Sample records for clinical radiobiological experience

  1. In vitro irradiation system for radiobiological experiments

    PubMed Central

    2013-01-01

    Background Although two-dimensional (2-D) monolayer cell cultures provide important information on basic tumor biology and radiobiology, they are not representative of the complexity of three-dimensional (3-D) solid tumors. In particular, new models reproducing clinical conditions as closely as possible are needed for radiobiological studies to provide information that can be translated from bench to bedside. Methods We developed a novel system for the irradiation, under sterile conditions, of 3-D tumor spheroids, the in vitro model considered as a bridge between the complex architectural organization of in vivo tumors and the very simple one of in vitro monolayer cell cultures. The system exploits the same equipment as that used for patient treatments, without the need for dedicated and highly expensive instruments. To mimic the passage of radiation beams through human tissues before they reach the target tumor mass, 96-multiwell plates containing the multicellular tumor spheroids (MCTS) are inserted into a custom-built phantom made of plexiglass, the material most similar to water, the main component of human tissue. Results The system was used to irradiate CAEP- and A549-derived MCTS, pre-treated or not with 20 ?M cisplatin, with a dose of 20 Gy delivered in one session. We also tested the same treatment schemes on monolayer CAEP and A549 cells. Our preliminary results indicated a significant increment in radiotoxicity 20 days after the end of irradiation in the CAEP spheroids pre-treated with cisplatin compared to those treated with cisplatin or irradiation alone. Conversely, the effect of the radio- chemotherapy combination in A549-derived MCTS was similar to that induced by cisplatin or irradiation alone. Finally, the 20 Gy dose did not affect cell survival in monolayer CAEP and A549 cells, whereas cisplatin or cisplatin plus radiation caused 100% cell death, regardless of the type of cell line used. Conclusions We set up a system for the irradiation, under sterile conditions, of tumor cells grown in 3-D which allows for the use of the same dose intensities and schedules utilized in clinical practice. This irradiation system, coupled with 3-D cell cultures, has the potential to generate information that could be used to individually tailor radiotherapy. PMID:24180359

  2. Simple preparation of thin CR-39 detectors for alpha-particle radiobiological experiments

    E-print Network

    Yu, K.N.

    , and thus provide transparent detectors for radiobiological experiments. UV radiation was employed to shorten track formation time on these thin CR-39 detectors. After exposure to UV light (UVA + B radiation for sterilizing the substrate. The commercially available CR-39 solid-state nuclear track detectors (SSNTDs

  3. 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.

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

    PubMed

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

    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 (?/? 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

  5. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2011-11-01

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

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

    NASA Technical Reports Server (NTRS)

    1973-01-01

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

  8. Determination of radiobiological parameters for the safe clinical application of BNCT

    SciTech Connect

    Hopewell, J.W.; Morris, G.M. [Univ. of Oxford (United Kingdom). Research Inst.; Coderre, J.A. [Brookhaven National Lab., Upton, NY (United States)

    1993-12-31

    In the present report the effects of BNCT irradiation on the skin and spinal cord of Fischer 344 rats, for known concentrations of {sup 10}B in the blood and these normal tissues, are compared with the effects of the neutron beam alone or photon irradiation. The biological effectiveness of irradiation in the presence of the capture agents BSH and BPA have been compared. Irradiations were carried out using the thermal beam of the Brookhaven Medical Research Reactor (BMRR). Therapy experiments were also carried out as part of this study, using the rat 9L-gliosarcoma cell line, in order to establish the potential therapeutic advantage that might be achieved using the above capture agents. This cell line grows as a solid tumor in vivo as well as in vitro. The implications of these findings, with respect to the clinical use of the Petten HBII based epithermal neutron beam, will be discussed.

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

    NASA Astrophysics Data System (ADS)

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

    2009-03-01

    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.

  10. Dose escalation to combat hypoxia in prostate cancer: a radiobiological study on clinical data

    Microsoft Academic Search

    J Z Wang; X A Li; N A Mayr

    2006-01-01

    Earlier studies have demonstrated that hypoxic regions exist in human prostate cancer and the degree of hypoxia correlates with the treatment outcome of radiotherapy. Using the concept of the clinical oxygen enhancement ratio (COER), the linear-quadratic (LQ) model was extended to account for the effect of tumour hypoxia. The clinical data collected at the Fox Chase Cancer Center for prostate

  11. Direct evaluation of radiobiological parameters from clinical data in the case of ion beam therapy: an alternative approach to the relative biological effectiveness.

    PubMed

    Cometto, A; Russo, G; Bourhaleb, F; Milian, F M; Giordanengo, S; Marchetto, F; Cirio, R; Attili, A

    2014-12-01

    The relative biological effectiveness (RBE) concept is commonly used in treatment planning for ion beam therapy. Whether models based on in vitro/in vivo RBE data can be used to predict human response to treatments is an open issue. In this work an alternative method, based on an effective radiobiological parameterization directly derived from clinical data, is presented. The method has been applied to the analysis of prostate cancer trials with protons and carbon ions.Prostate cancer trials with proton and carbon ion beams reporting 5 year-local control (LC5) and grade 2 (G2) or higher genitourinary toxicity rates (TOX) were selected from literature to test the method. Treatment simulations were performed on a representative subset of patients to produce dose and linear energy transfer distribution, which were used as explicative physical variables for the radiobiological modelling. Two models were taken into consideration: the microdosimetric kinetic model (MKM) and a linear model (LM). The radiobiological parameters of the LM and MKM were obtained by coupling them with the tumor control probability and normal tissue complication probability models to fit the LC5 and TOX data through likelihood maximization. The model ranking was based on the Akaike information criterion.Results showed large confidence intervals due to the limited variety of available treatment schedules. RBE values, such as RBE = 1.1 for protons in the treated volume, were derived as a by-product of the method, showing a consistency with current approaches. Carbon ion RBE values were also derived, showing lower values than those assumed for the original treatment planning in the target region, whereas higher values were found in the bladder. Most importantly, this work shows the possibility to infer the radiobiological parametrization for proton and carbon ion treatment directly from clinical data. PMID:25386876

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

    PubMed

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

    2014-07-01

    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

  13. 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

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

    NASA Astrophysics Data System (ADS)

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

    2007-08-01

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

  15. 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

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

    E-print Network

    Yu, K.N.

    rights reserved. Keywords: PADC; CR-39; Solid-state nuclear track detector; SSNTD; Radiobiology; Alpha particle 1. Introduction Ionizing radiation leads to production of reactive oxygen species in human cells. The effects of ionizing radiation can occur in irradiated (or targeted) cells or in non-irradiated (or non

  17. Non-extensive radiobiology

    SciTech Connect

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

    2011-03-14

    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.

  18. [Clinical experiences with noxiptilin].

    PubMed

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

    1976-04-01

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

  19. Proton radiobiology.

    PubMed

    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

  20. [Clinical experience with Leponex].

    PubMed

    Lange, E; König, L; Kühne, G E; Liefke, T

    1975-06-01

    Until now the "neuroleptic threshold" (Haase) was considered to be the efficiency criterion of the antipsychotic effect of a neuroleptic substance and it was thought therefore that the extrapyramidal symptoms were a necessary although undesired side effect. The benodiazepine derivative Leponex developed by Sandox - Basel upsets this view because it has an excellent antipsychotic effect without creating definite extrapyramidal symptoms. It is noted for its quick soporfic effect after only a few minutes, for subdueing psychopathological productivity in a very impressive way, for acting rapidly on the "plus"-symptomatology typical of psychosis, as early as in the first days of treatment, and for its equally visible effect on the "minus"-symptoms, typical of psychosis, in the last third of an average period of treatment lasting 40 days. The clinic using Leponex (Dresden, Halle, Brandenburg-Görden) belonged to the clinical application programme of the Sandox - Basel firm. The article gives a summary of essential results and particulars about the treatment. A detailed evaluation of the case sheets which are at present being statistically reviewed will be given in the next paper. PMID:1208707

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

    PubMed

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

    2008-08-01

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

  2. Radiobiology challenges for ELIMED

    SciTech Connect

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

    2013-07-26

    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.

  3. The radiobiology of hypofractionation.

    PubMed

    Nahum, Alan E

    2015-05-01

    If the ?/? 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 ?/? 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 (?/?)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 (?/?) 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 (?/?)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

  4. [Systemic approach to radiobiological studies].

    PubMed

    Bulanova, K Ia; Lobanok, L M

    2004-01-01

    The principles of information theory were applied for analysis of radiobiological effects. The perception of ionizing radiations as a signal enables living organism to discern their benefits or harm, to react to absolute and relatively small deviations, to keep the logic and chronicle of events, to use the former experience for reacting in presence, to forecast consequences. The systemic analysis of organism's response to ionizing radiations allows explaining the peculiarities of effects of different absorbed doses, hormesis, apoptosis, remote consequences and other post-radiation effects. PMID:15060932

  5. Integrated Clinical Experience 1 & 2 Clinical Skills Assessment Report Guidelines

    E-print Network

    Weber, David J.

    consistently demonstrates performance above the expected level based on the current stage of their clinical and linguistically . . .) Professionalism Appropriate attire Demonstrate initiative Accepts and responds1 Integrated Clinical Experience 1 & 2 Clinical Skills Assessment Report Guidelines Spring

  6. 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

  7. Radiobiological mechanisms of anti-inflammatory radiotherapy

    Microsoft Academic Search

    Klaus-Rüdiger Trott; Friedrich Kamprad

    1999-01-01

    Radiotherapy with total doses of ?6 Gy has been given as very effective and low risk treatment of painful degenerative joint diseases and other inflammatory processes. Recent radiobiological experiments in vitro and in vivo identified mechanisms which may be related to these anti-inflammatory radiation effects, in particular functional modulation of the adhesion of white blood cells to activated endothelial cells

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

    NASA Astrophysics Data System (ADS)

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

    2014-06-01

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

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

    PubMed

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

    2014-06-21

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

  10. Heavy ion beam model for radiobiology

    SciTech Connect

    Roth, R.A.; Katz, R.

    1980-09-01

    An ad hoc model of energetic heavy ion beams, including secondary and tertiary particles, has been constructed for predicting radiobiological experiments. While the beam model is relatively primitive, it yields depth-dose and depth-radiobiological calculations in good agreement with experiment upstream of the Bragg peak. Beyond the peak the model is somewhat coarse grained and seems to underestimate low-LET fragment production. These defects can be repaired at some cost in computer time. Presently a complete set of depth-dose and radiobiological results (RBE, OER, aerobic and hypoxic survival) is obtained in 4 to 8 min, for a single beam, at a cost of $10. The model can be extended to mixed radiation fields, or to explore the design of ridge filters. These predictions are based on cellular radiosensitivity parameters extracted from track-segment irradiations at about 8 MeV/amu. Their success implies that no new radiobiological results arise from irradiation with beams at 500 MeV/amu.

  11. Student Perceptions of Early Clinical Field Experiences.

    ERIC Educational Resources Information Center

    Bischoff, Judith; And Others

    1988-01-01

    Results of a study of 204 elementary education majors who had taken a junior year clinical experience (either a four week half-day or a three week full-day format) suggest that a full-day clinical experience is preferred by students. Students expressed concern for more organization and coordination of learning experiences. (IAH)

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

    SciTech Connect

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

    2000-11-12

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

  13. Gender variations in clinical pain experience

    Microsoft Academic Search

    Anita M. Unruh

    1996-01-01

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

  14. [Clinical experience in renal transplantation].

    PubMed

    Pak, K; Hayashida, H; Watanabe, J; Wakabayashi, Y; Arai, Y; Konishi, T; Konami, T; Takeuchi, H; Takayama, H; Tomoyoshi, T

    1985-08-01

    In Shiga Prefecture, 378 chronic renal failure patients were registered at the end of 1981. In 1982, the Kidney Transplantation Group, composed of the department of Urology and the 1st division of Surgery, was organized in our hospital and 10 living related renal transplantations and 8 cadaver renal transplantations were performed between July 1982 and October 1984. As immunosuppressants, azathioprine, mizoribine, cyclosporine, prednisolone, methylprednisolone and ALG were used. Azathioprine was used mainly for living transplantation and cyclosporine mainly for cadaver transplantation. ALG was used only for the initial 3 living transplantations. Mizoribine was sometimes used in combination with azathioprine to reduce the dose of azathioprine and reduce its severe side effects. Seven episodes of acute rejection were experienced and all episodes were remitted by methylprednisolone pulse therapy. There were 20 major post-transplant complications in 13 recipients and among them 2 pulmonary infections were fetal (1 from aspergillus infection and 1 from cytomegalovirus infection). The 10 living related kidney transplantation recipients are all well and none have undergone hemodialysis. Three of the 8 cadaver renal transplantation are well without hemodialysis. One patient could not obtain diuresis. In addition to our experience of renal transplantation, the preoperative scheduled blood transfusion with combination of azathioprine administration, was briefly discussed. PMID:3909789

  15. Natural orifice surgery: initial clinical experience

    Microsoft Academic Search

    Santiago Horgan; John P. Cullen; Mark A. Talamini; Yoav Mintz; Alberto Ferreres; Garth R. Jacobsen; Bryan Sandler; Julie Bosia; Thomas Savides; David W. Easter; Michelle K. Savu; Sonia L. Ramamoorthy; Emily Whitcomb; Sanjay Agarwal; Emily Lukacz; Guillermo Dominguez; Pedro Ferraina

    2009-01-01

    Background  Natural orifice translumenal endoscopic surgery (NOTES) has moved quickly from preclinical investigation to clinical implementation.\\u000a However, several major technical problems limit clinical NOTES including safe access, retraction and dissection of the gallbladder,\\u000a and clipping of key structures. This study aimed to identify challenges and develop solutions for NOTES during the initial\\u000a clinical experience.\\u000a \\u000a \\u000a \\u000a Methods  Under an Institutional Review Board (IRB)-approved protocol,

  16. Radiobiology of pions at LAMPF

    SciTech Connect

    Raju, M.R.; Tokita, N.

    1982-01-01

    Recent radiobiology data for pion beams used in therapy are presented. The biological systems used were cultured cells suspended in gelatin and intestinal crypt assay. The importance of fast neutrons from pion stars in large treatment volumes is discussed. The data for compensating the depth dose distribution to produce uniform cell killing across the peak region are presented. The changes in biological effectiveness with peak width for pion beams (unlike heavy ions) are small because of fast neutron contribution from pion stars. The need for innovative radiobiology programs to guide high-LET radiotherapy is discussed.

  17. 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

  18. Implementing a Clinical Experience for Student Trainers.

    ERIC Educational Resources Information Center

    Compton, Rod

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

  19. Design study of the ESS-Bilbao 50 MeV proton beam line for radiobiological studies

    NASA Astrophysics Data System (ADS)

    Huerta-Parajon, M.; Martinez-Ballarin, R.; Abad, E.

    2015-02-01

    The ESS-Bilbao proton accelerator facility has been designed fulfilling the European Spallation Source (ESS) specifications to serve as the Spanish contribution to the ESS construction. Furthermore, several applications of the ESS-Bilbao proton beam are being considered in order to contribute to the knowledge in the field of radiobiology, materials and aerospace components. Understanding of the interaction of radiation with biological systems is of vital importance as it affects important applications such as cancer treatment with ion beam therapy among others. ESS-Bilbao plans to house a facility exclusively dedicated to radiobiological experiments with protons up to 50 MeV. Beam line design, optimisation and initial calculations of flux densities and absorbed doses were undertaken using the Monte Carlo simulation package FLUKA. A proton beam with a flux density of about 106 protons/cm2 s reaches the water sample with a flat lateral distribution of the dose. The absorbed dose at the pristine Bragg peak calculated with FLUKA is 2.4 ± 0.1 Gy in 1 min of irradiation time. This value agrees with the clinically meaningful dose rates, i.e. around 2 Gy/min, used in hadrontherapy. Optimisation and validation studies in the ESS-Bilbao line for radiobiological experiments are detailed in this article.

  20. First time rounding experiences for nonclinicians: the cleveland clinic experience.

    PubMed

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

    2015-03-01

    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

  1. Clinical experience during the paediatric undergraduate course.

    PubMed Central

    Ahmed, S F; Hughes, I A

    1999-01-01

    Medical students at the Cambridge Clinical School are provided with a list of 42 core conditions they should encounter and 20 core skills they should perform during their attachment. By self-completion questionnaires we assessed their clinical experience and the amount of teaching they received, relating the results to marks gained in end-of-attachment assessments. 103 (93%) of 110 students in year one and 123 (96%) of 128 in year two completed the questionnaires. Of the 42 core conditions, 13 were seen by under 70% of the students in year one. In year two, exposure rate increased for 26 core conditions by a median of 7% (range 2-40) and decreased in 13 core conditions by a median value 4% (range 5-13) (P = 0.0005, chi 2). Only mandatory core skills were performed by over 90% of students. 5% of students did not perform any newborn examinations and under 60% observed neonatal resuscitation or a high-risk delivery. Students' core condition score was associated with their core skill score (r = 0.5), hospital grade (r = 0.3) and exposure to acute paediatrics (r = 0.3) (P < 0.005). There was no significant association between clinical experience and the objective examination score or the amount of teaching received. There was an inverse association between the number of students at a hospital and the number of core conditions with an exposure rate above 70% at that hospital (r = 0.7, P < 0.05). This study suggests that clinical experience may be better judged by the clinical supervisor than by assessment of theoretical knowledge. PMID:10472283

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

    Microsoft Academic Search

    Howard R. Hernandez

    2012-01-01

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

  3. Experience with fingolimod in clinical practice.

    PubMed

    Hersh, Carrie M; Hara-Cleaver, Claire; Rudick, Richard A; Cohen, Jeffrey A; Bermel, Robert A; Ontaneda, Daniel

    2014-10-29

    Aim: To report experience with fingolimod in clinical practice. Design/Methods: Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects (AEs), clinical measures, MRI data, and quality of life measures were assessed. Results: Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy (DMT) use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to AEs (n = 40) or breakthrough disease (n = 22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to AEs or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

  4. Neutron facility for radiobiological studies

    NASA Astrophysics Data System (ADS)

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

    1997-02-01

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

  5. 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)

  6. 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.)

  7. 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.

  8. 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.

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

    Microsoft Academic Search

    Philippe Baert; Tim van Cleynenbreugel; Jo Vandesompele; Sofie de Schynkel; Jos Vander Sloten; Patrick van Oostveldt

    2006-01-01

    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

  10. Transhiatal Esophagectomy: Clinical Experience and Refinements

    PubMed Central

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

    1999-01-01

    Objective To review the authors’ clinical experience with transhiatal esophagectomy (THE) and the refinements in this procedure that have evolved. Background Increased use of THE during the past two decades has generated controversy about the merits and safety of this approach compared with transthoracic esophageal resection. The authors’ large THE experience provides a valuable basis for benchmarking data regarding the procedure. Methods The results of THE were analyzed retrospectively using the authors’ prospectively established esophageal resection database and follow-up information on these patients. Results From 1976 to 1998, THE was performed in 1085 patients, 26% with benign disease and 74% with cancer. The procedure was possible in 98.6% of cases. Stomach was the esophageal substitute in 96%. The hospital mortality rate was 4%. Blood loss averaged 689 cc. Major complications were anastomotic leak (13%), atelectasis/pneumonia (2%), intrathoracic hemorrhage, recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration (<1% each). Actuarial survival of patients with carcinoma equaled or exceeded that reported after transthoracic esophagectomy. Late functional results were good or excellent in 70%. With preoperative pulmonary and physical conditioning, a side-to-side stapled cervical esophagogastric anastomosis (<3% incidence of leak), and postoperative epidural anesthesia, the need for an intensive care unit stay has been eliminated and the length of stay reduced to 7 days. Conclusion THE is possible in most patients requiring esophageal resection and can be performed with greater safety and fewer complications than the traditional transthoracic approaches. PMID:10493486

  11. 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

  12. Nursing students' initial clinical experience: a phenomenological study.

    PubMed

    Beck, C T

    1993-12-01

    Nursing students have revealed that one of the most anxiety-producing aspects of their clinical experience is the initial clinical experience. In order to help students through their initial clinical experience, faculty must first understand more fully the meaning of this experience for nursing students. A phenomenological study was conducted to explore the lived experience of nursing students' first clinical experience. Eighteen undergraduate nursing students described in writing an experience they had during their first day of clinical. Data were analyzed using Colaizzi's phenomenological method. Six theme clusters emerged: pervading anxiety, feeling abandoned, encountering reality shock, envisioning self as incompetent, doubting choices, and uplifting consequences. Implications for nurse educators are addressed. PMID:8288418

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

    NASA Astrophysics Data System (ADS)

    Herrera, Higmar; Yañez, Elvia; López, Jesús

    2012-10-01

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

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

    SciTech Connect

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

    2012-10-23

    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.

  15. Clinical experience with trisomies 18 and 13

    Microsoft Academic Search

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

    1978-01-01

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

  16. 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

  17. Mesenchymal stem cells: from experiment to clinic

    PubMed Central

    2011-01-01

    There is currently much interest in adult mesenchymal stem cells (MSCs) and their ability to differentiate into other cell types, and to partake in the anatomy and physiology of remote organs. It is now clear these cells may be purified from several organs in the body besides bone marrow. MSCs take part in wound healing by contributing to myofibroblast and possibly fibroblast populations, and may be involved in epithelial tissue regeneration in certain organs, although this remains more controversial. In this review, we examine the ability of MSCs to modulate liver, kidney, heart and intestinal repair, and we update their opposing qualities of being less immunogenic and therefore tolerated in a transplant situation, yet being able to contribute to xenograft models of human tumour formation in other contexts. However, such observations have not been replicated in the clinic. Recent studies showing the clinical safety of MSC in several pathologies are discussed. The possible opposing powers of MSC need careful understanding and control if their clinical potential is to be realised with long-term safety for patients. PMID:21902837

  18. Clinical nurse specialist regulation: the Maryland experience.

    PubMed

    Thurman, Paul

    2015-01-01

    High-quality care will continue to be a driver in the evolution of today's health care environment. Ensuring effective, cost-conscious, quality care is the core of clinical nurse specialist (CNS) practice. The CNS practice varies by state, depending on each state's Nurse Practice Act. Some states have separate scopes of practice for CNSs, including prescriptive authority, whereas some states do not recognize CNS practice as different from the practice of the registered nurse. The journey to state recognition and title protection for the CNS role in the state of Maryland is described. PMID:25594481

  19. 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…

  20. Recommendations for the future of translational radiobiology research: a Canadian perspective.

    PubMed

    Bristow, Robert G

    2004-02-01

    The use of molecular medicine is now merging into clinical practice with the advent of molecular targeting agents, molecular pathology and molecular imaging for both diagnosis and treatment response. Radiation oncologists must therefore gain expertise in utilizing this information to drive new treatment protocols. Recognizing the importance of this issue, the Canadian Association of Radiation Oncologists (CARO) charged a Task Force in Translational Radiobiology to: (1) critically assess training programs and research infrastructure in relation to current and future translational radiobiology requirements; and (2) make specific recommendations to accelerate the implementation of translational science into day-to-day practice. Selected Task Force recommendations included the principle that universities and departmental Chairs increase the opportunities for academic promotion, funding, and tenure track positions of radiobiologists and translational radiation oncologists. The dedication of 4 to 5 national centers as translational 'hubs', can serve as an interface between clinicians, clinical specimens and radiobiological sciences within the context of correlative clinical trials. The model of the clinician-scientist was encouraged as an important adjunct to good clinical care to be associated with strong enticement, training and mentoring programs and 75%-protected research time. Finally, an integrated model of radiobiological training programs and mutual continuing education between clinicians and basic scientists can be facilitated through a new national radiobiology meeting sponsored by CARO. These recommendations have been accepted by the national radiation oncology membership. Such a framework may serve useful for national programs wishing to develop rapid conduits from the lab to the clinic as a means of integrating molecular biology and the day-to-day practice of radiation oncology. PMID:15028402

  1. National Radiobiology Archives distributed access programmer's guide

    SciTech Connect

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

    1991-12-01

    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.

  2. Clinical intestinal transplantation: Experience in Miami

    Microsoft Academic Search

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

    1997-01-01

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

  3. Tinnitus: clinical experience of the psychosomatic connection

    PubMed Central

    Salviati, Massimo; Bersani, Francesco Saverio; Terlizzi, Samira; Melcore, Claudia; Panico, Roberta; Romano, Graziella Francesca; Valeriani, Guiseppe; Macrì, Francesco; Altissimi, Giancarlo; Mazzei, Filippo; Testugini, Valeria; Latini, Luca; Delle Chiaie, Roberto; Biondi, Massimo; Cianfrone, Giancarlo

    2014-01-01

    Background The connection between psychopathology and tinnitus is complex and not adequately studied. The aim of this study is to investigate the relationship between tinnitus and psychiatric comorbidities from different points of view: categorical, dimensional, temperamental, and perceived stress level. Methods Two hundred and thirty-nine patients affected by tinnitus were recruited between January and October 2012. Patients underwent a preliminary battery of tests including the Tinnitus Handicap Inventory (THI), Symptom Check List (SCL90-R), Temperament and Character Inventory (TCI), and Stress-Related Vulnerability Scale (VRS), and eventually a full psychiatric evaluation. Results One hundred and fourteen patients (48% of the total sample) presented psychiatric comorbidity. Among these, a higher prevalence of depression, somatization, obsession, and anxiety was found. More than 41% of patients affected by decompensated tinnitus reported a family history of psychiatric disorders. Significant positive correlations between the psychopathological screening tools (SCL90-R and VRS) and THI were found. Patients affected by comorbid psychiatric disorder showed specific temperamental and characterial predispositions. Conclusion Psychiatric comorbidity in subjects affected by tinnitus is frequent. Stress can be considered as a factor leading to damage and dysfunction of the auditory apparatus. The vulnerability to neurotic disorders and the lack of coping capabilities can play a critical role in the clinical history of patients affected by severe tinnitus. PMID:24550676

  4. [Apomorphine in off state--clinical experience].

    PubMed

    Rudzi?ska, Monika; Szczudlik, Andrzej

    2007-01-01

    Apomorphine, a non-ergot derivative, is a potent, directly acting dopamine receptor agonist with high affinity to D4, lower to D2, D3, D5, the lowest to D1-like dopamine receptors as well as to serotonin and adrenoreceptors. Subcutaneous apomorphine is currently used in Parkinson's disease as an add-on to levodopa therapy or monotherapy for management of sudden, unexpected and refractory to levodopa-induced off state and fluctuation in advanced stage of illness. Many clinical trials have shown markedly (about 50-72%) reduced time of off phases. Other indications include the challenge test for determining the dopaminergic responsiveness. Apomorphine is used subcutaneously either as intermittent rescue injections or continuous infusions. Several other routes - transdermal, sublingual, intranasal, rectal and intravenous infusion - have been tried. Oral administration is not recommended. Apomorphine has rapid onset of antiparkinsonian action, qualitatively comparable to that of levodopa, short duration of action and stable efficacy with usually mild adverse events similar to other dopamine agonists. Domperidone or trimethobenzamide should be introduced before starting apomorphine treatment to reduce occurrence of peripheral adverse events (nausea, vomiting, orthostatic hypotension). Dyskinesias, sleep disturbances, hallucinations, delusion, oedema and yawning can occur, but some side effects are connected only with a specific route (for example skin nodules appearing during subcutaneous administration). Despite its long history, apomorphine is registered and used in only a few countries. Apomorphine warrants wider application in treatment of advanced Parkinson disease but the high cost of the drug, the necessity of concomitant treatment for prevention of side effects and subcutaneous administration restrict its use. PMID:17941458

  5. TRIGA reactor facility at the Armed Forces Radiobiology Research Institute: a simplified technical description. Technical report

    Microsoft Academic Search

    M. L. Moore; S. Elsasser

    1986-01-01

    In support of its mission the Armed Forces Radiobiology Research Institute (AFRRI) operates a medium-sized research nuclear reactor. The reactor is used to generate radiations, primarily neutrons and gamma rays, which are used to conduct experimental biomedical research and to produce isotopes. The radiations are delivered to the experiments in one of two ways: a pulse operation delivers a very

  6. THREE YEARS CLINICAL EXPERIENCE WITH INTESTINAL TRANSPLANTATION

    PubMed Central

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

    2009-01-01

    BACKGROUND After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal transplantation worldwide were discouraging because of unsatisfactory graft and patient survival. The experimental and clinical demonstration of the superior therapeutic efficacy of FK 506, a new immunosuppressive drug, ushered in the current era of small bowel and multivisceral transplantation with initial promising results. STUDY DESIGN Forty-three consecutive patients with short bowel syndrome, intestinal insufficiency, or malignant tumors with or without associated liver disease, were given intestinal (n=15), hepatic and intestinal (n=21), or multivisceral allografts that contained four or more organs (n=7). Treatment was with FK 506 based immunosuppression. The ascending and right transverse colon were included with the small intestine in 13 of the 43 grafts, almost evenly distributed between the three groups. RESULTS After six to 39 months, 30 of the 43 patients are alive, 29 bearing grafts. The most rapid convalescence and resumption of diet, as well as the highest three month patient survival (100 percent) and graft survival (88 percent) were with the isolated intestinal procedure. However, this advantage was slowly eroded during the first two postoperative years, in part because the isolated intestine was more prone to rejection. By the end of this time, the best survival rate (86 percent) was with the multivisceral procedure. With all three operations, most of the patients were able to resume diet and discontinue parenteral alimentation, and in the best instances, the quality of life approached normal. However, the surveillance and intensity of care required for these patients for the first year, and in most instances thereafter, was very high, being far more than required for patients having transplants of the liver, kidney or heart. CONCLUSIONS Although intestinal transplantation has gone through the feasibility phase, strategies will be required to increase its practicality. One possibility is to combine intestinal transplantation with contemporaneous autologous bone marrow transplantation. PMID:7522850

  7. Postgraduate clinical education--the Canadian experience.

    PubMed

    Mueller, C B; Ames, F

    1974-10-19

    To obtain a quantitative measure of the extent to which graduate education and qualification for specialty practice have become an integral part of the total educational experience, samples of the graduating classes of 1960, 1964, 1968 and 1970 of Canadian medical schools were tracked through postgraduate educational training and into specialty certification. From the 1960 cohort 65% chose a career recognized by special certifying exams in Canada and/or the United States, entered a residency, completed it and achieved certification of special competence. From the 1970 cohort, by the end of 1972 approximately 50% had entered a recognized specialty training program leading to certification. The diminishing trend toward specialty practice is demonstrated by reviewing the comparative figures in the 1964 and 1968 cohorts. Evidence garnered in this study indicates a continuing strong motivation for specialty practice although family medicine and/or general practice appear increasingly attractive as career choices. Strong provincial educational forces as well as social and other forces will probably continue to modify career selection and may lead an increasing number of Canadian medical graduates into family practice. PMID:4420690

  8. National Radiobiology Archives Distributed Access user's manual

    SciTech Connect

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

    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. 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

  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. Vertebroplasty: clinical experience and follow-up results

    Microsoft Academic Search

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

    1999-01-01

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

  12. 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…

  13. 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…

  14. Creation of a virtual health system for leadership clinical experiences.

    PubMed

    Ross, Amy Miner; Crusoe, Kristen L

    2014-12-01

    Students had difficulty integrating leadership and outcomes management skills into their burgeoning novice practice. Further, the Baccalaureate Completion Program for RNs, an online program, expanded student enrollment, which created difficulty in finding enough clinical placements in agencies with staff experienced in leading teams and conducting performance improvement projects. The Leadership and Outcomes Management course was changed from a live clinical agency placement course to a virtual clinical agency experience. Students worked in teams on a virtual quality care delivery case within a virtual health care system. Students selected the case and where they worked within our full-service virtual health system. The virtual health system required interactions with staff, and faculty assumed several roles within the virtual health system as they guided the students through leadership skill development and the creation of a performance improvement system process. It also eliminated the need for live clinical agency placements. PMID:25406844

  15. [Hospital clinical experience: meanings for Family Health resident nurses].

    PubMed

    Landim, Simone Alves; Batista, Nildo Alves; da Silva, Gilberto Tadeu Reis

    2010-01-01

    This qualitative research in phenomenological design aimed at understanding the meaning of hospital clinical experience in the nurse's training in a Multiprofessional Family Health Residency. The study was developed in a teaching institution. Data collection was based on interviews and had as study population eight resident nurses. I investigated the residents' experience according to their speeches, by making the following guiding question: "Talk about your hospital experience, how does it show itself in your training as a resident"? One open category emerged from the subject' description: Causing to approach the hospital experience and the Primary Health Care. Among the meanings attributed to the hospital experience, there is the need and relevance as an integrant part of the curriculum vitae of the Multiprofessional Family Health Residency for the nurses. PMID:21308222

  16. Nursing preceptors' experiences of two clinical education models.

    PubMed

    Mamhidir, Anna-Greta; Kristofferzon, Marja-Leena; Hellström-Hyson, Eva; Persson, Elisabeth; Mårtensson, Gunilla

    2014-08-01

    Preceptors play an important role in the process of developing students' knowledge and skills. There is an ongoing search for the best learning and teaching models in clinical education. Little is known about preceptors' perspectives on different models. The aim of the study was to describe nursing preceptors' experiences of two clinical models of clinical education: peer learning and traditional supervision. A descriptive design and qualitative approach was used. Eighteen preceptors from surgical and medical departments at two hospitals were interviewed, ten representing peer learning (student work in pairs) and eight traditional supervision (one student follows a nurse during a shift). The findings showed that preceptors using peer learning created room for students to assume responsibility for their own learning, challenged students' knowledge by refraining from stepping in and encouraged critical thinking. Using traditional supervision, the preceptors' individual ambitions influenced the preceptorship and their own knowledge was empathized as being important to impart. They demonstrated, observed and gradually relinquished responsibility to the students. The choice of clinical education model is important. Peer learning seemed to create learning environments that integrate clinical and academic skills. Investigation of pedagogical models in clinical education should be of major concern to managers and preceptors. PMID:24512652

  17. 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

  18. 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)

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

    PubMed

    Bezecny, Pavel

    2014-06-01

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

  20. The interprofessional clinical experience: interprofessional education in the nursing home.

    PubMed

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

    2015-03-01

    Abstract The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. The post-experience assessment evaluated the trainees' perception of potential team members' roles and attitudes about interprofessional team care of the older adult. Attitudes toward interprofessional teamwork and the older adult were generally positive. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting. PMID:25140581

  1. Experiences of a Belgian multidisciplinary breath odour clinic.

    PubMed

    Delanghe, G; Ghyselen, J; Feenstra, L; van Steenberghe, D

    1997-01-01

    Experiences of a Belgian multidisciplinary breath odour clinic. Oral malodour is a frequent problem, which can benefit from a multidisciplinary approach (periodontology, ENT, internal medicine, psychiatry). An objective measurement of the amount of volatile sulphur compounds in the patient is very useful and easy to perform. Tongue coating is the most frequent cause. Initial treatment strategy should focus on oral hygiene. In a few cases, tonsillectomy or endoscopic sinus surgery may be necessary. PMID:9105483

  2. 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

  3. 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.

  4. Radiobiological studies using gamma and x rays.

    SciTech Connect

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

    2013-02-01

    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.

  5. Systematic review of new medics’ clinical task experience by country

    PubMed Central

    2014-01-01

    Objectives There is a need for research which informs on the overall size and significance of clinical skills deficits among new medics, globally. There is also the need for a meta-review of the similarities and differences between countries in the clinical skills deficits of new medics. Design A systematic review of published literature produced 68 articles from Google/Google Scholar, of which nine met the inclusion criteria (quantitative clinical skills data about new medical doctors). Participants One thousand three hundred twenty-nine new medical doctors (e.g. foundation year-1s, interns, postgraduate year-1 doctors). Setting Ten countries/regions. Main outcome measures One hundred twenty-three data points and representation of a broad range of clinical procedures. Results The average rate of inexperience with a wide range of clinical procedures was 35.92% (lower confidence interval [CI] 30.84, upper CI 40.99). The preliminary meta-analysis showed that the overall deficit in experience is significantly different from 0 in all countries. Focusing on a smaller selection of clinical skills such as catheterisation, IV cannulation, nasogastric tubing and venepuncture, the average rate of inexperience was 26.75% (lower CI 18.55, upper CI 35.54) and also significant. England presented the lowest average deficit (9.15%), followed by New Zealand (18.33%), then South Africa (19.53%), Egypt, Kuwait, Gulf Cooperation Council countries and Ireland (21.07%), after which was Nigeria (37.99%), then USA (38.5%) and Iran (44.75%). Conclusion A meta-analysis is needed to include data not yet in the public domain from more countries. These results provide some support for the UK General Medical Council’s clear, detailed curriculum, which has been heralded by other countries as good practice. PMID:25057392

  6. Experiences incorporating Tablet PCcs into clinical pharmacists' workflow.

    PubMed

    McCreadie, Scott R; McGregory, Michael E

    2005-01-01

    Tablet PCs are portable computers that combine the power of a laptop with an intuitive pendriven interface that have been heavily promoted for vertical industries such as healthcare. The authors describe their experiences with tablet PCs used by clinical pharmacists in a large academic medical center. A slate tablet with a large screen and wireless networking capability was chosen. Tablet PCs were issued to users with a customized 'pen-friendly" clinical application and secure access to the majority of available electronic patient information. In general, the feedback from the pilot users was positive. Users reported increased efficiency on patient care rounds; they say they reduced or eliminated paper notes and shadow charts from their daily routine. However, researchers also observed that some clinical practice workflow models or clinicians did not benefit from or were hindered by the mobile devices. The department plans to expand the use of tablet PCs through desktop replacement and is developing solutions to increase the applicability of tablet PCs for all clinical models and clinicians. PMID:16266030

  7. Practice nurses and their 'lived experience' of clinical supervision.

    PubMed

    Cutcliffe, J; McFeely, S

    Increased workload in primary care and the advent of primary care groups means that practice nurses (PNs) are experiencing a profusion of changes. As a result, PNs have taken on board many new skills, and this has increased the demands and stresses made upon them. Accordingly, this study investigated 17 PNs' lived experiences of clinical supervision following a 4-day training programme. It adopted a hermeneutic, phenomenological method. Data were collected by means of semistructured interviews within a series of focus groups. The data from the focus groups underwent a thematic analysis, which induced an emerging theory comprising five key themes: (1) providing support (2) nurturing and growth (3) enhancing and enriching practice (4) encountering a new experience, and (5) engaging in intellectually challenging and demanding work. The findings indicated that the central theme of the PNs' experience of clinical supervision was that of 'providing support', in that, without the presence and application of support, the effectiveness of the other themes appears to be diminished. The findings additionally indicated a range of issues, discussed under the headings: practice, education, policy, and further research. PMID:12170674

  8. 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

  9. 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

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

    PubMed Central

    Bonifaz, Alexandro; Váquez-González, Denisse; Fierro, Leonel; Araiza, Javier; Ponce, Rosa María

    2013-01-01

    Background: Trichomycosis is asymptomatic bacterial infection of the axillary hairs caused by Corynebacterium sp. Objective: to bring a series of cases of trichomycosis, its clinical and microbiological experience. Materials and Methods: This report consists in a linear and observational retrospective study of 15 years of cases of trichomycosis confirmed clinically and microbiologically. Results: Fifty six confirmed cases of trichomycosis were included in this report. The majority were men 53/56 (94.6%), mean age was 32.5 years. The most commonly affected area was the axilla (92%), trichomycosis flava was the principal variant 55/56 (98.2%) and signs and symptoms associated were hyperhidrosis (87.5%), hairs’ texture change (57.1%) and odor (35.7%). Bacterial concretions were observed in all cases, and the predominant causative agent in 89.3% of all cases was Corynebacterium sp. Thirty patients were included in therapeutic portion of the study, and 28 (93.3%) of them experienced a clinical and microbiological cure. Conclusion: Trichomycosis is asymptomatic, superficial infection, which primarily affects axillary hairs. PMID:23960390

  11. 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…

  12. 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

  13. 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

  14. 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…

  15. 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

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

    PubMed Central

    2013-01-01

    Background Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer. Methods Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database. Treatment was delivered using the CyberKnife® with doses of 35 Gy or 36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were recorded and scored using the CTCAE v.3. Quality of life was assessed before and after treatment using the Short Form-12 Health Survey (SF-12), the American Urological Association Symptom Score (AUA) and Sexual Health Inventory for Men (SHIM) questionnaires. Late urinary symptom flare was defined as an AUA score???15 with an increase of???5 points above baseline six months after the completion of SBRT. Results One hundred patients (37 low-, 55 intermediate- and 8 high-risk according to the D’Amico classification) at a median age of 69 years (range, 48–90 years) received SBRT, with 11 patients receiving ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.2 ng/ml (range, 1.9-31.6 ng/ml) and the median follow-up was 2.3 years (range, 1.4-3.5 years). At 2 years, median PSA decreased to 0.49 ng/ml (range, 0.1-1.9 ng/ml). Benign PSA bounce occurred in 31% of patients. There was one biochemical failure in a high-risk patient, yielding a two-year actuarial biochemical relapse free survival of 99%. The 2-year actuarial incidence rates of GI and GU toxicity???grade 2 were 1% and 31%, respectively. A median baseline AUA symptom score of 8 significantly increased to 11 at 1 month (p?=?0.001), however returned to baseline at 3 months (p?=?0.60). Twenty one percent of patients experienced a late transient urinary symptom flare in the first two years following treatment. Of patients who were sexually potent prior to treatment, 79% maintained potency at 2 years post-treatment. Conclusions SBRT for clinically localized prostate cancer was well tolerated, with an early biochemical response similar to other radiation therapy treatments. Benign PSA bounces were common. Late GI and GU toxicity rates were comparable to conventionally fractionated radiation therapy and brachytherapy. Late urinary symptom flares were observed but the majority resolved with conservative management. A high percentage of men who were potent prior to treatment remained potent two years following treatment. PMID:23497695

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

    Microsoft Academic Search

    Beverley Cole; Jean Wessel

    2008-01-01

    Purpose  There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at\\u000a the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students’ perceptions of\\u000a their learning experiences during an introductory clinical placement. Methods: Subjects were 51 physical therapy students participating in an introductory clinical placement following the first

  18. Clinical experience with a recombinant DNA hepatitis B vaccine.

    PubMed

    Andre, F E

    1988-09-01

    The clinical testing of EngerixR-B, the hepatitis B vaccine produced by SmithKline Biologicals using recombinant DNA technology, started in February 1984. Since extensive pre-clinical laboratory work had established that the polypeptide (HBsAg) expressed in genetically engineered yeast cells was after purification--physically, chemically and antigenically similar to the viral surface antigen particles found in the blood of chronic carriers, the aims of the clinical trials were to compare the safety, reactogenicity, immunogenicity and protective efficacy of yeast-derived (YDV) and plasma-derived (PDV) vaccines. By September 1987, 89 studies had been initiated involving a total of 10,545 subjects aged from birth to 82 years. This extensive experience has established that the risk of hypersensitivity to yeast-derived contaminants is negligible since no hypersensitivity reaction has been observed in any vaccinee, the incidence and severity of local reactions have not increased after repeated inoculations and no anti-yeast antibodies were produced by vaccination. Reactogenicity has been comparable to that of PDV's consisting essentially of transient mild irritation at the site of injection presumably caused by the aluminium hydroxide used as adjuvant. The anti-HBs responses to YDV and PDV's were quantitatively (seroconversion rates, peak antibody levels and persistence) as well as qualitatively (epitope specificity and affinity) similar. The expected protective effect of the immune response to the vaccine was confirmed in a challenge study in chimpanzees and in vaccinated human populations (male homosexuals, institutionalized mentally retarded patients, neonates of carrier women) with historically a high infection rate. PMID:2464196

  19. Advances in musculoskeletal oncology: experience of the Lublin Orthopedic Clinic.

    PubMed

    Warda, Edward; Mazurkiewicz, Tomasz; Kopacz, Jacek; Gronowska, Stanis?awa

    2004-10-30

    Major milestones in the diagnosis and treatment of musculoskeletal tumors and tumor-like lesions are presented on the basis of the authors' 40 years of experience in the Lublin Orthopedic Clinic. A prompt, adequate and complex diagnosis should be established using clinical, radiological and laboratory data. The biopsy (usually trepano-biopsy) that is performed routinely can be omitted in some patients. lmmunohistochemistry tests enable adequate differential diagnosis in many cases. Great progress has also been observed in treatment methods. Burring of sclerotic bony walls in benign osteolytic lesions is a major improvement over traditional but ineffective curettage. A multidisciplinary approach using neoadjuvant chemotherapy has radically improved outcomes in the treatment of ostegenic sarcoma and Ewing's sarcoma. Progress in surgical methods is enabling limb salvage by reconstructing large bone defects with modular endoprostheses. Patients with bone metastases are routinely operated for pathological fractures, large bone destruction or spinal cord compression. The authors call for the establishment of several Musculoskeletal Oncology centers in Poland. PMID:17618220

  20. Non-Invasive Prenatal Chromosomal Aneuploidy Testing - Clinical Experience: 100,000 Clinical Samples

    PubMed Central

    McCullough, Ron M.; Almasri, Eyad A.; Guan, Xiaojun; Geis, Jennifer A.; Hicks, Susan C.; Mazloom, Amin R.; Deciu, Cosmin; Oeth, Paul; Bombard, Allan T.; Paxton, Bill; Dharajiya, Nilesh; Saldivar, Juan-Sebastian

    2014-01-01

    Objective As the first laboratory to offer massively parallel sequencing-based noninvasive prenatal testing (NIPT) for fetal aneuploidies, Sequenom Laboratories has been able to collect the largest clinical population experience data to date, including >100,000 clinical samples from all 50 U.S. states and 13 other countries. The objective of this study is to give a robust clinical picture of the current laboratory performance of the MaterniT21 PLUS LDT. Study Design The study includes plasma samples collected from patients with high-risk pregnancies in our CLIA–licensed, CAP-accredited laboratory between August 2012 to June 2013. Samples were assessed for trisomies 13, 18, 21 and for the presence of chromosome Y-specific DNA. Sample data and ad hoc outcome information provided by the clinician was compiled and reviewed to determine the characteristics of this patient population, as well as estimate the assay performance in a clinical setting. Results NIPT patients most commonly undergo testing at an average of 15 weeks, 3 days gestation; and average 35.1 years of age. The average turnaround time is 4.54 business days and an overall 1.3% not reportable rate. The positivity rate for Trisomy 21 was 1.51%, followed by 0.45% and 0.21% rate for Trisomies 18 and 13, respectively. NIPT positivity rates are similar to previous large clinical studies of aneuploidy in women of maternal age ?35 undergoing amniocentesis. In this population 3519 patients had multifetal gestations (3.5%) with 2.61% yielding a positive NIPT result. Conclusion NIPT has been commercially offered for just over 2 years and the clinical use by patients and clinicians has increased significantly. The risks associated with invasive testing have been substantially reduced by providing another assessment of aneuploidy status in high-risk patients. The accuracy and NIPT assay positivity rate are as predicted by clinical validations and the test demonstrates improvement in the current standard of care. PMID:25289665

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

    SciTech Connect

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

    2010-01-15

    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.

