcolm C. Veidenheimer

1975-01-01

276

Voices from a minority: experiences of chinese male nursing students in clinical practice.  

PubMed

In Hong Kong, males constituted only about 10.2% of the nursing workforce in 2010. The learning experiences of male nursing students in Hong Kong during their clinical practicum have rarely been explored. If these students cannot maintain their psychological well-being and psychological health in formal education and clinical placements, then their physical health will also suffer. This ethnographic qualitative study gave male nursing students in Hong Kong a chance to voice their experiences during their clinical practicum. Selected through snowball sampling, 18 male nursing students from a local university participated in individual face-to-face semistructured interviews. The data were processed with content analysis. The findings indicated that male students not only received more support and understanding from male rather than female members of staff but endured a certain amount of oppression while working in female wards. According to the students' comments on nursing culture, the work climate of male nursing students could be improved by reorganizing the clinical placements and providing extra support to male nursing students. PMID:23339129

Chan, Z C Y; Lui, C W; Cheung, K L; Hung, K K; Yu, K H; Kei, S H

2013-01-20

277

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

278

A novel platform to simplify human observer performance experiments in clinical reading environments  

NASA Astrophysics Data System (ADS)

Human observer performance experiments (HOPE) are frequently carried out in controlled environments in order to maximize the influence of the performance parameter under study. As an example, the amount of ambient reading variables can be kept as low as possible during HOPE. This is contrasting with the dynamic nature of a clinical reading environment that may therefore be suboptimal for the majority of the experiments. The aim of current work was to extend our previously developed software platform Sara² to cope with the influences of the reading environment on HOPE experiments. Generic modules for ROC, LROC, FROC, MAFC and visual grading analysis/image quality criteria (VGA/IQC) experiments were developed for 2D and 3D input images. Additional modules were included in the platform for finding unexpected interruptions due to clinical emergencies by means of idle time and for mouse trajectory monitoring. Also a generic approach towards the inclusion of reading questionnaires and a RFID enabled secured login system was added. Next, we created a sensor network consisting of off-the-shelf components which continuously monitor ambient reading conditions like: temperature, ambient lighting, humidity, ambient noise levels and observer reading distance. These measured parameters can be synchronized with the reading findings. Finally we included a link to incorporate the use of specialized 3rd party PACS viewers in our software framework. Using the proposed software and hardware solution, we could simplify the setup and the performing of HOPE in clinical reading environments and we can now properly control our reading experiments.

Jacobs, J.; Zanca, F.; Bosmans, H.

2011-03-01

279

Peer Experiences of Anxious and Socially Withdrawn Youth: An Integrative Review of the Developmental and Clinical Literature  

ERIC Educational Resources Information Center

Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental…

Kingery, Julie Newman; Erdley, Cynthia A.; Marshall, Katherine C.; Whitaker, Kyle G.; Reuter, Tyson R.

2010-01-01

280

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

2013-02-11

281

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

Microsoft Academic Search

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

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

2008-01-01

282

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

PubMed Central

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 × 2 × 3 analyses of variance (length of clinical field experience × academic standing × 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 × 3 analysis of variance (sex × 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.

Miller, Michael G.; Berry, Leisha M.

2004-01-01

283

An application of the theory of planned behavior: Nursing students' intentions to seek clinical experiences using the Essential Clinical Behavior Database  

Microsoft Academic Search

This study examined the antecedents and determinants that are predictive of whether nursing students intend to ask for assignments to perform nursing behaviors after using a database to record essential clinical behaviors. Using a database students entered those behaviors completed in the clinical setting, allowing experiences and competencies to be tracked during the semester and in subsequent semesters. It was

Linda Hoellrich Meyer

1998-01-01

284

Radiobiological assessment of permanent implants using tumour repopulation factors in the linear-quadratic model.  

PubMed

By combining existing linear-quadratic equations relating to decaying-source therapy with an assumed tumour repopulation factor, it has been possible to devise a method for the radiobiological assessment of permanent implants. For calculation purposes there is a time after which an implant can no longer be considered effective in sterilizing tumour cells. This "effective" treatment time for a permanent implant can be approximately defined in terms of the radionuclide decay constant, the potential doubling time, the initial dose-rate and the value of alpha in the tumour alpha/beta ratio. The analytical technique has been applied to a specific intercomparison of commonly encountered implants using 125I and 198Au, and suggests that, even in the most favourable cases, the former radionuclide offers few radiobiological advantages. Although not specifically discussed here, the method can also be applied to the assessment of various forms of biologically targeted radiotherapy. PMID:2702381

Dale, R G

1989-03-01

285

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

286

Interprofessional education through shadowing experiences in multi-disciplinary clinical settings  

PubMed Central

The World Health Organization has recently added Interprofessional Education (IPE) to its global health agenda recognizing it as a necessary component of all health professionals' education. We suggest mandatory interprofessional shadowing experiences as a mechanism to be used by chiropractic institutions to address this agenda. IPE initiatives of other professions (pharmacy and medicine) are described along with chiropractic. This relative comparison of professions local to our jurisdiction in Ontario, Canada is made so that the chiropractic profession may take note that they are behind other health care providers in implementing IPE. Interprofessional shadowing experiences would likely take place in a multi-disciplinary clinical setting. We offer an example of how two separate professions within a Family Health Team (FHT) can work together in such a setting to enhance both student learning and patient care. For adult learners, using interprofessional shadowing experiences with learner-derived and active objectives across diverse health professional groups may help to improve the educational experience. Mandatory interprofessional shadowing experiences for chiropractors during their training can enhance future collaborative practice and provide success in reaching a goal common to each profession - improved patient care.

2010-01-01

287

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

288

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

NASA Astrophysics Data System (ADS)

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. Thereby, three key disciplines are investigated, namely dose delivery, dose assessment and radiobiology. In order to perform a quantitative analysis, a relative comparison between six different descriptions of nuclear interactions is carried out for carbon ions. The particle transport is simulated with the Monte Carlo code SHIELD-HIT10A while dose planning and radiobiology are covered by the analytic treatment planning program for particles TRiP, which determines the relative biological effectiveness (RBE) with the local effect model. The obtained results show that the physical dose distribution can in principle be significantly influenced by the modeling of fragmentation (about 10% for a 20% change in all inelastic nuclear cross sections for a target volume ranging from 15 to 25 cm). While the impact of nuclear fragmentation on stopping power ratios can be neglected, the fluence correction factor may be influenced by the applied nuclear models. In contrast to the results for the physical dose, the variation of the RBE is only small (about 1% for a 20% change in all inelastic nuclear cross sections) suggesting a relatively weak dependence of radiobiology on the detailed composition of the particle energy spectrum of the mixed radiation field. Also, no significant change (about 0.2 mm) of the lateral penumbra of the RBE-weighted dose is observed.

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

2012-08-01

289

Introducing and adapting a novel method for investigating learning experiences in clinical learning environments.  

PubMed

The Contextual Activity Sampling System (CASS) is a novel methodology designed for collecting data of on-going learning experiences through frequent sampling by using mobile phones. This paper describes how it for the first time has been introduced to clinical learning environments. The purposes of this study were to cross-culturally adapt the CASS tool and questionnaire for use in clinical learning environments, investigate whether the methodology is suitable for collecting data and how it is experienced by students. A study was carried out with 51 students who reported about their activities and experiences five times a day during a 2-week course on an interprofessional training ward. Interviews were conducted after the course. The study showed that CASS provided a range of detailed and interesting qualitative and quantitative data, which we would not have been able to collect using traditional methods such as post-course questionnaires or interviews. Moreover, the participants reported that CASS worked well, was easy to use, helped them structure their days and reflect on their learning activities. This methodology proved to be a fruitful way of collecting information about experiences, which could be useful for not only researchers but also students, teachers and course designers. PMID:22713123

Lachmann, Hanna; Ponzer, Sari; Johansson, Unn-Britt; Karlgren, Klas

2012-06-19

290

Teaching Residents to Work with Torture Survivors: Experiences from the Bronx Human Rights Clinic  

PubMed Central

Introduction Despite the 1984 United Nations’s Convention Against Torture calling to train doctors to work with torture survivors, many physicians are unaware of their obligation and few are taught the requisite clinical skills. Aim To describe the development, implementation, and evaluation of a curriculum to teach residents to work with torture survivors. Participants Medicine residents in New York City Program Description A 2-component curriculum consisting of a series of workshops and clinical experiences, which provide content, skills, and practices regarding the medical, psychological, ethical, and legal aspects of evaluating and caring for torture survivors. Curriculum Evaluation All 22 trainees received surveys before and after training. Surveys assessed residents’ relevant prior experience, beliefs, skills, and attitudes regarding working with torture survivors. At baseline, 23% of residents described previous human rights trainings and 17% had work experiences with torture survivors. Before the curriculum, 81% of residents reported doctors should know how to evaluate survivors, although only 5% routinely screened patients for torture. After the curriculum, residents reported significant improvements in 3 educational domains—general knowledge, sequelae, and self-efficacy to evaluate torture survivors. Discussion This curriculum addresses the disparity between doctors’ obligations, and training to work with torture survivors. It is likely to achieve its educational goals, and can potentially be adapted to other residencies.

Asgary, Ramin G.; Cooperman, Nina; Smith, Clyde L.; Du, Evelyn; Modali, Laxmi; Sacajiu, Galit

2008-01-01

291

Radiobiological prediction of normal tissue toxicities and tumour response in the radiotherapy of advanced non-small-cell lung cancer.  

PubMed

A number of randomized studies have been carried out in the UK and USA to determine the optimal radiotherapy dose schedule for advanced non-small-cell lung cancer (NSCLC). We have examined eight radiotherapy regimens from data taken from four randomized phase III studies carried out in the UK (1264 patients): 10 Gy single fraction; 17 Gy in two fractions over 8 days; 30 Gy in ten fractions over 14 days; 22.5 Gy in five fractions in 5 days; 27 Gy in six fractions over 11 days; 30 Gy in six fractions over 11 days; 36 Gy in 12 fractions over 16 days; and 39 Gy in 13 fractions over 17 days. We compared the clinical results in palliation, toxicity and survival with four regimens taken from one randomized study from the USA (365 patients): 40 Gy in 20 fractions over 4 weeks; 40 Gy 'split course' in ten fractions in 4 weeks; 50 Gy in 25 fractions over 5 weeks; and 60 Gy in 30 fractions over 6 weeks. Using the linear-quadratic (LQ) radiobiological model, we have calculated the radiobiological equivalent dose (BED) for acute-reacting tissues (BED10), late-reacting tissues (BED1.7) and tumour (BED25), and related the predicted response to the observed response in each tissue. There was a good correlation between the predicted response and the reported response in the case of late-reacting tissue toxicity and tumour response. The model confirmed that, in good performance status patients, a higher value for BED25 correlated with a higher degree of local control and survival and that radiotherapy regimens with a higher value for BED1.7 were associated with five cases of cord myelopathy, if the spinal cord was not shielded. In poor performance status patients the model suggested that the optimal regimen was a single fraction of 10 Gy because this resulted in an equivalent degree of symptom control as other regimens, needed only one hospital visit and was less likely to result in cord damage, thus, allowing for the possibility of retreatment at a later date. PMID:9862575

Singer, J M; Price, P; Dale, R G

1998-12-01

292

Radiobiological prediction of normal tissue toxicities and tumour response in the radiotherapy of advanced non-small-cell lung cancer.  

PubMed Central

A number of randomized studies have been carried out in the UK and USA to determine the optimal radiotherapy dose schedule for advanced non-small-cell lung cancer (NSCLC). We have examined eight radiotherapy regimens from data taken from four randomized phase III studies carried out in the UK (1264 patients): 10 Gy single fraction; 17 Gy in two fractions over 8 days; 30 Gy in ten fractions over 14 days; 22.5 Gy in five fractions in 5 days; 27 Gy in six fractions over 11 days; 30 Gy in six fractions over 11 days; 36 Gy in 12 fractions over 16 days; and 39 Gy in 13 fractions over 17 days. We compared the clinical results in palliation, toxicity and survival with four regimens taken from one randomized study from the USA (365 patients): 40 Gy in 20 fractions over 4 weeks; 40 Gy 'split course' in ten fractions in 4 weeks; 50 Gy in 25 fractions over 5 weeks; and 60 Gy in 30 fractions over 6 weeks. Using the linear-quadratic (LQ) radiobiological model, we have calculated the radiobiological equivalent dose (BED) for acute-reacting tissues (BED10), late-reacting tissues (BED1.7) and tumour (BED25), and related the predicted response to the observed response in each tissue. There was a good correlation between the predicted response and the reported response in the case of late-reacting tissue toxicity and tumour response. The model confirmed that, in good performance status patients, a higher value for BED25 correlated with a higher degree of local control and survival and that radiotherapy regimens with a higher value for BED1.7 were associated with five cases of cord myelopathy, if the spinal cord was not shielded. In poor performance status patients the model suggested that the optimal regimen was a single fraction of 10 Gy because this resulted in an equivalent degree of symptom control as other regimens, needed only one hospital visit and was less likely to result in cord damage, thus, allowing for the possibility of retreatment at a later date.

Singer, J. M.; Price, P.; Dale, R. G.

1998-01-01

293

Rapid assessment of radiobiological doses for terrestrial and interplanetary space missions.  

PubMed

This paper presents the doses levels expected in orbits in chart form, covering the range 300-800 km of altitude and 0-90 degrees of inclination behind shieldings similar to the Hermes spacecraft and the EVA spacesuit matter distributions. These charts allow users to rapidly find the radiobiological dose received in the most critical organs of the human body either in normal situations or during a large solar event. Outside the magnetosphere, during interplanetary or lunar missions, when the dose received during crossing of the radiation belts become negligible, the dose is due to galactic cosmic rays (GCR) and solar flares. The correct radiobiological assessment of the components of this radiation field becomes a major problem. On the Moon a permanent ground-based station can be shielded by lunar materials against meteoroids and radiations. The radiobiological hazard, essentially linked to the solar flare risk during the transfer phase and the extra-station activities, may be solved by mission planning. For interplanetary flights the problem comes from both increased risk of solar events and from the continuous exposure to GCR. These energetic particles cannot be easily stopped by shieldings; cost considerations imply that more effective materials must be used. Impact on the vehicle design and the mission planning is important. PMID:11538449

Melkonian, G; Bourrieau, J

1994-11-01

294

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

295

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

296

Human Brucellosis in Macedonia - 10 Years of Clinical Experience in Endemic Region  

PubMed Central

Aim To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. Methods A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. Results Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%). Conclusion Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

Bosilkovski, Mile; Krteva, Ljiljana; Dimzova, Marija; Vidinic, Ivan; Sopova, Zaklina; Spasovska, Katerina

2010-01-01

297

Clinical experience and minority group students. A perspective from Harvard Medical School.  

PubMed

Medical educators realize that there are no simple predictors for student performance in the clinical training years. College grades and Medical College Admission Test scores may suggest the strength of a student's achievement in the basic sciences but cannot be relied on to predict efficacy in patient care. There is no fool proof way of assessing noncognitive abilities critical to clinical competence. However, in admissions, extracurricular activities, community service, leadership abilities, recommendations, and interviews are examined to assess personal strengths. The author's observations suggest that noncognitive attributes are important in the success of disadvantaged students. Although some, but not all, with low Medical College Admission Test scores may not excel in the basic sciences, once they reach the clinical years, a leveling of the playing field gives them an opportunity to show their special competence with patients. Minority students, perhaps because of their own life experiences, often are alert to the needs and sensitivities of patients. As a group, they are respectful of the dignity of patients. Many embrace the dictum: treat every patient as you would want a family member to be treated. Most minority students, despite pressures of being a minority in predominantly white environments, perform at a very high level in the clinical years and thereafter. PMID:10335283

Poussaint, A F

1999-05-01

298

The 10-year experience of an academically affiliated occupational and environmental medicine clinic.  

PubMed Central

Occupational and environmental diseases are underrecognized. Among the barriers to the successful diagnosis, treatment, and prevention of these conditions are inadequate consultative and information resources. We describe the 10-year clinical and training experiences of an academically affiliated referral center that has as its primary goal the identification of work-related and other environmental diseases. The University of Washington Occupational and Environmental Medicine Program has evaluated 6,048 patients in its diagnostic and screening clinics. Among the 2,841 seen in the diagnostic clinics, 1,553 (55%) had a work-related condition. The most prevalent diagnoses included asbestos-related lung disease (n = 603), toxic encephalopathy (n = 160), asthma (n = 119), other specific respiratory conditions (n = 197), carpal tunnel syndrome (n = 86), and dermatitis (n = 82). The clinics serve as a training site for fellows in the specialty training program, primary care internal medicine residents, residents from other medical specialties, and students in industrial hygiene, toxicology, and occupational health nursing. The program serves two additional important functions: providing consultative services to community physicians and training specialists and other physicians in this underserved area of medicine.

