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Extensive coronary calcification: a clinically unrecognised condition.  


Atheroma calcification is a common feature of advanced atherosclerosis, however with the advent of CT scanning it has become possible to detect extensive coronary calcification in the absence of flow-limiting lesions. While this phenomenon is known in renal disease, it also exists in some patients with exertional angina. Vascular pathology suggests biomineralisation associated with development of osteoblast-like cells in the arterial wall. While some conventional risk factors are shared with atheroma formation, others such as ethnicity and medications appear more specific to extensive calcification and may mirror those for osteoporosis. Similarly an atherogenic diet can predispose to both conditions while some elements promote or inhibit coronary calcification but not atheroma formation. The immune and endocrine systems contribute to both conditions but not necessarily in the same way, with vitamins D and K more related to calcification than atheroma formation. Finally, statins significantly lower low density lipoprotein (LDL) cholesterol and reduce atheroma formation but are largely powerless against extensive calcification. Although investigations into the exact cause of extensive coronary calcification are in their infancy, early results suggest that it is sufficiently different in nature from atheroma formation to be considered as a separate condition. Further research would yield a greater understanding, which would aid management and the development of specific biomarkers to reduce the cost and radiation risk of CT scanning. PMID:20180769

Nicoll, Rachel; Henein, Michael



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.


[Clinical experiences with noxiptilin].  


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

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



[Extensive resections in rectal carcinoma. Our experiences].  


The authors review their experience in the surgical management of rectal cancer. They analyze rectal malignancies and their recurrences from natural history to surgical strategies and survival rates. In particular, the need to perform extended operations in order to offer patients a better prognosis is discussed. PMID:1292562

Barabino, M; Tommasi, G V; Arcuri, V; Morelli, N; Fontana, I; Casolino, V; Mondello, R; Carisetto, A; Bacigalupo, P; Valente, U



Extensive composite molar restorations: 3 years clinical evaluation.  


Abstract Objective. To evaluate the clinical performance of extensive direct composite restorations in molars after 1 and 3 years and to find out the importance of extent of the restorations and other factors related to their performance. Materials and methods. Seventy-four patients with a molar tooth in need of a restoration covering at least three surfaces and one cusp were selected. Patient-related factors were registered and the tooth was prepared and restored by using a nano-filled composite. A topographic system for classification of extensive posterior restorations was developed. At baseline, the operator recorded a clinical evaluation, using modified USPHS-criteria. After 1 and 3 years, an independent observer evaluated the restorations. Post-operative problems arising during the observation period were registered. Results. A change in clinical score from baseline to the 1 and 3 year recall was recorded for all clinical criteria. A total of nine restorations were graded as unacceptable after 3 years (3-year survival rate of 87.7% and a mean annual failure rate of 4.2%). Except for gender (p = 0.022), none of the patient-related factors investigated (age, caries risk, extension of the restoration and presence of cervical enamel) had a significant influence on the survival of the restorations. Conclusions. Extensive direct posterior composite restorations showed an acceptable clinical performance after 3 years. Men had a significantly greater restoration failure rate than women. PMID:21780983

Laegreid, Torgils; Gjerdet, Nils Roar; Johansson, Ann-Katrin



Extension and Refinement of the Valuation of Air Force Experience.  

National Technical Information Service (NTIS)

This paper documents the extension and enhancements made to three previously developed value of Air Force experience models. Full investment cost, stochastic rewards valuation, and expected net present value models were applied to 10 additional enlisted a...

B. M. Stone L. M. Grossman L. T. Looper S. K. Engquist



The Cleveland Clinic's magnet experience.  


The awarding of Magnet Status by the Magnet Nursing Services Recognition Program of the American Nursing Credentialing Center is acknowledged as the achievement of Excellence in Nursing. In this article, The Cleveland Clinic shares insights from its experience in becoming the 72nd Magnet hospital. Questions to ponder when conducting a readiness assessment before embarking on the Magnet journey, techniques to engage the staff in the application process, and writing and organizing tips are shared. PMID:15682881

Kuhar, Peggy A; Lewicki, Linda J; Modic, Mary Beth; Schaab, Debbie; Rump, Colleen; Bixler, Sarah



A modular Clinical Decision Support System Clinical prototype extensible into multiple clinical settings  

Microsoft Academic Search

Traditionally, Clinical Decision Support Systems (CDSS) collect patient data from physiological monitors and other sources, providing clinicians with derived instructions and information to aid treatment planning. With advancements in telecommunication networks, CDSS functionality can be extended over distances, and accessed remotely (e.g. by appropriate healthcare providers not available in the patient's immediate surroundings). This paper discusses a modular CDSS that

Fran Wu; Mitch Williams; Peter Kazanzides; Ken Brady; Jim Fackler



Extensive Mongolian spots: a clinical sign merits special attention.  


Although typical and limited Mongolian spots are benign skin markings at birth which fade and disappear as the child grows, extensive Mongolian spots deserve special attention as possible indications of associated inborn error of metabolism. A few cases of extensive Mongolian spots in association with inheritable storage diseases have been reported. Some hypotheses have been put forward, but further investigation is necessary to elucidate the causative factors. This report describes three infants with generalized Mongolian spots, two infants with GM1 gangliosidosis type 1, and one in association with Hurler syndrome. Findings of generalized Mongolian spots in newborns may lead to an early detection and early treatment before irreversible organ damage occurs. PMID:16458829

Ashrafi, Mahmood Reza; Shabanian, Reza; Mohammadi, Mahmood; Kavusi, Susan



Counselor and clinical supervisor perceptions of OASAS tobacco-free regulation implementation extensiveness, perceived accountability, and use of resources.  


New York State required substance use disorder (SUD) treatment programs to be 100% tobacco-free in 2008. The current study examined counselor (N = 364) and clinical supervisor (N = 98) perceptions of how extensively the tobacco-free regulation was implemented in their treatment programs, perceived accountability for implementing the regulation, and use of OASAS-provided resources to aid implementation one year after the regulation went into effect. Results showed that compared to counselors, supervisors perceive greater implementation extensiveness and report using more resources, yet they perceive lower accountability. In addition, whereas perceived accountability is significantly and positively associated with implementation extensiveness perceptions for counselors, the relationship is negative for supervisors. The association between use of resources and implementation extensiveness perceptions is significant and positive for both counselors and supervisors. We conclude that implementation experiences differ between counselors and clinical supervisors, suggesting the importance of tailoring interventions to promote tobacco-free policies in SUD treatment programs. PMID:24592668

Laschober, Tanja C; Eby, Lillian T



[Continuous dopaminergic stimulation - clinical experience].  


Both disease progression and pulsatile stimulation of dopaminergic receptors are responsible for development of fluctuations and dyskinesia in about 50% of patients with Parkinson disease (PD) after 4-6 years of therapy with levodopa. In order to prevent motor complications, the ideal therapy should secure continuous dopaminergic stimulation (CDS). The concept of CDS is supported by the results of both experimental and clinical studies. Several treatment options are available to achieve CDS. Dopamine agonists have a longer half-life than levodopa and the development of dyskinesia is delayed when they are used as monotherapy in early PD. Continuous delivery of agonists can be improved with prolonged-release oral preparations, a transdermal delivery system or continuous subcutaneous infusion. Continuous enteral infusion of levodopa is another way to achieve CDS and it is very effective in reducing motor complications in advanced PD. PMID:20827612

Bogucki, Andrzej; S?awek, Jaros?aw



Decontamination and Decorporation: The Clinical Experience.  

National Technical Information Service (NTIS)

Decontamination and decorporation are quite interrelated when dealing with a contaminated person. Some clinical experiences from a transuranium production facility are offered. Skin decontamination is accomplished by washing with detergent and water. Stub...

G. A. Poda



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



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



First detection of extensive air showers with the EEE experiment  

NASA Astrophysics Data System (ADS)

The Extreme Energy Events (EEE) Project is devoted to the study of extremely high energy cosmic rays by means of an array of particle detectors distributed all over the Italian territory. Each element of the array (called telescope in the following) is installed in a High School, with the further goal to introduce students to particle and astroparticle physics, and consists of three Multigap Resistive Plate Chambers (MRPC), that have excellent time resolution and good tracking capability. In this paper the first results on the detection of extensive air showers by means of time coincidences between two telescopes are presented.

Moro, R.



Implementing a Clinical Experience for Student Trainers.  

ERIC Educational Resources Information Center

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

Compton, Rod


The ethics of simulated nursing clinical experiences  

Microsoft Academic Search

Simulation has the capacity to alleviate many of the problems facing associate degree nursing education today. As the use of simulation increases, nurse educators must examine the ethical aspects of simulated clinical experience. The purpose of this article was to explore the ethical issues surrounding simulation in associate degree nursing education. Current literature supports simulation as an adjunct to traditional

Janeen Berndt



Long-term clinical experience with zofenopril.  


Angiotensin-converting enzyme inhibitors are extensively used to improve clinical outcome of patients with several cardiovascular diseases. Zofenopril proved to be very effective in patients with coronary artery disease and myocardial infarction, thanks to its unique effective mechanism of action for improving blood pressure control, left ventricular function and myocardial ischemia burden, as well as angiotensin-converting enzyme inhibition. The SMILE project involved more than 3500 patients with coronary artery disease and demonstrated that zofenopril treatment may reduce mortality and morbidity in patients with myocardial infarction, also when combined with acetyl salicylic acid and to a greater extent than lisinopril and ramipril. In addition, the results of the SMILE-ISCHEMIA study have demonstrated an interesting anti-ischemic effect of zofenopril, and these properties largely contribute to the overall clinical benefit of the drug. The effects of zofenopril on blood pressure control and cardiovascular protection clearly support its primary role for prevention and treatment of cardiovascular diseases. PMID:23030285

Borghi, Claudio; Bacchelli, Stefano; Degli Esposti, Daniela



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.



Planning a study abroad clinical experience.  


Not only is globalization expanding areas of human activity, it is also influencing the variety of educational offerings in universities. Therefore, globalization must be considered by nurse educators as they reevaluate ways of preparing nursing students to meet the health care needs of populations they currently serve and will care for in the future. Study abroad programs have been encouraged to be part of the college experience in the United States for more than 30 years; however, these programs have been relatively lacking in nursing education. Most of the study abroad programs described in the nursing literature are research-based or first-person accounts of an experience and provide little information about planning a study abroad program. This article describes a study abroad learning experience for senior nursing students and discusses the issues such as student selection, student safety, and available clinical experiences that need to be considered before undertaking such an endeavor. PMID:20143756

Wright, Dolores J



Practicum and clinical experiences: postpracticum students' views.  


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



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



Extension Educators' Perceptions of Community Readiness, Knowledge of Prevention Science, and Experience with Collaboration  

ERIC Educational Resources Information Center

This investigation compared Extension educators' perceptions of community readiness, knowledge of prevention science, and experience with community collaborations with the perceptions of community human service professionals. First, Cooperative Extension System (CES) educators and human service professionals were found to hold similar perceptions…

Perkins, Daniel F.; Mincemoyer, Claudia C.; Lillehoj, Catherine J.



The CONSORT Patient-Reported Outcome (PRO) extension: implications for clinical trials and practice  

PubMed Central

To inform clinical guidelines and patient care we need high quality evidence on the relative benefits and harms of intervention. Patient reported outcome (PRO) data from clinical trials can “empower patients to make decisions based on their values” and “level the playing field between physician and patient”. While clinicians have a good understanding of the concept of health-related quality of life and other PROs, evidence suggests that many do not feel comfortable in using the data from trials to inform discussions with patients and clinical practice. This may in part reflect concerns over the integrity of the data and difficulties in interpreting the results arising from poor reporting. The new CONSORT PRO extension aims to improve the reporting of PROs in trials to facilitate the use of results to inform clinical practice and health policy. While the CONSORT PRO extension is an important first step in the process, we need broader engagement with the guidance to facilitate optimal reporting and maximize use of PRO data in a clinical setting. Endorsement by journal editors, authors and peer reviewers are crucial steps. Improved design, implementation and transparent reporting of PROs in clinical trials are necessary to provide high quality evidence to inform evidence synthesis and clinical practice guidelines.



Clinical experience in temporomandibular joint arthroscopy.  


Clinical experience of arthroscopy in 12 temporomandibular joints with a clinical diagnosis of closed lock was described. There were 10 patients and all were females with a mean age of 31.2 years (range 20 to 59 years). The antero-lateral approach was used for entry into 11 joints. The clinical findings were adhesions (64%), fibrillation (64%), anterior displacement of disc (36%) and scuffing of the articular surface of the glenoid fossa (9%). Two of the joints that had arthrocentesis prior to arthroscopy did not show any different findings from the rest. Of the 8 patients who had pre-arthroscopy pain, 7 patients (88%) had reduction of the symptom. Three patients (38%) had complete resolution of pain. The range of mouth opening (measured as maximal incisor opening) increased in all patients two weeks following arthroscopy. The average change in maximal incisor opening was 40.3% with a range of 22% to 85%. The mean follow-up was 34 months (range 4 to 68 months). PMID:8924004

Go, W S; Teh, L Y; Peck, R H; Chew, S C; Chua, E K



A Curriculum Model for an Integrated Senior Year Clinical Experience.  

ERIC Educational Resources Information Center

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

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



Hypersensitivity reactions to ethylene oxide: clinical experience.  


A hypersensitivity reaction occurring in the first minute of the dialysis procedure was observed in seven haemodialysis patients in one day. Hollow-fibre dialysers were used, five made of saponified cellulose ester (SCE) and two of cuprammonium cellulose (CC). All were sterilised with ethylene oxide (ETO) and used for the first time. The severity of the reactions was grade 2. The whole series of dialysers was examined for the presence of ETO concentration. A significantly higher concentration of ETO was found in the polyurethane potting than in the capillaries. The ETO concentrations were 122, 185, 440, 274, 342, and 280 p.p.m. in the following dialysers: Cordis Dow (cellulose acetate CA), Cordis Dow-Plivadial (SCE), Fresenius C-1.3 (CC), Fresenius E-2 (CC), Fresenius E-3 (CC), and Travenol-Medial S 11 flate plate (CC) respectively. According to the clinical signs, ETO concentrations in the dialysers and the lack of reaction when extensive rinsing was used, it can be presumed that these reactions are related to ETO although other mechanisms cannot be excluded. PMID:1775268

Masin, G; Polenakovi?, M; Ivanovski, N; Atanasov, N; Olivera, S; Cakalaroski, K



Diagnosis and management of extensive vascular malformations of the lower limb: part I. Clinical diagnosis.  


There is significant confusion in the literature when describing vascular anomalies, and vascular malformations are often misnamed or incorrectly classified. Part I of this two-part series on the diagnosis and management of extensive vascular malformations of the lower limbs will discuss the dermatologist's role in the diagnosis of these lesions. At least nine types of vascular malformations with specific clinical and radiologic characteristics must be distinguished in the lower limbs: Klippel-Trénaunay syndrome, port-wine stain with or without hypertrophy, cutis marmorata telangiectatica congenita, macrocephaly-capillary malformation, Parkes Weber syndrome, Stewart-Bluefarb syndrome, venous malformation, glomuvenous malformation, and lymphatic malformation. This article highlights the differences in clinical appearance and discusses the differential diagnosis of extensive vascular malformations in an attempt to ensure earlier diagnosis and better outcomes for these patients. PMID:22000870

Redondo, Pedro; Aguado, Leyre; Martínez-Cuesta, Antonio



Extensive in vitro activity of guanidine hydrochloride polymer analogs against antibiotics-resistant clinically isolated strains  

Microsoft Academic Search

Polyhexamethylene guanidine hydrochloride (PHMG) possesses great potential in the development of covalently bound permanent sterile-surface materials for hospital infection control. This study aimed at evaluating the extensive activity of PHMG and its three novel analogs, including polybutamethylene guanidine hydrochloride, polyoctamethylene guanidine hydrochloride (POMG) and poly(m-xylylene guanidine hydrochloride), against 370 clinical strains, especially 96 isolates of which were antibiotics-resistant. Their in

Zhongxin Zhou; Dafu Wei; Yong Guan; Anna Zheng; Jian-Jiang Zhong



Clinical and operational value of the extensively drug-resistant tuberculosis definition  

Microsoft Academic Search

Currently, no information is available on the effect of resistance\\/susceptibility to first-line drugs different from isoniazid and rifampicin in determining the outcome of extensively drug-resistant tuberculosis (XDR-TB) patients, and whether being XDR-TB is a more accurate indicator of poor clinical outcome than being resistant to all first-line anti-tuberculosis (TB) drugs. To investigate this issue, a large series of multidrug-resistant TB

G. B. Migliori; G. Besozzi; E. Girardi; K. Kliiman; C. Lange; O. S. Toungoussova; G. Ferrara; D. M. Cirillo; A. Gori; A. Matteelli; A. Spanevello; L. R. Codecasa; M. C. Raviglione



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



Clinical relevance of symptomatic superficial-vein thrombosis extension: lessons from the CALISTO study.  


The clinical relevance of symptomatic extension of spontaneous, acute, symptomatic, lower-limb superficial-vein thrombosis (SVT) is debated. We performed a post hoc analysis of a double-blind trial comparing fondaparinux with placebo. The main study outcome was SVT extension by day 77, whether to ? 3 cm or > 3 cm from the sapheno-femoral junction (SFJ). All events were objectively confirmed and validated by an adjudication committee. With placebo (n = 1500), symptomatic SVT extension to ? 3 cm or > 3 cm from the SFJ occurred in 54 (3.6%) and 56 (3.7%) patients, respectively, inducing comparable medical resource consumption (eg, anticoagulant drugs and SFJ ligation); subsequent deep-vein thrombosis or pulmonary embolism occurred in 9.3% (5/54) and 8.9% (5/56) of patients, respectively. Fondaparinux was associated with lower incidences of SVT extension to ? 3 cm (0.3%; 5/1502; P < .001) and > 3 cm (0.8%; 12/1502; P < .001) from the SFJ and reduced related use of medical resources; no subsequent deep-vein thrombosis or pulmonary embolism was observed in fondaparinux patients. Thus, symptomatic extensions are common SVT complications and, whether or not reaching the SFJ, are associated with a significant risk of venous thromboembolic complications and medical resource consumption, all reduced by fondaparinux. PMID:23821661

Leizorovicz, Alain; Becker, François; Buchmüller, Andrea; Quéré, Isabelle; Prandoni, Paolo; Decousus, Hervé



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

Microsoft Academic Search

The aim of this study is to describe student nurses’ perceptions of clinical learning experiences in the context of the clinical learning environment. We use the phenomenological approach by Colaizzi. The data was collected by unstructured interviews. Altogether 16 student nurses were asked to describe the significance of clinical learning experiences and good and bad learning experiences. Four elements sum

Mikaela von Bonsdorff



Clinical use of the meropenem-clavulanate combination for extensively drug-resistant tuberculosis.  


Mycobacterium tuberculosis strains resistant to almost all available anti-tuberculosis drugs are an increasing threat to public health worldwide. Among existing drugs with potential antimycobacterial effects, the combination of meropenem with clavulanate has been shown to have potent in vitro bactericidal activity against extensively drug-resistant tuberculosis (XDR-TB). To explore its potential clinical efficacy, a meropenem-clavulanate-containing salvage regimen was started in six patients with severe pulmonary XDR-TB, in association with the only one or two remaining active second-line drugs. Encouraging preliminary data are detailed and discussed. PMID:22325421

Payen, M C; De Wit, S; Martin, C; Sergysels, R; Muylle, I; Van Laethem, Y; Clumeck, N



Pyrosequencing for rapid detection of extensively drug-resistant Mycobacterium tuberculosis in clinical isolates and clinical specimens.  


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

Lin, S-Y Grace; Rodwell, Timothy C; Victor, Thomas C; Rider, Errin C; Pham, Lucy; Catanzaro, Antonino; Desmond, Edward P



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.

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



Cooperative Digoxin Experiment I - Summary Report, Clinical Chemistry Division, 1977.  

National Technical Information Service (NTIS)

Numerous clinical laboratories and manufacturers of diagnostic products were invited to participate in an experiment to assess the present status of assays for the quantitation of digoxin. The response was excellent, and a cooperative digoxin experiment w...

W. H. Hannon D. M. Fast



Preserved spatial memory after hippocampal lesions: effects of extensive experience in a complex environment.  


Damage to the hippocampus typically impairs spatial learning and memory in animals, but humans with hippocampal lesions retain spatial memories of premorbidly familiar environments. We showed that, like humans, normal rats reared in a complex environment and then given hippocampal lesions retained allocentric spatial memory for that environment. These results, which ruled out dependency on single cues, landmarks or specific routes, suggest that extensive premorbid experience leads to spatial representations that are independent of the hippocampus. PMID:15723062

Winocur, Gordon; Moscovitch, Morris; Fogel, Stuart; Rosenbaum, R Shayna; Sekeres, Melanie



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

Microsoft Academic Search

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, and it is never too late. From a research perspective,

Charles H. Zeanah



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.



Extrathyroidal extension predicts extranodal extension in patients with positive lymph nodes: an important association that may affect clinical management.  


Background: While there is consensus that significant extrathyroidal extension (ETE) (T4) should upstage a patient with well-differentiated thyroid cancer, the importance of minimal ETE (T3) remains controversial. Additionally, the importance of nodal metastases on prognosis has come under scrutiny. Recent publications highlight the importance of size, number of positive nodes, and, in particular, the presence of extranodal extension (ENE) as measures of disease aggressiveness. In this study, we examined whether ETE is a predictor of ENE. Methods: A retrospective review was conducted from January 2004 to March 2013. All node-positive patients who underwent total or completion thyroidectomy were included. Histologic features defined by the College of American Pathologists (CAP) protocol for thyroid carcinoma were recorded. Results: A total of 193 patients qualified for review. Patients who were found to have ETE were 12 times more likely to have lymph nodes in the primary setting with ENE than patients with intrathyroidal primary tumors (p<0.000). After exclusion of all T4 cases (n=6), patients with minimal ETE were 13 times more likely to have ENE than those with no ETE (p<0.000). Twenty percent of microcarcinomas with ETE demonstrated ENE. Conclusion: We have found that the biology of the primary tumor is conferred to the lymph node in that the presence of ETE leads to a significantly higher incidence of ENE. Awareness of this relationship should be accounted for in the management of primary and recurrent lymph nodes. This study shows that minimal ETE is a significant predictor of ENE. Although long-term survival and recurrence follow-up is not available for the majority of patients in this series, the presence of ENE as a surrogate for more aggressive disease biology and its strong association with minimal ETE supports the upstaging of patients with minimal ETE. PMID:24443878

Clain, Jason B; Scherl, Sophie; Dos Reis, Laura; Turk, Andrew; Wenig, Bruce M; Mehra, Saral; Karle, William E; Urken, Mark L



Using the extensible markup language (XML) in automated clinical practice guidelines.  

PubMed Central

Much work has been done in the area of web-based clinical practice guidelines. Issues such as representation, description, architectures, and implementation have been explored previously. Most if not all of these web-based applications rely exclusively on HTML, the HyperText Markup Language. In the process of prototyping a guideline service to be used in a diabetes operations improvement project, we developed a model for a guideline engine that makes use of the Extensible Markup Language (XML), both as an interface to the engine and as a vehicle for delivering structured guideline content. We feel that XML may offer advantages in implementing guideline services that are difficult (if not impossible) to accomplish with HTML alone.

Dubey, A. K.; Chueh, H.



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



Clinical experience with inactivated, virosomal influenza vaccine  

Microsoft Academic Search

Current available influenza vaccines are safe and effective in preventing influenza. Nevertheless, there is a need for influenza vaccines with improved efficacy in the elderly. This need is underscored by both the observation that influenza has a major clinical and economic impact in the elderly and the fact that currently available vaccines are generally less effective in elderly than in

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



Collaborative Clinical Practice: An Alternate Field Experience  

ERIC Educational Resources Information Center

Teacher education in the 21st century is encountering increased scrutiny, added pressure, and escalating external regulations but does not have practical and immediate solutions for improving programs. While reforms in teacher education call for additional and improved clinical practice for candidates, through strengthened partnerships with local…

Dee, Amy Lynn



A Simulated Interprofessional Rounding Experience in a Clinical Assessment Course  

PubMed Central

Objective To implement a simulated interprofessional rounding experience using human patient simulators as a required activity for third-year pharmacy students in a clinical assessment course. Design Interprofessional student teams consisting of pharmacy, medical, and physician assistant students participated in a simulated interprofessional rounding experience in which they provided comprehensive medical care for a simulated patient in an inpatient setting. Assessment Students completed a survey instrument to assess interprofessional attitudes and satisfaction before and after participation in the simulated interprofessional rounding experience. Overall student attitudes regarding interprofessional teamwork and communication significantly improved; student satisfaction with the experience was high and students’ self-perceived clinical confidence improved after participation. The mean team clinical performance scores were 65% and 75% for each simulated interprofessional rounding experience. Conclusion Incorporating a simulated interprofessional rounding experience into a required clinical assessment course improved student attitudes regarding interprofessional teamwork and was associated with high student satisfaction.

Shrader, Sarah; McRae, Lacy; King, William M.; Kern, Donna



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.



Tocilizumab in pediatric rheumatology: the clinical experience.  


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

Gurion, Reut; Singer, Nora G



A constitutive equation for the Mullins effect in stress controlled uniaxial extension experiments  

NASA Astrophysics Data System (ADS)

A one-dimensional constitutive equation for the Mullins effect in rubberlike materials, which is motivated by the two phase microstructural material model proposed by Mullins and Tobin [I], is developed in [2]. The constitutive equation is used in [2] to predict the effect of stress softening on the small transverse vibration of a rubber string loaded in uniaxial extension. The two functions which comprise the constitutive equation were assumed to be monotone, but no further analysis of the actual nature of these functions was necessary. In this paper, we examine more closely how the results of a stress controlled uniaxial extension experiment can be used to gain insight into the specific nature of the microstructural strain and the strain amplification functions which comprise the constitutive equation. We examine experimental representations of the two functions which are independent of any special microstructural interpretations. Stress controlled uniaxial extension experiments with buna-n, neoprene, and silicone rubber cords are examined. We demonstrate how the experimental data can be applied to yield representations of the functions of interest to within a multiplicative constant; but no attempt is made to find specific analytical representations of these functions. For buna-n and neoprene samples, we observe behavior consistent with our monotone assumptions, while anomalous behavior is observed with silicone rubber.

Johnson, M. A.; Beatty, M. F.



Korean Supervisors' Experiences in Clinical Supervision  

ERIC Educational Resources Information Center

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

Bang, Keeyeon; Park, Jeeseon



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.

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



Clinical intestinal transplantation: Experience in Miami  

Microsoft Academic Search

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

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



[Somatostatin and the digestive system. Clinical experiences].  


The effect of somatostatin on the gastrointestinal tract is complex; it inhibits the release of gastrointestinal hormones, the exocrine function of the stomach, pancreas and bile, decreases motility and influences absorption as well. Based on these diverse effects there was an increased expectation towards the success of somatostatin therapy in various gastrointestinal disorders. The preconditions for somatostatin treatment was created by the development of long acting somatostatin analogues (octreotide, lanreotide). During the last twenty-five years large trials clarified the role of somatostatin analogues in the treatment of various gastrointestinal diseases. This study summarizes shortly these results. Somatostatin analogue treatment could be effective in various pathological conditions of the gastrointestinal tract, however, this therapeutic modality became a part of the clinical routine only in neuroendocrine tumours and adjuvant treatment of oesophageal variceal bleeding and pancreatic fistulas. PMID:24058098

Herszényi, László; Mihály, Emese; Tulassay, Zsolt



Clinical evaluation of terconazole. European experience.  


