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1

[Brachytherapy with pulsed dosage. General considerations. Radiobiological considerations. First clinical experience in Mestre (Venice)].  

PubMed

The pulsed dose rate (PDR) brachytherapy technique is analyzed and compared with the low and high dose rate (LDR and HDR, respectively) techniques relative to therapy and management, considering the advantages and pitfalls of each technique. From a radiobiological viewpoint, PDR optimization is aimed at obtaining the same therapeutic results as with LDR and HDR relative to both tumor cell killing and possible late damage. PDR permits to administer the same nominal dose rates as with LDR and HDR, but with very different pulse intervals and length. March, 1995, through March, 1996, forty-two patients were treated with microSelectron PDR at the radiotherapy Department of Umberto I Hospital in Mestre (Venice). Twenty-two patients were irradiated on the vaginal vault, 14 on the anal canal, 4 on the breast, one on the endometrium and one on the urethra (the latter patient was a man). Dose rates were 250-300 cGy/h in the vaginal vault and 90 cGy/h in the other sites. Source-dwell interval in the applicators was 2.5 mm, dwelling time for each position ranged 6.8-122 s, 3-73 pulses were applied lasting 167-1958 s. The unit was reliable and the only problem was the need to recalibrate it every 5-6 applications because of computer memory saturation. Because of the short minimum follow-up (3 months), only the early reactions to treatment have been assessed: no toxicity was found in the vaginal vault, endometrium and breast. Low-grade proctitis was observed in 11 of 14 treated anal canals and another patient complained of more severe symptoms for two weeks; the disease progressed in two anal canal patients, as in the urethra patient. In conclusion, PDR brachytherapy appears a reliable technique whose early clinical results are encouraging. PMID:9221420

Pizzi, G B; Marchetti, C

1997-03-01

2

In vitro irradiation system for radiobiological experiments  

PubMed Central

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

2013-01-01

3

In vitro irradiation station for broad beam radiobiological experiments  

NASA Astrophysics Data System (ADS)

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

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

2011-12-01

4

[Plantar fasciitis and radiotherapy. Clinical and radiobiological treatment results].  

PubMed

Patients with plantar fasciitis and pain refractory to conventional therapy are treated with low-dose radiotherapy (RT), but no conclusive evidence-based and radiobiological studies had been performed. In 2001 the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) carried out a study by mailing a standardized questionnaire. A total of 136 institutions treated 3621 patients/year with chronic or refractory pain. The median total dose was 6 Gy (median single dose: 1 Gy); 76 institutions reported data of their clinical evaluation of a total of 7947 patients. Pain relief lasting for at least 3 months was reported in 70% and persistent pain relief in 65%. There were no acute or chronic radiogenic side effects observed. The radiobiological studies showed a significant increase of granulocyte function at 1.5 Gy and a significant decrease at 3.5 and 4.0 Gy. These results may provide a possible explanation for a local anti-inflammatory effect of low-dose RT. RT may be an excellent alternative for patients with contraindications to long-term treatment with steroids or NSAID. PMID:15883784

Micke, O; Seeegenschmiedt, M H; Mücke, R; de Vries, A; Schäfer, U; Willich, N

2005-06-01

5

Feasibility studies of colorless LR 115 SSNTD for alpha-particle radiobiological experiments  

NASA Astrophysics Data System (ADS)

The feasibility of using the active layer of the colorless LR 115 SSNTD for alpha-particle radiobiological experiments was studied. The track revelation time on the bottom side (the side attached to the polyester base) was much longer than that on the top side (the side not attached to the polyester base) of the active layer so track formation on the top side was more desirable. In relation to this, culture of HeLa cells on the bottom side of the active layer was found feasible although the cultured cell number was relatively smaller. The feasibility of using this SSNTD for alpha-particle radiobiological experiments was demonstrated by culturing cells on the bottom side while performing alpha-particle irradiation and chemical etching on the top side, and by taking photographs of the cells and alpha-particle tracks together under the optical microscope.

Chan, K. F.; Tse, A. K. W.; Fong, W. F.; Yu, K. N.

2006-06-01

6

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning  

NASA Astrophysics Data System (ADS)

Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to design new treatment strategies. The purpose of this work is to derive a plausible set of radiobiological parameters that can be used for RT treatment planning. The derivation is based on existing clinical data and is consistent with the analysis of a large number of published clinical studies on early-stage breast cancer. A large number of published clinical studies on the treatment of early breast cancer with BCS plus RT (including whole breast EBRT with or without a boost to the tumour bed, whole breast EBRT alone, brachytherapy alone) and RT alone are compiled and analysed. The linear quadratic (LQ) model is used in the analysis. Three of these clinical studies are selected to derive a plausible set of LQ parameters. The potential doubling time is set a priori in the derivation according to in vitro measurements from the literature. The impact of considering lower or higher Tpot is investigated. The effects of inhomogeneous dose distributions are considered using clinically representative dose volume histograms. The derived LQ parameters are used to compare a large number of clinical studies using different regimes (e.g., RT modality and/or different fractionation schemes with different prescribed dose) in order to validate their applicability. The values of the equivalent uniform dose (EUD) and biologically effective dose (BED) are used as a common metric to compare the biological effectiveness of each treatment regime. We have obtained a plausible set of radiobiological parameters for breast cancer: agr = 0.3 Gy-1, agr/bgr = 10 Gy and sub-lethal damage repair time Trep = 1 h (mono-exponential behaviour is assumed). This set of parameters is consistent with in vitro experiments and with previously reported analyses. Using this set of parameters, we have found that most of the studies, using BCS plus whole breast RT and a boost to the tumour bed, have EUDs ranging from 60-70 Gy. No correlation is found between BED and the local recurrence rate. The treatments of BCS plus brachytherapy alone have a wide range of EUD (30-50 Gy), which is significantly lower than the treatments with whole breast EBRT plus a boost of the tumour bed. The studies with different fractionation schemes for whole breast EBRT also show a significant variation of EUD. Carefully designed clinical studies with large numbers of patients are required to determine clinically the relative effectiveness of these treatment variations. The derived LQ parameter set based on clinical data is consistent with in vitro experiments and previous studies. As demonstrated in the present work, these radiobiological parameters can be potentially useful in radiotherapy treatment planning for early breast cancer, e.g., in comparing biological effectiveness of different radiotherapy modalities, different fractionation schemes and in designing new treatment strategies.

Guerrero, M.; Li, X. Allen

2003-10-01

7

Preliminary analysis of a radiobiological experiment for LifeSat  

NASA Technical Reports Server (NTRS)

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

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

1991-01-01

8

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

PubMed

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

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

2014-01-01

9

Radiobiological experiments with plant seeds aboard the biosatellite Kosmos 1887  

NASA Technical Reports Server (NTRS)

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

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

1990-01-01

10

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

NASA Astrophysics Data System (ADS)

Alpha-particle radiobiological experiments involve irradiating cells with alpha particles and require accurate positions where the alpha particles hit the cells. In the present work, we prepared thin CR-39 detectors from commercially available CR-39 SSNTDs with a thickness of 100 ?m by etching them in 1 N NaOH/ethanol at 40 °C to below 20 ?m. The desired final thickness was achieved within ˜8 h. Such etching conditions can provide relatively small roughness of the detector as revealed by atomic force microscope, 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 2-3 h with doses from 259 to 389 W/cm 2, 5 MeV alpha-particle tracks can be seen to develop on these CR-39 detectors clearly under the optical microscope within 2 h in 14 N KOH at 37 °C. As an example for practical use, custom-made petri dishes, with a hole drilled at the bottom and covered with a thin CR-39 detector, were used for culturing HeLa cells. The feasibility of using these thin CR-39 detectors is demonstrated by taking photographs of the cells and alpha-particle tracks together under the optical microscope, which can allow the hit positions on the cells by the alpha particles to be determined accurately.

Chan, K. F.; Lau, B. M. F.; Nikezic, D.; Tse, A. K. W.; Fong, W. F.; Yu, K. N.

2007-10-01

11

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

NASA Astrophysics Data System (ADS)

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%.

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

12

Radiobiology in radiotherapy  

SciTech Connect

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

Bleehen, N.M.

1988-01-01

13

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

NASA Technical Reports Server (NTRS)

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

1973-01-01

14

Transformation of Physical DVHs to Radiobiologically Equivalent Ones in Hypofractionated Radiotherapy Analyzing Dosimetric and Clinical Parameters: A Practical Approach for Routine Clinical Practice in Radiation Oncology  

PubMed Central

Purpose. The purpose of this study was to transform DVHs from physical to radiobiological ones as well as to evaluate their reliability by correlations of dosimetric and clinical parameters for 50 patients with prostate cancer and 50 patients with breast cancer, who were submitted to Hypofractionated Radiotherapy. Methods and Materials. To achieve this transformation, we used both the linear-quadratic model (LQ model) and the Niemierko model. The outcome of radiobiological DVHs was correlated with acute toxicity score according to EORTC/RTOG criteria. Results. Concerning the prostate radiotherapy, there was a significant correlation between RTOG acute rectal toxicity and D50 (P < 0.001) and V60 (P = 0.001) dosimetric parameters, calculated for ?/? = 10?Gy. Moreover, concerning the breast radiotherapy there was a significant correlation between RTOG skin toxicity and V?60 dosimetric parameter, calculated for both ?/? = 2.3?Gy (P < 0.001) and ?/? = 10?Gy (P < 0.001). The new tool seems reliable and user-friendly. Conclusions. Our proposed model seems user-friendly. Its reliability in terms of agreement with the presented acute radiation induced toxicity was satisfactory. However, more patients are needed to extract safe conclusions. PMID:24348743

Thrapsanioti, Zoi; Karanasiou, Irene; Platoni, Kalliopi; Efstathopoulos, Efstathios P.; Matsopoulos, George; Dilvoi, Maria; Patatoukas, George; Chaldeopoulos, Demetrios; Kelekis, Nikolaos; Kouloulias, Vassilis

2013-01-01

15

Preclinical Radiobiology and Predictive Assays  

NASA Astrophysics Data System (ADS)

Physical measurements of absorbed particle radiation doses are currently inadequate to estimate biological outcome at the stopping ranges of particle beams from protons to heavier ions. Estimates of biological significance and clinical impact are essential additional elements to implement ion beam therapy (IBT). This chapter provides a brief review of the current status of preclinical molecular and cellular radiobiology and predictive assays with a focus on the current use of radiobiology to characterize radiation fields of ions, to implement treatment planning with scanned ion beams, and to predict successful clinical outcome.

Blakely, Eleanor A.; Chang, Polly Y.

16

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

PubMed Central

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

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

2014-01-01

17

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

PubMed

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

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

2014-07-01

18

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

NASA Astrophysics Data System (ADS)

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

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

2007-08-01

19

Recent results of comparative radiobiological experiments with short and long term expositions of Arabidopsis seed embryos  

NASA Astrophysics Data System (ADS)

Comparison of experimental data obtained from short (SDEF) and long duration exposure flights (LDEF) recently led to results, which will contribute for the estimation of genetic risk for long and/or repeated stay of man in space. Under orbital conditions biological stress and damage are induced in test subjects by cosmic radiation, especially the high energetic, densely ionizing component of heavy ions. Plant seeds were successful model systems for a biotest in studying the physiological damages and mutagenic effects caused by ionizing radiation in particular stem cells. In this article we present an overview of our space experiments with Arabidopis thaliana seeds. We present first results of investigations on certain damage endpoints (seed germination, plant survival, mutation frequencies), caused by cosmic ionizing radiation in dry dormant plant seeds ofArabidopsis thaliana after different short term (e.g. IML-1 and D-2) and long term (e.g. EURECA and LDEF-1) space exposures. Total dose effects of heavy ions and the other components of the mixed radiation field on damage endpoints and survival after space exposure and gamma-ray pre-irradiation were obtained. A new method of total dose spectrometry by neutron activation has been applied.

Zimmermann, M. W.; Gartenbach, K. E.; Kranz, A. R.; Baican, B.; Schopper, E.; Heilmann, C.; Reitz, G.

1996-01-01

20

Radiobiology challenges for ELIMED  

NASA Astrophysics Data System (ADS)

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

Schettino, G.

2013-07-01

21

Non-extensive radiobiology  

NASA Astrophysics Data System (ADS)

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

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

2011-03-01

22

Non-extensive radiobiology  

SciTech Connect

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

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

2011-03-14

23

Clinical experience with bemiparin.  

PubMed

Subcutaneous bemiparin has been evaluated for the prevention of venous thromboembolism (VTE) in moderate to high-risk patients undergoing surgery, and for the acute and long-term treatment of established VTE. General and orthopaedic surgery is associated with VTE incidence rates of 15-60% in the absence of thromboprophylaxis and this can be reduced by over 70% with appropriate thromboembolic prophylaxis. Bemiparin was as effective as unfractionated heparin (UFH) in the prevention of VTE, when both were initiated preoperatively, but was associated with significantly fewer bleeding episodes than UFH. Bemiparin prophylaxis initiated postoperatively was at least as effective as bemiparin initiated preoperatively and was associated with a lower incidence of bleeding complications than preoperative initiation. In terms of patients with cancer undergoing abdominal or pelvic surgery, preliminary results from a recent study with bemiparin showed that extended prophylaxis for 4 weeks significantly reduced the rate of major VTE, without increasing bleeding risk, compared with prophylaxis for one week. Bemiparin, initiated postoperatively, was as effective as enoxaparin, initiated preoperatively, in the prevention of VTE in patients undergoing total knee replacement. The incidence of bleeding complications was similar between groups, although the incidence of injection site haematoma was significantly higher with enoxaparin than with bemiparin. Postoperative initiation of bemiparin thromboprophylaxis minimized the risk of spinal haematoma in patients using neuraxial anaesthesia (approximately 93% of patients). In addition, postoperative initiation is likely to reduce the total costs, because patients do not need to be admitted to hospital the day before surgery. Bemiparin was more effective than intravenous UFH in the acute treatment of established deep vein thrombosis (DVT) and was as effective as oral warfarin in the subsequent secondary prevention of VTE over 3 months of therapy, while bleeding complications over 3 months of therapy were similarly low. In a European study, acute treatment of DVT with bemiparin for one week followed by 12 weeks' secondary prevention with bemiparin (i.e. bemiparin/bemiparin) was associated with a cost saving of &U20AC;908 per patient compared with UFH/warfarin. Similarly, bemiparin/warfarin produced a cost saving of &U20AC;769 compared with UFH/warfarin. The savings were predominantly the result of reduced hospital stays during acute treatment with bemiparin. Bemiparin was also associated with increased quality-adjusted life expectancy. Observational studies in routine clinical practice demonstrated that outpatient treatment of acute VTE was as effective as inpatient treatment, but with lower costs, and bemiparin was as effective as vitamin K antagonists over 3 months for secondary prevention, with VTE recurrence rates of 0% and 0.3% over 3 months in separate studies. Bemiparin is thus an effective, well tolerated agent for thromboprophylaxis in surgery, and for the acute and long-term treatment of established VTE, having advantages over UFH and particular benefits as a result of initiating therapy postoperatively. PMID:21162607

Abad Rico, José Ignacio; Lozano Sánchez, Francisco S; Rocha, Eduardo

2010-12-14

24

Proton radiobiology.  

PubMed

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

Tommasino, Francesco; Durante, Marco

2015-01-01

25

Clinical Experiences in Athletic Training.  

ERIC Educational Resources Information Center

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

Knight, Kenneth L.

26

Radiobiology challenges for ELIMED  

SciTech Connect

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

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

2013-07-26

27

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning  

Microsoft Academic Search

Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and\\/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to

M. Guerrero; X. Allen Li

2003-01-01

28

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

PubMed

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

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

2014-06-21

29

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

NASA Astrophysics Data System (ADS)

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

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

2014-06-01

30

Radiobiological effectiveness of laser accelerated electrons in comparison to electron beams from a conventional linear accelerator.  

PubMed

The notable progress in laser particle acceleration technology promises potential medical application in cancer therapy through compact and cost effective laser devices that are suitable for already existing clinics. Previously, consequences on the radiobiological response by laser driven particle beams characterised by an ultra high peak dose rate have to be investigated. Therefore, tumour and non-malignant cells were irradiated with pulsed laser accelerated electrons at the JETI facility for the comparison with continuous electrons of a conventional therapy LINAC. Dose response curves were measured for the biological endpoints clonogenic survival and residual DNA double strand breaks. The overall results show no significant differences in radiobiological response for in vitro cell experiments between laser accelerated pulsed and clinical used electron beams. These first systematic in vitro cell response studies with precise dosimetry to laser driven electron beams represent a first step toward the long term aim of the application of laser accelerated particles in radiotherapy. PMID:22739009

Laschinsky, Lydia; Baumann, Michael; Beyreuther, Elke; Enghardt, Wolfgang; Kaluza, Malte; Karsch, Leonhard; Lessmann, Elisabeth; Naumburger, Doreen; Nicolai, Maria; Richter, Christian; Sauerbrey, Roland; Schlenvoigt, Hans-Peter; Pawelke, Jörg

2012-01-01

31

Clinical experience with CT colonography  

NASA Astrophysics Data System (ADS)

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

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

2000-04-01

32

Gender variations in clinical pain experience  

Microsoft Academic Search

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

Anita M. Unruh

1996-01-01

33

CRC handbook of radiobiology  

SciTech Connect

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

Prasad, K.N.

1984-01-01

34

A radiobiological model for the relative biological effectiveness of high-dose-rate 252Cf brachytherapy.  

PubMed

While there is significant clinical experience using both low- and high-dose-rate 252Cf brachytherapy, there are minimal data regarding values for the neutron relative biological effectiveness (RBE) with both modalities. The aim of this research was to derive a radiobiological model for 252Cf neutron RBE and to compare these results with neutron RBE values used clinically in Russia. The linear-quadratic (LQ) model was used as the basis to characterize cell survival after irradiation, with identical cell killing rates (S(N) = S(gamma)) between 252Cf neutrons and photons used for derivation of RBE. Using this equality, a relationship among neutron dose and LQ radiobiological parameter (i.e., alpha(N), beta(N), alpha(gamma), beta(gamma)) was obtained without the need to specify the photon dose. These results were used to derive the 252Cf neutron RBE, which was then compared with Russian neutron RBE values. The 252Cf neutron RBE was determined after incorporating the LQ radiobiological parameters obtained from cell survival studies with fast neutrons and teletherapy photons. For single-fraction high-dose-rate neutron doses of 0.5, 1.0, 1.5 and 2.0 Gy, the total biologically equivalent doses were 1.8, 3.4, 4.7 and 6.0 RBE Gy with 252Cf neutron RBE values of 3.2, 2.9, 2.7 and 2.5, respectively. Using clinical data for late-responding reactions from 252Cf, Russian investigators created an empirical model that predicted high-dose-rate 252Cf neutron RBE values ranging from 3.6 to 2.9 for similar doses and fractionation schemes and observed that 252Cf neutron RBE increases with the number of treatment fractions. Using these relationships, our results were in general concordance with high-dose-rate 252Cf RBE values obtained from Russian clinical experience. PMID:16137205

Rivard, Mark J; Melhus, Christopher S; Zinkin, Heather D; Stapleford, Liza J; Evans, Krista E; Wazer, David E; Odlozilíková, Anna

2005-09-01

35

Monte Carlo role in radiobiological modelling of radiotherapy outcomes  

NASA Astrophysics Data System (ADS)

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

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

2012-06-01

36

First year clinical tutorials: students’ learning experience  

PubMed Central

Background Bedside teaching lies at the heart of medical education. The learning environment afforded to students during clinical tutorials contributes substantially to their knowledge, thinking, and learning. Situated cognition theory posits that the depth and breadth of the students’ learning experience is dependent upon the attitude of the clinical teacher, the structure of the tutorial, and the understanding of tutorial and learning objectives. This theory provides a useful framework to conceptualize how students’ experience within their clinical tutorials impacts their knowledge, thinking, and learning. Methods The study was conducted with one cohort (n=301) of students who had completed year 1 of the medical program at Sydney Medical School in 2013. All students were asked to complete a three-part questionnaire regarding their perceptions of their clinical tutor’s attributes, the consistency of the tutor, and the best features of the tutorials and need for improvement. Both quantitative and qualitative data were collected and analyzed using descriptive statistics. Results The response rate to the questionnaire was 88% (265/301). Students perceived that their tutors displayed good communication skills and enthusiasm, encouraged their learning, and were empathetic toward patients. Fifty-two percent of students reported having the same communications tutor for the entire year, and 28% reported having the same physical examination tutor for the entire year. Students would like increased patient contact, greater structure within their tutorials, and greater alignment of teaching with the curriculum. Conclusion Situated cognition theory provides a valuable lens to view students’ experience of learning within the clinical environment. Our findings demonstrate students’ appreciation of clinical tutors as role models, the need for consistency in feedback, the importance of structure within tutorials, and the need for tutors to have an understanding of the curriculum and learning objectives for each teaching session. PMID:25489253

Burgess, Annette; Oates, Kim; Goulston, Kerry; Mellis, Craig

2014-01-01

37

Practicum and clinical experiences: postpracticum students' views.  

PubMed

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

Ralph, Edwin; Walker, Keith; Wimmer, Randolph

2009-08-01

38

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

Microsoft Academic Search

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

Howard R. Hernandez

2012-01-01

39

Status of the European space radiobiology program (IBER)  

NASA Astrophysics Data System (ADS)

The European Space Agency (ESA) started an experimental radiobiology program in 2008, based at the SIS18 accelerator at GSI. This program supported several European groups who performed different experiments with heavy ions in cell, tissue, and animal models. The current status of the program will be presented and future perspectives in the novel FAIR accelerator currently under construction.

Durante, Marco; Angerer, Oliver

40

Experience with fingolimod in clinical practice.  

PubMed

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

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

2014-10-29

41

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

NASA Astrophysics Data System (ADS)

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.

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

2015-02-01

42

Clinical experience with ureteral metal stents  

PubMed Central

Ureteral metal stents (MSs) present a minimally invasive tool to preserve the drainage of renal pelvis whenever ureteral patency is at risk to be obstructed due to extrinsic or intrinsic etiologies. Clinical experience with these stents demonstrates that they impose a promising alternative treatment option in ureteral pathologies that are difficult to be treated via common polymeric stents. Current application of MSs in the treatment of both benign and malignant ureteral obstruction reveals quite promising results. Nevertheless, the ideal MS that would provide uncomplicated long-term effectiveness is still lucking and current MS usage is facing several adverse effects between which stent obstruction, encrustation, infection, migration, and patient discomfort. Ongoing attempts to create more inert stent with sophisticated novel designs are expected to improve current MS efficiency. MSs will play a major role in the future as a routine management of a variety of ureteral pathologies. PMID:21369375

Al Aown, Abdulrahman; Iason, Kyriazis; Panagiotis, Kallidonis; Liatsikos, Evangelos N.

2010-01-01

43

Johnson Space Center Flight Medicine Clinic Experience  

NASA Technical Reports Server (NTRS)

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

Landry, Trela

2006-01-01

44

The lived experience of the oncology clinical nurse specialist  

Microsoft Academic Search

The purpose of this study was to explore what was important and what was unique in the experience of the oncology clinical nurse specialist (OCNS). The sample included eight clinical nurse specialists from one geographical area. One to one interviews focused on reflection on two critical incidents from the OCNSs’ own clinical experience: one which they thought had gone particularly

Linda A Loftus; Joan McDowell

2000-01-01

45

Experiments on the Automated Selection of Patients for Clinical Trials  

E-print Network

Experiments on the Automated Selection of Patients for Clinical Trials Eugene Fink eugene Introduction When clinicians conduct treatment experiments, called clinical trials, they have to recruit patients, which delays the com- pletion of clinical trials [7, 17]. To address this problem, several

Fink, Eugene

46

Experiments on the Automated Selection of Patients for Clinical Trials  

E-print Network

Experiments on the Automated Selection of Patients for Clinical Trials Eugene Fink eugene clinicians conduct treatment experiments, called clinical trials, they have to recruit participants from the com­ pletion of clinical trials [7, 17]. To address this problem, several researchers built ex­ pert

Fink, Eugene

47

Particle beam therapy (hadrontherapy): basis for interest and clinical experience.  

PubMed

The particle or hadron beams deployed in radiotherapy (protons, neutrons and helium, carbon, oxygen and neon ions) have physical and radiobiological characteristics which differ from those of conventional radiotherapy beams (photons) and which offer a number of theoretical advantages over conventional radiotherapy. After briefly describing the properties of hadron beams in comparison to photons, this review discusses the indications for hadrontherapy and analyses accumulated experience on the use of this modality to treat mainly neoplastic lesions, as published by the relatively few hadrontherapy centres operating around the world. The analysis indicates that for selected patients and tumours (particularly uveal melanomas and base of skull/spinal chordomas and chondrosarcomas), hadrontherapy produces greater disease-free survival. The advantages of hadrontherapy are most promisingly realised when used in conjunction with modern patient positioning, radiation delivery and focusing techniques (e.g. on-line imaging, three-dimensional conformal radiotherapy) developed to improve the efficacy of photon therapy. Although the construction and running costs of hadrontherapy units are considerably greater than those of conventional facilities, a comprehensive analysis that considers all the costs, particularly those resulting from the failure of less effective conventional radiotherapy, might indicate that hadrontherapy could be cost effective. In conclusion, the growing interest in this form of treatment seems to be fully justified by the results obtained to date, although more efficacy and dosing studies are required. PMID:9713294

Orecchia, R; Zurlo, A; Loasses, A; Krengli, M; Tosi, G; Zurrida, S; Zucali, P; Veronesi, U

1998-03-01

48

Fundamental space radiobiology  

NASA Technical Reports Server (NTRS)

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

Nelson, Gregory A.