Rosenstock, L; Daniell, W; Barnhart, S; Stover, B; Castorina, J; Mason, S E; Heyer, N J; Hubbard, R; Kaufman, J D; Brodkin, C A

1992-01-01

299

Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience  

PubMed Central

Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors.

Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

2011-01-01

300

Injection drug users' experience with and attitudes toward methadone clinics in Denver, CO.  

PubMed

Clients' perceptions and attitudes toward methadone treatment programs are frequently overlooked in substance abuse research. Given the importance of methadone maintenance as a harm-reduction strategy and clients' concerns about treatment, it is essential to understand perceptions and attitudes toward existing programs. Using data from the 2009 National HIV Behavioral Surveillance system with injection drug users in Denver, CO, we evaluated participants' experiences with methadone clinics and examined predictive factors associated with ever being a client of a methadone clinic. Costs of services, perceptions of staff not caring about the client, and attitudes toward the counseling services seemed to be the major barriers to program retention. Besides heroin use, previous attempt at self-detoxification and being infected with hepatitis C were the strongest predictors of ever being on methadone treatment. Addressing the barriers to program retention and encouraging treatment engagement are essential to embracing methadone maintenance as a harm-reduction strategy for injection drug users. PMID:21371849

Al-Tayyib, Alia A; Koester, Stephen

2011-03-02

301

Long-term clinical trial safety experience with the inactivated split influenza vaccine, Vaxigrip.  

PubMed

Safety data on the inactivated split influenza vaccine, Vaxigrip, were compiled and analysed from 28 clinical trials (total: 4599 subjects aged 6 months to 99 years) to provide a robust estimate of the reactogenicity profile. The most frequent solicited reactions were non-severe injection site pain and erythema in children, adults, and elderly. Mild or moderate fever was the most frequent reaction in 6-36 months olds; few systemic reactions were reported in older groups. Reactogenicity was comparable in healthy and high-risk children. The long-term experience with the world's most widely used influenza vaccine, Vaxigrip, confirms its excellent tolerability, and supports its continued use in clinical practice worldwide. PMID:16271424

Delore, Valentine; Salamand, Camille; Marsh, Grenville; Arnoux, Sabine; Pepin, Stephanie; Saliou, Pierre

2005-10-18

302

Clinical experience with titanium implants, especially with the limited contact dynamic compression plate system.  

PubMed

AO/ASIF with its collaborating laboratories has developed cold worked pure titanium material for implants with an outstanding biocompatibility. The first prospectively controlled clinical series dates back to 1966 and was reported to be most successful. Pure titanium also became the material of choice for implants to be used in patients suffering from metal allergy. Today, a long-term and well-documented experience with these implants exists. It therefore seemed logical to use pure titanium for the new limited contact dynamic compression plate (LC-DCP) system described in the previous article by Perren. Pilot clinics started to implant titanium LC-DCP in 1987, and already 271 plates have been used, mainly for the treatment of fresh fractures. Some 57 plates have so far been removed. The preliminary results are most favourable; they confirm especially the outstanding biocompatibility of pure titanium. PMID:2073448

Matter, P; Burch, H B

1990-01-01

303

Transesophageal echocardiography using cypress-miniaturized echocardiogram unit: initial clinical experience.  

PubMed

Transesophageal echocardiography (TEE) was introduced clinically in the United States in 1987. Recent technologic advances have resulted in the creation of a small portable hand-carried ultrasound (HCU) device that can be easily carried throughout the hospital with greater flexibility for cardiac imaging. These HCU devices have harmonic, color, and spectral Doppler (continuous/pulsed wave). Siemens Medical Solutions USA, Inc. has incorporated a TEE connector, which connects to its Cypress (highly miniaturized echocardiogram unit) and allows the performance of a TEE with this unit, which is mildly heavier than a typical HCU. We describe our initial clinical experience with this unit. The image quality is comparable to routine TEEs, with the advantages of shorter duration, portability, affordable cost, avoiding the use of high-end machine from the echo lab, availability of non-HCU units for other studies, and preventing the need for an echo technician to be involved in the procedure. PMID:16343162

Herzog, Eyal; Pudpud, Danny; Chaudhry, Farooq A

2005-11-01

304

Safety Overview of Postmarketing and Clinical Experience of Sodium Oxybate (Xyrem): Abuse, Misuse, Dependence, and Diversion  

PubMed Central

Study Objectives: This study reviewed the cumulative postmarketing and clinical safety experience with sodium oxybate (Xyrem®), a treatment approved for cataplexy and excessive daytime sleepiness in narcolepsy. Study objectives were to investigate the occurrence of abuse/misuse of sodium oxybate since first market introduction in 2002, classify cases using DSM-IV criteria for substance abuse and dependence, and describe specific characteristics of these cases. Methods: We retrospectively reviewed postmarketing spontaneous adverse event (AE) reports from 15 countries for all cases containing reporting terminology related to abuse/misuse to determine its occurrence. All death cases independent of causality were reviewed to identify associated risk factors. Results: Approximately 26,000 patients worldwide received sodium oxybate from first market introduction in 2002 through March 2008. Of those 26,000 patients, 0.2% reported ? 1 of the events studied. These included 10 cases (0.039%) meeting DSM-IV abuse criteria, 4 cases (0.016%) meeting DSM-IV dependence criteria, 8 cases (0.031%, including 3 of the previous 4) with withdrawal symptoms reported after discontinuation of sodium oxybate, 2 confirmed cases (0.008%) of sodium oxybate–facilitated sexual assault, 8 cases (0.031%) of overdose with suicidal intent, 21 deaths (0.08%) in patients receiving sodium oxybate treatment with 1 death known to be related to sodium oxybate, and 3 cases (0.01%) of traffic accidents involving drivers taking sodium oxybate. During this period, approximately 600,000 bottles of sodium oxybate were distributed, and 5 incidents (0.0009%) of diversion were reported. Conclusion: Cumulative postmarketing and clinical experience indicates a very low risk of abuse/misuse of sodium oxybate. Citation: Wang YG; Swick TJ; Carter LP; Thorpy MJ; Benowitz NL. Safety overview of postmarketing and clinical experience of sodium oxybate (xyrem): abuse, misuse, dependence, and diversion. J Clin Sleep Med 2009;5(4):365-371.

Wang, Y. Grace; Swick, Todd J.; Carter, Lawrence P.; Thorpy, Michael J.; Benowitz, Neal L.

2009-01-01

305

Clinical Experiences on the Effect of Scrambler Therapy for Patients with Postherpetic Neuralgia  

PubMed Central

Postherpetic neuralgia (PHN) is a debilitating complication of herpes zoster, especially in elderly and comorbid patients. Unfortunately, the currently available treatments have shown limited efficacy and some adverse events that are poorly tolerated in elderly patients. Scrambler Therapy, proposed as an alternative treatment for chronic neuropathic pain recently, is a noninvasive approach to relieve pain by changing pain perception at the brain level. Here, we report our clinical experiences on the effect of Scrambler Therapy for three patients with PHN refractory to conventional treatment.

Lee, Ho Young; Lee, Wang Yong

2013-01-01

306

Telehealth nurse practitioner student clinical experiences: an essential educational component for today's health care setting.  

PubMed

In order to meet the continuous changes and innovations within the health care system, nurse practitioner faculty must look to the future and prepare nurse practitioner graduates who deliver safe, quality patient care addressing the realities of a global society with a fast-paced expansion of technologies. Preparing nurse practitioner students for practice must include more than information technology knowledge in graduate nursing programs. Formal clinical experiences using various telehealth applications must be integrated into nurse practitioner training. Innovative strategies must be explored by nurse practitioner faculty to assure that graduates can meet the demanding technological demands of our current health care society. PMID:22503296

Hawkins, Shelley Yerger

2012-04-13

307

Clinical experience with a novel subcutaneous implantable defibrillator system in a single center  

Microsoft Academic Search

Background  Implantable cardioverter-defibrillators (ICDs) reduce mortality in both primary and secondary prevention, but are associated\\u000a with substantial short- and long-term morbidity. A totally subcutaneous ICD (S-ICD) system has been developed. We report the\\u000a initial clinical experience of the first 31 patients implanted at our hospital.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All patients had an ICD indication according to the ACC\\/AHA\\/ESC guidelines. The first 11 patients were

Lara Dabiri Abkenari; Dominic A. M. J. Theuns; Suzanne D. A. Valk; Yves Van Belle; Natasja M. de Groot; David Haitsma; Agnes Muskens-Heemskerk; Tamas Szili-Torok; Luc Jordaens

308

Participants' experiences of being debriefed to placebo allocation in a clinical trial.  

PubMed

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 4 participants in a trial of acupuncture for irritable bowel syndrome before, during, and after they received a course of placebo treatments over 6 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. The 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. PMID:22673094

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

2012-06-06

309

The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.  

PubMed Central

OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy.

Sosa, J A; Bowman, H M; Tielsch, J M; Powe, N R; Gordon, T A; Udelsman, R

1998-01-01

310

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience  

PubMed Central

Introduction To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4 minutes. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials. Methods We conducted a literature review between 1990 and 2006 in MEDLINE using the following MeSH headings: swine, dogs, resuscitation, heart arrest, EMS, EMT, ambulance, ventricular fibrillation, drug therapy, epinephrine, vasopressin, amiodarone, lidocaine, magnesium, and sodium bicarbonate. We reviewed the abstracts of 331 studies and 197 full manuscripts. Exclusion criteria included: non-peer reviewed, all without primary animal data, and traumatic models. From these, we identified 119 papers that contained unique information on time to medication administration. The data are reported as mean, ranges, and 95% confidence intervals. Mean time to first drug administration in animal laboratory studies and clinical trials was compared with a t-test. Regression analysis was performed to determine if time to drug predicted ROSC. Results Mean time to first drug administration in 2378 animals was 9.5 minutes (range 3.0–28.0; 95% CI around mean 2.78, 16.22). This is less than the time reported in clinical trials (19.4 min, p<0.001). Time to drug predicted ROSC (Odds Ratio 0.844; 95% CI 0.738, 0.966). Conclusion Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena.

Reynolds, Joshua C.; Rittenberger, Jon C.; Menegazzi, James J.

2007-01-01

311

'Initial Clinical Experience' articles are poorly cited and negatively affect the impact factor of the publishing journal: a review  

PubMed Central

Objectives The phrase ‘Initial Clinical Experience’ in a manuscript's title implies that the described technique offers promise of future clinical relevance. We assessed, using rates of subsequent citations, the actual academic relevance of such articles in comparison to articles not containing the phrase. Design We searched ISI database for articles that included the studied phrase in their titles between 1975 and 2009 and grouped the results by the related medical specialty. We excluded articles from journals with no available impact factor. For each identified article, we extracted number of included patients, citations/year, the average impact factor of the publishing journal over the last five years and the proportion of articles published in the same journal that garnered zero subsequent citations. Setting Retrospective review of a scientific database. Participants None Main outcome measures Citation rate Results Among a total of 982,127 articles published in 186 journals representing eight major publishing medical specialties, 531 (0.05%) were Initial Clinical Experience articles. Thirty percent of Initial Clinical Experience articles were never cited compared with 7% of the overall article volume (p < 0.0001). Citations/year for Initial Clinical Experience articles were significantly lower than the median impact factor (p < 0.0001). There was no correlation between citations and number of patients described in the Initial Clinical Experience articles (p = 0.61). Conclusions Initial Clinical Experience articles are cited less frequently than the average, especially in Cardiovascular, Radiology and Ophthalmology journals.

Ahmed, Ahmed T; Rezek, Issa; McDonald, Jennifer S; Kallmes, David F

2013-01-01

312

Insights on GRACE (Gender, Race, And Clinical Experience) from the patient's perspective: GRACE participant survey.  

PubMed

The Gender, Race And Clinical Experience (GRACE) study was conducted between October 2006 and December 2008 to evaluate sex- and race-based differences in outcomes after treatment with a darunavir/ritonavir-based antiretroviral regimen. Between June 2010 and June 2011, former participants of the GRACE trial at participating sites were asked to complete a 40-item questionnaire as part of the GRACE Participant Survey study, with a primary objective of assessing patients' characteristics, experiences, and opinions about participation in GRACE. Of 243 potential survey respondents, 151 (62%) completed the survey. Respondents were representative of the overall GRACE population and were predominantly female (64%); fewer were black, and more reported recreational drug use compared with nonrespondents (55% vs. 62% and 17% vs. 10%, respectively). Access to treatment (41%) and too many blood draws (26%) were reported as the best and worst part of GRACE, respectively. Support from study site staff was reported as the most important factor in completing the study (47%). Factors associated with nonadherence, study discontinuation, and poor virologic response in univariate analyses were being the primary caregiver for children, unemployment, and transportation difficulties, respectively. Patients with these characteristics may be at risk of poor study outcomes and may benefit from additional adherence and retention strategies in future studies and routine clinical care. PMID:23701200

Squires, Kathleen; Feinberg, Judith; Bridge, Dawn Averitt; Currier, Judith; Ryan, Robert; Seyedkazemi, Setareh; Dayaram, Yaswant K; Mrus, Joseph

2013-05-23

313

Fluorescence endoscopy of gastrointestinal diseases: basic principles, techniques, and clinical experience.  

PubMed

Visual detection of tumors, especially during the early stages, is expected to be improved considerably by examining the fluorescence either of tumor-selective exogenous dyes such as protoporphyrin IX, induced by 5-aminolevulinic acid, or by analyzing the autofluorescent properties of healthy and neoplastic tissue. The present paper describes technical devices using light sources for fluorescence excitation, and sensitive detection systems such as intensified cameras and optical multichannel analyzers used for fiber-assisted point measurements. In the discussion of these systems, special consideration is given to their commercial availability and potential for endoscopic applications in the gastrointestinal tract. In this clinical discipline, the major interest lies in the ability to locate malignancies in the esophagus and colon. In recent years, there has been increasing clinical experience in this area, particularly in detecting adenocarcinoma in Barrett's esophagus and malignant alterations in the colon, such as in ulcerative colitis and polyps. Although several research groups have reported sensitivities and specificities for fluorescence gastroscopy of more than 80%, the potential benefits of the technique to patients need to be evaluated in further clinical studies. PMID:9689513

Stepp, H; Sroka, R; Baumgartner, R

1998-05-01

314

Chimerism-based experimental models for tolerance induction in vascularized composite allografts: Cleveland clinic research experience.  

PubMed

The preclinical experimental models of vascularized composite allografts (VCAs) have been rapidly developed for the assessment of immunomodulatory protocols for clinical application. Recently, researchers have focused on immunomodulatory protocols which overcome the immunologic barrier between the allogeneic donor and recipient and may lead to tolerance induction. In order to test the feasibility of chimerism induction, experimental VCAs have been performed in different models including rodents, large animals, and nonhuman primates. These models differ in the complexity of transplanted tissue and in their responses to immunomodulatory protocols. In most applications, VCA contains multiple-tissue components; however, each individual component of CTA possesses unique immunologic characteristics that ultimately contribute to the chimerism induction and successful outcome of the VCA. Heterogenic character and complexity of tissue components in different VCA models determine the quality and robustness of donor-specific chimerism. As introduced in experimental studies, variable immunomodulatory options have been studied to achieve tolerance to VCA in rodents and large animal models allowing for widespread application in clinic. In this paper, based on our own experience, we have analyzed the current knowledge of tolerance-inducing strategies via chimerism induction in VCA experimental models in the context of immunomodulatory protocols and VCA complexity and their relevance and applicability to clinical practice. PMID:23573114

Siemionow, Maria; Klimczak, Aleksandra

2013-03-14

315

Chimerism-Based Experimental Models for Tolerance Induction in Vascularized Composite Allografts: Cleveland Clinic Research Experience  

PubMed Central

The preclinical experimental models of vascularized composite allografts (VCAs) have been rapidly developed for the assessment of immunomodulatory protocols for clinical application. Recently, researchers have focused on immunomodulatory protocols which overcome the immunologic barrier between the allogeneic donor and recipient and may lead to tolerance induction. In order to test the feasibility of chimerism induction, experimental VCAs have been performed in different models including rodents, large animals, and nonhuman primates. These models differ in the complexity of transplanted tissue and in their responses to immunomodulatory protocols. In most applications, VCA contains multiple-tissue components; however, each individual component of CTA possesses unique immunologic characteristics that ultimately contribute to the chimerism induction and successful outcome of the VCA. Heterogenic character and complexity of tissue components in different VCA models determine the quality and robustness of donor-specific chimerism. As introduced in experimental studies, variable immunomodulatory options have been studied to achieve tolerance to VCA in rodents and large animal models allowing for widespread application in clinic. In this paper, based on our own experience, we have analyzed the current knowledge of tolerance-inducing strategies via chimerism induction in VCA experimental models in the context of immunomodulatory protocols and VCA complexity and their relevance and applicability to clinical practice.

