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1

Clinical experience of postage stamp autograft with porcine skin onlay dressing in extensive burns.  

PubMed

Fifteen patients with extensive burns (deep second-degree burn > 50%, or third-degree burn > 30% of total body surface area) were treated with postage stamp autograft and meshed porcine skin onlay dressing from 1992 to 1996. All patients received the procedure within 10 days of sustaining the burn, with an average of 6.3 days. The areas chosen for postage stamp autograft were the anterior chest, abdomen, back, buttocks and the proximal part of the extremities. The scalp was the donor site of choice when available. The harvested skin was cut into 0.5-1.0 cm postage-stamp-like squares and applied to the recipient sites separated by a distance of 0.5-2.0 cm. The expansion ratio was from 1:4 to 1:9. Meshed porcine skin was then used for onlay dressing. The average graft area was 26% of the total body surface area. The success rate of the skin grafts was nearly 100% in 14 patients. One patient had a 40% loss due to contamination from adjacent wounds. In conclusion, the postage stamp autograft with porcine skin overlay is an effective way to treat extensive burn wounds in the early stages. PMID:9677031

Chang, L Y; Yang, J Y

1998-05-01

2

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

3

Extension Service Agricultural Experiment Station  

E-print Network

joy of gardening People learn to use native plants, conserve water and grow organic produce The Oregon, it provides technical support to dozens of community gardens. It also operates the Learning Gardens Laboratory. In Washington County, Extension-trained Master Gardeners advised community members how to landscape a road

Tullos, Desiree

4

Farmer Experience of Pluralistic Agricultural Extension, Malawi  

ERIC Educational Resources Information Center

Purpose: Malawi's current extension policy supports pluralism and advocates responsiveness to farmer demand. We investigate whether smallholder farmers' experience supports the assumption that access to multiple service providers leads to extension and advisory services that respond to the needs of farmers. Design/methodology/approach: Within a…

Chowa, Clodina; Garforth, Chris; Cardey, Sarah

2013-01-01

5

Developing Effective Extension Agents: Experience Concerns.  

ERIC Educational Resources Information Center

This paper is a description of the requirements placed on persons selected to fill the role of extension agents for the purpose of penetrating an educational environment, installing change in an educational organization, and completing tasks as a resource outside of the education establishment. These experience concerns are summarized by…

Goddu, Roland

6

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

7

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.

8

Semirigid Cantilever Extension System for Splinting Implants: A Clinical Report  

PubMed Central

In mandibular edentulous patients, treatment based on immediate loading with rigid splinting in the mandible is well accepted; however, it is cost and time dependent, which sometimes limits this type of rehabilitation. To overcome these problems, the technique of immediate loading using a semirigid splinting extension system has been developed. Its advantages include low cost, technical feasibility, and reduced clinic time. This clinical report presents the applicability and the predictability of semirigid splinting of implants in the mandibular arch of an edentulous patient using a distal extension bar prosthesis system. PMID:25161775

Machado, Raissa Micaella Marcello; Pinto, Luciana de Rezende; Chagas Júnior, Otacílio Luiz

2014-01-01

9

Telelearning for Extension Agents: The Virginia Experience.  

ERIC Educational Resources Information Center

The creation of the Virginia Tech Teleport Facility and the installation of a nine-meter (diameter) C-Band satellite uplink antenna provided the initial impetus for the Virginia Cooperative Extension Service (VCES) to explore the use of satellite technology for information and program delivery. The $600,000 uplink became operational in September…

Murphy, William F., Jr.

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

Tunka-Rex: a Radio Extension of the Tunka Experiment  

NASA Astrophysics Data System (ADS)

Tunka-Rex, the Tunka radio extension, is an array of about 20 antennas currently under construction, which covers an area of 1 km2. Tunka-Rex measures the radio emission of cosmic-ray air showers above 1016 eV. It is triggered by the photomultipliers of the Tunka-133 experiment which simultaneously measure the Cherenkov light emitted by the same air showers. The radio-Cherenkov-hybrid measurements thus offer a unique opportunity for a cross-calibration of both detection methods. The main goal of Tunka-Rex is to determine the precision of the radio reconstruction for the energy and the atmospheric depth of the shower maximum, Xmax, and thus to experimentally test theoretical predictions that the radio precision can be similar to the precision of air-Cherenkov and fluorescence measurements. At the same time, Tunka-Rex can demonstrate that radio measurements can be performed on a large area for a relatively cheap price, since the antennas will be connected to the already existing Tunka DAQ. Finally, radio-antenna arrays have the perspective to increase the effective observation time compared to air-Cherenkov and fluorescence detectors by an order of magnitude, since radio measurements are possible under almost any atmospheric and light conditions.

Schröder, F. G.; Besson, D.; Budnev, N. M.; Gress, O. A.; Haungs, A.; Hiller, R.; Kazarina, Y.; Kleifges, M.; Konstantinov, A.; Korosteleva, E. E.; Kostunin, D.; Krömer, O.; Kuzmichev, L. A.; Mirgazov, R. R.; Pankov, A.; Prosin, V. V.; Rubtsov, G. I.; Rühle, C.; Savinov, V.; Stockham, J.; Stockham, M.; Svetnitsky, E.; Wischnewski, R.; Zagorodnikov, A.

2013-02-01

19

A nightmare for haematology clinics: extensively drug-resistant (XDR) Acinetobacter baumannnii.  

PubMed

The purpose of our study was to share experience on demographic characteristics and clinical outcome of the patients infected with extensively drug-resistant Acinetobacter baumannii (XDRAB) in haematology clinics, focusing on the period with a sudden increase in the number of XDRAB cases. A regular patient-based infection control programme was set up in haematology clinics and haematopoietic stem cell transplant centre starting from 2008. An infection control nurse visited all patients daily. A form including demographic data and laboratory results were recorded for all patients. The source of infections was identified according to the criteria proposed by the Centers for Disease Control and Prevention. While haematology ward-acquired XRDAB was rare before 2012, between January 2012 and July 2013, 29 A. baumannii infection episodes were detected in 28 patients. All but one isolate were MDR and 72.4% (21 out of 29) were XDR. Blood cultures revealed A. baumannii in 26 out of 29 episodes. While the haematological malignancy was relapsing or not under remission in 15 patients, four patients were under remission, and 10 patients were newly diagnosed. The mortality rate was 81.2%. All patients with a poor outcome died in the first week after the index blood culture was performed. In 16 out of 29 episodes, the patients died before the culture results became available. Colistin was initiated for the treatment in 11 out of 29 episodes. Three patients received colistin combined with sulbactam or sulbactam containing beta-lactams; the remaining eight patients who received colistin monotherapy were already under carbapenems. In conclusion, XDRAB infections can easily become nightmares for haematology clinics without any reliable treatment option. PMID:25551842

Metan, Gokhan; Pala, Cigdem; Kaynar, Leylagul; Cevahir, Fatma; Alp, Emine

2014-12-01

20

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

21

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

22

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

23

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

24

Intravenous leiomyomatosis with intracardiac extension: a single-institution experience  

PubMed Central

OBJECTIVE The aim of this study was to outline the surgical management and outcomes for patients diagnosed with intravenous leiomyomatosis with intracardiac extension at a single institution. STUDY DESIGN This was a retrospective review of patients diagnosed with intravenous leiomyomatosis with intracardiac extension between 2002–2008. RESULTS Four patients were identified. The surgical approach in 3 (75%) patients was a single-stage operation. Four (100%) patients presented with cardiac symptoms: 3 (75%) with syncope and 1 (25%) with an abnormal electrocardiogram. Mean age at presentation was 48 years (range, 42–58 years). Complete resection of tumor was obtained in 1 (25%) patient and 3 (75%) patients experienced incomplete resection. Mean follow-up, including surveillance imaging, was 25.5 months (range, 8–57 months) and all 4 patients (100%) are currently free of recurrence. CONCLUSION Surgical excision remains an effective therapy for treating patients with benign metastasizing leiomyomatosis. Incomplete surgical resection may result in favorable response. PMID:19729144

Worley, Micheal J.; Aelion, Anate; Caputo, Thomas A.; Kent, Kenneth C.; Salemi, Arash; Krieger, Karl H.; Goldstein, Michael J.; Kuo, Dennis Y.; Slomovitz, Brian M.

2015-01-01

25

The multiwire proportional chamber for extensive air shower experiments  

NASA Astrophysics Data System (ADS)

This work describes the construction and parameters of the multiwire proportional chamber to be employed as a detector of the hadron component of extensive air showers. The chamber can locate and measure densities of the particle bursts resulting from hadron interactions. The cheap and simple analog-to-digital converter which can be used when a very high read-out channel number is required, has also been described.

Bogorodzki, Adam; Olejniczak, Wielis?aw; Rychtelski, Andrzej

1983-11-01

26

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

27

An extensible software library for developing tactile perception experiments  

E-print Network

A system was designed to reduce the time undergraduate student researchers spend programming while developing tactile perception experiments. The system allows students to program in Matlab, a high-level, interpreted ...

Meghani, Samir V. (Samir Vijay), 1983-

2004-01-01

28

Extension of drop experiments with the MIKROBA balloon drop facility  

Microsoft Academic Search

The German balloon drop facility MIKROBA extends the worldwide available drop experiment opportunities to the presently highest usable experimentation time span of 55 s at microgravity conditions better than 0.001 g. The microgravity period is started with the typical quasi-deal step function from 1 to 0 g. MIKROBA allows flexible experiment design, short access time, and easy hands-on payload integration.

K. Sommer; K. Kretzschmar; C. Dorn

1992-01-01

29

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

30

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

31

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

32

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

33

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

34

Extension of drop experiments with the MIKROBA balloon drop facility  

NASA Astrophysics Data System (ADS)

The German balloon drop facility MIKROBA extends the worldwide available drop experiment opportunities to the presently highest usable experimentation time span of 55 s at microgravity conditions better than 0.001 g. The microgravity period is started with the typical quasi-deal step function from 1 to 0 g. MIKROBA allows flexible experiment design, short access time, and easy hands-on payload integration. The transport to the operational height is realized by soft energies and technologies compatible with the earth's environment. Balloon campaigns are not restricted to a certain test range, i.e., several suitable sites are available all over the world. MIKROBA combines negligible mechanical loads at the mission start, typical of all drop facilities, with extremely low drop deceleration loads (less than g), due to the implemented three-stage parachute and airbag recovery subsystem.

Sommer, K.; Kretzschmar, K.; Dorn, C.

1992-12-01

35

Factors Influencing Career Experiences of Selected Chinese Faculty Employed at an American Research Extensive University  

ERIC Educational Resources Information Center

Whereas research related to the experience of faculty of color is increasing, few attentions have been focused on Chinese faculty's career experience in the US. This study examined career experiences of 16 Chinese faculty members across different disciplines, ranks and genders at a studied research extensive university in Texas, US. The study used…

Cooksey, Yan Zhang; Cole, Bryan R.

2012-01-01

36

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

37

[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

38

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

39

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

40

Pyrosequencing for Rapid Detection of Extensively Drug-Resistant Mycobacterium tuberculosis in Clinical Isolates and Clinical Specimens  

PubMed Central

Treating extensively drug-resistant (XDR) tuberculosis (TB) is a serious challenge. Culture-based drug susceptibility testing (DST) may take 4 weeks or longer from specimen collection to the availability of results. We developed a pyrosequencing (PSQ) assay including eight subassays for the rapid identification of Mycobacterium tuberculosis complex (MTBC) and concurrent detection of mutations associated with resistance to drugs defining XDR TB. The entire procedure, from DNA extraction to the availability of results, was accomplished within 6 h. The assay was validated for testing clinical isolates and clinical specimens, which improves the turnaround time for molecular DST and maximizes the benefit of using molecular testing. A total of 130 clinical isolates and 129 clinical specimens were studied. The correlations between the PSQ results and the phenotypic DST results were 94.3% for isoniazid, 98.7% for rifampin, 97.6% for quinolones (ofloxacin, levofloxacin, or moxifloxacin), 99.2% for amikacin, 99.2% for capreomycin, and 96.4% for kanamycin. For testing clinical specimens, the PSQ assay yielded a 98.4% sensitivity for detecting MTBC and a 95.8% sensitivity for generating complete sequencing results from all subassays. The PSQ assay was able to rapidly and accurately detect drug resistance mutations with the sequence information provided, which allows further study of the association of drug resistance or susceptibility with each mutation and the accumulation of such knowledge for future interpretation of results. Thus, reporting of false resistance for mutations known not to confer resistance can be prevented, which is a significant benefit of the assay over existing molecular diagnostic methods endorsed by the World Health Organization. PMID:24478476

Rodwell, Timothy C.; Victor, Thomas C.; Rider, Errin C.; Pham, Lucy; Catanzaro, Antonino; Desmond, Edward P.

2014-01-01

41

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.

42

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

43

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

44

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

45

Study on the extension of experiment resources in the MAUS project  

NASA Astrophysics Data System (ADS)

Concepts for the extensions of the MAUS-experiment-resource-limits were analyzed. The limits for the experiment parameters such as volume, mass, energy and dissipation are increased by connecting several get away special (GAS) containers to MAUS-clusters. The analyzed concepts are discussed and for one selected concept the development phase are prepared by the design of hardware, by electronic layouts and by planning of the procurement (with working scheme and schedule).

Anderle, H.; Boerchers, G.; Fechner, G.; Groth, V.; Haase, B.; Stolze, H.; Vits, P.

1984-12-01

46

Rheology and Dynamics of Associative Polymers in Shear and Extension: Theory and Experiments  

E-print Network

Rheology and Dynamics of Associative Polymers in Shear and Extension: Theory and Experiments applications in which careful control of the rheology of the solution is required, e.g., paints, foods along the polymer backbone. The driving force for the association process is the interaction between

47

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

48

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

49

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

50

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

51

Orthodontic extrusion of an extensively broken down anterior tooth: a clinical report.  

PubMed

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure. PMID:15732544

Smidt, Ami; Lachish-Tandlich, Moshik; Venezia, Eyal

2005-02-01

52

Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions  

PubMed Central

Background Neuromyelitis optica (NMO) shows various brain magnetic resonance imaging (MRI) abnormalities with recurrent central nervous system (CNS) attacks, although predominantly affecting the spinal cord and optic nerve. However, NMO with extensive involvement of the brain has infrequently been studied. We investigated the clinical, radiographic features and immunomodulating changes of NMO patients with extensive brain lesions (EBLs) in China. Methods NMO patients (including 16 NMO patients with EBLs and 53 NMO patients without EBLs) hospitalized during January 2006 and February 2010 were recruited and analyzed retrospectively. Data of clinical characteristics, magnetic resonance imaging (MRI) features, laboratory abnormalities, treatment details and outcomes were analyzed. All the patients received the follow-up visits for two years. Results EBLs in NMO were classified into four categories according to their respective MRI characteristics: 1) Tumefactive-like lesions (n=4, 25%); 2) Acute disseminated encephalomyelitis (ADEM)-like lesions (n=6, 37.5%); 3) Multiple sclerosis (MS)-like lesions (n=5, 31.25%); 4) Posterior reversible encephalopathy syndrome (PRES)-like lesions (n=1, 6.25%). NMO patients with EBLs had higher rates of encephalopathy symptoms (37.5% vs. 5.6%, p = 0.004), homonymous hemianopia (18.8% vs. 0%, p = 0.011) and AQP4 seropositivity (100% vs. 69.8%, p = 0.008) than NMO patients without EBLs (NEBLs). Immunomodulating changes (including the levels of C3, C4, ESR and CRP) were significantly higher in patients with EBLs than those without EBLs. The relapse times in EBLs during the follow-up period were more frequent than those happened in NEBLs (1.88 ± 0.30 vs. 1.23 ± 0.14, p = 0.04). The EDSS scores in EBLs patients were also much higher than those in NEBLs throughout all the whole visits of follow-up. Conclusions The presence of EBLs in NMO may indicate a higher diseases activity and portend a worse prognosis. CRP is a useful marker in monitoring diseases activity. Systemic inflammation may be crucial to the formation of EBLs in NMO. PMID:23819854

2013-01-01

53

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

54

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

55

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

56

78 FR 21958 - Non-Competitive One-Year Extension With Funds for Black Lung/Coal Miner Clinics Program (H37...  

Federal Register 2010, 2011, 2012, 2013

...One-Year Extension With Funds for Black Lung/Coal Miner Clinics Program (H37) Current...one-year extension with funds for the Black Lung/Coal Miner Clinics Program awards to...in fiscal year (FY) 2012. The Black Lung/Coal Miner Clinics Program supports...

2013-04-12

57

Are There Clinical Differences in Limited Systemic Sclerosis according to Extension of Skin Involvement?  

PubMed Central

Objectives. To examine the characteristics of our patients with limited systemic sclerosis (lSSc) for differences between Barnett Type 1 (sclerodactyly only) and Type 2 or intermediate (acrosclerosis-distal but may reach up to elbows and/or knees plus face) subsets. Methods. Records of patients between January 1, 2000, and December 31, 2011, with SSc or those with anti-Scl-70, anticentromere, or antinucleolar antibodies were reviewed. Only cases fulfilling ACR 1980 criteria were included and classified as diffuse or limited according to LeRoy's criteria. Limited SSc was separated into sclerodactyly and acrosclerosis (Barnett's Types 1 and 2). Results. 234 SSc patients (216 females) fulfilled criteria. Female/male ratio was 12?:?1; 24% had dSSc and 76% lSSC (64% Type 1 and 12% Type 2). Total follow-up was 688 patient-years. Within lSSC, the Type 2 group had significantly shorter duration of Raynaud's and more anti-Scl-70 and less anticentromere antibodies. In particular, interstitial lung disease (ILD) was significantly more prevalent in Type 2 group and similar to Type 3. Conclusions. These results appear to confirm that extension of skin involvement within limited SSc may identify two different subsets with clinical and serologic characteristics. PMID:25435879

Scolnik, Marina; Catoggio, Luis J.; Lancioni, Eliana; Sabelli, Mirtha R.; Saucedo, Carla M.; Marin, Josefina; Soriano, Enrique R.