2003-01-01

49

Fundamental space radiobiology.  

PubMed

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. PMID:12959129

Nelson, Gregory A

2003-06-01

50

Target fragmentation in radiobiology  

NASA Technical Reports Server (NTRS)

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

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

1993-01-01

51

Target fragmentation in radiobiology  

SciTech Connect

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

Wilson, J.W.; Cucinotta, F.A.; Shinn, J.L.; Townsend, L.W.

1993-02-01

52

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

ERIC Educational Resources Information Center

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

Zeanah, Charles H.

2009-01-01

53

Experiences in a dental emergency clinic.  

PubMed

This report provides descriptive information on the Dental Emergency Clinic at the Royal London Dental Hospital. General information was recorded over 6 months (January-July 2001) regarding total number of patients presenting for treatment, number of patients turned away, sex, age, and ethnic origin of the patient. Demographic information was recorded as well as reason for attendance source of referral and treatment carried out. This data was statistically analysed. Between January and July 2001 6299 patients presented to the Royal London Dental Hospital for treatment on the Dental Emergency Clinic. 73% of patients were seen on the Dental Emergency Clinic, whilst 27% were turned away. The mean daily attendance on the clinic was 31 patients. The majority of patients who attended this clinic were white (English, Scottish and Welsh, 39.1%). The next largest ethnic group were Bangladeshi (8.2%). The highest rate of attendance was in the 20-39 year old age band. The majority of patients attended from the surrounding health authority region (East London and City). The majority of patients attended without referral (78.9%), nearly a quarter were referred by their general dental practitioner (21%). Dental pain was the main reason for attendance (73%). 4054 patients were seen and treated with 4325 items of treatment carried out. There was an 8.4% increase in items of treatment between January-March 2001 and May-July 2001. April was excluded to avoid bias due to re-organisation of the clinic. This increase did not show statistical significance (p > 0.05). Most of the patients attending the Dental Emergency Clinic are aged between 20 to 39 years and from the surrounding health authority region. The majority of the patients are from the indigenous population, even though the clinic is situated in a culturally diverse part of London. Since April 2001 there was a reorganisation of the Dental Emergency Clinic. Although the mean number of patients attending the clinic did not increase, the number of items of treatment increased by 8.4%. This reflects the trend of increase in items of treatment being provided for the patients on the day of presentation. PMID:15058175

Sayers, M; Rowland, H; Djemal, S

2004-03-01

54

Pulsed radiobiology with laser-driven plasma accelerators  

NASA Astrophysics Data System (ADS)

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

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

2011-05-01

55

Ultrafast networks (ATM): First clinical experiences  

Microsoft Academic Search

Ultrafast networks using asynchronous transfer mode (ATM) technology can provide the bandwidth and throughput that may be sufficient to satisfy the medical imaging community. Several trials are underway to assess the effect of ATM network capabilities on the clinical practice of radiology, by providing immediate interactive radiology consultations between subspecialists and general radiologists at affiliated academic institutions. The hardware to

André J. Duerinckx; Daniel J. Valentino; Alek Hayrapetian; Girish Hagan; Edward G. Grant

1996-01-01

56

Clinical experience with trisomies 18 and 13  

Microsoft Academic Search

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

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

1978-01-01

57

Monte Carlo Simulations for Radiobiology  

NASA Astrophysics Data System (ADS)

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

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

2012-02-01

58

Clinical experiences with local microwave hyperthermia  

SciTech Connect

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

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

1981-05-01

59

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

ERIC Educational Resources Information Center

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

Schilling, Jim

2011-01-01

60

Particle beam therapy (hadrontherapy): basis for interest and clinical experience  

Microsoft Academic Search

The particle or hadron beams deployed in radiotherapy (protons, neutrons and helium, carbon, oxygen and neon ions) have physical and radiobiological characteristics which differ from those of conventional radiotherapy beams (photons) and which offer a number of theoretical advantages over conventional radiotherapy. After briefly describing the properties of hadron beams in comparison to photons, this review discusses the indications for

R. Orecchia; A. Zurlo; A. Loasses; M. Krengli; G. Tosi; S. Zurrida; P. Zucali; U. Veronesi

1998-01-01

61

A qualitative study of nursing student experiences of clinical practice  

PubMed Central

Background Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice. Methods Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly from two hundred students and were arranged in 9 groups of ten students. To analyze the data the method used to code and categories focus group data were adapted from approaches to qualitative data analysis. Results Four themes emerged from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap"," clinical supervision", professional role", were considered as important factors in clinical experience. Conclusion The result of this study showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting. PMID:16280087

Sharif, Farkhondeh; Masoumi, Sara

2005-01-01

62

Clinical Experience with Treatment of Angioleiomyoma  

PubMed Central

Background Angioleiomyoma, a vascular leiomyoma, is a rare, benign smooth-muscle tumor that originates in the tunica media of vessels. It occurs anywhere in the body, most frequently in the lower extremities. Methods We reviewed the medical records of 16 patients who were treated for angioleiomyoma between 2000 and 2012. The clinical features of angioleiomyoma and the correlation between symptoms and pathological subtypes were investigated. Results There were 9 males and 6 females. Ages of the patients ranged from 21 to 61. Pain was the primary symptom in 44% of the patients. Tumors were smaller than 2.0 cm in all dimensions and were located in the face in 4 patients, whereas 5 lesions occurred in the upper extremities and the remaining 7 in the lower extremities. Three histologic subtypes were identified: solid, venous, and cavernous. The subtypes did not correlate with the clinical symptoms. Conclusions Angioleiomyoma appears to be a rare tumor that occurs in the face and the extremities. The tumor usually occurs in middle age. A differential diagnosis of this tumor is difficult, but the tumor should be considered in the diagnosis of painful subcutaneous masses. Ultrasonography and magnetic resonance imaging can be helpful in the diagnosis of angioleiomyoma. These tumors can be successfully treated with simple excision, with a low recurrence rate. PMID:25075360

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

2014-01-01

63

[Clinical experience in using agomelatin (valdoxan) in the neurological practice].  

PubMed

The author presents the own clinical experience of the use of agomelatin (valdoxan) in the complex treatment of patients with ischemic stroke, migraine, fibromyalgia and during "drug holidays" after the withdrawal of benzodiazepines. In all cases of comorbid neurological diseases and clinically diagnosed insomnia and depression, valdoxan demonstrated its efficacy and safety. PMID:22611674

Levin, Ia I

2011-01-01

64

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

NASA Astrophysics Data System (ADS)

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

Herrera, Higmar; Yañez, Elvia; López, Jesús

2012-10-01

65

Tinnitus: clinical experience of the psychosomatic connection  

PubMed Central

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

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

66

Clinical mentoring of nurse practitioners: the doctors' experience.  

PubMed

The clinical development of nurse practitioners (NPs) has historically been dependent on mentorship from medical practitioners, yet their experience of this mentorship is generally unexplored. NPs have an ambiguous relationship with medicine as they have been dependent on medical mentorship to develop clinical skills, and they substitute into roles traditionally associated with medical practice. Consequently, NPs challenge professional boundaries and present particular concerns to their medical mentors. Practitioner ethnography examined the experiences of medical mentors, nurse practitioner students and academic staff during a clinical degree programme. This paper reports specifically on the medical mentors, focusing primarily on their professional authority relationship with their students and on their experience of imparting and sharing clinical knowledge. These experiences fell into three perspective stages, the provisional perspective, transitional perspective, and final perspective. Medical mentors were instrumental to the advanced clinical role of the student NP. This resulted in a conflicting experience of promoting a clinical role that challenged traditional medical authority. The effect of this was a cautious re-negotiation of professional boundaries. In future NP students (and their academic teachers) need to acknowledge this if they are to mutually gain the most from their relationship with their medical mentors. PMID:16936606

Barton, Thomas David

67

Coordination of Scheduling Clinical Externship or Clinical Practice Experiences for Students in Physical Therapy Educational Programs.  

ERIC Educational Resources Information Center

A project to coordinate the scheduling of allied health occupations students for clinical practice or externship experiences in Southeast Florida is described. A model clinical facility utilization and time schedule matrix was developed for four programs: the physical therapy programs at Florida International University (FIU) and the University of…

Patterson, Robert K.; Kass, Susan H.

68

Education/community collaborations for undergraduate nursing gerontological clinical experiences.  

PubMed

In 2000, the American Association of Colleges of Nursing and the John A. Hartford Foundation Institute for Geriatric Nursing developed guidelines to help nurse educators incorporate gerontological nursing content into baccalaureate curricula. In 2001, the Hartford Foundation also provided grant monies to nursing programs to support gerontology curricular innovations and new clinical experiences. The funding allowed faculty to focus time, energy, and resources on gerontological nursing education. We, the authors, representing two funded schools of nursing, collaborated with community agencies to develop undergraduate gerontological clinical learning experiences and are encouraged by the results. This article describes the development of these collaborations and serves as a model for other schools of nursing. The education/community collaborations described here focus on clinical learning strategies, implementation activities, and outcomes/benefits of the experiences. Both educational programs had supportive administration, faculty willing to participate in curriculum change, organized plans to implement geriatric curricular enhancement, and long-standing community partnerships. PMID:16564476

Barba, Beth E; Gendler, Phyllis

2006-01-01

69

Our clinical experience in low-energy laser medical treatments  

NASA Astrophysics Data System (ADS)

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

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

1996-05-01

70

Creation of a virtual health system for leadership clinical experiences.  

PubMed

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

Ross, Amy Miner; Crusoe, Kristen L

2014-12-01

71

National Radiobiology Archives Distributed Access user's manual  

SciTech Connect

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

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

1991-11-01

72

[Aerospace radiobiology: 35 years (1960-1995)].  

PubMed

The paper gives a brief history of the birth and development of aerospace radiobiology at the Institute of Aviation and Space Medicine. It covers from the first radiobiological investigations in space to the insurance of radiation safety for helicopter air crews who took part in cleaning-up operations of consequences of the Chernobyl accident. The workers of the Radiobiological Laboratory have performed some research theoretical and practical tasks in the interests of aviation and space, civil and military medicine: the impact of gravitation and radiation on genetic structures has been studied, a radiation safety system for vehicles of different use has been developed, new principles in the standardization of EMF for radiofrequency and microwave bands have been proposed, the new radioprotective agent indralin (B, B-190) has been discovered, which is accepted for supply and used in rotary wing aircraft pilots during liquidation works at the Chernobyl atomic power station. New experimental data on the combined effects of radiation and non-radiation flight factors have been obtained. Basically new data on the mechanism of action of ionizing and non-ionizing radiation on the brain have been also gained, a system for assessing the health and rehabilitation of pilots that cleaned-up the Chernobyl accident has been developed. Professor Pavel Petrovich Saksonov, RF Honoured Scientist, has the honour to create a school of aerospace radiobiology. PMID:8963185

Ushakov, I B; Davydov, B I

1996-01-01

73

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

PubMed Central

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

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

2014-01-01

74

Interprofessional student experiences on the HAVEN free clinic leadership board.  

PubMed

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

Scott, Elizabeth Anne; Swartz, Martha K

2015-01-01

75

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

PubMed Central

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

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

76

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

PubMed

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

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

2015-03-01

77

Workshop on radiobiological effectiveness of neutrons  

SciTech Connect

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

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

1985-09-01

78

Therapeutic Radionuclides: Biophysical and Radiobiologic Principles  

PubMed Central

Although the general radiobiologic principles underlying external beam therapy and radionuclide therapy are the same, there are significant differences in the biophysical and radiobiologic effects from the two types of radiation. In addition to the emission of particulate radiation, targeted radionuclide therapy is characterized by (i) extended exposures and, usually, declining dose rates; (ii) nonuniformities in the distribution of radioactivity and, thus, absorbed dose; and (iii) particles of varying ionization density and, hence, quality. This chapter explores the special features that distinguish the biologic effects consequent to the traversal of charged particles through mammalian cells. It also highlights what has been learned when these radionuclides and radiotargeting pharmaceuticals are used to treat cancers. PMID:18662557

Kassis, Amin I.

2008-01-01

79

Experiences incorporating Tablet PCcs into clinical pharmacists' workflow.  

PubMed

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

McCreadie, Scott R; McGregory, Michael E

2005-01-01

80

Developing a leadership pipeline: the Cleveland Clinic experience.  

PubMed

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

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

2014-11-01

81

Introductory Laboratory Exercises in Radiobiology  

ERIC Educational Resources Information Center

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

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

1970-01-01

82

Space radiobiology on the Moon  

NASA Astrophysics Data System (ADS)

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

Durante, M.

2012-12-01

83

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

PubMed Central

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

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

2013-01-01

84

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

PubMed Central

Objectives To improve clinical study developments for elderly populations, we aim to understand how they transfer their experiences into validated, standardised self-completed study measurement instruments. We analysed how women (mean 78±8?years of age) participating in a randomised controlled trial (RCT) cognised study instruments used to evaluate outcomes of the intervention. Setting The interview study was nested in an RCT on chronic neck pain using common measurement instruments situated in an elderly community in Berlin, Germany, which comprised of units for independent and assisted-living options. Participants The sample (n=20 women) was selected from the RCT sample (n=117, 95% women, mean age 76 (SD±8)?years). Interview participants were selected using a purposive sampling list based on the RCT outcomes. Outcomes We asked participants about their experiences completing the RCT questionnaires. Interviews were analysed thematically, then compared with the questionnaires. Results Interviewees had difficulties in translating complex experiences into a single value on a scale and understanding the relationship of the questionnaires to study aims. Interviewees considered important for the trial that their actual experiences were understood by trial organisers. This information was not transferrable by means of the questionnaires. To rectify these difficulties, interviewees used strategies such as adding notes, adding response categories or skipping an item. Conclusions Elderly interview participants understood the importance of completing questionnaires for trial success. This led to strategies of completing the questionnaires that resulted in ‘missing’ or ambiguous data. To improve data collection in elderly populations, educational materials addressing the differential logics should be developed and tested. Pilot testing validated instruments using cognitive interviews may be particularly important in such populations. Finally, when the target of an intervention is a subjective experience, it seems important to create a method by which participants can convey their personal experiences. These could be nested qualitative studies. Trial registration number ISRCTN77108101807. PMID:24662446

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

2014-01-01

85

Artificial Pancreas: Model Predictive Control Design from Clinical Experience  

PubMed Central

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

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

2013-01-01

86

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

ERIC Educational Resources Information Center

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

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

2009-01-01

87

Medical academia clinical experiences of Ward Round Teaching curriculum  

PubMed Central

Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners. PMID:24627858

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

2014-01-01

88

The initial Trinidad experience with Cine MRI in clinical cardiology.  

PubMed

We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases. PMID:12089881

Thomas, C N; Maharaj, P; Bodapati, S; John, R; Rahaman, R; Henry, R; Brann, S

2002-03-01

89

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

PubMed Central

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

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

90

Biological wound dressings sterilized with gamma radiation: Mexican clinical experience  

NASA Astrophysics Data System (ADS)

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

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

2007-11-01

91

Molecular Breast Imaging: A review of the Mayo Clinic experience  

PubMed Central

Summary Molecular Breast Imaging (MBI) is a nuclear medicine technique used to image the breast. In this review we discuss our experience with this technique and clinical applications for the use of MBI. Background Molecular Breast Imaging (MBI) depicts functional uptake of targeted radiotracers in the breast using dedicated gamma cameras. Methods MBI studies were performed under several institutional protocols evaluating the use of MBI in screening and diagnosis. Results Using a single head system, sensitivity for breast cancer detection was 85% (57/67) overall and 29% for tumors ?5mm in diameter. Sensitivity improved to 91% (117/128) overall and 69% for tumors ?5mm.using a dual head system. In 650 high risk patients undergoing breast cancer screening, MBI detected 7 cancers, 5 which were missed on mammography. In 24/149 (16%) breast cancer patients MBI detected additional disease not seen on mammography. Sensitivity of MBI was 88% (83/94) for IDC, 79% (23/29) for ILC, 89% (25/28) for DCIS. Conclusion MBI can detect IDC, DCIS, and ILC. It has a promising role in evaluating extent of disease and multifocal disease in the breast for surgical treatment planning. PMID:18723155

Hruska, Carrie B.; Boughey, Judy C.; Phillips, Stephen W.; Rhodes, Deborah J.; Wahner-Roedler, Dietlind L.; Whaley, Dana H.; Degnim, Amy C.; O’Connor, Michael K.

2008-01-01

92

The Use of Harmonic Scalpels in Thyroidectomies: Clinical Experiences  

PubMed Central

Objective: Many studies have been conducted to investigate the efficacy of harmonic scalpels in thyroidectomies. Here, we present our clinical experiences with the instrument. Materials and Methods: The study was conducted at the General Surgery Department of the Ataturk University School of Medicine between January 2005 and July 2008. It was a prospective, randomized, controlled study. Patients with benign nodular goiter (BNG) were included in the study and randomly divided into three groups. The first group consisted of 47 patients, the second group consisted of 57 patients, and the third group consisted of 41 patients. Patients in the first group underwent the classical thyroidectomy. Those in the second group had only the superior thyroid arteries and veins ligated (with silk or polyglactin), while the other vascular structures were divided using a harmonic scalpel. In the third group, all arteries and veins of the thyroid gland were divided using a harmonic scalpel. In each group, mean operation time, amount of bleeding, amount of postoperative drainage, and other postoperative complications were recorded. Results: Operation time was significantly lower for patients in the third group. The degree of bleeding and postoperative drainage was lower in the second and third groups with respect to the first group. There was no significant difference among the groups in terms of the development of transient hypocalcemia or voice impairment. Conclusion: We conclude that the use of harmonic scalpels for a thyroidectomy is safe, shortens operative time, and decreases intraoperative bleeding.

Basoglu, Mahmut; Ozturk, Gurkan; Atamanalp, S. Selcuk; Aydinli, Bulent; Yildirgan, M. Ilhan; Oren, Durkaya

2008-01-01

93

Doctoral Internship in Clinical & Community Psychology The Yale Experience will change you professionally --and personally.  

E-print Network

Internship in Clinical & Community Psychology The Yale Experience will change you professionally internships in clinical and community psychology, developing the next generation. Philosophy The internship year is a supervised, intensive, experiential learning

Johnson, Marcia K.

94

BNL accelerator-based radiobiology facilities  

NASA Technical Reports Server (NTRS)

For the past several years, the Alternating Gradient Synchrotron (AGS) at Brookhaven National Laboratory (USA) has provided ions of iron, silicon and gold, at energies from 600 MeV/nucleon to 10 GeV/nucleon, for the US National Aeronautics and Space Administration (NASA) radiobiology research program. NASA has recently funded the construction of a new dedicated ion facility, the Booster Applications Facility (BAF). The Booster synchrotron will supply ion beams ranging from protons to gold, in an energy range from 40-3000 MeV/nucleon with maximum beam intensities of 10(10) to 10(11) ions per pulse. The BAF Project will be described and the future AGS and BAF operation plans will be presented.

Lowenstein, D. I.

2001-01-01

95

Radiobiology with heavy charged particles: a historical review.  

PubMed

Radiobiological studies using heavy charged particles followed closely the development of accelerators to produce beams of ever-increasing energy, driven primarily by the aspirations of physicists and chemists interested in the structure of matter. An impressive share of this development took place at Berkeley, beginning with the invention of the cyclotron by Ernest Lawrence in 1930. There followed a series of cyclotrons, synchrotrons and linear accelerators, culminating in the BEVALAC, which provided the first source of very heavy ions (helium to argon) to be used clinically, beginning in 1975. Other early entrants (1950's-1960's) in the clinical use of heavy ion beams (protons only) included Uppsala, Harvard/MGH and several facilities in the USSR. During the 1970's negative pi-meson (pion) beams for clinical use were developed in the US (LAMPF), Switzerland (SIN/PSI) and Canada (TRIUMF). Although the first accelerator built primarily for medical use, the Crocker Medical Cyclotron, was completed at Berkeley in 1939 (it was used primarily to produce neutron beams) it was not until 1990 that the next clearly dedicated medical heavy ion facility went into operation: the 3-gantry proton synchrotron at Loma Linda. There are several reasons for this long hiatus: the long time required to complete clinical trials; the need to develop more economic and flexible accelerators and beam handling systems; the early discouraging clinical results obtained with neutron beams at Berkeley in the 1940's, before the dose response differences for early and late effects were fully understood. During the last decade or so there has been a rapid increase in the number of proton beam facilities; heavier ion beams are so far available only at HIMAC in Japan and GSI in Germany. Earlier studies with radioactive alpha-particle sources and plant cells had already shown, by the early 1930's that high LET radiations were biologically more effective than X-rays in producing damage in eukaryotes. The increased penetration of high energy particles from accelerators made it possible to carry out in vivo radiobiological studies in animals, and the publication by Puck of the first radiation survival response for cultured mammalian cells in 1956, provided another valuable tool for radiobiological studies. One of the earliest systematic studies of the dependence of RBE (relative biological effectiveness) and OER (oxygen enhancement ratio) on LET (linear energy transfer) was that by Barendsen in the early 1960's; he irradiated cultured human kidney cells with deuterium and alpha-particles, and showed that RBE reached a maximum at an LET of 100-200 keV/micrometer, the same LET at which the OER decreased to approximately 1.0. More recent studies (Belli, Folkard, etc.) show that the RBE 'peaks' at a LET which is particle-dependent (for protons, RBE maximum is at approximately 30 keV/micrometer), indicating that LET alone does not adequately define the microscopic energy deposition and its influence on biological effect. One of the complications with heavy ion and pion beams is the increase in RBE with depth in the stopping region. Cultured cell techniques were developed to accurately map these RBE changes, which were investigated at each of the heavy ion and pion facilities, allowing physical dose profiles to be shaped to compensate for the change in biological effectiveness. With the heavier ions, RBE is also dependent on dose and on the dose fractionation scheme used. In vivo systems are the most suitable for such measurements and a variety of normal tissue and tumour end-points has been employed for such studies. A review of the published RBE values for proton beams, 1975-1997, shows very good consistency between the various centres, with average in vivo and average in vitro values falling in the range 1.11-1.18. In this article we have, due to space limitations, only been able to review a representative fraction of the extensive literature on heavy ion radiobiology. We have arbitrarily limited our discussion to mammalian systems, except for a few very early e

Skarsgard, L D

1998-07-01

96

Clinical Experience With A Portable 3-D Reconstruction Program  

NASA Astrophysics Data System (ADS)

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

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

1988-06-01

97

Links between Innate Immunity and Normal Tissue Radiobiology  

PubMed Central

The body senses “danger” from “damaged self” molecules through members of the same receptor superfamily it uses for microbial “non-self”, triggering canonical signaling pathways that lead to the generation of acute inflammatory responses. For this reason, the biology of normal tissue responses to moderate and clinically relevant doses of radiation is inextricably connected to innate immunity. The complex sequence of inflammatory events that ensues causes further cell and tissue damage to eliminate potential invaders but also leads to cytoprotective responses that limit the spread of damage and to wound healing through tissue regeneration or replacement. These sequential processes are orchestrated through multiple feedback control mechanisms involving cyclical production of free radicals and cytokines that are common to both radiation and immune signaling. This requires a concerted effort by resident tissue and inflammatory cell types, with macrophages apparently leading the way. The initial response to moderate doses of radiation therefore feeds into a pro-inflammatory paradigm whose eventual outcome is critically dependent upon the properties of the immune cells that are involved in tissue damage, regeneration and repair and that are in part under genetic influence. Importantly, these canonical pathways provide targets for interventions aimed at modifying normal tissue radiation responses. In this review, we examine areas of intersection between innate immunity and normal tissue radiobiology. PMID:20334512

Schaue, Dörthe; McBride, William H.

2010-01-01

98

Heavy-ion tumor therapy: Physical and radiobiological benefits  

SciTech Connect

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

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

2010-01-15

99

Heavy-ion tumor therapy: Physical and radiobiological benefits  

NASA Astrophysics Data System (ADS)

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

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

2010-01-01

100

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

SciTech Connect

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.

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

101

Determination of high LET cosmic particles' trajectories for space radiobiological studies.  

PubMed

During IML-1 mission, we carried out space experiments on radiobiological effect of a single HZE cosmic particle. In the experiment, the precise determination of the distance between the center of the particle trajectory and the individual biological objects around it is an indispensable condition. For the detection of HZE particles CR-39 track detectors were used and analyzed by the video image processing. The positions of biological objects in relation to a particle trajectory were measured by referring to the laser grid marks which were printed on the surface of CR-39 detector. We describe such an experimental method and report the applicability of this method. PMID:11543205

Ogura, K; Doke, T; Kasuya, T; Kuwahara, K; Matsushima, M; Nagaoka, S; Ohnishi, H; Takahashi, T; Yamada, H; Yatagai, F

1993-01-01

102

77 FR 68155 - The Armed Forces Radiobiology Research Institute TRIGA Reactor: Facility Operating License No. R-84  

Federal Register 2010, 2011, 2012, 2013, 2014

...NRC-2012-0272] The Armed Forces Radiobiology Research Institute TRIGA Reactor...currently authorizes the Armed Forces Radiobiology Research Institute (the licensee) to operate the Armed Forces Radiobiology Research Institute (AFFRI)...

2012-11-15

103

Differences in Clinical Experiences of ADN and BSN Students.  

ERIC Educational Resources Information Center

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

Oermann, Marilyn H.