Terconazole is a new topical antifungal agent that differs structurally and functionally from the imidazoles. European clinical trials were conducted to determine (1) the lowest effective dose for a given treatment period, (2) which formulation should be tested further, and (3) how terconazole compares with other topical antifungal agents in terms of safety and efficacy. The results of dose-response studies demonstrated that 80- and 240-mg suppositories and 0.4% cream were the most effective formulations. Data from multicenter studies of pregnant and nonpregnant women in Belgium and Luxembourg indicate that the efficacy of terconazole cream is superior to that of miconazole nitrate cream and clotrimazole cream. Terconazole cream is also more effective than clotrimazole cream in terms of lower relapse rates. PMID:2677364

Hirsch, H A



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



Cancer therapy with bispecific antibodies: Clinical experience  

PubMed Central

The binding of at least two molecular targets simultaneously with a single bispecific antibody is an attractive concept. The use of bispecific antibodies as possible therapeutic agents for cancer treatment was proposed in the mid-1980s. The design and production of bispecific antibodies using antibody- and/or receptor-based platform technology has improved significantly with advances in the knowledge of molecular manipulations, protein engineering techniques, and the expression of antigens and receptors on healthy and malignant cells. The common strategy for making bispecific antibodies involves combining the variable domains of the desired mAbs into a single bispecific structure. Many different formats of bispecific antibodies have been generated within the research field of bispecific immunotherapeutics, including the chemical heteroconjugation of two complete molecules or fragments of mAbs, quadromas, F(ab’)2, diabodies, tandem diabodies and single-chain antibodies. This review describes key modifications in the development of bispecific antibodies that can improve their efficacy and stability, and provides a clinical perspective on the application of bispecific antibodies for the treatment of solid and liquid tumors, including the promises and research limitations of this approach.

Thakur, Archana; Lum, Lawrence G



Rhinocerebral and systemic mucormycosis. Clinical experience with 36 cases  

Microsoft Academic Search

We analysed retrospectively our clinical experience with 36 cases of mucormycosis. They were seen during the last 15 years. The diagnosis suspected on clinical grounds, was confirmed in 31 cases by finding the hyphae in hematoxylin-eosin stained material obtained from aspirated or tissue biopsy or by isolation of the fungus in culture. Rhinocerebral mucormycosis was diagnosed in 22 patients. Diabetes

Ricardo A Rangel-Guerra; Héctor R Martínez; Corando Sáenz; Francisco Bosques-Padilla; Ingrid Estrada-Bellmann



ECG devices interoperability in hospital environment: clinical experience  

Microsoft Academic Search

The clinical use of information systems is now widely accepted in hospital departments. Among diagnostic instrumental examinations the electrocardiogram is the most popular diagnostic procedure in hospitals and out- patient points of care and its integration in Hospital Information System (HIS) is mandatory. We report our experience in integrating ECG devices in the clinical HIS of an advanced Health Care

C. Carpeggiani; F. Conforti; S. Dalmiani; M. Emdin; A. Macerata




PubMed Central

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

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



Laparoscopic aortofemoral bypass grafting: Human cadaveric and initial clinical experiences  

Microsoft Academic Search

Purpose: Postoperative complications are mainly related to the surgical trauma derived from the extensive abdominal incision and dissection after a conventional aortofemoral bypass grafting procedure. In an attempt to reduce postoperative complications, a concept of video-endoscopic vascular surgery on the infrarenal aortoiliac artery has been developed. On the basis of our experience with the practicability of video-endoscopic vascular surgery in

Samir Said; Julian Mall; Frank Peter; Joachim M. Müller



Enhancing nursing students' clinical placement experiences: a quality improvement project.  


Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students' clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians' perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues. Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates' readiness for practice. Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made. PMID:17083320

Levett-Jones, Tracy; Fahy, Kathleen; Parsons, Kimberly; Mitchell, Amanda



Course Experiences and Perceptions of Farmers in Esfahan as a Basis for a Competency Profile of Extension Instructors  

ERIC Educational Resources Information Center

The purpose of this study was to analyze farmers' experiences with and perceptions of agricultural extension courses and their instructors in Esfahan, Iran. This study is part of a larger project on the development of a competency profile of extension instructors. Many attempts have been made to develop competency profiles for professionals (Shim,…

Karbasioun, Mostafa; Mulder, Martin; Biemans, Harm



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.

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



Female genital mutilation: Experience in a West London clinic.  


In 1997, a new clinic was established at the Central Middlesex Hospital to serve the needs of a mainly Somali population who had suffered genital mutilation in childhood. Between June 1997 and January 2005, 4,125 clinic attendances were recorded. A total of 215 reversals of circumcision were carried out (FGM 3), all on a day-care basis. In the majority of cases, an intact and undamaged clitoris was found under the scar tissue. The clinic staff were able to draw attention to cultural and religious issues which proved important in the medical management of these women. The experience of this clinic has shown that where there is a large immigrant population of women from the Horn of Africa, clinics such as this are efficient and cost-effective and encourage women to attend with a variety of health concerns. The clinic also encourages these women to take their health concerns seriously. PMID:17654198

Gordon, H; Comerasamy, H; Morris, N H



Rural clinical experiences for emergency medicine residents: a curriculum template.  


Rural emergency departments (EDs) in the United States are less likely to be staffed with emergency medicine (EM) residency-trained and American Board of Emergency Medicine (ABEM)-certified physicians than urban EDs. Rural EM clinical experiences during residency training have been suggested as a strategy to encourage future rural practice, but past Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine program requirements and a lack of familiarity with rural rotations in the EM graduate medical education (GME) community have limited their availability. To provide a template for the development and implementation of a rural EM clinical experience, Kern's six-step approach was followed. PMID:23167861

Wadman, Michael C; Clark, Ted R; Kupas, Douglas F; Macht, Marlow; McLaughlin, Steve; Mize, Terry; Casaletto, Jennifer; Muelleman, Robert L



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



The beneficial effects of preimplantation genetic diagnosis for aneuploidy support extensive clinical application  

Microsoft Academic Search

The aim of this study was to evaluate the clinical impact of preimplantation genetic diagnosis (PGD) for aneuploidy on 193 patients who subsequently achieved 208 clinical pregnancies, in relation to their reproductive history. The 208 clinical pregnancies included in the study resulted from 1029 assisted conception cycles in combination with PGD for aneuploidy in 740 couples with a history of

Luca Gianaroli; M Cristina Magli; Anna P Ferraretti; Carla Tabanelli; Vincenzo Trengia; Valeria Farfalli; Giorgio Cavallini



Providing premedical students with quality clinical and research experience  

PubMed Central

Undergraduate premedical students face a prodigious decision as they work to determine whether to pursue a profession in medicine. Experience in clinical medicine and research is essential to inform students what it might be like to be a physician. Undergraduates, however, face a number of obstacles to obtaining the kind of quality clinical and research experience needed to best inform them on this decision. Growing regulations designed to protect patient confidentiality, though undeniably important, pose a barrier to students seeking patient contact. Traditional passive physician shadowing often does not provide ample opportunities for one-on-one patient interaction or problem solving. Finally, research opportunities available to students typically are not associated with clinical work and therefore do not provide an experiential model of how empirical evidence informs medical practice. This report provides a description of the University of Wisconsin Tobacco Science Scholars Program, a pilot program designed to grapple with some of these barriers. The program provides supervision for students so that they might fulfill institutional requirements required for patient contact, provides an active model of clinical patient interaction and problem solving, and provides access to research that is integrated into the student’s clinical experience so the student might better understand the nature of research-based evidence in medicine. Program details and limitations are discussed.

Davis, James; Anderson, Maggie; Stankevitz, Kristen



Designing Nursing Simulation Clinical Experiences to Promote Critical Inquiry  

ERIC Educational Resources Information Center

The use of high fidelity simulation (HFS) learning opportunities in nursing education has received increased attention in the literature. This article describes the design of a systematic framework used to promote critical inquiry and provide meaningful simulation clinical experiences for second year nursing students. Critical inquiry, as defined…

Beattie, Bev; Koroll, Donna; Price, Susan



Vertebroplasty: clinical experience and follow-up results  

Microsoft Academic Search

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

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



Teachers' Clinical Experiences and Attitudes toward Technology Inclusion  

ERIC Educational Resources Information Center

The purpose of this qualitative multisite case study is to examine participants' attitudes toward technology, types of technology available for participant use, and the extent to which technology is used by preservice and mentor teachers during clinical experiences. Research supports the benefit of improved attitudes toward technology integration…

Paganelli, Andrea Lynch



Ambulance clinical placements - A pilot study of students' experience  

PubMed Central

Background Undergraduate paramedic students undertake clinical placements in a variety of locations. These placements are considered an essential element for paramedic pre-employment education. However, anecdotal evidence suggests some students have not had positive experiences on their emergency ambulance placements. The objective of this study was to identify the type of experiences had by students during ambulance clinical placements and to provide feedback to the ambulance services. Methods In this pilot study we employed a cross-sectional study methodology, using a convenience sample of undergraduate paramedic students available in semester one of 2007 to ascertain the students' views on their reception by on-road paramedics and their overall experience on emergency ambulance clinical placements. Ethics approval was granted. Results There were 77 students who participated in the survey, 64% were females, with 92% of students < 25 years of age and 55% < 65 Kg in weight. There was a statistically significant difference in average height between the genders (Male 179 cm vs Female 168 cm, p < 0.001). Clinical instructors were available to 44% of students with 30% of students excluded from patient management. Thirty percent of students felt there was a lot of unproductive down time during the placement. Paramedics remarked to 40% of students that they doubted their ability to perform the physical role of a paramedic, of this group 36% were advised this more than once. Conclusion This study demonstrates that for a small group of students, emergency ambulance clinical placements were not a positive experience clinically or educationally. Some qualified paramedics doubt if a number of female students can perform the physical role of a paramedic.

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



Ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii: risk factors, clinical features, and outcomes.  


Acinetobacter baumannii is characterized by a rapid development of resistance to the commonly used antimicrobial agents. We investigated the risk factors, clinical features, and outcomes in ventilator-associated pneumonia (VAP) caused by extensive drug-resistant Acinetobacter baumannii (XDRAB). Clinical parameters and overall in-hospital mortality rates were compared between the VAP with and without XDRAB infection groups. This study showed that VAP caused by XDRAB was not associated with in-hospital mortality. However, it was related to high Simplified Acute Physiology Score II scores and increasing durations of hospital stays. PMID:24485378

Özgür, Eylem Sercan; Horasan, Elif Sahin; Karaca, Kerem; Ersöz, Gülden; Nayc? At??, Sibel; Kaya, Ali



Extension to High Frequencies of the Experiment Capability of SEIS-UK  

NASA Astrophysics Data System (ADS)

The seismic equipment facility serving the UK academic community, SEIS-UK, has recently purchased 15 high frequency seismic recording systems capable of sampling at up to 24kHz. A suite of 3 component 30Hz geophones and piezoelectric accelerometers has also been acquired. The SAQS systems, designed and built by ISS International of South Africa, represent a significant extension in the capability of the SEIS-UK facility. The units record 24bit data from 6 channels, at sample rates of 50Hz to 24kHz, in continuous or triggered mode. An external GPS antenna and removable hard disk allow the systems to run autonomously. The 6 channels can be configured as any combination of tri-, bi- or uni-axial systems. The recording systems are also compatible with broadband seismometers. Although originally designed for the purpose of hardrock mine monitoring, the SAQS system is a good solution for a range of high frequency seismic monitoring experiments, especially controlled source or high-resolution surveys. The SEIS-UK systems have been modified with disk-heaters to extend the environmental operating capability. The addition of an external GPS antenna means the units can be used in the same way as any other passive seismic field system. However, the functionality of the recorder is significantly greater than that of many standard seismic systems. The equipment is currently loaned to the British Antarctic Survey for use as part of a large multi-disciplinary experiment on the Rutford Ice Stream in Antarctica. The instruments will be deployed in an array centred on the main sub-glacial access hole. Instruments will detect events from the bed of the glacier with the aim of investigating the ice flow mechanisms and for determining the relationship between the ice sheet, sub-glacial bed and tidal motion.

Brisbourne, A.; Horleston, A.; Denton, P.



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



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?

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



Clinical diagnostic clues in Crohn's disease: a 41-year experience.  


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; Alvarez, M; O'Brien, A



Laboratory and clinical experience with neodymium:YAG laser prostatectomy  

NASA Astrophysics Data System (ADS)

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

Kabalin, John N.



Extensive physiologic melanin pigmentation on the tongue: An unusual clinical presentation  

PubMed Central

Pigmented lesions are commonly found in the oral cavity. Pigmentation has a multifactorial etiology. Most of the oral pigmentations are physiologic but sometimes it can be a precursor of severe diseases. Evaluation of a patient presented with a pigmented lesion should include a full medical and dental history, extraoral and intraoral examinations and even in some cases biopsy and laboratory investigations are required. In this article, we report a case of extensive physiologic pigmentation on the tongue in a 32-year-old female patient, posing a diagnostic challenge.

Chandra, Sunira; Keluskar, Vaishali; Bagewadi, Anjana; Sah, Kunal



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


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

Bezecny, Pavel



The Influence of an Extensive Inquiry-Based Field Experience on Pre-Service Elementary Student Teachers' Science Teaching Beliefs  

ERIC Educational Resources Information Center

This study examined the effects of an extensive inquiry-based field experience on pre service elementary teachers' personal agency beliefs, a composite measure of context beliefs and capability beliefs related to teaching science. The research combined quantitative and qualitative approaches and included an experimental group that utilized the…

Bhattacharyya, Sumita; Volk, Trudi; Lumpe, Andrew



Clinical encounter experiences of patients with nasopharyngeal carcinoma.  


Nasopharyngeal carcinoma (NPC) is a commonly occurring cancer among Hong Kong Chinese, especially in the relatively young population group. Since the disease carries a favorable prognosis, sequelae following treatment have become an important concern for patients suffering from NPC, particularly because of the strong interplay of psychological, social, and biological issues during their rehabilitation. In this qualitative study, in-depth, semistructured audiotaped interviews were undertaken with 32 patients receiving rehabilitation at the physiotherapy department of a regional teaching hospital in Hong Kong. The objective of the study was to examine the rehabilitation experiences of NPC survivors to identify factors that contributed to a satisfying clinical encounter experience. During the study, data collection and analysis using a grounded theory approach were concurrently conducted. The 3 main themes that shaped the rehabilitation experiences of NPC survivors were the patient-clinician relationship, participation in therapeutic alliance, and quality rehabilitation service provision. These, together with the identified needs of the participants, contributed to the participants' perceived health-related quality of life. A constructive clinical experience was perceived when their needs were met. The findings highlight the importance of patient-centeredness in the treatment delivery and a multifaceted role of clinicians in meeting the needs of this group of cancer survivors. PMID:18292592

Lee, Edwin W C; Twinn, Sheila; Moore, Ann P; Jones, Mark P; Leung, S F



Resolution of extensive leptomeningeal metastasis and clinical spinal cord compression from breast cancer using weekly docetaxel chemotherapy.  


Metastatic breast cancer to the leptomeninges is a late event in the disease course and is associated with significant morbidity and a grave prognosis. Treatment typically involves direct intrathecal injection of chemotherapy into the cerebrospinal fluid compartment since systemic chemotherapy penetrates poorly to the central nervous system. Here we report an interesting clinical observation involving a patient presenting with leptomeningeal spread of breast cancer causing extensive spinal cord compression with obliteration of the subarachnoid space, thus precluding the use of direct intrathecal chemotherapy. We administered systemic chemotherapy using weekly docetaxel with complete radiographic resolution of her disease and recovery from clinical spinal cord compression. While this is a single clinical observation, weekly administration of docetaxel in this circumstance may have been associated with improved drug "escape" into the central nervous system and better antitumor effect. Because leptomeningeal disease is typically a late event in metastatic breast cancer, resistance to therapeutic intervention may reflect intrinsically resistant disease in the setting of extensive prior therapy rather than a routine problem with systemic drug delivery to the CNS. Studying patterns of disease relapse in patients who had received adjuvant weekly taxanes may provide insights into this hypothesis. PMID:22037782

Wilson, Bethany; Sapp, Christy; Abdeen, Ghadeer; Kamona, Atheel; Massarweh, Suleiman



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

PubMed Central

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

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



Federated Web-accessible Clinical Data Management within an Extensible NeuroImaging Database  

Microsoft Academic Search

Managing vast datasets collected throughout multiple clinical imaging communities has become critical with the ever increasing\\u000a and diverse nature of datasets. Development of data management infrastructure is further complicated by technical and experimental\\u000a advances that drive modifications to existing protocols and acquisition of new types of research data to be incorporated into\\u000a existing data management systems. In this paper, an

I. Burak Ozyurt; David B. Keator; Dingying Wei; Christine Fennema-Notestine; Karen R. Pease; Jeremy Bockholt; Jeffrey S. Grethe



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.



Systematic review of new medics' clinical task experience by country  

PubMed Central

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



Clinical experience with adolescent diabetes in a Nigerian teaching hospital.  

PubMed Central

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

Akanji, A. O.



Druy ureteral stent set: clinical experience in 25 patients.  


Clinical experience with a new universal-length silicone ureteral stent set is described. The technique for placing the stent is discussed in detail. The softness and universal length of the stent are important advantages over rigid stents. The set includes a peel-away sheath-introducing system, which allows for easy and rapid placement of a soft stent in most cases. Thirty-one stents have been placed since July 1985, with a mean follow-up of 17 weeks for 21 patients. There have been no stent malfunctions, and no significant complications have been encountered. PMID:3737912

Rozenblit, G; Tarasov, E; Srur, M F; Neithamer, C D; Sumers, E H; Sos, T A



[Professor OUYANG Qun's clinical experience on application of single point].  


The clinical experience of Professor OUYANG Qun in using single acupoint includes treatment of Meniere's syndrome with Baihui (GV 20), optic neuritis with "Fengyan" (Extra point), painful heel with Xiaguan (ST 7), lymphoid tuberculosis with Quchi (LI 11), acute sore throat with Kongzui (LU 6), painful diseases with "Luolingwu" (Extra point), chest distress with "Kuanxiong" (Extra point), hordeolum with Feishu (BL 13), headache in menstrual period with Xuehai (SP 10), frozen shoulder with Tiaokou (ST 38), toothache with Waihuaijian (Extra point), occipital pain with Chengshan (BL 57) and vomiting with Yongquan (KI 1). PMID:18085152

Huang, Yong; Chen, Jun-Qi



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



The Impact of Specific Prior Experiences on Infants' Extension of Animal Properties  

ERIC Educational Resources Information Center

We examined the influence of prior exposure to specific animal properties on 15-month-old infants' inductive generalization. Using picture books, 29 infants were trained on properties linked in a congruent or incongruent manner with four animal categories. A generalized imitation task was then administered to assess patterns of property extension

Furrer, Stephanie D.; Younger, Barbara A.



Implant-supported obturator overdenture for extensive maxillary resection patient: a clinical report.  


This clinical report presents an implant-retained obturator overdenture solution for a Prosthodontic Diagnostic Index Class IV maxillectomy patient with a large oronasal communication and severe facial asymmetry, loss of upper lip and midfacial support, severe impairment of mastication, deglutition, phonetics, and speech intelligibility. Due to insufficient bone support to provide satisfactory zygomaticus implant anchorage, conventional implants were placed in the body of the left zygomatic arch and in the right maxillary tuberosity. Using a modified impression technique, a cobalt-chromium alloy framework with three overdenture attachments was constructed to retain a complete maxillary obturator. Patient-reported functional and quality of life measure outcomes were dramatically improved after treatment and at the two-year follow-up. PMID:20040025

Leles, Cláudio Rodrigues; Leles, José Luiz Rodrigues; de Paula Souza, Carlos; Martins, Rafael Ragonezi; Mendonça, Elismauro Francisco



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.

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



Mutuality: clinical and metapsychological potentials of a failed experiment.  


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

Castillo Mendoza, Carlos Alberto



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.

Bonifaz, Alexandro; Vaquez-Gonzalez, Denisse; Fierro, Leonel; Araiza, Javier; Ponce, Rosa Maria



Conformal Radiotherapy in the Treatment of Advanced Juvenile Nasopharyngeal Angiofibroma With Intracranial Extension: An Institutional Experience  

SciTech Connect

Purpose: To describe the results of conformal radiotherapy in advanced juvenile nasopharyngeal angiofibroma in a tertiary care institution. Methods and Materials: Retrospective chart review was conducted for 8 patients treated with conformal radiotherapy between 2006 and 2009. The median follow-up was 17 months. All patients had Stage IIIB disease with intracranial extension. Radiotherapy was considered as treatment because patients were deemed inoperable owing to extensive intracranial/intraorbital extension or proximity to optic nerve. All but 1 patient were treated with intensity-modulated radiotherapy using seven coplanar fields. Median (range) dose prescribed was 39.6 (30-46) Gy. Actuarial analysis of local control and descriptive analysis of toxicity profile was conducted. Results: Despite the large and complex target volume (median planning target volume, 292 cm{sup 3}), intensity-modulated radiotherapy achieved conformal dose distributions (median van't Reit index, 0.66). Significant sparing of the surrounding organs at risk was obtained. No significant Grade 3/4 toxicities were experienced during or after treatment. Actual local control at 2 years was 87.5%. One patient died 1 month after radiotherapy secondary to massive epistaxis. The remaining 7 patients had progressive resolution of disease and were symptom-free at last follow-up. Persistent rhinitis was the only significant toxicity, seen in 1 patient. Conclusions: Conformal radiotherapy results in good local control with minimal acute and late side effects in juvenile nasopharyngeal angiofibromas, even in the presence of advanced disease.

Chakraborty, Santam, E-mail: [Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh (India); Ghoshal, Sushmita; Patil, Vijay Maruti; Oinam, Arun Singh; Sharma, Suresh C. [Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh (India)



Clinicians' experiences of becoming a clinical manager: a qualitative study  

PubMed Central

Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers.



XGAP: a uniform and extensible data model and software platform for genotype and phenotype experiments  

PubMed Central

We present an extensible software model for the genotype and phenotype community, XGAP. Readers can download a standard XGAP ( or auto-generate a custom version using MOLGENIS with programming interfaces to R-software and web-services or user interfaces for biologists. XGAP has simple load formats for any type of genotype, epigenotype, transcript, protein, metabolite or other phenotype data. Current functionality includes tools ranging from eQTL analysis in mouse to genome-wide association studies in humans.



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.



Solar Dynamic Power System Concept: Terrestrial Experiences and Their Extension to Space Applications.  

National Technical Information Service (NTIS)

The characteristics of solar thermal concentration power systems for terrestrial applications are described. Designs and experiences on steam and gas solar plants and components are reported. Comparison of alternatives for use in solar dynamic power syste...

A. Lucifredi E. Ravina F. Repetto



[Use of Valtrac in digestive surgery. Initial clinical experience].  


Stapling instruments are being currently used for digestive or colorectal anastomoses with definite advantages. The authors report their initial clinical experience about BAR utilization to restore intestinal continuity after upper digestive and colorectal resections. The authors have been carried out 20 anastomoses on 18 patients: 11 males and 7 females. Eleven (61.1%) of them were affected with malignant neoplasms and in 9 cases were performed an urgency procedure. The colorectal and jejunal-jejunal anastomoses were performed, respectively, in 8 cases; gastric-jejunal and ileo-colic anastomoses, respectively, in 2. The satisfactory results obtained seem to demonstrate that the biofragmentable anastomotic ring constitutes a "safe" method of bowel junction of the whole digestive apparatus. PMID:9324675

Monaco, A; Moncelli, G; Gastaldi, L; Verna, C; Scifo, M; Nizia, R; Maio, C; Governato, L; Deirino, A; Mangione, F; Volterrani, P



Pedicled Thoracodorsal Artery Perforator Flap in Breast Reconstruction: Clinical Experience  

PubMed Central

Background: The thoracodorsal artery perforator (TDAP) flap has been described for reconstruction of the head and neck, trunk and extremities. Yet, its use as a pedicled flap in breast reconstruction has not gained wide popularity and has not been widely documented, especially not for complete breast reconstruction or in combination with expanders or permanent implants. The authors present their clinical experience with the thoracodorsal artery perforator flap in breast reconstruction. Methods: From February 2007 to February 2009, eighteen patients had breast reconstruction utilizing a TDAP flap. Retrospective analyzes of patient characteristics, breast history, clinical indications, complications and outcomes were performed. The follow-up period ranged from 1 to 17 months. Results: Eleven patients had complete breast reconstruction using a TDAP flap with simultaneous insertion of an expander or implant. Four cases were partial reconstruction to gain additional volume after previous breast reconstruction and the 3 other cases were reconstruction after lumpectomy. All flaps survived. Two case required evacuation of hematoma. One case had late extrusion of the expander after expansion in the previously irradiated tissue, requiring expander removal. There were no donor site complications. Conclusions: The TDAP flap has proven to be a reliable flap with minimal donor site morbidity. Patients who had radiation treatment prior to reconstruction with pronounced radiated chest skin changes might still benefit from additional tissue from the LD muscle.

Adler, Neta; Seitz, Iris A.; Song, David H.



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.

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



Genotyping and clinical characteristics of multidrug and extensively drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China  

PubMed Central

Background There is a lack of information on the clinical characteristics of multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR) TB in the Jiangxi Province of China; furthermore, data have not been reported on the utility of mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analyses in genotyping Mycobacterium tuberculosis strains isolated from this region. The aim of this study was to analyse the clinical features of patients with MDR and XDR TB from Jiangxi Province and to evaluate the discriminatory power of the 15-loci MIRU-VNTR method. Methods A retrospective study was conducted on patients diagnosed with MDR and XDR TB at the Jiangxi Chest Hospital from July 2010 to June 2011. The RD105 deletion-targeted multiplex PCR (DTM-PCR) and the 15-loci MIRU-VNTR method were used to determine the genetic background of the identified MDR and XDR M. tuberculosis clinical isolates. Results Of 804?M. tuberculosis clinical isolates, 159 (159/804, 19.8%) of the isolates were identified as MDR with first-line drug susceptibility testing. Of the 123 available MDR isolates, 13 (13/123, 10.6%) were XDR. The RD105 deletion-targeted multiplex PCR method identified 85 (85/110, 77.3%) MDR and 12 (12/13, 92.3%) XDR isolates as the Beijing genotype. MIRU-VNTR cluster analysis demonstrated that 101 MDR and 13 XDR strains had unique genotype patterns; the remaining 9 MDR strains were in 4 clusters, namely 1 cluster with 3 strains and 3 clusters with 2 strains, resulting in a low clustering rate (4.06%). The Hunter-Gaston discriminatory index (HGDI) of the 15-loci MIRU-VNTR method was as high as 0.992. In addition, clinical surveys showed that 87 (87/110, 79.1%) MDR TB patients and 10 (10/13, 76.9%) XDR TB patients had been previously treated. Diabetes mellitus was the most common comorbidity in both MDR TB (16/110, 14.5%) and XDR TB (2/13, 15.4%) patients. Conclusions Based on our preliminary data, the MDR and XDR M. tuberculosis clinical isolates identified at the Jiangxi Chest Hospital were genetically diverse and clustered at a low frequency. The 15-loci MIRU-VNTR method showed high discriminatory power and may be used as a first-line genotyping tool in investigating the molecular epidemiology of M. tuberculosis in Jiangxi, China. Decisive measures are urgently needed to effectively prevent and manage MDR and XDR tuberculosis in this province.



Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital  

PubMed Central

Purpose Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. Methods We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. Results The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. Conclusion Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Jung, Soo Jung; Kim, Jun Hyun; Kong, Pil Sung; Kim, Kyung Ha; Bae, Sung Woo



The solar dynamic power system concept: Terrestrial experiences and their extension to space applications  

Microsoft Academic Search

The characteristics of solar thermal concentration power systems for terrestrial applications are described. Designs and experiences on steam and gas solar plants and components are reported. Comparison of alternatives for use in solar dynamic power systems (photovoltaic, solar dynamic, nuclear) shows an intermediate range of power where a potential exists for the use of solar dynamic systems adopting parabolic dish

A. Lucifredi; E. Ravina; F. Repetto



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



Initial Clinical Experience with Contrast-Enhanced Digital Breast Tomosynthesis  

PubMed Central

RATIONALE and OBJECTIVES Contrast-enhanced digital mammography and digital breast tomosynthesis are 2 imaging techniques that attempt to increase malignant breast lesion conspicuity. The combination of these into a single technique, contrast-enhanced digital breast tomosynthesis (CE-DBT), could potentially integrate the strengths of both. The objectives of this study were to assess the clinical feasibility of CE-DBT as an adjunct to digital mammography, and to correlate lesion enhancement characteristics and morphology obtained with CE-DBT to digital mammography, ultrasound, and magnetic resonance (MR). MATERIALS and METHODS CE-DBT (GE Senographe 2000D, Milwaukee, WI) was performed as a pilot study in an ongoing NCI-funded grant (P01 CA85484) studying multimodality breast imaging. 13 patients with ACR BI-RADS category 4 or 5 breast lesions underwent imaging with digital mammography, ultrasound, MR, and CE-DBT. CE-DBT was performed at 45-49 kVp with a rhodium target and a 0.27 mm copper (Alfa Aesar, Ward Hill, MA) filter. Pre- and post-injection DBT image sets were acquired in the MLO projection with slight compression. Each image set consists of 9 images acquired over a 50° arc and was obtained with a mean glandular x-ray dose comparable to two conventional mammographic views. Between the pre- and post-contrast DBT image sets, a single bolus of iodinated contrast agent (1 ml/kg at 2 ml/s; Omnipaque-300, Amersham Health Inc., Princeton, NJ) was administered. Images were reconstructed using filtered-backprojection in 1 mm increments, and transmitted to a clinical PACS workstation. RESULTS Initial experience suggests that CE-DBT provides morphologic and vascular characteristics of breast lesions qualitatively concordant with that of digital mammography and MR. CONCLUSION As an adjunct to digital mammography, CE-DBT may be a potential alternative tool for breast lesion morphologic and vascular characterization.

Chen, Sara C.; Carton, Ann-Katherine; Albert, Michael; Conant, Emily F.; Schnall, Mitchell D.; Maidment, Andrew D. A.



Long-term experience with pravastatin in clinical research trials.  


Pravastatin is a new lipid-lowering drug belonging to the class of 3-hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase inhibitors. Since 1986, more than 15,000 patients have received pravastatin in sponsored clinical research trials with more than 21,000 cumulative patient-years of exposure to the drug. Analysis of long-term follow-up data from 1142 patients participating between 1986 and 1990 in six core randomized clinical trials in the United States confirms the favorable safety profile of pravastatin. Rash, gastrointestinal complaints, musculoskeletal pain, and elevations in liver transaminase levels, whether or not attributed to treatment, were the most common reasons for patients withdrawing from these trials. Ophthalmologic monitoring revealed no adverse effects on the crystalline lens. Safety assessments continue for two core trials in more than 400 patients with up to 7 years of continuous follow-up. The effects of pravastatin on serum cholesterol levels are not influenced by the age, sex, weight, or initial cholesterol level of the patient. Vitamin E, A, and D metabolism remain normal during treatment. Combination therapy with pravastatin and bile-acid-binding resins or niacin is well tolerated, with additive effects on low-density lipoprotein cholesterol. There is limited experience with the combination of pravastatin and gemfibrozil or cyclosporine. An ongoing arteriosclerosis research program with more than 21,000 patients enrolled will further define the long-term safety of pravastatin and its effects on atherosclerosis progression, as well as its role in the primary and secondary prevention of coronary heart disease. PMID:8458055

McGovern, M E; Mellies, M J



Clinical and laboratory experience of chorionic villous sampling in Nigeria.  


Background: Chorionic villous sampling is a first trimester invasive diagnosis procedure that was introduced in Nigeria < 2 decades ago. Objective: The objective of the following study is to review experience with chorionic villous sampling in relation to clinical and laboratory procedures, including general characteristics of women, indications and outcome, complications, laboratory analysis and learning curve. Materials and Methods: Descriptive study of chorionic villous samplings between 2005 and 2012. Clinical and laboratory data were extracted from records. The women had trans-abdominal or trans-cervical procedure after counseling. Deoxyribonucleic acid extraction was by boiling method and molecular diagnosis by restriction fragment length polymorphism or quantitative fluorescence polymerase chain reaction. Analyzed data were presented using simple frequency tables. Results: A total of 426 women were analyzed. The major indications were Sickle cell anemia (97.2%), gender determination (1.9%) and aneuploidy (0.7%) respectively. Most procedures (71.2%) were done between 11 +0 and 13 +6 weeks by trans-abdominal approach (88.7%). Overall success at the first sampling was 98.8%. Error in laboratory diagnosis recorded in 3 (0.7%) pregnancies, while 5 (1.2%) were reanalyzed due to maternal decidua/inadequate fetal sample (0.7%) or failure of amplification (0.5%) respectively. Primary sex ratio was 5 (XY): 3 (XX). Down syndrome was the most common aneuploidy diagnosed with a detection rate of 66.7%. Learning curve was evident from reducing the incidence of abortion, number of aspirations and increasing success at the first attempt and villi yield. Conclusion: The present study shows acceptance and utilization of chorionic villus sampling and also demonstrates its safety and reliability. PMID:24909479

Oloyede, O A; Olaide, A; Onyinye, N



Telephotography in trauma: a 2-year clinical experience.  


Abstract Introduction: Smartphones can be used to record and transmit high-quality clinical photographs. The aim of this study was to describe our experience with smartphone telephotography in the care of trauma patients. We hypothesized that smartphone telephotography can be safely and effectively implemented on a trauma service. Subjects and Methods: We performed a 2-year (January 2011-December 2012) prospective analysis of all patient photographs recorded by members of our trauma team at our Level I trauma center. All members of the trauma team recorded patient photographs and e-mailed them to a secure e-mail account. An administrative assistant uploaded a copy of each photgrapho into the patient's electronic medical record. We assessed the number of photographs collected and uploaded, as well as the success, failure, and complication rates. Results: Our trauma team sent 7,200 photographs to a secure e-mail account. Of those, 6,120 (85%) were considered, after an initial review, to be of good quality. Of these, 3,320 photographs (54%) were successfully uploaded into a patient's electronic medical record; the remaining 2,800 photographs lacked adequate labeling and could not be uploaded. The average interval to uploading was 3 months. In total, 10 photographs were uploaded into the wrong patient's electronic medical record, for an error rate of 0.003%. We received only three complaints during the study period. Conclusions: Telephotography can be safely and effectively implemented in trauma clinical practice. Fears of Health Insurance Portability and Accountability Act violations are not valid, as the incidence of patient complaints is minimal when telephotography is implemented under strict guidelines and rules. Dedicated administrative personnel are essential for effective implementation of smartphone photography. PMID:24443926

Joseph, Bellal; Pandit, Viraj; Wynne, Julie; Aziz, Hassan; Tang, Andrew; Kulvatunyou, Narong; Webster, Arvie; O'Keeffe, Terence; Ziemba, Michelle; Friese, Randall S; Weinstein, Ronald S; Rhee, Peter



Comparison of Efficacy of Regional and Extensive Clinical Target Volumes in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma  

SciTech Connect

Purpose: To compare and analyze the effect of different clinical target volumes (CTVs) on survival rate after postoperative radiotherapy (RT) for esophageal squamous cell carcinoma (SCC). Methods and Materials: We studied 102 patients who underwent postoperative RT after radical resection for esophageal SCC (T3/4 or N1). The radiation dose was {>=}50 Gy. In the extensive portal group (E group, 43 patients), the CTV encompassed the bilateral supraclavicular region, all mediastinal lymph nodes, the anastomosis site, and the left gastric and pericardial lymphatic. In the regional portal group (R group, 59 patients), the CTV was confined to tumor bed and the lymph nodes in the immediate region of the primary lesion. The 1-, 3-, and 5-year survival rates were compared between the groups, and multivariate/univariate analysis for factors predicting survival was studied. Results: For the entire group, the 1-, 3- and 5-year survival rates were 76.3%, 50.5%, and 42.9%, respectively (median survival, 30 months). The 1-, 3-, and 5-year survival rates were 76.5%, 52.1%, and 41.3%, respectively, in the E group and 76.2%, 49.2%, and 44.6%, respectively, in the R group (not significant). According to the multivariate analysis, N stage, number of lymph nodes with metastatic disease, and tumor length were the independent prognostic factors for survival. Conclusions: Using a regional portal in postoperative RT for esophageal SCC is not associated with compromised survival compared with extensive portal RT and therefore should be considered. N stage, number of affected lymph nodes, and tumor length predict poor survival.

Qiao Xueying; Wang Wei; Zhou Zhiguo [Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang (China); Gao Xianshu [Department of Radiation Oncology, Peking University First Hospital, Beijing (China); Chang, Joe Y. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail:



Prospective clinical experience with research biopsies in breast cancer patients.  


There are ethical concerns regarding the performance of biopsies in patients for research purposes. We examined our single-institution experience regarding acceptance, safety, and success rate with research biopsies in patients with breast cancer. Among patients with data from paired samples, receptor status agreement between primary and metastatic samples was examined, either on first recurrence or after progression on one or more lines of therapy. An IRB-approved prospective study at the Dana-Farber Cancer Institute collects research biopsies as additional passes at the time of a clinical biopsy (AB, additional biopsy) or as a separate procedure for banking purposes (RPOB, research purposes only biopsy). Biopsies are not linked to a specific therapeutic or correlative trial. Grade 2-5 adverse events are prospectively collected. 151 patients were included in the analytic cohort (total procedures = 161); 80.8 % underwent AB, 17.2 % underwent RPOB, and 2.0 % underwent both AB and RPOB. Most patients were white (88.7 %) with a performance status of 0-1 (94.0 %). 96.0 % of patients underwent a biopsy in the setting of known or suspected metastatic disease. Receptor status between primary cancer and recurrent research biopsies differed in 43.2 % of patients with available data (18.8 % among patients who underwent the research biopsy before any systemic treatment, 48.1 % after treatment). Tissue was successfully collected in 92.3 % of patients undergoing AB and 100 % patients undergoing RPOB. Only three (2.0 %) patients had adverse events ? grade-2: one grade-2 pain; one grade-2 pneumothorax; and one grade-3 pain. Our experience suggests research biopsies can be performed safely with a high rate of successful tissue collection. Consistent with previous reports we found a high rate of discordance between primary and metastatic samples, which was even higher among treated patients. This supports continued efforts to study tissue samples at multiple points in a patient's disease course. PMID:24113744

Vaz-Luis, Ines; Zeghibe, Catherine A; Frank, Elizabeth S; Sohl, Jessica; Washington, Kimberly E; Silverman, Stuart G; Fonte, Joseph M; Mayer, Erica L; Overmoyer, Beth A; Richardson, Andrea L; Krop, Ian E; Winer, Eric P; Lin, Nancy U



Students' experiences of learning manual clinical skills through simulation.  


Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students' experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten third-year undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision™, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in three themes: what the students learn, how the students learn, and the simulator's contribution to the students' learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection. PMID:22395307

Johannesson, Eva; Silén, Charlotte; Kvist, Joanna; Hult, Håkan



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.



Mobile Computed Tomography : Three Year Clinical Experience in Korea  

PubMed Central

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

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



The Effects of an Institutional Clinical Experience on Pharmacy Student Professional Status Perceptions  

ERIC Educational Resources Information Center

Senior pharmacy students' perceptions prior to and after clinical experience were examined as they rated the occupations of BS pharmacist, PharmD pharmacist, physician, and nurse in one of three teaching hospitals in which the clinical course was conducted. The clinical experience did not significantly change students' previous perceptions. (LBH)

McCook, William M.; Speranza, Kenneth A., Sr.



New p+C data in fixed target experiments and the muon component in extensive air showers  

NASA Astrophysics Data System (ADS)

The interpretation of extensive air shower (EAS) measurements is strongly dependent on the hadronic interaction models used for simulating reference showers. We study the importance of low-energy hadronic interactions in simulated air showers, generated with the simulation package CORSIKA, for the observed characteristics of extensive air showers. In particular we investigate in detail the energy and the phase space regions of secondary particle production which are most important for muon production. This phase space region is covered by fixed target experiments at CERN. In the second part of this work we present preliminary momentum spectra of secondary ? and ? in p+C collisions at 12 GeV/c measured with the HARP spectrometer at the PS accelerator at CERN. In addition we use the new p+C NA49 data at 158 GeV/c to check the reliability of hadronic interaction models for muon production in EAS. Finally, possibilities to measure relevant quantities of hadron production in existing and planned accelerator experiments are discussed.

HARP Collaboration; Blümer, J.; Engel, R.; Haungs, A.; Roth, M.



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.

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.



Preliminary Results From the Serpentinite, Extension and Regional Porosity Experiment Across the Nicaraguan Trench (SERPENT)  

NASA Astrophysics Data System (ADS)

Water plays an important role in the volcanic processes occurring at convergent margins, as the release of water from the downgoing slab affects the rheology of the mantle, increases melting by lowering the solidus temperature, and alters the chemistry of arc-lavas. Yet, one of the major uncertainties in terms of fluid inputs into the subduction factory concerns the extent of serpentinization of the oceanic upper mantle and the volumes of water that are being carried into the subduction system through this route. In April 2010 we conducted a large-scale marine electromagnetic experiment along a 300 km profile offshore Nicaragua in a region that shows evidence for substantial fault related fluid circulation in the crust and possibly upper mantle, and high Ba/La ratios and water contents in adjacent onshore volcanics that suggest a strong slab fluid input into the arc-melting. Our project is the largest combined controlled-source electromagnetic (CSEM) and magnetotelluric (MT) data set ever collected on an active subduction zone. During the single 28 day research cruise aboard the R/V Melville we collected 54 stations of broadband marine magnetotelluric (MT) data and deep-towed nearly 800 km of controlled-source electromagnetic (CSEM) data. Robust multiple-station array processing of the MT data yields high quality MT responses from 10 to 20,000 s period. The MT responses are fairly 1D over the abyssal plain, showing the effects of a thin veneer of conductive sediments overlying a resistive lithosphere and a deeper conductive mantle. The responses become strongly 2D on the trench outer rise and exhibit large 3D distortions at the bottom of the trench, likely due to a combination of effects from severe topography and seafloor conductivity variations. Two circular CSEM tows of 30 km radius were measured by special long-wire EM (LEM) sensors on the abyssal plain and the outer rise. The LEM data reveals a distinct pattern of electromagnetic polarization that is characteristic of mantle transverse anisotropy. Since the conductive axis is aligned with the fossil ridge-parallel direction and reactivated normal faults in the trench, we interpret this to be caused by conductive serpentinized mantle penetrating faults. Conventional CSEM data recorded at a broad suite of transmission frequencies along the 300 km long profile and a 50 km along strike profile provide constraints on crustal conductivity variations. The analysis of these data is ongoing and will provide a comprehensive picture of the electrical conductivity structure from the seafloor to the upper mantle, representing the entire input into this part of the Central American subduction system. Since conductivity is highly dependent on thermal structure, crack porosity and the presence of serpentinite, our experiment will provide constraints on the depth of active fluid circulation within the oceanic crust and mantle, the variation of fluid circulation with distance from the trench and hence with the degree of plate bending, and the extent of dewatering of the subducting slab in the shallow portion of the mantle wedge.

Key, K. W.; Constable, S.; Evans, R. L.; Naif, S.; Matsuno, T.; Lizarralde, D.



[Nursing students' perceptions of the factors in the field of general clinical experience which facilitate learning].  


Learning through clinical experience forms an integral part of student nurses' academic and professional foundation. The extent to which learning is facilitated for student nurses is determined by the structuring of the field of clinical experience as well as by student nurses' perception of the field of clinical experience. The purpose of this study is to determine student nurses' perception of factors in the field of general clinical experience which facilitate learning. Literature pertaining to factors in the field of general clinical experience which impact on the learning by students was studied. A descriptive, exploratory survey was done through the medium of a questionnaire completed by B.Cur-students. The results of this study indicate, despite the fact that student nurses experience some aspects pertaining to learning in the general clinical field negatively, their overall impression is positive and favourable. Factors restraining learning were identified. Recommendations are made to counter the restraining factors. PMID:9791346

van Velden, C E; van Wyk, N C; van Niekerk, S E



Clinical governance development: learning from the New Zealand experience.  


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

Gauld, Robin



Learning to Practice: The Design of Clinical Experience in Teacher Preparation  

NSDL National Science Digital Library

Few would disagree that clinical experience is critical for teacher development. Teaching is, after all, a demanding clinical practice, requiring teachers to orchestrate complex classroom interactions designed to help children learn. While clinical practice rests on a body of professional knowledge, ultimately teachers need to be able to put this knowledge to use in practice. Clinical experiences during professional education provide opportunities for teachers to develop and hone their craft.

Grossman, Pam



Clinical Interdisciplinary Health Team Care: An Educational Experiment.  

ERIC Educational Resources Information Center

Patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting are described. Questions are raised concerning the effect of clinical teams on the quality of patient care, cost-effectiveness, etc. (Author/MLW)

And Others; Mazur, Harold



Managing Medical Images and Clinical Information: InCor's Experience  

Microsoft Academic Search

Patients usually get medical assistance in several clinics and hospitals during their lifetime, archiving vital information in a dispersed way. Clearly, a proper patient care should take into account that information in order to check for incompatibilities, avoid unnecessary exams, and get relevant clinical history. The Heart Institute (InCor) of Satildeo Paulo, Brazil, has been committed to the goal of

Sérgio Shiguemi Furuie; Marina S. Rebelo; Ramon Alfredo Moreno; Marcelo Santos; Nivaldo Bertozzo; Gustavo H. M. B. Motta; Fabio A. Pires; Marco Antonio A. Gutierrez



Femtosecond laser eye surgery: the first clinical experience  

NASA Astrophysics Data System (ADS)

A brief review of commercial applications of femtosecond lasers in a clinical setting with emphasis on applications to corneal surgery is presented. The first clinical results of 208 procedures conducted from June to November 2000 is reported. The results show that femtosecond lasers may be safely used as keratome for use in LASIK procedures.

Juhasz, Tibor; Kurtz, Ron M.; Horvath, Christopher; Suarez, Carlos G.; Nordan, Lee; Slade, Steven



Experience with a Family-Practice-Resident-Directed Obstetrical Clinic.  

ERIC Educational Resources Information Center

At Toledo Hospital, family practice residents have assumed responsibility for the normal obstetrics clinic. Specialty consultations are provided by the hospital's obstetrics residency program. A medical audit of the clinic indicates that the family practice residents obtained consultations and made referrals at the appropriate times. (JMD)

Hunter, Jerry L.; Snyder, Frank



Experience with school-based interventions against soil-transmitted helminths and extension of coverage to non-enrolled children.  


This paper reviews the experience with school-based interventions against soil-transmitted helminths with regard to reduction in prevalence, intensity of infection and morbidity. It also examines the existing experience with coverage of school-based programmes to non-enrolled children. However, as this experience is limited, the paper also seeks to give an overview of the need for school control programmes to include other segments of the community. The experiences from the programmes indicate that treatment should be performed twice or thrice yearly without prior diagnosis, should be school-based and involving schoolteachers assisted by health staff, if possible. The drugs of choice are a single dose of 400 mg albendazole or 500 mg mebendazole. If intensities of Trichuris trichiura or hookworm infections are high, a double or triple dose of one of these drugs could be considered to maximise reduction in intensities. For the benefit of growth and iron status, it should be considered to supplement with iron and other micronutrients. School-based programmes should include non-enrolled school age children and pre-school children, and the system of having 'treatment days' at school, where these groups are invited for treatment, seems to be a promising strategy. While antenatal clinics have been involved in the anthelminthic treatment of pregnant women, they have not covered non-pregnant adolescent girls and women. These could be offered treatment through the 'treatment days' at school mentioned earlier. PMID:12745142

Olsen, Annette



Experience with validation of clinical trial materials: an inspector's viewpoint.  


The new EU directive now states quite clearly that GMP applies to Clinical Trials Manufacturers and implicit in this is process validation. Although it is generally accepted that full process validation may not be possible at Clinical Trails, there are many areas which can and should be validated, and certainly when a product is administered to patients. It is also noteworthy that Annex 13 is currently being revised and this has implications with regard to validation, especially of equipment and facilities. PMID:14620849

Wolfe, L



Clinical and Field-based Experiences To Prepare Teachers for Wholistic Practice.  

ERIC Educational Resources Information Center

Care must be taken to ensure that students in teacher preparation programs are prepared to benefit maximally from field experiences. A curriculum that provides prerequisite knowledge, contrived teaching experiences on campus, proper sequencing of experiences, and balance between formal instruction and field experience is needed. Clinical and…

Clarken, Rodney H.


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

ERIC Educational Resources Information Center

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

Baecher, Laura



Second Life ® as a Clinical Conference Environment: Experience of Students and Faculty  

Microsoft Academic Search

The purpose of this article is to discuss the students’ and faculty members’ experience of using Second Life® during a psychiatric mental health clinical conference. The clinical conference is explained, as well as the process in which students were oriented to the use of Second Life. The students’ and faculty members’ experience, obstacles encountered, and lessons learned are also presented.

Melinda Hermanns; Carol Kilmon


Our Experience in a Psychodermatology Liaison Clinic at Manipal, India  

PubMed Central

Psychodermatology is an emerging specialty in dermatology which deals with the interactions between mind and skin. Psychocutaneous diseases can be either primary psychiatric or primary cutaneous, with various degrees of associations between psyche and skin. Unless the dermatologist cultivates a special interest in this field, many an invisible mental disorder may be missed leading to sub optimal treatment of the visible skin condition. Though Dermatology Psychiatry liaison clinics are common in Europe and other western countries, it is just an emerging concept in India. Here we describe the working pattern of psychodermatology liaison clinic established in Manipal in August 2010 and describe briefly the type of cases attended to.

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



Influence of Clinical Experience and Productivity on Emergency Medicine Faculty Teaching Scores  

PubMed Central

Background Commonly cited barriers to effective teaching in emergency medicine include lack of time, competing demands for patient care, and a lack of formal teaching experience. Teaching may be negatively affected by demands for increased clinical productivity, or positively influenced by clinical experience. Objective To examine the association between faculty teaching scores and clinical productivity, years of clinical experience, and amount of clinical contact with resident physicians. Methods We conducted a retrospective, observational study with existing data on full-time faculty at a high-volume, urban emergency medicine residency training program for academic year 2008–2009. Residents rated faculty on 9 domains of teaching, including willingness to teach, enthusiasm for teaching, medical knowledge, preparation, and communication. Clinical productivity data for relative value units per hour and number of patients per hour, years of clinical experience, and annual clinical hours were obtained from existing databases. Results For the 25 core faculty members included in the study, there was no relationship between faculty teaching scores and clinical productivity measures (relative value units per hour: r2??=??0.01, P??=??.96, patients per hour: r2??=??0.00, P??=??.76), or between teaching scores and total clinical hours with residents (r2??=??0.07, P??=??.19). There was a significant negative relationship between years of experience and teaching scores (r2??=??0.27, P?clinical productivity or amount of clinical contact with residents. Teaching scores were inversely related to number of years of clinical experience, with more experienced faculty earning the lowest teaching scores. Further study is necessary to determine if there are clinical measures that identify good educators.

Clyne, Brian; Smith, Jessica L.; Napoli, Anthony M.



Cleveland Clinic experience with interstitial laser coagulation of the prostate  

NASA Astrophysics Data System (ADS)

Transurethral resection of the prostate (TURP) has long been considered the gold standard therapy for benign prostatic hyperplasia (BPH). The problems associated with the TURP, which have been extensively described, include significant bleeding, TUR syndrome, incontinence, stricture, bladder neck contracture, and sexual dysfunction. The desire for simpler, less morbid alternative therapies to TURP has led to an eruption of research and development in the last decade. This is fueled by the continued research for more economical alternatives in our current high cost health care system.

Ulchaker, James C.; Ng, Christopher S.; Palone, David; Angie, Michelle; Kursh, Elroy D.



Clinical experience and acceptability of the etonogestrel subdermal contraceptive implant  

Microsoft Academic Search

Objective: To evaluate efficacy, adverse effects, and user continuation rate of an etonogestrel subdermal single-rod contraceptive implant. Methods: A total of 417 healthy volunteers of childbearing age were included in this multicenter trial. After implant insertion, the women were followed up during the 3 years of contraceptive action. At each visit, clinical findings, side effects, and bleeding patterns were recorded.

J. B. Otero Flores; M. Lozano Balderas; M. Cortés Bonilla; L. Vázquez-Estrada



Geriatric hip fracture clinical pathway: the Hong Kong experience  

PubMed Central

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

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



Antenatal noninvasive DNA testing: clinical experience and impact.  


Background?Nearly two decades ago, the discovery of circulating cell-free fetal DNA in maternal blood created a paradigm shift in prenatal testing. Recent advances in DNA sequencing technology have facilitated the rapid translation of DNA-based testing into clinical antenatal care. Content?In this review, we summarize the technical approaches and current clinical applications of noninvasive testing using cell-free DNA in maternal plasma. We discuss the impact of these tests on clinical care, outline proposed integration models, and suggest future directions for the field. Summary?The use of cell-free DNA in maternal blood for the detection of fetal rhesus D antigen status, fetal sex, and common whole chromosomal aneuploidies is now well established, although testing for aneuploidy is still considered screening and not diagnostic. Further advances in technology and bioinformatics may see future clinical applications extend to the noninvasive detection of fetal subchromosomal aneuploidy, single gene disorders, and the entire fetal genome. PMID:24683075

Ferres, Millie A; Hui, Lisa; Bianchi, Diana W



rHuEPO and Treatment Outcomes: the Clinical Experience  

Microsoft Academic Search

Increasingly, anemia is being recognized as a negative prognostic and predictive factor for patients undergoing chemotherapy, radiation therapy, or a combination of these treatment modalities. The results of clinical studies have shown correlations between anemia and shorter survival times in patients with a wide variety of solid tumors and hematologic malignancies, including lung, ovarian, breast, and head\\/neck cancers, non-Hodgkin's lymphoma,



Sick Sinus Syndrome: Experience of a Cardiac Pacemaker Clinic  

Microsoft Academic Search

Out of a pacemaker clinic population of 182 patients 21 (11·5%) were found to have the sick sinus syndrome. Their ages ranged from 30 to 80 years and averaged 62. Ischaemic heart disease was more commonly an aetiological factor than in patients with chronic atrioventricular heart block. Other aetiologies were familial cardiomyopathy, postcardiac surgery, and dystrophia myotonica.Cardioversion before pacemaker insertion

Dorothy J. Radford; D. G. Julian



The Clinical/Practicum Experience in Professional Preparation: Preliminary Findings  

ERIC Educational Resources Information Center

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

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



Clinical gait analysis by neural networks: issues and experiences  

Microsoft Academic Search

Clinical gait analysis is an area aiming at the provision of support for diagnoses and therapyconsiderations, the development of bio-feedback systems to train patients, and the recognition ofeffects of multiple diseases and still active compensation. The data recorded with ground reactionforce measurement platforms is a convenient starting point for gait analysis. We argue in favor ofusing the raw data from

Monika Köhle; Dieter Merkl; Josef Kastner



Review of cleveland clinic experience with penile fracture  

Microsoft Academic Search

Objectives. Fracture of the penis is an uncommon injury that results from trauma to the erect penis, usually during sexual intercourse. In some cases, the urethra is injured as well. To determine the outcome of immediate surgical management, we reviewed the cases of 8 patients with fracture of the penis who presented to the Cleveland Clinic from 1992 to 1998.Methods.