Siemionow, Maria; Klimczak, Aleksandra

2013-01-01

316

Update on percutaneous mitral valve therapy: clinical results and real life experience.  

PubMed

Mitral regurgitation (MR) is a common valvulopathy worldwide increasing in prevalence. Cardiac surgical intervention, preferable repair, is the standard of care, but a relevant number of patients with severe MR do not undergo surgery because of high peri-operative risk. Percutaneous mitral valve repair with the MitraClip System has evolved as a new tool for the treatment of severe MR. The procedure simulates the surgical edge-to-edge technique, developed by Alfieri in 1991, creating a double orifice valve by a permanent approximation of the two mitral valve leaflets. Several preclinical studies, registries and Food and Drug Administration approved clinical trials (EVEREST, ACCESS-EU) are currently available. The percutaneous approach has been recently studied in a randomized controlled trial, concluding that the device is less effective at reducing MR, when compared with surgery, by associated with a lower adverse event rate. The patients enrolled in this trial had a normal surgical risk and mainly degenerative MR with preserved left ventricular function. On the other hand, results derived from the clinical "real life" experience, show that patients actually treated in Europe present a higher surgical risk profile, more complex mitral valve anatomy and functional MR in the most of cases. Thus these data suggest that MitraClip procedure is feasible and safe in this subgroup of patients that should be excluded from the EVEREST trial due to rigid exclusion criteria. Despite the promising results clinical experience is still small, and no data related the durability are currently available. Therefore, MitraClip device should be reserved now to high risk or inoperable patients. PMID:22322574

Ussia, G P; Cammalleri, V; Scandura, S; Immè, S; Pistritto, A M; Ministeri, M; Chiarandà, M; Caggegi, A; Barbanti, M; Aruta, P; Tamburino, C

2012-02-01

317

Comparison of Quality and Safety Education for Nurses (QSEN)-Related Student Experiences During Pediatric Clinical and Simulation Rotations.  

PubMed

Nurse educators are challenged with providing meaningful clinical experiences for students. However, patient safety regulations constrain what nursing students are able to accomplish in the pediatric setting. So, what are students actually doing in their clinical rotation? This pilot observational study was undertaken to provide a snapshot of the experiences available to nursing students that develop the six Quality and Safety Education for Nurses (QSEN) competencies. Students were directly observed during pediatric clinical and pediatric simulation rotations, and their time-on-task was calculated and categorized. Three of the six QSEN competencies were observed more often than the others during both the simulation and clinical experiences. Much work needs to be done to include all QSEN-related knowledge and skills into prelicensure clinical rotations. [J Nurs Educ. 2013;52(9):534-538.]. PMID:23952771

Pauly-O'Neill, Susan; Prion, Susan; Nguyen, Helen

2013-08-19

318

The Need for Information on Adverse Drug Reactions Including the Reactions of Present and Potential Readers to Clinical Experience Abstracts.  

National Technical Information Service (NTIS)

The report includes surveys of more than 1,000 respondents from three groups (present Clinical Experience Abstract (CEA) recipients, members of the American Society of Hospital Pharmacists, and physicians who were specialists in either internal medicine o...

R. F. Clarke H. Shosteck

1974-01-01

319

42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...  

Code of Federal Regulations, 2010 CFR

...outcome requirements for re-approval of transplant centers. 482.82 Section 482...Requirements for Specialty Hospitals Transplant Center Data Submission, Clinical Experience...outcome requirements for re-approval of transplant centers. Except as specified in...

2010-10-01

320

42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...  

Code of Federal Regulations, 2010 CFR

...outcome requirements for re-approval of transplant centers. 482.82 Section 482...Requirements for Specialty Hospitals Transplant Center Data Submission, Clinical Experience...outcome requirements for re-approval of transplant centers. Except as specified in...

2009-10-01

321

Comparative proteomic and radiobiological analyses in human lung adenocarcinoma cells  

Microsoft Academic Search

In clinic, many non-small cell lung cancer (NSCLC) patients receive radiation therapy after chemotherapy failure. However,\\u000a whether the multidrug resistance (MDR) can elevate the radioresistance (RDR) remains unclear. To evaluate the MDR’s effect\\u000a on the RDR, screen MDR- and RDR-related proteins in human lung adenocarcinoma (HLA) cells and tissues A549, and A549\\/DDP cells\\u000a after irradiation were analyzed by colony-forming assay

Rui Wei; Yingjin Zhang; Liangfang Shen; Wuzhong Jiang; Cui Li; Meizuo Zhong; Yun Xie; Dingyi Yang; Lili He; Qing Zhou

322

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

323

Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: clinical experience of a respiratory ward  

Microsoft Academic Search

Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: clinical experience of a respiratory ward. R. Scala, M. Naldi, I. Archinucci, G. Coniglio. Background: Although a controlled trial demonstrat- ed that non-invasive positive pressure ventilation (NIV) can be successfully applied to a respiratory ward (RW) for selected cases of acute hypercapnic respiratory failure (AHRF), clinical practice data about NIV use

R. Scala; M. Naldi; G. Coniglio

324

Clinical experience with long-term use of implantable left ventricular assist devices: Indications, implantation, and outcomes  

Microsoft Academic Search

We describe our clinical experience with 205 implantable left ventricular assist devices at the Cleveland Clinic between December 1991 and January 2000, along with manufacturers' data submitted to the Food and Drug Administration. In patients with end-stage cardiac failure who are suitable candidates for transplantation, these devices serve as excellent bridges to transplantation. Recent modifications have increased pump reliability and

Vigneshwar Kasirajan; Patrick M. McCarthy; Katherine J. Hoercher; Randall C. Starling; James B. Young; Michael K. Banbury; Nicholas G. Smedira

2000-01-01

325

The educational preparation of undergraduate nursing students in pharmacology: clinical nurses’ perceptions and experiences of graduate nurses’ medication knowledge  

Microsoft Academic Search

This paper explores clinical nurses’ perceptions and experiences of graduate nurses’ pharmacology knowledge. Six focus group interviews were conducted with clinical nurses of various appointment levels at two metropolitan public and two regional public hospitals in Victoria, Australia. Four major themes emerged from the study. First, participants indicated that graduate nurses had an overall lack of depth of pharmacology knowledge.

Elizabeth Manias; Shane Bullock

2002-01-01

326

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

327

Applying the Theory of Planned Behavior: Nursing Students' Intention To Seek Clinical Experiences Using the Essential Clinical Behavior Database.  

ERIC Educational Resources Information Center

|Nursing students (n=92) recorded skills and behavior in the Essential Clinical Behavior database, then requested clinical assignments to perform nursing behaviors. Analysis using the theory of planned behavior indicated that attitude and subjective norm influenced intention to ask for assignments. Control beliefs had a negative impact on…

Meyer, Linda

2002-01-01

328

Radiobiologic effect of intermittent radiation exposure in murine tumors  

SciTech Connect

Purpose: In stereotactic irradiation using a linear accelerator, the effect of radiation may be reduced during intermittent exposures owing to recovery from sublethal damage in tumor cells. After our previous in vitro study suggesting this phenomenon, we investigated the issue in murine tumors. Methods and Materials: We used EMT6 and SCCVII tumors approximately 1 cm in diameter growing in the hind legs of syngeneic mice. Three schedules of intermittent radiation were investigated. First, 2 fractions of 10 Gy were given at an interval of 15-360 min to investigate the pattern of recovery from sublethal damage. Second, 5 fractions of 4 Gy were given with interfraction intervals of 2.5-15 min each. Third, 10 fractions of 2 Gy were given with interfraction intervals of 1-7 min each. Doses of 15-20 Gy were also given without interruption to estimate the dose-modifying factors. Tumors were excised 20 h later, and tumor cell survival was determined by an in vivo-in vitro assay. Results: In the 2-fraction experiment, the increase in cell survival with elongation of the interval was much less than that observed in our previous in vitro study. In the 5- and 10-fraction experiments, no significant increase in cell survival was observed after the intermittent exposures. Moreover, cell survival decreased at most points of the 5-fraction experiments by interruption of radiation in both EMT6 and SCCVII tumors. In the 10-fraction experiment, cell survival also decreased when the interruption was 3 or 7 min in EMT6 tumors. Conclusion: The results of the present in vivo studies were different from those of our in vitro studies in which cell survival increased significantly when a few minutes or longer intervals were posed between fractions. This suggests that recovery from sublethal damage in vivo may be counterbalanced by other phenomena such as reoxygenation that sensitizes tumor cells to subsequent irradiation.

Sugie, Chikao [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan)]. E-mail: chikao@bg8.so-net.ne.jp; Shibamoto, Yuta [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Ito, Masato [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Ogino, Hiroyuki [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Miyamoto, Akihiko [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Fukaya, Nobuyuki [Department of Radiology, Kariya General Hospital, Kariya, Aichi (Japan); Niimi, Hiroshige [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Hashizume, Takuya [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan)

2006-02-01

329

USING SET OF EXPERIENCE KNOWLEDGE STRUCTURE TO EXTEND A RULE SET OF CLINICAL DECISION SUPPORT SYSTEM FOR ALZHEIMER'S DISEASE DIAGNOSIS  

Microsoft Academic Search

In this article we present an experience-based clinical decision support system (CDSS) for the diagnosis of Alzheimer's disease, which enables the discovery of new knowledge in the system and the generation of new rules that drive reasoning. In order to evolve an initial set of production rules given by medical experts we make use of the Set of Experience Knowledge

Carlos Toro; Eider Sanchez; Eduardo Carrasco; Leonardo Mancilla-Amaya; Cesar Sanín; Edward Szczerbicki; Manuel Graña; Patricia Bonachela; Carlos Parra; Gloria Bueno; Frank Guijarro

2012-01-01

330

Migrating toward a Next-Generation Clinical Decision Support Application: The BJC HealthCare Experience  

PubMed Central

The next-generation model outlined in the AMIA Roadmap for National Action on Clinical Decision Support (CDS) is aimed to optimize the effectiveness of CDS interventions, and to achieve widespread adoption. BJC HealthCare re-engineered its existing CDS system in alignment with the AMIA roadmap and plans to use it for guidance on further enhancements. We present our experience and discuss an incremental approach to migrate towards the next generation of CDS applications from the viewpoint of a healthcare institution. Specifically, a CDS rule engine service with a standards-based rule representation format was built to simplify maintenance and deployment. Rules were separated from execution code and made customizable for multi-facility deployment. Those changes resulted in system improvements in the short term while aligning with long-term strategic objectives.

Huang, Yan; Noirot, Laura A.; Heard, Kevin M.; Reichley, Richard M.; Dunagan, Wm. Claiborne; Bailey, Thomas C.

2007-01-01

331

[Excimer laser angioplasty. II: Initial clinical experience with peripheral arterial occlusive diseases].  

PubMed

First clinical experiences in the treatment of chronically occluded arteries with 7F-multi-fiber catheter systems transmitting pulsed laser light are presented. 16 patients (7 stadium IIb, 4 stadium III, 5 stadium IVa Fontain) underwent the procedure. 14 of 16 lesions (distance: 0.5-10 cm), most of them with visible calcification, could be recanalized successfully. After the catheter had passed lesions several times, remaining stenoses of 48% (mean value) could be reduced by balloon angioplasty. By moving the catheter with less speed than the experimentally determined speed of laser light ablation and by guiding it over a safety wire, perforation and embolization could be avoided. In one case, occlusion material was pressed into collateral vessels and in two cases groin hematomas had to be observed. PMID:2157246

Huppert, P E; Duda, S H; Haase, K K; Karsch, K R; Claussen, C D

1990-03-01

332

[A new psycho-dermatology clinic in Israel: our first year experience].  

PubMed

Psychodermatology involves the interrelationships between the skin and the mind, especially when considering the formation and evolution of certain common skin conditions. It appears that 30-40% of dermatology patients suffer from certain psychological problems as defined by the ICD-10, in a way that influences their disease severity and progression, as well as their quality of Life. Treatment of such cases requires a multi-disciplinary approach and should involve both a dermatologist and a mental health specialist working together In this article, the authors summarize the preliminary experience of the first year of the only psychodermatology clinic in Israel in several decades, work methods and patients' characteristics and preliminary conclusions. PMID:21449148

Orion, Edith; Ben-Avi, Orit

2011-01-01

333

Clinical implications of I-125 dosimetry of bone and bone-soft tissue interfaces.  

PubMed

The dose to bone from I-125 photon interactions is expected to be approximately five times greater than the dose to soft tissue for the same photon fluence because of the dominance of the photoelectric effect. However, adverse clinical effects are not observed for I-125 implants near bone. Both the strong absorption of I-125 photons in bone and the narrowness (about 10 mu) of the high dose transition zone at a bone-soft tissue interface act to limit the volume of radiation sensitive tissue in the high dose region. Examples of calculated implant dose distributions in bone and in soft tissue cavities in bone are presented. Radiobiological measurements are consistent with the theoretical interface calculations. Calculation of the macroscopic dose distribution uses a recently measured radial dose function, while at the bone-soft tissue interface an analytic theory of the transition zone that is applicable to regular shaped cavities is used. Radiobiological experiments comparing cell survival for cells irradiated with 70 kvP X rays at Al-water and polystyrene-water interfaces are consistent with the transition zone calculations. PMID:1938571

Yorke, E D; Huang, Y C; Schell, M C; Wong, R; Ling, C C

1991-11-01

334

Comparison of treatment effects between animal experiments and clinical trials: systematic review  

PubMed Central

Objective To examine concordance between treatment effects in animal experiments and clinical trials. Study design Systematic review. Data sources Medline, Embase, SIGLE, NTIS, Science Citation Index, CAB, BIOSIS. Study selection Animal studies for interventions with unambiguous evidence of a treatment effect (benefit or harm) in clinical trials: head injury, antifibrinolytics in haemorrhage, thrombolysis in acute ischaemic stroke, tirilazad in acute ischaemic stroke, antenatal corticosteroids to prevent neonatal respiratory distress syndrome, and bisphosphonates to treat osteoporosis. Review methods Data were extracted on study design, allocation concealment, number of randomised animals, type of model, intervention, and outcome. Results Corticosteroids did not show any benefit in clinical trials of treatment for head injury but did show a benefit in animal models (pooled odds ratio for adverse functional outcome 0.58, 95% confidence interval 0.41 to 0.83). Antifibrinolytics reduced bleeding in clinical trials but the data were inconclusive in animal models. Thrombolysis improved outcome in patients with ischaemic stroke. In animal models, tissue plasminogen activator reduced infarct volume by 24% (95% confidence interval 20% to 28%) and improved neurobehavioural scores by 23% (17% to 29%). Tirilazad was associated with a worse outcome in patients with ischaemic stroke. In animal models, tirilazad reduced infarct volume by 29% (21% to 37%) and improved neurobehavioural scores by 48% (29% to 67%). Antenatal corticosteroids reduced respiratory distress and mortality in neonates whereas in animal models respiratory distress was reduced but the effect on mortality was inconclusive (odds ratio 4.2, 95% confidence interval 0.85 to 20.9). Bisphosphonates increased bone mineral density in patients with osteoporosis. In animal models the bisphosphonate alendronate increased bone mineral density compared with placebo by 11.0% (95% confidence interval 9.2% to 12.9%) in the combined results for the hip region. The corresponding treatment effect in the lumbar spine was 8.5% (5.8% to 11.2%) and in the combined results for the forearms (baboons only) was 1.7% (?1.4% to 4.7%). Conclusions Discordance between animal and human studies may be due to bias or to the failure of animal models to mimic clinical disease adequately.