1998-01-01

104

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

Microsoft Academic Search

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

Chris Riha; Roger Dzwonczyk

2011-01-01

105

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

PubMed Central

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

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

2010-01-01

106

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

Microsoft Academic Search

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

D. Kane; B. Bresnihan; O. FitzGerald

2003-01-01

107

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

E-print Network

The 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 significant. From a software point of view, a clinical trial is largely an exercise in data management

Oxford, University of

108

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

SciTech Connect

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.

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

109

[Problems of radiobiology and p53 protein].  

PubMed

The data about the structure and the mechanisms of participation of p53 protein in regulation of the cell cycle checkpoints, DNA repair and apoptosis in normal conditions and after ionizing irradiation are considered. The double strand break of DNA, as a signal of radiation damage, lead to binding of ATM protein with DNA, to appearance of the protein kinase activity at the ATM protein, that after phosphorylation of p53 protein lead to its stabilization and activation. It is noted, that the p53 protein is an integrator of environmental lesion signals, which triggers the transcription, that activate or inhibite the synthesis of protein factors leading to cell cycle arrest in the checkpoints, to increase of DNA repair or to apoptosis. The data evidenced the participation of p53 protein in radioresistance formation are considered: p53 protein after mutation changes loses the control over the cell cycle, DNA repair and apoptosis, and that leads both to the radioresistance increase and to the possibility of the radiation-induced defects retention in progeny of the irradiated cells and organisms. Potential prospective research directions in radiobiology in connection with the data on the molecular biology of p53 gene and protein (the problems of norm, radiosensitivity/radioresistance, drug research for prophylaxe and treatment of radiation injury, low dose effect including by high density irradiation) are reviewed. PMID:11721349

Mazurik, V K; Moroz, B B

2001-01-01

110

Review of clinical experience with ion beam radiotherapy  

PubMed Central

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

Jensen, A D; Münter, M W; Debus, J

2011-01-01

111

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

ERIC Educational Resources Information Center

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…

Chenail, Ronald J.

2011-01-01

112

High-resolution diagnostic workstation development: initial clinical experience  

NASA Astrophysics Data System (ADS)

Picture archival and communication (PACS) and teleradiology systems require workstations for image display, however not all areas demand the same functionality and performance. A comparison was made between the Vortech Personal Display System (PDS), the Dupont Clinical Review System (CRS), and the dual 2 K X 2.5 K Megascan Diagnostic Workstation (MDW) under development within the department.

Frost, Meryll M.; Honeyman, Janice C.; Siker, David; Staab, Edward V.

1992-05-01

113

Preclinical experiments in the deep-seated tumor heavy-ion therapy terminal at HIRFL-CSR  

Microsoft Academic Search

A heavy-ion therapy terminal dedicated to deep-seated tumor treatment has been constructed at the Heavy Ion Research Facility\\u000a in Lanzhou - Cooling Storage Ring (HIRFLCSR). Pre-clinical experiments such as beam test, irradiation field shaping and cell\\u000a radiobiological assay have been carried out in the therapy terminal using carbon ions with energies in the range of 150 to\\u000a 200MeV\\/u. These tests

Q. Li; Z. Y. Dai; X. G. Liu; Q. F. Wu; X. D. Jin; P. Li; J. J. Tao

114

A Comparison of a Traditional Clinical Experience to a Precepted Clinical Experience for Baccalaureate-Seeking Nursing Students in Their Second Semester  

PubMed Central

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

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

2012-01-01

115

Radiobiological evaluation of low dose-rate prostate brachytherapy implants  

NASA Astrophysics Data System (ADS)

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

Knaup, Courtney James

116

Digital Mammography Clinical Trials: The North American Experience  

Microsoft Academic Search

\\u000a There have been two major clinical trials of digital mammography in North America. The Colorado-Massachusetts trial was groundbreaking\\u000a in its design, as the first trial to test the modalities head-to-head, and to consider findings detected by each modality\\u000a equally. This trial showed a significant decrease in the recall rate for digital and a nonsig-nificant trend for film in increased\\u000a cancer

John M. Lewin

117

Theoretical implications of incorporating relative biological effectiveness into radiobiological equivalence relationships  

PubMed Central

Objective: Earlier radiobiological equivalence relationships as derived for low-linear energy transfer (LET) radiations are revisited in the light of newer radiobiological models that incorporate an allowance for relative biological effectiveness (RBE). Methods: Linear-quadratic (LQ) radiobiological equations for calculating biologically effective dose at both low- and high-LET radiations are used to derive new conditions of equivalence between a variety of radiation delivery techniques. The theoretical implications are discussed. Results: The original (pre-LQ) concept of equivalence between fractionated and continuous radiotherapy schedules, in which the same physical dose is delivered in each schedule, inherently assumed that low-LET radiation would be used in both schedules. LQ-based equivalence relationships that allow for RBE and are derived assuming equal total physical dose between schedules are shown to be valid only in limited circumstances. Removing the constraint of equality of total physical dose allows the identification of more general (and more practical) relationships. Conclusion: If the respective schedules under consideration for equivalence both involve radiations of identical LET, then the original equivalence relationships remain valid. However, if the compared schedules involve radiations of differing LET, then new (and more restrictive) equivalence relationships are found to apply. Advances in knowledge: Theoretically derived equivalence relationships based on the LQ model provide a framework for the design and intercomparison of a wide range of clinical techniques including those involving high- and/or low-LET radiations. They also provide a means of testing for the validity of variously assumed tissue repair kinetics. PMID:23385996

Dale, R G

2013-01-01

118

A laser-driven nanosecond proton source for radiobiological studies  

NASA Astrophysics Data System (ADS)

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

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

2012-12-01

119

[Clinical experiences with clotrimazole in treating vaginal candidiasis].  

PubMed

The results of a clinical trial using Clotrimazole (Canesten) vaginal pessaries in the treatment of mycologically confirmed cases of vaginal candidiasis are presented. Treatment schedule consisted in the application of vaginal pessaries each containing 100 mg Clotramizole at bedtime on 6 successive days. In 68 patients who adhered to the treatment schedule and completed the observation and follow-up periods an overall cure-rate of 78.4% was recorded. There were no adverse reactions. Treatment schedules would vary from case to case and in instances of reinfection a repeated course of treatment is recommended. PMID:392965

Emokpare, N A

1979-08-15

120

Co-Learning: Maximizing Learning in Clinical Experiences  

ERIC Educational Resources Information Center

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…

Merk, Hillary; Waggoner, Jacqueline; Carroll, James

2013-01-01

121

Students' Experiences of Learning Manual Clinical Skills through Simulation  

ERIC Educational Resources Information Center

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

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

2013-01-01

122

Long-term clinical experience with a topical retinoid.  

PubMed

Topical tretinoin is a well-established treatment for acne, with a low incidence of reported adverse effects, most of which are local skin reactions. The retinoid has limited absorption through the skin, so that even with repeated applications plasma concentrations do not exceed normal endogenous levels. In mice, lifetime treatment with topical tretinoin improved skin texture and did not have any tumorigenic effects. Data from multicentre clinical trials have shown that 0.05% tretinoin emollient cream reduced fine wrinkling, surface roughness and mottled hyperpigmentation caused by photodamage. Improvement of these clinical signs was maintained after 12 months of daily tretinoin therapy, and regressed slowly after cessation of therapy. However, maintenance of the visible effects of topical tretinoin was reported after continued therapy with once or three times weekly applications of tretinoin emollient cream. Data from multicentre studies suggested that 0.1% tretinoin cream has a potential role in the treatment of solar keratoses. It is concluded that the application of tretinoin to photodamaged skin used in conjunction with sunscreens and judicious sun exposure is an effective regimen to treat the damaging cutaneous effects of chronic sun exposure. PMID:1390184

Thorne, E G

1992-09-01

123

Clinical experience with a new multiprogrammable dual chamber pacemaker.  

PubMed

We evaluated the clinical performance of a new dual chamber pacemaker, ELA Chorus, in 35 patients. This device incorporates linear rate adaptive AV delay (AVDR), rate smoothing, fallback, impedance telemetry, pacemaker mediated tachycardia (PMT) recognition and reprogramming software, intracardiac electrogram displays, autothreshold testing, diagnostic data, battery depletion curves, and laptop computer programming. Mean patient age was 68 years; 18 patients had AV block, six had sinus node dysfunction (one with AV block), nine had carotid sinus hypersensitivity (three with AV block), and two had vagally mediated syncope. At hospital discharge, programming was DDD with a mean low rate of 60 (50-70) beats/min, mean high rate of 126 (120-154) beats/min; AVDR was ON in 21 patients, rate smoothing ON in six patients, fallback ON in six patients, and PMT reprogramming algorithm ON in 27 patients. Pacemaker follow-up involved 500 clinic visits over 14.3 months (1-36). Three patients developed atrial fibrillation, reprogrammed to DDI mode (two patients) or fallback (one patient). Fallback was used 617 times. PMT occurred 427 times in six patients; the PMT algorithm reprogrammed AV delay and postventricular atrial refractory period (PVARP) automatically, a function unique to the Chorus. Intracardiac electrograms and autothreshold testing improved follow-up efficiency. This new dual chamber pacemaker enhances programming flexibility and improves diagnostic accuracy at follow-up. PMID:1279556

Kutalek, S P; Schuster, M M; Hessen, S E; Sheppard, R; Maquilan, M; Nydegger, C

1992-11-01

124

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

Code of Federal Regulations, 2011 CFR

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

2011-10-01

125

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

Code of Federal Regulations, 2013 CFR

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

2013-10-01

126

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

Code of Federal Regulations, 2014 CFR

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

2014-10-01

127

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

128

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

129

TRANSVERSE RETUBULARIZED ILEUM: EARLY CLINICAL EXPERIENCE WITH A NEW SECOND LINE MITROFANOFF TUBE  

Microsoft Academic Search

PurposeTransverse retubularization of small ileal segments has been described as a new time and labor saving variation of the Mitrofanoff principle in a dog model with good functional results. We report our initial clinical experience with this technique.

Elmar W. Gerharz; Tariq Tassadaq; Robert S. Pickard; P. Julian R. Shah; Christopher R. J. Woodhouse; Philip G. Ransley

1998-01-01

130

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

PubMed

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

Allan, Helen

2007-06-01

131

Gay men's experiences of surrogacy clinics in India.  

PubMed

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

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

2015-01-01

132

Cooperating Teacher Evaluation of Candidates in Clinical Practice and Field Experiences  

ERIC Educational Resources Information Center

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

Moffett, David W.; Zhou, Yunfang

2009-01-01

133

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

E-print Network

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

Yates, Andrew

134

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

ERIC Educational Resources Information Center

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

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

2010-01-01

135

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

ERIC Educational Resources Information Center

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

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

2013-01-01

136

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

ERIC Educational Resources Information Center

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…

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

2014-01-01

137

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

ERIC Educational Resources Information Center

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

Gordon, Michael; Russo, Kate

2009-01-01

138

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

ERIC Educational Resources Information Center

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

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

2009-01-01

139

Early Clinical Experience With Argon Ion Laser Endarterectomy  

NASA Astrophysics Data System (ADS)

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.

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

1989-09-01

140

The Clinical Presentation of Celiac Disease: Experiences from Northeastern Iran  

PubMed Central

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

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

2014-01-01

141

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

PubMed Central

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

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

2014-01-01

142

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

NASA Astrophysics Data System (ADS)

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

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

2012-11-01

143

Inclusion of black Americans in oncology clinical trials: the Louisiana State University Medical Center experience.  

PubMed

Recruitment of patients from diverse ethnic, racial, and socioeconomic backgrounds for clinical trials is desirable for both scientific and ethical reasons. Participation rates in clinical trials are low for minorities and especially for black Americans. This report summarizes the experience at Louisiana State University Medical Center in Shreveport, Louisiana, in enrolling black Americans in oncology treatment and prevention trials. Barriers to enrollment are identified and discussed. Although major strides must still be made in the area of cancer prevention, the university's experience demonstrates that black Americans can be encouraged to participate in and can be enrolled in cancer clinical trials. PMID:10025373

Holcombe, R F; Jacobson, J; Li, A; Moinpour, C M

1999-02-01

144

Clinical experience of marketed Levetiracetam in an epilepsy clinic—a one year follow up study  

Microsoft Academic Search

Levetiracetam is a new anti-convulsant with impressive pivotal trial credentials. We examined its effectiveness in refractory clinic patients with epilepsy with a year’s follow up. Six months after initiation 32% of the patients were seizure free, and 26% at one year.By the end of the 12 months follow up 77% of patients were still taking the drug, having gained benefit

TIM BETTS; HELEN YARROW; LYN GREENHILL; MARY BARRETT

2003-01-01

145

Microwave imaging for neoadjuvant chemotherapy monitoring: initial clinical experience  

PubMed Central

Introduction Microwave tomography recovers images of tissue dielectric properties, which appear to be specific for breast cancer, with low-cost technology that does not present an exposure risk, suggesting the modality may be a good candidate for monitoring neoadjuvant chemotherapy. Methods Eight patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer were imaged longitudinally five to eight times during the course of treatment. At the start of therapy, regions of interest (ROIs) were identified from contrast-enhanced magnetic resonance imaging studies. During subsequent microwave examinations, subjects were positioned with their breasts pendant in a coupling fluid and surrounded by an immersed antenna array. Microwave property values were extracted from the ROIs through an automated procedure and statistical analyses were performed to assess short term (30 days) and longer term (four to six months) dielectric property changes. Results Two patient cases (one complete and one partial response) are presented in detail and demonstrate changes in microwave properties commensurate with the degree of treatment response observed pathologically. Normalized mean conductivity in ROIs from patients with complete pathological responses was significantly different from that of partial responders (P value = 0.004). In addition, the normalized conductivity measure also correlated well with complete pathological response at 30 days (P value = 0.002). Conclusions These preliminary findings suggest that both early and late conductivity property changes correlate well with overall treatment response to neoadjuvant therapy in locally advanced breast cancer. This result is consistent with earlier clinical outcomes that lesion conductivity is specific to differentiating breast cancer from benign lesions and normal tissue. PMID:23621959

2013-01-01

146

Stereotactic Radiosurgery for Single Brainstem Metastases: The Cleveland Clinic Experience  

SciTech Connect

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

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

2010-10-01

147

Clinical Experience of a Diet Designed to Reduce Aging  

PubMed Central

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

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

2010-01-01

148

Outcomes of transoral robotic surgery: a preliminary clinical experience  

PubMed Central

Objective To report long-term, health-related quality of life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS). Study Design Prospective clinical study on functional and HRQOL outcomes in TORS. Setting University tertiary care facility. Subjects Patients who underwent TORS at The Ohio State University Medical Center. Methods All patients undergoing TORS were asked to complete the Head and Neck Cancer Inventory before treatment, and at 3 weeks, 3, 6, and 12 months postoperatively. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected for each patient. Results Sixty four patients who underwent TORS were enrolled with a median age of 56.8years. A total of 113 TORS procedures were performed. Mean follow up time was 16.3 ± 7.49 months (range 6 to 33). Majority of TORS were performed for squamous cell carcinoma (88%). No patients experienced immediate postoperative complications, with all of the patients tolerating an oral diet without any airway compromise on the day of surgery. There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the one year follow up, the HRQOL scores in the aesthetic, social, and overall QOL domains were near baseline. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (p<.05). Forty nine patients (77%) underwent adjuvant radiation therapy (RT), and 61% had chemoradiation (CRT) therapy. Patients who underwent adjuvant XRT or CRT had lower postoperative scores in the eating, social and overall QOL domains, compared to those who did not (p<.05). Conclusion TORS is a safe procedure with good functional and HRQOL outcomes. Patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising future alternative surgical treatment for laryngopharyngeal tumors. PMID:21810777

Hurtuk, Agnes; Marcinow, Anna; Agrawal, Amit; Old, Matthew; Teknos, Theodoros N; Ozer, Enver

2014-01-01

149

Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings.  

PubMed

This article investigates clinical decision making in acute care hospitals by cardiorespiratory physiotherapists with differing degrees of clinical experience. Participants were observed as they engaged in their everyday practice and were interviewed about their decision making. Texts of the data were interpreted by using a hermeneutic approach that involved repeated reading and analysis of fieldnotes and interview transcripts to develop an understanding of the effect of experience on clinical decision making. Participants were classified into categories of cardiorespiratory physiotherapy experience: less experienced (<2 years), intermediate experience (2.5-4 years), and more experienced (>7 years). Four dimensions characteristic of increasing experience in cardiorespiratory physiotherapy clinical decision making were identified: 1) an individual practice model, 2) refined approaches to clinical decision making, 3) working in context, and 4) social and emotional capability. Underpinning these dimensions was evidence of reflection on practice, motivation to achieve best practice, critique of new knowledge, increasing confidence, and relationships with knowledgeable colleagues. These findings reflect characteristics of physiotherapy expertise that have been described in the literature. This study adds knowledge about the field of cardiorespiratory physiotherapy to the existing body of research on clinical decision making and broadens the existing understanding of characteristics of physiotherapy expertise. PMID:20067358

Smith, Megan; Higgs, Joy; Ellis, Elizabeth

2010-02-01

150

Implementation of an intraoperative clinical experience for senior level baccalaureate nursing students.  

PubMed

Perioperative nursing is a specialty that has been eliminated from many nursing education programs. With the loss of perioperative clinical experiences, the number of students pursuing a career in perioperative nursing after graduation has declined. A faculty member at one Midwestern school of nursing developed and implemented a perioperative clinical experience for senior-level baccalaureate nursing students in a critical care nursing course. This program, developed with the assistance of four local hospitals and the college of nursing, included an eight-hour OR orientation and 56 clinical hours. Students were placed in the OR under preceptor guidance and supervision. Feedback from evaluations was positive and provided recommendations for improving the program, in particular, to allow more clinical hours and more hands-on experience for the students. PMID:22464617

Mott, Jason

2012-04-01

151

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

ERIC Educational Resources Information Center

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…

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

2015-01-01

152

A study of the use of past experiences in clinical decision making in emergency situations  

Microsoft Academic Search

Making decisions to call emergency assistance to patients is an important dimension of nursing practice. Most usually these decision making situations are uncertain and it is expected nurses rely on past clinical experiences. This study, approved by the ethics committees of both a university and an area health service, aimed to describe nurses’ reliance on past experiences and identify associated

J Cioffi

2001-01-01

153

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

ERIC Educational Resources Information Center

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

Leeds, Andrew L.

1993-01-01

154

The electromagnetic bio-field: clinical experiments and interferences  

PubMed Central

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

Burnei, G; Hodorogea, D; Georgescu, I; Gavriliu, ?; Dr?ghici, I; Dan, D; Vlad, C; Dr?ghici, L

2012-01-01

155

Double hit lymphoma: the MD Anderson Cancer Center clinical experience.  

PubMed

We report our experience with 129 cases of double hit lymphoma (DHL), defined as B-cell lymphoma with translocations and/or extra signals involving MYC plus BCL2 and/or BCL6. All cases were reviewed for histopathological classification. Median age was 62 years (range, 18-85), 84% of patients had advanced-stage disease, and 87% had an International Prognostic Index score ?2. Fourteen patients (11%) had a history of low-grade follicular lymphoma. MYC translocation was present in 81%, and extra signals of MYC in 25% of patients. IGH-BCL2 translocation was present in 84% and extra signals of BCL2 in 12% of patients. Two-year event-free survival (EFS) rates in all patients and patients who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), and R-HyperCVAD/MA (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, alternating with cytarabine plus methotrexate) were 33%, 25%, 67% and 32%, respectively. In patients achieving complete response with initial therapy (n = 71), 2-year EFS rates in patients who did (n = 23) or did not (n = 48) receive frontline stem cell transplantation were 68% and 53%, respectively (P = 0·155). The cumulative incidence of central nervous system involvement was 13% at 3 years. Multivariate analysis identified performance status ?2 and bone marrow involvement as independent adverse prognostic factors for EFS and OS. Further research is needed to identify predictive and/or targetable biological markers and novel therapeutic approaches for DHL patients. PMID:24943107

Oki, Yasuhiro; Noorani, Mansoor; Lin, Pei; Davis, Richard E; Neelapu, Sattva S; Ma, Long; Ahmed, Mohamed; Rodriguez, Maria Alma; Hagemeister, Fredrick B; Fowler, Nathan; Wang, Michael; Fanale, Michelle A; Nastoupil, Loretta; Samaniego, Felipe; Lee, Hun J; Dabaja, Bouthaina S; Pinnix, Chelsea C; Medeiros, Leonard J; Nieto, Yago; Khouri, Issa; Kwak, Larry W; Turturro, Francesco; Romaguera, Jorge E; Fayad, Luis E; Westin, Jason R

2014-09-01

156

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

PubMed Central

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

Lowenstein, Pedro R.; Castro, Maria G.

2009-01-01

157

Alpha-particle radiobiological experiments using thin CR-39 detectors.  

PubMed

The present paper studied the feasibility of applying comet assay to evaluate the DNA damage in individual HeLa cervix cancer cells after alpha-particle irradiation. We prepared thin CR-39 detectors (<20 microm) as cell-culture substrates, with UV irradiation to shorten the track formation time. After irradiation of the HeLa cells by alpha particles, the tracks on the underside of the CR-39 detector were developed by chemical etching in (while floating on) a 14 N KOH solution at 37 degrees C. 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 of the CR-39 detectors could also be observed by just changing the focal plane of the confocal microscope. PMID:17132662

Chan, K F; Siu, S Y M; McClella, K E; Tse, A K W; Lau, B M F; Nikezic, D; Richardson, B J; Lam, P K S; Fong, W F; Yu, K N

2006-01-01

158

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

SciTech Connect

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

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

2011-09-06

159

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

PubMed Central

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

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

2013-01-01

160

Effect of different cell cluster models on the radiobiological output for (211)At-radioimmunotherapy.  

PubMed

The cell cluster modeling is a widely used method to estimate the small-scale dosimetry and provides the implication for a clinic. This work evaluated the effect of different regular cluster models on the radiobiological outputs for (211)At-radioimmunotherapy. The cell activity threshold was estimated using a tumor control probability of 0.90. Basically, regular models show similar features with cluster configuration and cell dimension variation. However, their individual results such as the cumulated activity threshold per cell and the prescription dose per volume should not be substituted reciprocally. The tissue composed of smaller cells or midcell packing will need a little more high prescription dose per volume. The radiation sensitivity parameters in a linear-quadratic model are critical to decide the radiobiological response with dose. The cumulated cell activity threshold increases exponentially with ? decreasing, and its influence on the big cell dimension is more than on the small one. The different subsources affect radioresistant organs or tissues more remarkably than radiosensitive ones, especially the cells with large cytoplasm. The heterogeneous activity of Gaussian distribution will decrease the therapeutical effectiveness for the nucleus source, but its influence on the cytoplasm and cell surface sources is a little uncertain, as their real mean value is always higher than its set mean value by assuming the cell activity uptakes from zero. Careful usage of underdose with heterogeneous activity distribution should be practiced in clinics. The deteriorated heterogeneous distribution will salvage the potential subversive and lead to the failure of tumor local control. Some cells with no or little activity that are located on the edge or vertex of cube or corner models will have the ability to survive, as there is a lack of a part of the cross-fire dose effect, and so more attention should be paid in selecting the dosage. Although this work focuses on the clinic implication of (211)At in ?-radioimmunotherapy, these cell cluster models can be generalized to other radionuclides. PMID:21355780

Lin, Hui; Jing, Jia; Xu, Yuanying

2011-02-01

161

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

NASA Astrophysics Data System (ADS)

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

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

2007-07-01

162

Clinical review: Noninvasive ventilation in the clinical setting – experience from the past 10 years  

PubMed Central

This brief review analyses the progress of noninvasive ventilation (NIV) over the last decade. NIV has gained the dignity of first line intervention for acute exacerbation of chronic obstructive pulmonary disease, assuring reduction of the intubation rate, rate of infection and mortality. Despite positive results, NIV still remains controversial as a treatment for acute hypoxemic respiratory failure, largely due to the different pathophysiology of hypoxemia. The infection rate reduction effect achieved by NIV application is crucial for immunocompromised patients for whom the endotracheal intubation represents a high risk. Improvements in skills acquired with experience over time progressively allowed successful treatment of more severe patients. PMID:15693991

Antonelli, Massimo; Pennisi, Mariano Alberto; Montini, Luca

2005-01-01

163

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

Microsoft Academic Search

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

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

2000-01-01

164

Prevalence and reversibility of the hepatopulmonary syndrome after liver transplantation. The Cleveland Clinic experience.  