Amr F Fergany; Kenneth W Angermeier; Drogo K Montague



PACS archive upgrade and data migration: clinical experiences  

NASA Astrophysics Data System (ADS)

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

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



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.



Clinical experience in cell-based therapeutics: intervention and outcome  

Microsoft Academic Search

Disc herniation treated by discectomy results in a significant loss of nucleus material and disc height. Biological restoration\\u000a through the use of autologous disc chondrocyte transplantation (ADCT) offers a potential to achieve functional integration\\u000a of disc metabolism and mechanics. Nucleus regeneration using autologous cultured disc-derived chondrocytes has been demonstrated\\u000a in a canine model and in clinical pilot studies. In 2002

Hans Joerg Meisel; Timothy Ganey; William C. Hutton; Jeanette Libera; Yvonne Minkus; Olivera Alasevic



Nursing process documentation systems in clinical routine - prerequisites and experiences  

Microsoft Academic Search

Documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality and high writing efforts, are reported. However, it is still unclear if computer-based documentation systems can reduce these problems. At the Heidelberg University Medical Center, computer-based nursing process

Elske Ammenwerth; Ulrike Kutscha; Ansgar Kutscha; Cornelia Mahler; Ronald Eichstädter; Reinhold Haux



ART in Clinic of Infertility INTERMEDICA: 2 years experience  

Microsoft Academic Search

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

Anna Kaczmarek-Sroka; ?ukasz Sroka; Maciej Kurpisz



Clinical experience with monoclonal antibodies to epidermal growth factor receptor  

Microsoft Academic Search

Recent knowledge about the intermediate steps and final consequences of ligand-dependent epidermal growth factor receptor\\u000a (EGFR) activation has clearly supported the notion that EGFR plays a fundamental role in regulating the proliferation and\\u000a survival of malignant neoplasms. Among the rationally designed target-based therapeutics that are being assessed, those targeting\\u000a EGFR appear to be some of the most clinically relevant. The

Emiliano Calvo; Eric K. Rowinsky



Navigating a guide wire through total occlusions: clinical experience  

NASA Astrophysics Data System (ADS)

One of the last remaining frontiers in angioplasty interventions is successfully recanalizing arteries containing total occlusions. The primary limiting condition is the inability to pass a guide wire safely across the total occlusion to facilitate therapeutic interventions. The operator has to perform the intervention without the assistance of x-ray imaging to define the vessel's path since the contrast media flow is blocked by the occlusion. To overcome this limitation, a guide wire system has been developed that transmits low coherence near-infrared light through an optical fiber internal to the guide wire and illuminates the tissue adjacent the distal end. Differences in the scattering of near-infrared light by the normal arterial wall and occluding tissues are detected by optical coherence reflectometry (OCR) techniques. Through a real-time monitoring system and display, the physician is warned if the guide wire approaches the normal arterial wall, allowing the guide wire to be redirected to prevent perforating the vessel. The system has been used in clinical coronary angioplasty cases demonstrating the ability to cross 10 out of 11 total occlusions without any perforations or dissections. The OCR guide wire system has demonstrated clinical potential and will require additional testing for clinical efficacy claims.

Neet, John M.; Winston, Thomas R.; Hedrick, Allan D.; Koolen, Jaques J.; Bonnier, Hans



Unexploded ordnance detection experiments at extensive fully ground-truthed test sites at Yuma Proving Ground and Eglin AFB  

NASA Astrophysics Data System (ADS)

The US Army Research Laboratory (ARL), under the sponsorship of the Strategic Environmental Research and Development Program, is conducting experiments to establish and enhance the ability of low-frequency, ultra-wideband synthetic aperture radar (SAR) to detect and discriminate unexploded ordnance (UXO). Preliminary investigations using ARL's BoomSAR - a UWB radar mounted atop a mobile boom lift platform - concluded that the radar image texture and frequency-dependent scattering from mines and mine-like targets could be exploited in the development of automatic target detection algorithms. To support further investigations, ARL established extensive UXO test sites at the US Army Yuma Proving Ground, Arizona, and Eglin AFB, Florida. The soils at both test sties have been characterized in terms of physical, chemical and electromagnetic properties. Precise location, depth, and orientation information was recorded for each of the approximately 500 inert ordnance test targets at each site. This information helps researchers to better understand the phenomenology associated with UXO target scattering and to more accurately evaluate and modify data processing programs. The ultimate goal is to develop innovative automatic target detection algorithms that provide a high probability of detection with an acceptable false-alarm rate under varying environmental conditions and operational scenarios. This paper present details on the design and characterization of the two test sites and some initial results from BoomSAR data collections.

Deluca, Clyde C.; Marinelli, Vincent; Ressler, Marc A.; Ton, Tuan T.



The Chinese version of the Obsessive-Compulsive Inventory-Revised scale: Replication and extension to non-clinical and clinical individuals with OCD symptoms  

PubMed Central

Background The Obsessive-Compulsive Inventory-Revised (OCI-R) was designed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical samples. The aim of the study was to evaluate the psychometric properties of a Chinese version of this scale. Methods The Chinese version of the OCI-R was administered to both a non-clinical sample (209 undergraduate students) and a clinical sample (56 obsessive-compulsive disorder (OCD) patients). Confirmatory factor analysis was conducted to examine the construct validity of the OCI-R in the non-clinical sample. The internal consistency at baseline and test-retest reliabilities at 4-week interval was examined in both the non-clinical and clinical samples. Results The confirmatory factor analysis of the non-clinical sample confirmed a 6-factor model suggested by the original authors of the instrument (df = 120, RMSEA = 0.068, CFI = 0.88, NNFI = 0.85, GFI = 0.89). The internal consistency and test-retest reliability were at an acceptable range for both the non-clinical and clinical samples. The OCI-R also showed good clinical discrimination for patients with OCD from healthy controls. Conclusions The Chinese version of the OCI-R is a valid and reliable instrument for measuring OCD symptoms in the Chinese context.



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

PubMed Central

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

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



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


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

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



Transapical Transcatheter Aortic Valve Implantation in Humans Initial Clinical Experience  

Microsoft Academic Search

Background—Aortic valve replacement with cardiopulmonary bypass is currently the treatment of choice for symptomatic aortic stenosis but carries a significant risk of morbidity and mortality, particularly in patients with comorbidities. Recently, percutaneous transfemoral aortic valve implantation has been proposed as a viable alternative in selected patients. We describe our experience with a new, minimally invasive, catheter-based approach to aortic valve

Samuel V. Lichtenstein; Anson Cheung; Jian Ye; Christopher R. Thompson; Ronald G. Carere; Sanjeevan Pasupati; John G. Webb



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



Clinical experience with Zarzio® in Europe: what have we learned?  


Biosimilars are similar, but non-identical, versions of existing biological drugs for which patents have expired. Despite the rigorous approval process for biosimilars, concerns have been expressed about the efficacy and safety of these products in clinical practice. Biosimilars of filgrastim, based on the originator product Neupogen®, have been available since 2008 and are now in widespread clinical use in Europe and elsewhere. Three biosimilar G-CSFs have been approved based on a combination of physicochemical and biological protein characterisation, pharmacokinetic and pharmacodynamic assessment in healthy volunteers and efficacy and safety data in patients with cancer. To assess whether biosimilars are effective in the real-world clinical practice setting, a pooled analysis of five post-approval studies of biosimilar G-CSF (Zarzio®) that included 1,302 adult patients who received at least one cycle of chemotherapy with G-CSF support for the prevention of neutropenia was conducted. A total of 36 % of patients had a febrile neutropenia risk of >20 %, while 39.6 % had a risk of 10-20 % based on chemotherapy regimen. The occurrence of severe or febrile neutropenia was within the range of that observed in previous studies of originator G-CSF. In addition, the safety profile of Zarzio® was consistent with that reported for originator G-CSF and the known safety profile of G-CSF. Initial concerns about the use of biosimilars, at least with regard to biosimilar G-CSFs, appear to be unfounded. Adoption of cost-effective biosimilars should help reduce healthcare costs and improve patient access to biological treatments. PMID:23903799

Gascón, Pere; Tesch, Hans; Verpoort, Karl; Rosati, Maria Sofia; Salesi, Nello; Agrawal, Samir; Wilking, Nils; Barker, Helen; Muenzberg, Michael; Turner, Matthew



Experience of a Clinic for Afghan Refugees in Pakistan  

PubMed Central

Since the Soviets invaded Afghanistan in 1979, 3.5 to 4 million refugees have moved into Pakistan and Iran. Even before the war, the health status of the Afghans was extremely poor and the medical personnel limited. Various international efforts are attempting to cope with the health care needs of the refugees. Economic, language, and cultural problems hamper the projects. One clinic found the most common problems were of the gastrointestinal tract, then the respiratory tract, with a problem ranking similar to that of pre-war Afghanistan. Many of the health problems are linked to deficiencies in sanitation and nutrition.

Morgan, Walter A.



Madreporique stemmed total hip replacement: five years' clinical experience1  

PubMed Central

Between February 1975 and December 1980, 1214 total hip arthroplasties were performed with a new type of rough surface implant. The results, pitfalls and complications are presented with special reference to the first 173 cases which have had a complete clinical and radiological follow up for at least five years. The indications for operations in both primary and revision arthroplasties are defined. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 9.Figure 10.Figure 11.Figure 12. AFigure 12. BFigure 13. AFigure 13. B

Lord, Gerald A



Initial Clinical Experience Using the Amplatzer Vascular Plug  

Microsoft Academic Search

Background and purpose  The Amplatzer Vascular Plug (AVP) is a self-expanding nitinol wire mesh vascular embolization device derived from the Amplatz\\u000a septal occluder. We assessed the results of vascular embolization obtained using the AVP.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective review was carried out of 23 consecutive cases of vascular embolization using the AVP in a variety of different\\u000a clinical settings. The AVP was chosen

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



Radiosurgery for epilepsy: clinical experience and potential antiepileptic mechanisms  

PubMed Central

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

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



Lessons learned during 15 years of clinical information system experience.  


This article describes lessons learned during an initial intensive care unit point-of-care clinical information system implementation and subsequent expansions to other units and hospitals in a multihospital healthcare delivery system. Although the implementation and expansions were primarily successful, lessons learned include developing a broad base of support, making decisions through consensus, addressing conflict when it occurs, keeping user expectations realistic, preparing for the change process, implementing the computer information system in stages, challenging existing work processes, viewing the implementation as a process, and choosing a project leader with outstanding communication and group process skills in addition to technical skills. PMID:11477738

Miranda, D; Fields, W; Lund, K



A reappraisal of the clinical efficacy of nebulized flunisolide in pediatric asthma: the Italian experience.  


Flunisolide (FLU) is a synthetic corticosteroid with potent topical anti-inflammatory activity. Its oral bioavailability is poor (6.7%). After gastrointestinal and lung absorption, the drug undergoes rapid and extensive first-pass metabolism by the liver to an inactive 6beta-hydroxylated metabolite. Plasma half-life is estimated to be 3.9 to 4.6 hours. FLU has a low volume of distribution at steady state and a short terminal half-life after inhalation (96 L and 1.6 hour, respectively). FLU, like budesonide, has a short pulmonary residence time and it is hypothesized that it may undergo esterification in the cell due to the presence of a free hydroxyl group at C21. Nebulization may offer important advantages over other inhalation methods. Nebulizers allow drug delivery in very young children through passive inhalation, depending less on patient coordination and cooperation. Comparative studies indicate that FLU is nebulized to a better advantage than beclomethasone dipropionate and budesonide. This is attributed to its elevated water solubility. The aim of this article is to outline the factors that influence drug nebulization and the pharmacokinetics-pharmacodynamics of FLU compared to other inhaled corticosteroids. In addition, we report a series of clinical data regarding the efficacy of nebulized FLU with focus on the Italian experience. Overall, the physicochemical characteristics and pharmacokinetic profile of FLU favor its use for nebulization. Clinical data indicate that nebulized FLU is effective in asthma treatment in infants and children. Side effects were not reported at the commonly used doses. PMID:17883883

Kantar, Ahmad; Mroueh, Salman; Fiocchi, Alessandro



First clinical experiences with perampanel--the Kork experience in 74 patients.  


Perampanel (PER) has been approved for adjunctive treatment of partial-onset seizures in patients age 12 years and older. In Germany, PER was licensed and marketed in September of 2012. At our tertiary referral epilepsy center, a couple of difficult-to-treat patients were awaiting this introduction of PER; therefore, we were able to initiate treatment in many patients within a short period of time. For this report we collected and analyzed the data of the first patients who had been started on add-on PER between September and December of 2012, so that we were able to evaluate at least 6 months of treatment when we made this analysis. At cutoff in June of 2013, 74 patients could be analyzed. Mean age was 38.4 years (range 15-71 years). PER doses ranged from 4 to 14 mg (mean 8.8 mg). All patients took PER once daily at bedtime. Seventy-one patients had focal epileptic seizures; the remaining four patients had Lennox-Gastaut syndrome. Considering the last 3 months of observation compared with baseline, 34 patients (46%) were responders with a reduction of seizure frequency of at least 50%. Ten patients of these (14% of all) were seizure-free. Adverse events were reported in 40 patients (54%). Leading side effects were somnolence (n = 31, 42%) and dizziness (n = 13, 18%), followed by ataxia, irritability, falls, cognitive slowing, and depression in single cases. Six-month retention rate was 70%. Our first clinical experiences with add-on PER in a highly selected group of difficult-to-treat epilepsies are promising. PMID:24400693

Steinhoff, Bernhard J; Bacher, Matthias; Bast, Thomas; Kornmeier, Reinhold; Kurth, Christoph; Scholly, Julia; Staack, Anke M; Wisniewski, Ilona



First report of an extensively drug-resistant VIM-2 metallo-?-lactamase-producing Brevundimonas diminuta clinical isolate.  


In the literature, only three Brevundimonas diminuta environmental isolates carrying metallo-?-lactamase genes were recently published. However, so far, no B. diminuta clinical isolates carrying these carbapenem resistance genes have been described. Here we report the first VIM-2 metallo-?-lactamase-producing B. diminuta clinical isolate obtained from an immunocompromised patient. PMID:22692741

Almuzara, Marisa N; Barberis, Claudia M; Rodríguez, Carlos H; Famiglietti, Angela M R; Ramirez, Maria S; Vay, Carlos A



Clinical experience with microdialysis catheters in pediatric liver transplants.  


Ischemic vascular complications and rejection occur more frequently with pediatric liver transplants versus adult liver transplants. Using intrahepatic microdialysis catheters, we measured lactate, pyruvate, glucose, and glycerol values at the bedside for a median of 10 days in 20 pediatric liver grafts. Ischemia (n = 6), which was defined as a lactate level > 3.0 mM and a lactate/pyruvate ratio > 20, was detected without a measurable time delay with 100% sensitivity and 86% specificity. Rejection (n = 8), which was defined as a lactate level > 2.0 mM and a lactate/pyruvate ratio < 20 lasting for 6 or more hours, was detected with 88% sensitivity and 45% specificity. With additional clinical criteria, the specificity was 83% without a decrease in the sensitivity. Rejection was detected at a median of 4 days (range = 1-7 days) before alanine aminotransferase increased (n = 5, P = 0.11), at a median of 4 days (range = 2-9 days) before total bilirubin increased 25% or more (n = 7, P = 0.04), and at a median of 6 days (range = 4-11 days) before biopsy was performed (n = 8, P = 0.05). In conclusion, microdialysis catheters can be used to detect episodes of ischemia and rejection before current standard methods in pediatric liver transplants with clinically acceptable levels of sensitivity and specificity. The catheters were well tolerated by the children, and no major complications related to the catheters were observed. PMID:23193034

Haugaa, Håkon; Almaas, Runar; Thorgersen, Ebbe Billmann; Foss, Aksel; Line, Pål Dag; Sanengen, Truls; Bergmann, Gísli Björn; Ohlin, Per; Waelgaard, Lars; Grindheim, Guro; Pischke, Soeren Erik; Mollnes, Tom Eirik; Tønnessen, Tor Inge



Clinical experience with thalidomide and lenalidomide in multiple myeloma.  


Thal has antiangiogenic and immunomodulatory activity. Clinical research provided clear evidence that Thal belongs to the most active drugs for the treatment of multiple myeloma e.g. leading to decrease of monoclonal protein of at least 50 % in 30 % of patients with relapsed or refractory multiple myeloma. Randomized trials that were designed based on a large body of evidence from phase II trials determined that Thal significantly increases total response rate, progression-free and in some studies overall survival in combination regimens (dexamethason and or chemotherapy) for relapsed as well as newly diagnosed patients and was therefore approved for first-line treatment of Multiple Myeloma. Strict guidelines apply due to the teratogenic effects of Thal and to monitor and prevent other potential adverse events as neuropathy and thrombosis has been recognized by leading organizations as part of the treatment concept for patients with relapsed or refractory disease. The success of Thal has sparked the development of Thal analogues with Lenalidomide (Len) the most advanced compound which was approved for relapsed multiple myeloma. As Len has a lower incidence of polyneuropathy, constipation and somnolence compared to Thalidomid but at least equal if not higher efficacy Len is meanwhile used more frequently in clinical routine and has advantages in combination therapies with Bortezomib. Additional randomized studies will now define the status of Thal and Len for maintenance therapy and their optimal integration in multi-agent treatment regimen. PMID:22229246

Moehler, T



Clinical experiences in fungal keratitis caused by Acremonium  

PubMed Central

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

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



Differential diagnoses to MS: experiences from an optic neuritis clinic.  


Optic neuritis (ON) is closely linked to multiple sclerosis (MS). It may, however, also be associated to a range of autoimmune or infectious diseases. The purpose of this study was to assess the differential diagnoses in patients with suspected ON. In this retrospective study, we reviewed the files of all patients referred to the Clinic of Optic Neuritis, Glostrup Hospital, University of Copenhagen, Denmark, between January 2000 and November 2011. All patients were referred by ophthalmologists with possible ON. Patients diagnosed with MS prior to referral were excluded from the study. A total of 643 patients were included in the study. Apart from ON, the most frequent diagnoses were tumors (n = 15), ischemic or hypertensive neuropathies (n = 13), and retinal or choroid disorders (n = 9). Six patients were diagnosed with neuromyelitis optica. Rarer causes of visual loss were infections (n = 5), giant cell arteritis (n = 4), sarcoidosis (n = 3), thyrotoxicosis (n = 2), and hereditary or toxic neuropathies (n = 2). Nine percent of patients referred to the Clinic of Optic Neuritis had symptoms caused by medical, neurosurgical or ophthalmic disorders, and 0.9 % of our patients had NMO. Though most of these conditions are rare, it is of importance to keep them in mind upon encountering patients with symptoms of ON. PMID:24158275

Horwitz, Henrik; Friis, Tina; Modvig, Signe; Roed, Hanne; Tsakiri, Anna; Laursen, Bjarne; Frederiksen, Jette Lautrup



[Clinical experiences of interval treatment with dermatologic agents containing urea].  


Topical vehicles containing urea are increasingly used in dermatology because of their favorable pharmacological properties, which are due to the following capacities of urea: (1) its beneficial influence on the structure and physiology of the skin, and (2) its therapeutic effect in combination with other topically active agents in various skin diseases, such as psoriasis, ichthyosis, and chronic eczema. Our own experiences presented here are in accordance with these statements. PMID:2284833

Petres, J; Antal, I; Füzesi, S



Twelve years of clinical experience with lithium pulse generators.  


The clinical performance of 9,651 lithium pulse generators, which were implanted at our registry hospitals since 1973, was assessed by analysis of actuarial survival data and information obtained at the time of pacemaker failure. Cumulative survival estimates for all units were: 5 years, 94 percent, 7 years, 81 percent, 10 years, 62 percent. Discriminant actuarial analysis revealed no differences between lithium iodine and lithium cupric sulfide longevity. Battery depletion was found in 49.1 percent of 277 units subjected to detailed explant analysis, while 31 percent and 8.7 percent had component and hermetic seal defects, respectively. Of the pulse generators with battery depletion, all but two units exhibited normal end-of-battery life behavior. We conclude that the lithium iodine and lithium cupric sulfide batteries are safe, long-term energy sources; however, the impact of reduced battery size and dual chamber pacing on these performance parameters is unknown. PMID:2432547

Hauser, R G; Wimer, E A; Timmis, G C; Gordon, S; Staller, B; Klodnycky, M; Eisenhauer, A; Goren, C; Moran, J F; Davis, A A



Japanese experience with clinical trials of fast neutrons  

SciTech Connect

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

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



Japanese experience with clinical trails of fast neutrons  

SciTech Connect

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

Tsunemoto, H. (National Inst. of Radiological Sciences, Chiba-shi, Japan); Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.



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


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



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.

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



Assessing Research Participants' Perceptions of their Clinical Research Experiences  

PubMed Central

Introduction Participants’ perceptions of their research experiences provide valuable measures of ethical treatment, yet no validated instruments exist to measure these experiences. We conducted focus groups of research participants and professionals as the initial step in developing a validated instrument. Methods Research participants enrolled in twelve focus groups, consisting of: 1) individuals with disorders undergoing interventions or 2) in natural history studies; or 3) healthy volunteers. Research professionals participated in six separate groups of 1) IRB members, ethicists, Research Subject Advocates, 2) research nurses/coordinators, or 3) investigators. Focus groups used standard methodologies. Results 85 participants and 29 professionals enrolled at 8 academic centers. Altruism and personal relevance of the research were commonly identified motivators; financial compensation was less commonly mentioned. Participants were satisfied with informed consent processes but disappointed if not provided test results, or study outcomes. Positive relationships with research teams were valued highly. Research professionals were concerned about risks, undue influence, and informed consent. Conclusions Participants join studies for varied, complex reasons, notably altruism and personal relevance. They value staff relationships, health gains, new knowledge, and compensation, and expect professionalism and good organization. Based on these insights, we propose specific actions to enhance participant recruitment, retention and satisfaction.

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



Clinical Experience with the Bentall Procedure: 28 Years  

PubMed Central

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

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



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


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



Clinical Experience of an Iontophoresis Based Glucose Measuring System  

PubMed Central

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45±52.99 mg/dL with a mean absolute relative error of 20±15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p<0.05)) and this correlation was independent of time of data collection. However, after excluding confounding variables this correlation coefficient exhibited a tendency to increase. 98.9% of the results were clinically acceptable by Clarke error grid analysis. We concluded that RIGMD does not have the reliability and accuracy required to wholly replace conventional methods. However, further technical advancements that reduce its shortcomings would make this device useful for the management of diabetes.

Rhee, Sang Youl; Chon, Suk; Koh, Gwanpyo; Paeng, Jeong Ryung; Oh, Seungjoon; Woo, Jeong-taek; Kim, Sung Woon; Kim, Jin-Woo



Clinical experience with psychoanalytic post-termination meetings.  


The authors describe post-termination meetings in order to examine the controversial issue of the proper relationship between analyst and patient at this stage. In the first case the meetings facilitated the patient's re-entering treatment, leading to significant further growth. In the second and third cases, the meetings re-ignited mourning for the analyst and furthered analytic gains. The authors' overall impression was that the post-termination contacts were helpful for all three patients. Their limited data contradicted the long-standing assumption that all post-termination contact, unless specified as a course of further treatment, is harmful to the patient. The authors suggest that such meetings stabilise analytic gains, provide a joint assessment of analytic outcome from a useful later perspective and provide an opportunity for further analytic work. The consideration of any post-termination changes in the patient allows for a more inclusive evaluation of the analysis than was possible earlier. While acknowledging the need to consider such meetings thoughtfully in order to avoid any harmful enactment of wishes by the patient or the analyst, the authors encourage analysts to explore and report such meetings to replace unexamined assumptions and develop a body of clinical data about the effects of post-termination contacts. PMID:9513017

Schachter, J; Martin, G C; Gundle, M J; O'Neil, M K



A telepsychiatry transition clinic: the first 12 months experience.  


To improve the management of soldiers with combat-related mental health problems, an interdisciplinary telepsychiatry service was established between a clinic at the Fort Bragg army base and the Veterans Affairs (VA) Medical Center in Salem. In the first 12 months of operation, 120 soldiers (105 males) were seen in a total of 394 telepsychiatry sessions. The time spent on telepsychiatry by the six VA psychiatrists increased from 13 hours in the first month to 41 hours in the twelfth month. The number of telepsychiatry sessions increased from nine in the first month to 56 in the twelfth month. The mean global assessment of function score (GAF) in the soldiers increased significantly (P < 0.001) from 58.0 at intake to 62.3 at the last visit. Soldiers received VA telepsychiatry on average 22 days after the initial consultation with a primary care provider, a reduction of at least eight days compared to the previous delay. The majority of soldiers (89%) who were treated by VA psychiatrists enrolled in the VA within about six months of discharge. Similar VA-US Military collaborations may prove beneficial for other military bases that have returning combat soldiers. PMID:21844181

Detweiler, Mark B; Arif, Saira; Candelario, Joseph; Altman, Joanne; Murphy, Pamela F; Halling, Mary H; Detweiler, Jonna G; Vasudeva, Sachinder



Paradoxical vocal cord dysfunction: clinical experience and personal considerations  

PubMed Central

Summary Paradoxical vocal cord dysfunction is a nosographic entity that remains to be fully elucidated as far as concerns criteria required for diagnosis and underlying aetiopathogenesis. The disorder manifests with repeated episodes of acute dyspnoea associated with a series of symptoms that may include hoarseness, globus, chest pain and “shortness of breath”. A retrospective analysis of cases with acute dyspnoea referred to our Department between June 2004 and June 2005 revealed 3 patients with paradoxical vocal cord dysfunction. In 2 of these 3 cases, concomitant psychiatric morbidity was observed and the third also presented gastro-oesophageal reflux. In one patient, the episodes of dyspnoea were triggered by inspiration of irritating substances. Diagnosis of the condition requires a high level of suspicion, which is confirmed by a laryngoscopic investigation that demonstrates hyperadduction of the true vocal cords and a reduction of at least 50% in the breathing space. From a therapeutic point of view, patients with paradoxical vocal cord dysfunction require, in our opinion, a multidisciplinary approach; in fact, only a team comprising otorhinolaryngologists, phoniatricians, pulmonologists, neurologists, allergologists, psychotherapists and speech therapists is capable of defining the appropriate treatment according to the clinical and psychological characteristics of each individual patient. Our results with speech therapy, focused on respiratory and speech retraining, are reported.

Nacci, A; Fattori, B; Ursino, F; Rocchi, V; Matteucci, F; Citi, C; Bruschini, L; Rognini, F; La Vela, R; Dallan, I



Paradoxical vocal cord dysfunction: clinical experience and personal considerations.  