2014-01-01

58

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

59

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

60

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

61

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

62

Locoregional extension patterns of nasopharyngeal carcinoma and suggestions for clinical target volume delineation  

PubMed Central

Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%–30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level II), middle neck (levels III and Va), and lower neck (levels IV and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium- or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P < 0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6%, 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible. PMID:22854064

Li, Wen-Fei; Sun, Ying; Chen, Mo; Tang, Ling-Long; Liu, Li-Zhi; Mao, Yan-Ping; Chen, Lei; Zhou, Guan-Qun; Li, Li; Ma, Jun

2012-01-01

63

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

64

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

65

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

66

78 FR 26638 - Non-Competitive One-Year Extension With Funds for Black Lung/Coal Miner Clinics Program (H37...  

Federal Register 2010, 2011, 2012, 2013

...Administration Non-Competitive One-Year Extension With Funds for Black Lung/Coal Miner Clinics Program (H37) Current Grantee AGENCY...non-competitive one-year extension with funds for the Black Lung/Coal Miner Clinics Program awards to the current...

2013-05-07

67

Prolonged incubation and extensive subculturing do not increase recovery of clinically significant microorganisms from standard automated blood cultures.  

PubMed

An extensive blood culture protocol, including prolonged incubation of cultures, for 215 patients believed to have had endocarditis yielded only 3 clinically relevant results. Twenty-four Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella (i.e., HACEK) organisms were recovered from standard 5-day blood cultures during the same time period. Specialized methods and not extended incubation times are recommended for recovery of fastidious agents of septicemia. PMID:16267743

Baron, Ellen Jo; Scott, John D; Tompkins, Lucy S

2005-12-01

68

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

69

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

70

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

71

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

72

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.

73

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

74

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

75

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

76

The current status of the GRAPES-3 extensive air shower experiment  

NASA Astrophysics Data System (ADS)

The GRAPES-3 is a dense extensive air shower array operating with ˜400 scintillator detectors and it also contains a 560 m 2 tracking muon detector ( E>1 GeV), at Ooty in India. 25% of scintillator detectors are instrumented with two fast photomultiplier tubes (PMTs) for extending the dynamic range to ˜5×10 particles m -2 . The scintillators, signal processing electronics and data recording systems were fabricated in-house to cut costs and optimize performance. The muon multiplicity distribution of the EAS is used to probe the composition of primary cosmic rays below the 'knee', with an overlap with direct measurements. Search for multi-TeV ?-rays from point sources is done with the aid of the muon detector. A good angular resolution of 0.7° at 30 TeV, is measured from the shadow of the Moon on the isotropic flux of cosmic rays. A sensitive limit on the diffuse flux of 100 TeV ?-rays is placed by using muon detector to filter the charged cosmic ray background. A tracking muon detector allows sensitive measurements on coronal mass ejections and solar flares through Forbush decrease events. We have major expansion plans to enhance the sensitivity of the GRAPES-3 experiment in the areas listed above.

Gupta, S. K.; Antia, H. M.; Dugad, S. R.; Goswami, U. D.; Hayashi, Y.; Iyer, A.; Ito, N.; Jagadeesan, P.; Jain, A.; Karthikeyan, S.; Kawakami, S.; Minamino, M.; Mohanty, P. K.; Morris, S. D.; Nayak, P. K.; Nonaka, T.; Oshima, A.; Rao, B. S.; Ravindran, K. C.; Tanaka, H.; Tonwar, S. C.; Grapes-3 Collaboration

2009-12-01

77

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

78

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

79

Quality of reporting of clinical non-inferiority and equivalence randomised trials - update and extension  

PubMed Central

Background Non-inferiority and equivalence trials require tailored methodology and therefore adequate conduct and reporting is an ambitious task. The aim of our review was to assess whether the criteria recommended by the CONSORT extension were followed. Methods We searched the Medline database and the Cochrane Central Register for reports of randomised non-inferiority and equivalence trials published in English language. We excluded reports on bioequivalence studies, reports targeting on other than the main results of a trial, and articles of which the full-text version was not available. In total, we identified 209 reports (167 non-inferiority, 42 equivalence trials) and assessed the reporting and methodological quality using abstracted items of the CONSORT extension. Results Half of the articles did not report on the method of randomisation and only a third of the trials were reported to use blinding. The non-inferiority or equivalence margin was defined in most reports (94%), but was justified only for a quarter of the trials. Sample size calculation was reported for a proportion of 90%, but the margin was taken into account in only 78% of the trials reported. Both intention-to-treat and per-protocol analysis were presented in less than half of the reports. When reporting the results, a confidence interval was given for 85% trials. A proportion of 21% of the reports presented a conclusion that was wrong or incomprehensible. Overall, we found a substantial lack of quality in reporting and conduct. The need to improve also applied to aspects generally recommended for randomised trials. The quality was partly better in high-impact journals as compared to others. Conclusions There are still important deficiencies in the reporting on the methodological approach as well as on results and interpretation even in high-impact journals. It seems to take more than guidelines to improve conduct and reporting of non-inferiority and equivalence trials. PMID:23157733

2012-01-01

80

Eat, Grow, Lead 4-H: An Innovative Approach to Deliver Campus- Based Field Experiences to Pre-Entry Extension Educators  

ERIC Educational Resources Information Center

Eat, Grow, Lead 4-H Club was created as a pilot program for college students seeking to gain experience as non-formal youth educators, specifically serving pre-entry level Extension educators through a university-based 4-H club. Seventeen student volunteers contributed an estimated 630 hours of service to the club during spring 2011. The club…

Weeks, Penny Pennington; Weeks, William G.

2012-01-01

81

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

82

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

83

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

84

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

85

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

86

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

87

[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

88

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

89

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

90

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

91

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

92

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

93

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

94

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

...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

95

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

96

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

97

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

98

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

99

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

100

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

101

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

102

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

103

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

104

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

105

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

106

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

107

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

108

An extensible platform for interactive, entertaining social experiences with an animatronic character  

Microsoft Academic Search

The fields of human-robot interaction and entertainment robotics are truly interdisciplinary, combining the best of computer science, psychology, and mechanical engineering. However, they are areas which have thus far been largely limited to technical specialists, excluding animators, writers, and other artists from the development of interactive con- tent. We attempt to open these fields to non-technologists through an easily extensible

Sabrina A. Haskell; Andrew Hosmer; Eugenia Leu

2005-01-01

109

Effective Extensive Reading outside the Classroom: A Large-Scale Experiment  

ERIC Educational Resources Information Center

We report on a large-scale implementation of extensive reading (ER) in a university setting in Japan where all students were required to read outside class time as part of their course requirement. A pre/posttest comparison between the 2009 cohort of students who read outside of class and the 2008 cohort who did no outside reading shows that the…

Robb, Thomas; Kano, Makimi

2013-01-01

110

A Method for Building Models Automatically. Experiments with an Extension of OTTER  

Microsoft Academic Search

. A previous work on Herbrand model construction is extendedin two ways. The first extension increases the capabilities of the method,by extending one of its key rules. The second, more important one, definesa new method for simultaneous search of refutations and modelsfor set of equational clauses. The essential properties of the new methodare given. The main theoretical result of the

Christophe Bourely; Ricardo Caferra; Nicolas Peltier

1994-01-01

111

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

112

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

113

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

114

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

115

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

116

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

117

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

118

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

119

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

120

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

121

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

122

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

123

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

124

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

125

Characterization of mutations in multi- and extensive drug resistance among strains of Mycobacterium tuberculosis clinical isolates in Republic of Korea.  

PubMed

In order to characterize molecular mechanisms of first- and second-line drug resistance in Mycobacterium tuberculosis and to evaluate the use of molecular markers of resistance, we analyzed 62 multidrug-resistant, 100 extensively drug-resistant, and 30 pan-susceptible isolates from Korean tuberculosis patients. Twelve genome regions associated with drug resistance, including katG, ahpC, and inhA promoter for isoniazid (INH); embB for ethambutol (EMB), rpoB for rifampin (RIF), pncA for pyrazinamide (PZA), gyrA for fluoroquinolones; rpsL, gidB, and rrs for streptomycin; rrs and eis for kanamycin (KM); rrs and tylA for capreomycin (CAP); and rrs for amikacin (AMK) were amplified simultaneously by polymerase chain reaction, and the DNA sequences were determined. We found mutations in 140 of 160 INH-resistant isolates (87.5%), 159 of 162 RIF-resistant isolates (98.15%), 127 of 143 EMB-resistant isolates (88.8%), 108 of 123 ofloxacin-resistant isolates (87.8%), and 107 of 122 PZA-resistant isolates (87.7%); 43 of 51 STM-resistant isolates (84.3%), 15 of 17 KM-resistant isolates (88.2%), and 14 of 15 (AMK and CAP)-resistant isolates (93.3%) had mutations related to specific drug resistance. In addition, the sequence analyses of the study revealed many novel mutations involving these loci. This result suggests that mutations in the rpoB531, katGSer315Thr, and C-15T in the inhA promoter region, and gyrA94, embB306, pncA159, rpsL43, and A1401G in the rrs gene could serve as useful markers for rapid detection of resistance profile in the clinical isolates of M. tuberculosis in Korea, with potentials for the new therapeutic benefits in actual clinical practice. PMID:23561273

Jnawali, Hum Nath; Hwang, Sung Chul; Park, Young Kil; Kim, Hyejin; Lee, Yeong Seon; Chung, Gyung Tae; Choe, Kang Hyeon; Ryoo, Sungweon

2013-06-01

126

Evaluation of pyrosequencing for detecting extensively drug-resistant Mycobacterium tuberculosis among clinical isolates from four high-burden countries.  

PubMed

Reliable molecular diagnostics, which detect specific mutations associated with drug resistance, are promising technologies for the rapid identification and monitoring of drug resistance in Mycobacterium tuberculosis isolates. Pyrosequencing (PSQ) has the ability to detect mutations associated with first- and second-line anti-tuberculosis (TB) drugs, with the additional advantage of being rapidly adaptable for the identification of new mutations. The aim of this project was to evaluate the performance of PSQ in predicting phenotypic drug resistance in multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) clinical isolates from India, South Africa, Moldova, and the Philippines. A total of 187 archived isolates were run through a PSQ assay in order to identify M. tuberculosis (via the IS6110 marker), and to detect mutations associated with M/XDR-TB within small stretches of nucleotides in selected loci. The molecular targets included katG, the inhA promoter and the ahpC-oxyR intergenic region for isoniazid (INH) resistance; the rpoB core region for rifampin (RIF) resistance; gyrA for fluoroquinolone (FQ) resistance; and rrs for amikacin (AMK), capreomycin (CAP), and kanamycin (KAN) resistance. PSQ data were compared to phenotypic mycobacterial growth indicator tube (MGIT) 960 drug susceptibility testing results for performance analysis. The PSQ assay illustrated good sensitivity for the detection of resistance to INH (94%), RIF (96%), FQ (93%), AMK (84%), CAP (88%), and KAN (68%). The specificities of the assay were 96% for INH, 100% for RIF, FQ, AMK, and KAN, and 97% for CAP. PSQ is a highly efficient diagnostic tool that reveals specific nucleotide changes associated with resistance to the first- and second-line anti-TB drug medications. This methodology has the potential to be linked to mutation-specific clinical interpretation algorithms for rapid treatment decisions. PMID:25367911

Ajbani, Kanchan; Lin, Shou-Yean Grace; Rodrigues, Camilla; Nguyen, Duylinh; Arroyo, Francine; Kaping, Janice; Jackson, Lynn; Garfein, Richard S; Catanzaro, Donald; Eisenach, Kathleen; Victor, Thomas C; Crudu, Valeru; Gler, Maria Tarcela; Ismail, Nazir; Desmond, Edward; Catanzaro, Antonino; Rodwell, Timothy C

2015-01-01

127

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

128

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

129

Factors Influencing Career Experiences of Selected Chinese Faculty Employed at a Research Extensive University in Texas  

E-print Network

significant influences in determining Chinese faculty decisions to work within academia in the United States. Additionally, Chinese faculty tended to regard individual barriers (i.e. challenges in mastery of English language, a lack of teaching experience...

Zhang, Yan

2010-10-12

130

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

131

Shelf-life extension program (SLEP) as a significant contributor to Strategic National Stockpile Maintenance: the Israeli experience with ciprofloxacin.  

PubMed

In the past decade, the 2001 anthrax incident in the U.S. and the 2003 SARS epidemic have highlighted the biological threat to civilian populations. The risk posed by the natural or manmade spread of biological agents among the population dictates a need for better national preparedness. One key component of this preparation is the establishment of a Strategic National Stockpile (SNS) of pharmaceuticals that would provide appropriate medical countermeasures in case of an outbreak. However, to reduce the expense of such a stockpile and to make it worthwhile, there is also a need for a shelf-life extension program (SLEP) through which pharmaceuticals could be extended beyond manufacturer-ascribed shelf life, as long as they meet regulation standards. In this article, we review the Israeli experience with the national ciprofloxacin stockpile procurement and shelf-life extension program. PMID:22578017

Bodas, Moran; Yuval, Landschaft; Zadok, Ron; Hess, Zippora; Haran, Batya; Kaplan, Mimi; Eisenkraft, Arik

2012-06-01

132

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

133

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

134

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

135

How extensive are yield declines in long-term rice–wheat experiments in Asia?  

Microsoft Academic Search

The rice–wheat cropping system, occupying 24 million hectares of the productive area in South Asia and China, is important for food security. Monitoring long-term changes in crop yields and identifying the factors associated with such changes are essential to maintain and\\/or improve crop productivity. Long-term experiments (LTE) provide these opportunities. We analyzed 33 rice–wheat LTE in the Indo-Gangetic Plains (IGP)

J. K Ladha; D Dawe; H Pathak; A. T Padre; R. L Yadav; Bijay Singh; Yadvinder Singh; P Singh; A. L Kundu; R Sakal; N Ram; A. P Regmi; S. K Gami; A. L Bhandari; R Amin; C. R Yadav; E. M Bhattarai; S Das; H. P Aggarwal; R. K Gupta; P. R Hobbs

2003-01-01

136

Experience with severe extensive blistering skin disease in a paediatric burns unit.  

PubMed

Vesiculobullous disorders are thankfully uncommon. A brief overview of the literature is presented together with our experience of managing these cases on a paediatric burns unit in the six years 1992 1998. The advantages of management on such a unit are outlined and include a facility for major dressings and frequent changes and a familiarity with fluid resuscitation in the child with major skin loss. The financial cost of treatment and rehabilitation of these children is high. PMID:10630323

Greenwood, J E; Dunn, K W; Davenport, P J

2000-02-01

137

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

138

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

139

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

140

Extensive inflammatory eosinophilic bladder tumors in children: experience with three cases.  

PubMed

Eosinophilic cystitis, an uncommon lesion, is rare in children; < 25 cases have been reported. The intense inflammatory changes in the bladder wall associated with this lesion may produce heaped-up excrescences, which resemble vesical rhabdomyosarcoma. Our experience with 3 patients shows that the initial diagnosis of eosinophilic cystitis may not be easily made, and that the lesions produced may mask other disease processes. We alsoreport the fifth case of eosinophilic infiltration of the bladder occurring in association with chronic granulomatous disease. PMID:12356107

Redman, John F; Parham, David M

2002-09-01

141

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

142

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

143

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.

144

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

145

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

146

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

147

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

148

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

149

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

150

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

151

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

152

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

153

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

154

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

155

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

156

[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

157

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

158

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

159

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

160

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

161

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

162

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

163

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

164

Vertical versus lateral flux of magma in dykes during crustal extension: new insights from simple laboratory experiments  

NASA Astrophysics Data System (ADS)

During intrusion of buoyant magma into a rift zone, it is a common belief that the magmatic flux will be dominantly vertical and therefore will lead rather readily to volcanic eruptions. Nevertheless, many dykes in active rift zones (such as those in Hawaii, Iceland or the Afar) are blade-shaped (i.e. horizontal length, L, versus vertical height, H, within the plane of the dyke > 1). Therefore lateral (horizontal) fluxes may also be important in such extensional settings. According to the theory of elastic hydraulic fracturing, a fracture ceases to propagate vertically, when the pressure at its upper tip drops to that of the adjacent host rock (driving pressure = 0). On approaching these conditions, lateral propagation may become important. Topographic slopes or oblique tectonic extension may also influence the main directions of magma flux and hence the final aspect ratio L/H of a dyke. Here we describe some simple laboratory experiments, in which models consisted of silica powder (representing brittle crust) and vegetable oil (representing magma of low viscosity). The latter was hot and buoyant, yet solidified at room temperature. A motor induced the powder to stretch at a steady rate (R), forming a rift that was orthogonal to the extension direction and had a nearly flat floor. Simultaneously, oil intruded from an underlying point source at a preset flow rate (Q). In each of the experiments, a single hydraulic fracture formed. It was blade-like (L/H > 1), oil-filled, sub-vertical and sub-parallel to the rift axis. As it propagated, the oil cut across and/or, at least locally, followed some of the normal fault planes that developed within the rift. Immediately before erupting, the oil tended to fill an open fracture within the powder, very near the rift floor. During these experiments running simultaneous powder stretching and oil injection, the intrusion propagated laterally, faster than it did vertically. In contrast, in other experiments when oil intruded unstretching powders, either pre-rifted (that is once dilation had ceased to be active), or not rifted at all, the L/H ratios of the fractures were close to, or smaller than, unity. In the experiments, the final aspect ratio of a fracture or dyke reflected the main propagation direction of the oil during intrusion. Therefore, we infer that the faster a crust stretches, the longer are the dykes, magmatic input conditions being invariant. Thus active extensional dilation appears as a process favouring lateral intrusion, instead of eruption, and during which relatively large volumes of buoyant magma can be trapped at depth, possibly limiting those available for eruption. We also show that not one of the classical explanations for dyke-like intrusions, having large values of L/H, applies to our experiments.