PubMed Central

To ascertain the prevalence and reversibility of the hepatopulmonary syndrome, we reviewed the cases of 98 patients undergoing liver transplantation at the Cleveland (Ohio) Clinic Foundation from June 1988 through July 1992 and identified 4 patients with clinically recognized hepatopulmonary syndrome (prevalence 4%). All 4 patients ultimately had complete reversal of their disorder. As reviewed herein, the prevalence of the hepatopulmonary syndrome in the current series is lower than in previous reports, possibly reflecting a dependence on its clinical recognition in this series rather than the use of routine screening tests. This report confirms previous experience that the hepatopulmonary syndrome may be reversible after transplantation. PMID:7571560

Stoller, J K; Lange, P A; Westveer, M K; Carey, W D; Vogt, D; Henderson, J M

1995-01-01

165

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

PubMed Central

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

Wa?kowicz, Zofia

2013-01-01

166

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

SciTech Connect

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

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

2013-02-15

167

Ultrashort Pulse Laser Accelerated Proton Beams for First Radiobiological Applications  

SciTech Connect

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

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

2010-11-04

168

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

PubMed

The purpose of this study is to determine dosimetric and radiobiological predictors of biochemical control after recalculation of prostate implant dosimetry using updated AAPM Task Group 43 (TG-43) parameters and the radiobiological parameters recommended by TG-137. All biochemical failures among patients implanted with 125I Or 103Pd sources between 1994 and March 2006 were matched 2:1 with nonfailure controls. The individual matching was by risk group, radionuclide, prescribed dose, and time of implant (one match before and one after the failed patient) resulting in a median follow-up of 10.9 years. Complete dose volume histogram (DVH) data were recalculated for all 55 cases and 110 controls after updating the original source strength by the retrospectively determined ratios of TG-43. Differential DVH data were acquired in 179 increments of prostate volume versus percentage prescribed dose. At each incremental dose level i, the biologically equivalent dose BEDi, equivalent uniform dose EUDi, and tumor control probability TCPi were calculated from the implant dose plus any external beam delivered to the patient. Total BED, EUD, and TCP were then derived from the incremental values for comparison with single point dosimetric quality parameters and DVH-based averages. There was no significant difference between failures and controls in terms of total BED (143 vs 142 Gy), EUD (95 vs 94 Gy), or TCP (0.87 vs 0.89). Conditional logistic regression analysis factored out the matching variables and stratified the cohort into each case and its controls, but no radiobiological parameter was predictive of biochemical failure. However, there was a significant difference between radiobiological parameters of 125I and 103Pd due to less complete coverage of the target volume by the former isotope. The implant BED and TCP were highly correlated with the D90 and natural prescription doses and a series of mean DVH-based doses such as the harmonic mean and expressions of the generalized EUD. In this case-control study of prostate brachytherapy biochemical failures and nonfailures, there were no radiobiological parameters derived from detailed DVH-based analysis that predicted for biochemical control. This may indicate that in our approach, implant dosimetry is at or near the limits of clinically effective dose escalation. PMID:19378738

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

2009-03-01

169

Dosimetry for radiobiological studies of the human hematopoietic system  

NASA Technical Reports Server (NTRS)

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

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

1972-01-01

170

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

PubMed

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

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

2013-07-01

171

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

PubMed

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

Williams, Angela; Taylor, Cathy

2008-11-01

172

Quantitative modeling of chronic myeloid leukemia: insights from radiobiology.  

PubMed

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

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

2012-05-10

173

(Radio)Biological Optimization of External-Beam Radiotherapy  

PubMed Central

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

Nahum, Alan E.; Uzan, Julien

2012-01-01

174

Collaborative peer lyric writing during music therapy training: a tool for facilitating students' reflections about clinical practicum experiences  

Microsoft Academic Search

Self-reflection is integral to effective clinical practice and yet is a skill that many intelligent students struggle to develop. This paper reports on the findings of a pilot study where students shared both positive and challenging experiences with each other and co-wrote songs that captured their experiences. Four students attending clinical practicum engaged in collaborative songwriting experiences with peers from

Felicity Baker; Robert E. Krout

2011-01-01

175

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.

176

The North Carolina Sentencing Seminar: An Experiment in Controlled Clinical Legal Education  

ERIC Educational Resources Information Center

A semester course at the law school of the University of North Carolina offers a unique experiment in controlled clinical legal education. It combines a thorough survey and analysis of major legal and constitutional issues in criminal sentencing with a broad exposure to courts and correction agencies and opportunities for students to take part in…

Andrews, Thomas J.

1977-01-01

177

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

ERIC Educational Resources Information Center

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

LaFauci, Frances F.

2009-01-01

178

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

ERIC Educational Resources Information Center

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

Harland, Darci J.; Wondra, Joshua D.

2011-01-01

179

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

ERIC Educational Resources Information Center

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

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

2012-01-01

180

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

Microsoft Academic Search

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

Katri Elina Clemens; Eberhard Klaschik

2007-01-01

181

The Dor procedure for left ventricular reconstruction. Ten-year clinical experience  

Microsoft Academic Search

Objective: Surgical ventricular restoration by means of the Dor procedure is a surgical option in patients with coronary artery disease, postinfarction left ventricular aneurysm or ischemic dilated cardiomyopathy with or without ventricular tachycardia. The aim of this study was to evaluate the 10-year clinical experience of this procedure in our institution. Methods: From May 1994 to June 2004, surgical ventricular

Ulrik Sartipy; Anders Albage; Dan Lindblom

2010-01-01

182

Analysis of the multidimensionality of hallucination-like experiences in clinical and nonclinical Spanish samples and their relation to clinical symptoms: implications for the model of continuity.  

PubMed

Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a quasi-continuum approach and that total scores on these scales explain a state of vulnerability to general perceptual disturbance. PMID:22044132

Langer, Alvaro I; Cangas, Adolfo J; Serper, Mark

2011-02-01

183

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

PubMed

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

Gold, Hugo; Hall, Georgina; Gillam, Lynn

2011-09-01

184

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

PubMed

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

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

2014-11-28

185

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

PubMed Central

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

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

2015-01-01

186

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

PubMed Central

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

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

2012-01-01

187

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

NASA Technical Reports Server (NTRS)

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

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

1992-01-01

188

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

PubMed Central

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

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

2011-01-01

189

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

PubMed

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

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

2011-06-01

190

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

PubMed

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. PMID:23399781

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

191

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

NASA Astrophysics Data System (ADS)

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

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

2013-03-01

192

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

PubMed

ABSTRACTClinical practice guidelines are an important vehicle for knowledge translation and improving patient care. For most learners, these documents can be daunting and confusing. We describe a novel educational experience that clarified the guideline generation process for learners while at the same time creating clinical educational guidelines (simplified learning aids) for junior learners in the emergency department (ED). We devised a system using near-peer mentors to generate a series of clinical education guideline learning materials created by residents and junior learners for the evaluation of undifferentiated chest pain in the ED. This process assisted in teaching residents and junior learners and generated an endurable educational product. PMID:25358281

Baw, Bandar; Chan, Teresa; Upadhye, Suneel

2014-11-01

193

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

PubMed

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

Lindl, Toni; Voelkel, Manfred; Kolar, Roman

2005-01-01

194

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

PubMed

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

Knight, Andrew

2007-12-01

195

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

PubMed Central

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

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

196

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

Microsoft Academic Search

BACKGROUND: Many women experience breastfeeding difficulties. Sometimes these difficulties lead to breastfeeding cessation. Breastfeeding clinics provide support for women facing such problems. This study aims to describe the breastfeeding experience of women, particularly those who use the services of the breastfeeding clinic located in the Greater Quebec City area. METHODS: This is a descriptive study based on information gathered through

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

2008-01-01

197

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

ERIC Educational Resources Information Center

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

Flowers, Claudia

2006-01-01

198

The experiences of English as second language radiation therapy students in the undergraduate clinical program: Perceptions of staff and students  

Microsoft Academic Search

IntroductionThis qualitative study explores the experiences of undergraduate radiation therapy students who have English as a second language (ESL) in the clinical environment, as well as the experiences of staff members who teach these students. Specific study aims were to increase understanding of the issues faced by this subset of students, including identifying potential barriers to clinical learning.

Amanda Bolderston; Cathryne Palmer; Wendy Flanagan; Neil McParland

2008-01-01

199

Students' satisfaction with simulated clinical experiences: validation of an assessment scale  

PubMed Central

OBJECTIVE: validate an assessment instrument of nursing students' satisfaction with simulated clinical experiences. METHOD: a 17-item scale was applied to students from the Teaching Diploma Program in Nursing, after a set of simulated clinical experiences. Factorial analysis with orthogonal varimax rotation was used, and the internal consistency was estimated to determine the validity of the scale. RESULTS: in a sample of 181 students, we found a high correlation between practically all items and the total scale, with an Alpha coefficient of 0.914. The scale items were divided in three factors: practical dimension, realism dimension and cognitive dimension, with good internal consistency coefficients of 0.89; 0.88 and 0.73, respectively. CONCLUSION: the scale complies with the validity requisites, revealing a high potential for use in research. PMID:25493664

Baptista, Rui Carlos Negrão; Martins, José Carlos Amado; Pereira, Maria Fátima Carneiro Ribeiro; Mazzo, Alessandra

2014-01-01

200

Intraarterial chemotherapy for head and neck cancer, Part 2: Clinical experience.  

PubMed

Despite almost 3 decades of experience, the use of intraarterial (IA) chemotherapy for the treatment of head and neck cancer is not universally accepted. The overall reported response rates are not substantially different from the therapeutic results obtained with systemic therapy. The additional complications associated with establishing and maintaining arterial access have further dampened enthusiasm for this approach. It is clear that considerable improvement in the techniques and efficacy of IA chemotherapy is necessary. This second and last part of this article considers the past and present clinical experience with IA therapy in the treatment of head and neck cancer and explores future developments. PMID:6198307

Baker, S R; Wheeler, R

1984-01-01

201

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

PubMed Central

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

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

202

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

PubMed

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

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

2013-07-01

203

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

Microsoft Academic Search

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

P. Matter; H. B. Burch

1990-01-01

204

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

Microsoft Academic Search

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

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

1975-01-01

205

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

PubMed Central

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

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

206

Sensory integration intervention: Historical concepts, treatment strategies and clinical experiences in three patients with succinic semialdehyde dehydrogenase (SSADH) deficiency  

Microsoft Academic Search

Summary  This paper is a review of clinical experiences providing developmental therapy services for three boys diagnosed with paediatric\\u000a neurotransmitter disease. The clinical presentation of paediatric neurotransmitter diseases might parallel other diagnostic\\u000a characteristics seen in a typical paediatric therapy clinic (i.e. hypotonia, motor and cognitive delays, coordination, expressive\\u000a speech, and ocular motor difficulties.) From the clinical perspective of the author, sensory

S. V. Kratz

2009-01-01

207

A fuzzy convolution model for radiobiologically optimized radiotherapy margins.  

PubMed

In this study we investigate the use of a new knowledge-based fuzzy logic technique to derive radiotherapy margins based on radiotherapy uncertainties and their radiobiological effects. The main radiotherapy uncertainties considered and used to build the model were delineation, set-up and organ motion-induced errors. The radiobiological effects of these combined errors, in terms of prostate tumour control probability and rectal normal tissue complication probability, were used to formulate the rule base and membership functions for a Sugeno type fuzzy system linking the error effect to the treatment margin. The defuzzified output was optimized by convolving it with a Gaussian convolution kernel to give a uniformly varying transfer function which was used to calculate the required treatment margins. The margin derived using the fuzzy technique showed good agreement compared to current prostate margins based on the commonly used margin formulation proposed by van Herk et al (2000 Int. J. Radiat. Oncol. Biol. Phys. 47 1121-35), and has nonlinear variation above combined errors of 5 mm standard deviation. The derived margin is on average 0.5 mm bigger than currently used margins in the region of small treatment uncertainties where margin reduction would be applicable. The new margin was applied in an intensity modulated radiotherapy prostate treatment planning example where margin reduction and a dose escalation regime were implemented, and by inducing equivalent treatment uncertainties, the resulting target and organs at risk doses were found to compare well to results obtained using currently recommended margins. PMID:20479517

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

2010-06-01

208

[Radiobiology base change: long term effects of ionizing radiation].  

PubMed

By definition, radiobiology studies energy transferring from ionizing radiations to biological material. For a long time, radiobiologists have mainly focused in physical issues and its impact on biological cells and tissues. Moreover, DNA damage, specifically of single and double strands (correctly or not restored by enzymatic repair processes), was studied through diverse mathematical models but only one experimental method: cell death measurement. Today, radiobiology has become again a strictly biological science, focused on the future of energy deposit. Genomic instability is the first step, as it studies the amplification over time of a gene signal in a clonal population derived from a single surviving cell after radiation exposure, independently of initial radiation doses. Bystander effect demonstrates that damage signals may be transmitted from irradiated to non-irradiated cells in a population with the same long term radio-induced effect. Abscopal effect is a reaction produced following irradiation, but occurring outside the site of radiation absorption (for example, from irradiated right lung to DNA damage of the left lung). Clastogenic factors are chromosome damaging substances which are present in irradiated patients's plasma. These data could change the fundamentals of radioprotection, as declared UNSCEAR during the 54th session of may 2006. PMID:19025204

Behar, A

2008-01-01

209

Learning experience of Chinese nursing students in an online clinical English course: Qualitative study.  

PubMed

The low English proficiency of Chinese nurse/nursing students affects their performance when they work in English-speaking countries. However, limited resources are available to help them improve their workplace English, i.e. English used in a clinical setting. To this end, it is essential to look for an appropriate and effective means to assist them in improving their clinical English. The objective of this study is to evaluate the learning experience of Chinese nursing students after they have completed an online clinical English course. Focus group interview was used to explore their learning experience. 100 students in nursing programs at Tung Wah College were recruited. The inclusion criteria were: (1) currently enrolled in a nursing program; and (2) having clinical experience. Eligible participants self-registered for the online English course, and were required to complete the course within 3months. After that, semi-structured interviews were conducted on students whom completed the whole and less than half of the course. One of the researchers joined each of the interviews as a facilitator and an observer. Thematic analysis was used to analyze the data. Finally, 7 themes emerged from the interviews: technical issues, adequacy of support, time requirement, motivation, clarity of course instruction, course design, and relevancy of the course. Participants had varied opinions on the 2 themes: motivation and relevancy of the course. Overall, results of this study suggest that the online English course helped students improve their English. Factors which support their learning are interactive course design, no time constraint, and relevancy to their work/study. Factors which detracted from their learning are poor accessibility, poor technical and learning support and no peer support throughout the course. PMID:25497137

Tang, Anson C Y; Wong, Nick; Wong, Thomas K S

2015-02-01

210

Experience inheritance from famous specialists based on real-world clinical research paradigm of traditional Chinese medicine.  

PubMed

The current modes of experience inheritance from famous specialists in traditional Chinese medicine (TCM) include master and disciple, literature review, clinical-epidemiology-based clinical research observation, and analysis and data mining via computer and database technologies. Each mode has its advantages and disadvantages. However, a scientific and instructive experience inheritance mode has not been developed. The advent of the big data era as well as the formation and practice accumulation of the TCM clinical research paradigm in the real world have provided new perspectives, techniques, and methods for inheriting experience from famous TCM specialists. Through continuous exploration and practice, the research group proposes the innovation research mode based on the real-world TCM clinical research paradigm, which involves the inheritance and innovation of the existing modes. This mode is formulated in line with its own development regularity of TCM and is expected to become the main mode of experience inheritance in the clinical field. PMID:25159993

Song, Guanli; Wang, Yinghui; Zhang, Runshun; Liu, Baoyan; Zhou, Xuezhong; Zhou, Xiaji; Zhang, Hong; Guo, Yufeng; Xue, Yanxing; Xu, Lili

2014-09-01

211

Best clinical practice with ziprasidone IM: update after 2 years of experience.  

PubMed

Acute agitation is a common psychiatric emergency often treated with intramuscular (i.m.) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional i.m. antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon) is the first second-generation, or atypical, antipsychotic to become available in an i.m. formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings. In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol i.m. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from i.m. to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical setting are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics. PMID:16247923

Zimbroff, Dan L; Allen, Michael H; Battaglia, John; Citrome, Leslie; Fishkind, Avrim; Francis, Andrew; Herr, Daniel L; Hughes, Douglas; Martel, Marc; Preval, Horacio; Ross, Ruth

2005-09-01

212

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

PubMed

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

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

2014-01-01

213

The importance of clinical experience for mental health nursing - part 1: undergraduate nursing students' attitudes, preparedness and satisfaction.  

PubMed

Government inquiries and workforce data continue to draw attention to the current and impending crisis in mental health nursing. While undergraduate nursing education has been found at least partially responsible for the negative attitudes nursing students tend to hold towards mental health nursing, clinical experience has been identified as a potential strategy in enhancing more positive attitudes. However, research to date has not focused on the impact of clinical experience on specific factors such as attitudes to mental health nursing to people experiencing mental illness and perceived preparedness for the mental health field. This quasi-experimental study measured changes in students' attitudes to the three factors, including satisfaction with clinical experience following a placement in mental health nursing. A questionnaire was administered to undergraduate nursing students on the first and last day of a mental health clinical placement. This, the first of a two-part paper, compares student responses over the two-time periods and describes satisfaction with the clinical experience. The findings suggest that clinical experience in mental health nursing experience can positively influence attitudes, preparedness for practice, and the popularity of mental health nursing. Satisfaction with clinical experience was also high. PMID:18789042

Happell, Brenda

2008-10-01

214

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

PubMed Central

Whole genome analysis, now including whole genome sequencing, is moving rapidly into the clinical setting, leading to detection of human variation on a broader scale than ever before. Interpreting this information will depend on the availability of thorough and accurate phenotype information, and the ability to curate, store, and access data on genotype-phenotype relationships. This idea has already been demonstrated within the context of chromosome microarray (CMA) testing. The International Standards for Cytogenomic Arrays (ISCA) Consortium promotes standardization of variant interpretation for this technology through its initiatives, including the formation of a publicly available database housing clinical CMA data. Recognizing that phenotypic data is essential for the interpretation of genomic variants, the ISCA Consortium has developed tools to facilitate the collection of this data and its deposition in a standardized, structured format within the ISCA Consortium database. This rich source of phenotypic data can also be used within broader applications, such as developing phenotypic profiles of emerging genomic disorders, the identification of candidate regions for particular phenotypes, or the creation of tools for use in clinical practice. We summarize the ISCA experience as a model for ongoing efforts incorporating phenotype data with genotype data to improve the quality of research and clinical care in human genetics. PMID:22331816

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

2012-01-01

215

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

PubMed Central

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

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

216

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

PubMed Central

Aim To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. Methods A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. Results Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%). Conclusion Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it. PMID:20718086

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

2010-01-01

217

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.

218

Chromatin structure and radiation-induced DNA damage: from structural biology to radiobiology.  

PubMed

Genomic DNA in eukaryotic cells is basically divided into chromosomes, each consisting of a single huge nucleosomal fiber. It is now clear that chromatin structure and dynamics play a critical role in all processes involved in DNA metabolism, e.g. replication, transcription, repair and recombination. Radiation is a useful tool to study the biological effects of chromatin alterations. Conversely, radiotherapy and radiodiagnosis raise questions about the influence of chromatin integrity on clinical features and secondary effects. This review focuses on the link between DNA damage and chromatin structure at different scales, showing how a comprehensive multiscale vision is required to understand better the effect of radiations on DNA. Clinical aspects related to high- and low-dose of radiation and chromosomal instability will be discussed. At the same time, we will show that the analysis of the radiation-induced DNA damage distribution provides good insight on chromatin structure. Hence, we argue that chromatin "structuralists" and radiobiological "clinicians" would each benefit from more collaboration with the other. We hope that this focused review will help in this regard. PMID:24486235

Lavelle, Christophe; Foray, Nicolas

2014-04-01

219

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

PubMed

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

Matter, P; Burch, H B

1990-01-01

220

Clinical experience and future directions for low-density lipoprotein apheresis in the United States.  

PubMed

The United States Liposorber Study was a 22 week randomized controlled study of low-density lipoprotein (LDL) apheresis with an optional follow-up phase. The procedure was found to acutely lower LDL cholesterol by up to 81%, have good tolerability, and produce a reduction in the frequency of cardiovascular events. Studies outside the United States have found therapy with LDL apheresis to be associated with a favorable clinical outcome including improved myocardial perfusion, but variable regression of coronary artery disease (CAD). Improvement in blood viscosity and endothelial function may help explain the symptomatic benefits observed with relatively small changes in angiography. Based upon favorable clinical experience, LDL apheresis using dextran sulfate cellulose columns has recently received approval for commercialization in the United States in patients with inadequate responses to diet and drug therapy and LDL levels > or = 200 mg with CAD present or LDL levels > or = 300 mg/dl without CAD. PMID:10225747

Gordon, B R; Saal, S D

1997-08-01

221

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

PubMed Central

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

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

2014-01-01

222

Internal medicine residents’ clinical and didactic experiences after work hour regulation  

Microsoft Academic Search

BACKGROUND: Work hour regulations for house staff were intended in part to improve resident clinical and educational performance.\\u000a \\u000a \\u000a OBJECTIVE: To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic\\u000a education.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Cross-sectional mail survey.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Chief residents at all accredited U.S. internal medicine residency programs outside New York.\\u000a \\u000a \\u000a \\u000a \\u000a MEASUREMENTS AND MAIN RESULTS: The

Leora I. Horwitz; Harlan M. Krumholz; Stephen J. Huot; Michael L. Green

2006-01-01

223

The Safe use of Radioactive Isotopes in Teaching Experiments  

ERIC Educational Resources Information Center

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

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

1974-01-01

224

The Usefulness of Systematic Reviews of Animal Experiments for the Design of Preclinical and Clinical Studies  

PubMed Central

The question of how animal studies should be designed, conducted, and analyzed remains underexposed in societal debates on animal experimentation. This is not only a scientific but also a moral question. After all, if animal experiments are not appropriately designed, conducted, and analyzed, the results produced are unlikely to be reliable and the animals have in effect been wasted. In this article, we focus on one particular method to address this moral question, namely systematic reviews of previously performed animal experiments. We discuss how the design, conduct, and analysis of future (animal and human) experiments may be optimized through such systematic reviews. In particular, we illustrate how these reviews can help improve the methodological quality of animal experiments, make the choice of an animal model and the translation of animal data to the clinic more evidence-based, and implement the 3Rs. Moreover, we discuss which measures are being taken and which need to be taken in the future to ensure that systematic reviews will actually contribute to optimizing experimental design and thereby to meeting a necessary condition for making the use of animals in these experiments justified. PMID:25541545

de Vries, Rob B. M.; Wever, Kimberley E.; Avey, Marc T.; Stephens, Martin L.; Sena, Emily S.; Leenaars, Marlies

2014-01-01

225

Could hyperthermia with proton therapy mimic carbon ion therapy? Exploring a thermo-radiobiological rationale.  

PubMed

Hyperthermia has been conventionally used in conjunction with photon beam irradiation. With a gradual increase in particle therapy facilities worldwide, this paper explores the physical, thermal and radiobiological implications of using a combination of hyperthermia with proton beam therapy. Hyperthermia is known to exhibit radiobiological features similar to those of high linear energy transfer radiation. Protons have many of the physical dose distribution properties of (12)C ion therapy. Thus, the thermo-radiobiological advantages of hyperthermia coupled with the physical dose distribution advantages of proton beams could possibly mimic (12)C ion therapy. PMID:25314095

Datta, Niloy R; Puric, Emsad; Schneider, Ralf; Weber, Damien C; Rogers, Susanne; Bodis, Stephan

2014-11-01

226

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

PubMed Central

Study Objectives: This study reviewed the cumulative postmarketing and clinical safety experience with sodium oxybate (Xyrem®), a treatment approved for cataplexy and excessive daytime sleepiness in narcolepsy. Study objectives were to investigate the occurrence of abuse/misuse of sodium oxybate since first market introduction in 2002, classify cases using DSM-IV criteria for substance abuse and dependence, and describe specific characteristics of these cases. Methods: We retrospectively reviewed postmarketing spontaneous adverse event (AE) reports from 15 countries for all cases containing reporting terminology related to abuse/misuse to determine its occurrence. All death cases independent of causality were reviewed to identify associated risk factors. Results: Approximately 26,000 patients worldwide received sodium oxybate from first market introduction in 2002 through March 2008. Of those 26,000 patients, 0.2% reported ? 1 of the events studied. These included 10 cases (0.039%) meeting DSM-IV abuse criteria, 4 cases (0.016%) meeting DSM-IV dependence criteria, 8 cases (0.031%, including 3 of the previous 4) with withdrawal symptoms reported after discontinuation of sodium oxybate, 2 confirmed cases (0.008%) of sodium oxybate–facilitated sexual assault, 8 cases (0.031%) of overdose with suicidal intent, 21 deaths (0.08%) in patients receiving sodium oxybate treatment with 1 death known to be related to sodium oxybate, and 3 cases (0.01%) of traffic accidents involving drivers taking sodium oxybate. During this period, approximately 600,000 bottles of sodium oxybate were distributed, and 5 incidents (0.0009%) of diversion were reported. Conclusion: Cumulative postmarketing and clinical experience indicates a very low risk of abuse/misuse of sodium oxybate. Citation: Wang YG; Swick TJ; Carter LP; Thorpy MJ; Benowitz NL. Safety overview of postmarketing and clinical experience of sodium oxybate (xyrem): abuse, misuse, dependence, and diversion. J Clin Sleep Med 2009;5(4):365-371. PMID:19968016

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

2009-01-01

227

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

NASA Astrophysics Data System (ADS)

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

Pyakuryal, Anil Prasad

228

Clinical Experience in Using the Water Jet in Burn Wound Debridement  

PubMed Central

Summary Water jets have been used in many areas of surgery. Recently a new surgical debridement device was launched onto the market - VersajetTM. VersajetTM is a unique hydrosurgical device that uses a precise jet of water to simultaneously hold, cut, and remove devitalized or necrotic tissue. This paper describes our experience with ten patients comparing Weck knives with the newly designed hydrosurgical device when debriding burn wounds. The patients' age ranged from 27 to 60 yr (average, 37.8 yr) and the burn wounds treated were between 3 and 7% total body surface area, involving the face, abdomen, and limbs. The hydrosurgical system is a very useful tool for irregular and complex burn wound debridement. This paper represents the first written clinical experience utilizing hydrosurgery in the burn wound management in an Eastern country. PMID:21991073

Yang, J.-Y.; Hwuang, J.-Y.; Chuang, S.-S.

2007-01-01

229

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

230

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

231

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

Code of Federal Regulations, 2013 CFR

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

2013-10-01

232

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

Code of Federal Regulations, 2014 CFR

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

2014-10-01

233

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

Code of Federal Regulations, 2011 CFR

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

2011-10-01

234

Insulin degludec early clinical experience: does the promise from the clinical trials translate into clinical practice-a case-based evaluation.  