Roberts, Ian; Sena, Emily; Wheble, Philipa; Briscoe, Catherine; Sandercock, Peter; Macleod, Malcolm; Mignini, Luciano E; Jayaram, Pradeep; Khan, Khalid S

2007-01-01

335

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

336

Experience with the clinical development of influenza vaccines for potential pandemics.  

PubMed

During normal interpandemic influenza seasons, immune responses to vaccines are quite predictable and meet the licensing criteria of the European Union (EU) Committee for Proprietary Medicinal Products (CPMP). In a pandemic situation, large sections, if not all of the community will be immunologically naïve and therefore new immunisation strategies will be needed. In 1976 and 1977 H1N1 vaccines were prepared and tested clinically. To stimulate 'protective' antibody responses, two doses of vaccine were needed in people below the age of 24 years (no previous experience of H1N1 virus), whereas one conventional dose was adequate in older people. In 1997, the highly pathogenic avian influenza H5N1 virus caused widespread concern when it infected man, with lethal effects. Due to safety concerns it was necessary to adopt new strategies for vaccine development and one such strategy was to produce vaccine from an avirulent H5N3 virus, A/Duck/Singapore-Q/F119-2/97. Clinical trials of a subunit vaccine prepared from A/Duck/Sing/97 virus revealed that even two doses of twice the normal vaccine concentration (i.e. 30 micro g haemagglutinin) were poorly immunogenic, whereas an H5N3 vaccine adjuvanted with microfluidised emulsion (MF) 59 stimulated antibody levels that complied with CPMP criteria after two half strength doses (i.e. 7.5 micro g haemagglutinin). PMID:12458360

Wood, J M; Nicholson, K G; Stephenson, I; Zambon, M; Newman, R W; Major, D L; Podda, A

2002-09-11

337

Intensity-modulated radiotherapy for pituitary adenomas: The preliminary report of Cleveland Clinic experience  

SciTech Connect

Purpose: Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of pituitary adenomas. However, there have been few published data on the short- and long-term outcomes of this treatment. This is the initial report of Cleveland Clinic's experience. Methods and Materials: Between February 1998 and December 2003, 34 patients with pituitary adenomas were treated with IMRT. A retrospective chart review was conducted for data analysis. Results: With a median follow-up of 42.5 months, the treatment has proven to be well tolerated, with performance status remaining stable in 90% of patients. Radiographic local control was 89%, and among patients with secretory tumors, 100% had a biochemical response. Only 1 patient required salvage surgery for progressive disease, giving a clinical progression free survival of 97%. The only patient who received more than 46 Gy experienced optic neuropathy 8 months after radiation. Smaller tumor volume significantly correlated with subjective improvements in nonvisual neurologic complaints (p = 0.03), and larger tumor volume significantly correlated with subjective worsening of visual symptoms (p = 0.05). New hormonal supplementation was required for 40% of patients. Younger patients were significantly more likely to require hormonal supplementation (p 0.03). Conclusions: Intensity-modulated radiation therapy is a safe and effective treatment for pituitary adenomas over the short term. Longer follow-up is necessary to determine if IMRT confers any advantage with respect to either tumor control or toxicity over conventional radiation modalities.

Mackley, Heath B. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States)]. E-mail: hmackley@alumni.upenn.edu; Reddy, Chandana A. M.S. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Lee, S.-Y. [Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI (United States); Harnisch, Gayle A. [Department of Radiation Oncology, Porter Adventist Hospital, Denver, CO (United States); Mayberg, Marc R. [Swedish Neuroscience Institute, Swedish Hospital, Seattle, WA (United States); Hamrahian, Amir H. [Department of Endocrinology, Cleveland Clinic, Cleveland, OH (United States); Suh, John H. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Brain Tumor Institute, Cleveland Clinic, Cleveland, OH (United States)

2007-01-01

338

Magnetic resonance angiography at 3.0 Tesla: initial clinical experience.  

PubMed

Magnetic resonance (MR) angiography has undergone significant development over the past decade. It has gone from being a novelty application of MR with limited clinical use to replacing catheter angiography in some clinical applications. One of the principal limitations inherent to all MR angiographic techniques is that they remain signal limited when pushed to the limits of higher resolution and short acquisition time. Developments in magnetic gradient hardware, coil design, and pulse sequences now are well optimized for MR angiography obtained at 1.5-T main magnetic field (B-field) strength, with acquisition times and imaging matrix size near their optimal limits, respectively. Recently, the United States Food and Drug Administration (FDA) approved use of clinical magnetic resonance imaging with main magnetic field strengths of up to 4 T. Before FDA approval, use of MR with magnetic field strengths much greater than 1.5 T was essentially reserved for investigational or research applications. The main advantage of high B-field imaging is a significant improvement in the signal-to-noise ratio (SNR), which increases in an approximately linear fashion with field strength in the range of 1.5 to 3.0 T. This increased SNR is directly available when performing MR angiographic acquisitions at higher magnetic field strengths, allowing for better resolution and conspicuity of vessels with similar acquisition times. Little has been reported on the benefits of performing MR angiography at magnetic field strengths >1.5 T. The purpose of this article is to summarize our current experience with intracranial and cervical MR angiographic techniques at 3.0 T. PMID:11432577

Campeau, N G; Huston, J; Bernstein, M A; Lin, C; Gibbs, G F

2001-06-01

339

Regulatory approvals in a large multinational clinical trial: the ESPRIT experience.  

PubMed

While accepted as serving an important function to safeguard human subjects, the process of obtaining regulatory approvals to conduct clinical trials is generally regarded as cumbersome and time-consuming. For large multinational trials, U.S. federally sponsored human subject research abroad involves specific U.S. regulatory requirements, in addition to those of the host country, that act as further hurdles. These requirements may include obtaining an Assurance of Protection for Human Subjects from the Office of Human Research Protection of the U.S. Department of Health and Human Services, maintaining specific Ethics Committee/Institutional Review Board (EC/IRB) composition, and incorporating mandated elements in informed consents, all of which may differ from local policies and guidelines. Specific examples of issues that led to delays in regulatory approvals for sites participating in the multinational clinical trial entitled Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT) are presented here. While the goal of these requirements is to protect the rights and welfare of human subjects, they may create substantial delays and engender resentment over the notion of lack of respect for individual country sovereignty. Substudies within ESPRIT have been undertaken to obtain feedback from EC/IRB chairpersons, site personnel responsible for processing the required assurances, ESPRIT investigators, and study participants regarding aspects of current U.S. regulatory requirements related to human subject protection and ethical issues in multinational research. The purpose of these substudies is to compare the attitudes and experiences across countries regarding important ethical issues associated with conducting ESPRIT. One objective of the substudies is to gather additional insight to the impact of U.S. regulatory processes. Another is to help to inform the debate about how to best maximize the rights and welfare of clinical trial participants without delaying the initiation of research, while respecting the importance of national sensitivities. PMID:11852166

McNay, Laura A; Tavel, Jorge A; Oseekey, Karen; McDermott, Cathy M; Mollerup, David; Bebchuk, Judith D

2002-02-01

340

Blood-Brain Barrier Experiments with Clinical Magnetic Resonance Imaging and an Immunohistochemical Study  

PubMed Central

Objective The purpose of study was to evaluate the feasibility of brain magnetic resonance (MR) images of the rat obtained using a 1.5T MR machine in several blood-brain barrier (BBB) experiments. Methods Male Sprague-Dawley rats were used. MR images were obtained using a clinical 1.5T MR machine. A microcatheter was introduced via the femoral artery to the carotid artery. Normal saline (group 1, n = 4), clotted autologous blood (group 2, n = 4), triolein emulsion (group 3, n = 4), and oleic acid emulsion (group 4, n = 4) were infused into the carotid artery through a microcatheter. Conventional and diffusion-weighted images, the apparent coefficient map, perfusion-weighted images, and contrast-enhanced MR images were obtained. Brain tissue was obtained and triphenyltetrazolium chloride (TTC) staining was performed in group 2. Fluorescein isothiocyanate (FITC)-labeled dextran images and endothelial barrier antigen (EBA) studies were performed in group 4. Results The MR images in group 1 were of good quality. The MR images in group 2 revealed typical findings of acute cerebral infarction. Perfusion defects were noted on the perfusion-weighted images. The MR images in group 3 showed vasogenic edema and contrast enhancement, representing vascular damage. The rats in group 4 had vasogenic edema on the MR images and leakage of dextran on the FITC-labeled dextran image, representing increased vascular permeability. The immune reaction was decreased on the EBA study. Conclusion Clinical 1.5T MR images using a rat depicted many informative results in the present study. These results can be used in further researches of the BBB using combined clinical MR machines and immunohistochemical examinations.

Park, Jun Woo; Kim, Hak Jin; Han, Hyung Soo

2010-01-01

341

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 1012 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

342

Oxygen as a product of water radiolysis in high-LET tracks. II. Radiobiological implications  

SciTech Connect

Consideration is given to the possibility that molecular oxygen generated in the tracks of energetic heavy ions is responsible for the reduction in oxygen enhancement ratio (OER) with increasing linear energy transfer (LET) observed for the loss of reproductive capacity caused by radiation in many cellular organisms. Yields of oxygen relationship of OER to LET for two organisms, Chlamydomonas reinhardii and Shigella flexneri, using a simple diffusion kinetic model for radiobiological action which takes account of the diffusion of oxygen after its formation. The results of these calculations show that the model accounts well for the shape of the OER vs. LET relationship.

Baverstock, K.F. (MRC Radiobiology Unit, Harwell, England); Burns, W.G.

1981-04-01

343

Worldwide clinical experience with the CorCap Cardiac Support Device.  

PubMed

It has been hypothesized that the mechanical burden associated with LV remodeling leads to increased myocardial wall stress and adverse remodeling, all of which serve to further impair cardiac performance and contribute to disease progression. The CorCap Cardiac Support Device (CSD) (Acorn Cardiovascular, Inc., St. Paul, Minnesota) is a mesh-like device that is surgically implanted around the heart. The device is designed to provide circumferential myocardial wall support, and reduce wall stress and myocyte stretch. Clinical experience with CorCap CSD implants in patients with heart failure can be divided into 3 phases: (1) initial safety studies, (2) randomized controlled trials, and (3) limited marketed release. Initial safety studies were undertaken in 48 patients recruited between April 1999 and April of 2001. In 11 patients with complete follow-up, it was noted that LV size, as measured by LV end-diastolic dimension, significantly decreased as early as 3 months postimplant, with an even greater reduction at 6 months. Most importantly, this benefit was sustained, so that the LV end-diastolic dimension stayed smaller at 1, 2, and 3 years of follow-up. There was also an improvement in LV function, as manifested by changes in LV ejection fraction. Ejection fraction was significantly increased by 3 months and appeared to reach a peak improvement by 6 months. This benefit was likewise maintained at 1, 2, and 3 years postsurgery. Hemodynamic data did not show any evidence of constrictive physiology. These preliminary safety studies had shown that the CorCap CSD could be implanted safely and without excess operative morbidity or mortality. The primary objective of the Acorn Randomized Clinical Trial is to assess the efficacy and safety of the CorCap CSD in patients with advanced heart failure despite optimal medical therapy. A randomized trial with 2 arms (mitral valve surgery randomized to CSD and cardiomyopathy randomized to medical therapy alone or with CSD) enrolled 300 patients. The primary endpoint of the trial is a change in clinical status from baseline to the end of the efficacy phase as determined by a clinical composite score. The Acorn CorCap CSD received CE mark approval in Europe in 2001 and has been available to a small number of centers in a Limited Market Release Surveillance Study (LMRSS). PMID:15803555

Starling, Randall C; Jessup, Mariell

2004-12-01

344

Effective beam directions using radiobiologically optimized IMRT of node positive breast cancer.  

PubMed

The purpose of this study was to investigate the optimal coplanar beam directions when treating an early breast cancer with locoregional lymphatic spread with a few radiobiologically optimized intensity modulated beams. Also to determine the increase in the probability of complication-free cure with the number of beam portals and the smallest number required to perform a close to optimal treatment for this tumour site. Four test patients with stage II left-sided breast cancer were studied with heart, lung and contralateral breast as principal organs at risk. The clinical target volume consisted of the breast tissue remaining after surgery, the axillary, the internal mammary as well as the supraclavicular lymph nodes. Through an exhaustive search of all possible beam directions the most effective coplanar beams with one to four intensity modulated photon beam portals were investigated. Comparisons with uniform beam treatment techniques and up to 12 intensity modulated beams were also made. The different plans were optimized using the probability of complication-free tumour cure, P(+), as biological objective function. When using two intensity modulated beam directions three major sets of suitable directions were identified denoted by A, P and T. A corresponds to an anterior oblique pair of beams around 25 degrees and 325 degrees , P is a perpendicular lateral pair at around 50 degrees and 130 degrees whereas T is a more conventional tangential pair at around 155 degrees and 300 degrees . Interestingly, these configurations identify simply three major effective beam directions namely at 30 degrees +/-20 degrees , 145 degrees +/-20 degrees and 310 degrees +/-15 degrees . For the three intensity modulated beam technique a combination of these three effective beam directions generally covered the global maximum of the probability of complication-free tumour control. The improvement in complication-free cure probability with two optimally selected intensity modulated beams is around 10% when compared to a uniform beam technique with three to four beam portals. This increase is mainly due to a reduction by almost 1% in the probability of injury to the heart and an increase of 6% in the probability of local tumour control. When three or four biologically optimized beam portals are used a further increase in the probability of complication-free cure of about 6% can often be obtained. This improvement is caused by a small decrease in the probability of injury to the heart, left lung and other surrounding normal tissue, as well as a slight further increase in the probability of tumour control. The increase in the treatment outcome is minimal when more than four intensity modulated beams are employed. A small increase in dose homogeneity in the target volume and a slight decrease in the normal tissue volume receiving high dose may be seen, but without appreciably improving the complication-free cure probability. For a stage II breast cancer, three and in more complex cases four optimally oriented beams are sufficient to reach close to the maximum probability of complication-free tumour control when biologically optimized intensity modulated dose delivery is used. Angle of incidence optimization may then be advantageous starting from the given most effective three beam directions. PMID:17664150

Ferreira, Brigida Costa; Svensson, Roger; Lind, Bengt; Johansson, Jonas; Brahme, Anders

345

Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience.  

PubMed

Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0.001 vs. baseline). Rather unexpectedly, before the tutorial, the performance of VI-year students and of residents was not significantly different from their III-year colleagues, since the two groups correctly identified 14.2 and 16.2 % of the diagnoses, respectively. After the tutorial, the VI-year students and the residents also improved their overall performance (to 73.1 and 76.1 %, respectively; p < 0.001 for both when compared to before the tutorial). The persistence of this capability after 3 years was remarkable, since the 85 students who repeated the test without any further exposure to the 10-h teaching session with Harvey(©) correctly identified 68.4 % of the possible cardiac diagnoses (p < 0.001 vs. baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the "missing link" between formal lecturing and bedside teaching of heart sounds and murmurs. PMID:22767224

Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco

2012-07-01

346

Issues and problems for radiobiological research in space.  

PubMed

The uniqueness of the space radiation field creates specific problems in the evaluation of hazards to men and materials. Comprehensive measurements of all physical parameters are necessary but not sufficient. Particular attention has to be paid to variables like solar flares by applying fast-responding active dosimetry. The assessment of biological consequences poses even more problems. There are no human data for the kinds of particles seen in space and they will presumably never be available. The only reasonable approach is therefore to use the information obtained for other radiations and check their applicability for the space situation. This involves both the study of fundamental processes in ground experiments as well as their verification in space missions. Special emphasis has to be laid on the modification of radiation effects by flight-dynamic factors and microgravity. Radiation protection guidelines for space flights cannot simply be transformed from existent regulations designed for radiation workers on earth but have to be tailored to the specific situation in space. PMID:11540043

Kiefer, J

1994-10-01

347

Expanded clinical experience with 4DDome(R) composite prosthesis in elective open inguinal herniorrhaphy.  

