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Sample records for clinical radiobiological experience

  1. Dosimetry for radiobiology experiments at GANIL

    NASA Astrophysics Data System (ADS)

    Durantel, Florent; Balanzat, Emmanuel; Cassimi, Amine; Chevalier, François; Ngono-Ravache, Yvette; Madi, Toiammou; Poully, Jean-Christophe; Ramillon, Jean-Marc; Rothard, Hermann; Ropars, Frédéric; Schwob, Lucas; Testard, Isabelle; Saintigny, Yannick

    2016-04-01

    Mainly encouraged by the increasing application of ion beams for cancer treatment (hadron-therapy) including carbon beams, the use of heavy ion facilities for radiobiology is expanding rapidly today. As an alternative to dedicated centers for treatment and medical research, accelerators like GANIL offer the possibility to undertake such experiments. Since 20 years, CIMAP, reinforced 15 years ago by the biological host laboratory LARIA, has been receiving researchers in radiobiology and assisted them in performing experiments in different fields such as hadron-therapy, space radioprotection and fundamental biological and physico-chemical mechanisms. We present here a short description of the beam line and the on-line equipments that allow the automatic irradiation of up to 24 biological samples at once. We also developed an original on-line beam monitoring procedure for low ion flux (low dose rates) based on the measurement of the K-shell X-rays emitted from a thin iron foil. This detector is calibrated on an absolute scale before each experiment by counting etched tracks on an irradiated CR39 polymer plate. We present the performances and limits of this method and finally give typical fluence (dose) uncertainties for a standard irradiation in radiobiology.

  2. In vitro irradiation station for broad beam radiobiological experiments

    NASA Astrophysics Data System (ADS)

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

    2011-12-01

    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.

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

    SciTech Connect

    Tai, An; Erickson, Beth; Khater, Kevin A.; Li, X. Allen

    2008-03-01

    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.

  4. Feasibility of BNCT radiobiological experiments at the HYTHOR facility

    NASA Astrophysics Data System (ADS)

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

    2008-06-01

    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.

  5. The RENT-project: radiobiological results and planned clinical application.

    PubMed

    Ries, G; Breit, A; Kummermehr, J; Breiter, N; Trott, K R

    1985-12-01

    Various preclinical tests have been performed to determine the properties of fast neutrons of a mean energy of 2 MeV produced by an U-235 converter plate in the research reactor of the Technical University of Munich. Experiments have been carried out using two specific beams denoted as RENT I and RENT II (RENT stands for Reaktor Neutron Therapy). RENT II is the unmodified beam with a dose rate of 65 rd/min and a gamma-contamination of nearly 50% in 2 cm depth of a perspex phantom. In RENT I the gamma-component is reduced to 25% after filtration of the beam with 2.5 cm lead, whereas the total dose rate is reduced to 22 rd/min. PMID:4082214

  6. Physical conditions for conducting radiobiological experiments in beams of accelerated particles with high linear energy transfer

    NASA Technical Reports Server (NTRS)

    Kudryashov, Y. I.; Marennyy, A. M.; Popov, V. I.; Aykhorn, K.; Ertsgreber, G.

    1974-01-01

    The design and construction of an accelerator to conduct radiobiological experiments is reported that uses aluminum filters to control the accelerated ion beam while preserving its stability, and a vacuum chamber to conduct the ion beam with the help of a collector through a lavsan exit port to the target. Depth distribution of the absorbed dose from a monodirectional ion beam is practically completely represented by the change in the energy spectrum of the biological object.

  7. Radiobiological modifiers in clinical radiation oncology: current reality and future potential.

    PubMed

    Allison, Ron R

    2014-12-01

    Radiation therapy can successfully ablate tumors. However, the same ionization process that destroys a cancer can also permanently damage surrounding organs resulting in unwanted clinical morbidity. Therefore, modern radiation therapy attempts to minimize dose to normal tissue to prevent side effects. Still, as tumors and normal tissues intercalate, the risk of normal tissue injury often may prevent tumoricidal doses of radiation therapy to be delivered. This paper will review current outcomes and limitations of radiobiological modifiers that may selectively enhance the radiosensitivity of tumors as well as parallel techniques that may protect normal tissues from radiation injury. Future endeavors based in part upon newly elucidated genetic pathways will be highlighted. PMID:25525845

  8. Preliminary analysis of a radiobiological experiment for LifeSat

    NASA Technical Reports Server (NTRS)

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

    1991-01-01

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

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

    PubMed Central

    2014-01-01

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

  10. Radiobiological experiments with plant seeds aboard the biosatellite Kosmos 1887

    NASA Technical Reports Server (NTRS)

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

    1990-01-01

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

  11. Radiobiological experiments with plant seeds aboard the biosatellite Kosmos 1887.

    PubMed

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

    1990-01-01

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

  12. Radiobiological experiments with plant seeds aboard the biosatellite Cosmos 1887

    NASA Technical Reports Server (NTRS)

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

    1995-01-01

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

  13. In vivo radiobiological assessment of the new clinical carbon ion beams at CNAO.

    PubMed

    Facoetti, A; Vischioni, B; Ciocca, M; Ferrarini, M; Furusawa, Y; Mairani, A; Matsumoto, Y; Mirandola, A; Molinelli, S; Uzawa, A; Vilches, Freixas G; Orecchia, R

    2015-09-01

    In this article, the in vivo study performed to evaluate the uniformity of biological doses within an hypothetical target volume and calculate the values of relative biological effectiveness (RBE) at different depths in the spread-out Bragg peak (SOBP) of the new CNAO (National Centre for Oncological Hadrontherapy) carbon beams is presented, in the framework of a typical radiobiological beam calibration procedure. The RBE values (relative to (60)Co ? rays) of the CNAO active scanning carbon ion beams were determined using jejunal crypt regeneration in mice as biological system at the entrance, centre and distal end of a 6-cm SOBP. The RBE values calculated from the iso-effective doses to reduce crypt survival per circumference to 10, ranged from 1.52 at the middle of the SOBP to 1.75 at the distal position and are in agreement with those previously reported from other carbon ion facilities. In conclusion, this first set of in vivo experiments shows that the CNAO carbon beam is radiobiologically comparable with the NIRS (National Institute of Radiological Sciences, Chiba, Japan) and GSI (Helmholtzzentrum fr Schwerionenforschung, Darmstadt, Germany) ones. PMID:25877541

  14. Development of a compact laser-produced plasma soft X-ray source for radiobiology experiments

    NASA Astrophysics Data System (ADS)

    Adjei, Daniel; Ayele, Mesfin Getachew; Wachulak, Przemyslaw; Bartnik, Andrzej; Wegrzynski, Łukasz; Fiedorowicz, Henryk; Vyšín, Luděk; Wiechec, Anna; Lekki, Janusz; Kwiatek, Wojciech M.; Pina, Ladislav; Davídková, Marie; Juha, Libor

    2015-12-01

    A desk-top laser-produced plasma (LPP) source of soft X-rays (SXR) has been developed for radiobiology research. The source is based on a double-stream gas puff target, irradiated with the focused beam of a commercial Nd:YAG laser. The source has been optimized to get a maximum photon emission from LPP in the X-ray "water window" spectral wavelength range from 2.3 nm (i.e., an absorption edge of oxygen) to 4.4 nm (i.e., an absorption edge of carbon) (280-540 eV in photon energy units) by using argon gas-puff target and spectral filtering by free-standing thin foils. The present source delivers nanosecond pulses of soft X-rays at a fluence of about 4.2 × 103 photons/μm2/pulse on a sample placed inside the vacuum chamber. In this paper, the source design, radiation output characterization measurements and initial irradiation experiments are described. The source can be useful in addressing observations related to biomolecular, cellular and organisms' sensitivity to pulsed radiation in the "water window", where carbon atoms absorb X-rays more strongly than the oxygen, mostly present in water. The combination of the SXR source and the radiobiology irradiation layout, reported in this article, make possible a systematic investigation of relationships between direct and indirect action of ionizing radiation, an increase of a local dose in carbon-rich compartments of the cell (e.g., lipid membranes), an experimental estimation of a particular role of the Auger effect (in particular in carbon atoms) in the damage to biological systems, and the study of ionization/excitation-density (LET - Linear Energy Transfer) and dose-rate effects in radiobiology.

  15. Studies of SSNTDs made from LR-115 in view of their applicability in radiobiological experiments with alpha particles

    NASA Astrophysics Data System (ADS)

    Dörschel, B.; Hermsdorf, D.; Pieck, S.; Starke, S.; Thiele, H.; Weickert, F.

    2003-06-01

    Radiobiological studies on cell monolayers irradiated by charged particles need to determine the number and position of particle traversals. Solid state nuclear track detectors used as basic substrate for the cell layers are in principle suitable for this purpose. The detector foils must be as thin as possible but still guaranteeing mechanical stability. Two types of LR-115, red coloured and colourless, were tested in the present work. The studies aimed at optimisation of the etching conditions and determination of the registration efficiency for alpha particles in a wide range of energies and angles of incidence. Specific requirements have to be fulfilled for application of the detector foils under the environmental conditions of radiobiological experiments. Most important are biocompatibility between detector and cells and registration properties insensible against special treatments, as UV sterilisation and cell plating prior to irradiation as well as cell incubation after the irradiation. The experimental studies performed with alpha particles showed that environmental conditions of radiobiological experiments do not change the registration properties of LR-115 detectors significantly.

  16. Automation of the particle dosimetry and the dose application for radiobiological experiments at a vertical proton beam

    NASA Astrophysics Data System (ADS)

    Mörtel, H.; Georgi, J.; Eyrich, W.; Fritsch, M.; Distel, L.

    2002-08-01

    A facility with a vertical beam for radiobiological experiments with low-energy protons has been setup at the Tandem accelerator at Erlangen. This energy region is optimal to investigate the biological effects of the linear energy transfer in the Bragg region under physiological conditions. A new automated data acquisition system for dosimetry and monitoring based on a personal computer was developed and optimized for this setup. A specially designed sample holder offers possibilities of cooling or changing of atmosphere during irradiation. First irradiations of biological samples have shown the functionality of the setup.

  17. Real-Time Dosimetry for Radiobiology Experiments Using 25 MeV LINAC

    SciTech Connect

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

    2009-03-10

    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.

  18. Enhanced radiobiological effects at the distal end of a clinical proton beam: in vitro study

    PubMed Central

    Matsumoto, Yoshitaka; Matsuura, Taeko; Wada, Mami; Egashira, Yusuke; Nishio, Teiji; Furusawa, Yoshiya

    2014-01-01

    In the clinic, the relative biological effectiveness (RBE) value of 1.1 has usually been used in relation to the whole depth of the spread-out Bragg-peak (SOBP) of proton beams. The aim of this study was to confirm the actual biological effect in the SOBP at the very distal end of clinical proton beams using an in vitro cell system. A human salivary gland tumor cell line, HSG, was irradiated with clinical proton beams (accelerated by 190 MeV/u) and examined at different depths in the distal part and the center of the SOBP. Surviving fractions were analyzed with the colony formation assay. Cell survival curves and the survival parameters were obtained by fitting with the linear–quadratic (LQ) model. The RBE at each depth of the proton SOBP compared with that for X-rays was calculated by the biological equivalent dose, and the biological dose distribution was calculated from the RBE and the absorbed dose at each position. Although the physical dose distribution was flat in the SOBP, the RBE values calculated by the equivalent dose were significantly higher (up to 1.56 times) at the distal end than at the center of the SOBP. Additionally, the range of the isoeffective dose was extended beyond the range of the SOBP (up to 4.1 mm). From a clinical point of view, this may cause unexpected side effects to normal tissues at the distal position of the beam. It is important that the beam design and treatment planning take into consideration the biological dose distribution. PMID:24824674

  19. Radiobiological results from the Bacillus subtilis Biostack experiments within the Apollo and the ASTP space flights.

    PubMed

    Facius, R; Bucker, H; Hildebrand, D; Horneck, G; Holtz, G; Reitz, G; Schafer, M; Toth, B

    1978-01-01

    In order to check the results of earlier Biostack experiments, new experimental techniques were developed for the Biostack III experiment in the Apollo-Soyuz test project (ASTP). These techniques resulted in an increased accuracy of localization down to 0.2 micrometers for the determination of the impact parameter, accompanied by an increase in the sample size available for biological investigation. In addition, colony forming ability, metabolic mutations, and mutations affecting UV- and x-ray sensitivity were rendered observable by these methods. The biological and physical results obtained so far from the evaluation of the Bacillus subtilis experiment within Biostack III confirm and extend the findings of the previous Biostack experiments. They also add to the questions about the mechanisms of action of the radiation field under investigation, since the observed effects cannot be interpreted in terms of standard concepts. PMID:11965659

  20. Update on clinical radiobiology

    PubMed Central

    2006-01-01

    Radiation therapy is an important local cytotoxic modality for cancer treatment whose aim is to control the disease while minimising damage to normal tissue. The combination of different treatment modalities offers a more effective cure and reduction in normal tissue toxicity. However, the differences in genetic profiles can cause diverse treatment outcomes. Multidisciplinary research, where technologies and knowledge from different areas are integrated, is necessary to design the optimal regimen for individualised cancer treatment. This paper offers an overview of some new cancer treatment strategies; the impact of molecular imaging on radiation oncology; and a computer simulation model to optimise treatment planning based on patient information. It briefly discusses molecular targeted therapy, tumour microenvironment and bioreductive agents, and evidence for making individualised medicine a reality. Using DNA microarrays and proteomic technologies, information on defined molecular targets and genetic profiling for individual patients can be obtained and new algorithms for radiation oncology-related diagnosis, treatment response and prognosis can be developed. PMID:21614219

  1. New beam monitoring tool for radiobiology experiments at the cyclotron ARRONAX.

    PubMed

    Schwob, L; Koumeir, C; Servagent, N; Cherel, M; Guertin, A; Haddad, F; Métivier, V; Michel, N; Poirier, F; Rahmani, A; Varmenot, N

    2015-09-01

    The ARRONAX cyclotron is able to deliver alpha particles at 68 MeV. In the frame of radiological research, a new method is studied to infer in situ the deposited dose: it is based on the online measurement of the bremsstrahlung (>1 keV) produced by the interaction of the incident particle with the medium. Experiments are made using bombarded poly(methyl methacrylate) (PMMA)-equivalent water targets in order to characterise this continuous X-ray spectrum. The intensity of the bremsstrahlung spectrum allows for the beam monitoring. A simulation code of the bremsstrahlung has been built, and a good agreement is found with the experimental spectra. With this simulation, it is possible to predict the sensibility of this method: it varies with the target thickness, showing a good sensibility for thin target (<1000 µm) and saturation for thicker ones. Bremsstrahlung spectrum also shows a sensibility on the target's chemical composition. PMID:25897142

  2. SU-E-J-233: A Facility for Radiobiological Experiments in a Large Magnetic Field

    SciTech Connect

    Carlone, M; Heaton, R; Keller, H; Wouters, B; Jaffray, D

    2014-06-01

    Purpose: There is considerable interest in developing medical linear accelerators with integrated image guidance by MRI. Less work has been done on the fundamental biology of cell survival in the presence of a strong magnetic field. The purpose of this work is to describe an experimental system capable of measuring cell survival response in the types of MRI-linac systems currently under development. Methods: We have integrated a cobalt irradiator with a solenoid magnet. The solenoid magnet has inner diameter of 10 cm. To enable measurement of the biological effects as a function of depth, we are utilizing the sliced gel technique, in which cells are embedded and fixed within a gelatin matrix. Irradiated cells at defined positions (sub mm resolution) can subsequently be recovered and assessed for cell survival or other biological effects. Results: The magnetic field profile in the solenoid has a peak magnetic field 36 cm below the top edge of the magnet bore and can be placed at and SAD of 100 cm. At a solenoid current of 35 A, the peak magnetic field is 0.25 T. The dose rate of the cobalt irradiator is 16 cGy/min at 100 cm SAD. EBT3 film was used to demonstrate the system functionality. It was irradiated at 1 cm depth at 100 cm SSD with a 4×4 field to 1.5 Gy in a 0.25 T magnetic field. The dose profile was similar between this film and the control exposure without magnetic field. Conclusion: Integrating a cobalt irradiator with a high field magnet is demonstrated. The magnetic field at the cobalt defining head was minimal and did not interfere with the functioning of this unit. Cell survival experiments can be reproduced exactly in the presence or absence of a magnetic field since a resistive magnet is used.

  3. Radiobiology challenges for ELIMED

    NASA Astrophysics Data System (ADS)

    Schettino, G.

    2013-07-01

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

  4. Non-extensive radiobiology

    SciTech Connect

    Sotolongo-Grau, O.; Rodriguez-Perez, D.; Antoranz, J. C.; Sotolongo-Costa, O.

    2011-03-14

    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.

  5. Proton Radiobiology

    PubMed Central

    Tommasino, Francesco; Durante, Marco

    2015-01-01

    In addition to the physical advantages (Bragg peak), the use of charged particles in cancer therapy can be associated with distinct biological effects compared to X-rays. While heavy ions (densely ionizing radiation) are known to have an energy- and charge-dependent increased Relative Biological Effectiveness (RBE), protons should not be very different from sparsely ionizing photons. A slightly increased biological effectiveness is taken into account in proton treatment planning by assuming a fixed RBE of 1.1 for the whole radiation field. However, data emerging from recent studies suggest that, for several end points of clinical relevance, the biological response is differentially modulated by protons compared to photons. In parallel, research in the field of medical physics highlighted how variations in RBE that are currently neglected might actually result in deposition of significant doses in healthy organs. This seems to be relevant in particular for normal tissues in the entrance region and for organs at risk close behind the tumor. All these aspects will be considered and discussed in this review, highlighting how a re-discussion of the role of a variable RBE in proton therapy might be well-timed. PMID:25686476

  6. [Pulmonary embolectomy. Clinical experience].

    PubMed

    Jaumin, P; Moriau, M; el Gariani, A; Rubay, J; Baele, P; Dautrebande, J; Goenen, M; Servaye-Kestens, Y; Ponlot, R

    1986-01-01

    Between 1969 and 1984, twenty-three patients underwent an emergency pulmonary embolectomy under extracorporeal circulation in the Catholic University of Louvain (UCL), Department of Cardiovascular and Thoracic Surgery. The aim of this paper is to delineate the indications of this procedure. Patients were 23 to 70 years old. Diagnosis of Pulmonary Embolism was made according to clinical signs, ECG and Chest X Ray with Swan-Ganz catheter insertion into the pulmonary artery and the help of pulmonary angiogram if time permitted. The surgical technique is briefly described. Four patients died during the immediate postoperative period and three died later. The sixteen survivors all enjoy a normal life. PMID:3716721

  7. Simulations of a vacuum window and in-beam ion detection for use in radiobiological experiments with 50 MeV particle beams

    NASA Astrophysics Data System (ADS)

    Caldwell, L.; Warren, D. R.; Abler, D.; Peach, K.; Partridge, M.; Timlin, C.

    2015-05-01

    The vacuum window and in-beam ion detection of a radiobiological endstation have been studied using the Monte Carlo particle transport code MCNPX 2.5.0, investigating the effects of different elements on an incident beam of 50 MeV protons. The scattering and energy spread as well as secondary particle generation are analysed. A 200 nm thick silicon nitride vacuum window was found to have the least effect on the incident beam, giving an energy spread of 5.01(8)× 10-4 MeV. Placing a silicon pixel detector before the sample caused scattering of the beam of around 15 μm in radius; too much to be used for experiments targeting individual nuclei.

  8. Radiobiology challenges for ELIMED

    SciTech Connect

    Schettino, G.

    2013-07-26

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

  9. The radiobiology of hypofractionation.

    PubMed

    Nahum, Alan E

    2015-05-01

    If the α/β ratio is high (e.g. 10 Gy) for tumour clonogen killing, but low (e.g. 3 Gy) for late normal tissue complications, then delivering external beam radiotherapy in a large number (20-30) of small (≈2 Gy) dose fractions should yield the highest 'therapeutic ratio'; this is demonstrated via the linear-quadratic model of cell killing. However, this 'conventional wisdom' is increasingly being challenged, partly by the success of stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) extreme hypofractionation regimens of three to five large fractions for early stage non-small cell lung cancer and partly by indications that for certain tumours (prostate, breast) the α/β ratio may be of the same order or even lower than that characterising late complications. It is shown how highly conformal dose delivery combined with quasi-parallel normal tissue behaviour (n close to 1) enables 'safe' hypofractionation; this can be predicted by the (α/β)eff concept for normal tissues. Recent analyses of the clinical outcomes of non-small cell lung cancer radiotherapy covering 'conventional' hyper- to extreme hypofractionation (stereotactic ablative radiotherapy) regimens are consistent with linear-quadratic radiobiology, even at the largest fraction sizes, despite there being theoretical reasons to expect 'LQ violation' above a certain dose. Impairment of re-oxygenation between fractions and the very high (α/β) for hypoxic cells can complicate the picture regarding the analysis of clinical outcomes; it has also been suggested that vascular damage may play a role for very large dose fractions. Finally, the link between high values of (α/β)eff and normal-tissue sparing for quasi-parallel normal tissues, thereby favouring hypofractionation, may be particularly important for proton therapy, but more generally, improved conformality, achieved by whatever technique, can be translated into individualisation of both prescription dose and fraction number via the 'isotoxic' (iso-normal tissue complication probability) concept. PMID:25797579

  10. Clinical Experiences in Athletic Training.

    ERIC Educational Resources Information Center

    Knight, Kenneth L.

    This book offers a systematic approach to teaching athletic training. Modules are separated into 10 content areas: direct clinical experience; policies and procedures; emergency procedures; modality operation; advanced modality operation; taping, wrapping, bracing, and padding; management of specific injuries; examination; supervision; and…

  11. Introduction to Radiobiology of Targeted Radionuclide Therapy

    PubMed Central

    Pouget, Jean-Pierre; Lozza, Catherine; Deshayes, Emmanuel; Boudousq, Vincent; Navarro-Teulon, Isabelle

    2015-01-01

    During the last decades, new radionuclide-based targeted therapies have emerged as efficient tools for cancer treatment. Targeted radionuclide therapies (TRTs) are based on a multidisciplinary approach that involves the cooperation of specialists in several research fields. Among them, radiobiologists investigate the biological effects of ionizing radiation, specifically the molecular and cellular mechanisms involved in the radiation response. Most of the knowledge about radiation effects concerns external beam radiation therapy (EBRT) and radiobiology has then strongly contributed to the development of this therapeutic approach. Similarly, radiobiology and dosimetry are also assumed to be ways for improving TRT, in particular in the therapy of solid tumors, which are radioresistant. However, extrapolation of EBRT radiobiology to TRT is not straightforward. Indeed, the specific physical characteristics of TRT (heterogeneous and mixed irradiation, protracted exposure, and low absorbed dose rate) differ from those of conventional EBRT (homogeneous irradiation, short exposure, and high absorbed dose rate), and consequently the response of irradiated tissues might be different. Therefore, specific TRT radiobiology needs to be explored. Determining dose–effect correlation is also a prerequisite for rigorous preclinical radiobiology studies because dosimetry provides the necessary referential to all TRT situations. It is required too for developing patient-tailored TRT in the clinic in order to estimate the best dose for tumor control, while protecting the healthy tissues, thereby improving therapeutic efficacy. Finally, it will allow to determine the relative contribution of targeted effects (assumed to be dose-related) and non-targeted effects (assumed to be non-dose-related) of ionizing radiation. However, conversely to EBRT where it is routinely used, dosimetry is still challenging in TRT. Therefore, it constitutes with radiobiology, one of the main challenges of TRT in the future. PMID:25853132

  12. Chernobyl: a radiobiological perspective

    SciTech Connect

    Goldman, M.

    1987-01-01

    The author discusses the global impact of Chernobyl in relation to health effects. Taken the full perspective, the impact of Chernobyl from a radiological aspect depends on two major radiobiological factors. The most significant factor is the determination of the actual radiation dose absorbed into tissues. The second major factor to be considered in the radiation risk factor.

  13. Pancreatic ductal adenocarcinoma: From genetics to biology to radiobiology to oncoimmunology and all the way back to the clinic.

    PubMed

    Fokas, Emmanouil; O'Neill, Eric; Gordon-Weeks, Alex; Mukherjee, Somnath; McKenna, W Gillies; Muschel, Ruth J

    2015-01-01

    Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer death. Despite improvements in the clinical management, the prognosis of PDAC remains dismal. In the present comprehensive review, we will examine the knowledge of PDAC genetics and the new insights into human genome sequencing and clonal evolution. Additionally, the biology and the role of the stroma in tumour progression and response to treatment will be presented. Furthermore, we will describe the evidence on tumour chemoresistance and radioresistance and will provide an overview on the recent advances in PDAC metabolism and circulating tumour cells. Next, we will explore the characteristics and merits of the different mouse models of PDAC. The inflammatory milieu and the immunosuppressive microenvironment mediate tumour initiation and treatment failure. Hence, we will also review the inflammatory and immune escaping mechanisms and the new immunotherapies tested in PDAC. A better understanding of the different mechanisms of tumour formation and progression will help us to identify the best targets for testing in future clinical studies of PDAC. PMID:25489989

  14. Joint bone radiobiology workshop

    SciTech Connect

    Tomich, P.A.

    1991-01-01

    The Joint Bone Radiobiology Workshop was held on July 12--13, 1991 in Toronto, Canada. This document contains the papers presented at the meeting. The five sections were: Dose-effects, Endogenous Cofactors, Tumorigenesis, New Methods and Medical Implications. The papers covered risk assessment, tissue distribution of radionuclides, lifetime studies, biological half-lifes, the influence of age at time of exposure, tumor induction by different radionuclides, microscopic localization of radionuclides, and nuclear medicine issues including tissue distribution in the skeleton and bone marrow transplantation. (MHB)

  15. CRC handbook of radiobiology

    SciTech Connect

    Prasad, K.N.

    1984-01-01

    The author presents Development of Radiobiology. A Review. Basic Cell Biology. Physics of Radiation Biology. Cellular Radiation Damage. Modifications of Cellular Radiation Damage. Repair of Radiation Damage. Molecular Radiation Biology. Radiation Syndromes and their Modifications. Radiation Damage of Skin and Mucous Membrane. Radiation Damage of Nervous Tissue. Radiation Damage of Reproductive Organs. Radiation Damage of Other Organ Systems. Radiation Immunology. Background, Medical and Commercial Sources. Radiation Injuries to Human Fetuses. Radiation-Induced Genetic Damage. Radiation Carcinogenesis: Tissue Culture Model. Radiation Carcinogenesis: Animal Model. Radiation Carcinogenesis: Human Model. Radiation Carcinogenesis: Secondary Neoplasms. After Therapy of Tumors. Other Late Effects: Aging, Cataract, Aplastic Anemia. Maximum Permissible Dose (MPD). Radiation Response of Human Tumor. Radioisotopes in Biology and Medicine.

  16. Designing a Curriculum for Clinical Experiences

    ERIC Educational Resources Information Center

    Henning, John E.; Erb, Dorothy J.; Randles, Halle Schoener; Fults, Nanette; Webb, Kathy

    2016-01-01

    The purpose of this article is to describe a collaborative effort among five teacher preparation programs to create a conceptual tool designed to put clinical experiences at the center of our programs. The authors refer to the resulting product as a clinical curriculum. The clinical curriculum describes a developmental sequence of clinical…

  17. Clinical experience with cinacalcet HCl.

    PubMed

    Ureña Torres, Pablo

    2004-08-01

    Secondary hyperparathyroidism (SHPT) is associated with parathyroid gland hyperplasia, increased parathyroid hormone (PTH) production and secretion, disturbed bone and mineral metabolism, soft tissue calcification and an increased risk of death. The condition is an almost universal complication of end-stage renal disease (ESRD) and currently is managed by treatment with phosphate binders and vitamin D compounds, both of which are associated with significant side effects, including hypercalcaemia and hyperphosphataemia. Therapy with calcimimetics is a new approach to the treatment of SHPT. These agents act at the calcium-sensing receptor (CaR), where they increase the sensitivity of the receptor to ionized serum calcium. Activation of the CaR results in a rapid reduction in PTH secretion. The calcimimetic drug cinacalcet HCl currently is undergoing clinical trials in dialysis patients who have uncontrolled SHPT, despite treatment with vitamin D compounds and/or phosphate binders. Clinical trials have confirmed that the drug rapidly reduces plasma PTH, phosphorus and calcium-phosphorus product (Ca x P) levels, and that levels of PTH, phosphorus and Ca x P remain suppressed for up to 3 years. In clinical trials, cinacalcet HCl was a well-tolerated drug; only nausea and vomiting occurred more frequently in patients who took cinacalcet HCl than in those who took placebo, and the occurrence of transient hypocalcaemia was limited to the initial phase of the treatment. Cinacalcet HCl is therefore a potentially highly effective and well-tolerated treatment for SHPT in patients with ESRD. PMID:15284357

  18. Clinical experience with intravenous fenoldopam.

    PubMed

    Holcslaw, T L; Beck, T R

    1990-06-01

    Fenoldopam (Corlopam), a new dopaminergic agent in clinical development by SmithKline Beecham Pharmaceuticals, is a dopamine-1 (DA1) agonist at post-synaptic dopamine receptors. Preclinical and clinical studies have demonstrated that it is a potent renal vasodilator as well as a peripheral vasodilator. In both normal volunteers and hypertensive patients intravenous fenoldopam causes dose-related decreases in blood pressure and important increases in renal hemodynamics and function including increased renal blood flow, diuresis and natriuresis. Fenoldopam does not alter glomerular filtration. Intravenous fenoldopam has been demonstrated to be efficacious in severe hypertensive patients in several multicenter, multinational trials. In severe hypertension efficacy trials fenoldopam was judged to be as effective as sodium nitroprusside and to produce less serious side effects. In patients with moderate to severe heart failure, fenoldopam has been demonstrated to produce dose-related acute increases in cardiac output, stroke volume and work index, decreased systemic vascular resistance but no important changes in pulmonary wedge pressure or right atrial pressure. In CHF patients fenoldopam has been demonstrated to be as efficacious as sodium nitroprusside. Fenoldopam, as a specific (DA1) agonist resulting in decreased peripheral and renal vascular resistance, diuresis, natriuresis and increases in cardiac hemodynamics on intravenous administration, appears to be an efficacious agent which offers a reasonable alternative in the treatment of severe hypertension and acute congestive heart failure. PMID:1974440

  19. Clinical experience with electromechanical impactor.

    PubMed

    Dretler, S P

    1993-11-01

    The electromechanical impactor is a 3.0F electrohydraulic electrode within a stainless steel sheath attached to a distal compression spring with a conical titanium tip. Each electrical discharge causes a 2.7 mm. tip extension and a kinetic impact energy of 900 bar. It is 5F, flexible and placed within the straight working port of a 9.5F to 10.0F rigid or semirigid ureteroscope. A clinical trial was performed and 15 patients (16 ureters with calculi) were treated with this device. An upper ureteral stone partially fragmented and migrated cephalad, 1 stone failed to break and was basket extracted, and there was 1 machine failure. The 13 other calculi were successfully broken to fragments less than 5 mm. In 2 patients baskets were also used to remove the larger monohydrate fragments. A secondary procedure was required to basket a 4 mm. calcium oxalate monohydrate fragment in a patient with 3 ureteral calculi. The average size of the calculi was 14 mm. in largest diameter. Excluding the machine failure, the average number of pulses required for fragmentation was 764. The life of each device was 600 to 800 pulses. Of the 15 cases 1 electrode was used in 10, 2 in 3 and 3 in 2. There was no evidence of ureteral wall injury, abrasion or perforation. The electromechanical impactor is a safe and effective method of ureteral stone fragmentation. PMID:8411409

  20. Clinical experience with CT colonography

    NASA Astrophysics Data System (ADS)

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

    2000-04-01

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

  1. Clinical experience with nuclear pacemakers.

    PubMed

    Parsonnet, V; Myers, G H; Gilbert, L; Zucker, I R

    1975-12-01

    Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. Fifty-nine of the 64 units are in service and continue to function normally in a follow-up period of up to 2 years. In the total worldwide experience, 70 pacemakers are out of service, approximately half because of the patient's death, and the rest for infection or lead problems, and only three or four because of difficulties with components. The first 15 ARCO pacemakers implanted 2 years ago continue to function well. Of the 15 control pacemakers implanted at the same time, one unit has failed. We have concluded that a nuclear pacemaker should not be used in a patient with limited life expectancy or in an infant, but for the otherwise healthy young or middle-age individual, it should be the unit of choice. PMID:1188620

  2. The Importance of Dosimetry Standardization in Radiobiology

    PubMed Central

    Desrosiers, Marc; DeWerd, Larry; Deye, James; Lindsay, Patricia; Murphy, Mark K; Mitch, Michael; Macchiarini, Francesca; Stojadinovic, Strahinja; Stone, Helen

    2013-01-01

    Radiation dose is central to much of radiobiological research. Precision and accuracy of dose measurements and reporting of the measurement details should be sufficient to allow the work to be interpreted and repeated and to allow valid comparisons to be made, both in the same laboratory and by other laboratories. Despite this, a careful reading of published manuscripts suggests that measurement and reporting of radiation dosimetry and setup for radiobiology research is frequently inadequate, thus undermining the reliability and reproducibility of the findings. To address these problems and propose a course of action, the National Cancer Institute (NCI), the National Institute of Allergy and Infectious Diseases (NIAID), and the National Institute of Standards and Technology (NIST) brought together representatives of the radiobiology and radiation physics communities in a workshop in September, 2011. The workshop participants arrived at a number of specific recommendations as enumerated in this paper and they expressed the desirability of creating dosimetry standard operating procedures (SOPs) for cell culture and for small and large animal experiments. It was also felt that these SOPs would be most useful if they are made widely available through mechanism(s) such as the web, where they can provide guidance to both radiobiologists and radiation physicists, be cited in publications, and be updated as the field and needs evolve. Other broad areas covered were the need for continuing education through tutorials at national conferences, and for journals to establish standards for reporting dosimetry. This workshop did not address issues of dosimetry for studies involving radiation focused at the sub-cellular level, internally-administered radionuclides, biodosimetry based on biological markers of radiation exposure, or dose reconstruction for epidemiological studies. PMID:26401441

  3. Shared-Learning Experience During a Clinical Pharmacy Practice Experience

    PubMed Central

    Awaisu, Ahmed

    2011-01-01

    Objective To implement a shared learning approach through fourth-year students’ mentorship of third-year students and to assess the perceptions of the mentored students on the value of their shared learning experience. Design We introduced the shared learning experience in clinical pharmacy and pharmacotherapeutic practice experiences involving 87 third-year and 51 fourth-year students. Both student groups undertook the practice experiences together, with third-year students working in smaller groups mentored by fourth-year students. Assessment A majority of the students (> 75%) believed that they learned to work as a team during their practice experiences and that the shared learning approach provided an opportunity to practice their communication skills. Similarly, most respondents (> 70%) agreed that the new approach would help them become effective members of the healthcare team and would facilitate their professional relationships in future practice. Almost two-thirds of the students believed that the shared learning enhanced their ability to understand clinical problems. However, about 31% of the pharmacy students felt that they could have learned clinical problem-solving skills equally well working only with peers from their own student group. Conclusions The pharmacy students in the current study generally believed that the shared-learning approach enhanced their ability to understand clinical problems and improved their communication and teamwork skills. Both groups of students were positive that they had acquired some skills through the shared-learning approach. PMID:21769151

  4. First time rounding experiences for nonclinicians: the Cleveland Clinic experience.

    PubMed

    Greenwald, Laura R; Nowacki, Amy S; Stoller, James K

    2015-01-01

    Clinical rounds serve several key objectives in academic medical centers: providing a forum for patient communication, clinical decision making, and teaching. Nonclinical colleagues ordinarily do not have the opportunity to round, and the idea of implementing a rounding program that includes nonclinical colleagues has received little attention to date. Reasoning that a rounding program with nonclinicians could enhance (1) understanding of the organization's clinical mission, (2) appreciation of caregivers' roles, and (3) engagement, the authors created such a program. From 2010 to 2013, 51 nonclinicians within the Cleveland Clinic Education Institute participated; 14 submitted written reflections, and 27 responded to a survey about their experience. Overall, 12 themes emerged that suggest an enhanced familiarity with the institution and increased engagement and alignment with its mission. Notably, the results align with a long-standing focus on organizational engagement and an observed increase in mean engagement scores since the program was implemented. PMID:24519444

  5. Practicum and clinical experiences: postpracticum students' views.

    PubMed

    Ralph, Edwin; Walker, Keith; Wimmer, Randolph

    2009-08-01

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

  6. Review of European clinical experience with fenofibrate.

    PubMed

    Blane, G F

    1989-01-01

    Since the introduction of fenofibrate to European clinical practice in 1975, some 6.5 million patient-years of experience in the treatment of hyperlipidemia have been accumulated. A review of results of clinical trials shows fenofibrate to have a broad spectrum of lipid-lowering activity, reducing the total cholesterol level by 20-25% in type IIa patients and triglycerides by 40-60% in type IIb and IV patients. High levels of low-density lipoprotein cholesterol are reduced and, where low at baseline, high-density lipoprotein levels are increased. An associated activity is a 10-28% reduction in serum uric acid levels. Adverse reactions in the mostly open clinical trials ranged from 2-15%; mild gastrointestinal problems dominated, and occurred with much the same frequency in the placebo-treated groups of controlled trials. There are also reports of fatigue, headache, loss of libido, dizziness, and insomnia. Some excess of skin rash emerged as the only statistically significant unwanted clinical effect in one placebo-controlled trial. Biochemically, there are occasional fluctuations in serum transaminase values, while gamma-glucuronyl transferase and alkaline phosphatase are often decreased, all without apparent clinical significance. Lithogenicity of the bile is often increased above pretreatment levels, but there is no evidence from trials or postmarketing surveillance that the use of fenofibrate is associated with an increase of gallstone formation. PMID:2653620

  7. Nurses’ experiences of humour in clinical settings

    PubMed Central

    Ghaffari, Fatemeh; Dehghan-Nayeri, Nahid; Shali, Mahboubeh

    2015-01-01

    Background: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses’ health and influence nursing care. The aim of this study was to describe nurses’ experiences of humour in clinical settings and factors affecting it. Methods: This qualitative study investigated nurses’ experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master’s and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. Results: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. Conclusion: Understanding nurses’ perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients’ mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students. PMID:26034735

  8. Fundamental space radiobiology

    NASA Technical Reports Server (NTRS)

    Nelson, Gregory A.

    2003-01-01

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

  9. Nursing students' perceptions of clinical experience.

    PubMed

    Windsor, A

    1987-04-01

    Senior nursing students were interviewed in this study to better understand the clinical learning experience from the students' point of view. Results of the study revealed that the nursing students were indeed learning in their clinical experience. The major categories of learning were classified as nursing skills, time management, and professional socialization. The quality of learning was reportedly affected by the quality of the student's preparation, characteristics of the instructor, and the variety of clinical opportunities to which students were exposed. The data also reflected a pattern of student development which was separated into three stages. The first stage was permeated with anxiety and obsession with the rules of task performance. The second stage was a difficult transition period where students struggled with identifying the roles of nurses. During the final stage, the students become more comfortable with performing nursing tasks and become interested in expanding their role and becoming more independent. As the students strived for independence, they identified more closely with staff nurses and withdrew from instructors. PMID:3035128

  10. Target fragmentation in radiobiology

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  11. Toolkit for determination of dose-response relations, validation of radiobiological parameters and treatment plan optimization based on radiobiological measures.

    PubMed

    Mavroidis, Panayiotis; Tzikas, Athanasios; Papanikolaou, Nikos; Lind, Bengt K

    2010-10-01

    Accurately determined dose-response relations of the different tumors and normal tissues should be estimated and used in the clinic. The aim of this study is to demonstrate developed tools that are necessary for determining the dose-response parameters of tumors and normal tissues, for clinically verifying already published parameter sets using local patient materials and for making use of all this information in the optimization and comparison of different treatment plans and radiation techniques. One of the software modules (the Parameter Determination Module) is designed to determine the dose-response parameters of tumors and normal tissues. This is accomplished by performing a maximum likelihood fitting to calculate the best estimates and confidence intervals of the parameters used by different radiobiological models. Another module of this software (the Parameter Validation Module) concerns the validation and compatibility of external or reported dose-response parameters describing tumor control and normal tissue complications. This is accomplished by associating the expected response rates, which are calculated using different models and published parameter sets, with the clinical follow-up records of the local patient population. Finally, the last module of the software (the Radiobiological Plan Evaluation Module) is used for estimating and optimizing the effectiveness a treatment plan in terms of complication-free tumor control, P(+). The use of the Parameter Determination Module is demonstrated by deriving the dose-response relation of proximal esophagus from head and neck cancer radiotherapy. The application of the Parameter Validation Module is illustrated by verifying the clinical compatibility of those dose-response parameters with the examined treatment methodologies. The Radiobiological Plan Evaluation Module is demonstrated by evaluating and optimizing the effectiveness of head and neck cancer treatment plans. The results of the radiobiological evaluation are compared against dosimetric criteria. The presented toolkit appears to be very convenient and efficient for clinical implementation of radiobiological modeling. It can also be used for the development of a clinical data and health information database for assisting the performance of epidemiological studies and the collaboration between different institutions within research and clinical frameworks. PMID:20815424

  12. Radioembolization of Hepatic Lesions from a Radiobiology and Dosimetric Perspective

    PubMed Central

    Cremonesi, Marta; Chiesa, Carlo; Strigari, Lidia; Ferrari, Mahila; Botta, Francesca; Guerriero, Francesco; De Cicco, Concetta; Bonomo, Guido; Orsi, Franco; Bodei, Lisa; Di Dia, Amalia; Grana, Chiara Maria; Orecchia, Roberto

    2014-01-01

    Radioembolization (RE) of liver cancer with 90Y-microspheres has been applied in the last two decades with notable responses and acceptable toxicity. Two types of microspheres are available, glass and resin, the main difference being the activity/sphere. Generally, administered activities are established by empirical methods and differ for the two types. Treatment planning based on dosimetry is a prerogative of few centers, but has notably gained interest, with evidence of predictive power of dosimetry on toxicity, lesion response, and overall survival (OS). Radiobiological correlations between absorbed doses and toxicity to organs at risk, and tumor response, have been obtained in many clinical studies. Dosimetry methods have evolved from the macroscopic approach at the organ level to voxel analysis, providing absorbed dose spatial distributions and dose–volume histograms (DVH). The well-known effects of the external beam radiation therapy (EBRT), such as the volume effect, underlying disease influence, cumulative damage in parallel organs, and different tolerability of re-treatment, have been observed also in RE, identifying in EBRT a foremost reference to compare with. The radiobiological models – normal tissue complication probability and tumor control probability – and/or the style (DVH concepts) used in EBRT are introduced in RE. Moreover, attention has been paid to the intrinsic different activity distribution of resin and glass spheres at the microscopic scale, with dosimetric and radiobiological consequences. Dedicated studies and mathematical models have developed this issue and explain some clinical evidences, e.g., the shift of dose to higher toxicity thresholds using glass as compared to resin spheres. This paper offers a comprehensive review of the literature incident to dosimetry and radiobiological issues in RE, with the aim to summarize the results and to identify the most useful methods and information that should accompany future studies. PMID:25191640

  13. Percutaneous endoscopic lumbar discectomy - early clinical experience.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Takeda, Masaaki; Itoh, Yasunobu; Matsuoka, Hidenori; Watanabe, Kazuo

    2012-01-01

    We report our early clinical experience with percutaneous endoscopic lumbar discectomy (PELD) for herniated nucleus pulposus (HNP) in the lumbar spine. We introduced PELD to our clinical practice in June 2009. A total of 311 patients with degenerative lumbar spine disease were treated in our hospital up to August 2011. Thirty-seven patients with lumbar HNP were treated by PELD. PELD was carried out under local anesthesia, and the endoscope was continuously irrigated with saline. Twenty-eight patients were treated through the transforaminal approach, 5 were treated through the interlaminar approach, and 4 were treated through the extraforaminal approach. Surgery was discontinued due to uncontrollable intraoperative pain or anatomical inaccessibility in one case of the interlaminar approach and 2 cases of the extraforaminal approach. In the other 34 patients, the elapsed time of surgery was 34 to 103 minutes (mean 62.4 minutes). Extracorporeal blood loss was insignificant. Immediate symptom relief was achieved in all patients, and postoperative magnetic resonance imaging revealed sufficient removal of the HNP. The length of the postoperative hospital stay was 1 or 2 days in all patients. The surgical method of PELD is completely different from percutaneous nucleotomy, and the aim is to directly remove the HNP with minimum damage to the musculoskeletal structure. Although this study is based on our early clinical outcomes, PELD seemed to be a promising minimally invasive surgery for HNP in the lumbar spine. PMID:23006872

  14. A Curriculum Model for an Integrated Senior Year Clinical Experience.

    ERIC Educational Resources Information Center

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

    2000-01-01

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

  15. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

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

  16. Pulsed radiobiology with laser-driven plasma accelerators

    NASA Astrophysics Data System (ADS)

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

    2011-05-01

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

  17. Novel Radiobiological Gamma Index for Evaluation of 3-Dimensional Predicted Dose Distribution

    SciTech Connect

    Sumida, Iori; Yamaguchi, Hajime; Kizaki, Hisao; Aboshi, Keiko; Tsujii, Mari; Yoshikawa, Nobuhiko; Yamada, Yuji; Suzuki, Osamu; Seo, Yuji; Isohashi, Fumiaki; Yoshioka, Yasuo; Ogawa, Kazuhiko

    2015-07-15

    Purpose: To propose a gamma index-based dose evaluation index that integrates the radiobiological parameters of tumor control (TCP) and normal tissue complication probabilities (NTCP). Methods and Materials: Fifteen prostate and head and neck (H&N) cancer patients received intensity modulated radiation therapy. Before treatment, patient-specific quality assurance was conducted via beam-by-beam analysis, and beam-specific dose error distributions were generated. The predicted 3-dimensional (3D) dose distribution was calculated by back-projection of relative dose error distribution per beam. A 3D gamma analysis of different organs (prostate: clinical [CTV] and planned target volumes [PTV], rectum, bladder, femoral heads; H&N: gross tumor volume [GTV], CTV, spinal cord, brain stem, both parotids) was performed using predicted and planned dose distributions under 2%/2 mm tolerance and physical gamma passing rate was calculated. TCP and NTCP values were calculated for voxels with physical gamma indices (PGI) >1. We propose a new radiobiological gamma index (RGI) to quantify the radiobiological effects of TCP and NTCP and calculate radiobiological gamma passing rates. Results: The mean RGI gamma passing rates for prostate cases were significantly different compared with those of PGI (P<.03–.001). The mean RGI gamma passing rates for H&N cases (except for GTV) were significantly different compared with those of PGI (P<.001). Differences in gamma passing rates between PGI and RGI were due to dose differences between the planned and predicted dose distributions. Radiobiological gamma distribution was visualized to identify areas where the dose was radiobiologically important. Conclusions: RGI was proposed to integrate radiobiological effects into PGI. This index would assist physicians and medical physicists not only in physical evaluations of treatment delivery accuracy, but also in clinical evaluations of predicted dose distribution.

  18. Variable radiobiological responses of spheroids

    SciTech Connect

    Durand, R.E.

    1980-01-01

    Several techniques are now available for the growth of mammalian cells in culture as three-dimensional spheroids. Use of these spheroids as in vitro models of solid tumors is increasing, yet little characterization of most systems, other than histological appearance, has been forthcoming. Data are presented here which indicate that spheroids produced with different sublines of V79 Chinese hamster cells can exhibit vastly different radiobiological properties, despite having a similar histological appearance. Quantitative characterization of the radiation response of these spheroids indicates that the responses are highly dependent upon cell type, whether spheroids are irradiated in stirred or unstirred cultures, and the techniques used to recover cells from spheroids. Further, the extent and/or degree of hypoxia within spheroids does not always correlate with spheroid radiosensitivity or development of central necrosis. These results clearly indicate the necessity of adequately characterizing such model systems, and thus suggest, that results obtained with one spheroid system cannot be used as a baseline for another.