PubMed

Abstract Background: Clinical experience of patients is an additional source of information that can inform prescribing decisions for new therapies in practice. In diabetes, for example, patients with recurrent hypoglycemia may be excluded from trials conducted for regulatory purposes. Using insulin degludec (IDeg), a new basal insulin with an ultra-long duration of action as an example, an interim analysis is presented describing whether the decision to prescribe IDeg to patients experiencing treatment-limiting problems on their existing insulin regimes represented good clinical and economic value. Methods: Records from the first 51 consecutive patients with diabetes (35 type 1 [T1D] and 16 type 2 [T2D]) switching to insulin degludec from either insulin glargine (IGlar) or insulin detemir (IDet), mostly due to problems with hypoglycemia (39/51, 76.5%), were reviewed at up to 37 weeks. Patients indicated frequency of hypoglycemia and completed a disease-specific questionnaire reporting six measures of confidence and treatment satisfaction. For the largest group of exposed patents, the T1D module of the IMS Core Diabetes Model (CDM) was used to evaluate the cost-effectiveness of the treatment decision. Findings: HbA1c decreased by 0.5?±?0.3% points and 0.7?±?0.3% points for T1D and T2D, respectively. Hypoglycemic events decreased by >90%. Combined mean scores were ?3.7 (1?=?much worse, 3?=?no change, 5?=?much improved) for all six satisfaction and confidence items. In T1D, the treatment decision was highly cost-effective in the CDM lifetime analysis. Even when excluding benefits beyond hypoglycemia reduction, predicted cost per quality-adjusted life-year for IDeg vs IGlar/IDet was £10,754. Interpretation: These data illustrate the complementary nature of clinical trial and practice data when evaluating the value of therapeutic innovations in diabetes care. There were reductions in patient-reported hypoglycemia, reduced HbA1c, and improved treatment satisfaction in relation to the decision to prescribe IDeg. Initial health economic evaluation suggested that the decision to prescribe IDeg in this phenotypic group of T1D patients represented good value for money. PMID:25325179

Evans, Marc; McEwan, Phil; Foos, Volker

2014-10-29

235

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

NASA Technical Reports Server (NTRS)

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

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

1998-01-01

236

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

PubMed Central

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

Siemionow, Maria; Klimczak, Aleksandra

2013-01-01

237

Who benefits most from THC:CBD spray? Learning from clinical experience.  

PubMed

Patients with multiple sclerosis (MS) represent a diverse and heterogeneous population varying in terms of disease type, its severity and variable progression/time-course, and with regard to the wide range of presenting symptoms. Consequently, detailed experience with individual patients is important to provide examples of therapy to specific patient types. In this article, real-life data from clinical practice showing specific aspects relating to use of 9-delta-tetrahydocannabinol and cannabidiol (THC:CBD) oromucosal spray (Sativex®) in patients with moderate to severe spasticity resistant to usual therapy will be presented. Three common clinical scenarios will be considered: MS patients with resistance to usual spasticity therapies; patients with impairment in MS spasticity symptoms; MS patients with relevant impairment in quality of life/activities of daily living (QoL/ADL). These case reports highlight the diverse nature of the MS spasticity population and they show the possible usefulness of THC:CBD oromucosal spray in individual patients with moderate to severe spasticity resistant to existing therapies, within the frame of use approved after large clinical trial results. Perhaps the most important finding is the possibility of obtaining relevant improvements in QoL/ADL in some patients with resistant MS spasticity, allowing them to engage back in physical and social activities. PMID:24457847

Koehler, Jürgen

2014-01-01

238

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

PubMed

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

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

2013-06-01

239

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

E-print Network

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 ...

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

2005-01-01

240

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

E-print Network

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 ...

Chung, Yoonsun

2008-01-01

241

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

PubMed

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

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

2012-02-01

242

Three endpoints of in vivo tumour radiobiology and their statistical estimation  

PubMed Central

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

Demidenko, Eugene

2010-01-01

243

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

NASA Astrophysics Data System (ADS)

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

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

2014-09-01

244

Medical management of radiation accidents: capabilities and deployment principles of the Bundeswehr Institute of Radiobiology.  

PubMed

Radiation accidents are fortunately infrequent occurrences, but since their consequences can be very serious as in the Chernobyl and the Fukushima nuclear accidents, medical management of radiation accidents is of great importance. Besides several other tasks, medical management of radiation accidents is one of the key tasks of the Bundeswehr Institute of Radiobiology. Within a Task Force Unit for medical chemical, biological, radiological, and nuclear (CBRN) Defense, the institute provides designated personnel who will perform clinical investigations on the scene and will liaise with the institute, where different methods for biological dosimetry and dose reconstruction will be performed. The most important aspects of efficient medical management of radiation accidents are diagnosis of radiation-induced health damage, determination of the cause, dealing with contamination/incorporation, pathophysiological and therapeutic principles, preparatory planning, national and international cooperation and training. Military and non-military institutions have to work closely together when it comes to radiation accidents and since national resources are limited and could be exhausted, international networks can help to ensure medical treatment for radiation accident victims. PMID:22987120

Dörr, Harald; Meineke, Viktor

2012-10-01

245

Clinical Audits in a Postgraduate General Practice Training Program: An Evaluation of 8 Years' Experience  

PubMed Central

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

Al-Baho, Abeer; Serour, Maleka; Al-Weqayyn, Adnan; AlHilali, Mohammed; Sadek, Ali A. A.

2012-01-01

246

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

PubMed

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

Lindop, E; Cannon, S

2001-06-01

247

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

PubMed

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

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

2004-01-01

248

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

PubMed Central

Objective To examine concordance between treatment effects in animal experiments and clinical trials. Study design Systematic review. Data sources Medline, Embase, SIGLE, NTIS, Science Citation Index, CAB, BIOSIS. Study selection Animal studies for interventions with unambiguous evidence of a treatment effect (benefit or harm) in clinical trials: head injury, antifibrinolytics in haemorrhage, thrombolysis in acute ischaemic stroke, tirilazad in acute ischaemic stroke, antenatal corticosteroids to prevent neonatal respiratory distress syndrome, and bisphosphonates to treat osteoporosis. Review methods Data were extracted on study design, allocation concealment, number of randomised animals, type of model, intervention, and outcome. Results Corticosteroids did not show any benefit in clinical trials of treatment for head injury but did show a benefit in animal models (pooled odds ratio for adverse functional outcome 0.58, 95% confidence interval 0.41 to 0.83). Antifibrinolytics reduced bleeding in clinical trials but the data were inconclusive in animal models. Thrombolysis improved outcome in patients with ischaemic stroke. In animal models, tissue plasminogen activator reduced infarct volume by 24% (95% confidence interval 20% to 28%) and improved neurobehavioural scores by 23% (17% to 29%). Tirilazad was associated with a worse outcome in patients with ischaemic stroke. In animal models, tirilazad reduced infarct volume by 29% (21% to 37%) and improved neurobehavioural scores by 48% (29% to 67%). Antenatal corticosteroids reduced respiratory distress and mortality in neonates whereas in animal models respiratory distress was reduced but the effect on mortality was inconclusive (odds ratio 4.2, 95% confidence interval 0.85 to 20.9). Bisphosphonates increased bone mineral density in patients with osteoporosis. In animal models the bisphosphonate alendronate increased bone mineral density compared with placebo by 11.0% (95% confidence interval 9.2% to 12.9%) in the combined results for the hip region. The corresponding treatment effect in the lumbar spine was 8.5% (5.8% to 11.2%) and in the combined results for the forearms (baboons only) was 1.7% (?1.4% to 4.7%). Conclusions Discordance between animal and human studies may be due to bias or to the failure of animal models to mimic clinical disease adequately. PMID:17175568

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

2007-01-01

249

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

SciTech Connect

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

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

2013-04-01

250

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

PubMed Central

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

Javaid, Mahvesh Rana

2013-01-01

251

[Established certainty: experiences with clinical chaplaincy between doubt, evidence and revelation].  

PubMed

Medicine must not be understood just as applied science. Modern physics, namely Quantum Theory, the theory of complementarity, and the "End of Certainty" (Ilya Prigogine) have proved the cogency of the perception of medicine as a mixture of the art of uncertainty and the science of probability. Research into chaos and order has revealed the dynamic structure of complex systems that no longer allow for undoubted prognosis. The only thing a physician can definitely promise is his readiness never to abandon a patient and to keep up personal integrity. Thus it is not only knowledge and skill that matter. It is background and authenticity that counts, which will make the doctor a guarantee of a covenant relationship that the patient may rely on. The importance of standing surety for someone in a therapeutic setting is demonstrated by giving examples from literature and personal experience in clinical chaplaincy. PMID:15487389

Schlaudraff, Udo

2004-08-01

252

Cervical esophageal perforation: a 10-year clinical experience in north of iran.  

PubMed

Perforations of the cervical esophagus are infrequent severe conditions associated with a high rate of morbidity and mortality if misdiagnosed. The diagnosis and management of cervical esophageal perforation remains a challenging clinical problem. We aimed to present our experience of the etiology, presentation, management and outcome of cervical esophageal perforation in a 10 years period. In this cross-sectional study, we reviewed the records of all patients with a diagnosis of cervical esophageal perforation admitted at the teaching Razi Hospital of Rasht, north of Iran, between 2001 and 2011. 26 patients (15 male) were studied with mean age of 47.6 ± 13.78 years, a range from 10 to 68 years. Only 16 (61.5 %) of patients were referred within 24 h of injury. The etiology was iatrogenic in 15 cases (57.69 %), foreign body ingestion in 7 cases (26.9 %), and penetrating traumatic injury in 4 cases (15.4 %). The common clinical manifestations of perforation were neck pain in 22 cases (84.6 %), fever in 19 cases (73.1 %), and subcutaneous emphysema in 12 cases (46.2 %). Barium and gastrografin swallow were performed in 57.7 and 23.1 % of patients, respectively and flexible esophagoscopy was used in 23.06 %. Most of patients (65.4 %) were managed by primary repair. Overall, mortality rate was 7.7 %. Our study demonstrates that the most common cause of cervical esophageal perforation is iatrogenic injury. Clinical suspicion is most important problem. Furthermore, Diagnosis is mainly made by Barium and gastrografin swallow. For a successful outcome, primary repair is a preferred treatment for most perforation patients. PMID:25621251

Aghajanzadeh, Manouchehr; Porkar, Nastaran Farahmand; Ebrahimi, Hannan

2015-03-01

253

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

PubMed Central

Chromosomal microarray analysis (CMA) is now established as the first-tier cytogenetic diagnostic test for fast and accurate detection of chromosomal abnormalities in patients with developmental delay/intellectual disability (DD/ID), multiple congenital anomalies (MCA), and autism spectrum disorders (ASD). We present our experience with using CMA for postnatal and prenatal diagnosis in Estonian patients during 2009–2012. Since 2011, CMA is on the official service list of the Estonian Health Insurance Fund and is performed as the first-tier cytogenetic test for patients with DD/ID, MCA or ASD. A total of 1191 patients were analyzed, including postnatal (1072 [90%] patients and 59 [5%] family members) and prenatal referrals (60 [5%] fetuses). Abnormal results were reported in 298 (25%) patients, with a total of 351 findings (1–3 per individual): 147 (42%) deletions, 106 (30%) duplications, 89 (25%) long contiguous stretches of homozygosity (LCSH) events (>5?Mb), and nine (3%) aneuploidies. Of all findings, 143 (41%) were defined as pathogenic or likely pathogenic; for another 143 findings (41%), most of which were LCSH, the clinical significance remained unknown, while 61 (18%) reported findings can now be reclassified as benign or likely benign. Clinically relevant findings were detected in 126 (11%) patients. However, the proportion of variants of unknown clinical significance was quite high (41% of all findings). It seems that our ability to detect chromosomal abnormalities has far outpaced our ability to understand their role in disease. Thus, the interpretation of CMA findings remains a rather difficult task requiring a close collaboration between clinicians and cytogeneticists. PMID:24689080

Žilina, Olga; Teek, Rita; Tammur, Pille; Kuuse, Kati; Yakoreva, Maria; Vaidla, Eve; Mölter-Väär, Triin; Reimand, Tiia; Kurg, Ants; Õunap, Katrin

2014-01-01

254

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

PubMed Central

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.

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

2014-01-01

255

Clinical experience with levetiracetam in idiopathic generalized epilepsy according to different syndrome subtypes.  

PubMed

Clinical experience in open-label studies and anectodal reports suggest that levetiracetam is effective in generalized epilepsy. In this open-label prospective study, 19 patients (3 men, 16 women) affected by idiopathic generalized epilepsy were followed for at least 6 months following the introduction of levetiracetam. Patients were categorized according to syndrome subtype: juvenile myoclonic epilepsy (8), juvenile absence epilepsy (5), childhood absence epilepsy (4), and eyelid myoclonia with absences (2). Eleven patients received levetiracetam as monotherapy, eight as add-on therapy. Effectiveness was demonstrated in 18 patients: 13 became seizure-free (five juvenile myoclonic epilepsy, five juvenile absence epilepsy, three childhood absence epilepsy), and five achieved significant reductions in seizure frequency (three juvenile myoclonic epilepsy, one childhood absence epilepsy, one eyelid myoclonia with absences). Only one patient experienced no change in seizure frequency (eyelid myoclonia with absences). Clinical improvement was accompanied by EEG abnormality suppression or reduction. Levetiracetam was well tolerated; no patient reported side-effects. PMID:16162433

Di Bonaventura, Carlo; Fattouch, Jinane; Mari, Francesco; Egeo, Gabriella; Vaudano, Anna Elisabetta; Prencipe, Massimiliano; Manfredi, Mario; Giallonardo, Anna Teresa

2005-09-01

256

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

SciTech Connect

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.

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

2006-12-15

257

Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited.  

PubMed

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients. PMID:23857712

Treuer, Tamás; Liu, Chia-Yih; Salazar, Gerardo; Kongsakon, Ronnachai; Jia, Fujun; Habil, Hussain; Lee, Min-Soo; Lowry, Amanda; Dueñas, Héctor

2013-12-01

258

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

PubMed Central

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

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

259

Diagnostic yield and clinical management after capsule endoscopy in daily clinical practice: A single-center experience  

PubMed Central

Background: Capsule endoscopy is an effective method of examining the small bowel in patients with obscure gastrointestinal bleeding, suspected inflammatory mucosal diseases and neoplasms. We herein evaluate the diagnostic yield of capsule endoscopy and its effect on clinical management in daily clinical practice. Patients and Methods: One hundred and one capsule endoscopies performed at the Department of Endoscopy and Motility Unit of G. Gennimatas General Hospital of Thessaloniki from May 2007 to February 2009 were retrospectively reviewed. Clinical management following capsule endoscopy findings was evaluated. The most frequent indication was obscure gastrointestinal bleeding (n=56, overt=20). Results: The overall diagnostic yield was 47.5%. The diagnostic yield was 88.9% in patients with overt bleeding who underwent early capsule endoscopy (within 5 days), versus 36.4% in patients who underwent late capsule endoscopy (p=0.028). Moreover, it reached 81.8% in patients with abdominal pain, with/without diarrhea and abnormal biological markers, versus 8.3% in patients with normal biological markers (p<0.0001). Capsule endoscopy was diagnostic in all patients with symptomatic celiac disease. Adenomas were found in 9 of 14 familial adenomatous polyposis patients. Capsule retention (>72 hours) occurred in two patients. Forty-three of 48 (89.6%) patients with positive capsule endoscopy findings that received intervention or medical treatment had positive clinical outcomes. Conclusions: Capsule endoscopy has an important diagnostic role and contribution in the clinical management during routine clinical practice; however, it remains to be determined which patients are more likely to benefit from this expensive examination. PMID:21311636

Katsinelos, P; Fasoylas, K; Chatzimavroudis, Gr; Lazaraki, G; Zavos, C; Pilpilidis, I; Terzoudis, S; Kokonis, G; Patsis, I; Beltsis, A; Paroutoglou, G; Kountouras, J

2010-01-01

260

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

NASA Astrophysics Data System (ADS)

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

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

2014-03-01

261

Radiosurgery for benign tumors of the spine: clinical experience and current trends.  

PubMed

In distinction to the development of the clinical indications for intracranial radiosurgery, spine radiosurgery's initial primary focus was and still remains the treatment of malignant disease. The role of stereotactic radiosurgery for the treatment of intracranial benign tumors has been well established. However, there is much less experience and much more controversy regarding the use of radiosurgery for the treatment of benign tumors of the spine. This study presents the clinical experience and current trends of radiosurgery in the treatment paradigm of benign tumors of the spine as part of a dedicated spine radiosurgery program. Forty consecutive benign spine tumors were treated using cone beam computed tomography (CBCT) image guidance technology for target localization. Lesion location included 13 cervical, 9 thoracic, 11 lumbar, and 7 sacral tumors. Thirty-four cases (85%) were intradural. The most common tumor histologies were schwannoma (15 cases), neurofibroma (7 cases), and meningioma (8 cases). Eighteen cases (45%) had previously undergone open surgical resection, and 4 lesions (10%) had previously been treated with conventional fractionated external beam irradiation techniques. This cohort was compared to a prior institutional experience of 73 consecutive benign spine tumors treated with radiosurgery. No subacute or long term spinal cord or cauda equina toxicity occurred during the follow-up period (median 26 months). Radiosurgery was used as the primary treatment modality in 22 cases (55%) and for recurrence after prior open surgical resection in 18 cases (45%). The mean prescribed dose to the gross tumor volume (GTV) was 14 Gy (range 11 to 17) delivered in a single fraction in 35 cases. In 5 cases in which the tumor was found to be intimately associated with the spinal cord with distortion of the spinal cord itself, the prescribed dose to the GTV was 18 to 21 Gy delivered in 3 fractions. The GTV ranged from 0.37 to 94.5 cm(3) (mean 13.2 cm(3), median 5.1 cm(3)). No evidence of tumor growth was seen on serial imaging in any case. Compared to the prior cohort, there was a trend towards increased patient age, GTV, and use of radiosurgery in the post-surgical setting, as well as a simultaneous decrease in the prescription dose. Radiosurgery is a safe and clinically effective treatment alternative for benign spinal neoplasms. While surgical extirpation is currently felt to be the best initial treatment option for most benign spinal tumors, spine radiosurgery has been demonstrated to have long-term clinical and radiographic benefit for the treatment of such lesions. In a similar manner in which spine radiosurgery has become a primary treatment option for a variety of intracranial benign tumors, radiosurgery may become the most favorable treatment alternative for similar histologies when found in the spine. The application of radiosurgery for non-neoplastic spine disease deserves future investigation. PMID:22335407

Gerszten, Peter C; Quader, Mubina; Novotny, Josef; Flickinger, John C

2012-04-01

262

Radiobiology of radioimmunotherapy with 90Y ibritumomab tiuxetan (Zevalin).  

PubMed

Radioimmunotherapy represents a significant advance over unlabeled immunotherapy for the treatment of patients with B-cell non-Hodgkin's lymphoma. The efficacy of radioimmunotherapeutic agents depends in large part on the basic biological effects associated with their components, monoclonal antibodies and radionuclides, separately and in combination. The radiobiological effects associated with yttrium 90-labeled ibritumomab tiuxetan (Zevalin; Biogen Idec Inc, Cambridge, MA) include the induction of apoptosis and cell-cycle redistribution (eg, arrest of cells in the G(2)/M phase of the cell cycle). Because of dose-rate effects, tumor cells may, in some cases, be more susceptible to the low-dose-rate radiation used in radioimmunotherapy than to the high-dose-rate radiation used in external beam radiotherapy. The efficacy of radioimmunotherapy may potentially be optimized through a variety of approaches, including the use of agents that increase the expression of certain tumor antigens (thus facilitating improved biodistribution of radiolabeled monoclonal antibodies) or that sensitize tumor cells to radiation. PMID:14710397

Hernandez, M Carmen; Knox, Susan J

2003-12-01

263

Radiobiological study by using laser-driven proton beams  

NASA Astrophysics Data System (ADS)

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

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

2009-07-01

264

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

PubMed Central

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

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

2012-01-01

265

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

PubMed Central

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

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

2013-01-01

266

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

SciTech Connect

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

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

2006-11-01

267

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

PubMed Central

Objective To describe the clinical recognition, pathology, and management of Richter’s hernia and to review the relevant literature of the past 400 years. Summary Background Data The earliest known reported case of Richter’s hernia occurred in 1598 and was described by Fabricius Hildanus. The first scientific description of this particular hernia was given by August Gottlob Richter in 1778, who presented it as “the small rupture.” In 1887, Sir Frederick Treves gave an excellent overview on the topic and proposed the title “Richter’s hernia.” To his work—a cornerstone to modern understanding—hardly any new aspects can be added today. Since then, only occasional case reports or small series of retrospectively collected Richter’s hernias have been published. Methods The authors draw on their experience with 18 prospectively collected cases treated in the ICRC Lopiding Hospital for War Surgery in northern Kenya between February and December 1998 and review the relevant literature of the past 400 years. Results The classic features of Richter’s hernia were confirmed in all case studies of patients: only part of the circumference of the bowel is entrapped and strangulated in the hernial orifice. The involved segment may rapidly pass into gangrene, yet signs of intestinal obstruction are often absent. The death rate in the authors’ collective was 17%. Conclusion Richter’s hernia is a deceptive entity whose high death rate can be reduced by accurate diagnosis and early surgery. Considering the increasing incidence at laparoscope insertion sites, awareness of this special type of hernia with its misleading clinical appearance is important and of general interest. PMID:11066144

Steinke, Wolfgang; Zellweger, René

2000-01-01

268

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

PubMed Central

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

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

2014-01-01

269

Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis  

PubMed Central

Background In the United States, an estimated 70 stillbirths occur each day, on average 25,000 each year. Research into the prevalence and causes of stillbirth is ongoing, but meanwhile, many parents suffer this devastating loss, largely in silence, due to persistent stigma and taboo; and many health providers report feeling ill equipped to support grieving parents. Interventions to address bereavement after neonatal death are increasingly common in U.S. hospitals, and there is growing data on the nature of parent bereavement after a stillbirth. However, further research is needed to evaluate supportive interventions and to investigate the parent-clinician encounter during hospitalization following a stillbirth. Qualitative inquiry offers opportunities to better understand the lived experience of parents against the backdrop of clinicians’ beliefs, intentions, and well-meaning efforts to support grieving parents. Methods We present a secondary qualitative analysis of transcript data from 3 semi-structured focus groups conducted with parents who had experienced a stillbirth and delivered in a hospital, and 2 focus groups with obstetrician-gynecologists. Participants were drawn from the greater Seattle region in Washington State. We examine parents’ and physicians’ experiences and beliefs surrounding stillbirth during the clinical encounter using iterative discourse analysis. Results Women reported that the cheery, bustling environment of the labor and delivery setting was a painful place for parents who had had a stillbirth, and that the well-meaning attempts of physicians to offer comfort often had the opposite effect. Parents also reported that their grief is deeply felt but not socially recognized. While physicians recognized patients’ grief, they did not grasp its depth or duration. Physicians viewed stillbirth as an unexpected clinical tragedy, though several considered stillbirth less traumatic than the death of a neonate. In the months and years following a stillbirth, these parents continue to memorialize their children as part of their family. Conclusions Hospitals need to examine the physical environment for deliveries and, wherever possible, offer designated private areas with staff trained in stillbirth care. Training programs in obstetrics need to better address the bereavement needs of parents following a stillbirth, and research is needed to evaluate effective bereavement interventions, accounting for cultural variation. Critical improvements are also needed for mental health support beyond hospitalization. Finally, medical professionals and parents can play an important role in reversing the stigma that surrounds stillbirth. PMID:23181615

2012-01-01

270

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

SciTech Connect

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.

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

271

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

PubMed

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

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

2012-09-25

272

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

PubMed

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

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

2012-12-01

273

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

PubMed

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

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

2012-11-01

274

Modulating peroxisome proliferator–activated receptors for therapeutic benefit? Biology, clinical experience, and future prospects  

PubMed Central

Clinical trials of cardiovascular disease (CVD) prevention in patients with type 2 diabetes mellitus primarily have been directed at the modification of a single major risk factor; however, in trials that enroll patients with and without diabetes, the absolute risk in CVD events remains higher in patients with diabetes. Efforts to reduce the macrovascular and microvascular residual risk have been directed toward a multifactorial CVD risk-factor modification; nonetheless, long-term complications remain high. Dual-peroxisome proliferator–activated receptor (PPAR) ?/? agonists may offer opportunities to lower macrovascular and microvascular complications of type 2 diabetes mellitus beyond the reductions achieved with conventional risk-factor modification. The information presented elucidates the differentiation of compound-specific vs class-effect properties of PPARs as the basis for future development of a new candidate molecule. Prior experience with thiazolidinediones, an approved class of PPAR? agonists, and glitazars, investigational class of dual-PPAR?/? agonists, also provides important lessons about the risks and benefits of targeting a nuclear receptor while revealing some of the future challenges for regulatory approval. PMID:23137497

Rosenson, Robert S.; Wright, R. Scott; Farkouh, Michael; Plutzky, Jorge

2014-01-01

275

Turner syndrome: review of clinical, neuropsychiatric, and EEG status: an experience of tertiary center.  