Paradoxical vocal cord dysfunction is a nosographic entity that remains to be fully elucidated as far as concerns criteria required for diagnosis and underlying aetiopathogenesis. The disorder manifests with repeated episodes of acute dyspnoea associated with a series of symptoms that may include hoarseness, globus, chest pain and "shortness of breath". A retrospective analysis of cases with acute dyspnoea referred to our Department between June 2004 and June 2005 revealed 3 patients with paradoxical vocal cord dysfunction. In 2 of these 3 cases, concomitant psychiatric morbidity was observed and the third also presented gastro-oesophageal reflux. In one patient, the episodes of dyspnoea were triggered by inspiration of irritating substances. Diagnosis of the condition requires a high level of suspicion, which is confirmed by a laryngoscopic investigation that demonstrates hyperadduction of the true vocal cords and a reduction of at least 50% in the breathing space. From a therapeutic point of view, patients with paradoxical vocal cord dysfunction require, in our opinion, a multidisciplinary approach; in fact, only a team comprising otorhinolaryngologists, phoniatricians, pulmonologists, neurologists, allergologists, psychotherapists and speech therapists is capable of defining the appropriate treatment according to the clinical and psychological characteristics of each individual patient. Our results with speech therapy, focused on respiratory and speech retraining, are reported. PMID:18198755

Nacci, A; Fattori, B; Ursino, F; Rocchi, V; Matteucci, F; Citi, C; Bruschini, L; Rognini, F; La Vela, R; Dallan, I



Clinical experience with continuous glucose monitoring in adults.  


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

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



Surgical management of coracoid fractures: technical tricks and clinical experience.  


The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures; surgical management may be warranted to avoid functional compromise or impingement. A direct approach through Langer's lines allows for easy exposure and direct visualization for an anatomic reduction of simple fractures through the shaft or base of the coracoid. An anterior approach for fractures that extend into the superior glenoid fossa allows for direct exposure to obtain an anatomic articular reduction and indirect reduction of the coracoid fracture. In cases where a complex glenoid or scapula neck/body fracture is being addressed simultaneously either a posterior Judet approach can be used with an indirect reduction method or a separate anterior approach must be combined to address it if not in continuity with the superior scapular segment. Implant selection, primarily interfragmentary screws or a buttress plate, should be based on the size of the fragment, the degree of comminution, and the degree of articular involvement to ensure adequate stabilization. The purpose of this manuscript was to describe a stepwise approach to the surgical management of displaced coracoid fractures, describe surgical tips and techniques, and to present the clinical outcomes in 22 patients after surgical treatment with this approach. PMID:24751608

Hill, Brian W; Jacobson, Aaron R; Anavian, Jack; Cole, Peter A



Surgical treatment of colon cancer: Colentina surgical clinic experience.  


Most patients with colon cancer are surgically treated, with postoperative association of chemotherapy and possibly immunotherapy in advanced cases. Surgical treatment is chosen depending on the evolution stage, tumor topography and the existence of complications, colonic surgery being dictated by colonic vascularization. The radical character of the surgical intervention can be assured only in the early stages of the tumor. Colostomy is rarely necessary in patients with colon cancer. In the period of the last 5 years (2007-2011), 307 patients with colon cancer were operated in "Colentina" Surgical Clinic, radical intervention being possible only in 219 cases. 48 cases were emergency interventions for occlusion or perforation with peritonitis. Every time the mechanical preparation of the bowel was not possible, the intraoperative washout technique was used. Postoperative complications were met in 27 cases, being represented by bleeding (3 cases), peritoneal abscess (5 cases), anastomotic fistula (7 cases), abdominal wound infection (12 cases). In 5 cases the operation was done laparoscopically. Preoperative mortality was of 13 cases. Postoperative chemotherapy was done in the great majority of cases. PMID:23144667

Mastalier, B; Tihon, C; Ghi??, B; Botezatu, C; Deaconescu, V; Mandisodza, P; Dr?ghici, C; Simion, S



Initial Clinical Experience Using the Amplatzer Vascular Plug  

SciTech Connect

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

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



[Clinical experience with BCG immune prevention in superficial bladder cancer].  


Previous randomized studies have shown that in cases of superficial urothelial carcinoma or carcinoma in situ of the urinary bladder, complete and long-lasting remission can be obtained by immunotherapy with bacillus Calmette-Guérin (BCG). Such studies have shown that BCG reduces the recurrence rate significantly compared with transurethral resection alone. Our 6-year experience with BCG Pasteur strain (and Connaught strain, respectively) in tumour stages pTis, pTa and pT1 (G I-II) shows lasting remission in 88.5% (73%) of 78 (26) patients after transurethral resection of the tumour. A complete remission was found in 92% of patients with carcinoma in situ (12 patients). The local and the rare systemic side effects were all of limited duration, tolerable, easily treated and fully reversible. PMID:1302409

Bach, D; Romics, I; Rüssel, C



Clinical experience with automatic midline echoencephalography: cooperative study of three neurosurgical clinics  

Microsoft Academic Search

Computerized midline echoencephalography was developed in order to make the determination of the midline more objective. In a group study involving the neurosurgical clinics in Berlin, Erlangen, and Munich, a total of 1,889 patients with various intracranial diseases was examined by this method. An exact analysis of the results obtained is presented: 18 percent were unsatisfactory.

M Klinger; E Kazner; T Grumme; V Amtenbrink; G Graef; K H Hartmann; H Hopman; W Meese; B Vogel



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.



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



Undergraduate Nursing Students' Clinical Experiences in Rural and Remote Areas: Recruitment Implications.  

ERIC Educational Resources Information Center

Two urban Australian nursing students' stories of their experiences in clinical placements in rural and Aboriginal communities indicate their interest in and enthusiasm for returning to rural nursing after graduation. Unfortunately, many urban students are disadvantaged financially by the added expense of their rural clinical rotation. Assisting…

Neill, Jane; Taylor, Kerry



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



Learning on clinical placement:the experience of six Australian student nurses  

Microsoft Academic Search

Concerns about the adequacy of clinical education in nursing courses in Australia have escalatedsince the transfer of pre-registration nursing education into the tertiary sector. This descriptive, interpretative study, informed by the tradition of critical social science, sought to understand the clinical learning experiences of undergraduate nursing students. At the same time, it fostered an active participation of students in their

Carol A. Nolan



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.



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

PubMed Central

Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.

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



Clinical management of cocaine body packers: the Hillingdon experience  

PubMed Central

Background International smuggling of cocaine by internal concealment is a serious and growing problem. People who engage in this practice are commonly referred to as body packers or mules. The most serious risks associated with body packing include intestinal obstruction and death from cocaine intoxication. These patients were previously managed primarily by surgical retrieval. This was associated with significant mortality due to rupture of poorly constructed cocaine packages. More recently, conservative management using whole bowel irrigation with polyethylene-glycol (Klean-prep Norgine) has been shown to be safe for most patients. To date, however, a consistent approach for the management of these patients has not been established. Methods We retrospectively reviewed the case notes, prescription charts and radiological investigations of all body packers admitted to our unit between 2000 and 2005, concentrating on initial management, complications and outcome. Results We identified 61 patients for inclusion. Of these, 56 were managed conservatively with a selection of aperients and laxatives. Six patients were treated successfully for cocaine toxicity and 5 required surgical retrieval of cocaine packets. Conclusion Our results confirm the safety of a conservative approach. Based on our experience and a review of the literature, we have devised a treatment protocol to reduce the risk of complications and the length of stay in hospital.

Beckley, Ian; Ansari, Nabeel A.A.; Khwaja, Haris A.; Mohsen, Yasser



"Drop in" gastroscopy outpatient clinic - experience after 9 months  

PubMed Central

Background Logistics handling referrals for gastroscopy may be more time consuming than the examination itself. For the patient, "drop in" gastroscopy may reduce uncertainty, inadequate therapy and time off work. Methods After an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with "drop in" gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated. Results 112 patients had "drop in" gastroscopy and 101 gastroscopy by appointment. The number of "drop in" patients varied between 3 and 12 per day (mean 6.5). Mean time from first GP consultation to gastroscopy was 3.6 weeks in the "drop in" group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing "drop in" to 1022 after (47% increase) and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with "drop in". Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff. Conclusions "Drop in" gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise "drop in" outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented.



Work Experience Program at a Metropolitan Paediatric Hospital: Assisting Rural and Metropolitan Allied Health Professionals Exchange Clinical Skills.  

ERIC Educational Resources Information Center

A clinical experience program provided 29 rural Australian allied health professionals with experience in pediatric clinical areas and opportunities to share clinical knowledge and develop networks with metropolitan peers. Questionnaires and focus groups indicated that networking, clinical skills, knowledge, confidence, and awareness of rural…

Parkin, Ann E.; McMahon, Sandra; Upfield, Nancy; Copley, Jodie; Hollands, Karen



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.



Experiences of clinical teaching for dental core trainees working in hospital.  


There is recognition that the provision of excellence in education and training results in a skilled and competent workforce. However, the educational experiences of dental core trainees (DCT's) working in the hospital oral and maxillofacial surgery (OMFS) setting have not been previously investigated. In this paper, we examine DCT's learning experiences both 'formal' and 'non-formal' within the hospital setting of ward and clinic-based teaching. Are hospital dental core trainees receiving a meaningful educational experience? To conclude this paper, the authors recommend methods, based upon sound educational principles, to maximise the value of clinical sessions for teaching. PMID:25012332

Mannion, C J; Brotherton, P



Clinical experience with exenatide in a routine secondary care diabetes clinic  

Microsoft Academic Search

Exenatide use in type 2 diabetes is limited in routine clinical practice. We examined a cross-section of 90 patients. Mean weight and HBA1c were 114.9±20.6kg, 10.3±2.1% at initiation; 108.0±15.3kg (p<0.0001), 9.0±2.1% (p<0.001) at 3 months; 109.2±18.2kg (p<0.0001), 9.5±2.3% (p=0.08) at 6 months. Exenatide appears effective in reducing HBA1c and weight.

B. Natarajan; M. Edavalath; J. Davies; L. Jenkins; N. Marshall-Richards; D. Evans; D. E. Price; S. C. Bain; J. W. Stephens



Hand-held dynamometry in patients with haematological malignancies: Measurement error in the clinical assessment of knee extension strength  

PubMed Central

Background Hand-held dynamometry is a portable and inexpensive method to quantify muscle strength. To determine if muscle strength has changed, an examiner must know what part of the difference between a patient's pre-treatment and post-treatment measurements is attributable to real change, and what part is due to measurement error. This study aimed to determine the relative and absolute reliability of intra and inter-observer strength measurements with a hand-held dynamometer (HHD). Methods Two observers performed maximum voluntary peak torque measurements (MVPT) for isometric knee extension in 24 patients with haematological malignancies. For each patient, the measurements were carried out on the same day. The main outcome measures were the intraclass correlation coefficient (ICC ± 95%CI), the standard error of measurement (SEM), the smallest detectable difference (SDD), the relative values as % of the grand mean of the SEM and SDD, and the limits of agreement for the intra- and inter-observer '3 repetition average' and the 'highest value of 3 MVPT' knee extension strength measures. Results The intra-observer ICCs were 0.94 for the average of 3 MVPT (95%CI: 0.86–0.97) and 0.86 for the highest value of 3 MVPT (95%CI: 0.71–0.94). The ICCs for the inter-observer measurements were 0.89 for the average of 3 MVPT (95%CI: 0.75–0.95) and 0.77 for the highest value of 3 MVPT (95%CI: 0.54–0.90). The SEMs for the intra-observer measurements were 6.22 Nm (3.98% of the grand mean (GM) and 9.83 Nm (5.88% of GM). For the inter-observer measurements, the SEMs were 9.65 Nm (6.65% of GM) and 11.41 Nm (6.73% of GM). The SDDs for the generated parameters varied from 17.23 Nm (11.04% of GM) to 27.26 Nm (17.09% of GM) for intra-observer measurements, and 26.76 Nm (16.77% of GM) to 31.62 Nm (18.66% of GM) for inter-observer measurements, with similar results for the limits of agreement. Conclusion The results indicate that there is acceptable relative reliability for evaluating knee strength with a HHD, while the measurement error observed was modest. The HHD may be useful in detecting changes in knee extension strength at the individual patient level.

Knols, Ruud H; Aufdemkampe, Geert; de Bruin, Eling D; Uebelhart, Daniel; Aaronson, Neil K



Easing the Formalization of Clinical Guidelines with a User-tailored, Extensible Agile Model Driven Development (AMDD)  

Microsoft Academic Search

Transforming a text-based clinical guideline in a computer-interpretable form is a time-consuming and de- manding task due to the various users involved, who have different technical and medical background. In the past, different guideline representation languages and support- ing tools have been developed, however, these approaches seldom address the various users' demands and needs in the different steps of the

Patrick Martini; Katharina Kaiser; Silvia Miksch



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


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



Extension decision  

Microsoft Academic Search

On the viewpoint of system theory, this paper expounds connotations and characteristics about extension decision applied branch of extension science, introduces operation sequences, techniques and methods on extension decision, points out its working achievement and the direction in its development.

Bo Sun; Julong Chen



In utero Repair of Myelomeningocele: Rationale, Initial Clinical Experience and a Randomized Controlled Prospective Clinical Trial  

PubMed Central

Myelomeningocele (MMC), one of the most common congenital malformations, can result in severe lifelong disabilities, including paraplegia, hydrocephalus, Arnold-Chiari II malformation, incontinence, sexual dysfunction, skeletal deformations, and mental impairment. MMC was the first nonlethal anomaly to be treated by fetal surgery. Studies in animals provide compelling evidence that the primary cause of the neurological deficit associated with MMC is not simply incomplete neurulation but rather chronic mechanical injury and amniotic-fluid-induced chemical trauma that progressively damage the exposed neural tissue during gestation. Initial results suggest that the surgical repair of MMC before 25 weeks of gestation may preserve neurological function, reverse the hindbrain herniation of the Arnold-Chiari II malformation, and obviate the need for postnatal placement of a ventriculoperitoneal shunt. As it is currently unknown whether fetal surgery for MMC is truly beneficial compared to standard postnatal care, a randomized, controlled clinical trial has been initiated within the United States.

Danzer, Enrico; Flake, Alan W.



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.

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.



Experiments on Stability of A Spin-axis Extension Mast and Technology of Improving Micro Gravity Environment  

Microsoft Academic Search

One of important issues to be addressed to realize the practical space inflatable structure is how to control the movement during its deployment or extension and how to harden the structure and maintain the accuracy of shape for a long term after extended. To resolve this issue, two types of inflatable structure have been developed by making use of structural

Kazuki Watanabe; Susumu Takezawa; Akihito Watanabe; Tadahiko Sekiya


Lessons from New Experiences in Extension in West Africa: Management Advice for Family Farms and Farmers' Governance  

ERIC Educational Resources Information Center

The emergence of Management Advice for Family Farms in West Africa is closely related to the increased integration of farmers into an open market economy. This is creating a strong demand from farmers for advisory support services, focusing on management of the farm. With the gradual withdrawal of the State from extension services delivery, a…

Faure, Guy; Kleene, Paul



[Calcium blockers in the therapy of vertebrobasilar insufficiency. Results of animal experiments and clinical studies].  


Vertebrobasilar insufficiency (VBI) is a clinical syndrome which includes different transient brain stem symptoms. In addition to anamnesis and clinical study electronystagmography (ENG) is regarded as the most important method for testing the labyrinthine and brain stem system. Typical findings, not only in patients with VBI, but also in animal experiments (occlusion of one vertebral artery) are an increase in nystagmus frequency and decrease in nystagmus amplitude. The present study concerns two calcium antagonists: flunarizine and nimodipine. During tests on patients the caloric and the rotatory nystagmus and during animal experiments the rotatory nystagmus was investigated. Patient tests as well as animal experiments showed, that flunarizine and nimodipine have a depressant influence on the pathologically increased nystagmus frequency. With both substances there was also a trend to normalization of nystagmus amplitude as well as an improvement of clinical symptoms. PMID:6383990

Hofferberth, B



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:; 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)



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.

Wankowicz, Zofia



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


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



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


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



Multidimensional analysis of data obtained in experiments with X-ray emulsion chambers and extensive air showers  

NASA Astrophysics Data System (ADS)

Nonparametric statistical methods are used to carry out the quantitative comparison of the model and the experimental data. The same methods enable one to select the events initiated by the heavy nuclei and to calculate the portion of the corresponding events. For this purpose it is necessary to have the data on artificial events describing the experiment sufficiently well established. At present, the model with the small scaling violation in the fragmentation region is the closest to the experiments. Therefore, the treatment of gamma families obtained in the Pamir' experiment is being carried out at present with the application of these models.

Chilingaryan, A. A.; Galfayan, S. K.; Zazyan, M. Z.; Dunaevsky, A. M.



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

PubMed Central

Objective. To describe the development, implementation, and assessment of an introductory and an advanced pharmacy practice experience (IPPE and APPE) integrated within campus-based influenza clinics. Design. The influenza clinics were designed to incorporate the learning objectives for the IPPE and APPE, and included preparatory sessions, online learning, and direct patient interactions tailored to the appropriate education level of the learner. Assessment. The clinics provided influenza vaccinations to 2,292 and 2,877 individuals in 2010 and 2011, respectively. The clinics allowed for experiential education of 39 students earning a total of 467 IPPE and APPE hours in 2010 and 58 students earning a total of 656 IPPE and APPE hours in 2011. Third-year students were assessed before and after completing the IPPE, and improvement was seen in knowledge and self-ratings of perceptions and attitudes toward administering immunizations. Conclusions. Integrating pharmacy practice experiences within campus-based influenza clinics was an effective way to provide students with direct patient care experience and preventive health services knowledge.

Johnson, Eric J.; Hagemann, Tracy M.



Animal experiments and clinical application of olfactory ensheathing cell transplantation for treatment of spinal cord injury  

Microsoft Academic Search

BACKGROUND: The olfactory epithelium can still generate new neurons after arresting its growth and development in the human body. Axons can still be generated and pass through peripheral tissue to reach the olfactory bulb. Thus, olfactory cells have been widely used in the repair of spinal cord injury. OBJECTIVE: Using animal experiments in conjunction with a clinical study of olfactory

Nan Liu; Wei Liu; Baiyu Zhou; Jing Wang; Bing Li


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



Nursing students'experience of care planning activities in clinical education  

Microsoft Academic Search

This paper summarises a research studyinquiring into the experiences of nursing students of their practice of individualised care planning as a learning activity. The survey was conducted in the final stage of the students' education and concerned three groups of students in the years 1990, 1992 and 1993 who were asked to evaluate their main clinical placements in surgical, medical

Ingrid Thorell-Ekstrand; Hjördis Bjorvell



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.



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

ERIC Educational Resources Information Center

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

Dumas, Louise; Villeneuve, Jean; Chevrier, Jacques



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



Personal Experiences of Taking Part in Clinical Trials - A Qualitative Study |

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.


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


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



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



Clinical outcome of the chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterium treated by extensive tenosynovectomy and drugs.  


Chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterial (NTM) infection is uncommon. Although some authors have recommended combining surgical and drug therapy, there are few reports about the timing of drug administration after operation. The purpose of this retrospective study was to analyse the clinical outcome of the protocol, which consisted of extensive tenosynovectomy and drug therapy administered after culture results had been obtained. Four men and one woman were included. Average age was 57.4 years and average follow-up period was 46.7 months. Extensive tenosynovectomy was performed and surgical specimen was examined histopathologically and microbiologically. After a positive culture result had been obtained, three kinds of drugs were administered. Clinical outcome including infectious condition, range of motion, and grip strength was examined. All patients were immunocompetent and had no underlying disease. Three patients were diagnosed at first operation and two were diagnosed at second operation. The average period of drug therapy was 5.5 months. In four patients, infection resolved with combination therapy. In one patient with surgical treatment, only swelling remained. Osteomyelitis of the scaphoid was found in one patient to whom systemic steroid had been administered because of a negative culture result at first operation. For immunocompetent patients, flexor tenosynovitis in the hand caused by NTM was resolved with a combination of surgical and drug treatment. Drug treatment seemed to be essential after a reduction of the infectious lesion and the timing of administration was safe enough to resolve in four patients. PMID:23875916

Yano, Koichi; Yoshida, Takeshi; Minoda, Yukihide; Horiki, Mitsuru; Denno, Kakuro; Yoneda, Masahiro; Tada, Koichi



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

PubMed Central

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



Neural and cognitive basis of spiritual experience: biopsychosocial and ethical implications for clinical medicine.  


The role of patient spirituality and spiritual/liminal experience(s; SE) in the clinical setting has generated considerable equivocality within the medical community. Spiritual experience(s), characterized by circumstance, manifestation, and interpretation, reflect patients' explanatory models. We seek to demonstrate the importance of SE to clinical medicine by illustrating biological, cognitive, and psychosocial domains of effect. Specifically, we address where in the brain these events are processed and what types of neural events may be occurring. We posit that existing evidence suggests that SE can induce both intermediate level processing (ILP) to generate attentional awareness (ie, "consciousness of") effects and perhaps nonintermediate level processing to generate nonattentive, subliminal (ie, "state of") consciousness effects. Recognition of neural and cognitive mechanisms is important to clinicians' understanding of the biological basis of noetic, salutogenic, and putative physiologic effects. We posit that neurocognitive mechanisms, fortified by anthropologic and social contexts, led to the incorporation of SE-evoked behaviors into health-based ritual(s) and religious practice(s). Thus, these experiences not only exert biological effects but may provide important means for enhancing patients' locus of control. By recognizing these variables, we advocate clinicians to act within an ethical scope of practice as therapeutic and moral agents to afford patients resources to accommodate their specific desire(s) and/or need(s) for spiritual experiences, in acknowledgement of the underlying mechanisms and potential outcomes that may be health promotional. PMID:16781644

Giordano, James; Engebretson, Joan



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


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

Baw, Bandar; Chan, Teresa; Upadhye, Suneel



Prognostic significance of soft tissue extension, International Prognostic Index, and multifocality in primary bone lymphoma: a single institutional experience.  


Primary bone lymphoma (PBL) is a rare disease. The literature is inconsistent in regard to definition, stage and prognostic factors. We examined the PBL cases seen at the Moffitt Cancer Center between 1998 and 2013 using the 2013 World Health Organization criteria for bone/soft tissue tumours. Seventy PBL patients were included, of whom 53 (75·7%) patients were histologically classified as primary bone diffuse large B-cell lymphoma (PB-DLBCL). Femur was the most commonly involved site in PBLs with unifocal bone lesions, whereas PBLs with multifocal bone lesions most frequently presented with spine disease. Further analysis of the PB-DLBCL subgroup showed that these patients had 3- and 5-year progression-free survival (PFS) of 61·2% and 46·9%, respectively and 5- and 10-year overall survival (OS) of 81·1% and 74·7%, respectively. Multivariate analysis identified soft tissue extension and International Prognostic Index (IPI) score as the most important unfavourable prognostic factors for both PFS and OS. Multifocality was also highly significantly associated with a worse PFS (P = 0·002) and OS (P < 0·001), although it was not identified in multivariate analysis due to its incorporation into the IPI. The results warrant further investigation regarding whether PBL with multifocal bone lesions could be considered as a systemic and more aggressive disease rather than a conventional PBL. PMID:24673481

Wu, Huanwen; Zhang, Ling; Shao, Haipeng; Sokol, Lubomir; Sotomayor, Eduardo; Letson, Douglas; Bui, Marilyn M



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


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



Nevirapine Exposure with WHO Pediatric Weight Band Dosing: Enhanced Therapeutic Concentrations Predicted Based on Extensive International Pharmacokinetic Experience  

PubMed Central

Nevirapine (NVP) is a nonnucleoside reverse transcriptase inhibitor (NNRTI) used worldwide as part of combination antiretroviral therapy in infants and children to treat HIV infection. Dosing based on either weight or body surface area has been approved by the U.S. Food and Drug Administration (FDA) but can be difficult to implement in resource-limited settings. The World Health Organization (WHO) has developed simplified weight band dosing for NVP, but it has not been critically evaluated. NVP pharmacokinetic data were combined from eight pediatric clinical trials (Pediatric AIDS Clinical Trials Group [PACTG] studies 245, 356, 366, 377, 403, 1056, and 1069 and Children with HIV in Africa Pharmacokinetics and Adherence of Simple Antiretroviral Regimens [CHAPAS]) representing subjects from multiple continents and across the pediatric age continuum. A population pharmacokinetic model was developed to characterize developmental changes in NVP disposition, identify potential sources of NVP pharmacokinetic variability, and assess various pediatric dosing strategies and their impact on NVP exposure. Age, CYP2B6 genotype, and ritonavir were independent predictors of oral NVP clearance. The Triomune fixed-dose tablet was an independent predictor of bioavailability compared to the liquid and other tablet formulations. Monte Carlo simulations of the final model were used to assess WHO weight band dosing recommendations. The final pharmacokinetic model indicated that WHO weight band dosing is likely to result in a percentage of children with NVP exposure within the target range similar to that obtained with FDA dosing. Weight band dosing of NVP proposed by the WHO has the potential to provide a simple and effective dosing strategy for resource limited settings.

Nikanjam, Mina; Kabamba, Desire; Cressey, Tim R.; Burger, David; Aweeka, Francesca T.; Acosta, Edward P.; Spector, Stephen A.



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

PubMed Central

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

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



Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences  

Microsoft Academic Search

Background  Victimisation in childhood may be associated with adult psychosis. The current study examined this association in the crucial\\u000a developmental period of early adolescence and investigated whether (1) unwanted sexual experiences, and (2) being bullied,\\u000a were associated with non-clinical delusional ideation and hallucinatory experiences in a general population sample of 14 year\\u000a olds.\\u000a \\u000a \\u000a \\u000a Methods  Data were derived from standard health screenings of the

Tineke Lataster; Jim van Os; Marjan Drukker; Cécile Henquet; Frans Feron; Nicole Gunther; Inez Myin-Germeys



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


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

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



Anxious and non-anxious adolescents' experiences of non-clinical magnetic resonance imaging research.  


Magnetic resonance imaging (MRI) has become a ubiquitous research tool for developmental neuroscientists interested in brain structure and function in children and adolescents. However, ethical concerns are sometimes raised about using MRI with children and adolescents, especially when participants have anxiety. We asked 17 clinically/sub-clinically anxious and 19 non-anxious adolescents about their experiences of taking part in MRI for research purposes. Although the anxious group reported experiencing more anxiety during the scan, these differences had attenuated by the time participants got home. We found no evidence that anxious adolescents would be less likely to choose to have another scan or would feel more nervous during another scan. There was some evidence that more trait anxious adolescents found the MRI study enjoyable. These findings should give ethics committees, clinicians, and parents confidence that so long as researchers exercise appropriate care, MRI research is acceptable to adolescents, including those with clinical anxiety. PMID:23232793

Haddad, Anneke D M; Platt, Belinda; James, Anthony C; Lau, Jennifer Y F



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

PubMed Central

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

Bouras-vallianatos, Petros



Experiences and barriers to implementation of clinical practice guideline for depression in Korea  

PubMed Central

Background Clinical guidelines can improve health-care delivery, but there are a number of challenges in adopting and implementing the current practice guidelines for depression. The aim of this study was to determine clinical experiences and perceived barriers to the implementation of these guidelines in psychiatric care. Methods A web-based survey was conducted with 386 psychiatric specialists to inquire about experiences and attitudes related to the depression guidelines and barriers influencing the use of the guidelines. Quantitative data were analyzed, and qualitative data were transcribed and coded manually. Results Almost three quarters of the psychiatrists (74.6%) were aware of the clinical guidelines for depression, and over half of participants (55.7%) had had clinical experiences with the guidelines in practice. The main reported advantages of the guidelines were that they helped in clinical decision making and provided informative resources for the patients and their caregivers. Despite this, some psychiatrists were making treatment decisions that were not in accordance with the depression guidelines. Lack of knowledge was the main obstacle to the implementation of guidelines assessed by the psychiatrists. Other complaints addressed difficulties in accessing the guidelines, lack of support for mental health services, and general attitudes toward guideline necessity. Overall, the responses suggested that adding a summary booklet, providing teaching sessions, and improving guidance delivery systems could be effective tools for increasing depression guideline usage. Conclusion Individual barriers, such as lack of awareness and lack of familiarity, and external barriers, such as the supplying system, can affect whether physicians’ implement the guidelines for the treatment of depression in Korea. These findings suggest that further medical education to disseminate guidelines contents could improve public health for depression.