  19. Relevance of radiobiological concepts in radionuclide therapy of cancer.

    PubMed

    Kumar, Chandan; Shetake, Neena; Desai, Sejal; Kumar, Amit; Samuel, Grace; Pandey, Badri N

    2016-04-01

    Purpose Radionuclide therapy (RNT) is a rapidly growing area of clinical nuclear medicine, wherein radionuclides are employed to deliver cytotoxic dose of radiation to the diseased cells/tissues. During RNT, radionuclides are either directly administered or delivered through biomolecules targeting the diseased site. RNT has been clinically used for diverse range of diseases including cancer, which is the focus of the review. Conclusions The major emphasis in RNT has so far been given towards developing peptides/antibodies and other molecules to conjugate a variety of therapeutic radioisotopes for improved targeting/delivery of radiation dose to the tumor cells. Despite that, many of the RNT approaches have not achieved their desired therapeutic success probably due to poor knowledge about complex and dynamic (i) fate of radiolabeled molecules; (ii) radiation dose delivered; (iii) cellular heterogeneity in tumor mass; and (iv) cellular radiobiological response. Based on understanding gathered during recent years, it may be stated that besides the absorbed dose, the net radiobiological response of tumor/normal cells also determines the clinical response of radiotherapeutic modalities including RNT. The radiosensitivity of tumor/normal cells is governed by radiobiological phenomenon such as radiation-induced bystander effect, genomic instability, adaptive response and low dose hyper-radiosensitivity. These concepts have been well investigated in the context of external beam radiotherapy, but their clinical implications during RNT have received meagre attention. In this direction, a few studies performed using in vitro and in vivo models envisage the possibilities of exploiting the radiobiological knowledge for improved therapeutic outcome of RNT. Abbreviations ALL Acute Lymphoid Leukaemia AML Acute Myeloid Leukaemia CEA Carcinoembryonic Antigen CD Cluster of Differentiation CLL Chronic Lymphocytic Leukaemia CNS Central Nervous System CPP Cell Penetrating Peptide, DC, Dendritic Cell DOTA 1,4,7,10-Tetraazacyclododecane-1,4,7,10-Tetraacetic Acid DTPA Diethylene Triamine Pentaacetic Acid EDTMP Ethylenediamine Tetra(methylene Phosphonic Acid); EGFR, Epidermal Growth Factor Receptor EU European Union FDA Food and Drug Administration Her2 Human Epidermal Growth Factor Receptor 2 HEDP 1-Hydroxy Ethylidene-1,1-Diphosphonic Acid GI Gastro Intestinal HLA Human Leukocyte Antigen HRS Hyper-radiosensitivity LET Linear Energy Transfer MCL Mantle Cell Lymphoma MIBG Metaiodobenzylguanidine MN Micronuclie 4-NCS-Bz-TCMC S-2-(4-isothiocyanatobenzyl) -1,4,7,10-tetraaza-1,4,7,10-tetra(2-carbamoylmethyl) cyclododecane NHL Non-Hodgkin's Lymphoma PSMA Prostate Specific Membrane Antigen RGD Arginylglycylaspartic Acid RIAR Radiation-Induced Adaptive Response RIBE Radiation-Induced Bystander Effect RIGI Radiation-Induced Genomic Instability RNT Radionuclide Therapy TAT Targeted Alpha Therapy TATE Tyr3-octreotate TIMP Tissue Inhibitor of Metalloproteinase TOC Tyr3-octreotide VEGF Vascular Endothelial Growth Factor. PMID:26917443

  20. Fundamental Radiobiology and its Application to Radiation Oncology

    NASA Astrophysics Data System (ADS)

    Buffa, Francesca M.

    A brief overview of fundamental concepts in radiobiology is provided. The concept of cell survival as ability to retain reproductive integrity is introduced, and critical variables influencing the cell survival curve as a function of absorbed radiation dose are discussed. Application of these concepts to radiation oncology and radiotherapy is then outlined. Examples are provided of clinical studies that can be performed with current high-throughput molecular biology and imaging technology. The type of information derived from these studies and its potential are discussed in the context of radiotherapy trial design, radiotherapy schedule and modality tailoring, and planning of treatment dose.

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

    SciTech Connect

    Herrera, Higmar; Yanez, Elvia; Lopez, Jesus

    2012-10-23

    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.

  2. Minimally invasive thymectomy: the Mayo Clinic experience

    PubMed Central

    Rowse, Phillip G.; Roden, Anja C.; Corl, Frank M.; Allen, Mark S.; Cassivi, Stephen D.; Nichols, Francis C.; Shen, K. Robert; Wigle, Dennis A.

    2015-01-01

    Background The prevalence of minimally invasive thymectomy (MIT) is increasing and may have significant benefit to patients in terms of morbidity and post-operative recovery. Our aim was to review the Mayo Clinic experience of MIT. Methods We reviewed data from all MIT cases collected in a prospectively maintained database from January 1995 to February 2015. Data were collected regarding patient demographics, perioperative management and patient outcomes. Results A total of 510 thymectomies were performed in 20 years. Fifty-six patients underwent MIT (45 video-assisted thoracoscopy, 11 robotic-assisted). The median age was 55 years (range, 23-87 years) with male to female ratio of 25:31. Thymoma was the main pathologic diagnosis in 27/56 patients (48%), with 11/27 (41%) associated with myasthenia gravis (MG), and 16/27 (59%) non-MG. Other pathologies included 1/56 (2%) of each teratoma, lymphoma, lymphangioma, carcinoma and thymolipoma. There were 3/56 (5%) atrophic glands, 4/56 (7%) cysts, 6/56 (11%) benign glands and 11/56 (20%) hyperplastic. Mean blood loss (mL) and operative time (min) were significantly lower in the video-assisted thoracoscopic surgery (VATS) group compared to robotic (65±41 vs. 160±205 mL, P=0.04 and 102±39 vs. 178±53 min, P=0.001, respectively). There was no 30-day mortality. Post-operative morbidity occurred in 7/45 (16%) VATS patients (phrenic nerve palsy 7%, pericarditis 4%, atrial fibrillation 2%, pleural effusion 2%) and 1/11 (9%) robotic (urinary retention requiring self-catheterization). Reoperation was required in 1/3 of VATS patients with phrenic nerve palsy. There was no significant difference in length of hospital stay [VATS 1.5 days (range, 1-4 days) and robotic 2 days (range, 1-5 days) VATS; P=0.05]. Mean follow-up was 18.4 months (range, 1-50.4 months) with no tumor recurrences. Conclusions MIT can be performed with low morbidity and mortality. VATS is associated with reduced blood loss, operative times and earlier hospital discharge compared to robotic MIT. PMID:26693147

  3. National Radiobiology Archives distributed access programmer's guide

    SciTech Connect

    Prather, J. C.; Smith, S. K.; Watson, C. R.

    1991-12-01

    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.

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

    ERIC Educational Resources Information Center

    Zeanah, Charles H.

    2009-01-01

    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,

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

    ERIC Educational Resources Information Center

    Zeanah, Charles H.

    2009-01-01

    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,…

  6. Clinical Engineering: Experiences of assisted professional practices

    NASA Astrophysics Data System (ADS)

    Langone, Luis; Vanetta, Marcos; Vazquez, Marcelo; Rotger, Viviana; Olivera, Juan Manuel

    2007-11-01

    In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y Tecnología of the Universidad Nacional de Tucumán, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic.

  7. Tocilizumab in pediatric rheumatology: the clinical experience.

    PubMed

    Gurion, Reut; Singer, Nora G

    2013-07-01

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

  8. National Radiobiology Archives Distributed Access user's manual

    SciTech Connect

    Watson, C.; Smith, S. ); Prather, J. )

    1991-11-01

    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.

  9. Korean Supervisors' Experiences in Clinical Supervision

    ERIC Educational Resources Information Center

    Bang, Keeyeon; Park, Jeeseon

    2009-01-01

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

  10. Adult Autoimmune Enteropathy: Mayo Clinic Rochester Experience

    PubMed Central

    Akram, Salma; Murray, Joseph A.; Pardi, Darrell S.; Alexander, Glenn L.; Schaffner, John A.; Russo, Pierre A.; Abraham, Susan C.

    2007-01-01

    Purpose Autoimmune enteropathy is a rare cause of intractable diarrhea associated with circulating gut autoantibodies and a predisposition to autoimmunity. It is rarely observed in adults with only eleven cases reported to date. Methods Fifteen adults with autoimmune enteropathy were identified at the Mayo Clinic, Rochester, from May 2001 to June 2006. The demographic, clinical and treatment data were abstracted from their records. Results The study population was 87% Caucasian, 47% females, with median age of 55 years (interquartile range: 42 to 67 years). All patients had diarrhea, weight loss and malnutrition. Celiac disease was excluded by lack of response to gluten free diet or absence of the celiac disease susceptibility HLA genotypes. Fourteen patients were tested for gut epithelial cell antibodies and 93% were positive for anti-enterocyte and/or anti-goblet cell antibodies. Predisposition to autoimmune diseases was noted in 80%, as indicated by a variety of circulating autoantibodies. Small intestinal histopathologic findings included subtotal villous atrophy and lymphoplasmacytic infiltration in the lamina propria with relatively few surface intraepithelial lymphocytes. T-cell receptor gene rearrangement studies were negative in all cases. Immunosuppressive therapy was required in 93% cases. Clinical improvement was noted in 60% after 18 weeks of steroid therapy. Conclusion Autoimmune enteropathy is a heterogeneous disease and should be considered in the differential diagnosis of malabsorption and small bowel villous atrophy. The presence of gut epithelial cell antibodies can help confirm the diagnosis. No single agent is unequivocally effective in inducing remission, and immunosuppressive therapy is required in most cases. PMID:17683994

  11. Paranasal sinus mucoceles: our clinical experiments

    PubMed Central

    Topdag, Murat; Iseri, Mete; Sari, Fatih; Erdogan, Selvet; Keskin, I Gurkan

    2015-01-01

    Objectives: We present the clinical and radiological features, treatment protocols, and medium-long-term results of our patients following surgery for paranasal sinus mucocele, along with a review of the relevant literature. Materials and methods: A total of 18 patients (11 women and 7 men) who underwent surgery for paranasal sinus mucocele at Kocaeli University Faculty of Medicine, Department of Otolaryngology, between 2006 and 2013 were examined retrospectively. The mean patient age was 41 (range 4-73). Demographic and radiological features, symptoms, treatment protocols, and postoperative outcomes were recorded. Results: The most frequently affected sinus was the maxillary sinus (n=9, 50%) followed by the frontal sinus (n=6, 33%) and sphenoidal sinus (n=3, 16%). The main symptom was headache. Endoscopic marsupialization of the mucocele was applied in all 18 patients, while frontal sinus exploration with the osteoplastic flap procedure was performed in one patient and the Caldwell-Luc operation was performed in another patient. The Caldwell-Luc procedure was subsequently required in one patient (6%) and endoscopic revision surgery was required in another patient (6%). Conclusion: Sinus mucocele that enlarges, eroding the surrounding bone tissue, and induces various clinical symptoms due to the impression of the expansile mass, is treated surgically, and must be planned carefully to prevent serious complications. PMID:26770462

  12. Neural stimulation: clinical and laboratory experiences.

    PubMed

    Pudenz, R H

    1993-03-01

    This is a report of some of the experiences of the author and his associates with electrical stimulation of the animal and human nervous systems. It was presented as a personal history rather than a review of recent investigations and publications concerned with safe and effective stimulation of neural tissue with the ultimate goals of developing neural prostheses. Much of the information presented herein has been published. PMID:8456389

  13. [Euthanasia--experiences from Norwegian pain clinics].

    PubMed

    Meidell, N K; Naess, A C

    1998-10-10

    This survey focuses on the subject of euthanasia. A questionnaire was sent to 90 doctors working in pain clinics in Norwegian hospitals. 60 doctors (67%) returned the questionnaire. Only 18 doctors (30%) had ever received a request for euthanasia. The patients who requested euthanasia suffered from refractory pain, depression, fear of pain and fear of becoming helpless. 67% of the doctors were satisfied with the present Norwegian law, while 13% favoured a liberalization of the law. Only 5% were willing to comply with the patient's request for euthanasia under today's law. One third of the doctors would leave the decision to an officially appointed "board" if euthanasia were to become legalized. A majority wanted a doctor to commit the actual procedure, but there were also suggestions that a lawyer or other lay person should carry out the act of euthanasia. Our conclusion is that the closer the patient-doctor relationship is, the more opposed the doctor is to euthanasia. PMID:9816949

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

    ERIC Educational Resources Information Center

    Schilling, Jim

    2011-01-01

    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…

  15. Clinical experience with Angiojet: a comprehensive review.

    PubMed

    Ierardi, A M; Xhepa, G; Piffaretti, G; Bacuzzi, A; Tozzi, M; Carbone, M; Barile, A; Squillaci, E; Fonio, P; Brunese, L; Carrafiello, G

    2015-12-01

    The development of various sophisticated mechanical thrombectomy devices and the amassed experience of physicians in minimal invasive therapy produced a paradigm shift in vascular access management toward percutaneous declotting procedures, using pharmaceutical thrombolysis, mechanical thrombectomy, balloon thrombectomy, and a combination of the above techniques. In this setting, in the last years, AngioJet™ (Possis, Minneapolis, MN, USA) rheolytic thrombectomy (RT) showed an increasing use in emergency and election patients. The purpose of this review is to present the current status of percutaneous rheolytic thrombectomy in different fields of applications. PMID:26498886

  16. The experience of nursing students who make mistakes in clinical.

    PubMed

    Zieber, Mark Pijl; Williams, Beverley

    2015-01-01

    The experience of nursing students who make mistakes during clinical practice is poorly understood. The literature identifies clinical practice mistakes as a significant issue in nursing practice and education but there is very little research on the topic. This study used a grounded theory approach to explore the experience of undergraduate nursing students who had made at least one mistake in their clinical practice. What emerged is a theory that illuminates the process of how students move through the positive and negative elements of the mistake experience the core variable that emerged from the study was "living through the mistake experience." The mistake experience was clearly a traumatic process for nursing students and students reported feeling unprepared and lacking the capability to manage the mistake experience. A number of recommendations for nursing education are proposed. PMID:25951134

  17. Threaded cup acetabuloplasty. Early clinical experience.

    PubMed

    Apel, D M; Smith, D G; Schwartz, C M; Paprosky, W G

    1989-04-01

    Loosening of the acetabular cup component in total hip arthroplasty (THA) remains a source of ongoing concern. Threaded cup acetabuloplasty (TCA) utilizes torque and compression to gain purchase of the acetabular cup into the bony margin of the acetabulum. In an earlier study of 121 patients who had THA with TCA, patient assessments and roentgenograms were examined at an average of 30 months after surgery. Twenty percent of the cases were carried out for failed arthroplasty and 20% of the procedures required bone-graft reconstruction. A 22% incidence of moderate to severe postoperative pain, a 3% incidence of cup dislodgement, and a 24% incidence of radiolucencies between 1-2 mm were observed. The four cup dislodgements occurred in patients with severe osteopenia or in those requiring extensive bone-graft acetabular reconstruction. Good clinical results were obtained for osteoarthritic patients treated with primary THA. These early findings suggest that there is no advantage, but there are possible disadvantages, to threaded cup acetabuloplasty when compared to cup fixation with cement. PMID:2924461

  18. Pre-clinical experience with daptomycin.

    PubMed

    Hawkey, P M

    2008-11-01

    Daptomycin is a broad-spectrum, bactericidal agent active against Gram-positive bacteria, acting largely and unusually through membrane depolarization. Activity is markedly affected in vitro by the availability of calcium ions, and its high molecular weight with associated poor diffusion means that conventional disc diffusion testing is not reliable (and as a consequence not available). In order to allow susceptibility categorization, it is recommended that the MIC be determined in the presence of a defined calcium concentration. The activity of daptomycin is concentration-dependent with a prolonged post-antibiotic effect. It has linear pharmacokinetics, with a half-life of 8-9 h, the primary route of excretion is renal, it exhibits serum protein binding of approximately 92% and there is no interaction with the P450 cytochrome. Daptomycin is inactivated by surfactant in the lung and, in consequence, is not recommended for the treatment of respiratory infections. Daptomycin is currently licensed for the treatment of complicated skin and soft tissue infections and for bacteraemia and right-sided endocarditis due to methicillin-susceptible and -resistant Staphylococcus aureus. To date, daptomycin-resistant bacteria have rarely been isolated from patients, although increases in vancomycin MIC may be linked to reduced susceptibility to daptomycin. Close monitoring of resistance is essential to maintain the clinical utility of the drug. Using once-daily dosing, daptomycin has been generally well tolerated; however, weekly monitoring of creatinine phosphokinase is recommended, as myopathy in skeletal muscles has been seen, albeit rarely. The rapid bactericidal action of daptomycin makes it a useful addition to the therapeutic armamentarium for the treatment of Gram-positive infections, providing a valuable alternative to vancomycin when it is inappropriate or resistance is a problem. PMID:18829726

  19. Dedicated Breast CT: Initial Clinical Experience1

    PubMed Central

    Lindfors, Karen K.; Boone, John M.; Nelson, Thomas R.; Yang, Kai; Kwan, Alexander L. C.; Miller, DeWitt F.

    2008-01-01

    Purpose: To prospectively and intraindividually compare dedicated breast computed tomographic (CT) images with screen-film mammograms. Materials and Methods: All patient studies were performed according to protocols approved by the institutional review board and Radiation Use Committee; informed consent was obtained. A breast CT scanner prototype was used to individually scan uncompressed breasts in 10 healthy volunteers (mean age, 52.1 years) and 69 women with Breast Imaging Reporting and Data System category 4 and 5 lesions (mean age, 54.4 years). In women with lesions, breast CT images were compared with screen-film mammograms by an experienced mammographer and ranked with a continuous scale of 1–10 (score 1, excellent lesion visualization with CT and poor visualization with mammography; score 5.5, equal visualization with both modalities; and score 10, poor visualization with CT and excellent visualization with mammography). A Wilcoxon signed rank procedure was used to test the null hypothesis that ratings were symmetric at about a score of 5.5 for the entire group and for distinguishing microcalcifications versus masses and other findings and benign versus malignant lesions and for effect of breast density on lesion visualization. Women were asked to compare their comfort during CT with that during mammography on a continuous scale of 1–10. With a Wilcoxon signed rank procedure, the null hypothesis that comfort ratings were symmetric about a score of 5.5 (equal comfort with CT and mammography) was tested. Results: Overall, CT was equal to mammography for visualization of breast lesions. Breast CT was significantly better than mammography for visualization of masses (P = .002); mammography outperformed CT for visualization of microcalcifications (P = .006). No significant differences between CT and mammography were seen among benign versus malignant lesions or for effect of breast density on lesion visualization. Subjects found CT significantly more comfortable than mammography (P < .001). Conclusion: Some technical challenges remain, but breast CT is promising and may have potential clinical applications. © RSNA, 2008 PMID:18195383

  20. Workshop on radiobiological effectiveness of neutrons

    SciTech Connect

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

    1985-09-01

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

  1. Workshop on Radiobiological Effectiveness of Neutrons

    NASA Astrophysics Data System (ADS)

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

    1985-09-01

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

  2. Clinical and Applied Experience in Rehabilitation Counselor Education

    ERIC Educational Resources Information Center

    Tschopp, Molly K.; Chronister, Julie A.

    2008-01-01

    Applied training of pre-practicum, practicum, and internship are important gateway experiences for rehabilitation counselors-in-training. Counselor educators and supervisors must be aware of requirements and expectations of counselor-in-training supervision and common ethical issues specific to these clinical experiences of rehabilitation

  3. Clinical Needs Finding: Developing the Virtual Experience, A Case Study

    PubMed Central

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

    2013-01-01

    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 for 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

  4. Introductory Laboratory Exercises in Radiobiology

    ERIC Educational Resources Information Center

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

    1970-01-01

    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)

  5. Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

    PubMed

    Perusini, Darsi J; Llacuachaqui, Marcia; Sigal, Michael J; Dempster, Laura J

    2016-03-01

    Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations. PMID:26933105

  6. Operation and Maintenance of the National Radiobiology Archives

    SciTech Connect

    Dr. Anthony C. James; Stacey L. McCord

    2012-03-07

    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.

  7. Enrichment of the Educational Psychology Curriculum through Clinical Experiences.

    ERIC Educational Resources Information Center

    Shaker, Paul; Ullrich, Walter

    An educational psychology curriculum for preservice teachers that attempts to overcome some of the shortcomings of most such curricula while providing clinical experience is described. The curriculum is based on three major propositions: (1) preservice teachers must acquire psychologically informed inquiry skills and a general understanding of…

  8. Time Keeps on Ticking: The Experience of Clinical Judgment

    ERIC Educational Resources Information Center

    Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.

    2009-01-01

    The reactions by Ridley and Shaw-Ridley (EJ832451) and Lichtenberg (EJ832452) to the authors' meta-analysis on the effects of experience on judgment accuracy add positively to what is hoped will become an ever more focused discourse on this most basic question: How can mental health clinical decision making be improved? In this rejoinder, the…

  9. Designing Nursing Simulation Clinical Experiences to Promote Critical Inquiry

    ERIC Educational Resources Information Center

    Beattie, Bev; Koroll, Donna; Price, Susan

    2010-01-01

    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…

  10. Teachers' Clinical Experiences and Attitudes toward Technology Inclusion

    ERIC Educational Resources Information Center

    Paganelli, Andrea Lynch

    2010-01-01

    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…

  11. Radiobiological studies using gamma and x rays.

    SciTech Connect

    Potter, Charles Augustus; Longley, Susan W.; Scott, Bobby R.; Lin, Yong; Wilder, Julie; Hutt, Julie A.; Padilla, Mabel T.; Gott, Katherine M.

    2013-02-01

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

  12. Bystander effects and their implications for clinical radiation therapy: Insights from multiscale in silico experiments.

    PubMed

    Powathil, Gibin G; Munro, Alastair J; Chaplain, Mark A J; Swat, Maciej

    2016-07-21

    Radiotherapy is a commonly used treatment for cancer and is usually given in varying doses. At low radiation doses relatively few cells die as a direct response to radiation but secondary radiation effects, such as DNA mutation or bystander phenomena, may affect many cells. Consequently it is at low radiation levels where an understanding of bystander effects is essential in designing novel therapies with superior clinical outcomes. In this paper, we use a hybrid multiscale mathematical model to study the direct effects of radiation as well as radiation-induced bystander effects on both tumour cells and normal cells. We show that bystander responses play a major role in mediating radiation damage to cells at low-doses of radiotherapy, doing more damage than that due to direct radiation. The survival curves derived from our computational simulations showed an area of hyper-radiosensitivity at low-doses that are not obtained using a traditional radiobiological model. PMID:27084360

  13. Ambulance clinical placements – A pilot study of students' experience

    PubMed Central

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

    2008-01-01

    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. PMID:18400111

  14. E-health stakeholders experiences with clinical modelling and standardizations.

    PubMed

    Geg, Kirstine Rosenbeck; Elberg, Pia Britt; Hjen, Anne Randorff

    2015-01-01

    Stakeholders in e-health such as governance officials, health IT-implementers and vendors have to co-operate to achieve the goal of a future-proof interoperable e-health infrastructure. Co-operation requires knowledge on the responsibility and competences of stakeholder groups. To increase awareness on clinical modeling and standardization we conducted a workshop for Danish and a few Norwegian e-health stakeholders' and made them discuss their views on different aspects of clinical modeling using a theoretical model as a point of departure. Based on the model, we traced stakeholders' experiences. Our results showed there was a tendency that stakeholders were more familiar with e-health requirements than with design methods, clinical information models and clinical terminology as they are described in the scientific literature. The workshop made it possible for stakeholders to discuss their roles and expectations to each other. PMID:25991150

  15. Mapping students' clinical experiences to pediatric clerkship goals.

    PubMed

    Lee, Aaron; Sharkey, Angela; McGann, Kathleen; Sumner, Walton

    2006-01-01

    In anticipation of new LCME accreditation requirements, our third year clerkship students began tracking pediatric clinical experiences using a hand-held Electronic Student Encounter Log (ESEL) in June 2005. ESEL was tailored to support rapid documentation of diseases seen at a pediatric tertiary care hospital, while retaining access to primary care diagnoses. We matched encounters that 37 students documented to experiences that fulfill the pediatric clerkship's 19 educational goals. We discovered omissions in both ESEL and the goal definitions. No student documented meeting all goals, and no goal was met by all students. Handheld encounter logs are useful for tracking clinical experiences. Logs, logging instructions, and goals require regular compatibility checks. PMID:17238622

  16. Mapping Students Clinical Experiences to Pediatric Clerkship Goals

    PubMed Central

    Lee, Aaron; Sharkey, Angela; McGann, Kathleen; Sumner, Walton

    2006-01-01

    In anticipation of new LCME accreditation requirements, our third year clerkship students began tracking pediatric clinical experiences using a hand-held Electronic Student Encounter Log (ESEL) in June 2005. ESEL was tailored to support rapid documentation of diseases seen at a pediatric tertiary care hospital, while retaining access to primary care diagnoses. We matched encounters that 37 students documented to experiences that fulfill the pediatric clerkships 19 educational goals. We discovered omissions in both ESEL and the goal definitions. No student documented meeting all goals, and no goal was met by all students. Handheld encounter logs are useful for tracking clinical experiences. Logs, logging instructions, and goals require regular compatibility checks. PMID:17238622

  17. Student nurses experience of learning in the clinical environment.

    PubMed

    Papastavrou, Evridiki; Lambrinou, Ekaterini; Tsangari, Haritini; Saarikoski, Mikko; Leino-Kilpi, Helena

    2010-05-01

    The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Exploration of this environment gives insight into the educational functioning of the clinical areas and allows nurse teachers to enhance students' opportunities for learning. Since Cyprus is undergoing major reforms in nursing education, building on the experience and knowledge gained, this study aims to explore the present clinical situation and how this would impact on nursing education moves to the university. As nursing education would take on a different approach, it is assumed the learning approach would also be different, and so utilization of the clinical environment would also be improved. Six hundred and forty five students participated in the study. Data were collected by means of the clinical learning environment and supervision instrument. A statistically significant correlation was found between the sub-dimensions "premises of nursing care" and "premises of learning" indicating that students are relating learning environment with the quality of nursing care and patient relationships. The ward atmosphere and the leadership style of the manager were rated as less important factors for learning. The majority of students experienced a group supervision model, but the more satisfied students were those with a "personal mentor" that was considered as the most successful mentor relationship. The findings suggest more thorough examination and understanding of the characteristics of the clinical environment that are conductive to learning. PMID:19700368

  18. The renaissance in basic cellular radiobiology and its significance for radiation therapy

    SciTech Connect

    Lett, J.T.

    1994-12-31

    Cellular radiobiology is undergoing a renaissance. The renaissance provides the impetus for change in the content of graduate courses in basic cellular radiobiology, and especially those designed for residents in radiation therapy. Emphasis on radiation physics should be reduced to a bare minimum; emphasis on the roles of biochemistry, chemistry, molecular biology, molecular genetics, and so forth in the cellular radiation response must be accentuated. Improvements in radiation therapy should follow a major shift in research emphasis to the identification of enzymes involved in cellular recovery. Theoretically, it is possible to change a survival curve by modulating or inhibiting the enzymatic processes involved in the amelioration of radiation damage to DNA. Split-dose recovery at the cellular level would be eliminated. Effective clinical utilization of specific enzyme inhibitors would increase the fiscal and logistic advantages of `conventional` therapy with sparsely ionizing radiations. 59 refs., 10 figs., 1 tab.

  19. Solvent/detergent plasma: pharmaceutical characteristics and clinical experience.

    PubMed

    Liumbruno, Giancarlo Maria; Franchini, Massimo

    2015-01-01

    The solvent/detergent treatment is an established virus inactivation technology that has been industrially applied for manufacturing plasma derived medicinal products for almost 30 years. Solvent/detergent plasma is a pharmaceutical product with standardised content of clotting factors, devoid of antibodies implicated in transfusion-related acute lung injury pathogenesis, and with a very high level of decontamination from transfusion-transmissible infectious agents. Many clinical studies have confirmed its safety and efficacy in the setting of congenital as well as acquired bleeding disorders. This narrative review will focus on the pharmaceutical characteristics of solvent/detergent plasma and the clinical experience with this blood product. PMID:24844804

  20. Oncolytic HSV-1 Virotherapy: Clinical Experience and Opportunities for Progress

    PubMed Central

    Kaur, Balveen; Chiocca, E. Antonio; Cripe, Timothy P

    2014-01-01

    Oncolytic virotherapy with mutants derived from Herpes simplex virus (HSV) type 1 exhibit significant antitumor effects in preclinical models. Several mutants have now been tested in clinical trials for a variety of cancer types, and all have been found to be safe. While there have been hints of antitumor efficacy with prolonged survival in some cases compared with historical controls, dramatic responses have been elusive. We review the clinical experience published to date and discuss some of the biologic factors that may be limiting for virus infection and spread, as well as new strategies currently under development to enhance antitumor efficacy. PMID:21740359

  1. Interprofessional student experiences on the HAVEN free clinic leadership board.

    PubMed

    Scott, Elizabeth Anne; Swartz, Martha K

    2015-01-01

    In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context. PMID:25003548

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

    PubMed Central

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

    2012-01-01

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

  3. Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context

    PubMed Central

    McHugh, Matthew D.; Lake, Eileen T.

    2010-01-01

    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

  4. Hospice clinical experiences for nursing students: living to the fullest.

    PubMed

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

    Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources. PMID:25585469

  5. Exploring clinical nursing experiences: listening to student nurses.

    PubMed

    Pearcey, Patricia; Draper, Peter

    2008-07-01

    Student nurses spend one half of their educational programme in the clinical area. The success of an educationally sound clinical placement is crucial to forming a professional nursing identity that will encompass the seen and 'unseen' aspects of the nurses' role. The aim of this study was to explore the clinical nursing environment through the perceptions of first year student nurses. Semi-structured interviews were used to collect data from 12 student nurses who each had four weeks clinical experience, representing 21 wards and five hospitals. Results suggest that these student nurses were disillusioned with the reality of clinical nursing and that their expectations of nursing were not realised. They perceived that paperwork, completing tasks and meeting targets were dominant features of nursing work at the expense of patient contact and communication. A majority indicated that nursing was not as caring as they expected and vowed to hold on to their personal values of caring about patients and forming communicative, interpersonal relationships with them. PMID:17950499

  6. Italian nurse students' and clinical preceptors' perceptions about clinical practice experiences: a questionnaire survey.

    PubMed

    Quattrin, Rosanna; Zanini, Antonietta; Bulfone, Giampiera; Farneti, Federico; Panariti, Matteo; Calligaris, Laura; Brusaferro, Silvio

    2010-01-01

    Aims of the study was to compare perception of both clinical preceptors and nursing students in relation to clinical nursing practice in Italy. The recent introduction of primary level nursing education to Italian University primed many changes in processes and required to think new methods and contents. Special attention was adopted on revaluation of clinical practice. The study was part of a large investigation conducted from 2005 until 2006 as prevalence survey throughout two questionnaire addressed to nurses student and to clinical guides. Participants were all students (tot. 172) from one School of Nursing and their clinical guides (tot.120) working in a high specialization hospital located in a large urban area in Northern Italy. Students' and nurses' perceptions differed in these fields: knowledge of students' learning objectives, explanation of students' competences and objectives already reached, prevalence execution of assistance activity, organization of briefing/debriefing meetings, planning of a learning programme with students at the beginning of tutorship, choosing occasions related to nursing subjects discussed in classroom, filling an intermediate evaluation of the student tutorship in addiction to the final. The perceptions of the students and preceptors were opposite on several factors. This means that students and clinical guides approach the clinical experience from individualized viewpoints. PMID:21358770

  7. Narrativizing Nursing Students' Experiences With Medical Errors During Clinicals.

    PubMed

    Noland, Carey M; Carmack, Heather J

    2015-10-01

    The ways providers story their mistake experiences help to explain how providers understand medical errors and how they communicate about those errors. Communication scholars have slowly begun to explore the communicative nature of medical error experiences, with communication research becoming more abundant over the past few years. Missing from this discussion is how students in health professions, in this case nursing students, tell medical errors narratives and how the stories help them determine how to respond to mistakes. In this article, we explore how nursing students narrativize their medical errors experiences during clinicals. Qualitative interviews were conducted with 68 nursing students. The interviews were transcribed and resulted in a total of 1,261 single-spaced pages of data. We found that nursing students told three different narratives: (a) the "save the day" narrative, (b) the "silence" narrative, and (c) the "not always right" narrative. Finally, we discuss the implications of these narratives and their impact on nursing education. PMID:25539633

  8. 3-D Imaging Based, Radiobiological Dosimetry

    PubMed Central

    Sgouros, George; Frey, Eric; Wahl, Richard; He, Bin; Prideaux, Andrew; Hobbs, Robert

    2008-01-01

    Targeted radionuclide therapy holds promise as a new treatment against cancer. Advances in imaging are making it possible to evaluate the spatial distribution of radioactivity in tumors and normal organs over time. Matched anatomical imaging such as combined SPECT/CT and PET/CT have also made it possible to obtain tissue density information in conjunction with the radioactivity distribution. Coupled with sophisticated iterative reconstruction algorithims, these advances have made it possible to perform highly patient-specific dosimetry that also incorporates radiobiological modeling. Such sophisticated dosimetry techniques are still in the research investigation phase. Given the attendant logistical and financial costs, a demonstrated improvement in patient care will be a prerequisite for the adoption of such highly-patient specific internal dosimetry methods. PMID:18662554

  9. BNL ACCELERATOR-BASED RADIOBIOLOGY FACILITIES

    SciTech Connect

    LOWENSTEIN,D.I.

    2000-05-28

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

  10. Radiobiology of neutron effects on normal tissues

    SciTech Connect

    Hornsey, S.

    1986-01-01

    New facilities are being installed at a number of hospitals in the USA and in Europe which will deliver high energy neutron beams much more suitable for the treatment of tumours than the beams which have been available heretofore. The beam penetration into tissue will be at least as good as /sup 60/Co ..gamma..-rays. Treatment planning will be improved so that smaller volumes will be treated to the higher doses. In particular the more penetrating neutron beams will enable clinicians to treat deep seated tumours in the abdomen. Perhaps therefore the most urgent need is for radiobiological information on the tissues and organs which will be at risk and which will determine tolerance in the abdomen.

  11. BNL accelerator-based radiobiology facilities

    NASA Technical Reports Server (NTRS)

    Lowenstein, D. I.

    2001-01-01

    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.

  12. The potential (radio-)biological impact of launch vibration

    NASA Astrophysics Data System (ADS)

    Baert, Philippe; Van Cleynenbreugel, Tim; Vandesompele, Jo; De Schynkel, Sofie; Vander Sloten, Jos; Van Oostveldt, Patrick

    2006-05-01

    The differences observed between microgravity exposed samples and 1×g control samples on ground in a typical cell biological space experiment may be explained by unwanted side-effects like cosmic rays, launch vibrations or acceleration effects. This study investigated the impact of vibrational stress accompanying a typical launch in the field of radiobiology. Cultures of primary bone marrow cells were hard-mounted on a vibration table in a direction parallel (launch direction) and perpendicular to the cell culture's substrate. The cell cultures were then vibrated according to the qualification tests of Biobox space hardware. The g-levels in those separate directions measured 11.3×g and 4.5×g rms, respectively. Expression levels of six genes controlling apoptosis or genome damage/repair ( c-Fos, Gadd45 a, p21, Mdm2, Bax and Hspa4) were quantified with real-time PCR based on a panel of stable genes. A significant change in gene expression was seen in the launch direction. Considering the one-shot philosophy of space experimentation, simultaneous vibration of ground samples at launch of experiments should be mandatory for biological experiments.

  13. Safety of tacrine: clinical trials, treatment IND, and postmarketing experience.

    PubMed

    Gracon, S I; Knapp, M J; Berghoff, W G; Pierce, M; DeJong, R; Lobbestael, S J; Symons, J; Dombey, S L; Luscombe, F A; Kraemer, D

    1998-06-01

    The safety of tacrine (Cognex), a centrally active, reversible acetylcholinesterase inhibitor approved in 1993 for the treatment of mild to moderate dementia of the Alzheimer type, was evaluated in 2,706 patients with Alzheimer disease (AD) in clinical trials and in 9861 patients with AD in a treatment investigational new drug (TIND) program. More than 190,000 patients in the United States received tacrine during the first 2 years following marketing approval. The most common tacrine-associated adverse events were elevated liver transaminase levels [alanine aminotransferase (ALT) and, to a lesser degree, aspartate aminotransferase] and peripheral cholinergic events involving primarily the digestive system (nausea, vomiting, diarrhea, dyspepsia, anorexia, and weight loss). Based on clinical trial experience, potentially clinically significant (>3 x upper limit of normal) ALT elevations occurred in 25% of patients, requiring routine monitoring early in treatment. The elevations were almost always asymptomatic, rarely accompanied by significant increases in bilirubin, and related to time on drug rather than to dose (90% occurred within the first 12 weeks of treatment). Gastrointestinal events were related to dose and generally of mild to moderate intensity. Tacrine-associated events, including ALT elevations, were reversible. Cholinergic events were manageable with dosage adjustment. Tacrine was not associated with permanent liver injury in clinical trials or a TIND setting. PMID:9651138

  14. Developing a leadership pipeline: the Cleveland Clinic experience.

    PubMed

    Hess, Caryl A; Barss, Christina; Stoller, James K

    2014-11-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report, detail an expanded health care leadership development programme called the Cleveland Clinic Academy (CCA). CCA consists of a broad suite of offerings, including cohort-based learning and 'a la carte' half- or full-day courses addressing specific competencies to manage and to lead. Academy attendance is optional and is available to all physicians, nurses, and administrators with the requisite experience. Course selection is guided by competency matrices which map leadership competencies to specific courses. As of December 2012, a total of 285 course sessions have been offered to 6,050 attendees with uniformly high ratings of course quality and impact. During the past 10 years, Cleveland Clinic's leadership and management curriculum has successfully created a pipeline of health care leaders to fill executive positions, search committees, board openings, and various other organizational leadership positions. Health care leadership can be taught and learned. PMID:25082312

  15. Investigator experiences with financial conflicts of interest in clinical trials

    PubMed Central

    2011-01-01

    Background Financial conflicts of interest (fCOI) can introduce actions that bias clinical trial results and reduce their objectivity. We obtained information from investigators about adherence to practices that minimize the introduction of such bias in their clinical trials experience. Methods Email survey of clinical trial investigators from Canadian sites to learn about adherence to practices that help maintain research independence across all stages of trial preparation, conduct, and dissemination. The main outcome was the proportion of investigators that reported full adherence to preferred trial practices for all of their trials conducted from 2001-2006, stratified by funding source. Results 844 investigators responded (76%) and 732 (66%) provided useful information. Full adherence to preferred clinical trial practices was highest for institutional review of signed contracts and budgets (82% and 75% of investigators respectively). Lower rates of full adherence were reported for the other two practices in the trial preparation stage (avoidance of confidentiality clauses, 12%; trial registration after 2005, 39%). Lower rates of full adherence were reported for 7 practices in the trial conduct (35% to 43%) and dissemination (53% to 64%) stages, particularly in industry funded trials. 269 investigators personally experienced (n = 85) or witnessed (n = 236) a fCOI; over 70% of these situations related to industry trials. Conclusion Full adherence to practices designed to promote the objectivity of research varied across trial stages and was low overall, particularly for industry funded trials. PMID:21226951

  16. Clinical experience with adolescent diabetes in a Nigerian teaching hospital.

    PubMed Central

    Akanji, A. O.

    1996-01-01

    Diabetes mellitus presenting in adolescents age 10 to 20 years accounts for less than 5% of all diabetes in tropical African countries. Consequently, inadequate attention is paid to the medical and psychosocial problems attendant on adolescent diabetes in those countries. This article highlights our clinical experience in the management of 30 adolescent diabetic subjects who presented consecutively in the diabetic clinic of a major Nigerian teaching hospital. In these patients, adolescent diabetes appeared heterogeneous, comprising classical insulin-dependent diabetes mellitus (IDDM) in approximately 80%; the remaining fraction (20%) was contributed variably by malnutrition-related diabetes (MRDM) and an "atypical" form of IDDM. The most common medical complications were recurrent hypoglycemia, ketoacidosis, and infections. About 80% of the patients were poor, and up to two thirds had to withdraw from school or trade because of recurrent illness. One third of the girls had a history of unwanted pregnancies. Almost all (93%) had a history of general rebelliousness and clinic truancy. Therefore, the high prevalence of acute metabolic decompensation may be related to the increased frequency of psychosocial problems, especially poverty, in these patients. It is suggested that agencies in tropical Africa increase welfare facilities for adolescent chronic disease, and also establish and encourage clinics dedicated to adolescent diabetes care. PMID:8776066

  17. Describing depression: Congruence between patient experiences and clinical assessments

    PubMed Central

    Kelly, Morgen A. R.; Morse, Jennifer Q.; Stover, Angela; Hofkens, Tara; Huisman, Emily; Shulman, Stuart; Eisen, Susan V.; Becker, Sara J.; Weinfurt, Kevin; Boland, Elaine; Pilkonis, Paul A.

    2011-01-01

    Objectives Efforts to describe depression have relied on top-down methods in which theory and clinical experience define depression but may not reflect the individuals’ experiences with depression. We assessed the degree of overlap between academic descriptions of depression and patient-reported symptoms as conceptualized in the Patient-Reported Outcomes Measurement Information System® (PROMIS®). By extension, this work assesses the degree of overlap between current clinical descriptions of depression and patient-reported symptoms. Design In this content analysis study, four focus groups were conducted across two sites to elicit symptoms and the experience of depression from depressed and medically ill patients. Methods Depressed and medically ill patients were asked to describe symptoms that characterize depression. Data were transcribed and then coded using an a priori list of 43 facets of depression derived from extant depression measures. Results Participants described 93% of the symptoms from the a priori list, supporting the validity of current depression measures. Interpersonal difficulties were underscored as was anger. In general, results from the focus groups did not require the generation of new items for depression and supported the content validity of the PROMIS hierarchical framework and item pool created originally. Conclusions This work supports the validity of current depression assessment, but suggests further investigation of interpersonal functioning and anger may add to the depth and breadth of depression assessment. PMID:21332520

  18. Exploring nursing students’ experience of peer learning in clinical practice

    PubMed Central

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

    Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

  19. 100 years of radiobiology: implications for biomedicine and future perspectives.

    PubMed

    Fritz-Niggli, H

    1995-07-14

    The development of radiobiology from the very early detection of the biological action of X-rays to the knowledge of today is described in sections on radiation chemistry and biochemistry, mutation and cancer induction, and embryonic damage, as well as the dependence of radiation response on radiation quality and temporal dose distribution (repair) and the interaction with other factors. For medicine radiobiology serves as a basis for radiotherapy and radiological protection. The effect of very low doses, and their possible biopositive effect (hormesis and adaptive response), is also discussed, as are the health hazard of radon, health risks after the Chernobyl accident, and space radiobiology. The radiobiology of the future will be concerned with biomolecular and genetic implications, problems of damage and repair, and connected problems like hormesis. PMID:7628576

  20. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed Central

    Ohaeri, J. U.

    1992-01-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment. PMID:1608064

  1. Experience of isolated sleep paralysis in clinical practice in Nigeria.

    PubMed

    Ohaeri, J U

    1992-06-01

    The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment. PMID:1608064

  2. Incorporating professionalism into medical education: the Mayo Clinic experience.

    PubMed

    Mueller, Paul S

    2009-09-01

    Professionalism is a core competency of physicians. In this article, the statements of professional societies (e.g., the Charter on Medical Professionalism), the expectations of patients and society regarding professionalism, and a framework for defining medical professionalism are described. The framework's foundation consists of clinical competence, communication skills, and a sound understanding of the ethical and legal aspects of medicine. Rising from this foundation are attributes of professionalism: accountability, altruism, excellence, and humanism. The capstone of the framework is professionalism, or the complete physician. Reasons for teaching professionalism to and assessing professionalism among medical students, physicians in training, and physicians in practice are also described. These reasons include patient expectations; the association between professionalism and improved clinical outcomes (and the association between unprofessional behavior and adverse outcomes); accreditation organization requirements; and observations that professionalism can be taught, learned, and assessed. In addition, methods for teaching professionalism are described (e.g., didactic lectures, discussion groups, simulation, and role-modeling). To ensure that medical students, physicians in training, and physicians in practice are competent in professionalism, they should be assessed for professionalism. Thus, approaches to assessing professionalism are also described (e.g., multiple tools and observers). Professionalism assessments can be used for formative and summative feedback, evaluation of professionalism education programs, and generating hypotheses for professionalism research. Finally, the rich history and culture of clinical excellence and professionalism and specific programs for teaching and assessing professionalism at Mayo Clinic are described throughout this article. Indeed, the Mayo Clinic experience validates professionalism a s a core physician competency. PMID:19826207

  3. Pediatric residents' experiences of a clinical rotation in Adolescent Medicine

    PubMed Central

    2010-01-01

    Background Although Adolescent Medicine is a pediatric subspecialty, it addresses many issues that differ from other aspects of pediatrics clinical training. The aim of this study was to explore the general experiences of pediatric residents during their rotations in Adolescent Medicine. Methods Qualitative methods were applied. Semi-structured individual interviews were conducted with pediatric residents who had completed a rotation in Adolescent Medicine. Emergent themes were identified. Results Three key themes emerged: gaining exposure, taking on a professional role, and achieving self-awareness. Subcategories were also identified. There was particular emphasis on the multidisciplinary team and the biopsychosocial approach to adolescent health care. Conclusions The experiences in Adolescent Medicine reflected residents' learning, notably gains in the "non-expert" as well as "medical expert" physician competencies. Future studies should explore how the interprofessional nature of an Adolescent Medicine team and the patient populations themselves contribute to this learning. PMID:21122143

  4. Mutuality: clinical and metapsychological potentials of a failed experiment.

    PubMed

    Castillo Mendoza, Carlos Alberto

    2012-03-01

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

  5. Fingolimod Real World Experience: Efficacy and Safety in Clinical Practice

    PubMed Central

    Fonseca, Joaquim

    2015-01-01

    Fingolimod is a multiple sclerosis treatment licensed in Europe since 2011. Its efficacy has been demonstrated in three large phase III trials, used in the regulatory submissions throughout the world. As usual, in these trials the inclusion and exclusion criteria were designed to obtain a homogeneous population, with interchangeable characteristics in the different treatment arms. Although this is the best strategy to achieve a robust answer to the investigation question, it does not guaranty the treatment efficacy in the clinical practice, since in the real world there are concomitant treatments, comorbidities, adherence, and persistence challenges. But, to make informed treatment decision for a real life patient, we need to have evidence of the treatment efficacy, what has been called treatment effectiveness. This work aims to review fingolimod effectiveness, using, as source of information, abstracts, posters, and manuscripts. This unorthodox strategy was developed because more than half of the published experience with fingolimod is still on abstracts and posters. Only a small part of the studies reviewed are already published in peer reviewed journals. Fingolimod seems to be, at least, as effective and safe as it was on clinical trials, and with its long-term experience no new safety signals were observed. PMID:26693475

  6. Artificial Pancreas: Model Predictive Control Design from Clinical Experience

    PubMed Central

    Toffanin, Chiara; Messori, Mirko; Palma, Federico Di; Nicolao, Giuseppe De; Cobelli, Claudio; Magni, Lalo

    2013-01-01

    Background The objective of this research is to develop a new artificial pancreas that takes into account the experience accumulated during more than 5000 h of closed-loop control in several clinical research centers. The main objective is to reduce the mean glucose value without exacerbating hypo phenomena. Controller design and in silico testing were performed on a new virtual population of the University of Virginia/Padova simulator. Methods A new sensor model was developed based on the Comparison of Two Artificial Pancreas Systems for Closed-Loop Blood Glucose Control versus Open-Loop Control in Patients with Type 1 Diabetes trial AP@home data. The Kalman filter incorporated in the controller has been tuned using plasma and pump insulin as well as plasma and continuous glucose monitoring measures collected in clinical research centers. New constraints describing clinical knowledge not incorporated in the simulator but very critical in real patients (e.g., pump shutoff) have been introduced. The proposed model predictive control (MPC) is characterized by a low computational burden and memory requirements, and it is ready for an embedded implementation. Results The new MPC was tested with an intensive simulation study on the University of Virginia/Padova simulator equipped with a new virtual population. It was also used in some preliminary outpatient pilot trials. The obtained results are very promising in terms of mean glucose and number of patients in the critical zone of the control variability grid analysis. Conclusions The proposed MPC improves on the performance of a previous controller already tested in several experiments in the AP@home and JDRF projects. This algorithm complemented with a safety supervision module is a significant step toward deploying artificial pancreases into outpatient environments for extended periods of time. J Diabetes Sci Technol 2013;7(6):1470-1483 PMID:24351173

  7. General Practitioners’ responses to global climate change - lessons from clinical experience and the clinical method

    PubMed Central

    2012-01-01

    Background Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action. Discussion We contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism. Summary General practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change. PMID:22873633

  8. Questioning Skills Demonstrated by Approved Clinical Instructors During Clinical Field Experiences

    PubMed Central

    Barnum, Mary G

    2008-01-01

    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. PMID:18523565

  9. Managing medical images and clinical information: InCor's experience.

    PubMed

    Furuie, Sergio S; Rebelo, Marina S; Moreno, Ramon A; Santos, Marcelo; Bertozzo, Nivaldo; Motta, Gustavo H M B; Pires, Fabio A; Gutierrez, Marco A

    2007-01-01

    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 São Paulo, Brazil, has been committed to the goal of integrating all exams and clinical information within the institution and other hospitals. Since InCor is one of the six institutes of the University of São Paulo Medical School and each institute has its own information system, exchanging information among the institutes is also a very important aspect that has been considered. In the last few years, a system for transmission, archiving, retrieval, processing, and visualization of medical images integrated with a hospital information system has been successfully created and constitutes the InCor's electronic patient record (EPR). This work describes the experience in the effort to develop a functional and comprehensive EPR, which includes laboratory exams, images (static, dynamic, and three dimensional), clinical reports, documents, and even real-time vital signals. A security policy based on a contextual role-based access control model was implemented to regulate user's access to EPR. Currently, more than 10 TB of digital imaging and communications in medicine (DICOM) images have been stored using the proposed architecture and the EPR stores daily more than 11 GB of integrated data. The proposed storage subsystem allows 6 months of visibility for rapid retrieval and more than two years for automatic retrieval using a jukebox. This paper addresses also a prototype for the integration of distributed and heterogeneous EPR. PMID:17249400

  10. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    PubMed Central

    2012-01-01

    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. PMID:23173953

  11. Heavy-ion tumor therapy: Physical and radiobiological benefits

    NASA Astrophysics Data System (ADS)

    Schardt, Dieter; Elsässer, Thilo; Schulz-Ertner, Daniela

    2010-01-01

    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.