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

    SciTech Connect

    Brown, J. Martin, E-mail: mbrown@stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Carlson, David J. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Brenner, David J. [Center for Radiological Research, Columbia University Medical Center, New York, New York (United States)

    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.

  3. 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

  4. 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

  5. PARENTS’ EXPERIENCES WITH PEDIATRIC CARE AT RETAIL CLINICS

    PubMed Central

    Garbutt, Jane M.; Mandrell, Kathy M.; Allen, Melissa; Sterkel, Randall; Epstein, Jay; Kreusser, Katherine; O’Neil, Jerome; Sayre, Blaine; Sitrin, Harold; Stahl, Kristin; Strunk, Robert C.

    2014-01-01

    Objective To describe the rationale and experiences of families with a pediatrician who also use retail clinics (RCs) for pediatric care. Design Cross-sectional study Setting 19 pediatric practices in a Midwestern practice-based research network Exposure Self-administered paper survey Participants Parents attending the pediatrician’s office Outcome Measures Parents’ experience with RC care for their children Results 1484 parents (92% response) completed the survey. Parents (23%) who used RC for pediatric care were more likely to report RC care for themselves (OR 7.79, 95% CI, 5.13 to 11.84), have > 1 child (OR 2.16, 95%CI 1.55 to 3.02), and be older (OR 1.05, 95%CI 1.03 to 1.08). Seventy-four percent first considered going to the pediatrician but reported they chose the RC because the RC had more convenient hours (37%), no office appointment was available (25%), they did not want to bother the pediatrician after hours (15%), or because the problem was not serious enough (13%). Forty-six percent of RC visits occurred between 8am and 4pm on weekdays or 8am and noon on the weekend. Most commonly, visits were reportedly for acute upper respiratory illnesses (34% sore throat, 26% ear infection, 19% colds or flu) and for physicals (13%). While 7% recalled the RC indicating they would inform the pediatrician of the visit, only 42% informed the pediatrician themselves. Conclusions Parents with established relationships with a pediatrician most commonly took their children to RCs for care because access was convenient. Almost half the visits occurred when the pediatricians’ offices were likely open. PMID:23877236

  6. Radiobiological applications of ultrashort pulse laser-accelerated proton beams

    NASA Astrophysics Data System (ADS)

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

    2010-11-01

    Ultrashort pulse laser proton acceleration is demonstrated to yield energies hitherto only accessible with high energy lasers. Up to 20 MeV protons are observed with the FZD Draco Ti:Sa laser with 30 fs pulses and only 2 J. This proton energy range allows for first well controlled applications. The radiation dose per shot observed for energies above 10 amounts to few Gy and thus provides excellent starting conditions for the irradiation of in vitro tumour cells with the aim of determining dose dependent biological damage. A first experiment demonstrates the availability of all components indispensable for systematic radiobiological studies: A laser-plasma accelerator providing stable proton spectra with maximum energy exceeding 15MeV over hundreds of pulses and applicable doses of a few Gy within few minutes, a beam transport and filtering system, an in-air irradiation site, a dedicated dosimetry system providing both online dose monitoring and a precise absolute dose information applied to the cell sample, and the full infrastructure for analysing radiation induced damage in cells.[4pt] [1] S.D. Kraft, K. Zeil, et al., New J. Phys. 12, 085003 (2010).

  7. 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

  8. Mobile Computed Tomography : Three Year Clinical Experience in Korea

    PubMed Central

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

    2013-01-01

    Objective Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. Methods A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. Results Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. Conclusion mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency. PMID:23440939

  9. 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.

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

    SciTech Connect

    Jones, Bleddyn [Birmingham Cancer Centre, University Hospital Birmingham, Birmingham (United Kingdom)]. E-mail: b.jones.1@bham.ac.uk; Sanghera, Paul [Birmingham Cancer Centre, University Hospital Birmingham, Birmingham (United Kingdom)

    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.

  11. Redesigning clinical experience for undergraduate nursing students: an innovative model

    Microsoft Academic Search

    Karen Wotton; Judy Gonda

    1999-01-01

    This paper provides an overview of the evaluation of an innovative clinical placement model for undergraduate nursing students, known as Dedicated Education Units (DEU). Dedicated Education Units, existing health care units collaboratively developed by clinicians and academics, were first introduced at a South Australian University School of Nursing in 1997 with the aim of providing an optimal and flexible clinical

  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. Project HOPE Clinical (Biomedical) Engineering Program - Experiences and Initiatives

    Microsoft Academic Search

    Chris Riha; Roger Dzwonczyk

    2011-01-01

    Abstract Project HOPE is a nonprofit healthcare organization that provides wide ranging humanitarian and educational aid to people in underserved and developing countries as well as conducts global health policy research. HOPE's clinical focus includes women and children's health, tuberculosis, HIV\\/AIDS, diabetes and other chronic and infectious diseases. HOPE has a strong, active technical focus and expertise in building clinical

  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. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience

    Microsoft Academic Search

    D. Kane; B. Bresnihan; O. FitzGerald

    2003-01-01

    Objective. To determine the clinical presentation and clinical and radiological outcome of early psoriatic arthritis (PsA) at 1 and 2 yr. Methods. Patients with PsA were assessed at the St. Vincent's University Hospital Early Synovitis Clinic. Standardized clinical and laboratory assessment was performed at presentation and 1- and 2-yr follow-up. Radiographs of the hands and feet were evaluated in chronological

  16. The CancerGrid Experience: Metadata-Based Model-Driven Engineering for Clinical Trials

    E-print Network

    Oxford, University of

    -driven engineering, clinical informatics, electronic government 1. Introduction 1.1. Background Randomized controlledThe CancerGrid Experience: Metadata-Based Model-Driven Engineering for Clinical Trials Jim Davies Abstract The CancerGrid approach to software support for clinical trials is based on two principles

  17. Case Conceptualization Strategies: The Relationship Between Psychologists' Experience Levels, Academic Training, and Mode of Clinical Inquiry

    Microsoft Academic Search

    Robert Brammer

    1997-01-01

    Psychologists and psychology students (n = 138) were provided an artificial-intelligence program that simulated a date rape client's responses to typed questions. Participants were asked to conduct a clinical interview by typing in their questions. Clinical experience was unrelated to participants' levels of confidence, perceived expertise, and efficiency in generating or analyzing questions. Both experience and academic level of training,

  18. 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…

  19. 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…

  20. Increasing the Quality of the Clinical Education Experience.

    ERIC Educational Resources Information Center

    Boucher, James A.

    1996-01-01

    Issues of quality in clinical education that have emerged in the evaluation of colleges of optometry according to new Council on Optometric Education standards are reviewed. Specific standards and problems are cited, and common areas of weakness are summarized. (MSE)

  1. Pre-clinical and clinical experiences with novel somatostatin ligands: advantages, disadvantages and new prospects.

    PubMed

    Hofland, L J; van der Hoek, J; Feelders, R; van der Lely, A J; de Herder, W; Lamberts, S W J

    2005-01-01

    Since the cloning and characterization of the five human somatostatin receptor (SSTR) subtypes, our understanding of the expression and functional role of the five SSTR subtypes in human (neuro-)endocrine tumors has increased significantly. The majority of human (neuro-)endocrine tumors express multiple SSTR. GH-secreting pituitary adenomas preferentially express SSTR2 and SSTR5, prolactinomas SSTR1 and SSTR5, and corticotroph adenomas express SSTR2 (low number) and predominantly SSTR5s. In addition, gastroenteropancreatic (GEP) neuroendocrine tumors frequently express multiple SSTR as well, with SSTR2 being expressed at the highest level. Treatment with the current generation of octapeptide somatostatin-analogs, e.g. octreotide and lanreotide, normalizes circulating GH- and IGF-I levels in approximately 60-70% of acromegalic patients, thereby remaining about one-third of patients uncontrolled. In patients with GEP neuroendocrine tumors, both somatostatin-analogs effectively suppress the production of bioactive peptides and hormones by the tumor cells, resulting in an important improvement of the related clinical symptomatology. However, a considerable proportion of patients experience an escape from treatment within months to several years. Altogether, the current generation of somatostatin analogs are effective medical tools in the treatment of acromegalic patients and of patients with neuroendocrine GEP tumors, but there is certainly a need for novel somatostatin analogs. In recent years, a significant number of novel somatostatin-ligands has been developed. These ligands include SSTR selective-, bi-specific, universal, as well as chimeric dopamine (DA)-somatostatin ligands. In vitro studies using human pituitary adenoma cells demonstrate a more profound inhibition of GH, PRL and ACTH secretion by somatostatin-analogs targeting both SSTR2s and SSTR5s, compared with SSTR2-preferential somatostatin-analogs. This likely reflects the SSTR subtype expression pattern in the adenoma cells. A first proof-of-concept trial with the more universal somatostatin-ligand SOM230 in 12 acromegalic patients shows that a single dose of SOM230 is effective in suppressing circulating GH concentrations in a significant larger number of patients compared with octreotide. In animal models, SOM230 has a better effect on GH and IGF-I level with less signs of tachyphylaxis compared with octreotide. Depending on the SSTR expression pattern on neuroendocrine GEP tumors, somatostatin-analogs targeting multiple SSTRs may play a future role in the more long-term control of patients with neuroendocrine GEP tumors. The first clinical trial comparing octreotide and SOM230 is ongoing. However, every advantage has its disadvantage. Targeting multiple SSTR potentially induces more adverse effects as well. Especially, glucose homeostasis might induce new problems in the long-term use of universal ligands. PMID:16625843

  2. 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

  3. 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.

  4. 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.

  5. Review of clinical experience with ion beam radiotherapy.

    PubMed

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

    2011-12-01

    The article describes both the early development of oncology as a core discipline at the University of Heidelberg Hospital and the first steps towards ion beam treatment, from the pilot project carried out in co-operation with the Gesellschaft für Schwerionenforschung Darmstadt to the initial start-up of clinical service at the Heidelberg Heavy Ion Centre (HIT). We present an overview, based on data published in the literature, of the available clinical evidence relating the use of ion beam therapy to treat major indications in active particle centres. A rationale for the use of particle therapy in each of these indications is given. In view of the limited availability of data, we discuss the necessity to conduct clinical trials. We also look forward towards the next activities to be undertaken at the HIT. PMID:21427183

  6. 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…

  7. Clinical experience of clerks and dressers: a three-year study of Birmingham medical students.

    PubMed

    Lockwood, D N; Goldman, L H; McManus, I C

    1986-01-01

    A survey of the clinical experience of junior medical clerks and surgical dressers on their first clinical attachment in the Birmingham University Teaching Hospitals was organized by students over a three-year period. A typical clinical student had performed basic clinical procedures such as putting up a drip, doing an ECG, bladder catheterization and seen a wide range of other procedures. Most students felt involved in the work of the firm, had clerked routine admissions, and regularly attended the firm's emergency admission night. Consultants on most firms were felt to be concerned about student progress. Students attached to district general hospitals gained a wider range of clinical experience than those at established teaching hospitals. Student-run audit is a useful way of monitoring the clinical experience gained by medical students. PMID:3944819

  8. THE LIVED EXPERIENCE OF PRECEPTORS IN RESPIRATORY CARE CLINICAL EDUCATION

    Microsoft Academic Search

    Kathy Jones-Boggs Rye; Erna L. Boone; Heather Neal-Rice

    Background: Respiratory Therapist (RT) preceptors provide expert clinical instruction and support for respiratory care students. These RTs are often faced with the conundrum of heavy workloads, short staffing, and mandatory overtime. Yet, in the midst of this de- manding work environment, selected RTs are often being asked to act as preceptors for students. The purpose of this paper was to

  9. Master's Student Professional Attire Policy for Clinical Visits and Experiences

    E-print Network

    Connor, Ed

    nurses, graduate students are expected to dress in professional rather than school, attire when working with preceptors and/or visiting clinical sites, even if not working directly with patients. Clean, pressed lab than one in each earlobe, other jewelry or long or artificial nails that may distract or pose a health

  10. Adaptive Designs for Group Sequential Clinical Survival Experiments

    E-print Network

    Johnson, Raymond L.

    to unexpected accrual or control-group mortality rates. This paper formulates trial design as a decision Program, University of Maryland College Park, USA Abstract: Randomized two-group clinical survival theoretic problem with a finite number of interim looks and a large class of loss functions, in the setting

  11. 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.

  12. 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

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

    PubMed

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

    2012-01-01

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

  14. PACS archive upgrade and data migration: clinical experiences

    NASA Astrophysics Data System (ADS)

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

    2002-05-01

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

  15. Clinical use of Insulin Degludec: Practical Experience and Pragmatic Suggestions

    PubMed Central

    Kalra, Sanjay; Gupta, Yashdeep

    2015-01-01

    Insulin degludec (IDeg) is an ultralong acting basal insulin. IDeg has unique pharmacokinetic and pharmacodynamic properties which allow once a daily dosage, at any time of the day. Its use is associated with a significantly lower risk of hypoglycemia. This review discusses the pragmatic use of IDeg, based on available evidence. A complete search of all nine original research papers (BEGIN® clinical trial program) pertaining to IDeg, listed in PubMed, was made to prepare this article.

  16. ART in Clinic of Infertility INTERMEDICA: 2 years experience

    Microsoft Academic Search

    Anna Kaczmarek-Sroka; ?ukasz Sroka; Maciej Kurpisz

    2004-01-01

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

  17. Agalsidase Beta Clinical Trials and Long Term Experience

    Microsoft Academic Search

    Carlos E. Prada; Robert J. Hopkin

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

  18. 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.

  19. Developing an evening clinical experience for baccalaureate community health nursing students.

    PubMed

    Rajek, N J

    1987-05-01

    With the ever-changing directions in health care delivery, baccalaureate nursing instructors are being challenged with the task of seeking out innovative approaches to community health nursing clinical experiences. With the focus on "community as client," an evening clinical program was designed and piloted for nontraditional nursing students who, because of daytime employment, were in need of evening courses to further their nursing education. The pilot project incorporated family nursing care, community-centered practice, and observational experiences. The evening community health nursing clinical experience was found to be mutually beneficial to clients and students and served to fill a gap in health teaching within the community. PMID:3035140

  20. 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

  1. Reviewing non clinical data for a granulocyte colony stimulatory factor product: experience in Brazil.

    PubMed

    Castanheira, Laura Gomes

    2011-09-01

    Non clinical studies are one of the requirements for the Brazilian National Regulatory Authority, ANVISA, for licensing a similar biotherapeutic product. During the WHO/KFDA workshop on implementing WHO guidelines on evaluating similar biotherapeutic products (SBP) in Seoul, Republic of Korea, the Brazilian experience with the non clinical studies of a Granulocyte Colony Stimulatory Factor (G-CSF), filgrastim, was presented. The applicant presented a reduced non clinical data package, but the key studies with relevant species were conducted and the non-clinical studies were considered sufficient for approval. Using the comparability exercise, these studies were taken together with the appropriate quality and clinical packages presented. PMID:21784651

  2. Minimally invasive aortic valve surgery: Cleveland Clinic experience

    PubMed Central

    Johnston, Douglas R.

    2015-01-01

    Background Minimally invasive surgery has become a routine approach for aortic valve disease over the last 18 years at the Cleveland Clinic. It is performed in isolation or in combination with other procedures. The objective of this study is to review trends and outcomes in these patients. Methods Cleveland Clinic Cardiovascular Information Registry (CVIR) was searched for aortic valve procedures from 1996 to 2013. All patients undergoing isolated or combined aortic valve operations were included for analysis. The incision type and procedure type were reviewed and trends were evaluated over time. Cleveland Clinic outcomes with minimally invasive approaches to the aortic valve are reviewed. Results A total of 22,766 aortic valve surgical procedures were performed in this 18-year timeframe. Of these, 3,385 (14.9%) were minimally invasive procedures (MIPs) and 2,379 (10.5%) were isolated minimally invasive aortic valves. MIPs increased from 12.4% to 29.6% of the total aortic valve volume over the period of the study. Combined procedures, including concomitant surgery on the aorta, mitral valve, tricuspid valve, and arrhythmia surgery increased over time as well. Overall mortality for primary and reoperative aortic valve operations continues to decline and has consistently been less than 1% for several years. Conclusions A programmed approach to minimally invasive aortic valve surgery (MIAVS) with careful patient selection, appropriate use of preoperative imaging, and selective conversion to sternotomy when necessary, allows for aortic valve replacement (AVR) and a wide range of concomitant procedures to be performed safely in a large number of patients.

  3. Radiosurgery for epilepsy: clinical experience and potential antiepileptic mechanisms

    PubMed Central

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

    2012-01-01

    Summary Stereotactic radiosurgery, well established in the noninvasive treatment of focal lesions that are otherwise difficult to access through open surgery, is an emerging technology in the treatment of focal epileptic lesions. Recent studies suggest that seizures from hypothalamic hamartomas and mesial temporal lobe epilepsy remit at clinically significant rates with radiosurgery, but large variations among different studies have raised questions about appropriate treatment protocols and mechanisms. Proposed anticonvulsant mechanisms include neuromodulatory effects or ischemic necrosis of epileptic tissue. An ongoing trial that directly compares efficacy, morbidities, and cost of radiosurgery versus open surgery for mesial temporal lobe epilepsy is underway. PMID:22191545

  4. [First clinical experience with nonreamed intramedullary nailing in Lithuania].

    PubMed

    Pamerneckas, Algimantas; Petrulis, Algimantas; Pilipavicius, Giedrius; Tamulaitis, Gintaras; Toliusis, Vytautas

    2004-01-01

    Long bone diaphyseal fractures are very common. Limited choice of implants for treatment of these fractures in Lithuania often leads to unsatisfactory treatment results and complications. Unreamed intramedullary nailing is relatively simple and effective method for treatment of severely injured patients. Using this method early stabilization and rehabilitation, decreased number of complications, and shortened stay in hospital can be ensured. Indications, technique and early results of first fifty intramedullary fixations with unreamed nails performed in the Clinic of Orthopedics and Traumatology, Kaunas University of Medicine are presented. PMID:15111744

  5. 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…

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

    PubMed

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

    2014-08-01

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

  7. 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…

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

    Microsoft Academic Search

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

    2005-01-01

    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

  9. A Collaborative International Community Health Nursing: Clinical Experience in China

    Microsoft Academic Search

    Jie Hu; Susan Andreatta; Liping Yu; Sijian Li

    2010-01-01

    With increasing changes in the demographic characteristics of the U.S. population, providing culturally competent health care to patients has become an important component of nursing. Study abroad experiences can enhance students’ international perspective, facilitate personal and professional growth, develop cultural competence skills, and help students better understand other cultures and global issues. This article describes University of North Carolina at

  10. ALPHA-PARTICLE RADIOBIOLOGICAL EXPERIMENTS USING THIN CR-39 DETECTORS

    E-print Network

    Yu, K.N.

    , Serbia and Monte Negro The present paper studied the feasibility of applying comet assay to evaluate. Comet assay was then applied. Diffusion of DNA out of the cells could be generally observed from the images of stained DNA. The alpha-particle tracks corresponding to the comets developed on the underside

  11. 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

  12. Fast neutrons in prostatic adenocarcinomas: worldwide clinical experience.

    PubMed

    Lindsley, K L; Cho, P; Stelzer, K J; Koh, W J; Austin-Seymour, M; Russell, K J; Laramore, G E; Griffin, T W

    1998-01-01

    Primary tumor control remains a major problem in the treatment of locally advanced prostate carcinoma. Clinical local failure rates approach 30-40% and may be significantly higher when results of prostatic biopsy or prostate-specific antigen (PSA) levels are considered. The low growth rate and cycling fraction of prostate adenocarcinoma suggest potential therapeutic advantage for the high linear energy transfer (LET) of neutrons. The Radiation Therapy Oncology Group (RTOG) performed a multi-institutional randomized trial (RTOG 77-04) comparing mixed beam (neutron plus photon) irradiation to conventional photon irradiation for the treatment of locally advanced prostate cancer. A subsequent trial by the Neutron Therapy Collaborative Working Group (NTCWG 85-23) compared pure neutron irradiation to standard photon irradiation. Both randomized trials demonstrate significant improvement in locoregional control with neutron irradiation compared to conventional photon irradiation in the treatment of locally advanced prostate carcinoma. To date, only the mixed beam trial has shown a significant survival benefit. Future analysis of the larger NTCWG trial at the 10-year point should confirm whether or not improved locoregional control translates into a survival advantage. These findings have significant implications for all local treatment strategies including dose-escalated conformal photon irradiation, prostate implantation, and neutron radiation. Given the large numbers of patients afflicted with this disease, a positive survival advantage for neutrons or mixed beam therapy would provide a strong incentive for the development of economically feasible clinical neutron facilities. PMID:9670287

  13. 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.

  14. 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

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

    Microsoft Academic Search

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

    2007-01-01

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

  16. 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…

  17. 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,…

  18. 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…

  19. 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…

  20. 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…

  1. Guidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences Abroad

    E-print Network

    Yates, Andrew

    patient autonomy is one of the core values of medical ethics; it is particularly important to honorGuidelines for Premedical and Medical Students Providing Patient Care During Clinical Experiences and medical student preparation. Many students are now taking advantage of opportunities to gain clinical

  2. Clinical experience of argatroban for anticoagulation in cardiovascular surgery

    Microsoft Academic Search

    Hitoshi Ohteki; Kojiro Furukawa; Hiroyuki Ohnishi; Yasushi Narita; Masahito Sakai; Kazuyoshi Doi

    2000-01-01

    Purpose: We have reviewed our experience with Argatroban-a direct thrombin inhibitor for anticoagulation in a variety of cardiovascular\\u000a operations, and in extracorporeal circulation, as a substitute for heparin.Subjects and methods 60 patients receiving anticoagulation with Argatroban were classified into the following four groups. Group 1; 20 patients\\u000a with anticoagulation therapy after cardiac surgery. Group 2; 8 patients with extracorporeal circulation

  3. 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

  4. Early Clinical Experience With Argon Ion Laser Endarterectomy

    NASA Astrophysics Data System (ADS)

    Eugene, John; Baribeau, Yvon; Ott, Richard A.; McColgan, Stephen J.; Berns, Michael W.

    1989-09-01

    This report describes our progress in the development of argon ion laser endarterectomy for arteriosclerotic cardiovascular disease. Nine patients underwent 10 vascular reconstructions for claudication (6), rest pain (1), and gangrene (2). There was 1 aortoiliac endarterectomy, 6 superficial femoral artery endarterectomies, 1 profunda femoris endarterectomy and 2 popliteal endarterectomies. The reconstructions were 6 cm to 60 cm in length. The operations were performed using low power argon ion laser radiation, 1.0 W. All patients experienced symptomatic relief and had palpable pulses postoperatively. There were no perforations and there were no injuries to surrounding tissues from laser radiation. Surgical complications occurred and these were technical problems that should be eliminated from the operation with further developments. The early clinical results show that laser endarterectomy can be performed for peripheral vascular reconstruction using low power argon ion laser radiation.

  5. 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

  6. The Clinical Presentation of Celiac Disease: Experiences from Northeastern Iran

    PubMed Central

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

    2014-01-01

    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

  7. 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.

  8. 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

  9. Clinical Experience with the Bentall Procedure: 28 Years

    PubMed Central

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

    2012-01-01

    Purpose We retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease. Materials and Methods Between March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%). Results The early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0±81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively. Conclusion In our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients. PMID:22869473

  10. Initial Clinical Experience Using the Amplatzer Vascular Plug

    SciTech Connect

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

    2007-07-15

    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.

  11. [Clinical experience of bromazepam for psychogenic impotence patients].

    PubMed

    Matsuhashi, M; Maki, A; Takanami, M; Fujio, K; Miura, K; Nakayama, K; Shirai, M; Ando, K

    1984-11-01

    A clinical trial was performed with the tranquilizer Bromazepam on 39 patients undergoing diagnosis of psychogenic impotence, and the drug effect was evaluated according to the criteria based on our protocol. The protocol specifies 8 tests (1 for libido, 4 for erection, 2 for ejaculation, 1 for orgasm) which are scored according to an arbitrary logarithmic scoring system. At the end of the study the points made in the 8 tests were added to obtain the total score as the basis for evaluation of the overall drug effect. After treatment all tests showed an improvement, and the improvement in erection during masturbation, reflective erection, and condition of ejaculation was statistically significant. The total score also improved from 16.77 +/- 2.62 (mean +/- S.D.) before treatment to 11.42 +/- 1.96 after treatment, and the change was again statistically significant (P less than 0.05). The rate of satisfaction as a subjective symptom of improvement also increased from 25.38 +/- 4.40% to 39.10 +/- 4.53%. The results of the present study provide evidence to indicate that Bromazepam is beneficial for psychogenic impotence. PMID:6152121

  12. Stem cell experiments and initial clinical trial of cellular cardiomyoplasty.

    PubMed

    Guhathakurta, Soma; Subramanyan, Usha R; Balasundari, Ramesh; Das, Chandan K; Madhusankar, Nainar; Cherian, Kotturathu Mammen

    2009-12-01

    Growing myocardial cells from human stem cells and stem cell transplantation to repair injured myocardium are new frontiers in cardiovascular research. The 1st stage of this study was conducted to determine whether transplantation of autologous bone marrow stem cells into infarcted myocardium of sheep could differentiate into beating cardiomyocytes. The 2nd stage was to demonstrate transdifferentiation of human bone marrow mesenchymal stem cells to precursor cardiomyocytes in vitro, using a novel conditioning medium. In the 3rd stage, a clinical trial of stem cell implantation in patients with severe myocardial dysfunction involved injection of peripheral blood-derived endothelial precursor cells in 11 patients and autologous bone marrow mononuclear cells in 29. A marginal improvement in myocardial function was noted at 3 months (mean increase in ejection fraction, 6% +/- 1%), although it plateaued at 6 months. The trial proved to be safe because there was no procedure-related mortality. There is growing optimism that stem cell therapy may delay heart transplantation. PMID:20026532

  13. 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

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

    PubMed Central

    Doyle, Cathal; Lennox, Laura; Bell, Derek

    2013-01-01

    Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness. PMID:23293244

  15. Cervical cancer screening in a sexually transmitted disease clinic: screening adoption experiences from a midwestern clinic.

    PubMed

    Meyerson, Beth E; Sayegh, M Aaron; Davis, Alissa; Arno, Janet N; Zimet, Gregory D; LeMonte, Ann M; Williams, James A; Barclay, Lynn; Van Der Pol, Barbara

    2015-04-01

    Objectives. We examined whether a sexually transmitted disease (STD) clinic could reach women who had not received a Papanicolau (Pap) test in the past 3 years. We also explored staff attitudes and implementation of cervical cancer screening. Methods. Women (n?=?123) aged 30 to 50 years were offered cervical cancer screening in an Indiana STD clinic. We measured effectiveness by the patients' self-reported last Pap test. We explored adoption of screening through focus groups with 34 staff members by documenting their attitudes about cervical cancer screening and screening strategy adaptation. We also documented recruitment and screening implementation. Results. Almost half (47.9%) of participants reported a last Pap test 3 or more years previously; 30% had reported a last Pap more than 5 years ago, and 11.4% had a high-risk test outcome that required referral to colposcopy. Staff supported screening because of mission alignment and perceived patient benefit. Screening adaptations included eligibility, results provision, and follow-up. Conclusions. Cervical cancer screening was possible and potentially beneficial in STD clinics. Future effectiveness-implementation studies should expand to include all female patients, and should examine the degree to which adaptation of selected adoption frameworks is feasible. PMID:25689199

  16. 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.

  17. 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

  18. 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

  19. Early Clinical Experience with the Mobi-C Disc Prosthesis

    PubMed Central

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

    2007-01-01

    Purpose We have experienced 23 patients who had underwent cervical disc replacement with Mobi-C disc prosthesis and analyzed their radiological results to evaluate its efficacy. Patients and Methods This study was performed on 23 patients with degenerative cervical disc disease who underwent CDR with Mobi-C disc prosthesis from March 2006 to June 2006. Results The age of the study population ranged from 31 to 62 years with mean of 43 years, and 16 male and 7 female cases. Regarding axial pain, the average preoperative VAS score was 6.47 ± 1.4, while at final follow-up it was 1.4 ± 0.7 (p < 0.001). The preoperatively VAS score for radiculopathy was 6.7 ± 0.7 compared with an average score of 0 ± 0 at the final follow-up (p < 0.001). At postoperative 6th month, Odom's criteria were excellent, good, or fair for all 23 patients (100%). 7 patients (30.4%) were classified as excellent, 15 patients (65.2%) as good, and 1 patients (4.4%) as fair. Prolo economic and functional rating scale was average 8.9 ± 0.7 at postoperative 6th month. ROM in C2-7, ROM of FSU, and ROM in upper adjacent level were well preserved after CDR. Conclusion This report would be the first document about the CDR with Mobi-C disc prosthesis in the treatment of degenerative cervical disc disease. CDR with Mobi-C disc prosthesis provided a favorable clinical and radiological outcome in this study. However, Long-term follow-up studies are required to prove its efficacy and ability to prevent adjacent segment disease. PMID:17594154

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

    ERIC Educational Resources Information Center

    Leeds, Andrew L.

    1993-01-01

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

  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. (Radio)biological optimization of external-beam radiotherapy.

    PubMed

    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 D(presc) at fixed fraction number. D(presc) 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 D(presc) 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

  3. 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, ?-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

  4. 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

  5. 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

  6. Radiofrequency ablation in palliative supportive care: early clinical experience.

    PubMed

    Marchal, Frédéric; Brunaud, Laurent; Bazin, Christophe; Boccacini, Hervé; Henrot, Philippe; Troufleau, Philippe; Krakowski, Ivan; Regent, Denis

    2006-02-01

    We report our early experience with radiofrequency ablation (RFA) in palliative supportive care. The medical files of eight patients were retrospectively reviewed. Four patients had a renal tumor, and nephrectomy was contraindicated in each patient since they had a poor general status. The fifth patient had a local recurrence in the site of a previous nephrectomy with a pancreatic tail extension, and surgical resection was contraindicated because of abdominal carcinomatosis. Two other patients had bone metastasis, one with a painful metastasis of mammary carcinoma in the head of the humerus resistant to radiotherapy, and the other with metastasis of the tibia of cutaneous melanoma. The last patient had a local recurrence of a sacral chordoma. Management, outcomes and complications were evaluated with 13.1+/-0.3 months follow-up. All five patients with renal carcinomas did not have local recurrence. The two patients treated for bone metastases had no pain 8 weeks after RFA and remained stable over time. One complication occurred 2 months after using the procedure to treat the chordoma, and this patient was hospitalized for a fistula between the sigmoid and hypogastric artery false aneurysm and subsequently died. In conclusion, RFA can be a safe and useful adjuvant treatment in supportive care or unresponsive cancer pain patients. However, the destruction of tumoral tissues in contact with sensitive structures using RFA should be done with caution due to potentially severe complications. PMID:16391875

  7. 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

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

    PubMed

    Bidra, Avinash S; Agar, John R

    2010-02-01

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

  9. Clinical experience with darbepoietin alfa (NESP) in children undergoing hemodialysis.

    PubMed

    De Palo, Tommaso; Giordano, Mario; Palumbo, Fabrizio; Bellantuono, Rosa; Messina, Giovanni; Colella, Vincenzo; Caringella, Angela D

    2004-03-01

    Darbepoietin alfa (NESP) is a new long-acting erythropoietin, with a half-life 3 times longer than the old epoietins. In the present study, we evaluated the efficacy of NESP in a group of children on hemodialysis. Seven children, five male and two female, with a mean age of 11.5 +/- 3 years and a mean weight of 34.1 +/- 11 kg, were enrolled in the study. All had been treated for at least 6 months with epoietin alfa at a mean dose of 106 +/- 76 IU/kg 3 times/week i.v. They were then given NESP at a mean dose of 1.59 +/- 1.19 microg/kg once a week i.v., according to the suggested conversion index (weekly epoietin alfa dose/200=weekly NESP dose). Anemia was evaluated at the end of a dialysis session. This was especially important for children less compliant with water restriction. Serum ferritin and percentage transferrin saturation (TSAT) were also monitored, as were dialysis efficacy (Kt/V), blood pressure, and heparin requirements. Before starting the new treatment, all patients had an adequate mean hemoglobin (Hb) level (11.19 +/- 1.7 g/dl) and an adequate iron status (TSAT 24.2 +/- 11.5, serum ferritin 220 +/- 105 mg/dl). Five of the seven patients were also treated with intravenous ferric gluconate (10-20 mg/kg per week). Six children were on antihypertensive treatment. After the 1st month of treatment, we observed an excessive increase in Hb, 12.3 +/- 1.7 g/dl, (P<0.05), with severe hypertension in the youngest two patients (Hb>13 g/dl). A short discontinuation of the medication, followed by restarting at a decreased dosage, allowed us to continue with the treatment. At the 2nd month of follow-up, a mean plasma Hb level of 12.2 +/- 1.2 g/dl was observed, with a NESP mean dose of 0.79 +/- 0.4 microg/kg per week. Steady state was reached at 3 months, with a mean Hb of 11.8 +/- 1.4 g/dl and a mean NESP dose of 0.51 +/- 0.18 microg/kg per week (P<0.05). These results persisted at 6 months of follow-up; only one child had a persistent increase in platelet level (373,000 vs. 555,000). Dialysis efficiency and heparin requirements during dialysis did not change significantly. The high efficacy of NESP allowed a consistent reduction in dosage. The suggested conversion index does not appear to be correct for pediatric patients. Our experience suggests that in this population the correct dose could be 0.25-0.75 microg/kg per week. Hypertension was the only major side effect reported. The influence of NESP on platelet proliferation needs to be further investigated. The single weekly administration of NESP could be effective and beneficial for both patients and clinicians. PMID:14745634

  10. 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.