Hallot, E.; Galland, O.; Cobbold, P. R.; Delavaud, G.

2012-04-01

165

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

166

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

167

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

168

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

169

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

170

Significance of atypical small acinar proliferation and extensive high-grade prostatic intraepithelial neoplasm in clinical practice  

PubMed Central

Introduction Prostate cancer (PCa) is one of the most commonly diagnosed neoplasms in elderly men. The precancerous lesion of PCa is considered a high-grade prostate intraepithelial neoplasm (HG-PIN), while atypical small acinar proliferation (ASAP) is commonly considered as an under-diagnosed cancer. The aim of the study was to establish the impact of ASAP and extensive HG-PIN on pre-biopsy prostate-specific antigen (PSA) levels and the risk of cancer development in subsequent biopseis. Material and methods The 1,010 men suspected for PCa were included in the study based on elevated PSA, and/or positive rectal examination. Transrectal ultrasound (TRUS) guided 10 core biopsy was performed. In those with extensive HG-PIN or ASAP on the first biopsy, and/or elevated PSA value, a second biopsy was performed. Results In the second biopsy, PCa was diagnosed in 6 of 19 patients (31.57%) with extensive HG-PIN, in four of 40 (10%) with BPH, and in 4 of 18 (22.22%) with ASAP. There was a statistically significant difference between the values of PSA in the group of patients with ASAP in comparison to those with benign prostate hyperplasia (BPH) (p = 0.005) as well as in patients with HG-PIN in comparison to BPH (p = 0.02). Conclusions A precancerous lesion diagnosed upon biopsy causes a statistically significant increase in the values of PSA in relation to BPH, as well as in the case of ASAP and extensive HG-PIN. The estimate of risk of PCa diagnosis in patients with ASAP and those with extensive HG-PIN in the first biopsy is comparable, which is why there are no reasons for different treatment of patients with the above-mentioned diagnoses. Both should be subjected to urgent second biopsy in around the 4-6 weeks following the initial biopsy. PMID:25140226

Wolski, Zbigniew; Butkiewicz, Romuald; Nussbeutel, Joanna; Drewa, Tomasz

2014-01-01

171

The treatment of extensive scalp lesions using coplanar and non-coplanar photon IMRT: a single institution experience  

PubMed Central

Background This clinical study compared four different cases of extensive scalp malignancies treated by intensity-modulated radiation therapy. The merits of coplanar and non-coplanar Step-and-shoot total scalp irradiation techniques were evaluated against the background of the literature. Methods Four patients (angiosarcoma, n=2, cutaneous B-cell non-Hodgkin lymphoma, B-NHL, n=1, mycosis fungoides, n=1) treated between 2008 and 2012 at our institution were retrospectively analyzed. For every patient with executed coplanar plan, a non-coplanar plan and vice versa has been calculated additionally for direct comparison. Three patients underwent limited surgery before radiotherapy. Individual adapted bolus material was used for every patient (helmet). Total scalp dose was 30 Gy (B-NHL, mycosis fungoides) and 50 Gy (angiosarcoma) with fractional doses of 2.0-2.5 Gy (without sequential local boost in three patients). Conformity and homogeneity indexes and dose volume histograms were used for treatment plan comparison. Results Dose hot spots were higher in coplanar plans (110-128% Dmax). Non-coplanar plans showed a more homogeneous dose distribution (HI = .12 - .17) and superior PTV coverage (88 - 96%). Target dose coverage was 81-117% in non-coplanar and 30-128% in coplanar plans. Coplanar plans yielded a stronger dose gradient across the target (.7-1.6 Gy/mm) compared to non-coplanar plans (.8-1.3 Gy/mm). The most conformal plan was a non-coplanar plan (CI = .7). Mean and maximum brain doses were comparable and showed an almost linear decrease between min. and max. dose. The optic chiasm and brain stem was spared most with non-coplanar plans, mean doses to the lenses ranged between 4 and 8 Gy and were higher in non-coplanar plans as were doses to the optic nerves. Radiotherapy tolerance was acceptable and acute side effects included erythema, scalp pain, alopecia and radiodermatitis which all spontaneously resolved. Two patients accomplished partial response, two patients showed complete response after radiotherapy. Three patients had locally controlled tumors without recurrence until their deaths or at last follow up, one patient had local progression shortly after radiotherapy. Conclusions Photon-IMRT is an effective and feasible approach to treat extensive scalp malignancies. Non-coplanar beams could increase dose homogeneity and PTV coverage and might reduce doses particularly to the optic chiasm. PMID:24656070

2014-01-01

172

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

173

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

174

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

175

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

176

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

177

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

178

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

179

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.

180

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

181

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

182

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

183

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

184

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

185

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

186

Implementation of the three-field electron wraparound technique for extensive recurrent chest wall carcinoma: dosimetric and clinical considerations.  

PubMed

Treatment of extensive recurrent chest wall carcinoma is a challenge for the radiation oncologist as well as the physics team responsible for setup, computer planning, and daily reproducibility. While electron arc therapy is desirable, unfortunately, most sites do not have this capability. The alternative method of treatment discussed here involves the use of a three-field electron wraparound technique for the chest wall when electron arc therapy is not available. This technique yields an excellent alternative treatment modality with flexibility to accommodate multiple electron energies to compensate for varying chest wall thickness. An additional anterior photon beam is used when skin lesions extend superiorly to the clavicle and along the proximal aspect of the arm. Computerized tomography (CT) interfaced radiotherapy computer planning is used to precisely calculate the sequential gantry angles, skin gaps for adjacent electron fields, and the appropriate junction moves to create a feathering effect of all overlap areas. Treatment aids include extensive shaping of electron and photon fields and the application of bolus material on all four fields. A Smithers Medical Products' Alpha Cradle is used to make this intricate setup possible, providing patient comfort and daily reproducibility for a more efficient treatment. PMID:1910473

Norris, M

1991-09-01

187

[Cardiologic application of a clinical database with graphic extension and its utilization in inter-hospital teleconsultation].  

PubMed

A local area network of personal computers has been operative in our Cardiology Department for seven years, to collect and retrieve on-line character-based data. At present, the network is based on 2 servers and 21 workstations. DBF and DOS files are used by a Clipper 5.2d compiled program to handle demographic data, clinical reports (32,000/year) and diagnostic codes of more than 52,000 patients. In the last two years, we started entring ECG tracings using: RS232 connection, floppy disk transfer, and modem connection with commercially available machines as well as by image scanner. We integrated our clinical database with three dedicated subsystems, written in Assembly and C languages, to manage drawings, digital ECGs and complete reports. Mass storage is provided by a 10 Gbyte magneto-optical disk autochanger physically connected to a dedicated server running an original software manager to optimize routine access to the optical disks. Interhospital network connections were established with two different institutions to allow clinical information sharing, long distance consultation and ECG transfer. The system has been found to be fast, user-friendly and suitable for daily operation of a large cardiological database. Standardized versions of the system are running in seven other cardiology institutions in Italy. PMID:8682226

Cervesato, E; Nicolosi, G L; Zanuttini, D

1995-10-01

188

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

189

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

190

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

191

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

192

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

...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

193

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

194

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

195

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

196

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

197

Extensive Genomic Plasticity in Pseudomonas aeruginosa Revealed by Identification and Distribution Studies of Novel Genes among Clinical Isolates  

PubMed Central

The distributed genome hypothesis (DGH) states that each strain within a bacterial species receives a unique distribution of genes from a population-based supragenome that is many times larger than the genome of any given strain. The observations that natural infecting populations are often polyclonal and that most chronic bacterial pathogens have highly developed mechanisms for horizontal gene transfer suggested the DGH and provided the means and the mechanisms to explain how chronic infections persist in the face of a mammalian host's adaptive defense mechanisms. Having previously established the validity of the DGH for obligate pathogens, we wished to evaluate its applicability to an opportunistic bacterial pathogen. This was accomplished by construction and analysis of a highly redundant pooled genomic library containing approximately 216,000 functional clones that was constructed from 12 low-passage clinical isolates of Pseudomonas aeruginosa, 6 otorrheic isolates and 6 from other body sites. Sequence analysis of 3,214 randomly picked clones (mean insert size, ?1.4 kb) from this library demonstrated that 348 (10.8%) of the clones were unique with respect to all genomic sequences of the P. aeruginosa prototype strain, PAO1. Hypothetical translations of the open reading frames within these unique sequences demonstrated protein homologies to a number of bacterial virulence factors and other proteins not previously identified in P. aeruginosa. PCR and reverse transcription-PCR-based assays were performed to analyze the distribution and expression patterns of a 70-open reading frame subset of these sequences among 11 of the clinical strains. These sequences were unevenly distributed among the clinical isolates, with nearly half (34/70) of the novel sequences being present in only one or two of the individual strains. Expression profiling revealed that a vast majority of these sequences are expressed, strongly suggesting they encode functional proteins. PMID:16926421

Shen, Kai; Sayeed, Sameera; Antalis, Patricia; Gladitz, John; Ahmed, Azad; Dice, Bethany; Janto, Benjamin; Dopico, Richard; Keefe, Randy; Hayes, Jay; Johnson, Sandra; Yu, Sujun; Ehrlich, Nathan; Jocz, Jennifer; Kropp, Laura; Wong, Ray; Wadowsky, Robert M.; Slifkin, Malcolm; Preston, Robert A.; Erdos, Geza; Post, J. Christopher; Ehrlich, Garth D.; Hu, Fen Z.

2006-01-01

198

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

199

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

200

Multidrug and Extensive Drug Resistance in Pseudomonas aeruginosa Clinical Isolates from a Portuguese Central Hospital: 10-Year Survey.  

PubMed

Multidrug-resistant (MDR) Pseudomonas aeruginosa isolates are increasing worldwide and greatly limit therapeutic options, particularly when considering extensively drug-resistant (XDR) or pandrug-resistant isolates. The resistance profile of P. aeruginosa isolates from a Portuguese central hospital was surveyed during 10 years (n=3,778). About 39.9% were classified as MDR and 2.9% as XDR. Statistical analysis (Mann-Whitney test and regression modeling) revealed a decrease in total MDR rates over time but an increase in XDR rates. This suggests a tendency for higher proportions of XDR isolates in the future, which is of great concern. Isolates of nosocomial origin presented similar results to total population but, when analyzing them according to the different wards of origin, it was still observed a trend of increase in MDR rates in some wards, particularly pneumology, neurology, and neurosurgery. Similar analysis considering the nosocomial specimen source revealed a negative trend of evolution in MDR rates of respiratory origin and a positive trend over time in XDR rates of isolates collected from urine. Regarding the association of antibiotic resistance to MDR and XDR profiles, it was observed a negative relation over time between imipenem resistance and MDR and gentamicin resistance and XDR, suggesting that resistance to these antibiotics may predict the absence of MDR or XDR in P. aeruginosa isolates, respectively. Similar studies in other European hospitals should be performed to give further information to physicians, important for their empirical antibiotherapy regimens. PMID:25372011

Gonçalves Pereira, Sónia; Marques, Margarida; Pereira, João; Cardoso, Olga

2014-11-01

201

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

202

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

203

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

204

Preliminary clinical experience with a new radioisotope-powered cardiac pacemaker.  

PubMed

A small light-weight nuclear-powered pacer has been developed. The pulse generator weight 61 Gm. and occupies a volume of 33 sq. cm. It is a standard R-wave inhibited (VVI) demand pulse generator. The unit has met all United States and foreign atomic energy commission safety specifications including mechanical shock, industrial fire, accidental crush, cremation, impact, and corrosion. Its calculated life is in excess of 20 years. The unit has been shown to be insensitive to electromagnetic interference (EMI) over a wide range of commonly encountered sources of interference. An extensive dog testing program has been carried out and is continuing. The United States Atomic Energy Commission (AEC) has issued a license to conduct clinical trials. These began in October, 1974, and a total of 30 units of 30 units have been implanted so far. An equal number of chemical battery-powered pulse generators has been implanted in a control series of 30 patients. Preliminary results have been gratifying. PMID:1107679

Smyth, N P; Magovern, G J; Cushing, W J; Keshishian, J M; Kelly, L C; Dixon, M

1976-02-01

205

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

206

Concepts in local treatment of extensive paediatric burns  

PubMed Central

Abstract There is a wide variety of local therapeutical methods for extensive burns. This article aims to be a general overview of the most common methods used in the local treatment for extensive burns, both in our clinic and globally. Clinical examples are shown from our clinic; cases of the last 8 years. None of the less there is no such thing as the "perfect method of treatment" but a thin balance between the clinical experience of plastic surgeons, every case particularities and specified characteristics, meaning advantages, disadvantages and limited indications of local topics or methods of skin covering. PMID:25408723

Ungureanu, M

2014-01-01

207

Paralytic shellfish toxins in clinical matrices: Extension of AOAC official method 2005.06 to human urine and serum and application to a 2007 case study in Maine  

NASA Astrophysics Data System (ADS)

Paralytic shellfish poisoning (PSP), a potentially fatal foodborne illness, is often diagnosed anecdotally based on symptoms and dietary history. The neurotoxins responsible for PSP, collectively referred to as the saxitoxins or paralytic shellfish toxins (PSTs), are natural toxins, produced by certain dinoflagellates, that may accumulate in seafood, particularly filter-feeding bivalves. Illnesses are rare because of effective monitoring programs, yet occasional poisonings occur. Rarely are contaminated food and human clinical samples (e.g., urine and serum) available for testing. There are currently few methods, none of which are validated, for determining PSTs in clinical matrices. This study evaluated AOAC (Association of Analytical Communities) Official Method of Analysis (OMA) 2005.06. [AOAC Official Method 2005.06 Paralytic Shellfish Poisoning Toxins in Shellfish: Prechormatographic Oxidation and Liquid Chromatography with Fluorescence Detection. In Official Methods of Analysis of AOAC International ], validated only for shellfish extracts, for its extension to human urine and serum samples. Initial assessment of control urine and serum matrices resulted in a sample cleanup modification when working with urine to remove hippuric acid, a natural urinary compound of environmental/dietary origin, which co-eluted with saxitoxin. Commercially available urine and serum matrices were then quantitatively spiked with PSTs that were available as certified reference materials (STX, dcSTX, B1, GTX2/3, C1/2, NEO, and GTX1/4) to assess method performance characteristics. The method was subsequently applied successfully to a PSP case study that occurred in July 2007 in Maine. Not only were PSTs identified in the patient urine and serum samples, the measured time series also led to the first report of human PST-specific urinary elimination rates. The LC-FD data generated from this case study compared remarkably well to results obtained using AOAC OMA 2011.27 [AOAC Official Method 2011.27 Paralytic Shellfish Toxins (PSTs) in Shellfish, Receptor Binding Assay. In Official Methods of Analysis of AOAC International ], further demonstrating successful extension of the LC-FD method to these clinical matrices. Moreover, data generated from this poisoning event reiterated that urine is a preferable clinical matrix, compared to serum, for diagnostic purposes due to higher accumulation and longer residence times in urine.