PubMed

Prosthetic material composition is implicated in the phenomenon of postoperative chronic groin pain that has undermined elective open inguinal herniorrhaphy. Reported herein are our 'all-comers' experiences with a novel dual component mesh (4DDome(R)). A prospective cohort (Phase II) study was performed that involved all patients undergoing elective open inguinal herniorrhaphy during a four-year period. Conventional operative technique was used except for choice of prosthesis. The 4DDome mesh comprises a molded dome-shaped composite (10% polypropylene, 90% poly-L-lactic acid) with a lightweight polypropylene mesh overlay. Short- (1 week) and intermediate-term (18 months) clinical follow-up with examination and symptom questionnaire judged outcome while surgeons rated their approval using a visual analogue scale. One hundred ninety-six patients (mean age, 65.5 years; Mean BMI, 25.5; Mean ASA, 1.8, 178 males) underwent repair of 201 inguinal hernias by six surgeons (three residents). The majority of patients had an indirect hernia (n=119) 93 being combined with a posterior wall defect [Nyhus IIIa], whereas 66 had a direct hernia [Nyhus IIIb], and 11 had a recurrent hernia.) Mean operative time was 44.6 minutes with 92 patients being operated under local anesthesia. Ten patients developed seromas and two had hematomas early postoperatively. Median intermediate-term follow-up is currently 19 (range: 3-72) months for the 147 (75%) patients still available for contact. The incidence of chronic groin pain is 8.8%, whereas there has been one hernia recurrence. Surgeon satisfaction and confidence were high. The 4DDome provides appropriate clinical results and, therefore, appears valid for use in routine practice. PMID:20437353

Mutter, Didier; Callari, Cosimo; D Agostino, Jacopo; Cahill, Ronan A; Forgione, Antonello; Vix, Michel; Leroy, Joël; Marescaux, Jacques

2010-04-01

348

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

PubMed

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. PMID:22927632

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

2012-09-01

349

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

350

Richter's Hernia and Sir Frederick Treves: An Original Clinical Experience, Review, and Historical Overview  

PubMed Central

Objective To describe the clinical recognition, pathology, and management of Richter’s hernia and to review the relevant literature of the past 400 years. Summary Background Data The earliest known reported case of Richter’s hernia occurred in 1598 and was described by Fabricius Hildanus. The first scientific description of this particular hernia was given by August Gottlob Richter in 1778, who presented it as “the small rupture.” In 1887, Sir Frederick Treves gave an excellent overview on the topic and proposed the title “Richter’s hernia.” To his work—a cornerstone to modern understanding—hardly any new aspects can be added today. Since then, only occasional case reports or small series of retrospectively collected Richter’s hernias have been published. Methods The authors draw on their experience with 18 prospectively collected cases treated in the ICRC Lopiding Hospital for War Surgery in northern Kenya between February and December 1998 and review the relevant literature of the past 400 years. Results The classic features of Richter’s hernia were confirmed in all case studies of patients: only part of the circumference of the bowel is entrapped and strangulated in the hernial orifice. The involved segment may rapidly pass into gangrene, yet signs of intestinal obstruction are often absent. The death rate in the authors’ collective was 17%. Conclusion Richter’s hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incidence at laparoscope insertion sites, awareness of this special type of hernia with its misleading clinical appearance is important and of general interest.

Steinke, Wolfgang; Zellweger, Rene

2000-01-01

351

Clinical experience with daptomycin in Europe: the first 2.5 years  

PubMed Central

Objectives To describe the patient populations and infections being treated with daptomycin, as well as the efficacy and safety outcomes. Patients and methods Data from the European Cubicin Outcomes Registry and Experience (EU-CORESM), retrospectively collected at 118 institutions between January 2006 and August 2008, were analysed. Results Daptomycin treatment was documented in 1127 patients with diverse infections, including complicated skin and soft tissue infections (33%), bacteraemia (22%), endocarditis (12%) and osteomyelitis (6%). It was used empirically, before microbiological results became available, in 53% of patients. Staphylococcus aureus was the most common pathogen (34%), with 52% of isolates resistant to methicillin; coagulase-negative staphylococci and enterococci were also frequent, with 22% of Enterococcus faecium isolates resistant to vancomycin. Daptomycin was used as first-line therapy in 302 (27%) patients. When used second line, the most common reasons for discontinuation of previous antibiotic were treatment failure and toxicity or intolerance. The use of concomitant antibiotics was reported in 65% of patients. Most frequent doses were 6 mg/kg (47%) and 4 mg/kg (32%). The median duration of daptomycin therapy was 10 days (range 1–246 days) in the inpatient setting and 13 days (range 2–189 days) in the outpatient setting. The overall clinical success rate was 79%, with a clinical failure rate of <10% for all infection types. Low failure rates were observed in first- and second-line therapy (6% and 8%, respectively). Daptomycin demonstrated a favourable safety and tolerability profile regardless of treatment duration. Conclusions Daptomycin has a relevant role in the treatment of Gram-positive infections.

Gonzalez-Ruiz, Armando; Beiras-Fernandez, Andres; Lehmkuhl, Hans; Seaton, R. Andrew; Loeffler, Juergen; Chaves, Ricardo L.

2011-01-01

352

Preventing rabies with the Verorab vaccine: 1985-2005 Twenty years of clinical experience.  

PubMed

Purified rabies vaccine cultured on Vero cells (Verorab, sanofi pasteur) is WHO-approved for pre- and post-exposure prophylaxis by intradermal and intramuscular routes. During 20 years of use, over 40 million doses of Verorab have been administered in more than 100 countries. No serious adverse event due to Verorab has been reported in clinical trials involving 3937 persons, and Verorab is better tolerated than human diploid cell vaccine (HDCV). Pre-exposure prophylaxis is confirmed immunogenic in 1437 subjects by all routes, with prompt responses following boosting; Verorab boosts effectively subjects pre-immunized with HDCV. Unlike HDCV, Verorab is not associated with post-boosting serum sickness. In the absence of data in immunodeficient/HIV-positive individuals, pre-exposure immunization is urged as early as possible. Essen, Zagreb, Thai Red Cross Intradermal (TRC-ID) and other post-exposure intramuscular and intradermal regimens are documented. Two thousand one hundred and eighty-three subjects received post-exposure prophylaxis, including 874 high risk, severe or confirmed rabid attacks. Co-administration of rabies immune globulin (RIG) does not affect neutralizing antibody levels when Essen or TRC-ID regimens are employed; levels are lower with the Zagreb regimen. Verorab has been administered safely and effectively post-exposure to 251 pregnant women, without any increase in congenital malformations or spontaneous abortions. From a pediatric perspective, safety and efficacy have been demonstrated in 759 children (0-15 years). Intradermal post-exposure Verorab is an effective and inexpensive option for developing countries. Inadvertent subcutaneous administration does not reduce immunogenicity. WHO already strongly recommends the replacement of nerve tissue vaccines with modern vaccines. Extensive clinical experience supports the use of Verorab for intramuscular and intradermal pre- and post-exposure prophylaxis, including in special situations. PMID:17983973

Toovey, Stephen

2007-09-17

353

Pulsatile ECMO in neonates and infants: first European clinical experience with a new device.  

PubMed

This study presents the first European clinical experience with the Medos DeltaStream DP1, a new pulsatile flow pump, in neonates and infants. Between January 2002 and December 2004, 420 patients at our institution underwent congenital heart surgery on cardiopulmonary bypass. During this period, 10 patients required extracorporeal membrane oxygenation (ECMO) support for acute postcardiotomy heart failure. Seven patients (median age 7 days, range 1-70 days), were supported by a nonpulsatile Biomedicus centrifugal pump, whereas three patients (aged 1 month, 1 year, and 12 years) were supported by a pulsatile Medos DP1. The DP1 is an extracorporeal rotary blood pump. The pump features a diagonal-flow impeller, and can be used for both continuous and pulsatile output. Special characteristics include a small priming volume of approximately 30 ml and a high pumping capacity. A temperature sensor and speed sensors are integrated in the pump. The pump has a delivery rate of up to 8 l/min and a speed range of 100-10,000 rpm. Overall mortality was 40% (4 of 10 patients), and all four deaths were in the nonpulsatile Biomedicus group. In the nonpulsatile group, the median support duration was 95 hours with a range of 48-140 hours. Two patients assisted with the pulsatile pump system were successfully weaned after 36 and 53 hours, respectively; the 12-year-old patient was successfully transplanted on the eighth postimplant day and discharged from the hospital on the 32nd posttransplant day. Although this preliminary experience doesn't allow for statistical analysis, clinically it was possible to observe a better performance in pulsatile flow recipients with faster lactate recovery, reduced need for inotropic support, reduced assistance duration in bridge-to-recovery settings, and smoother intensive care management. ECMO for postcardiotomy heart failure in neonates and infants still carries high mortality and morbidity rates. Pulsatile flow with the Medos DeltaStream DP1 pump system improves results by producing more physiologic hemodynamics, reducing the duration of support in the case of bridge to recovery, and improving end-organ function. PMID:16322707

Agati, Salvatore; Mignosa, Carmelo; Ciccarello, Giuseppe; Dario, Salvo; Undar, Akif

354

Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis  

PubMed Central

Background In the United States, an estimated 70 stillbirths occur each day, on average 25,000 each year. Research into the prevalence and causes of stillbirth is ongoing, but meanwhile, many parents suffer this devastating loss, largely in silence, due to persistent stigma and taboo; and many health providers report feeling ill equipped to support grieving parents. Interventions to address bereavement after neonatal death are increasingly common in U.S. hospitals, and there is growing data on the nature of parent bereavement after a stillbirth. However, further research is needed to evaluate supportive interventions and to investigate the parent-clinician encounter during hospitalization following a stillbirth. Qualitative inquiry offers opportunities to better understand the lived experience of parents against the backdrop of clinicians’ beliefs, intentions, and well-meaning efforts to support grieving parents. Methods We present a secondary qualitative analysis of transcript data from 3 semi-structured focus groups conducted with parents who had experienced a stillbirth and delivered in a hospital, and 2 focus groups with obstetrician-gynecologists. Participants were drawn from the greater Seattle region in Washington State. We examine parents’ and physicians’ experiences and beliefs surrounding stillbirth during the clinical encounter using iterative discourse analysis. Results Women reported that the cheery, bustling environment of the labor and delivery setting was a painful place for parents who had had a stillbirth, and that the well-meaning attempts of physicians to offer comfort often had the opposite effect. Parents also reported that their grief is deeply felt but not socially recognized. While physicians recognized patients’ grief, they did not grasp its depth or duration. Physicians viewed stillbirth as an unexpected clinical tragedy, though several considered stillbirth less traumatic than the death of a neonate. In the months and years following a stillbirth, these parents continue to memorialize their children as part of their family. Conclusions Hospitals need to examine the physical environment for deliveries and, wherever possible, offer designated private areas with staff trained in stillbirth care. Training programs in obstetrics need to better address the bereavement needs of parents following a stillbirth, and research is needed to evaluate effective bereavement interventions, accounting for cultural variation. Critical improvements are also needed for mental health support beyond hospitalization. Finally, medical professionals and parents can play an important role in reversing the stigma that surrounds stillbirth.

2012-01-01

355

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

356

Design of a radiation facility for very small specimens used in radiobiology studies  

NASA Astrophysics Data System (ADS)

A design of a radiation facility for very small specimens used in radiobiology is presented. This micro-irradiator has been primarily designed to irradiate partial bodies in zebrafish embryos 3-4 mm in length. A miniature x-ray, 50 kV photon beam, is used as a radiation source. The source is inserted in a cylindrical brass collimator that has a pinhole of 1.0 mm in diameter along the central axis to produce a pencil photon beam. The collimator with the source is attached underneath a computer-controlled movable table which holds the specimens. Using a 45° tilted mirror, a digital camera, connected to the computer, takes pictures of the specimen and the pinhole collimator. From the image provided by the camera, the relative distance from the specimen to the pinhole axis is calculated and coordinates are sent to the movable table to properly position the samples in the beam path. Due to its monitoring system, characteristic of the radiation beam, accuracy and precision of specimen positioning, and automatic image-based specimen recognition, this radiation facility is a suitable tool to irradiate partial bodies in zebrafish embryos, cell cultures or any other small specimen used in radiobiology research.

Rodriguez, Manuel; Jeraj, Robert

2008-06-01

357

AFRRI (Armed Forces Radiobiology Research Institute). Annual research report, 1 October 1984-30 September 1985  

SciTech Connect

The Armed Forces Radiobiology Research Inst.(AFRRI) is the primary DOD facility for scientific research in the field of radiobiology and related matters. It conducts applied and basic research that is essential for the operational and medical support of the DOD. The work is carried out by five scientific departments: Behavioral sciences - Effects on ionizing radiation, chemicals, and drugs on performance. Biochemistry - Elucidation of mechanisms of injury, repair, and protection from the effects of ionizing radiation alone or in combination with other agents; development of improved methods to detect and quantify the severity of radiation injury. Experimental Hematology - Investigation of radiation injury of bone marrow; development of therapy for damage from intermediate radiation doses; determination and treatment of injuries caused by combined effects of radiation, blast, and burns. Physiology - Research on cellular, tissue, and whole-animal models to determine physiological and biophysical changes resulting from radiation either alone or in combination with drugs and other chemicals. and Radiation Sciences - Operation, maintenance, and quality control of all AFRRI radiation sources, radiation dosimetry and estimation of tissue doses at various depths in different kinds if tissues; development and use of nuclear medicine and magnetic spectroscopic techniques for determining radiation damage in animals and model systems.

Not Available

1985-09-30

358

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

359

A radiobiological analysis of the effect of 3D versus 4D image-based planning in lung cancer radiotherapy  

NASA Astrophysics Data System (ADS)

Dose distributions generated on a static anatomy may differ significantly from those delivered to temporally varying anatomy such as for abdominal and thoracic tumors, due largely in part to the unavoidable organ motion and deformation effects stemming from respiration. In this work, the degree of such variation for three treatment techniques, namely static conventional, gating and target tracking radiotherapy, was investigated. The actual delivered dose was approximated by planning all the phases of a 4DCT image set. Data from six (n = 6) previously treated lung cancer patients were used for this study with tumor motion ranging from 2 to 10 mm. Complete radiobiological analyses were performed to assess the clinical significance of the observed discrepancies between the 3D and 4DCT image-based dose distributions. Using the complication-free tumor control probability (P+) objective, we observed small differences in P+ between the 3D and 4DCT image-based plans (<2.0% difference on average) for the gating and static conventional regimens and higher differences in P+ (4.0% on average) for the tracking regimen. Furthermore, we observed, as a general trend, that the 3D plan underestimated the P+ values. While it is not possible to draw any general conclusions from a small patient cohort, our results suggest that there exists a patient population in which 4D planning does not provide any additional benefits beyond that afforded by 3D planning for static conventional or gated radiotherapy. This statement is consistent with previous studies based on physical dosimetric evaluations only. The higher differences observed with the tracking technique suggest that individual patient plans should be evaluated on a case-by-case basis to assess if 3D or 4D imaging is appropriate for the tracking technique.

Roland, Teboh; Mavroidis, Panayiotis; Gutierrez, Alonso; Goytia, Virginia; Papanikolaou, Niko

2009-09-01

360

A unified spatio-temporal parallelization framework for accelerated Monte Carlo radiobiological modeling of electron tracks and subsequent radiation chemistry  

NASA Astrophysics Data System (ADS)

Monte Carlo (MC) nano-scale modeling of the cellular damage is desirable but most times is prohibitive for large scaled systems due to their intensive computational cost. In this study a parallelized computational framework is presented, for accelerated MC simulations of both particle propagation and subsequent radiation chemistry at the subcellular level. Given the inherent parallelism of the electron tracks, the physical stage was "embarrassingly parallelized" into a number of independent tasks. For the chemical stage, the diffusion–reaction of the radical species was simulated with a time-driven kinetic Monte Carlo algorithm (KMC) based on the Smoluchowski formalism and the parallelization was realized by employing a spatio-temporal linked-list cell method based on a spatial subdivision with a uniform grid. The evaluation of our method was established on two metrics: speedup and efficiency. The results indicated a linear speedup ratio for the physical stage and a linear latency for shared- versus a distributed-memory system with a maximum of 3.6?10?3% per electron track. For the chemical stage, a series of simulations were performed to show how the execution time per step was scaling with respect to the number of radical species and a 5.7× speedup was achieved when a larger number of reactants were simulated and eight processors were employed. The simulations were deployed on the Amazon EC2 infrastructure. It is also elucidated how the overhead started becoming significant as the number of reactant species decrease relative to the number of processors. The method reported here lays the methodological foundations for accelerated MC simulations and allows envisaging a future use for large-scale radiobiological modeling of multi-cellular systems involved into a clinical scenario.