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    SciTech Connect

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

    2013-02-15

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

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

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

    PubMed Central

    Wa?kowicz, 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

  16. Differences in the internal structure of hallucinatory experiences between clinical and nonclinical populations.

    PubMed

    Chang, Jae Seung; Kim, Yeni; Kim, Se Hyun; Hwang, Samuel; Kim, Jayoun; Chung, In-Won; Kim, Yong Sik; Jung, Hee-Yeon

    2015-03-30

    We investigated differential patterns of hallucinatory experiences between nonclinical and clinical samples. A total of 223 nonclinical individuals (108 females) and 111 subjects with schizophrenia (54 females) completed the Launay-Slade Hallucination Scale-Revised (LSHS-R) and Perceptual Aberration Scale (PAS). The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was used for the nonclinical group, and the Positive and Negative Syndrome Scale (PANSS) hallucination item was used for the clinical group. Cronbach?s alpha values showed good internal consistency for the LSHS-R. In the two groups, significant associations were found between LSHS-R and PAS scores. Two factors were extracted through a principal component analysis (PCA) in the nonclinical group, and three factors were identified in the clinical group. The results of a hierarchical cluster analysis (HCA) revealed that a perception-cognition dimension was clear cluster discriminating element for the nonclinical group, whereas alterations in perception-cognition dimension were characteristic in cluster structure of the clinical group. Our findings suggest that the nature of hallucinatory experiences may differ qualitatively between a nonclinical population and subjects with schizophrenia. Perceptual or cognitive aberrations may add a psychopathologic dimension to hallucinatory experiences. Exploring the internal structure of hallucinatory experiences may provide explanatory insight into these experiences in the general population. PMID:25619435

  17. Nuclear Physics and Radiobiology - Issues for Humans in Space and on Earth

    Microsoft Academic Search

    Ram Tripathi

    2008-01-01

    Nuclear physics is playing a vital role in human biological applications, specifically in planned space missions, in hadron radiotherapy, and in low dose radiobiology. While seemingly disparate, these and other areas share a common need for the understanding of nuclear interactions in biological systems. Radiobiology continues to provide valuable information that will help develop better methods for using radiation in

  18. 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

  19. Clinical experiences in using cognitive-behavior therapy to treat panic disorder.

    PubMed

    Wolf, Abraham W; Goldfried, Marvin R

    2014-01-01

    Although there is a growing body of research to support the use of psychological treatments for specific disorders, there has been no way for practitioners to provide feedback to researchers on the barriers they encounter in implementing these treatments in their day-to-day clinical work. In order to provide practitioners a means to give researchers information about their clinical experience, the Society of Clinical Psychology and the Division of Psychotherapy of the American Psychological Association collaborated on an initiative to build a two-way bridge between practice and research. A questionnaire was developed on the therapist, patient, and contextual variables that undermine the effective use of CBT in reducing the symptoms of panic disorder, a clinical problem that occurs frequently in clinical practice and has an extensive research base. An Internet-based survey was advertised internationally in listservs and professional newsletters, asking clinicians to indicate all aspects of CBT that they used in treating panic disorder, and to respond to a series of questions with variables that presumably limited successful symptom reduction in clinical work using CBT to treat panic disorder. The final database included responses from 338 participants who varied in experience in applying CBT to the treatment of panic disorders. Participants identified a wide range of patient factors that were barriers to symptom reduction, including symptoms related to panic, motivation, social system, and the psychotherapy relationship, in addition to specific problems with implementing CBT for the treatment of panic disorder. PMID:24411112

  20. 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…

  1. A Practical Framework for Evaluating the Impact of Clinical Simulation Experiences in Prelicensure Nursing Education

    Microsoft Academic Search

    Susan Prion

    2008-01-01

    Clinical simulation is used with increasing frequency in prelicensure nursing education curricula. Nurse educators intuitively sense that the simulation experience is a powerful student learning strategy, yet much of the published nursing research is limited to student self-report data about affective variables such as self-confidence and satisfaction. With increased use of simulation, there is a corresponding need to measure the

  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. First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder

    E-print Network

    Paris-Sud XI, Université de

    First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder Moreau-Gaudry (4)5 1- Grenoble University hospital, Urology Department (France) 2- Saint for correspondence Dr Jean-Alexandre LONG15 Urology Department Grenoble University Hospital 38 043 GRENOBLE Cedex 9

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

    Cancer.gov

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

  5. 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…

  6. Constructing a nursing identity within the clinical environment: The student nurse experience.

    PubMed

    Walker, Sandra; Dwyer, Trudy; Broadbent, Marc; Moxham, Lorna; Sander, Teresa; Edwards, Kristin

    2014-11-28

    Abstract Background: Nursing identity is an important element of being a nurse. Student nurses begin the construction of their nursing identity during their clinical placements. Aim: The aim of this research was to examine how the student nurses of a regional Australian university construct their identity when on off-campus clinical placement. Methods/Design: Using a constructivist approach an online survey was used to elicit data in response to the question 'What elements are needed during the work integrated learning experience to enable undergraduate nursing students to construct their nursing identity?' Results/Findings: Findings reveal five key elements to the construction of students' nursing identity; positive role models, belonging, peer support, critical thinking abilities and confidence. Conclusion: Such findings are important as they provide information for student nurses, preceptors and educators in guiding clinical placement experiences that are able to facilitate the development of the nursing identity. PMID:25429770

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

    PubMed Central

    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

  8. 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

  9. 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

  10. Experiences with a PDA-based documentation system in clinical research.

    PubMed

    Becker, Torben K; Gries, André; Martin, Eike; Bernhard, Michael

    2012-04-01

    New clinical treatment concepts and the implementation of algorithms usually require extensive documentation for scientifical evaluation and quality assurance. A consequent electronic documentation approach potentially facilitates data integrity and availablity and decreases the amount of time spent with manual transfer from paper data into computer systems. The development and the components of the "Heidelberg PDA-based Clinical Documentation Suite" are described. This system allows electronic documentation and post-processing in a timely manner using an affordable standard Personal Digital Assistant (PDA). It features almost universal customizability to new documentation requirements and can be used with only minimal prior training. Initial experiences are reported and prospective improvement possibilities are discussed. PMID:20703667

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

    PubMed

    Baw, Bandar; Chan, Teresa; Upadhye, Suneel

    2014-01-01

    ABSTRACTClinical practice guidelines are an important vehicle for knowledge translation and improving patient care. For most learners, these documents can be daunting and confusing. We describe a novel educational experience that clarified the guideline generation process for learners while at the same time creating clinical educational guidelines (simplified learning aids) for junior learners in the emergency department (ED). We devised a system using near-peer mentors to generate a series of clinical education guideline learning materials created by residents and junior learners for the evaluation of undifferentiated chest pain in the ED. This process assisted in teaching residents and junior learners and generated an endurable educational product. PMID:24810780

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

    PubMed

    Baw, Bandar; Chan, Teresa; Upadhye, Suneel

    2014-04-01

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

  13. An Eight-Year Clinic Experience with Clozapine Use in a Parkinson’s Disease Clinic Setting

    PubMed Central

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

    2014-01-01

    Background To examine our eight year clinic-based experience in a Parkinson’s disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). Methods The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. Results There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45–87 years (mean 68.3±10.15), disease duration of 17–240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r?=??0.36, p<0.01) and H&Y score (r?=??0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r?=?0.21, p>0.05). Conclusions This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting. PMID:24646688

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

    PubMed

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

    2014-07-01

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

  15. 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).

  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. 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

  18. Cardiac Image Fusion from Stand-Alone SPECT and CT: Clinical Experience

    Microsoft Academic Search

    Oliver Gaemperli; Tiziano Schepis; Ines Valenta; Lars Husmann; Hans Scheffel; Victor Duerst; Franz R. Eberli; Thomas F. Luscher; Hatem Alkadhi; Philipp A. Kaufmann

    Myocardial perfusion imaging with SPECT (SPECT-MPI) and 64- slice CT angiography (CTA) are both established techniques for the noninvasive evaluation of coronary artery disease (CAD). Three-dimensional (3D) SPECT\\/CT image fusion may offer an in- cremental diagnostic value by integrating both sets of informa- tion. We report our first clinical experiences with fused 3D SPECT\\/CT in CAD patients. Methods: Thirty-eight consecutive

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

    Microsoft Academic Search

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

    2010-01-01

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

  20. 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.

  1. Six-year experience of a nurse-led colorectal cancer follow-up clinic.

    PubMed

    Al Chalabi, Hasan; O'Riordan, James M; Richardson, Alex; Flannery, Delia; O'Connor, Katrina; Stuart, Charlotte; Larkin, John; McCormick, Paul; Mehigan, Brian

    2014-01-01

    Aims and Objectives. To review the experience of a nurse-led colorectal cancer follow-up clinic in a tertiary referral colorectal cancer centre. Methodology. Data from the nurse-led colorectal cancer follow-up clinic in our unit was prospectively maintained in a colorectal cancer database. Data was analysed from January 1, 2006 until the December 31, 2011. Results. 1125 patients were diagnosed with colorectal cancer, and referred to our unit as a tertiary centre for specialised colorectal cancer. Nine hundred and four patients had surgical resection of their colorectal cancer. Four hundred and seven patients were referred to the nurse-led colorectal cancer clinic for surveillance. The mean age of the patient cohort was 67 years (range 32-88) and 56% of patients were male. One hundred and seventeen patients were discharged to their general practitioner having been disease free after 5 years of followup. Fifty-four patients were diagnosed with either local or distant recurrence. Conclusion. A nurse-led colorectal cancer follow-up clinic is running according to strict follow-up protocols. This type of clinic significantly reduces the number of routine follow-up patients that have to be seen by the colorectal surgical consultant. PMID:25374950

  2. Six-Year Experience of a Nurse-Led Colorectal Cancer Follow-Up Clinic

    PubMed Central

    Al Chalabi, Hasan; O'Riordan, James M.; Richardson, Alex; Flannery, Delia; O'Connor, Katrina; Stuart, Charlotte; Larkin, John; McCormick, Paul; Mehigan, Brian

    2014-01-01

    Aims and Objectives. To review the experience of a nurse-led colorectal cancer follow-up clinic in a tertiary referral colorectal cancer centre. Methodology. Data from the nurse-led colorectal cancer follow-up clinic in our unit was prospectively maintained in a colorectal cancer database. Data was analysed from January 1, 2006 until the December 31, 2011. Results. 1125 patients were diagnosed with colorectal cancer, and referred to our unit as a tertiary centre for specialised colorectal cancer. Nine hundred and four patients had surgical resection of their colorectal cancer. Four hundred and seven patients were referred to the nurse-led colorectal cancer clinic for surveillance. The mean age of the patient cohort was 67 years (range 32–88) and 56% of patients were male. One hundred and seventeen patients were discharged to their general practitioner having been disease free after 5 years of followup. Fifty-four patients were diagnosed with either local or distant recurrence. Conclusion. A nurse-led colorectal cancer follow-up clinic is running according to strict follow-up protocols. This type of clinic significantly reduces the number of routine follow-up patients that have to be seen by the colorectal surgical consultant. PMID:25374950

  3. Radiobiological evaluation of new boron delivery agents for boron neutron capture therapy

    E-print Network

    Chung, Yoonsun

    2008-01-01

    This thesis evaluates the radiobiological effectiveness of three new boron compounds namely a boronated porphyrin (BOPP) and two liposome formulations for neutron capture therapy (BNCT). The methodology utilizes in vitro ...

  4. Development, characterization, and application of a charged particle microbeam for radiobiological research

    E-print Network

    Folkert, Michael R. (Michael Ryan), 1975-

    2005-01-01

    The goal of this work is to develop a charged-particle microbeam for use in radiobiological research at the MIT Laboratory for Accelerator Beam Applications (LABA). The purpose of this device is to precisely explore the ...

  5. Health risks of failed silicone gel breast implants: a 30-year clinical experience.

    PubMed

    Duffy, M J; Woods, J E

    1994-08-01

    The purpose of this paper is an assessment of clinically evident systemic health problems associated with failed silicone gel breast implants. A computer search of the medical records of 2033 patients receiving implants in the years 1962-1992 revealed that between 1970 and 1992, 200 women 14 to 75 years of age underwent secondary silicone gel breast implant procedures by a single surgeon. This allowed determination of the exact integrity status of 681 implants collectively placed in these 200 patients between 1962 and 1992 and followed clinically for a median of 49 months. The common indications for surgical reexploration in these 200 patients were capsulectomy, open capsulotomy, or implant exchange/removal. All patients had a minimum clinical follow-up of 6 months. Surgical findings revealed that 577 (85 percent) implants were intact in 135 (67.5 percent) patients and that in 65 (32.5 percent) patients, 104 (15 percent) implant failures were found. The patients' medical records were reviewed with specific attention to diagnoses suggesting immune-related disorders, siliconoma, acquired non-breast malignancies, metachronous breast cancer, and recurrent breast carcinomas. In this very select subgroup of 65 patients with silicone gel breast implants which had failed or were deteriorating, no excess of expected immune-related disorders or malignancies was identified. Our 30-year clinical experience with silicone gel breast implants for augmentation mammaplasty or breast reconstruction failed to demonstrate that clinically evident adverse health problems are incurred by those women who subsequently experience a silicone gel breast implant failure. PMID:8041820

  6. [Professor WU Xu's clinical experiences on acupuncture for acute upper abdominal pain].

    PubMed

    Wu, Xiao-Liang; Lu, Bin; Sun, Jian-Hua; Ai, Bing-Wei; Bao, Chao; Wu, Wen-Zhong; Li, Jian-Bing; Liu, Lan-Ying; Wu, Wen-Yun; Pei, Li-Xia; Zhou, Jun-Ling; Li, Yan-Cai; Qin, Shan

    2014-03-01

    The clinical experiences and proven cases of distinguished doctor of TCM, professor WU Xu, on acupuncture for acute upper abdominal pain is introduced. Professor WU's manipulation characteristics of acupuncture for acute upper abdominal pain, including acute cholecystitis, kidney stone, acute stomach pain, are one-hand shape but both hands in nature, moving like Tai Chi, force on the tip of needle, movement of qi mainly. The main technique posture is one-hand holding needle with middle finger for pressing, the needle is hold by thumb and index finger, and is assisted by middle finger. The special acupuncture experience of emergency is treatment according to syndrome differentiation, combination of acupuncture and moxibustion, selecting acupoint based on experience, blood-letting acupuncture therapy and so on. PMID:24843977

  7. 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)

  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. International radiobiology archives of long-term animal studies: structure, possible uses and potential extension.

    PubMed

    Gerber, G B; Wick, R R; Watson, C R; Gössner, W; Kellerer, A M

    1999-07-01

    Animal experiments have contributed a great deal to our information on effects and risks arising from exposure to radionuclides. This applies, in particular, to alpha-emitting radionuclides where information from man is limited to thorotrast, 224Ra and 226Ra. The late C.W. Mays was the first to suggest that animal data in conjunction with epidemiological data could allow estimates of human risks for radionuclides - predominantly from actinides - where information in man is scarce. The 'International Radiobiology Archives of Long-term Animal Studies' were created through the combined efforts of European, American and Japanese scientists and aim to safeguard the large amount of existing data on long-term animal experiments and make them available for, among others, an improved assessment of risks from alpha-emitting radionuclides. This paper summarizes the structure of the archives and reviews their present status and future plans. It also demonstrates the extensive information available in these archives on alpha-emitting radionuclides which is suitable for further analysis. Also, the structure of the animal archives could - in a slightly modified form - accommodate the epidemiological data available on 224Ra and thorotrast and, thus, facilitate a direct comparison of data from man, dogs and rodents. PMID:10461752

  10. 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 ?m thick) for the beam extraction in air. The set-up was simulated by the GATE v6.1 Monte-Carlo platform. The measurement of the proton energy distribution, the evaluation of the fluence-homogeneity over the sample and the calibration of the monitoring system were performed using a silicon PIPS detector, placed in air in the same position as the biological samples to be irradiated. The irradiation proton fluence was found to be homogeneous to within ±2% over a circular field of 20 mm diameter. As preliminary biological experiment, two Human Head and Neck Squamous Carcinoma Cell lines (with different radiosensitivities) were irradiated with 2.9 MeV protons. The measured survival curves are compared to those obtained after X-ray irradiation, giving a Relative Biological Efficiency between 1.3 and 1.4.

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

    PubMed Central

    Leland, Arne; Dale, Jan Gunnar

    2013-01-01

    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

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

    Cancer.gov

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

  13. 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

  14. Does experience in general practice influence the clinical thinking of foundation trainees?

    PubMed

    Kibble, Sharon; Scallan, Samantha; Wilson, Sally; Odbert, Reg; Lyon-Maris, Johnny; Leach, Camilla

    2014-11-01

    The aim of this exploratory study was to capture and identify changes in clinical thinking amongst foundation trainees after a four-month attachment in general practice, and to develop a means of analysing the data collected to inform understanding about how clinical thinking develops and changes for a trainee - the learner - in the context of clinical experience. We use the term 'clinical thinking' consistently throughout our paper to refer to the trainees' general thinking about a case, and do so in the same way as other academics. Through the innovative use of Mind Maps, we have sought to demonstrate whether there was a significant change in the themes and key features contained in maps drawn by foundation year 2 trainees before and after an attachment in general practice, and to locate the nature of the change if present. Being able to identify such change is potentially valuable as it can assist in revealing a trainee's learning needs and shape future learning. PMID:25693153

  15. Results of extracorporeal life support implementation in routine clinical practice: single center experience

    PubMed Central

    Bio?ina, Bojan; Petri?evi?, Mate; Belina, Dražen; Gašparovi?, Hrvoje; Svetina, Lucija; Konosi?, Sanja; White, Alexandra; Ivan?an, Višnja; Kopjar, Tomislav; Mili?i?, Davor

    2014-01-01

    Aim To describe our experience in the clinical application of extracorporeal life support (ECLS) and analyze whether ECLS leads to acceptable clinical outcomes in patients with cardiac failure. Methods Data from clinical database of University Hospital Center Zagreb, Croatia, on 75 patients undergoing ECLS support from 2009 to 2014 due to cardiac failure were retrospectively analyzed. Outcomes were defined as procedural and clinical outcomes. ECLS as a primary procedure and ECLS as a postcardiotomy procedure due to inability to wean from cardiopulmonary bypass were analyzed. Results ECLS was used in 75 adult patients, and in 24 (32%) of those procedural success was noted. ECLS was implemented as a primary procedure in 36 patients and as a postcardiotomy procedure in 39 patients. Nine out of 39 (23.08%) patients had postcardiotomy ECLS after heart transplantation. Bleeding complications occurred in 30 (40%) patients, both in primary (11/36 patients) and postcardiotomy group (19/39 patients). ECLS was established by peripheral approach in 46 patients and by central cannulation in 27 patients. In 2 patients, combined cannulation was performed, with an inflow cannula placed into the right atrium and an outflow cannula placed into the femoral artery. Eleven patients treated with peripheral approach had ischemic complications. Conclusion ECLS is a useful tool in the treatment of patients with refractory cardiac failure and its results are encouraging in patients who otherwise have an unfavorable prognosis. PMID:25559831

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

    PubMed

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

    2006-03-01

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

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

    PubMed Central

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

    2014-01-01

    Focal therapy of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility. This review presents the principles of laser ablation, the role of multiparametric MRI for delineating the site of significant prostate cancer, a summary of published clinical studies, and our initial experience with 23 patients, criteria for selecting candidates for focal prostate ablation, and speculation regarding future directions. PMID:25009445

  18. 30 years of rabies vaccination with Rabipur: a summary of clinical data and global experience.

    PubMed

    Giesen, Alexandra; Gniel, Dieter; Malerczyk, Claudius

    2015-03-01

    Rabies poses a threat to more than 3.3 billion people worldwide and is estimated to cause about 60,000 deaths a year. However, according to the WHO, it is still one of the most neglected diseases in developing countries. Human rabies vaccinations are critical components of pre-exposure and post-exposure prophylaxis. Rabipur, the first purified chick embryo cell-culture vaccine, was licensed in Germany in 1984, and later in more than 60 countries worldwide. The immunogenicity, efficacy and safety of Rabipur have been assessed in numerous clinical trials in pre- and post-exposure regimens, using both intramuscular and intradermal routes of administration. The trial populations have involved adults and children, including healthy volunteers and individuals bitten by laboratory-proven rabid animals, malnourished children and immunocompromised individuals. Extensive, worldwide clinical experience with Rabipur over the past 30 years has shown the vaccine to be immunogenic, effective and generally well tolerated. PMID:25683583

  19. 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

  20. 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.

  1. Senior dental students' experience with Cariogram in a pediatric dentistry clinic.

    PubMed

    Gonzalez, Cesar D; Okunseri, Christopher

    2010-02-01

    The study objective was to assess predoctoral dental students' experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program "Cariogram." The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school. PMID:20145067

  2. 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

  3. Comparison of patients' experiences in public and private primary care clinics in Malta.

    PubMed

    Pullicino, Glorianne; Sciortino, Philip; Calleja, Neville; Schäfer, Willemijn; Boerma, Wienke; Groenewegen, Peter

    2014-11-12

    Demographic changes, technological developments and rising expectations require the analysis of public-private primary care (PC) service provision to inform policy makers. We conducted a descriptive, cross-sectional study using the dataset of the Maltese arm of the QUALICOPC Project to compare the PC patients' experiences provided by public-funded and private (independent) general practitioners in Malta. Seven hundred patients from 70 clinics completed a self-administered questionnaire. Direct logistic regression showed that patients visiting the private sector experienced better continuity of care with more difficulty in accessing out-of-hours care. Such findings help to improve (primary) healthcare service provision and resource allocation. PMID:25395398

  4. Interlocking detachable platinum coils, a controlled embolization device: Early clinical experience

    Microsoft Academic Search

    John F. Reidy; Shakeel A. Qureshi

    1996-01-01

    Purpose  To present the early clinical experience of a new mechanically controlled-release embolization device—the interlocking detachable\\u000a coil (IDC)—in complex embolization outside the head.\\u000a \\u000a \\u000a \\u000a Methods  IDCs were used only when conventional embolization techniques were considered too risky or unsafe. The soils consist of unfibered\\u000a coiled platinum (0.012 inch), mechanically connected to a pusher wire and deployed through a Tracker 18 catheter. IDCs come

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

    SciTech Connect

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

    2013-04-01

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

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

    PubMed Central

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

    2012-01-01

    Objective Non-clinical psychotic experiences are common and distressing. It has been hypothesized that early life vitamin D deficiency may be a risk factor for psychosis-related outcomes, but it is not known if circulating concentrations of 25-hydroxyvitamin D (25(OH)D) during childhood are associated with psychosis-related outcomes or whether the two different forms of 25(OH)D, (25(OH)D3 and 25(OH)D2, have similar associations with psychosis-related outcomes. Methods We investigated the association between serum 25(OH)D3 and 25(OH)D2 concentrations and psychotic experiences in a prospective birth cohort study. Serum 25(OH)D3 and 25(OH)D2 concentrations were measured at mean age 9.8 years and psychotic experiences assessed at mean age 12.8 years by a psychologist (N?=?3182). Results Higher 25(OH)D3 concentrations were associated with lower risk of definite psychotic experiences (adjusted odds ratio: OR (95% confidence interval: CI) 0.85 (0.75–0.95)). Higher concentrations of 25(OH)D2 were associated with higher risk of suspected and definite psychotic experiences (adjusted odds ratio: OR (95% confidence interval: CI) 1.26 (1.11, 1.43)). Higher 25(OD)D2 concentrations were also weakly associated with definite psychotic experiences (adjusted OR (95% CI) 1.17 (0.96, 1.43), though with wide confidence intervals including the null value. Conclusions Our findings of an inverse association of 25(OH)D3 with definite psychotic experiences is consistent with the hypothesis that vitamin D may protect against psychosis-related outcomes. PMID:22848531

  7. Comparison of Quality and Safety Education for Nurses (QSEN)-related student experiences during pediatric clinical and simulation rotations.

    PubMed

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

    2013-09-01

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

  8. Participants’ Experiences of Being Debriefed to Placebo Allocation in a Clinical Trial

    PubMed Central

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

    2013-01-01

    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 four participants in a trial of acupuncture for irritable bowel syndrome, before, during, and after they received a course of placebo treatments over six weeks. During the final interview, we informed participants that they had received a course of placebo treatments. We used an idiographic phenomenological approach based on the Sheffield School to describe each participant’s experiences of being blinded to and then debriefed to placebo allocation. Our participants’ experiences of blinding and debriefing were embodied, related to their goals in undertaking the study, and social (e.g., embedded in trusting and valued relationships with acupuncturists). We suggest ways in which debriefing to placebo allocation can be managed sensitively to facilitate positive outcomes for participants. PMID:22673094

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

    PubMed Central

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

    1997-01-01

    OBJECTIVE: The purpose of this study was to develop a bioartificial liver (BAL) to treat patients with severe liver failure until they can be either transplanted or recover spontaneously. SUMMARY BACKGROUND DATA: Severe acute liver failure is associated with high mortality. Liver transplantation has emerged as an effective therapy for patients who did not respond to standard management. However, because of the donor organ shortage and urgent need for transplantation, many patients die before they can be transplanted and others do not survive after transplantation, primarily because of intracranial hypertension. METHODS: Three groups of patients with severe acute liver failure were treated with the BAL. In group 1 (n = 18) were patients with fulminant hepatic failure (FHF), in group 2 (n = 3) were patients with primary nonfunction (PNF) of a transplanted liver, and in group 3 (n = 10) were patients with acute exacerbation of chronic liver disease. Patients in groups 1 and 2 were candidates for transplantation at the time they entered the study, whereas patients in group 3 were not. RESULTS: In group 1, 16 patients were "bridged" successfully to transplantation, 1 patient was bridged to recovery without a transplant, and 1 patient died because of concomitant severe pancreatitis. In group 2, all patients were bridged successfully to retransplantation. In group 3, two patients were supported to recovery and successful transplants at later dates; the other eight patients, although supported temporarily with the BAL, later died because they were not candidates for transplantation. CONCLUSIONS: The authors' clinical experience with the BAL has yielded encouraging results. A randomized, controlled, prospective trial (phase II-III) is being initiated to determine the efficacy of the system. Images Figure 1. PMID:9193176

  10. Experiences with community core clinical microbiology laboratories: Practices and models that work and those that don't

    Microsoft Academic Search

    Larry D. Gray; J. Michael Miller; Robin Connelly

    2006-01-01

    For the last several years, most clinical microbiologists have heard, talked, and thought about; have been threatened with; or have actually experienced the consolidation of clinical microbiology (CM) services. We present (i) concepts, experiences, and practices that we and others have found to be successful during the operation of consolidated CM laboratories, (ii) practices that were disappointingly unsuccessful, (iii) seven

  11. Research Article Open Access J Clinic Experiment Ophthalmol Ophthalmology: Case Reports ISSN:2155-9570 JCEO an open access journal

    E-print Network

    Peli, Eli

    Research Article Open Access J Clinic Experiment Ophthalmol Ophthalmology: Case Reports ISSN:2155-9570 JCEO an open access journal Open AccessCase Report Clinical & Experimental Ophthalmology Bronstad et al, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School,20 Staniford St, Boston, MA 02114

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

    PubMed Central

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

    2012-01-01

    Background The National Dementia Strategy in England stressed the importance of earlier diagnosis of dementia. In-depth knowledge of the experiences of patients using such services remains an evidence gap. Aim To increase understanding of the experiences of people developing dementia and of their carers, to inform practice and decision making. Design and setting A retrospective and prospective qualitative interview study of participants recruited from four memory clinics in London, the north-west and the north-east of England. Method Purposive sampling was used to recruit 27 individuals with memory problems and 26 supporters and carers. Interviews explored referral pathways, assessment processes, disclosure of the diagnosis, experiences of being prescribed medication to help with symptoms, and issues of risk and decision making. Results Few participants experienced the process of memory assessment as patient centred. Where assessment processes were lengthy and drawn out, participants experienced considerable uncertainty. Many experienced tests and assessments as distressing, sometimes in settings that were perceived as alarming or potentially stigmatising by association. Information provision and communication were variable and practitioners were not always thought to help people to make sense of their experiences. Conclusion The transition from the early stages of cognitive impairment is not straightforward. There is potentially much uncertainty and waiting. Primary care practitioners may be better able to provide tailored support to individuals and their carers during this time if they are aware of what patients are anticipating and are informed about the diagnostic ‘journey’ by the insights of those who have experienced it. PMID:23336476

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

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

    PubMed

    Bria, Pietro; Lombardi, Riccardo

    2008-08-01

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

  16. 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

  17. [Professor LIN Lin's clinical experiences of comprehensive internal and external therapy for asthma].

    PubMed

    Zheng, Lin-Bo

    2013-05-01

    Professor LIN Lin's clinical experiences of comprehensive internal and external therapy for asthma was summarized in the paper. According to professor LIN Lin's experiences, asthma was differentiated as cold, heat, wind, stasis and deficiency pattern/syndrome in clinic. Asthma of cold type was treated with Xiao qinglong Decoction and Sanzi Yangqin Decoction combined with cupping, moxibustion, acupuncture and Bian stone therapy. Asthma of heat type was treated with Dingchuan Decoction combined with acupuncture, scraping therapy and moving cupping. Asthma of wind type was treated with Masu Erchen Decoction combined with acupuncture and cupping. Asthma of stasis type was treated with Xue fu Zhuyu Decoction combined with acupuncture, tapping manipulation, moving cupping and Bian stone therapy. Asthma of deficiency type was treated with Buzhong Yiqi Decoction, Shenge Shenqi Pill combined with warming needling therapy, acupoint injection and Bian stone therapy. A medical case was enclosed to explain the diagnosis and treatment idea "seeking the root cause of the disease in treatment" and "strengthening the antipathogenic qi to eliminate pathogenic factors" in the comprehensive internal and external therapy. PMID:23885623

  18. 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

  19. 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

  20. 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, sb?(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 ?=.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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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

  6. The Nature and Effectiveness of Peer Feedback during an Early Clinical Experience in an Elementary Education Program

    ERIC Educational Resources Information Center

    Shin, Eui-kyung; Wilkins, Elizabeth A.; Ainsworth, Janet

    2007-01-01

    Lack of communication between cooperating teachers and preservice teachers is one of the most commonly reported problems during field experiences. To provide more opportunity for feedback during preservice teachers' clinical experiences, a large elementary education program in a midwestern university implemented the use of peer feedback practices…

  7. A qualitative study of patients' experiences of a nurse-led memory clinic.

    PubMed

    Stirling, Christine; Campbell, Briony; Bentley, Michael; Bucher, Hazel; Morrissey, Martin

    2013-12-18

    Little is known about patients' decision-making to attend a nurse-led memory clinic (NLMC) or of their experiences in the months following attendance. This paper reports qualitative follow-up data from 13 participants who attended a NLMC run by a Nurse Practitioner, and who were interviewed later in their own homes. Participants attended the NLMC seeking 'benchmarking' against the broader population or confirmation of diagnosis, with the Nurse Practitioner perceived as having more time to talk. Although we anticipated that participants would have changed some behaviours to incorporate 'brain health material', we found that the focus was on maintaining current capacity and lifestyle with most participants delaying planning and decisions about future lifestyle changes until 'necessary'. Understanding why people contact a NLMC and how their participation influences future planning can help us better target health care messages with the aim of improving health literacy. PMID:24381213

  8. The clinical experience of the challenges of oncology in South East Asia

    PubMed Central

    Javaid, Mahvesh Rana

    2013-01-01

    An unforgettable summer elective in the heart of Pakistan, discovering the specialities of internal medicine at the state-of-the-art cancer centre—Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCHRC). Cancer incidence and mortality are rising across the world, forcing medical research to find new and better treatments, all the time. The SKMCHRC is the only charity-funded cancer centre providing free treatment for anyone diagnosed with cancer in Pakistan. It is definitely the beginning of a new future for cancer patients in Pakistan, giving them a chance for a better quality of life, even those in poverty. Just like this, there are many appreciations and memories from my uplifting clinical experience at SKMCHRC. PMID:23420735

  9. Numerical studies on alternative therapies for femoral head necrosis: A finite element approach and clinical experience.

    PubMed

    Lutz, André; Nackenhorst, Udo; von Lewinski, Gabriela; Windhagen, Henning; Floerkemeier, Thilo

    2011-10-01

    Numerical investigations with regard to the subtrochanteric fracture risk induced by three alternative methods for the treatment of femoral head necrosis are outlined in this presentation. The traditional core decompression technique will be compared with minimal invasive multiple low diameter drillings and the implantation of an innovative tantalum implant. With emphasis to the newly introduced computational strategies and modeling approaches, the modeling of critical loading conditions as well as mesh convergence is outlined in detail. In addition to the immediate postoperative fracture risk, the long-term stability of the different approaches for treating femoral head necrosis is predicted by performing well-established bone remodeling simulation techniques. The computed results are augmented for results obtained from clinical experience. PMID:21053044

  10. HLA-B*5701 clinical testing: early experience in the United States.

    PubMed

    Faruki, Hawazin; Heine, Uwe; Brown, Trisha; Koester, Ruth; Lai-Goldman, Myla

    2007-10-01

    HLA-B*5701 testing to provide risk stratification for abacavir hypersensitivity has the potential to reduce incidence of hypersensitivity reactions in susceptible individuals. Early experience with clinical HLA-B*5701 testing of the first 100 specimens, from a large clinical reference laboratory in the United States, is presented. Patient samples were tested using a two-step approach. The first step allowed rapid identification of most HLA-B*5701-negative samples in a high throughput mode. The second step involved resolution of putative positives by DNA sequencing to identify B*5701 specifically as well as other B57 subtypes. Test reporting included a phone call from a genetic counselor to obtain the ethnic background and indication for testing and to provide a patient-specific interpretation. The patients population was comprised of Caucasians, 84%; Hispanics, 13%; and African Americans, 3%. Among the 100 samples tested, 92% were HLA-B*5701-negative and 8% were positive for the HLA-B*5701 allele. All HLA-B*5701 allele positives were identified in Caucasian patients. Where the indication for testing was obtainable (57 patients), pre-abacavir therapy screening was the indication 67% of the time. Clarification of previous suspected history of hypersensitivity was the indication 33% of the time. Among samples tested to help clarify a previous history of hypersensitivity, 16/19 or 84% did not carry the HLA-B*5701 allele whereas 3/19 (16%) were carriers of the HLA-B*5701 allele. Early utilization of HLA-B*5701 testing in community practice was not always consistent with the clinical indications for testing. Post-test communication assisted in providing physician education and interpretation of patient-specific results. PMID:17885623

  11. 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

  12. Review of 10 years of clinical experience with Chinese domestic trivalent influenza vaccine Anflu®

    PubMed Central

    Liu, Yan; Wu, Jun-Yu; Wang, Xu; Chen, Jiang-Ting; Xia, Ming; Hu, Wei; Zou, Yong; Yin, Wei-Dong

    2014-01-01

    Influenza viruses cause annual winter epidemics globally and influenza vaccination is most effective way to prevent the disease or severe outcomes from the illness, especially in developing countries. However, the majority of the world’s total production capacity of influenza vaccine is concentrated in several large multinational manufacturers. A safe and effective preventive vaccine for the developing countries is urgent. Anflu®, a Chinese domestic preservative-free, split-virus trivalent influenza vaccine (TIV), was introduced by Sinovac Biotech Ltd. in 2006. Until now, 20.6 million doses worldwide of Anflu® were sold. Since 2003, 13 company-sponsored clinical studies investigating the immunogenicity and safety of Anflu® have been completed, in which 6642 subjects participated and were vaccinated by Anflu®. Anflu® was generally well tolerated in all age groups, and highly immunogenic in healthy adults and elderly and exceeded the licensure criteria in Europe. This review presents and discusses the experience with Anflu® during the past decade. A new Chinese domestic, preservative-free, unadjuvanted, inactivated split-virus trivalent influenza vaccine (TIV), Anflu®, was introduced into human clinical trials in 2003 and then licensed in China in 2006. The vaccine contains 15 µg /0.5 ml hemagglutinin from each of the 3 influenza virus strains (including an H1N1 influenza A virus subtype, an H3N2 influenza A virus subtype, and an influenza B virus) that are expected to be circulating in the up-coming influenza season. The clinical data pertaining to Anflu® will be reviewed and compared with other TIVs available at present. PMID:24104060

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

    SciTech Connect

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

    2007-01-01

    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.

  14. New Embolization Microcoil Consisting of Firm and Flexible Segments: Preliminary Clinical Experience

    SciTech Connect

    Irie, Toshiyuki [Hitachi General Hospital, Department of Radiology (Japan)], E-mail: toshiyuki.irie@ibabyo.hitachi.co.jp

    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.

  15. 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

  16. Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: initial clinical experience.

    PubMed

    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. PMID:25706821

  17. Results of 1 year of clinical experience with independent dose calculation software for VMAT fields.

    PubMed

    Colodro, Juan Fernando Mata; Berna, Alfredo Serna; Puchades, Vicente Puchades; Amores, David Ramos; Baños, Miguel Alcaraz

    2014-10-01

    It is widely accepted that a redundant independent dose calculation (RIDC) must be included in any treatment planning verification procedure. Specifically, volumetric modulated arc therapy (VMAT) technique implies a comprehensive quality assurance (QA) program in which RIDC should be included. In this paper, the results obtained in 1 year of clinical experience are presented. Eclipse from Varian is the treatment planning system (TPS), here in use. RIDC were performed with the commercial software; Diamond(®) (PTW) which is capable of calculating VMAT fields. Once the plan is clinically accepted, it is exported via Digital Imaging and Communications in Medicine (DICOM) to RIDC, together with the body contour, and then a point dose calculation is performed, usually at the isocenter. A total of 459 plans were evaluated. The total average deviation was -0.3 ± 1.8% (one standard deviation (1SD)). For higher clearance the plans were grouped by location in: Prostate, pelvis, abdomen, chest, head and neck, brain, stereotactic radiosurgery, lung stereotactic body radiation therapy, and miscellaneous. The highest absolute deviation was -0.8 ± 1.5% corresponding to the prostate. A linear fit between doses calculated by RIDC and by TPS produced a correlation coefficient of 0.9991 and a slope of 1.0023. These results are very close to those obtained in the validation process. This agreement led us to consider this RIDC software as a valuable tool for QA in VMAT plans. PMID:25525309

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

    PubMed Central

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

    2005-01-01

    In October 2002, the U.S. Food and Drug Administration approved buprenorphine-naloxone (Suboxone®) sublingual tablets as an opioid dependence treatment available for use outside traditionally licensed opioid treatment programs. The NIDA Center for Clinical Trials Network (CTN) sponsored two clinical trials assessing buprenorphine-naloxone for short-term opioid detoxification. These trials provided an unprecedented field test of its use in twelve diverse community-based treatment programs. Opioid-dependent men and women were randomized to a thirteen-day buprenorphine-naloxone taper regimen for short-term opioid detoxification. The 234 buprenorphine-naloxone patients averaged 37 years old and used mostly intravenous heroin. Direct and rapid induction onto buprenorphine-naloxone was safe and well tolerated. Most patients (83%) received 8 mg buprenorphine-2 mg naloxone on the first day and 90% successfully completed induction and reached a target dose of 16mg buprenorphine-4 mg naloxone in three days. Medication compliance and treatment engagement was high. An average of 81% of available doses was ingested, and 68% of patients completed the detoxification. Most (80.3%) patients received some ancillary medications with an average of 2.3 withdrawal symptoms treated. The safety profile of buprenorphine-naloxone was excellent. Of eighteen serious adverse events reported, only one was possibly related to buprenorphine-naloxone. All providers successfully integrated buprenorphine-naloxone into their existing treatment milieus. Overall, data from the CTN field experience suggest that buprenorphine-naloxone is practical and safe for use in diverse community treatment settings, including those with minimal experience providing opioid-based pharmacotherapy and/or medical detoxification for opioid dependence. PMID:15204675

  19. Who am I now? The experience of being a post-registration children's student nurse in the first clinical placement.

    PubMed

    Begley, Thelma

    2007-07-01

    Role transition from staff nurse to post-registration student is not a well researched area of nursing. Two previous Irish studies have been reported of the experiences of post-registration midwifery students [McCrea, H., Thompson, K., Carswell, L., Whittington, D., 1994. Student midwives' learning experience on the wards. Journal of Clinical Nursing 3, 97-102; Begley, C., 1997. Midwives in the making: a longitudinal study of the experiences of student midwives during their two-year training in Ireland. Unpublished PhD Thesis, School of Nursing and Midwifery, Trinity College, Dublin.] but there is limited research into post-registration children's student nurses experiences. A broadly phenomenological approach was employed to interpret what it means to be a post-registration children's student nurse during the first clinical placement. Data was collected from a purposive sample of six students, using unstructured tape recorded interviews. Thematic content analysis was utilised to produce an interpretation of nurses' experience within the first clinical placement. The findings reflect the participants' role confusion when changing from being a staff nurse in one discipline of nursing to being a post-registration student in another. They find previous experience is not recognised and that students originating from different disciplines in nursing have different experiences within the first placement. Coping mechanisms are discussed along with preparation for and supports available in the clinical area. PMID:16934372

  20. Determination of Variation Parameters as a Crucial Step in Designing TMT-Based Clinical Proteomics Experiments.

    PubMed

    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

  1. 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

  2. Impact of the University of Colorado's Advanced Clinical Training and Service (ACTS) Program on dental students' clinical experience and cognitive skills, 1994-2006.

    PubMed

    Berg, Rob; Call, Richard L; Maguire, Kerry; Berkey, Douglas B; Karshmer, Bernard A; Guyton, Brad; Tawara-Jones, Karen

    2010-04-01

    The University of Colorado Denver School of Dental Medicine has operated a community-based dental education program for all of its students since 1985. A database of student productivity has been maintained in a standardized format, capable of multiyear compilation, since 1994. This study utilizes twelve years of these data to profile the type and amount of clinical treatment that can be provided by a typical fourth-year dental student during a 100-day community-based training experience. Between 1994 and 2006, the school's 423 graduates provided a mean of 922 treatment procedures per student at a mean of 498 patient visits per student. During a typical four-week clinical affiliation, each student provided a mean of approximately twenty-seven restorations on permanent teeth, sixteen restorations on primary teeth, and twenty-four oral surgery procedures (extractions). Students also gained considerable experience in periodontics, fixed and removable prosthodontics, and endodontics. Self-assessed competency ratings tended to increase after completing the program, as did willingness to treat underserved populations after graduation. About 16 percent of graduates reported planning to practice in the public sector after completing dental school. A community-based experience such as this appears to offer an opportunity to substantially augment dental students' clinical training experiences. PMID:20388816

  3. The combined effect of ionizing radiation and other space flight factors (results of flight experiments)

    NASA Technical Reports Server (NTRS)

    1973-01-01

    Problems and conditions of conducting radiobiological experiments in outer space are investigated. Effects of ionizing radiation and other prolonged space flight factors on animals are studied. Relationship of nonradiation space flight factors to radiation damage is evaluated.