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

    PubMed Central

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

    2010-01-01

    Phantom-based and patient-specific imaging-based dosimetry methodologies have traditionally yielded mean organ-absorbed doses or spatial dose distributions over tumors and normal organs. In this work, radiobiologic modeling is introduced to convert the spatial distribution of absorbed dose into biologically effective dose and equivalent uniform dose parameters. The methodology is illustrated using data from a thyroid cancer patient treated with radioiodine. Methods Three registered SPECT/CT scans were used to generate 3-dimensional images of radionuclide kinetics (clearance rate) and cumulated activity. The cumulated activity image and corresponding CT scan were provided as input into an EGSnrc-based Monte Carlo calculation: The cumulated activity image was used to define the distribution of decays, and an attenuation image derived from CT was used to define the corresponding spatial tissue density and composition distribution. The rate images were used to convert the spatial absorbed dose distribution to a biologically effective dose distribution, which was then used to estimate a single equivalent uniform dose for segmented volumes of interest. Equivalent uniform dose was also calculated from the absorbed dose distribution directly. Results We validate the method using simple models; compare the dose-volume histogram with a previously analyzed clinical case; and give the mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for an illustrative case of a pediatric thyroid cancer patient with diffuse lung metastases. The mean absorbed dose, mean biologically effective dose, and equivalent uniform dose for the tumor were 57.7, 58.5, and 25.0 Gy, respectively. Corresponding values for normal lung tissue were 9.5, 9.8, and 8.3 Gy, respectively. Conclusion The analysis demonstrates the impact of radiobiologic modeling on response prediction. The 57% reduction in the equivalent dose value for the tumor reflects a high level of dose nonuniformity in the tumor and a corresponding reduced likelihood of achieving a tumor response. Such analyses are expected to be useful in treatment planning for radionuclide therapy. PMID:17504874

  13. Hot particle dosimetry and radiobiology--past and present.

    PubMed

    Charles, M W; Harrison, J D

    2007-09-01

    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

  14. The Tumor Radiobiology of SRS and SBRT: Are More Than the 5 Rs Involved?

    SciTech Connect

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

    2014-02-01

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

  15. Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer

    SciTech Connect

    Warren, Samantha; Partridge, Mike; Carrington, Rhys; Hurt, Chris; Crosby, Thomas; Hawkins, Maria A.

    2014-10-01

    Purpose: This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. Methods and Materials: Twenty-one patients with mid-esophageal cancer were selected from the SCOPE1 database (International Standard Randomised Controlled Trials number 47718479), with a mean planning target volume (PTV) of 327 cm{sup 3}. A boost volume, PTV2 (GTV + 0.5 cm margin), was created. Radiobiological modeling of tumor control probability (TCP) estimated the dose required for a clinically significant (+20%) increase in local control as 62.5 Gy/25 fractions. A RapidArc (RA) plan with a simultaneously integrated boost (SIB) to PTV2 (RA{sub 62.5}) was compared to a standard dose plan of 50 Gy/25 fractions (RA{sub 50}). Dose-volume metrics and estimates of normal tissue complication probability (NTCP) for heart and lungs were compared. Results: Clinically acceptable dose escalation was feasible for 16 of 21 patients, with significant gains (>18%) in tumor control from 38.2% (RA{sub 50}) to 56.3% (RA{sub 62.5}), and only a small increase in predicted toxicity: median heart NTCP 4.4% (RA{sub 50}) versus 5.6% (RA{sub 62.5}) P<.001 and median lung NTCP 6.5% (RA{sub 50}) versus 7.5% (RA{sub 62.5}) P<.001. Conclusions: Dose escalation to the GTV to improve local control is possible when overlap between PTV and organ-at-risk (<8% heart volume and <2.5% lung volume overlap for this study) generates only negligible increase in lung or heart toxicity. These predictions from radiobiological modeling should be tested in future clinical trials.

  16. Biophysical and biomathematical adventures in radiobiology

    SciTech Connect

    Scott, B.R.

    1991-01-01

    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.

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  18. Prescribing exercise training in pulmonary rehabilitation: a clinical experience.

    PubMed

    Bernard, S; Ribeiro, F; Maltais, F; Saey, D

    2014-01-01

    Built around exercise training, pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based, comprehensive approach to working with the patient as a whole and not just the pulmonary component of the disease. Integrated into the individualized treatment, this intervention aims to reduce symptoms, optimize functional status, increase participation in daily life, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease. Although there are many other components that should be considered to manage the impairment and symptom burden, supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation. This paper addresses our clinical experience at Institut universitaire de cardiologie et de pneumologie de Québec to assess and manage exercise training in line with the current recommendations and guidelines surrounding PR. PMID:24480488

  19. [The Doppler in obstetrics: experience of the Baudelocque Clinic].

    PubMed

    Uzan, M; Cynober, E; Uzan, S; Blot, P; Sureau, C

    1987-01-01

    The authors report three years of experience with the use of the Doppler in Obstetrics. Certain notions may be integrated to the principles of clinical decision. The diastolic index D at the umbilical artery increases regularly during a normal pregnancy. It is significantly decreased in case of intra-uterine growth delay (IUGD). When this index reaches zero, it may be considered as a reliable criteria for fetal extraction. Certain notions must be verified: the index seems frequently altered in case of chromosomal abnormality. Some results still depend on research. The index measured at the uterine arteries could predict IUGD and at the level of the fetus' internal carotids, its elevation could be one of the first signs of fetal hypoxia. Finally, the index was measured during normal labor. In case of deceleration it is markedly altered. Thus, this could be an additional element of fetal monitoring. PMID:2953060

  20. Clinical experience with halofantrine in the treatment of malaria.

    PubMed

    Horton, R J; Parr, S N; Bokor, L C

    1990-01-01

    Halofantrine hydrochloride (HF) belongs to a new class of antimalarials, the phenanthrene methanols. Preliminary clinical studies suggested that an adult dose of 500 mg 6-hourly for three doses, with a weight-based regimen of 8 mg/kg 6-hourly for three doses in children, would be effective. In an ongoing clinical programme, 1973 patients with acute malaria were analysed, of whom 1474 (1315 with P. falciparum and 122 with P. vivax malaria) received the above regimen. In the studies 931 adults and older children were treated (61 with capsules and 870 with tablets) while 520 infants and young children used 5% or 2% suspension. The majority of studies were performed in areas of high chloroquine or multidrug resistance. Only eight (0.6%) of 1282 evaluable patients with falciparum malaria failed to clear their parasitaemias within 7 days. Recrudescence of parasitaemia occurred in 77 patients (6.0%). Reinfection cannot be excluded in several of the cases, where protection from malaria transmission was not maintained. The majority of recrudescent patients were either non-immune (normally residing in malaria-free areas) or were infants below 2 years of age. In vivax malaria cases, there were six recrudescences (5.4%). The mean parasite clearance time was 57.9 h and the fever clearance time 50.2 h in falciparum malaria cases, while the clearance times for vivax cases were 57.3 h and 49.6 h respectively. Clinical events were uncommon and consisted of mild transient diarrhoea or abdominal pain in less than 5% of cases. Laboratory findings were generally abnormalities related to the acute disease rather than drug treatment. Experience to date would indicate that HF is a safe and useful drug for the treatment of acute malaria, particularly in areas where there is extensive resistance to current antimalarials. PMID:2100732

  1. Dasatinib first-line: Multicentric Italian experience outside clinical trials.

    PubMed

    Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

    2016-01-01

    Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. PMID:26643920

  2. One Thousand Patients With Primary Myelofibrosis: The Mayo Clinic Experience

    PubMed Central

    Tefferi, Ayalew; Lasho, Terra L.; Jimma, Thitina; Finke, Christy M.; Gangat, Naseema; Vaidya, Rakhee; Begna, Kebede H.; Al-Kali, Aref; Ketterling, Rhett P.; Hanson, Curtis A.; Pardanani, Animesh

    2012-01-01

    Objective To share our decades of experience with primary myelofibrosis and underscore the importance of outcomes research studies in designing clinical trials and interpreting their results. Patients and Methods One thousand consecutive patients with primary myelofibrosis seen at Mayo Clinic between November 4, 1977, and September 1, 2011, were considered. The International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus were applied for risk stratification. Separate analyses were included for patients seen at time of referral (N=1000), at initial diagnosis (N=340), and within or after 1 year of diagnosis (N=660). Results To date, 592 deaths and 68 leukemic transformations have been documented. Parameters at initial diagnosis vs time of referral included median age (66 vs 65 years), male sex (61% vs 62%), red cell transfusion need (24% vs 38%), hemoglobin level less than 10 g/dL (38% vs 54%), platelet count less than 100 × 109/L (18% vs 26%), leukocyte count more than 25 × 109/L (13% vs 16%), marked splenomegaly (21% vs 31%), constitutional symptoms (29% vs 34%), and abnormal karyotype (31% vs 41%). Mutational frequencies were 61% for JAK2V617F, 8% for MPLW515, and 4% for IDH1/2. DIPSS-plus risk distributions at time of referral were 10% low, 15% intermediate-1, 37% intermediate-2, and 37% high. The corresponding median survivals were 17.5, 7.8, 3.6, and 1.8 years vs 20.0, 14.3, 5.3, and 1.7 years for patients younger than 60 years of age. Compared with both DIPSS and IPSS, DIPSS-plus showed better discrimination among risk groups. Five-year leukemic transformation rates were 6% and 21% in low- and high-risk patients, respectively. Conclusion The current document should serve as a valuable resource for patients and physicians and provides context for the design and interpretation of clinical trials. PMID:22212965

  3. Fulvestrant ("Faslodex"): clinical experience from the Compassionate Use Programme.

    PubMed

    Steger, Guenther G; Gips, Maya; Simon, Sergio D; Lluch, Ana; Vinholes, Jefferson; Kaufman, Bella; Wardley, Andrew; Mauriac, Louis

    2005-01-01

    Fulvestrant ("Faslodex") is a new oestrogen receptor (ER) antagonist with no agonist effects that is licensed in the USA, Brazil, Europe and elsewhere for the treatment of advanced breast cancer (ABC) in postmenopausal women following progression on other endocrine agents. This report consolidates clinical experience from the "Faslodex" Compassionate Use Programme, including a total of 339 patients treated at eight cancer centres. Patients received fulvestrant as first- (n=22), second- (n=125), third- (n=105), fourth- (n=58), fifth- (n=22) or sixth-line (n=5) hormonal treatment for ABC, with two patients receiving fulvestrant after more than six other endocrine therapies. Objective response was achieved by 40 patients and stable disease lasting 6 months by 92 patients, giving overall clinical benefit (CB) in 132/339 patients (39%). The CB rate decreased as fulvestrant was used later in the sequence of endocrine treatments, from 46% (10/22) with first-line fulvestrant to 27% (6/22) with fifth-line fulvestrant. Increased benefit was found in patients with tumours expressing both ER and progesterone receptor (PgR) compared with other combinations, although good activity was reported in patients expressing either ER or PgR as well as in tumours expressing human epidermal growth factor receptor 2. Fulvestrant was well tolerated; adverse events were noted in 18/339 patients (5%). These findings concur with data from the clinical-trial setting and further support the assertion that greater benefit is derived when fulvestrant is used early in the treatment sequence. PMID:16198057

  4. Clinical experience of spontaneous pneumomediastinum: diagnosis and treatment

    PubMed Central

    Kim, Kyung Soo; Jeon, Hyun Woo; Moon, Youngkyu; Kim, Young Du; Ahn, Myeong Im; Park, Jae Kil

    2015-01-01

    Background Spontaneous pneumomediastinum (SPM) is a benign disease with a variety degree of severity but definite treatment modality is not clearly identified with its rarity. The purpose of this study was to review our experience and discuss the management of SPM according to the severity of disease. Methods From March 1996 to December 2012, total 64 patients were enrolled and classified as mild, moderate and severe groups and subsequent clinical courses were analyzed retrospectively. Results Fifty-one were males and 13 were females (M:F =3.9:1) with a mean age of 18 years old (range: 10-30 years old). Thirty-six patients were in mild, 22 in moderate and 6 in severe group. Chief complaints were chest pain (50 cases; 78.1%), neck pain (35 cases; 54.7%), dyspnea (18 cases; 28.1%), odynophagia (9 cases; 14.1%) and precipitating factors were coughing in 12 cases, feeding problems in 9 cases, and vomiting in 7 cases; however, 34 patients (53.1%) had no precipitating signs. All patients received oxygen therapy (100%), prophylactic antibiotics in 57 patients (89.1%), and pain medications in 47 patients (73.4%). The mean hospital stay was 4.6 days (range: 1-10 days). There was an increased linear trend according to time to visit (P=0.023) but clinical course demonstrated no significant trend between groups. Conclusions These data demonstrated that there was no difference in symptom, clinical course and SPM was adequately treated with conservative management regardless of the degree of severity of SPM. PMID:26623105

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

    PubMed

    Ozkanlar, Seckin; Akcay, Fatih

    2012-01-01

    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

  6. How Clinical Instructors Can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement

    ERIC Educational Resources Information Center

    Cole, Beverley; Wessel, Jean

    2008-01-01

    Purpose: There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. Methods: Subjects were

  7. How Clinical Instructors Can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement

    ERIC Educational Resources Information Center

    Cole, Beverley; Wessel, Jean

    2008-01-01

    Purpose: There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. Methods: Subjects were…

  8. Estimation of Radiobiologic Parameters and Equivalent Radiation Dose of Cytotoxic Chemotherapy in Malignant Glioma

    SciTech Connect

    Jones, Bleddyn . E-mail: b.jones.1@bham.ac.uk; Sanghera, Paul

    2007-06-01

    Purpose: To determine the radiobiologic parameters for high-grade gliomas. Methods and Materials: The biologic effective dose concept is used to estimate the {alpha}/{beta} ratio and K (dose equivalent for tumor repopulation/d) for high-grade glioma patients treated in a randomized fractionation trial. The equivalent radiation dose of temozolomide (Temodar) chemotherapy was estimated from another randomized study. The method assumes that the radiotherapy biologic effective dose is proportional to the adjusted radiotherapy survival duration of high-grade glioma patients. Results: The median tumor {alpha}/{beta} and K estimate is 9.32 Gy and 0.23 Gy/d, respectively. Using the published surviving fraction after 2-Gy exposure (SF{sub 2}) data, and the above {alpha}/{beta} ratio, the estimated median {alpha} value was 0.077 Gy{sup -1}, {beta} was 0.009 Gy{sup -2}, and the cellular doubling time was 39.5 days. The median equivalent biologic effective dose of temozolomide was 11.03 Gy{sub 9.3} (equivalent to a radiation dose of 9.1 Gy given in 2-Gy fractions). Random sampling trial simulations based on a cure threshold of 70 Gy in high-grade gliomas have shown the potential increase in tumor cure with dose escalation. Partial elimination of hypoxic cells (by chemical hypoxic cell sensitizers or carbon ion therapy) has suggested that considerable gains in tumor control, which are further supplemented by temozolomide, are achievable. Conclusion: The radiobiologic parameters for human high-grade gliomas can be estimated from clinical trials and could be used to inform future clinical trials, particularly combined modality treatments with newer forms of radiotherapy. Other incurable cancers should be studied using similar radiobiologic analysis.

  9. Clinical Experiences in Teacher Education Prior to Student Teaching at Southeast Missouri State University. Report of the Task Force on Alternatives for Clinical Laboratory Experiences in Teacher Education.

    ERIC Educational Resources Information Center

    Southeast Missouri State Univ., Cape Girardeau.

    A study was made of the clinical experiences, offered by Southeast Missouri State University, for students preparing to be teachers. The study was conducted to determine if modifications in the current system would make possible reallocation of resources, while at the same time preserving the quality of clinical experiences for the students. The

  10. Sequencing of Simulation and Clinic Experiences in an Introductory Pharmacy Practice Experience.

    PubMed

    Leon, Nicholas; Hajjar, Emily; DeSevo Bellottie, Gina

    2015-10-25

    Objective. To examine how the intrasemester sequencing of a simulation component, delivered during an ambulatory care introductory pharmacy practice experience (IPPE), affects student performance on a series of 3 assessments delivered during the second professional (P2) year. Design. At the Jefferson College of Pharmacy (JCP), P2 student pharmacists were randomly assigned to 6 weeks of simulation activities, followed by 6 weeks on site at an ambulatory care clinic or vice versa during either the fall or spring semesters. At the end of each semester, these students completed 3 skills-based assessments: answering a series of drug information (DI) questions; conducting medication adherence counseling; and conducting a medication history. The 2 groups' raw scores on assessment rubrics were compared. Assessment. During academic years 2011-2012 and 2012-2013, 180 P2 student pharmacists participated in the required ambulatory care IPPE. Ninety experienced simulation first, while the other 90 experienced the clinic first. Students assessed over a 2-year time span performed similarly on each of 3 skills-based assessments, regardless of how simulation experiences were sequenced within the IPPE. Conclusion. The lack of significant difference in student performance suggests that schools of pharmacy may have flexibility with regard to how they choose to incorporate simulation into clinical ambulatory care IPPEs. PMID:26688585

  11. Sequencing of Simulation and Clinic Experiences in an Introductory Pharmacy Practice Experience

    PubMed Central

    Hajjar, Emily; DeSevo Bellottie, Gina

    2015-01-01

    Objective. To examine how the intrasemester sequencing of a simulation component, delivered during an ambulatory care introductory pharmacy practice experience (IPPE), affects student performance on a series of 3 assessments delivered during the second professional (P2) year. Design. At the Jefferson College of Pharmacy (JCP), P2 student pharmacists were randomly assigned to 6 weeks of simulation activities, followed by 6 weeks on site at an ambulatory care clinic or vice versa during either the fall or spring semesters. At the end of each semester, these students completed 3 skills-based assessments: answering a series of drug information (DI) questions; conducting medication adherence counseling; and conducting a medication history. The 2 groups’ raw scores on assessment rubrics were compared. Assessment. During academic years 2011-2012 and 2012-2013, 180 P2 student pharmacists participated in the required ambulatory care IPPE. Ninety experienced simulation first, while the other 90 experienced the clinic first. Students assessed over a 2-year time span performed similarly on each of 3 skills-based assessments, regardless of how simulation experiences were sequenced within the IPPE. Conclusion. The lack of significant difference in student performance suggests that schools of pharmacy may have flexibility with regard to how they choose to incorporate simulation into clinical ambulatory care IPPEs. PMID:26688585

  12. Centralization of a regional clinical microbiology service: The Calgary experience

    PubMed Central

    Church, Deirdre L; Hall, Paula

    1999-01-01

    Diagnostic laboratory services in Alberta have been dramatically restructured over the past five years. In 1994, Alberta Health embarked on an aggressive laboratory restructuring that cut back approximately 30% of the overall monies previously paid to the laboratory service sector in Calgary. A unique service delivery model consolidated all institutional and community-based diagnostic testing in a company called Calgary Laboratory Services (CLS) in late 1996. CLS was formed by a public/private partnership between the Calgary Regional Health Care Authority (CRHA) and MDS-Kasper Laboratories. By virtue of its customer service base and scope of testing, CLS provides comprehensive regional laboratory services to the entire populace. Regional microbiology services within CLS have been successfully consolidated over the past three years into a centralized high volume laboratory (HVL). Because the HVL is not located in a hospital, rapid response laboratories (RRLs) are operated at each acute care site. Although the initial principle behind the proposed test menus for the RRLs was that only procedures requiring a clinical turnaround time of more than 2 h stay on-site, many other principles had to be used to develop and implement an efficient and clinically relevant RRL model for microbiology. From these guiding principles, a detailed assessment of the needs of each institution and extensive networking with user groups, the functions of the microbiology RRLs were established and a detailed implementation plan drawn up. The experience at CLS with regards to restructuring a regional microbiology service is described herein. A post-hoc analysis provides the pros and cons of directing and operating a regionalized microbiology service. PMID:22346397

  13. Molecular and cellular radiobiological effects of Auger emitting radionuclides

    PubMed Central

    Kassis, Amin I.

    2011-01-01

    Although the general radiobiologic principles underlying external beam therapy and radionuclide therapy are similar, significant differences in the biophysical and radiobiologic effects from the two types of radiation continue to accumulate. Here, I will address the unique features that distinguish the molecular and cellular radiobiological effects of Auger electron-emitting radionuclides consequent to (1) the physical characteristics of the decaying atom and its subcellular localisation, (2) DNA topology and (3) the bystander effect. Based on these experimental findings, I postulate that the ability of track structural simulations as primary tools in modelling DNA damage and cellular survival at the molecular level would be greatly enhanced when these contributions are factored in. PMID:21106639

  14. Radiobiological evaluation of low dose-rate prostate brachytherapy implants

    NASA Astrophysics Data System (ADS)

    Knaup, Courtney James

    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.

  15. Students' experiences of learning manual clinical skills through simulation.

    PubMed

    Johannesson, Eva; Siln, Charlotte; Kvist, Joanna; Hult, Hkan

    2013-03-01

    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

  16. [MODIFICATION OF THE PROTON BEAM PHYSICAL PARAMETERS AND RADIOBIOLOGICAL CHARACTERISTICS BY ELEMENTS OF SPACECRAFT RADIATION PROTECTION].

    PubMed

    Ivanov, A A; Molokanov, A G; Shurshakov, V A; Bulynina, T M; Liakhova, K N; Severiukhin, Yu S; Abrosimova, A N; Ushakov, I B

    2015-01-01

    The experiment was performed with outbred ICR (CD-1). female mice (SPF). The animals were irradiated by 171 MeV protons at a dose of 20 cGy. The spacecraft radiation protection elements used in the experiment were a construction of wet hygiene wipes called a "protective blind", and a glass plate imitating an ISS window. Physical obstacles on the path of 171 MeV protons increase their linear energy transfer leading to the absorbed dose elevation and strengthening of the radiobiological effect. In the experiment, two types of obstacles together raised the absorbed dose from 20 to 23.2 cGy. Chemically different materials (glass and water in the wipes) were found to exert unequal modifying effects on physical and biological parameters of the proton-irradiated mice. There was a distinct dose-dependent reduction of bone marrow cellularity within the dose range from 20 cGy to 23.2 cGy in 24 hours after exposure. No modifying effect of the radiation protection elements on spontaneous motor activity was discovered when compared with entrance protons. The group of animals protected by the glass plate exhibited normal orientative-trying reactions and weakened grip with the forelimbs. Rationalization of physical methods of spacecrew protection should be based as on knowledge in physical dosimetry (ionizing chambers, thermoluminescent, track detectors etc.), so the radiobiological criteria established in experiments with animals. PMID:26738306

  17. [Radiobiological aspects of diagnostic X-ray use in dentistry].

    PubMed

    Hoogeveen, R C; van den Aardweg, G J M J

    2015-05-01

    Soon after the discovery of X-rays, it became clear that their use can cause detrimental effects. The field of radiobiology deals with these detrimental effects. In this article, the theoretical concepts of radiobiology relevant to diagnostic X-ray use are presented. The effects of radiation on living tissues, the relationship between dose and effect, and a translation of these effects into the dental application are discussed. X-rays cannot be considered to be harmless even when used at the relatively low doses as in dentistry. If applied with justification and optimization, the risk to the patient will, however, be small. PMID:26210221

  18. A laser-driven nanosecond proton source for radiobiological studies

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

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

  19. Management of laryngeal radionecrosis: Animal and clinical experience

    SciTech Connect

    Oppenheimer, R.W.; Krespi, Y.P.; Einhorn, R.K.

    1989-05-01

    Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

  20. Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

    PubMed Central

    Oguz, Abdullah; Gümüş, Metehan; Turkoglu, Ahmet; Bozdağ, Zübeyir; Ülger, Burak Veli; Agaçayak, Elif; Böyük, Abdullah

    2015-01-01

    We aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary. PMID:25859652

  1. Biological wound dressings sterilized with gamma radiation: Mexican clinical experience

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

  2. A computational tool for patient specific dosimetry and radiobiological modeling of selective internal radiation therapy with (90)Y microspheres.

    PubMed

    Kalantzis, Georgios; Leventouri, Theodora; Apte, Aditiya; Shang, Charles

    2015-11-01

    In recent years we have witnessed tremendous progress in selective internal radiation therapy. In clinical practice, quite often, radionuclide therapy is planned using simple models based on standard activity values or activity administered per unit body weight or surface area in spite of the admission that radiation-dose methods provide more accurate dosimetric results. To address that issue, the authors developed a Matlab-based computational software, named Patient Specific Yttrium-90 Dosimetry Toolkit (PSYDT). PSYDT was designed for patient specific voxel-based dosimetric calculations and radiobiological modeling of selective internal radiation therapy with (90)Y microspheres. The developed toolkit is composed of three dimensional dose calculations for both bremsstrahlung and beta emissions. Subsequently, radiobiological modeling is performed on a per-voxel basis and cumulative dose volume histograms (DVHs) are generated. In this report we describe the functionality and visualization features of PSYDT. PMID:26296058

  3. Clinical Experience With A Portable 3-D Reconstruction Program

    NASA Astrophysics Data System (ADS)

    Holshouser, Barbara A.; Christiansen, Edwin L.; Thompson, Joseph R.; Reynolds, R. Anthony; Goldwasser, Samuel M.

    1988-06-01

    Clinical experience with a computer program for reconstructing and visualizing three-dimensional (3-D) structures is reported. Applications to the study of soft-tissue and skeletal structures, such as the temporomandibular joint and craniofacial anatomy, using computed tomography (CT) data are described. Several features specific to the computer algorithm are demonstrated and evaluated. These include: (1) manipulation of density windows to selectively visualize bone or soft tissue structures; (2) the efficacy of gradient shading algorithms in revealing fine surface detail; and (3) the rapid generation of cut-away views revealing details of internal structures. Also demonstrated is the importance of high resolution data as input to the 3-D program. The implementation of the program (VoxelView-32) described here, is on a MASSCOMP computer running UNIX. Data were collected with General Electric or Siemens CT scanners and transferred to the MASSCOMP for off-line 3-D recon-struction, via magnetic tape or Ethernet. An interactive graphics facility on the MASSCOMP allows viewing of 2-D slices, subregioning, and selection of lower and upper density thresholds for segmentation. The software then enters a pre-processing phase during which a volume representation of the segmented object (soft tissue or bone) is automatically created. This is followed by a rendering phase during which multiple views of the segmented object are automatically generated. The pre-processing phase typically takes 4 to 8 minutes (although very large datasets may require as much as 30 minutes) and the rendering phase typically takes 1 to 2 minutes for each 3-D view. Volume representation and rendering techniques are used at all stages of the processing, and gradient shading is used for enhanced surface detail.

  4. Initial clinical experience using a novel laparoscopy assistant.

    PubMed

    Mishra, Raineesh; Martínez, Arturo Minor; Lorias Espinoza, Daniel

    2011-05-01

    This article presents the first clinical and experimental experiences of the PMASS (Postural Mechatronic Assistance Solo Surgery) from a prospective study carried on on thirteen laparoscopic procedures. Also, their advantages and disadvantages are identified. The PMASS is a system with three articulations; two articulations are passive and one is active; this handles the optic in real time, reducing the latency time by spatial relocation. The surgeons assisted themselves visually in 13 surgical procedures, having direct and intuitive control in real time of the laparoscopic vision field using the PMASS. The surgical and delay time was documented for each surgery. The surgical procedures were: Laparoscopic appendicectomy, ovarian cystectomy and laparoscopic sterilization. In all procedures, surgeons were able to auto-navigate in real time and there was no visual tremor while using the system. The global average times taken to perform the self-assisted surgery with the PMASS for the laparoscopic appendicectomies were 45 ± 4.5 minutes, ovarian cystectomies 49 ± 3.5 minutes and for the laparoscopic sterilization 22 ± 2 minutes. The approximate set-up time of PMASS was one minute, and removal almost a minute (the time required by the surgeon to remove the harness after completing the surgery). The laparoscope itself disengages from the PMASS in a couple of seconds approximately. There were no transoperative or postoperative complications during the procedures. Thirteen laparoscopic procedures were performed, the design of the mechatronic assistance allowed the surgeon to self-assist visually in real time and in an autonomous way in the solo-surgery mode, without compromising the surgical performance and the morbidity. Additionally, the latency times are also reduced by space relocation and coupling of the telescope. PMID:21105849

  5. Low LET protons focused to submicrometer shows enhanced radiobiological effectiveness

    NASA Astrophysics Data System (ADS)

    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

    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.

  6. Low LET protons focused to submicrometer shows enhanced radiobiological effectiveness.

    PubMed

    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

    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

  7. Clinical governance development: learning from the New Zealand experience.

    PubMed

    Gauld, Robin

    2014-01-01

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

  8. Tritium radiobiology research in the US DOE program

    SciTech Connect

    Carsten, A.L.

    1986-01-01

    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.

  9. Issues for Simulation of Galactic Cosmic Ray Exposures for Radiobiological Research at Ground-Based Accelerators.

    PubMed

    Kim, Myung-Hee Y; Rusek, Adam; Cucinotta, Francis A

    2015-01-01

    For radiobiology research on the health risks of galactic cosmic rays (GCR) ground-based accelerators have been used with mono-energetic beams of single high charge, Z and energy, E (HZE) particles. In this paper, we consider the pros and cons of a GCR reference field at a particle accelerator. At the NASA Space Radiation Laboratory (NSRL), we have proposed a GCR simulator, which implements a new rapid switching mode and higher energy beam extraction to 1.5 GeV/u, in order to integrate multiple ions into a single simulation within hours or longer for chronic exposures. After considering the GCR environment and energy limitations of NSRL, we performed extensive simulation studies using the stochastic transport code, GERMcode (GCR Event Risk Model) to define a GCR reference field using 9 HZE particle beam-energy combinations each with a unique absorber thickness to provide fragmentation and 10 or more energies of proton and (4)He beams. The reference field is shown to well represent the charge dependence of GCR dose in several energy bins behind shielding compared to a simulated GCR environment. However, a more significant challenge for space radiobiology research is to consider chronic GCR exposure of up to 3 years in relation to simulations with animal models of human risks. We discuss issues in approaches to map important biological time scales in experimental models using ground-based simulation, with extended exposure of up to a few weeks using chronic or fractionation exposures. A kinetics model of HZE particle hit probabilities suggests that experimental simulations of several weeks will be needed to avoid high fluence rate artifacts, which places limitations on the experiments to be performed. Ultimately risk estimates are limited by theoretical understanding, and focus on improving knowledge of mechanisms and development of experimental models to improve this understanding should remain the highest priority for space radiobiology research. PMID:26090339

  10. Issues for Simulation of Galactic Cosmic Ray Exposures for Radiobiological Research at Ground-Based Accelerators

    PubMed Central

    Kim, Myung-Hee Y.; Rusek, Adam; Cucinotta, Francis A.

    2015-01-01

    For radiobiology research on the health risks of galactic cosmic rays (GCR) ground-based accelerators have been used with mono-energetic beams of single high charge, Z and energy, E (HZE) particles. In this paper, we consider the pros and cons of a GCR reference field at a particle accelerator. At the NASA Space Radiation Laboratory (NSRL), we have proposed a GCR simulator, which implements a new rapid switching mode and higher energy beam extraction to 1.5 GeV/u, in order to integrate multiple ions into a single simulation within hours or longer for chronic exposures. After considering the GCR environment and energy limitations of NSRL, we performed extensive simulation studies using the stochastic transport code, GERMcode (GCR Event Risk Model) to define a GCR reference field using 9 HZE particle beam–energy combinations each with a unique absorber thickness to provide fragmentation and 10 or more energies of proton and 4He beams. The reference field is shown to well represent the charge dependence of GCR dose in several energy bins behind shielding compared to a simulated GCR environment. However, a more significant challenge for space radiobiology research is to consider chronic GCR exposure of up to 3 years in relation to simulations with animal models of human risks. We discuss issues in approaches to map important biological time scales in experimental models using ground-based simulation, with extended exposure of up to a few weeks using chronic or fractionation exposures. A kinetics model of HZE particle hit probabilities suggests that experimental simulations of several weeks will be needed to avoid high fluence rate artifacts, which places limitations on the experiments to be performed. Ultimately risk estimates are limited by theoretical understanding, and focus on improving knowledge of mechanisms and development of experimental models to improve this understanding should remain the highest priority for space radiobiology research. PMID:26090339

  11. A new research program for ground-based space radiobiology in Europe

    NASA Astrophysics Data System (ADS)

    Durante, M.; Kraft, G.; O'Neill, P.; Reitz, G.; Sabatier, L.; Schneider, U.

    Space radiation has been long acknowledged as a potential showstopper for long duration manned interplanetary missions Our knowledge of biological effects of cosmic radiation in deep space is almost exclusively derived from ground-based accelerator experiments with heavy ions in animal or in vitro models In an effort to gain more information on space radiation risk and to develop countermeasures NASA started several years ago a Space Radiation Health Program which is currently supporting biological experiments performed at the Brookhaven National Laboratory Upton NY Accelerator-based radiobiology research in the field of space radiation research is also under way in Russia and Japan The European Space Agency ESA has recently established an ambitious exploration program AURORA and within this program it has been decided to start a space radiation research program Europe has a wide tradition in radiobiology research at accelerators generally focussing on charged-particle cancer therapy This expertise can be adapted to address the issue of space radiation risk To support research in this field in Europe ESA issued in 2005 a call for tender for a preliminary study of investigations on biological effects of space radiation IBER This study will prepare future ESA supported-activities in space radiation research by selecting the best European accelerator facilities to be targeted for cooperation and by drafting a roadmap for future research activities The roadmap will include a prioritisation of research topics and a detailed proposal

  12. Preparatory study of a ground-based space radiobiology program in Europe

    NASA Astrophysics Data System (ADS)

    Durante, M.; Kraft, G.; O'Neill, P.; Reitz, G.; Sabatier, L.; Schneider, U.

    Space radiation has long been acknowledged as a potential showstopper for long duration manned interplanetary missions. Our knowledge of biological effects of cosmic radiation in deep space is almost exclusively derived from ground-based accelerator experiments with heavy ions in animal or in vitro models. In an effort to gain more information on space radiation risk and to develop countermeasures, NASA initiated several years ago a Space Radiation Health Program, which is currently supporting biological experiments performed at the Brookhaven National Laboratory. Accelerator-based radiobiology research in the field of space radiation research is also under way in Russia and Japan. The European Space Agency (ESA) has recently established an ambitious exploration program (AURORA), and within this program it has been decided to include a space radiation research program. Europe has a long tradition in radiobiology research at accelerators, generally focussing on charged-particle cancer therapy. This expertise can be adapted to address the issue of space radiation risk. To support research in this field in Europe, ESA issued a call for tender in 2005 for a preliminary study of investigations on biological effects of space radiation (IBER). This study will provide guidance on future ESA-supported activities in space radiation research by identifying the most appropriate European accelerator facilities to be targeted for cooperation, and by drafting a roadmap for future research activities. The roadmap will include a prioritisation of research topics, and a detailed proposal for experimental campaigns for the following 5 10 years.

  13. A dedicated undergraduate gynaecology teaching clinic: The Keele experience.

    PubMed

    Katali, Hamza Mahamadu; Parry-Smith, William Rhys; Eliot, Rees L; O'Mahony, Fidelma

    2016-02-01

    Much discussion in the literature centres on how best to teach medical students the intricacies of gynaecological assessment and the subsequent formulation of a management plan. At Keele University skills are initially developed in a simulated setting and then transferred to the workplace where students continue to develop their skills. A dedicated undergraduate gynaecology teaching clinic has been developed and comprises of 2-3 students and a tutor. All 38 students rotating through the department between January and June 2013 were invited to complete an anonymous questionnaire to evaluate this clinic and 36 (95%) of them responded. Respondents felt significantly more comfortable taking a gynaecology history, ensuring privacy during examination and formulating a management plan post-clinic (all p < 0.001), with female students feeling significantly more comfortable than their male counterparts (p = 0.04). The use of this clinic shows great promise to help students learn an unfamiliar and challenging skill. PMID:26492580

  14. Preclinical and clinical experience with a viscoelastic total disc replacement

    PubMed Central

    Rischke, Burkhard; Ross, Raymond S.; Jollenbeck, Boris A.; Zimmers, Kari B.; Defibaugh, Neal D.

    2011-01-01

    Background The purpose of this study is to describe the mechanical durability and the clinical and radiographic outcomes of a viscoelastic total disc replacement (VTDR). The human intervertebral disc is a complex, viscoelastic structure, permitting and constraining motion in 3 axes, thus providing stability. The ideal disc replacement should be viscoelastic and deformable in all directions, and it should restore disc height and angle. Methods Mechanical testing was conducted to validate the durability of the VTDR, and a clinical study was conducted to evaluate safety and performance. Fifty patients with single-level, symptomatic lumbar degenerative disc disease at L4-5 or L5-S1 were enrolled in a clinical trial at 3 European sites. Patients were assessed clinically and radiographically for 2 years by the Oswestry Disability Index (ODI), a visual analog scale (VAS), and independent radiographic analyses. Results The VTDR showed a fatigue life in excess of 50 million cycles (50-year equivalent) and a physiologically appropriate level of stiffness, motion, geometry, and viscoelasticity. We enrolled 28 men and 22 women in the clinical study, with a mean age of 40 years. Independent quantitative radiographic assessment indicated that the VTDR restored and maintained disc height and lordosis while providing physiologic motion. Mean ODI scores decreased from 48% preoperatively to 23% at 2 years’ follow-up. Mean VAS low-back pain scores decreased from 7.1 cm to 2.9 cm. Median scores indicated that half of the patient population had ODI scores below 10% and VAS low-back pain scores below 0.95 cm at 2 years. Conclusions The VTDR has excellent durability and performs clinically and radiographically as intended for the treatment of symptomatic lumbar degenerative disc disease. Clinical Relevance The VTDR is intended to restore healthy anatomic properties and stability characteristics to the spinal segment. This study is the first to evaluate a VTDR in a 50-patient, multicenter European study. PMID:25802675

  15. Clinical interdisciplinary health team care: an educational experiment.

    PubMed

    Mazur, H; Beeston, J J; Yerxa, E J

    1979-09-01

    With increasing concern for teamwork in clinical practice in health care settings, the need to identify the concepts, methods, and learning processes for improving interdisciplinary team skills is apparent. This paper describes patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting. The teams were involved in the theory and practice of team-building, including weekly sessions on leadership styles, communication, group decision-making, and team effectiveness assessment. Objective and subjective measurements were administered throughout the program. The results indicate that task-oriented patient care favors the learning of team skills, especially when all levels of administration support and participate in the processes. Question are raised concerning the effect of clinical teams on the quality of patient care, their cost-effectiveness, and the low priority given to teaching interdisciplinary team skills in professional education. PMID:158089

  16. How to Conduct Clinical Qualitative Research on the Patient's Experience

    ERIC Educational Resources Information Center

    Chenail, Ronald J.

    2011-01-01

    From a perspective of patient-centered healthcare, exploring patients' (a) preconceptions, (b) treatment experiences, (c) quality of life, (d) satisfaction, (e) illness understandings, and (f) design are all critical components in improving primary health care and research. Utilizing qualitative approaches to discover patients' experiences can…

  17. Clinical Experience of the Klippel-Trenaunay Syndrome

    PubMed Central

    Sung, Hyung Min; Lee, Seok Jong; Lee, Jong Min; Huh, Seung; Lee, Jeong Woo; Choi, Kang Young; Yang, Jung Dug; Cho, Byung Chae

    2015-01-01

    Background The Klippel-Trenaunay syndrome (KTS) is characterized by three clinical features, namely cutaneous capillary malformations, venous malformations, and soft tissue and/or bony hypertrophy of the extremities. The varied manifestations are attributed to the unpredictable clinical nature and prognosis of the syndrome. To elucidate the clinical characteristics of this disease, we reviewed a relatively large number of KTS patients who presented to our vascular anomalies center. Methods We conducted a retrospective study with 19 patients who were diagnosed with KTS and treated in our vascular anomalies clinic between 2003 and 2014, and examined their demographic characteristics, their clinical features, and the treatments administered. Results The sex distribution was balanced, with 9 (47%) males and 10 (53%) females. The mean follow-up period was 4.1 years (range, 7 months-9 years). Most of the patients received conservative treatments such as medication or physiotherapy. Compression therapies such as wearing of elastic garments/bandages were also administered, and surgical interventions were considered only when the patients became excessively symptomatic. Other treatments included laser therapy and sclerotherapy, and all the treatments were adjusted according to each case, tailored to the conditions of the individual patients. Conclusions KTS is an extremely rare, multifactorial disorder that induces widely varied symptoms. Because of this unique feature, plastic surgeons, when not careful, tend to attach a one-sided importance to typical symptoms such as limb hypertrophy or capillary malformation and thus overlook other symptoms and clinical features. KTS can be suspected in all infants who show capillary malformations or limb hypertrophy and require a multi-disciplinary approach for comprehensive management. PMID:26430625

  18. Our Experience in a Psychodermatology Liaison Clinic at Manipal, India

    PubMed Central

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

    2013-01-01

    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

  19. Review of clinical and laboratory experiences with molindone hydrochloride.

    PubMed

    Claghorn, J L

    1985-08-01

    The literature concerning the pharmacokinetics, pharmacodynamics, receptor physiology, and clinical use of molindone is reviewed. Unanswered questions about the drug are addressed. Although molindone is reputed to have a short half-life (1.5 hours), clinical observations report a prolonged effect from a once-daily dose. Early in treatment, some patients show intolerance due to akathisia or extrapyramidal symptoms. This may be withdrawal dyskinesia due to discontinuation of another drug or an early adverse effect of molindone. Different effects on dopamine receptors have been described, but the significance of these properties for the development of tardive dyskinesia remains unclear. PMID:3894340

  20. Necrotizing Craniocervical Soft Tissue Infections: Clinical Experience and Personal Considerations

    PubMed Central

    Lenzi, Riccardo; Castelnuovo, Paolo; Dallan, Iacopo

    2012-01-01

    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. PMID:23304596

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

    SciTech Connect

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

    2011-09-06

    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.

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

    PubMed Central

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

    2013-01-01

    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. PMID:22004930

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

    ERIC Educational Resources Information Center

    Duxbury, Mark

    2004-01-01

    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…

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

    ERIC Educational Resources Information Center

    Baecher, Laura

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Baecher, Laura

    2012-01-01

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

  6. Evaluating Perceptions of Culminating Clinical Education Experiences of Senior Athletic Training Students

    ERIC Educational Resources Information Center

    Aronson, Patricia A.; Bowman, Thomas G.; Mazerolle, Stephanie M.

    2015-01-01

    Context: The perceptions of athletic training students (ATSs) regarding their clinical education experiences are not fully understood. It is important to investigate ATS perceptions of clinical education to allow athletic training educators to provide educational experiences that will maximize learning. Objective: To determine what ATSs value…

  7. Assessment of radiobiological metrics applied to patient-specific QA process of VMAT prostate treatments.

    PubMed

    Clemente-Gutiérrez, Francisco; Pérez-Vara, Consuelo; Clavo-Herranz, María H; López-Carrizosa, Concepción; Pérez-Regadera, José; Ibáñez-Villoslada, Carmen

    2016-01-01

    VMAT is a powerful technique to deliver hypofractionated prostate treatments. The lack of correlations between usual 2D pretreatment QA results and the clini-cal impact of possible mistakes has allowed the development of 3D verification systems. Dose determination on patient anatomy has provided clinical predictive capability to patient-specific QA process. Dose-volume metrics, as evaluation crite-ria, should be replaced or complemented by radiobiological indices. These metrics can be incorporated into individualized QA extracting the information for response parameters (gEUD, TCP, NTCP) from DVHs. The aim of this study is to assess the role of two 3D verification systems dealing with radiobiological metrics applied to a prostate VMAT QA program. Radiobiological calculations were performed for AAPM TG-166 test cases. Maximum differences were 9.3% for gEUD, -1.3% for TCP, and 5.3% for NTCP calculations. Gamma tests and DVH-based comparisons were carried out for both systems in order to assess their performance in 3D dose determination for prostate treatments (high-, intermediate-, and low-risk, as well as prostate bed patients). Mean gamma passing rates for all structures were bet-ter than 92.0% and 99.1% for both 2%/2 mm and 3%/3 mm criteria. Maximum discrepancies were (2.4% ± 0.8%) and (6.2% ± 1.3%) for targets and normal tis-sues, respectively. Values for gEUD, TCP, and NTCP were extracted from TPS and compared to the results obtained with the two systems. Three models were used for TCP calculations (Poisson, sigmoidal, and Niemierko) and two models for NTCP determinations (LKB and Niemierko). The maximum mean difference for gEUD calculations was (4.7% ± 1.3%); for TCP, the maximum discrepancy was (-2.4% ± 1.1%); and NTCP comparisons led to a maximum deviation of (1.5% ± 0.5%). The potential usefulness of biological metrics in patient-specific QA has been explored. Both systems have been successfully assessed as potential tools for evaluating the clinical outcome of a radiotherapy treatment in the scope of pretreatment QA. PMID:27074458

  8. The Clinical/Practicum Experience in Professional Preparation: Preliminary Findings

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  9. Mechanisms of electrode induced injury. Part 2: Clinical experience.

    PubMed

    Patterson, Terry; Stecker, Mark M; Netherton, Brett L

    2007-06-01

    In the previous paper in this series, basic mechanisms of electrode related injuries were discussed. In this paper, the discussion begins with some of the clinical aspects of burns. This is followed by a summary of the clinical literature on injuries produced by surface and subdermal electrodes. This clinical literature demonstrates that most electrode burns are related to the presence of high frequency electric fields (RF) created either by an electrosurgical unit or a magnetic resonance imaging (MRI) scanner. A smaller number of lesions are produced by low current, long duration direct current (DC) stimulation and during high current stimulation such as defibrillation. A discussion of the clinical complications from indwelling intracranial electrodes centers on electrodes placed for deep brain stimulation (DBS) that are currently used therapeutically in a wide array of neurologic disorders. The probability of considering a post-implant MRI scan is high and the safety of such scans is the focus of discussion. A very small number of adverse incidents have indicated a downward revision in the specific absorption rate recommendations for MRI examination with those patients who present with indwelling DBS leads and internal pulse generators. Continued vigilance when any type of electrode is used is important. PMID:17679578

  10. Geriatric hip fracture clinical pathway: the Hong Kong experience

    PubMed Central

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

    2010-01-01

    Geriatric hip fracture is one of the commonest fractures in orthopaedic trauma. There is a trend of further increase in its incidence in the coming decades. Besides the development of techniques and implants to overcome the difficulties in fixation of osteoporosis bone, the general management of the hip fracture is also very challenging in terms of the preparation of the generally poorer pre-morbid state and complicate social problems associated with this group of patients. In order to cope with the increasing demand, our hospital started a geriatric hip fracture clinical pathway in 2007. The aim of this pathway is to provide better care for this group of patients through multidisciplinary approach. From year 2007 to 2009, we had managed 964 hip fracture patients. After the implementation of the pathway, the pre-operative and the total length of stay in acute hospital were shortened by over 5 days. Other clinical outcomes including surgical site infection, 30 days mortality and also incidence of pressure sore improved when compared to the data before the pathway. The rate of surgical site infection was 0.98%, and the 30 days mortality was 1.67% in 2009. The active participation of physiotherapists, occupational therapists as well as medical social workers also helped to formulate the discharge plan as early as the patient is admitted. In conclusion, a well-planned and executed clinical pathway for hip fracture can improve the clinical outcomes of the geriatric hip fractures. PMID:19543764

  11. The drug discovery by nanomedicine and its clinical experience.

    PubMed

    Matsumura, Yasuhiro

    2014-06-01

    It is expected that the incidence of various adverse effects of anticancer agents maybe decreased owing to the reduced drug distribution in normal tissue. Anticancer agent incorporating nanoparticles including micelles and liposomes can evade non-specific capture by the reticuloendothelial system because the outer shell of the nanoparticles is covered with polyethylene glycol. Consequently, the micellar and liposomal carrier can be delivered selectively to a tumor by utilizing the enhanced permeability and retention effect. Presently, several anticancer agent-incorporating nano-carrier systems are under preclinical and clinical evaluation. Several drug delivery system formulations have been approved worldwide. Regarding a pipeline of clinical development of anticancer agent incorporating micelle carrier system, several clinical trials are now underway not only in Japan but also in other countries. A Phase 3 trial of NK105, a paclitaxel incorporating micelle is now underway. In this paper, preclinical and clinical studies of NK105, NC-6004, cisplatin incorporating micelle, NC-6300, epirubicin incorporating micelle and the concept of cancer stromal targeting therapy using nanoparticles and monoclonal antibodies against cancer related stromal components are reviewed. PMID:24755547

  12. Differences in Clinical Experiences of ADN and BSN Students.

    ERIC Educational Resources Information Center

    Oermann, Marilyn H.