DeGrasse, Stacey; Rivera, Victor; Roach, John; White, Kevin; Callahan, John; Couture, Darcie; Simone, Karen; Peredy, Tamas; Poli, Mark

2014-05-01

208

Characterization of the Genetic Diversity of Extensively-Drug Resistant Mycobacterium tuberculosis Clinical Isolates from Pulmonary Tuberculosis Patients in Peru  

PubMed Central

Background Peru holds the fourth highest burden of tuberculosis in the Americas. Despite an apparently well-functioning DOTS control program, the prevalence of multidrug resistant tuberculosis (MDR-TB) continues to increase. To worsen this situation, cases of extensively drug resistance tuberculosis (XDR-TB) have been detected. Little information exists about the genetic diversity of drug-susceptible vs. MDR-TB and XDR-TB. Methods Cryopreserved samples of XDR strains from 2007 to 2009 (second semester), were identified and collected. Starting from 227 frozen samples, a total of 142 XDR-TB strains of Mycobacterium tuberculosis complex (MTBC; 1 isolate per patient) were retained for this study. Each strain DNA was analyzed by spoligotyping and the 15-loci Mycobacterial Interspersed Repetitive Unit (MIRU-15). Results Among the 142 isolates analyzed, only 2 samples (1.41%) could not be matched to any lineage. The most prevalent sublineage was Haarlem (43.66%), followed by T (27.46%), LAM (16.2%), Beijing (9.15%), and X clade (1.41%). Spoligotype analysis identified clustering for 128/142 (90.1%) isolates vs. 49/142 (34.5%) with MIRUs. Of the samples, 90.85% belonged to retreated patients. The drug resistant profile demonstrated that 62.67% showed resistance to injectable drugs capreomycin (CAP) and kanamycin (KAN) vs. 15.5% to CAP alone and 21.8% to KAN alone. The SIT219/T1 and SIT50/H3 were the most prevalent patterns in our study. The spoligoforest analysis showed that SIT53/T1 was at the origin of many of the T lineage strains as well as a big proportion of Haarlem lineage strains (SIT50/H3, followed by SIT47/H1, SIT49/H3, and SIT2375/H1), as opposed to the SIT1/Beijing strains that did not appear to evolve into minor Beijing sublineages among the XDR-TB strains. Conclusion In contrast with other Latin-American countries where LAM sublineage is the most predominant, we found the Haarlem to be the most common followed by T sublineage among the XDR-TB strains. PMID:25489950

Cáceres, Omar; Rastogi, Nalin; Bartra, Carlos; Couvin, David; Galarza, Marco; Asencios, Luis; Mendoza-Ticona, Alberto

2014-01-01

209

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

210

[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

211

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

212

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

213

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

214

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

215

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

216

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

217

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

218

Evolution of crustal stress patterns and fault orientations during oblique extension: Numerical 3D experiments from rift to break-up  

NASA Astrophysics Data System (ADS)

In continental rifts, extension is often oblique to the rift trend. This was the case during formation of the South Atlantic (especially in the Equatorial Segment), and the North Atlantic (Baffin Bay and Fram Strait). Oblique extension formed the Gulf of California, the Gulf of Aden and is presently active in the Ethiopian Rift System, as well as the Dead Sea Fault System. This study addresses the evolution of crustal stress patterns and fault geometries during oblique extension. It presents 3D numerical experiments on lithospheric scale that cover the rift evolution from initial deformation to break-up. Each simulation involves a different direction of extension in order to explore the whole extensional spectrum (i.e. rift-orthogonal extension, low to high obliquity, strike-slip deformation). The applied elasto-visco-plastic numerical model (SLIM3D) is based on the finite element method which allows an efficient implementation of a free surface and involves nonlinear stress- and temperature-dependent viscosity with laboratory-based parameters. Analog experiments have a rich history in studying the fault patterns of oblique rifts, however, reproducing realistic rheologies and temperature-dependent viscosity is problematic. While these issues are overcome in present day numerical models, they are limited by computational power which constrains 3D models to a relatively coarse resolution. In this study, I widen the scope of numerical 3D models by introducing a post-processing method that uses the stress-tensor to evaluate both the stress regime (extensional, strike-slip, compressional) and the preferred fault azimuth at each surface element assuming that faults are formed with optimal orientation in the stress field. Numerical results are validated by comparison to previous analog experiments. The numerical models exhibit a characteristic three-phase rift evolution. Individual phases can be characterised in terms of rift-parallel, extension-orthogonal, and intermediate normal fault directions as well as strike-slip faults with Riedel shear orientations. In experiments with low obliquity, sigmoidal en-echelon patterns emerge that result from the rotation of long-lived shear zones. Strain partitioning occurs in models of intermediate and high obliquity where the rift center and the rift flanks experience strike-slip deformation and normal faulting, respectively.

Brune, Sascha

2013-04-01

219

Novel mutations including deletions of the entire OFD1 gene in 30 families with type 1 orofaciodigital syndrome: a study of the extensive clinical variability.  

PubMed

OFD1, now recognized as a ciliopathy, is characterized by malformations of the face, oral cavity and digits, and is transmitted as an X-linked condition with lethality in males. Mutations in OFD1 also cause X-linked Joubert syndrome (JBTS10) and Simpson-Golabi-Behmel syndrome type 2 (SGBS2). We have studied 55 sporadic and six familial cases of suspected OFD1. Comprehensive mutation analysis in OFD1 revealed mutations in 37 female patients from 30 families; 22 mutations have not been previously described including two heterozygous deletions spanning OFD1 and neighbouring genes. Analysis of clinical findings in patients with mutations revealed that oral features are the most reliable diagnostic criteria. A first, detailed evaluation of brain MRIs from seven patients with cognitive defects illustrated extensive variability with the complete brain phenotype consisting of complete agenesis of the corpus callosum, large single or multiple interhemispheric cysts, striking cortical infolding of gyri, ventriculomegaly, mild molar tooth malformation and moderate to severe cerebellar vermis hypoplasia. Although the OFD1 gene apparently escapes X-inactivation, skewed inactivation was observed in seven of 14 patients. The direction of skewing did not correlate with disease severity, reinforcing the hypothesis that additional factors contribute to the extensive intrafamilial variability. PMID:23033313

Bisschoff, Izak J; Zeschnigk, Christine; Horn, Denise; Wellek, Brigitte; Rieß, Angelika; Wessels, Maja; Willems, Patrick; Jensen, Peter; Busche, Andreas; Bekkebraten, Jens; Chopra, Maya; Hove, Hanne Dahlgaard; Evers, Christina; Heimdal, Ketil; Kaiser, Ann-Sophie; Kunstmann, Erdmut; Robinson, Kristina Lagerstedt; Linné, Maja; Martin, Patricia; McGrath, James; Pradel, Winnie; Prescott, Katrina E; Roesler, Bernd; Rudolf, Gorazd; Siebers-Renelt, Ulrike; Tyshchenko, Nataliya; Wieczorek, Dagmar; Wolff, Gerhard; Dobyns, William B; Morris-Rosendahl, Deborah J

2013-01-01

220

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

221

Participation and Persistence in Continuing Lifelong Learning Experiences of the Ohio Cooperative Extension Service: An Investigation Using Expectancy Valence.  

ERIC Educational Resources Information Center

From sample of 599, 276 adult participants in Ohio Cooperative Extension Service (OCES) programs completed questionnaire that revealed five influences on decision to participate: anticipated quality of information, social involvement, difficulties with arrangements, commitment to OCES, and internal motivation. They were most satisfied when they…

Van Tilburg, Emmalou

1989-01-01

222

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

223

Influenza A pandemics: clinical and organizational aspects: the experience in Chile.  

PubMed

Recently, the World Health Organization declared a pandemic mediated by the novel A H1N1 influenza virus. Soon after the first report from Mexico, the disease arrived in Chile, where it spread quickly from south to north, mimicking cold weather progression through the country. Between May and September 2009, 366,624 cases of H1N1 were reported; 12,248 were confirmed by real-time reverse-transcription polymerase chain reaction and 1562 were hospitalized. One hundred thirty-two deaths were attributable to the infection, creating a death rate of 0.78 per 100,000 inhabitants. Common comorbidities were present in 59%, including obesity, chronic obstructive pulmonary disease, hypertension, type II diabetes, and congestive heart failure. Nine percent were pregnant. Severe disease developed early; the median time to admittance was 5 days, and the most common clinical manifestations were cough, fever, dyspnea, and myalgia. Mean acute physiology and chronic health evaluation II and sequential organ failure assessment scores were 14 and 5, respectively. Highlighted laboratory data were lactate dehydrogenase and creatine kinase elevation, leukocytosis in 50%, elevated creatinine in a 25%, and thrombocytopenia in 20%. Severe respiratory failure requiring high-frequency oscillatory ventilation and extracorporeal membrane oxygenation as sophisticated modes of respiratory support was seen in 17%. Acute renal failure occurred in 25% of the intensive care unit patients, with death rates near 50%. Health systems reinforced outpatient guards with extra staff and extension of the duty schedules. Antivirals were supplied free for medically diagnosed cases. Admissions for severe cases were prioritized, reconverting hospital beds into advanced care ones; a central coordination station rationed their assignment. Recommendations for small hospitals include adding ventilators, using videoconferences, providing tutorial activity from experts, developing guidelines for disease management, and outlining criteria for transport. PMID:19935412

Ugarte, Sebastián; Arancibia, Francisco; Soto, Rodrigo

2010-04-01

224

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

225

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

226

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

227

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

228

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

229

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

230

Detection of reflected Cherenkov light from extensive air showers in the SPHERE experiment as a method of studying superhigh energy cosmic rays  

NASA Astrophysics Data System (ADS)

Although a large number of experiments were carried out during the last few decades, the uncertainty in the spectrum of all nuclei of primary cosmic rays (PCRs) with superhigh energies is still high, and the results of many experiments on nuclear composition of PCRs are contradictory. An overview of the SPHERE experiment on detecting Vavilov-Cherenkov radiation from extensive air shower (EAS) reflected from a ground snow surface is given. A number of experimental studies implementing this method are presented and their results are analyzed. Some other popular methods of studying PCRs with superhigh energies ( E 0 > 1015 eV) and their main advantages and drawbacks are briefly considered. The detecting equipment of the SPHERE-2 experiment and the technique of its calibration are considered. The optical properties of snow, which are important for experiments on reflected Cherenkov light (CL) from EAS, are discussed and the history of observing reflected EAS CL is described. The algorithm of simulating the detector response and calculating the fiducial acceptance of shower detection is described. The procedure of processing the experimental data with a subsequent reconstruction of the spectrum of all PCR nuclei and analysis of the mass composition is shown. The first results of reconstructing the spectrum and separating groups of cosmic-ray nuclei with high energies in the SPHERE-2 experiment are presented. Main sources of systematic errors are considered. The prospects of developing the technique of observation of reflected EAS CL in future experiments are discussed.

Antonov, R. A.; Aulova, T. V.; Bonvech, E. A.; Galkin, V. I.; Dzhatdoev, T. A.; Podgrudkov, D. A.; Roganova, T. M.; Chernov, D. V.

2015-01-01

231

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

232

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

233

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

234

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

235

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

236

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

237

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

238

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

239

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

240

Non-extensive statistical physics properties of acoustic and pressure-stimulated current emissions measured concurrently during triaxial deformation experiments on marble and limestone samples  

NASA Astrophysics Data System (ADS)

We present preliminary results from triaxial compression experiments on samples of marble and limestone, recording concurrently for the first time both acoustic and electric current signals emitted during the deformation process. The expression 'pressure-stimulated currents' describes the emission of a small (peak values of 10-12 - 10-9 A) transient, polarising electric current from a solid containing charged defects and undergoing a gradual change in pressure. Experiments to date on non-piezoelectric rocks such as marble, amphibolite and cement-based materials have shown that these currents accompany the process of crack formation and growth during rock deformation. Further understanding of the processes that generate these currents and how they relate to the cracking process is particularly important for the study of seismic precursors. Constant strain rate experiments were conducted in a triaxial deformation apparatus at room temperature with effective confining pressures of 30 MPa (c.f. 3 km depth) on both dry and saturated samples. Strain rates were varied from 10-6 - 10-4 s-1 in order to investigate the dependence of pressure-stimulated current emissions on strain rate and their non-extensive properties in comparison with those of the associated acoustic emissions. The non-extensive q-parameter was determined using the q-logarithm function from analysis of the cumulative distribution function, P(>x), of the energy distributions of the laboratory data. Results are discussed in the frame of non-extensive statistical physics. Non-extensive statistical physics has previously been used to study patterns of seismicity, since rock deformation involves complex non-equilibrium phenomena such as multi-fractal distributions, self-organized criticality, long range interaction and intermittency. The approach offers a consistent theoretical framework to analyse rock fracture populations, which exhibit power law behaviour. Electrical emissions occur during the non-linear region of mechanical behaviour related to slip or dislocation mechanisms at an atomic level and are associated with changes in acoustic emissions phenomena. The non-extensive evaluation of these data sheds new light on deformation mechanisms with respect to the cracking process. Selected

Cartwright-Taylor, A.; Vallianatos, F.; Sammonds, P.

2012-04-01

241

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

242

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

243

Clinical and treatment-related risk factors for nosocomial colonisation with extensively drug-resistant Pseudomonas aeruginosa in a haematological patient population: a matched case control study.  

PubMed

BackgroundThis study aimed to investigate risk factors for colonisation with extensively drug-resistant P. aeruginosa (XDR-PA) in immunocompromised patients and to build a clinical risk score (CRS) based on these results.MethodsWe conducted a matched case¿control study with 31 cases and 93 controls (1:3). Cases were colonised with XDR-PA during hospitalisation. Independent risk factors were determined using a three step conditional logistic regression procedure. A CRS was built with respect to the corresponding risk fraction of each risk factor, and its discriminatory power was estimated by receiver operating characteristic (ROC) analysis.ResultsThe presence of a central venous catheter (OR 7.41, P¿=¿0.0008), the presence of a urinary catheter (OR 21.04, P¿<¿0.0001), CRP¿>¿10 mg/dl (OR 7.36, P¿=¿0.0015), and ciprofloxacin administration (OR 5.53, P¿=¿0.025) were independent risk factors. The CRS exhibited a high discriminatory power, defining a high risk population with an approximately fourteen times greater risk for XDR-PA colonisation.ConclusionsUnnecessary use of antibiotics, particularly ciprofloxacin should be avoided, and a high standard of infection control measures must be achieved when using medical devices. A CRS can be used for adaptation of the active screening culture policy to the local setting. PMID:25490897

Willmann, Matthias; Klimek, Anna M; Vogel, Wichard; Liese, Jan; Marschal, Matthias; Autenrieth, Ingo B; Peter, Silke; Buhl, Michael

2014-12-10

244

Taking the Pain out of Waiting: The Oral Health Counselling Experiences of Parents of Children with Extensive Dental Caries  

ERIC Educational Resources Information Center

Objective: The Tooth Smart Programme is a hospital-based parent-counselling programme established to stabilize existing carious lesions and prevent new caries in children. The purpose of this qualitative study was to: explore participating parents' experiences of and views about parent counselling; identify and describe factors that influence the…

Cashmore, Aaron W.; Noller, Jennifer; Johnson, Bronwyn; Ritchie, Jan; Blinkhorn, Anthony S.

2011-01-01

245

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

246

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

247

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

248

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

249

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

250

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

251

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

252

Getting Acquainted: An Induction Training Guide for First-Year Extension Agents. Suggestions for Completing Certain Learning Experiences Included in the Induction Training Guide; a Supplement to "Getting Acquainted."  

ERIC Educational Resources Information Center

An induction guide to help the extension agent get acquainted with his role and suggestions for completing learning experiences that are included in the guide comprise this two-part publication. The training guide learning experiences, a total of 25, are made up of: Objectives of the New Worker; When Completed; Learning Experiences; Person(s)…

Collings, Mary Louise; Gassie, Edward W.

253

"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

254

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

255

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.

256

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

257

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

258

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

259

Incidence of Small Lymph Node Metastases With Evidence of Extracapsular Extension: Clinical Implications in Patients With Head and Neck Squamous Cell Carcinoma  

SciTech Connect

Purpose: Small lymph nodes (LN) show evidence of extracapsular extension (ECE) in a significant number of patients. This study was performed to determine the impact of ECE in LN {<=}7 mm as compared with ECE in larger LN. Methods and Materials: All tumor-positive LN of 74 head and neck squamous cell carcinoma (HNSCC) patients with at least one ECE positive LN were analyzed retrospectively for the LN diameter and the extent of ECE. Clinical endpoints were regional relapse-free survival, distant metastasis-free survival, and overall survival. The median follow-up for the surviving patients was 2.1 years (range, 0.3-9.2 years). Results: Forty-four of 74 patients (60%) had at least one ECE positive LN {<=}10 mm. These small ECE positive LN had a median diameter of 7 mm, which was used as a cutoff. Thirty patients (41%) had at least one ECE positive LN {<=}7 mm. In both univariate and multivariate Cox regression analyses, the incidence of at least one ECE positive LN {<=}7 mm was a statistically significant prognostic factor for decreased regional relapse-free survival (adjusted hazard ratio [HR]: 2.7, p = 0.03, 95% confidence interval [CI]: 1.1-6.4), distant metastasis-free survival (HR: 2.6, p = 0.04, 95% CI: 1.0-6.6), and overall survival (HR: 2.5, p = 0.03, 95% CI: 1.1-5.8). Conclusions: The incidence of small ECE positive LN metastases is a significant prognostic factor in HNSCC patients. Small ECE positive LN may represent more invasive tumor biology and could be used as prognostic markers.

Ghadjar, Pirus [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern (Switzerland); Simcock, Mathew [Swiss Group for Clinical Cancer Research Coordinating Center, Bern (Switzerland); Schreiber-Facklam, Heide [Department of Pathology, University of Bern, Bern (Switzerland); Zimmer, Yitzhak [Department of Clinical Research, University of Bern, Bern (Switzerland); Graeter, Ruth; Evers, Christina [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern (Switzerland); Arnold, Andreas [Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern (Switzerland); Wilkens, Ludwig [Department of Pathology, University of Bern, Bern (Switzerland); Aebersold, Daniel M., E-mail: daniel.aebersold@insel.c [Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern (Switzerland)

2010-12-01

260

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

261

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

262

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

263

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

264

The effect of the atmospheric condition on the extensive air shower analysis at the Telescope Array experiment  

NASA Astrophysics Data System (ADS)

The accuracies in determination of air shower parameters such as longitudinal profiles or primary energies with the fluorescence detection technique are strongly dependent on atmospheric conditions of the molecular and aerosol components. Moreover, air fluorescence photon yield depends on the atmospheric density, and the transparency of the air for fluorescence photons depends on the atmospheric conditions from EAS to FDs. In this paper, we describe the atmospheric monitoring system in the Telescope Array (TA experiment), and the impact of the atmospheric conditions in air shower reconstructions. The systematic uncertainties of the determination of the primary cosmic ray energies and of the measurement of depth of maximum development (Xmax) of EASs due to atmospheric variance are evaluated by Monte Carlo simulation.