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

    PubMed Central

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

    2012-01-01

    Our institute has constructed a new treatment facility for carbon ion scanning beam therapy. The first clinical trials were successfully completed at the end of November 2011. To evaluate patient setup accuracy, positional errors between the reference Computed Tomography (CT) scan and final patient setup images were calculated using 2D-3D registration software. Eleven patients with tumors of the head and neck, prostate and pelvis receiving carbon ion scanning beam treatment participated. The patient setup process takes orthogonal X-ray flat panel detector (FPD) images and the therapists adjust the patient table position in six degrees of freedom to register the reference position by manual or auto- (or both) registration functions. We calculated residual positional errors with the 2D-3D auto-registration function using the final patient setup orthogonal FPD images and treatment planning CT data. Residual error averaged over all patients in each fraction decreased from the initial to the last treatment fraction [1.09 mm/0.76° (averaged in the 1st and 2nd fractions) to 0.77 mm/0.61° (averaged in the 15th and 16th fractions)]. 2D-3D registration calculation time was 8.0 s on average throughout the treatment course. Residual errors in translation and rotation averaged over all patients as a function of date decreased with the passage of time (1.6 mm/1.2° in May 2011 to 0.4 mm/0.2° in December 2011). This retrospective residual positional error analysis shows that the accuracy of patient setup during the first clinical trials of carbon ion beam scanning therapy was good and improved with increasing therapist experience. PMID:22927632

  5. Clinical experience with daptomycin in Europe: the first 2.5 years

    PubMed Central

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

    2011-01-01

    Objectives To describe the patient populations and infections being treated with daptomycin, as well as the efficacy and safety outcomes. Patients and methods Data from the European Cubicin Outcomes Registry and Experience (EU-CORESM), retrospectively collected at 118 institutions between January 2006 and August 2008, were analysed. Results Daptomycin treatment was documented in 1127 patients with diverse infections, including complicated skin and soft tissue infections (33%), bacteraemia (22%), endocarditis (12%) and osteomyelitis (6%). It was used empirically, before microbiological results became available, in 53% of patients. Staphylococcus aureus was the most common pathogen (34%), with 52% of isolates resistant to methicillin; coagulase-negative staphylococci and enterococci were also frequent, with 22% of Enterococcus faecium isolates resistant to vancomycin. Daptomycin was used as first-line therapy in 302 (27%) patients. When used second line, the most common reasons for discontinuation of previous antibiotic were treatment failure and toxicity or intolerance. The use of concomitant antibiotics was reported in 65% of patients. Most frequent doses were 6 mg/kg (47%) and 4 mg/kg (32%). The median duration of daptomycin therapy was 10 days (range 1–246 days) in the inpatient setting and 13 days (range 2–189 days) in the outpatient setting. The overall clinical success rate was 79%, with a clinical failure rate of <10% for all infection types. Low failure rates were observed in first- and second-line therapy (6% and 8%, respectively). Daptomycin demonstrated a favourable safety and tolerability profile regardless of treatment duration. Conclusions Daptomycin has a relevant role in the treatment of Gram-positive infections. PMID:21393205

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

    SciTech Connect

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

    2006-11-01

    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.

  7. 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

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

    PubMed Central

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

    2013-01-01

    Objective The aim of this study is to report the experience of noninvasive prenatal DNA testing using massively parallel sequencing in an accredited clinical laboratory. Methods Laboratory information was examined for blood samples received for testing between February and November 2012 for chromosome 21 (Chr21), Chr18, and Chr13. Monosomy X (MX) testing was available from July 2012 for cystic hygroma indication. Outcomes were collected from providers on samples with positive results. Results There were 5974 samples tested, and results were issued within an average of 5.1 business days. Aneuploidy was detected in 284 (4.8%) samples (155 Chr21, 66 Chr18, 19 Chr13, 40 MX, and four double aneuploidy). Follow-ups are available for 245/284 (86%), and 77/284 (27.1%) are confirmed, including one double-aneuploidy case concordant with cytogenetics from maternal malignancy. Fourteen (0.2%) discordant (putative false-positive) results (one Chr21, six Chr18, three Chr13, three MX, and one Chr21/13) have been identified. Five (0.08%) false-negative cases are reported (two trisomy 21, two trisomy 18, and one MX). In 170 (2.8%) cases, the result for a single chromosome was indefinite. Conclusions This report suggests that clinical testing of maternal cell-free DNA for fetal aneuploidy operates within performance parameters established in validation studies. Noninvasive prenatal testing is sensitive to biological contributions from placental and maternal sources. ©2013 Verinata Health, Inc. Prenatal Diagnosis published by John Wiley & Sons, Ltd. PMID:23592485

  9. Disulfiram Implantation for the Treatment of Alcoholism: Clinical Experiences from the Plastic Surgeon's Point of View

    PubMed Central

    Sibar, Serhat; Bulam, Hakan; Findikcioglu, Kemal; Tuncer, Serhan; Dogan, Bilge

    2014-01-01

    Background Disulfiram implantation is a widely used treatment alternative for alcohol abuse, yet reports on the surgical aspect of disulfiram implantation with respect to patient and drug-related treatment efficacy and wound complications are very limited. We present our clinical experiences with disulfiram implantation and discuss the surgical outcomes obtained with different anatomical planes for implantation. Methods Medical records of all patients referred to our clinic from the psychiatry department between 2007 and 2013 for disulfiram implantation were retrospectively analyzed. Implantation was carried out using 10 sterile Disulfiram tablets (WZF Polfa S.A.), each tablet containing 100 mg of disulfiram. The procedure was carried out by implanting the tablets randomly in either a subcutaneous or an intramuscular plane. The location and the plane of implantation and the complications were recorded for each patient and compared to determine the differences in the outcomes. Results A total of 32 implantation procedures were evaluated for this study. Twenty-five implants were placed in the intramuscular plane (78.2%), while seven implants were placed subcutaneously (21.8%). Exposure was encountered in three of the seven subcutaneous implants (42.9%), while no exposure was seen with the intramuscular implants. Incomplete absorption of the tablets was encountered in one patient with a previous subcutaneous implant who presented 1 year later for re-implantation as part of the continuation of therapy. Conclusions To overcome the issue of treatment continuation in the case of disulfiram therapy, which may be ceased due to frequently encountered wound complications, we believe that implantation in the subscapular intramuscular plane allows both uneventful healing and an out-of-reach implant location. PMID:25276651

  10. 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

  11. 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

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

    PubMed

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

    2005-01-01

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

  13. Clinical factors predictive of malignant and premalignant cystic neoplasms of the pancreas: a single institution experience

    PubMed Central

    Jones, Natalie B; Hatzaras, Ioannis; George, Nathaniel; Muscarella, Peter; Ellison, E Christopher; Melvin, W Scott; Bloomston, Mark

    2009-01-01

    Background: As cystic neoplasms of the pancreas are discovered with advanced imaging techniques, pancreatic surgeons often struggle with identifying who is at risk of having or developing pancreatic cancer. We sought to review our experience with the surgical management of cystic neoplasms of the pancreas to determine pre-operative clinical indicators of malignancy or premalignant (i.e. mucinous) lesions. Methods: Between 1996 and 2007, 114 consecutive patients with cystic neoplasms of the pancreas underwent a pancreatectomy. Invasive adenocarcinoma was identified in 35 whereas 79 had benign lesions. Mucinous lesions were considered premalignant and consisted of 29 intraductal papillary mucinous neoplasms (IPMN) and 17 mucinous cystic neoplasms (MCN). The remaining 33 benign lesions were serous microcystic adenomas. Descriptive statistics were calculated and multivariate logistic regression was performed. Receiver-operating characteristic (ROC) curves were constructed for continuous variables and the area under the curves compared. Likelihood ratios were calculated from the combinations of predictors. Results: Patients with pancreatic cancer arising from a cystic neoplasm were older than those with benign cysts. Mucinous lesions with or without associated cancer were more likely to be symptomatic and present with elevated serum carbohydrate antigen (CA)19-9 levels. Cancers more commonly presented in the head of the pancreas and were associated with longer hospitalizations after resection. Using multivariate logistic regression, size and elevated CA19-9 were predictors of malignancy whereas male gender and size were predictors of mucinous lesions with or without malignancy. Size, however, was not an accurate test to determine premalignant or malignant lesions using area under the ROC curve analysis whereas CA19-9 performed the best regardless of gender or lesion location. Conclusions: Based upon our single institution experience with resection of cystic neoplasms of the pancreas, we advocate an aggressive surgical approach to any patient with a cystic neoplasm of the pancreas and associated elevated CA19-9. PMID:20495634

  14. NCIC Clinical Trials Group experience of employing patient-reported outcomes in clinical trials: an illustrative study in a palliative setting.

    PubMed

    Brundage, Michael; Bezjak, Andrea; Tu, Dongsheng; Palmer, Michael; Pater, Joseph

    2008-06-01

    In this article we briefly review the experience of the National Cancer Institute of Canada (NCIC) Clinical Trials Group (CTG) with respect to the assessment of patient reported outcomes in clinical trials, and illustrate issues important to assessing symptom palliation in clinical trials of cancer therapy. We highlight a standard approach taken by the NCIC CTG, and illustrate how this approach may be applied to the complex problem of symptom control analysis in patients with locally advanced NSCLC. We further illustrate how variations in this analysis yield different apparent rates of palliation. Apparent rates of palliation critically depended on the outcome measures used: single symptom response across patients (5-32%, depending on the symptom of interest), symptom response in specific symptomatic patients (37-100%), symptom control (45-82%), index symptom response (60%), proportion of patients experiencing improvement in all symptoms (21%), or health-related quality of life (HRQoL) improvement (23%, global). Rates also varied substantively depending on which cohort of patients was considered relevant to each analysis (i.e., was included in the respective denominator). Substantive discordance in patients' apparent palliation was seen when HRQoL data were compared with symptom diary data. Appropriate and valid descriptions of palliative outcomes in clinical trials are complex undertakings. We conclude that several measures are required for a textured clinical description of outcome, and recommend reporting palliation according to individual symptom response rates and HRQoL response rates, in order to address each construct of palliation success. PMID:20528376

  15. 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

  16. 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

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

    PubMed

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

    2014-07-01

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

  18. International nursing student exchange: rural and remote clinical experiences in Australia.

    PubMed

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

    2010-01-01

    A rural and remote international clinical exchange permits the senior nursing student to experience another culture and to develop a feel for daily life and nursing practice abroad. In a student exchange between Australia and Canada, similarities exist with regard to life and work for nurses who live in these developed countries. Similarities extend to a growing population base of original inhabitants or indigenous peoples with complex health challenges. Differences, however, are also apparent in rural and remote health care delivery due to the uniqueness of each country's demographics, nursing programs, nursing culture, and health care systems. In the rural hospitals of the Riverland region, South Australia, the Australian public and private health care systems are witnessed working side by side. Aboriginal health care with its unique cultural care practices was experienced in the remote Aboriginal community of Hermannsburg in the Northern Territory, and in the district hospital in Alice Springs. The international exchange provided the opportunity to reflect on the impact of the social determinants of health, and the similarities and differences between developed countries in nursing practice and nursing culture. The sense of community and autonomy gained in rural and remote placements in Australia provided incentive for nursing students to consider this area of practice on their return to Canada. PMID:20390733

  19. Interlocking Detachable Platinum Coils, A Controlled Embolization Device: Early Clinical Experience

    SciTech Connect

    Reidy, John F. [Department of Radiology, 2nd Floor, Guy's Tower, Guy's Hospital, St. Thomas Street, London, SE1 9RT (United Kingdom); Qureshi, Shakeel A. [Pediatric Cardiology Department, 11th Floor, Guy's Tower, Guy's Hospital, St. Thomas Street, London, SE1 9RT (United Kingdom)

    1996-03-15

    Purpose: To present the early clinical experience of a new mechanically controlled-release embolization device<+>-<+>the interlocking detachable coil (IDC)-in complex embolization outside the head. Methods: IDCs were used only when conventional embolization techniques were considered too risky or unsafe. The coils consist of unfibered coiled platinum (0.012 inch), mechanically connected to a pusher wire and deployed through a Tracker 18 catheter. IDCs come in a range of diameters (2<+>-<+>8 mm) and lengths (1<+>-<+>30 cm). Results: A total of 87 IDCs were used for 27 procedures in 25 patients (mean 14.5 years) to occlude 31 arteries or vascular lesions. Control of the coil and its release were satisfactory and all coils were fully retrievable up to the point of deployment. Two IDC coils embolized inadvertently but were retrieved; there were no other complications. The IDC coils could not be satisfactorily placed in one high-flow arteriovenous (AV) fistula, and in another case there was a small residual fistula. Occlusion was produced in 29 of 31 lesions. Ancillary techniques were needed in 5 patients: temporary balloon occlusion in 2 and 0.038-inch coils in 3. Conclusion: The IDC coil is an effective device that allows controlled embolization to be performed, especially in aneurysms and in high-flow AV fistulas in children.

  20. 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

  1. 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

  2. Unsupervised Biomedical Named Entity Recognition: Experiments with Clinical and Biological Texts

    PubMed Central

    Zhang, Shaodian; Elhadad, Nóemie

    2013-01-01

    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

  3. 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.

  4. 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

  5. Is tumor (R)ejection by the immune system the “5th R” of radiobiology?

    PubMed Central

    Golden, Encouse B; Formenti, Silvia C

    2014-01-01

    Traditional factors of DNA damage and tumor cell kill, described by the “4 R’s” of radiobiology (Reassortment, Reoxygenation, Repair, and Repopulation) fall short in explaining the role of immunity in hosts treated with radiotherapy. We propose a “5th R,” (immune-mediated) Rejection, which recognizes the contribution of the immune system to the antineoplastic effects of radiotherapy. PMID:24800177

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

    Cancer.gov

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

  7. 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

  8. 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 [Institute of Radiation Physics, Lausanne University Hospital, 1007 Lausanne (Switzerland); Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231 (United States); Department of Nuclear Medicine, Lausanne University Hospital, 1011 Lausanne (Switzerland); Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231 (United States)

    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.

  9. A microRNA network functioning in the regulation of radiobiological effects

    PubMed Central

    Wu, Xin; Ding, Nan; Hu, Wentao; He, Jinpeng; Chang, Lei; Xu, Shuai; Pei, Hailong; Hua, Junrui; Wang, Jufang; Zhou, Guangming

    2014-01-01

    MicroRNA (miRNA), a small non-coding RNA molecule, is vital in genetic regulation, and miRNA pathway, which regulates gene expression through degradation or translational suppression of their target transcripts, is highly conservative in evolution. Although profiles of miRNAs are different in various cell types and tissues, miRNAs have been considered as a crucial class of regulators in cellular response to ionizing radiation (IR). By carrying out a series of experiments, we have found that altered transcriptional regulation network composed of radiation-mediated miRNAs regulates the expression of their downstream target genes in most biological processes to control cell growth, cell cycle and apoptosis. For example, the newly identified miR-3928 negatively regulates the expression of Dicer, which has been validated by the luciferase assay and western blotting. Dicer is not only a key participant in responding to radiation, but also a critical factor for the maturation of miRNAs, suggesting that miR-3928 affects on the expression of other miRNAs through regulating Dicer. Among the miRNAs controlled by the Dicer, we reveal that miR-185 and miR-663 can efficiently suppress ATR and TGF-?1 expression, which are both important responders in the process of radiobiological effects. Further experiments reveal that the expression of Dicer is suppressed by miR-3928 induced by IR and consequently, the maturation of other miRNAs including miR-185 and miR-663 is inhibited, resulting in the abundantly enhanced expression of ATR and TGF-?1 respectively. This mechanism to hammer at fixing DNA damage or promote cells to apoptosis caused by IR has important implications in the decision of cell fates. Moreover, it has been shown that the expression of BTG1 is characterized in response to factors that induce growth arrest and subsequent differentiation both in vivo and in vitro, affecting cellular physiological progresses of angiogenesis, follicular development and myoblast and B cell differentiation, through regulating cell growth, migration, cell cycle, apoptosis and differentiation. BTG1 gene is phylogenetically highly conserved in its coding and 3?-untranslated region (UTR), which is considered as a decisive element involved in regulation of BTG1 expression. We present evidence that BTG1 can be induced by IR and confirm that miR-454-3p, whose gene locates in the intron of Ska2 gene, can regulate BTG1 expression through directly binding to the 3?-UTR of BTG1 mRNA. These results point out that increased expression of BTG1 caused by the down-regulation of miR-454-3p in case that IR modulates endogenous activity of PRMT1, a BTG1-binding partner, which can methylate endogenous transcription factors to change gene expression pattern and reply radiostilumation. An inverse relationship between the levels of expression of BTG1 and miR-454-3p reveals that there exists a new pathway in response to IR stimulation. Furthermore, cell growth will be transiently increased by the knockdown of BTG1 by transfecting BTG1 siRNA or miR-454-3p mimic. However, the apoptotic state of cells can be tested after 2 days. Down-regulation of BTG1 by miR-454-3p increases the sensitivity of human renal cell carcinoma 786-O cells to IR-induced apoptosis, suggesting that BTG1 could serve as a terget for sensitizing renal carcinoma to standard radiotherapy. Taken together, all these data indicate that alteration of miRNA expression is evident in the cellular response to IR. MiR-3928, miR-185, miR-663 and miR-454-3p may constitute a complex network contributing to the regulation of radiobiological effects. It is apparent that the study of radiation-related miRNAs is beneficial to qualitatively and quantitatively modulating radiobiological effects, and also in favor of the advanced research of miRNA functions.

  10. A Comparison of the ancient use of ginseng in traditional Chinese medicine with modern pharmacological experiments and clinical trials

    Microsoft Academic Search

    2008-01-01

    Panax ginseng C.A. Meyer is a well-known medicinal herb native to China and Korea, and has been used as a herbal remedy in eastern Asia for thousands of years. However, there is different evidence of ginseng efficacy between traditional Chinese medicine (TCM), modern pharmacological experiments and clinical trials. In TCM, ginseng is a highly valued herb and has been applied

  11. Diversity characteristics and the experiences of nursing students' during clinical placements: A qualitative study of students and supervisors views.

    PubMed

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2014-11-10

    Abstract Background: Little is known about which diversity characteristics if any, impact on nursing students' clinical placements or how these may affect the quality of their learning experiences. There is therefore a need to better understand these effects not only from the student's perspective but also from the perspective of the staff who supervise them, in order to ensure students obtain maximal benefit from their placements. Aim: To describe the clinical experiences of nursing students and the diversity characteristics that affect this learning experience. Methods: Data were collected from a series of open-ended questions embedded within a larger anonymous web-based survey, from August 2011 to March 2012. Participants included first, second and third year undergraduate Bachelor of Nursing students (N=704) and faculty members involved in the clinical learning environment (N = 165) from seven Australian universities. Findings: Qualitative findings were clustered into three main themes, differences, difficulty and discrimination, each with three subthemes. Conclusion: Findings suggest a need to offer appropriate support for nursing students who feel different because of diversity characteristics. Whilst some of the participant perceptions are confronting they provide valuable insights for universities developing curricula and the clinical placement facilities where students obtain their experience. PMID:25381798

  12. References (RAND -08/05) 1 Papers that explain how to use clinical experience, theory, etc to form dynamic

    E-print Network

    Murphy, Susan A.

    References (RAND - 08/05) 1 Papers that explain how to use clinical experience, theory, etc to form and David A. Stephens (2005). Demystifying Optimal Dynamic Treatment Regimes. UW Biostatistics Working Paper:1410-1423. [2] J. Bagnell and J. Schneider (2001). Autonomous Helicopter Control using Reinforcement Learning

  13. 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…

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

    PubMed

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

    2014-04-01

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

  15. 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

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

    2008-08-11

    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.

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

    PubMed Central

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

    2010-01-01

    We report on our assessment of two types of real time target tracking modalities for lung cancer radiotherapy namely (1) single phase propagation (SPP) where motion compensation assumes a rigid target and (2) multi-phase propagation (MPP) where motion compensation considers a deformable target. In a retrospective study involving 4DCT volumes from six (n=6) previously treated lung cancer patients, four-dimensional treatment plans representative of the delivery scenarios were generated per modality and the corresponding dose distributions were derived. The modalities were then evaluated (a) Dosimetrically for target coverage adequacy and normal tissue sparing by computing the mean GTV dose, relative conformity gradient index (CGI), mean lung dose (MLD) and lung V20; (b) Radiobiologically by calculating the biological effective uniform dose (D?) for the target and organs at risk (OAR) and the complication free tumor control probability (P+). As a reference for the comparative study, we included a 4D Static modality, which was a conventional approach to account for organ motion and involved the use of individualized motion margins. With reference to the 4D Static modality, the average percent decrease in lung V20 and MLD were respectively (13.1±6.9) % and (11.4±5.6) % for the MPP modality, whereas for the SPP modality they were (9.4±6.2) % and (7.2±4.7) %. On the other hand, the CGI was observed to improve by 15.3±13.2 and 9.6±10.0 points for the MPP and SPP modalities, respectively while the mean GTV dose agreed to better than 3% difference across all the modalities. A similar trend was observed in the radiobiological analysis where the P+ improved on average by (6.7±4.9) % and (4.1±3.6) % for the MPP and SPP modalities, respectively while the D? computed for the OAR decreased on average by (6.2±3.6) % and (3.8±3.5) % for the MPP and SPP tracking modalities, respectively. The D? calculated for the GTV for all the modalities was in agreement to better than 2% difference. In general, respiratory motion induces target displacement and deformation and therefore the complex MPP real time target tracking modality is the preferred. On the other hand, the SPP approach affords simplicity in implementation at the expense of failing to account for target deformation. Radiobiological and dosimetric analyses enabled us to investigate the consequences of failing to compensate for deformation and assess the impact if any on the clinical outcome. While it is not possible to draw any general conclusions on a small patient cohort, our study suggests that the two tracking modalities can lead to comparable clinical outcomes and as expected are advantageous when compared with the static conventional modality. PMID:20218742

  18. Outcomes of Research Biopsies in Phase I Clinical Trials: The MD Anderson Cancer Center Experience

    PubMed Central

    El-Osta, Hazem; Wheler, Jennifer; Fu, Siqing; Naing, Aung; Falchook, Gerald; Hicks, Marshall; Wen, Sijin; Tsimberidou, Apostolia M.; Kurzrock, Razelle

    2011-01-01

    Background. Research biopsies are crucial for exploring the impact of novel agents on putative targets. The current study assesses the safety and success rate associated with performing such biopsies. Methods. We reviewed the medical records of 155 consecutive patients who had one or more research biopsies as part of a phase I trial from September 2004 to October 2009. Results. Of 281 research biopsies performed, 118 were paired before and after treatment biopsies (total = 236 biopsies). The most common sites of biopsy were superficial lymph node (19.9%), followed by liver (16.4%), and then soft tissue (15.7%). Ultrasound-guided biopsies were the most frequent type (53.7%). Among 142 patients who consented for mandatory biopsy, 86.6% had the biopsy performed, compared with 4.4% of 911 patients offered a biopsy on an optional basis (p < .0001). Biopsy was obtained most frequently on industry-sponsored trials; lack of funding on nonindustry trials was the most common reason that biopsies were not obtained. Of 281 single biopsies, only 4 (1.4%) had complications: pneumothorax requiring chest tube placement (n = 2), infection requiring admission (n = 1), and arrhythmia with hypotension (n = 1). All but one biopsy was successful in obtaining tissue. No deaths were attributable to biopsy. Conclusions. Our experience demonstrates that research biopsies in early phase clinical trials are safe (1.4% risk of serious complications), and a higher percentage of patients underwent mandatory biopsies (86.6%) compared with that of the patients with optional biopsies (4.4%). PMID:21859821

  19. Endoscopic Submucosal Dissection for Early Colorectal Neoplasms: Clinical Experience in a Tertiary Medical Center in Taiwan

    PubMed Central

    Tseng, Mei-Yu; Lin, Jung-Chun; Huang, Tien-Yu; Shih, Yu-Lueng; Chu, Heng-Cheng; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Chen, Peng-Jen

    2013-01-01

    Objectives. Endoscopic submucosal dissection (ESD) is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1) lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG) ?20?mm and laterally spreading tumors-granular type (LST-G) ?30?mm; (2) lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3 ± 12.9 years, and the male-female ratio was 1.8?:?1. The mean tumor size was 37.2 ± 17.9?mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0%) and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD. PMID:23533391

  20. Learning pathways during clinical placement of physiotherapy students: a Malaysian experience of using learning contracts and reflective diaries

    PubMed Central

    2013-01-01

    Purpose: Learning contracts and reflective diaries are educational tools that have been recently introduced to physiotherapy students from Malaysia during clinical education. It is unclear how students perceive the experience of using a learning contract and reflective diary. This study explores the learning pathways of the students after using a learning contract and a reflective diary for the first time in their clinical placement. Methods: A total of 26 final-year physiotherapy students completed a learning contract and a reflective diary during clinical placements. Two researchers explored the data qualitatively by the thematic content analysis method using NVivo. Results: A total of four and six main learning themes were identified from the data of the students through a learning contract and reflective diary. Conclusion: These learning themes reflected the views of the students about what they have considered to be important learning pathways during their clinical placements. They give valuable insights into the experiences and opinions of students during their clinical education process, which should be useful for enhancing teaching and learning methods in physiotherapy education. PMID:23997897

  1. "I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

    PubMed Central

    2011-01-01

    Background Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors. Methods Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method. Results In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: (a) Pleasure and stimulation. Informants appreciated tutorship and meeting both students and fellow tutors, (b) Disappointment and stagnation. Occasionally, tutors were frustrated and expressed negative feelings, (c) Demands and duty. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, (d) Impact of workplace relations. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and (e) Multitasking difficulties. Combining several duties with those of a tutorship was often reported as difficult. Conclusions It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system. PMID:21975057

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

    Cancer.gov

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

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

    Microsoft Academic Search

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

    2010-01-01

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

  4. Dietary trial in prostate cancer: Early experience and implications for clinical trial design

    Microsoft Academic Search

    Dean M Ornish; Keith L Lee; William R Fair; Elaine B Pettengill; Peter R Carroll

    2001-01-01

    Much epidemiologic and case-controlled evidence suggests that diet may be a modifier of prostate cancer risk. However, the role of dietary modification in men known to have prostate cancer is a matter of some debate. To elucidate the effect of diet and comprehensive lifestyle changes on cancer risk, we are conducting a randomized, prospective clinical trial on men with clinically

  5. Primary lymphoma of the thyroid: A review of the mayo clinic experience through 1978

    Microsoft Academic Search

    Richard M. Devine; Anthony J. Edis; Peter M. Banks

    1981-01-01

    At the Mayo Clinic, 103 patients with primary malignant lymphoma of the thyroid have been diagnosed and treated through 1978. This study examines the clinical findings in the 57 new cases seen since the last review in 1966; pathology and survival are evaluated for the series as a whole, including the 46 patients reported previously. Age and sex patterns were

  6. Introduction The primary purpose of medical students involved in clinical educational experiences is

    E-print Network

    Alford, Simon

    at clinical sites (hospital, clinic, nursing home, etc.) should not exceed 80 hours per week. 2. Students should not work longer than 16 continuous hours. 3. Night shift hours should not be required the day: University of Illinois College of Medicine Policy on Student Work Hours University of Illinois College

  7. Introduction The primary purpose of medical students involved in clinical educational experiences is

    E-print Network

    Gilbert, Matthew

    at clinical sites (hospital, clinic, nursing home, etc.) should not exceed 80 hours per week. 2. There should Executive: 17 June 09 University of Illinois College of Medicine Policy on Student Work Hours #12; is to learn. As extended hours can cause fatigue and compromise the student's ability to retain information

  8. [The value of the triad: clinical examination, mammography and needle aspiration cytology in the diagnosis of breast carcinoma. Our experience].

    PubMed

    Cipolla, C; Amato, C; Di Lisi, G; Graceffa, G; Cassano, T; Salanitro, L; Bajardi, G; De Simone, G F; Barberi, G; Tomasino, R M

    1990-11-01

    Based on the authors' personal experience of the use of the triad, clinical examination, mammography and needle-aspiration cytology, in the strategic diagnosis of breast cancer, the paper emphasizes the importance of early diagnosis as the sole means of obtaining an improved outcome. Using this integrated methodology the authors have obtained a specificity of 99%, sensitivity of 97.8%, and a diagnostic accuracy and prognostic value for positive tests of 98%. In conclusion, the authors affirm that the comparative interpretation of clinical examination, mammography and cytology appears to be an extremely efficacious and reliable method for the diagnosis of the nature of breast nodules. PMID:2097562

  9. Ileal substitute of ureter with reflux-plasty by terminal intussusception of bowel: animal experiments and clinical experience.

    PubMed

    Tscholl, R; Tettamanti, F; Zingg, E

    1977-04-01

    The conflicting results reported after substitution of the ureter by isolated bowel segments suggest that the procedure is still hazardous. This induced us to check experimentally the performance of the ileal ureter with antireflux-plasty before using it clinically. The antireflux mechanism is constructed by intussuscepting the terminal 8 cm. of an isolated ileal segment into each other thus forming a nipple. After vesicoileostomy the nipple protrudes into the urinary bladder. In the pig vesicoileorenal reflux was prevented, and anterograde urinary flow from the kidney through the ileal ureter into the bladder was unobstructed. Finally, the case of a patient is recorded who was submitted to the same procedure successfully. PMID:857371

  10. Evaluation of chest tomosynthesis for the detection of pulmonary nodules: effect of clinical experience and comparison with chest radiography

    NASA Astrophysics Data System (ADS)

    Zachrisson, Sara; Vikgren, Jenny; Svalkvist, Angelica; Johnsson, Åse A.; Boijsen, Marianne; Flinck, Agneta; Månsson, Lars Gunnar; Kheddache, Susanne; Båth, Magnus

    2009-02-01

    Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability due to additional clinical experience of tomosynthesis.

  11. The Eastern Québec Telepathology Network: a three-year experience of clinical diagnostic services

    PubMed Central

    2014-01-01

    Background The Eastern Quebec Telepathology Network (called Réseau de Télépathologie de l'Est du Québec in French) was created to provide uniform diagnostic telepathology services in a huge territory with low population density. We report our first 3-year experience. Methods The network was funded equally by the Québec ministry of Health and Canada Health Infoway, a federal telehealth funding agency. The coverage includes intraoperative consultations (IOC), expert opinions, urgent analyses and supervision of macroscopic description. The deployment of the equipment and software started in 2010 and clinical activities began in January 2011. This network comprises 24 hospitals providing oncologic surgery, of which 7 have no pathology laboratory and 4 have a pathology laboratory but no pathologist. The real-time gross evaluation during IOC was performed using a macroscopy station and the sample selection was performed distantly by a technician, a pathology assistant or the surgeon under on-site pathologist supervision. Slides were scanned into whole-slide images (WSI). Results As per March 2014, 7,440 slides had been scanned for primary/urgent diagnosis; 1,329 for IOC cases and 2,308 for expert opinions. A 98% concordance rate was found for IOC compared to paraffin material and the average turnaround time was 20 minutes. Expert opinion reports were signed out within 24 hours in 68% of cases and within 72 hours in 85%. A recent multi-method evaluation study of the Network demonstrated that, thanks to telepathology: 1. interruption of IOC service was prevented in hospitals with no pathologist on site; 2. two-stage surgeries and patients transfers were prevented according to surgeons and pathologists; 3. retention and recruitment of surgeons in remote hospitals were facilitated; and 4. professional isolation among pathologists working alone was reduced. This study also demonstrated that wider adoption of telepathology would require technological improvement and that the sustainability of the network requires better coordination and the development of a supra-regional pathology organisation. Conclusion The Eastern Quebec Telepathology Network allowed the maintenance of rapid and high quality pathology services in more than 20 sites disseminated on a huge territory. A second phase is underway to expand telepathology to other regions across the province. PMID:25564940

  12. Crossing over: The lived experiences of clinical laboratory science education teachers as they transition from traditional to online instruction

    NASA Astrophysics Data System (ADS)

    Veldkamp, Ruth B.

    A phenomenological study was undertaken to understand and describe the nature and meaning of the live experiences of faculty transition from traditional to teaching online clinical laboratory science courses. In order to gain insight into the lived experiences of faculty, in-depth interviews were conducted with 10 faculty members. The task of the researcher was to allow the participants to speak for themselves, and reveal the meaning of the experiences, rather than to discover causal connections or patterns of correlation. The key criterion in choosing purposeful sampling procedure was to obtain the deepest understanding possible of the lived experiences of faculty transitioning to online teaching, which were likely to be a rich source of the data of interest. Analyses of the interview text were based on three essential considerations. The three essential considerations were (a) the traditional role of the faculty, (b) factors affecting the changing role of the faculty, and (c) the effects of web-based technology on teaching role.

  13. Implementation of the exception from informed consent regulations in a large multicenter emergency clinical trials network: the RAMPART experience.

    PubMed

    Silbergleit, Robert; Biros, Michelle H; Harney, Deneil; Dickert, Neal; Baren, Jill

    2012-04-01

    Clinical trials investigating therapies for acutely and critically ill and injured patients in the earliest phases of treatment often can only be performed under regulations allowing for exception from informed consent (EFIC) for emergency research. Implementation of these regulations in multicenter clinical trials involves special challenges and opportunities. The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART), the first EFIC trial conducted by the Neurological Emergencies Treatment Trials (NETT) network, combined centralized resources and coordination with retention of local control and flexibility to facilitate compliance with the EFIC regulations. Specific methods used by the NETT included common tools for community consultation and public disclosure, sharing of experiences and knowledge, and reporting of aggregate results. Tracking of community consultation and public disclosure activities and feedback facilitates empirical research on EFIC methods in the network and supports quality improvements for future NETT trials. The NETT model used in RAMPART demonstrates how EFIC may be effectively performed in established clinical trial networks. PMID:22506949

  14. Implementation of the Exception from Informed Consent Regulations in a Large Multicenter Emergency Clinical Trials Network; the RAMPART Experience

    PubMed Central

    Silbergleit, Robert; Biros, Michelle H.; Harney, Deneil; Dickert, Neal; Baren, Jill

    2012-01-01

    Clinical trials investigating therapies for acutely and critically ill and injured patients in the earliest phases of treatment often can only be performed under regulations allowing for exception from informed consent (EFIC) for emergency research. Implementation of these regulations in multicenter clinical trials involves special challenges and opportunities. The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART), the first EFIC trial conducted by the Neurological Emergencies Treatment Trials (NETT) network, combined centralized resources and coordination with retention of local control and flexibility to facilitate compliance with the EFIC regulations. Specific methods used by the NETT included common tools for community consultation and public disclosure, sharing of experiences and knowledge, and reporting of aggregate results. Tracking of community consultation and public disclosure activities and feedback facilitates empirical research on EFIC methods in the network and supports quality improvements for future NETT trials. The NETT model used in RAMPART demonstrates how EFIC may be effectively performed in established clinical trial networks. PMID:22506949

  15. Teachers' Perceptions of Their Mentoring Role in Three Different Clinical Settings: Student Teaching, Early Field Experiences, and Entry Year Teaching

    ERIC Educational Resources Information Center

    Gut, Dianne M.; Beam, Pamela C.; Henning, John E.; Cochran, Deborah C.; Knight, Rhonda Talford

    2014-01-01

    The purpose of this study was to determine the differences in mentoring across three different clinical settings: student teaching, early field experiences, and entry year teachers. Eighteen teachers with mentoring experience in all three clinical settings were selected and interviewed. The teachers' expectations for teacher development,…

  16. Assessing changes in competency of fourth-year veterinary medical students following a defined clinical experience

    E-print Network

    Espitia, Noberto Francisco

    2009-05-15

    The purpose of this study was to measure the competency of problem solving skills of fourth-year veterinary students. The study identified two primary objectives, (a) define clinical competency for fourth-year veterinary medical students, and (b...

  17. Clinical and research data integration: the i2b2-FSM experience.

    PubMed

    Segagni, Daniele; Tibollo, Valentina; Dagliati, Arianna; Malovini, Alberto; Zambelli, Alberto; Napolitano, Carlo; Priori, Silvia G; Bellazzi, Riccardo

    2013-01-01

    In order to support and improve the efficiency of clinical research in specific health area, the University of Pavia and the IRCCS Fondazione Salvatore Maugeri of Pavia (FSM) are developing and implementing an i2b2 based platform, designed to collect data coming from hospital clinical practice and scientific research. The work made in FSM is committed to support an affordable, less intrusive and more personalized care, increasing the quality of clinical practice as well as improving the scientific results. Such a aim depends on the application of information and communication technologies and the use of data. An integrated data warehouse has been implemented to support clinicians and researchers in two medical fields with a great impact on the population: oncology and cardiology. Furthermore the data warehouse approach has been tested with administrative information, allowing a financial view of clinical data. PMID:24303274

  18. Exploring the clinical learning experience: voices of Malawian undergraduate student nurses. 

    E-print Network

    Msiska, Gladys

    2012-11-28

    Very little has been done to define the process of clinical learning in Malawi and yet anecdotal observations reveal that it is more challenging than classroom teaching and learning. This set the impetus for this hermeneutic ...

  19. Clinical Experience for the Graduate Student in Pathology and Medical Bacteriology

    E-print Network

    Fraser, Roy

    1914-05-01

    , clear, frothy, white, homogeneous. Microscopic ecamination made at Dr.W Hospital. Negative to Bordet-Gengou becil- lus, and pneumococcus only present in strikingly small quantity. Clinically the case was a complication of whooping-cough and lobar...

  20. Recruitment experience in clinical trials: literature summary and annotated bibliography. | accrualnet.cancer.gov

    Cancer.gov

    This article summarizes a literature review that was conducted to determine what problems exist in accruing patients for clinical trials. Delays in recruitment typically result in increased costs for recruitment and the entire trial.

  1. Answering the question, "what is a clinical nurse leader?": transition experience of four direct-entry master's students.

    PubMed

    Bombard, Emily; Chapman, Kimberly; Doyle, Marcy; Wright, Danielle K; Shippee-Rice, Raelene V; Kasik, Dot Radius

    2010-01-01

    Understanding the experience of students learning the clinical nurse leader (CNL) role can be useful for faculty, preceptors, staff nurses, and interdisciplinary team members who guide them. This article analyzes the experience of four direct-entry master's students in the first cohort to complete the CNL curriculum and to sit for the pilot CNL certification examination. Using action research methodology, the students worked with the clinical immersion practicum faculty and a writing consultant to develop the study purpose, collect and analyze data, and prepare a manuscript. The main theme that emerged was, answering the question, "what is a CNL?" Subthemes supporting the main theme involved coming to the edge, trusting the process, rounding the corner, and valuing becoming. The analysis confirmed the value the CNL offers as a new vision to nursing education and practice. The students offered suggestions for the CNL curriculum and practicum. PMID:21078501

  2. Frequency, Clinical Presentation and Evolution of Renal Oncocytomas: Multicentric Experience from a European Database

    Microsoft Academic Search

    Leo Romis; Luca Cindolo; Jean Jacques Patard; Giovanni Messina; Vincenzo Altieri; Laurent Salomon; Claude Clement Abbou; Dominique Chopin; Bernard Lobel; Alexandre de La Taille

    2004-01-01

    Objectives: To understand the clinical behavior of renal oncocytoma in a retrospective analysis of a European multicentric nephrectomies database.Methods: The records of 891 patients who underwent surgical resection of renal neoplasm were reviewed. Relevant clinical and pathological data for each patient were retrieved in a database.Results: Thirty-two (3.6%) cases of renal oncocytoma were identified. Twenty patients (62.5%) were asymptomatic. No

  3. Clinical Pilot Experiences Using the Marijuana Screening Inventory (MSI-X): Screening Guidelines and Case Illustrations

    Microsoft Academic Search

    Dale Alexander

    2003-01-01

    A review of the literature indicates that there is a need for marijuana specific screening. The Marijuana Screening Inventory (MSI-X) was developed as a psychometrically reliable and valid tool for clinical use in general health and primary care settings. This paper describes the MSI-X, its potential assessment benefits, and clinical screening guidelines. It discusses the pilot application of the MSI-X

  4. Five-year clinical experiences with NOVA T®380 copper IUD

    Microsoft Academic Search

    I Batár; A Kuukankorpi; M Siljander; K Elomaa; I Rauramo

    2002-01-01

    In an open, single-group, phase III clinical trial of 5 years, the clinical performance of NOVA T®380 was investigated in three centers. The device having a higher copper surface of 380 mm2 is a modification of NOVA T®. A total of 400 voluntary women were enrolled in the study. The mean age was 31.4 years (SD 5.5) with the minimum

  5. Two-year clinical experience with Nova-T 380, a novel copper–silver IUD

    Microsoft Academic Search

    I. Batár; A. Kuukankorpi; I. Rauramo; M. Siljander

    1999-01-01

    In 1992, an open single-group phase III clinical trial was started at three centers to investigate the clinical performance of the high copper surface area Nova-T 380, a modification of Nova-T. This report presents the interim results of the first two years of use. A total of 400 women volunteers were enrolled in the study. The mean age was 31.4

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

    PubMed

    Kidd, Lori I; Tusaie, Kathleen R

    2004-06-01

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

  7. Relational continuity of care in integrated maternity and child health clinics improve parents’ service experiences

    PubMed Central

    Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Rautava, Päivi

    2014-01-01

    Introduction In the Finnish primary health care, relational continuity of care is implemented in integrated maternity and child health clinics where the same nurse takes care of the family from the pregnancy until the child reaches school age. The aim of this study was to clarify the association between this relational continuity of care and the availability, utilisation and selected features of the maternity and child health clinic services, as evaluated by the parents. Methods A comparative, cross-sectional service evaluation survey was used. Eighteen months after their baby's delivery, mothers (N = 987) and fathers (N = 835) from Southwest Finland evaluated specific maternity and child health clinic services. Comparisons were made between the parents who had relational continuity of care in the integrated maternity and child health clinics and those who did not. Results Home visits were more frequently provided when relational continuity of care in integrated maternity and child health clinics existed. Parents who had this relational continuity of care, evaluated several features of the service, especially provided support, more positively than parents who did not. Conclusions Relational continuity of care in integrated maternity and child health clinics seems to increase parents’ satisfaction with the services and might increase the provision of home visits. PMID:25411571

  8. Efficacy of candesartan cilexetil as add-on therapy in hypertensive patients uncontrolled on background therapy: a clinical experience trial

    Microsoft Academic Search

    Matthew R. Weir; Michael A. Weber; Joel M. Neutel; Jennifer Vendetti; Eric L. Michelson; Rebecca Y. Wang

    2001-01-01

    A large-scale, 8-week, open-label, clinical experience trial evaluated the efficacy of the angiotensin II receptor (AT1 subtype) blocker candesartan cilexetil (16 to 32 mg once daily) either alone or as add-on therapy in 6465 hypertensive patients. The study population was 52% female and 16% African American with a mean age of 58 years. It included 5446 patients who had essential

  9. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): Clinical Center Recruitment Experience

    Microsoft Academic Search

    Jackson T. Wright; William C. Cushman; Barry R. Davis; Joshua Barzilay; Pedro Colon; Debra Egan; Tracy Lucente; Sara Pressel; Frans H. H. Leenen; Joseph Frolkis; Rebecca Letterer; Sandra Walsh; Jonathan N. Tobin; Grant E. Deger

    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized clinical outcome trial of antihypertensive and lipid- lowering therapy in a diverse population (including substantial numbers of women and minorities) of 42,419 high-risk hypertensives aged ? 55 years with a planned mean fol- low-up of 6 years. In this paper, we describe our experience in the

  10. 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.