PubMed

We reviewed the clinical, neuropsychiatric, and EEG status of 53 turner syndrome (TS) females, aged 3-16 years, in Assiut university hospitals, Upper Egypt. The diagnosis and care of patients with TS in Egypt is still in the developing stage. Hence this study was undertaken to review the details of patients with TS with respect to the pattern of cognitive, psychiatric, and motor dysfunction. We aimed to provide a comprehensive data about the experience of our center comparable to previous studies, which have been published in this field. This will contribute to a better definition of the neuropsychiatric features that may be specific to TS that allows early and better detection and management of these cases. We found FSIQ and verbal IQ that seem to be at a nearly normal level and a decreased performance IQ. ADHD and autistic symptoms were found in 20.70 and 3.77 % of our cohort, respectively. The motor performance in TS was disturbed, with some neurological deficits present in 17 % (reduced muscle tone and reduced muscle power). In addition, females with TS in our study exhibit social and emotional problems, including anxiety (5.66 %) and depression (11.30 %). The EEG results revealed abnormalities in seven patients (13.20 %). One patient presenting with generalized tonic-clonic seizures showed generalized epileptiform activity, and six patients presenting with intellectual disabilities showed abnormal EEG background activity. PMID:24338760

Saad, Khaled; Abdelrahman, Ahmed A; Abdel-Raheem, Yasser F; Othman, Essam R; Badry, Reda; Othman, Hisham A K; Sobhy, Karema M

2014-03-01

276

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

PubMed Central

Summary Background Patients requiring knee and hip revision arthroplasty often present with difficult anatomical situations that limit options for surgery. Customised mega-implants may be one of few remaining treatment options. However, extensive damage to residual bone stock may also be present, and in such cases even customised prosthetics may be difficult to implant. Small quantities of lost bone can be replaced with standard allografts or autologous bone. Larger defects may require structural macro-allografts, sometimes in combination with implants (allograft-prosthesis composites). Methods Herein, we describe a process for manufacturing lesion-specific large structural allografts according to a 3D, full-scale, lithographically generated defect model. These macro-allografts deliver the volume and the mechanical stability necessary for certain complex revisions. They are patient-and implant-matched, negate some requirements for additional implants and biomaterials and save time in the operating theatre by eliminating the requirement for intra-operative sizing and shaping of standard allografts. Conclusion While a robust data set from long-term follow-up of patients receiving customised macro-allografts is not yet available, initial clinical experience and results suggest that lesion-matched macro-allografts can be an important component of revision joint surgery. PMID:23800856

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

2012-01-01

277

Unsupervised biomedical named entity recognition: experiments with clinical and biological texts.  

PubMed

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

Zhang, Shaodian; Elhadad, Noémie

2013-12-01

278

Building an Office of Clinical Research and Trials: The UC Irvine Experience  

Microsoft Academic Search

The University of California, Irvine School of Medicine (SOM) established an Office of Clinical Research and Trials (OCRT) to assist investigators with clinical research regulatory, budgetary and compliance functions, help junior investigators navigate through University bureaucracy, and facilitate the conduct of clinical trials. The OCRT assists investigators in preparing materials for submission to the Institutional Review Board (IRB), developing study

Jill Y. Kay; Barrie Pitts; Randall F. Holcombe

2009-01-01

279

A Meta-Synthesis of Behavioral Outcomes from Telemedicine Clinical Trials for Type 2 Diabetes and the Clinical User-Experience Evaluation (CUE).  

PubMed

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

Jalil, Sakib; Myers, Trina; Atkinson, Ian

2015-03-01

280

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

PubMed

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

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

2014-11-10

281

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

Microsoft Academic Search

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

2008-01-01

282

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

PubMed

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

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

2012-05-01

283

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

PubMed Central

Background: Student-teacher relationship is a salient issue in nursing education and has long-lasting implication in professional development of nursing students. Nowadays, this relationship in clinical settings is different from the past due to changing in nursing education paradigm. The purpose of this qualitative study was to explore the experiences of students and teachers about student-teacher relationship in the context of clinical nursing education in Iran. Materials and Methods: In this qualitative study that has been carried out adopting conventional qualitative content analysis approach, six bachelor nursing students and six clinical teachers in school of Nursing and Midwifery, were selected through purposive sampling. Semi-structured interview and participant observation were used for data collection. Interviews transcribed verbatim and analyzed using conventional content analysis through the process of data reduction and condensation, coding and also generating the categories and themes. Results: Results of the study showed the existence of a type of relationship in clinical education in which supportive actions of clinical teachers were prominent. These supportive actions appeared as three major categories including educational support, emotional support and social support which emerged from data. Conclusion: The results of this study explicit the ways that support could be provided for students in their relationship with clinical teachers. It also determines the teachers’ need to know more about the influence of their supportive relationship on students’ learning and the best possible outcomes of their education in clinical settings. PMID:24554945

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

2013-01-01

284

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

PubMed Central

Objective: To share our clinical experience with exenatide in obese North Indian subjects with type 2 diabetes. Materials and Methods: We share our experience with use of exenatide in 74 patients treated at Indraprastha Apollo Hospital, a tertiary care centre in New Delhi, India Subjects included obese / overweight subjects (mean weight and BMI; 97.67 ± 5.6 kg and 34.56 kg/m2) with known history of type 2 DM (Mean: 9 ± 5.6 years) and maintaining suboptimal glycemic control (HbA1c >7%) on oral antidiabetic agents, with or without basal insulin. Metformin and sulphonylureas were continued (with dose adjustment if indicated), as was basal insulin (glargine / detemir). TZDs and DPP4 inhibitors were discontinued. The dose of exenatide was increased to 10 mcg twice a day after 4-12 weeks. 56 patients completed minimum 3 month therapy. 42 patients completed 6 months, 32, 9 months and 25 completed 12 months. Data of patients who had completed at-least 3 months of therapy was included for analysis. Results and Discussion: 69.77, 67.44, and 13.95% of the patients were receiving metformin, secretagogues or thiazolidinediones alone or in combination; 17.76% of the patients were on basal insulin. The change in fasting and post-prandial blood glucose levels were significant at 3, 6, 9 and 12 months with p-value <0.05. The mean weight loss at one, three, and six months and one year was 1.7 ± 1.3, 3.8 ± 2.5, 6.3 ± 3.4, and 8.3 ± 4.3 kg, respectively (P <0.05). The mean HbA1c (baseline: 8.8 ± 1.3%) at 3, 6 months and at one year was 7.8 ± 0.9, 7.7 ± 0.8 and 7.2 ± 0.8 (P <0.05). Thirty-five percent of the patients had a ‘good’ A1c value (< 7%) at the end of 12 months. 13 patients discontinued exenatide (three due to lack of response, six due to cost of therapy and four due to severe nausea). Nausea was the most common side effect, occurring in 95% patients within 1 month, although the incidence declined with passage of time. Conclusions: Clinical use of Exenatide is associated with significant improvement in glycemic control and major weight loss (8.3±4.3 kg at 1 year) in obese subjects with type 2 diabetes. Nausea is the most common side effect. In conclusion, exenatide is a effective and useful option for treatment of type 2 diabetes in obese Indian subjects. PMID:23776858

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

2013-01-01

285

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

PubMed Central

Background Age-related macular degeneration (AMD) is a degenerative process that leads to severe vision loss. Wet AMD is defined by choroidal neovascularisation, leading to the accumulation of subretinal fluid (SRF), macular oedema (ME), and pigment epithelium detachments (PED). Purpose To evaluate the initial clinical experience of conversion from bevacizumab or ranibizumab to aflibercept in wet AMD patients. Methods Records of 250 consecutive wet AMD patients were retrospectively reviewed. Of 250 patients, 29 were naive (with no previous treatment), and 221 were previously treated with bevacizumab (1/3) or ranibizumab (2/3). On average, converted patients received 14 injections every 6?weeks on a treat-and-extend regimen with Avastin or Lucentis before being converted to aflibercept every 7?weeks on average (no loading dose) for three doses. For the purposes of this study, we concentrated on the patients converted to aflibercept since the number of naive patients was too small to draw any conclusion from. Snellen (as logMar) visual acuities, and optical coherence tomography (OCT) were compared predrug and postdrug conversion. Results Converted patients did not show a significant difference in visual acuity or average OCT thickness from preconversion values; however, small improvements in ME (p=0.0001), SRF (p=0.0001), and PED (p=0.008) grading were noted on average after conversion to aflibercept. Conclusions No significant difference in visual outcome or average OCT thickness was observed when switched from bevacizumab or ranibizumab q6?week to aflibercept 7-week dosing, on average. Mild anatomic improvements did occur in converted patients with regard to ME, SRF and PED improvement, on average, after conversion to aflibercept, and aflibercept was injected less frequently. No serious adverse reactions, including ocular infections or inflammation, as well as ocular and systemic effects were noted. PMID:24795335

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

2014-01-01

286

Developing Regulatory-compliant Electronic Case Report Forms for Clinical Trials: Experience with The Demand Trial  

PubMed Central

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

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

2009-01-01

287

Radiobiologic research for head and neck cancer therapy. Therapeutic implications  

SciTech Connect

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

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

1983-12-01

288

Postapproval clinical experience in the treatment of Dupuytren's contracture with collagenase clostridium histolyticum (CCH): the first 1,000 days.  

PubMed

Dupuytren's contracture is a benign fibromatosis of the palmar and digital fascia of the hand of uncertain etiology, resulting in nodules and cords beneath the skin of the palm of the hands that may lead to the development of contractures. Surgical intervention is often considered when metacarpophalangeal (MP) joint contracture is 30° or more, or when there is any degree of proximal interphalangeal (PIP) joint contracture. Collagenase clostridium histolyticum (CCH) is a nonsurgical, minimally invasive enzymatic drug indicated for the treatment of adult patients with Dupuytren's contracture (DC) and palpable cord. CCH has been available for approximately 3.5 years, and postapproval experience indicates that the effectiveness of CCH is equivalent to or better than efficacy observed in clinical trials, as seen by lower injection rates to achieve clinical success. Postapproval experience has shown a risk-benefit profile that favors CCH for patients not indicated for surgery based on current recommendations and shows also that treating earlier-stage vs later-stage joint contracture results in significantly better outcomes on average. Postapproval surveillance reveals a safety profile similar to that observed in clinical trials. Nonserious adverse events are mainly local reactions; tendon rupture, a serious adverse event, is reported rarely in the clinical practice setting and at a lower rate than in clinical trials. Risk Evaluation and Mitigation Strategy (REMS) training is designed to mitigate benefit vs risk to achieve safe and effective use of CCH. PMID:25414604

Schulze, Scott M; Tursi, James P

2014-12-01

289

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

PubMed Central

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

2013-01-01

290

The impact of clinical experience with alcoholics on Brazilian nursing students' attitudes toward alcoholism and associated problems.  

PubMed

This quasiexperimental study assessed the impact of a clinical experience involving alcoholics on nursing students' attitudes. The study participants were 195 students at a large university-based nursing school in Brazil. They were divided into experimental and control groups. Individuals in the experimental group (n = 56) participated in 6 weeks of a clinical practicum at a specialized treatment service for addiction, during a course in psychiatric nursing. In the same period, the control group (n = 144) participated in a 6-week clinical practicum at a specialized mental health service that did not treat people with addiction. At the end of the theoretical course and clinical practica, both groups completed an attitude measurement scale. Data analysis, using analysis of variance, indicated a statistically significant difference in the overall score on the attitude scale between the experimental and control groups (p = .04), indicating that the experimental group participants' have more positive attitudes, perceptions, opinions, and feelings toward alcoholic individuals and working and relating to these patients. In conclusion, educational interventions that include clinical experience with alcoholics may be an effective teaching strategy that contributes to better skill preparation and more comfortable feelings for nurses intervening in problems related to the use and abuse of alcohol and other drugs. PMID:24621548

de Vargas, Divane

2013-01-01

291

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

PubMed Central

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

2011-01-01

292

Cultural Values and Professional Issues in Clinical Psychology: Implications From the Hong Kong Experience  

Microsoft Academic Search

The graduate program in clinical psychology, introduced as a formally defined specialization at the University of Hong Kong in 1971, is one of the few that exists in the Third World. Although the number of clinical psychologists in Hong Kong is dwarfed when scaled against that of North America, it is already among the largest in Asia. The growth of

David Y. F. Ho

1985-01-01

293

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.

294

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

SciTech Connect

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

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

1994-09-30

295

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

PubMed

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

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

2007-01-01

296

Quality assurance of research protocols conducted in the community: The National Institute on Drug Abuse Clinical Trials Network Experience  

PubMed Central

Background: Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. Purpose: This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. Methods: The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Results: Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. Limitations: QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. Conclusions: The lessons learned from the CTN's experience include the need for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed. PMID:19342468

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-01-01

297

A Radiobiological Analysis of Multicenter Data for Postoperative Keloid Radiotherapy  

SciTech Connect

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

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

2011-03-15

298

Practical aspects of recruitment and retention in clinical trials of rare genetic diseases: the phenylketonuria (PKU) experience.  

PubMed

Bringing treatments for rare genetic diseases to patients requires clinical research. Despite increasing activism from patient support and advocacy groups to increase access to clinical research studies, connecting rare disease patients with the clinical research opportunities that may help them has proven challenging. Chief among these challenges are the low incidence of these diseases resulting in a very small pool of known patients with a particular disease, difficulty of diagnosing rare genetic diseases, logistical issues such as long distances to the nearest treatment center, and substantial disease burden leading to loss of independence. Using clinical studies of phenylketonuria as an example, this paper discusses how, based on the authors' collective experience, partnership among clinicians, patients, study coordinators, genetic counselors, dietitians, industry, patient support groups, and families can help overcome the challenges of recruiting and retaining patients in rare disease clinical trials. We discuss specific methods of collaboration, communication, and education as part of a long-term effort to build a community committed to advancing the medical care of patients with rare genetic diseases. By talking to patients and families regularly about research initiatives and taking steps to make study participation as easy as possible, rare disease clinic staff can help ensure adequate study enrollment and successful study completion. PMID:24014152

DeWard, Stephanie J; Wilson, Ashley; Bausell, Heather; Volz, Ashley S; Mooney, Kimberly

2014-02-01

299

A comprehensive test of clinical reasoning for medical students: An olympiad experience in Iran  

PubMed Central

Background: Although some tests for clinical reasoning assessment are now available, the theories of medical expertise have not played a major role in this filed. In this paper, illness script theory was chose as a theoretical framework and contemporary clinical reasoning tests were put together based on this theoretical model. Materials and Methods: This paper is a qualitative study performed with an action research approach. This style of research is performed in a context where authorities focus on promoting their organizations’ performance and is carried out in the form of teamwork called participatory research. Results: Results are presented in four parts as basic concepts, clinical reasoning assessment, test framework, and scoring. Conclusion: we concluded that no single test could thoroughly assess clinical reasoning competency, and therefore a battery of clinical reasoning tests is needed. This battery should cover all three parts of clinical reasoning process: script activation, selection and verification. In addition, not only both analytical and non-analytical reasoning, but also both diagnostic and management reasoning should evenly take into consideration in this battery. This paper explains the process of designing and implementing the battery of clinical reasoning in the Olympiad for medical sciences students through an action research. PMID:23555113

Monajemi, Alireza; Arabshahi, Kamran Soltani; Soltani, Akbar; Arbabi, Farshid; Akbari, Roghieh; Custers, Eugene; Hadadgar, Arash; Hadizadeh, Fatemeh; Changiz, Tahereh; Adibi, Peyman

2012-01-01

300

Expectations and experiences of investigators and parents involved in a clinical trial for Duchenne/Becker muscular dystrophy  

PubMed Central

Background The social context of rare disease research is changing, with increased community engagement around drug development and clinical trials. This engagement may benefit patients and families, but may also lead to heightened trial expectations and therapeutic misconception. Clinical investigators are also susceptible to harboring high expectations. Little is known about parental motivations and expectations for clinical trials for rare pediatric disorders. Purpose We describe the experience of parents and clinical investigators involved in a phase II clinical trial for Duchenne and Becker muscular dystrophy: their expectations, hopes, motivations, and reactions to the termination of the trial. Methods This qualitative study was based on interviews with clinical investigators and parents of sons with DBMD who participated in the phase IIa or IIb ataluren clinical trial in the United States. Interviews were transcribed and coded for thematic analysis. Results Participants were twelve parents of affected boys receiving active drug and nine clinical investigators. High trial expectations of direct benefit were reported by parents and many clinicians. Investigators described monitoring and managing parents’ expectations; several worried about their own involvement in increasing parents’ expectations. Most parents were able to differentiate their expectations from their optimistic hopes for a cure. Parents’ expectations arose from other parents, advocacy organizations, and the sponsor. All parents reported some degree of clinical benefit to their children. Secondary benefits were hopefulness and powerful feelings associated with active efforts to affect the disease course. Parents and clinical investigators reported strong, close relationships that were mutually important. Parents and clinicians felt valued by the sponsor for the majority of the trial. When the trial abruptly stopped, they described loss of engagement, distress, and feeling unprepared for the possibility of trial termination. Limitations This was a retrospective study of one clinical trial. We were unable to recruit participants whose children received placebo. The interviews occurred during a time of significant uncertainty and distress for many of the participants. Conclusions This pilot study reflects complex outcomes of strong community engagement. The findings highlight a need for renewed education about, and support for, clinical trial termination and loss of drug access. The primary positive outcome was demonstration of strong relationships among committed parents and study teams. These relationships were highly valued by both parties, and may suggest an ideal intervention opportunity for efforts to improve psychological wellbeing. A negative outcome attributed, in part, to community engagement was inappropriately high trial expectations. More optimistically, high expectations were attributed, in part, to the importance of hope and powerful feelings associated with active efforts to affect the disease course. PMID:24311736

Peay, Holly L; Tibben, Aad; Fisher, Tyler; Brenna, Ethan; Biesecker, Barbara B

2014-01-01

301

Fluctuations in energy loss and their implications for dosimetry and radiobiology  

NASA Technical Reports Server (NTRS)

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

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

1972-01-01

302

Radiobiological effects of heavy ions and protons. [on cells of mammals, bacteria and viruses  

NASA Technical Reports Server (NTRS)

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.

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

303

Fast neutrons: Inexpensive and reliable tool to investigate high-LET particle radiobiology  

Microsoft Academic Search

Radiation therapy with carbon ions as well as missions into outer space have boosted the interest for high-LET particle radiobiology. Optimization of treatments in accordance with technical developments, as well as the radioprotection of cosmonauts during long missions require that research in these domains continue. Therefore suitable radiation fields are needed. Fast neutrons and carbon ions exhibit comparable LET values

J. Gueulette; J. P. Slabbert; P. Bischoff; J. M. Denis; A. Wambersie; D. Jones

2010-01-01

304

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

PubMed Central

Objective Radiobiological models provide a means of evaluating treatment plans. Keeping in mind their inherent limitations, they can also be used prospectively to design new treatment strategies which maximise therapeutic ratio. We propose here a new method to customise fractionation and prescription dose. Methods To illustrate our new approach, two non-small cell lung cancer treatment plans and one prostate plan from our archive are analysed using the in-house software tool BioSuite. BioSuite computes normal tissue complication probability and tumour control probability using various radiobiological models and can suggest radiobiologically optimal prescription doses and fractionation schemes with limited toxicity. Results Dose–response curves present varied aspects depending on the nature of each case. The optimisation process suggests doses and fractionation schemes differing from the original ones. Patterns of optimisation depend on the degree of conformality, the behaviour of the normal tissue (i.e. “serial” or “parallel”), the volume of the tumour and the parameters of clonogen proliferation. Conclusion Individualising the prescription dose and number of fractions with the help of BioSuite results in improved therapeutic ratios as evaluated by radiobiological models. PMID:22457318

Uzan, J; Nahum, A E

2012-01-01

305

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

Microsoft Academic Search

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

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

2012-01-01

306

Experience-Based Quality Control of Clinical Intensity-Modulated Radiotherapy Planning  

SciTech Connect

Purpose: To incorporate a quality control tool, according to previous planning experience and patient-specific anatomic information, into the intensity-modulated radiotherapy (IMRT) plan generation process and to determine whether the tool improved treatment plan quality. Methods and Materials: A retrospective study of 42 IMRT plans demonstrated a correlation between the fraction of organs at risk (OARs) overlapping the planning target volume and the mean dose. This yielded a model, predicted dose = prescription dose (0.2 + 0.8 [1 - exp(-3 overlapping planning target volume/volume of OAR)]), that predicted the achievable mean doses according to the planning target volume overlap/volume of OAR and the prescription dose. The model was incorporated into the planning process by way of a user-executable script that reported the predicted dose for any OAR. The script was introduced to clinicians engaged in IMRT planning and deployed thereafter. The script's effect was evaluated by tracking {delta} = (mean dose-predicted dose)/predicted dose, the fraction by which the mean dose exceeded the model. Results: All OARs under investigation (rectum and bladder in prostate cancer; parotid glands, esophagus, and larynx in head-and-neck cancer) exhibited both smaller {delta} and reduced variability after script implementation. These effects were substantial for the parotid glands, for which the previous {delta} = 0.28 {+-} 0.24 was reduced to {delta} = 0.13 {+-} 0.10. The clinical relevance was most evident in the subset of cases in which the parotid glands were potentially salvageable (predicted dose <30 Gy). Before script implementation, an average of 30.1 Gy was delivered to the salvageable cases, with an average predicted dose of 20.3 Gy. After implementation, an average of 18.7 Gy was delivered to salvageable cases, with an average predicted dose of 17.2 Gy. In the prostate cases, the rectum model excess was reduced from {delta} = 0.28 {+-} 0.20 to {delta} = 0.07 {+-} 0.15. On surveying dosimetrists at the end of the study, most reported that the script both improved their IMRT planning (8 of 10) and increased their efficiency (6 of 10). Conclusions: This tool proved successful in increasing normal tissue sparing and reducing interclinician variability, providing effective quality control of the IMRT plan development process.

Moore, Kevin L., E-mail: kmoore@radonc.wustl.edu [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Brame, R. Scott [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA (United States); Low, Daniel A.; Mutic, Sasa [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)

2011-10-01

307

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

PubMed Central

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

2014-01-01

308

[Diagnostic-therapeutic pathways as instruments of clinical management: experience at the S. Maria Hospital in Terni].  

PubMed

Diagnostic-therapeutic itineraries and treatment profiles are instruments of clinical management. The authors report on their experience with the experimental creation of such itineraries in thyroid nodular pathology. These are the fruit of collaboration between the management team, endocrinological surgeons, and the hospital computer staff. The drawing-up of guidelines in the hospital setting allows the systematic organisation of clinical activities to be accomplished in the health-care facility, quantifying costs for all diseases in order to be able to plan and implement changes in resources and staff utilisation. Application of the method, in addition, helps to develop a common language among hospital doctors and nurses, facilitates proper communication with patients, and ensures adequate patient information regarding the clinical itinerary the patient will have to take for his or her condition. PMID:16999150

Lucchini, Roberta; Donetti, Daniela; D'Ajello, Michele; Calzolari, Filippo; Pacchiarini, Diamante; Bolli, Lorenzina; Sanguinetti, Alessandro; Puxeddu, Efisio; Monacelli, Massimo; Misso, Claudia; Gianmartino, Camillo; Macchitell, Luigi; Avenia, Nicola

2006-01-01

309

Holmium:YAG laser coronary angioplasty: quantitative angiography and clinical results in a large experience of a single medical center  

NASA Astrophysics Data System (ADS)

Clinical experience with the mid IR holmium:YAG laser in a single medical center (St. Paul Ramsey Medical Center, University of Minnesota Medical School, St. Paul, MN) includes 112 patients who underwent holmium laser coronary angioplasty. Utilizing a unique lasing technique; `pulse and retreat,' we applied this laser to thrombotic and nonthrombotic lesions in patients presenting with unstable angina, stable angina, and acute myocardial infarction. A very high clinical success and very low complication rates were achieved. Holmium:YAG laser is effective and safe therapy for patients with symptomatic coronary artery disease. Unlike excimer lasers, the clinical success, efficacy and safety of holmium laser angioplasty is not compromised when thrombus is present.

Topaz, On; Luxenberg, Michael; Schumacher, Audrey

1994-07-01

310

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.

311

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

E-print Network

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...

Espitia, Noberto Francisco

2009-05-15

312

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

SciTech Connect

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.

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

313

Assessment and Development of Competency of Clinical Engineering Practitioners - South East Asian Experience  

Microsoft Academic Search

\\u000a Clinical Engineering was relatively unknown and remained an obscure engineering discipline in South East Asian countries until\\u000a the 1990s. Typically for most healthcare institutions, the management of medical equipment within the hospital environment\\u000a mainly focused on reactive breakdown maintenance management. Hospitals were unable to develop in-house clinical engineering\\u000a capabilities, since there was a severe shortage of skilled and competent technical

Ashok V. Shah; Azman Hamid

314

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

Microsoft Academic Search

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

Dale Alexander

2003-01-01

315

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

Microsoft Academic Search

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

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

316

North American Clinical Experience with the EKOS MicroLysUS Infusion Catheter for the Treatment of Embolic Stroke  

Microsoft Academic Search

BACKGROUND AND PURPOSE: We present early experience with the EKOS MicroLysUS infusion catheter for acute embolic stroke treatment in North America. This study was designed to demonstrate the safety of the device and to determine if sonography accelerates thrombolysis and improves clinical outcomes. METHODS: Fourteen patients aged 40 -77 years with anterior- or posterior-circulation occlusion presented with cerebral ischemia 3-

Brian R. Mahon; Gary M. Nesbit; Stanley L. Barnwell; Wayne Clark; Thomas R. Marotta; Alain Weill; Phillip A. Teal; Adnan I. Qureshi

317

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

Microsoft Academic Search

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

Thomas M. Kozak; Andrea Kozak Miller

318

The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers.  