Kobayashi, Y.; Tsunesada, Y.; Tokuno, H.; Tomida, T.; Kakimoto, F.

2011-09-01

265

[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

266

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

267

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.

268

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

269

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

270

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

271

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

272

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

273

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

274

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

275

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

276

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

277

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

278

Ketamine: an update on the first twenty-five years of clinical experience  

Microsoft Academic Search

\\u000a Résumé  Pendant presque 25 ans ?expérience clinique, les bénéfices et les limitations de ?anesthésie à la kétamine ont été généralement\\u000a bien définis. Les revues extensives de White et al.2 ainsi que celles de Reeves et al.43 ont énormément aidé à comprendre ?anesthésie dissociative. Néanmoins, des études récentes continuent à nous éclairer sur\\u000a les différents aspects de la pharmacologie de la kétamine

David L. Reich; George Silvay

1989-01-01

279

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

280

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

281

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

282

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

283

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.

284

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

285

[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

286

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

287

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

288

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

289

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

290

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

291

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

292

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

293

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

294

Duloxetine in the long-term management of diabetic peripheral neuropathic pain: An open-label, 52-week extension of a randomized controlled clinical trial  

PubMed Central

Background: Duloxetine hydrochloride, a selective serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor, is relatively balanced in its affinity for both 5-HT and NE reuptake inhibition and is the first US Food and Drug Administration-approved prescription drug for the management of diabetic peripheral neuropathic pain (DPNP). Objectives: The aim of this study was to determine whether management of DPNP with duloxetine interferes with the treatment of diabetes. It also examined the tolerability of long-term exposure to duloxetine with regard to the progression of diabetic complications, and assessed the impact of DPNP management with duloxetine versus routine care. Methods: This was a 52-week, multicenter, re-randomized, open-label extension of a parallel, double-blind, randomized, placebo-controlled, acute (12-week) study. Patients who completed the duloxetine or placebo acute treatment period were randomly reassigned in a 2:1 ratio to treatment with duloxetine 60 mg BID or routine care for an additional 52 weeks. The study included male and female outpatients aged ?18 years with a diagnosis of DPNP caused by type 1 or type 2 diabetes. Over the course of the 52-week study, visits were scheduled on the following weeks (of the extension phase of the study): 1 (via phone only), 2, 4, 8, 12, 20, 28, 40, and 52. Tolerability was assessed by review and analyses of discontinuation rates, adverse events (AEs), laboratory data, vital signs, electrocardiographic results, concomitant medications, and diabetic complications. Treatment-emergent AEs (TEAEs) were defined as AEs that appeared during therapy (were not present at baseline) or were exacerbated during treatment. Data on AEs and concomitant medications were collected at every visit. Data on blood pressure, heart rate, and significant hypoglycemic events were collected at every visit starting from week 2. Fasting clinical chemistry and electrolyte group laboratory assessments were done at every visit, starting from week 4. Electrocardiographic data was collected at weeks 4 and 52, and glycosylated hemoglobin and lipid profile data were collected at weeks 20 and 52. Hematology and urinalysis laboratory assessments and diabetic complication assessments were done at week 52. All safety data was assessed in cases of early discontinuation. Treatment differences on quality of life (QOL) were compared using the Short Form-36 Health Status Survey (SF-36) and the EQ-5D instrument of the European Health-Related Quality of Life Measures. This was assessed at the last visit or at early discontinuation. Results: The open-label extension-phase study included 337 patients (duloxetine, n = 222; routine care, n = 115). For the duloxetine group, mean age was 60.2 years, 61.3% were male, and 78.4% were white. For the routine-care group, mean age was 58.9 years, 60.0% were male, and 74.8% were white. Mean weight was 95.3 kg for both groups. None of the TEAEs occurred significantly more often in the duloxetine-treated group than in the routine-care-treated group. No TEAEs were reported by >10% of patients in the duloxetine group. The TEAEs reported by >10% of patients in the routine-care group included dizziness (11.3%), somnolence (13.0%), headache (10.4%), and vomiting (10.4%). No significant differences were found between treatment groups in the occurrence of serious AEs or in the number of patients discontinuing because of AEs. Duloxetine was significantly better than routine care on the bodily pain subscale of the SF-36 (mean change: 1.5 vs ?4.1; P= 0.021) and on the EQ-5D (mean change: ?0.00 vs ?0.09; P = 0.001). Conclusions: Over 52 weeks of follow-up, treatment of these diabetic patients with duloxetine for peripheral neuropathic pain was associated with outcomes similar to, or significantly better than, that of routine care on most measures of tolerability, diabetic complications, and QOL. PMID:24678103

Wernicke, Joachim F.; Raskin, Joel; Rosen, Amy; Pritchett, Yili L.; D'Souza, Deborah N.; Iyengar, Smriti; Knopp, Kelly; Le, Trong K.

2006-01-01

295

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

296

[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

297

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.

298

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

299

[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

300

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

301

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

302

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

303

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

304

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

305

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

306

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

307

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

308

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

309

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

310

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

311

Extension Service Agricultural Experiment Station  

E-print Network

that threatens valuable crops Halting pest's spread in Oregon is vital to future of hazelnut, wine industries nut. It's no surprise given that Oregon grows 99 percent of the U.S. crop. Oregon's approxi- mately estimates, however, say the number of new acres during that time was 11,000 to 12,000, with more than half

Tullos, Desiree

312

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

313

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

314

[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

315

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

316

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

317

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

318

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

319

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

320

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

321

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

322

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

323

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

324

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

325

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

326

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

327

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

328

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

329

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

330

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

331

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

332

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

333

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

334

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.

335

[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

336

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

337

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

338

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

339

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

340

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

341

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

342

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

343

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

344

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

345

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

346

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

347

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

348

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

349

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

350

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

351

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

352

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

353

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

354

System for interstitial photodynamic therapy with online dosimetry: first clinical experiences of prostate cancer  

NASA Astrophysics Data System (ADS)

The first results from a clinical study for Temoporfin-mediated photodynamic therapy (PDT) of low-grade (T1c) primary prostate cancer using online dosimetry are presented. Dosimetric feedback in real time was applied, for the first time to our knowledge, in interstitial photodynamic therapy. The dosimetry software IDOSE provided dose plans, including optical fiber positions and light doses based on 3-D tissue models generated from ultrasound images. Tissue optical property measurements were obtained using the same fibers used for light delivery. Measurements were taken before, during, and after the treatment session. On the basis of these real-time measured optical properties, the light-dose plan was recalculated. The aim of the treatment was to ablate the entire prostate while minimizing exposure to surrounding organs. The results indicate that online dosimetry based on real-time tissue optical property measurements enabled the light dose to be adapted and optimized. However, histopathological analysis of tissue biopsies taken six months post-PDT treatment showed there were still residual viable cancer cells present in the prostate tissue sections. The authors propose that the incomplete treatment of the prostate tissue could be due to a too low light threshold dose, which was set to 5 J/cm2.

Swartling, Johannes; Axelsson, Johan; Ahlgren, Göran; Kälkner, Karl Mikael; Nilsson, Sten; Svanberg, Sune; Svanberg, Katarina; Andersson-Engels, Stefan

2010-09-01

355

Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis  

PubMed Central

Since its discovery in 2007, the encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) has entered the mainstream of neurology and other disciplines. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, and language disintegration into a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. The disorder predominantly affects children and young adults, occurs with or without tumour association, and responds to treatment but can relapse. The presence of a tumour (usually an ovarian teratoma) is dependent on age, sex, and ethnicity, being more frequent in women older than 18 years, and slightly more predominant in black women than it is in white women. Patients treated with tumour resection and immunotherapy (corticosteroids, intravenous immunoglobulin, or plasma exchange) respond faster to treatment and less frequently need second-line immunotherapy (cyclophosphamide or rituximab, or both) than do patients without a tumour who receive similar initial immunotherapy. More than 75% of all patients have substantial recovery that occurs in inverse order of symptom development and is associated with a decline of antibody titres. Patients’ antibodies cause a titre-dependent, reversible decrease of synaptic NMDAR by a mechanism of crosslinking and internalisation. On the basis of models of pharmacological or genetic disruption of NMDAR, these antibody effects reveal a probable pathogenic relation between the depletion of receptors and the clinical features of anti-NMDAR encephalitis. PMID:21163445

Dalmau, Josep; Lancaster, Eric; Martinez-Hernandez, Eugenia; Rosenfeld, Myrna R; Balice-Gordon, Rita

2011-01-01

356

Clinical features and treatment experience: a review of 292 Chinese cobra snakebites.  

PubMed

Although Chinese cobra snakebite is the most common type of snake venenation in China, it still lacks a comprehensive and systematic description. Hence, we aimed to study Chinese cobra bite cases with particular attention to demography, epidemiology and clinical profile. In this study, a total of 292 cases of Chinese cobra snakebite, presenting between January 1, 2008 and December 31, 2012, were retrospectively reviewed. To investigate the effect of treatment at different presentation times (time from snakebite to admission), the patients were divided into two groups: group A included 133 cases that presented <12 h after the bite; group B included 159 cases that presented ?12 h after the bite. To assess the correlation between application of a tourniquet and skin grafting, the cases were re-divided into two groups according to whether or not a tourniquet was used after the snakebite: tourniquet group (n=220) and non-tourniquet group (n=72). The results showed that Chinese cobra snakebites were most commonly seen during the summer, in the upper limbs, and in males, young adults, and snake-hunters. Group A experienced milder intoxication than group B (P<0.001). The rate of skin grafting was significantly higher in the tourniquet group (20.0%, compared with 9.7% in the non-tourniquet group, P<0.05). The results of this study indicate that anti-cobra venom and swift admission (within 12 h of the snakebite) are recommended for Chinese cobra snakebite. Tourniquet use is not recommended. PMID:24577231

Wang, Wei; Chen, Quan-Fang; Yin, Rui-Xing; Zhu, Ji-Jin; Li, Qi-Bin; Chang, Hai-Hua; Wu, Yan-Bi; Michelson, Edward

2014-03-01

357

[Out-of-the-hospital care for terminal cancer patients. Clinical and organizational features. Our experience].  

PubMed

Home care for terminal oncological patients is, in Italy and in many other highly developed countries, a rapidly expanding part of the health system. At the time of writing it would appear to be the most valid response to the mounting economic and social demands of the population. The present paper has two purposes: 1) to propose an integrated home care operating model for the cancer patient that comprises various operating stages: a) recruitment of patients on the basis of the seriousness of the cancer, life expectancy and socioeconomic conditions of the family; b) interdisciplinary planning of a personalized care project; c) implementation of an integrated care programme at the home of the patient; d) periodic control of the project team; e) periodic professional courses for health personnel; 2) to illustrate our specific clinical expertise in the sector, in 16 months of activity (October 94-February 96) during which we handled on a home basis 27 cancer patients at an advanced stage of the disease; specifically, we describe the main internal-oncological and palliative type problems encountered during the home care period; 3) finally, to highlight in terms of cost/benefit ratio the economic advantages of home compared to the traditional hospitalization care model. PMID:9132628

Marchei, P; Simeoni, F; Bianco, V; Santini, D; Balducci, M; Vecchione, A; Frati, L

1997-01-01

358

Foreign Bodies in the Oesophagus: The Experience of the Buenos Aires Paediatric ORL Clinic  

PubMed Central

The ingestion of foreign bodies causing esophageal injuries is a common event, mostly in children's population. The aim of the present paper is to present foreign body (FB) ingestion cases observed in a five-year period at the Children's Hospital Gutierrez, Buenos Aires, Argentina and to compare the main findings with data coming from other well-known case series, already published in scientific literature. A prospective study on 320 of esophageal foreign body was carried out , with regard to age and sex distributions, type, dimensions and consistency, location, clinical presentation, removal and complications. In the majority of cases injuries happened while children were playing and in 85.3% adults were present. Children most frequently ingested coins (83.8% cases). Removal was performed in all cases under general anaesthesia, in 34 by esophageal forceps and in 286 cases by Magill hypopharyngeal forceps. Just one case showed complications, presenting esophageal perforation. The final results of this study show that injuries usually happen under adults' supervision and highlight that FBs involved in the incident belong to classes of objects not conceived for children's use and not suitable for their age. Therefore, educational strategies regarding safe behaviours have a key role in FB injuries prevention. PMID:20886022

Chinski, Alberto; Foltran, Francesca; Gregori, Dario; Ballali, Simonetta; Passali, Desiderio; Bellussi, Luisa

2010-01-01

359

Epidemiology and Clinical Experience of Chronic Intestinal Pseudo-Obstruction in Japan: A Nationwide Epidemiologic Survey  

PubMed Central

Background We estimated the prevalence and incidence of chronic intestinal pseudo-obstruction (CIPO) in Japan, investigated the patterns of hospital visits among those with CIPO, and examined present knowledge of CIPO among medical professionals. Methods A self-administered questionnaire survey was distributed to targeted hospitals throughout Japan, which were selected using stratified random sampling. The questionnaire asked about the number of patients receiving treatment for CIPO, the frequency of their hospital visits, and overall clinical knowledge of CIPO among medical professionals. Results CIPO prevalence was estimated to be 1.00 and 0.80 cases per 100 000 males and females, respectively. Incidence was 0.21 and 0.24 cases per 100 000 males and females, respectively. Prevalence and incidence did not significantly differ males and females. Mean age of patients was 63.1 years for males and 59.2 for females. Accurate diagnosis of CIPO sometimes required more than 3 months after initial presentation. Most medical professionals were unaware of or poorly understood CIPO. Conclusions We estimated the prevalence and incidence of CIPO in Japan, using data from a nationwide survey. The findings suggest that knowledge of CIPO should be further disseminated so that the disease is not overlooked and is diagnosed without delay. PMID:23831693

Iida, Hiroshi; Ohkubo, Hidenori; Inamori, Masahiko; Nakajima, Atsushi; Sato, Hajime

2013-01-01

360

CT-Guided Interventions Using a Free-Hand, Optical Tracking System: Initial Clinical Experience  

SciTech Connect

PurposeThe present study was designed to evaluate the geometrical accuracy and clinical applicability of a new, free-hand, CT-guided, optical navigation system.MethodsFifteen procedures in 14 consecutive patients were retrospectively analyzed. The navigation system was applied for interventional procedures on small target lesions, in cases with long needle paths, narrow access windows, or when an out-of-plane access was expected. Mean lesion volume was 27.9 ml, and mean distance to target measured was 107.5 mm. Eleven of 15 needle trajectories were planned as out-of-plane approaches regarding the axial CT plane.ResultsNinety-one percent of the biopsies were diagnostic. All therapeutic interventions were technically successful. Targeting precision was high with a mean distance of the needle tip from planned target of 1.98 mm. Mean intervention time was 1:12 h. A statistically significant correlation between angular needle deviation and intervention time (p = 0.007), respiratory movement of the target (p = 0.008), and body mass index (p = 0.02) was detected. None of the evaluated parameters correlated significantly with the distance from the needle tip to the planned target.ConclusionsThe application of a navigation system for complex CT-guided procedures provided safe and effective targeting within a reasonable intervention time in our series.

Schubert, Tilman, E-mail: TSchubert@uhbs.ch; Jacob, Augustinus L.; Pansini, Michele [University Hospital Basel, Department of Radiology and Nuclear Medicine (Switzerland); Liu, David [Vancouver General Hospital, University of British Columbia, Department of Radiology (Canada); Gutzeit, Andreas [Winterthur Cantonal Hospital, Department of Radiology (Switzerland); Kos, Sebastian [University Hospital Basel, Department of Radiology and Nuclear Medicine (Switzerland)

2013-08-01

361

Interdisciplinary preceptor teams to improve the clinical nurse leader student experience.  

PubMed

The Clinical Nurse Leader (CNL) role was introduced by the American Association of Colleges of Nursing (AACN) in 2003 (AACN, 2003). There are now over 2,500 certified CNLs in the United States. Still some areas of the country have no CNLs in practice; this was true of north central Texas until May 2010 when Texas Christian University (TCU) had its first graduating class. Lack of CNLs to serve as preceptors for the practicum courses in the CNL program was one concern, although AACN does offer options when CNLs are not available. TCU's CNL teaching team developed the interdisciplinary preceptor team (IPT) model to strengthen the practicum component of CNL education at TCU. One advantage of the IPT model is the match it provides with several CNL competencies: lateral integration of care via interdisciplinary teams, member and leader of health care teams, skillful communication within teams, and implementation of an interdisciplinary approach to safe, quality, patient care. Components of the IPT model are discussed with specific information about preceptor selection, team development, and examples of feedback from preceptors and students. PMID:24939328

Moore, Penny; Schmidt, Debra; Howington, Lynnette

2014-01-01

362

Paediatric dilated cardiomyopathy: clinical profile and outcome. The experience of a tertiary centre for paediatric cardiology.  