  11. Hearing New Voices: Registered Nurses and Health Technicians Experience Caring for Chronic Pain Patients in Primary Care Clinics

    PubMed Central

    Pellico, Linda H.; Gilliam, Wesley P.; Lee, Allison W.; Kerns, Robert D.

    2014-01-01

    Recent national estimates from the U.S. reveal that as many as one-third of all Americans experience chronic pain resulting in high prevalence rates of visits to primary care clinics (PCC). Indeed, chronic pain appears to be an emerging global health problem. Research has largely ignored the perspective of PCC staff other than physicians in providing care for patients with chronic pain. We wanted to gain insights from the experiences of Registered Nurses (RNs) and Health Technicians (HTs) who care for this patient population. Krippendorff’s method for content analysis was used to analyze comments written in an open-ended survey from fifty-seven primary care clinic staff (RNs-N=27 and HTs-N=30) respondents. This represented an overall response rate of 75%. Five themes emerged related to the experience of RNs and HTs caring for patients with chronic pain: 1) Primacy of Medications and Accompanying Clinical Quandaries; 2) System Barriers; 3) Dealing with Failure; 4) Primacy of Patient Centered Care; and 5) Importance of Team Based Care. This study demonstrates that nursing staff provide patient-centered care, recognize the importance of their role within an interdisciplinary team and can offer valuable insight about the care of patients with chronic pain. This study provides insight into strategies that can mitigate barriers to chronic pain management while sustaining those aspects that RNs and HTs view as essential for improving patient care for this vulnerable population in PCCs. PMID:25246996

  12. Accelerator-based radiation sources for next-generation radiobiological research

    Microsoft Academic Search

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

    2006-01-01

    The Idaho Accelerator Center (IAC) of Idaho State University has developed a unique radiation research facility to answer next-generation radiobiological questions. The IAC has 10 operating research accelerators. These include continuously delivered radiation beams such as a 950keV electron beam and a 2MeV light-ion Van de Graaff. The IAC also has a number of pulsed electron linacs which range in

  13. 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.

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

    Microsoft Academic Search

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

    1988-01-01

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

  15. Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology

    Microsoft Academic Search

    Søren M. Bentzen

    2006-01-01

    Radiation therapy has curative or palliative potential in roughly half of all incident solid tumours, and offers organ and function preservation in most cases. Unfortunately, early and late toxicity limits the deliverable intensity of radiotherapy, and might affect the long-term health-related quality of life of the patient. Recent progress in molecular pathology and normal-tissue radiobiology has improved the mechanistic understanding

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

    SciTech Connect

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

    1989-02-01

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

  17. 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

  18. Establishing a clinical trials network in nephrology: experience of the Australasian Kidney Trials Network

    PubMed Central

    Morrish, Alicia T; Hawley, Carmel M; Johnson, David W; Badve, Sunil V; Perkovic, Vlado; Reidlinger, Donna M; Cass, Alan

    2014-01-01

    Chronic kidney disease is a major public health problem globally. Despite this, there are fewer high-quality, high-impact clinical trials in nephrology than other internal medicine specialties, which has led to large gaps in evidence. To address this deficiency, the Australasian Kidney Trials Network, a Collaborative Research Group, was formed in 2005. Since then, the Network has provided infrastructure and expertise to conduct patient-focused high-quality, investigator-initiated clinical trials in nephrology. The Network has not only been successful in engaging the nephrology community in Australia and New Zealand but also in forming collaborations with leading researchers from other countries. This article describes the establishment, development, and functions of the Network. The article also discusses the current and future funding strategies to ensure uninterrupted conduct of much needed clinical trials in nephrology to improve the outcomes of patients affected by kidney diseases with cost-effective interventions. PMID:24088955

  19. Substance abuse intervention services in public STD clinics: a pilot experience.

    PubMed

    Yu, Jiang; Appel, Philip W; Warren, Barbara E; Rubin, Steve; Gutierrez, Rodolfo; Larson, Brett; Robinson, Harold

    2008-04-01

    Past research reported a gap in substance abuse treatment for patients in sexually transmitted disease (STD) clinics. Studies in New York City indicate that approximately 20% of patients with STD show symptoms of alcohol and substance abuse, but only 1% have ever received treatment services. This article reports findings from a pilot project that implemented early intervention service procedures in an STD clinic in New York City. Services implemented included screening for substance use problems, brief interventions, and referral for treatment. Four main issues were explored in this pilot study: the feasibility of implementing early intervention services in an STD clinic; the extent to which patients would accept such interventions; the extent to which STD staff would be ready to integrate substance abuse services into their primary care protocols; and the likelihood of sustaining such services in an STD environment. Results and recommendations are provided and discussed. PMID:17614241

  20. Experience and challenges from clinical trials with malaria vaccines in Africa

    PubMed Central

    2013-01-01

    Malaria vaccines are considered amongst the most important modalities for potential elimination of malaria disease and transmission. Research and development in this field has been an area of intense effort by many groups over the last few decades. Despite this, there is currently no licensed malaria vaccine. Researchers, clinical trialists and vaccine developers have been working on many approached to make malaria vaccine available. African research institutions have developed and demonstrated a great capacity to undertake clinical trials in accordance to the International Conference on Harmonization-Good Clinical Practice (ICH-GCP) standards in the last decade; particularly in the field of malaria vaccines and anti-malarial drugs. This capacity is a result of networking among African scientists in collaboration with other partners; this has traversed both clinical trials and malaria control programmes as part of the Global Malaria Action Plan (GMAP). GMAP outlined and support global strategies toward the elimination and eradication of malaria in many areas, translating in reduction in public health burden, especially for African children. In the sub-Saharan region the capacity to undertake more clinical trials remains small in comparison to the actual need. However, sustainability of the already developed capacity is essential and crucial for the evaluation of different interventions and diagnostic tools/strategies for other diseases like TB, HIV, neglected tropical diseases and non-communicable diseases. There is urgent need for innovative mechanisms for the sustainability and expansion of the capacity in clinical trials in sub-Saharan Africa as the catalyst for health improvement and maintained. PMID:23496910

  1. Rheumatologic manifestations of human parvovirus B19 infection in adults. Initial two-year clinical experience.

    PubMed

    Naides, S J; Scharosch, L L; Foto, F; Howard, E J

    1990-09-01

    During 1987 and 1988, we identified 9 adults at the Medical and Rheumatology Services of the University of Iowa Hospitals and Clinics who had a clinical diagnosis of fifth disease; 8 of the 9 had symptoms of joint involvement. Another 12 adults with serologic positivity for anti-parvovirus B19 IgM antibody presented with polyarthralgia/polyarthritis. Patients were usually found to be seronegative for rheumatoid factor, and none developed nodules or erosive disease. Many patients with chronic disease met criteria for a diagnosis of rheumatoid arthritis. A diagnosis of parvovirus B19 infection should be considered during the initial visit of patients with polyarthralgia/polyarthritis. PMID:2169746

  2. Family medicine trainees¿ clinical experience of chronic disease during training: a cross-sectional analysis from the registrars¿ clinical encounters in training study.

    PubMed

    Magin, Parker; Morgan, Simon; Henderson, Kim; Tapley, Amanda; McElduff, Patrick; Pearlman, James; Goode, Susan; Spike, Neil; Laurence, Caroline; Scott, John; Thomson, Allison; van Driel, Mieke

    2014-12-10

    BackgroundA broad case-mix in family physicians¿ (general practitioners¿, GPs¿) vocational trainee experience is deemed essential in producing competent independent practitioners. It is suggested that the patient-mix should include common and significant conditions and be similar to that of established GPs. But the content of contemporary GP trainees¿ clinical experience in training is not well-documented. In particular, how well trainees¿ experience reflects changing general practice demographics (with an increasing prevalence of chronic disease) is unknown. We aimed to establish levels of trainees¿ clinical exposure to chronic disease in training (and associations of this exposure) and to establish content differences in chronic disease consultations (compared to other consultations), and differences in trainees¿ actions arising from these consultations.MethodsA cross-sectional analysis from the Registrars¿ Clinical Encounters in Training (ReCEnT) study, a cohort study of GP registrars¿ (trainees¿) consultations in four Australian GP training organisations. Trainees record detailed data from 60 consecutive consultations per six-month training term. Diagnoses/problems encountered are coded using the International Classification of Primary Care-2 PLUS (ICPC-2 PLUS). A classification system derived from ICPC-2 PLUS was used to define diagnoses/problems as chronic/non-chronic disease. The outcome factor for analyses was trainees¿ consultations in which chronic disease was encountered. Independent variables were a range of patient, trainee, practice, consultation and educational factors.ResultsOf 48,112 consultations (of 400 individual trainees), 29.5% included chronic disease problems/diagnoses. Associations of a consultation including chronic disease were the patient being older, male, and having consulted the trainee previously, and the practice routinely bulk-billing (not personally charging) patients. Consultations involving a chronic disease lasted longer, dealt with more problems/diagnoses, and were more likely to result in specialist referrals and trainees generating a personal learning goal. They were associated with less pathology tests being ordered.ConclusionsTrainees saw chronic disease less frequently than have established GPs in comparable studies. The longer duration and more frequent generation of learning goals in chronic disease-containing consultations suggest trainees may find these consultations particularly challenging. Our findings may inform the design of measures aimed at increasing the chronic disease component of trainees¿ patient-mix. PMID:25491229

  3. A hand-held imaging probe for radio-guided surgery: physical performance and preliminary clinical experience.

    PubMed

    Pitre, Stéphanie; Ménard, Laurent; Ricard, Marcel; Solal, Maurice; Garbay, Jean-Rémi; Charon, Yves

    2003-03-01

    Improvements in the specificity of radiopharmaceutical compounds have been paralleled by an upsurge of interest in developing small detectors to assist surgeons in localizing tumour tissue during surgery. This study reports the main technical features and physical characteristics of a new hand-held gamma camera dedicated to accurate and real-time intra-operative imaging. First clinical experience is also reported. The POCI (Per-operative Compact Imager) camera consists of a head module composed of a high-resolution interchangeable lead collimator and a CsI(Na) crystal plate optically coupled to an intensified position-sensitive diode. The current prototype has a 40-mm diameter field of view, an outer diameter of 9.5 cm, a length of 9 cm and a weight of 1.2 kg. Overall detector imaging characteristics were evaluated by technetium-99m phantom measurements. Three patients with breast cancer previously scheduled to undergo sentinel lymph node detection were selected for the preliminary clinical experience. Preoperative images of the lymphatic basin obtained using the POCI camera were compared with conventional transcutaneous explorations using a non-imaging gamma probe. The full-width at half-maximum (FWHM) spatial resolution was investigated in both air and scattering medium; when the phantom was placed in contact with the collimator, the POCI camera exhibited a 3.2 mm FWHM. The corresponding sensitivity was 290 cps/MBq. The preliminary clinical results showed that POCI was able to predict the number and location of all SLNs. In one case, two deep radioactive nodes missed by the gamma probe were detected on the intra-operative images. This very initial experience demonstrates that the physical performance of the POCI camera is adequate for radio-guided surgery. These results are sufficiently encouraging to prompt further evaluation studies designed to determine the specific and optimal clinical role of intra-operative imaging devices. PMID:12634960

  4. Developing a clinical hypermedia corpus: experiences from the use of a practice-centered method.

    PubMed Central

    Timpka, T.; Nyce, J. M.; Sjöberg, C.; Hedblom, P.; Lindblom, P.

    1992-01-01

    This paper outlines a practice-centered method for creation of a hypermedia corpus. It also describes experiences with creating such a corpus of information to support interprofessional work at a Primary Healthcare Center. From these experiences, a number of basic issues regarding information systems development within medical informatics will be discussed. PMID:1482924

  5. Decision-making and breast cancer clinical trials: How experience challenges attitudes. | accrualnet.cancer.gov

    Cancer.gov

    Mancini J,Genève J,Dalenc F,Genre D,Monnier A,Kerbrat P,Largillier R,Serin D,Rios M,Roche H,Jimenez M,Tarpin C,the Patients’ Committee for Clinical trials of the Ligue Nationale,Reynier CJ. Contemp Clin Trials. 2007. 28. 6. 684-94.

  6. Skeletal stabilization with a multiplane external fixation device. Design rationale and preliminary clinical experience.

    PubMed

    Fischer, D A

    1983-11-01

    A multiplane circumferential frame solves many of the technical, biomechanical, physiologic, and psychologic problems connected with external skeletal fixation. Predrilling of pins, uniplane adjustment capabilities, and titanium and aluminum alloy materials provide adaptability, adjustability, and compatibility. Preliminary clinical trials show multiplane half-pin fixation to the tibia to be adequate and uniquely applicable to complicated open fractures in severely injured limbs. PMID:6627797

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

    Microsoft Academic Search

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

    2006-01-01

    Safety data on the inactivated split influenza vaccine, Vaxigrip®, were compiled and analysed from 28 clinical trials (total: 4599 subjects aged 6 months to 99 years) to provide a robust estimate of the reactogenicity profile. The most frequent solicited reactions were non-severe injection site pain and erythema in children, adults, and elderly. Mild or moderate fever was the most frequent

  8. Remembering Childhood Sexual Abuse: A National Survey of Psychologists' Clinical Practices, Beliefs, and Personal Experiences

    Microsoft Academic Search

    Melissa A. Polusny; Victoria M. Follette

    1996-01-01

    A national survey of 1, 000 psychologists, to which 223 responded, assessed professionals' clinical practices and beliefs about the treatment of adult survivors of childhood sexual abuse (CSA), personal CSA history, and the phenomenon of clients remembering CSA in therapy. Results indicated that over 25% of therapists reported using guided imagery, dream interpretation, bibliotherapy regarding sexual abuse, referral to sexual

  9. Korean Speech-Language Pathologists' Attitudes toward Stuttering According to Clinical Experiences

    ERIC Educational Resources Information Center

    Lee, Kyungjae

    2014-01-01

    Background: Negative attitudes toward stuttering and people who stutter (PWS) are found in various groups of people in many regions. However the results of previous studies examining the influence of fluency coursework and clinical certification on the attitudes of speech-language pathologists (SLPs) toward PWS are equivocal. Furthermore, there…

  10. Creating Positive Attitudes: The Effects of Knowledge and Clinical Experience of Psychiatry in Student Nurse Education.

    ERIC Educational Resources Information Center

    Chan, Sally; Cheng, Bing-shu

    2001-01-01

    Students (n=90) enrolled in mental health nursing in Hong Kong completed the Opinion about Mental Illness Scale before and after the course and clinical placements. Postcourse results showed more positive attitudes toward clients with mental health problems. (Contains 37 references.) (SK)

  11. Substance abuse in pregnant women. Experiences from a special child welfare clinic in Norway

    Microsoft Academic Search

    Bjørg Hjerkinn; Morten Lindbæk; Elin Olaug Rosvold

    2007-01-01

    BACKGROUND: Substance abuse during pregnancy may harm the foetus and can cause neonatal abstinence syndrome. Exposure to alcohol and other substances can influence the child for the rest of its life. A special child welfare clinic was set up in 1994 in Kristiansand, Norway, targeting pregnant women with substance abuse problems in the county of Vest-Agder. Pregnancy is not an

  12. Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience.

    PubMed

    Wright, Scott M; Kravet, Steven; Christmas, Colleen; Burkhart, Kathleen; Durso, Samuel C

    2010-12-01

    Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives. PMID:20978424

  13. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience

    Microsoft Academic Search

    J C Cappelleri; R C Rosen

    2005-01-01

    The Sexual Health Inventory for Men (SHIM) is a widely used scale for screening and diagnosis of erectile dysfunction (ED) and severity of ED in clinical practice and research. In reviewing the SHIM-related literature, we sought to provide a compendium of studies in which the SHIM was used, to provide a systematic framework for organizing and evaluating the studies, and

  14. Knowledge of Ethical Lapses and Other Experiences on Clinical Licensure Examinations.

    ERIC Educational Resources Information Center

    Feil, Philip; Meeske, Jessica; Fortman, Jared

    1999-01-01

    A survey of 429 general dentists attempted to verify anecdotal reports of ethical lapses in clinical dental licensing examinations. It found significant occurrence of not arranging followup care for the patient even though indicated, intentional creation of lesions, premature treatment for the purpose of the examinations, coercing patients into…

  15. Development of a new, completely implantable intraventricular pressure meter and preliminary report of its clinical experience

    NASA Technical Reports Server (NTRS)

    Osaka, K.; Murata, T.; Okamoto, S.; Ohta, T.; Ozaki, T.; Maeda, T.; Mori, K.; Handa, H.; Matsumoto, S.; Sakaguchi, I.

    1982-01-01

    A completely implantable intracranial pressure sensor designed for long-term measurement of intraventricular pressure in hydrocephalic patients is described. The measurement principal of the device is discussed along with the electronic and component structure and sources of instrument error. Clinical tests of this implanted pressure device involving both humans and animals showed it to be comparable to other methods of intracranial pressure measurement.

  16. Erythromelalgia? A clinical study of people who experience red, hot, painful feet in the community.

    PubMed

    Friberg, D; Chen, T; Tarr, G; van Rij, A

    2013-01-01

    We recruited a population of people who clinically suffer from the symptoms of erythromelalgia, red, hot, painful feet made worse by heat and improved by cooling, to better characterise this population and measure their quality of life (QOL). Ninety-two individuals completed the QOL surveys, and 56 individuals were clinically assessed. There was a 3?:?1 ratio of females to males with an average age of 61 years. The estimated prevalence of people who had clinical symptoms of erythromelalgia in the Dunedin community was 15/100,000. Only 27% of people had received a diagnosis for their symptoms despite seeking medical attention. People in the study population had worse quality of life than the general New Zealand population (P < 0.001). In the majority of participants symptoms had a mild-moderate effect on their quality of life. The results of this study indicate that the number of people who have clinical symptoms of erythromelalgia is much greater than is commonly accepted and that the majority of these individuals go unrecognised by the medical profession despite seeking help. They have significantly diminished QOL with the majority of people having mild-to-moderate symptoms. PMID:23762561

  17. Erythromelalgia? A Clinical Study of People Who Experience Red, Hot, Painful Feet in the Community

    PubMed Central

    Friberg, D.; Chen, T.; Tarr, G.; van Rij, A.

    2013-01-01

    We recruited a population of people who clinically suffer from the symptoms of erythromelalgia, red, hot, painful feet made worse by heat and improved by cooling, to better characterise this population and measure their quality of life (QOL). Ninety-two individuals completed the QOL surveys, and 56 individuals were clinically assessed. There was a 3?:?1 ratio of females to males with an average age of 61 years. The estimated prevalence of people who had clinical symptoms of erythromelalgia in the Dunedin community was 15/100,000. Only 27% of people had received a diagnosis for their symptoms despite seeking medical attention. People in the study population had worse quality of life than the general New Zealand population (P < 0.001). In the majority of participants symptoms had a mild-moderate effect on their quality of life. The results of this study indicate that the number of people who have clinical symptoms of erythromelalgia is much greater than is commonly accepted and that the majority of these individuals go unrecognised by the medical profession despite seeking help. They have significantly diminished QOL with the majority of people having mild-to-moderate symptoms. PMID:23762561

  18. Gadolinium-DTPA as a contrast agent in MRI: initial clinical experience in 20 patients

    Microsoft Academic Search

    D. H. Carr; J. Brown; G. M. Bydder; R. E. Steiner; H.-J. Weinmann; U. Speck; A. S. Hall; I. R. Young

    1984-01-01

    Magnetic resonance imaging (MRI) was performed in 20 patients before and after intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Twelve of the patients had clinical and histologic diagnoses of cerebral tumor, six had hepatic tumors, one had hepatic cysts, and one had transitional cell carcinoma of the bladder. Contrast enhancement was seen with all tumors, but not with the hepatic

  19. Infants' Dermatitis Quality of Life Index: a decade of experience of validation and clinical application.

    PubMed

    Basra, M K A; Gada, V; Ungaro, S; Finlay, A Y; Salek, S M

    2013-10-01

    The Infants' Dermatitis Quality of Life Index (IDQoL) is a questionnaire completed by parents to assess the impact of atopic dermatitis on the quality of life of infants aged 0-3 years. The aim was to review all clinical and psychometric data on the use of the IDQoL from its inception in 2001 until November 2012, to serve as a single reference source. A literature search was carried out using Medline, PubMed, EBSCOhost, Science Direct and Google Scholar. Articles and abstracts that described the clinical use of the IDQoL and those that investigated its psychometric properties were included. Articles not in English were excluded. Fifty-one publications were identified, of which 46 fulfilled the inclusion criteria. IDQoL data relating to psychometric, descriptive and clinical practice research, drug trials and therapeutic interventions were extracted. The IDQoL has been translated into 21 languages and used in 18 countries, including two multinational studies. Thirty-one studies demonstrated its psychometric properties, such as test-retest reliability, internal consistency, validity, responsiveness to change and interpretability. No studies investigated dimensionality, carried out factor analysis or described the minimal clinically important difference of the tool. Eight studies used the IDQoL to assess the effectiveness of therapeutic interventions such as education programmes, consultations and wet-wrap therapy, while seven studies described the use of IDQoL in topical interventions. When deciding whether to use the IDQoL, researchers and clinicians should consider the validation data, the relevant comparative clinical data available and the potential burden on the respondents. PMID:23909890

  20. Surgical Treatment of Craniovertebral Junction Instability : Clinical Outcomes and Effectiveness in Personal Experience

    PubMed Central

    Song, Gyo-Chang; Cho, Kyoung-Suok; Yoo, Do-Sung; Huh, Pil-Woo

    2010-01-01

    Objective Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. Methods Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. Results Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. Conclusion The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion. PMID:20717510

  1. Photodynamic therapy with the phthalocyanine photosensitizer Pc 4: The case experience with preclinical mechanistic and early clinical-translational studies

    SciTech Connect

    Miller, Janine D. [Department of Dermatology, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Case Skin Diseases Research Center, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Case Comprehensive Cancer Center, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Baron, Elma D. [Department of Dermatology, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Case Skin Diseases Research Center, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Case Comprehensive Cancer Center, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Louis-Stokes VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (United States); Scull, Heather [Department of Dermatology, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Case Skin Diseases Research Center, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Case Comprehensive Cancer Center, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Hsia, Andrew [Department of Dermatology, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Berlin, Jeffrey C. [Department of Dermatology, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States); Department of Chemistry, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH 44106 (United States)] (and others)

    2007-11-01

    Photodynamic therapy (PDT) is emerging as a promising non-invasive treatment for cancers. PDT involves either local or systemic administration of a photosensitizing drug, which preferentially localizes within the tumor, followed by illumination of the involved organ with light, usually from a laser source. Here, we provide a selective overview of our experience with PDT at Case Western Reserve University, specifically with the silicon phthalocyanine photosensitizer Pc 4. We first review our in vitro studies evaluating the mechanism of cell killing by Pc 4-PDT. Then we briefly describe our clinical experience in a Phase I trial of Pc 4-PDT and our preliminary translational studies evaluating the mechanisms behind tumor responses. Preclinical work identified (a) cardiolipin and the anti-apoptotic proteins Bcl-2 and Bcl-xL as targets of Pc 4-PDT, (b) the intrinsic pathway of apoptosis, with the key participation of caspase-3, as a central response of many human cancer cells to Pc 4-PDT, (c) signaling pathways that could modify apoptosis, and (d) a formulation by which Pc 4 could be applied topically to human skin and penetrate at least through the basal layer of the epidermis. Clinical-translational studies enabled us to develop an immunohistochemical assay for caspase-3 activation, using biopsies from patients treated with topical Pc 4 in a Phase I PDT trial for cutaneous T-cell lymphoma. Results suggest that this assay may be used as an early biomarker of clinical response.

  2. Connecting patients, researchers and clinical genetics services: the experiences of participants in the Australian Ovarian Cancer Study (AOCS).

    PubMed

    Crook, Ashley; Plunkett, Loren; Forrest, Laura E; Hallowell, Nina; Wake, Samantha; Alsop, Kathryn; Gleeson, Margaret; Bowtell, David; Mitchell, Gillian; Young, Mary-Anne

    2015-02-01

    Population-based genetic research may produce information that has clinical implications for participants and their family. Researchers notify participants or their next of kin (NoK) about the availability of genetic information via a notification letter; however, many subsequently do not contact a family cancer centre (FCC) to clarify their genetic status. Therefore, the purpose of this study was to examine research participants' experience of receiving a notification letter and the factors that influenced contact with an FCC. Twenty-five semi-structured interviews were conducted with research participants (n=10) or their NoK (n=15) who had received a notification letter following participation in the Australian Ovarian Cancer Study. There were a number of factors which impacted participants' access to genetic counselling at an FCC. Some participants had unmet information and support needs, which were addressed by their participation in this psychosocial interview study. Recruitment and participation in this study therefore inadvertently increased a number of participants' intention to contact an FCC. For others, participation in this study facilitated access to an FCC. Recommendations are proposed regarding future notification as well as implications for clinical practice. An approach that also provides opportunity to address research participants' support and informational needs before contacting a clinical genetics service as well as practical guidance for accessing genetic services would facilitate timely and smooth access for research participants who are interested in following up clinically relevant genetic test results. PMID:24824132

  3. Further Radiobiologic Modeling of Palliative Radiotherapy: Use of Virtual Trials

    SciTech Connect

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

    2007-09-01

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

  4. Pre-Clinical Experience with Full-Wave Inverse-Scattering for Breast Imaging

    NASA Astrophysics Data System (ADS)

    André, M. P.; Barker, C. H.; Sekhon, N.; Wiskin, J.; Borup, D.; Callahan, K.

    A new transmission ultrasound CT breast scanner (Techniscan Medical Systems, Inc.) was installed for pre-clinical testing at UCSD Medical Center. The scanner utilizes a 3D inverse scattering method to produce whole-breast tomographic images with resolution approximately 1.5 mm in plane, 3.5 mm slice profile and slice spacing of 1 mm. Sound speed accuracy and sensitivity were found to be highly linear (R2=0.99) over the wide range of 1370-1620 m/sec. Attenuation provided a wide image contrast and is able to localize and identify breast lesions. We present representative cases of human subjects enrolled in the pre-clinical study and describe future plans for the system.

  5. [Professor HE Tianyou's clinical experience of acupuncture and medicine on intractable facial paralysis].

    PubMed

    Yan, Fenghua; Yao, Xuhong; Yan, Xingke; Zhang, Yongkui; Jing, Xiaohui; He, Tianyou

    2015-02-01

    Professor HE Tianyou's unique understanding and treatment characteristics for intractahle facial paralysis are introduced. In clinical practice professor HE highly values acupoint selection and manipulation application, and integrates Chinese and western medicine to flexibly choose acupoints and formulate prescriptions according to syndrome differentiation and location differentiation, besides, he creates several specialized manipulation methods including "tug-of war opposite acupuncture method" and "tractive flash cupping". Based on strengthening body and dredging collaterals. more attention is given on stimulation to local paralyzed facial nerves; meanwhile acupuncture and medication are combined to improve clinical efficacy. During the treatment, the important role of psychological counseling on patient's anxiety is emphasized, and comprehensive treatment is given physically and psychologically in order to achieve the purpose of total rehabilitation. PMID:25854027

  6. Experimental and clinical experience with iodine 123-labeled iodophenylpentadecanoic acid in cardiology.

    PubMed

    Reske, S N

    1994-01-01

    Iodine 123-labeled iodophenylpentadecanoic acid (IPPA) has been synthesized for investigating myocardial free fatty acid (FFA) metabolism. The diagnostic application of labeled FFA in heart disease may be important, because FFA is the preferred substrate of cardiac energy metabolism at rest in the fasting state. In addition, regional myocardial FFA uptake and regional myocardial blood flow are tightly coupled in normal myocardium with beta-oxidation, which is extremely sensitive to oxygen deprivation. This article outlines basic physiologic pathways of cardiac IPPA metabolism in normal, acutely ischemic, and reperfused viable myocardium and summarizes the results of experimental studies in animals, validating the application of IPPA as an 123I-labeled fatty acid analog. In addition, the most important clinical studies indicating the clinical use of IPPA for diagnosis of coronary heart disease and myocardial viability are presented. PMID:9420699

  7. Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic.

    PubMed Central

    Gateley, C A; Miers, M; Mansel, R E; Hughes, L E

    1992-01-01

    Mastalgia commonly presents to medical practitioners. The majority of patients can be managed by exclusion of cancer and reassurance. In some the severity of pain affects the quality of life and drug treatment should be considered. Since its inception 324 patients with cyclical mastalgia and 90 with non-cyclical mastalgia have received a therapeutic trial of drug treatment in the Cardiff Mastalgia Clinic. Overall 92% of those with cyclical mastalgia and 64% with non-cyclical mastalgia obtained a clinically useful response to therapy. Danazol was the most effective drug, with bromocriptine and evening primrose oil having equivalent efficacy. Many fewer adverse events were complained of by patients treated with evening primrose oil than danazol or bromocriptine. PMID:1548647

  8. The Floppy Infant: Retrospective Analysis of Clinical Experience (1990—2000) in a Tertiary Care Facility

    Microsoft Academic Search

    Kirandeep Birdi; Asuri N. Prasad; Chitra Prasad; Bernard Chodirker; Albert E. Chudley

    2005-01-01

    We describe the results of a retrospective study of floppy infants evaluated at the Children's Hospital of Winnipeg, a tertiary care children's facility. Cases were ascertained by a systematic search of clinical databases, hospital and electromyographic records for “floppy” infants age < 1 year, referred over a period of 11 years (1990—2000). Eighty-nine infants, 42 female (47.2%) and 47 male

  9. Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience

    Microsoft Academic Search

    Abdurrahman Comlekci; Serkan Yener; Senem Ertilav; Mustafa Secil; Baris Akinci; Tevfik Demir; Levent Kebapcilar; Firat Bayraktar; Sena Yesil; Sevinc Eraslan

    2010-01-01

    To investigate clinical characteristics, metabolic parameters and follow-up findings of subjects with incidentally discovered\\u000a adrenal tumors. 376 consecutive subjects who have been evaluated since 2002 were included. Initial radiological examination\\u000a was CT. Hormonal evaluation included 8.00 a.m. cortisol, DHEA-S, ACTH and in hypertensive subjects, plasma renin activity,\\u000a and serum aldosterone. Urinary free cortisol (UFC), urinary normetanephrine, and metanephrine were measured.

  10. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    PubMed Central

    Soeteman, Marijn; Peters, Vera; Busari, Jamiu O

    2015-01-01

    Objective In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1) accessibility to caregivers and 2) quality of service and available amenities. Design We conducted a multi-method survey using 1) a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2) specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55%) felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%). Finally, a large number of patients (97%) were satisfied with the quality of service and with the accessibility to caregivers (94%). Conclusion The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of service in patients. PMID:25848303

  11. 290 Surgical Procedures for Ulnar Nerve Entrapment at the Elbow: Physiopathology, Clinical Experience and Results

    Microsoft Academic Search

    M. Artico; F. S. Pastore; F. Nucci; R. Giuffre

    2000-01-01

    Summary  ??Ulnar nerve entrapment at the elbow is an important and relatively frequent pathological condition that may be related to\\u000a diffent causes depending on individual or external factors. The cause of the nerve lesion is also idiopathic in about one-quarter\\u000a to one-third of cases. This variable aetiopathogenetic presentation has often suggested different diagnostic and clinical\\u000a approaches and, moreover, various surgical procedures.

  12. Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer

    Microsoft Academic Search

    Michael J Zelefsky; Zvi Fuks; Laura Happersett; Henry J Lee; C. Clifton Ling; Chandra M Burman; Margie Hunt; Theresa Wolfe; E. S Venkatraman; Andrew Jackson; Mark Skwarchuk; Steven A Leibel

    2000-01-01

    Purpose: To compare acute and late toxicities of high-dose radiation for prostate cancer delivered by either conventional three-dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT).Materials and methods: Between September 1992 and February 1998, 61 patients with clinical stage T1c- T3 prostate cancer were treated with 3D-CRT and 171 with IMRT to a prescribed dose of 81 Gy.

  13. Demographic and Clinical Characteristics of Patients with Autosomal Dominant Polycystic Kidney Disease: A Multicenter Experience

    Microsoft Academic Search

    Rumeyza Kazancioglu; Tevfik Ecder; Lutfullah Altintepe; Mehmet Riza Altiparmak; Serhan Tuglular; Abdullah Uyanik; Caner Cavdar; Sabahat Alisir Ecder; Bulent Tokgoz; Neval Duman; Ali Duzova; Ramazan Cetinkaya

    2011-01-01

    Aim: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. It accounts for 5–10% of patients with end-stage renal disease (ESRD). The aim of this multicenter study was to investigate the demographic and clinical characteristics of patients with ADPKD. Methods: 1,139 patients with ADPKD who were followed up at 12 different centers were recruited for this

  14. Magnetic Resonance-Guided Percutaneous Cryoablation of Uterine Fibroids: Early Clinical Experiences

    SciTech Connect

    Sakuhara, Yusuke, E-mail: YRB03514@nifty.com; Shimizu, Tadashi; Kodama, Yoshihisa; Sawada, Akihiro [Hokkaido University School of Medicine, Department of Radiology (Japan); Endo, Hideho [Kitami Red Cross Hospital, Department of Radiology (Japan); Abo, Daisuke [Hokkaido University School of Medicine, Department of Radiology (Japan); Hasegawa, Tenshu [Asahikawa Red Cross Hospital, Department of Obstetrics and Gynecology (Japan); Miyasaka, Kazuo [Hokkaido University School of Medicine, Department of Radiology (Japan)

    2006-08-15

    Purpose. Uterine fibroids (leiomyomas) are the most common tumors of the uterus. The present study evaluated the feasibility and effectiveness of magnetic resonance (MR)-guided percutaneous cryoablation for uterine fibroids as a minimally invasive treatment alternative. Methods. From August 2001 to June 2002, MR-guided percutaneous cryoablation was performed on seven uterine fibroids in 6 patients who displayed clinical symptoms related to tumors. Using a horizontal-type open MR system, cryoablation probes were percutaneously placed in fibroids. Fibroids were ablated, and the site and size of ice balls were monitored on MR imaging. Postoperatively, patients completed a questionnaire to assess changes in presenting clinical symptoms, and MR images were obtained for all patients at follow-up. Changes in clinical symptoms and tumor volume were evaluated in each patient. Results. All treated patients showed reductions in tumor size. Mean volume reduction rate was 40.3% at 6 weeks postoperatively, and 79.4% at 9-12 months. All patients reported fever after treatment. Surgical drainage was required for abscess in the probe channel in one patient, and transient liver damage occurred in another. Subjective symptoms improved in all patients except one who had multiple tumors, and no patient complained of new symptoms after cryoablation during follow-up. Conclusion. MR-guided percutaneous cryoablation represents a feasible and effective treatment for uterine fibroids.

  15. Clinical experience and results of a Sentinel Health Investigation related to indoor fungal exposure.

    PubMed Central

    Johanning, E; Landsbergis, P; Gareis, M; Yang, C S; Olmsted, E

    1999-01-01

    This is a review of exposure conditions, clinical presentation, and morbidity of children and adults with indoor fungal exposure such as toxic Stachybotrys chartarum. Indoor exposure was characterized using different methods including microscopic, culture, cytotoxicity screening tests, and chemical analyses. Clinical case histories and physical and laboratory findings are presented of children (age < 18 years, n = 22; mean age 9 years; 60% females) and adults (age >18 years, n = 125; mean age 39 years, 67% females) who consulted an environmental health specialty clinic. In the pediatric patients' exposure history, widespread fungal contamination of water-damaged building materials with known toxic or allergic fungi was identified. Primarily disorders of the respiratory system, skin, mucous membranes, and central nervous system were reported. Some enumeration and functional laboratory abnormalities, mainly of the lymphatic blood cells, were observed, although no statistically significant differences were found. IgE or IgG fungi-specific antibodies, used as exposure markers, were positive in less than 25% of all tested cases. In an evaluation of a symptomatic girl 11 years of age (sentinel case investigation) living in an apartment with verified toxigenic fungi (i.e., S. chartarum), several health indicators showed improvement after exposure cessation. Images Figure 1 PMID:10346997

  16. The Arden Syntax standard for clinical decision support: experiences and directions.

    PubMed

    Samwald, Matthias; Fehre, Karsten; de Bruin, Jeroen; Adlassnig, Klaus-Peter

    2012-08-01

    Arden Syntax is a widely recognized standard for representing clinical and scientific knowledge in an executable format. It has a history that reaches back until 1989 and is currently maintained by the Health Level 7 (HL7) organization. We created a production-ready development environment, compiler, rule engine and application server for Arden Syntax. Over the course of several years, we have applied this Arden - Syntax - based CDS system in a wide variety of clinical problem domains, such as hepatitis serology interpretation, monitoring of nosocomial infections or the prediction of metastatic events in melanoma patients. We found the Arden Syntax standard to be very suitable for the practical implementation of CDS systems. Among the advantages of Arden Syntax are its status as an actively developed HL7 standard, the readability of the syntax, and various syntactic features such as flexible list handling. A major challenge we encountered was the technical integration of our CDS systems in existing, heterogeneous health information systems. To address this issue, we are currently working on incorporating the HL7 standard GELLO, which provides a standardized interface and query language for accessing data in health information systems. We hope that these planned extensions of the Arden Syntax might eventually help in realizing the vision of a global, interoperable and shared library of clinical decision support knowledge. PMID:22342733

  17. Genetic counselors' views and experiences with the clinical integration of genome sequencing.

    PubMed

    Machini, Kalotina; Douglas, Jessica; Braxton, Alicia; Tsipis, Judith; Kramer, Kate

    2014-08-01

    In recent years, new sequencing technologies known as next generation sequencing (NGS) have provided scientists the ability to rapidly sequence all known coding as well as non-coding sequences in the human genome. As the two emerging approaches, whole exome (WES) and whole genome (WGS) sequencing, have started to be integrated in the clinical arena, we sought to survey health care professionals who are likely to be involved in the implementation process now and/or in the future (e.g., genetic counselors, geneticists and nurse practitioners). Two hundred twenty-one genetic counselors- one third of whom currently offer WES/WGS-participated in an anonymous online survey. The aims of the survey were first, to identify barriers to the implementation of WES/WGS, as perceived by survey participants; second, to provide the first systematic report of current practices regarding the integration of WES/WGS in clinic and/or research across the US and Canada and to illuminate the roles and challenges of genetic counselors participating in this process; and third to evaluate the impact of WES/WGS on patient care. Our results showed that genetic counseling practices with respect to WES/WGS are consistent with the criteria set forth in the ACMG 2012 policy statement, which highlights indications for testing, reporting, and pre/post test considerations. Our respondents described challenges related to offering WES/WGS, which included billing issues, the duration and content of the consent process, result interpretation and disclosure of incidental findings and variants of unknown significance. In addition, respondents indicated that specialty area (i.e., prenatal and cancer), lack of clinical utility of WES/WGS and concerns about interpretation of test results were factors that prevented them from offering this technology to patients. Finally, study participants identified the aspects of their professional training which have been most beneficial in aiding with the integration of WES/WGS into the clinical setting (molecular/clinical genetics, counseling and bioethics) and suggested that counseling aids (to assist them when explaining aspects of these tests to patients) and webinars focused on WES/WGS (for genetic counselors and other health care professionals) would be useful educational tools. Future research should permit us to further enhance our knowledge of pitfalls and benefits associated with the introduction of these powerful technologies in patient care and to further explore the roles and opportunities for genetic counselors in this rapidly evolving field. PMID:24671342

  18. Clinical Experiments of Communication by ALS Patient Utilizing Detecting Event-Related Potential

    NASA Astrophysics Data System (ADS)

    Kanou, Naoyuki; Sakuma, Kenji; Nakashima, Kenji

    Amyotrophic Lateral Sclerosis(ALS) patients are unable to successfully communicate their desires, although their mentality is normal, and so, the necessity of Communication Aids(CA) for ALS patients is realized. Therefore, the authors are focused on Event-Related Potential(ERP) which is elicited primarily for the target by visual and auditory stimuli. P200, N200 and P300 are components of ERP. These are potentials that are elicited when the subject focuses attention on stimuli that appears infrequently. ALS patient participated in two experiments. In the first experiment, a target word out of five words on a computer display was specified. The five words were linked to an each electric appliance, allowing the ALS patient to switch on a target appliance by ERP. In the second experiment, a target word in a 5×5 matrix was specified by measure of ERP. The rows and columns of the matrix were reversed randomly. The word on a crossing point of rows and columns including the target word, was specified as the target word. The rate of correct judgment in the first and second experiments were 100% in N200 and 96% in P200. For practical use of this system, it is very important to determine suitable communication algorithms for each patient by performing these experiments evaluating the results.

  19. Beagle Dog Tissue Archive (previously part of National Radiobiology Archives): from the Janus Tissue Archive at Northwestern University

    DOE Data Explorer

    Watson, Charles R.