Haemate P/Humate-P for the treatment of von Willebrand disease: considerations for use and clinical experience.  


von Willebrand disease (VWD) is a heterogeneous bleeding disorder with symptoms in affected patients ranging from mild effects to potentially devastating haemorrhagic events. Desmopressin (DDAVP) and von Willebrand factor/factor VIII (VWF/FVIII) concentrates are the principal treatments. Haemate P/Humate-P is an intermediate-purity VWF/FVIII concentrate with extensive clinical experience in VWD. This concentrate has been shown to correct haemostatic defects of VWD, with efficacy ratings of good/excellent in nearly all patients treated for bleeding or surgical events. Haemate P/Humate-P has a high content of the high molecular weight (HMW) VWF multimer fraction, which has been shown to be very effective in achieving haemostasis. The HMW VWF multimer pattern in Haemate P/Humate-P is more similar to that of normal human plasma (94% for Haemate P/Humate-P vs. 100% for normal human plasma) than that of other VWF/FVIII concentrates and correlates with functional VWF activities including ristocetin cofactor activity (VWF:RCo) and collagen-binding activity. The recommended dosing of Haemate P/Humate-P is based preferentially on VWF:RCo activity, which is approximately twice that of FVIII:C (2.4:1). Haemate P/Humate-P has been shown to be safe; no serious adverse events or cases of thrombosis have been observed in clinical trials and no documented cases of viral transmission in nearly three decades of clinical use. While DDAVP is effective in a large proportion of VWD patients, it may not provide adequate haemostasis in all situations. In such cases, Haemate P/Humate-P is an effective replacement concentrate for all types of VWD in both adult and paediatric patients. PMID:18786009

Auerswald, G; Kreuz, W



Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy  

Microsoft Academic Search

BACKGROUND: To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology. METHODS: Forty-five patients with a median age of 72 ± 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0

Gianfranco A Pesce; Alessandro Clivio; Luca Cozzi; Giorgia Nicolini; Antonella Richetti; Emanuela Salati; Mariacarla Valli; Eugenio Vanetti; Antonella Fogliata



Initial clinical experience with a video-based patient positioning system  

Microsoft Academic Search

Purpose: To report initial clinical experience with an interactive, video-based patient positioning system that is inexpensive, quick, accurate, and easy to use.Methods and Materials: System hardware includes two black-and-white CCD cameras, zoom lenses, and a PC equipped with a frame grabber. Custom software is used to acquire and archive video images, as well as to display real-time subtraction images revealing

L. S. Johnson; B. D. Milliken; S. W. Hadley; C. A. Pelizzari; D. J. Haraf; G. T. Y. Chen



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

Microsoft Academic Search

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

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



Tegress(TM) Urethral Implant Phase III Clinical Experience and Product Uniqueness  

PubMed Central

Advances in materials technology, coupled with a heightened understanding of wound healing and tissue-materials interactions in the lower urinary tract, have led to the development of a variety of new urethral bulking agents that are expected to be available in the near future. Experience with such bulking agents continues to grow and study results are disseminated as more clinical trials are initiated and completed. The intention of this report is to review the characteristics and initial clinical results for one of these new agents: Tegress™ Urethral Implant (C. R. Bard, Inc., Murray Hill, NJ). This material, with unique phase-change properties upon exposure to body temperature fluids, offers ease of injection and requires less volume for clinical effect than bovine collagen. Additionally, Tegress Urethral Implant performance in clinical trials has suggested improved durability and correspondingly higher continence and improvement rates versus bovine collagen. As these materials evolve, an understanding of preferential implant techniques is being gained also. Delivery method and implant site may prove to substantially alter the biologic activity of these compounds. As outlined in this review, experience with Tegress Implant resulted in changes in delivery technique that translated into improved materials and tissue interaction.

Dmochowski, Roger R



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

SciTech Connect

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 (X{sub max}) of EASs due to atmospheric variance are evaluated by Monte Carlo simulation.

Kobayashi, Y.; Tsunesada, Y.; Tokuno, H.; Kakimoto, F. [Graduate School of Science and Engineering, Tokyo Institute of Technology, Meguro, Tokyo 152-8551 (Japan); Tomida, T. [Graduate School of Medicine and Engineering, University of Yamanashi, Kofu, Yamanashi 400-8511 (Japan)



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.



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


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

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



Education, Postgraduate Training, Board Certification, and Experience Requirements in Advertisements for Clinical Faculty Positions  

PubMed Central

Objectives To compare requirements for pharmacy practice faculty positions in advertisements from 2002 through 2006 to those reported from 1990 through 1994. Methods Positions advertised from January 2002 through December 2006 in 3 newsletters and journals were evaluated for required or preferred degree, completion of residencies and/or fellowships, years of work experience, board certification, and other postgraduate training and education. Advertisements were separated by tenure-eligibility and rank. Results Of 426 advertisements for faculty members, 77% required additional training, including residencies and fellowships or their equivalent in experience. Board certification was required in only 0.9% but preferred in 11%. Advertisements for tenure-eligible positions did not have more extensive requirements than nontenured, nor did upper vs. lower rank. Conclusions Compared to 1996, the number of advertisements requiring postgraduate training to secure a faculty position almost doubled. Whether the qualifications of faculty members recruited match the requirements is unknown.

Hawkey, Lisa



BLAST model: an innovative approach to prepare second-degree accelerated BSN students for inpatient psychiatric clinical experiences.  


This article describes the design, development, and implementation of an innovative teaching/learning model involving integration of classroom teaching, clinical simulation, and debriefing/critical thinking to prepare accelerated baccalaureate nursing students for clinical practice experiences in the inpatient psychiatric setting. Lessons learned and future directions for simulation experiences involving standardized patient scenarios in undergraduate psychiatric nursing education are shared. PMID:23394963

Lang, Carol S; Hahn, Joyce A



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



Evaluating Quality in Clinical Cancer Research: The M.D. Anderson Cancer Center Experience  

PubMed Central

Background Despite the unquestionable importance of clinically oriented research designed to test the safety and efficacy of new therapies in patients with malignant disease, there is limited information regarding strategies to evaluate the quality of such efforts at academic institutions. Methods To address this issue, a committee of senior faculty at the University of Texas M.D. Anderson Cancer Center established specific criteria by which investigators from all departments engaged in clinical research could be formally evaluated. Scoring criteria were established and revised based on the results of a pilot study. Beginning in January 2004, the committee evaluated all faculty involved in clinical research within 35 departments. Scores for individual faculty members were assigned on a scale of 1 (outstanding) to 5; a score of 3 was set as the standard for the institution. Each department also received a score. The results of the evaluation were shared with departmental chairs and the Chief Academic Officer. Results 392 faculty were evaluated. The median score was 3. Full professors more frequently received a score of 1, but all faculty ranks received scores of 4 and 5. As a group, tenure/tenure track faculty achieved superior scores compared to nontenure track faculty. Conclusions Based on our experience, we believe it is possible to conduct a rigorous consensus-based evaluation of the quality of clinical cancer research being conducted at an academic medical center. It is reasonable to suggest such evaluations can be used as a management tool and may lead to higher-quality clinical research.

Cox, James D.; Giralt, Sergio A.; Veazie, Mary L.; Ajani, Jaffer A.; Bruner, Janet M.; Chan, Ka Wah; Hittelman, Walter N.; Hunt, Kelly K.; Iyer, Revathy B.; Karp, Daniel D.; Kuban, Deborah A.; Lippman, Scott M.; Raad, Issam I.; Rodriguez-Bigas, Miguel A.; Zwelling, Leonard A.; Markman, Maurie



Student pharmacists' clinical interventions in advanced pharmacy practice experiences at a community nonteaching hospital.  


Objective. To assess student pharmacists' clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used. Methods. Clinical interventions of 120 fourth-year (P4) student pharmacists in advanced institutional, medication safety, or internal medicine APPEs were collected over a 3½-year period. Clinical interventions were analyzed for cost savings, intervention type, and acceptance rates. A secondary analysis of paper-based vs electronic-based documentation of completed interventions was performed. Results. There were 2,170 clinical interventions attempted with an acceptance rate of 97%. The estimated cost savings was $280,297. A comparable number of interventions and cost savings per student was observed between paper-based and electronic-based documentation methods. Conclusion. Student pharmacists at a community nonteaching hospital have many opportunities for participation in patient-centered activities, and for interaction and collaboration with other healthcare professionals. They can significantly benefit patient care through clinical interventions, while also contributing to cost savings for the institution. PMID:24761011

Shogbon, Angela O; Lundquist, Lisa M



Student Pharmacists' Clinical Interventions in Advanced Pharmacy Practice Experiences at a Community Nonteaching Hospital  

PubMed Central

Objective. To assess student pharmacists’ clinical interventions in advanced pharmacy practice experiences (APPEs) at a community nonteaching hospital and evaluate completed interventions based on the type of documentation method used. Methods. Clinical interventions of 120 fourth-year (P4) student pharmacists in advanced institutional, medication safety, or internal medicine APPEs were collected over a 3½-year period. Clinical interventions were analyzed for cost savings, intervention type, and acceptance rates. A secondary analysis of paper-based vs electronic-based documentation of completed interventions was performed. Results. There were 2,170 clinical interventions attempted with an acceptance rate of 97%. The estimated cost savings was $280,297. A comparable number of interventions and cost savings per student was observed between paper-based and electronic-based documentation methods. Conclusion. Student pharmacists at a community nonteaching hospital have many opportunities for participation in patient-centered activities, and for interaction and collaboration with other healthcare professionals. They can significantly benefit patient care through clinical interventions, while also contributing to cost savings for the institution.

Lundquist, Lisa M.



Is total debranching a safe procedure for extensive aortic-arch disease? A single experience of 27 cases  

PubMed Central

OBJECTIVE Thoracic, arch, and proximal descending thoracic aorta diseases are still considered an enormous challenge. The hybrid approach developed in recent years (supra-aortic trunks debranching and thoracic endovascular repair aortic repair; TEVAR) may improve the morbidity and mortality of the population at risk. The aim of this study was to analyze retrospectively our experience in the hybrid treatment of aortic-arch aneurysms and dissections. METHOD We carried out a retrospective review of 27 patients who required a surgical debranching of the supra-aortic trunks and a TEVAR in the management of the aortic arch and proximal descending thoracic aortic disease. The aortic lesions included 18 degenerative arch-aortic aneurysms, four complicated aortic dissections, two subclavian artery aneurysms, and three penetrating atherosclerotic ulcers. Technical success was achieved in all patients. RESULTS The 30-day mortality rate was 11.1% (3/27). Mean follow-up was 16.7 months (range, 1–56), and the survival rate was 77.8%. The endoleaks’ rate was 3.7% (1/27), due to a stent-graft migration. CONCLUSION Hybrid approaches may represent an alternative option in the treatment of complex aortic lesions involving the arch and the proximal descending thoracic aorta in high-risk patients and emergency cases. However, the promising early results need to be confirmed by longer follow-up and larger comparative series.

Ferrero, Emanuele; Ferri, Michelangelo; Viazzo, Andrea; Robaldo, Alessandro; Zingarelli, Edoardo; Sansone, Fabrizio; Casabona, Riccardo; Nessi, Franco



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


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

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



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


OBJECTIVE: Our purpose was to examine undergraduate athletic training students' perceptions of how time is utilized during clinical field experiences while enrolled in Commission on Accreditation of Allied Health Education Program (CAAHEP)-accredited athletic training programs and to determine the effects of clinical field-experience length and setting, academic standing, sex, clinical assignment, and National Collegiate Athletic Association level on active learning. DESIGN AND SETTING: Using the Athletic Training-Clinical Education Time Framework (AT-CETF) and Utilizing Time and Active Learning Survey, subjects completed a 1-day, self-reported observation of how their clinical field-experience time was utilized. SUBJECTS: Program directors at 131 CAAHEP-accredited athletic training programs were sent survey packages. Seventy-two (41%) male subjects and 105 (59%) female subjects from 25 institutions completed the survey packages. Eight of the 10 National Athletic Trainers' Association districts were represented in the study. MEASUREMENTS: The AT-CETF is a behavioral time-profiling framework that measures athletic training students' perceptions of utilization of clinical field-experience time based on the performance domains associated with the 1999 National Athletic Trainers' Association Board of Certification Role Delineation Study and literature related to time and learning. RESULTS: Subjects spent 51% of their clinical field-experience time engaged in active learning, 9% in managerial activities, 17% in unengaged activities, and 23% in waiting activities. Multiple 2 x 2 x 3 analyses of variance (length of clinical field experience x academic standing x clinical field-experience setting) revealed a significant difference between the levels of clinical field-experience setting and the dependent variables of perceived percentage of active learning time and waiting time. A 2 x 3 analysis of variance (sex x clinical assignment) revealed a significant difference between the levels of clinical assignment and the dependent variable of perceived percentage of active learning time. CONCLUSIONS: The type of clinical field-experience setting and clinical assignment affects the amount of time spent in active learning. Therefore, profiling students' use of time may allow educators to identify clinical field-experience settings that maximize active learning time, expose students to their own unique learning situations, and offer students access to clinical field-experience settings aligned with their professional goals. PMID:15173870

Berry, David C.; Miller, Michael G.; Berry, Leisha M.



In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?  


A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?'. Altogether more than 200 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Subcutaneous emphysema is usually a benign, self-limiting condition only requiring conservative management. Interventions are useful in the context of severe patient discomfort, respiratory distress or persistent air leak. In the absence of any comparative study, it is not possible to choose definitively between infraclavicular incisions, drain insertion and increasing suction on an in situ drain as the best method for managing severe subcutaneous emphysema. All the three techniques described have been shown to provide effective relief. Increasing suction on a chest tube already in situ provided rapid relief in patients developing SE following pulmonary resection. A retrospective study showed resolution in 66%, increasing to 98% in those who underwent video-assisted thoracic surgery with identification and closure of the leak. Insertion of a drain into the subcutaneous tissue also provided rapid sustained relief. Several studies aided drainage by using regular compressive massage. Infraclavicular incisions were also shown to provide rapid relief, but were noted to be more invasive and carried the potential for cosmetic defect. No major complications were illustrated. PMID:24572767

Johnson, Charles H N; Lang, Sommer A; Bilal, Haris; Rammohan, Kandadai S



Effects of low-dose and high-dose postoperative radioiodine therapy on the clinical outcome in patients with small differentiated thyroid cancer having microscopic extrathyroidal extension.  


Background: It is unclear whether differentiated thyroid cancer (DTC) patients classified as intermediate risk based on the presence of microscopic extrathyroidal extension (ETE) should be treated with low or high doses of radioiodine (RAI) after surgery. We evaluated success rates and long-term clinical outcomes of patients with DTC of small tumor size, microscopic ETE, and no cervical lymph node (LN) metastasis treated either with a low (1.1?GBq) or high RAI dose (5.5?GBq). Methods: This is a retrospective analysis of a historical cohort from 2000 to 2010 in a tertiary referral hospital. A total of 176 patients with small (?2?cm) DTC, microscopic ETE, and no cervical LN metastasis were included. Ninety-six patients were treated with 1.1?GBq (LO group) and 80 patients with 5.5?GBq (HI group). Successful RAI therapy was defined as (i) negative stimulated thyroglobulin (Tg) in the absence of Tg antibodies, and (ii) absence of remnant thyroid tissue and of abnormal cervical LNs on ultrasonography. Clinical recurrence was defined as the reappearance of disease after ablation, which was confirmed by cytologically or pathologically proven malignant tissue or of distant metastatic lesions. Results: There was no significant difference in the rate of successful RAI therapy between the LO and HI groups (p=0.75). In a subgroup analysis based on tumor size, success rates were not different between the LO group (34/35, 97%) and the HI group (50/56, 89%) in patients with a tumor size of 1-2?cm (p=0.24). In patients with smaller tumor size (?1?cm), there was no significant difference in success rates between the LO (59/61, 97%) and HI groups (22/24, 92%; p=0.30). No patient had clinical recurrences in either group during the median 7.2 years of follow-up. Conclusions: Low-dose RAI therapy is sufficient to treat DTC patients classified as intermediate risk just by the presence of microscopic ETE. PMID:24328997

Han, Ji Min; Kim, Won Gu; Kim, Tae Yong; Jeon, Min Ji; Ryu, Jin-Sook; Song, Dong Eun; Hong, Suck Joon; Shong, Young Kee; Kim, Won Bae



Preliminary Experience with Small Animal SPECT Imaging on Clinical Gamma Cameras  

PubMed Central

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.

Aguiar, P.; Silva-Rodriguez, J.; Herranz, M.; Ruibal, A.



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

PubMed Central

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

Leland, Arne; Dale, Jan Gunnar



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

PubMed Central

We have developed a microwave tomography system for experimental breast imaging. In this paper we illustrate a strategy for optimizing the coupling liquid for the antenna array based on in vivo measurement data. We present representative phantom experiments to illustrate the imaging system’s ability to recover accurate property distributions over the range of dielectric properties expected to be encountered clinically. To demonstrate clinical feasibility and assess the microwave properties of the normal breast in vivo, we summarize our initial experience with microwave breast exams of 43 women categorized as BIRADS 1. The clinical results show a high degree of bilateral symmetry in the whole breast average microwave properties. Focal assessments of microwave properties are associated with breast tissue composition evaluated through radiographic density categorization verified through MR image correlation in selected cases. Specifically, both whole breast average and local microwave properties increase with increasing radiographic density where the latter exhibits a more substantial rise. These findings support our hypothesis that water content variations in the breast play an influential role in dictating the overall dielectric property distributions and indicate that the microwave properties in the breast are more heterogeneous than previously believed based on ex vivo property measurements reported in the literature.

Meaney, Paul M.; Fanning, Margaret W.; Raynolds, Timothy; Fox, Colleen J.; Fang, Qianqian; Kogel, Christine A.; Poplack, Steven P.; Paulsen, Keith D.



Preliminary Experience with Small Animal SPECT Imaging on Clinical Gamma Cameras.  


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



Posttraumatic stress disorder in women--experiences form the Psychiatric Clinic, University Hospital Center Zagreb, Croatia.  


Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops after a severe traumatic event or experience. Lifetime prevalence rate in the European population is 1.9 % and it is higher for women (2.9%) then for men (0.9 %). The aim of this study was to examine rates and sociodemographic and clinical characteristics of women with PTSD who were hospitalized at the Psychiatric clinic of University Hospital Center in Croatia over the years 1990-2007. Data were gathered retrospectively from the medical charts. We found that 67 women were diagnosed with PTSD which is 0.58% of all admissions over these years. Majority suffered from comorbid depression (N = 51) and various somatic conditions, especially malignant gynecological tumors (N = 23). No significant differences were found in distribution of PTSD symptoms in relation to the combat vs. civilian trauma. We found that patients with combat trauma often suffer from comorbid depression, while those with civilian traumas more often reported somatic conditions, especially malignant gynecological tumors. Our institution is a speciality clinic at a tertiary care medical center which tends to accumulate patients with serious forms of the disorder, and therefore our results can not be generalized to other settings involved in working with women with PTSD. Our results indicate that psychiatrists' assessment of female patients should inevitably include lifetime traumatic experiences, and among those with PTSD, special attention should be paid to comorbid depression and malignant tumors. PMID:19408636

Jovanovi?, Nikolina; Kuzman, Martina Rojni?; Medved, Vesna; Saboli?, Andelina Boki?; Grubisin, Jasmina; Hotujac, Ljubomir



Clinical experiences with an ASP model backup archive for PACS images  

NASA Astrophysics Data System (ADS)

Last year we presented a Fault-Tolerant Backup Archive using an Application Service Provider (ASP) model for disaster recovery. The purpose of this paper is to update and provide clinical experiences related towards implementing the ASP model archive solution for short-term backup of clinical PACS image data as well as possible applications other than disaster recovery. The ASP backup archive provides instantaneous, automatic backup of acquired PACS image data and instantaneous recovery of stored PACS image data all at a low operational cost and with little human intervention. This solution can be used for a variety of scheduled and unscheduled downtimes that occur on the main PACS archive. A backup archive server with hierarchical storage was implemented offsite from the main PACS archive location. Clinical data from a hospital PACS is sent to this ASP storage server in parallel to the exams being archived in the main server. Initially, connectivity between the main archive and the ASP storage server is established via a T-1 connection. In the future, other more cost-effective means of connectivity will be researched such as the Internet 2. We have integrated the ASP model backup archive with a clinical PACS at Saint JohnÕs Health Center and has been operational for over 6 months. Pitfalls encountered during integration with a live clinical PACS and the impact to clinical workflow will be discussed. In addition, estimations of the cost of establishing such a solution as well as the cost charged to the users will be included. Clinical downtime scenarios, such as a scheduled mandatory downtime and an unscheduled downtime due to a disaster event to the main archive, were simulated and the PACS exams were sent successfully from the offsite ASP storage server back to the hospital PACS in less than 1 day. The ASP backup archive was able to recover PACS image data for comparison studies with no complex operational procedures. Furthermore, no image data loss was encountered during the recovery. During any clinical downtime scenario, the ASP backup archive server can repopulate a clinical PACS quickly with the majority of studies available for comparison during the interim until the main PACS archive is fully recovered.

Liu, Brent J.; Cao, Fei; Documet, Luis; Huang, H. K.; Muldoon, Jean



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

PubMed Central

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

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



Clinical Experience With Gene Therapy for the Treatment of Prostate Cancer  

PubMed Central

Localized prostate cancer can be treated effectively with radical prostatectomy or radiation therapy. The treatment options for metastatic prostate cancer are limited to hormonal therapy; hormone-refractory cancer is treated with taxane-based chemotherapy, which provides only a modest survival benefit. New treatments are needed. The gene for the initiation of prostate cancer has not been identified; however, gene therapy can involve tumor injection of a gene to kill cells, systemic gene delivery to target and kill metastases, or local gene expression intended to generate a systemic response. This review will provide an overview of the various strategies of cancer gene therapy, focusing on those that have gone to clinical trial, detailing clinical experience in prostate cancer patients.

Stanizzi, Matthew A; Hall, Simon J



The lived experience of seeking tenure while practicing clinically: finding balance in academia.  


The purpose of this hermeneutic phenomenological research study was to assess the lived experience of seeking tenure while teaching and practicing at the bedside and to identify how a sense of balance was maintained throughout the process. Six nursing faculty were interviewed while actively seeking tenure or within 2 years after seeking tenure. Four themes were identified and will be discussed. The process of tenure is a stressful time for faculty and even more stressful when the faculty try to balance the demands for academe with clinical scholarship. These participants felt that their clinical practice was recognized or valued only when it was of benefit to the academic institution. In many institutions, creativity must be utilized to enhance the tenure portfolio. PMID:23222230

Beck, Julie; Ruth-Sahd, Lisa



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.

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



Clinical experience with In-Ceram Spinell crowns: 5-year follow-up.  


Prompted by increased patient requests for esthetic treatment, restorative clinicians have evaluated a variety of new materials and procedures. This study reports on 5 years' experience with In-Ceram Spinell all-ceramic crowns. A total of 40 anterior crowns were positioned in 13 patients from October 1995 to December 1998. The clinical examination was made following modified California Dental Association/Ryge criteria. Final evaluation was carried out in October 2000, for an observation period of 22 to 60 months (mean 50 months). Only one failure was recorded, and the fractured crown needed to be replaced; according to Kaplan-Meier analysis, the estimated success rate was 97.5%. A thorough description of the clinical procedures through which anterior teeth can be successfully treated with all-ceramic Spinell crowns is described. PMID:12516824

Fradeani, Mauro; Aquilano, Augusto; Corrado, Marcantonio



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

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.


Risk communication in clinical trials: A cognitive experiment and a survey  

PubMed Central

Background A Royal Statistical Society Working Party recently recommended that "Greater use should be made of numerical, as opposed to verbal, descriptions of risk" in first-in-man clinical trials. This echoed the view of many clinicians and psychologists about risk communication. As the clinical trial industry expands rapidly across the globe, it is important to understand risk communication in Asian countries. Methods We conducted a cognitive experiment about participation in a hypothetical clinical trial of a pain relief medication and a survey in cancer and arthritis patients in Singapore. In part 1 of the experiment, the patients received information about the risk of side effects in one of three formats (frequency, percentage and verbal descriptor) and in one of two sequences (from least to most severe and from most to least severe), and were asked about their willingness to participate. In part 2, the patients received information about the risk in all three formats, in the same sequence, and were again asked about their willingness to participate. A survey of preference for risk presentation methods and usage of verbal descriptors immediately followed. Results Willingness to participate and the likelihood of changing one's decision were not affected by the risk presentation methods. Most patients indicated a preference for the frequency format, but patients with primary school or no formal education were indifferent. While the patients used the verbal descriptors "very common", "common" and "very rare" in ways similar to the European Commission's Guidelines, their usage of the descriptors "uncommon" and "rare" was substantially different from the EU's. Conclusion In this sample of Asian cancer and arthritis patients, risk presentation format had no impact on willingness to participate in a clinical trial. However, there is a clear preference for the frequency format. The lay use of verbal descriptors was substantially different from the EU's.



A cross-sectional study investigating clinical predictors and physical experiences of pain in Parkinson's disease  

PubMed Central

Summary Pain is a non-motor symptom of Parkinson’s disease (PD) that is often neglected due to its high prevalence in both the PD and the normal elderly population. The aims of this cross-sectional study were to establish the prevalence of pain, investigate its clinical predictors and analyze physical experiences of pain as described by PD patients. A total of 121 patients diagnosed with PD were included. The patients underwent a neurological examination and a structured interview and completed questionnaires focusing on clinical types and physical experiences of pain. Logistic regressions were used to analyze possible predictors. Pain was reported by 80 (66%) patients with a mean age at PD diagnosis of 67.26±11.43 years. The most common clinical types of pain experienced by the patients were dystonic pain (48%), paresthesia/neuropathic pain (36%) and musculoskeletal pain (28%). The PD patients described their physical experience of pain as aching (46%), a feeling of tension (18%), sharp pain (12%), deep pain (12%) and dull pain (11%). Patients with PD affecting the right side of the body were four times more likely to report pain on the right side of the body; however, no such relation was found for the left side of the body. A higher UPDRS-III scale score and longer PD duration reduced the likelihood of patients reporting dull pain. The presence of paresthesia/neuropathic pain was shown to decrease the likelihood of patients reporting sharp pain. No significant relationships were found between the magnitude of pain and gender, age at PD diagnosis, PD duration, UPDRS-III score, or Hoehn and Yahr stage of PD. Although 40% of the PD patients felt that medication had a (direct) effect on their pain, no relationship could be found between pain severity and PD medication.

Rana, Abdul Qayyum; Saeed, Usman; Masroor, Mohamed Sufian; Yousuf, Muhammad Saad; Siddiqui, Ishraq



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

PubMed Central

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

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



Vas deferens occlusion by percutaneous injection of polyurethane elastomer plugs: clinical experience and reversibility.  


A non-incision method of vas occlusion based on the percutaneous injection of polyurethane elastomer solution to form plugs is described. The results are based on clinical experience in 12,000 men in which only 56 cases of minor complications were recorded. Follow-up of 500 men for up to 3 years demonstrated an azoospermia rate of 98%. Plugs have been removed from 86 men and, to date, 51 have made their wives pregnant. In those from which the plugs have been removed for more than 1 year (n = 31), the pregnancy rate is 100%. PMID:2347193

Zhao, S C



Participants' Experiences of Being Debriefed to Placebo Allocation in a Clinical Trial  

PubMed Central

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

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



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

PubMed Central

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

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



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

PubMed Central

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

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



Three clinical experiences with SNP array results consistent with parental incest: a narrative with lessons learned.  