    1998-01-01

    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…

  13. Managing University Clinical Partnership: Learning from International Experience

    ERIC Educational Resources Information Center

    Davies, Stephen; Smith, Tom

    2004-01-01

    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…

  14. Manual Aspiration Thrombectomy in Acute Myocardial Infarction: A Clinical Experience.

    PubMed

    Jaiswal, Abhishek; Pollack, Simcha; Chichra, Astha; Moustakakis, Emmanuel; Park, Chong; Kerwin, Todd

    2016-03-01

    Multiple clinical studies have failed to establish the role of routine use of thrombectomy in ST-elevation myocardial infarction (STEMI) patients. There is a paucity of data on the impact of thrombectomy in unselected STEMI patients outside clinical trials. We sought to evaluate the clinical variables and outcomes associated with the performance of thrombectomy in STEMI patients. We retrospectively examined the clinical outcomes in all STEMI patients who underwent successful percutaneous intervention (PCI) at our center. Patients were divided into two groups, one with patients who underwent conventional PCI and another with patients who had thrombus aspiration in addition to conventional PCI. We compared the baseline clinical characteristics, laboratory investigations, re-infarction rates, and all-cause mortality. Total 477 consecutive STEMI patients were identified. Overall, 29% (139) of the patients underwent conventional PCI and 71% (338) of the patients were treated with aspiration thrombectomy and PCI. In addition to the presence of thrombus, patients with nonanterior infarction, and patients with hemodynamic instability requiring intra-aortic balloon pump support were more likely to undergo thrombectomy. Thrombectomy was associated with higher enzymatic infarction (creatine kinase: 2,796 [2,575] vs. 1,716 [1,662]; p < 0.0001; CK-MB: 210.6 [156.0] vs. 142.0 [121.9], p < 0.0001). However, thrombectomy was not associated with any difference in 30 day reinfarction rate (3.3 vs. 2.9%, p = 0.83), mortality (5.0 vs. 7.2%, p = 0.35), or composite of death and 30 day reinfarction (7.7 vs. 9.4%, p = 0.55). We observed that STEMI patients with anterior infarction and hemodynamic instability were more likely to undergo thrombectomy during primary PCI. PMID:26900308

  15. Improving biological relevancy of transcriptional biomarkers experiments by applying the MIQE guidelines to pre-clinical and clinical trials.

    PubMed

    Dooms, M; Chango, A; Barbour, E; Pouillart, P; Abdel Nour, A M

    2013-01-01

    The "Minimum Information for the Publication of qPCR Experiments" (MIQE [3]) guidelines are very much targeted at basic research experiments and have to our knowledge not been applied to qPCR assays carried out in the context of clinical trials. This report details the use of the MIQE qPCR app for iPhone (App Store, Apple) to assess the MIQE compliance of one clinical and five pre-clinical trials. This resulted in the need to include 14 modifications that make the guidelines more relevant for the assessment of this special type of application. We also discuss the need for flexibility, since while some parameters increase experimental quality, they also require more reagents and more time, which is not always feasible in a clinical setting. PMID:22910527

  16. [Clinical experience with imipenem-cilastatin in intensive therapy].

    PubMed

    Verre, M; D'Antona, R; Macrina, E

    1991-02-28

    The authors describe their experience with imipenem-cilastatin in 36 patients in critical conditions due to multiresistant bacterial infections. The efficacy and tolerability of the antibiotic are stressed. PMID:1827390

  17. Ultrashort Pulse Laser Accelerated Proton Beams for First Radiobiological Applications

    NASA Astrophysics Data System (ADS)

    Schramm, U.; Zeil, K.; Richter, C.; Beyreuther, E.; Bussmann, M.; Cowan, T. E.; Enghardt, W.; Karsch, L.; Kluge, T.; Kraft, S.; Laschinsky, L.; Metzkes, J.; Naumburger, D.; Pawelke, J.; Sauerbrey, R.

    2010-11-01

    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.

  18. Ultrashort Pulse Laser Accelerated Proton Beams for First Radiobiological Applications

    SciTech Connect

    Schramm, U.; Zeil, K.; Beyreuther, E.; Bussmann, M.; Cowan, T. E.; Kluge, T.; Kraft, S.; Metzkes, J.; Sauerbrey, R.; Richter, C.; Enghardt, W.; Pawelke, J.; Karsch, L.; Laschinsky, L.; Naumburger, D.

    2010-11-04

    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.

  19. Clinical and experimental experiences of graft-induced dyskinesia.

    PubMed

    Lane, Emma L

    2011-01-01

    Clinical trials evaluating transplantation of fetal tissue for the treatment of Parkinson's disease identified the unexpected side effect of abnormal movements in the 'off'l-DOPA state. Termed graft-induced dyskinesia (GID), various hypotheses have been put forward as to their cause but unfortunately the significant differences in clinical trial protocols and lack of a truly representative animal model has hindered the search for a conclusive basis for their appearance. Likely causative factors have been identified through careful examination of patient data and the use of amphetamine-induced dyskinesia in a rodent model of Parkinson's disease. New trials being planned in Europe hope to avoid GID, whilst maximizing on the functional benefit that can be afforded by this treatment approach but questions still remain as to the underlying mechanism. PMID:21907087

  20. Experience of targeted Usher exome sequencing as a clinical test

    PubMed Central

    Besnard, Thomas; García-García, Gema; Baux, David; Vaché, Christel; Faugère, Valérie; Larrieu, Lise; Léonard, Susana; Millan, Jose M; Malcolm, Sue; Claustres, Mireille; Roux, Anne-Françoise

    2014-01-01

    We show that massively parallel targeted sequencing of 19 genes provides a new and reliable strategy for molecular diagnosis of Usher syndrome (USH) and nonsyndromic deafness, particularly appropriate for these disorders characterized by a high clinical and genetic heterogeneity and a complex structure of several of the genes involved. A series of 71 patients including Usher patients previously screened by Sanger sequencing plus newly referred patients was studied. Ninety-eight percent of the variants previously identified by Sanger sequencing were found by next-generation sequencing (NGS). NGS proved to be efficient as it offers analysis of all relevant genes which is laborious to reach with Sanger sequencing. Among the 13 newly referred Usher patients, both mutations in the same gene were identified in 77% of cases (10 patients) and one candidate pathogenic variant in two additional patients. This work can be considered as pilot for implementing NGS for genetically heterogeneous diseases in clinical service. PMID:24498627

  1. Rapid extraction of DNA from archival clinical specimens: our experiences.

    PubMed

    Poljak, M; Seme, K; Gale, N

    2000-01-01

    The analysis of DNA extracted from archival clinical specimens using polymerase chain reaction represents the basis of a variety of research and diagnostic protocols in medicine. However, the selection of optimal DNA extraction method is critical if such an analysis is to be successful. Recently, we have evaluated a number of rapid DNA extraction protocols in order to find the most suitable method for routine processing of the most common archival materials in pathological and cytological laboratories: paraffin-embedded tissues and Papanicolaou- or Giemsa-stained smears. Our results demonstrate that rapid DNA extraction methods have comparable DNA extraction efficiencies with standard DNA isolation protocols on archival clinical specimens with the exception of Giemsa-stained smears. PMID:10653137

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

    NASA Astrophysics Data System (ADS)

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

    2007-07-01

    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.

  3. Radiobiological risk and single event effects during manned space flights.

    PubMed

    Bourrieau, J; Calvet, M C

    1995-01-01

    Radiation hazard during previous manned space flights was not a critical problem as seen from monitoring on board MIR and the SHUTTLE. Future Martian and Lunar missions as well as flights on inclined or high altitude orbits around the Earth can be exposed to a large radiobiological risk and critical reliability losses can be expected, due to Single Event Effects on VLSI devices. The main characteristics of these hazards and some counter-measures to be provided for are given. PMID:11540985

  4. Dosimetry for radiobiological studies of the human hematopoietic system

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

  5. Initial experience with a rapid access blackouts triage clinic.

    PubMed

    Petkar, S; Bell, W; Rice, N; Iddon, P; Cooper, P; McKee, D; Curtis, N; Hanley, M; Stuart, J; Mackway Jones, K; Fitzpatrick, A P

    2011-02-01

    Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. The majority of patients had syncope, and very few had epilepsy. A high proportion had an abnormal ECG. A specialist-nurse-led rapid access blackouts triage clinic (RABTC) provided rapid effective triage for risk, a comprehensive assessment format, direct treatment for many patients, and otherwise a prompt appropriate onward referral. Rapid assessment through a RABTC reduced re-admissions with blackouts. Widespread use of the web-based blackouts tool could provide the NHS with a performance map. The U.K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate. PMID:21404775

  6. Laboratory and clinical experience with neodymium:YAG laser prostatectomy

    NASA Astrophysics Data System (ADS)

    Kabalin, John N.

    1996-05-01

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

  7. New challenges in high-energy particle radiobiology.

    PubMed

    Durante, M

    2014-03-01

    Densely ionizing radiation has always been a main topic in radiobiology. In fact, ?-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space. PMID:24198199

  8. (Radio)Biological Optimization of External-Beam Radiotherapy

    PubMed Central

    Nahum, Alan E.; Uzan, Julien

    2012-01-01

    “Biological optimization” (BIOP) means planning treatments using (radio)biological criteria and models, that is, tumour control probability and normal-tissue complication probability. Four different levels of BIOP are identified: Level I is “isotoxic” individualization of prescription dose Dpresc at fixed fraction number. Dpresc is varied to keep the NTCP of the organ at risk constant. Significant improvements in local control are expected for non-small-cell lung tumours. Level II involves the determination of an individualized isotoxic combination of Dpresc and fractionation scheme. This approach is appropriate for “parallel” OARs (lung, parotids). Examples are given using our BioSuite software. Hypofractionated SABR for early-stage NSCLC is effectively Level-II BIOP. Level-III BIOP uses radiobiological functions as part of the inverse planning of IMRT, for example, maximizing TCP whilst not exceeding a given NTCP. This results in non-uniform target doses. The NTCP model parameters (reflecting tissue “architecture”) drive the optimizer to emphasize different regions of the DVH, for example, penalising high doses for quasi-serial OARs such as rectum. Level-IV BIOP adds functional imaging information, for example, hypoxia or clonogen location, to Level III; examples are given of our prostate “dose painting” protocol, BioProp. The limitations of and uncertainties inherent in the radiobiological models are emphasized. PMID:23251227

  9. New challenges in high-energy particle radiobiology

    PubMed Central

    2014-01-01

    Densely ionizing radiation has always been a main topic in radiobiology. In fact, α-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space. PMID:24198199

  10. Quantitative modeling of chronic myeloid leukemia: insights from radiobiology.

    PubMed

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

    2012-05-10

    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

  11. Students' Experiences of Learning Manual Clinical Skills through Simulation

    ERIC Educational Resources Information Center

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

    2013-01-01

    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

  12. Co-Learning: Maximizing Learning in Clinical Experiences

    ERIC Educational Resources Information Center

    Merk, Hillary; Waggoner, Jacqueline; Carroll, James

    2013-01-01

    Researchers and teacher educators have given increased attention to co-teaching during the student teaching experience. Co-teaching facilitates an apprenticeship arrangement that encourages modeling of classroom practice for the candidate and a chance to implement directly what is being learned by the apprentice. The co-teaching model can be…

  13. Students' Experiences of Learning Manual Clinical Skills through Simulation

    ERIC Educational Resources Information Center

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

    2013-01-01

    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…

  14. Support for Clinical Experiences in Educational Administration Preparation Programs.

    ERIC Educational Resources Information Center

    Achilles, C. M.

    School administration is an applied field requiring synthesis of ideas from diverse sources and application of these ideas in skillful practice. Administrator preparation programs must include opportunities for new administrators to practice their craft in nonthreatening environments and share experiences with peers while being supervised by

  15. Perampanel for focal epilepsy: insights from early clinical experience.

    PubMed

    Trinka, E; Steinhoff, B J; Nikanorova, M; Brodie, M J

    2016-03-01

    Perampanel is approved for adjunctive therapy of focal epilepsy with or without secondarily generalized seizures in patients aged >12 years. This narrative review uses real-world and clinical trial data to elucidate perampanel's role in the clinic. Audit data show good tolerability with perampanel and higher freedom-from-seizure rates in elderly vs younger patients. When using perampanel in elderly patients, special attention should be given to comorbidities and co-medication to avoid potential interactions or adverse events. Slower titration is generally recommended, and seizure control should be reassessed at a dose of 4 mg before further dose increases. Perampanel efficacy is similar in adolescents and adults; however, somnolence, nasopharyngitis, and aggression are more frequent in adolescents vs the overall population. Individualized and slow-dose titration can minimize adverse events. Low serum concentrations of perampanel may occur in patients also receiving some enzyme-inducing anti-epileptic drugs; a perampanel dose increase may be required. Adverse events of importance with perampanel include dizziness; anger, aggression, and hostile behavior (particularly in adolescents); and falls (particularly in patients >65 years). An individualized approach to dosing, including slower up-titration and bedtime dosing, reduces dizziness risk. Other drugs may cause or aggravate dizziness; reducing concomitant drugs may be necessary when up-titrating perampanel. It would seem clinically appropriate to give due consideration to avoiding use in patients with a history of anger or hostile/aggressive behavior. The possibility of such behaviors should be discussed with patients before starting perampanel, with monitoring during up-titration. Slower up-titration of perampanel in older patients helps reduce fall risk. PMID:26506904

  16. Lesch-Nyhan disease: clinical experience with nineteen patients.

    PubMed

    Christie, R; Bay, C; Kaufman, I A; Bakay, B; Borden, M; Nyhan, W L

    1982-06-01

    The clinical phenotype in Lesch-Nyhan disease has been analyzed in 19 patients studied in hospital. In each case the diagnosis was made on the basis of inactivity of the enzyme hypoxanthine guanine phosphoribosyltransferase in erythrocyte lysates. All had hyperuricemia, and the presence of 'orange sand' in the diaper was a prominent early complaint. All had self-mutilative behavior, of which the most characteristic form was biting the fingers or lips. All had the neurological syndrome of spasticity and choreoathetoid involuntary movements. All but one had less-than-normal intelligence. PMID:7095300

  17. The osmotic tissue expander: a three-year clinical experience.

    PubMed

    Obdeijn, Miryam C; Nicolai, Jean-Philippe A; Werker, Paul M N

    2009-09-01

    Closure of defects after trauma or excision of neoplasms is a basic skill in plastic surgery. Local, regional and distant flaps lead to additional scars. Skin recruitment by serial excision or skin expansion is a less damaging option for defects that must be closed. Advantages of tissue expansion include good colour and texture match. Disadvantages are the need for a second operation, use of an implant with the attendant risk of infection, time needed for inflation of the device, repeat visits to the clinic, and punctures to inflate the expander. To overcome the last disadvantage, an osmotic expander was developed in Germany in 1999 by OSMED GmbH (Ilmenau). PMID:18755643

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

    SciTech Connect

    Butler, Wayne M.; Stewart, Renee R.; Merrick, Gregory S.

    2009-03-15

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

  19. Caring touch - patients' experiences in an anthroposophic clinical context.

    PubMed

    Ozolins, Lise-Lotte; Hörberg, Ulrica; Dahlberg, Karin

    2015-12-01

    This study describes the phenomenon of caring touch from the patients' perspective in an anthroposophic clinical context where caring touch is often used to promote health and alleviate suffering. The aim of the study was to explore and phenomenologically describe the phenomenon of caring touch from the patients' perspectives. The study has been carried out with a Reflective Lifeworld Research approach in order to understand and describe human existential phenomena. Ten female patients were interviewed in an anthroposophic clinic in Sweden. The findings show how caring touch has multifaceted meanings and makes the patients' feel present and anchored in a meaningful context. The patients' feel that they are seen, accepted and confirmed. Furthermore, touch creates a caring space where the patients become receptive for care and has the power to alleviate the patients' suffering, as well as to frighten and cause or worsen the suffering. In order to take advantage of the caring potential, the patient needs to be invited to a respectful and sensitive form of touch. An interpersonal flexible space is necessary where the touch can be effective, and where a dynamic interplay can develop. In conclusion, caring touch is an opportunity for carers to support well-being and health. The carers need to approach their patients in both a sensitive and reflective way. A caring science perspective can serve as a help to further understand touch as a unique caring act. PMID:26178972

  20. Clinical experiences in fungal keratitis caused by Acremonium

    PubMed Central

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

    2014-01-01

    Purpose To report the predisposing risk factors, clinical presentation, management, and therapeutic outcomes of fungal keratitis caused by Acremonium. Methods This is a retrospective study of cases with Acremonium fungal keratitis that presented to our tertiary referral center between January 2006 and August 2012. Patient demographic and clinical details were determined and reported. Results Five cases of fungal keratitis from Acremonium species were identified in five patients (three males, two females). The mean age of the patients was of 73.4±5.46 years, with a mean follow-up time of 124±72 days. All patients had a history of corneal trauma with vegetable matter. Four cases were unresponsive to initial treatment (0.2% fluconazole, 0.15% amphotericin B) and required topical 5% natamycin, and, in two out of five cases, topical 1% voriconazole. Conclusion The most common risk factors for Acremonium fungal keratitis was ocular trauma. When a corneal lesion is found to be unresponsive to the initial treatment, we should consider adding or substituting topical natamycin or voriconazole for treatment. PMID:24492439

  1. Gay men's experiences of surrogacy clinics in India.

    PubMed

    Riggs, Damien W; Due, Clemence; Power, Jennifer

    2015-01-01

    While growing numbers of Australian gay men are entering into 'offshore' surrogacy arrangements in order to become parents, little empirical research has been conducted with this population. This article reports on a qualitative analysis of interviews with 12 gay men who had entered into surrogacy arrangements in India. The findings outline both positive and negative experiences in terms of support pre-conception, during the birth and post-birth. Changes to legislation in India mean that gay men can no longer access surrogacy services there, but it is important to understand the experiences of men who had previously accessed those services. The article concludes by highlighting aspects of the data that demonstrate the particular experiences of gay men who undertake offshore surrogacy arrangements, especially with regard to their need for support and involvement in all aspects of the process. A more thoroughly developed network of care may help to facilitate such support and this may further increase the positive outcomes reported by gay men who form families through surrogacy arrangements. PMID:25351689

  2. SU-E-T-399: Determination of the Radiobiological Parameters That Describe the Dose-Response Relations of Xerostomia and Disgeusia From Head and Neck Radiotherapy

    SciTech Connect

    Mavroidis, P; Stathakis, S; Papanikolaou, N; Peixoto Xavier, C; Costa Ferreira, B; Khouri, L; Carmo Lopes, M do

    2014-06-01

    Purpose: To estimate the radiobiological parameters that describe the doseresponse relations of xerostomia and disgeusia from head and neck cancer radiotherapy. To identify the organs that are best correlated with the manifestation of those clinical endpoints. Finally, to evaluate the goodnessof- fit by comparing the model predictions against the actual clinical results. Methods: In this study, 349 head and neck cancer patients were included. For each patient the dose volume histograms (DVH) of parotids (separate and combined), mandible, submandibular glands (separate and combined) and salivary glands were calculated. The follow-up of those patients was recorded at different times after the completion of the treatment (7 weeks, 3, 7, 12, 18 and 24 months). Acute and late xerostomia and acute disgeusia were the clinical endpoints examined. A maximum likelihood fitting was performed to calculate the best estimates of the parameters used by the relative seriality model. The statistical methods of the error distribution, the receiver operating characteristic (ROC) curve, the Pearson's test and the Akaike's information criterion were utilized to assess the goodness-of-fit and the agreement between the pattern of the radiobiological predictions with that of the clinical records. Results: The estimated values of the radiobiological parameters of salivary glands are D50 = 25.2 Gy, γ = 0.52, s = 0.001. The statistical analysis confirmed the clinical validity of those parameters (area under the ROC curve = 0.65 and AIC = 38.3). Conclusion: The analysis proved that the treatment outcome pattern of the patient material can be reproduced by the relative seriality model and the estimated radiobiological parameters. Salivary glands were found to have strong volume dependence (low relative seriality). Diminishing the biologically effective uniform dose to salivary glands below 30 Gy may significantly reduce the risk of complications to the patients irradiated for prostate cancer.

  3. Clinical experience with the noninvasive ICP monitoring system.

    PubMed

    Zhao, Y L; Zhou, J Y; Zhu, G H

    2005-01-01

    The Noninvasive ICP (Intracranial Pressure) Monitoring System NIP-200/210 has been used in several hospitals with more than 2000 patients since March 2002. It is based on the N2 wave response to flash visual evoked potentials (FVEP). According to our data, the mean latency period for the FVEP-induced N2 wave in healthy controls was 126.61 +/- 14.64 ms, in which that of females was shorter than that of males (123.95 +/- 10.345 ms vs. 130.75 +/- 14.632 ms; p < 0.05). There was no significant difference between the left or right side response (126.71 +/- 14.91 ms vs. 124.468 +/- 15.043 ms, p > 0.05). No significant difference in latency was found across age groups in our patient pool. In general, the N2 wave was stable and easily identified in most of the patients or healthy controls. When the data obtained with the NIP-200/210 Noninvasive ICP Monitoring System was compared with that from invasive techniques, the results were quite consistent (correlation index 0.651-0.97, standard error 8-15%). From our clinical trial results, we conclude that the latency periods for the FVEP-induced N2 wave reflected ICP values. However this technique is not suitable in patients with bifrontal hematoma, retinal concussion, or contusion of the optical nerve, because an FVEP value cannot be measured accurately in these cases. In our clinical trials, we used the FVEP technique to determine the effectiveness of mannitol in decreasing the ICP. The data revealed that ICP values decreased significantly within 20 minutes after a mannitol injection, and reached a minimum level at 40 minutes. For a single bolus of mannitol, the duration of the ICP decrease ranged from 30-210 minutes. Elevated ICP is one of the most important clinical issues in neurosurgery and neurology. The present noninvasive technique is safe and easy to perform, with a minimal risk of complications. PMID:16463880

  4. Impact of Simulation and Clinical Experience on Self-efficacy in Nursing Students: Intervention Study.

    PubMed

    Kimhi, Einat; Reishtein, Judith L; Cohen, Miri; Friger, Michael; Hurvitz, Nancy; Avraham, Rinat

    2016-01-01

    This study compared the effect of simulation and clinical experience timing on self-confidence/self-efficacy for the nursing process. Using a randomized, double-crossover design, self-efficacy was measured 3 times. Although self-efficacy was significantly higher at time 1 for students who had clinical experience, there was no difference between the groups at the end of the course (time 2). Thus, simulation increased self-confidence/self-efficacy equivalently if placed either before or after clinical experience. PMID:26218009

  5. Expertise in Clinical Psychology. The Effects of University Training and Practical Experience on Expertise in Clinical Psychology

    PubMed Central

    Vollmer, Sabine; Spada, Hans; Caspar, Franz; Burri, Salome

    2013-01-01

    How do university training and subsequent practical experience affect expertise in clinical psychology? To answer this question we developed methods to assess psychological knowledge and the competence to diagnose, construct case conceptualizations, and plan psychotherapeutic treatment: a knowledge test and short case studies in a first study, and a complex, dynamically evolving case study in the second study. In our cross-sectional studies, psychology students, trainees in a certified postgraduate psychotherapist curriculum, and behavior therapists with more than 10 years of experience were tested (100 in total: 20 each of novice, intermediate, and advanced university students, postgraduate trainees, and therapists). Clinical knowledge and competence increased up to the level of trainees but unexpectedly decreased at the level of experienced therapists. We discuss the results against the background of expertise research and the training of clinical psychologists (in Germany). Important factors for the continuing professional development of psychotherapists are proposed. PMID:23543213

  6. Clinical events in mad honey poisoning: a single centre experience.

    PubMed

    Bostan, Mehmet; Bostan, Habib; Kaya, Ali Osman; Bilir, Ozlem; Satiroglu, Omer; Kazdal, Hizir; Karadag, Zakir; Bozkurt, Engin

    2010-01-01

    The aim was to evaluate the clinical findings of patients who admitted to the hospital with the diagnosis of grayanotoxin/mad honey poisoning. Thirty-three patients were included in this study. Three patients were female (9%) and the others male (91%). Median age of patients was 52 (42-68). The most frequently observed findings were sinus bradycardia (91%), nausea-vomiting (81.8%), and dizziness (78.8%). Average heart rate was 55.35 +/- 6.72 beats/min. Mean systolic and diastolic blood pressures were 77.86 +/- 16.64 mmHg and 46.42 +/- 12.30 mmHg, respectively. Mad honey poisoning is an important problem that is life-threatening in the Black Sea region of Turkey. PMID:19937314

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

    PubMed Central

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

    1976-01-01

    A 10% soybean oil emulsion (Intralipid 10%), used extensively in Europe for intravenous alimentation, has now been clinically evaluated in the United States. Controlled studies have shown that the soybean oil emulsion can be substituted for glucose to supply one-third to two-thirds of the total calories, and can be administered peripherally without significant vein irritation. Essential fatty acid deficiencies, frequently encountered in patients dependent on parenteral alimentation with fat-free solutions, are prevented and corrected by use of this preparation. Data on long-term tolerance to Intralipid 10% infusions are presented for 292 patients treated for more than 6,000 patient days. The soybean oil emulsion was usually well tolerated. Side effects were reported in two of 133 adults and 12 of 159 pediatric patients. PMID:820291

  8. Clinical experience with aurora kinase inhibitors: a review.

    PubMed

    Boss, David S; Beijnen, Jos H; Schellens, Jan H M

    2009-08-01

    The aurora kinase family of serine/threonine kinases comprises three members, designated auroras A, B, and C. Auroras A and B are essential components of the mitotic pathway, ensuring proper chromosome assembly, formation of the mitotic spindle, and cytokinesis. The role of aurora C is less clear. Overexpression of aurora A and B has been observed in several tumor types, and has been linked with a poor prognosis of cancer patients. Several small molecules targeting aurora kinases A and B or both have been evaluated preclinically and in early phase I trials. In this review we aim to summarize the most recent advances in the development of aurora kinase inhibitors, with a focus on the clinical data. PMID:19684075

  9. An R package for simulation experiments evaluating clinical trial designs.

    PubMed

    Wang, Yuanyuan; Day, Roger

    2010-01-01

    This paper presents an open-source application for evaluating competing clinical trial (CT) designs using simulations. The S4 system of classes and methods is utilized. Using object-oriented programming provides extensibility through careful, clear interface specification; using R, an open-source widely-used statistical language, makes the application extendible by the people who design CTs: biostatisticians. Four key classes define the specifications of the population models, CT designs, outcome models and evaluation criteria. Five key methods define the interfaces for generating patient baseline characteristics, stopping rule, assigning treatment, generating patient outcomes and calculating the criteria. Documentation of their connections with the user input screens, with the central simulation loop, and with each other faciliates the extensibility. New subclasses and instances of existing classes meeting these interfaces can integrate immediately into the application. To illustrate the application, we evaluate the effect of patient pharmacokinetic heterogeneity on the performance of a common Phase I "3+3" design. PMID:21347151

  10. Japanese experience with clinical trails of fast neutrons

    SciTech Connect

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

    1982-12-01

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

  11. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience

    PubMed Central

    Kasargod, Vasunethra; Awad, Nilkanth Tukaram

    2016-01-01

    Introduction: Hydropneumothorax is an abnormal presence of air and fluid in the pleural space. Even though the knowledge of hydro-pneumothorax dates back to the days of ancient Greece, not many national or international literatures are documented. Aim: To study clinical presentation, etiological diagnosis, and management of the patients of hydropneumothorax. Materials and Methods: Patients admitted in a tertiary care hospital with diagnosis of hydropneumothorax between 2012 and 2014 were prospectively studied. Detailed history and clinical examination were recorded. Blood, pleural fluid, sputum investigations, and computed tomography (CT) thorax (if necessary) were done. Intercostal drainage (ICD) tube was inserted and patients were followed up till 3 months. Results: Fifty-seven patients were studied. Breathlessness, anorexia, weight loss, and cough were the most common symptoms. Tachypnea was present in 68.4% patients. Mean PaO2 was 71.7 mm of Hg (standard deviation ±12.4). Hypoxemia was present in 35 patients (61.4%). All patients had exudative effusion. Etiological diagnosis was possible in 35 patients by initial work-up and 22 required CT thorax for arriving at a diagnosis. Tuberculosis (TB) was etiology in 80.7% patients, acute bacterial infection in 14%, malignancy in 3.5%, and obstructive airway disease in 1.8%. All patients required ICD tube insertion. ICD was required for 24.8 days (±13.1). Conclusion: Most patients presented with symptoms and signs of cardiorespiratory distress along with cough, anorexia, and weight loss. Extensive pleural fluid analysis is essential in establishing etiological diagnosis. TB is the most common etiology. ICD for long duration with antimicrobial chemotherapy is the management. PMID:27185991

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

    PubMed

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

    2014-04-01

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

  13. Japanese experience with clinical trials of fast neutrons

    SciTech Connect

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

    1982-12-01

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

  14. Patient experience of source isolation: lessons for clinical practice.

    PubMed

    Barratt, Ruth Linda; Shaban, Ramon; Moyle, Wendy

    2011-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information. PMID:22551431

  15. [Organizational model and clinical evaluation in Day Surgery: our experience].

    PubMed

    Rossitto, M; Buonamonte, S; Panacea, D; Manfré, A; Ardizzone, A; Ciccolo, A

    2005-01-01

    Surgical treatments in Day Surgery (DS) are characterised by limited hospitalisation during daytime on the base of an organizational model established by appropriate protocols. According to it, the patient at low operational risk and the patient whose post-operative management is easy is admitted to the programme. The Authors report their experience of DS focusing on the surgical and anaesthesiological qualifications that help to control the risk factors reducing the complications and thus guaranteeing the safety and effectiveness of the service. PMID:15847097

  16. Assessing Research Participants’ Perceptions of their Clinical Research Experiences

    PubMed Central

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

    2013-01-01

    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. PMID:22212221

  17. Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

    PubMed Central

    Relhan, Nidhi; Pathengay, Avinash; Raval, Vishal; Nayak, Sameera; Choudhury, Himadri; Flynn, Harry W

    2015-01-01

    Purpose To describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN). Methods A noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed. Results The current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008. Conclusion DUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery. PMID:26491239

  18. Clinical experience in Europe with uroselective alpha1-antagonists.

    PubMed

    Debruyne, F M; Van der Poel, H G

    1999-01-01

    alpha1-Adrenoreceptors are thought to be involved in prostate smooth muscle contractions and could hence play a role in the dynamic component of intravesical obstruction associated with symptomatic BPH. Consequently, since the mid-eighties alpha receptor blocking agents have been used for the treatment of BPH. Non-selective alpha blockers are usually associated with systemic side-effects which resulted in an exclusion or withdrawal of many patients from this form of treatment. With the availability of so-called uroselective alpha blockers the management picture has changed since it was anticipated that these compounds cause lesser side-effects with at least the same, or even better, efficacy. Comparative clinical studies are essential for determining the eventual advantages of the uroselective alpha1-antagonists and a large number of such studies have been performed worldwide studying the various available compounds. European studies with terazosin showed clear superiority of the drug over the placebo while causing only limited side-effects. Various other studies using alpha-blocking agents such as doxazosin, tamsulosin and alfuzosin yielded identical results. Especially with tamsulosin and alfuzosin, the side-effects were comparable with those encountered in the placebo group. About 7% of the patients using tamsulosin experienced retrograde ejaculation in one study which did not occur in the alfuzosin studies. Important studies in Europe have also investigated the value of a combination of an alpha blocker with a 5alpha-reductase inhibitor. Comparable studies in which both alfuzosin and doxazosin were combined with the 5alpha-reductase inhibitor Proscar have shown that a combination is not superior to a blocker monotherapy and especially in the ALFIN study the results show that alfuzosin monotherapy is superior to Proscar in the management of symptomatic BPH. European studies have evaluated Quality of Life, sexuality as well as socio-economical outcome of the treatment with alpha1 receptor antagonists. These studies completed the spectrum of clinical research in Europe in the important field of management of symptomatic BPH with uroselective alpha1 antagonists. PMID:10393474

  19. Experience in international clinical research: the HIV Prevention Trials Network

    PubMed Central

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

    2012-01-01

    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!’). PMID:22348195

  20. MIBG in the evaluation of suspected pheochromocytoma: Mayo Clinic experience

    SciTech Connect

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

    1984-01-01

    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.

  1. The universal serial bus endoscope: design and initial clinical experience.

    PubMed

    Hernandez-Zendejas, Gregorio; Dobke, Marek K; Guerrerosantos, Jose

    2004-01-01

    Endoscopic forehead lift is a well-established procedure in aesthetic plastic surgery. Many agree that currently available video-endoscopic equipment is bulky, multipieced and sometimes cumbersome in the operating theater. A novel system, the Universal Serial Bus Endoscope (USBE) was designed to simplify and reduce the number of necessary equipment pieces in the endoscopic setup. The USBE is attached by a single cable to a Universal Serial Bus (USB) port of a laptop computer. A built-in miniaturized cold light source provides illumination. A built-in digital camera chip enables procedure recording. The real-time images and movies obtained with USBE are displayed on the computer's screen and recorded on the laptop's hard disk drive. In this study, 25 patients underwent endoscopic browlift using the USBE system to test its clinical usefulness, all with good results and without complications or need for revision. The USBE was found to be reliable and easier to use than current video-endoscope equipment. The operative time needed to complete the procedure by the authors was reduced approximately 50%. The design and main technical characteristics of the USBE are presented. PMID:15383889

  2. [Brain-Computer Interface: the First Clinical Experience in Russia].

    PubMed

    Mokienko, O A; Lyukmanov, R Kh; Chernikova, L A; Suponeva, N A; Piradov, M A; Frolov, A A

    2016-01-01

    Motor imagery is suggested to stimulate the same plastic mechanisms in the brain as a real movement. The brain-computer interface (BCI) controls motor imagery by converting EEG during this process into the commands for an external device. This article presents the results of two-stage study of the clinical use of non-invasive BCI in the rehabilitation of patients with severe hemiparesis caused by focal brain damage. It was found that the ability to control BCI did not depend on the duration of a disease, brain lesion localization and the degree of neurological deficit. The first step of the study involved 36 patients; it showed that the efficacy of rehabilitation was higher in the group with the use of BCI (the score on the Action Research Arm Test (ARAT) improved from 1 [0; 2] to 5 [0; 16] points, p = 0.012; no significant improvement was observed in control group). The second step of the study involved 19 patients; the complex BCI-exoskeleton (i.e. with the kinesthetic feedback) was used for motor imagery trainings. The improvement of the motor function of hands was proved by ARAT (the score improved from 2 [0; 37] to 4 [1; 45:5] points, p = 0.005) and Fugl-Meyer scale (from 72 [63; 110 ] to 79 [68; 115] points, p = 0.005). PMID:27188145

  3. Clinical experience with continuous glucose monitoring in adults.

    PubMed

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

    2009-06-01

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

  4. Initial Clinical Experience Using the Amplatzer Vascular Plug

    SciTech Connect

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

    2007-07-15

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

  5. Clinical experiences of NBI laryngoscope in diagnosis of laryngeal lesions

    PubMed Central

    Qi, Xinmeng; Yu, Dan; Zhao, Xue; Jin, Chunshun; Sun, Changling; Liu, Xueshibojie; Cheng, Jinzhang; Zhang, Dejun

    2014-01-01

    Endoscopy is essential for the diagnosis and treatment of cancers derived from the larynx. However, a laryngoscope with conventional white light (CWL) has technical limitations in detecting small or superficial lesions on the mucosa. Narrow band imaging especially combined with magnifying endoscopy (ME) is useful for the detection of superficial squamous cell carcinoma (SCC) within the oropharynx, hypopharynx, and oral cavity. A total of 3675 patients who have come to the outpatient clinic and complained of inspiratory stridor, dyspnea, phonation problems or foreign body sensation, were enrolled in this study. We describe the glottic conditions of the patients. All 3675 patients underwent laryngoscopy equipped with conventional white light (CWL) and NBI system. 1149 patients received a biopsy process. And 1153 lesions were classified into different groups according to their histopathological results. Among all the 1149 patients, 346 patients (312 males, 34 females; mean age 62.2±10.5 years) were suspected of having a total of 347 precancerous or cancerous (T1 or T2 without lymphnode involvement) lesions of the larynx under the CWL. Thus, we expected to attain a complete vision of what laryngeal lesions look like under the NBI view of a laryngoscope. The aim was to develop a complete description list of each laryngeal conditions (e.g. polyps, papilloma, leukoplakia, etc.), which can serve as a criteria for further laryngoscopic examinations and diagnosis. PMID:25419362

  6. Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients▿

    PubMed Central

    Troke, Peter; Aguirrebengoa, Koldo; Arteaga, Carmen; Ellis, David; Heath, Christopher H.; Lutsar, Irja; Rovira, Montserrat; Nguyen, Quoc; Slavin, Monica; Chen, Sharon C. A.

    2008-01-01

    The efficacy of voriconazole in 107 patients with scedosporiosis was analyzed. Principal infection sites were the lungs/sinuses (24%), central nervous system (CNS) (20%), and bone (18%), while 21% of patients had disseminated infection. Solid organ transplantation (22%), hematological malignancy (21%), and surgery/trauma (15%) were the predominant underlying conditions. A successful therapeutic response was achieved in 57% of patients (median, 103 therapy days), with >98% of those responding receiving ≥28 days of therapy. Patients receiving primary therapy showed a 61% response versus 56% for the others. The best therapeutic responses were seen for skin/subcutaneous (91%) or bone (79%) infections, and the lowest for CNS infections (43%). Patients without major immune suppression (72%) or those with solid organ transplantation (63%) or various hematological conditions (60%) showed the best responses by underlying condition. Median known survival time was 133 days (therapy successes, 252 days; failures, 21 days). In all, 43 (40%) patients died, 73% due to scedosporiosis. Patients with Scedosporium prolificans infection had significantly reduced survival times (P = 0.0259) and were more likely to die from fungal infection (P = 0.002) than were Scedosporium apiospermum-infected patients. In a subset of 43 patients where voriconazole baseline MICs were available, response to voriconazole was higher for S. apiospermum-infected patients (54% response; MIC50, 0.25 μg/ml) than for S. prolificans-infected patients (40% response; MIC50, 4.0 μg/ml). Voriconazole demonstrated clinically useful activity in the treatment of both S. apiospermum and S. prolificans infections and was well tolerated. PMID:18212110

  7. Surgical management of amiodarone-associated thyrotoxicosis: Mayo Clinic experience.

    PubMed

    Houghton, Scott G; Farley, David R; Brennan, Michael D; van Heerden, Jon A; Thompson, Geoffrey B; Grant, Clive S

    2004-11-01

    Amiodarone-associated thyrotoxicosis (AAT) is often poorly tolerated owing to underlying cardiac disease, and it is frequently refractory to conventional medical treatment. The goal of this study was to describe the patient characteristics, management, and outcomes of all the patients treated surgically for AAT at a single institution. We conducted a retrospective chart review of all patients managed surgically for AAT (April 1985 through November 2002) at the Mayo Clinic in Rochester, Minnesota. Altogether, 29 men and 5 women, ages 39 to 85 years (median 60 years), treated with amiodarone for 3 to 108 months underwent near-total or total thyroidectomy. Frequent symptoms were worsening heart failure, fatigue, weight loss, and tremor. Altogether, 12 patients failed medical management of their AAT, and 21 received no preoperative medical therapy. One patient had been successfully managed medically but required definitive treatment. Common indications for operation were the need to remain on amiodarone, cardiac decompensation, medically refractory disease, and severe symptoms, both hyperthyroid and cardiac, necessitating prompt resolution. The median+/-SD American Society of Anesthesiologists (ASA) classification (1 = healthy through 5 = moribund) was 3.00+/-0.58. A total of 27 specimens had histology consistent with AAT. Complications included death (n = 3), rehospitalization (n = 3), symptomatic hypocalcemia (n = 2), pneumonia (n = 2), cervical hematoma (n = 1), prolonged ventilatorywean (n = 1), and stroke (n = 1); one patient developed hypotension, adult respiratory distress syndrome, and sepsis. Of the 31 surviving patients, 25 (80%) remained on amiodarone postoperatively. The median follow-up was 29 months, at which time all surviving patients were free of hyperthyroid symptoms. Thyroidectomy is an effective treatment for AAT but has a high incidence of perioperative morbidity and mortality. The cardiovascular co-morbidities and high operative risk in this group of patients may account for the increased complication rate. PMID:15490061

  8. Clinical Experience of a Diet Designed to Reduce Aging

    PubMed Central

    Rosedale, Ron; Westman, Eric C.; Konhilas, John P.

    2010-01-01

    Objective: Aging is associated with elevated levels of glucose, insulin, and triglycerides. Our objective was to assess the effect of a nutritional program designed to reduce these correlates of aging. Design: This is a retrospective chart review of patients attending an outpatient metabolic management program including a high-fat, adequate-protein, low-carbohydrate diet, nutritional supplementation and periodic individual visits. Outcomes measured at baseline and follow-up included body weight, fasting serum glucose, insulin, leptin, lipids, and thyroid hormone. Results: Thirty-one patients were identified with complete information. The mean age of patients was 57.6 2.4 consisting of 53% female and 47% male patients. The average duration between follow up visits was 91.5 8.5 days. Of the parameters measured at the follow-up visit, body weight, serum leptin, insulin, fasting glucose, triglyceride, and free T3 significantly decreased by 8.1 0.8%, 48.2 3.8%, 40.1 4.7%, 7.6 2.1%, 28.3 5.7%, and 10.8 1.8%, respectively. Furthermore, the triglyceride/high density lipoprotein ratio decreased from 5.1 1.7 to 2.6 0.5. Conclusions: In the context of an outpatient medical clinic, a high-fat, adequate-protein, low-carbohydrate diet with nutritional supplementation led to improvements in serum factors related to the aging process. Further research regarding this dietary approach and its relationship to aging is in order. PMID:20204146

  9. Microwave imaging for neoadjuvant chemotherapy monitoring: initial clinical experience

    PubMed Central

    2013-01-01

    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. PMID:23621959

  10. Autoimmune Hemolytic Anemia in Children: Mayo Clinic Experience.

    PubMed

    Sankaran, Janani; Rodriguez, Vilmarie; Jacob, Eapen K; Kreuter, Justin D; Go, Ronald S

    2016-04-01

    We studied 35 pediatric patients with autoimmune hemolytic anemia seen at Mayo Clinic from 1994 to 2014. The median age was 10.0 years and 65.7% were males. Most had warm antibodies (80.0%) and some secondary to viral (14.3%) or autoimmune disorders (31.4%). Seven (20.0%) patients presented with Evans syndrome, 3 of whom also had common variable immunodeficiency. The median hemoglobin at diagnosis was 6.1 g/dL and 62.8% patients required red cell transfusions. The severity of anemia was worse among children below 10 years (median 5.5 vs. 7.0 g/dL, P=0.01). Steroid was the initial treatment for 88.5% patients, with overall response rate of 82.7% (68.5% complete, 14.2% partial) and median response duration of 10.7 months (range, 0.2 to 129.7+ mo). After median follow-up of 26.6 months, 8 (22.8%) patients relapsed. Salvage treatments included splenectomy, intravenous immunoglobulin, rituximab, and mycophenolate mofetil. Infectious complications occurred in 9 (25.7%) patients and 1 patient died of cytomegalovirus infection. Four patients had cold agglutinin disease and 3 (75.0%) responded to steroids. Autoimmune hemolytic anemia is a rare disorder in pediatric population and most respond well to steroids regardless of the type of antibody. Infectious complications are common and screening for immunodeficiency is recommended among those with Evans syndrome. PMID:26925716

  11. Clinical experiences of bixalomer usage at our hospital.

    PubMed

    Shima, Hideaki; Makino, Ryojiro; Hata, Kenichiro; Ban, Akihiko; Funao, Kiyoaki; Sugita, Syouzou; Furumitsu, Yutaka; Inoue, Keisuke; Yoshimoto, Mitsuru; Okamura, Mikio

    2014-06-01

    In 2012, bixalomer was launched as new non-calcium (Ca) containing phosphorus (P) binder, increasing the choices available for the treatment of hyperphosphatemia. In this study, among the maintenance dialysis patients at our hospital, we newly administered bixalomer to 21 patients who were not receiving any P binders, and switched to bixalomer for 13 patients who had been receiving sevelamer hydrochloride and 23 patients who had been receiving lanthanum carbonate. The initial dosage of bixalomer was set as 1500?mg/day for new administration patients and dosage equivalent to that of the previously-used P binder for patients who were switched to bixalomer. The dosage of bixalomer was increased if the effects were insufficient. The serum P, Ca and intact parathyroid hormone concentrations as well as serum pH, HCO3 concentration and base excess were evaluated prior to administering bixalomer, 3 months and 6 months after administering bixalomer. For the group who were newly administered bixalomer, significant reductions in serum P concentrations were seen (P<0.01) and no significant changes were seen in clinical test items that serve as indices for acidosis. For the group who were switched from sevelamer hydrochloride to bixalomer, significant reductions in serum P concentrations were seen (P<0.01) together with significant improvements in acidosis (P<0.01). For the group who were switched from lanthanum carbonate to bixalomer, by increasing the dosage of bixalomer to approximately three times the dosage of lanthanum carbonate, it was possible to maintain post-switch serum P concentrations at almost the same levels as before the switch. Furthermore, there were minor, yet significant improvements in acidosis (P<0.01). From these results, it was shown that bixalomer can be useful treatment alternative in dialysis patients for whom it is necessary to change the P binder due to insufficient management of serum P concentrations or development of acidosis. PMID:24975890

  12. Stereotactic Radiosurgery for Single Brainstem Metastases: The Cleveland Clinic Experience

    SciTech Connect

    Koyfman, Shlomo A.; Tendulkar, Rahul D.; Chao, Samuel T.

    2010-10-01

    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.

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

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

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

    PubMed

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

    1992-01-01

    The biological effects of heavy charged particle (HZE) radiation are of particular interest to travellers and planners for long-duration space flights where exposure levels represent a potential health hazard. The unique feature of HZE radiation is the structured pattern of its energy deposition in targets. There are many consequences of this feature to biological endpoints when compared with effects of ionizing photons. Dose vs response and dose-rate kinetics may be modified, DNA and cellular repair systems may be altered in their abilities to cope with damage, and the qualitative features of damage may be unique for different ions. The nematode Caenorhabditis elegans is being used to address these and related questions associated with exposure to radiation. HZE-induced mutation, chromosome aberration, cell inactivation and altered organogenesis are discussed along with plans for radiobiological experiments in space. PMID:11537531

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

    PubMed

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

    2011-06-01

    Ionizing radiation causes many types of DNA damage, including base damage and single- and double-strand breaks. Photons, including X-rays and γ-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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

    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…

  17. Cooperating Teacher Evaluation of Candidates in Clinical Practice and Field Experiences

    ERIC Educational Resources Information Center

    Moffett, David W.; Zhou, Yunfang

    2009-01-01

    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…

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

    ERIC Educational Resources Information Center

    Gordon, Michael; Russo, Kate

    2009-01-01

    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…

  19. Using a Web-Based Database to Record and Monitor Athletic Training Students' Clinical Experiences

    ERIC Educational Resources Information Center

    Brown, Kirk W.; Williams, Lisa; Janicki, Thomas

    2008-01-01

    Objective: The purpose of this article is to introduce a documentation recording system employing the Microsoft Structured Query Language (MS-SQL) database used by the Athletic Training Education Program (ATEP) for recording and monitoring of athletic training student (ATS) clinical experiences and hours. Background: Monitoring ATSs clinical

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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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,…

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

    ERIC Educational Resources Information Center

    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

    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

  2. Diagnostic games: from adequate formalization of clinical experience to structure discovery.

    PubMed

    Shifrin, Michael A; Kasparova, Eva I

    2008-01-01

    A method of obtaining well-founded and reproducible results in clinical decision making is presented. It is based on "diagnostic games", a procedure of elicitation and formalization of experts' knowledge and experience. The use of this procedure allows formulating decision rules in the terms of an adequate language, that are both unambiguous and clinically clear. PMID:18487742

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

    ERIC Educational Resources Information Center

    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

    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…

  4. The Impact of Clinical Experiences from Athletic Training Student and Preceptor Perspectives

    ERIC Educational Resources Information Center

    Benes, Sarah S.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2014-01-01

    Context: Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of

  5. Role of Clinical Education Experiences on Athletic Training Students' Development of Professional Commitment

    ERIC Educational Resources Information Center

    Mazerolle, Stephanie M.; Dodge, Thomas

    2015-01-01

    Context: Limited evidence exists on the role clinical education can play in the development of athletic training student commitment for the profession. Objective: Investigating the role clinical education experiences play on the development of passion for athletic training. Design: Exploratory qualitative study. Setting: Athletic training

  6. Experiences of Student Speech-Language Pathology Clinicians in the Initial Clinical Practicum: A Phenomenological Study

    ERIC Educational Resources Information Center

    Nelson, Lori A.