Kalantzis, Georgios; Emfietzoglou, Dimitrios; Hadjidoukas, Panagiotis

2012-08-01

361

Comparison of internal emitter radiobiology in animals and humans.  

PubMed

Investigations of radionuclide metabolism and effects in various mammalian species revealed important similarities between animals and humans and between some animal species. These include skeletal deposition of radium and radiostrontium in bone volume; deposition on bone surfaces of plutonium and other actinides; liver deposition of actinides; induction of skeletal or liver malignancies by these radionuclides; induction of tooth and jaw abnormalities; mammary cancer induction by radium in humans and in the beagle; depression of circulating cells in blood; and induction of bone fractures. There are also inter-species differences that may not have been noted if multiple species (including humans) had not been studied. Some of these are more rapid excretion of radium in humans compared with most other mammals; induction by radium of eye melanomas in animals but not humans; rapid loss of deposited plutonium from liver in many species of mice and rats but not in humans and dog; substantial sex-related differences in skeletal plutonium retention and bone sarcoma induction in mice but not in humans or dog; and induction of head sinus carcinomas by 226Ra in humans but not the beagle. Leukemia and other related neoplasms were not induced in radionuclide-injected lifespan dogs in excess of the occurrence in control animals. Much of our current understanding of skeletal biology and radionuclide behavior in mammals was derived from this and related projects. The primary goal of the Utah experiment of estimating toxicities of bone-seeking radionuclides relative to radium has been accomplished. For 226Ra = 1.0, comparative toxicities (ratios) of a single injection for bone tumor induction in beagles were about 16 +/- 5 for monomeric 239Pu (32 +/- 10 for chronic exposure), 6 +/- 0.8 for 241Am, 8.5 +/- 2.3 for 228Th, 6 +/- 3 for 249Cf, 4 +/- 2 for 252Cf, 6 +/- 2 for 224Ra (16 +/- 5 for 50 weekly injections), 2 +/- 0.5 for 228Ra, and between 0.01 +/- 0.01 and 1.0 +/- 0.5 for 90Sr, depending on the dose-rate, with the lowest dose-rates approaching a ratio of zero. Corresponding ratios in mice for 226Ra = 1.0 were 16 +/- 4 for monomeric 239Pu, 5.4 +/- 2.0 for 224Ra (16 for 50 weekly injections), 4.9 +/- 1.4 for 241Am, 5.0 +/- 1.4 for 249Cf, 2.6 +/- 0.8 for 252Cf, 4.4 +/- 1.8 for 243,244Cm and about 1.0 for 90Sr at high doses, decreasing to near zero for low doses. PMID:8972834

Lloyd, R D; Miller, S C; Taylor, G N; Bruenger, F W; Angus, W; Jee, W S

1997-01-01

362

Analysis of stress fractures in athletes based on our clinical experience  

PubMed Central

AIM: To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS: We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS: During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION: The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

Iwamoto, Jun; Sato, Yoshihiro; Takeda, Tsuyoshi; Matsumoto, Hideo

2011-01-01

363

Clinical experience with linezolid in the treatment of resistant gram-positive infections.  

PubMed Central

This study presents our clinical experience with linezolid in 19 patients with serious resistant gram-positive infections enrolled as part of the compassionate study. In this prospective, non-randomized, noncomparative study, 19 patients were enrolled as part of the National Compassionate Study Protocol conducted by Pharmacia-Upjohn. At the time of this writing, these patients had not been published in the literature. All of the patients had to have documented evidence of serious gram-positive infections in normally sterile sites and should have been unable to tolerate available antimicrobial therapy or be unresponsive to available drugs. Clinical characteristics, laboratory values, and pharmacokinetic and pharmacodynamic parameters were obtained. Patients were followed both short-term and long-term after completion of therapy. Nineteen patients were enrolled: 13 females and 6 males. The average age was 63 years. The average length of therapy with linezolid was 22 days. Methicillin-resistant Staphylococcus aureus (MRSA) was treated in eight patients, methicillin-resistant Staphylococcus epidermidis (MRSE) in two patients, vancomycin-resistant Enterococcus faecium (VREF) in eight patients, and coagulase-negative Staphylococcus in two patients. Co-infecting organisms include Enterococcus species colonization in six patients, Pseudomonas species in one patient, Serratia marcenens in one patient, and Candida albicans in one patient. Sterile sites that were infected included bone and joint (wounds and septic joints) in six patients, gastrointestinal system (hepatobiliary, liver abscess, Crohn's) in five patients, genitourinary (kidney and urine) in two patients, blood in five patients, respiratory in one patient, and aortic valve in 1 patient. Linezolid was given at 600 mg IV every 12 hours with a mean length of therapy of 22 days. Surgical drainage was used in combination with linezolid in 11 of the patients. Seventy nine percent of these patients achieved clinical and microbiologic cure, and none of the deaths reported in this series were related to the drug. Adverse events included skin rash in one patient, mild bone marrow suppression in two patients, and mild elevation in liver function tests in two patients. No life-threatening adverse events were noted. It appears that linezolid, along with surgical intervention (when necessary), appears to be an effective treatment option for resistant gram-positive infections. Long-term studies evaluating the possible resistance rates are necessary.

Antony, S. J.; Diaz-Vasquez, E.; Stratton, C.

2001-01-01

364

Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review.  

PubMed

Documented experience of treatment of digital nerve lesions with the termino-lateral (end-to-side) nerve suture is limited. Our clinical experience of this technique is detailed here alongside a systematic review of the previous literature. We performed, from 2002 to 2008, seven termino-lateral sutures with epineural window opening for digital nerve lesions. Functional outcome was analysed using the two-point discrimination test and the Semmes-Weinstein monofilament test. The results showed a sensory recovery of S3+ in six cases and S3 in one case. The mean distance found in the two-point discrimination test was 12.7 mm (range 8-18 mm). After a review of the literature, we were able to obtain homogeneous data from 17 additional patients operated by termino-lateral coaptation. The overall number of cases included in our review was 24. A sensory recovery was observed in 23 out of 24 patients. The functional results were S0 in one case, S3 in one case, S3+ in twenty cases and S4 in two cases. Excluding the one unfavourable case, the mean distance in the two-point discrimination test was 9.7 mm (range 3-18 mm). It can thus be concluded that the treatment of digital nerve lesions with termino-lateral suture showed encouraging results. Based on the results obtained in this current study we believe that in case of loss of substance, end-to-side nerve coaptation may be an alternative to biological and synthetic tubulisation when a digital nerve reconstruction by means of nerve autograft is declined by the patient. PMID:19687081

Artiaco, S; Tos, P; Conforti, L G; Geuna, S; Battiston, B

2009-08-17

365

Sacral neuromodulation in Norway: clinical experience of the first three years.  

PubMed

We present our first three years' experience of sacral neromodulation as first line therapy in patients with a non-neurogenic refractory urge incontinence. In 53 patients, 45 women and 8 men with a mean age of 54 years (range 17-76 years), tested by subacute percutan nerve evaluation, 19 patients were declared as responders according to our programme. Fourteen patients, twelve women and two men with a mean age of 47 years (range 33-73 years), agreed to implantation of a neuroprosthesis (Medtronic Interstim Model 3031), which was placed in a subcutaneous buttock pocket in 12 patients. In the first two patients, the device was implanted subcutaneously corresponding to the lower quadrants of the abdominal wall. In two patients, the lead was repositioned from S:4 to S:3 six to twelve months after the primary implantation. In one woman with sensory urgency, the neuroprosthesis was removed six months after it was implanted because of failure. The patients were followed every six months using voiding diary, uroflowmetry, residual urine and cystometry. Eight patients reported total continence, and five declared >50% improvement. One woman has chronic bacteriuria and intermittently symptomatic urinary tract infection, which reduce the response to the chronic sacral nerve stimulation. Because of residual urine, four women are following an individual self-catheterisation programme. In conclusion, we have documented that sacral neuromodulation is an effective and safe procedure in patients with refractory urge incontinence depending on detrusor overactivity. We confirm the clinical results reported by other centres with long experience of sacral neuromodulation. PMID:12475023

Hedlund, Hans; Schultz, Alexander; Talseth, Trygve; Tonseth, Kim; van der Hagen, Arvid

2002-01-01

366

Tomotherapy as a tool in image-guided radiation therapy (IGRT): current clinical experience and outcomes  

PubMed Central

Modern radiotherapy is characterised by a better target definition through medical imaging accompanied by significantly improved radiation delivery methods, most notably Intensity-Modulate Radiation Therapy (IMRT). However, the treatment can only be as accurate as the positioning of patients for their daily radiotherapy fraction. It is in this context that a number of imaging modalities - ranging from ultrasound to on-board kilovoltage imaging and computed tomography (CT) - have found their way into the treatment room where they verify accurate patient positioning prior to or even during delivery of radiation. Helical tomotherapy (HT) combines IMRT delivery with in-built image guidance using megavoltage CT scanning. This paper discusses the initial experience of different centres with IGRT using HT illustrated by a number of clinical examples from the installation in London in Ontario, Canada, one of the world’s first HT sites. We found that HT allows the delivery of highly conformal radiation dose distributions combined with adequate daily image acquisition. An important feature of this unit is its seamless integration, which also includes a customised inverse treatment planning system and a quality assurance module for individual patients.

Yartsev, S; Kron, T; Van Dyk, J

2007-01-01

367

Improving anal cancer screening in an ambulatory HIV clinic: experience from a quality improvement initiative.  

PubMed

Evidence suggests that persons living with HIV (PLWH) are at increased risk for anal cancer. Early detection of anal cancer is an important prevention measure, but screening rates have been low. This report describes the experience of a quality improvement initiative to increase anal cancer screening at an HIV-specialty clinic. Chart reviews were conducted for three time periods: baseline year, prior to program discussion; transition year, during planning; and implementation year, during program availability. Odds ratios using Fisher's exact test showed that the odds of receiving anal cancer screening increased significantly in the transition year, odds ratio (OR)?=?2.859, 95% confidence interval (CI): [1.798; 4.546], Fisher's z?=?4.40, p??8.2, p?

Kwong, Jeffrey J; Cook, Paul; Bradley-Springer, Lucy

2011-01-15

368

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

369

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

370

Recruitment of ethnic minorities into cancer clinical trials: experience from the front lines  

PubMed Central

Throughout the world there are problems recruiting ethnic minority patients into cancer clinical trials. A major barrier to trial entry may be distrust of research and the medical system. This may be compounded by the regulatory framework governing research with an emphasis on written consent, closed questions and consent documentation, as well as fiscal issues. The Leicester UK experience is that trial accrual is better if British South Asian patients are approached by a senior doctor rather than someone of perceived lesser hierarchical status and a greater partnership between the hospital and General Practitioner may increase trial participation of this particular ethnic minority. In Los Angeles, USA, trial recruitment was improved by a greater utilisation of Hispanic staff and a Spanish language-based education programme. Involvement of community leaders is essential. While adhering to national, legal and ethnical standards, information sheets and consent, it helps if forms can be tailored towards the local ethnic minority population. Written translations are often of limited value in the recruitment of patients with no or limited knowledge of English. In some cultural settings, tape-recorded verbal consent (following approval presentations) may be an acceptable substitute for written consent, and appropriate legislative changes should be considered to facilitate this option. Approaches should be tailored to specific minority populations, taking consideration of their unique characteristics and with input from their community leadership.

Symonds, R P; Lord, K; Mitchell, A J; Raghavan, D

2012-01-01

371

Recruitment of ethnic minorities into cancer clinical trials: experience from the front lines.  

PubMed

Throughout the world there are problems recruiting ethnic minority patients into cancer clinical trials. A major barrier to trial entry may be distrust of research and the medical system. This may be compounded by the regulatory framework governing research with an emphasis on written consent, closed questions and consent documentation, as well as fiscal issues. The Leicester UK experience is that trial accrual is better if British South Asian patients are approached by a senior doctor rather than someone of perceived lesser hierarchical status and a greater partnership between the hospital and General Practitioner may increase trial participation of this particular ethnic minority. In Los Angeles, USA, trial recruitment was improved by a greater utilisation of Hispanic staff and a Spanish language-based education programme. Involvement of community leaders is essential. While adhering to national, legal and ethnical standards, information sheets and consent, it helps if forms can be tailored towards the local ethnic minority population. Written translations are often of limited value in the recruitment of patients with no or limited knowledge of English. In some cultural settings, tape-recorded verbal consent (following approval presentations) may be an acceptable substitute for written consent, and appropriate legislative changes should be considered to facilitate this option. Approaches should be tailored to specific minority populations, taking consideration of their unique characteristics and with input from their community leadership. PMID:23011540

Symonds, R P; Lord, K; Mitchell, A J; Raghavan, D

2012-05-31

372

Clinical Experience of Bronchoscopy-Guided Radiofrequency Ablation for Peripheral-Type Lung Cancer  

PubMed Central

We have developed a new internal cooled electrode for radiofrequency ablation (RFA) (Japan Application no. 2006-88228) suitable for forceps channel bronchoscopy. Here, we present our clinical experience with bronchoscopy-guided RFA under computed tomography (CT) monitoring for patients with peripheral-type non-small-cell lung cancer (NSCLC). Bronchoscopy-guided RFA was performed in two patients (80 and 70 years old) with NSCLC, who had no lymph node involvement and distant metastases (T1N0M0), but not indicated for surgery because of other complications, such as advanced age, poor pulmonary function, and refusal of thoracic surgery. The locations of the tumors were right S2 and left S3, respectively. Although the tumors showed ground-glass opacity (GGO) with solid components in both cases, radiographic findings changed to reduced mass-like shadow and remained stable for 4 and 3.5 years after bronchoscopy-guided RFA. As the former case developed progressive disease on chest CT, bronchoscopy-guided RFA was repeated in the same lesion, resulting in no change for the subsequent 1 year. There were no adverse reactions during the procedures. Thus, bronchoscopy-guided RFA is a safe and feasible procedure that represents a potentially useful therapeutic tool in local control in medically inoperable patients with stage I NSCLC.

Koizumi, Tomonobu; Kobayashi, Takashi; Tanabe, Tsuyoshi; Tsushima, Kenji; Yasuo, Masanori

2013-01-01

373

[Professor Li Shi-zhen's clinical experiences on compatibility application of hegu (LI 4)].  

PubMed

The present paper introduces professor LI Shi-zhen's clinical experiences on compatibility application of Hegu (LI 4). Hegu (LI 4) is mostly used to treat acute pyreticosis, exterior syndrome of exogenous diseases, mind diseases and deficiency of vital energy. Acupuncture at this acupoint by using reducing method can dispel wind to relieve exterior syndrome, clear away heat to disperse lung. Powerful stimulation by needle can dredge stagnant meridian, open orifice to activate spirit. Acupuncture at this acupoint by using reinforcing method can invigorate qi to strengthen superficies and replenish qi to prevent collapse. Based on this method, reinforcing Zusanli (ST 36) and Baihui (GV 20) can strengthen middle energizer to nourish qi, which show the same benefits as Buzhong Yiqi Decoction; reinforcing Sanyinjiao (SP 6) can nourish both qi and blood, which show the same benefits as Decoction of Eight Ingredients; reducing Neiting (ST 44) can clear away evil heat of qifen in yangming meridians, which show the same benefits as Baihu Decoction. PMID:20214075

Li, Chuan-qi

2010-02-01

374

Experience as a doctor in the developing world: does it benefit the clinical and organisational performance in general practice?  

PubMed Central

Background Many physicians have medical experience in developing countries early in their career, but its association with their medical performance later is not known. To explore possible associations we compared primary care physicians (GPs) with and without professional experience in a developing country in performance both clinical and organisational. Methods A retrospective survey using two databases to analyse clinical and organisational performance respectively. Analysis was done at the GP level and practice level. 517 GPs received a questionnaire regarding relevant working experience in a developing country. Indicators for clinical performance were: prescription, referral, external diagnostic procedures and minor procedures. We used the district health insurance data base covering 570.000 patients. Explorative secondary analysis of practice visits of 1004 GPs in 566 practices in the Netherlands from 1999 till 2001. We used a validated practice visit method (VIP; 385 indicators in 51 dimensions of practice management) to compare having experience in a developing country or not. Results Almost 8% of the GPs had experience in a developing country of at least two years. These GPs referred 9,5% less than their colleagues and did more surgical procedures. However, in the multivariate analysis 'experience in a developing country' was not significantly associated with clinical performance or with other GP- and practice characteristics. 16% of the practices a GP or GPs with at least two years experience in a developing country. They worked more often in group and rural practices with less patients per fte GP and more often part-time. These practices are more hygienic, collaborate more with the hospital and score better on organisation of the practice. These practices score less on service and availability, spend less time on patients in the consultation and the quality of recording in the EMD is lower. Conclusions We found interesting differences in clinical and organisational performance between GPs with and without medical experience in developing countries and between their practices. It is not possible to attribute these differences to this experience, because the choice for medical experience in a tropical country probably reflects individual differences in professional motivation and personality. Experience in a developing country may be just as valuable for later performance in general practice as experience at home.