    Following the advent of the atomic age, many nations have investigated the effects of radioactive exposure in animal models. Some of these investigations involved costly and unique experiments that produced tissue and data archives which are unlikely to be reproduced. In an effort to extract the value from these collections, programs have started in Japan, Europe, and America to preserve and make public the data and tissues from these studies for further investigation. The Beagle Dog Experiments, carried out at Argonne National Laboratory from 1952 to 1991 by Thomas Fritz, William Norris, and Tom Seed and supported by grants from the Atomic Energy Commission, investigated the effects of Cobalt-60 radiation on beagle dogs. Documentation from these studies is availible in pdf form. This web portal seeks to make accessible the animal tissues and study data from the Beagle Dog Experiments using data organized by Charles Watson. Use the search form to the left to look for dog data from particular experimental conditions. Click a dog number to return the full dog record. Use the dog record to find tissues of interest and make a sample tissue request. These tissue samples and the data were known until recently as the the U.S. National Radiobiology Archives (NRA) and were maintained as the United States Transuranium and Uranium Registries (USTUR) at Washington State University. Life-span studies using beagle dogs were done at the Argonne National Laboratory, University of California at Davis, Pacific Northwest National Laboratory, Inhalation Toxicology Research Institute, and the University of Utah. The results and many microscope slides from these life-span studies, totaling some 6000 dogs, are now available to researchers. A seminal work included in the Archive is The Atlas of Experimentally-Induced Neoplasia in the Beagle Dog (Watson et al, 1997).

  20. Sociodemographic and clinical factors related to devaluation\\/discrimination and rejection experiences among users of mental health services

    Microsoft Academic Search

    Bertil Lundberg; Lars Hansson; Elisabeth Wentz; Tommy Björkman

    2007-01-01

    Background  A major goal in mental health research and policy is to identify ways to reduce stigma among persons with mental illness.\\u000a \\u000a \\u000a \\u000a Aims  The aims of the present study were to (1) investigate the prevalence of rejection and devaluation\\/discrimination in a cross-sectional\\u000a sample of 200 individuals with experiences of mental illness and (2) investigate the relationship between sociodemographic\\u000a and clinical, client characteristics

  1. Fast neutron radiotherapy in the treatment of locally advanced adenocarcinoma of the prostate. Clinical experience and future directions.

    PubMed

    Russell, K J; Laramore, G E; Griffin, T W; Parker, R G; Maor, M H; Davis, L W; Krall, J M

    1989-08-01

    The major clinical experiences using fast neutrons for the treatment of locally advanced prostatic carcinomas are reviewed. In all trials to date, there is evidence that treatment regimens employing a component of fast neutrons achieve results that equal or surpass those obtainable with conventional megavoltage external beam irradiation for comparable groups of patients. Late complications of neutron treatment have not exceeded the complication rate expected by photon irradiation. The structure of the current Radiation Therapy Oncology Group phase III randomized trial comparing neutron and photon treatment of patients with stages B2, C, and D1 disease is discussed. PMID:2502905

  2. The experience of primary care providers with an integrated mental health care program in safety-net clinics.

    PubMed

    Bentham, Wayne D; Ratzliff, Anna; Harrison, David; Chan, Ya-Fen; Vannoy, Steven; Unützer, Jürgen

    2015-01-01

    Primary care providers participating in a statewide implementation of an integrated mental health care program for "safety-net" patients in primary care clinics were surveyed to elicit their experiences and level of satisfaction. Quantitative analyses were performed to identify respondent characteristics and satisfaction with the program. Qualitative analyses were done to identify common themes in response to the question "How could psychiatric consultation [in the program] be improved?" Primary care providers were generally satisfied with the integrated mental health care program and raised several concerns that suggest important principles for successful future implementations of these types of programs. PMID:25739063

  3. Clinical experience of IL-6 blockade in rheumatic diseases - implications on IL-6 biology and disease pathogenesis.

    PubMed

    Davies, Ruth; Choy, Ernest

    2014-02-01

    Interleukin 6 (IL-6) plays a significant role in many rheumatological diseases and has been described as both a pro- and anti-inflammatory cytokine. IL-6 blockade has been investigated in various rheumatic diseases and a humanised anti-IL-6 receptor antibody has been licensed for use in rheumatoid arthritis, systemic and polyarticular juvenile idiopathic arthritis. The increasing clinical experience of IL-6 blockade in rheumatic diseases adds to the existing knowledge regarding the physiological and pathological roles of IL-6. PMID:24389239

  4. Clinical experience transitioning from IMRT to VMAT for head and neck cancer.

    PubMed

    Studenski, Matthew T; Bar-Ad, Voichita; Siglin, Joshua; Cognetti, David; Curry, Joseph; Tuluc, Madalina; Harrison, Amy S

    2013-01-01

    To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion. PMID:23246253

  5. Clinical features of vestibular schwannomas in patients who experience hearing improvement after surgery.

    PubMed

    Kohno, Michihiro; Sora, Shigeo; Sato, Hiroaki; Shinogami, Masanobu; Yoneyama, Hidehiko

    2015-04-01

    Postoperative improvements in hearing in patients with vestibular schwannoma are extremely rare. We reviewed nine cases retrospectively to investigate the clinical features of these cases. Hearing improvement was defined as an improvement in hearing class according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria. The nine patients comprised five men and four women with a mean age of 40.4 years. Of the nine tumors, three were solid and six cystic; mean tumor size was 29.7 mm. Mean pure tone average (PTA) and mean speech discrimination scores (SDS) were 47.5 dB and 22.8 %, respectively, preoperatively and 29.6 dB and 83.9 %, respectively, postoperatively. AAO-HNS class distribution was class B:1 and D:8, preoperatively, and class A: 5 and B:4, postoperatively. A lateral suboccipital retrosigmoid approach with a lateral (park bench) position was used in all nine patients. Clinical features of these vestibular schwannomas included (1) large cystic tumors, (2) sudden onset hearing loss, (3) the presence of a valley shape in the middle-pitch area on preoperative audiograms, (4) almost intact preoperative inner ear function, (5) a low SDS relative to PTA preoperatively, (6) surgical treatment via a lateral suboccipital approach within 6 months of the most recent exacerbation of hearing loss, (7) observation of I waves in preoperative, intraoperative, and postoperative auditory brainstem response (ABR) recordings, and (8) postoperative improvement in mainly the middle-pitch range and SDS. For surgical treatment of vestibular schwannomas with the above clinical features, a translabyrinthine approach and cochlear nerve section (unless the I wave on the intraoperative ABR trace disappears) should be avoided, regardless of the patient's preoperative hearing level, if a surgeon hopes to maximize the chances of preserving or improving hearing. PMID:25528569

  6. Preclinical, Clinical, and Over-the-Counter Postmarketing Experience with a New Vaginal Cup: Menstrual Collection

    PubMed Central

    North, Barbara B.

    2011-01-01

    Abstract Background Menstrual cups have been available for decades, but their use is limited by bulky design and the need for multiple sizes. The Softcup® (Instead, Inc., San Diego, CA) is a simple single-size disposable over-the-counter (OTC) menstrual cup that compresses to tampon shape to facilitate insertion and can be worn during coitus. This report describes preclinical evaluation, clinical testing, and postmarketing monitoring of the Softcup. Methods Preclinical testing complied with U.S. Food and Drug Administration (FDA) guidelines and used standard United States Pharmacopoeia methodologies for assessment of potential toxicity. Clinical testing enrolled 406 women in seven U.S. centers. A detailed written questionnaire assessed safety, acceptability, and effectiveness for menstrual collection. Study safety parameters included pelvic examinations, Pap smears, colposcopy, urinalysis, vaginal pH, wet mounts, gram stain, and vaginal microflora cultures. Postmarketing surveillance of over 100 million Softcups has been conducted by the manufacturer and by the FDA Medwatch system. Results No toxicity or mutagenicity was observed in preclinical evaluations. In clinical testing, after three cycles of cup use, 37% of subjects rated the cup as better than, 29% as worse than, and 34% as equal to pads or tampons. The cup was preferred for comfort, dryness, and less odor. Cups received lower ratings for disposal and convenience. Eighty-one percent of enrolled women were able to insert and remove their first cup using only written instructions. Use difficulties resulting in study discontinuations included cramping (1%), leakage (1%), and improper fit (3%). No safety parameters were adversely affected. No significant health risks were reported during postmarketing surveillance. Conclusions These results demonstrate that a single-size vaginal device has no significant health risks and is acceptable to many women without the need for fitting or other medical services. PMID:21194348

  7. Phantom experiment and clinical utility of quantitative shear wave elastography for differentiating thyroid nodules.

    PubMed

    Fukuhara, Takahiro; Matsuda, Eriko; Fujiwara, Kazunori; Tanimura, Chika; Izawa, Shoichiro; Kataoka, Hideyuki; Kitano, Hiroya

    2014-01-01

    Shear wave elastography (SWE) using acoustic radiation force impulse (ARFI) is a novel ultrasonography technique. The aim of this study was to investigate the clinical usefulness of quantitative SWE for differentiating thyroid nodules. For phantom study, we measured the shear wave velocities (SWVs) of the four spheres of 2- and 1-cm diameters with varying hardness. For clinical study, the SWVs of normal thyroid glands and thyroid nodules, that were classified as benign or malignant according to either cytological or pathological findings, were measured. The SWVs of each thyroid patient were compared with that of a normal thyroid and each other. In phantom study, the SWVs for the 2-cm spheres correlated with the hardness of the targets, whereas the values for the 1-cm spheres did not. In clinical study, 112 nodules identified in 167 patients and 94 normal thyroid glands were analyzed according to the criteria for the study. The nodules included 84 benign nodules, and 28 papillary carcinoma. The mean SWVs of each group were 1.64 ± 0.47 m/s for normal thyroid, 1.88 ± 0.62 m/s for benign nodules and 2.67 ± 0.76 m/s for papillary carcinoma. The SWVs of papillary carcinoma were significantly higher than those of benign nodules (P < 0.001). The area under the ROC curve was 0.809 with a cut-off value of 2.01 m/s. The sensitivity and specificity were 85.7% and 62.0% respectively. Results showed that SWE provides new information on tumor characteristics, such as hardness and larger nodules tended to provide stable measurements. PMID:24717719

  8. Lymphomatoid granulomatosis--a single institute experience: pathologic findings and clinical correlations.

    PubMed

    Song, Joo Y; Pittaluga, Stefania; Dunleavy, Kieron; Grant, Nicole; White, Therese; Jiang, Liuyan; Davies-Hill, Theresa; Raffeld, Mark; Wilson, Wyndham H; Jaffe, Elaine S

    2015-02-01

    Lymphomatoid granulomatosis (LYG) is a rare angiocentric and angiodestructive Epstein-Barr virus (EBV)-associated B-cell lymphoproliferative disorder. It is hypothesized that these patients have dysregulated immune surveillance of EBV. We reviewed the biopsies of 55 patients with LYG who were referred for a prospective trial at the National Cancer Institute (1995 to 2010) and evaluated the histologic, immunohistochemical, in situ hybridization, and molecular findings of these biopsies in conjunction with clinical information. Grading of the lesions was based on morphologic features and the number of EBV-positive B cells. The median age was 46 years (M:F 2.2:1). Clinically, all patients had lung involvement (100%), with the next most common site being the central nervous system (38%). No patient had nodal or bone marrow disease. All patients had past EBV exposure by serology but with a low median EBV viral load. We reviewed 122 biopsies; the most common site was lung (73%), followed by skin/subcutaneous tissue (17%); other sites included kidney, nasal cavity, gastrointestinal tract, conjunctiva, liver, and adrenal gland. Histologically, the lesions showed angiocentricity, were rich in T cells, had large atypical B cells, and were positive for EBV. Grading was performed predominantly on the lung biopsy at diagnosis; they were distributed as follows: LYG grade 1 (30%), grade 2 (22%), and grade 3 (48%). Necrosis was seen in all grades, with a greater degree in high-grade lesions. Immunoglobulin gene rearrangement studies were performed, and a higher percentage of clonal rearrangements were seen in LYG grade 2 (50%) and grade 3 (69%) as compared with grade 1 (8%). LYG is a distinct entity that can usually be differentiated from other EBV-associated B-cell lymphoproliferative disorders on the basis of the combination of clinical presentation, histology, and EBV studies. Grading of these lesions is important because it dictates the treatment choice. PMID:25321327

  9. Clinical experience transitioning from IMRT to VMAT for head and neck cancer

    SciTech Connect

    Studenski, Matthew T., E-mail: matthew.studenski@jeffersonhospital.org [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Bar-Ad, Voichita; Siglin, Joshua [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Cognetti, David; Curry, Joseph [Department of Otolaryngology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Tuluc, Madalina [Department of Pathology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Harrison, Amy S. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States)

    2013-07-01

    To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion.

  10. The Lived Experience of Nurses Working with Student Nurses in the Clinical Environment

    ERIC Educational Resources Information Center

    Hathorn, Donna; Machtmes, Krisanna; Tillman, Ken

    2009-01-01

    One response to the nursing shortage is to increase promotion and retention in nursing programs: However, negative attitudes of nurses threaten student progression and retention. A phenomenological study explored the lived experience of nurses who worked with student nurses to discover "what" attitudes nurses had toward student nurses and "how"…

  11. Clinical experience with epidural cooling for spinal cord protection during thoracic and thoracoabdominal aneurysm repair

    Microsoft Academic Search

    Richard P. Cambria; J. Kenneth Davison; Simona Zannetti; Gilbert L'Italien; David C. Brewster; Jonathan P. Gertler; Ashby C. Moncure; Glenn M. LaMuraglia; William M. Abbott

    1997-01-01

    Purpose: This report summarizes our experience with epidural cooling (EC) to achieve regional spinal cord hypothermia and thereby decrease the risk of spinal cord ischemic injury during the course of descending thoracic aneurysm (TA) and thoracoabdominal aneurysm (TAA) repair.Methods: During the interval July 1993 to Dec. 1995, 70 patients underwent TA (n = 9, 13%) or TAA (n = 61)

  12. The Use of Behavioral Experiments to Modify Delusions and Paranoia: Clinical Guidelines and Recommendations

    ERIC Educational Resources Information Center

    Combs, Dennis R.; Tiegreen, Joshua; Nelson, Amelia

    2007-01-01

    Recently, there has been a renewed interested in the treatment of psychosis and it is now appears possible to modify specific symptoms of psychosis such as paranoia and delusions using methods derived from Cognitive-Behavioral Therapy. One specific technique that has received less attention is the use of behavioral experiments. In this paper, we…

  13. View of physicians on and barriers to patient enrollment in a multicenter clinical trial: experience in a Japanese rural area

    PubMed Central

    2010-01-01

    Background Clinical trials in the general practice setting are important for providing evidence on the effectiveness and safety of different agents under various conditions. In conducting these trials, the participation of physicians and patient recruitment are important issues. Various investigations in the literature have reported views and attitudes of physicians on various types of clinical trials. Nevertheless, there is still little information concerning physicians participating in a clinical trial and among them, those who could not recruit any patients (unsuccessful physician recruiters). Methods In 2003, we collaborated in a large-scale multicenter study of Japanese hypertensive patients (COPE Trial). In Tokushima University Hospital and 18 other medical institutions, we investigated the views and attitudes of unsuccessful physician recruiters in comparison with successful physician recruiters, using a questionnaire. Results The questionnaire was provided by mail to 47 physicians and 27 (57%) responded. The response rate was 79% for successful physician recruiters compared to 43% (P = 0.014) for unsuccessful physician recruiters. More successful physician recruiters (73%) than unsuccessful physician recruiters (42%) stated they had participated and enrolled patients in previous multicenter clinical trials. A significantly higher number of successful physician recruiters than unsuccessful physician recruiters (42%; P = 0.040) considered the presence of a support system with clinical research coordinators (CRC) as the reason for participation (80%). A large number of unsuccessful physician recruiters experienced difficulty in obtaining informed consent (67%), whereas a significantly smaller number of successful physician recruiters experienced such difficulty (20%; P = 0.014). The difficulties experienced by unsuccessful physician recruiters in the trial were as follows: inability to find possible participants (100%), difficulty in obtaining informed consent (58%), cumbersome procedures (58%), difficulty in long-term follow up (33%), and insufficient tools for explanation and obtaining informed consent (8%). Conclusion This survey showed that successful physician recruiters consider a support system with CRC of value, and that they are skillful in obtaining informed consent. These views and attitudes may have originated from past experience involving clinical trials. In this regard, we need to develop an infrastructure to enlighten physicians on this support system for the promotion of clinical trials. PMID:20525325

  14. Rothia Bacteremia: a 10-Year Experience at Mayo Clinic, Rochester, Minnesota

    PubMed Central

    Ramanan, Poornima; Barreto, Jason N.; Osmon, Douglas R.

    2014-01-01

    Rothia spp. are Gram-positive cocco-bacilli that cause a wide range of serious infections, especially in immunocompromised hosts. Risk factors for Rothia mucilaginosa (previously known as Stomatococcus mucilaginosus) bacteremia include prolonged and profound neutropenia, malignancy, and an indwelling vascular foreign body. Here, we describe 67 adults at the Mayo Clinic in Rochester, MN, from 2002 to 2012 with blood cultures positive for Rothia. Twenty-five of these patients had multiple positive blood cultures, indicating true clinical infection. Among these, 88% (22/25) were neutropenic, and 76% (19/25) had leukemia. Common sources of bacteremia were presumed gut translocation, mucositis, and catheter-related infection. One patient died with Rothia infection. Neutropenic patients were less likely to have a single positive blood culture than were nonneutropenic patients. Antimicrobial susceptibility testing was performed on 21% of the isolates. All of the tested isolates were susceptible to vancomycin and most beta-lactams; however, four of six tested isolates were resistant to oxacillin. There was no difference between the neutropenic and nonneutropenic patients in need of intensive care unit care, mortality, or attributable mortality. PMID:24951810

  15. A short perspective on gene therapy: Clinical experience on gene therapy of gliomablastoma multiforme.

    PubMed

    Wirth, Thomas

    2011-12-20

    More than two decades have passed since the first gene therapy clinical trial was conducted. During this time, we have gained much knowledge regarding gene therapy in general, but also learned to understand the fear that persists in society. We have experienced drawbacks and successes. More than 1700 clinical trials have been conducted where gene therapy is used as a means for therapy. In the very first trial, patients with advanced melanoma were treated with tumor infiltrating lymphocytes genetically modified ex-vivo to express tumor necrosis factor. Around the same time the first gene therapy trial was conducted, the ethical aspects of performing gene therapy on humans was intensively discussed. What are the risks involved with gene therapy? Can we control the technology? What is ethically acceptable and what are the indications gene therapy can be used for? Initially, gene therapy was thought to be implemented mainly for the treatment of monogenetic diseases, such as adenosine deaminase deficiency. However, other therapeutic areas have become of interest and currently cancer is the most studied therapeutic area for gene therapy based medicines. In this review I will be giving a short introduction into gene therapy and will direct the discussion to where we should go from here. Furthermore, I will focus on the use of the Herpes simplex virus-thymidine kinase for gene therapy of malignant gliomas and highlight the efficacy of gene therapy for the treatment of malignant gliomas, but other strategies will also be mentioned. PMID:24520527

  16. Cyproterone acetate in the treatment of sexual disorders: pharmacological base and clinical experience.

    PubMed

    Neumann, F; Kalmus, J

    1991-01-01

    Cyproterone acetate (CPA) has been discovered more than 25 years ago and it was the first antiandrogen suitable for clinical use. CPA inhibits the action of endogenous and exogenous androgens at all androgen target organs; these include the prostate, seminal vesicles, testes, and the vas deferens. However, this antiandrogen also antagonizes less sex-specific effects of androgens, for example ossification of the epiphyseal cartilage, sebaceous gland function and skin thickness. Indications for CPA: Prostate cancer, androgen induced disorders of the skin (acne, seborrhoea, hirsutism, alopecia), precocious puberty and sexual disorders in men. Concerning sexual deviations clinical trials started in 1966. CPA leads to loss of libido and the ability to achieve erection, followed by the inability to achieve orgasm, after about 14 days of treatment (100-200 mg daily orally or 300 mg weekly i.m.). These effects are reversed in the same order as the onset. About 75 to 80% of patients respond to this therapy. CPA is generally well tolerated. Tiredness, lack of drive, listlessness and depressive moods have been reported as non-specific side-effects. Slight gynecomastia occurs in about 20% of patients. There are no good alternatives in this indication. Pure antiandrogens are unsuitable, because these are unable to inhibit libido sufficiently. Tranquilizers are not very effective, high doses of estrogens are associated with severe (cardiovascular) side effects. Orchidectomy is an irreversible intervention, LHRH analogues are associated with hot flushes and the initial increase in testosterone (flare phenomenon). PMID:1838080

  17. Personalized Oncogenomics: Clinical Experience with Malignant Peritoneal Mesothelioma Using Whole Genome Sequencing

    PubMed Central

    Sheffield, Brandon S.; Tinker, Anna V.; Shen, Yaoqing; Hwang, Harry; Li-Chang, Hector H.; Pleasance, Erin; Ch’ng, Carolyn; Lum, Amy; Lorette, Julie; McConnell, Yarrow J.; Sun, Sophie; Jones, Steven J. M.; Gown, Allen M.; Huntsman, David G.; Schaeffer, David F.; Churg, Andrew; Yip, Stephen; Laskin, Janessa; Marra, Marco A.

    2015-01-01

    Peritoneal mesothelioma is a rare and sometimes lethal malignancy that presents a clinical challenge for both diagnosis and management. Recent studies have led to a better understanding of the molecular biology of peritoneal mesothelioma. Translation of the emerging data into better treatments and outcome is needed. From two patients with peritoneal mesothelioma, we derived whole genome sequences, RNA expression profiles, and targeted deep sequencing data. Molecular data were made available for translation into a clinical treatment plan. Treatment responses and outcomes were later examined in the context of molecular findings. Molecular studies presented here provide the first reported whole genome sequences of peritoneal mesothelioma. Mutations in known mesothelioma-related genes NF2, CDKN2A, LATS2, amongst others, were identified. Activation of MET-related signaling pathways was demonstrated in both cases. A hypermutated phenotype was observed in one case (434 vs. 18 single nucleotide variants) and was associated with a favourable outcome despite sarcomatoid histology and multifocal disease. This study represents the first report of whole genome analyses of peritoneal mesothelioma, a key step in the understanding and treatment of this disease. PMID:25798586

  18. Dietary trial in prostate cancer: Early experience and implications for clinical trial design.

    PubMed

    Ornish, D M; Lee, K L; Fair, W R; Pettengill, E B; Carroll, P R

    2001-04-01

    Much epidemiologic and case-controlled evidence suggests that diet may be a modifier of prostate cancer risk. However, the role of dietary modification in men known to have prostate cancer is a matter of some debate. To elucidate the effect of diet and comprehensive lifestyle changes on cancer risk, we are conducting a randomized, prospective clinical trial on men with clinically localized prostate cancer who have selected "watchful waiting" as primary therapy. Since its inception in April 1997, 93 men have been randomized to control (n = 47) or dietary and lifestyle intervention (n = 46). Patients in the intervention group are asked to eat a low-fat, soy-supplemented vegan diet and take part in stress management, psychosocial group support, and exercise programs. After 1 year, adherence to all four interventions was greater than 80%, and no deaths or adverse outcomes have occurred. To date, we have collected prostate-specific antigen and endorectal magnetic resonance imaging and spectroscopy data on 63 patients (34 control and 29 intervention). This study demonstrates that a randomized, prospective dietary trial for men with localized prostate cancer is safe and feasible. The methodologies used provide insights into practical aspects of diet design and compliance assessment that may be useful templates for future dietary trials. PMID:11295627

  19. A case series of 46 patients with lichen planopilaris: Demographics, clinical evaluation, and treatment experience.

    PubMed

    Lyakhovitsky, A; Amichai, B; Sizopoulou, C; Barzilai, A

    2014-07-01

    Abstract Background: Lichen planopilaris (LPP) is as a lymphocytic variant of primary cicatricial alopecia. Objective: To evaluate the demographics, clinical findings, natural history, and response to various treatments of LPP. Methods: A retrospective review of medical records of all patients with clinical and histopathological diagnoses of LPP. Results: Out of 46 patients, there were 38 (82.6%) women and 8 (17.4%) men. There was no clear association of specific medical background and medications with disease onset. The most frequent complaint was itching scalp. Asymptomatic hair loss was observed in 39.2%. LPP involved the entire scalp in 39.1%, vertex in 28.3%, anterior scalp and vertex in 17.4%, fronto-temporal scalp in 6.5%, and posterior and parietal scalp in 6.5%. The topical treatment that caused the highest rate of symptomatic improvement was intralesional injection of corticosteroids. The treatment that led to the highest rate of remission was hydroxychloroquine combined with topical corticosteroid application. The remission rate was 6.5% after 3 months and 33% after 18 months. Of patients who achieved remission, 50% need continuous treatment to maintain remission. No patient had any visible hair regrowth on any treatment. Conclusion: The range of empiric topical and systemic treatments used gives unsatisfactory results, in LPP patients. PMID:24913130

  20. Offering Acupuncture as an Adjunct for Tobacco Cessation: A Community Clinic Experience

    PubMed Central

    Chang, Emiley; Fung, Lei-Chun; Li, Chin-Shang; Lin, Tzu-Chun; Tam, Leonard; Tang, Carrie; Tong, Elisa K.

    2014-01-01

    Disparities in smoking rates remain prominent within Asian Americans. Medical pluralism and cultural tailoring may enhance Asian Americans engaging with tobacco cessation assistance. We conducted a retrospective analysis of a community clinic’s smoking cessation program targeting a Chinese population that offered acupuncture, nicotine replacement therapy (NRT), and counseling from 2007 to 2010. Most participants used acupuncture, with about half choosing acupuncture and NRT, followed by more than 40% choosing acupuncture only; few chose NRT only. Tobacco cessation rates at 6 months were relatively high for the acupuncture + NRT group and only acupuncture group (37.7% vs. 28.9%). In comparing tobacco reduction >50% from baseline with an expanded only NRT group, the acupuncture + NRT group had a higher odds ratio than the only acupuncture group, which had a lower odds ratio. Our evaluation of this real-world community program offering acupuncture as a cultural adjunct to a tobacco cessation program suggests that acupuncture might help with engagement by Chinese American male smokers into a tobacco cessation program that offers counseling and NRT. Future larger studies should further evaluate the efficacy of offering acupuncture in combination with NRT on the outcomes of cessation and reduction. PMID:23667059

  1. Effectiveness of the ThinPrep Imaging System: clinical experience in a low risk screening population.

    PubMed

    Papillo, Jacalyn L; St John, Timothy L; Leiman, Gladwyn

    2008-03-01

    The Cytyc ThinPrep Imaging System was FDA approved based on a multi-institutional clinical trial, in which the HSIL+ prevalence rate was 0.7%. This study determines the effectiveness of the Imager in clinical practice at an academic medical center with a historical HSIL+ rate of 0.25%. Cytological interpretations were compared for two 12-month periods pre- and post-Imager implementation. Data was compiled by cytologic diagnoses, and variations in prevalence rates were analyzed for statistical significance. Interpretations of ASC-US, ASC-H, and LSIL were correlated with Digene Hybrid Capture2 High Risk HPV DNA testing; interpretations of ASC-H, LSIL, and HSIL+ were correlated with subsequent surgical follow-up. ASC-US, ASC-H, and LSIL detection rates increased 34, 48, and 29%, respectively, with the Imager (P<0.001); whereas the detection of HSIL increased 24% (P<0.051). Surgical correlation revealed no statistical differences in the positive predictive value (PPV) for ASC-H and LSIL. However, an increase in the PPV of HSIL was found (P<0.05). High risk HPV results were lower for ASC-US (P<0.001), but statistically equivalent for ASC-H and LSIL. Results of surgical correlation and HPV testing validated an increase in detection rates of ASC-H, LSIL, and HSIL, as well as increased PPV of HSIL with the ThinPrep Imaging System. PMID:18232005

  2. Cognitive-motor profile, clinical characteristics and diagnosis of CHARGE syndrome: an Italian experience.

    PubMed

    Santoro, Lucia; Ficcadenti, Anna; Zallocco, Federica; Del Baldo, Giada; Piraccini, Francesca; Gesuita, Rosaria; Ceccarani, Patrizia; Gabrielli, Orazio

    2014-12-01

    Since 2005, the Pediatric Clinic of Maternal-Infantile Sciences Institute in Ancona, in collaboration with the Lega del Filo d'Oro in Osimo, has been taking care of 35 patients with clinical and molecular diagnosis of CHARGE syndrome. Our investigation is the largest Italian cohort study of CHARGE patients. CHARGE syndrome is a multiple malformation syndrome involving ocular coloboma, heart defects, choanal atresia, retardation of growth and\\or development, genital anomalies and\\or urinary and ear abnormalities which leads to visual-auditory disabilities, cognitive impairment and behavioral abnormalities. Our purpose is to expand the knowledge of this syndrome by reviewing this group of affected patients in order to delineate in detail the natural history of the disease, and in particular to define the cognitive and motor profiles using an Italian questionnaire called "Progress Guide". Our main results show that Italian CHARGE patients have more delayed development in their physical abilities or skills with respect to normal patients. In particular, the delay is statistically significant in regard to self-care skills (worse toileting, better washing) and the communication skill (language). On the other hand, the expressive skills are still preserved. When patients are considered according to their age (?3 years) and (>3 years), the older ones have more delayed development than the younger ones when compared with healthy individuals of the same age. PMID:25255904

  3. Personalized oncogenomics: clinical experience with malignant peritoneal mesothelioma using whole genome sequencing.

    PubMed

    Sheffield, Brandon S; Tinker, Anna V; Shen, Yaoqing; Hwang, Harry; Li-Chang, Hector H; Pleasance, Erin; Ch'ng, Carolyn; Lum, Amy; Lorette, Julie; McConnell, Yarrow J; Sun, Sophie; Jones, Steven J M; Gown, Allen M; Huntsman, David G; Schaeffer, David F; Churg, Andrew; Yip, Stephen; Laskin, Janessa; Marra, Marco A

    2015-01-01

    Peritoneal mesothelioma is a rare and sometimes lethal malignancy that presents a clinical challenge for both diagnosis and management. Recent studies have led to a better understanding of the molecular biology of peritoneal mesothelioma. Translation of the emerging data into better treatments and outcome is needed. From two patients with peritoneal mesothelioma, we derived whole genome sequences, RNA expression profiles, and targeted deep sequencing data. Molecular data were made available for translation into a clinical treatment plan. Treatment responses and outcomes were later examined in the context of molecular findings. Molecular studies presented here provide the first reported whole genome sequences of peritoneal mesothelioma. Mutations in known mesothelioma-related genes NF2, CDKN2A, LATS2, amongst others, were identified. Activation of MET-related signaling pathways was demonstrated in both cases. A hypermutated phenotype was observed in one case (434 vs. 18 single nucleotide variants) and was associated with a favourable outcome despite sarcomatoid histology and multifocal disease. This study represents the first report of whole genome analyses of peritoneal mesothelioma, a key step in the understanding and treatment of this disease. PMID:25798586

  4. High-intensity focused ultrasound for the treatment of solid tumor: Chinese clinical experience

    NASA Astrophysics Data System (ADS)

    Takeuchi, Akira; Zhang, Hong; Sun, Kun; Hasumura, Hiromi; Liu, Botao; Fu, Yurui; Yang, Zaocheng

    2006-05-01

    As a non-invasive modality, high-intensity focused ultrasound (HIFU) therapy has been received an interest for the treatment of solid tumor. There are some makers of HIFU for the equipment in China. The Sonic CZ901 is developed from the Mianyang stream that has a great advantage for guiding by color Doppler ultrasound imaging. For the research about possibility of this equipment, we evaluate the clinical usefulness to the solid tumor of HIFU treatment at Wujing general hospital in Beijing. We elucidate the result in 28 cases with benign and malignant tumor (Uterine myoma:16, Benign prostatic hypertrophy:5, Benign breast tumor:2, Breast cancer:1, Retroperitoneal tumor:1, Pheochromocytoma:1, Liver cancer: 2) . After 14˜90days, all cases show the reduction of tumor size (Max.3.2cm, Min.1.6cm, :Mean 2.2cm reduced), and the blood flow of tumor completely reduced in 7/23, partially reduced in16/23. Clinical symptoms disappeared in 7, clearly improved in 14, improved in 7. All treatments had no adverse event except for two cases of liver cancer. They felt an abdominal pain that controllable by medicine and it improved within 6hours. It is concluded that HIFU with guide by ultrasound imaging is very safe, painless and effective as the anti-tumor treatment.

  5. Rothia bacteremia: a 10-year experience at Mayo Clinic, Rochester, Minnesota.

    PubMed

    Ramanan, Poornima; Barreto, Jason N; Osmon, Douglas R; Tosh, Pritish K

    2014-09-01

    Rothia spp. are Gram-positive cocco-bacilli that cause a wide range of serious infections, especially in immunocompromised hosts. Risk factors for Rothia mucilaginosa (previously known as Stomatococcus mucilaginosus) bacteremia include prolonged and profound neutropenia, malignancy, and an indwelling vascular foreign body. Here, we describe 67 adults at the Mayo Clinic in Rochester, MN, from 2002 to 2012 with blood cultures positive for Rothia. Twenty-five of these patients had multiple positive blood cultures, indicating true clinical infection. Among these, 88% (22/25) were neutropenic, and 76% (19/25) had leukemia. Common sources of bacteremia were presumed gut translocation, mucositis, and catheter-related infection. One patient died with Rothia infection. Neutropenic patients were less likely to have a single positive blood culture than were nonneutropenic patients. Antimicrobial susceptibility testing was performed on 21% of the isolates. All of the tested isolates were susceptible to vancomycin and most beta-lactams; however, four of six tested isolates were resistant to oxacillin. There was no difference between the neutropenic and nonneutropenic patients in need of intensive care unit care, mortality, or attributable mortality. PMID:24951810

  6. Toward an implantable artificial heart. Experimental and clinical experience at The Pennsylvania State University.

    PubMed

    Davis, P K; Pae, W E; Pierce, W S

    1989-01-01

    The number of patients who would be candidates for replacement of their failing native heart with an artificial device increases every year. A multidisciplinary group at The Pennsylvania State University is working toward the development of a reliable, totally implantable artificial heart. Initial work resulted in a pneumatic total artificial heart that has performed well in animal implants and has been used clinically in three patients as a temporary bridge to cardiac transplantation. Although pneumatic total artificial hearts have demonstrated utility as temporary mechanical circulatory support devices, attempts at permanent implantation by other groups have been fraught with complications. Because of the suboptimal performance of the pneumatic devices used for permanent implantation, the authors' groups at Penn State is developing n electric motor-driven total artificial heart with encouraging results in calf implants. This artificial heart of the future will use a transcutaneous energy transmission system that will obviate the need for percutaneous lines. Thus, the patient will be provided with as near a normal life-style as possible. At present the technology is at hand to implant an electric blood pump system that should provide a reasonable life-style and function reliably with minimal care. Ongoing cooperative experimental efforts will help to provide the answers necessary to make this system ready for clinical use. PMID:2645241

  7. A Psychometric Evaluation of an Advanced Pharmacy Practice Experience Clinical Competency Framework

    PubMed Central

    Doty, Randell E.; Nemire, Ruth E.

    2015-01-01

    Objective. To assess the psychometric properties of the clinical competency framework known as the System of Universal Clinical Competency Evaluation in the Sunshine State (SUCCESS), including its internal consistency and content, construct, and criterion validity. Methods. Sub-competency items within each hypothesized competency pair were subjected to principal components factor analysis to demonstrate convergent and discriminant validity. Varimax rotation was conducted for each competency pair (eg, competency 1 vs competency 2, competency 1 vs competency 3, competency 2 vs competency 3). Internal consistency was evaluated using Cronbach alpha. Results. Of the initial 78 pairings, 44 (56%) demonstrated convergent and discriminant validity. Five pairs of competencies were unidimensional. Of the 34 pairs where at least 1 competency was multidimensional, most (91%) were from competencies 7, 11, and 12, indicating modifications were warranted in those competencies. After reconfiguring the competencies, 76 (94%) of the 81 pairs resulted in 2 factors as required. A unidimensional factor emerged when all 13 of the competencies were entered into a factor analysis. The internal consistency of all of the competencies was satisfactory. Conclusion. Psychometric evaluation shows the SUCCESS framework demonstrates adequate reliability and validity for most competencies. However, it also provides guidance where improvements are needed as part of a continuous quality improvement program.

  8. The evaluation of drug provocation tests in pediatric allergy clinic: a single center experience.

    PubMed

    Vezir, Emine; Erkocoglu, Mustafa; Civelek, Ersoy; Kaya, Aysenur; Azkur, Dilek; Akan, Aysegül; Ozcan, Celal; Toyran, Muge; Ginis, Tayfur; Misirlioglu, Emine Dibek; Kocabas, Can Naci

    2014-01-01

    Drug provocation tests (DPTs) are gold standard to diagnose drug allergy. Our goal was to evaluate the results and safety of diagnostic methods including DPTs during childhood. Between January 2010 and February 2013 DPTs were performed and evaluated, prospectively, in children who attended our pediatric allergy clinic with a suspected drug hypersensitivity reaction. One hundred ninety-eight suspected drug reactions in 175 patients (88 boys and 87 girls) were evaluated. The median age of the subjects at the time of the suspected drug-induced hypersensitivity reaction and at the time of the study was 56 (interquartile range [IQR] = 24-120 months) months and 76 (IQR = 35-149 months) months, respectively. Suspected drugs were beta-lactam antibiotics in 108 cases (54.5%), non-beta-lactam antibiotics in 22 cases (11.1%), and nonsteroid anti-inflammatory drugs in 52 cases (26.3%). The history was compatible with immediate-type reactions in 69 cases (34.8%). Skin-prick tests were not positive in any of the cases. Intradermal tests were positive in three cases (4%). DPTs were positive in 13 (6.8%) of 191 provocation cases, which were performed with culprit drugs. Our results suggest that a positive clinical history is not enough to make a diagnosis of drug allergy, which highlights the significance of undertaking further diagnostic evaluation especially for DPTs. PMID:24717793

  9. A short perspective on gene therapy: Clinical experience on gene therapy of gliomablastoma multiforme

    PubMed Central

    Wirth, Thomas

    2011-01-01

    More than two decades have passed since the first gene therapy clinical trial was conducted. During this time, we have gained much knowledge regarding gene therapy in general, but also learned to understand the fear that persists in society. We have experienced drawbacks and successes. More than 1700 clinical trials have been conducted where gene therapy is used as a means for therapy. In the very first trial, patients with advanced melanoma were treated with tumor infiltrating lymphocytes genetically modified ex-vivo to express tumor necrosis factor. Around the same time the first gene therapy trial was conducted, the ethical aspects of performing gene therapy on humans was intensively discussed. What are the risks involved with gene therapy? Can we control the technology? What is ethically acceptable and what are the indications gene therapy can be used for? Initially, gene therapy was thought to be implemented mainly for the treatment of monogenetic diseases, such as adenosine deaminase deficiency. However, other therapeutic areas have become of interest and currently cancer is the most studied therapeutic area for gene therapy based medicines. In this review I will be giving a short introduction into gene therapy and will direct the discussion to where we should go from here. Furthermore, I will focus on the use of the Herpes simplex virus-thymidine kinase for gene therapy of malignant gliomas and highlight the efficacy of gene therapy for the treatment of malignant gliomas, but other strategies will also be mentioned. PMID:24520527

  10. Implementing computerized adaptive tests in routine clinical practice: experience implementing CATs.

    PubMed

    Hart, Dennis L; Deutscher, Daniel; Werneke, Mark W; Holder, Judy; Wang, Ying-Chih

    2010-01-01

    This paper traces the development, testing and use of CATs in outpatient rehabilitation from the perspective of one proprietary international medical rehabilitation database management company, Focus On Therapeutic Outcomes, Inc. (FOTO). Between the FOTO data in the United States and Maccabi Healthcare Services data in Israel, over 1.5 million CATs have been administered. Using findings from published studies and results of internal public relations surveys, we discuss (1) reasons for CAT development, (2) how the CATs were received by clinicians and patients in the United States and Israel, (3) results of psychometric property assessments of CAT estimated measures of functional status in routine clinical practice, (4) clinical interpretation of CAT functional status measures, and (5) future development directions. Results of scientific studies and business history provide confidence that CATs are pertinent and valuable to clinicians, patients and payers, and suggest CATs will be prominent in the development of future integrated computerized electronic medical record systems with electronic outcomes data collection. PMID:20847476

  11. Clinical experience with percutaneous holmium:YAG laser discectomy in dogs

    NASA Astrophysics Data System (ADS)

    Henry, George A.; Bartels, Kenneth E.; Dickey, D. Thomas

    1995-05-01

    Thirty-five clinical cases received laser disc ablation utilizing a uniplanar fluoroscopically guided percutaneous technique over a three year period. With the dog in right lateral recumbency, uniplanar fluoroscopy was utilized to guide the placement of 20-gauge, 2.5 inch spinal needles percutaneously through the left epaxial soft tissues into the nucleus pulposus with the dog in right lateral recumbency. The needle was advanced in increments following palpation and brief fluoroscopic observations to insure avoidance of the spinal cord and other vital structures. Entrance into the intervertebral disc was identified by a characteristic `gritty' feel of the needle passing through the annulus fibrosus. The dog was then placed in sternal recumbency, and the needles adjusted to place the tip approximately one-third of the distance into the disc. The laser fiber was then placed through the needle into the nucleus pulposus to ablate the nucleus with holmium laser energy. No detrimental side effects of this technique have been identified with the exception of one case. This single exception suggests that this procedure should not be performed on dogs with acute disc herniation. The technique appears safe given adherence to careful placement of the spinal needles and proper clinical criteria for patient selection.