    2011-01-01

    Speech-language pathology literature is limited in describing the clinical practicum process from the student perspective. Much of the supervision literature in this field focuses on quantitative research and/or the point of view of the supervisor. Understanding the student experience serves to enhance the quality of clinical supervision. Of…

  7. Role of Clinical Education Experiences on Athletic Training Students' Development of Professional Commitment

    ERIC Educational Resources Information Center

    Mazerolle, Stephanie M.; Dodge, Thomas

    2015-01-01

    Context: Limited evidence exists on the role clinical education can play in the development of athletic training student commitment for the profession. Objective: Investigating the role clinical education experiences play on the development of passion for athletic training. Design: Exploratory qualitative study. Setting: Athletic training…

  8. The Impact of Clinical Experiences from Athletic Training Student and Preceptor Perspectives

    ERIC Educational Resources Information Center

    Benes, Sarah S.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2014-01-01

    Context: Clinical education is an integral part of athletic training programs. This is where students should develop their professional identities and become socialized into the profession. Understanding the student and preceptor perspectives of the impact that clinical experiences have on students can provide valuable insight into this aspect of…

  9. Clinical experiences with three different designs of ankle prostheses.

    PubMed

    Rippstein, Pascal F

    2002-12-01

    Until 1995, fusion was in our institution the only rational surgical option for a severe ankle arthrosis. Consistent reports about good mid- and long-term results with ankle replacement allowed us to change our minds. Ankle replacement became the gold standard and fusion was then almost totally banished. Because ankle arthrosis can be morphologically different from one patient to another, we soon believed that one single type of ankle prosthesis would not be the universal optimal solution for all patients. We therefore divided the ankle arthrosis into three groups. Each group shows the best solution from each of the ankle prostheses with which we had gained experience (Agility, STAR, and BP). The Agility prosthesis, which was indicated for ankles with extremely damaged geometry, did not restore sufficiently the ankle motion. Preoperatively stiff ankles remained stiff postoperatively. Additionally, significant residual pain was more likely to occur in those patients. These cases did not show significant advantages compared with ankle fusion, especially from a functional point of view. Fusion for these stiff ankles is therefore today our first treatment of choice. In our experience, the malleolar joints do not have to be replaced. Even a severe arthrosis at this level does not produce significant pain, provided that osteophytes have been removed and joint height has been restored by the implanted prosthesis. It is our strong belief that these malleolar joints are also less sensitive to pain, similar to the femoropatellar joint. For these reasons, a replacement of the malleolar joints and the resurfacing of the talar sides is not necessary. Leaving the talar sides untouched requires less bone resection and makes the implantation of the talar component easier. Although we obtained good results with the STAR prosthesis, we progressively abandoned it because of these reasons, and we preferred the BP prosthesis. The BP prosthesis works on the same biomechanic principle as the STAR prosthesis. Some features, however, like the untouched malleolar joints, the large exposition of the joint, the easier adjustments of its position, the possibility of enhancing the press fit, and the good short- and midterm results we obtained with it led us to the decision of using it as our only design for cases of nice and acceptable arthroses. Even if mostly good and excellent results have been achieved with all prostheses currently used, some results are still disappointing. Some ankles become stiff postoperatively and some remain diffusely painful; the explanations for these problems are often difficult to attain. This clearly shows that despite all the progress made over the last few years, there is still a lot to be learned about ankle arthroplasty. PMID:12516736

  10. CLINICAL EXPERIENCE AND IMPACT OF A COMMUNITY-LED VOLUNTEER ATMOSPHERIC HAZE CLINIC IN SINGAPORE.

    PubMed

    Yeo, Benson; Liew, Choon Fong; Oon, Hazel H

    2014-11-01

    The Pollutant Standards Index reached a life-threatening level of 401 in Singapore on 21 June 2013. Grassroot leaders in Ulu Pandan Constituency conducted the first community-led free atmospheric Haze Clinic from 25 June 2013 to 11 July 2013 to provide accessible medical assessment for affected community members. This provided insight into the common conditions afflicting that community during the haze period while allaying public anxiety. Seventy-two consultations were conducted over the 3 week period, of which 26 (36.1%) were haze related, 18 (25%) were possibly haze related and 28 (38.9%) were non-haze related. The majority of haze-related complaints were respiratory, eye and skin-related. During a haze crisis, such adhoc community-led clinics may help alleviate the surge in patients seen at emergency departments and public primary health clinics. Many of the patients seen were from low income families and a significant number (38.9%) sought help for non-haze related medical conditions. PMID:26466431

  11. [Application of portfolio in teaching dermatology clinic: an experience in teaching of medicine].

    PubMed

    de Cabalier, M E; Chalub, D M

    2009-01-01

    We present a learning experience conducted in the Chair of Dermatology Clinic of the Faculty of Medical Sciences, National University of Cordoba in the context of curriculum change. For comprehension,present a theoretical framework and practical from the conceptualization of the "portfolio" teaching and its role teaching and learning paradigms sustained constructivist medical education. The portfolio Teach-ing is not a collection of papers, but a coherent set of experiences led thoughtful learning between teachers and students. This resource allows to account for the "qualitative achievements" of students from their work produced, sorted and evaluated in a carefully planned sequence of experiences and case Dermatology Clinic. To introduce the teaching portfolio, the planned new student grouping shapes and a sequence of learning experiences for the construction of this resource, namely: "The development of theoretical material iconographic resources and working guidelines for students. "The clinical reasoning on a case or laboratory experience-Clinical case Discussion and bibliography. -The development of records to from observation of patients. "The study of clinical cases: diagnosis and evolution of clinical cases. Interconsultations-Registration and referrals. "The magazine room and sharing experiences. In each of these, production, tutorial feedback Team teaching and assessment tasks allowed assessment approach to learning and improving he achievements of the students to the approval of the subject. PMID:21138664

  12. Efficiency of Clinical Decision Support Systems Improves with Experience.

    PubMed

    Meulendijk, Michiel C; Spruit, Marco R; Willeboordse, Floor; Numans, Mattijs E; Brinkkemper, Sjaak; Knol, Wilma; Jansen, Paul A F; Askari, Marjan

    2016-04-01

    Efficiency, or the resources spent while performing a specific task, is widely regarded as one the determinants of usability. In this study, the authors hypothesize that having a group of users perform a similar task over a prolonged period of time will lead to improvements in efficiency of that task. This study was performed in the domain of decision-supported medication reviews. Data was gathered during a randomized controlled trial. Three expert teams consisting of an independent physician and an independent pharmacist conducted 150 computerized medication reviews on patients in 13 general practices located in Amsterdam, the Netherlands. Results were analyzed with a linear mixed model. A fixed effects test on the linear mixed model showed a significant difference in the time required to conduct medication reviews over time; F(31.145) = 14.043, p < .001. The average time in minutes required to conduct medication reviews up to the first quartile was M = 20.42 (SD = 9.00), while the time from the third quartile up was M = 9.81 (SD = 6.13). This leads the authors to conclude that the amount of time users needed to perform similar tasks decreased significantly as they gained experience over time. PMID:26791992

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

    PubMed Central

    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

    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. PMID:16277738

  14. The electromagnetic bio-field: clinical experiments and interferences

    PubMed Central

    Burnei, G; Hodorogea, D; Georgescu, I; Gavriliu, Ş; Drăghici, I; Dan, D; Vlad, C; Drăghici, L

    2012-01-01

    Introduction: One of the most important factors is the technical and scientifically rapid development that is continually modifying the world we live in and polluting it with electromagnetic radiations. A functional and structural influence of magnetic and electromagnetic field on living organisms is presented in the literature by many performed experiments. Material and methods: The notion of bio-field represents the electromagnetic field generated by the bio-structures, not only in their normal physiological activities but also in their pathological states. There is a tight interdependency between the bio-field and the bio-structure, which respects the primary notion of an electromagnetic field given by the Maxwell-Faraday laws, in which, the electromagnetic phenomena are simplified to the field variations. These variations can be expressed in a coherent differential equation system that bounds the field vectors to different space points at different time moments. Results: The living organisms cannot contain electrostatic and magneto-static fields due to the intense activity of the bio-structures. The biochemical reactions that have high rhythms and speeds always impose the electrodynamics character of the biologic field that also corresponds to the stability of the protein molecule that can be explained only through a dynamic way. The existent energy is not considered an exciting agent, and it does not lead to any effects. Conclusions: The parameters of these elementary bio-fields cannot yet be fully known due to technical reasons. The biological structures are very complex ones and undergo continuous dynamical activity. That is why the calculus model should be related to the constant dynamics, nowadays being very difficult to express. PMID:22802878

  15. Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

    PubMed Central

    van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

    2014-01-01

    Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS measures of psychopathology, similarly moderated by momentary interactions with emotions and context. Conclusion The results suggest that psychopathology, represented as an interactome at the momentary level of temporal resolution, is informative in diagnosing clinical needs, over and above traditional symptom measures. PMID:24466189

  16. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care

    PubMed Central

    Kuntz, Gretchen M.; Edwards, Mary E.; Butson, Linda C.; Auten, Beth

    2016-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n=21), interviews (n=2), and an online survey (n=167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly effective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians’ perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  17. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care.

    PubMed

    Lyon, Jennifer A; Kuntz, Gretchen M; Edwards, Mary E; Butson, Linda C; Auten, Beth

    2015-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n = 21), interviews (n = 2), and an online survey (n = 167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly affective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians' perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  18. Left atrial appendage isolation using percutaneous (endocardial/epicardial) devices: Pre-clinical and clinical experience.

    PubMed

    Romero, Jorge; Natale, Andrea; Engstrom, Krysthel; Di Biase, Luigi

    2016-02-01

    Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and it is associated with a four-fold to five-fold increased risk of thromboembolic events. It was not until the mid-1950s that the left atrial appendage (LAA) was identified as the main location of thrombus formation, particularly in patients with non-valvular AF. In this review, we explain at some extent its embryology, anatomy and physiology, and as well as the clinical and pre-clinical trials published to date testing the safety and efficacy of most LAA closure devices. Among those devices, the most studied include the PLAATO system (ev3 Endovascular, Plymouth, MN), the Amplatzer cardiac plug (St Jude, Golden Valley, MN; St. Jude Medical, Minneapolis, MN), the WATCHMAN device (Boston Scientific, Plymouth, MN; Atritech Inc., Plymouth, MN), and the LARIAT device (SentreHEART, Palo Alto, CA). Similarly, newer LAA closure devices currently under investigation such as the Transcatheter Patch (Custom Medical Devices, Athens, Greece), AEGIS, and the Coherex WaveCrest (Salt Lake City, UT) will also be discussed. Future perspectives and the need for well-designed prospective studies between devices and new oral anticoagulant drugs are also proposed. PMID:26141854

  19. Experience of Adjunct Novice Clinical Nursing Faculty: An Interpretive Case Study

    ERIC Educational Resources Information Center

    Mann, Carol

    2013-01-01

    The purpose of this qualitative interpretive case study was to describe the experience of adjunct novice clinical nursing faculty who has less than three years teaching experience or feels novice in this setting. The nursing shortage in the United States is well documented and is forecasted to have significant impacts on the health care delivery…

  20. Comprehensive Experiment--Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

    ERIC Educational Resources Information Center

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a…

  1. Comprehensive Experiment--Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

    ERIC Educational Resources Information Center

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a

  2. Clinical Experiences for Agricultural Teacher Education Programs in North Carolina, South Carolina and Virginia.

    ERIC Educational Resources Information Center

    Dobbins, Thomas R.; Camp, W. G.

    A study was conducted to build a task list for the clinical experience program for agricultural teacher education programs in North Carolina, South Carolina, and Virginia. A modified Delphi technique was used to survey a panel of experts to identify the tasks that should be included in the early field experiences (EFEs) and student teaching…

  3. What Students Really Learn: Contrasting Medical and Nursing Students' Experiences of the Clinical Learning Environment

    ERIC Educational Resources Information Center

    Liljedahl, Matilda; Boman, Lena Engqvist; Fält, Charlotte Porthén; Bolander Laksov, Klara

    2015-01-01

    This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a…

  4. Professor Hassan K. Awwad; The Father of Radiation Oncology and Radiobiology in Egypt and the Arab World, His Good Deeds Last Forever and Inspire us for the Future.

    PubMed

    Zaghloul, Mohamed S; El-Badawi, Samy A; Abd Elbaky, Hoda

    2007-03-01

    Our most respected professor Hassan K. Awwad passed away on January 5th, 2007, at the age of 81. He was considered as the father of radiotherapy in Egypt. He was always named "The Professor", as he was the founder of the radiotherapy departments at the National Cancer Institute, Cairo University&Faculty of Medicine, Alexandria University. He also shared in developing NEMROCK (Kasr El Aini Center of Radiation Oncology and Nuclear Medicine), the place where he graduated and worked during his early years of experience. He, together with professor Reda Hamza, dean of NCI, Cairo at that time, had initiated 7 oncology centers all over Egypt, from Aswan in the South to Dammietta and Damanhour in the North. These 7 centers were developed by the Ministry of Health. Prof. Awwad and Prof. Hamza were responsible for facility providing and plans. They chose all the necessary equipment, tools and personnel. These centers were in action since 1988 and are currently taking care of the oncology patients in a wide area of the country. Prof. Awwad graduated from the Faculty of medicine, Cairo University, in 1949. He had his Medical Doctorate (MD) in Radiotherapy from Alexandria University in 1956. The International Atomic Energy Agency (IAEA) awarded him fellowships in France (Institute Gustave Rossy) to gain experience in brachytherapy in 1956 and 1971, England 1956, 1959. Another fellowship was awarded to Prof Awwad in Harvard University (Peter Bent Brigham Hospital) in radiobiology and radiotherapy during the years 1964-1965. He personally and with other members of the National Cancer Institute gave much of their efforts and time to teach, train and guide young radiotherapists, biologists, physicists and radiation therapists through direct on-hand teaching and training as well as holding training courses for radiation oncologists, physicists and technologists. He insisted to ensure its regularity 4 times yearly. These courses trained a lot of personnel from all over Egypt, Sudan, Libya, Palastine, Iraq, Uganda, Nigeria and other countries. He himself had many teaching missions in different Arab countries (Saudi Arabia, Kuwait and others) for the sake of groups of his students that could not come to Egypt. He served as the head of the Department of Radiation Oncology for more than 15 years (1970-1985), full time Professor in Radiation Oncology and Radiobiology (1985-2007), Professor of Radiotherapy, Alexandria University (1954-1970), Chief of the Department of Nuclear Medicine, Medical Research Institute, University of Alexandria (1963-1964), Chief of the Radiotherapy Unit in the Heliopolis Hospital, Ministry of Public Health, 1985-2007. He was co-founder of the Egyptian Society of Cancer and acted as vice present and head of the scientific committee of the society. He shared the activities of many Egyptian, Arab and international scientific societies. His activities in these societies were great. Prof. Awwad had direct contact with his students that never ended, even after some of them left to work in other places in USA, Canada, Europe or Arab Countries. His students' specialty varied between radiobiology, pharmacology, biochemistry, tumor biology, radiation oncology, medical oncology and surgical oncology. Prof. Awwad had more than 100 published articles on hypoxia and hypoxic cell radiosensitizers, biology of growth of human tumors, biology and clinical models of the time factor in external beam radiotherapy, biology and mathematical models of time factor in brachytherapy, radioactive dynamic cancer studies of plasma protein metabolism, radioactive dynamic factor studies of blood disorders and lymphoma, radiation damage of DNA and normal tissues,head and neck cancer, bladder cancer, breast cancer, cervical cancer and development and optimization of clinical radiotherapy. He had continuous cooperation and collaboration with many of the great scientists and clinicians in Holland, France, United Kingdom, USA and Japan. He continued to exchange ideas with these great people all through his life and till the last moments of his extended fruitful life. Prof. Awwad wrote many books for a wide diversity of readers, for the lay people in Arabic, for radiographers, young oncologist, and the highly experienced radiation oncologists and radiobiologists. His book "Radiation Oncology: Radiobiological and Physiobiological Perspectives" was a real translation of radiobiology language to the oncologist and at the same time translation of the oncologist language to the biologist. This book ended with establishing a common language for both teams. In addition, it led other books in these specialties to communicate with the same language. The good news is that Prof. Awwad had completed the second edition of this book just before passing away. This second edition is really a totally new book coping with the advancement of knowledge reached till the end of 2006. We are sure that this book with all other good deeds performed by Prof. Awwad, will keep his memory in Egypt as well as elsewhere in the whole world. PMID:18839029

  5. Nursing faculty teaching a module in clinical skills to medical students: a Lebanese experience

    PubMed Central

    Abdallah, Bahia; Irani, Jihad; Sailian, Silva Dakessian; Gebran, Vicky George; Rizk, Ursula

    2014-01-01

    Nursing faculty teaching medical students a module in clinical skills is a relatively new trend. Collaboration in education among medical and nursing professions can improve students’ performance in clinical skills and consequently positively impact the quality of care delivery. In 2011, the Faculty of Medicine in collaboration with the Faculty of Health Sciences at the University of Balamand, Beirut, Lebanon, launched a module in clinical skills as part of clinical skills teaching to first-year medical students. The module is prepared and delivered by nursing faculty in a laboratory setting. It consists of informative lectures as well as hands-on clinical practice. The clinical competencies taught are hand-washing, medication administration, intravenous initiation and removal, and nasogastric tube insertion and removal. Around sixty-five medical students attend this module every year. A Likert scale-based questionnaire is used to evaluate their experience. Medical students agree that the module provides adequate opportunities to enhance clinical skills and knowledge and favor cross-professional education between nursing and medical disciplines. Most of the respondents report that this experience prepares them better for clinical rotations while increasing their confidence and decreasing anxiety level. Medical students highly appreciate the nursing faculties’ expertise and perceive them as knowledgeable and resourceful. Nursing faculty participating in medical students’ skills teaching is well perceived, has a positive impact, and shows nurses are proficient teachers to medical students. Cross professional education is an attractive model when it comes to teaching clinical skills in medical school. PMID:25419165

  6. Uncertainty in the Translation of Preclinical Experiments to Clinical Trials. Why do Most Phase III Clinical Trials Fail?

    PubMed Central

    Lowenstein, Pedro R.; Castro, Maria G.

    2009-01-01

    A large majority of Phase III, large scale, clinical trials will fail, including gene therapy trials. This paper attempts to address some of the causes that may have inadvertently led to such a high failure rate. After briefly reviewing the detailed and high quality work that goes both into the preparation and conduct of such large Phase III clinical trials, and the preclinical science that is used to support and originate such trials, this paper proposes a novel approach to translational medicine which would increase the predictability of success of Phase III clinical trials. We propose that a likely cause of such failures is the lack of “robustness” in the preclinical science underpinning the Phase I/II and III clinical trials. Robustness is defined as stability/reproducibility in the face of challenges. Many times preclinical experiments are tested in a very narrow set of experimental conditions. Thus, when such approaches are finally tested in the context of human disease, the challenge provided by the varied age of patients, the complex genetic makeup of human populations, and the complexities of the diseases to be treated provide challenges which were never tested or modeled. We believe that the introduction of revised approaches to preclinical science, including the use of the latest developments in statistical, scientific, mathematical, and biological models, ought to lead to more robust preclinical experimentation with its subsequent translation, to more robust Phase III clinical trials. PMID:19860651

  7. Radiobiologic comparison of helical tomotherapy, intensity modulated radiotherapy, and conformal radiotherapy in treating lung cancer accounting for secondary malignancy risks.

    PubMed

    Komisopoulos, Georgios; Mavroidis, Panayiotis; Rodriguez, Salvador; Stathakis, Sotirios; Papanikolaou, Nikos; Nikiforidis, Georgios C; Sakellaropoulos, Georgios C

    2014-01-01

    The aim of the present study is to examine the importance of using measures to predict the risk of inducing secondary malignancies in association with the clinical effectiveness of treatment plans in terms of tumor control and normal tissue complication probabilities. This is achieved by using radiobiologic parameters and measures, which may provide a closer association between clinical outcome and treatment delivery. Overall, 4 patients having been treated for lung cancer were examined. For each of them, 3 treatment plans were developed based on the helical tomotherapy (HT), multileaf collimator-based intensity modulated radiation therapy (IMRT), and 3-dimensional conformal radiation therapy (CRT) modalities. The different plans were evaluated using the complication-free tumor control probability (p+), the overall probability of injury (pI), the overall probability of control/benefit (pB), and the biologically effective uniform dose (D¯¯). These radiobiologic measures were used to develop dose-response curves (p-D¯¯ diagram), which can help to evaluate different treatment plans when used in conjunction with standard dosimetric criteria. The risks for secondary malignancies in the heart and the contralateral lung were calculated for the 3 radiation modalities based on the corresponding dose-volume histograms (DVHs) of each patient. Regarding the overall evaluation of the different radiation modalities based on the p+ index, the average values of the HT, IMRT, and CRT are 67.3%, 61.2%, and 68.2%, respectively. The corresponding average values of pB are 75.6%, 70.5%, and 71.0%, respectively, whereas the average values of pI are 8.3%, 9.3%, and 2.8%, respectively. Among the organs at risk (OARs), lungs show the highest probabilities for complications, which are 7.1%, 8.0%, and 1.3% for the HT, IMRT, and CRT modalities, respectively. Similarly, the biologically effective prescription doses (DB¯¯) for the HT, IMRT, and CRT modalities are 64.0, 60.9, and 60.8Gy, respectively. Regarding the risk for secondary cancer, for the heart, the lowest average risk is produced by IMRT (0.10%) compared with the HT (0.17%) and CRT (0.12%) modalities, whereas the 3 radiation modalities show almost equivalent results regarding the contralateral lung (0.8% for HT, 0.9% for IMRT, and 0.9% for CRT). The use of radiobiologic parameters in the evaluation of different treatment plans and estimation of their expected clinical outcome is shown to provide very useful clinical information. The radiobiologic analysis of the response probabilities showed that different radiation modalities appear to be more effective in different patient geometries and target sizes and locations. Furthermore, there is not a clear pattern between the plans that appear to be more effective for the treatment and the risk of secondary malignancy. It seems that radiobiologically based treatment planning taking into account the risk of secondary cancer can be established as an effective clinical tool for a more clinically relevant treatment optimization. PMID:25168596

  8. Radiobiologic comparison of helical tomotherapy, intensity modulated radiotherapy, and conformal radiotherapy in treating lung cancer accounting for secondary malignancy risks

    SciTech Connect

    Komisopoulos, Georgios; Mavroidis, Panayiotis; Rodriguez, Salvador; Stathakis, Sotirios; Papanikolaou, Nikos; Nikiforidis, Georgios C.; Sakellaropoulos, Georgios C.

    2014-01-01

    The aim of the present study is to examine the importance of using measures to predict the risk of inducing secondary malignancies in association with the clinical effectiveness of treatment plans in terms of tumor control and normal tissue complication probabilities. This is achieved by using radiobiologic parameters and measures, which may provide a closer association between clinical outcome and treatment delivery. Overall, 4 patients having been treated for lung cancer were examined. For each of them, 3 treatment plans were developed based on the helical tomotherapy (HT), multileaf collimator-based intensity modulated radiation therapy (IMRT), and 3-dimensional conformal radiation therapy (CRT) modalities. The different plans were evaluated using the complication-free tumor control probability (p{sub +}), the overall probability of injury (p{sub I}), the overall probability of control/benefit (p{sub B}), and the biologically effective uniform dose (D{sup ¯¯}). These radiobiologic measures were used to develop dose-response curves (p-D{sup ¯¯} diagram), which can help to evaluate different treatment plans when used in conjunction with standard dosimetric criteria. The risks for secondary malignancies in the heart and the contralateral lung were calculated for the 3 radiation modalities based on the corresponding dose-volume histograms (DVHs) of each patient. Regarding the overall evaluation of the different radiation modalities based on the p{sub +} index, the average values of the HT, IMRT, and CRT are 67.3%, 61.2%, and 68.2%, respectively. The corresponding average values of p{sub B} are 75.6%, 70.5%, and 71.0%, respectively, whereas the average values of p{sub I} are 8.3%, 9.3%, and 2.8%, respectively. Among the organs at risk (OARs), lungs show the highest probabilities for complications, which are 7.1%, 8.0%, and 1.3% for the HT, IMRT, and CRT modalities, respectively. Similarly, the biologically effective prescription doses (D{sub B}{sup ¯¯}) for the HT, IMRT, and CRT modalities are 64.0, 60.9, and 60.8 Gy, respectively. Regarding the risk for secondary cancer, for the heart, the lowest average risk is produced by IMRT (0.10%) compared with the HT (0.17%) and CRT (0.12%) modalities, whereas the 3 radiation modalities show almost equivalent results regarding the contralateral lung (0.8% for HT, 0.9% for IMRT, and 0.9% for CRT). The use of radiobiologic parameters in the evaluation of different treatment plans and estimation of their expected clinical outcome is shown to provide very useful clinical information. The radiobiologic analysis of the response probabilities showed that different radiation modalities appear to be more effective in different patient geometries and target sizes and locations. Furthermore, there is not a clear pattern between the plans that appear to be more effective for the treatment and the risk of secondary malignancy. It seems that radiobiologically based treatment planning taking into account the risk of secondary cancer can be established as an effective clinical tool for a more clinically relevant treatment optimization.

  9. Social and clinical correlates of the persistence of psychotic experiences in the general population.

    PubMed

    DeVylder, Jordan E; Lehmann, Meshan; Chen, Fang-pei

    2015-12-01

    Recent epidemiological evidence suggests that sub-threshold psychotic experiences commonly occur in the general population. When these experiences persist over time, they may increase risk for psychotic disorder or lead to other clinical or functional impairments. The aims of this study were to distinguish the relative importance of sociodemographic factors and clinical factors, including characteristics of the psychotic experiences themselves, in determining the course of psychotic symptoms over time. Participants were drawn from the Collaborative Psychiatric Epidemiology Surveys. We tested for retrospectively-reported predictors of current psychotic experiences among individuals who reported lifetime psychotic experiences, with onset prior to the past year (n=921), using logistic regression. Persistence was primarily related to demographic variables, with lower odds associated with being married and having at least a college education. Individuals reporting prior to the past year auditory hallucinations were more likely to have persistent psychotic experiences than those reporting other types of psychotic experiences. Interventions aiming at strengthening family support and social skills may reduce the likelihood of persistence among individuals with psychotic experiences, thereby reducing risk for psychotic disorders and other related outcomes. Future studies should continue to identify predictors of persistence versus remission and further explore clinical services for those with persistent psychotic experiences. PMID:26386897

  10. Cell irradiation setup and dosimetry for radiobiological studies at ELBE

    NASA Astrophysics Data System (ADS)

    Zeil, K.; Beyreuther, E.; Lessmann, E.; Wagner, W.; Pawelke, J.

    2009-07-01

    The radiation source ELBE delivers different types of secondary radiation, which is used for cell irradiation studies in radiobiological research. Thereby an important issue is the determination of the biological effectiveness of photon radiation as a function of photon energy by using low-energetic, monochromatic channeling radiation (10-100 keV) and high-energetic bremsstrahlung (up to 40 MV). Radiobiological studies at the research facility ELBE demand special technical and dosimetric prerequisites. Therefore, a cell irradiation system (CIS) has been designed, constructed and installed at the beam line. The CIS allows automatic irradiation of a larger cell sample number and the compensation of spatial inhomogeneity of the dose distribution within the beam spot. The recently introduced GafChromic ® EBT radiochromic film model has been used to verify the cell irradiation dose deposition achieving a dose uncertainty of <5%. Both, the installed cell irradiation system and the developed dosimetric procedure based on the use of the EBT film have been experimentally tested at ELBE. The biological effectiveness of 34 MV bremsstrahlung with respect to 200 kV X-rays from a conventional X-ray tube has been determined. An RBE value of 0.75 has been measured in good agreement with literature.

  11. A fuzzy convolution model for radiobiologically optimized radiotherapy margins

    NASA Astrophysics Data System (ADS)

    Mzenda, Bongile; Hosseini-Ashrafi, Mir; Gegov, Alex; Brown, David J.

    2010-06-01

    In this study we investigate the use of a new knowledge-based fuzzy logic technique to derive radiotherapy margins based on radiotherapy uncertainties and their radiobiological effects. The main radiotherapy uncertainties considered and used to build the model were delineation, set-up and organ motion-induced errors. The radiobiological effects of these combined errors, in terms of prostate tumour control probability and rectal normal tissue complication probability, were used to formulate the rule base and membership functions for a Sugeno type fuzzy system linking the error effect to the treatment margin. The defuzzified output was optimized by convolving it with a Gaussian convolution kernel to give a uniformly varying transfer function which was used to calculate the required treatment margins. The margin derived using the fuzzy technique showed good agreement compared to current prostate margins based on the commonly used margin formulation proposed by van Herk et al (2000 Int. J. Radiat. Oncol. Biol. Phys. 47 1121-35), and has nonlinear variation above combined errors of 5 mm standard deviation. The derived margin is on average 0.5 mm bigger than currently used margins in the region of small treatment uncertainties where margin reduction would be applicable. The new margin was applied in an intensity modulated radiotherapy prostate treatment planning example where margin reduction and a dose escalation regime were implemented, and by inducing equivalent treatment uncertainties, the resulting target and organs at risk doses were found to compare well to results obtained using currently recommended margins.

  12. Use of Tablet Computers to Promote Physical Therapy Students' Engagement in Knowledge Translation During Clinical Experiences

    PubMed Central

    Loeb, Kathryn; Barbosa, Sabrina; Jiang, Fei; Lee, Karin T.

    2016-01-01

    Background and Purpose: Physical therapists strive to integrate research into daily practice. The tablet computer is a potentially transformational tool for accessing information within the clinical practice environment. The purpose of this study was to measure and describe patterns of tablet computer use among physical therapy students during clinical rotation experiences. Methods: Doctor of physical therapy students (n = 13 users) tracked their use of tablet computers (iPad), loaded with commercially available apps, during 16 clinical experiences (6-16 weeks in duration). Results: The tablets were used on 70% of 691 clinic days, averaging 1.3 uses per day. Information seeking represented 48% of uses; 33% of those were foreground searches for research articles and syntheses and 66% were for background medical information. Other common uses included patient education (19%), medical record documentation (13%), and professional communication (9%). The most frequently used app was Safari, the preloaded web browser (representing 281 [36.5%] incidents of use). Users accessed 56 total apps to support clinical practice. Discussion and Conclusions: Physical therapy students successfully integrated use of a tablet computer into their clinical experiences including regular activities of information seeking. Our findings suggest that the tablet computer represents a potentially transformational tool for promoting knowledge translation in the clinical practice environment. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A127). PMID:26945431

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

    SciTech Connect

    Mailli, Leto Filippiadis, Dimitrios K.; Brountzos, Elias N.; Alexopoulou, Efthymia; Kelekis, Nikolaos; Kelekis, Alexios

    2013-02-15

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

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

    PubMed Central

    Wańkowicz, Zofia

    2013-01-01

    The 50th anniversary of dialysotherapy celebrated by nephrologists around the world in 2012 provided an opportunity for discussion on the role of clinical experience in relation to technological progress in the evolution of dialysis, especially of recently observed inadequate decrease in mortality/morbidity rates of patients on chronic dialysis. My report, based on almost 50 years of career in nephrology, refers the evolution of dialysis, from catharsis to modern dialysotherapy with special attention devoted to nowadays gravely underestimated role of clinical experience and personalized professional care for patients. PMID:24226207

  15. Women’s Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study

    PubMed Central

    Bilardi, Jade; Walker, Sandra; McNair, Ruth; Mooney-Somers, Julie; Temple-Smith, Meredith; Bellhouse, Clare; Fairley, Christopher; Chen, Marcus; Bradshaw, Catriona

    2016-01-01

    Background Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women’s recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. Methods A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. Results The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women’s frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. Conclusion In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors. PMID:27010725

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

    PubMed

    Williams, Angela; Taylor, Cathy

    2008-11-01

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

  17. Appraisals and Responses to Experimental Symptom Analogues in Clinical and Nonclinical Individuals With Psychotic Experiences

    PubMed Central

    Ward, Thomas A.; Gaynor, Keith J.; Hunter, Mike D.; Woodruff, Peter W. R.; Garety, Philippa A.; Peters, Emmanuelle R.

    2014-01-01

    Objective: Cognitive models of psychosis suggest that anomalous experiences alone do not always lead to clinical psychosis, with appraisals and responses to experiences being central to understanding the transition to “need for care”. Methods: The appraisals and response styles of Clinical (C; n = 28) and Nonclinical (NC; n = 34) individuals with psychotic experiences were compared following experimental analogues of thought interference (Cards Task) and auditory hallucinations (Virtual Acoustic Space Paradigm). Results: The groups were matched in terms of their psychotic experiences. As predicted, the C group scored higher than the NC group on maladaptive appraisals following both tasks, rated the experience as more personally significant, and was more likely to incorporate the experimental setup into their ongoing experiences. The C group also appraised the Cards Task as more salient, distressing, and threatening; this group scored higher on maladaptive—and lower on adaptive—response styles, than the NC group on both tasks. Conclusions: The findings are consistent with cognitive models of psychosis, with maladaptive appraisals and response styles characterizing the C group only. Clinical applications of both tasks are suggested to facilitate the identification and modification of maladaptive appraisals. PMID:23858493

  18. An Exploration of Dental Students' Assumptions About Community-Based Clinical Experiences.

    PubMed

    Major, Nicole; McQuistan, Michelle R

    2016-03-01

    The aim of this study was to ascertain which assumptions dental students recalled feeling prior to beginning community-based clinical experiences and whether those assumptions were fulfilled or challenged. All fourth-year students at the University of Iowa College of Dentistry & Dental Clinics participate in community-based clinical experiences. At the completion of their rotations, they write a guided reflection paper detailing the assumptions they had prior to beginning their rotations and assessing the accuracy of their assumptions. For this qualitative descriptive study, the 218 papers from three classes (2011-13) were analyzed for common themes. The results showed that the students had a variety of assumptions about their rotations. They were apprehensive about working with challenging patients, performing procedures for which they had minimal experience, and working too slowly. In contrast, they looked forward to improving their clinical and patient management skills and knowledge. Other assumptions involved the site (e.g., the equipment/facility would be outdated; protocols/procedures would be similar to the dental school's). Upon reflection, students reported experiences that both fulfilled and challenged their assumptions. Some continued to feel apprehensive about treating certain patient populations, while others found it easier than anticipated. Students were able to treat multiple patients per day, which led to increased speed and patient management skills. However, some reported challenges with time management. Similarly, students were surprised to discover some clinics were new/updated although some had limited instruments and materials. Based on this study's findings about students' recalled assumptions and reflective experiences, educators should consider assessing and addressing their students' assumptions prior to beginning community-based dental education experiences. PMID:26933101

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

    PubMed Central

    Johnson, Eric J.; Hagemann, Tracy M.

    2013-01-01

    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

  20. Clinical placements in Australian general practice: (Part 1) the experiences of pre-registration nursing students.

    PubMed

    McInnes, Susan; Peters, Kath; Hardy, Jennifer; Halcomb, Elizabeth

    2015-11-01

    An international shift towards strengthening primary care services has stimulated the growth of nursing in general (family) practice. As learning in the clinical setting comprises a core component of pre-registration nursing education, it is logical that clinical placement opportunities would follow the workforce growth in this setting. Beyond simply offering placements in relevant clinical areas, it is vital to ensure high quality learning experiences that meet the educational needs of pre-registration nurses. Part 1 of a two part series reports on the qualitative study of a mixed methods project. Fifteen pre-registration nursing students participated in semi-structured interviews following a clinical placement in an Australian general practice. Interviews were transcribed verbatim and underwent a process of thematic analysis. Findings are presented in the following four themes; (1) Knowledge of the practice nurse role: I had very limited understanding, (2) Quality of the learning experience: It was a fantastic placement, (3) Support, belonging and mutual respect: I really felt part of the team, (4) Employment prospects: I would really, really love to go to a general practice but …… General practice placements exposed students to a diverse range of clinical skills which would equip them for future employment in primary care. Exposure to nursing in general practice also stimulated students to consider a future career in this clinical setting. PMID:25979152

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

    ERIC Educational Resources Information Center

    Dumas, Louise; Villeneuve, Jean; Chevrier, Jacques

    2000-01-01

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

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

    ERIC Educational Resources Information Center

    LaFauci, Frances F.

    2009-01-01

    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…

  3. Using a Web-Based Database to Record and Monitor Athletic Training Students' Clinical Experiences

    ERIC Educational Resources Information Center

    Brown, Kirk W.; Williams, Lisa; Janicki, Thomas

    2008-01-01

    Objective: The purpose of this article is to introduce a documentation recording system employing the Microsoft Structured Query Language (MS-SQL) database used by the Athletic Training Education Program (ATEP) for recording and monitoring of athletic training student (ATS) clinical experiences and hours. Background: Monitoring ATSs clinical…

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

    ERIC Educational Resources Information Center

    Purcell, Laura; Milner, Brigid

    2005-01-01

    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…

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

    ERIC Educational Resources Information Center

    Harland, Darci J.; Wondra, Joshua D.

    2011-01-01

    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…

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

    ERIC Educational Resources Information Center

    Waimon, Morton D.; And Others

    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…

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

    ERIC Educational Resources Information Center

    Purcell, Laura; Milner, Brigid

    2005-01-01

    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

  8. Computerized Evaluation of Clinical Experiences in the Training of Health Professionals.

    ERIC Educational Resources Information Center

    Niland-Weiss, J.; And Others

    1985-01-01

    The Physician Assistant Program at the University of Southern California School of Medicine in Los Angeles established a computerized database in 1980 to evaluate the clinical experiences of its students. The design of the patient data system, the computerization process, the implementation of the program, and its applications are discussed.…

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  10. Why Clinical Experience and Mentoring Are Replacing Student Teaching on the Best Campuses. A White Paper

    ERIC Educational Resources Information Center

    Fraser, James W.; Watson, Audra M.

    2014-01-01

    Woodrow Wilson Senior Fellow James W. Fraser and Audra Watson, the Foundation's Director of Mentoring and Induction Strategy, take a look at emerging trends in clinical preparation for new teachers. This new white paper is based on experience with the Woodrow Wilson Teaching Fellowships, and includes observations from some of the colleges and…

  11. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Data submission, clinical experience, and outcome requirements for initial approval of transplant centers. 482.80 Section 482.80 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND...

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

    ERIC Educational Resources Information Center

    LaFauci, Frances F.

    2009-01-01

    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

  13. Comprehensive experiment-clinical biochemistry: determination of blood glucose and triglycerides in normal and diabetic rats.

    PubMed

    Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

    2015-01-01

    For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a standard clinical biochemistry exercise. The students are not only exposed to techniques and equipment but are also inspired to think more about the biochemical mechanisms of diseases. When linked with lecture topics about the metabolism of carbohydrates and lipids, the students obtain a better understanding of the relevance of abnormal metabolism in relation to diseases. Such understanding provides a solid foundation for the medical students' future research and for other clinical applications. PMID:25521692

  14. Nursing Students Achieving Community Health Competencies through Undergraduate Clinical Experiences: A Gap Analysis.

    PubMed

    Pijl-Zieber, Em M; Barton, Sylvia; Awosoga, Oluwagbohunmi A; Konkin, Jill

    2015-01-01

    In Canada, it is widely believed that nursing practice and health care will move from acute care into the community. At the same time, increasing numbers of nursing students are engaged in non-traditional clinical experiences for their community health rotation. These clinical experiences occur at agencies not organizationally affiliated with the health care system and typically do not employ registered nurses (RNs). What has yet to be established is the degree to which nursing students are actually being prepared for community health nursing roles through their community health clinical rotations. In this paper we report the findings of a mixed method study that explored the gap between desired and observed levels of competence in community health of senior nursing students and new graduates. The gap was quantified and then the nature of the gap further explored through focus groups. PMID:26461843

  15. Social justice as a framework for undergraduate community health clinical experiences in the United States.

    PubMed

    Boutain, Doris M

    2008-01-01

    Educating future registered nurses for social justice is an urgent, yet complex undertaking in undergraduate education. Although the need for social justice education is often highlighted, few articles describe practical teaching strategies for ensuring that undertaking. The purpose of this article is to illustrate how a curricular focus on social justice framed and supported the development of a clinical evaluation tool for undergraduate community health clinical experiences. First, social justice is defined and its relationship to baccalaureate nursing education explained. Then a description is provided of how social justice was highlighted in the vision, curriculum, and community health clinical evaluation tool of a College of Nursing. The article subsequently showcases the content and evaluation of students' journal entries about social justice. The development of the social justice component presented in this article may be useful to nurse educators striving to match theory and practice in the evaluation of social justice in students' community health experience. PMID:18976232

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

    NASA Astrophysics Data System (ADS)

    Pyakuryal, Anil Prasad

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

  17. [Zhu Lian's characteristics and experiences in clinical practice of acupuncture and moxibustion].

    PubMed

    Wei, Li fu; Pan, Xiaoria; Liu, Bing; Yue, Jin; Zhang, Lijian

    2015-01-01

    This paper aims at discussing the clinical characteristics and experiences of ZHU Lian, the renowned contemporary acupuncture master from the following three aspects: "characteristics of clinical manipulations and techniques", "thoughts on diagnosis and treatment" and "examples of clinical cases". The study has shown that ZHU Lian invented the slow insertion technique by rotating needle and the embedding needle technique, improved moxibustion technique with moxa roll and proposed the three keys on the treatment with acupuncture and moxibustion, as well as discovered new acupoints for treatment. The pioneering and distinguished achievements she con tributed play the great demonstrating and driving role in the development of clinical study and practice of acupuncture and moxibustion. PMID:25906582

  18. [Personal experiences with induced abortions in private clinics in Northeast Brazil].

    PubMed

    Silveira, Paloma; McCallum, Cecilia; Menezes, Greice

    2016-01-01

    Based on a qualitative study conducted in 2012, the article analyzes middle-class individuals' experiences with induced abortions performed in private clinics. Thirty-four stories of induced abortions were narrated by 19 women and five men living in two state capitals in Northeast Brazil. Thematic analysis revealed differences in types of clinics and care provided by the physicians. The article shows that abortion in private clinics fails to guarantee safe or humane care. The narratives furnish descriptions of diverse situations and practices, ranging from flaws such as lack of information on medicines to others involving severe abuses like procedures performed without anesthesia. The article concludes that criminalization of abortion in Brazil allows clinics to operate with no state regulation; it does not prevent women from having abortions, but exposes them to total vulnerability and violation of human rights. PMID:26958817

  19. Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

    PubMed

    Gustafsson, Louise; Hutchinson, Laura; Theodoros, Deborah; Williams, Katrina; Copley, Anna; Fagan, Amy; Desha, Laura

    2016-03-01

    Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals. PMID:26895418

  20. Challenges of the ward round teaching based on the experiences of medical clinical teachers

    PubMed Central

    Arabshahi, Kamran Soltani; Haghani, Fariba; Bigdeli, Shoaleh; Omid, Athar; Adibi, Peyman

    2015-01-01

    Background: Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011. Materials and Methods: This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability). Results: Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient's welfare, poor preparation, lack of motivation, ethical problems), factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system's monitoring, bad planning and inadequate resource). Conclusion: Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching. PMID:26109975

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

    PubMed Central

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

    2012-01-01

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

  2. Health Professionals' Expectations Versus Experiences of Internet-Based Telemonitoring: Survey Among Heart Failure Clinics

    PubMed Central

    van der Wal, Martje H.L; Nieuwenhuis, Maurice M.W; de Jong, Richard M; van Dijk, Rene B; Jaarsma, Tiny; Hillege, Hans L

    2013-01-01

    Background Although telemonitoring is increasingly used in heart failure care, data on expectations, experiences, and organizational implications concerning telemonitoring are rarely addressed, and the optimal profile of patients who can benefit from telemonitoring has yet to be defined. Objective To assess the actual status of use of telemonitoring and to describe the expectations, experiences, and organizational aspects involved in working with telemonitoring in heart failure in the Netherlands. Methods In collaboration with the Netherlands Organization for Applied Scientific Research (TNO), a 19-item survey was sent to all outpatient heart failure clinics in the Netherlands, addressed to cardiologists and heart failure nurses working in the clinics. Results Of the 109 heart failure clinics who received a survey, 86 clinics responded (79%). In total, 31 out of 86 (36%) heart failure clinics were using telemonitoring and 12 heart failure clinics (14%) planned to use telemonitoring within one year. The number of heart failure patients receiving telemonitoring generally varied between 10 and 50; although in two clinics more than 75 patients used telemonitoring. The main goals for using telemonitoring are “monitoring physical condition”, “monitoring signs of deterioration” (n=39, 91%), “monitoring treatment” (n=32, 74%), “adjusting medication” (n=24, 56%), and “educating patients” (n=33, 77%). Most patients using telemonitoring were in the New York Heart Association (NYHA) functional classes II (n=19, 61%) and III (n=27, 87%) and were offered the use of the telemonitoring system “as long as needed” or without a time limit. However, the expectations of the use of telemonitoring were not met after implementation. Eight of the 11 items about expectations versus experiences were significantly decreased (P<.001). Health care professionals experienced the most changes related to the use of telemonitoring in their work, in particular with respect to “keeping up with current development” (before 7.2, after 6.8, P=.15), “being innovative” (before 7.0, after 6.1, P=.003), and “better guideline adherence” (before 6.3, after 5.3, P=.005). Strikingly, 20 out of 31 heart failure clinics stated that they were considering using a different telemonitoring system than the system used at the time. Conclusions One third of all heart failure clinics surveyed were using telemonitoring as part of their care without any transparent, predefined criteria of user requirements. Prior expectations of telemonitoring were not reflected in actual experiences, possibly leading to disappointment. PMID:23305645

  3. Detailed characterization of the 1087 MeV/nucleon iron-56 beam used for radiobiology at the alternating gradient synchrotron

    NASA Technical Reports Server (NTRS)

    Zeitlin, C.; Heilbronn, L.; Miller, J.

    1998-01-01

    We report beam characterization and dosimetric measurements made using a 56Fe beam extracted from the Brookhaven National Laboratory Alternating Gradient Synchrotron (AGS) with a kinetic energy of 1087 MeV/nucleon. The measurements reveal that the depth-dose distribution of this beam differs significantly from that obtained with a 600 MeV/nucleon iron beam used in several earlier radiobiology experiments at the Lawrence Berkeley National Laboratory's BEVALAC. We present detailed measurements of beam parameters relevant for radiobiology, including track- and dose-averaged linear energy transfer (LET), fragment composition and LET spectra measured behind sample holders used in irradiations of biological samples. We also report measurements of fluence behind three depths (1.94, 4.68 and 9.35 g cm(-2)) of polyethylene targets with the 1087 MeV/nucleon beam, and behind 1.94 g cm(-2) of polyethylene with a 610 MeV/nucleon beam delivered by the AGS. These results are compared to earlier measurements with the 600 MeV/nucleon beam at the BEVALAC.

  4. Belongingness: a montage of nursing students' stories of their clinical placement experiences.

    PubMed

    Levett-Jones, Tracy; Lathlean, Judith; McMillan, Margaret; Higgins, Isabel

    2007-04-01

    The psychological and social sciences literature is replete with assertions that human beings are fundamentally and pervasively motivated by the need to belong. This paper reports on some of the findings from the qualitative phase of a mixed-method, multi-site study that explored nursing students' experience of belongingness while on clinical placements. Students from Australia and the United Kingdom were interviewed to identify factors that impact upon and are consequences of belongingness. A montage of participants' stories is used to illustrate some of the key features of clinical workplaces that are conducive to the development of belongingness. Contextual factors and interpersonal dynamics were seen to have a significant bearing on students' experiences. Clinical leaders/managers who were welcoming, accepting and supportive, and nursing staff who were inclusive and encouraging, facilitated students' perception of being valued and respected as members of the nursing team. Additionally, the provision of consistent, quality mentorship was identified as important to students' feelings of connectedness and fit. The experience of belongingness, in turn, enhanced students' potential for learning and influenced their future career decisions. Alternatively, alienation resulted from unreceptive and unwelcoming clinical environments and from the dissonance created when students' personal and professional values did not articulate with those evident in practice environments. Consequently, distress, detachment and disengagement occurred and students' capacity and motivation for learning was negatively impacted. PMID:17563325

  5. Perceived Experience of Fatigue in Clinical and General Population: Descriptors and Associated Reactivities.

    PubMed

    Fuentes-Márquez, Sandra; Senín-Calderón, Cristina; Rodríguez-Testal, Juan F; Carrasco, Miguel A

    2015-01-01

    The aim of this study is the analysis of different descriptors and reactions related to the experience of fatigue. Two groups were compared: a clinical sample (n = 92, 31 males, mean age = 38.87) and a non-clinical (n = 225, 135 males, mean age = 32.45) sample. The total sample was composed of 317 participants (52% males), ranging in age from 18 to 76 years. Findings show the experience of fatigue was mainly related to somatic terms (76% of the total sample). Specific results were found only for the clinical group: (a) significant relationships between fatigue and anxiety, χ2(1) = 34.71, p < .01; tension, χ2(1) = 16.80, p < .01; and sadness, χ2(1) = 24.59, p < .01; (b) higher intensity of fatigue (F = 84.15, p = .001), and predominance of the cognitive components of fatigue. Results showed that fatigue in subjects with a clinical disorder (versus those without) was associated both, to negative emotional states, and to a higher intensity of fatigue, especially in its cognitive elements. Important clinical implications for its assessment and intervention are discussed. PMID:26055395

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

    PubMed Central

    2010-01-01

    Background User reported experiences and satisfaction are increasingly used as basis for quality indicators in the health sector. However, there is limited understanding of factors associated with user reported experiences and satisfaction with casualty clinics. Methods A random sample of 542 patients that had contacted any of three casualty clinics from mid April to mid May 2008 was mailed a questionnaire. A reminder was sent to non-respondents after six weeks. Descriptive statistics for four user reported experiences scales and 20 single items are presented. Multivariate regression analysis was used to assess associations between background variables and user reported experiences, and between user reported experiences and user satisfaction. Results 225 (41.5%) patients, carers and guardians returned a completed questionnaire. Users reported most positive experiences with the doctor services and the nursing services at the casualty clinics; on a scale from 0 to 100, where 100 is the best possible experience the doctor scale was 82 and the nursing scale 81. Users reported least positive experiences with the organization of the casualty clinic, with a scale score of 65. Self perceived health was associated with user satisfaction, while self perceived health and age were associated with user reported experiences with organization of the clinics. A range of user reported experience domains were related to user satisfaction, after controlling for socio-demographic variables, including experiences with doctor services at the clinics, organization of the clinics, information and self perceived incorrect treatment. Conclusions Users report positive experiences with the three casualty clinics, with organization as the aspect with largest improvement potential. The importance of age and health status for users' experiences and satisfaction with casualty clinics was shown, but a range of user reported experiences with the clinics were the most important predictors for user satisfaction. PMID:20925930

  7. Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

    PubMed Central

    Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

    2012-01-01

    Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

  8. Realizing a laser-driven electron source applicable for radiobiological tumor irradiation

    NASA Astrophysics Data System (ADS)

    Nicolai, Maria; Sävert, Alexander; Reuter, Maria; Schnell, Michael; Polz, Jens; Jäckel, Oliver; Karsch, Leonhard; Schürer, Michael; Oppelt, Melanie; Pawelke, Jörg; Kaluza, Malte C.