2009-01-01

375

MEETING REPORT: Workshop on Comparative Radiobiology and Protection of the EnvironmentDublin, 21-24 October 2000  

Microsoft Academic Search

A workshop was held in Dublin on Comparative Radiobiology and Protection of the Environment last October. The workshop was organised by the Radiation and Environmental Science Centre at the Dublin Institute of Technology (DIT) in collaboration with the Radiological Protection Institute of Ireland (RPII). The international programme committee consisted of Dennis Woodhead, CEFAS, Jack Valentin, ICRP, Werner Mueller, University of

Carmel Mothersill

2001-01-01

376

Myocardial perfusion imaging: clinical experience and recent progress in radionuclide scintigraphy and magnetic resonance imaging  

Microsoft Academic Search

In the past 20 years, radionuclide scintigraphy has proven to be a sensitive clinical tool in the assessment of myocardial perfusion abnormalities. Magnetic resonance imaging may also be used to study myocardial perfusion, but its potential value still has to emerge in the clinical setting. This review addresses the potential and achievements of both methods in clinical cardiology.

Cess A. Visser; Jan T. Keijer; Jeroen J. Bax; Albert C. van Rossum; Frans C. Visser

1997-01-01

377

Coronally advanced flap and combination therapy for root coverage. Clinical strategies based on scientific evidence and clinical experience.  

PubMed

During the past three decades, several surgical techniques have been proposed to treat single and multiple gingival recessions. Evidence indicates that coronally advanced flap-based approaches result in the best clinical results. Among all the different techniques, the use of a graft under a coronally advanced flap results in the best short- and long-term outcomes in terms of root coverage and gain in keratinized tissue. The use of a coronally advanced flap?+?connective tissue graft would appear to be the best choice for root coverage. However, harvesting a graft from the palate adds morbidity, surgical chair-time and requires increased surgical skills. A potential alternative could be the use of enamel matrix derivatives under a coronally advanced flap, and this achieves similar clinical outcomes and is less invasive, but adds economic costs to the treatment. Evidence shows that a coronally advanced flap alone in many instances results in complete root coverage and is stable over time. A coronally advanced flap is less invasive for the patient, requires less chair-time and probably less surgical skill. It would therefore be desirable to use a coronally advanced flap approach when indicated. It has been hypothesized that a coronally advanced flap approach alone could be successfully applied when the residual gingiva is thick and wide, although existing evidence does not support this hypothesis in full. Accordingly, the adjunctive use of a graft or enamel matrix derivatives could be restricted to sites at which there is thin and narrow residual gingiva. PMID:22507065

Cortellini, Pierpaolo; Pini Prato, Giovanpaolo

2012-06-01

378

Clinical experience with exenatide in obese North Indian patients with type 2 diabetes mellitus  

PubMed Central

Objective: To share our clinical experience with exenatide in obese North Indian subjects with type 2 diabetes. Materials and Methods: We share our experience with use of exenatide in 74 patients treated at Indraprastha Apollo Hospital, a tertiary care centre in New Delhi, India Subjects included obese / overweight subjects (mean weight and BMI; 97.67 ± 5.6 kg and 34.56 kg/m2) with known history of type 2 DM (Mean: 9 ± 5.6 years) and maintaining suboptimal glycemic control (HbA1c >7%) on oral antidiabetic agents, with or without basal insulin. Metformin and sulphonylureas were continued (with dose adjustment if indicated), as was basal insulin (glargine / detemir). TZDs and DPP4 inhibitors were discontinued. The dose of exenatide was increased to 10 mcg twice a day after 4-12 weeks. 56 patients completed minimum 3 month therapy. 42 patients completed 6 months, 32, 9 months and 25 completed 12 months. Data of patients who had completed at-least 3 months of therapy was included for analysis. Results and Discussion: 69.77, 67.44, and 13.95% of the patients were receiving metformin, secretagogues or thiazolidinediones alone or in combination; 17.76% of the patients were on basal insulin. The change in fasting and post-prandial blood glucose levels were significant at 3, 6, 9 and 12 months with p-value <0.05. The mean weight loss at one, three, and six months and one year was 1.7 ± 1.3, 3.8 ± 2.5, 6.3 ± 3.4, and 8.3 ± 4.3 kg, respectively (P <0.05). The mean HbA1c (baseline: 8.8 ± 1.3%) at 3, 6 months and at one year was 7.8 ± 0.9, 7.7 ± 0.8 and 7.2 ± 0.8 (P <0.05). Thirty-five percent of the patients had a ‘good’ A1c value (< 7%) at the end of 12 months. 13 patients discontinued exenatide (three due to lack of response, six due to cost of therapy and four due to severe nausea). Nausea was the most common side effect, occurring in 95% patients within 1 month, although the incidence declined with passage of time. Conclusions: Clinical use of Exenatide is associated with significant improvement in glycemic control and major weight loss (8.3±4.3 kg at 1 year) in obese subjects with type 2 diabetes. Nausea is the most common side effect. In conclusion, exenatide is a effective and useful option for treatment of type 2 diabetes in obese Indian subjects.

Bawa, Tarunika; Dhingra, Vibha; Malhotra, Nidhi; Wasir, Jasjeet S.; Mithal, Ambrish

2013-01-01

379

Clinical characteristics and treatment of esophageal atresia: a single institutional experience  

PubMed Central

Purpose Treatment for esophageal atresia has advanced over several decades due to improvements in surgical techniques and neonatal intensive care. Subsequent to increased survival, postoperative morbidity has become an important issue in this disease. The aim of our study was to analyze our experience regarding the treatment of esophageal atresia. Methods We reviewed and analyzed the clinical data of patients who underwent surgery for esophageal atresia at Severance Children's Hospital from 1995 to 2010 regarding demographics, surgical procedures, and postoperative outcomes. Results Seventy-two patients had surgery for esophageal atresia. The most common gross type was C (81.9%), followed by type A (15.3%). Primary repair was performed in 52 patients. Staged operation was performed in 17 patients. Postoperative esophageal strictures developed in 43.1% of patients. Anastomotic leakages occurred in 23.6% of patients, and recurrence of tracheoesophageal fistula was reported in 8.3% of patients. Esophageal stricture was significantly associated with long-gap (?3 cm or three vertebral bodies) atresia (P = 0.042). The overall mortality rate was 15.3%. The mortality in patients weighing less than 2.5 kg was higher than in patients weighing at least 2.5 kg (P = 0.001). During the later period of this study, anastomotic leakage and mortality both significantly decreased compared to the earlier study period (P = 0.009 and 0.023, respectively). Conclusion The survival of patients with esophageal atresia has improved over the years and the rate of anastomotic leakage has been significantly reduced. However, overall morbidities related to surgical treatment of esophageal atresia still exists with high incidence.

Chang, Eun Young; Chang, Hye Kyung; Han, Seok Joo; Choi, Seung Hoon; Hwang, Eui Ho

2012-01-01

380

An 8 1/2-year clinical experience with surgery for atrial fibrillation.  

PubMed Central

OBJECTIVE: The authors analyzed the clinical results during the first 8 1/2 years' experience with the Maze procedure for the surgical treatment of atrial fibrillation. SUMMARY BACKGROUND DATA: Atrial fibrillation occurs in 0.4% to 2% of the general population and in approximately 10% of patients older than 60 years of age. It is associated with significant morbidity and mortality. The irregular heartbeat causes discomfort, the loss of synchronous atrioventricular contraction compromises hemodynamics and the stasis of blood flow increases the vulnerability to thromboembolism. METHODS: From September 25, 1987 to March 1, 1996, 178 patients underwent the Maze procedure. Thirty-two patients underwent the Maze-I procedure, 15 underwent the Maze-II procedure, and 118 underwent the Maze-III procedure. Patients were analyzed for recurrence of atrial flutter and atrial fibrillation between 3 months and 8 1/2 years after surgery (n = 164). Patients were analyzed for atrial transport function, sinus nodule function, and postoperative pacemaker requirements. RESULTS: Ninety-three percent of all patients were arrhythmia free without any antiarrhythmic medication. Of the remaining patients with arrhythmia recurrence, all were converted to sinus rhythm with medical therapy. All patients were documented to have atrial transport function by either direct visualization, transesophageal echocardiography, or atrioventricular versus ventricular pacing at the same rate. Ninety-eight percent had documented right atrial function, and 94% had left atrial function. Of the 107 patients in this series who were documented to have a normal sinus node preoperatively, only 1 patient required a permanent pacemaker. CONCLUSION: The Maze procedure is an effective treatment for medically refractory atrial fibrillation in properly selected patients.

Cox, J L; Schuessler, R B; Lappas, D G; Boineau, J P

1996-01-01

381

Events and Experiences Impacting the Development of Clinical Self Confidence: A Study of the First Year of Client Contact  

ERIC Educational Resources Information Center

Research was conducted to identify the events and experiences influencing the development of clinical self-confidence during the first year of client contact for beginning marriage and family therapists. Thirty-nine recent graduates of a master's degree training program participated in a semistructured interview in which they were asked to…

Bischoff, Richard J.; Barton, Marci; Thober, Jody; Hawley, Rachel

2002-01-01

382

Electronic data-capturing technology for clinical trials: experience with a global postmarketing study.  

PubMed

The purpose of this article was to address three questions: What were the electronic data-capturing (EDC) technologies employed in a typical industry-sponsored clinical study? How is the developed system meeting the clinical research need? What would we want more from this EDC technology? This article is prepared from industry perspectives to present and analyze the advantages, benefits, and challenges in applying EDC technologies to address industry's clinical trial operational needs based on a systematic overview. PMID:20659846

Lu, Zengwu

383

Developing regulatory-compliant electronic case report forms for clinical trials: experience with the demand trial.  

PubMed

The use of electronic case report forms (CRF) to gather data in randomized clinical trials has grown to progressively replace paper-based forms. Computerized form designs must ensure the same data quality expected of paper CRF, by following Good Clinical Practice rules. Electronic data capture (EDC) tools must also comply with applicable statutory and regulatory requirements. Here the authors focus on the development of computerized systems for clinical trials implementing FDA and EU recommendations and regulations, and describe a laptop-based electronic CRF used in a randomized, multicenter clinical trial. PMID:19261946

Ene-Iordache, Bogdan; Carminati, Sergio; Antiga, Luca; Rubis, Nadia; Ruggenenti, Piero; Remuzzi, Giuseppe; Remuzzi, Andrea

2009-03-04

384

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

385

AFRRI (Armed Forces Radiobiology Research Institute) reports, July, August and September 1986. Technical report  

SciTech Connect

Contents include: post-radiation regional cerebral blood flow in primates; heart-function studies in dogs after acute gamma irradiation of the precordium; the effect of anesthetic, sedative or narcotic drugs on intrahepatic and extrahepatic biliary kinetics; effect of gamma radiation on sodium channels in different conformations in neuroblastoma cells; effects of ethanol exposure on brain sodium channels; ionizing radiation alters the properties of sodium channels in rat brain synaptosomes; thymic hormones in thymus recovery from radiation injury; acute toxicity of petroleum- and shale-derived distillate fuel; light microscopic, hematologic, and serum chemistry studies; radioprotective properties of detoxified lipid A from Salmonella Minnesota R595; brain areas involved in production of morphine-induced locomotor hyperactivity of the C57B1/6J mouse; preliminary evaluation of US Army radiac detector DT-236/PD and radiac computer-indicator CP-696/UD; and calorimetric dose measurements and calorimetric system developed for the armed forces radiobiology research institute.

Not Available

1986-01-01

386

Extremity dose: its definition, standards and regulatory limits, radiobiological significance, measurement and practical considerations.  

PubMed

This paper reviews several inter-related aspects of partial-body exposures to ionizing radiation, with particular emphasis on hands. The topics featured in this review are: the definition of extremity, the radiobiological significance of extremity dose and its influence on dose standards, current and future dose standards and regulatory limits, monitoring requirements along with the availability and selection of suitable dosimeters, the question of dose averaging and dosimeter placement and practical considerations for the implementation of an extremity dosimetry program. The review is purposely kept general in nature and readers with a specific interest in a particular aspect are encouraged to read the original papers. This review is written from the perspective of a practicing health physicist who may wish to read the available literature on this topic and incorporate some of the information into an existing or planned extremity dosimetry program. PMID:3583735

Thind, K S

1987-06-01

387

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

SciTech Connect

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, (3) a twenty-film complete-mouth survey with E-speed film, long rectangular cone, (4) a four-film interproximal survey with E-speed film, long round cone, and (5) a four-film interproximal survey with E-speed film, long rectangular cone. The dose to the thyroid gland, the active bone marrow, the brain, and the salivary glands was evaluated by means of exposure of a tissue-equivalent phantom, fitted with lithium fluoride thermoluminescent dosimeters (TLDs) at the relevant locations.

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

1988-07-01

388

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

389

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

NASA Astrophysics Data System (ADS)

The goal of the study was to evaluate the first CR digital mammography system (® 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; Alfonso, Beatriz Y. Álvarez; Castellanos, Gustavo Casian; Enríquez, Jesús Gabriel Franco

2008-08-01

390

The clinical relevance of instrumented testing for ACL insufficiency. Experience with the UCLA clinical knee testing apparatus.  

PubMed

An instrumented clinical testing device developed at UCLA records a continuous anteroposterior force versus displacement curve of the tibia with respect to the femur at 20 degrees of flexion. Laxity and stiffness are calculated from the response curve. With this device, 95% of normal knees have an anterior laxity less than 7.5 mm and a side-to-side difference less than 2 mm. In contrast, an anterior cruciate ligament (ACL) absent knee has a mean anterior laxity of 10 mm and a mean side-to-side difference of 5 mm. In a small group of patients with an intraarticular ACL substitution using the medial or lateral one-third of the patellar tendon, laxity and stiffness of the injured knees were returned to within the normal range and remained constant three years after surgery. In a group of 76 patients treated with ACL substitution using the torn meniscus, 51% of the patients still had an anterior laxity outside the normal range 3.5 years after surgery. In a preliminary study of 19 patients receiving a Gore-Tex synthetic ACL substitution, 55% of the patients still had a side-to-side difference greater than 2 mm two years after the procedure. These studies illustrate the advantages of impartial, objective measurements of knee stability. Laxity and stiffness values can supplement, but never replace, a thorough patient examination and patient history. As sports medicine matures as a scientific discipline, improved instrumented test devices may ultimately provide a standardized means for reporting knee stability parameters. PMID:3652576

Markolf, K L; Amstutz, H C

1987-10-01

391

Molecular Genetics of Neuroblastoma and the Implications for Clinical Management: A Review of the MSKCC Experience  

Microsoft Academic Search

Neuroblastoma (NB) is a biological, genetic, and mor- phological heterogeneous neoplasm and demonstrates diverse clinical behavior. There exist at least three clinical patterns of NB: A) spontaneously regressing widespread dis- ease; B) not metastatic local-regional disease, and C) metastatic disease (stage 4), frequently with lethal conse- quences. Patients with non-stage 4 NB are expected to sur- vive even without medical

JAUME MORA; WILLIAM L. GERALD

392

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

393

Intensity modulated radiation therapy for oropharyngeal and oral cavity tumors: clinical use and experience  

Microsoft Academic Search

Background and purpose. Intensity modulated radiation therapy (IMRT) offers an opportunity to generate dose distributions highly conformal to the target volume. Head and neck cancer patients, referred for radiotherapy, may be good candidates to benefit from IMRT. This paper discusses the clinical implementation of IMRT for oropharyngeal and oral cavity tumors, and reports the clinical results of the 14 patients

Filip Claus; Wim Duthoy; Tom Boterberg; Werner De Gersem; John Huys; Hubert Vermeersch; Wilfried De Neve

2002-01-01

394

Reliable clinical monitoring using wireless sensor networks: experiences in a step-down hospital unit  

Microsoft Academic Search

This paper presents the design, deployment, and empirical study of a wireless clinical monitoring system that collects pulse and oxygen saturation readings from patients. The primary contribution of this paper is an in-depth clinical trial that assesses the feasibility of wireless sensor networks for patient monitoring in general hospital units. We present a detailed analysis of the system reliability from

Octav Chipara; Chenyang Lu; Thomas C. Bailey; Gruia-Catalin Roman

2010-01-01

395

Islet transplantation. The connection of experiment and clinic exemplified by the transplantation of islets of Langerhans.  