PubMed

Negative attitudes to patients with substance misuse disorders form a well-recognised barrier to the implementation of best practice. The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers was investigated at an Australian university. First-year students were surveyed before and after 3 weeks of drug and alcohol education and in the same year, fourth-year students were surveyed before and after a 9-week block. Males, older students and those with prior clinical experience tended to have more negative attitudes. Attitudes improved significantly after exposure to interactive learning modules which included contact with patients with substance dependence, including individuals in remission. The level of dislike of problem drinkers significantly decreased after teaching. After fourth-year education, students reported a greater sense of responsibility towards providing intervention and less anticipation of discomfort working with these patients. In particular, confidence and attitudes towards heroin users improved near the end of training after contact with illicit drug users in the small group or individual interview setting. By the end of drug and alcohol education, less than half (42%) of students reported they could not imagine working with substance misusers as a career. Findings support the provision of structured drug and alcohol education and supported clinical experience for every medical student if appropriate evidence-based treatment is to be provided. PMID:17364855

Silins, Edmund; Conigrave, Katherine M; Rakvin, Christine; Dobbins, Timothy; Curry, Kenneth

2007-03-01

319

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

PubMed Central

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

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

2014-01-01

320

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

PubMed Central

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

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

2010-01-01

321

Experience with DICOM for the clinical specialties in the healthcare enterprise  

NASA Astrophysics Data System (ADS)

DICOM is a success for radiology and cardiology and it is now beginning to be used for other clinical specialties. The US Department of Veterans Affairs has been instrumental in promoting this technological advancement. We have worked with a number of non-radiology imaging vendors over the past several years, encouraging them to support DICOM, providing requirement specifications, validating their implementations, installing their products, and integrating their systems with the VA healthcare enterprise. We require each new non-radiology vendor to support the DICOM Modality Worklist and Storage services, as specified in the IHE Technical Framework, and insist that they perform validation testing with us over the Internet before installing at a VA site. Three years ago we began working with commercial DICOM image acquisition applications in ophthalmology and endoscopy. Today we are interfacing with six vendors in ophthalmology, six in dental, and two in endoscopy. Getting imaging modality vendors to support DICOM is only part of the story, however. We have also developed the capabilities of the VistA hospital information system to properly handle DICOM interfaces to the different clinical specialties. The workflow in the clinical specialties is different than that of radiology, and is much more diverse. We designed the VistA DICOM image acquisition and display interface to use the generic order entry, result entry, result reporting, and appointment scheduling applications of our hospital information system, which are common to other hospital information systems, in order to maintain existing clinical workflow, minimize operational disruptions, simplify training, and win user acceptance. This software is now being field tested with dental and ophthalmology systems at a large number of VA medical centers. We have learned several things from this field test. The DICOM Modality Worklist and Storage services can be successfully used for image acquisition in the clinical specialties, although the specifications for some of the clinical specialty image types need to be enhanced. Special consideration needs to be given to the healthcare provider workflow in order to support DICOM requirements and to minimize change. The clinical specialties handle a large number of different kinds of requests, and imaging procedures may comprise only a small subset, which may need to be isolated out for efficient operation of DICOM Modality Worklist. The clinical specialties will acquire a large volume of images. Our goal is to incorporate all of the patient"s data into the electronic medical record and DICOM is making this easier for everyone. The work involved in extending DICOM to the clinical specialties and integrating them with the hospital information systems continues to be an ongoing and worthwhile challenge.

Kuzmak, Peter M.; Dayhoff, Ruth E.

2003-05-01

322

Developing a theory of clinical instructor identity using the experiences of medical laboratory science practitioners.  

PubMed

This study investigated medical laboratory science clinical instructors' beliefs about teaching and how they viewed themselves as teachers. The first phase of the study included an integrative literature review, which suggested that the development of teacher identity in school-based educators, and to a lesser extent higher education faculty, is dependent on four dimensions: personal factors, training factors, contextual factors, and reflective practice. The second phase of this study began qualitative inquiry into the ways that these participants described their teaching and professional identity. Interviews were conducted with medical laboratory science clinical instructors in order to gain an understanding of their perceptions of themselves as teachers. The data collected in this study indicate that this group of clinical instructors saw themselves as teachers who were responsible for providing students with technical skills needed to become competent practitioners and the theoretical foundation necessary to pass the national certification exam. The study participants also saw themselves as mentors who were responsible for passing along professional knowledge to the next generation of laboratory practitioners. During data analysis three themes emerged that represent aspects of teacher identity in clinical instructors: belief in one's teaching ability, desire to expand one's professional responsibilities, and reflection on one's teaching. The findings from this study may provide a foundation for future research designed to measure teacher identity in clinical instructors. PMID:25000652

Miller, Wendy

2014-01-01

323

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

PubMed Central

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

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

2014-01-01

324

Initial clinical experiences with a new, portable, single-use negative pressure wound therapy device.  

PubMed

Since the introduction of negative pressure wound therapy in combination with reticulated open cell foam (NPWT/ROCF) in 1997, the clinical and economic benefits of this therapy have been showed in several randomised-controlled studies. This article describes the clinical application of a new portable NPWT unit. The V.A.C.Via™ Therapy System (KCI USA, Inc., San Antonio, TX) offers continuous negative pressure and dynamic pressure control for wound treatment of low exudating (<80 ml/day), small-to-medium size wounds, grafts and flaps in all care settings, including homecare. We describe four cases in which this new device was successfully used. PMID:22432923

van den Bulck, Rosine; Siebers, Yvonne; Zimmer, Robert; Acton, Claire; Janzing, Heinrich; Lang, Werner

2013-04-01

325

Treatment of intracerebral arteriovenous malformations with isobutyl 2-cyanoacrylate: initial clinical experience.  

PubMed

From November 1976 to September 1979, 46 patients with intracranial arteriovenous malformations or fistulas participated in a clinical study using isobutyl 2-cyanoacrylate (IBCA), with tantalum, for palliative or preoperative occlusion of the blood supply to the abnormalities. Although failure to obtain satisfactory position of a functioning microcatheter precluded deposition of IBCA 10 times, a total of 51 of a possible 62 feeding vessels were occluded with the tantalum-impregnated glue. The technique, results, and complications are discussed in light of the clinical follow-up, which varied from 12 to 48 months. PMID:6165036

Bank, W O; Kerber, C W; Cromwell, L D

1981-06-01

326

The Effects of Early Clinical Teaching Experiences on Pre-Service Teachers' Self-Efficacy  

ERIC Educational Resources Information Center

In-service teachers are often lack sufficient teaching experience (Block et al., 2010) that leads to being psychologically unprepared to confront many challenges in teaching. Providing ample experiences for Physical Education Teacher Education (PETE) students in a pedagogical setting parallel to that which they will one day teach (Kirk &…

Androzzi, Jared

2011-01-01

327

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.

328

Clinical and practical requirements of online software for anesthesia documentation—an experience report  

Microsoft Academic Search

The aim of this paper is the presentation of a new version of the anesthesia documentation software, NarkoData, that has been used in routine clinical work in our department as part of an anesthesia information management system (AIMS) since 1995. The performance of this software is presented along with requirements for future development of such a system. The originally used

Matthias Benson; Axel Junger; Lorenzo Quinzio; Carsten Fuchs; Gregor Sciuk; Achim Michel; Kurt Marquardt; Gunter Hempelmann

2000-01-01

329

[Clinical experience with methoxybutropate vs. bromelin in the treatment of female pelvic inflammation].  

PubMed

This study reports the results of a controlled randomized clinical trial performed on 30 young women with PID (Pelvic Inflammatory Disease), using a new anti- inflammatory-analgesic: methoxybutropate. The quali-quantitative symptomatical assessment showed that the improvement of the pain has been more marked and faster with methoxybutropate than hot observed in control group treated with bromeline. PMID:2293074

Melis, G B

1990-01-01

330

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

NASA Technical Reports Server (NTRS)

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.

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

1982-01-01

331

Operational experience with DICOM for the clinical specialties in the healthcare enterprise  

NASA Astrophysics Data System (ADS)

A number of clinical specialties routinely use images in treating patients, for example ophthalmology, dentistry, cardiology, endoscopy, and surgery. These images are captured by a variety of commercial digital image acquisition systems. The US Department of Veterans Affairs has been working for several years on advancing the use of the Digital Imaging and Communications in Medicine (DICOM) Standard in these clinical specialties. This is an effort that has involved several facets: (1) working with the vendors to ensure that they satisfy existing DICOM requirements, (2) developing interface software to the VistA hospital information system (HIS), (3) field testing DICOM systems, (4) deploying these DICOM interfaces nation-wide to all VA medical centers, (5) working with the healthcare providers using the system, and (6) participating in the DICOM working groups to improve the standard. The VA is now beginning to develop clinical applications that make use of the DICOM interfaces in the clinical specialties. The first of these will be in ophthalmology to remotely screen patients for diabetic retinopathy.

Kuzmak, Peter M.; Dayhoff, Ruth E.

2004-04-01

332

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

ERIC Educational Resources Information Center

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…

Lee, Kyungjae

2014-01-01

333

Clinical Utility of Antithrombotic Prophylaxis in ART Procedures: An Italian Experience  

PubMed Central

Background The usefulness of antithrombotic prophylaxis in management of Assisted Reproductive Technologies (ART) is questionable. Objectives We prospectively examined the contribution of an antithrombotic prophylaxis in influencing clinical pregnancy and live-birth in an unselected cohort of women approaching ART. Patients/Methods 1107 women with fertility problems and a valid indication for ART were recruited. Baseline and follow-up information of obstetric outcomes and antithrombotic treatment were collected. Results and Conclusions Median follow-up time was 34.5 months (range: 2–143). During the follow-up period, 595 (53.8%) women underwent ART (total 1234 cycles); 202 (33.9%) women achieved a pregnancy for a total of 255 clinical pregnancies. The concomitant use of LMWH and aspirin was significantly associated with a higher rate of clinical pregnancies (p: 0.003, OR: 4.9, 95% CI: 1.7–14.2). The pregnancy rate was also significantly increased by the use of LMWH alone (p: 0.005, OR: 2.6, 95% CI: 1.3–5.0). Carriership of inherited or acquired thrombophilia did not affect clinical outcomes of the ART. The efficacy of antithrombotic treatment was confirmed when the outcome “ live-birth” was considered. Present data suggest a potential benefit of antithrombotic prophylaxis during ART in improving the number of live-births. PMID:24870449

Grandone, Elvira; Villani, Michela; Tiscia, Giovanni L.; Dentali, Francesco; Colaizzo, Donatella; Cappucci, Filomena; Fischetti, Lucia; Ageno, Walter; Margaglione, Maurizio

2014-01-01

334

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

Microsoft Academic Search

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

Bjørg Hjerkinn; Morten Lindbæk; Elin Olaug Rosvold

2007-01-01

335

Enhancing translation: guidelines for standard pre-clinical experiments in mdx mice  

PubMed Central

Duchenne Muscular Dystrophy is an X-linked disorder that affects boys and leads to muscle wasting and death due to cardiac involvement and respiratory complications. The cause is the absence of dystrophin, a large structural protein indispensable for muscle cell function and viability. Neither an effective treatment nor a cure is available at the present time. The mdx mouse has become the standard animal model for pre-clinical evaluation of potential therapeutic treatments. Recent years have seen a rapid increase in the number of experimental compounds being evaluated in the mdx mouse. There is, however, much variability in the design of these pre-clinical experimental studies. This has made it difficult to interpret and compare published data from different laboratories and to evaluate the potential of a treatment for application to patients. The authors therefore propose the introduction of a standard study design for the mdx mouse model. Several aspects, including animal care, sampling times and choice of tissues, as well as recommended endpoints and methodologies are addressed and, for each aspect, a standard procedure is proposed. Testing of all new molecules/drugs using a widely accepted and agreed upon standard experimental protocol would greatly improve the power of pre-clinical experimentations and help identifying promising therapies for the translation into clinical trials for boys with Duchenne Muscular Dystrophy. PMID:21737275

De Luca, Annamaria; Benatar, Michael; Grounds, Miranda; Dubach, Judith; Raymackers, Jean-Marc; Nagaraju, Kanneboyina

2011-01-01

336

Clinical Experiences Using Pneumatic Massage Therapy bfor Edematous Limbs Over the Last 10 Years  

Microsoft Academic Search

A pneumatic massage apparatus has been developed for the treatment of peripheral lymphedema. The stag nant lymph and venous blood are dis placed toward the heart by this pneu matic massage. It has been applied to more than 650 patients with edema tous limbs in the authors' Hadomer clinic over the last ten years. Satisfac tory results were obtained, including

Zenya Yamazaki; Yasuo Idezuki; Tetsu Nemoto; Tatsuo Togawa

1988-01-01

337

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

PubMed Central

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 indication for opioid replacement therapy in Norway, and one of the clinic's aims was to support the drug dependent women through their pregnancy without any replacements. The object of this paper is to describe concurrent health and social problems, as well as the predictors for stopping drug abuse, in the clinic's user group. Methods Retrospective cohort study. Data was gathered from the medical records of all 102 women seen in the clinic in the period between 1992 and 2002. The study includes 59 out of 60 women that were followed until their children were two years old or placed in alternative care, and a comparison group of twice the size. Both groups were presented with a questionnaire concerning both the pregnancy and health and socio-economic issues. Results Four (4.5 percent) of the women that completed their pregnancies did not manage to reduce their substance abuse. All the others reduced their substance abuse considerably. The odds ratio for stopping substance abuse within the first trimester was significantly associated with stopping smoking (O.R. 9.7) or being victims of rape (O.R. 5.3). Conclusion A low cost and low threshold initiative organised as a child welfare clinic may support women with substance abuse problems in their efforts to stop or reduce their substance abuse during pregnancy. PMID:17996120

Hjerkinn, Bjørg; Lindbæk, Morten; Rosvold, Elin Olaug

2007-01-01

338

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

PubMed

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

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

339

[The experience of using the atypical antipsychotic sertindole in psychiatric inpatient clinics in Russia].  

PubMed

One hundred and fifty psychiatrists from 61 clinics of 30 cities located in 8 regions of the Russian Federation took part in the study. The study included 896 patients treated with sertindole. The duration of illness was from 1 month to 50 years (mean 9,55 ± 8,21), a number of previous relapses varied from 0 to 20 and more (mean 5,79 ± 6,68). Each patient was followed up for 6 weeks. Patient's state was assessed clinically and with the CGI. The statistically significant improvement was seen from the first week of treatment and the percentage of patients with marked mental disorders was constantly decreased from the first to the 6th week. It has been concluded that sertindole is an effective drug for stopping psychotic symptoms in the real practice of treatment of schizophrenic patients. It is well-tolerated and allows to reduce a number of concurrent drugs used for treatment. PMID:21716249

Ivanets, N N; Kinkul'kina, M A; Avdeeva, T I

2011-01-01

340

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

NASA Astrophysics Data System (ADS)

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.

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

341

Clinical experience with pramipexole in the treatment of restless legs syndrome.  

PubMed

Pramipexole is a non-ergoline dopamine agonist with a high selectivity for D(2) and D(3) receptors. Initially approved for Parkinson's disease, it was approved by the FDA and EMEA in 2006 for the treatment of idiopathic restless legs syndrome in adults. A single oral dose of pramipexole of between 0.125 and 0.750 mg, taken 2 - 3 h before bedtime, is usually able to control sensory symptoms and motor signs of restless legs syndrome. In clinical practice, tailoring pramipexole treatment based on demographic and clinical characteristics of patients is recommended. In addition, pramipexole seems to be safe and well tolerated. Augmentation, the most common side effect of levodopa, is less prevalent after treatment with pramipexole. In addition, the recurrence of unpleasant symptoms due to pramipexole is uncommon. PMID:18248314

Merlino, Giovanni; Serafini, Anna; Robiony, Francesca; Valente, Mariarosaria; Gigli, Gian Luigi

2008-02-01

342

[Clinical use of pedobarographic examination--own experience and review of literature].  

PubMed

Pedobarography has been used for measuring underfoot pressure during the standing and during the gait. It is a non-invasive method, valuable for foot diseases and defects diagnosing and treatment monitoring. Pedobarography is used in examination of children and adults feet. The authors have introduced the clinical possibility of employment of this method and proposed its use for foot examination in orthopaedics, traumatology, rehabilitation, rheumatology, diabetology and neurology. PMID:17469520

Lorkowski, Jacek; Zarzycki, Daniel

2006-01-01

343

Clinical data analysis based on iterative subgroup discovery: experiments in brain ischaemia data analysis  

Microsoft Academic Search

This paper presents a case study of the process of insightful analysis of clinical data collected in regular hospital practice.\\u000a The approach is applied to a database describing patients suffering from brain ischaemia, either permanent as brain stroke\\u000a with positive computer tomography (CT) or reversible ischaemia with normal brain CT test. The goal of the analysis is the\\u000a extraction of

Dragan Gamberger; Nada Lavrac; Antonija Krstacic; Goran Krstacic

2007-01-01

344

Clinical Experience for the Graduate Student in Pathology and Medical Bacteriology  

E-print Network

sputum. Negative by Much and Ziehl-Neelson methods. Negative by antiformin method. 12. R.P. Acacia Case. Smears and cultures fro® throat. Negative to tuberculosis. Tonsilitis, with a long-stand- ing gl^iular disease, probably tubercular* 13. R... make a brief consideration of the relationship between the general practitioner and the clinical laboratory. This relationship is at present undergoing an era of tran- sition, and it can hardly be said in fairness that the present maladjustment...

Fraser, Roy

1914-05-01

345

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

Microsoft Academic Search

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

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

2005-01-01

346

Clinical Trial Experience with Fat-Restricted vs. Carbohydrate-Restricted Weight-Loss Diets  

Microsoft Academic Search

It is unlikely that one diet is optimal for all overweight or obese persons. Both low-fat and low-carbohydrate diets have been shown to induce weight loss and reduce obesity-related comorbidities. Low-carbohydrate diets cause greater short-term (up to 6 months) weight loss than low-fat diets, but the long-term clinical safety and efficacy of these diets has not been studied.

Samuel Klein

2004-01-01

347

Five-year experience of clinical ethics consultations in a pediatric teaching hospital.  

PubMed

Our retrospective study presents and evaluates clinical ethics consultations (CECs) in pediatrics as a structure for implementing hospital-wide ethics. We performed a descriptive and statistical analysis of clinical ethics decision making and its implementation in pediatric CECs at Zurich University Children's Hospital. Ninety-five CECs were held over 5 years for 80 patients. The care team reached a consensus treatment recommendation after one session in 75 consultations (89 %) and on 82 of 84 ethical issues (98 %) after two or more sessions (11 repeats). Fifty-seven CECs recommended limited treatment and 23 maximal treatment. Team recommendations were agreed outright by parents and/or patient in 59 of 73 consultations (81 %). Initial dissensus yielded to explanatory discussion or repeat CEC in seven consultations (10 %). In a further seven families (10 %), no solution was found within the CEC framework: five (7 %) required involvement of the child protection service, and in two families, the parents took their child elsewhere. Eventual team-parent/patient consensus was reached in 66 of 73 families (90 %) with documented parental/patient decisions (missing data, n?=?11). Patient preference was assessable in ten CECs. Patient autonomy was part of the ethical dilemma in only three CECs. The Zurich clinical ethics structure produced a 98 % intra-team consensus rate in 95 CECs and reduced initial team-parent dissensus from 21 to 10 %. Success depends closely on a standardized CEC protocol and an underlying institutional clinical ethics framework embodying a comprehensive set of transparently articulated values and opinions, with regular evaluation of decisions and their consequences for care teams and families. PMID:24323344

Streuli, Jürg C; Staubli, Georg; Pfändler-Poletti, Marlis; Baumann-Hölzle, Ruth; Ersch, Jörg

2014-05-01

348

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

Microsoft Academic Search

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.

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

349

Model for teaching population health and community-based care across diverse clinical experiences.  

PubMed

The pillars constructivist model is designed to offer a unifying clinical paradigm to support consistent learning opportunities across diverse configurations of community and public health clinical sites. Thirty-six students and six faculty members participated in a mixed methods evaluation to assess the model after its inaugural semester of implementation. The evaluation methods included a rating scale that measures the model's ability to provide consistent learning opportunities at both population health and direct care sites, a case study to measure student growth within the five conceptual pillars, and a faculty focus group. Results revealed that the model served as an effective means of clinical education to support the use of multiple, small-scale public health sites. Although measurements of student growth within the pillars are inconclusive, the findings suggest efficacy. The authors recommend the continued use of the pillars constructivist model in baccalaureate programs, with further study of the author-designed evaluation tools. [J Nurs Educ. 2015;54(2):97-101.]. PMID:25602586

Van Dyk, Elizabeth J; Valentine-Maher, Sarah K; Tracy, Janet P

2015-02-01

350

Auditory feedback during frameless image-guided surgery in a phantom model and initial clinical experience.  

PubMed

In this study the authors measured the effect of auditory feedback during image-guided surgery (IGS) in a phantom model and in a clinical setting. In the phantom setup, advanced IGS with complementary auditory feedback was compared with results obtained with 2 routine forms of IGS, either with an on-screen image display or with image injection via a microscope. The effect was measured by means of volumetric resection assessments. The authors also present their first clinical data concerning the effects of complementary auditory feedback on instrument handling during image-guided neurosurgery. When using image-injection through the microscope for navigation, however, resection quality was significantly worse. In the clinical portion of the study, the authors performed resections of cerebral mass lesions in 6 patients with the aid of auditory feedback. Instrument tip speeds were slightly (although significantly) influenced by this feedback during resection. Overall, the participating neurosurgeons reported that the auditory feedback helped in decision-making during resection without negatively influencing instrument use. Postoperative volumetric imaging studies revealed resection rates of > or = 95% when IGS with auditory feedback was used. There was only a minor amount of brain shift, and postoperative resection volumes corresponded well with the preoperative intentions of the neurosurgeon. Although the results of phantom surgery with auditory feedback revealed no significant effect on resection quality or extent, auditory cues may help prevent damage to eloquent brain structures. PMID:18928352

Woerdeman, Peter A; Willems, Peter W A; Noordmans, Herke Jan; van der Sprenkel, Jan Willem Berkelbach

2009-02-01

351

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

SciTech Connect

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.

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

352

Clinical experience with THC:CBD oromucosal spray in patients with multiple sclerosis-related spasticity.  

PubMed

This detailed medical charts' data collection study conducted at a multiple sclerosis (MS) clinic in Germany evaluated the effectiveness of tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray in patients with resistant MS spasticity. Over a 15-month timeframe, THC:CBD spray was initiated in 166 patients. Mean follow-up was 9 months. In all, 120 patients remained on treatment for a response rate of 72%. THC:CBD spray was used as add-on therapy in 95 patients and as monotherapy in 25 patients to achieve best-possible therapeutic results. Among responders, the mean spasticity 0-10 numerical rating scale (NRS) score decreased by 57%, from 7.0 before treatment to 3.0 within 10 days of starting THC:CBD spray. The mean dosage was 4 sprays/day. Most patients who withdrew from treatment (40/46) had been receiving THC:CBD spray for less than 60 days. Main reasons for treatment discontinuation were: adverse drug reactions, mainly dizziness, fatigue and oral discomfort (23 patients; 13.9%); lack of efficacy (14 patients; 8.4%); or need for a baclofen pump (9 patients; 5.4%). No new safety signals were noted with THC:CBD spray during the evaluation period. In this routine clinical practice setting at an MS clinic in Germany, THC:CBD spray was effective and well tolerated as add-on therapy or as monotherapy in a relevant proportion of patients with resistant MS spasticity. PMID:24392812

Koehler, Jürgen; Feneberg, Wolfgang; Meier, Martin; Pöllmann, Walter

2014-09-01

353

For us or against us? Perceptions of faculty bullying of students during undergraduate nursing education clinical experiences.  

PubMed

The purpose of this review is to determine what we currently know about faculty bullying of nursing students during undergraduate clinical experiences. The review included 31 peer-reviewed articles and dissertations investigating faculty bullying of nursing students and those factors which can influence the phenomenon. A significant finding of this review is that faculty bullying of students arises out of complex contextual influences involving the practice setting, as well as perceptions and coping strategies of both faculty members and students. This belies the current understanding of bullying within nursing education as intentional, and arising from the personal pathologies of the teacher or student. This has implications for clinical faculty members as well as Schools of Nursing. As well, it highlights future directions for research, including interventions to decrease faculty bullying of students. PMID:24090522

Seibel, Michelle

2014-05-01

354

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

NASA Astrophysics Data System (ADS)

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.

Kanou, Naoyuki; Sakuma, Kenji; Nakashima, Kenji

355

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

NASA Technical Reports Server (NTRS)

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

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

1993-01-01

356

Association of clinical experiences with patient-reported outcomes among breast cancer surgery patients: breast cancer quality care study  

Microsoft Academic Search

Background  We aimed to clarify the association of breast cancer patients’ clinical experiences with patient-reported outcomes (PRO) of\\u000a satisfaction with care, choice of the same type of surgery again, and health-related quality of life (HRQOL).\\u000a \\u000a \\u000a \\u000a Methods  There were 2,403 (25.9%) of 9,283 eligible women who had undergone primary curative surgery for breast cancer in one of five\\u000a selected hospitals between 1993 and

Dong Young Noh; Seok Jin Nam; Se Hyun Ahn; Byeong Woo Park; Eun Sook Lee; Myung Kyung Lee; Soo Hyun Kim; Yoo Min Kim; Sang Min Park; Young Ho Yun

2008-01-01

357

[Initial clinical experiences with the fast digital picture of roentgen transmission profiles in the human (the chronogram)].  