PubMed

Dilated cardiomyopathy is the most common form of cardiomyopathy in the paediatric population and an important cause of heart transplantation in children. The clinical profile and course of dilated cardiomyopathy in children have been poorly characterised. A retrospective review of 61 patients (37 female; 24 male) diagnosed with dilated cardiomyopathy from January, 2005 to June, 2012 at a single institution was performed. The median age at diagnosis was 15 months. Heart failure was present in 83.6% of patients and 44.3% required intensive care. The most prevalent causes were idiopathic (47.5%), viral myocarditis (18.0%) and inherited metabolic diseases (11.5%). In viral myocarditis, Parvovirus B19 was the most common identified agent, in concurrence with the increasing incidence documented recently. Inherited metabolic diseases were responsible for 11.5% of dilated cardiomyopathy cases compared with the 4-6% described in the literature, which reinforces the importance of considering this aetiology in differential diagnosis of paediatric dilated cardiomyopathy. The overall mortality rate was 16.1% and five patients underwent heart transplantation. In our series, age at diagnosis and aetiology were the most important prognosis factors. We report no mortality in the five patients who underwent heart transplantation, after 2 years of follow-up. PMID:24423967

Miranda, Joana O; Costa, Liane; Rodrigues, Esmeralda; Teles, Elisa L; Baptista, Maria J; Areias, José C

2015-02-01

363

Comparative pharmacokinetics and clinical experience with a new cephalosporin-derivative: cefazolin.  

PubMed

In a cross-over study in 12 normal individuals, the pharmacokinetic parameters of cefalotin, cefradine and cefazolin were determined after intravenous injection of 1,000 mg of each substance. The microbiological activities in urine and serum were determined using the agar diffusion test; the pharmacokinetic data were calculated by a computer system on the basis of a Fortran programme. Cefazolin has significantly higher serum concentrations than the other two cephalosporins, distinctly longer serum half-lives, higher protein binding, and smaller apparent volumina of distribution. In 36 inpatients with mainly chronical and acute infections of the urinary tract, we tested the antibacterial effectivity, the compatibility, and the application modalities of cefazolin. In 29 patients we had a satisfactory clinical result, in 25 cases we achieved the elimination of bacteria by the end of the therapy. The compatibility of cefazolin was good; apart from a minor, reversible, liver-specific increase in enzymes in 6 patients, no side effects could be detected. PMID:1097207

Lode, H; Gebert, S; Hendrischk, A

1975-01-01

364

Clinical characteristics of pediatric thalassemia in Korea: a single institute experience.  

PubMed

Few literatures have elaborated on the clinical characteristics of children with thalassemia from low-prevalence areas. A retrospective analysis was conducted on children genetically confirmed with thalassemia at Seoul National University Children's Hospital in Korea. Nine children (1? thalassemia trait, 6? thalassemia minor, 2? thalassemia intermedia) were diagnosed with thalassemia at median age of 4.3 yr old with median hemoglobin of 9.7 g/dL. Seven (78%) children were incidentally found to be anemic and only 2 with ? thalassemia intermedia had presenting symptoms. Five children (56%) were initially misdiagnosed with iron deficiency anemia. Despite the comorbidities due to ? thalassemia mental retardation syndrome, the child with ? thalassemia trait had mild hematologic profile. Children with ? thalassemia intermedia had the worst phenotypes due to dominantly inherited mutations. None of the children was transfusion dependent and most of them had no complications associated with thalassemia. Only 1 child (11%) with codon 60 (T?A) mutation of the HBB gene needed red blood cell transfusions. He also had splenomegaly, cholelithiasis, and calvarial vault thickening. Pediatricians in Korea must acknowledge thalassemia as a possible diagnosis in children with microcytic hypochromic hemolytic anemia. High level of suspicion will allow timely diagnosis and managements. PMID:24265529

Hong, Che Ry; Kang, Hyoung Jin; Lee, Ji Won; Kim, Hyery; Kim, Nam Hee; Park, Kyung Duk; Park, June Dong; Seong, Moon-Woo; Park, Sung Sup; Shin, Hee Young; Ahn, Hyo Seop

2013-11-01

365

Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases.  

PubMed

Sixty-five carotid-cavernous fistulas were studied at University Hospital, London, Canada, from 1978 to 1982, 20 of which fulfilled the clinical and angiographic criteria of a spontaneous carotid-cavernous fistula. Of these 20 fistulas, 17 were unilateral, and three were bilateral. In 18 cases the angiographic findings were typical of an arteriovenous malformation (AVM), and in two a ruptured giant intracavernous aneurysm was found. These patients were treated according to whether they had a nonresolving or progressive cavernous sinus syndrome or deterioration of vision. The cavernous dural AVM's were treated with polyvinyl-alcohol and/or isobutyl-2-cyanoacrylate (IBCA) embolization of the external carotid artery blood supply. Two patients underwent postembolization surgical procedures. The detachable balloon technique was used to occlude the fistulas associated with the two giant ruptured intracavernous aneurysms and a small dural intracavernous AVM. Eight patients received no therapy; in two, spontaneous obliteration of the fistula occurred. Of the nine cavernous AVM's embolized with particles and/or IBCA, successful transvascular embolization was achieved in seven cases, and partial embolization followed by surgery in two cases. Successful balloon obliteration of the giant intracavernous ruptured aneurysm was obtained in two cases. In one patient, right hemiplegia with aphasia resulted from reflux of IBCA emboli through the artery of the foramen rotundum into the left middle cerebral artery. PMID:6716167

Viñuela, F; Fox, A J; Debrun, G M; Peerless, S J; Drake, C G

1984-05-01

366

Clinical experience with intravenous zoledronic acid in the treatment of male osteoporosis: evidence and opinions  

PubMed Central

Osteoporosis frequently remains underrecognized and undertreated in men. Most osteoporosis-related fractures could be prevented if men at risk would be diagnosed, treated, and remained compliant with therapy. Bisphosphonates, the mainstay of osteoporosis treatment, are potent antiresorptive agents that inhibit osteoclast activity, suppress in vivo markers of bone turnover, increase bone mineral density, decrease fractures, and likely improve survival in men with osteoporosis. The focus of the article is on intravenous zoledronic acid, which may be a preferable alternative to oral bisphosphonate therapy in patients with cognitive dysfunction, the inability to sit upright, polypharmacy, significant gastrointestinal pathology or suspected medication noncompliance. Zoledronic acid is approved in the United States (US) and European Union (EU) as an annual 5 mg intravenous infusion to treat osteoporosis in men. The zoledronic acid 4 mg intravenous dose has been studied in the prevention of bone loss associated with androgen deprivation therapy. This article reviews the evidence for zoledronic acid, currently the most potent bisphosphonate available for clinical use, and its therapeutic effects in the treatment of men with osteoporosis. PMID:23904863

Ruza, Ieva; Mirfakhraee, Sasan; Orwoll, Eric

2013-01-01

367

Dura splitting decompression in Chiari type 1 malformation: clinical experience and radiological findings.  

PubMed

To restore the cerebrospinal fluid (CSF) flow at the craniocervical junction in Chiari I malformation (CM-I), most surgeons practice a suboccipital craniectomy with duraplasty. To reduce the risk of CSF leak, a dura splitting decompression is created removing only the dural outer layer. We report on a series of 11 patients with CM-I (five with syringomyelia) operated on between 2000 and 2007 using this technique. Neurological examination and cerebro-spinal MRI scan were performed before and after surgery. Symptoms improved completely in six patients. Headaches and cervicalgias disappeared for all patients. Dizziness and paresthesia in the upper limb remained unchanged for three and two patients, respectively. We observed no complications such as CSF leak, meningocele, or meningitis. Postoperative MRI scan showed a significant craniocervical decompression in ten patients. Four patients had a new cisterna magna. Two syringomyelias completely disappeared, two decreased, and one was stable. Dural splitting can be practiced to treat CM-I. Clinical results are similar to the other techniques with less complications. Radiological findings show satisfying posterior fossa decompression. PMID:19644715

Chauvet, Dorian; Carpentier, Alexandre; George, Bernard

2009-10-01

368

Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature.  

PubMed

Fragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment. A new comprehensive classification considers both fracture morphology and degree of instability. The classification system also provides recommendations for type and invasiveness of treatment. In this article, a literature review of treatment alternatives is presented and compared with our own experiences. Whereas FFP Type I lesions can be treated conservatively, FFP Types III and IV require surgical treatment. For FFP Type II lessions, percutaneous fixation techniques should be considered after a trial of conservative treatment. FFP Type III lesions need open reduction and internal fixation, whereas FFP Type IV lesions require bilateral fixation. The respective advantages and limitations of dorsal (sacroiliac screw fixation, sacroplasty, bridging plate fixation, transsacral positioning bar placement, angular stable plate) and anterior (external fixation, angular stable plate fixation, retrograde transpubic screw fixation) pelvic fixations are described. PMID:25323921

Rommens, Pol M; Ossendorf, Christian; Pairon, Philip; Dietz, Sven-Oliver; Wagner, Daniel; Hofmann, Alexander

2015-01-01

369

Clinical experience with silicone rubber grafts as shunts in portal hypertension.  

PubMed

We report the use of a woven silicone rubber graft as an alternative prosthesis for a shunt in 8 patients with portal hypertension. Four patients were operated on as emergencies and 4 electively. In 4 cases the graft was used as a standard mesocaval H graft, in 2 as a portocaval H graft and in 2 cases it was used to simplify the Warren selective distal splenorenal shunt. The material has properties which make it a superior graft to existing prostheses and autogenous vein. Our results confirm the experience of others, that the poor risk patients do badly whatever form of shunt is performed, and of those who survive, the total portal shunt carries the risk of postoperative encephalopathy. PMID:678776

Parr, D C; Hopkinson, B R

1978-08-01

370

[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

371

The use of high-dose melatonin in liver resection is safe: first clinical experience.  

PubMed

Experimental data suggest that melatonin decreases inflammatory changes after major liver resection, thus positively influencing the postoperative course. To assess the safety of a preoperative single dose of melatonin in patients undergoing major liver resection, a randomized controlled double-blind pilot clinical trial with two parallel study arms was designed at the Department of General and Transplantation Surgery, Ruprecht-Karls-University, Heidelberg. A total of 307 patients, who were referred for liver surgery, were screened. One hundred and thirteen patients, for whom a major liver resection (?3 segments) was scheduled, were eligible. Sixty-three eligible patients refused to participate, and therefore, 50 patients were randomized. A preoperative single dose of melatonin (50?mg/kg BW) dissolved in 250?mL of milk was administered through the gastric tube after the intubation for general anesthesia. Controls were given the same amount of microcrystalline cellulose. Primary endpoint was safety. Secondary endpoints were postoperative complications. Melatonin was effectively absorbed with serum concentrations of 1142.8?±?7.2?ng/mL (mean?±?S.E.M.) versus 0.3?±?7.8?ng/mL in controls (P?

Nickkholgh, Arash; Schneider, Heinz; Sobirey, Michael; Venetz, Werner P; Hinz, Ulf; Pelzl, Le H; Gotthardt, Daniel N; Cekauskas, Albertas; Manikas, Martynas; Mikalauskas, Saulius; Mikalauskene, Laura; Bruns, Helge; Zorn, Markus; Weigand, Markus A; Büchler, Markus W; Schemmer, Peter

2011-05-01

372

Etiology and clinical profile of patients with Cushing's syndrome: A single center experience  

PubMed Central

Background: There is little published literature on the profile of patients with Cushing's syndrome (CS) from India. The aim of this study was to compile data of CS patients treated at this hospital. Materials and Methods: Patients referred to the endocrine services of this hospital for diagnosis/treatment of CS from January 1985 to July 2012 were the subjects for this study. All patients had detailed medical history, physical examination and biochemical and hormonal assays (which changed with availability of tests and changing views). Assays for plasma adrenocorticotropic hormone (ACTH) (late 90s), salivary cortisol estimation, IJV sampling for ACTH and corticotrophin releasing hormone stimulation tests were added on later. Imaging included computed tomography (CT), magnetic resonance imaging (since the late 80's) and 68Ga DOTA-TOC/FDG PET-CT (2008). Results: Three hundred sixty-four patients (250 females, 114 males, age 6 months to 65 years, mean 28 years + 12 years) were diagnosed to have CS during this period. Two hundred and ninety-three patients (80.5%) were ACTH dependent (CD 215, ectopic ACTH syndrome 22, occult ACTH source 56) while 71 (19.5%) were ACTH independent (adrenal carcinoma 36, adenoma 30, primary pigmented nodular adrenal disease 4, AIMAH 1). Pituitary macro adenoma was seen in 14% of the CD cases. The most common presenting complaints were hypertension and diabetes mellitus. A total of 63% patients complained of weight gain while 15% had lost weight. Myopathy, infections, skeletal fractures and psychiatric problems were the other common observations in our patients. Conclusion: The clinical spectrum was broad. CD was the most common cause for CS. PMID:24701438

Ammini, Ariacherry C.; Tandon, Nikhil; Gupta, Nandita; Bhalla, Ashu Seith; Devasenaspathy, Kandaswamy; Kumar, Guresh; Sahoo, Jaiprakash P.; Chittawar, Sachin; Philip, Jim; Baruah, Manas P.; Dwarakanath, C. S.; Tripathi, Sudhir

2014-01-01

373

TREATMENT STRATEGIES IN PATIENTS WITH STATIN INTOLERANCE: THE CLEVELAND CLINIC EXPERIENCE  

PubMed Central

BACKGROUND Statin therapy is a proven effective treatment of hyperlipidemia. However, a significant number of patients cannot tolerate statins. This study was conducted to review treatment strategies for patients intolerant to statin therapy with a focus on intermittent statin dosing. METHODS AND RESULTS We performed a retrospective analysis of medical records of 1605 patients referred to the Cleveland Clinic Preventive Cardiology section for statin intolerance between January 1995 and March 2010 with at least a six-month follow-up. The changes in lipid profile, achievement of low-density lipoprotein cholesterol (LDL-C) goals and statin tolerance rate were analyzed. 72.5% of patients with prior statin intolerance were able to tolerate a statin for the median follow-up time of 31 months. Patients on intermittent statin dosing (n=149) had significantly lower LDL-C reduction compared to daily dosing group (n=1014) (21.3±4.0% vs 27.7±1.4%, p<0.001). But compared to the statin discontinued group (n=442), they had a significantly higher LDL-C reduction (21.3±4.0% vs 8.3±2.2%, p<0.001), and a significantly higher portion achieved their ATP–III goal of LDL-C (61% vs 44%, p<0.05). There was a trend toward a decrease in all-cause mortality at 8 years for patients on daily and intermittent statin dosing compared with those who discontinued statin (p=0.08). CONCLUSIONS The majority of patients with previous statin intolerance can tolerate subsequent trial of statin. A strategy of intermittent statin dosing can be an effective therapeutic option in some patients and may result in reduction in LDL-C and achievement of LDL-C goals. PMID:24016512

Mampuya, Warner M.; Frid, David; Rocco, Michael; Huang, Julie; Brennan, Danielle M.; Hazen, Stanley L.; Cho, Leslie

2014-01-01

374

Demographic and Clinical Characteristics of Type 1 Diabetes Mellitus in Omani Children - Single Center Experience  

PubMed Central

Objectives To describe the demographic characteristics and clinical presentation of Omani children with type 1 diabetes mellitus at Sultan Qaboos University Hospital, Muscat, Oman. Methods A retrospective analysis of all children with type 1 diabetes mellitus attending the Pediatric Endocrine Unit at Sultan Qaboos University Hospital, Oman from June 2006 to May 2013. Results One hundred and forty-four patients were included in the study. The mean±SD of age at diagnosis was 6.7 ± 3.7 years. The median duration of symptoms was 10 days (IQR; 5-14). The most commonly reported presenting symptoms were polyuria (94%), polydipsia (82%), and weight loss (59%). Diabetic ketoacidosis at initial presentation was diagnosed in 31% of the patients. Different insulin regimens were prescribed: multiple daily injections in 109 (76%) patients, twice daily insulin regimen in 23 (16%) patients, and insulin pump therapy in 12 (8%) patients. Family history of type 1 diabetes mellitus was present in 31 (22%) patients. There were no significant differences in presenting complaints (polyuria, p=0.182; polydipsia, p=0.848), duration of symptoms (p=0.331), reported weight loss (p=0.753), or diabetic ketoacidosis at presentation (p=0.608) between patients with and without family history of type 1 diabetes mellitus. Conclusion Polyuria, polydipsia and weight loss are the most common presenting symptoms. Family history of type 1 diabetes mellitus is highly prevalent among the studied patients. Diabetic ketoacidosis was found to be less common in Oman compared to other diabetes centers in the Middle East. PMID:24715939

Al-Yaarubi, Saif; Ullah, Irfan; Sharef, Sharef Waadallah; Al Shidhani, Azza; Al Hanai, Shaima; Al Kalbani, Rabaa; Al Jamoodi, Shamsa

2014-01-01

375

Addendum to material selection guidelines for geothermal energy-utilization systems. Part I. Extension of the field experience data base. Part II. Proceedings of the geothermal engineering and materials (GEM) program conference (San Diego, CA, 6-8 October 1982)  

SciTech Connect

The extension of the field experience data base includes the following: key corrosive species, updated field experiences, corrosion of secondary loop components or geothermal binary power plants, and suitability of conventional water-source heat pump evaporator materials for geothermal heat pump service. Twenty-four conference papers are included. Three were abstracted previously for EDB. Separate abstracts were prepared for twenty-one. (MHR)

Smith, C.S.; Ellis, P.F. II

1983-05-01

376

Salt balance: From space experiments to revolutionizing new clinical concepts on earth - A historical review  

NASA Astrophysics Data System (ADS)

For a long time, sodium balance appeared to be a “done deal” and was thought to be well understood. However, experiments in preparation of space missions showed that the concept of osmotic sodium storage and close correlations of sodium with water balance are only part of the regulatory mechanisms of body salt. By now it has turned out that the human skin is an important storage place and regulator for sodium, that sodium storage involves macrophages which in turn salt-dependently co-regulate blood pressure, that body sodium also strongly influences bone and protein metabolism, and that immune functions are also strongly influenced by sodium. In addition, the aging process appears to lead to increased body sodium storage, which in turn might influence the aging process of the human body. The current review article summarizes the developments that have led to these revolutionizing new findings and concepts as well as consequences deriving from these findings. Therefore, it is not intended in this article to give a complete literature overview over the whole field but to focus on such key literature and considerations that led to the respective developments.