    2014-09-01

    Laser-accelerated electron pulses have been used to irradiate human tumors grown on mice's ears during radiobiological experiments. These experiments have been carried out with the JETI laser system at the Institute of Optics and Quantum Electronics in Jena, Germany. To treat a total of more than 50 mice, a stable and reliable operation of the laser-electron accelerator with a dose rate exceeding 1 Gy/min was necessary. To achieve this, a sufficient number of electrons at energies in excess of 5 MeV had to be generated. The irradiation time for a single mouse was a few minutes. Furthermore, the particle pulses' parameters needed to remain achievable for a time period of several weeks. Due to the online detection of the radiation dose, the unavoidable shot-to-shot fluctuations, currently still typical for laser-based particle accelerators, could be compensated. The results demonstrate that particle pulses generated with laser-based accelerators have the potential to be a future alternative for conventional particle accelerators used for the irradiation of tumors.

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

    NASA Astrophysics Data System (ADS)

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

    2014-09-01

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

  10. Three endpoints of in vivo tumour radiobiology and their statistical estimation

    PubMed Central

    Demidenko, Eugene

    2010-01-01

    Purpose To review the existing endpoints of tumour growth delay assays in experimental radiobiology with an emphasis on their efficient estimation for statistically significant identification of the treatment effect. To mathematically define doubling time (DT), tumour-growth delay (TGD) and cancer-cell surviving fraction (SF) in vivo using exponential growth and regrowth models with tumour volume measurements obtained from animal experiments. Materials and methods A statistical model-based approach is used to define and efficiently estimate the three endpoints of tumour therapy in experimental cancer research. Results The log scale is advocated for plotting the tumour volume data and the respective analysis. Therefore, the geometric mean should be used to display the mean tumour volume data, and the group comparison should be a t-test for the log volume to comply with the Gaussian-distribution assumption. The relationship between cancer-cell SF, TGD and rate of growth is rigorously established. The widespread formula for cell kill is corrected; it has been rigorously shown that TGD is the difference between DTs. The software for the tumour growth delay analysis based on the mixed modeling approach with a complete set of instructions and example can be found on the author’s webpage. Conclusions The existing practice for TGD data analysis from animal experiments suffers from imprecision and large standard errors that yield low power and statistically insignificant treatment effect. This practice should be replaced with a model-based statistical analysis on the log scale. PMID:20148701

  11. International student nurses' experiences of clinical practice in the Finnish health care system.

    PubMed

    Mattila, Lea-Riitta; Pitkäjärvi, Marianne; Eriksson, Elina

    2010-05-01

    The purpose of this qualitative study was to describe international student nurses' experiences of their clinical practice in the Finnish health care system. The data were collected by semi-structured interviews. Fourteen international student nurses of African and Asian origin were interviewed, and the data were then analysed by qualitative content analysis. The results indicated that appreciative orientation, sense of belonging to the team, enhancing independent working, growing towards professionalism and working as a member of the team were descriptions of positive experiences. Descriptions of negative experiences were related to restricted learning and compromised human dignity, which lead to negative feelings of being an outsider, decreased self-esteem, sense of giving up and anticipation of difficulties. Despite the small sample size, the results indicate a need to develop clinical practice arrangements when the language of the learning environment is other than that of the student nurse. As the number of international students has increased in the Finnish health care sector and in nursing education, it is important to recognise the factors related to positive and negative experiences in clinical practice. PMID:19539530

  12. The first clinical experience on efficacy of topical flutamide on melasma compared with topical hydroquinone: a randomized clinical trial

    PubMed Central

    Adalatkhah, Hassan; Sadeghi-Bazargani, Homayoun

    2015-01-01

    Background Treatment of melasma is unsatisfactory most of the times. Hormonal role is shown to exist in pathogenesis of the melasma, and sex-hormone related drugs may have an effect on melasma. Aim To investigate efficacy of 1% flutamide cream versus 4% hydroquinone cream on melasma. Methods In a parallel randomized clinical trial, 74 women with melasma were allocated to receive a sunscreen along with 4% hydroquinone cream or 1% flutamide cream. Melasma Area and Severity Index (MASI), mexameter melanin assay, and patient satisfaction were investigated. Results Mean age of the participants was 33.8 years. Mean length of time suffering from Melasma was 96.3 months. The subjects reported in average 1.1 hours per day of exposure to sunlight. Mean standardized total patient satisfaction score was 28.8 (standard deviation [SD] 17.2) in flutamide group patients versus 18 (SD 15.5) in control group (P<0.01). Regardless of treatment group, the skin darkness assessed upon MASI scales was reduced over the treatment course (P<0.001). Using mixed effects, longitudinal modeling showed better treatment efficacy based on MASI scale for flutamide group compared to the hydroquinone group (P<0.05). However, longitudinal analysis of mexameter scores did not reveal any significant difference in melanin measurements between flutamide and hydroquinone. Conclusion Topical flutamide appeared as effective as topical hydroquinone in treating melasma using mexameter assessment but with a better MASI improvement trend and higher patient satisfaction in flutamide treatment versus topical hydroquinone. As the present study is possibly the first clinical experience on efficacy of topical flutamide on melasma, it would be quite unreasonable to recommend clinical use of it before future studies replicate the results on its efficacy and safety. PMID:26345129

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

    PubMed Central

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

    2011-01-01

    A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart. PMID:21876780

  14. Radiobiological mechanisms of stereotactic body radiation therapy and stereotactic radiation surgery

    PubMed Central

    Kim, Mi-Sook; Kim, Wonwoo; Park, In Hwan; Kim, Hee Jong; Lee, Eunjin; Jung, Jae-Hoon; Cho, Lawrence Chinsoo

    2015-01-01

    Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS. PMID:26756026

  15. The Safe use of Radioactive Isotopes in Teaching Experiments

    ERIC Educational Resources Information Center

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

    1974-01-01

    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)

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

    PubMed Central

    Bouras-vallianatos, Petros

    2014-01-01

    Alexander of Tralles, writing in the late sixth century, combined his wide-ranging practical knowledge with earlier medical theories. This article shows how clinical experience is used in Alexander’s works by concentrating on his therapeutic advice on epilepsy and, in particular, on pharmacology and the group of so-called natural remedies. I argue that clinical testing is used not only for the introduction of new medicines but also as an instrument for checking the therapeutic effect of popular healing practices. On another level, this article discusses Alexander’s role as the author of a medical compendium; it suggests that by marking the cases of clinical testing with a set of recurrent expressions, Alexander leads his audience to reflect on his medical authority and personal contribution. PMID:25045178

  17. Technical experiences of implementing a wireless tracking and facial biometric verification system for a clinical environment

    NASA Astrophysics Data System (ADS)

    Liu, Brent; Lee, Jasper; Documet, Jorge; Guo, Bing; King, Nelson; Huang, H. K.

    2006-03-01

    By implementing a tracking and verification system, clinical facilities can effectively monitor workflow and heighten information security in today's growing demand towards digital imaging informatics. This paper presents the technical design and implementation experiences encountered during the development of a Location Tracking and Verification System (LTVS) for a clinical environment. LTVS integrates facial biometrics with wireless tracking so that administrators can manage and monitor patient and staff through a web-based application. Implementation challenges fall into three main areas: 1) Development and Integration, 2) Calibration and Optimization of Wi-Fi Tracking System, and 3) Clinical Implementation. An initial prototype LTVS has been implemented within USC's Healthcare Consultation Center II Outpatient Facility, which currently has a fully digital imaging department environment with integrated HIS/RIS/PACS/VR (Voice Recognition).

  18. Clinical experiences with molecular targeted therapy in lung cancer in China

    PubMed Central

    Wang, Yan; Sun, Yan

    2015-01-01

    In the past decade, a dramatic shift has been witnessed in cancer therapy in China. Although traditional cytotoxic chemotherapy still remains the treatment of choice for many malignancies, targeted therapies are now a component of treatment for many types of cancer, including lung cancer. As molecular target agents are widely used in clinical practice and relevant studies have been conducted, we have accumulated valuable experience in the treatment strategy for advanced non-small cell lung cancer. On this basis we have successfully developed our Class-I new drug through independent research, which significantly accelerates the clinical development of targeted therapy for lung cancer. This article summarizes the clinical practice and relevant studies of current targeted therapies for lung cancer in China. PMID:26273390

  19. The near-death experience as a focus of clinical attention.

    PubMed

    Greyson, B

    1997-05-01

    Near-death experiences (NDEs) often produce profound changes in attitudes and behavior that can lead to psychosocial and psychospiritual problems. The diagnostic label of religious or spiritual problem, included in DSM-IV under the category of other conditions that may be a focus of clinical attention, was originally proposed to encompass NDEs and their aftereffects. Four cases are discussed in which patients presented with NDE-related problems, and differential diagnosis and current treatment strategies are reviewed. The inclusion of this new diagnostic category in the DSM-IV permits differentiation of NDEs and similar experiences from mental disorders and may lead to research into more effective treatment strategies. PMID:9171810

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

    PubMed Central

    Scott, B B; Losowsky, M S

    1976-01-01

    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 this instrument also enables multiple, precisely located biopsies to be taken from various levels of the small intestine, it could be considered the instrument of choice for peroral jejunal biopsy. PMID:1086269

  1. Radiobiology of radiolabeled antibody therapy as applied to tumor dosimetry.

    PubMed

    Langmuir, V K; Fowler, J F; Knox, S J; Wessels, B W; Sutherland, R M; Wong, J Y

    1993-01-01

    This paper reviews the radiobiological aspects of radioimmunotherapy (RIT) with radiolabeled antibodies, including comparisons between RIT and external beam irradiation. The effectiveness of cell killing by radiation decreases with the dose rate and the rate of decrease is determined by the size of the shoulder on the radiation survival curve. Tumors with poor repair capabilities exhibit less of a dose rate effect than tumors with good repair capabilities. Continued tumor cell proliferation during treatment occurs at very low dose rates and can contribute to the reduced effectiveness of low dose rate radiation. Toxicity to normal tissues will determine the total dose of radiolabeled antibody that can be given and this will be influenced by the choice of both the radionuclide and the antibody. The reported enhanced effectiveness of RIT may be due to multiple factors including selective targeting of cells responsible for tumor volume doubling, tumor surface binding rather than homogeneous binding throughout the tumor volume, targeting of the tumor vasculature, or block of cell cycle progression in G2. During RIT, there is less time for reoxygenation of hypoxic tumor cells than during a course of conventional external beam radiotherapy. It has not yet been determined whether this will have a detrimental effect on RIT. Probably the most important factor in the success of RIT is dose heterogeneity. Any viable portion of a tumor that is not targeted and does not receive a significant radiation dose will potentially lead to treatment failure, no matter how high the dose received by the remainder of the tumor. Comparisons between RIT and external beam radiation have shown a wide range of relative efficacy. Tumors most likely to respond to RIT are tumors with poor repair capabilities, tumors that are susceptible to blockage in radiosensitive phases of the cell cycle, tumors that reoxygenate rapidly, and tumors that express the relevant antigen homogeneously. From a radiobiological perspective, it appears that RIT alone is unlikely to cure many tumors and that combination with other treatment modalities will be essential. PMID:8492769

  2. Enhancing Prostate Cancer Care Through the Multidisciplinary Clinic Approach: A 15-Year Experience

    PubMed Central

    Gomella, Leonard G.; Lin, Jianqing; Hoffman-Censits, Jean; Dugan, Patricia; Guiles, Fran; Lallas, Costas D.; Singh, Jaspreet; McCue, Peter; Showalter, Timothy; Valicenti, Richard K.; Dicker, Adam; Trabulsi, Edouard J.

    2010-01-01

    Purpose: To report on the 15-year prostate cancer experience of our multidisciplinary genitourinary cancer clinic established in 1996 at the National Cancer Institute (NCI) –designated Jefferson Kimmel Cancer Center. Patients with genitourinary cancers were evaluated weekly by multiple specialists at a single site, and we focus on the 83% of patients with prostate cancer. To our knowledge, our multidisciplinary genitourinary cancer clinic is the longest continuously operating center of its kind at an NCI Cancer Center in the United States. Methods: Data from Jefferson's Oncology Data Services were compared to SEER prostate cancer outcomes. Data on treatment changes in localized disease, patient satisfaction, and related parameters were also assessed. Results: Ten-year survival data approach 100% in stage I and II prostate cancer. Ten-year data for stage III (T3 N0M0) and stage IV (T4 N0M0) disease show that our institutional survival rate exceeds SEER. There is a shift toward robotically assisted laparoscopic radical prostatectomy and a slight decrease in brachytherapy relative to external beam radiation therapy in localized disease. Patient satisfaction is high as measured by survey instruments. Conclusion: Our long-term experience suggests a benefit of the multidisciplinary clinic approach to prostate cancer, most pronounced for high-risk, locally advanced disease. A high level of satisfaction with this patient-centered model is seen. The multidisciplinary clinic approach to prostate cancer may enhance outcomes and possibly reduce treatment regret through a coordinated presentation of all therapeutic options. This clinic model serves as an interdisciplinary educational tool for patients, their families, and our trainees and supports clinical trial participation. PMID:21358951

  3. Nursing students in an expanded charge nurse role: a real clinical management experience.

    PubMed

    Isaacson, Julie J; Stacy, Annette S

    2004-01-01

    Ensuring that baccalaureate nursing students obtain a measure of management and leadership proficiency is a challenge for nurse educators. Having senior students manage juniors in a clinical course modeled in a peer hierarchal pattern that emulates advanced beginner practice is a creative approach that is both realistic and achievable. Through specific learning experiences, students are exposed to typical management functions and asked to demonstrate management and leadership skills at an expanded charge nurse level. PMID:15675377

  4. A different kind of clinical experience: poverty up close and personal.

    PubMed

    DeLashmutt, Mary B; Rankin, Elizabeth A

    2005-01-01

    Nursing faculty are faced with the dilemma of how to teach the complex health and social issues about poverty to students because most nursing students have limited exposure to the impoverished. A seminar-driven clinical experience at a crisis center was implemented to address this challenge. Preclinical and postclinical exposure questions helped both students and faculty alike identify growth in students' awareness of social responsibility, client advocacy, and ethical issues. PMID:16030449

  5. Clinical evaluation of music perception, appraisal and experience in cochlear implant users

    PubMed Central

    Drennan, Ward. R.; Oleson, Jacob J.; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D.; Won, Jong Ho; Anderson, Elizabeth S.; Rubinstein, Jay T.

    2014-01-01

    Objectives The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Design Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. Study sample One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Results Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Conclusions Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations. PMID:25177899

  6. Microdosimetric investigation of a fast neutron radiobiology facility utilising the d(4)-9Be reaction.

    PubMed

    Waker, A J; Maughan, R L

    1986-11-01

    For fast neutron therapy and radiobiology beams, knowledge of the primary neutron spectrum is the most fundamental requirement for the definition of radiation quality. However, microdosimetric measurements in the form of single-event spectra not only complement the primary neutron spectrum as a statement of radiation quality but also provide a sensitive method of detecting changes in the radiation field in situations where it is no longer possible to have precise knowledge of the primary neutron spectrum, for example after collimator changes and in positions where the radiation field consists of a large scattered component. For the various collimator arrangements employed at the Gray Laboratory facility small perturbations of the radiation field are observed which can be related to a softening of the primary neutron spectrum with increasing field size of the collimator. Gamma fraction determinations are in very good agreement with measurements employing the dual chamber technique and also show small changes with collimator field size giving rise to gamma components ranging from 0.09 to 0.12, the higher values being measured for the larger field sizes. Quality changes represented by the shape of the measured event-size spectra and the derived microdosimetric parameters were greatest for off axis and phantom measurements. With increasing depth in water, yD was found to decrease from 47.3 keV micron-1 at 5 cm to 35.6 keV micron-1 at 15 cm depth, and the gamma fraction was found to increase from 0.23 to 0.40. Although there is no generally accepted and agreed method of relating microdosimetric information to biological effectiveness, the dual radiation theory in its original form (Kellerer and Rossi 1972) has been shown to be a very useful model for the assessment of the biological effectiveness of fast neutrons (Kellerer et al 1976). The microdosimetric parameter which is used in the dual radiation model is the dose mean specific energy corrected for saturation zeta* which, for a 2 micron simulated diameter, is related to the dose mean lineal energy corrected for saturation y* by zeta* = y* keV micron-1 X 0.51 X 10(-2) Gy. Values of y* determined for each of the collimator arrangements used at the Gray Laboratory show a spread of some 6% (table 1) and, as the dose fraction between lineal energies 5 and 150 keV micron-1 (the recoil proton component) do not alter by more than 3%, radiobiological experiments performed with different collimator arrangements would show no observable differences.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3786413

  7. Monte Carlo application based on GEANT4 toolkit to simulate a laser-plasma electron beam line for radiobiological studies

    NASA Astrophysics Data System (ADS)

    Lamia, D.; Russo, G.; Casarino, C.; Gagliano, L.; Candiano, G. C.; Labate, L.; Baffigi, F.; Fulgentini, L.; Giulietti, A.; Koester, P.; Palla, D.; Gizzi, L. A.; Gilardi, M. C.

    2015-06-01

    We report on the development of a Monte Carlo application, based on the GEANT4 toolkit, for the characterization and optimization of electron beams for clinical applications produced by a laser-driven plasma source. The GEANT4 application is conceived so as to represent in the most general way the physical and geometrical features of a typical laser-driven accelerator. It is designed to provide standard dosimetric figures such as percentage dose depth curves, two-dimensional dose distributions and 3D dose profiles at different positions both inside and outside the interaction chamber. The application was validated by comparing its predictions to experimental measurements carried out on a real laser-driven accelerator. The work is aimed at optimizing the source, by using this novel application, for radiobiological studies and, in perspective, for medical applications.

  8. Three-dimensional radiobiological dosimetry (3D-RD) with 124I PET for 131I therapy of thyroid cancer

    PubMed Central

    Hobbs, Robert F.; Atkins, Francis B.; Van Nostrand, Douglas; Ladenson, Paul W.; Wahl, Richard L.

    2011-01-01

    Radioiodine therapy of thyroid cancer was the first and remains among the most successful radiopharmaceutical (RPT) treatments of cancer although its clinical use is based on imprecise dosimetry. The positron emitting radioiodine, 124I, in combination with positron emission tomography (PET)/CT has made it possible to measure the spatial distribution of radioiodine in tumors and normal organs at high resolution and sensitivity. The CT component of PET/CT has made it simpler to match the activity distribution to the corresponding anatomy. These developments have facilitated patient-specific dosimetry (PSD), utilizing software packages such as three-dimensional radiobiological dosimetry (3D-RD), which can account for individual patient differences in pharmacokinetics and anatomy. We highlight specific examples of such calculations and discuss the potential impact of 124I PET/CT on thyroid cancer therapy. PMID:21484384

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

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

    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.

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

    PubMed

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

    2012-11-01

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

  11. Radiobiological study by using laser-driven proton beams

    NASA Astrophysics Data System (ADS)

    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

    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 γ-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.

  12. Application of radiobiological dosimetry to radionuclide directed therapy.

    PubMed Central

    Millar, W. T.

    1990-01-01

    The standard linear quadratic model, which has been used to assess the radiobiological damage to tissue by external beam fractionated radiotherapy, has been extended to encompass a general continuous time varying dose rate protocol such as radionuclide therapy. If the radionuclide clearance from the tissue is purely exponential, the effect is readily calculated. Otherwise, the effect can be evaluated by numerical integration if the dose rate time-1 profile is known. It can be shown that if the maximum percentage initial uptake g-1 uptake in normal or tumour tissue is less than 0.046 or 0.23 for an administered activity of 50 mCi of 90Y or 131I respectively, then the radiation-induced damage will certainly be less than for 2 Gy fraction-1 external beam therapy for the same total dose. Preliminary imaging and knowledge of the radionuclide kinetics using a non-therapeutic dose may be used to calculate the predicted radiation damage to tissues for a particular therapeutic dose provided the tracer and therapy doses have identical kinetics. PMID:2383484

  13. Amchitka Radiobiological Program progress report, January 1979-December 1979

    SciTech Connect

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

    1980-07-01

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

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

    SciTech Connect

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

    1982-11-01

    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.

  15. Radiobiological study by using laser-driven proton beams

    SciTech Connect

    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.

    2009-07-25

    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.

  16. Impact of microgravity on radiobiological processes and efficiency of DNA repair.

    PubMed

    Horneck, G

    1999-12-01

    To study the influence of microgravity on radiobiological processes in space, space experiments have been performed, using an on-board 1xg reference centrifuge as in-flight control. The trajectory of individual heavy ions was localized in relation to the biological systems by use of the Biostack concept, or an additional high dose of radiation was applied either before the mission or during the mission from an on-board radiation source. In embryonic systems, such as early developmental stages of Drosophila melanogaster and Carausius morosus, the occurrence of chromosomal translocations and larval malformations was dramatically increased in response to microgravity and radiation. It has been hypothesized that these synergistic effects might be caused by an interference of microgravity with DNA repair processes. However, recent studies on bacteria, yeast cells and human fibroblasts suggest that a disturbance of cellular repair processes in the microgravity environment might not be a complete explanation for the reported synergism of radiation and microgravity. As an alternative explanation, an impact of microgravity on signal transduction, on the metabolic/physiological state or on the chromatin structure at the cellular level, or modification of self-assembly, intercellular communication, cell migration, pattern formation or differentiation at the tissue and organ level should be considered. PMID:10631336

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

    PubMed Central

    Miller, Michael G.; Berry, Leisha M.

    2004-01-01

    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. PMID:15173870

  18. Preliminary experience with small animal SPECT imaging on clinical gamma cameras.

    PubMed

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

    2014-01-01

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

  19. What factors facilitate good learning experiences in clinical studies in nursing: bachelor students' perceptions.

    PubMed

    Dale, Bjrg; Leland, Arne; Dale, Jan Gunnar

    2013-12-17

    Clinical studies constitute 50% of the bachelor program in nursing education in Norway, and the quality of these studies may be decisive for the students' opportunities to learn and develop their professional competences. The aim of this study was to explore what bachelor students' in nursing perceived to be important for having good learning experiences in clinical studies. Data was collected in a focus group interview with eight nursing students who were in the last year of the educational program. The interview was transcribed verbatim, and qualitative content analysis was used for exploring and interpreting the content of the interview text. One main theme emerged from the analysis: "being in a vulnerable and exposed position characterized by conflicting needs." Four categories were found: "aspects related to the clinical setting", "aspects related to the nurse supervisor," "aspects related to the student," and "aspects related to the student-supervisor relationship". The findings revealed that the students' learning experiences and motivation were related to individual, relational, and organizational aspects. The students highlighted their own as well as their supervisors' attitudes and competences and the importance of positive relationships. In addition, feeling welcomed, included, and valued in the ward improved their motivation, self-confidence, and self-respect. PMID:24455300

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

    PubMed Central

    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

    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. PMID:17236994

  1. Haemophilia in a real-world setting: the value of clinical experience in data collection.

    PubMed

    Dolan, Gerry; Iorio, Alfonso; Jokela, Vuokko; Juusola, Kristian; Lassila, Riitta

    2016-02-01

    At the 8th Annual Congress of the European Association for Haemophilia and Allied Disorders (EAHAD) held in Helsinki, Finland, in February 2015, Pfizer sponsored a satellite symposium entitled: 'Haemophilia in a real-world setting: The value of clinical experience in data collection' Co-chaired by Riitta Lassila (Helsinki University Central Hospital, Helsinki, Finland) and Gerry Dolan (Guy's and St Thomas' Hospital, London, UK); the symposium provided an opportunity to explore the practical value of real-world data in informing clinical decision-making. Gerry Dolan provided an introduction to the symposium by describing what is meant by real-world data (RWD), stressing the role RWD can play in optimising patient outcomes in haemophilia and highlighting the responsibility of all stakeholders to collaborate in continuous data collection. Kristian Juusola (Oulu University Hospital, Oulu, Finland) then provided personal experience as a haemophilia nurse around patient views on adherence to treatment regimes, and how collecting insights into real-world use of treatment can shape approaches to improving adherence. The importance of elucidating pharmacokinetic parameters in a real-world setting was then explored by Vuokko Jokela (Helsinki University, Helsinki, Finland). Finally, Alfonso Iorio (McMaster University, Hamilton, Ontario, Canada) highlighted the importance of quality data collection in translating clinical reality into scientific advances. PMID:26809546

  2. Does reflective web-based discussion strengthen nursing students' learning experiences during clinical training?

    PubMed

    Mettiäinen, Sari; Vähämaa, Kristiina

    2013-09-01

    The aim of this research was to study how a web-based discussion forum can be used as a supervision tool during nursing students' clinical training. The study emphasises peer support and its importance for the students. The empirical research was carried out at a Finnish university of applied sciences. 25 nursing students took part in web-based discussion during their eight-week clinical training period. All in all, 395 comments were submitted. The material was analysed by using categorisation and a thematic analysis process. Finally, the results were reported using a modified Salmon's (2002) 5-stage model of Teaching and Learning On-line and Mezirow's (1981) levels of reflection. The students motivated each other by sharing their feelings and experiences. They noticed the value of peer support and started to learn from each other as well. By reflecting on their experiences, the students progressed in their learning process and at the same time advanced their reflective thinking process. This combination of theoretical knowledge and practice, based on the students' needs and interests, could lead to a deeper understanding which could also result in better clinical skills. This method offers the lecturers the possibility to support and follow the professional growth process in a new evidence-based manner. PMID:23116619

  3. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience.

    PubMed

    Casani, A P; Dallan, I; Navari, E; Sellari Franceschini, S; Cerchiai, N

    2015-06-01

    The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected. PMID:26246662

  4. Radiobiologic Parameters and Local Effect Model Predictions for Head-and-Neck Squamous Cell Carcinomas Exposed to High Linear Energy Transfer Ions

    SciTech Connect

    Beuve, Michael Alphonse, Gersende Ph.D.; Maalouf, Mira; Colliaux, Anthony M.S.; Battiston-Montagne, Priscilla; Jalade, Patrice; Balanzat, Emmanuel; Demeyer, Albert; Bajard, Marcel; Rodriguez-Lafrasse, Claire

    2008-06-01

    Purpose: To establish the radiobiologic parameters of head-and-neck squamous cell carcinomas (HNSCC) in response to ion irradiation with various linear energy transfer (LET) values and to evaluate the relevance of the local effect model (LEM) in HNSCC. Methods and Materials: Cell survival curves were established in radiosensitive SCC61 and radioresistant SQ20B cell lines irradiated with [33.6 and 184 keV/n] carbon, [302 keV/n] argon, and X-rays. The results of ion experiments were confronted to LEM predictions. Results: The relative biologic efficiency ranged from 1.5 to 4.2 for SCC61 and 2.1 to 2.8 for SQ20B cells. Fixing an arbitrary D{sub 0} parameter, which characterized survival to X-ray at high doses (>10 Gy), gave unsatisfying LEM predictions for both cell lines. For D{sub 0} = 10 Gy, the error on survival fraction at 2 Gy amounted to a factor of 10 for [184 keV/n] carbon in SCC61 cells. We showed that the slope (s{sub max}) of the survival curve at high doses was much more reliable than D{sub 0}. Fitting s{sub max} to 2.5 Gy{sup -1} gave better predictions for both cell lines. Nevertheless, LEM could not predict the responses to fast and slow ions with the same accuracy. Conclusions: The LEM could predict the main trends of these experimental data with correct orders of magnitude while s{sub max} was optimized. Thus the efficiency of carbon ions cannot be simply extracted from the clinical response of a patient to X-rays. LEM should help to optimize planning for hadrontherapy if a set of experimental data is available for high-LET radiations in various types of tumors.

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

    PubMed Central

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

    2012-01-01

    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. PMID:22331816

  6. Human Brucellosis in Macedonia – 10 Years of Clinical Experience in Endemic Region

    PubMed Central

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

    2010-01-01

    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. PMID:20718086

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

    PubMed

    Poussaint, A F

    1999-05-01

    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

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

    PubMed Central

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

    2011-01-01

    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. PMID:22043184

  9. Supporting positive experiences and sustained participation in clinical trials: looking beyond information provision.

    PubMed

    Gillies, Kate; Entwistle, Vikki A

    2012-12-01

    Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. Drawing on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about 'voluntariness', underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. PMID:22875981

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

    PubMed Central

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

    2008-01-01

    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. PMID:18612740

  11. Psychotic experiences as indicators of suicidal ideation in a non-clinical college sample.

    PubMed

    DeVylder, Jordan E; Thompson, Elizabeth; Reeves, Gloria; Schiffman, Jason

    2015-04-30

    Suicide is a leading cause of preventable death. Epidemiological studies have shown strong associations between sub-threshold psychotic experiences and risk for suicidal ideation and behavior. Screens designed to assess psychotic experiences may have clinical utility in improving suicide prevention efforts. In the current study, we hypothesized that the Prodromal Questionnaire-Brief (PQ-B) would reliably distinguish levels of suicidal ideation within a sample of college students (n=376). As predicted, PQ-B scores varied significantly across levels of suicidal ideation, both when treated as a raw count of sub-threshold psychotic experiences and when taking into account subjective distress associated with those symptoms. In addition, we explored the feasibility of developing a short screen based on the most discriminating items, finding that a six-item version of the PQ-B yielded higher accuracy for detecting elevated suicidal ideation over the full measure. The PQ-B has the potential for clinical utility in detecting groups that might be at increased risk for suicidal ideation. PMID:25746171

  12. Accuracy of Reporting the Hyperdense Middle Cerebral Artery Sign as a Function of Clinical Experience

    PubMed Central

    Aouad, Patrick; Hughes, Andrew; Neeman, Terry; Lueck, Christian J.

    2015-01-01

    Background/Aim The hyperdense middle cerebral artery sign (HMCAS) is a useful clinical sign in the management of acute stroke and may alter time-critical decisions within an emergency setting. Though gold standards have been published, these are rarely used in clinical practice and scans tend to be reported subjectively. It is therefore possible that the level of experience of the doctor reporting the scan may impact on the accuracy of the reporting and hence patient management. This study was designed to evaluate the accuracy in detecting HMCAS across doctors with varying levels of experience. Methods Forty doctors were recruited into four categories of experience. Each subject received a brief computer-based tutorial on how to identify an HMCAS and was then asked to report on the presence or absence of an HMCAS in 19 pre-prepared CT scans using a standardised viewing template. Results The mean (±SE) percentage correct scores increased with experience from 76.8 ± 3.69 among interns and residents to 90.1 ± 2.23 (neurologists and radiologists; p < 0.01). Sensitivity and specificity as well as positive and negative predictive values all increased with experience. In addition, more experienced clinicians were better able to distinguish scans which met the radiological criteria for HMCAS from those which only just failed to do so. Conclusions Experienced neurologists and radiologists consistently and accurately reported the presence or absence of HMCAS, whereas less experienced clinicians tended to over-report the presence of HMCAS. This may have implications for the acute management of thromboembolic stroke. PMID:25759709

  13. Amelioration of erectile dysfunction following a switch from carbamazepine to oxcarbazepine: recent clinical experience.

    PubMed

    Sachdeo, Rajesh; Sathyan, Revathi R

    2005-07-01

    Oxcarbazepine is an antiepileptic drug (AED) indicated for use as monotherapy and add-on therapy in adults and children 4 years of age and older. Despite being structurally related to carbamazepine, oxcarbazepine differs substantially in its pharmacokinetic and safety profile; oxcarbazepine has a much lower risk of pharmacokinetic drug-drug interactions than carbamazepine. Carbamazepine has also been shown to induce the hepatic synthesis of sex hormone-binding globulin, thus reducing free serum testosterone levels and possibly causing erectile dysfunction (ED) in some men; these effects have not been observed with oxcarbazepine. This paper provides a discussion of recent clinical experience with men who presented in private clinical practice with complaints of ED while being treated with carbamazepine for seizure disorders. The four illustrative case studies presented in this report suggest that switching AED treatment from carbamazepine to oxcarbazepine in men with epilepsy can reduce the ED side effects observed with carbamazepine. PMID:16004674

  14. Practical guide for implementing hybrid PET/MR clinical service: lessons learned from our experience

    PubMed Central

    Parikh, Nainesh; Friedman, Kent P.; Shah, Shetal N.; Chandarana, Hersh

    2015-01-01

    Positron emission tomography (PET) and magnetic resonance imaging, until recently, have been performed on separate PET and MR systems with varying temporal delay between the two acquisitions. The interpretation of these two separately acquired studies requires cognitive fusion by radiologists/nuclear medicine physicians or dedicated and challenging post-processing. Recent advances in hardware and software with introduction of hybrid PET/MR systems have made it possible to acquire the PET and MR images simultaneously or near simultaneously. This review article serves as a road-map for clinical implementation of hybrid PET/MR systems and briefly discusses hardware systems, the personnel needs, safety and quality issues, and reimbursement topics based on experience at NYU Langone Medical Center and Cleveland Clinic. PMID:25985966

  15. [Professor ZHENG Kuishan's experience in the clinical treatment of bi syndrome with acupuncture and moxibustion].

    PubMed

    Liu, Baohu; Zheng, Jiatai; Guo, Yongming

    2015-06-01

    Professor ZHENG Kuishan has been engaged in the education and clinical practice of acupuncture and moxibustion for over 60 years. Professor ZHENG is strict in scholarly research and exquisite in medical techniques and he is good at treatment of bi syndrome induced by invasion of wind, cold and damp with warming and, promoting therapy. He emphasizes on syndrome differentiation and acupoint combination and selects the accurate manipulations. Not only are the symptoms relieved apparently, but also the body state is improved. As a result, the primary and secondary are treated simultaneously. In the paper, professor ZHENG's experience is introduced in the treatment of bi syndrome in the aspects of theory, method, formula, acupoint and technique. And his clinical therapeutic approaches have been deeply analyzed. PMID:26480566

  16. Clinical research for older adults in rural areas: the MINDED study experience.

    PubMed

    Fougère, Bertrand; Aubertin-Leheudre, Mylène; Vellas, Bruno; Andrieu, Sandrine; Demougeot, Laurent; Cluzan, Céline; Cesari, Matteo

    2016-04-01

    Due to the growing need to make clinical decisions based on valid and objective scientific evidence, the number of randomized controlled trials (RCTs) has increased over the last three decades. Nevertheless, evidence-based medicine has still limited applicability in older adults, because they are often excluded from clinical trials. Evidence-based medicine is even more challenging in rural areas, as its remote environment provides additional barriers. Nevertheless, given the high prevalence of older adults living in rural settings, research in this type of environment has become crucial. This can only be accomplished by considering the multiple additional challenges of these regions. In this paper, we examine potential environmental, procedural, and participants' barriers to the management of a RCT in a rural area. Possible solutions and suggestions are provided based on our experience-from the Multidomain Intervention to preveNt Disability in ElDers (MINDED) project. PMID:26891623

  17. Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

    PubMed

    Hubbard, Grace B

    2016-04-01

    The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 54(4), 38-43.]. PMID:27042927

  18. Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences.

    PubMed

    Lounsbery, Jody L; Pereira, Chrystian R; Harris, Ila M; Moon, Jean Y; Westberg, Sarah M; Kolar, Claire

    2016-02-25

    Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students' competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs. PMID:26941440

  19. Tracking Patient Encounters and Clinical Skills to Determine Competency in Ambulatory Care Advanced Pharmacy Practice Experiences

    PubMed Central

    Pereira, Chrystian R.; Harris, Ila M.; Moon, Jean Y.; Westberg, Sarah M.; Kolar, Claire

    2016-01-01

    Objective. To determine if the amount of exposure to patient encounters and clinical skills correlates to student clinical competency on ambulatory care advanced pharmacy practice experiences (APPEs). Design. Students in ambulatory care APPEs tracked the number of patients encountered by medical condition and the number of patient care skills performed. At the end of the APPE, preceptors evaluated students’ competency for each medical condition and skill, referencing the Dreyfus model for skill acquisition. Assessment. Data was collected from September 2012 through August 2014. Forty-six responses from a student tracking tool were matched to preceptor ratings. Students rated as competent saw more patients and performed more skills overall. Preceptors noted minimal impact on workload. Conclusions. Increased exposure to patient encounters and skills performed had a positive association with higher Dreyfus stage, which may represent a starting point in the conversation for more thoughtful design of ambulatory care APPEs. PMID:26941440

  20. Performance, emotion work, and transition: challenging experiences of complementary therapy student practitioners commencing clinical practice.

    PubMed

    Fixsen, Alison; Ridge, Damien

    2012-09-01

    Few researchers have explored the clinical experiences of complementary and alternative medical practitioners and students, including the emotion work they perform. In this article, using a constant comparison approach and a heuristic framework (a dramaturgical perspective), we analyze semistructured interviews with 9 undergraduate practitioners in training to examine challenges experienced when students first attend to patients. A feature of students' learning about clinical work concerned performance in a public arena and associated demands placed on the inchoate practitioner. Preliminary patient consultations represented a dramatic rite of passage and initiation into a transitional phase in professional identity. Juggling the roles of student and practitioner within an observed consultation led to anticipatory anxiety, impression management strategies, and conflict with other individuals. Of the coping strategies, participants regarded sharing and feedback from peer groups as most effective in examining and resolving the challenges of becoming a practitioner. PMID:22715135

  1. The Usefulness of Systematic Reviews of Animal Experiments for the Design of Preclinical and Clinical Studies

    PubMed Central

    de Vries, Rob B. M.; Wever, Kimberley E.; Avey, Marc T.; Stephens, Martin L.; Sena, Emily S.; Leenaars, Marlies

    2014-01-01

    The question of how animal studies should be designed, conducted, and analyzed remains underexposed in societal debates on animal experimentation. This is not only a scientific but also a moral question. After all, if animal experiments are not appropriately designed, conducted, and analyzed, the results produced are unlikely to be reliable and the animals have in effect been wasted. In this article, we focus on one particular method to address this moral question, namely systematic reviews of previously performed animal experiments. We discuss how the design, conduct, and analysis of future (animal and human) experiments may be optimized through such systematic reviews. In particular, we illustrate how these reviews can help improve the methodological quality of animal experiments, make the choice of an animal model and the translation of animal data to the clinic more evidence-based, and implement the 3Rs. Moreover, we discuss which measures are being taken and which need to be taken in the future to ensure that systematic reviews will actually contribute to optimizing experimental design and thereby to meeting a necessary condition for making the use of animals in these experiments justified. PMID:25541545

  2. The usefulness of systematic reviews of animal experiments for the design of preclinical and clinical studies.

    PubMed

    de Vries, Rob B M; Wever, Kimberley E; Avey, Marc T; Stephens, Martin L; Sena, Emily S; Leenaars, Marlies

    2014-01-01

    The question of how animal studies should be designed, conducted, and analyzed remains underexposed in societal debates on animal experimentation. This is not only a scientific but also a moral question. After all, if animal experiments are not appropriately designed, conducted, and analyzed, the results produced are unlikely to be reliable and the animals have in effect been wasted. In this article, we focus on one particular method to address this moral question, namely systematic reviews of previously performed animal experiments. We discuss how the design, conduct, and analysis of future (animal and human) experiments may be optimized through such systematic reviews. In particular, we illustrate how these reviews can help improve the methodological quality of animal experiments, make the choice of an animal model and the translation of animal data to the clinic more evidence-based, and implement the 3Rs. Moreover, we discuss which measures are being taken and which need to be taken in the future to ensure that systematic reviews will actually contribute to optimizing experimental design and thereby to meeting a necessary condition for making the use of animals in these experiments justified. PMID:25541545

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

    PubMed Central

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

    2009-01-01

    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. PMID:19968016

  4. Converging on a richer understanding of human behavior and experience through a blending of cognitive and clinical psychology.

    PubMed

    Roskos-Ewoldsen, Beverly

    2006-03-01

    McClelland, Kemps, and Tiggemann's (this issue) use of experimental methods typically used in cognitive psychology to reduce the intensity of food cravings formed the basis for maintaining that an understanding of human experiences and behaviors requires a blending of cognitive and clinical psychological approaches. Clinical psychology can adapt cognitive models of information processing to understand the mechanisms underlying clinical phenomena and to create and evaluate effective interventions. Cognitive psychology should broaden its scope to include information relevant to clinical phenomena, such as desire, attitudes, self-regulation, and temperament. Only through a blending of these two fields will we converge on a richer understanding of human behavior and experience. PMID:16385539

  5. SU-E-T-385: 4D Radiobiology

    SciTech Connect

    Fourkal, E; Hossain, M; Veltchev, I; Ma, C; Meyer, J; Horwitz, E; Nahum, A

    2014-06-01

    Purpose: The linear-quadratic model is the most prevalent model for planning dose fractionation in radiation therapy in the low dose per fraction regimens. However for high-dose fractions, used in SRS/SBRT/HDR treatments the LQ model does not yield accurate predictions, due to neglecting the reduction in the number of sublethal lesions as a result of their conversion to lethal lesions with subsequent irradiation. Proper accounting for this reduction in the number of sublethally damaged lesions leads to the dependence of the survival fraction on the temporal structure of the dose. The main objective of this work is to show that the functional dependence of the dose rate on time in each voxel is an important additional factor that can significantly influence the TCP. Methods: Two SBRT lung plans have been used to calculate the TCPs for the same patient. One plan is a 3D conformal plan and the other is an IMRT plan. Both plans are normalized so that 99.5% of PTV volume receives the same prescription dose of 50 Gy in 5 fractions. The dose rate in each individual voxel is calculated as a function of treatment time and subsequently used in the calculation of TCP. Results: The calculated TCPs show that shorter delivery times lead to greater TCP, despite all delivery times being short compared to the repair half-time for sublethal lesions. Furthermore, calculated TCP(IMRT) =0.308 for the IMRT plan is smaller than TCP(3D) =0.425 for 3D conformal, even though it shows greater tumor hot spots and equal PTV coverage. The calculated TCPs are considerably lower compared to those based on the LQ model for which TCP=1 for both plans. Conclusion: The functional dependence of the voxel-by-voxel dose rate on time may be an important factor in predicting the treatment outcome and cannot be neglected in radiobiological modeling.

  6. Credentialing in carotid angiography and carotid angioplasty/stenting: experience of Mayo Clinic Rochester.

    PubMed

    Brown, Robert D; Sullivan, Timothy M

    2005-06-01

    Carotid angioplasty and stenting is an evolving technique in the treatment of patients with carotid occlusive disease who are at increased risk for carotid endarterectomy. The literature has largely focused on the short and long-term results of this novel procedure. Due to the involvement of multiple disciplines, all of whom have legitimate claims to the carotid territory, credentialing has been a contentious issue at the local hospital level. This article describes the experience of Mayo Clinic Rochester in developing, in a multi-disciplinary manner, documents for credentialing in carotid angiography, carotid intervention, and guidelines for the use of this novel procedure. PMID:15986329

  7. Sexual harassment: four women describe their experiences--background and implications for the clinical nurse specialist.

    PubMed

    Hoyer, A

    1994-06-01

    Sexual harassment is receiving attention as women take a more prominent place in the workforce and academia. This article reviews the legal history and definition of sexual harassment, as well as contributing social factors. Interviews with four women victims describe the trauma of harassment and its deleterious effects. In addition, the women's reactions show how these cumulative effects may result in post-traumatic stress disorder. Experts in sexual harassment education, training, litigation, and dispute resolution comment on their experience in the field. The article proposes clinical nurse specialist role opportunities in the prevention and amelioration of sexual harassment. PMID:8080306

  8. Beyond a diagnosis: The experience of depression among clinically-referred adolescents.

    PubMed

    Midgley, Nick; Parkinson, Sally; Holmes, Josh; Stapley, Emily; Eatough, Virginia; Target, Mary

    2015-10-01

    Policy-makers have identified an urgent need to improve our ability to detect and diagnose depression in adolescents. This study aims to explore the lived experience of depression in clinically referred adolescents. 77 adolescents, aged between 11 and 17 with moderate to severe depression, were interviewed as part of a randomised controlled trial, using the Expectations of Therapy Interview. Data were analysed qualitatively using framework analysis, with a focus on how the adolescents spoke about their depression. The study identified five themes: 1) Misery, despair and tears; 2) Anger and violence towards self and others; 3) A bleak view of everything; 4) Isolation and cutting off from the world; and 5) The impact on education. Researchers and policy-makers need to develop an understanding of depression grounded in the experiences of adolescents to improve detection and diagnosis of depression. PMID:26325067

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

    PubMed

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

    2012-08-01

    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

  10. The Subjective Experience of Youths at Clinical High Risk for Psychosis: A Qualitative Study

    PubMed Central

    Ben-David, Shelly; Birnbaum, Michael; Eilenberg, Mara; DeVylder, Jordan; Gill, Kelly; Schienle, Jessica; Azimov, Neyra; Lukens, Ellen P.; Davidson, Larry; Corcoran, Cheryl Mary

    2015-01-01

    Objective Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. Methods Audiotaped interviews were conducted with 27 participants at clinical high risk (CHR) for psychosis (15 males; 12 females; mean age 21; ethnically diverse). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. Results Emergent themes differed by gender. Themes for males were feeling abnormal or “broken”; focus on going “crazy”; fantasy and escapism; and alienation and despair, with a desire for relationships. Themes for females were psychotic illness in family members; personal trauma; struggle with intimate relationships; and career and personal development. Conclusions The finding of relative social engagement and future-orientation of females identified as at risk for psychosis is novel, and has implications for outreach and treatment. PMID:25179420

  11. Clinical Experience in Using the Water Jet in Burn Wound Debridement

    PubMed Central

    Yang, J.-Y.; Hwuang, J.-Y.; Chuang, S.-S.