Single nucleotide polymorphism microarrays have the ability to reveal parental consanguinity which may or may not be known to healthcare providers. Consanguinity can have significant implications for the health of patients and for individual and family psychosocial well-being. These results often present ethical and legal dilemmas that can have important ramifications. Unexpected consanguinity can be confounding to healthcare professionals who may be unprepared to handle these results or to communicate them to families or other appropriate representatives. There are few published accounts of experiences with consanguinity and SNP arrays. In this paper we discuss three cases where molecular evidence of parental incest was identified by SNP microarray. We hope to further highlight consanguinity as a potential incidental finding, how the cases were handled by the clinical team, and what resources were found to be most helpful. This paper aims to contribute further to professional discourse on incidental findings with genomic technology and how they were addressed clinically. These experiences may provide some guidance on how others can prepare for these findings and help improve practice. As genetic and genomic testing is utilized more by non-genetics providers, we also hope to inform about the importance of engaging with geneticists and genetic counselors when addressing these findings. PMID:24222483

Helm, Benjamin M; Langley, Katherine; Spangler, Brooke; Vergano, Samantha



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


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

Bria, Pietro; Lombardi, Riccardo



Clinical experience with desvenlafaxine in treatment of pain associated with diabetic peripheral neuropathy  

PubMed Central

Purpose To assess the safety and efficacy of the serotonin–norepinephrine reuptake inhibitor desvenlafaxine in adults with painful diabetic peripheral neuropathy (DPN). identifiers NCT00283842, NCT01050218. Patients and methods This was a 13-week, randomized, double-blind, placebo-controlled, fixed-dose study of desvenlafaxine in adults with painful DPN. The primary efficacy endpoint was change from baseline in numeric rating scale (NRS) score. Patients who completed the 13-week trial could continue in a 9-month open-label, flexible-dose extension study. Results A total of 412 patients were randomized to treatment with placebo or desvenlafaxine 50, 100, 200, or 400 mg/day. Of those, 240 patients continued in the extension study. After a planned interim analysis, conducted when the first 225 patients had completed 6 weeks of treatment in the short-term study, randomization to the 50 mg or 400 mg doses was stopped. At week 13, the mean change from baseline in NRS score was significantly greater compared with placebo in the desvenlafaxine 200 mg (difference [95% confidence interval {CI}]: 1.10 [0.50 to 1.70]; P<0.001) and 400 mg groups (0.91 [95% CI: 0.23 to 1.59]; P=0.027); differences from placebo were not statistically significant for the 50 mg (0.58 [95% CI: ?0.08 to 1.25]) and 100 mg (0.59 [95% CI: –0.03 to 1.21]) groups. Nausea and dizziness were the most common treatment-emergent adverse events reported in the short-term study, and the most common adverse events leading to discontinuation in the short-term study and the extension. Adverse events rates were dose-dependent in the short-term studies. Conclusion Desvenlafaxine was effective in relieving pain associated with DPN at doses of 200 and 400 mg/day, and improved activity impairment at all doses assessed. Desvenlafaxine was generally well-tolerated in the short-term and long-term studies.

Allen, Rob; Sharma, Uma; Barlas, Suna



Clinical experience and psychometric properties of the Children's Dermatology Life Quality Index (CDLQI), 1995-2012.  


The Children's Dermatology Life Quality Index (CDLQI) is a widely used questionnaire to measure the quality of life of children aged from 4 to 16 years. The purpose of this review is to summarize all published data regarding the clinical experience of the CDLQI and its psychometric properties as a single reference source for potential users. A literature search was carried out to identify all articles describing the use of the CDLQI from 1995 to November 2012. One hundred and six articles were identified, with four excluded. The CDLQI has been used in 28 countries in 102 clinical studies and is available in 44 languages, including six cultural adaptations; a cartoon version is available in 10 languages. It has been used in 14 skin conditions and used in the assessment of 11 topical drugs, nine systemic drugs, 13 therapeutic interventions and two epidemiological and other studies. There is evidence of high internal consistency, test-retest reliability, responsiveness to change, and significant correlation with other subjective and objective measures. Rasch analysis has not been carried out and more information is needed concerning minimal clinically important difference; these are areas requiring further study. PMID:23679682

Salek, M S; Jung, S; Brincat-Ruffini, L A; MacFarlane, L; Lewis-Jones, M S; Basra, M K A; Finlay, A Y



Eight years' experience of regional audit: an assessment of its value as a clinical governance tool.  


Strengthening clinical audit is crucial for improving the quality of healthcare provision. The West Midlands Rheumatology Service and Training Committee coordinates an innovative programme of regional audits and the experience of rheumatology healthcare professionals involved was surveyed. This was a questionnaire-based study in which respondents rated statements relating to regional audit on Likert scales. Out of 105 staff, 70 replied. There was consensus that results of regional audit have been robust, valid and reliable; regional audits benefit patients and units; provide educational opportunities for specialist registrars (SpRs); and are more efficient than local audit by allowing comparison between units. Opinion was divided about how well informed respondents were and how effective they are at closing the audit loop. Many units reported changes in practice. Regional audit is widely perceived to be a valuable clinical governance tool supporting significant changes to clinical practice, and an excellent training opportunity for SpRs. Recommendations for a successful regional audit scheme are described in this article. PMID:20408300

John, H; Paskins, Z; Hassell, A; Rowe, I F



Care of Pediatric Neurosurgical Patients in Iraq in 2007: Clinical and Ethical Experience of a Field Hospital.  

National Technical Information Service (NTIS)

Object. Care for host-nation pediatric casualties and disease or nonbattle injuries is an essential mission of deployed military medical assets. Clinical experience with pediatric patients at field hospitals has been increasingly reported since 2001, with...

J. E. Martin P. C. Spinella R. J. Teff



Correction of congenital diaphragmatic hernia in utero, V. Initial clinical experience.  


Review of our experience with 45 cases of prenatally diagnosed congenital diaphragmatic hernia (CDH) confirms that most fetuses (77%) will not survive despite optimal pre- and postnatal care. Polyhydramnios, associated anomalies, early diagnosis, and a large volume of herniated viscera (including liver) are associated with a particularly dismal prognosis. After extensive experimental work demonstrated the efficacy, feasibility, and safety of repair in utero, we attempted to salvage six highly selected fetuses with severe CDH by open fetal surgery. Five had liver incarcerated in the chest: three died at operation because attempts to reduce the liver compromised umbilical venous return. In one, a Goretex diaphragm was constructed around the liver, but the baby died after birth. The last two fetuses, one with incarcerated liver, were successfully repaired. Both demonstrated rapid growth of the lung in utero, had surprisingly good lung function after birth despite prematurity, had the abdominal patch removed at 2 weeks, and subsequently died of nonpulmonary problems (an unrelated nursery accident in one and intestinal complications in the other). The only maternal complication was amniotic fluid leak and preterm labor. All six women are well and four have had subsequent normal children. From this phase I experience, we conclude that fetal surgery appears safe for the mother and her reproductive potential, that fetal CDH repair is feasible in selected cases, and that the fetal lung responds quickly after decompression. However, fetal repair remains a formidable technical challenge. PMID:2405147

Harrison, M R; Langer, J C; Adzick, N S; Golbus, M S; Filly, R A; Anderson, R L; Rosen, M A; Callen, P W; Goldstein, R B; deLorimier, A A



Unification and extension of the similarity scaling criteria and mixing transition for studying astrophysics using high energy density laboratory experiments or numerical simulations  

NASA Astrophysics Data System (ADS)

The Euler similarity criteria for laboratory experiments and time-dependent mixing transition are important concepts introduced recently for application to prediction and analysis of astrophysical phenomena. However, Euler scaling by itself provides no information on the distinctive spectral range of high Reynolds number turbulent flows found in astrophysics situations. On the other hand, time-dependent mixing transition gives no indication on whether a flow that just passed the mixing transition is sufficient to capture all of the significant dynamics of the complete astrophysical spectral range. In this paper, a new approach, based on additional insight gained from review of Navier-Stokes turbulence theory, is developed. It allows for revelations about the distinctive spectral scale dynamics associated with high Reynolds number astrophysical flows. From this perspective, the energy-containing range of the turbulent flow measured in a laboratory setting must not be unintentionally contaminated in such a way that the interactive influences of this spectral scale range in the corresponding astrophysical situation cannot be faithfully represented. In this paper, the concept of a minimum state is introduced as the lowest Reynolds number turbulent flow that a time-dependent mixing transition must achieve to fulfill this objective. Later in the paper, the Reynolds number of the minimum state is determined as 1.6×105. The temporal criterion for the minimum state is also obtained. The efforts here can be viewed as a unification and extension of the concepts of both similarity scaling and transient mixing transition concepts. Finally, the implications of our approach in planning future intensive laser experiments or massively parallel numerical simulations are discussed. A systematic procedure is outlined so that as the capabilities of the laser interaction experiments and supporting results from detailed numerical simulations performed in recently advanced supercomputing facilities increase progressively, a strategy is developed so that a progressively increasing range of dynamic structures and their statistical influences on evolving astrophysical flows can be attained in laboratory investigations.

Zhou, Ye



Clinical application of single incision thoracoscopic surgery: early experience of 264 cases  

PubMed Central

Background Single incision thoracoscopic surgery (SITS) is recognized as a difficult procedure and surgeons hesitate to perform this technique. We describe our experience of SITS and determine whether SITS can be a routine approach in minimally invasive surgery. Methods From May 2011 to April 2013, a single operator attempted SITS for 264 cases. Their medical records were retrospectively reviewed with regard to age, sex, diagnosis, operation time, hospital stay, need of additional incision, morbidity, and early outcome. Results A number of thoracic diseases and procedures were attempted with SITS including primary (n?=?172) or secondary (n?=?22) spontaneous pneumothorax, biopsy for lung (n?=?29), pleura (n?=?3), and mediastinal lymph node (n?=?3), mediastinal mass excision (n?=?11), empyema decortication (n?=?11), lobectomy (n?=?6), pulmonary metastasectomy (n?=?3), pericardial window formation (n?=?3), and hematoma evacuation (n?=?1). Of these, 237 cases underwent SITS successfully. However, additional incision was needed in 10.2% (n?=?27). Reasons for conversions were as follows: extensive pleural adhesion (n?=?14), difficulty in endoscopic stapling (n?=?11), bleeding (n?=?1), and intolerance of one lung ventilation (n?=?1). Conversion rate of empyema was 54.5%, which was the most difficult for SITS. In contrast, the conversion rate of PSP was 4.7%, which means PSP was the most applicable for SITS. Postoperative complications included air leak (?3 days) (n?=?1), wound problem (n?=?4), delayed pleural effusion (n?=?1), and postoperative bleeding (n?=?1). Conclusions SITS can be a routine approach from simple to more complicated diseases. However, we still have difficulties in cases with extensive pleural adhesion or location of lesion with difficult accessibility for endoscopic stapling.



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


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



Nurse practitioners' knowledge, experience, and intention to use health literacy strategies in clinical practice.  


Nurse practitioners' (NPs) knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework. NPs who work in outpatient settings were recruited at a national NP conference. Participants were administered 3 self-report instruments: Health Literacy Knowledge and Experience Survey, Parts I and II; and the Health Literacy Strategies Behavioral Intention Questionnaire. Overall knowledge of health literacy and health literacy strategies was found to be low. Screening patients for low health literacy and evaluating patient education materials were found to be areas of knowledge deficit. Most NP participants used written patient education materials with alternate formats for patient education, such as audiotapes, videotapes, or computer software rarely used. Statistically significant differences were found in mean experience scores between NP level of educational preparation and NP practice settings. The intention to use health literacy strategies in practice was found to be strong. The findings of this investigation offer implications for enhancing NP curriculum and for continuing education opportunities. Increasing NPs' knowledge of health literacy and facilitating the use of health literacy strategies has the potential to change clinical practice and support improved patient outcomes. PMID:24093347

Cafiero, Madeline



Nurse Practitioners' Knowledge, Experience, and Intention to Use Health Literacy Strategies in Clinical Practice  

PubMed Central

Nurse practitioners' (NPs) knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework. NPs who work in outpatient settings were recruited at a national NP conference. Participants were administered 3 self-report instruments: Health Literacy Knowledge and Experience Survey, Parts I and II; and the Health Literacy Strategies Behavioral Intention Questionnaire. Overall knowledge of health literacy and health literacy strategies was found to be low. Screening patients for low health literacy and evaluating patient education materials were found to be areas of knowledge deficit. Most NP participants used written patient education materials with alternate formats for patient education, such as audiotapes, videotapes, or computer software rarely used. Statistically significant differences were found in mean experience scores between NP level of educational preparation and NP practice settings. The intention to use health literacy strategies in practice was found to be strong. The findings of this investigation offer implications for enhancing NP curriculum and for continuing education opportunities. Increasing NPs' knowledge of health literacy and facilitating the use of health literacy strategies has the potential to change clinical practice and support improved patient outcomes.

Cafiero, Madeline



Privatising Agricultural Extension: Caveat Emptor.  

ERIC Educational Resources Information Center

Discusses forces promoting privatization of agricultural extension. Discusses experiences of privatization and commercialization of extension and related problems in various countries, particularly developing countries. Suggests that the state will continue to play an important role in agricultural extension in many countries and that…

Kidd, A. D.; Lamers, J. P. A.; Ficarelli, P. P.; Hoffmann, V.



Privatising agricultural extension: caveat emptor  

Microsoft Academic Search

Improvement in agricultural systems requires good information and sound advice. This has often been provided to farmers through public extension systems. The paper describes some of the forces that require a reduced role for the public sector in agricultural extension and greater reliance on the private sector. Some experiences of privatisation and commercialisation of extension, as well as the caveats

A. D Kidd; J. P. A Lamers; P. P Ficarelli; V Hoffmann



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


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



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

Federal Register 2010, 2011, 2012, 2013

...Miner Clinics Program (H37) Current Grantee AGENCY: Health Resources and Services...Clinics Program awards to the current grantees (included in attached chart), in SUPPLEMENTARY INFORMATION: Grantees of record and intended award...



An exploration of the experience of compassion fatigue in clinical oncology nurses.  


Compassion fatigue (CF) is "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers' stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided. PMID:21661623

Perry, Beth; Toffner, Greg; Merrick, Trish; Dalton, Janice



New minimal immunosuppression strategies for composite tissue allograft transplantation: the cleveland clinic experience.  


Clinical application of composite tissue allografts requires the introduction of new minimal immunosuppressive or tolerance-inducing protocols. We have established a protocol for tolerance induction under ?/? selective blocking antibody T-cell receptor combined with interleukin-2 blocker cyclosporin A therapy. Application of this therapy resulted in induction of tolerance in fully allogenic and semiallogenic limb allograft transplants. Based on this experience we have found that the bone marrow component of the allograft is essential for tolerance induction and have confirmed that injection of bone marrow of donor origin directly into the bone marrow compartment of allograft recipients resulted in higher chimerism levels. In addition, we have developed a system for isolation of chimeric cells, which are specific for both the donor and recipient, by using magnetic activated cell sorting technique and flow cytometry. These new, experimental approaches confirm that introducing minimal suppression to patients undergoing hand or face transplantation will likely be achieved in the near future. PMID:21304046

Siemionow, Maria



Portaclamp in video-assisted minimally invasive cardiac surgery: surgical technique and preliminary clinical experience.  


Video-assisted minimally invasive cardiac surgery (VAMICS) is currently performed with various indications. However, despite the increasing evidence of its effectiveness, new approaches have to be defined to simplify this procedure, minimize its potential complications and limit its costs, for a wider use in the surgical community. The limited access to the aorta is a key point in VAMICS and mandates specific clamping modalities with their own limitations, costs and drawbacks. The Portaclamp (Cardio Life Research SA, Louvain la Neuve, Belgium), a new autoguided extravascular aortic cross-clamping system, has been recently proposed to facilitate VAMICS. Herein, we describe the Portaclamp approach and report our indications and preliminary clinical experience so to define its role in VAMICS. PMID:15896633

Marchetto, Giovanni; D'Armini, Andrea M; Rinaldi, Mauro; Viganò, Mario



Clinical experience results with clindamycin 1% benzoyl peroxide 5% gel (Duac) as monotherapy and in combination.  


This article will examine various clinical experiences with acne patients successfully treated with topical clindamycin 1% benzoyl peroxide 5% gel (Duac) alone and in combination with other acne treatments. Clindamycin 1% benzoyl peroxide 5%, the only once-daily prescription topical aqueous gel combining a benzoyl peroxide and an antibiotic, has demonstrated excellent tolerability and efficacy and is stable when used concomitantly with other therapies. A regimen of topical clindamycin 1% benzoyl peroxide 5% gel, oral doxycycline hyclate (Doryx), and adapalene gel (Differin) seems especially advantageous from a theoretical and practical perspective. Improvement is noted by means of photographic, physician, and/or patient assessments at baseline and follow-up visits. PMID:15776773

Bikowski, Joseph B



Clinical experience with stem cells and other cell therapies in neurological diseases.  


To overcome the limited capacity of the CNS for regeneration, the theoretical alternative would be to use stem cells for more effective management of chronic degenerative and inflammatory neurological conditions, and also of acute neuronal damage from injuries or cerebrovascular diseases. Although the adult brain contains small numbers of stem cells in restricted areas, this intrinsic stem cell repertoire is small and does not measurably contribute to functional recovery. Embryonic cells carrying pluripotent and self-renewal properties represent the stem cell prototype, but there are additional somatic stem cells that may be harvested and expanded from various tissues during adult life. Stem cell transplantation is based on the assumption that such cells may have the potential to regenerate or support the survival of the existing, partially damaged cells. This review summarizes the state-of-the-art and the clinical worldwide experience with the use of various types of stem cells in neurological diseases. PMID:23107343

Karussis, Dimitrios; Petrou, Panayiota; Kassis, Ibrahim



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

PubMed Central

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

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



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.

Zilina, Olga; Teek, Rita; Tammur, Pille; Kuuse, Kati; Yakoreva, Maria; Vaidla, Eve; Molter-Vaar, Triin; Reimand, Tiia; Kurg, Ants; Ounap, Katrin



Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator.  


Seventy patients received the automatic implantable defibrillator, five original devices and 72 modified second-generation devices using only bipolar rate sensing and delivering an R wave synchronous cardioverting/defibrillating shock, for either ventricular tachycardia or fibrillation. The primary clinical arrhythmia was sustained ventricular tachycardia in 32 patients, ventricular fibrillation in 20 patients, and both ventricular tachycardia and fibrillation in 18 patients. Before implantation of the device the patients had survived 3.1 +/- 2.3 arrhythmic episodes, including 1.9 +/- 1.7 cardiac arrest, and had received 4.0 +/- 2.1 antiarrhythmic drugs without improvement. Sixty-eight patients ultimately received devices. After a follow-up period of 8.9 +/- 7.7 months (range 1 to 33), 37 patients received a total of 463 discharges. Inability to determine the precise reason for most discharges and the unpleasant nature of the discharges were the major clinical problems encountered. Complications included postoperative death (one patient), lead problems (six patients), inadequate energy requiring explanation (two patients), and pocket infection (one patient. Life-table analysis revealed 6 and 12 month cardiovascular survival of 95.0% and 89.9% and sudden death survival of 98.2%. In our experience, survival with the automatic implantable cardioverter/defibrillator exceeds that with other forms of therapy. PMID:3965173

Echt, D S; Armstrong, K; Schmidt, P; Oyer, P E; Stinson, E B; Winkle, R A



Flagging clinical adverse experiences: reducing false discoveries without materially compromising power for detecting true signals.  


Comparative analyses of safety/tolerability data from a typical phase III randomized clinical trial generate multiple p-values associated with adverse experiences (AEs) across several body systems. A common approach is to 'flag' any AE with a p-value less than or equal to 0.05, ignoring the multiplicity problem. Despite the fact that this approach can result in excessive false discoveries (false positives), many researchers avoid a multiplicity adjustment to curtail the risk of missing true safety signals. We propose a new flagging mechanism that significantly lowers the false discovery rate (FDR) without materially compromising the power for detecting true signals, relative to the common no-adjustment approach. Our simple two-step procedure is an enhancement of the Mehrotra-Heyse-Tukey approach that leverages the natural grouping of AEs by body systems. We use simulations to show that, on the basis of FDR and power, our procedure is an attractive alternative to the following: (i) the no-adjustment approach; (ii) a one-step FDR approach that ignores the grouping of AEs by body systems; and (iii) a recently proposed two-step FDR approach for much larger-scale settings such as genome-wide association studies. We use three clinical trial examples for illustration. PMID:22415725

Mehrotra, Devan V; Adewale, Adeniyi J



Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients  

PubMed Central

Background To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology. Methods During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45Gy and 69.96Gy in 33 fractions (group A); 54.45Gy and 66Gy in 33 fractions (group B) and 55Gy in 25 fractions (group C). Results Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition. Conclusions These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities.



Evaluation of Clinical Pharmacy Programs: The D.D. Eisenhower Army Medical Center Experience.  

National Technical Information Service (NTIS)

Although clinical pharmacy services have existed for a number of years, their cost effectiveness has not been adequately assessed. Clinical pharmacists are members of the patient care team. Besides providing direct patient counseling, clinical pharmacists...

K. H. Dexter



Team-based learning, a learning strategy for clinical reasoning, in students with problem-based learning tutorial experiences.  


Acquiring clinical reasoning skills in lectures may be difficult, but it can be learnt through problem-solving in the context of clinical practice. Problem finding and solving are skills required for clinical reasoning; however, students who underwent problem-based learning (PBL) still have difficulty in acquiring clinical reasoning skills. We hypothesized that team-based learning (TBL), a learning strategy that provides the opportunity to solve problems by repeatedly taking tests, can enhance the clinical reasoning ability in medical students with PBL experiences during the pre-clinical years. TBL courses were designed for 4(th) year students in a 6-year program in 2008, 2009, and 2010. TBL individual scores, consisting of a combination of individual and group tests, were compared with scores of several examinations including computer-based testing (CBT), an original examination assessing clinical reasoning ability (problem-solving ability test; P-SAT), term examinations, and Objective Structured Clinical Examination (OSCE). CBT, OSCE and P-SAT scores were compared with those of students who learned clinical reasoning only through PBL tutorials in 2005, 2006, and 2007 (non-TBL students). Individual TBL scores of students did not correlate with scores of any other examination. Assessments on clinical reasoning ability, such as CBT, OSCE, and P-SAT scores, were significantly higher in TBL students compared with non-TBL students. Students found TBL to be effective, particularly in areas of problem solving by both individuals and teams, and feedback from specialists. In conclusion, TBL for clinical reasoning is useful in improving clinical reasoning ability in students with PBL experiences with limited clinical exposure. PMID:22516766

Okubo, Yumiko; Ishiguro, Naoko; Suganuma, Taiyo; Nishikawa, Toshio; Takubo, Toshio; Kojimahara, Noriko; Yago, Rie; Nunoda, Shinichi; Sugihara, Shigetaka; Yoshioka, Toshimasa



A flexible count data model to fit the wide diversity of expression profiles arising from extensively replicated RNA-seq experiments  

PubMed Central

Background High-throughput RNA sequencing (RNA-seq) offers unprecedented power to capture the real dynamics of gene expression. Experimental designs with extensive biological replication present a unique opportunity to exploit this feature and distinguish expression profiles with higher resolution. RNA-seq data analysis methods so far have been mostly applied to data sets with few replicates and their default settings try to provide the best performance under this constraint. These methods are based on two well-known count data distributions: the Poisson and the negative binomial. The way to properly calibrate them with large RNA-seq data sets is not trivial for the non-expert bioinformatics user. Results Here we show that expression profiles produced by extensively-replicated RNA-seq experiments lead to a rich diversity of count data distributions beyond the Poisson and the negative binomial, such as Poisson-Inverse Gaussian or Pólya-Aeppli, which can be captured by a more general family of count data distributions called the Poisson-Tweedie. The flexibility of the Poisson-Tweedie family enables a direct fitting of emerging features of large expression profiles, such as heavy-tails or zero-inflation, without the need to alter a single configuration parameter. We provide a software package for R called tweeDEseq implementing a new test for differential expression based on the Poisson-Tweedie family. Using simulations on synthetic and real RNA-seq data we show that tweeDEseq yields P-values that are equally or more accurate than competing methods under different configuration parameters. By surveying the tiny fraction of sex-specific gene expression changes in human lymphoblastoid cell lines, we also show that tweeDEseq accurately detects differentially expressed genes in a real large RNA-seq data set with improved performance and reproducibility over the previously compared methodologies. Finally, we compared the results with those obtained from microarrays in order to check for reproducibility. Conclusions RNA-seq data with many replicates leads to a handful of count data distributions which can be accurately estimated with the statistical model illustrated in this paper. This method provides a better fit to the underlying biological variability; this may be critical when comparing groups of RNA-seq samples with markedly different count data distributions. The tweeDEseq package forms part of the Bioconductor project and it is available for download at



Does recruitment lead to retention? - Rural Clinical School training experiences and subsequent intern choices  

Microsoft Academic Search

Introduction: The Australian Rural Clinical Schools, established nationally in 2000- 2001, have provided an opportunity for medical students to undertake their clinical training across a network of hospitals, general practice surgeries and community medical centres in locations throughout Australia. The Rural Clinical School at the University of Queensland was established in 2002, as the Rural Clinical Division (RCD) of the

Diann Eley; Australia Peter Baker


The effects of severe femoral bone loss on the flexion extension joint space in revision total knee arthroplasty: a cadaveric analysis and clinical consequences.  


Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femoral bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibial position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45 degrees and 90 degrees of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2+/-8.9 mm of joint space is created in 90 degrees of flexion, whereas the joint space in full extension is conserved (1.5+/-1.7 mm). With additional loss of the posterior capsule, the joint space at 90 degrees of flexion increased to 26.2+/-6.1 mm, with minimal changes in the extension gap (3.4+/-0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap. PMID:11284594

Krackow, K A; Mihalko, W M



Clinical trials in cancer: the role of surrogate patients in defining what constitutes an ethically acceptable clinical experiment.  

PubMed Central

Doctors who treat lung cancer in Ontario were previously asked how they would wish to be managed if they developed non-small cell lung cancer and whether they would consent to participate in six clinical trials for which they might be eligible. The proportion of these expert surrogate patients who would consent to each clinical trial ranged from 11 to 64%. The results of this study were transmitted to the same group of doctors who were asked to comment on the ethical acceptability of each trial in the light of this information. The majority of physicians said that those trials to which less than 50% of expert surrogates consented should not have been opened to patients. Sixty-nine per cent of doctors thought that new trials should be evaluated in this way. We also present the results of a survey of 400 lay people in Ontario who were asked to imagine that they had lung cancer and whether they would consent to participate in two of these same clinical trials. Fifty per cent of lay people consented to a randomised trial of lobectomy versus segmentectomy in early, operable disease (LCSC-821) compared to 64% of expert surrogates, and 48% of lay people consented to a randomised trial of five different forms of chemotherapy in metastatic disease (SWOG-8241) compared to 19% of doctors. It was concluded that the lay people were unable to discern differences in the acceptability of clinical trials which were clear to experts in the field. Subsequently, respondents were told about the decisions which doctors would make in the same circumstances and asked if this information would modify their previous decisions. There is no net change in the proportion of patients consenting to the surgery trial but the proportion of people consenting to the chemotherapy trial decreased by 40%. The majority of lay people said that they would wish to have access to this type of information before consenting to participate in a clinical trial.

Mackillop, W. J.; Palmer, M. J.; O'Sullivan, B.; Ward, G. K.; Steele, R.; Dotsikas, G.