Gerzer, Rupert

2014-11-01

377

Clinical experience with alumina ceramic transcutaneous connector to prevent skin-exit infection around CAPD catheter.  

PubMed

To prevent skin-exit infection, an important CAPD complication, we developed a transcutaneous connector made of Alumina ceramic. The new connector could be downsized, because an Alumina ceramic is characteristically bio-inert, rigid and non-porous. Our animal experiments with Alumina ceramic in soft tissue demonstrated the outstanding bio-compatibility of this material. The shape of the new transcutaneous connector was of simple cylindrical configuration so as to inhibit macrostress beneath the skin. To make contact with this connector in the body, a silicon tube was made into a Swan-necked catheter with a disk-shaped polyester cuff, which was positioned subcutaneously beneath the transcutaneous connector in order to reinforce adhesion to soft tissue. The silicon tube itself was L-shaped in its outside portion just before reaching the connector. We are now using this new transcutaneous connector made of Alumina ceramic on a CAPD catheter in 8 patients. In the longest case of a patient using it, there has been no skin-exit infection for 12 months. Also, there has been virtually no downgrowth phenomenon in the skin around the connector, and the connector and tissue have remained in very close contact, although fibrous connective tissue has been seen to form in the area. PMID:1982797

Amano, I; Katoh, T; Inagaki, Y

1990-01-01

378

Clinical experience with a high definition exoscope system for surgery of pineal region lesions.  

PubMed

VITOM-90 (Karl Storz Endoscopy, Tuttlingen, Germany) is a new technology that can be used as an alternative to the operating microscope. We have found that this device substantially improves surgeon comfort during infra-tentorial supracerebellar approaches to pineal region masses, and now report our experiences. The VITOM-90 is a specially designed scope that is attached to a high definition (HD) digital camera and displayed on a HD video monitor. This system was utilized in five patients undergoing infratentorial supracerebellar approaches for pineal region lesions. Surgical outcomes and pathologies are described. The device was used by three surgeons during five procedures. Three patients underwent surgery in the sitting position and two in the modified prone (Concorde) position. Pathologies included pineocytoma, lipoma, and germinoma. Total resection was achieved in three patients and subtotal in two patients. Surgeon assessment was positive; surgeons indicated that surgery with the VITOM-90 was more comfortable than with the operating microscope. Lack of stereopsis was considered a minor drawback. The VITOM-90 permitted a natural head and neck position. Operating room personnel and residents reported improved visualization of the anatomy. Using the VITOM-90 benefited surgeons during pineal region surgery by reducing strain and allowing the surgeon to operate from a comfortable position without increased operative time or complications. The improved comfort levels may translate into safer, more accurate surgeries in this complex area. PMID:24534630

Birch, Kurtis; Drazin, Doniel; Black, Keith L; Williams, James; Berci, George; Mamelak, Adam N

2014-07-01

379

The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters  

PubMed Central

Continuous peripheral nerve blocks (CPNB) are commonly used for intraoperative and postoperative analgesia. Our study aimed at describing our experience with ambulatory peripheral nerve catheters. After Institutional Review Board approval, records for all patients discharged with supraclavicular or popliteal catheters between January 1, 2009 and December 31, 2011 were reviewed. A licensed practitioner provided verbal and written instructions to the patients prior to discharge. Daily follow-up phone calls were conducted. Patients either removed their catheters at home with real-time simultaneous telephone guidance by a member of the Acute Pain Service or had them removed by the surgeon during a regular office visit. The primary outcome of this analysis was the incidence of complications, categorized as pharmacologic, infectious, or other. The secondary outcome measure was the average daily pain score. Our study included a total of 1059 patients with ambulatory catheters (769 supraclavicular, 290 popliteal). The median infusion duration was 5 days for both groups. Forty-two possible complications were identified: 13 infectious, 23 pharmacologic, and 6 labeled as other. Two patients had retained catheters, 2 had catheter leakage, and 2 had shortness of breath. Our study showed that prolonged use of ambulatory catheters for a median period of 5 days did not lead to an increased incidence of complications.

Gharabawy, Ramez; Eid, Gamal; Mendoza, Maria; Mounir-Soliman, Loran; Ali Sakr Esa, Wael

2014-01-01

380

Radiotherapy for malignancy in patients with scleroderma: The Mayo Clinic experience  

SciTech Connect

Purpose: To determine the frequency of acute and chronic adverse effects in patients with scleroderma who receive radiotherapy for treatment of cancer. Methods and Materials: Records were reviewed of 20 patients with scleroderma who received radiotherapy. Acute and chronic toxic effects attributable to radiotherapy were analyzed, and freedom from radiation-related toxicity was calculated. Results: Of the 20 patients, 15 had acute toxic effects, with Grade 3 or higher toxicity for 3 patients. Seven patients had self-limited Grade 1 or 2 radiation dermatitis, and no patient had Grade 3 or higher radiation dermatitis. Thirteen patients had chronic toxic effects, with Grade 3 or higher chronic toxicity for 3 patients. The median estimated time to any grade chronic toxicity was 0.4 years, and the median estimated time to Grade 3 or higher chronic toxicity has not been reached. Conclusions: The results suggest that although some patients with scleroderma treated with radiation experience considerable toxic effects, the occurrence of Grade 3 or higher toxicity may be less than previously anticipated.

Gold, Douglas G. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Miller, Robert C. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Osborn, Thomas G. [Division of Rheumatology, Mayo Clinic, Rochester, MN (United States)

2007-02-01

381

Providing Science-based Knowledge to the Commonwealth Virginia Cooperative Extension and Virginia Agricultural Experiment Station perform two separate yet integrated functions --  

E-print Network

the research efforts of the 12 Agricultural Research and Extension Centers (ARECs) located throughout of turnover in those areas. nOver the 10-year period FY 2001 to FY 2010 the proportion of FTEs dedicated industry, Extension specialists are developing protocols for best management practices to recycle

Liskiewicz, Maciej

382

Preoperative Topical Hypothermia used in Prolonged Severe Lower Limb Ischemia to Avoid Ischemic Damage - The First Clinical Experience  

PubMed Central

Severe lower limb ischemia TASC IIB/III with sensory and motor neurologic deficiencies leads to prolonged hospital care, amputation, and death in 20-70 % of cases. We present our first clinical experience of the use of preoperative topical hypothermia to improve muscular viability in these patients. Two hours after onset of symptoms, six 4-liter plastic bags were filled with snow and packed against the ischemic leg which was protected from frost injury by a layer of towels. After surgical revascularization four hours later muscular and neural functions in the leg were completely restored. A maximum serum myoglobin of 6500 ng/L (median 12000 ng/L in similar but untreated patients) postoperatively decreased to 1400 ng/L after 27 hours. PMID:24170993

Forsell, Claes; Åberg, Jonas; Szabó, Zoltán

2013-01-01

383

Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study  

PubMed Central

Background Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs. Methods Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data. Results 320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided. Conclusions There are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies. PMID:24602148

2014-01-01

384

Clinical Experience of Weight Loss Surgery in Morbidly Obese Korean Adolescents  

PubMed Central

Purpose Comprehensive multidisciplinary weight management programs encompassing various conservative measures have shown only modest weight loss results in obese children and adolescents; therefore, bariatric surgery for this population has become a matter of discussion. This study aimed to present our experience with and outcomes for laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbidly obese Korean adolescents. Materials and Methods The prospectively established database of all patients undergoing bariatric surgery at Soonchunhyang University Seoul Hospital, Korea between January 2011 and January 2013 was retrospectively reviewed. Adolescents aged 14 to 20 years were included in the present analyses. Results Twenty-two adolescents underwent bariatric surgery during the study period; 14 underwent LSG and 8, LRYGB. Of these, 17 were female and 5 were male. The mean age was 19 years. Their mean body weight and body mass index (BMI) before surgery were 115 kg and 40.1 kg/m2. The only postoperative complication was intraluminal bleeding in 1 patient, which was managed conservatively. The mean BMI decreased to 29.1 kg/m2 after a mean follow-up of 10 months. The percent excess weight loss (%EWL) at 1, 3, 6, and 12 months postoperatively were 19.6, 39.9, 52.6, and 74.2%, respectively. Only 1 patient showed %EWL less than 30% at 12 months after surgery. All patients with diabetes and sleep apnea were cured of their disease, and other comorbidities also improved or resolved after surgery. Conclusion Bariatric surgery leads to significant short-term weight loss along with resolution of obesity-related comorbidities in obese children and adolescents. PMID:25048498

Park, Ji Yeon; Song, Dan

2014-01-01

385

Renal Tumors: Technical Success and Early Clinical Experience with Radiofrequency Ablation of 18 Tumors  

SciTech Connect

Purpose. To evaluate the feasibility, safety, and technical efficacy of image-guided radiofrequency ablation (RFA) for the treatment of small peripheral renal tumors and to report our early results with this treatment modality. Methods. Twenty-two RFA sessions for 18 tumors were performed in 11 patients with renal tumors. Indications included coexistent morbidity, high surgical or anesthetic risk, solitary kidney, and hereditary predisposition to renal cell carcinoma. Ten patients had CT-guided percutaneous RFA performed on an outpatient basis. One patient had open intraoperative ultrasound-guided RFA. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. With the exception of one patient with renal insufficiency who required gadolinium-enhanced MRI, the remaining patients underwent contrast-enhanced CT for post-treatment follow-up assessment. Follow-up was performed after 2-4 weeks and then at 3, 6, 12 months, and every 12 months thereafter. Results. Fourteen (78%) of 18 tumors were successfully ablated with one session. Three of the remaining four tumors required two sessions for successful ablation. One tumor will require a third session for areas of persistent enhancement. Mean patient age was 72.82 {+-} 10.43 years. Mean tumor size was 1.95 {+-} 0.79 cm. Mean follow-up time was 10.91 months. All procedures were performed without any major complications. Conclusions. Our early experience with percutaneous image-guided radiofrequency ablation demonstrates it to be a feasible, safe, noninvasive, and effective treatment of small peripheral renal tumors.

Sabharwal, Rohan, E-mail: rohan50000@yahoo.com; Vladica, Philip [Westmead Hospital, Department of Radiology (Australia)

2006-04-15

386

Minimally Invasive Spinal Arthrodesis in Osteoporotic Population Using a Cannulated and Fenestrated Augmented Screw: Technical Description and Clinical Experience  

PubMed Central

We describe a percutaneous or minimally invasive approach to apply an augmentation of pedicle fenestrated screws by injection of the PMMA bone cement through the implant and determine the safety and efficiency of this technique in a clinical series of 15 elderly osteoporotic patients. Clinical outcome and the function were assessed using respectively the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI). Peri- and post-operative complications were monitored during a minimum of 2 years of follow-up. Radiographic follow-up was based on plain fluoroscopic control at 3, 6 and 12 months and every year. In this approach, four steps were considered with care: optimal positioning of the screws, correct alignment of the screw heads, waiting time before the injection of cement, fluoroscopic control of the cement injection. Using these precautions, only 2 minor complications occurred. VAS scores and ODI questionnaires showed a statistically significant improvement up to 13.3 months postoperatively. No radiological complications were observed. Based on this experience, PMMA augmentation technique through the novel fenestrated screws provided an effective and long lasting fixation in osteoporotic patients. Applying this procedure through percutaneous or minimally invasive approach under fluoroscopic control seems to be safe. PMID:22970360

Lubansu, Alphonse; Rynkowski, Michal; Abeloos, Laurence; Appelboom, Geoffrey; Dewitte, Olivier

2012-01-01

387

Small Molecule Sequential Dual-Targeting Theragnostic Strategy (SMSDTTS): from Preclinical Experiments towards Possible Clinical Anticancer Applications  

PubMed Central

Hitting the evasive tumor cells proves challenging in targeted cancer therapies. A general and unconventional anticancer approach namely small molecule sequential dual-targeting theragnostic strategy (SMSDTTS) has recently been introduced with the aims to target and debulk the tumor mass, wipe out the residual tumor cells, and meanwhile enable cancer detectability. This dual targeting approach works in two steps for systemic delivery of two naturally derived drugs. First, an anti-tubulin vascular disrupting agent, e.g., combretastatin A4 phosphate (CA4P), is injected to selectively cut off tumor blood supply and to cause massive necrosis, which nevertheless always leaves peripheral tumor residues. Secondly, a necrosis-avid radiopharmaceutical, namely 131I-hypericin (131I-Hyp), is administered the next day, which accumulates in intratumoral necrosis and irradiates the residual cancer cells with beta particles. Theoretically, this complementary targeted approach may biologically and radioactively ablate solid tumors and reduce the risk of local recurrence, remote metastases, and thus cancer mortality. Meanwhile, the emitted gamma rays facilitate radio-scintigraphy to detect tumors and follow up the therapy, hence a simultaneous theragnostic approach. SMSDTTS has now shown promise from multicenter animal experiments and may demonstrate unique anticancer efficacy in upcoming preliminary clinical trials. In this short review article, information about the two involved agents, the rationale of SMSDTTS, its preclinical antitumor efficacy, multifocal targetability, simultaneous theragnostic property, and toxicities of the dose regimens are summarized. Meanwhile, possible drawbacks, practical challenges and future improvement with SMSDTTS are discussed, which hopefully may help to push forward this strategy from preclinical experiments towards possible clinical applications. PMID:23412554

Li, Junjie; Oyen, Raymond; Verbruggen, Alfons; Ni, Yicheng

2013-01-01

388

The project IMPACT experience to date: increasing minority participation and awareness of clinical trials. | accrualnet.cancer.gov  

Cancer.gov

The most commonly cited physician barriers to clinical trials participation were lack of awareness of clinical trial opportunities and lack of resources to conduct clinical trials. Physicians felt that minority patients face barriers to clinical trial involvement including patient fear of experimentation, lack of minority physician participation on the research team, lack of patient awareness, and lack of patient time. However, most respondents had referred patients to clinical trials and desired involvement in clinical trials as investigators.

389

Clinical experience with spiramycin in bisphosphonate-associated osteonecrosis of the jaw.  

PubMed

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) consists of an exposure of the jaw bone that persists for over 8 weeks in patients with positive history for bisphosphonates. Symptomatology is characterized by dull and ceaseless pain, and in advanced stages, the exposure of necrotic bone is evident, which is frequently associated with purulent secretions and faetor oris. Despite many different studies on BRONJ, there are no general guidelines to treat this disease. In this work, the authors present their experience in BRONJ conservative therapy with spiramycin by comparing the results achieved with amoxicillin and clavulanic acid. From January 1, 2008 to June 30, 2008, our department received 25 patients who were affected by osteonecrosis secondary to bisphosphonates. Thirteen had taken bisphosphonates for osteoporosis and 12 for malignancies. We divided the 25 patients into two groups: those who had not received any treatment and those who had received treatment. The first group of 13 patients had been treated only with spiramycin (S). The results from this group were only evaluated to test the efficacy of spiramycin and were not considered in the study. The second group of 12 patients had not undergone any previous treatment. This group was further divided in two groups of 6 patients each; one group was treated with spiramycin and the other with amoxicillin and clavulanic acid (ACA). The following criteria were used to evaluate the results of the study: pain, sensibility deficits, purulent secretion and bone exposure. All group results were evaluated according to the criteria chosen, and positive results were achieved in both groups S and ACA, such as reduction or disappearance of pain, sensibility deficits and purulent secretion and healing of bone exposition, although spiramycin showed itself to be more effective than the combination of amoxicillin and clavulanic acid. Spiramycin is a macrolide antibiotic with a wide spectrum of activity against Streptococci, Pneumococci, Diplococci, Gonococci and Staphylococci, which are typical in BRONJ. No resistance was indicated. Administration of the antibiotics can be intravenous, intramuscular, rectal or oral, which remains the most frequently used since spiramycin elimination also occurs with saliva and the antibiotic reaches high concentrations in the oral cavity where BRONJ is situated. Good compliance to the spiramycin regimen was observed in all three groups, with a general improvement in all of the parameters considered. In only two cases did patients have to undergo surgical curettage. The results showed that spiramycin can be a first choice drug in the treatment of BRONJ, and it should be strongly considered for patients where previous antibiotic therapy did not prove to be effective. PMID:20646357

Gasparini, G; Saponaro, G; Di Nardo, F; Moro, A; Boniello, R; Cervelli, D; Marianetti, T M; Palazzoni, G; Pelo, S

2010-01-01

390

Nursing students' experiences with screening, brief intervention, and referral to treatment for substance use in the clinical/hospital setting.  