    2007-01-01

    Summary Water jets have been used in many areas of surgery. Recently a new surgical debridement device was launched onto the market - VersajetTM. VersajetTM is a unique hydrosurgical device that uses a precise jet of water to simultaneously hold, cut, and remove devitalized or necrotic tissue. This paper describes our experience with ten patients comparing Weck knives with the newly designed hydrosurgical device when debriding burn wounds. The patients' age ranged from 27 to 60 yr (average, 37.8 yr) and the burn wounds treated were between 3 and 7% total body surface area, involving the face, abdomen, and limbs. The hydrosurgical system is a very useful tool for irregular and complex burn wound debridement. This paper represents the first written clinical experience utilizing hydrosurgery in the burn wound management in an Eastern country. PMID:21991073

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

    PubMed

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

    2009-11-01

    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

  13. Clinical analysis on anti-N-methyl-D-aspartate receptor encephalitis cases: Chinese experience

    PubMed Central

    Huang, Xiaoqin; Fan, Chunqiu; Wu, Jian; Ye, Jing; Zhan, Shuqin; Song, Haiqing; Liu, Aihua; Su, Yingying; Jia, Jianping

    2015-01-01

    As a kind of autoimmune encephalitis which was just identified, the clinical manifestations of the anti-N methyl-D aspartate (anti-NMDA) receptor encephalitis are complex, diverse and in severe condition. The immunotherapy has shown good effect on the treatment but in generally, the diagnosis and treatment are still in the experience accumulation stage. More clinical research in different population is necessary, for example, in the Chinese population. This study was completed in anti-NMDA receptor encephalitis patients who were diagnosed in Beijing Xuan Wu Hospital (China) during the time from 2011 to 2013. Total 33 patients were involved with the average age of 29.7 years old when the diseases were onset. With diverse clinical manifestations, most patients displayed positively by NMDAR antibody test and 63.6% of them were associated with elevated CSF-lgA. Patients also showed abnormal MRI and EEG. Only three patients had teratomas. With hormone therapy, gamma globulin treatment or plasma exchange, more than three quarters of patients fully recovered and the others had moderate symptoms. Based on our results, we suggest that NMDAR antibody test would be helpful to make a timely diagnosis and to administer immunotherapy. PMID:26770517

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

    PubMed

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

    2013-10-01

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

  15. Clinical Experiences of Korean Medicine Treatment against Urinary Bladder Cancer in General Practice

    PubMed Central

    Park, Taeyeol; Lee, Sanghun

    2016-01-01

    Urinary bladder cancer (UBC) is one of the most common cancers, with 1 out of every 26 men and 1 out of every 80 women worldwide developing the disease during their lifetime. Moreover, it is a disease that predominantly affects the elderly and is becoming a major health problem as the elderly population continues to rapidly increase. In spite of the rapid development of medical science, the 5-year survival rate has remained around 75% since the 1990s, and the FDA has approved no new drugs for UBC over the last 10 years. In addition, most patients experience frequent recurrence and poor quality of life after diagnosis. Therefore, in order to solve unmet needs by alternative methods, we present our clinical cases of UBC where we observed outstanding results including regression and recurrence prevention exclusively through Traditional Korean Medicine such as (1) herbal therapy, (2) acupuncture, (3) pharmacopuncture and needle-embedding therapy, (4) moxibustion, and (5) cupping therapy. From our experience, it appears that multimodal strategies for synergistic efficiency are more effective than single Korean Medicine treatment. We hope this will encourage investigation of the efficacy of Korean Medicine treatment in clinical trials for UBC patients. PMID:27190532

  16. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

    PubMed Central

    Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

    2015-01-01

    Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. PMID:25834455

  17. The disclosure of dyslexia in clinical practice: experiences of student nurses in the United Kingdom.

    PubMed

    Morris, David K; Turnbull, Patricia A

    2007-01-01

    Heightened awareness and increasingly sophisticated psychological tests have seen a dramatic rise in the numbers of people diagnosed with dyslexia. Accordingly, there is a reported increase in the numbers of students with dyslexia entering Higher Education (HE) in the United Kingdom (UK) [Singleton, C.H., Chair, 1999. Dyslexia in higher education: policy, provision and practice. Report of the national working party on dyslexia in higher education. University of Hull on behalf of the Higher Education Funding Councils of England and Scotland, Hull], [Higher Education Statistics Agency. HESA. Available from: (accessed 21.12.05)]. Studies researching the effects of dyslexia on the clinical practice of nurses are almost non-existent. This paper reports part of a UK study exploring the clinical experiences of student nurses with dyslexia. In depth interviewing of 18 adult branch student nurses revealed a range of difficulties encountered and a variety of coping mechanisms to manage these. Other than in exceptional circumstances there is no legal requirement to disclose a dyslexia diagnosis. The decision to conceal or disclose their dyslexia was particularly prominent and contentious for these participants. This related to the attitudes of co-workers, concerns for patient safety, expectations of support, confidentiality issues and potential discrimination. Dyslexia continues to attract an unwarranted stigma and can adversely affect the learning experience. The need for disability awareness training in the workplace and improved education/service partnerships to support these students is considered crucial. PMID:16624451

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

    PubMed

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

    2014-08-01

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

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

    PubMed

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

    2013-06-01

    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

  20. Insights on GRACE (Gender, Race, And Clinical Experience) from the Patient's Perspective: GRACE Participant Survey

    PubMed Central

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

    2013-01-01

    Abstract 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

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

    PubMed

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

    2012-05-01

    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

  2. Assessing decentering: validation, psychometric properties, and clinical usefulness of the Experiences Questionnaire in a Spanish sample.

    PubMed

    Soler, Joaquim; Franquesa, Alba; Feliu-Soler, Albert; Cebolla, Ausias; García-Campayo, Javier; Tejedor, Rosa; Demarzo, Marcelo; Baños, Rosa; Pascual, Juan Carlos; Portella, Maria J

    2014-11-01

    Decentering is defined as the ability to observe one's thoughts and feelings in a detached manner. The Experiences Questionnaire (EQ) is a self-report instrument that originally assessed decentering and rumination. The purpose of this study was to evaluate the psychometric properties of the Spanish version of EQ-Decentering and to explore its clinical usefulness. The 11-item EQ-Decentering subscale was translated into Spanish and psychometric properties were examined in a sample of 921 adult individuals, 231 with psychiatric disorders and 690 without. The subsample of nonpsychiatric participants was also split according to their previous meditative experience (meditative participants, n=341; and nonmeditative participants, n=349). Additionally, differences among these three subgroups were explored to determine clinical validity of the scale. Finally, EQ-Decentering was administered twice in a group of borderline personality disorder, before and after a 10-week mindfulness intervention. Confirmatory factor analysis indicated acceptable model fit, sbχ(2)=243.8836 (p<.001), CFI=.939, GFI=.936, SRMR=.040, and RMSEA=.06 (.060-.077), and psychometric properties were found to be satisfactory (reliability: Cronbach's α=.893; convergent validity: r>.46; and divergent validity: r<-.35). The scale detected changes in decentering after a 10-session intervention in mindfulness (t=-4.692, p<.00001). Differences among groups were significant (F=134.8, p<.000001), where psychiatric participants showed the lowest scores compared to nonpsychiatric meditative and nonmeditative participants. The Spanish version of the EQ-Decentering is a valid and reliable instrument to assess decentering either in clinical and nonclinical samples. In addition, the findings show that EQ-Decentering seems an adequate outcome instrument to detect changes after mindfulness-based interventions. PMID:25311294

  3. Critical periods after stroke study: translating animal stroke recovery experiments into a clinical trial

    PubMed Central

    Dromerick, Alexander W.; Edwardson, Matthew A.; Edwards, Dorothy F.; Giannetti, Margot L.; Barth, Jessica; Brady, Kathaleen P.; Chan, Evan; Tan, Ming T.; Tamboli, Irfan; Chia, Ruth; Orquiza, Michael; Padilla, Robert M.; Cheema, Amrita K.; Mapstone, Mark E.; Fiandaca, Massimo S.; Federoff, Howard J.; Newport, Elissa L.

    2015-01-01

    Introduction: Seven hundred ninety-five thousand Americans will have a stroke this year, and half will have a chronic hemiparesis. Substantial animal literature suggests that the mammalian brain has much potential to recover from acute injury using mechanisms of neuroplasticity, and that these mechanisms can be accessed using training paradigms and neurotransmitter manipulation. However, most of these findings have not been tested or confirmed in the rehabilitation setting, in large part because of the challenges in translating a conceptually straightforward laboratory experiment into a meaningful and rigorous clinical trial in humans. Through presentation of methods for a Phase II trial, we discuss these issues and describe our approach. Methods: In rodents there is compelling evidence for timing effects in rehabilitation; motor training delivered at certain times after stroke may be more effective than the same training delivered earlier or later, suggesting that there is a critical or sensitive period for strongest rehabilitation training effects. If analogous critical/sensitive periods can be identified after human stroke, then existing clinical resources can be better utilized to promote recovery. The Critical Periods after Stroke Study (CPASS) is a phase II randomized, controlled trial designed to explore whether such a sensitive period exists. We will randomize 64 persons to receive an additional 20 h of upper extremity therapy either immediately upon rehab admission, 2–3 months after stroke onset, 6 months after onset, or to an observation-only control group. The primary outcome measure will be the Action Research Arm Test (ARAT) at 1 year. Blood will be drawn at up to 3 time points for later biomarker studies. Conclusion: CPASS is an example of the translation of rodent motor recovery experiments into the clinical setting; data obtained from this single site randomized controlled trial will be used to finalize the design of a Phase III trial. PMID:25972803

  4. The need for oncogenetic counselling. Ten years' experience of a regional oncogenetic clinic.

    PubMed

    Henriksson, Karin; Olsson, Hkan; Kristoffersson, Ulf

    2004-01-01

    A monogenic inheritance, mainly seen as a dominant pattern, accounts for 5-10% of all cancer cases. The increased knowledge and identification of high-risk genes have led to a need for specialized cancer family clinic was the expression used by Eeles and Murday. The Oncogenetic Clinic at the University Hospital in Lund was started in 1993 and the authors' 10-year experience is summarized in this paper. The clinic offers service to the South Swedish Health Care Region comprising a total of 1.6 million inhabitants. During these first 10 years a total of 1059 individuals from 789 families have been individually counselled. The most common reason for referral was a family history of breast cancer, followed by a family history of colorectal cancer. According to the commonly used criteria, 437 (55%) of the families were considered as autosomal dominantly inherited; 147 families (19%) did not fulfil these criteria but had a strong clustering of breast/ovarian or colorectal/endometrial cancer. The remaining 205 families (26%) were not recognized as any previously described hereditary cancer syndrome with early onset. However, most of these families had a family history of cancer. Mutation analysis was performed in 386/789 (49%) of the families. In families with breast and ovarian cancer a genetic aberration was identified in 45/76 (59%) and in breast-only families in 27/129 (21%). In MSI-positive colon cancer families 16/34 (47%) of the families had a germline mutation. Thus, the majority of the families referred to the clinic were in obvious need of genetic counselling concerning cancer and heredity and in a substantial number of the families a germline mutation could be identified. PMID:15545184

  5. Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates

    PubMed Central

    Doherty, Jane; Conco, Daphney; Couper, Ian; Fonn, Sharon

    2013-01-01

    Background Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008. Objective We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker. Methods We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed. Results Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards. Conclusions This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives. PMID:23364079

  6. SU-E-T-344: Validation and Clinical Experience of Eclipse Electron Monte Carlo Algorithm (EMC)

    SciTech Connect

    Pokharel, S; Rana, S

    2014-06-01

    Purpose: The purpose of this study is to validate Eclipse Electron Monte Carlo (Algorithm for routine clinical uses. Methods: The PTW inhomogeneity phantom (T40037) with different combination of heterogeneous slabs has been CT-scanned with Philips Brilliance 16 slice scanner. The phantom contains blocks of Rando Alderson materials mimicking lung, Polystyrene (Tissue), PTFE (Bone) and PMAA. The phantom has 30×30×2.5 cm base plate with 2cm recesses to insert inhomogeneity. The detector systems used in this study are diode, tlds and Gafchromic EBT2 films. The diode and tlds were included in CT scans. The CT sets are transferred to Eclipse treatment planning system. Several plans have been created with Eclipse Monte Carlo (EMC) algorithm 11.0.21. Measurements have been carried out in Varian TrueBeam machine for energy from 6–22mev. Results: The measured and calculated doses agreed very well for tissue like media. The agreement was reasonably okay for the presence of lung inhomogeneity. The point dose agreement was within 3.5% and Gamma passing rate at 3%/3mm was greater than 93% except for 6Mev(85%). The disagreement can reach as high as 10% in the presence of bone inhomogeneity. This is due to eclipse reporting dose to the medium as opposed to the dose to the water as in conventional calculation engines. Conclusion: Care must be taken when using Varian Eclipse EMC algorithm for dose calculation for routine clinical uses. The algorithm dose not report dose to water in which most of the clinical experiences are based on rather it just reports dose to medium directly. In the presence of inhomogeneity such as bone, the dose discrepancy can be as high as 10% or even more depending on the location of normalization point or volume. As Radiation oncology as an empirical science, care must be taken before using EMC reported monitor units for clinical uses.

  7. Fetoscopic surgery: encouraged by clinical experience and boosted by instrument innovation.

    PubMed

    Deprest, Jan; Jani, Jacques; Lewi, Liesbeth; Ochsenbein-Klble, Nicole; Cannie, Mieke; Don, Elisa; Roubliova, Xenia; Van Mieghem, Tim; Debeer, Anne; Debuck, Frederik; Sbragia, Laureno; Toelen, Jaan; Devlieger, Roland; Lewi, Paul; Van de Velde, Marc

    2006-12-01

    Today, modern ultrasound equipment and the wide implementation of screening programmes allow the timely diagnosis of many congenital anomalies. For some of these, fetal surgery may be a life-saving option. In Europe, open fetal surgery became poorly accepted because of its invasiveness and the high incidence of postoperative premature labour and rupture of the fetal membranes. In the 1990s, the merger of fetoscopy and advanced video-endoscopic surgery formed the basis for endoscopic fetal surgery. We review the current applications of fetal surgery via both methods of access. The first clinical fetoscopic surgeries were interventions on the umbilical cord and the placenta, often referred to as obstetrical endoscopy. The outcome of a randomized clinical trial demonstrating that fetoscopic laser coagulation of chorionic plate vessels is the most effective treatment for twin-twin transfusion syndrome (TTTS) has revived interest in endoscopic fetal therapy. Operating on the fetus is another more challenging enterprise. Clinical fetal surgery programmes were virtually non-existent in Europe until minimally invasive fetoscopic surgery made such operations clinically possible as well as maternally acceptable. At present, most experience has been gathered with fetal tracheal occlusion as a therapy for severe congenital diaphragmatic hernia. As in other fields, minimally invasive surgery has pushed back boundaries and now allows safe operations to be performed on the fetal patient. Whereas minimal access seems to solve the problem of preterm labour, all procedures remain invasive, and carry a risk to the mother and a substantial risk of preterm prelabour rupture of the membranes (PPROM). The latter problem may prove to be a bottleneck for further developments, although treatment modalities are currently being evaluated. PMID:17056307

  8. The importance of clinical experience for mental health nursing - part 2: relationships between undergraduate nursing students' attitudes, preparedness, and satisfaction.

    PubMed

    Happell, Brenda

    2008-10-01

    Clinical experience is consistently emphasized in research findings as the primary influence in encouraging more positive attitudes to mental health nursing. The available research, however, presents two major limitations. First, it does not measure the specific factors that might contribute to a positive clinical experience. Second, it does not consider the relationship between clinical experience and attitudes towards people experiencing a mental illness or towards mental health nursing. This is the second of a two-part paper presenting findings from a statewide survey of undergraduate nursing students in Victoria. A pre-/post-test design was used to measure the impact of clinical experience on the following subscales: (i) attitudes towards people experiencing a mental illness; (ii) attitudes toward mental health nursing; and (iii) preparedness for mental health practice. Subscale (iv) satisfaction with clinical experience was also measured in the post-test phase. The findings demonstrated an improvement on all three subscales in the post-test phase and a high level of satisfaction with clinical experience. Furthermore, a relationship between all four subscales was evident. PMID:18789043

  9. The principles of Katz's cellular track structure radiobiological model.

    PubMed

    Waligórski, M P R; Grzanka, L; Korcyl, M

    2015-09-01

    The cellular track structure theory (TST), introduced by Katz in 1968, applies the concept of action cross section as the probability of targets in the radiation detector being activated to elicit the observed endpoint (e.g. cell killing). The ion beam radiation field is specified by the charge Z, speed β (or energy), fluence and linear energy transfer (LET) of the ion, rather than by its total absorbed dose or dose-averaged LET. The detector is represented by radiosensitive elements of size a0 and radiosensitivity D0, its gamma-ray response being represented by c-hit or multi-target expressions rather than by the linear-quadratic formula. Key to TST is the Dδ(r) formula describing the radial distribution of delta-ray dose (RDD) around the ion path. This formula, when folded with the dose response of the detector and radially integrated, yields the 'point target' action cross section value, σPT. The averaged value of the cross section, σ, is obtained by radially integrating the a0-averaged RDD. In the 'track width' regime which may occur at the distal end of the ion's path, the value of σ may considerably exceed its geometrical value, [Formula: see text]. Several scaling principles are applied in TST, resulting in its simple analytic formulation. Multi-target detectors, such as cells, are represented in TST by m, D0, σ0 (the 'saturation value' of the cross section which replaces a0) and κ (a 'detector saturation index'), as the fourth model parameter. With increasing LET of the ion, the two-component formulation of TST allows for successive transition from shouldered survival curves at low LET values to exponential ones at radiobiological effectiveness (RBE) maximum, followed by 'thindown' at the end of the ion track. For a given cell line, having best-fitted the four model parameters (m, D0, σ0 and κ) to an available data set of measured survival curves, TST is able to quantitatively predict cell survival and RBE for this cell line after any other ion irradiation. PMID:25904694

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

    PubMed

    Lindop, E; Cannon, S

    2001-06-01

    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

  11. Effect of dentist's clinical experience on treatment satisfaction of a complete denture.

    PubMed

    Kimoto, S; Kimoto, K; Kitamura, A; Saita, M; Iijima, M; Kawai, Y

    2013-12-01

    The relationship between the prosthodontic experience of dentists and satisfaction of complete denture wearers remains unknown. To investigate whether a prosthodontist's clinical experience affects treatment satisfaction of a complete denture wearer. From April 2004 to July 2006, we conducted a randomised controlled trial at two centres, including 74 edentulous patients; of these, 32 and 30 were randomly allocated to the ED or ID group, respectively. All the patients rated their satisfaction with dentures, including general satisfaction and satisfaction of chewing ability, speaking, cleaning, stability, retention, comfort and aesthetics. These satisfaction ratings were measured by a 100-mm visual analog scale (VAS). Perceived chewing ability to foods, divided into five grades, was measured using a questionnaire. The mastication index (MI) was calculated for each grade. General satisfaction and satisfaction of speaking, stability and retention were significantly higher in the ED than in the ID group (P = 0·049, 0·003, 0·019 and 0·041, respectively). No significant difference existed between the MI of the ED (71·3 ± 18·4) and ID group (64·1 ± 16·53). However, the perceived chewing ability of grade 5 food, whose texture was the hardest among all the grades, was significantly higher in the ED group than in the ID group. Within its limitations, this study showed that a clinician's prosthodontic experience affects a complete denture wearer's satisfaction ratings. PMID:24237360

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

    PubMed Central

    Cafiero, Madeline

    2013-01-01

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

  13. Clinical Audits in a Postgraduate General Practice Training Program: An Evaluation of 8 Years' Experience

    PubMed Central

    Al-Baho, Abeer; Serour, Maleka; Al-Weqayyn, Adnan; AlHilali, Mohammed; Sadek, Ali A. A.

    2012-01-01

    Background Clinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP) in Kuwait. This study was undertaken to draw a picture of trainees' understanding of the audit project with attention to the knowledge of audit theory and its educational significance and scrutinize the difficulties confronted during the experience. Methodology/Principal Findings The materials included the records of 133 audits carried out by trainees and 165 post course questionnaires carried out between 2004 and 2011. They were reviewed and analyzed. The majority of audit projects were performed on diabetic (44.4%) and hypertensive (38.3%) care. Regarding audits done on diabetic care, they were carried out to assess doctors' awareness about screening for smoking status (8.6%), microalbuminuria (19.3%), hemoglobin A1c (15.5%), retinopathy (10.3%), dyslipidemia (15.8%), peripheral neuropathy (8.8%), and other problems (21.7%). As for audits concerning hypertensive care, they were carried out to assess doctors' awareness about screening for smoking status (38.0%), obesity (26.0%), dyslipidemia (12.0%), microalbuminuria (10.0%) and other problems (14.0%). More than half the participants (68.48%) who attended the audit course stated that they ‘definitely agreed’ about understanding the meaning of clinical audit. Most of them (75.8%) ‘definitely agreed’ about realizing the importance of clinical audit in improving patients' care. About half (49.7%) of them ‘agreed’ that they can distinguish between ‘criteria’ and ‘standards’. Conclusion The eight years of experience were beneficial. Trainees showed a good understanding of the idea behind auditing the services provided. They demonstrated their ability to improve the care given in health centers in which these projects were undertaken. PMID:22970146

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

    PubMed

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

    2011-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Wang, Rui-Zhong; Wang, Zhen-he; Lu, Kuang-sheng; Yang, Xiao-zhi; Lu, Bo-kao

    1991-07-01

    This paper is to report and analyze our clinical experience in ap].ying endosoopi. c Nd:YAG laser to treat 451 esophagostenoses (1197 peraon times) including all kinds of then. All kinds of esophagostexiosis were mainly characterized by having difficulties swallowing foods. Some of their esophagus were even oompletely obstructed and could not drink even a drop of water On the basis of experint&xts in animals, fresh organs of the body, we started to treat all kinds of esophagostenosis with endoscopio Nd:YAG laser in 1985. By the end of 1989, 451 patients bad been treated in our hospital. Boh the patients and we felt satisfactory with the results we gain.

  16. Diabetes Management in End of Life: A Preliminary Report Stemming From Clinical Experience.

    PubMed

    Dionisio, R; Giardini, A; De Cata, P; Pirali, B; Rossi, S; Negri, E M; Ferrari, P; Preti, P

    2015-09-01

    The increasing coexistence of cancer and diabetes within the elderly population requires specific palliative care skills on diabetes treatment. We report our experience of diabetes management in a palliative care setting. In our retrospective 3-year activity sample (n = 563), 27.2% of patients have a diagnosis of diabetes mellitus: 80% have cancer whereas 20% have a main diagnosis of other severe chronic diseases. As to the presence/absence of diabetes, no differences emerge in the examined clinical indicators and global survival, with the exception of body mass index and days of hospitalization. At lifetime analysis, Barthel index and palliative prognostic index are the only parameters significantly related to death. Even if diabetes seems not to modify the prognosis, it significantly influences the health care burden and the team engagement. PMID:24782575

  17. Clinical Experiences With Clients Who Are Low-Income: Mental Health Practitioners' Perspectives.

    PubMed

    Thompson, Mindi N; Nitzarim, Rachel S; Cole, Odessa D; Frost, Nickholas D; Ramirez Stege, Alyssa; Vue, Pa Tou

    2015-12-01

    The experiences of nine licensed mental health practitioners regarding their work with clients from low-income backgrounds were examined utilizing grounded theory methodology. Themes that emerged from the semi-structured interviews highlighted a rich narrative that portrayed the work as both deeply satisfying and inherently complex. Participants described the personal nature of this work, including countertransference elicited because of their own personal economic contexts and emotional reactions experienced within and outside the therapy room. Their stories acknowledged systematic challenges that act as barriers to treatment. Some participants noted that this has contributed to feelings of disillusionment toward the field as well as fears about the future of the mental health care. Based on these findings, we discuss implications for training, future research, and clinical practice. PMID:25583959

  18. [FlU Zhonghua's clinical experience of Fu's subcutaneous needling for cervical spondylosis].

    PubMed

    Zhong, Minying; Zhang, Xiyu

    2015-08-01

    Professor FU Zhonghua's unique clinical experience of Fu's subcutaneous needling (FSN) for cervical spondylosis (CS) is discussed in this paper, which is analyzed from the aspects of recognition of CS pathogenesis, treatment mechanism of FSN, advantage indications of FSN for CS and examples of medical cases. Professor FU introduced the theory of myofascial trigger points (MTrP) into the field of the management of CS. The site of neck MTrP should be carefully examined, and FSN needles for single use are used to sweep the affected area or subcutaneous layer of adjacent upper limb. This method can rapidly improve ischemia and hypoxia state of the relevant muscles and prompt the self-recovery of neck muscles. During FSN treatment, reperfusion approach is recommended to adopt to improve the qi and blood circulation and recovery of neck function. PMID:26571902

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

    PubMed Central

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

    2007-01-01

    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. PMID:18693855

  20. Clinical and human resource planning for the downsizing of psychiatric hospitals: the British Columbia experience.

    PubMed

    Macfarlane, D; Fortin, P; Fox, J; Gundry, S; Oshry, J; Warren, E

    1997-01-01

    Riverview Hospital, B.C.'s only and Canada's largest remaining provincial psychiatric hospital began a formal planned "downsizing" process in 1992. This initiative was an important element in the Province's strategic plan to shift to a more community-focused mental health system and to bring tertiary psychiatric services "closer to home" by redeveloping Riverview Hospital on three sites. The paper summarizes the literature pertaining to the "downsizing" of psychiatric hospital services in relation both to clinical and human resource planning. It describes the mental health system in B.C. and the service system context in which this exercise is occurring. It is based on the first three years of experience in identifying the major challenges and the strategies developed to meet these challenges. It draws some conclusions about the effectiveness of these strategies and it speculates about the likely future challenges as the "downsizing" process continues. PMID:9021839

  1. Clinical Experience with Daptomycin for the Treatment of Gram-positive Infections in Children and Adolescents

    PubMed Central

    Syriopoulou, Vassiliki; Dailiana, Zoe; Dmitriy, Nisichenko; Utili, Riccardo; Pathan, Rashidkhan

    2016-01-01

    Background: This subgroup analysis of the European Cubicin Outcomes Registry Experience evaluated the safety and effectiveness of daptomycin in children and adolescent patients (<18 years). Methods: Clinical outcomes at the end of therapy were assessed as success (cured or improved), failure or nonevaluable. Safety was assessed for up to 30 days post treatment. Results: Eighty-one children and adolescent patients were included in this study. The most common primary infections were bacteremia (19.8%), complicated skin and soft-tissue infection (18.5%), osteomyelitis (13.6%), endocarditis (12.3%), foreign body/prosthetic infection (12.3%), uncomplicated skin and soft-tissue infection (9.9%) and other (13.6%). Daptomycin doses ranged from 4 to >10 mg/kg/day. Median duration of therapy was 12.5 (interquartile range, 7–25; mean, 16.7; standard deviation, 12.8) days. Staphylococcus aureus (46.7%) was the most commonly isolated pathogen (23.8% methicillin-resistant S. aureus). Forty-nine (60.5%) patients completed daptomycin therapy without further antibiotics, 27 (33.3%) switched to another antibiotic, 4 (4.9%) discontinued because of adverse events (AEs) and 1 (1.2%) discontinued because of other reason. Overall, 75 (92.6%; 95% confidence interval: 95.2–100.0%) patients achieved clinical success; 39 of 41 (95.1%) patients receiving daptomycin monotherapy and 36 of 40 (90.0%) patients receiving concomitant antibiotics. Six (7.4%) patients reported AEs, including 1 patient with increased blood creatine phosphokinase. Three (3.7%) patients had serious AEs; 1 (1.2%) had a serious AE possibly related to daptomycin. Conclusion: Daptomycin, alone or combined with other antibiotics and/or surgery, demonstrated high clinical success rates against a wide variety of infections and was well tolerated in children and adolescents. PMID:26849158

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

    PubMed Central

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

    2010-01-01

    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. PMID:20379473

  3. Clinical results with Jarvik 2000 axial flow left ventricular assist device: Osaka University Experience.

    PubMed

    Yoshioka, Daisuke; Matsumiya, Goro; Toda, Koichi; Sakaguchi, Taichi; Yoshikawa, Yasushi; Saito, Shunsuke; Matsuda, Hikaru; Sawa, Yoshiki

    2014-12-01

    The aim of this study was to evaluate our clinical experience with the Jarvik 2000 axial flow pump (Jarvik Heart, Inc, New York, NY, USA), a miniature axial flow left ventricular assist device (LVAD). The clinical results of eight patients, who underwent LVAD implantation with the Jarvik 2000 (median age 55.0 years; six men) between 2005 and 2010, including two who participated in a multicenter clinical trial in Japan, were reviewed. Two patients underwent LVAD implantation as destination therapy. Four patients underwent Jarvik 2000 implantation via median sternotomy, while the other four underwent implantation via left thoracotomy. There were no major complications during surgery. Four patients were supported for more than 2 years. The longest support duration was 1,618 days. Six patients successfully bridged to heart transplantation after a median 725 days of support. One patient on destination therapy died of a cerebral infarction. The other patient on destination therapy had had the LVAD for 1,618 days. The overall survival rates at 1, 2, and 3 years were 100, 86, and 86%, respectively. The median postoperative serum lactate dehydrogenase level was 860.5 U/L at 1 month, 735 U/L at 6 months, and 692 U/L at 1 year. There were no fatal device-related infections. We found that the Jarvik 2000 with pin bearing could support patients with end-stage heart failure with acceptable mortality and morbidity rates. Further evaluations of the prevalence of thromboembolic and hemolytic events in patients with the new conical-bearing Jarvik 2000 are required. PMID:25048655

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

    PubMed Central

    Žilina, Olga; Teek, Rita; Tammur, Pille; Kuuse, Kati; Yakoreva, Maria; Vaidla, Eve; Mölter-Väär, Triin; Reimand, Tiia; Kurg, Ants; Õunap, Katrin

    2014-01-01

    Chromosomal microarray analysis (CMA) is now established as the first-tier cytogenetic diagnostic test for fast and accurate detection of chromosomal abnormalities in patients with developmental delay/intellectual disability (DD/ID), multiple congenital anomalies (MCA), and autism spectrum disorders (ASD). We present our experience with using CMA for postnatal and prenatal diagnosis in Estonian patients during 2009–2012. Since 2011, CMA is on the official service list of the Estonian Health Insurance Fund and is performed as the first-tier cytogenetic test for patients with DD/ID, MCA or ASD. A total of 1191 patients were analyzed, including postnatal (1072 [90%] patients and 59 [5%] family members) and prenatal referrals (60 [5%] fetuses). Abnormal results were reported in 298 (25%) patients, with a total of 351 findings (1–3 per individual): 147 (42%) deletions, 106 (30%) duplications, 89 (25%) long contiguous stretches of homozygosity (LCSH) events (>5 Mb), and nine (3%) aneuploidies. Of all findings, 143 (41%) were defined as pathogenic or likely pathogenic; for another 143 findings (41%), most of which were LCSH, the clinical significance remained unknown, while 61 (18%) reported findings can now be reclassified as benign or likely benign. Clinically relevant findings were detected in 126 (11%) patients. However, the proportion of variants of unknown clinical significance was quite high (41% of all findings). It seems that our ability to detect chromosomal abnormalities has far outpaced our ability to understand their role in disease. Thus, the interpretation of CMA findings remains a rather difficult task requiring a close collaboration between clinicians and cytogeneticists. PMID:24689080

  5. Radiobiological effects of heavy ions and protons. [on cells of mammals, bacteria and viruses

    NASA Technical Reports Server (NTRS)

    Ryzhov, N. I.; Vorozhtsova, S. V.; Krasavin, Y. A.; Mashinskaya, T. Y.; Savchenko, N. Y.; Fedorov, B. S.; Khlaponina, V. F.; Shelegedin, V. N.; Gut, L.; Sabo, L.

    1974-01-01

    Radiobiological effects of heavy ions and protons are studied on cells of mammals, bacteria, viruses and DNA of bacteria. Results show that the dose effect dependence bears an exponential character; the reduction of RBE as LET of particle increases reflects the different character of microdistribution of absorbed energy in biological objects with different levels of biological organization.

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

    PubMed Central

    Uzan, J; Nahum, A E

    2012-01-01

    Objective Radiobiological models provide a means of evaluating treatment plans. Keeping in mind their inherent limitations, they can also be used prospectively to design new treatment strategies which maximise therapeutic ratio. We propose here a new method to customise fractionation and prescription dose. Methods To illustrate our new approach, two non-small cell lung cancer treatment plans and one prostate plan from our archive are analysed using the in-house software tool BioSuite. BioSuite computes normal tissue complication probability and tumour control probability using various radiobiological models and can suggest radiobiologically optimal prescription doses and fractionation schemes with limited toxicity. Results Dose–response curves present varied aspects depending on the nature of each case. The optimisation process suggests doses and fractionation schemes differing from the original ones. Patterns of optimisation depend on the degree of conformality, the behaviour of the normal tissue (i.e. “serial” or “parallel”), the volume of the tumour and the parameters of clonogen proliferation. Conclusion Individualising the prescription dose and number of fractions with the help of BioSuite results in improved therapeutic ratios as evaluated by radiobiological models. PMID:22457318

  7. Fluctuations in energy loss and their implications for dosimetry and radiobiology

    NASA Technical Reports Server (NTRS)

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

    1972-01-01

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

  8. Isavuconazole: Pharmacology, Pharmacodynamics, and Current Clinical Experience with a New Triazole Antifungal Agent.

    PubMed

    Rybak, Jeffrey M; Marx, Kayleigh R; Nishimoto, Andrew T; Rogers, P David

    2015-11-01

    Coinciding with the continually increasing population of immunocompromised patients worldwide, the incidence of invasive fungal infections has grown over the past 4 decades. Unfortunately, infections caused by both yeasts such as Candida and molds such as Aspergillus or Mucorales remain associated with unacceptably high morbidity and mortality. In addition, the available antifungals with proven efficacy in the treatment of these infections remain severely limited. Although previously available second-generation triazole antifungals have significantly expanded the spectrum of the triazole antifungal class, these agents are laden with shortcomings in their safety profiles as well as formulation and pharmacokinetic challenges. Isavuconazole, administered as the prodrug isavuconazonium, is the latest second-generation triazole antifungal to receive U.S. Food and Drug Administration approval. Approved for the treatment of both invasive aspergillosis and invasive mucormycosis, and currently under investigation for the treatment of candidemia and invasive candidiasis, isavuconazole may have therapeutic advantages over its predecessors. With clinically relevant antifungal potency against a broad range of yeasts, dimorphic fungi, and molds, isavuconazole has a spectrum of activity reminiscent of the polyene amphotericin B. Moreover, clinical experience thus far has revealed isavuconazole to be associated with fewer toxicities than voriconazole, even when administered without therapeutic drug monitoring. These characteristics, in an agent available in both a highly bioavailable oral and a β-cyclodextrin-free intravenous formulation, will likely make isavuconazole a welcome addition to the triazole class of antifungals. PMID:26598096

  9. Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: initial clinical experience

    PubMed Central

    Flores, Eileen S.; Cordova, Miguel; Kose, Kivanc; Phillips, William; Rossi, Anthony; Nehal, Kishwer; Rajadhyaksha, Milind

    2015-01-01

    Abstract. Mohs surgery for the removal of nonmelanoma skin cancers (NMSCs) is performed in stages, while being guided by the examination for residual tumor with frozen pathology. However, preparation of frozen pathology at each stage is time consuming and labor intensive. Real-time intraoperative reflectance confocal microscopy (RCM), combined with video mosaicking, may enable rapid detection of residual tumor directly in the surgical wounds on patients. We report our initial experience on 25 patients, using aluminum chloride for nuclear contrast. Imaging was performed in quadrants in the wound to simulate the Mohs surgeon’s examination of pathology. Images and videos of the epidermal and dermal margins were found to be of clinically acceptable quality. Bright nuclear morphology was identified at the epidermal margin and detectable in residual NMSC tumors. The presence of residual tumor and normal skin features could be detected in the peripheral and deep dermal margins. Intraoperative RCM imaging may enable detection of residual tumor directly on patients during Mohs surgery, and may serve as an adjunct for frozen pathology. Ultimately, for routine clinical utility, a stronger tumor-to-dermis contrast may be necessary, and also a smaller microscope with an automated approach for imaging in the entire wound in a rapid and controlled manner. PMID:25706821

  10. Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: initial clinical experience

    NASA Astrophysics Data System (ADS)

    Flores, Eileen S.; Cordova, Miguel; Kose, Kivanc; Phillips, William; Rossi, Anthony; Nehal, Kishwer; Rajadhyaksha, Milind

    2015-06-01

    Mohs surgery for the removal of nonmelanoma skin cancers (NMSCs) is performed in stages, while being guided by the examination for residual tumor with frozen pathology. However, preparation of frozen pathology at each stage is time consuming and labor intensive. Real-time intraoperative reflectance confocal microscopy (RCM), combined with video mosaicking, may enable rapid detection of residual tumor directly in the surgical wounds on patients. We report our initial experience on 25 patients, using aluminum chloride for nuclear contrast. Imaging was performed in quadrants in the wound to simulate the Mohs surgeon's examination of pathology. Images and videos of the epidermal and dermal margins were found to be of clinically acceptable quality. Bright nuclear morphology was identified at the epidermal margin and detectable in residual NMSC tumors. The presence of residual tumor and normal skin features could be detected in the peripheral and deep dermal margins. Intraoperative RCM imaging may enable detection of residual tumor directly on patients during Mohs surgery, and may serve as an adjunct for frozen pathology. Ultimately, for routine clinical utility, a stronger tumor-to-dermis contrast may be necessary, and also a smaller microscope with an automated approach for imaging in the entire wound in a rapid and controlled manner.

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

    SciTech Connect

    Mackley, Heath B. . E-mail: hmackley@alumni.upenn.edu; Reddy, Chandana A. M.S.; Lee, S.-Y.; Harnisch, Gayle A.; Mayberg, Marc R.; Hamrahian, Amir H.; Suh, John H.

    2007-01-01

    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.

  12. Clinical experience with the new oral anticoagulants for treatment of venous thromboembolism.

    PubMed

    Bacchus, Farzana; Schulman, Sam

    2015-03-01

    Four non-vitamin K antagonist oral anticoagulants, apixaban, dabigatran, edoxaban, and rivaroxaban, have been evaluated in phase III clinical trials for the treatment of acute venous thromboembolism, and all except edoxaban have also been studied for extended secondary prophylaxis after venous thromboembolism. Rivaroxaban, and recently also dabigatran, has been approved for this indication, and it is therefore timely to review the characteristics, efficacy, and safety of these drugs with emphasis on patients with venous thromboembolism. This review focuses on the clinical results from the phase III trials, separately for each of the drugs as compared with vitamin K antagonists. We also address the results from meta-analyses that were published recently. Finally, the results in some special groups of interest-renal impairment, elderly patients, and patients with cancer-are reviewed, although they only comprised small minorities of the study populations. All 4 drugs demonstrated noninferiority against vitamin K antagonists in the acute treatment and clear superiority against placebo in the extended treatment (not performed with edoxaban). The risk of bleeding was generally lower with non-vitamin K antagonist oral anticoagulants, and the reduction of risk of intracranial hemorrhage seems to mirror the experience from atrial fibrillation trials. In conclusion, during the past 30 years we have moved from a week of hospitalization and intravenous heparin therapy, via low-molecular-weight heparin injections subcutaneously and early discharge from the hospital, to the possibility of only oral outpatient therapy without coagulation monitoring, yet safe for patients with acute venous thromboembolism. PMID:25717178

  13. Nursing students' experiences of ethical issues in clinical practice: A New Zealand study.

    PubMed

    Sinclair, J; Papps, E; Marshall, B

    2016-03-01

    Nursing students experience ethical problems in clinical practice in a different way from registered nurses. In order to develop ethical reasoning and competence in nursing students, nurse educators must recognise the unique issues students face. This research described the occurrence of ethical issues in clinical practice for 373 undergraduate nursing students who responded to a national questionnaire investigating the frequency of pre-determined ethical issues and the corresponding level of distress. Over two thirds of respondents experienced breaches of a patient's right to confidentiality, privacy, dignity or respect and 87% experienced unsafe working conditions. The most distressing issues were those that compromised patient safety, including unsafe healthcare practices, working conditions and suspected abuse or neglect. Themes that emerged from an open-ended question included lack of support and supervision, bullying and end of life issues. This research found the frequency at which ethical issues are experienced was highest in year three participants. However, the overall distress levels were lower for the majority of issues for those participants in the later part of their degree. Recommendations from this research include developing ethics education around the main concerns that students face in order to enhance students' understanding, resilience and ability to respond appropriately. PMID:27038081

  14. Clinical experience with infliximab biosimilar Remsima (CT-P13) in inflammatory bowel disease patients.

    PubMed

    Jahnsen, Jørgen

    2016-05-01

    Many reference biological therapies have now reached or are near to patent expiry, and therefore a number of biosimilars have been or will be developed. The term biosimilar can be defined as a biotherapeutic product that is similar in efficacy, safety and quality to the licensed reference product. Biosimilars may lead to a reduced price and significant cost savings for the health community and hopefully more patients globally will have easier access to biological therapy when indicated. CT-P13, which is a TNF-alfa inhibitor, is the first monoclonal antibody biosimilar being used in clinical practice. The drug is approved for all indications as an innovator product although clinical efficacy has only been demonstrated in rheumatic diseases. Until now the number of patients with inflammatory bowel disease (IBD) treated with CT-P13 is confined, but experience is continuously growing. Based on current data, CT-P13 seems to be efficacious and generally well tolerated in IBD especially in patients who are naïve to biological therapy. Knowledge with regard to interchangeability between CT-P13 and the originator infliximab is however, still rather sparse and more data are desired. Immunogenicity and long-term safety related to CT-P13 are other areas of great importance and good and reliable postmarketing pharmacovigilance is therefore required in the coming years. PMID:27134662

  15. Clinical Experience With A High Resolution Digital Imaging System For Gastro-Intestinal Radiology

    NASA Astrophysics Data System (ADS)

    Edmonds, E. W.; Rowlands, J. A.; Hynes, D. M.; Toth, B. D.; Porter, A. J.

    1987-01-01

    In our department, it is planned that the gastro-intestinal fluoroscopic area will be equipped entirely with digital imaging systems. The use of the 1024 X 1024 pixel frame store, backed by a hard disc for rapid image transfer, and the production of hard copy on a laser imager has reached the point where clinical efficacy and acceptance are assured. The further addition of facilities for annotation and the application of digital post-processing techniques are being explored both at the clinical site and at the research laboratorieS. The use of laser imaging has produced a further improvement in image quality and some of the practical problems related to this apparatus will be described. The availability of larger capacity laser disc image storage enables the local area network or "mini-PACS" system for fluoroscopy areas to become a concept worthy of investigation. We present our experience over a number of years with these systems, together with our latest investigations into potential applications of laser technology to the practice of radiology in a busy imaging centre.

  16. Pre-clinical Experience with a Multi-Chordal Patch for Mitral Valve Repair.

    PubMed

    Chawla, Surendra K; Shi, Weiwei; McIver, Bryant V; Vinten-Johansen, Jakob; Frater, Robert W M; Padala, Muralidhar

    2016-04-01

    Surgical repair of flail mitral valve leaflets with neochordoplasty has good outcomes, but implementing it in anterior and bi-leaflet leaflet repair is challenging. Placing and sizing individual neochordae is time consuming and error prone, with persistent localized flail if performed incorrectly. In this study, we report our pre-clinical experience with a novel multi-chordal patch for mitral valve repair. The device was designed based on human cadaver hearts, and laser cut from expanded polytetrafluoroethylene. The prototypes were tested in: (stage 1) ex vivo hearts with leaflet flail (N = 6), (stage 2) acute swine induced with flail (N = 6), and (stage 3) two chronic swine survived to 23 and 120 days (N = 2). A2 and P2 prolapse were successfully repaired with coaptation length restored to 8.1 ± 2.2mm after posterior repair and to 10.2 ± 1.3mm after anterior repair in ex vivo hearts. In vivo, trace regurgitation was seen after repair with excellent patch durability, healing, and endothelialization at euthanasia. A new device for easier mitral repair is reported, with good early pre-clinical outcomes. PMID:26801477

  17. New Embolization Microcoil Consisting of Firm and Flexible Segments: Preliminary Clinical Experience

    SciTech Connect

    Irie, Toshiyuki

    2006-12-15

    Purpose. To describe the preliminary clinical experience with a new embolization microcoil. Methods. The microcoil was made of a platinum coil spring, and consisted of firm and flexible segments. The firm segment functioned as an anchor and the flexible segment was well compacted to occlude the arteries. No Dacron fiber was attached. Seventy-one new microcoils were placed via microcatheters in 28 visceral arteries of 17 patients. Two other types of microcoils with Dacron fibers were used together in 8 arteries. Results. Sixty-nine new microcoils were placed and compacted successfully. Two coils were misplaced; one was retrieved and the other was left in the migrated artery, which remained patent 5 months later. All 28 arteries were occluded, and the goals of intervention were achieved successfully in all 17 cases. Conclusion. The new microcoils anchored and compacted well in the arteries. The clinical feasibility of this coil design was confirmed. The additional use of other types of microcoils with Dacron fiber was necessary to obtain rapid occlusion in some cases.

  18. SIADH-related hyponatremia in hospital day care units: clinical experience and management with tolvaptan.

    PubMed

    De las Peñas, Ramón; Ponce, Santiago; Henao, Fernando; Camps Herrero, Carlos; Carcereny, Enric; Escobar Álvarez, Yolanda; Rodríguez, César A; Virizuela, Juan Antonio; López López, Rafael

    2016-01-01

    Hyponatremia (Na ˂ 135 mmol/l) is the most frequent electrolyte disorder in clinical practice, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the commonest cause of hyponatremia in cancer patients. Correcting hyponatremia in these patients can reduce morbidity and mortality, increase the response to anti-cancer agents, and help reduce hospital length of stay and costs. Tolvaptan is an oral medication used to treat SIADH-related hyponatremia patients that needs to be initiated at hospital so patients can have their serum sodium monitored. If tolvaptan could be initiated in hospital day care units (DCUs), performing the same tests, hospitalization could be avoided, quality of life improved, and costs reduced. This is the first publication where a panel of oncologists are sharing their experience and making some recommendations with the use of tolvaptan to treat SIADH-related hyponatremia in DCU after collecting and examining 35 clinical cases with these type of patients. The conclusion from this retrospective observational analysis is that the use of tolvaptan in DCU is safe and effective in the therapeutic management of SIADH-related hyponatremia. PMID:26431960

  19. Clinical routine operation of a filmless radiology department: three years experience

    NASA Astrophysics Data System (ADS)

    Mosser, Hans M.; Paertan, Gerald; Hruby, Walter

    1995-05-01

    This paper communicates the operational implementation of filmless digital radiology in clinical routine, its feasibility and its effect on the radiology profession, based on the three years clinical experience from the filmless digital radiology department of the Danube Hospital, a major teaching hospital in Vienna, Austria, with currently 850 acute-care beds. Since April 1992 all radiological modalities are reported from the monitors of 16 reporting consoles in the radiology department. Images and reports are distributed by the hospital-wide network (Sienet, Siemens Medical Systems, Erlangen), and can be viewed on 60 display consoles throughout the hospital. Filmless radiology primarily is an efficient hospital-wide infrastructure to deliver radiological services along with other medical information, providing safe and fast access to this information anytime and anywhere, necessary for the conduct of the diagnostic and therapeutic task of patient care. In a comparative study of the Danube Hospital with the film based Rudolfstiftung Hospital in Vienna, we found a significant decrease of the mean patient length of hospital stay (1.99 to 3.72 days) that partially might be attributed to the implementation of filmless radiology.

  20. Clinical experience with infliximab biosimilar Remsima (CT-P13) in inflammatory bowel disease patients

    PubMed Central

    Jahnsen, Jørgen

    2016-01-01

    Many reference biological therapies have now reached or are near to patent expiry, and therefore a number of biosimilars have been or will be developed. The term biosimilar can be defined as a biotherapeutic product that is similar in efficacy, safety and quality to the licensed reference product. Biosimilars may lead to a reduced price and significant cost savings for the health community and hopefully more patients globally will have easier access to biological therapy when indicated. CT-P13, which is a TNF-alfa inhibitor, is the first monoclonal antibody biosimilar being used in clinical practice. The drug is approved for all indications as an innovator product although clinical efficacy has only been demonstrated in rheumatic diseases. Until now the number of patients with inflammatory bowel disease (IBD) treated with CT-P13 is confined, but experience is continuously growing. Based on current data, CT-P13 seems to be efficacious and generally well tolerated in IBD especially in patients who are naïve to biological therapy. Knowledge with regard to interchangeability between CT-P13 and the originator infliximab is however, still rather sparse and more data are desired. Immunogenicity and long-term safety related to CT-P13 are other areas of great importance and good and reliable postmarketing pharmacovigilance is therefore required in the coming years. PMID:27134662

  1. Formative Evaluation of Clinician Experience with Integrating Family History-Based Clinical Decision Support into Clinical Practice

    PubMed Central

    Doerr, Megan; Edelman, Emily; Gabitzsch, Emily; Eng, Charis; Teng, Kathryn

    2014-01-01

    Family health history is a leading predictor of disease risk. Nonetheless, it is underutilized to guide care and, therefore, is ripe for health information technology intervention. To fill the family health history practice gap, Cleveland Clinic has developed a family health history collection and clinical decision support tool, MyFamily. This report describes the impact and process of implementing MyFamily into primary care, cancer survivorship and cancer genetics clinics. Ten providers participated in semi-structured interviews that were analyzed to identify opportunities for process improvement. Participants universally noted positive effects on patient care, including increases in quality, personalization of care and patient engagement. The impact on clinical workflow varied by practice setting, with differences observed in the ease of integration and the use of specific report elements. Tension between the length of the report and desired detail was appreciated. Barriers and facilitators to the process of implementation were noted, dominated by the theme of increased integration with the electronic medical record. These results fed real-time improvement cycles to reinforce clinician use. This model will be applied in future institutional efforts to integrate clinical genomic applications into practice and may be useful for other institutions considering the implementation of tools for personalizing medical management. PMID:25563219

  2. Determination of Variation Parameters as a Crucial Step in Designing TMT-Based Clinical Proteomics Experiments

    PubMed Central

    Maes, Evelyne; Valkenborg, Dirk; Baggerman, Geert; Willems, Hanny; Landuyt, Bart; Schoofs, Liliane; Mertens, Inge

    2015-01-01

    In quantitative shotgun proteomic analyses by liquid chromatography and mass spectrometry, a rigid study design is necessary in order to obtain statistically relevant results. Hypothesis testing, sample size calculation and power estimation are fundamental concepts that require consideration upon designing an experiment. For this reason, the reproducibility and variability of the proteomic platform needs to be assessed. In this study, we evaluate the technical (sample preparation), labeling (isobaric labels), and total (biological + technical + labeling + experimental) variability and reproducibility of a workflow that employs a shotgun LC-MS/MS approach in combination with TMT peptide labeling for the quantification of peripheral blood mononuclear cell (PBMC) proteome. We illustrate that the variability induced by TMT labeling is small when compared to the technical variation. The latter is also responsible for a substantial part of the total variation. Prior knowledge about the experimental variability allows for a correct design, a prerequisite for the detection of biologically significant disease-specific differential proteins in clinical proteomics experiments. PMID:25775046

  3. Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center

    PubMed Central

    Amerine, Lindsey B.; Chen, Sheh-Li; Luter, David N.; Arnall, Justin; Smith, Shayna; Roth, Mary T.; Rodgers, Philip T.; Williams, Dennis M.; Pinelli, Nicole R.