  12. Ionization-chamber intercomparison in mixed neutron and gamma-ray radiation fields by National Bureau of Standards and Armed Forces Radiobiology Research Institute. Technical report

    Microsoft Academic Search

    M. Dooley; L. J. Goodman; G. H. Zeman; R. B. Schwartz; C. M. Eisenhauer

    1986-01-01

    This report describes a dosimetry intercomparison conducted between the Armed Forces Radiobiology Research Institute (AFRRI) and the National Bureau of Standards (NBS). The project was undertaken as part of an overall program to validate the reliability and credibility of the neutron dosimetry system used with the AFRRI TRIGA reactor in support of radiobiology research. The intercomparison included adsorbed dose measurements

  13. View of physicians on and barriers to patient enrollment in a multicenter clinical trial: experience in a Japanese rural area. | accrualnet.cancer.gov

    Cancer.gov

    This study investigates the views and attitudes of unsuccessful physician recruiters in comparison with successful physician recruiters who took part in a large-scale multicenter hypertension study in Japan. Successful recruiters most likely had more past experience in participating and enrolling patients in clinical trials, and were more aware of the workload of clinical trials, as well as contributions of outside support resources.

  14. Is family medicine meeting the HIV\\/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

    Microsoft Academic Search

    John Gerard Ryan

    1991-01-01

    A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and

  15. Evaluation of the biocompatibility of NiTi dental wires: a comparison of laboratory experiments and clinical conditions.

    PubMed

    Toker, S M; Canadinc, D

    2014-07-01

    Effects of intraoral environment on the surface degradation of nickel-titanium (NiTi) shape memory alloy orthodontic wires was simulated through ex situ static immersion experiments in artificial saliva. The tested wires were compared to companion wires retrieved from patients in terms of chemical changes and formation of new structures on the surface. Results of the ex situ experiments revealed that the acidic erosion effective at the earlier stages of immersion led to the formation of new structures as the immersion period approached 30 days. Moreover, comparison of these results with the analysis of wires utilized in clinical treatment evidenced that ex situ experiments are reliable in terms predicting C-rich structure formation on the wire surfaces. However, the formation of C pileups at the contact sites of arch wires and brackets could not be simulated with the aid of static immersion experiments, warranting the simulation of the intraoral environment in terms of both chemical and physical conditions, including mechanical loading, when evaluating the biocompatibility of NiTi orthodontic arch wires. PMID:24857476

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

    Microsoft Academic Search

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

    2004-01-01

    A link between dissociation proneness in adulthood and self-reports of childhood traumatic events (including familial loss in childhood, sexual\\/physical abuse and neglect) has been documented. Several studies have also provided evidence for an association between dissociative experiences and trauma in patients with various psychiatric disorders, including post-traumatic stress disorder, borderline personality, dissociative identity and eating disorders. Based on the relative

  17. Lithostar multiline.Initial clinical experience with a new multipurpose lithotripter

    Microsoft Academic Search

    U. Haag; J. E. Gschwend; K. Kleinschmidt; R. E. Hautmann

    1997-01-01

    Summary  \\u000a After > 10 000 treatments – our HM3\\/4 and MPL 9000 have been replaced by the Siemens Lithostar multiline. As a ESWL center\\u000a with ESWL as the primary treatment indication for all types of stones in kidney and ureter we report our initial experience\\u000a with this new multifunctional lithotripter. The system consists of an electromagnetic shock-wave emitter (Focus 80

  18. Mixed-field GCR Simulations for Radiobiological Research using Ground Based Accelerators

    NASA Astrophysics Data System (ADS)

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

    Space radiation is comprised of a large number of particle types and energies, which have differential ionization power from high energy protons to high charge and energy (HZE) particles and secondary neutrons produced by galactic cosmic rays (GCR). Ground based accelerators such as the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL) are used to simulate space radiation for radiobiology research and dosimetry, electronics parts, and shielding testing using mono-energetic beams for single ion species. As a tool to support research on new risk assessment models, we have developed a stochastic model of heavy ion beams and space radiation effects, the GCR Event-based Risk Model computer code (GERMcode). For radiobiological research on mixed-field space radiation, a new GCR simulator at NSRL is proposed. The NSRL-GCR simulator, which implements the rapid switching mode and the higher energy beam extraction to 1.5 GeV/u, can integrate multiple ions into a single simulation to create GCR Z-spectrum in major energy bins. After considering the GCR environment and energy limitations of NSRL, a GCR reference field is proposed after extensive simulation studies using the GERMcode. The GCR reference field is shown to reproduce the Z and LET spectra of GCR behind shielding within 20 percents accuracy compared to simulated full GCR environments behind shielding. A major challenge for space radiobiology research is to consider chronic GCR exposure of up to 3-years in relation to simulations with cell and animal models of human risks. We discuss possible approaches to map important biological time scales in experimental models using ground-based simulation with extended exposure of up to a few weeks and fractionation approaches at a GCR simulator.

  19. Mixed-field GCR Simulations for Radiobiological Research Using Ground Based Accelerators

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

    Space radiation is comprised of a large number of particle types and energies, which have differential ionization power from high energy protons to high charge and energy (HZE) particles and secondary neutrons produced by galactic cosmic rays (GCR). Ground based accelerators such as the NASA Space Radiation Laboratory (NSRL) at Brookhaven National Laboratory (BNL) are used to simulate space radiation for radiobiology research and dosimetry, electronics parts, and shielding testing using mono-energetic beams for single ion species. As a tool to support research on new risk assessment models, we have developed a stochastic model of heavy ion beams and space radiation effects, the GCR Event-based Risk Model computer code (GERMcode). For radiobiological research on mixed-field space radiation, a new GCR simulator at NSRL is proposed. The NSRL-GCR simulator, which implements the rapid switching mode and the higher energy beam extraction to 1.5 GeV/u, can integrate multiple ions into a single simulation to create GCR Z-spectrum in major energy bins. After considering the GCR environment and energy limitations of NSRL, a GCR reference field is proposed after extensive simulation studies using the GERMcode. The GCR reference field is shown to reproduce the Z and LET spectra of GCR behind shielding within 20% accuracy compared to simulated full GCR environments behind shielding. A major challenge for space radiobiology research is to consider chronic GCR exposure of up to 3-years in relation to simulations with cell and animal models of human risks. We discuss possible approaches to map important biological time scales in experimental models using ground-based simulation with extended exposure of up to a few weeks and fractionation approaches at a GCR simulator.

  20. Empathy in Clinical Practice: How Individual Dispositions, Gender, and Experience Moderate Empathic Concern, Burnout, and Emotional Distress in Physicians

    PubMed Central

    Gleichgerrcht, Ezequiel; Decety, Jean

    2013-01-01

    To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice. PMID:23620760

  1. Constructing a trial as a personal lifestyle change project: participants' experiences in a clinical study for nicotine vaccination.

    PubMed

    Wolters, Anna; de Wert, Guido; van Schayck, Onno; Horstman, Klasien

    2014-03-01

    The purpose of this study was to gain insight into the experiences and dynamics of the involvement of research participants in a randomized clinical trial for nicotine vaccination. Participants received an experimental nicotine vaccine or a placebo, in addition to quit smoking medication and counseling. The longitudinal design of this qualitative study allowed us to follow people from their first visit to the trial location until the unblinding of their treatment with either verum or placebo vaccine. The empirical data consisted of 49 semi-structured, in-depth interviews, field notes and memos, and trial documents collected in the Netherlands between 2010 and 2012. Participants' expectations and experiences of the innovative nicotine vaccine were characterized by ambivalence: Although they complied with the research design, throughout the study they tinkered with discourses, objects, and activities to make them serve their individual goals. They made the concepts of nicotine vaccination and placebo treatment meaningful for quitting, reshaped the meaning of research tests and obligatory visits to serve their own personal goals, and introduced a new element into the trial by creating space to discuss problems that might endanger the quit attempt. In short, the participants constructed the clinical study for nicotine vaccination as their own personal lifestyle change project. PMID:24581069

  2. Mycophenolate mofetil (RS-61443): preclinical, clinical, and three-year experience in heart transplantation.

    PubMed

    Taylor, D O; Ensley, R D; Olsen, S L; Dunn, D; Renlund, D G

    1994-01-01

    Mycophenolate mofetil (formerly known as RS-61443) is a morpholinoethyl ester of mycophenolic acid. Mycophenolic acid is a unique immunosuppressive agent because of its mechanism of action. By inhibiting the de novo pathway of purine synthesis, mycophenolic acid suppresses lymphocyte function much more than that of neutrophil, erythrocyte, and other rapidly dividing cell lines which can use the salvage purine synthesis pathway. Mycophenolate mofetil has been shown to be an effective immunosuppressive agent in both animal models and early human trials. This article describes the history, biochemistry, pharmacology, in vitro and in vivo effects, and clinical trials of myophenolate mofetil. In addition, previously unpublished 3-year follow-up of heart transplant recipients receiving mycophenolate mofetil is reported. PMID:7947873

  3. The experiences of faculty teaching in an innovative clinical immersion nursing curriculum.

    PubMed

    Paulson, Carole

    2011-01-01

    A lack of research exists regarding the impact of substantive curriculum reform on faculty teaching and attitudes. This report of an interpretive phenomenological study of one group of baccalaureate nursing faculty undergoing implementation of an innovative curriculum revealed that the curricular structure and program philosophy offered multiple new challenges. These included the integration of multiple concurrent learning activities, expansion of simulation, and a renewed focus on student assessment. The study design used Heideggerian hermeneutics, a reflexive approach to text analysis of interviews of seven full-time faculty who had worked in the school's traditional curriculum prior to the implementation of the clinical immersion model. The research offers insights into faculty adaptation to curriculum change and its effect on teaching and instruction. The results of this study may assist other schools contemplating or in the process of similar overarching program reforms. PMID:22235697

  4. [Clinical experiences of five cases with ulcerative colitis and recto- or anovaginal fistula].

    PubMed

    Koganei, Kazutaka; Kimura, Hideaki; Sugita, Akira; Arai, Katsuhiko; Fukushima, Tsuneo; Shimada, Hiroshi

    2006-12-01

    Clinical aspects, treatment and outcome of five patients with ulcerative colitis recto- or anovaginal fistula and were studied retrospectively. All patients had total colitis (relapse and remission type) and more than a 5 year history of ulcerative colitis. They all had anorectal complications, such as periproctal abscess, stenosis of fistula. Four patients had total colectomy with an ileal pouch anal canal anastomosis for intractability or dysplasia. One was treated conservatively. Complete closure of fistula was obtained in two patients;in one patient rectum was resected below the fistula and in one patient defect of the vaginal posterior wall was reconstructed by using a gluteal fold flap following colectomy. Recto- or anovaginal fistula complicating ulcerative colitis is rare but may occur in the patients with severe rectal inflammation and they can be managed by restorative proctocolectomy with an ileal pouch anal or anal canal anastomosis. PMID:17148923

  5. Infectious complications of pancreatic islet transplantation: clinical experience and unanswered questions.

    PubMed

    Pouch, Stephanie M

    2015-05-01

    Pancreatic islet transplantation is an evolving treatment modality for type I diabetes mellitus. While the field has advanced significantly over the course of the past three decades, our understanding of the infectious complications of pancreatic islet transplantation remains quite limited. This review aims to describe the current literature relating to infectious complications of pancreatic islet transplantation, including the role of microbiologically contaminated islet preparations in disease pathogenesis, our current understanding of the epidemiology and outcomes of cytomegalovirus and other infectious complications of pancreatic islet transplantation, and infectious concerns related to the use of porcine pancreatic islet cell xenografts. This review also highlights unanswered clinical questions and suggests areas of future research to mitigate infectious complications in recipients of islet transplantation. PMID:25896753

  6. Laparoscopic sterilization with the spring clip: instrumentation development and current clinical experience.

    PubMed

    Hulka, J F; Omran, K; Lieberman, B A; Gordon, A G

    1979-12-15

    Since the original spring clip sterilization studies were reported, a number of clinically important modifications to the spring clip and applicator have been developed. The spring-loaded clip, manufactured by Richard Wolf Medical Instruments Corporation of Chicago, Illinois, and Rocket of London, Inc., London, England, and New York, New York can be applied with either a one- or two-incision applicator and the clips and applicators currently available incorporate improvements to the original prototypes in design, manufacture, and quality control. The two-incision applicator is associated with significantly fewer misapplications and the high pregnancy rates reported with the original clip and applicator have not occurred with the current designs. Comparative studies between the clip and band have revealed less operative bleeding and pain associated with the clip. The method is appropriate to all women requesting sterilization but especially to those in the younger age group who may subsequently request reversal because of divorce and remarriage. PMID:160204

  7. First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder

    E-print Network

    Long, Jean-Alexandre; Lanchon, Cecilia; Voros, Sandrine; Medici, Maud; Descotes, Jean-Luc; Troccaz, Jocelyne; Cinquin, Philippe; Rambeaud, Jean-Jacques; Moreau-Gaudry, Alexandre

    2012-01-01

    Purpose: To report the feasibility and the safety of a surgeon-controlled robotic endoscope holder in laparoscopic surgery. Materials and methods: From March 2010 to September 2010, 20 patients were enrolled prospectively to undergo a laparoscopic surgery using an innovative robotic endoscope holder. Two surgeons performed 6 adrenalectomies, 4 sacrocolpopexies, 5 pyeloplasties, 4 radical prostatectomies and 1 radical nephrectomy. Demographic data, overall set-up time, operative time, number of assistants needed were reviewed. Surgeon's satisfaction regarding the ergonomics was assessed using a ten point scale. Postoperative clinical outcomes were reviewed at day 1 and 1 month postoperatively. Results: The per-protocol analysis was performed on 17 patients for whom the robot was effectively used for surgery. Median age was 63 years, 10 patients were female (59%). Median BMI was 26.8. Surgical procedures were completed with the robot in 12 cases (71 %). Median number of surgical assistant was 0. Overall set-up ...

  8. A new left ventricular assist device: clinical experience in two patients.

    PubMed

    Phillips, S J; Kongtahworn, C; Zeff, R H; Iannone, L A; Brown, T M; Kreamer, R; Gordon, D F

    1980-01-01

    A permanent parallel aortic pump (PAP), essentially a permanent intra-aortic balloon pump or modified dynamic aortic patch, has been designed to support failing left ventricles The PAP is a counterpulsation system in which an external energy source delivers a pulsatile wave into the central circulation during cardiac diastole and relaxes during cardiac systole. Clinical improvement occurred in two patients after PAP implantation. The initial regimen of continuous pumping evolved to intermittent left ventricular assistance, and the patients were able to be periodically disconnected from the pump and ambulated. The patients expired 39 and 34 days after implantation due to gastrointestinal bleeding and complications of chronic emphysema and tracheostomy. Autopsy revealed that surgery for both devices had entirely healed. PMID:6450314

  9. Clinical experience with novel oral anticoagulants for thromboprophylaxis after elective hip and knee arthroplasty.

    PubMed

    Messerschmidt, Cory; Friedman, Richard J

    2015-04-01

    Anticoagulant medications help to reduce the risk of thromboembolic events after total hip arthroplasty and total knee arthroplasty. Traditionally, this has been accomplished with medications, such as low-molecular-weight heparin and warfarin. However, these traditional anticoagulants possess a variety of shortcomings that leave much room for improvement. A new class of oral anticoagulants is now available, and present a more convenient option for safe and efficacious thromboprophylaxis in post arthroplasty patients, particularly in the outpatient setting. This review focuses on the direct thrombin inhibitor, dabigatran, and the selective factor Xa inhibitors, rivaroxaban and apixaban, and the clinical data to date about their use in total hip arthroplasty and total knee arthroplasty patients. PMID:25767271

  10. Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience

    PubMed Central

    Jeong, Seung Chan; Lee, Seungsoo; Ku, Ja Yoon

    2014-01-01

    Purpose We evaluated the clinical and therapeutic characteristics of adult cryptorchidism, which have been difficult to establish, given the small number of patients presenting to outpatient clinics. Materials and Methods A retrospective study of 20 adult patients with cryptorchid testis was performed. We analyzed their palpation of testis, location, surgical method, marital status, number of children, histologic findings, and semen analysis. Results In 17 cases with unilateral cryptorchidism, the mean age at surgery was 31.1±12.5 years. Fourteen patients had a palpable, small cryptorchid testis. The location of the testis, as verified, was inguinal in 14, prepubic in 2, and intra-abdominal in 1, respectively. We performed orchiopexy in 14 out of 15 patients who sought to have this procedure. Four among 6 married patients had children. Testis biopsy was performed in 12 patients, and all showed abnormal histologic findings. Three among 4 patients, performed semen analysis, showed abnormal findings. In three cases of bilateral cryptorchidism, the mean age at surgery was 35.7±12.5 years. All of these patients had palpated cryptorchid testes in the inguinal area and sought to have a bilateral orchiopexy. Two patients have been married but had no children. All showed abnormal findings in both testis biopsy and semen analysis. No testicular neoplasm was detected during the duration of follow-up. Conclusions Most adult patients with cryptorchidism preferred orchiopexy to orchiectomy. However, most of patients showed abnormal histology of the testis and semen analysis. Therefore, orchiopexy with regular scrotal examination may be considered a suitable treatment options for adult cryptorchidism. PMID:25237662

  11. Clinical evaluation of natural history of Peyronie's disease: our experience, old myths and new certainties.

    PubMed

    Paulis, Gianni; Cavallini, Giorgio

    2013-10-01

    Several studies describing the "natural history" of Peyronie's disease (PD) (Chronic Inflammation of the Tunica Albuginea-CITA) showed that untreated patients with PD seem to have spontaneous improvement. Because of these articles many physicians found to have a non-therapeutic behavior in case of PD. This paper tries to define the natural history of PD using penile dynamic duplex ultrasound evaluation in function of factors able to elicit fibrosis of the penis. Eighty-two patients have been studied, the mean time being between PD onset and diagnosis was 9.6 ± 3.8 months, mean age was 52.6 ± 10.69. Each patient underwent to two clinical assessments for PD, with a time-lag of 18.08 ± 9.2 months. Each assessment comprises: measurement of: plaque volume in cm(3) (with dynamic echocolor Doppler ultrasonography), penile curvature in degrees (with Kelami method), pain (with Pain Intensity Numerical Rating Scale/PINRS) and sexual function (with IIEF15 scale). The following clinical and laboratory assessments were carried out on each patient: body-mass index (BMI), blood pressure measurement, blood count, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, blood sugar, glycated haemoglobin and total testosterone. We assessed whether PD plaque volume, penile deformity, pain and modify by time, in function of risk factors of fibrosis (aging, smoking habit, erectile failure, number of comorbidities, BMI, radical prostatectomy) and/or of the severity of symptoms (plaque area, penile deformity and calcifications). Qualitative-quantitative non parametric multivariate analysis has been used as statistical test. The analysis indicated that PD symptoms increase by time in the majority of the patients, and that the increase is not linked to the severity of symptoms, but to the risk factors for developing fibrosis, with the exception of age that is inversely related. PD is a progressive disease, whose progression is linked to young age and to risk factors of fibrosis. PMID:23909888

  12. MRI experience with multiple sclerosis - Comparison to CT and clinical status

    SciTech Connect

    Reese, L.; Carr, T.; Nicholson, R.L.

    1985-05-01

    A Multiple Sclerosis (M.S.) Protocol was set--SEB (1000/60) volume acquisition and selected single slices SEC (1000/120) and IR (1500/450). Single slices SE 500/30, 1500/30 and 1530/60 were obtained for T1 and T2 calculation. New software and coils permitted multi-slice multi-echo acquisition so the Protocol was changed to multi-slice multi-echo transaxial SE 2120/60-120, and the T1 and T2 sets. The study consisted of 62 known M.S. patients and 35 controls. Of the 62 M.S. patients, 58 (94%) were positive on NMR. Thirty-two of these patients had CT scans of which 17 (53%) were positive. Of the 35 controls, 2 were positive on NMR for a false positive rate of 6%. The relative sensitivity of NMR, Double Dose Delayed CT(DDD) and contrast CT in the clinically early progressive group is 87%, 60% and 45% respectively. In the chronic stable group, the sensitivity is 100% for NMR and 55% for DDD. The NMR lesions were graded on a scale of 1 - 4 and the authors found poor correlation with either duration of disease or Kurtzke Functional Scale. The T1, T2 values showed good differentiation between white matter and lesions, although differentiation between lesions and grey matter was poor. White matter has T1 of 328 +- 28 and T2 of 85 +- 22, grey matter T1 of 515 +- 37 and T2 of 96 +- 32 and lesions T1 of 530 +- 76 and T2 of 106 +- 27. They conclude that multi-slice SE 2120/60-120 NMR imaging has proven to be a valuable tool in the clinical diagnosis of Multiple Sclerosis. Most of the lesions seen are asymptomatic and the number, size and distribution of lesions have little correlation with severity or acuity of the disease.

  13. Necessity and benefits of physician assistants' participation in international clinical experiences.

    PubMed

    Kibe, Lucy Wachera

    2012-01-01

    Several consultation stations have been set up in an unfinished stone building. My team is made up of a Kenyan physician assistant (called clinical officer), a Kenyan medical student, and me, a US physician assistant student. We are huddled around a small worn-out square table. A middle-aged woman and her two children, ages 2 and 6, approach the table. They have traveled 2 miles to the medical camp. The children, covered in dust, are emaciated with protruding abdomens, dry skin, and congested noses. The clinical officer (CO) conducts a brief interview in Swahili, the Kenyan national language. The mother explains that they have been coughing up thick yellow sputum for a week and have no appetite. They've also had diarrhea for a couple of weeks. I examine the children, who are obviously scared. Hot, moist skin. They are both running a fever. I listen to the lungs: reduced lung sounds. The protruding abdomens are rock hard. I report the findings to the team. The CO turns to the Kenyan medical student and me and quizzes us on differential diagnoses with rationale for each. We come up with malaria, pneumonia, TB, and worm infestation. Due to limited resources, medical diagnosis in Kenya relies heavily on history and physical exam. The CO explains that comorbid conditions are probable. Luckily, we have malaria-testing kits at the camp. They test negative for malaria. We decide to treat them for pneumonia. We also offer them a free hot meal, toothbrushes, T-shirts, coloring paper, and crayons. The children manage to smile. The mother is so grateful, she cries. PMID:23437625

  14. The Strategy of Combining Antidepressants in the Treatment of Major Depression: Clinical Experience in Spanish Outpatients

    PubMed Central

    Martín-López, Luis M.; Rojo, Jose E.; Gibert, Karina; Martín, Juan Carlos; Sperry, Lyli; Duñó, Lurdes; Bulbena, Antonio; Vallejo, Julio

    2011-01-01

    Introduction. The combination of antidepressants is a useful tool in the treatment of major depression, especially in cases where there is a partial response to antidepressant monotherapy. However, the use of this strategy is a matter of controversy, and its frequency of use in clinical practice is not clear. The aim of our study is to assess the use of antidepressants combination in Spain by reviewing three databases used between 1997 and 2001. Methods. Databases pertain to patients who are study subjects of major depression treatment. These databases are a result of studies performed in Spain and in which 550 psychiatrists participated. The total studied sample was comprised of N = 2, 842 patients, aged over 18, fitting DSM-IV criteria for Major Depressive Episode. The percentage of patients who received more than one antidepressant and the types of combinations used was described. Subsequently, a comparative study between the group which received a combination of antidepressants (N = 64) and the group which received antidepressant monotherapy (N = 775) was performed. Results. 27.1% of patients were on antidepressive monotherapy treatment, and 2.2% were on combination therapy. In the comparison of patients on combination therapy and monotherapy, there were significant differences only in episode duration (P = 0.001). The most frequent combinations are SSRIs and tricyclic antidepressants. The active principle most widely combined is fluoxetine. Conclusions. The prevalence of use of antidepressant combination therapy is 2.2% of the global sample and 8.3% of treated patients. Other than duration of the depressive episode, no clinical characteristics exclusive to patients who received combination rather than monotherapy were found. Our study found that the most frequent combination is SSRIs + TCAs, also being the most studied. PMID:21738865

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

    SciTech Connect

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

    1992-06-01

    This supplement to the NRA Distributed Access User's manual (PNL-7877), November 1991, describes installation and use of Version 1.1 of the software package; this is not a replacement of the previous manual. Version 1.1 of the NRA Distributed Access Package is a maintenance release. It eliminates several bugs, and includes a few new features which are described in this manual. Although the appearance of some menu screens has changed, we are confident that the Version 1.0 User's Manual will provide an adequate introduction to the system. Users who are unfamiliar with Version 1.0 may wish to experiment with that version before moving on to Version 1.1.

  16. Non-targeted radiation effects in vivo: a critical glance of the future in radiobiology.

    PubMed

    Hatzi, Vasiliki I; Laskaratou, Danae A; Mavragani, Ifigeneia V; Nikitaki, Zacharenia; Mangelis, Anastasios; Panayiotidis, Mihalis I; Pantelias, Gabriel E; Terzoudi, Georgia I; Georgakilas, Alexandros G

    2015-01-01

    Radiation-induced bystander effects (RIBE), demonstrate the induction of biological non-targeted effects in cells which have not directly hit by radiation or by free radicals produced by ionization events. Although RIBE have been demonstrated using a variety of biological endpoints the mechanism(s) of this phenomenon still remain unclear. The controversial results of the in vitro RIBE and the evidence of non-targeted effects in various in vivo systems are discussed. The experimental evidence on RIBE, indicate that a more analytical and mechanistic in depth approach is needed to secure an answer to one of the most intriguing questions in radiobiology. PMID:24333869

  17. Research in radiobiology. Annual report of work in progress in the Internal Irradiation Program

    SciTech Connect

    Miller, S.C. (ed.)

    1980-03-31

    Survival data on 160 nonirradiated control beagles of the University of Utah's Radiobiology Laboratory were analyzed. The animals died during a period from 1958 into 1979. The average age at death of animals which died during the 1958 to 1965 interval was significantly less than that of those whose deaths occurred in the 1965 to 1979 interval. The best estimate for average age at death for Super-Selected nonirradiated control beagles of the colony is 4864 +- 901 days. The Super-Selected dogs excluded those dying because of epilepsy, lymphosarcoma, lymphoma or accidents, and also excluded all dogs dying before 1966.

  18. Nuclear Physics and Radiobiology - Issues for Humans in Space and on Earth

    NASA Astrophysics Data System (ADS)

    Tripathi, Ram

    2008-10-01

    Nuclear physics is playing a vital role in human biological applications, specifically in planned space missions, in hadron radiotherapy, and in low dose radiobiology. While seemingly disparate, these and other areas share a common need for the understanding of nuclear interactions in biological systems. Radiobiology continues to provide valuable information that will help develop better methods for using radiation in the treatment of disease as well as provide a scientific basis for radiation protection standards. NASA is now focused on the agency's vision for space exploration encompassing a broad range of human and robotic missions including missions to the Moon, Mars and beyond. As a result, there is a focus on long duration space missions. Protection from hazards of space radiation has been identified as one of the five NASA critical areas for human space flight. The cost effective design of spacecraft demands a very stringent requirement on the optimization process. Exposures from the hazards of severe space radiation in deep space and/or long duration missions are very different from that of low earth orbit, and much needs to be done about their effects. However, it is clear that revolutionary technologies will need to be developed. Here on earth, particulate radiation treatment for cancer, such as proton radiotherapy, is playing an increasing important role, while the biological effectiveness remains less well understood than for x-rays and other forms of medical radiation treatments. Advanced imaging, dosimetric, Monte Carlo, and other techniques from nuclear physics are utilized to study the molecular basis of fractionation dependency and other tumor and normal tissue radiation responses, such as radiosensitivity. Moreover, advances developed by biological research efforts, such as the sequencing of the human genome, have opened new horizons for radiobiology. New techniques have made it possible to determine at the cellular / molecular level how living systems respond even to low doses of radiation. I will discuss the interplay between nuclear physics and human biological applications; Starting with high dose exposure in space applications, to controlled exposure in radiotherapy, and finally, low dose radiobiology. I will project how cellular level living system activities may provide the much needed impact of radiation exposure on living tissues in these applications.

  19. Inhalation anesthesia in experimental radiotherapy: a reliable and time-saving system for multifractionation studies in a clinical department

    SciTech Connect

    Ang, K.K. (Univ. Hospital, Leuven, Belgium); Van Der Kogel, A.J.; Van Der Schueren, E.

    1982-01-01

    An inhalation anesthesia system has been employed to overcome several of the limitations associated with the use of sodium pentobarbital and other i.p. administered anesthetics in experimental radiotherapy. The described method is reliable and time-saving. The depth and duration of anesthesia are easily controllable. Only 4 deaths have occurred with more than 6000 animal exposures. The use of polystyrene jigs is shown to provide adequate thermal isolation. Oxygen as a carrier of the anesthetic agent is expected to prevent a reduced tissue oxygenation and its radiobiological consequences. The whole system is constructed as a mobile unit in which up to 16 mice or rats can be anesthetized simultaneously and irradiated in a single field with clinical treatment equipment during short time intervals between patient irradiations. The described advantages of this method make it specially suited for experiments with protracted fractionation schedules.

  20. Adaptive Planning in Intensity-Modulated Radiation Therapy for Head and Neck Cancers: Single-Institution Experience and Clinical Implications

    SciTech Connect

    Ahn, Peter H.; Chen, Chin-Cheng [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Ahn, Andrew I. [Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Hong, Linda; Scripes, Paola G.; Shen Jin; Lee, Chen-Chiao; Miller, Ekeni; Kalnicki, Shalom [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Garg, Madhur K., E-mail: mgarg@montefiore.org [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States)

    2011-07-01

    Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

  1. Single-Isocenter Frameless Intensity-Modulated Stereotactic Radiosurgery for Simultaneous Treatment of Multiple Brain Metastases: Clinical Experience

    SciTech Connect

    Nath, Sameer K., E-mail: sameerknath@gmail.co [Department of Radiation Oncology, Rebecca and John Moores Cancer Comprehensive Cancer Center, University of California San Diego, La Jolla, CA (United States); Center for Advanced Radiotherapy Technologies, Rebecca and John Moores Cancer Comprehensive Cancer Center, University of California San Diego, La Jolla, CA (United States); Lawson, Joshua D.; Simpson, Daniel R. [Department of Radiation Oncology, Rebecca and John Moores Cancer Comprehensive Cancer Center, University of California San Diego, La Jolla, CA (United States); Center for Advanced Radiotherapy Technologies, Rebecca and John Moores Cancer Comprehensive Cancer Center, University of California San Diego, La Jolla, CA (United States)

    2010-09-01

    Purpose: To describe our clinical experience using a unique single-isocenter technique for frameless intensity-modulated stereotactic radiosurgery (IM-SRS) to treat multiple brain metastases. Methods and Materials: Twenty-six patients with a median of 5 metastases (range, 2-13) underwent optically guided frameless IM-SRS using a single, centrally located isocenter. Median prescription dose was 18 Gy (range, 14-25). Follow-up magnetic resonance imaging (MRI) and clinical examination occurred every 2-4 months. Results: Median follow-up for all patients was 3.3 months (range, 0.2-21.3), with 20 of 26 patients (77%) followed up until their death. For the remaining 6 patients alive at the time of analysis, median follow-up was 14.6 months (range, 9.3-18.0). Total treatment time ranged from 9.0 to 38.9 minutes (median, 21.0). Actuarial 6- and 12-month overall survivals were 50% (95% confidence interval [C.I.], 31-70%) and 38% (95% C.I., 19-56%), respectively. Actuarial 6- and 12-month local control (LC) rates were 97% (95% C.I., 93-100%) and 83% (95% C.I., 71-96%), respectively. Tumors {<=}1.5 cm had a better 6-month LC than those >1.5 cm (98% vs. 90%, p = 0.008). New intracranial metastatic disease occurring outside of the treatment volume was observed in 7 patients. Grade {>=}3 toxicity occurred in 2 patients (8%). Conclusion: Frameless IM-SRS using a single-isocenter approach for treating multiple intracranial metastases can produce clinical outcomes that compare favorably with those of conventional SRS in a much shorter treatment time (<40 minutes). Given its faster treatment time, this technique is appealing to both patients and personnel in busy clinics.

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

    PubMed

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

    2009-09-21

    Dose distributions generated on a static anatomy may differ significantly from those delivered to temporally varying anatomy such as for abdominal and thoracic tumors, due largely in part to the unavoidable organ motion and deformation effects stemming from respiration. In this work, the degree of such variation for three treatment techniques, namely static conventional, gating and target tracking radiotherapy, was investigated. The actual delivered dose was approximated by planning all the phases of a 4DCT image set. Data from six (n = 6) previously treated lung cancer patients were used for this study with tumor motion ranging from 2 to 10 mm. Complete radiobiological analyses were performed to assess the clinical significance of the observed discrepancies between the 3D and 4DCT image-based dose distributions. Using the complication-free tumor control probability (P+) objective, we observed small differences in P+ between the 3D and 4DCT image-based plans (<2.0% difference on average) for the gating and static conventional regimens and higher differences in P+ (4.0% on average) for the tracking regimen. Furthermore, we observed, as a general trend, that the 3D plan underestimated the P+ values. While it is not possible to draw any general conclusions from a small patient cohort, our results suggest that there exists a patient population in which 4D planning does not provide any additional benefits beyond that afforded by 3D planning for static conventional or gated radiotherapy. This statement is consistent with previous studies based on physical dosimetric evaluations only. The higher differences observed with the tracking technique suggest that individual patient plans should be evaluated on a case-by-case basis to assess if 3D or 4D imaging is appropriate for the tracking technique. PMID:19717886

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

    NASA Astrophysics Data System (ADS)

    Kalantzis, Georgios; Emfietzoglou, Dimitrios; Hadjidoukas, Panagiotis

    2012-08-01

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

  4. The Effect of Nursing Faculty Presence on Students' Level of Anxiety, Self-Confidence, and Clinical Performance During a Clinical Simulation Experience

    E-print Network

    Horsley, Trisha Leann

    2012-05-31

    Nursing schools design their clinical simulation labs based upon faculty's perception of the optimal environment to meet the students' learning needs, other programs' success with integrating high-tech clinical simulation, ...

  5. Clinical Characteristics of Dialysis Related Sclerosing Encapsulating Peritonitis: Multi-center Experience in Korea

    PubMed Central

    Kim, Beom Seok; Choi, Hoon Young; Ryu, Dong-Ryeol; Yoo, Tae Hyun; Park, Hyeong Cheon; Kang, Shin Wook; Choi, Kyu Hun; Ha, Sung Kyu; Han, Dae Suk

    2005-01-01

    Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication in patients with continuous ambulatory peritoneal dialysis (CAPD), and is characterized by a progressive, intra-abdominal, inflammatory process resulting in the formation of sheets of new fibrous tissue, which cover, bind, and constrict the viscera, thereby compromising the motility of the bowel. No satisfactory estimate is available on the comparative incidence of dialysis related SEP and the pathogenesis of SEP still remains uncertain. Although recent therapeutic approaches have reported varying degrees of success, an efficient measure to detect, at an early stage, patients at risk for SEP would be beneficial and a standardized treatment regimen to prevent the illness is urgently needed. This study aimed to evaluate the clinical features of SEP and to identify the possible risk factors for the development of SEP in CAPD patients. We retrospectively reviewed by questionnaire SEP cases among CAPD patients from 7 university hospital dialysis centers in Korea, including Yonsei University, Ajou University, Catholic University, Inha University, Kyungpook University, Seoul National University and Soonchunhyang University, from January 1981 to December 2002. Out of a total of 4,290 CAPD patients in these centers, 34 cases developed SEP with an overall prevalence of 0.79%. The male to female ratio was 17:17. The median age of these patients was 44.5 years (range 19 - 66). The median duration of CAPD before SEP was 64 months (9 - 144) and 68% of patients (23/34) had been on CAPD for more than 4 years. Peritonitis (including two fungal cases) was the main cause of catheter removal in SEP (27 cases, 79%). Seventy-five percent of the cases (15/20) were administered ?-blocker for a mean duration of 85 months (26 - 130). Among 10 cases with available peritoneal equilibration test (PET) data, 8 showed high transporter characteristics, and the remaining 2 were high average. Eighteen cases were diagnosed by clinical and radiologic methods, and 16 were surgically diagnosed. Eleven cases were surgically treated and the others were treated conservatively with intermittent total parenteral nutrition (TPN). The overall mortality rate was 24%. SEP is a serious, life threatening complication of CAPD. Most cases had a PD duration of more than 4 years, a history of severe peritonitis, and high transporter characteristics in PET. Therefore, to reduce the incidence of SEP, careful monitoring and treatment, including early catheter removal in patients with severe peritonitis, should be considered for long-term CAPD patients with the above characteristics. PMID:15744812

  6. Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience

    SciTech Connect

    Dieckmann, Karin [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria)]. E-mail: Karin.Dieckmann@akhwien.at; Georg, Dietmar [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Bogner, Joachim [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Zehetmayer, Martin [Department of Ophthalmology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Petersch, Bernhard [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Chorvat, Martin [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Weitmann, Hajo [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Poetter, Richard [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria)

    2006-11-15

    Purpose: To report on the clinical outcome of LINAC-based stereotactic radiotherapy (SRT) of uveal melanomas. Additionally, a new prototype (hardware and software) for automated eye monitoring and gated SRT using a noninvasive eye fixation technique is described. Patients and Methods: Between June 1997 and March 2004, 158 patients suffering from uveal melanoma were treated at a LINAC with 6 MV (5 x 14 Gy; 5 x 12 Gy prescribed to 80% isodose) photon beams. To guarantee identical patient setup during treatment planning (CT and MRI) and treatment delivery, patients were immobilized with a BrainLAB thermoplastic mask. Eye immobilization was achieved by instructing the patient to fixate on a light source integrated into the mask system. A mini-video camera was used to provide on-line information about the eye and pupil position, respectively. A new CT and magnetic resonance (MR) compatible prototype, based on head-and-neck fixation and the infrared tracking system ExacTrac, has been developed and evaluated since 2002. This system records maximum temporal and angular deviations during treatment and, based on tolerance limits, a feedback signal to the LINAC enables gated SRT. Results: After a median follow-up of 33.4 months (range, 3-85 months), local control was achieved in 98%. Fifteen patients (9.0%) developed metastases. Secondary enucleation was performed in 23 patients (13.8%). Long-term side effects were retinopathy (n = 70; 44%), cataract (n = 30; 23%), optic neuropathy (n = 65; 41%), and secondary neovascular glaucoma (n = 23; 13.8%). Typical situations when preset deviation criteria were exceeded were slow drifts (fatigue), large sudden eye movements (irritation), or eye closing (fatigue). In these cases, radiation was reliably interrupted by the gating system. In our clinical setup, the novel system for computer-controlled gated SRT of uveal melanoma was well tolerated by about 30 of the patients treated with this system so far. Conclusion: LINAC-based SRT of uveal melanomas provides good local control. The new prototype system improves the quality of treatment and offers the possibility of movement-gated treatments. In an ongoing study, treatment-related side effects are correlated with dose levels. Such correlations can be used to further optimize linac-based SRT of uveal melanoma.

  7. Issues and problems for radiobiological research in space.

    PubMed

    Kiefer, J

    1994-10-01

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

  8. Interviewing to develop Patient-Reported Outcome (PRO) measures for clinical research: eliciting patients’ experience

    PubMed Central

    2014-01-01

    Patient-reported outcome (PRO) measures must provide evidence that their development followed a rigorous process for ensuring their content validity. To this end, the collection of data is performed through qualitative interviews that allow for the elicitation of in-depth spontaneous reports of the patients’ experiences with their condition and/or its treatment. This paper provides a review of qualitative research applied to PRO measure development. A clear definition of what is a qualitative research interview is given as well as information about the form and content of qualitative interviews required for developing PRO measures. Particular attention is paid to the description of interviewing approaches (e.g., semi-structured and in-depth interviews, individual vs. focus group interviews). Information about how to get prepared for a qualitative interview is provided with the description of how to develop discussion guides for exploratory or cognitive interviews. Interviewing patients to obtain knowledge regarding their illness experience requires interpersonal and communication skills to facilitate patients’ expression. Those skills are described in details, as well as the skills needed to facilitate focus groups and to interview children, adolescents and the elderly. Special attention is also given to quality assurance and interview training. The paper ends on ethical considerations since interviewing for the development of PROs is performed in a context of illness and vulnerability. Therefore, it is all the more important that, in addition to soliciting informed consent, respectful interactions be ensured throughout the interview process. PMID:24499454

  9. Clinical and Oncological Value of Preoperative BMI in Gastric Cancer Patients: A Single Center Experience

    PubMed Central

    Voglino, Costantino; Di Mare, Giulio; Ferrara, Francesco; De Franco, Lorenzo; Roviello, Franco; Marrelli, Daniele

    2015-01-01

    Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results. Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25–30, group B), and an obesity group (?30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival. Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren's histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male gender (P < 0.05), diabetes (P < 0.001), and serum blood proteins (P < 0.01). A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups. Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients.

  10. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis

    PubMed Central

    Dalmau, Josep; Lancaster, Eric; Martinez-Hernandez, Eugenia; Rosenfeld, Myrna R; Balice-Gordon, Rita

    2011-01-01

    Since its discovery in 2007, the encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) has entered the mainstream of neurology and other disciplines. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, and language disintegration into a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. The disorder predominantly affects children and young adults, occurs with or without tumour association, and responds to treatment but can relapse. The presence of a tumour (usually an ovarian teratoma) is dependent on age, sex, and ethnicity, being more frequent in women older than 18 years, and slightly more predominant in black women than it is in white women. Patients treated with tumour resection and immunotherapy (corticosteroids, intravenous immunoglobulin, or plasma exchange) respond faster to treatment and less frequently need second-line immunotherapy (cyclophosphamide or rituximab, or both) than do patients without a tumour who receive similar initial immunotherapy. More than 75% of all patients have substantial recovery that occurs in inverse order of symptom development and is associated with a decline of antibody titres. Patients’ antibodies cause a titre-dependent, reversible decrease of synaptic NMDAR by a mechanism of crosslinking and internalisation. On the basis of models of pharmacological or genetic disruption of NMDAR, these antibody effects reveal a probable pathogenic relation between the depletion of receptors and the clinical features of anti-NMDAR encephalitis. PMID:21163445

  11. Initial Clinical Experience Performing Patient Treatment Verification With an Electronic Portal Imaging Device Transit Dosimeter

    SciTech Connect

    Berry, Sean L., E-mail: BerryS@MSKCC.org [Department of Applied Physics and Applied Mathematics, Columbia University, New York, New York (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Polvorosa, Cynthia; Cheng, Simon; Deutsch, Israel; Chao, K. S. Clifford; Wuu, Cheng-Shie [Department of Radiation Oncology, Columbia University, New York, New York (United States)

    2014-01-01

    Purpose: To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry. Methods and Materials: Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm ? criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm ? criterion. Results: There were 288 transit images analyzed. The overall ? pass rate was 89.1% ± 9.8% (average ± 1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the ? pass rate was 95.7% ± 2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment. Conclusions: The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.