PubMed

Although Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective early intervention when used across healthcare settings, its implementation has been difficult, in part because of lack of training, healthcare providers' feelings of low self-efficacy in performing SBIRT, and negative attitudes about people who use alcohol and drugs. This study used qualitative descriptive methods to examine baccalaureate nursing students' experiences with practicing SBIRT in clinical rotations following in-depth classroom work and skill-based training. Fifty-five junior level nursing students participated in four focus groups. Three overarching themes describe students' experiences with SBIRT. Students expressed a positive impact of the training on their attitudes and feelings of self-efficacy regarding the use of SBIRT, differences in opinions about whether SBIRT should be used universally with all patients or as a targeted intervention with only some patients, and that SBIRT is a nursing responsibility. These results suggest that education and training can affect attitudes and efficacy, but that attention needs to be paid to how SBIRT is implemented within different healthcare settings. PMID:25202808

Braxter, Betty J; Puskar, Kathy; Mitchell, Ann M; Hagle, Holly; Gotham, Heather; Terry, Martha Ann

2014-01-01

391

AGRICULTURAL EXTENSION.  

ERIC Educational Resources Information Center

AUSTRALIAN AGRICULTURAL EXTENSION HAS LONG EMPHASIZED TECHNICAL ADVISORY SERVICE AT THE EXPENSE OF THE SOCIOECONOMIC ASPECTS OF FARM PRODUCTION AND FARM LIFE. ONLY IN TASMANIA HAS FARM MANAGEMENT BEEN STRESSED. DEMANDS FOR THE WHOLE-FARM APPROACH HAVE PRODUCED A TREND TOWARD GENERALISM FOR DISTRICT OFFICERS IN MOST STATES. THE FEDERAL GOVERNMENT,…

FARQUHAR, R.N.

392

NH Agricultural Experiment Station -COLLEGE OF LIFE SCIENCES & AGRICULTURE http://extension.unh.edu/Agric3 3 3 3 3 http://www.colsa.unh.edu/aes/3  

E-print Network

://extension.unh.edu/Agric3 3 3 3 3 http://www.colsa.unh.edu/aes/3 3 Brussels3Sprouts3Variety3Trial3and3Topping3Study,320133 3 By#Becky#Sideman#and#Olivia#Saunders,#UNH#Extension# # Objectives3 1) compare*the*productivity*and*marketable*yields*of*nine*varieties*of*Brussels*sprouts* 2) measure*the*effects*of*topping*(removing*the*apical*meristem)*on*Brussels*sprouts*yield* 3

New Hampshire, University of

393

First clinical experiences about the neurotoxic envenomings inflicted by lowland populations of the Balkan adder, Vipera berus bosniensis.  

PubMed

The first overall clinical description of envenomings by the lowland populations of the Balkan adder (Vipera berus bosniensis) is provided by this study. Fifty-four incidents have been collected retrospectively from the south-western Hungarian and the northern Croatian distribution area of the taxon. There were five (9%) asymptomatic, 24 (44%) mild, 12 (22%) moderate, 12 (22%) severe, and one fatal (2%) case according to the Poisoning Severity Score. The single death is a 60-year-old Hungarian case that was caused by V.b. bosniensis. Average hospitalisation was 2.75 days. The most common systemic symptoms were gastrointestinal disorders, ECG changes, persisting hypotension and neurological disorders. The initial phase of neurotoxic manifestations was always expressed in cranial nerve disturbances: ptosis, external ophthalmoplegia, diplopia, reduced focusing capability and blurred vision. Neuromuscular paralysis progressed to dyspnoea and lower limb paralysis in the most severe cases. Unusual symptoms were fluctuating arterial hypertension, drowsiness, and hypokalaemia. Laboratory results reveal leucocytosis, while deviation in the other laboratory values is not common. Envenomings by V.b. bosniensis significantly differ from those by the European adder (Vipera berus berus) in lower manifestation rate of extensive oedema, anaemia, CNS depression, and haematuria but the development of neuromuscular paralysis is high (20%). Their bites rather resulted in mild and moderate local symptoms in envenomed patients than those inflicted by the nominate form. This study presents the evidence of the frequent neurotoxic manifestations in Balkan adder-bitten patients for the first time, which strongly suggests that the venom of the lowland populations of V.b. bosniensis has neurotoxic activity. PMID:21145353

Malina, Tamás; Krecsák, László; Jeli?, Dušan; Mareti?, Tomislav; Tóth, Tamás; Siško, Marijan; Pandak, Nenad

2011-01-01

394

Clinical experience in 52 patients with tigecycline-containing regimens for salvage treatment of Mycobacterium abscessus and Mycobacterium chelonae infections  

PubMed Central

Objectives We report the largest clinical experience using tigecycline-containing regimens for salvage treatment of patients with Mycobacterium abscessus and Mycobacterium chelonae. Patients and methods Data were collected from 52 patients on emergency/compassionate use (n?=?38) or two open-label studies (n?=?7 patients each). Based on information that was available, 46 (88.5%) of the subjects received antibiotic therapy prior to treatment with tigecycline. Treatment groups were evaluated based on length of tigecycline therapy (<1 and ?1 month). ClinicalTrials.gov identifiers: Study 205, NCT00600600 and Study 310, NCT00205816. Results The most commonly used concomitant antimicrobials were macrolides, amikacin and linezolid. Pulmonary disease was the most common presentation (36/52; 69.2%), and 58.3% of these patients had underlying cystic fibrosis. The majority were M. abscessus complex (n?=?30) or M. chelonae/abscessus (n?=?4). With therapy ?1 month (mean, 255.0?±?265.7 days), 10/15 patients (66.7%) with cystic fibrosis and 16/26 (61.5%) overall were considered improved. Skin/soft-tissue/bone infections were the most common extrapulmonary infections. With therapy ?1 month (mean, 143?±?123 days), 9/12 patients (75.0%) were considered improved. Nine of the 16 cases reported as failures regardless of site of infection occurred in patients who stopped treatment due to adverse events. There were eight deaths; none was related to tigecycline. Conclusions Tigecycline given for ?1 month as part of a multidrug regimen resulted in improvement in >60% of patients with M. abscessus and M. chelonae infections, including those with underlying cystic fibrosis, despite failure of prior antibiotic therapy. Adverse events were reported in >90% of cases, the most common being nausea and vomiting. PMID:24633206

Wallace, Richard J.; Dukart, Gary; Brown-Elliott, Barbara A.; Griffith, David E.; Scerpella, Ernesto G.; Marshall, Bonnie

2014-01-01

395

Extension 720  

NSDL National Science Digital Library

In a day and age where many radio programs rely on the powers of mere shock value, Extension 720 offers discerning and insightful commentary on a very wide range of issues. Based out of Chicago, the program is hosted by Milt Rosenberg, who is a professor emeritus at the University of Chicago. Since 1973, the program has featured the likes of Margaret Thatcher, Jimmy Carter, Charlton Heston, William Safire, and Calvin Trillin, among others. On the site, visitors can listen to the current program, or browse through the extensive archives, which date back to 2003. Additionally, visitors can also view highlights of interviews from the 1970s, 1980s, and 1990s. Some of the more recent programs have focused their attention on the world of stand-up comedy, organized crime in Chicago, and the current state of various Great Books curricula in American high schools and colleges.

396

De novo deletion 17p13.1 chronic lymphocytic leukemia shows significant clinical heterogeneity: the M. D.Anderson and Mayo Clinic experience  

Microsoft Academic Search

To determine the clinical fate of patients with de novo deletion 17p13.1 (17p) chronic lymphocytic leukemia (CLL), we retrospectively studied the outcome of 99 treatment-naive 17p CLL patients from the M. D. Anderson Cancer Center (n 64) and the Mayo Clinic (n 35). Among 67 asymptomatic patients fol- lowed for progression, 53% developed CLL requiring treatment over 3 years. Patients

Constantine S. Tam; Tait D. Shanafelt; William G. Wierda; Lynne V. Abruzzo; Daniel L. Van Dyke; Susan O'Brien; Alessandra Ferrajoli; Susan A. Lerner; Alice Lynn; Neil E. Kay; Michael J. Keating

397

Experiments  

NASA Astrophysics Data System (ADS)

Experiments were performed on the CERN cyclotron. Pion capture in Ta, Re, and Bi, quadrupole moments, nuclear gamma transitions, pion absorption in the nucleus, neutron multiplicity and angular momentum, and charged particles emission after pion absorption were studied.

Konijn, J.

398

Atypical clinic presentation of pandemic influenza A successfully rescued by extracorporeal membrane oxygenation - Our experience and review of the literature.  

PubMed

The novel pandemic influenza A (H1N1) caused an epidemic of critical illness, and some patients developed severe acute respiratory distress syndrome (ARDS) or severe cardiopulmonary failure despite the use of conventional management. Extracorporeal membrane oxygenation (ECMO) support may successfully rescue these severely ill patients. We demonstrate the causative role of H1N1 in refractory ARDS of a previously healthy 15-year-old man who presented to the intensive care unit with a hypoxic and persistent cardiogenic shock refractory to conventional management as the leading symptom of influenza A. Because of compromised cardiopulmonary function, venovenous ECMO was applied 24 h after admission. Despite that the patient was manifesting heart failure, we decided the placement of venovenous ECMO because we believed that the real problem was the uncontrollable hypoxia and hypercapnia. A normal left ventricular ejection fraction was documented on a 2D echocardiography on day 2. The patient, after 6 days of ECMO, recovered completely and was successfully weaned from the mechanical ventilator on the 9th day after admission. The patient was discharged from the hospital on the 15th day. This experience showed that ECMO can be lifesaving for severe H1N1 infection also in patients with atypical clinical presentation of influenza. PMID:24381738

Bonacchi, Massimo; Ciapetti, Marco; Di Lascio, Gabriella; Harmelin, Guy; Sani, Guido; Peris, Adriano

2013-12-01

399

Atypical clinic presentation of pandemic influenza A successfully rescued by extracorporeal membrane oxygenation – Our experience and review of the literature  

PubMed Central

The novel pandemic influenza A (H1N1) caused an epidemic of critical illness, and some patients developed severe acute respiratory distress syndrome (ARDS) or severe cardiopulmonary failure despite the use of conventional management. Extracorporeal membrane oxygenation (ECMO) support may successfully rescue these severely ill patients. We demonstrate the causative role of H1N1 in refractory ARDS of a previously healthy 15-year-old man who presented to the intensive care unit with a hypoxic and persistent cardiogenic shock refractory to conventional management as the leading symptom of influenza A. Because of compromised cardiopulmonary function, venovenous ECMO was applied 24 h after admission. Despite that the patient was manifesting heart failure, we decided the placement of venovenous ECMO because we believed that the real problem was the uncontrollable hypoxia and hypercapnia. A normal left ventricular ejection fraction was documented on a 2D echocardiography on day 2. The patient, after 6 days of ECMO, recovered completely and was successfully weaned from the mechanical ventilator on the 9th day after admission. The patient was discharged from the hospital on the 15th day. This experience showed that ECMO can be lifesaving for severe H1N1 infection also in patients with atypical clinical presentation of influenza. PMID:24381738

Ciapetti, Marco; Di Lascio, Gabriella; Harmelin, Guy; Sani, Guido; Peris, Adriano

2013-01-01

400

The versatility of the free lateral arm flap in head and neck soft tissue reconstruction: clinical experience of 210 cases.  

PubMed

A study of the authors' experience with 210 free lateral arm flaps used to repair head and neck oncological defects over an 8-year period. Patients' ages ranged from 4 to 83 years (average: 49.7 years). One hundred and forty-one were male and 66 female. Three patients received two consecutive flaps each. They were used to reconstruct: the tongue, 53 cases; retromolar trigone, 42 cases; soft/hard palate, 34 cases; skin/facial contour, 19 cases; hypopharynx, 17 cases; buccal mucosa, 12 cases; lips, five cases. Flap cutaneous dimensions ranged from 4 x 2 cm to 17 x 8 cm. Flap was composed of: skin and fascia, 18 cases; sensate (neurovascular) skin, six cases; subcutaneous fat tissue, five cases; skin and vascularised nerve graft, three cases, skin and partial triceps muscle, three cases. Nerve coaptations were performed for all lip reconstructions. All flaps survived except for nine (success rate: 95.2%). Severe postoperative clinical complications preceded flap failure and death in two cases. All but six donor sites were closed primarily. Complications related to the donor site were: paresthesia of the forearm, 210 cases; dog ear, 16 cases; hypertropic scar, 14 cases; weakness, nine cases; haematoma, five cases; seroma, three cases; dehiscence, one case. Radial nerve injury was not observed in this series. The lateral arm flap can be considered safe and versatile for most soft tissue head and neck microsurgical reconstructions. The possibility of sensory recovery through neural anastomoses and low donor site morbidity enhances its efficiency. PMID:18042444

Marques Faria, Jose Carlos; Rodrigues, Mônica Lucia; Scopel, Gean Paulo; Kowalski, Luiz Paulo; Ferreira, Marcus Castro

2008-01-01

401

NH Agricultural Experiment Station -COLLEGE OF LIFE SCIENCES & AGRICULTURE http://extension.unh.edu/Agric3 3 3 3 3 http://www.colsa.unh.edu/aes/3  

E-print Network

://extension.unh.edu/Agric3 3 3 3 3 http://www.colsa.unh.edu/aes/3 3 Brussels3Sprouts3Variety3Trials3and3Topping3Study,320103 3 Objectives3 1) compare*the*productivity*and*marketable*yields*of*five*varieties*of*Brussels*sprouts* 2) determine*the*effects*of*topping*Brussels*sprouts*(removing*the*apical*meristem)*on* marketable*yield*of*sprouts

New Hampshire, University of

402

Patient expectations and experiences of multiple sclerosis interferon ?-1a treatment: a longitudinal, observational study in routine UK clinical practice  

PubMed Central

Background Premature discontinuation and poor treatment adherence are problems in chronic conditions, such as multiple sclerosis in which patients must take long-term treatment in order to receive maximum benefit from their medication. The Assessing needs In Multiple Sclerosis (AIMS) study explored factors related to premature treatment discontinuation and patients’ experiences of subcutaneous (sc) interferon (IFN) ?-1a treatment in the UK. Methods A questionnaire-based survey was integrated into the Bupa Home Healthcare patient-support program, which delivers sc IFN ?-1a to patients in their home. Data were collected via patient questionnaires incorporated into routine clinical care and administered upon registration of a new patient by the coordinator, following initial delivery of treatment, prior to each delivery during therapy and at the end of treatment. Univariate and multivariate analyses were performed to identify factors associated with premature discontinuation. Results Data were collected from 2,390 patients (1,267 new; 1,123 existing) from 59 UK prescribing centers (November 2006–April 2011). Following the first delivery of sc IFN ?-1a, 94% (1,149/1,225) of patients had received training, and 73% (818/1,120) reported that they had no concerns. In total, 24% of new patients discontinued therapy by the end of the study. In the univariate model, none of the candidate variables tested were significant predictors of treatment discontinuation. The strongest predictors of discontinuation in multivariate analyses were lack of information prior to starting treatment and patients feeling unwell on treatment and geographic region (P<0.05 for each variable). Conclusion This study suggests that patients feeling well on treatment and provision of high-quality information are the main determinants of persistence with sc IFN ?-1a therapy. A package of care that targets these issues should therefore be considered when initiating sc IFN ?-1a therapy. PMID:24570582

Syed, Mehmood; Rog, David; Parkes, Laura; Shepherd, Gillian L

2014-01-01

403

Clinical pathway for acute exacerbations of chronic obstructive pulmonary disease: method development and five years of experience  

PubMed Central

Background Randomized controlled trials, evidence-based medicine, clinical guidelines, and total quality management are some of the approaches used to render science-based health care services. The clinical pathway for hospitalized patients suffering from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is poorly established, although a clinical pathway is an integral part of total quality management. Aim To evaluate the outcomes of patients hospitalized with AECOPD in Japan, treated with a clinical pathway following published guidelines. Methods Prospective data were collected for patients with AECOPD admitted to a general hospital over a 5-year period since 2003. The clinical pathway was designed to establish general rules for the entire treatment protocol. The clinical pathway indicates which treatments and interventions should be performed, and when. In this study, health care providers were required to check the clinical pathway sheets to determine the next step of treatment. Results This study analyzed 276 hospitalizations in 165 patients. The clinical pathway was interrupted and defined as a dropout in 45 cases (16.3%). Nine patients died during hospitalization (3.3%). Oxygen was administered in 232 hospitalizations (84.1%). Noninvasive positive pressure ventilation (NPPV) treatment was administered in 110 hospitalizations (39.9%). The rate of intubation in those cases where NPPV treatment had been administered was 8.2% (9 cases out of 110). The average length of stay (LOS) was 20.3 days, and the median value was 15 days. The LOS was longer than 30 days in 34 admissions (12.3%), mainly due to complications. Conclusion AECOPD can be managed using a clinical pathway. This clinical pathway could fill the gap between guidelines and clinical practice. PMID:21760723

Nishimura, Koichi; Yasui, Maya; Nishimura, Takashi; Oga, Toru

2011-01-01

404

Personal health records in a public hospital: experience at the HIV\\/AIDS clinic at San Francisco General Hospital  

Microsoft Academic Search

Personal health records (PHRs) are information repositories; however, PHRs may be less available to p