    2015-01-01

    Objective. To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center. Design. Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach. Assessment. Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice. Conclusion. Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice. PMID:26839428

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

    PubMed

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

    2010-01-01

    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 abortion, other factors influencing method selection were family support and distance from the facility. The degree of medicalisation that women wanted or felt was necessary also depended on the way expectations were set by their providers. Confirmation of abortion completion was a source of anxiety for many women and led to unnecessary interventions in a few cases. Ultimately, experiences depended more on women's expectations about the method, and on the level of emotional and logistic support they received rather than on inherent characteristics of the method. These findings emphasise the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. Women-centred counselling and care that takes into consideration individual circumstances are needed. PMID:19431005

  5. SU-E-T-275: Radiobiological Evaluation of Intensity Modulated Radiotherapy Treatment for Locally Advanced Head and Neck Squamous Cell Carcinomas

    SciTech Connect

    Rekha Reddy, B.; Ravikumar, M.; Tanvir Pasha, C.R; Anil Kumar, M.R; Varatharaj, C.; Pyakuryal, A; Narayanasamy, Ganesh

    2014-06-01

    Purpose: To evaluate the radiobiological outcome of Intensity Modulated Radiotherapy Treatment (IMRT) for locally advanced head and neck squamous cell carcinomas using HART (Histogram Analysis in Radiation Therapy; J Appl Clin Med Phys 11(1): 137–157, 2010) program and compare with the clinical outcomes. Methods: We have treated 20 patients of stage III and IV HNSCC Oropharynx and hypopharynx with accelerated IMRT technique and concurrent chemotherapy. Delineation of tumor and normal tissues were done using Danish Head and Neck Cancer Group (DAHANCA) contouring guidelines and radiotherapy was delivered to a dose of 70Gy in 35 fractions to the primary and involved lymph nodes, 63Gy to intermediate risk areas and 56 Gy to lower risk areas, Monday to Saturday, 6 Days/week using 6 MV Photons with an expected overall treatment time of 6 weeks. The TCP and NTCP's were calculated from the dose-volume histogram (DVH) statistics using the Poisson Statistics (PS) and JT Lyman models respectively and the Resultwas correlated with clinical outcomes of the patients with mean follow up of 24 months. Results: Using HART program, the TCP (0.89± 0.01) of primary tumor and the NTCP for parotids (0.20±0.12), spinal cord (0.05±0.01), esophagus (0.30±0.2), mandible (0.35±0.21), Oral cavity (0.37±0.18), Larynx (0.30±0.15) were estimated and correlated with clinical outcome of the patients. Conclusion: Accelerated IMRT with Chemotherapy is a clinical feasible option in the treatment of locally advanced HNSCC with encouraging initial tumour response and acceptable acute toxicities. The correlation between the clinical outcomes and radiobiological model estimated parameters using HART programs are found to be satisfactory.

  6. The pharmaceutical management system at Shade Tree Family Clinic: a medical student-run free clinic's experience.

    PubMed

    Rosenbaum, Benjamin P; Patel, Sanjay G; Guyer, Dana L; Dunn, Sarah R; Herceg, Megan E; Knox, Caroline K; Miller, Robert F

    2008-09-01

    The Shade Tree Family Clinic (STFC) is a student-run free walk-in health clinic opened by Vanderbilt University medical students in October 2005 to address the acute and chronic health needs of the underinsured community in East Nashville. STFC founders decided that the clinic would provide complete medical care, including dispensing commonly prescribed medications at no charge to patients. After several months of managing the inventory in a log book, a medical student author created a Web-based pharmaceutical tracking system to manage the medication formulary. In the process, the authors found little literature available addressing the logistics of setting up an electronic pharmacy system. The system created uses the freely available RxNorm and US Department of Veterans Affairs National Drug File Reference Terminology databases for medication and classification data. Incorporation of these databases allows medical students to dispense and restock medications with ease. The system ensures accurate data entry, improves efficiency, and facilitates continuity of care at a clinic staffed by hundreds of different students and physicians. The STFC pharmaceutical tracking system has facilitated the acquisition and efficient management of medications and consequently has had a great impact on the success of STFC. PMID:18850398

  7. A Framework for Usable and Effective Clinical Decision Support: Experience from the iCPR Randomized Clinical Trial

    PubMed Central

    Kannry, Joseph; McCullagh, Lauren; Kushniruk, Andre; Mann, Devin; Edonyabo, Daniel; McGinn, Thomas

    2015-01-01

    Introduction: The promise of Clinical Decision Support (CDS) has always been to transform patient care and improve patient outcomes through the delivery of timely and appropriate recommendations that are patient specific and, more often than not, are appropriately actionable. However, the users of CDS—providers—are frequently bombarded with inappropriate and inapplicable CDS that often are not informational, not integrated into the workflow, not patient specific, and that may present out of date and irrelevant recommendations. Methods: The integrated clinical prediction rule (iCPR) project was a randomized clinical trial (RCT) conducted to determine if a novel form of CDS, i.e., clinical prediction rules (CPRs), could be efficiently integrated into workflow and result in changes in outcomes (e.g., antibiotic ordering) when embedded within a commercial electronic health record (EHR). We use the lessons learned from the iCPR project to illustrate a framework for constructing usable, useful, and effective actionable CDS while employing off-the-shelf functionality in a production system. Innovations that make up the framework combine the following: (1) active and actionable decision support, (2) multiple rounds of usability testing with iterative development for user acceptance, (3) numerous context sensitive triggers, (4) dedicated training and support for users of the CDS tool for user adoption, and (5) support from clinical and administrative leadership. We define “context sensitive triggers” as being workflow events (i.e., context) that result in a CDS intervention. Discussion: Success of the framework can be measured by CDS adoption (i.e., intervention is being used), acceptance (compliance with recommendations), and clinical outcomes (where appropriate). This framework may have broader implications for the deployment of Health Information Technology (HIT). Results and Conclusion: iCPR was well adopted(57.4% of users) and accepted (42.7% of users). Usability testing identified and fixed many issues before the iCPR RCT. The level of leadership support and clinical guidance for iCPR was key in establishing a culture of acceptance for both the tool and its recommendations contributing to adoption and acceptance. The dedicated training and support lead to the majority of the residents reporting a high level of comfort with both iCPR tools strep pharyngitis (64.4 percent) and pneumonia (62.7 percent) as well as a high likelihood of using the tools in the future. A surprising framework addition resulted from usability testing: context sensitive triggers. PMID:26290888

  8. Clinical experience with a second-generation hospital-integrated picture archiving and communication system.

    PubMed

    Huang, H K; Wong, A W; Lou, A S; Bazzill, T M; Andriole, K; Zhang, J; Wang, J; Lee, J K

    1996-11-01

    In a previous report we described a second-generation hospital-integrated picture archiving and communication system (HI-PACS) developed in-house. This HI-PACS had four unique features not found in other PAC systems. In this report, we will share some of our clinical experiences pertaining to these features during the past 12 months. We first describe the usage characteristics of two 2,000-line workstations (WSs), one in the in-patient and the second in the out-patient neuroradiology reading area. These two WSs can access neuro-images from 10 computed tomographic and magnetic resonance scanners located two medical centers through an asynchronous transfer mode network connection. The second unique feature of the system is an intensive care unit (ICU) server, which supports three WSs in the pediatric, medical surgery, and cardiac ICUs. The users' experiences and requests for refinement of the WSs are given. Another feature is physician desk-top access of PACS data. The HI-PACS provides a server connected to more than 100 Macintosh users for direct access of PACS data from their offices. The server's performance and user critiques are described. The last feature is a digital imaging and communication in medicine (DICOM) connection of the HI-PACS to a manufacturer's ultrasound PACS module. The authors then outline the interfacing process and summarize some of the difficulties encountered. Developing an in-house PACS has many advantages but also some drawbacks. Based on experience, the authors have formulated three axioms as a guide for in-house PACS development. PMID:8951094

  9. Dental Students' Perceived Value of Peer-Mentoring Clinical Leadership Experiences.

    PubMed

    Sheridan, Rachel A; Hammaker, Daniel J; de Peralta, Tracy L; Fitzgerald, Mark

    2016-03-01

    This pilot study compared second- and fourth-year dental students' perceived values of newly implemented clinical leadership experiences (CLEs) at one U.S. dental school during the 2012-13 academic year. In the CLEs, fourth-year (D4) students mentored second-year (D2) dental students during faculty-supervised patient treatment. The two cohorts' perceived value of the experiences was measured with questionnaires consisting of five-point Likert scale questions and open text responses. Out of a total of 114 D2 and 109 D4 students, 46 D2 students and 35 D4 students participated (response rates of 40.4% and 32.1%, respectively). While responses from both cohorts showed they highly valued the CLEs, the D2s perceived greater value: 4.07 (0.53) v. 3.51 (0.95), p<0.003. Both cohorts reported feeling that D4s were prepared to mentor D2s, that the CLEs had educational benefits, and that the CLEs increased their comfort with peer communication. Theme analysis of open text questions revealed that the respondents perceived the D4s were more accessible than faculty and provided guidance and individual attention; the CLEs increased student comfort; the CLEs reinforced D4 skills, knowledge, and confidence; and the CLEs provided management, leadership, and collaborative work experience. Theme analysis also highlighted student concerns about a lack of program structure. Overall, the majority of both groups valued CLEs in their dental education. Particular advantages they perceived were increased comfort, guidance, and attention. Further program development should address student concerns. These results suggest that similar programs should be considered and/or expanded in other dental schools' curricula. PMID:26933106

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

    PubMed

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

    2014-03-01

    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

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

    SciTech Connect

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

    2012-10-15

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

  12. Contents of supervision needed by physical and occupational therapists for ability development: focusing on their clinical experience

    PubMed Central

    Sakurai, Hiroaki; Kanada, Yoshikiyo; Sugiura, Yoshito; Koyama, Soichiro; Tanabe, Shigeo

    2016-01-01

    [Purpose] This study examined the contents of supervision needed by novice therapists to develop clinical abilities, focusing on their clinical experience and using an original evaluation table. [Subjects and Methods] An evaluation of clinical abilities basic attitudes, therapeutic skills, and clinical practice-related thoughts was conducted in 29, 21, and 9 therapists with clinical experience of 0–1 (1 year group), 1–2 (2 years group), and 2–3 (3 years group) years, respectively. [Results] There were no significant differences among the 3 groups in basic attitudes. Therapeutic skills markedly varied between the 1 and 3 years groups. In clinical practice-related thoughts, significant differences were observed between the 1 and 3 years groups and between the 2 and 3 years groups. [Conclusion] It may be appropriate for educators to provide technical education regarding skills that are achievable for students in the early stages in consideration of applied movements. Also, education for novices should be provided with importance attached to abilities influenced by clinical experience. PMID:26957745

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

    SciTech Connect

    Pedicini, Piernicola; Strigari, Lidia; Benassi, Marcello

    2013-04-01

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

  14. SU-E-J-181: Magnetic Resonance Image-Guided Radiation Therapy Workflow: Initial Clinical Experience

    SciTech Connect

    Green, O; Kashani, R; Santanam, L; Wooten, H; Li, H; Rodriguez, V; Hu, Y; Mutic, S; Hand, T; Victoria, J; Steele, C

    2014-06-01

    Purpose: The aims of this work are to describe the workflow and initial clinical experience treating patients with an MRI-guided radiotherapy (MRIGRT) system. Methods: Patient treatments with a novel MR-IGRT system started at our institution in mid-January. The system consists of an on-board 0.35-T MRI, with IMRT-capable delivery via doubly-focused MLCs on three {sup 60} Co heads. In addition to volumetric MR-imaging, real-time planar imaging is performed during treatment. So far, eleven patients started treatment (six finished), ranging from bladder to lung SBRT. While the system is capable of online adaptive radiotherapy and gating, a conventional workflow was used to start, consisting of volumetric imaging for patient setup using visible tumor, evaluation of tumor motion outside of PTV on cine images, and real-time imaging. Workflow times were collected and evaluated to increase efficiency and evaluate feasibility of adding the adaptive and gating features while maintaining a reasonable patient throughput. Results: For the first month, physicians attended every fraction to provide guidance on identifying the tumor and an acceptable level of positioning and anatomical deviation. Average total treatment times (including setup) were reduced from 55 to 45 min after physician presence was no longer required and the therapists had learned to align patients based on soft-tissue imaging. Presently, the source strengths were at half maximum (7.7K Ci each), therefore beam-on times will be reduced after source replacement. Current patient load is 10 per day, with increase to 25 anticipated in the near future. Conclusion: On-board, real-time MRI-guided RT has been incorporated into clinical use. Treatment times were kept to reasonable lengths while including volumetric imaging, previews of tumor movement, and physician evaluation. Workflow and timing is being continuously evaluated to increase efficiency. In near future, adaptive and gating capabilities of the system will be implemented.

  15. Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Leiomyosarcoma: 27 Years of Experience

    PubMed Central

    Rothmund, R.; Huebner, M.; Joachim, C.; Hartkopf, A.; Fehm, T.; Bamberg, M.; Wallwiener, M.; Brucker, S.; Taran, F. A.

    2011-01-01

    Purpose: To review a single-center experience over a 27-year period in the management of uterine leiomyosarcoma (LMS) for insight into surgical practice, adjuvant therapy and clinical outcome. Material and Methods: This was a retrospective study of women with histologically proven uterine LMS who were treated at the Department of Obstetrics and Gynecology, University of Tuebingen, Germany, between 1983 and 2010. Inpatient and ambulatory records were reviewed; follow-up and survival data were ascertained. Results: The study sample comprised 32 patients with uterine LMS. Primary surgical treatment consisted of total abdominal hysterectomy in 28 patients (88 %) and laparoscopic total hysterectomy in 4 patients (12 %). Lymph nodes were dissected and evaluated in 17 women (53 %); positive lymph nodes were present in 1 patient (6 %). A total of 17 patients (53 %) received adjuvant therapy. Median follow-up for disease-free survival (DFS) was 35.6 months and median DFS was 27.0 months for all patients. The median follow-up for overall survival (OS) was 51.3 months and the median OS was 28.0 months for our study group. The 5-year survival rate was 30 %. There was no significant difference in DFS (p = 0.76) and OS (p = 0.51) between patients who received adjuvant therapy and those who did not. Conclusion: Uterine LMS are rare and aggressive uterine neoplasms with high recurrence rates and metastatic potential. Surgery consisting of total hysterectomy with or without bilateral salpingo-oophorectomy is the most important treatment-element in patients with uterine LMS. Lymphadenectomy should be reserved for patients with clinically suspicious nodes.

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

    SciTech Connect

    Kozak, Kevin R.; Smith, Barbara L.; Adams, Judith C.; Kornmehl, Ellen; Katz, Angela; Gadd, Michele; Specht, Michelle; Hughes, Kevin; Gioioso, Valeria; Lu, H.-M.; Braaten, Kristina; Recht, Abram; Powell, Simon N.; DeLaney, Thomas F.; Taghian, Alphonse G. . E-mail: ataghian@partners.org

    2006-11-01

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

  17. Preliminary Clinical Experience with a Bifurcated Y-Graft Fontan ProcedureA Feasibility Study

    PubMed Central

    Kanter, Kirk R.; Haggerty, Christopher M.; Restrepo, Maria; de Zelicourt, Diane A.; Rossignac, Jarek; Parks, W. James; Yoganathan, Ajit P.

    2012-01-01

    OBJECTIVE Optimizing flow and diminishing power loss in the Fontan circuit can improve hemodynamic efficiency potentially improving long-term outcomes. Computerized modeling has predicted improved energetics with a Y-graft Fontan. METHODS From August to December, 2010, six consecutive children had a completion Fontan (n=3) or a Fontan revision (n=3) using a bifurcated polytetrafluoroethylene Y-graft (1899 mm in 2, 201010 mm in 4) connecting the inferior vena cava (IVC) to the right and left pulmonary arteries (PAs) with separate graft limbs. Patents were imaged by magnetic resonance imaging (MRI; n-5) or computerized tomography (n=1). Computational fluid dynamics (CFD) assessed Fontan hemodynamics, power loss, and IVC flow splits to the branch PAs. Clinical parameters were compared with 12 patients immediately preceding this series who had a lateral Fontan procedure. RESULTS Despite longer crossclamp and bypass times (not statistically significant), the Y-graft Fontan patients had postoperative courses similar to the conventional Fontan patients. Other than two early readmissions for pleural effusions managed with diuretics, on 612 months follow-up (mean 8 months), all six patients have done well. Postoperative flow modeling demonstrated balanced distribution of IVC flow to both PAs with minimal flow disturbance. Improvements in hemodynamics and efficiency were noted when the Y-graft branches were anastomosed distally and aligned tangentially with the branch PAs. CONCLUSIONS This preliminary surgical experience demonstrates clinical feasibility of the bifurcated Y-graft Fontan. CFD shows acceptable hemodynamics with low calculated power losses and balanced distribution of IVC flow to the PAs as long as the branch grafts are anastomosed distally. PMID:22698555

  18. Oseltamivir in seasonal, pandemic, and avian influenza: a comprehensive review of 10-years clinical experience.

    PubMed

    Smith, James R; Rayner, Craig R; Donner, Barbara; Wollenhaupt, Martina; Klumpp, Klaus; Dutkowski, Regina

    2011-11-01

    Oseltamivir (Tamiflu®; F. Hoffmann-La Roche Ltd, Basel, Switzerland) is an orally administered antiviral for the treatment and prevention of influenza A and B infections that is registered in more than 100 countries worldwide. More than 83 million patients have been exposed to the product since its introduction. Oseltamivir is recommended by the World Health Organization (WHO) for use in the clinical management of pandemic and seasonal influenza of varying severity, and as the primary antiviral agent for treatment of avian H5N1 influenza infection in humans. This article is a nonsystematic review of the experience gained from the first 10 years of using oseltamivir for influenza infections since its launch in early 2000, emphasizing recent advances in our understanding of the product and its clinical utility in five main areas. The article reviews the pharmacokinetics of oseltamivir and its active metabolite, oseltamivir carboxylate, including information on special populations such as children and elderly adults, and the co-administration of oseltamivir with other agents. This is followed by a summary of data on the effectiveness of oseltamivir treatment and prophylaxis in patients with all types of influenza, including pandemic (H1N1) 2009 and avian H5N1 influenza. The implications of changes in susceptibility of circulating influenza viruses to oseltamivir and other antiviral agents are also described, as is the emergence of antiviral resistance during and after the 2009 pandemic. The fourth main section deals with the safety profile of oseltamivir in standard and special patient populations, and reviews spontaneously reported adverse event data from the pandemic and pre-pandemic periods and the topical issue of neuropsychiatric adverse events. Finally, the article considers the pharmacoeconomics of oseltamivir in comparison with vaccination and usual care regimens, and as a component of pandemic influenza mitigation strategies. PMID:22057727

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

    PubMed Central

    Steinke, Wolfgang; Zellweger, René

    2000-01-01

    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. PMID:11066144

  20. Clinical Characteristics and Outcomes of Cardiomyopathy in Barth Syndrome: The UK Experience.

    PubMed

    Kang, Sok-Leng; Forsey, Jonathan; Dudley, Declan; Steward, Colin G; Tsai-Goodman, Beverly

    2016-01-01

    Barth syndrome (BTHS) is an X-linked disorder characterised by cardiomyopathy, neutropenia, skeletal myopathy and growth delay. This study describes the UK national clinical experience and outcome of cardiomyopathy in BTHS. The clinical course and echocardiographic changes of all patients with BTHS in the UK were reviewed from 2004 to 2014. In addition, strain analysis using 2D speckle tracking echocardiography was performed to further assess left ventricular function in the most recent follow-up. At last follow-up, 22 of 27 patients were alive with a median age of 12.6 (2.0-23.8) years; seven underwent cardiac transplantation at a median age of 2 (0.33-3.6) years, and five died (18.5 %) at a median age of 1.8 (0.02-4.22) years. All deaths were related to cardiomyopathy or its management. Left ventricular diastolic dimension and systolic function measured by fractional shortening tended to normalise and stabilise after the first 3 years of life in the majority of patients. However, patients with BTHS (n = 16) had statistically significant reduction in global longitudinal and circumferential strain compared to controls (n = 18), (p < 0.001), despite apparent normal conventional measures of function. There was also reduced or reversed apical rotation and reduced left ventricular twist. Sustained ventricular arrhythmia was not seen at follow-up. Cardiac phenotype in BTHS is variable; however, longer-term outcome in our cohort suggests good prognosis after the first 5 years of life. Most patients appeared to have recovered near normal cardiac function by conventional echocardiographic measures, but strain analysis showed abnormal myocardial deformation and rotational mechanics. PMID:26337810

  1. Clinical Outcome of Parotidectomy with Reconstruction: Experience of a Regional Head and Neck Cancer Unit

    PubMed Central

    Okoturo, Eyituoyo; Osasuyi, Anslem

    2016-01-01

    Background: Salivary gland pathologies represent a histologically diverse group of benign and malignant neoplasms. Currently, World Health Organization recognizes 13 benign and 24 malignant variants of all salivary gland neoplasms. Surgery continues to remain the main-stay for treatment of parotid gland neoplasms. The aim of this study was to document our experiences of the patients treated for parotid tumors and find out if any compelling variable predicted the relative clinical outcomes. Materials and Methods: This was a retrospective study, from records of parotidectomies performed at the operating theatre by the head and neck cancer division of the study institution between 2010 and 2013. Eligibility for study inclusion included cases with benign or malignant parotid neoplasms requiring surgical management with or without adjunct radiotherapy. The predictors of postoperative complications, overall survival (OS), and disease-free survival (DFS) were analyzed. Results: A total of 20 patients underwent parotidectomy. The mean age was 42 years. Tumors were located on the left parotid in 13 cases (65%) and the right parotid in 7 cases (35%). The surgical procedures comprised 16 superficial parotidectomies, 1 total parotidectomy, and 3 radical parotidectomy (inclusive of facial nerve sacrifice) and 2 neck dissections levels II–V. The reconstructive procedures were 2 facial nerve branch cable grafts, 1 end-to-end facial-facial nerve branch anastomoses, and 2 facial re-animation surgeries (temporalis muscle suspensions). A total of five cases (33.3%) had postoperative complications. 2 variables (length of surgery and neck dissection) were found to have an impact on postoperative complications that were statistically significant. Additionally, length of surgery was a significant predictor on the 2 years OS and DFS. Conclusion: The result of this study showed good clinical outcome, especially in the benign cases. The comprehensive clinical outcome of the malignant cases could not be objectively assessed, as the OS and DFS were 50% at 2-years follow-up. It is our submission that a larger sample size is utilized in subsequent studies and quality of life evaluation is included in the methodology. PMID:27013855

  2. Analysis of stress fractures in athletes based on our clinical experience

    PubMed Central

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

    2011-01-01

    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. PMID:22474626

  3. Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis

    PubMed Central

    2012-01-01

    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. PMID:23181615

  4. Predictive power of individual factors and clinical learning experience on academic success: findings from a longitudinal study.

    PubMed

    Dante, Angelo; Fabris, Stefano; Palese, Alvisa

    2015-01-01

    Academic failure is the inability of a nursing student to graduate or to complete the nursing degree on time. This longitudinal cohort study, involving 2 Italian universities, documents the effects of selected individual variables and the quality of the clinical learning experience as perceived by students on academic success. Factors related to the clinical learning experience were the quality of the supervisory relationship, pedagogical atmosphere, and commitment of the ward related to the level of personalized nursing care delivered and clarity of nursing documentation. PMID:25643319

  5. Designing new collaborative learning spaces in clinical environments: experiences from a children's hospital in Australia.

    PubMed

    Bines, Julie E; Jamieson, Peter

    2013-09-01

    Hospitals are complex places that provide a rich learning environment for students, staff, patients and their families, professional groups and the community. The "new" Royal Children's Hospital opened in late 2011. Its mission is focused on improving health and well-being of children and adolescents through leadership in healthcare, research and education. Addressing the need to create "responsive learning environments" aligned with the shift to student-centred pedagogy, two distinct learning environments were developed within the new Royal Children's Hospital; (i) a dedicated education precinct providing a suite of physical environments to promote a more active, collaborative and social learning experience for education and training programs conducted on the Royal Children's Hospital campus and (ii) a suite of learning spaces embedded within clinical areas so that learning becomes an integral part of the daily activities of this busy Hospital environment. The aim of this article is to present the overarching educational principles that lead the design of these learning spaces and describe the opportunities and obstacles encountered in the development of collaborative learning spaces within a large hospital development. PMID:23701214

  6. Application of neuronavigation system to brain tumor surgery with clinical experience of 420 cases.

    PubMed

    Jung, T-Y; Jung, S; Kim, I-Y; Park, S-J; Kang, S-S; Kim, S-H; Lim, S-C

    2006-08-01

    A new era of neurosurgery has recently been unveiled with the advent of image-guided surgery. The use of neuronavigation is beginning to have a significant impact on a variety of intracranial procedures. Herein, we report our clinical experience using a neuronavigation system with different surgical applications and techniques for a variety of brain tumors. We used the BrainLab VectorVision neuronavigation system, which is a frameless and image-guided system. We operated on 420 cases having various types of brain tumor with the help of this system. The mean target localizing accuracy and mean volume were 1.15 mm and 30.8 mL (0.2-216.4 mL), respectively. We utilized this system to effectively make bone flaps, to detect critically located, deep-seated, subcortical, skull-base and skull bone tumors, and to operate on intraparenchymal lesions with grossly unclear margins, such as gliomas. We also performed tumor biopsy using the combination of a conventional stereotactic biopsy instrument and an endoscope. The application of the neuronavigation system not only revealed benefits for operative planning, appreciation of anatomy, lesion location and the safety of surgery, but also greatly enhanced surgical confidence. PMID:17041831

  7. Health-Related Quality of Life in the Gender, Race, And Clinical Experience Trial

    PubMed Central

    Feinberg, Judith; Saag, Michael; Squires, Kathleen; Currier, Judith; Ryan, Robert; Coate, Bruce; Mrus, Joseph

    2011-01-01

    Background. We report health-related QoL (HRQoL) from GRACE (Gender, Race, And Clinical Experience) study by sex and race over 48 weeks. Methods. 429 treatment-experienced adults (HIV-1 RNA ≥ 1000 copies/mL) received darunavir/ritonavir 600/100 mg twice daily plus an appropriate background regimen. QoL was measured by the Functional Assessment of HIV Infection (FAHI) questionnaire. Results. 67% women and 77% men, including 67.4% black, 76.0% Hispanic, and 73.8% white patients, completed the trial. Baseline total FAHI scores were similar between sexes and races. Total FAHI of the entire population improved by Week 4 (P < .05); near-maximum changes obtained by Week 12 were maintained through Week 48. Women and black patients demonstrated larger improvements in total FAHI versus men, and Hispanic and white patients, respectively. Conclusion. HRQoL improved in all sex and racial/ethnic groups. Sex-based and race-based differences in improvements in FAHI subscales may provide insight into subtle differences of HIV-1 and treatment on HRQoL in different populations. PMID:21904672

  8. Symptom Experience in HIV-Infected Adults: A Function of Demographic and Clinical Characteristics

    PubMed Central

    Lee, Kathryn A.; Gay, Caryl; Portillo, Carmen J.; Coggins, Traci; Davis, Harvey; Pullinger, Clive R.; Aouizerat, Bradley E.

    2009-01-01

    Personal characteristics that interact with both HIV diagnosis and its medical management can influence symptom experience. Little is known about how symptoms in chronic illness populations vary by age, sex, or socioeconomic factors. As part of an ongoing prospective longitudinal study, this study describes symptoms experienced by 317 men and women living with HIV/AIDS. Participants were recruited at HIV clinics and community sites in the San Francisco Bay area. Measures included their most recent CD4 cell count and viral load from the medical record, demographic and treatment variables, and the 32-item Memorial Symptom Assessment Scale to estimate prevalence, severity, and distress of each symptom as well as global symptom burden. The median number of symptoms was nine, and symptoms experienced by over half the sample included lack of energy (65%), feeling drowsy (57%), difficulty sleeping (56%), and pain (55%). Global symptom burden was unrelated to age or CD4 cell count. Those with an AIDS diagnosis had significantly higher symptom burden scores, as did those currently receiving anti-retroviral (ART) therapy. African Americans reported fewer symptoms than Caucasians or Mixed/Other race and women reported more symptom burden after controlling for AIDS diagnosis and race. Since high symptom burden is more likely to precipitate self-care strategies that may potentially be ineffective, strategies for symptom management would be better guided by tailored interventions from health care providers. PMID:19811886

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

    PubMed

    Li, Chuan-qi

    2010-02-01

    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

  10. Clinical utility of noninvasive fetal trisomy (NIFTY) test – early experience

    PubMed Central

    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

    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. PMID:22471583

  11. Modulating peroxisome proliferator–activated receptors for therapeutic benefit? Biology, clinical experience, and future prospects

    PubMed Central

    Rosenson, Robert S.; Wright, R. Scott; Farkouh, Michael; Plutzky, Jorge

    2014-01-01

    Clinical trials of cardiovascular disease (CVD) prevention in patients with type 2 diabetes mellitus primarily have been directed at the modification of a single major risk factor; however, in trials that enroll patients with and without diabetes, the absolute risk in CVD events remains higher in patients with diabetes. Efforts to reduce the macrovascular and microvascular residual risk have been directed toward a multifactorial CVD risk-factor modification; nonetheless, long-term complications remain high. Dual-peroxisome proliferator–activated receptor (PPAR) α/γ agonists may offer opportunities to lower macrovascular and microvascular complications of type 2 diabetes mellitus beyond the reductions achieved with conventional risk-factor modification. The information presented elucidates the differentiation of compound-specific vs class-effect properties of PPARs as the basis for future development of a new candidate molecule. Prior experience with thiazolidinediones, an approved class of PPARγ agonists, and glitazars, investigational class of dual-PPARα/γ agonists, also provides important lessons about the risks and benefits of targeting a nuclear receptor while revealing some of the future challenges for regulatory approval. PMID:23137497

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

    PubMed Central

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

    2012-01-01

    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

  13. Comparisons between MCNP, EGS4 and experiment for clinical electron beams.

    PubMed

    Jeraj, R; Keall, P J; Ostwald, P M

    1999-03-01

    Understanding the limitations of Monte Carlo codes is essential in order to avoid systematic errors in simulations, and to suggest further improvement of the codes. MCNP and EGS4, Monte Carlo codes commonly used in medical physics, were compared and evaluated against electron depth dose data and experimental backscatter results obtained using clinical radiotherapy beams. Different physical models and algorithms used in the codes give significantly different depth dose curves and electron backscattering factors. The default version of MCNP calculates electron depth dose curves which are too penetrating. The MCNP results agree better with experiment if the ITS-style energy-indexing algorithm is used. EGS4 underpredicts electron backscattering for high-Z materials. The results slightly improve if optimal PRESTA-I parameters are used. MCNP simulates backscattering well even for high-Z materials. To conclude the comparison, a timing study was performed. EGS4 is generally faster than MCNP and use of a large number of scoring voxels dramatically slows down the MCNP calculation. However, use of a large number of geometry voxels in MCNP only slightly affects the speed of the calculation. PMID:10211804

  14. Unsupervised biomedical named entity recognition: experiments with clinical and biological texts.

    PubMed

    Zhang, Shaodian; Elhadad, Noémie

    2013-12-01

    Named entity recognition is a crucial component of biomedical natural language processing, enabling information extraction and ultimately reasoning over and knowledge discovery from text. Much progress has been made in the design of rule-based and supervised tools, but they are often genre and task dependent. As such, adapting them to different genres of text or identifying new types of entities requires major effort in re-annotation or rule development. In this paper, we propose an unsupervised approach to extracting named entities from biomedical text. We describe a stepwise solution to tackle the challenges of entity boundary detection and entity type classification without relying on any handcrafted rules, heuristics, or annotated data. A noun phrase chunker followed by a filter based on inverse document frequency extracts candidate entities from free text. Classification of candidate entities into categories of interest is carried out by leveraging principles from distributional semantics. Experiments show that our system, especially the entity classification step, yields competitive results on two popular biomedical datasets of clinical notes and biological literature, and outperforms a baseline dictionary match approach. Detailed error analysis provides a road map for future work. PMID:23954592

  15. Treatment Options for Severe Epistaxis, the Experience of Coltea ENT Clinic

    PubMed Central

    ANGHEL, Alina Georgiana; SOREANU, Cristian Costin; DUMITRU, Mihai; ANGHEL, Ion

    2014-01-01

    Objectives: The study presents the experience of the Coltea ENT Clinic with the most common emergency in ENT pathology. Results: The study group comprises 51.24% women and 48.76% men with 73.14% of patients (177) coming from urban areas and the remaining 26.86% (65) from rural areas. The total number of days of hospitalization is 1411, representing an average of 5.83 days / patient. Epistaxis was anterior in 80.17% of cases (194 patients) and antero-posterior in 19.83% (48 patients). 132 patients, representing 54.55% presented elevated blood pressure whereas liver and hematological disorders are uncommon etiologies. Therapeutic interventions are mostly non-surgical 207 (85.54%), the remaining 35 cases (14.46%), requiring surgery. Conclusions: Epistaxis associated with high blood pressure is found in 54.55% of the study group. In 38.02% of cases the etiology cannot be determined. Pluri-factorial etiology is common. The most difficult to control were the cases with epistaxis of hepatic etiology, in which cases the surgical solution was required. PMID:25705275

  16. Development of Facial Rejuvenation Procedures: Thirty Years of Clinical Experience with Face Lifts

    PubMed Central

    Kim, Byung Jun; Choi, Jun Ho

    2015-01-01

    Facial rejuvenation procedures can be roughly divided into face lift surgery and nonoperative, less invasive procedures, such as fat grafts, fillers, botulinum toxin injections, thread lifts, or laserbrasion. Face lift surgery or rhytidectomy is the procedure most directly associated with rejuvenation, due to its fundamental ability to restore the anatomical changes caused by aging. Various methods of face lift surgery have been developed over the last hundred years, thanks to advances in the understanding of facial anatomy and the mechanisms of aging, as well as the dedication of innovative surgeons. However, no generally applicable standard method exists, because the condition of each patient is different, and each operative method has advantages and disadvantages. Specific characteristics of the skin of Asians and their skeletal anatomy should be considered when determining the operative method to be used on Asian patients. Plastic surgeons should improve their ability to analyze the original aesthetic properties and problem areas of each patient, drawing on scientific knowledge about the aging process, and they should develop the skills necessary to perform various rejuvenative techniques. In the present article, we reviewed various face lift procedures and the current methods of modified double plane face lift, based on our clinical experience of over 30 years. PMID:26430622

  17. Clinical experience with single-port access laparoscopic cystectomy and myomectomy

    PubMed Central

    Jeong, Jae-Hyeok; Kim, Yu-Ri; Hong, Kil-Pyo; Ha, Jae-Eun; Kim, Eun-Jeong; Hong, Da-Kyo

    2016-01-01

    Objective This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. Methods The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. Results The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33±0.78 g/dL and 4.14%±2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34±1.13 g/dL and 4.17%±3.24% in SPA laparoscopic myomectomy, respectively. Conclusion This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy. PMID:27104157

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

    PubMed

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

    2012-12-01

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

  19. Segmental composition of whole-body impedance cardiogram estimated by computer simulations and clinical experiments.

    PubMed

    Kauppinen, P K; Kööbi, T; Hyttinen, J; Malmivuo, J

    2000-03-01

    Whole-body impedance cardiography (ICGWB) has been proposed as a feasible means of measuring cardiac output (CO). However, the source distribution of heart-related impedance variations in the whole body is not known. To establish how much of a signal originates in each segment of the body and what the contribution of each is to stroke volume (SV) in ICGWB, impedance in the extremities and trunk were investigated in 15 healthy volunteers. In addition, the theoretical measurement properties of ICGWB were studied using a computer model of the whole-body anatomy as a volume conductor. The model confirmed the expected result that most of the basal impedance originates from the extremities. Clinical experiments revealed that the heart-related amplitude variations in the ICGWB signal originate more evenly from various body segments, the trunk slightly more than the arms or legs. The heart-related ICGWB signal represents a weighted sum of segmental pulsatile events in the body yielding physiologically meaningful data on almost the whole circulatory system. PMID:10735977

  20. Initial clinical experience using the EchoNavigator®-system during structural heart disease interventions

    PubMed Central

    Balzer, Jan; Zeus, Tobias; Hellhammer, Katharina; Veulemans, Verena; Eschenhagen, Silke; Kehmeier, Eva; Meyer, Christian; Rassaf, Tienush; Kelm, Malte

    2015-01-01

    AIM: To present our initial clinical experience using this innovative software solution for guidance of percutaneous structural heart disease interventions. METHODS: Left atrial appendage, atrial septal defect and paravalvular leak closure, transaortic valve repair and MitraClip® procedures were performed in the catheter laboratory under fluoroscopic and echocardiographic guidance. The two-dimensional and three-dimensional images generated by the transesophageal echocardiography probe were interfaced with the fluoroscopic images in real-time using the EchoNavigator®-system. RESULTS: The application of the novel image fusion technology was safe and led to a better appreciation of multimodality imaging guidance due to improved visualization of the complex relationship between catheter devices and anatomical structures. CONCLUSION: The EchoNavigator®-system is a feasible and safe tool for guidance of interventional procedures in structural heart disease. This innovative technology may improve confidence of interventional cardiologists in targeting and positioning interventional devices in order to increase safety, accuracy, and efficacy of percutaneous interventions in the catheter laboratory. PMID:26413233

  1. Clinical and practical requirements of online software for anesthesia documentation an experience report.

    PubMed

    Benson, M; Junger, A; Quinzio, L; Fuchs, C; Sciuk, G; Michel, A; Marquardt, K; Hempelmann, G

    2000-07-01

    The aim of this paper is the presentation of a new version of the anesthesia documentation software, NarkoData, that has been used in routine clinical work in our department as part of an anesthesia information management system (AIMS) since 1995. The performance of this software is presented along with requirements for future development of such a system. The originally used version, NarkoData 3.0, is an online anesthesia documentation software established by the software company ProLogic GmbH. It was primarily developed as a disk-based system for the MacOS operating system (Apple Computer Inc.). Based on our routine experience with the system, a catalogue of requirements was developed that concentrated on improvement in the sequence of work, administration and data management. In 1996, the concepts developed in our department, in close co-operation with medical personnel and the software company, led to a considerable enlargement of the program functions and the subsequent release of a new version of NarkoData. Since 1997, more than 20 000 anesthesia procedures have been recorded annually with this new version at 115 decentralized work stations at our university hospital. PMID:10961571

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

    PubMed Central

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

    2012-01-01

    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. PMID:23800856

  3. A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

    PubMed Central

    Rashid-Doubell, F; Mohamed, S; Elmusharaf, K; O'Neill, C S

    2016-01-01

    Objective The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital. Design Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting. Setting and participants Senior medical students at an international medical school in the Middle East. Results Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside. Conclusions Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner. PMID:27142860

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

    PubMed Central

    2013-01-01

    Background There is limited evidence of the unmet needs and experiences of adults with Attention Deficit Hyperactivity Disorder (ADHD) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients diagnosed during adulthood and childhood. Methods In this qualitative study, 30 adults with ADHD were recruited through an ADHD charity (n = 17) and two hospital outpatient clinics for adults with ADHD in England (n = 13). Half of the participants were diagnosed with ADHD during childhood or adolescence and the remainder during adulthood. Semi-structured interviews were conducted and data was analysed using a thematic approach based on Grounded Theory principles. Results Analysis revealed five core themes: ‘An uphill struggle’: the challenge of accessing services, ‘Accumulated Psychosocial Burden and the Impact of ADHD’, ‘Weighing up Costs vs. Benefits of ADHD Pharmacological Treatment’, ‘Value of Non-pharmacological Treatment’ and ‘Barriers to Treatment Adherence’. Accessing services and the challenges associated with securing a definitive diagnosis of ADHD in adulthood was an ‘uphill struggle’, often due to sceptical and negative attitudes towards ADHD by healthcare professionals. ADHD-related impairment had an overwhelmingly chaotic impact on every aspect of patients’ lives and many felt ill equipped to cope. A persistent sense of failure and missed potential from living with the impact of ADHD impairment had led to an accumulated psychosocial burden, especially among those diagnosed from late adolescence onwards. In contrast, positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many felt strongly that by itself, it was inadequate. Additional support in the form of psychological therapies or psycho-education was strongly desired. However, few patients had access to non-pharmacological treatment. In some, medication use was often inadequately monitored with little or no follow-up by healthcare professionals, leading to poor adherence and a sense of abandonment from the healthcare system. Conclusion The findings suggest that the unmet needs of adults with ADHD are substantial and that there is a wide gap between policy and current practice in England. PMID:23692803

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

    PubMed Central

    2009-01-01

    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. PMID:20003532

  6. A meta-synthesis of behavioral outcomes from telemedicine clinical trials for type 2 diabetes and the Clinical User-Experience Evaluation (CUE).

    PubMed

    Jalil, Sakib; Myers, Trina; Atkinson, Ian

    2015-03-01

    A worldwide demographic shift is in progress and the aged population proportion is projected to more than double across the next four decades. Our current healthcare models may not be adequate to handle this shift in demography, which may have serious consequences for the ageing population who are more prone to chronic diseases. One proposed remediation is to provide in-home assisted healthcare with technology-intervened approaches. Telemedicine, telehealth, e-health are paradigms found in scientific literature that provide clinical treatment through a technology intervention. In evidence-based medical science, these technology interventions are evaluated through clinical trials, which are targeted to measure improvements in medical conditions and the treatment's cost effectiveness. However, effectiveness of a technology also depends on the interaction pattern between the technology and its' users, especially the patients. This paper presents (1) a meta-synthesis of clinical trials for technology-intervened treatments of type 2 diabetes and (2) the Clinical User-Experience Evaluation (CUE). CUE is a recommendation for future telemedicine clinical trials that focuses on the patient as the user from Human-Computer Interaction (HCI) perspective and was developed as part of this research. The clinical trials reviewed were interpreted from a technology perspective and the non-medical or non-biological improvements of the users (patients) rather than the medical outcome. Results show that technology-intervened treatments provide positive behavior changes among patients and are potentially highly beneficial for chronic illness management such as type 2 diabetes. The results from the CUE method show how it complements clinical trials to capture patients' interaction with a technology. PMID:25677954

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

    PubMed

    Huk, W J; Gademann, G

    1984-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-08-01

    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.

  10. Ill-posed problem and regularization in reconstruction of radiobiological parameters from serial tumor imaging data

    NASA Astrophysics Data System (ADS)

    Chvetsov, Alevei V.; Sandison, George A.; Schwartz, Jeffrey L.; Rengan, Ramesh

    2015-11-01

    The main objective of this article is to improve the stability of reconstruction algorithms for estimation of radiobiological parameters using serial tumor imaging data acquired during radiation therapy. Serial images of tumor response to radiation therapy represent a complex summation of several exponential processes as treatment induced cell inactivation, tumor growth rates, and the rate of cell loss. Accurate assessment of treatment response would require separation of these processes because they define radiobiological determinants of treatment response and, correspondingly, tumor control probability. However, the estimation of radiobiological parameters using imaging data can be considered an inverse ill-posed problem because a sum of several exponentials would produce the Fredholm integral equation of the first kind which is ill posed. Therefore, the stability of reconstruction of radiobiological parameters presents a problem even for the simplest models of tumor response. To study stability of the parameter reconstruction problem, we used a set of serial CT imaging data for head and neck cancer and a simplest case of a two-level cell population model of tumor response. Inverse reconstruction was performed using a simulated annealing algorithm to minimize a least squared objective function. Results show that the reconstructed values of cell surviving fractions and cell doubling time exhibit significant nonphysical fluctuations if no stabilization algorithms are applied. However, after applying a stabilization algorithm based on variational regularization, the reconstruction produces statistical distributions for survival fractions and doubling time that are comparable to published in vitro data. This algorithm is an advance over our previous work where only cell surviving fractions were reconstructed. We conclude that variational regularization allows for an increase in the number of free parameters in our model which enables development of more-advanced parameter reconstruction algorithms.

  11. Intra-fraction dose delivery timing during stereotactic radiotherapy can influence the radiobiological effect

    SciTech Connect

    Murphy, Martin J.; Lin, Peck-Sun; Ozhasoglu, Cihat

    2007-02-15

    The sequence of incremental dose delivery during a radiotherapy fraction can potentially influence the radiobiological effect. This would be most noticeable during the long fractions characteristic of hypo-fractionated stereotactic radiotherapy and radiosurgery. We demonstrate here the spatio-temporal variation of dose delivery by the CyberKnife to a lung tumor and propose strategies to reduce and/or correct for any resultant dose-time cytotoxic effects.

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

    ERIC Educational Resources Information Center

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

    2002-01-01

    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

  13. 42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Data submission, clinical experience, and outcome requirements for re-approval of transplant centers. 482.82 Section 482.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS...

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

    SciTech Connect

    Gaona, Enrique; Enriquez, Jesus Gabriel Franco; Alfonso, Beatriz Y. Alvarez; Castellanos, Gustavo Casian

    2008-08-11

    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.

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

    PubMed Central

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

    2014-01-01

    Background Age-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular oedema (ME), and pigment epithelium detachments (PED). Purpose To evaluate the initial clinical experience of conversion from bevacizumab or ranibizumab to aflibercept in wet AMD patients. Methods Records of 250 consecutive wet AMD patients were retrospectively reviewed. Of 250 patients, 29 were naive (with no previous treatment), and 221 were previously treated with bevacizumab (1/3) or ranibizumab (2/3). On average, converted patients received 14 injections every 6 weeks on a treat-and-extend regimen with Avastin or Lucentis before being converted to aflibercept every 7 weeks on average (no loading dose) for three doses. For the purposes of this study, we concentrated on the patients converted to aflibercept since the number of naive patients was too small to draw any conclusion from. Snellen (as logMar) visual acuities, and optical coherence tomography (OCT) were compared predrug and postdrug conversion. Results Converted patients did not show a significant difference in visual acuity or average OCT thickness from preconversion values; however, small improvements in ME (p=0.0001), SRF (p=0.0001), and PED (p=0.008) grading were noted on average after conversion to aflibercept. Conclusions No significant difference in visual outcome or average OCT thickness was observed when switched from bevacizumab or ranibizumab q6 week to aflibercept 7-week dosing, on average. Mild anatomic improvements did occur in converted patients with regard to ME, SRF and PED improvement, on average, after conversion to aflibercept, and aflibercept was injected less frequently. No serious adverse reactions, including ocular infections or inflammation, as well as ocular and systemic effects were noted. PMID:24795335

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

    PubMed

    Melkonian, G; Bourrieau, J

    1994-11-01

    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

  17. Developing Regulatory-compliant Electronic Case Report Forms for Clinical Trials: Experience with The Demand Trial

    PubMed Central

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

    2009-01-01

    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

  18. Validation for clinical use of, and initial clinical experience with, a novel approach to population-based carrier screening using high-throughput, next-generation DNA sequencing.

    PubMed

    Hallam, Stephanie; Nelson, Heather; Greger, Valerie; Perreault-Micale, Cynthia; Davie, Jocelyn; Faulkner, Nicole; Neitzel, Dana; Casey, Kristie; Umbarger, Mark A; Chennagiri, Niru; Kramer, Alexander C; Porreca, Gregory J; Kennedy, Caleb J

    2014-03-01

    Traditional carrier screening assays are designed to look for only the most common mutations within a gene owing to cost considerations. Although this can yield high detection rates in specific populations for specific genes (such as cystic fibrosis in Caucasians), they are suboptimal for other ethnicities or for patients of mixed or unknown ethnic background. Next-generation DNA sequencing provides an opportunity to provide carrier screening using more comprehensive mutation panels that are limited primarily by information about the clinical impact of detected sequence changes. We describe a next-generation DNA sequencing-based assay capable of reliably screening patient samples in a timely and comprehensive manner. The analytic accuracy in a research setting has been documented. Here, we describe the additional studies performed to ensure the accuracy (analytic validity) and robustness of our assay for use in clinical practice and provide data from our experience offering this testing. Our clinical experience using this approach to screen 11,691 in vitro fertilization patients has identified 449 mutant alleles: 447 in carriers and 2 in an affected individual. In total, we found 87 distinct mutations in 14 different genes. Approximately one quarter of the mutations found are not included in traditional, limited, mutation panels, including 16 known mutations unique to our panel, and novel truncating mutations in several genes. PMID:24374108

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

    PubMed Central

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

    2013-01-01

    Background: Student-teacher relationship is a salient issue in nursing education and has long-lasting implication in professional development of nursing students. Nowadays, this relationship in clinical settings is different from the past due to changing in nursing education paradigm. The purpose of this qualitative study was to explore the experiences of students and teachers about student-teacher relationship in the context of clinical nursing education in Iran. Materials and Methods: In this qualitative study that has been carried out adopting conventional qualitative content analysis approach, six bachelor nursing students and six clinical teachers in school of Nursing and Midwifery, were selected through purposive sampling. Semi-structured interview and participant observation were used for data collection. Interviews transcribed verbatim and analyzed using conventional content analysis through the process of data reduction and condensation, coding and also generating the categories and themes. Results: Results of the study showed the existence of a type of relationship in clinical education in which supportive actions of clinical teachers were prominent. These supportive actions appeared as thre