PubMed

Since approximately 25 years islet transplantation as a mean for the treatment of diabetes has been developed from early attempts in rodents to first clinical applications in man in recent years. The review describes the results obtained in diabetic rats including metabolic effects as well as prevention of late complications. In the syngeneic system (Lewis-rats) the intraportal transplantation of 1,000-2,000 isolated islets may cure streptozotocin-induced diabetes for the whole lifespan of the animal. In the allogeneic system (across a major histocompatibility barrier), however, isolated islets are highly immunogenic. According to present knowledge, mainly class-II antigen bearing cells are responsible while the role of the endocrine cells seems to be less important. By various in vitro methods (e.g. low temperature culture at 24 degrees C) it was possible to induce immunoalteration of allogeneic islets which was followed by long-term acceptance by the host in rodents. Whether the same technique is effective in larger animals and in man remains open. New technologies for the isolation of high numbers of pure islets from human pancreatic glands have been the key for the use of islet transplantation in man in several centers. The review describes the details regarding institutions as well as results in patients on the basis of the International Islet Transplant Registry which is located at Giessen University. Although longer lasting insulin independency (longest lasting effect 2 1/2 years) has been observed only in a few patients, islet transplantation has been proven to be a very safe procedure for the patient. It is hoped that with increasing experiences regarding the factors which at present limit the function as number and quality of islets, immunosuppressive protocols etc. islet transplantation will develop to a definite alternative to whole-organ transplantation. One of the most important challenges for modern medicine is the fact of a worldwide increase of diabetic long-term complications such as kidney failure, coronary and peripheral vascular disease, blindness and neuropathy. Although intensified insulin treatment in a small percentage of patients may moderate morbidity and mortality, from experimental work there is sufficient evidence suggesting that only the restoration of normoglycemia early in the course of the disease may prevent complications. This, however, can only be achieved by the replacement of the destroyed islets of Langerhans either by transplantation of an intact vascularised pancreas or by isolated islets.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8157088

Federlin, K F

1993-01-01

396

Initial clinical experience with the picosecond Nd:YLF laser for intraocular therapeutic applications  

PubMed Central

AIMS/BACKGROUND—Compared with nanosecond (ns) pulses of conventional Nd-YAG lasers, picosecond (ps) laser pulses allow intraocular surgery at considerably lower pulse energy. The authors report initial clinical experiences using a Nd:YLF ps laser for the treatment of various indications for photodisruption.?METHODS—A Nd:YLF laser system (ISL 2001, wavelength 1053 nm) was used to apply pulse series of 100-400 µJ single pulse energy at a repetition rate of 0.12-1.0 kHz. Computer controlled patterns were used to perform iridectomies (n=53), capsulotomies (n=9), synechiolysis (n=3), and pupilloplasties (n=2). Other procedures were vitreoretinal strand incision (n=2) and peripheral retinotomy (n=1). For comparison, 10 capsulotomies and 20 iridotomies were performed with a Nd:YAG ns laser. The ps laser cut of an anterior capsule was assessed by scanning electron microscopy (SEM).?RESULTS—Open, well defined iridectomies (mean total energy 4028 mJ, mean diameter 724 µm) were achieved at first attempt in 92% of the cases. In 64% an iris bleeding and in 21% an IOP increase of >10 mm Hg occurred. All capsulotomies were performed successfully (mean energy 690 mJ/mm cutting length) but with a high incidence of intraocular lens damage. The attempted vitreoretinal applications remained unsuccessful as a result of optical aberrations of the eye and contact lens. Although ps laser capsulotomies and iridectomies required much higher total energy than ns procedures, the resulting tissue effects of the ps pulses were more clearly defined. SEM examination of a ps incision of the anterior lens capsule demonstrated, nevertheless, that the cut was more irregular than the edge of a continuous curvilinear capsulorhexis.?CONCLUSION—Series of ps pulses applied in computer controlled patterns can be used effectively for laser surgery in the anterior segment and are considerably less disruptive than ns pulses. The ps laser is well suited for laser iridectomies while the ns laser is preferable for posterior capsulotomies. As vitreoretinal applications remained unsuccessful, the range of indications for intraocular photodisruption could not be extended by the ps laser.?? Keywords: picosecond laser; intraocular photodisruption; capsulotomy; iridotomy; iridectomy

Geerling, G.; Roider, J.; Schmidt-Erfurt, U.; Nahen, K.; El-Hifnawi, E.; Laqua, H.; Vogel, A.

1998-01-01

397

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

398

[Clinical application of professor MA Rou's experience in treating hematological disease by arsenic-containing Chinese herbal medicine].  

PubMed

Professor MA Rou has been engaged in clinical and basic research of hematology for more than 40 years. He is excel in the treatment of refractory hematological diseases under the guidance of holism and syndrome differentiation in Chinese medicine. Application of arsenic-containing Chinese herbal medicine in treating myelodysplastic syndrome (MDS), primary polycythemia vera (CMPD-PV), primary thrombocythemia (CMPD-ET), MDS-U, myeloproliferative disease, acute non lymphocytic leukemia except for promyelocytic leukemia, Prof. MA has made great innovation and exploration. For some diseases, he has obtained much mature experiences. Although some are still in the stage of exploration, ideal clinical effects has been shown primarily. PMID:21910353

Li, Liu; Ma, Rou

2011-08-01

399

A web-based system for students to document their experiences within six core competency domains during all clinical clerkships.  

PubMed

The authors describe the design and implementation of a new Web-based system that allows students to record important features of their clinical encounters during all 10 required clinical clerkships, document their learning experiences in six major competency domains, and generate detailed real-time reports for themselves and their clerkship directors. A new Web-based system, DMEDS (Dartmouth Medical Encounter Documentation System), accepts input from computers and PDAs. Its design permits students to describe their patients, learning sites, interactions with preceptors, and important aspects of their clinical encounters in all of our medical school's competency domains. Using a common format for all required clerkships, clerkship directors select specific items most relevant to their clerkships from a common menu and set learning targets for specific diagnoses and clinical skills. This new system was designed in the fall of 2003, tested in the spring of 2004, and implemented in all clerkships for the 2004 to 2005 academic year. During the first full academic year that DMEDS was used, students documented nearly 32,000 discrete student-patient-preceptor encounters, an average of between 21 and 120 clinical encounters per Year 3 clerkship. Highlights of the analysis of these initial data include the following: (1) insights into how educational targets are set, (2) the extent of site-to-site variation in clerkship experiences, (3) the epidemiology of patients' declining student involvement, and (4) student experiences in and understanding of the newer competency domains.DMEDS can be used in all clinical clerkships and can address student experiences in all competency domains. It provides substantial value to students, clerkship directors, preceptors, and medical school administrators. As secondary benefits, the authors found that DMEDS facilitates educational research and is readily adapted for use in residency and fellowship programs as well. Student feedback highlights the need to pay close attention to the time invested by students documenting their clinical encounters. Course directors must ensure that the benefits to students (such as knowledge of meeting learning targets and preceptors providing direct feedback to students) are transparent. Finally, for other schools contemplating the change to a competency-based curriculum with the use of a clinical encounter documentation system, the time required for both students and faculty to adopt and fully engage these major educational culture shifts seems to be at least several years. PMID:17198293

Nierenberg, David W; Eliassen, M Scottie; McAllister, Stephen B; Reid, Brian P; Pipas, Catherine Florio; Young, William W; Ogrinc, Greg S

2007-01-01

400

Cumulative clinical experience with use of insulin lispro: critical appraisal, role in therapy, and patient considerations  

PubMed Central

We have now at our disposal the new rapid-acting insulin analogs, of which insulin lispro was the first to become commercially available. While the differences in pharmacokinetic and pharmacodynamic characteristics are indisputable, the clinical benefits attained by these changes have not been as clear. In the present review, we discuss the structure, pharmacology, and landmark studies related to insulin lispro. The clinical characteristics of insulin lispro are compared with those of insulin regular and other insulin analogs in different clinical situations. Also included are the aspects of quality of life and cost-effectiveness that may modify the modern practitioner’s decision to adopt one type of insulin over another.

Uy, J; Fogelfeld, L; Guerra, Y

2012-01-01

401

The effect of clinical experience, judgment task difficulty and time pressure on nurses' confidence calibration in a high fidelity clinical simulation  

PubMed Central

Background Misplaced or poorly calibrated confidence in healthcare professionals’ judgments compromises the quality of health care. Using higher fidelity clinical simulations to elicit clinicians’ confidence 'calibration' (i.e. overconfidence or underconfidence) in more realistic settings is a promising but underutilized tactic. In this study we examine nurses’ calibration of confidence with judgment accuracy for critical event risk assessment judgments in a high fidelity simulated clinical environment. The study also explores the effects of clinical experience, task difficulty and time pressure on the relationship between confidence and accuracy. Methods 63 student and 34 experienced nurses made dichotomous risk assessments on 25 scenarios simulated in a high fidelity clinical environment. Each nurse also assigned a score (0–100) reflecting the level of confidence in their judgments. Scenarios were derived from real patient cases and classified as easy or difficult judgment tasks. Nurses made half of their judgments under time pressure. Confidence calibration statistics were calculated and calibration curves generated. Results Nurse students were underconfident (mean over/underconfidence score ?1.05) and experienced nurses overconfident (mean over/underconfidence score 6.56), P?=?0.01. No significant differences in calibration and resolution were found between the two groups (P?=?0.80 and P?=?0.51, respectively). There was a significant interaction between time pressure and task difficulty on confidence (P?=?0.008); time pressure increased confidence in easy cases but reduced confidence in difficult cases. Time pressure had no effect on confidence or accuracy. Judgment task difficulty impacted significantly on nurses’ judgmental accuracy and confidence. A 'hard-easy' effect was observed: nurses were overconfident in difficult judgments and underconfident in easy judgments. Conclusion Nurses were poorly calibrated when making risk assessment judgments in a high fidelity simulated setting. Nurses with more experience tended toward overconfidence. Whilst time pressure had little effect on calibration, nurses’ over/underconfidence varied significantly with the degree of task difficulty. More research is required to identify strategies to minimize such cognitive biases.

2012-01-01

402

Clinical experience with the MicroMed DeBakey ventricular assist device  

Microsoft Academic Search

Background. The MicroMed DeBakey ventricular assist device (VAD) (MicroMed Technology, Inc, Houston, TX) is the first long-term axial flow circulatory assist device to be introduced into clinical trials as a bridge to transplantation. Clinical trials began in Europe in November 1998 and in the United States in June 2000.Methods. To qualify for the study, the patients must be listed for

George P Noon; Deborah L Morley; Suellen Irwin; Sandy V Abdelsayed; Robert J Benkowski; Bryan E Lynch

2001-01-01

403

[A model experiment with a specialty clinic for geriatrics with an open psychosomatic unit].  

PubMed

Report on a current exemplary test in which "animators and multiplicators" are being trained in a specialized course. The intention is to employ the trainees as voluntary lay assistants in a geriatric clinic. In the same clinic programs have been established aiming at the reduction of expenses for drug therapy by making extensive use of motion therapy, musical therapy, reality training, creativity training, autogenic training. PMID:3577192

Harwardt, P

1987-02-15

404

Phase III clinical evaluation of gadoteridol injection: Experience in pediatric neuro-oncologic MR imaging  

Microsoft Academic Search

Twenty-two pediatric patients with known CNS neoplasms underwent magnetic resonance (MR) imaging before and after intravenous injection of 0.1 mmol\\/kg gadoteridol injection as part of a Phase IIIB open label multicenter clinical trial. Intravenous administration of this neutral, nonionic contrast agent was found to be safe in children. No clinically relevant changes in vital signs or laboratory values (including complete

J. F. Debatin; S. N. Nadel; L. Gray; H. S. Friedman; P. Trotter; B. Hockenberger; W. J. Oakes

1992-01-01

405

Initial Experience of a Digital Training Resource for Modified Rankin Scale Assessment in Clinical Trials  

Microsoft Academic Search

Background and Purpose—The modified Rankin Scale (mRS) is the preferred measure of disability in cerebrovascular clinical trials, but its value is restricted by interobserver variability. Poor reliability reduces the statistical power of clinical trials and leads to underestimation of effect size. Strategies to improve mRS grading are required. Video training has previously improved application of the National Institutes of Health

Terence J. Quinn; Kennedy R. Lees; Hans-Goran Hardemark; Jesse Dawson; Matthew R. Walters

2010-01-01

406

Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience  

Microsoft Academic Search

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

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

2004-01-01

407

Open Access Appointment Scheduling—An Experience At A Community Clinic  

Microsoft Academic Search

This study concerns the execution of open access appointment scheduling system at an urban outpatient clinic. The clinic underwent a change of its patient appointment scheduling policy from the traditional up-to-one- year fixed booking to the same-day appointment open access system. In this study, we developed a queueing network and a simulation model that help the decision making process of

Po-Ching DeLaurentis; Renata Kopach; Ronald Rardin; Mark Lawley; Kumar Muthuraman; Leyla Ozsen; Paul Intrevado

408

Disconfirming beliefs: the use of poetry to know the lived experience of student nurses in mental health clinicals.  

PubMed

An aesthetic pattern of knowing involves moving beyond classifications and knowing the whole individual. Students are taught to provide holistic care to patients, but instructors evaluate students primarily from a scientific, empirical perspective. To add balance between the art and the science of nursing practice, students were assigned to write an original poem about their clinical experience in mental health nursing. This article reports a qualitative analysis of those poems to expand the instructors' knowledge of the student experience. Five themes and one consistent pattern were identified. Insights and implications of student poetry writing are explored. PMID:15204901

Kidd, Lori I; Tusaie, Kathleen R

2004-06-01

409

Ten years single surgeon experience with botulinum toxin in the urinary tract; clinical observations and research discovery  

Microsoft Academic Search

Background  This review details a single surgeon’s 10-year experience with botulinum toxin (BoNT) for lower urinary tract symptoms (LUTS).\\u000a \\u000a \\u000a \\u000a Methods  Review of author’s published clinical and research experience with BoNT in the prostate, bladder and urethral sphincter.\\u000a \\u000a \\u000a \\u000a Results  Key observations include that an approximate 90% decrease is needed for bladder augmentation and reconstruction. Detrusor\\u000a compliance and vesicoureteral reflux improved in over 50% of

Michael B. Chancellor

2010-01-01

410

Outside clinical setting experience in a public hospital and oral health promotion  

Microsoft Academic Search

Objective To describe a teaching aid activity aimed at providing experience for promoting collective oral health to graduating dental students. Methods This experience was based on the evaluation of students' performance as oral health educators as they had, among other duties, to motivate inpatients and their families to practice healthy habits aiming at a comprehensive and more human care of

Maria do Socorro; Costa Feitosa

411

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

412

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

413

The Clinical Experience of R x P-Trained Psychologists Working in Non-R x P States  

Microsoft Academic Search

\\u000a The purpose of this chapter is to describe the clinical experiences of psychologists who have completed prescription privilege\\u000a (RxP) training and who practice in states still awaiting the passage of prescription privilege legislation for psychologists.\\u000a The vignettes used are a compilation of examples experienced by many clinicians from several states in this category. To insure\\u000a confidentiality, anonymity was preserved. However,

Thomas M. Kozak; Andrea Kozak Miller

414

Early clinical experience with the 1440-nm wavelength internal pulsed laser in facial rejuvenation: two-year follow-up.  

PubMed

This article reports on the early experience with the 1440-nm wavelength, using a specially designed side-firing fiber, in a four-step approach, primarily to the lower third of the midface and neck. The author presents the clinical protocol, procedure steps, outcomes, and adverse events of use of the laser. Outcomes are described at 3 months, 6 months, and 18 months. PMID:23036291

Sasaki, Gordon H

2012-09-03

415