PubMed

By means of suitable hardware and software changes it becomes possible to obtain transmission profiles of high time resolution (up to 50 profiles/sec) with the help of a CT device which is suitable for the recording of digital radiographs, in one transversal body layer. In this manner, it becomes possible to measure changes in the density profile from 6 up to 50 sec and to analyse them. This method called "Chronogram", enables high-resolution recording of density changes, similar to kymography. The possibilities of using contrast media are demonstrated by means of phantom measurements, and initial clinical experiences are outlined on the basis of practical examples. PMID:6764889

Hübener, K H; Metzger, H O; Kalender, W

1982-06-01

358

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

PubMed

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

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

359

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

SciTech Connect

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.

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

360

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

NASA Astrophysics Data System (ADS)

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

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

2012-08-01

361

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

Microsoft Academic Search

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

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

1988-01-01

362

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

PubMed

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. PMID:22842768

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

2012-08-21

363

PreClinical Experience with Full-Wave Inverse-Scattering for Breast Imaging  

Microsoft Academic Search

\\u000a A new transmission ultrasound CT breast scanner (Techniscan Medical Systems, Inc.) was installed for pre-clinical testing\\u000a at UCSD Medical Center. The scanner utilizes a 3D inverse scattering method to produce whole-breast tomographic images with\\u000a resolution approximately 1.5 mm in plane, 3.5 mm slice profile and slice spacing of 1 mm. Sound speed accuracy and sensitivity\\u000a were found to be highly

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

364

Extensive clinical experience: a simple guide to basal insulin adjustments for long-distance travel.  

PubMed

Long-distance travel across multiple time zones presents unique challenges for patients taking insulin, requiring adjustments in both timing and dosage of basal insulin when several times zones (?5) are traversed. Travel across the International Date Line adds to the confusion, as existing resources and dosing calculators often do not account for the date change. We review recommendations from available guidelines and dosage calculators used for long-distance travel basal insulin adjustments and then present our patient handouts which allow for a safe, specific, single dose adjustment for eastward and westward travel. The included handouts are easy to use and can be freely reproduced for use in diabetes clinics. PMID:24360506

Pinsker, Jordan E; Becker, Erik; Mahnke, C Becket; Ching, Michael; Larson, Noelle S; Roy, Daniel

2013-01-01

365

Adult Day Care Center: A Unique Clinical Experience for Dietetic Students  

Microsoft Academic Search

Senior dietetic students worked closely with an elderly population and respective caregivers in an adult day-care program. Experiences included preparation of nutritional assessments, design of appropriate case management, and counseling clients and families. Nutrition education programs consonant with age-related changes in learning were planned and implemented. The food service system was monitored to assure that the needs of an aging

Connie E. Vickery

1988-01-01

366

An Experimental Model for Clinical Experiences: A Social Studies Preservice Preparation Program.  

ERIC Educational Resources Information Center

Reviews recent research which indicates the need for a variety of field-based learning experiences which are closely integrated with teacher preparation. Examines a program at the University of Iowa (Ames) in which the social studies methods course was moved to a high school so that students observed high school classes and received instruction…

Shive, R. Jerrald

1988-01-01

367

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

ERIC Educational Resources Information Center

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"…

Hathorn, Donna; Machtmes, Krisanna; Tillman, Ken

2009-01-01

368

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

Microsoft Academic Search

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)

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

369

Clinical undergraduate training and assessment in primary health care: Experiences gained from Crete, Greece  

Microsoft Academic Search

BACKGROUND: Primary Health Care (PHC) is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on

George Belos; Christos Lionis; Michael Fioretos; John Vlachonicolis; Anastas Philalithis

2005-01-01

370

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

Microsoft Academic Search

The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide

Edward Lindop; Sue Cannon

2001-01-01

371

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

NASA Astrophysics Data System (ADS)

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.

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

2006-05-01

372

The Clinical Characteristics and Surgical Outcomes of Epiblepharon in Korean Children: A 9-Year Experience  

PubMed Central

Purpose. To examine the demographic characteristics, clinical features, surgical outcomes, and long-term prognoses of epiblepharon in Korean children. Methods. Epiblepharon patients who were followed for ? 6 month following surgical correction between January 2005 and December 2013. The patient demographics, clinical features, concomitant disorders, surgical outcomes, and complications were retrospectively reviewed. Results. A total of 768 epiblepharon records were included in the analysis. The mean patient age was 6.55 ± 2.37 years. At presentation, 712 patients (92.8%) complained of typical epiblepharon symptoms. The mean patient age at surgery was 6.95 ± 2.52 years, with 629 patients (81.9%) on the lower lid and 72 patients (9.4%) on the upper lid and 82 patients (10.7%) undergoing surgery on both lids. The eyelid was well everted with no recurrence in 740 patients (96.4%). Conclusion. Epiblepharon frequently occurs in Korean children and is correctable with a simple surgery. Recurrence and serious complications do not occur often, and any suspicions of epiblepharon should be investigated. A thorough ocular examination can lead to a correct diagnosis and timely corrective surgery. Most procedures are successful and prevent secondary complications that often occur with uncorrected epiblepharon. PMID:25298888

Kim, Jong Soo; Jin, Sang Wook; Hur, Mun Chong; Kwon, Yoon Hyung; Ryu, Won Yeol; Jeong, Woo Jin; Ahn, Hee Bae

2014-01-01

373

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

PubMed Central

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

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

2014-01-01

374

Occlusion of large atrial septal defects with a centering buttoned device: early clinical experience.  

PubMed

A feasibility clinical study was conducted for the transcatheter occlusion of large ostium secundum atrial septal defects with the centering buttoned device. The centering buttoned device is a modification of the regular buttoned device in which a centering counter-occluder is sutured at the central 40% portion of the occluder. During centering it is stretched, forming a parachute-shaped structure and pulling the occluder over the center of the defect. During buttoning, the counter-occluder forms a double figure eight, opposing the right atrial side of the atrial septum. Occlusion was performed in 12 patients aged 6 to 56 years. All had been rejected for transcatheter occlusion by the regular buttoned device, because of either their defect size or the lack of adequate septal rim. The defect size varied between 23 and 31 mm, and the device size varied between 45 and 60 mm. Nine had immediate effective occlusions of their defects and three residual shunts. One patient with unbuttoning had hemolysis at 2 weeks and underwent surgery. Early results of the transcatheter occlusion of large atrial septal defects are promising, and larger clinical trials are justified. PMID:8579033

Sideris, E B; Leung, M; Yoon, J H; Chen, C R; Lochan, R; Worms, A M; Rey, C; Meier, B

1996-02-01

375

Role of clinical pharmacists to prevent drug interactions in cancer outpatients: a single-centre experience.  

PubMed

Background Cancer patients are especially vulnerable to drug interactions, which may alter the efficacy and toxicity of treatment, leading to severe clinical consequences. Objective Determine the incidence of such interactions in patients receiving chemotherapy, as well as to identify the drugs most frequently involved, investigate the influence of the pharmacist's interventions and verify the degree of acceptance of pharmacist's recommendations by the medical team. Setting The oncology department of a Spanish tertiary hospital. Methods During 3 months, all the drug interactions in the regular combined with treatment for cancer were analysed using two databases, and recommendations were made when clinically significant interactions (CSI) were identified. Main outcome measure Incidence of CSI in oncology outpatients; drugs involved in CSI. Results Of the 75 patients included, 31 (41 %) presented CSI. Most interactions were among drugs included in the patient's usual treatment. The principal drug groups involved in CSI were cytostatic agents, antiemetics and antidepressants. The hospital pharmacist intervened on 20 occasions (35 % of the patients presenting drug interactions). These interventions mainly focused on recommendations to modify or discontinue drug prescriptions, and were followed in 94 % of cases. Conclusion The incidence of drug interactions in cancer patients is high, and they most often involve medications to treat comorbid conditions. The pharmacist, as a member of the multidisciplinary team, can contribute significantly by checking the treatment prescribed and detecting interactions, to reduce medication-related problems and to optimise drug therapy for these patients. PMID:25326824

Lopez-Martin, Carmen; Garrido Siles, Margarita; Alcaide-Garcia, Julia; Faus Felipe, Vicente

2014-12-01

376

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

PubMed

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

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

2014-07-01

377

Clinical trial experience with the MitraClip catheter based mitral valve repair system.  

PubMed

Severe mitral regurgitation (MR) confers a poor prognosis, in particular for patients with heart failure. Based on the results of the Euro Heart Survey, a large proportion of patients with mitral regurgitation is not referred to surgery and many other patients are rejected for cardiac surgery due to the high surgical risk or co-pathologies. Improving ventricular function with ACE inhibitors, beta-blockers and CRT may reduce mitral regurgitation, but for most patients a mechanical intervention is ultimately preferable. Mitral valve surgery is invasive and requires a long recovery period; therefore, less invasive and effective approaches are highly desirable, particularly in high risk patients. Therefore, new techniques have been recently developed to treat MR with percutaneous approach. The MitraClip device (Abbott Vascular, Menlo Park, CA) is used to treat both functional and degenerative mitral valve regurgitation. Its safety and efficacy has been initially tested in the Endovascular Valve Edge-to-Edge REpair Study (EVEREST), while MitraClip has been compared to surgery in the EVEREST II randomized trial. Besides EVEREST trials, safety and efficacy of the device as well as its health economic value is under evaluation in ongoing registries. Although the field of catheter based management of MR is at an early stage, initial clinical results have demonstrated that catheter based approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR. PMID:21503702

Maisano, Francesco; Godino, Cosmo; Giacomini, Andrea; Denti, Paolo; Arendar, Iryna; Buzzatti, Nicola; Canna, Giovanni La; Alfieri, Ottavio; Colombo, Antonio

2011-12-01

378

Clinical experience with vagus nerve stimulation and deep brain stimulation in epilepsy  

Microsoft Academic Search

Patients with refractory epilepsy present a particular challenge to new therapies. Vagus nerve stimulation (VNS) for the control\\u000a of intractable seizures has become available since 1989. VNS is a relatively noninvasive treatment. It reduces seizure frequency\\u000a by ?50% in 1\\/3 of patients; an additional 1\\/3 of patients experience a worthwhile reduction of seizure frequency between 30\\u000a and 50%. In the

Paul Boon; V. De Herdt; K. Vonck; D. Van Roost

379

Clinical Performance of Breast Tomosynthesis as a Function of Radiologist Experience Level  

Microsoft Academic Search

This study reports the performance of breast tomosynthesis (3D images) combined with digital mammography (2D images), compared\\u000a to digital mammography alone, as a function of the experience of the radiologist. In this trial, twelve readers analyzed 316\\u000a image sets, giving BIRADS (and other) scores first for the digital mammograms, and subsequently for the combined datasets\\u000a of tomosynthesis and digital mammograms.

Andrew P. Smith; Elizabeth A. Rafferty; Loren Niklason

2008-01-01

380

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

Microsoft Academic Search

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

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

381

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.

382

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

PubMed

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

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

2006-12-01

383

Secrets to creating effective and interesting educational experiences: tips and suggestions for clinical educators.  

PubMed

Genetic Counselors (GCs) spend years learning about genetics and practicing counseling techniques in classroom environments. From the learner perspective, teaching may seem straightforward: provide appropriate information, develop tests or assignments and submit grades. When asked to teach for the first time, however, clinicians suddenly realize that there is a lot more to education than standing in front of a class and talking. This article introduces clinical educators to strategies and learning principles that help make the teaching/learning process more interesting and successful for faculty and students alike. The instructional concepts presented here are useful across the entire spectrum of learning situations; a 1 hour discussion with a lay audience, a 3 hour workshop at a professional meeting, a 15 week graduate course, or a series of courses culminating in an advanced degree. The article offers suggestions for writing course competencies, selecting instructional approaches, embedding learning engagement options, leveling course content and choosing evaluation strategies. PMID:18259847

Seibert, Diane C

2008-04-01

384

Anal fissure in children: a 10-year clinical experience with nifedipine gel and lidocaine.  

PubMed

We aimed to evaluate efficacy and safety of the use of nifedipine gel with lidocaine in the treatment of acute anal fissures in children by reviewing of 106 children with acute anal fissure treated conservatively by nifedipine gel with lidocaine between the years 2003--2012. There were 48 males and 58 females. Their clinical presentation consisted of constipation, rectal bleeding, anal pain, perianal itching, abdominal pain, irritability and rectal prolapsed. Posterior, anterior, both anterior and posterior, multiple, both posterior and lateral locations were the main physical findings in 65,23,10,7,and 1 cases. Ninety nine patients completed the 4--week treatment course of nifedipine gel with lidocaine successfully (93.40%), with complete healing of the fissure. The recurrence rate observed was very low (6.60%). Topical 0.2% nifedipine with lidocaine appears an efficient mode of treatment for anal fissures in children, with a significant healing rate and no side effects. PMID:25411941

Klin, B; Efrati, Y; Berkovitch, M; Abu-Kishk, I

2014-11-20

385

Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians.  

PubMed

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

Gleichgerrcht, Ezequiel; Decety, Jean

2013-01-01

386

Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience  

PubMed Central

Background Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way. Method In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor. Results From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it. Conclusions Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health. PMID:21962009

2011-01-01

387

CLINICAL STAGING AND SURVIVAL IN REFRACTORY CELIAC DISEASE: A SINGLE CENTER EXPERIENCE  

PubMed Central

Background & Aims Refractory celiac disease (RCD) occurs when both symptoms and intestinal damage persist or recur despite strict adherence to a gluten-free diet. In RCD, the immunophenotype of intraepithelial lymphocytes may be normal and polyclonal (RCD I) or abnormal and monoclonal (RCD II). The aim is to describe the clinical characteristics, treatment, and long-term outcome in a large single-center cohort of patients with RCD. Methods We compared the clinical characteristics and outcome in 57 patients with RCD: 42 with RCD I and 15 with RCD II. Results The overall 5-year cumulative survival is 70, 80 and 45 percent in the entire cohort, RCD I, and RCD II respectively (p = 0.07, among subtypes). The drop in survival was more evident during the first two years after the diagnosis. Fifteen (26%) patients died (n=8 with RCD I and n=7 with RCD II). The refractory state itself and enteropathy-associated T-cell lymphoma (EATL) were the most common causes of death, respectively. A new staging system is proposed based on the cumulative effect of five prognostic factors investigated at the time of the refractory state diagnosis: for patients in stages I, II, and III, the 5-year cumulative survival rate was 96, 71, and 19 percent, respectively (p<0.0001). Conclusions RCD is associated with high mortality with RCD II having an especially poor prognosis because of the development of EATL. A new staging model is proposed that may improve the precision of prognosis in patients with RCD. PMID:18996383

Rubio-Tapia, Alberto; Kelly, Darlene G; Lahr, Brian D; Dogan, Ahmet; Wu, Tsung-Teh; Murray, Joseph A

2012-01-01

388

MRI experience with multiple sclerosis - Comparison to CT and clinical status  

SciTech Connect

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.

Reese, L.; Carr, T.; Nicholson, R.L.

1985-05-01

389

Necessity and benefits of physician assistants' participation in international clinical experiences.  

PubMed

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

Kibe, Lucy Wachera

2012-01-01

390

Clinical evaluation of natural history of Peyronie's disease: our experience, old myths and new certainties.  

PubMed

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

Paulis, Gianni; Cavallini, Giorgio

2013-10-01

391

Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience  

PubMed Central

Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years) who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8%) girls and 64 (51.2%) boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60%) patients, followed by fever in 35 (28%). Erythema (33.6%), esophageal ulcer (11.2%), and whitish patch (8.0%) were the most common endoscopic findings, while reflux esophagitis (32.8%), chronic (6.4%) and acute esophagitis (5.6%), and candida esophagitis (5.6%) were the most common histological diagnoses. Only one (0.8%) patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression. PMID:24031107

Zahmatkeshan, Mozhgan; Najib, Khadijesadat; Geramizadeh, Bita; Fallahzadeh, Ebrahim; Haghighat, Mahmood; Imanieh, Mohammad Hadi

2013-01-01

392

Management of malignant airway compromise with laser and low dose rate brachytherapy. The Mayo Clinic experience  

SciTech Connect

Between January 1983 and October 1985, 65 patients with malignant airway compromise have had 93 flexible bronchoscopic placements of a nylon afterloading catheter for low dose rate iridium-192 temporary intraluminal brachytherapy. All patients received prior (59 patients) and/or concurrent (13 patients) external beam irradiation to tolerance and were not candidates for surgery. Forty of these patients also received neodymium-YAG laser treatment prior to brachytherapy in a planned combined approach to provide immediate symptomatic relief and facilitate catheter placement. A dose of 3000 cGy is prescribed to 5 mm and 10 mm radii over 20-40 hours in the bronchus and trachea, respectively. Of 59 patients treated with palliative intent, 40 patients (68%) have had follow-up bronchoscopy, 18 patients have had clinical follow-up only, and one patient was lost to follow-up. Of 40 patients examined by bronchoscope in follow-up, 24 (60%) responded, eight were stable, and eight progressed. Lack of progression after prior external beam radiation for periods of greater than 12 months, six-12 months and less than six months yielded response rates to brachytherapy in 83, 50 and 31%, respectively. Most patients with clinical follow-up only expired at early intervals with airway palliation from extra-airway disease progression. Four of five patients treated with curative intent are disease-free at a median of 16 months. Eleven patients have experienced fistula and/or hemorrhage, of which seven instances (11% of all patients) appear to be treatment-induced. This brachytherapy technique is simple, well tolerated, and convenient for the patient providing airway palliation in the significant majority of patients with acceptable risk.

Schray, M.F.; McDougall, J.C.; Martinez, A.; Cortese, D.A.; Brutinel, W.M.

1988-02-01

393

Recruitment of patients with lung cancer into a randomised clinical trial: experience at two centres  

PubMed Central

BACKGROUND—The entry of patients into randomised clinical trials (RCTs) in lung cancer is low. A study was undertaken to assess the reasons why patients with non-small cell lung cancer did not enter a trial involving randomisation to receive or not receive three courses of cisplatin based chemotherapy in addition to primary treatment by surgery, radiotherapy, or best supportive care.?METHODS—The study was carried out in two large London institutions with a special interest in recruiting patients to lung cancer trials. Patients recently diagnosed as having non-small cell lung cancer were prospectively identified and followed to see whether they entered the RCT and, if not, to identify the main reasons why.?RESULTS—Six hundred and eighty eight patients newly diagnosed with non-small cell lung cancer were identified between November 1995and July 1998; 274 (39.8%) were deemed ineligible for the RCT for clinical reasons, most frequently their general condition rendering them unfit for chemotherapy. Another 161 (23.4%) were ineligible for logistical reasons—for example, they were discharged to centres not participating in the RCT or they were not considered for the trial at an appropriate time in their management. Of 253potentially eligible patients, only 63 (24.9% of those eligible) agreed to enter the RCT and four entered another study. Of those who did not enter, 77 (41.4%) declined without stating a reason, 61 (32.8%) did not want chemotherapy, and only eight (4.3%) expressed a wish to have chemotherapy.?CONCLUSIONS—Despite considerable time and effort, the proportion of patients recruited was small (9.2%). Many seen were ineligible but, of 253 potentially eligible patients, 186 (73.5%) refused to enter the RCT.?? PMID:10817793

Spiro, S; Gower, N; Evans, M; Facchini, F; Rudd, R

2000-01-01

394

Single-Isocenter Frameless Intensity-Modulated Stereotactic Radiosurgery for Simultaneous Treatment of Multiple Brain Metastases: Clinical Experience  

SciTech Connect

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.

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

395

Survey of European clinical geneticists on awareness, experiences and attitudes towards direct-to-consumer genetic testing  

PubMed Central

Background The advent of direct-to-consumer (DTC) genetic testing (GT) has sparked a number of debates regarding the scientific validity of tests, their broad health and ethical implications for society as well as their legal status. To date, relatively few empirical studies have been published regarding this phenomenon. We conducted a survey of European clinical geneticists to gauge their awareness of, experiences with, and attitudes towards DTC GT. Methods We invited 300 clinical geneticists from 28 European countries to complete an online questionnaire. Statistical analyses of closed-ended questions were performed using the STATISTICA software package. Answers to open-ended questions were analysed for recurring themes. Results One hundred and thirty-one clinical geneticists answered our survey (response rate, 44%). Eighty-six percent (110/128) of respondents were aware of DTC GT, and over one-third had been contacted by at least one patient regarding these services. The majority (84%) of respondents did not agree with telephone medical supervision outside of an established doctor-patient relationship. The majority of clinical geneticists also found it unacceptable to provide non-face-to-face medical supervision for: (i) a presymptomatic test for a condition with very high penetrance; (ii) a predictive test for a condition that has a 'medium' penetrance of 50% to 60%; and (iii) carrier testing. For conditions that are neither treatable nor preventable and for disorders with serious health consequences, clinical geneticists were almost unanimous in expressing the unacceptability of offering such genetic tests outside of the traditional healthcare setting, without an established physician-patient relationship and without face-to-face medical supervision. Conclusion A high percentage of European clinical geneticists are aware of DTC GT and the majority do not agree with the model of provision used by many commercial companies for certain severe or actionable health conditions. Despite this disagreement with the DTC model of provision, >85% of respondents said that they would offer genetic counselling to patients who asked for a consultation after having undergone DTC genetic testing. The understanding of the views and opinions of this expert stakeholder group should be considered in the attempts to shape responsible policy and guidelines for these services. PMID:23697740

2013-01-01

396

The Effect of Nursing Faculty Presence on Students' Level of Anxiety, Self-Confidence, and Clinical Performance During a Clinical Simulation Experience  

E-print Network

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, ...

Horsley, Trisha Leann

2012-05-31

397

Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience  

SciTech Connect

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.

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

398

Acquired factor VIII inhibitors in non-haemophilic patients: clinical experience of 15 cases.  

PubMed

We retrospectively analysed 15 non-haemophilic patients with acquired factor VIII inhibitors seen in our regional haemophilia centre. The median age was 55 years (range: 21-80). About 70% of patients older than 50 were male, while all five patients younger than 50 were female. The most common underlying condition was pregnancy or postpartum status (20%). About 27% of cases had no identifiable underlying condition. About 27% of patients had medical conditions that were unlikely to be related to acquired inhibitors. The most frequent presenting symptom was spontaneous haemorrhage of soft tissues, skin or joints. Twelve of 13 (92.3%) evaluable patients achieved complete remission (CR) with prednisone alone and/or combined prednisone and cyclophosphamide, but their clinical courses were highly variable. The median time to response was 21.5 weeks (range: 2-176) and the median treatment duration was 9 months (range: 1.25-66). All six patients treated with prednisone initially, and then combined prednisone/cyclophosphamide if no response (NR) to prednisone within 3-4 months (three patients), achieved CR; while four of five patients treated initially with combined prednisone/cyclophosphamide had CR. Patients older than 50 years had a similar response rate, median time to response and median treatment duration as did patients younger than 50 years (83% vs. 100%; 21.5 vs. 32 weeks, and 8 vs 16.5 months, respectively). Furthermore, the differences in the median time to response and treatment duration for patients with high or low baseline or peak inhibitor titres were negligible. Only one patient died of a treatment-related pulmonary aspergillosis 18 months after an acquired inhibitor was diagnosed. None of these patients died of bleeding complications. In conclusion, our patients with acquired FVIII inhibitor had highly variable clinical courses and responses to steroid or immunosuppressive therapy. The inhibitors in the majority of patients resolved in less than 6 months although in two cases it persisted for longer than 1 year before resolving. Treatment with prednisone alone as first line, then combined prednisone with cyclophosphamide if NR to prednisone seemed equally effective when compared with using combined prednisone and cyclophosphamide initially. Further studies of newer therapeutic agents such as 2-chlorodeoxyadenosine (2-CDA) and rituximab are warranted for patients refractory to conventional immunosupressive therapy. PMID:15569166

Huang, Y-W; Saidi, P; Philipp, C

2004-11-01

399

Interviewing to develop Patient-Reported Outcome (PRO) measures for clinical research: eliciting patients’ experience  

PubMed Central

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

2014-01-01

400

Penicillin allergy evaluation: experience from a drug allergy clinic in an Arabian Gulf Country, Kuwait  

PubMed Central

Background Hypersensitivity to penicillin has been studied worldwide, but data regarding patterns of sensitization in Arabian Gulf countries are scarce. Objective To describe the patterns of penicillin hypersensitivity during a 6-year study in Kuwait in terms of demographics, type of the culprit drug, in vivo and in vitro allergy testing. Methods One hundred and twenty-four patients referred to the drug allergy clinic for penicillin allergy were fully evaluated by skin prick and intradermal testing. Drug provocation test was done on patients with negative results. Results A total of 124 patients were evaluated for penicillin allergy. Mean age was 37.8 (standard deviation, 12.7) years, range from 8 to 74 years. Thirty-nine male (31.5%) and 85 female patients (68.5%) were included. Diagnosis of penicillin allergy was confirmed in 46 patients (37.1%). Among the 44 confirmed allergic patients by skin evaluation we had 15 (34.1%) positive skin prick test, and 29 (65.9%) positive intradermal testing. Among patients with positive skin testing, 47.7% were positive to major determinant benzylpenicilloyl poly-L-lysine, 20.4% to minor determinant mixture, 50.0% to penicillin G and 40.9% to ampicillin; 13.6% of patients were positive to amoxicillin by skin prick test. One patient had a positive radioallergosorbent test and one had a positive challenge test. Conclusion Penicillin allergy is a common problem with an incidence of about one third in our study subjects. PMID:24809016

Rodriguez Bouza, Tito; Arifhodzic, Nermina

2014-01-01