  12. Clinical Characteristics of Pediatric Thalassemia in Korea: A Single Institute Experience

    PubMed Central

    Hong, Che Ry; Kang, Hyoung Jin; Lee, Ji Won; Kim, Hyery; Kim, Nam Hee; Park, Kyung Duk; Park, June Dong; Seong, Moon-Woo; Park, Sung Sup; Ahn, Hyo Seop

    2013-01-01

    Few literatures have elaborated on the clinical characteristics of children with thalassemia from low-prevalence areas. A retrospective analysis was conducted on children genetically confirmed with thalassemia at Seoul National University Children's Hospital in Korea. Nine children (1? thalassemia trait, 6? thalassemia minor, 2? thalassemia intermedia) were diagnosed with thalassemia at median age of 4.3 yr old with median hemoglobin of 9.7 g/dL. Seven (78%) children were incidentally found to be anemic and only 2 with ? thalassemia intermedia had presenting symptoms. Five children (56%) were initially misdiagnosed with iron deficiency anemia. Despite the comorbidities due to ? thalassemia mental retardation syndrome, the child with ? thalassemia trait had mild hematologic profile. Children with ? thalassemia intermedia had the worst phenotypes due to dominantly inherited mutations. None of the children was transfusion dependent and most of them had no complications associated with thalassemia. Only 1 child (11%) with codon 60 (T?A) mutation of the HBB gene needed red blood cell transfusions. He also had splenomegaly, cholelithiasis, and calvarial vault thickening. Pediatricians in Korea must acknowledge thalassemia as a possible diagnosis in children with microcytic hypochromic hemolytic anemia. High level of suspicion will allow timely diagnosis and managements. PMID:24265529

  13. Interdisciplinary preceptor teams to improve the clinical nurse leader student experience.

    PubMed

    Moore, Penny; Schmidt, Debra; Howington, Lynnette

    2014-01-01

    The Clinical Nurse Leader (CNL) role was introduced by the American Association of Colleges of Nursing (AACN) in 2003 (AACN, 2003). There are now over 2,500 certified CNLs in the United States. Still some areas of the country have no CNLs in practice; this was true of north central Texas until May 2010 when Texas Christian University (TCU) had its first graduating class. Lack of CNLs to serve as preceptors for the practicum courses in the CNL program was one concern, although AACN does offer options when CNLs are not available. TCU's CNL teaching team developed the interdisciplinary preceptor team (IPT) model to strengthen the practicum component of CNL education at TCU. One advantage of the IPT model is the match it provides with several CNL competencies: lateral integration of care via interdisciplinary teams, member and leader of health care teams, skillful communication within teams, and implementation of an interdisciplinary approach to safe, quality, patient care. Components of the IPT model are discussed with specific information about preceptor selection, team development, and examples of feedback from preceptors and students. PMID:24939328

  14. The effect of the photobiomodulation in the treatment of Bell's palsy: clinical experience

    NASA Astrophysics Data System (ADS)

    Colombo, Fabio; Marques, Aparecida Maria C.; Carvalho, Carolina M.; Paraguassu, Gardenia M.; de Sousa, José A. C.; Magalhaes, Edival; Cangussu, Maria Cristina T.; de A. Reis, Silvia Regina; Pinheiro, Antonio Luiz B.

    2012-03-01

    The Bell's palsy (G51) consists of a unilateral face paralysis that sudden begins with unknown cause and can result in complete mimic loss or partial paralysis of the face. Damage to the VII cranial nerve can be found in the pathology, promoting mussel's inactivity. The light Photobiomodulation (LPBM) has presented ability of rush the tissue repair, favoring the regeneration of neural structures. The present study aimed to assess the effectiveness use of the 780nm laser and 850nm LED (light-emitting diode) in the treatment of the face paralysis. Were evaluated 14 patients that suffer of Bell's palsy whom were submitted to the light administration, on the Laser Clinic of the UFBA between 2005 and 2010. The treatment was performed by infrared Laser in 11 patients (78.57%), and by LED in 3 patients (21.42%). At the end of the 12 sections, 11 patients (78.57%) had presented themselves cure or with substantial improvement of the initial picture, however 3 patients (21.42%) dealt with infra-red Laser ?780nm had not evolution. The light presented as an effective method for the treatment of Bell's palsy, but the association with the physiotherapy and medications is important.

  15. CT-Guided Interventions Using a Free-Hand, Optical Tracking System: Initial Clinical Experience

    SciTech Connect

    Schubert, Tilman, E-mail: TSchubert@uhbs.ch; Jacob, Augustinus L.; Pansini, Michele [University Hospital Basel, Department of Radiology and Nuclear Medicine (Switzerland); Liu, David [Vancouver General Hospital, University of British Columbia, Department of Radiology (Canada); Gutzeit, Andreas [Winterthur Cantonal Hospital, Department of Radiology (Switzerland); Kos, Sebastian [University Hospital Basel, Department of Radiology and Nuclear Medicine (Switzerland)

    2013-08-01

    PurposeThe present study was designed to evaluate the geometrical accuracy and clinical applicability of a new, free-hand, CT-guided, optical navigation system.MethodsFifteen procedures in 14 consecutive patients were retrospectively analyzed. The navigation system was applied for interventional procedures on small target lesions, in cases with long needle paths, narrow access windows, or when an out-of-plane access was expected. Mean lesion volume was 27.9 ml, and mean distance to target measured was 107.5 mm. Eleven of 15 needle trajectories were planned as out-of-plane approaches regarding the axial CT plane.ResultsNinety-one percent of the biopsies were diagnostic. All therapeutic interventions were technically successful. Targeting precision was high with a mean distance of the needle tip from planned target of 1.98 mm. Mean intervention time was 1:12 h. A statistically significant correlation between angular needle deviation and intervention time (p = 0.007), respiratory movement of the target (p = 0.008), and body mass index (p = 0.02) was detected. None of the evaluated parameters correlated significantly with the distance from the needle tip to the planned target.ConclusionsThe application of a navigation system for complex CT-guided procedures provided safe and effective targeting within a reasonable intervention time in our series.

  16. A novel vacuum device for extremity immobilisation during digital angiography: preliminary clinical experiences.

    PubMed

    Bale, R J; Lottersberger, C; Vogele, M; Prassl, A; Czermak, B; Dessl, A; Sweeney, R A; Waldenberger, P; Jaschke, W

    2002-12-01

    Our objective was to develop and evaluate a non-invasive device for rigid immobilisation during extremity angiography. The patented BodyFix immobilisation device (Medical Intelligence, Schwabmünchen, Germany) consists of a vacuum pump connected to special cushions and a plastic foil that covers the body part to be immobilised. First, the patient's extremity is covered by a thin plastic bag and then wrapped in one of the cushions, placed on the top of the therapy couch, and covered with the plastic foil. The air is evacuated from the cushion under the covering foil by the vacuum pump, resulting a hardening of the cushion and thus immobilisation of the patient's extremity. The rigid immobilisation resulted in a complete absence of motion artefacts in the majority of patients. No pixeling of the images was required in any of the 100 patients vs 32% in the control group. Repetition of series could be avoided in all cases and a substantial increase in the quality of the images was obtained. Setup of the device takes an additional 1-2 min. Vacuum immobilisation allows for comfortable, effective immobilisation during digital subtraction angiography, eliminating motion artefacts. This device has become an indispensable tool in daily clinical routine at our department. PMID:12439566

  17. Suicidal thoughts in cancer patients: clinical experience in psycho-oncology.

    PubMed

    Akechi, T; Kugaya, A; Okamura, H; Nakano, T; Okuyama, T; Mikami, I; Shima, Y; Yamawaki, S; Uchitomi, Y

    1999-10-01

    Because cancer is a life-threatening illness, its impact on the patient's emotional well-being, such as suicidal thoughts, has become a significant problem in public health as well as in clinical oncology. Factors such as the pain and hopelessness are suggested as making cancer patients more vulnerable to suicide. On the other hand, euthanasia and physician-assisted suicide are now important medical and social issues all over the world. However, little is known about the relationship between the characteristics of cancer patients and suicidal thoughts. The present study investigated the characteristics of patients who were referred to the Psychiatry Division, National Cancer Center Hospital East, due to risk of suicide or suicide attempts. Fourteen patients were referred, representing 3.9% of all consultations. Most of these patients suffered from advanced cancer and poor physical functioning. The most frequent psychiatric diagnosis was mood disorder (57%), and the next was delirium (29%). In patients with mood disorders (8 cases), suicidal thoughts disappeared after psychiatric treatment in 5 cases, but not in 3 cases. Those three patients survived a significantly shorter time than the others after psychiatric consultation. These empirical data might indicate that most suicidal thoughts experienced by cancer patients are not rational, and a careful evaluation, including psychiatric assessment, should be conducted in such patients. PMID:10595681

  18. Imaging breast lesions using the Twente photoacoustic mammoscope: ongoing clinical experience

    NASA Astrophysics Data System (ADS)

    Heijblom, M.; Piras, D.; Xia, W.; van Hespen, J. C. G.; van den Engh, F. M.; Klaase, J. M.; van Leeuwen, T. G.; Steenbergen, W.; Manohar, S.

    2012-02-01

    Current imaging modalities are often not able to detect early stages of breast cancer with high imaging contrast. Visualizing malignancy-associated increased hemoglobin concentrations might improve breast cancer diagnosis. Photoacoustic imaging can visualize hemoglobin in tissue with optical contrast and ultrasound resolution, which makes it potentially ideal for breast imaging. The Twente Photoacoustic Mammoscope (PAM) has been designed specifically for this purpose. Based on a successful pilot study in 2007, a large clinical study using PAM has been started in December 2010. PAM uses a pulsed Q-switched Nd:YAG laser at 1064 nm to illuminate a region of interest on the breast. Photoacoustic signals are detected with a 1MHz, unfocused ultrasound detector array. Three dimensional data are reconstructed using an acoustic backprojection algorithm. Those reconstructed images are compared with conventional imaging and histopathology. In the first phase of the study, the goal was to optimize the visualization of malignancies. We performed sixteen technically acceptable measurements on confined breast malignancies. In the reconstructed volumes of all malignancies, a confined high contrast region could be identified at the expected lesion depth. After ten successful measurements, the illumination area was increased and the fluence was substantially decreased. This caused a further significant increase in PAM lesion contrast.

  19. Paediatric dilated cardiomyopathy: clinical profile and outcome. The experience of a tertiary centre for paediatric cardiology.

    PubMed

    Miranda, Joana O; Costa, Liane; Rodrigues, Esmeralda; Teles, Elisa L; Baptista, Maria J; Areias, José C

    2015-02-01

    Dilated cardiomyopathy is the most common form of cardiomyopathy in the paediatric population and an important cause of heart transplantation in children. The clinical profile and course of dilated cardiomyopathy in children have been poorly characterised. A retrospective review of 61 patients (37 female; 24 male) diagnosed with dilated cardiomyopathy from January, 2005 to June, 2012 at a single institution was performed. The median age at diagnosis was 15 months. Heart failure was present in 83.6% of patients and 44.3% required intensive care. The most prevalent causes were idiopathic (47.5%), viral myocarditis (18.0%) and inherited metabolic diseases (11.5%). In viral myocarditis, Parvovirus B19 was the most common identified agent, in concurrence with the increasing incidence documented recently. Inherited metabolic diseases were responsible for 11.5% of dilated cardiomyopathy cases compared with the 4-6% described in the literature, which reinforces the importance of considering this aetiology in differential diagnosis of paediatric dilated cardiomyopathy. The overall mortality rate was 16.1% and five patients underwent heart transplantation. In our series, age at diagnosis and aetiology were the most important prognosis factors. We report no mortality in the five patients who underwent heart transplantation, after 2 years of follow-up. PMID:24423967

  20. In-vivo measurement of phosphorus in bones of the hands: ten years of clinical experience

    NASA Astrophysics Data System (ADS)

    Kalef-Ezra, John A.; Hatzikonstantinou, Ioannis; Glaros, Dimitrios C.; Yasumura, Seiichi

    1997-02-01

    A facility was constructed for the in vivo measurement of phosphorus in the bones of the human hands. The technique is based on the detection of the delayed (gamma) -rays emitted from 28Al produced via the 31P(n,(alpha) )28Al reaction. The 4-min irradiation by two 241Am-Be sources is followed by a 4-min counting of the induced activity with two Nal(Tl) detectors. The long-term in vivo precision of the measurements was found to be 2.8 percent and the effective dose is 50 (mu) Sv. To date, well over 1000 measurements have been carried out. The amount of phosphorus in hands in healthy adults was correlated with sex, age, height, forearm bone mineral content, bone mineral density in the spine, total body fat free mass and total body cell mass. Moreover, the measurement of phosphorus in the bones of the hands of patients provided answers to a number of clinical problems.

  1. CSD, BBB and MMP-9 elevations: animal experiments versus clinical phenomena in migraine.

    PubMed

    Gupta, Vinod Kumar

    2009-11-01

    Cortical spreading depression (CSD) has been at the center stage of migraine pathophysiology for approximately six decades. Reanalysis of CSD reveals several major unbridgeable gaps in this experimental neurophysiologic concept for migraine. Key phenotypic and pharmacological features of migraine challenge the assumed pathophysiologic role of CSD. Detection of subclinical infarct-like white matter lesions (WMLs) in the brain of some migraine patients stimulated the concept of CSD-related BBB disruption. Raised plasma levels of matrix metalloproteinases (MMPs) in migraine patients in the headache phase, specifically MMP-9, suggested a pathogenetic role for MMP elevation in the development of both migraine attacks and WMLs. Migraine attacks with or without aura present a unique, profound and protracted vasodilatory challenge to the homeostatic systems of the brain. To accommodate the rather sudden increase in cerebral blood flow, the brain circulatory network must dilate and the BBB must expand considerably. MMPs can influence expansion of the extracellular matrix of the BBB and loosening of the intercellular tight junctions between endothelial cells through proteolytic degradation during migrainous cerebrovascular dilatation. WMLs most probably reflect transient and discrete breakdown of the BBB consequent to sustained cerebral hyperperfusion rather than hypoperfusion. Systemic elevations of MMPs are not specific to migraine but are found in a variety of neurological and extra-neurological disorders. This perspective presents a conceptual dissociation between the effects of CSD on the brain of experimental animals and the clinical phenomena in migraine patients. PMID:19903020

  2. Clinical experience with intravenous zoledronic acid in the treatment of male osteoporosis: evidence and opinions

    PubMed Central

    Ruza, Ieva; Mirfakhraee, Sasan; Orwoll, Eric

    2013-01-01

    Osteoporosis frequently remains underrecognized and undertreated in men. Most osteoporosis-related fractures could be prevented if men at risk would be diagnosed, treated, and remained compliant with therapy. Bisphosphonates, the mainstay of osteoporosis treatment, are potent antiresorptive agents that inhibit osteoclast activity, suppress in vivo markers of bone turnover, increase bone mineral density, decrease fractures, and likely improve survival in men with osteoporosis. The focus of the article is on intravenous zoledronic acid, which may be a preferable alternative to oral bisphosphonate therapy in patients with cognitive dysfunction, the inability to sit upright, polypharmacy, significant gastrointestinal pathology or suspected medication noncompliance. Zoledronic acid is approved in the United States (US) and European Union (EU) as an annual 5 mg intravenous infusion to treat osteoporosis in men. The zoledronic acid 4 mg intravenous dose has been studied in the prevention of bone loss associated with androgen deprivation therapy. This article reviews the evidence for zoledronic acid, currently the most potent bisphosphonate available for clinical use, and its therapeutic effects in the treatment of men with osteoporosis. PMID:23904863

  3. Radiobiological foundation of crew radiation risk for Mars mission

    NASA Astrophysics Data System (ADS)

    Aleksandr, Shafirkin; Grigoriev, Yurj

    The results of a comprehensive clinico-physiological study of 250 dogs after 22 hours per day chronic exposure to gamma-radiation throughout their life are presented. The exposure duration was 3 and 6 years. The dose rate varied between 25 and 150 cSv/year to simulate galactic cosmic ray dose of crew members during mars mission. Several groups of the dogs received an additional acute dose of 10 and 50 cSv during a day three times per year to simulate stochastic irradiation caused by solar cosmic rays. Data on the status of regulatory systems of organism, exchange processes dynamics, organism reaction on additional functional loads are also presented. Organism reaction and dynamics of kinetic relations are considered in detail for most radiosensitive and regenerating tissue systems of the organism, namely, bloodforming system and spermatogenic epithelium. The results on life span reduction of the dogs and dog race characteristics after the radiation exposure are discussed. Based on the results obtained in this study and in model experiments realized with big amount of small laboratory animals that were exposed to a wide dose range, using other published data, mathematical models were developed, e. g. a model of radiation damage forming as dependent on time with taking into account recovery processes, and a model of radiation mortality rate of mammals. Based on these models and analysis of radiation environment behind various shielding on the route to Mars, crew radiation risk was calculated for space missions of various durations. Total radiation risk values for cosmonaut lifetime after the missions were also estimated together with expected life span reduction.

  4. Design of, and some clinical experience with, a novel optical surface measurement system in radiotherapy

    NASA Astrophysics Data System (ADS)

    Price, G. J.; Marchant, T. E.; Parkhurst, J. M.; Sharrock, P. J.; Whitfield, G.; Moore, C. J.

    2010-04-01

    Optical imaging is becoming more prevalent in image guided radiotherapy as a complementary technology to traditional ionizing radiation based modalities. We present a novel structured light based device that can capture a patient's body surface topology with a large field of view and high spatial and temporal resolution. The system is composed of three cross-calibrated sensor heads that enable 'wrap around' imaging previously unavailable with similar line of sight optical techniques. The system has been installed in a treatment bunker at the Christie Hospital alongside an Elekta linear accelerator equipped with cone beam CT (CBCT) on-board imaging. In this paper we describe the system, focussing on the methodologies required to create a robust and practical device. We show examples of measurements made to ascertain its repeatability and accuracy, and present some initial experiences in using the device for pre-treatment patient set-up.

  5. Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study.

    PubMed

    Kashyap, Shankar N; van Ommeren, J W

    2008-06-01

    We compared 25 consecutive cases of total knee arthroplasty performed through less invasive techniques with 25 cases of age and BMI matched cases of standard knee replacements. Early experience suggests functional recovery is earlier with less invasive technique as compared with open access. Patients in less invasive group had better knee flexion (an average of 116 degrees compared to 97 degrees ), walking ability and stair climbing at 6 months than those with standard technique at 6 months. At 2 years this difference was maintained to a lesser extent. More patients with less invasive group could kneel and could do "normal up and down" the stairs at 6 months and also at 2 years. There was no significant difference in alignment and component sizing between the two groups. This should translate to similar long term results after less invasive knee arthroplasty as after open access total knee arthroplasty. PMID:18365178

  6. Photodynamic diagnosis following intravesical instillation of aminolevulinic acid (ALA): first clinical experiences in urology

    NASA Astrophysics Data System (ADS)

    Baumgartner, Reinhold; Kriegmair, M.; Stepp, Herbert G.; Lumper, W.; Heil, Peter; Riesenberg, Rainer; Stocker, Susanne; Hofstetter, Alfons G.

    1993-06-01

    Delta Aminolevulinic acid (ALA), a precursor of Protoporphyrin IX (PP IX) in hem biosynthesis has been topically applied in urinary bladders in order to study its potential as fluorescent tumor marker. Preclinical experiments have been performed on chemically induced tumors in rats, revealing a ratio of PP IX-fluorescence intensity up to 20:1 in tumors as compared to healthy urothelium. Synthesis of PP IX has been stimulated in 56 patients by intravesical instillation of a pH-neutral ALA-solution. After an incubation time of two to four hours strong red fluorescence was endoscopically observed even in tiny superficial tumors. Brightness and contrast allows visualization of early stage urothelial diseases with naked eyes and without the necessity suppressing background fluorescence or violet excitation light.

  7. First clinical experience and in situ treatment of ureteric stones using Lithostar Multiline lithotripter.

    PubMed

    Thüroff, S; Chaussy, C G

    1995-10-01

    This article reviews the first experience using the Siemens Lithostar Multiline lithotripter in 372 consecutive treatments of ureteric and kidney stones. The disintegration rate was 97.7%, and a stone-free rate of 87% was achieved at the end of 3 months. Auxillary procedures were required in only 11% of the patients. No medication was required for pain management in 60.4% of the patients. The results were especially impressive in the management of ureteric stones, with a success rate of 91%, these patients being stone free after 1 week using the new booster technique. Analysis of the data indicates that the Siemens Lithostar Multiline is a safe, effective, and economically sound device to treat patients with ureteric and renal stones. PMID:8580933

  8. Technical experience from clinical studies with INPRES and a concept for a miniature augmented reality system

    NASA Astrophysics Data System (ADS)

    Sudra, Gunther; Marmulla, Ruediger; Salb, Tobias; Gockel, Tilo; Eggers, Georg; Giesler, Bjoern; Ghanai, Sassan; Fritz, Dominik; Dillmann, Ruediger; Muehling, Joachim

    2005-04-01

    This paper is going to present a summary of our technical experience with the INPRES System -- an augmented reality system based upon a tracked see-through head-mounted display. With INPRES a complete augmented reality solution has been developed that has crucial advantages when compared with previous navigation systems. Using these techniques the surgeon does not need to turn his head from the patient to the computer monitor and vice versa. The system's purpose is to display virtual objects, e.g. cutting trajectories, tumours and risk-areas from computer-based surgical planning systems directly in the surgical site. The INPRES system was evaluated in several patient experiments in craniofacial surgery at the Department of Oral and Maxillofacial Surgery/University of Heidelberg. We will discuss the technical advantages as well as the limitations of INPRES and present two strategies as a result. On the one hand we will improve the existing and successful INPRES system with new hardware and a new calibration method to compensate for the stated disadvantage. On the other hand we will focus on miniaturized augmented reality systems and present a new concept based on fibre optics. This new system should be easily adaptable at surgical instruments and capable of projecting small structures. It consists of a source of light, a miniature TFT display, a fibre optic cable and a tool grip. Compared to established projection systems it has the capability of projecting into areas that are only accessible by a narrow path. No wide surgical exposure of the region is necessary for the use of augmented reality.

  9. Patterns in deer-related traffic injuries over a decade: the Mayo clinic experience

    PubMed Central

    2010-01-01

    Background Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC). We characterized injury patterns between motorcycle/all-terrain vehicles (MCC) and automobile (MVC) crashes related to dMVC (deer motor vehicle crash) with the hypotheses that MCC will present with higher Injury Severity Score (ISS) and that it would be related to whether the driver struck the deer or swerved. Methods The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS). Results Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p < 0.001). Median Abbreviated Injury Score (AIS) of the spine for MCC riders was higher (3 vs 0, p < 0.001) if they swerved rather than collided. Seventy-seven percent of riders were not wearing a helmet which did not result in a statistically significant increase in median ISS (16 vs 10), head AIS (2 vs 0) or spine AIS (0 vs 0). Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5) and AIS of all body regions. Conclusions Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained. PMID:20716341

  10. Clinical profile and outcome of renal tubular disorders in children: A single center experience

    PubMed Central

    Kiran, B. Vijay; Barman, H.; Iyengar, A

    2014-01-01

    Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT) in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA) (44%), Bartter-like (Bartter's and Gitelman) syndromes (22%) followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome) (13%) and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11) years. Growth failure was the presenting feature in 86% of children followed by polyuria (60%) and bone deformities (47%). In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD) within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well. PMID:25484529

  11. Initial clinical experience with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO)

    PubMed Central

    Tuan, J.; Vischioni, B.; Fossati, P.; Srivastava, A.; Vitolo, V.; Iannalfi, A.; Fiore, M.R.; Krengli, M.; Mizoe, J.E.; Orecchia, R.

    2013-01-01

    We report the initial toxicity data with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). In September 2011, CNAO commenced patient treatment with scanned proton beams within two prospective Phase II protocols approved by the Italian Health Ministry. Patients with chondrosarcoma or chordoma of the skull base or spine were eligible. By October 2012, 21 patients had completed treatment. Immobilization was performed using rigid non-perforated thermoplastic-masks and customized headrests or body-pillows as indicated. Non-contrast CT scans with immobilization devices in place and MRI scans in supine position were performed for treatment-planning. For chordoma, the prescribed doses were 74 cobalt grey equivalent (CGE) and 54 CGE to planning target volume 1 (PTV1) and PTV2, respectively. For chondrosarcoma, the prescribed doses were 70 CGE and 54 CGE to PTV1 and PTV2, respectively. Treatment was delivered five days a week in 35–37 fractions. Prior to treatment, the patients' positions were verified using an optical tracking system and orthogonal X-ray images. Proton beams were delivered using fixed-horizontal portals on a robotic couch. Weekly MRI incorporating diffusion-weighted-imaging was performed during the course of proton therapy. Patients were reviewed once weekly and acute toxicities were graded with the Common Terminology Criteria for Adverse Events (CTCAE). Median age of patients = 50 years (range, 21–74). All 21 patients completed the proton therapy without major toxicities and without treatment interruption. Median dose delivered was 74 CGE (range, 70–74). The maximum toxicity recorded was CTCAE Grade 2 in four patients. Our preliminary data demonstrates the clinical feasibility of scanned proton beams in Italy. PMID:23824124

  12. Evaluation of Analytical Errors in a Clinical Chemistry Laboratory: A 3 Year Experience

    PubMed Central

    Sakyi, AS; Laing, EF; Ephraim, RK; Asibey, OF; Sadique, OK

    2015-01-01

    Background: Proficient laboratory service is the cornerstone of modern healthcare systems and has an impact on over 70% of medical decisions on admission, discharge, and medications. In recent years, there is an increasing awareness of the importance of errors in laboratory practice and their possible negative impact on patient outcomes. Aim: We retrospectively analyzed data spanning a period of 3 years on analytical errors observed in our laboratory. The data covered errors over the whole testing cycle including pre-, intra-, and post-analytical phases and discussed strategies pertinent to our settings to minimize their occurrence. Materials and Methods: We described the occurrence of pre-analytical, analytical and post-analytical errors observed at the Komfo Anokye Teaching Hospital clinical biochemistry laboratory during a 3-year period from January, 2010 to December, 2012. Data were analyzed with Graph Pad Prism 5(GraphPad Software Inc. CA USA). Results: A total of 589,510 tests was performed on 188,503 outpatients and hospitalized patients. The overall error rate for the 3 years was 4.7% (27,520/58,950). Pre-analytical, analytical and post-analytical errors contributed 3.7% (2210/58,950), 0.1% (108/58,950), and 0.9% (512/58,950), respectively. The number of tests reduced significantly over the 3-year period, but this did not correspond with a reduction in the overall error rate (P = 0.90) along with the years. Conclusion: Analytical errors are embedded within our total process setup especially pre-analytical and post-analytical phases. Strategic measures including quality assessment programs for staff involved in pre-analytical processes should be intensified. PMID:25745569

  13. Vertebral Augmentation with Nitinol Endoprosthesis: Clinical Experience in 40 Patients with 1-Year Follow-up

    SciTech Connect

    Anselmetti, Giovanni Carlo, E-mail: gc.anselmetti@fastwebnet.it [Villa Maria Hospital, Interventional Radiology Unit (Italy); Manca, Antonio, E-mail: anto.manca@gmail.com [Institute for Cancer Research and Treatment (IRCC), Interventional Radiology Unit (Italy); Marcia, Stefano, E-mail: stemarcia@gmail.com [Institute of Radiology, University of Cagliari (Italy); Chiara, Gabriele, E-mail: gabriele.chiara@ircc.it [Institute for Cancer Research and Treatment (IRCC), Interventional Radiology Unit (Italy); Marini, Stefano, E-mail: stemarini@gmail.com [Institute of Radiology, University of Cagliari (Italy); Baroud, Gamal, E-mail: gamalbaroud@gmail.com [University of Sherbrooke, Departement de Genie Mecanique (Canada); Regge, Daniele, E-mail: daniele.regge@ircc.it [Institute for Cancer Research and Treatment (IRCC), Radiology Unit (Italy); Montemurro, Filippo, E-mail: filippo.montemurro@ircc.it [Institute for Cancer Research and Treatment (IRCC), Internal Medicine Unit (Italy)

    2013-05-08

    PurposeThis study was designed to assess the clinical outcomes of patients treated by vertebral augmentation with nitinol endoprosthesis (VNE) to treat painful vertebral compression fractures.MethodsForty patients with one or more painful osteoporotic VCF, confirmed by MRI and accompanied by back-pain unresponsive to a minimum 2 months of conservative medical treatment, underwent VNE at 42 levels. Preoperative and postoperative pain measured with Visual Analog Scale (VAS), disability measured by Oswestry Disability Index (ODI), and vertebral height restoration (measured with 2-dimensional reconstruction CT) were compared at last follow-up (average follow-up 15 months). Cement extravasation, subsequent fractures, and implant migration were recorded.ResultsLong-term follow-up was obtained in 38 of 40 patients. Both VAS and ODI significantly improved from a median of 8.0 (range 5–10) and 66 % (range 44–88 %) to 0.5 (range 0–8) and 6 % (range 6–66 %), respectively, at 1 year (p < 0.0001). Vertebral height measurements comparing time points increased in a statistically significant manner (ANOVA, p < 0.001). Overall cement extravasation rate was 9.5 %. Discal and venous leakage rates were 7.1 and 0 % respectively. No symptomatic extravasations occurred. Five of 38 (13.1 %) patients experienced new spontaneous, osteoporotic fractures. No device change or migration was observed.ConclusionsVNE is a safe and effective procedure that is able to provide long-lasting pain relief and durable vertebral height gain with a low rate of new fractures and cement leakages.

  14. Clinical profile and outcome of renal tubular disorders in children: A single center experience.

    PubMed

    Kiran, B Vijay; Barman, H; Iyengar, A

    2014-11-01

    Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT) in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA) (44%), Bartter-like (Bartter's and Gitelman) syndromes (22%) followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome) (13%) and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11) years. Growth failure was the presenting feature in 86% of children followed by polyuria (60%) and bone deformities (47%). In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD) within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well. PMID:25484529

  15. Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy

    PubMed Central

    Kimura, Tomoki; Doi, Yoshiko; Nakashima, Takeo; Imano, Nobuki; Katsuta, Tsuyoshi; Takahashi, Shigeo; Kenjo, Masahiro; Ozawa, Shuichi; Murakami, Yuji; Nagata, Yasushi

    2015-01-01

    The purpose of this study was to evaluate the efficacy and safety of volumetric modulated arc therapy (VMAT) after extrapleural pneumonectomy (EPP) in patients with malignant pleural mesothelioma (MPM). A total of 15 patients who received VMAT after EPP were enrolled. All patients were males, and the median age was 67 years (Stage IB in two, II in six, and III in seven patients). The clinical target volume (CTV) included the entire preoperative ipsilateral hemithorax and involved nodal stations. The CTV was generally expanded by 10–15 mm beyond the planning target volume (PTV). The dose prescription was designed to cover 95% of the PTV with 54 Gy in 30 fractions. The median follow-up period was 11 months. Treatment-related toxicities were evaluated by Common Terminology Criteria for Adverse Events (CTCAE) ver. 4. One-year local control, disease-free survival, and overall survival rates were 55.7% [95% confidence interval (CI): 25.6–85.8%], 29.3% (95% CI: 5.3–53.3%), and 43.1% (95% CI: 17.1–69.0%), respectively. According to the histological analysis, the one-year LC rate was significantly worse in patients with non-epithelial type (biphasic and sarcomatoid types) than in patients with epithelial type [epithelial type: 83.3% (95% CI, 53.5–100%), non-epithelial type: 0% (95% CI, 0%), P = 0.0011]. Grade 3 pneumonitis after VMAT was observed in three patients (20.0%); however, no patients died of pulmonary toxicity. VMAT appears to be relatively safe for patients with MPM after EPP because of the low pulmonary dose. PMID:25599996

  16. Etiology and clinical profile of patients with Cushing's syndrome: A single center experience

    PubMed Central

    Ammini, Ariacherry C.; Tandon, Nikhil; Gupta, Nandita; Bhalla, Ashu Seith; Devasenaspathy, Kandaswamy; Kumar, Guresh; Sahoo, Jaiprakash P.; Chittawar, Sachin; Philip, Jim; Baruah, Manas P.; Dwarakanath, C. S.; Tripathi, Sudhir

    2014-01-01

    Background: There is little published literature on the profile of patients with Cushing's syndrome (CS) from India. The aim of this study was to compile data of CS patients treated at this hospital. Materials and Methods: Patients referred to the endocrine services of this hospital for diagnosis/treatment of CS from January 1985 to July 2012 were the subjects for this study. All patients had detailed medical history, physical examination and biochemical and hormonal assays (which changed with availability of tests and changing views). Assays for plasma adrenocorticotropic hormone (ACTH) (late 90s), salivary cortisol estimation, IJV sampling for ACTH and corticotrophin releasing hormone stimulation tests were added on later. Imaging included computed tomography (CT), magnetic resonance imaging (since the late 80's) and 68Ga DOTA-TOC/FDG PET-CT (2008). Results: Three hundred sixty-four patients (250 females, 114 males, age 6 months to 65 years, mean 28 years + 12 years) were diagnosed to have CS during this period. Two hundred and ninety-three patients (80.5%) were ACTH dependent (CD 215, ectopic ACTH syndrome 22, occult ACTH source 56) while 71 (19.5%) were ACTH independent (adrenal carcinoma 36, adenoma 30, primary pigmented nodular adrenal disease 4, AIMAH 1). Pituitary macro adenoma was seen in 14% of the CD cases. The most common presenting complaints were hypertension and diabetes mellitus. A total of 63% patients complained of weight gain while 15% had lost weight. Myopathy, infections, skeletal fractures and psychiatric problems were the other common observations in our patients. Conclusion: The clinical spectrum was broad. CD was the most common cause for CS. PMID:24701438

  17. Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy.

    PubMed

    Kimura, Tomoki; Doi, Yoshiko; Nakashima, Takeo; Imano, Nobuki; Katsuta, Tsuyoshi; Takahashi, Shigeo; Kenjo, Masahiro; Ozawa, Shuichi; Murakami, Yuji; Nagata, Yasushi

    2015-03-01

    The purpose of this study was to evaluate the efficacy and safety of volumetric modulated arc therapy (VMAT) after extrapleural pneumonectomy (EPP) in patients with malignant pleural mesothelioma (MPM). A total of 15 patients who received VMAT after EPP were enrolled. All patients were males, and the median age was 67 years (Stage IB in two, II in six, and III in seven patients). The clinical target volume (CTV) included the entire preoperative ipsilateral hemithorax and involved nodal stations. The CTV was generally expanded by 10-15 mm beyond the planning target volume (PTV). The dose prescription was designed to cover 95% of the PTV with 54 Gy in 30 fractions. The median follow-up period was 11 months. Treatment-related toxicities were evaluated by Common Terminology Criteria for Adverse Events (CTCAE) ver. 4. One-year local control, disease-free survival, and overall survival rates were 55.7% [95% confidence interval (CI): 25.6-85.8%], 29.3% (95% CI: 5.3-53.3%), and 43.1% (95% CI: 17.1-69.0%), respectively. According to the histological analysis, the one-year LC rate was significantly worse in patients with non-epithelial type (biphasic and sarcomatoid types) than in patients with epithelial type [epithelial type: 83.3% (95% CI, 53.5-100%), non-epithelial type: 0% (95% CI, 0%), P = 0.0011]. Grade 3 pneumonitis after VMAT was observed in three patients (20.0%); however, no patients died of pulmonary toxicity. VMAT appears to be relatively safe for patients with MPM after EPP because of the low pulmonary dose. PMID:25599996

  18. Clinical benefit, survival and adverse events in patients with implantable cardioverter defibrillators: the initial Rotterdam experience

    PubMed Central

    Theuns, D.A.M.J.; Klootwijk, A.P.J.; Kimman, G.P.; Simoons, M.L.; Roelandt, J.R.T.C.; Jordaens, L.J.L.M.

    2001-01-01

    Background The implantable cardioverter defibrillator (ICD) has become a widely accepted therapy for patients with severe life-threatening ventricular tachyarrhythmias. The aim of this study was to illustrate the possible advantages of ICDs with respect to survival and clinical events. Methods and results Between 1998 and 2000, 92 patients (aged 58±15 years; ejection fraction 36±15%; coronary artery disease 71%) were treated with an ICD in combination with an endocardial lead system. Benefit of the ICD was estimated as the difference between total cardiac death and the projected death rate of fast ventricular tachyarrhythmias (>200 bpm), assuming that most fast ventricular tachyarrhythmias would have been fatal without termination by the ICD. Adverse events were classified according to European standards. The cardiac mortality rate was 5.5% and 9.8%, at one and two years respectively. The recurrence rate of fast VT (>200 bpm) was 22.4% and 30.2%, at one and two years respectively. The observed difference between cardiac death and projected death was very significant (p=0.002) and suggests a clear benefit from ICD implantation. Low ejection fraction (<35%) and NYHA class ?II correlated with a higher projected death. The most common adverse event was inappropriate therapy (18%). Conclusion The results from our small series support the existing data that especially patients with poor ejection fraction (<35%) benefit from ICD implantation. The adverse event rate was low. However, inappropriate therapy remains a matter of concern. Given the high workload of correct screening and follow-up, we expect that the actual number of centres in the Netherlands permitted to implant ICDs will be unable to cope with the widening spectrum of ICD indications. PMID:25696731

  19. [Lithostar Multiline. A multi-function lithotripter for ESWL and endourology: initial clinical experiences].

    PubMed

    Haag, U; Gschwend, J E; Kleinschmidt, K; Hautmann, R E

    1997-09-01

    After > 10,000 treatments-our HM3/4 and MPL 9000 have been replaced by the Siemens Lithostar multiline. As a ESWL center with ESWL as the primary treatment indication for all types of stones in kidney and ureter we report our initial experience with this new multifunctional lithotripter. The system consists of an electromagnetic shock-wave emitter (Focus 80 x 5 mm) and a digital fluoroscopy unit. Stone localization is achieved in a - 10 degrees and + 30 degrees position without movement of the patient. The treatment table itself allows most endourologic and percutaneous auxiliary procedures. Additionally, an intergrated inline ultrasound is available. From 10/94 to 08/95, 204 male and 96 female patients with a mean age of 50.7 (4-92) years underwent ESWL with the Lithostar multiline. The mean stone diameter was 10.3 (2-20) mm with 53% ureteral and 47% renal stones. 300 patients underwent 480 treatments (average shocks 3673, range 793-8000; mean energy level 5.5, range 1-9). Stone localization was achieved after 5 (1-39) min (mean fluoroscopy time 3.1 (0.5-16.2) min). In 92.7% no analgesic premedication was done, 56% of the patients needed no analgesics at all during ESWL. 44% received 8.1 (2-15) mg Piritramid intravenously. Epidural anesthesia was performed in only 2.3% for a second treatment. 95% of the patients had complete stone disintegration. In 68% disintegration was achieved in one session. ESWL was repeated for further disintegration in 18.5%, because of an unsuccessful treatment in 11.5% and because of technical interruption of the previous session in 2.5%. We saw subkapsular haematomas in 2%. Auxiliary procedures following ESWL were necessary in only 9.2% of the patients. In situ ESWL with the new Lithostar Multiline seems to be effective as the Domler HM3/4. Analgesia-free treatment was performed in more than 50% of the patients. Auxiliary procedures were less frequently necessary as compared to our previous experience with in situ ESWL. PMID:9424799

  20. Clinical controversies: Pediatric tumors

    PubMed Central

    Merchant, Thomas E.

    2013-01-01

    Despite the claim in the published literature, the introduction of proton therapy for children is not analogous to the evolution of conformal photon irradiation relying on the understanding of the impact of altered dose distributions. The differences in radiobiological effect when comparing photons to protons means that we are comparing a known entity to an unknown entity: the dose-volume histogram for proton therapy might mean something substantially different than the dose-volume histogram for photon therapy. The multifaceted difference between the two modalities supports the argument for careful evaluation, follow-up and clinical trials with adverse event monitoring when using proton therapy in children. We review the current data on the outcome of proton therapy in a range of pediatric tumours and compare them to the often excellent results of photon therapy in the setting of multidisciplinary management of childhood cancer. It is hoped that the apparent dosimetric advantage of proton therapy over photons will lead to improved indications for therapy, disease control and functional outcomes. While physical dose distribution is of clear importance, the multimodality management of children by an expert pediatric oncology team and the availability of ancillary measures that improve the quality of treatment delivery may be more important than the actual beam. In addition, current estimates of the benefit of proton therapy over photon therapy based on toxicity reduction will only be realized when survivorship has been achieved. Once substantive data proton therapy data become available, it will be necessary to demonstrate benefit in clinically relevant outcome measures in comparison to best existing photon outcome data. Such an effort will require improved funding and appreciation for late effects research. Only real clinical outcome data combined with better understanding of the radiobiological differences between protons and photons will help us to further reduce side effects in children and exploit the full curative potential of this relatively new modality. PMID:23473686