Recurrent and founder mutations in the Netherlands: Extensive clinical variability in Marfan syndrome patients with a single novel recurrent fibrillin-1 missense mutation  

Microsoft Academic Search

Background\\/Methods. Marfan syndrome (MFS) is a heritable connective tissue disorder usually caused by a mutation in the fibrillin 1 (FBN1) gene. Typical characteristics of MPS that have been described include dolichostenomelia, ectopia lentis and aortic root dilatation. However, there is great clinical variability in the expression of the syndrome's manifestations, both between and within families. Here we discuss the clinical

J. J. J. Aalberts; A. G. Schuurman; G. Pals; B. J. C. Hamel; G. Bosman; Y. Hilhorst-Hofstee; D. Q. C. M. Barge-Schaapveld; B. J. M. Mulder; Berg van den M. P; Tintelen van J. P



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

Federal Register 2010, 2011, 2012, 2013

...Miner Clinics Program (H37) Current Grantee AGENCY: Health Resources and Services...Clinics Program awards to the current grantees (included in attached chart), in amounts...the Award(s): Each of the current grantees will receive support at the same...



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:



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

PubMed Central

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

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



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.

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



Rediscovering the essence of nursing: exploring the impact of in clinical experience in Thailand for undergraduate nursing students from Australia.  


Cultural competence is now widely recognised as an essential characteristic for undergraduate nursing students. Clinical experience in foreign countries has become increasingly popular as a strategy to enhance cultural awareness and competence. However, published research articulating the experience and outcomes of these initiatives is relatively rare, particularly from an Australian perspective. This paper presents the findings of a qualitative, exploratory research project. Individual semi-structure interviews were conducted with eight undergraduate nursing students before, during and at the conclusion of a four week clinical placement in Surin, Thailand. Data analysis identified the following major themes: first interview - anticipation; second interview - making a difference; contrasting worlds; and part of the group; third interview - reality check and group dynamics. These findings suggest that international clinical experience has potential benefits beyond the development of cultural competence. The importance of caring in nursing and the importance of group dynamics were particularly valued by student participants. PMID:21256636

Reid-Searl, Kerry; Dwyer, Trudy; Moxham, Lorna; Happell, Brenda; Sander, Teresa



V.A.C. Therapy in the management of paediatric wounds: clinical review and experience.  


Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure (V.A.C. Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C. Therapy System. PMID:19614789

Baharestani, Mona; Amjad, Ibrahim; Bookout, Kim; Fleck, Tatjana; Gabriel, Allen; Kaufman, David; McCord, Shannon Stone; Moores, Donald C; Olutoye, Oluyinka O; Salazar, Jorge D; Song, David H; Teich, Steven; Gupta, Subhas



The coordination of clinical and didactic learning experiences to improve critical-thinking skills and academic performance  

Microsoft Academic Search

Teaching strategies to improve critical-thinking skills and knowledge construction in associate degree (AD) nursing education are most effective when they actively engage the student. Faculty in an Illinois nursing program developed a schedule that correlated classroom content with clinical experiences for the predominant medical–surgical units. While planned didactic\\/clinical correlation yielded mixed results as a strategy to improve academic performance, providing

Cynthia L. Maskey



Experiences and challenges in data monitoring for clinical trials within an international tropical disease research network  

PubMed Central

Background Models for the structure and procedures of data and safety monitoring boards (DSMBs) continue to evolve in response to issues of new and of old concern. Some authors have called for an open dialogue on these questions through publication of the experiences of DSMBs in addressing them. Purpose The goal of this paper is to add to the current discussion about acceptable models for establishing, serving on, and reporting to monitoring committees, particularly those that oversee multiple studies in less developed countries. The paper seeks to do so by describing the establishment and subsequent operation of one such multi-trial DSMB over a five-year period. This DSMB was formed to monitor trials conducted by members of the International Centers for Tropical Disease Research (ICTDR) network of the National Institute of Allergy and Infectious Diseases (NIAID). Methods The operational model and experiences are summarized by the authors, who had immediate responsibilities for directing the DSMB's activities. Results The board played an active, traditional role in assuring that patient safety was maintained and that current standards for clinical research were met. In addition, both NIAID and the board members viewed education of investigators to be an important role for the board to play in this particular setting. This affected the threshold for identifying which trials would be monitored, and it impacted several procedures adopted by the board. Limitations This report reflects the observations of those involved in managing the DSMB, including comments offered by the DSMB and by investigators, but not data gathered in a systematic way. Conclusions The operational model described here has allowed the DSMB to fulfill its role in the oversight of the trials. We hope that the ideas we present may help others facing similar situations and may stimulate further critical thinking about DSMB structure and function.

Chen-Mok, M; VanRaden, MJ; Higgs, ES; Dominik, R



Work experience program at a metropolitan paediatric hospital: assisting rural and metropolitan allied health professionals exchange clinical skills.  


The needs of rural allied health professionals (AHPs) have been widely documented. In particular, problems of professional isolation, lack of professional development opportunities and limited support systems have been highlighted as problems associated with working in rural and remote areas. This research aimed to provide rural and remote AHPs with an opportunity to gain experience in paediatric clinical areas of their choice, to provide rural/remote and metropolitan AHPs with an opportunity to share clinical knowledge and expertise, and to develop networks between rural/remote and metropolitan AHPs. A clinical experience program was developed to meet these aims. Twenty-nine AHPs from rural and remote areas of Queensland participated in the program. Participants completed questionnaires at the end of clinical experience program and 4-8 weeks after the visit. A focus group was also conducted. Analyses found the program met the majority of participants goals and expectations. Enhanced clinical skills in specialist paediatric areas, increased networking and access to resources were reported by rural/remote AHPs as benefits of the program. The role of a clinical consultant was found to be critical to the success of the program. PMID:11998265

Parkin, A E; McMahon, S; Upfield, N; Copley, J; Hollands, K



Preliminary experience with a hospital blood pressure follow up clinic with nurse practitioner assessment and microprocessor based data retrieval.  


Experience over two years with 376 hypertensive patients managed at a clinic where the primary observations are made by a trained nurse, clinical information is held on a microprocessor, and treatment follows a standard stepped care approach has been assessed. Blood pressure control after both one and two years was appreciably improved, with over 70% of patients having diastolic pressure below 90 mm Hg compared with 22% of patients when they first attended the new clinic. The non-attendance rate was half that of the conventional hospital outpatient clinic. A computer based record system with a nurse run hypertension clinic is acceptable to patients and offers the possibility of more effective long term control of blood pressure in large numbers of patients. PMID:6432180

Rubin, P C; Curzio, J L; Kelman, A; Elliott, H L; Reid, J L



Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review.  


Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation. PMID:15617960

Ewers, R; Schicho, K; Undt, G; Wanschitz, F; Truppe, M; Seemann, R; Wagner, A



Postoperative radiotherapy in DBCG during 30 years. Techniques, indications and clinical radiobiological experience.  


During the time period 1977-2007 postoperative radiotherapy in DBCG has varied considerably with regard to techniques and indications together with changes in the extent of surgery and adjuvant systemic therapy. The radiation treatment has been developed on the basis of clinical, radiophysical and radiobiological principles, encompassing also practical problems such as available equipment in the different centres and at times lack of sufficient machine capacity. The paper focus especially on the comprehensive work done prior to the DBCG 82 b&c studies, in order to optimize radiotherapy in all aspects prior to the evaluation of the efficacy of this treatment modality. The results from these trials did succeed in clear evidence that radiotherapy has an important role in the multidisciplinary treatment of early breast cancer. In parallel to these studies a new and challenging use of radiotherapy after breast conserving surgery was evaluated in the DBCG TM 82 protocol. The experience obtained with different techniques in this study formed the basis for the current principles of radiotherapy after lumpectomy. Reduction of radiation related morbidity has been a major issue for the DBCG radiotherapy group, and in this aspect several studies, including quality control visits, have been carried out to make the relevant modifications and to evaluate deviations from the guidelines between the centres. The background for the changes in radiotherapy is described for each of the programme periods as well as future perspectives which will include further refinements of the target and adjustments of dose and fractionation in selected patients. PMID:18465332

Overgaard, Marie; Christensen, Jens Juul



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


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

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



Psychiatric outpatients report their experiences as participants in a randomized clinical trial.  


We conducted exit interviews with 45 outpatients with severe and persistent mental illness (SPMI) who had participated in a randomized clinical trial. The interviews followed a semistructured format and were audiotaped for later transcription and rating by two independent raters. Content analyses of the interviews revealed that most participants evaluated their experiences quite favorably. For example, most noted that the assessment process was thought-provoking and motivational and that the intervention groups led to increased self-confidence and new friendships. Although a few participants noted that the assessment contained sensitive material, all appreciated the frequent reminders that information disclosed was strictly confidential. These results indicate that persons living with a SPMI often enjoy participating in behavioral research, which can yield immediate benefits to patient-participants. Exit interview research such as this can help investigators to understand reasons for consent and participation, to identify needs for protocol modifications, and to facilitate the integration of evidence-based interventions into the mental health care systems. PMID:11379973

Carey, M P; Morrison-Beedy, D; Carey, K B; Maisto, S A; Gordon, C M; Pedlow, C T



A pilot experience with competency-based clinical skills assessment in a surgical clerkship.  


This investigation examines a competency-based clinical skills assessment program for surgical clerks using checklists and rating forms for precise measurement of physical exam (PE) skills, physician-patient interaction (PPI) skills, and patient write-up (PW) skills. Analysis of variance demonstrated improvement in PW skills across the academic year when measured by the rating instrument, but this improvement was not detected on traditional subjective rating forms (SRF). PPI skills improved between first rotations across 2 academic years with the addition of orientation to expectations (mean, 79% versus 92%, P = 0.000). Poor correlation was noted between the National Board of Medical Examiners Surgery Subtest scores and PE skills (r = .19), PW skills (r = .20), and PPI skills (r = .15). While the overall ratings given by faculty on SRF correlated with the SRF ratings of PE skills (r = .77) and PPI skills (r = .58), these same faculty ratings correlated poorly with these skills as assessed by checklist (r = .16 and r = .14, respectively). This pilot experience demonstrates that PE skills, PW skills, and PPI skills (1) improve only with orientation to expectations and feedback, (2) correlate poorly with fund of knowledge assessment, and (3) are best assessed with precise measurement (eg, checklist, direct observation), which avoids the halo effect of overall evaluation that occurs with subjective rating forms. PMID:8209937

Dunnington, G L; Wright, K; Hoffman, K



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


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



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


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



Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases  

PubMed Central

Purpose: The purpose of this study is to report the clinical and functional outcomes of patients, treated between 2004 and 2009, with high-risk popliteal vascular injuries due to compound fractures about the knee. Patients and methods: A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%), primary anastomosis in 20 (32.3%), and lateral repair in 3 (4.8%) patients. The patients were divided into 2 study groups: limb salvage group (group 1) and amputation group (group 2). Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage. Results: In the entire cohort of patients, 60 patients (97%) were male and 2 were female (3%); the mean age was 34.1 years (16–49 years). The overall amputation rate in this study was 37.1% (23 amputations). Significant (P < 0.05) independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions. Conclusion: Expeditious recognition of vascular injury, transport to repair, and repair of associated venous injury when possible are necessary to optimize limb salvage. The importance of a high level of suspicion and low threshold for timely amputation has been emphasized when limb salvage was deemed impossible to prevent life-threatening complication. Delays in surgery, extensive soft tissue defect, compound tibia–fibula fracture, and other factors are associated with high amputation rate following popliteal artery injury.

Pourzand, Ali; Fakhri, Bassir A; Azhough, Ramin; Hassanzadeh, Mohammad Ali; Hashemzadeh, Shahryar; Bayat, Amrollah M



Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study  

PubMed Central

Background There is limited evidence of the unmet needs and experiences of adults with Attention Deficit Hyperactivity Disorder (ADHD) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients diagnosed during adulthood and childhood. Methods In this qualitative study, 30 adults with ADHD were recruited through an ADHD charity (n?=?17) and two hospital outpatient clinics for adults with ADHD in England (n?=?13). Half of the participants were diagnosed with ADHD during childhood or adolescence and the remainder during adulthood. Semi-structured interviews were conducted and data was analysed using a thematic approach based on Grounded Theory principles. Results Analysis revealed five core themes: ‘An uphill struggle’: the challenge of accessing services, ‘Accumulated Psychosocial Burden and the Impact of ADHD’, ‘Weighing up Costs vs. Benefits of ADHD Pharmacological Treatment’, ‘Value of Non-pharmacological Treatment’ and ‘Barriers to Treatment Adherence’. Accessing services and the challenges associated with securing a definitive diagnosis of ADHD in adulthood was an ‘uphill struggle’, often due to sceptical and negative attitudes towards ADHD by healthcare professionals. ADHD-related impairment had an overwhelmingly chaotic impact on every aspect of patients’ lives and many felt ill equipped to cope. A persistent sense of failure and missed potential from living with the impact of ADHD impairment had led to an accumulated psychosocial burden, especially among those diagnosed from late adolescence onwards. In contrast, positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many felt strongly that by itself, it was inadequate. Additional support in the form of psychological therapies or psycho-education was strongly desired. However, few patients had access to non-pharmacological treatment. In some, medication use was often inadequately monitored with little or no follow-up by healthcare professionals, leading to poor adherence and a sense of abandonment from the healthcare system. Conclusion The findings suggest that the unmet needs of adults with ADHD are substantial and that there is a wide gap between policy and current practice in England.



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

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


Magnetic resonance imaging (MRI): method and early clinical experiences in diseases of the central nervous system.  


Magnetic resonance imaging (MRI) has undergone a rapid development which is still continuing. In this article a survey is given of the present status of this new diagnostic tool in the evaluation of diseases of the central nervous system. When atoms with uneven numbers of protons or neutrons in a homogeneous magnetic field are tilted against the main vector of this field by a radiofrequency pulse, nuclear magnetic resonance can be observed. During the relaxation of the little dipoles back to the direction of the underlying magnetic field, a resonance signal is generated. The superposition of variable field gradients enables the scanning of sectional images in the axial, frontal and sagittal plane. The variables of H+-magnetic resonance which can be utilized for imaging are: the proton density, the relaxation times T1 (spin-lattice) and T2 (spin-spin) and flow effects. While the proton density in organic tissue fluctuates only by some 10%, the relaxation times may vary by several hundred per cent. Tissue contrast, therefore, is mainly based on relaxation times differences. The image character can also be influenced by variations of imaging parameters (i.e. repetition rate, interpulse delay, read out or echo delay) in different imaging sequences, such as the spin-echo and the inversion recovery technique. Depending on these imaging parameters T1 and T2 will contribute to the signal to a varying degree. This fact is most important for the diagnostic information of MRI. In initial clinical experiences in the diagnosis of diseases of the central nervous system, MRI has demonstrated high sensitivity in the detection of lesions (such as oedema, neoplasms, demyelinating disease), but less significance in lesion discrimination. In spinal disease the direct sagittal imaging of MRI enables MRI-myelography without contrast medium, superior to conventional myelography in many cases. For detailed evaluation of disc disease, however, the spatial resolution still has to be improved. Promising results have been obtained from flow effects. Depending on the flow velocity of blood, vessels appear white with intensive signals (slow flow) or black due to low signal intensities (rapid flow). MRI-angiography including measurement of blood flow seems possible. MRI-contrast media are not yet available for routine clinical use. Promising results have been reported on the basis of rare-earth elements, such as gadolinium Gd3+. These substances decrease T1 and T2 with subsequent increase in signal intensity. Concerning harmful side-effects of MRI, three possible sources have to be considered: the static magnetic field, the changing magnetic field, and radiofrequency heating.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6397697

Huk, W J; Gademann, G



Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy  

PubMed Central

Background To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology. Methods Forty-five patients with a median age of 72 ± 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0 ± 3.0 ng/mL, were treated with RapidArc in a feasibility study. All patients were treated with single arc using 6MV photons. Dose prescription ranged between 76 (7 patients) and 78 Gy (38 patients) in 2Gy/fraction. Plan quality was assessed by means of Dose Volume Histogram (DVH) analysis. Technical parameters of arcs and pre-treatment quality assurance results (Gamma Agreement Index, GAI) are reported to describe delivery features. Early toxicity was scored (according to the Common Terminology Criteria of Adverse Effects scale, CTCAE, scale) at the end of treatment together with biochemical outcome (PSA). Results From DVH data, target coverage was fulfilling planning objectives: V95% was in average higher than 98% and V107%~0.0% (D2%~104.0% in average). Homogeneity D5%-D95% ranged between 6.2 ± 1.0% to 6.7 ± 1.3%. For rectum, all planning objectives were largely met (e.g. V70Gy = 10.7 ± 5.5% against an objective of < 25%) similarly for bladder (e.g. D2% = 79.4 ± 1.2Gy against an objective of 80.0Gy). Maximum dose to femurs was D2% = 36.7 ± 5.4Gy against an objective of 47Gy. Monitor Units resulted: MU/Gy = 239 ± 37. Average beam on time was 1.24 ± 0.0 minutes. Pre-treatment GAI resulted in 98.1 ± 1.1%. Clinical data were recorded as PSA at 6 weeks after RT, with median values of 0.4 ± 0.4 ng/mL. Concerning acute toxicity, no patient showed grade 2-3 rectal toxicity; 5/42 (12%) patients experienced grade 2 dysuria; 18/41 (44%) patients preserved complete or partial erectile function. Conclusion RapidArc proved to be a safe, qualitative and advantageous treatment modality for prostate cancer.



In search of specificity: "not just right experiences" and obsessive-compulsive symptoms in non-clinical and clinical Italian individuals.  


The cognitive model of OCD proposes that certain beliefs may contribute to the development and maintenance of this disorder. To date, however, it is not yet clear which beliefs are more relevant for explaining OCD symptomatology; moreover, their causal status is yet to be clearly established. In the effort to identify other constructs and processes related to OCD, the phenomenon labeled "not just right experiences" (NJREs) has received increasing attention. In this study, measures of NJREs (the NJRE-Q-R), OCD symptoms, general distress (i.e., anxiety, and depression), and perfectionism were administered to a large sample of college students and a small sample of OCD and non-OCD patients. The clinical sample also completed a measure of OC beliefs. Results showed that NJREs could be reliably measured through a self-report format in non-clinical and clinical Italian individuals. A specific association between NJREs severity and OCD symptoms was found in the non-clinical sample, after controlling for anxiety, depression, and perfectionism. The NJRE-Q-R Severity scale clearly discriminated OCD patients from patients with other anxiety disorders or depression. Lastly, the NJREs measure differentiated the clinical groups when OC beliefs were controlled, whereas OC beliefs did not discriminate among the groups after NJREs severity was controlled. The concept of NJREs may contribute to improve current psychological and biological model of OCD. PMID:20627224

Ghisi, Marta; Chiri, Luigi Rocco; Marchetti, Igor; Sanavio, Ezio; Sica, Claudio



The Intact porcine bioprosthesis: early world-wide clinical experience and analysis of a single institution's experience  

Microsoft Academic Search

The Intact porcine bioprosthesis is a new-generation valve fixed under stress-free conditions and subjected to a mineralization-inhibiting treatment. The valve is undergoing multi-centre prospective clinical evaluation sponsored by Medtronic, Inc., with 19 centres participating world wide. Since April 1986,1465 valves have been implanted in the aortic position (AVR, n = 965), mitral position (MVR, n = 438), or both (n

E Vermeulen; G. Rennink; S. Ernst; W. Jaarsma; P. A. Chevalier; D. V. Lutz



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

PubMed Central

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 telephone questionnaires that were administered in 2006 to a sample of 86 women and semi-structured interviews conducted with 12 of these women. Results Painful nipples/breasts, low milk supply and latching difficulties were the three most frequent major breastfeeding problems identified by women. Their personal characteristics as well as the moral and physical support provided by family and friends and by health professional and clinicians at the breastfeeding clinic were the factors identified most often as having a positive influence on the breastfeeding experience. Conclusion The results suggest that breastfeeding clinics have a critical role to play in improving the breastfeeding experience of women with major difficulties.

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



[Neuroendocrine tumors of a pancreas: 30 year's experience of clinic of faculty surgery of N.N. Burdenko].  


N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times. PMID:23887317

Chernousov, A F; Egorov, A V; Musaev, G Kh; Fominykh, E V; Kondrashin, S A; Vasil'ev, I A; Parnova, V A; Anisimova, O V



Experience with a physician-directed, clinic-based program for outpatient parenteral antibiotic therapy in the USA  

Microsoft Academic Search

The experience with 538 patients who received outpatient parenteral antibiotic therapy (OPAT) in 1993 in a private institute in Tacoma, Washington, USA, is reviewed here. Clinical outcomes suggested a successful resolution of infection in 99 % of cases. Bacteriological outcomes showed that eradication of the organism had occurred in 92 % of patients by the end of therapy. The success

A. D. Tice



Robotic pancreatic surgery is no substitute for experience and clinical judgment: an initial experience and literature review  

PubMed Central

Robotic pancreatic surgery offers technical advantages, and has been applied across many surgical specialties. We report an initial experience of 12 distal pancreatic resections for benign tumors from an established pancreatic center with previous general and biliary laparoscopic experience. Of a total of 12 patients, 7 were women; the mean age was 55.5 years, and the lesions included 8 distal intraductal papillary mucinous tumors, 1 insulinoma and in 3 a non-functioning neuroendocrine tumor. All operations were performed in between 90 and 180 minutes, and blood loss and hospital stay were minimal.



Clinical Experience With the Swiss Lithoclast Master in Treatment of Bladder Calculi.  


Abstract Background and Purpose: Bladder calculi account for 5% of urinary tract calculi in the Western world, and many different treatment modalities have been presented throughout the decades. We report our clinical experience using the Swiss LithoClast® Master (SLM). Materials and Methods: The SLM is a rigid, hand-held endourologic probe including a pneumatic lithotriptor and an ultrasonic lithotriptor. Attached to the ultrasonic modality is a suction system. The two lithotriptor modalities are controlled by a footswitch and can be activated separately or simultaneously. The SLM is used via a rigid endoscope. Indications for treatment were medical complaints such as hematuria, lower urinary tract symptoms, pain, recurrent urinary tract infections, recurrent bursts of balloon in indwelling catheters, and difficulties performing clean intermittent self-catheterization. Results: From August 1, 2009, to August 1, 2011, 27 patients were treated for bladder calculi (24 men). Five had a neurogenic voiding dysfunction, 3 had prostate cancer, and 19 had benign prostatic enlargement or detrusor muscle insufficiency. Median age was 74 years (range 45-86 years). Stone clearance was obtained in 26 (96%) patients. Stone burden was one or multiple bladder calculi. Median stone size of the largest stone in each patient was 20 (5-40) mm. Under the same anesthesia, two patients underwent a transurethral resection of the prostate because of a very large prostate. Median lithotripsy time was 60 (range 20-144) minutes. All patients were discharged within 24 hours. Conclusion: The method described is a safe and quick method for endoscopic lithotripsy of bladder calculi rendering the patients stone free in the vast majority of cases. The procedure can be performed as day-case surgery. PMID:23384337

Kingo, Pernille S; Ryhammer, Allan M; Fuglsig, Sven



Measurement of Subvisible Particulates in Lyophilised Erwinia chrysanthemi L-asparaginase and Relationship with Clinical Experience.  


In order to generate further characterisation data for the lyophilised product Erwinia chrysanthemi L-asparaginase, reconstituted drug product (DP; marketed as Erwinase or Erwinaze) was analysed for subvisible (2-10 ?m) particulate content using both the light obscuration (LO) method and the newer flow-imaging microscopy (FIM) technique. No correlation of subvisible particulate counts exists between FIM and LO nor do the counts correlate with activity at both release and on stability. The subvisible particulate content of lyophilised Erwinia L-asparaginase appears to be consistent and stable over time and in line with other parenteral biopharmaceutical products. The majority (ca. 75%) of subvisible particulates in L-asparaginase DP were at the low end of the measurement range by FIM (2-4 ?m). In this size range, FIM was unable to definitively classify the particulates as either protein or non-protein. More sensitive measurement techniques would be needed to classify the particulates in lyophilised L-asparaginase into type (protein and non-protein), so the LO technique has been chosen for on-going DP analyses. E. chrysanthemi L-asparaginase has a lower rate of hypersensitivity compared with native Escherichia coli preparations, but a subset of patients develop hypersensitivity to the Erwinia enzyme. A DP lot that had subvisible particulate counts on the upper end of the measurement range by both LO and FIM had the same incidence of allergic hypersensitivity in clinical experience as lots at all levels of observed subvisible particulate content, suggesting that the presence of L-asparaginase subvisible particulates is not important with respect to allergic response. PMID:24854894

Gervais, David; Corn, Tim; Downer, Andrew; Smith, Stuart; Jennings, Alan



Clinical encounters in tactical medicine: a mission-specific analysis of the Maryland state police experience.  


Introduction: The Maryland State Police (MSP) Tactical Medical Unit (TMU) provides tactical emergency medical support (TEMS) through the deployment of specially trained state trooper tactical paramedics. The MSP TMU maintains an operational database of all mission related medical activity. This information constitutes a robust dataset derived from real world operational medicine experiences. Methods: A retrospective analysis of de-identified entries from the MSP TMU operational response database was performed for the 5-year period of 2007?2013. A summative analysis of missions, as well as a subgroup analysis of types of patients encountered, was performed to further characterize patient encounters based on the type of law enforcement tactical mission. Results: Analysis was performed on 1,042 tactical missions, of which there were 367 total patient encounters during the study period. The majority (67%; 246/367) of patients encountered were law enforcement tactical team personnel. The most frequently occurring mission, by type, was high-risk warrant service, accounting for 45% (470/1,042) of all missions in this series. Law enforcement training support missions comprised 25% (259/1,042), and 15% (157/1,042) of all missions in the database were medical standbys for law enforcement operations. The highest number of patient contacts were associated with training activities, resulting in 29% (108/367) of clinical encounters. The next most common mission associated with patient encounters was high-risk warrant service (24%; 88/367). Conclusion: The 5-year analysis conducted in this study represents the largest known retrospective assessment of a state police tactical medical program. Training activities resulted in the highest number of patient encounters by this program, with law enforcement/tactical team personnel comprising the majority of patient encounters. The majority of chief complaints encountered were non?life threatening and reinforce the need for expanded scope of practice training and enhanced treatment protocols for tactical medics. PMID:24952050

Levy, Matthew J; Smith, Rebecca; Gerold, Kevin B; Alves, Donald W; Tang, Nelson



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.

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



Extension of resistance to cefepime and cefpirome associated to a six amino acid deletion in the H-10 helix of the cephalosporinase of an Enterobacter cloacae clinical isolate  

Microsoft Academic Search

Enterobacter cloacae CHE, a clinical strain with overproduced cephalosporinase was found to be highly resistant to the new cephalosporins, cefepime and cefpirome (MICs?128 ?g ml?1). The strain was isolated from a child previously treated with cefepime. The catalytic efficiency of the purified enzyme with the third-generation cephalosporins, cefepime and cefpirome, was 10 times higher than that with the E. cloacae

Guilène Barnaud; Roger Labia; Laurent Raskine; Marie José Sanson-Le Pors; Alain Philippon; Guillaume Arlet



Added value of health-related quality of life measurement in cancer clinical trials: the experience of the NCIC CTG.  


Health-related quality-of-life (HRQoL) data are often included in Phase III clinical trials. We evaluate and classify the value added to Phase III trials by HRQoL outcomes, through a review of the National Cancer Institute of Canada Clinical Trials Group clinical trials experience within various cancer patient populations. HRQoL may add value in a variety of ways, including the provision of data that may contrast with or may support the primary study outcome; or that assess a unique perspective or subgroup, not addressed by the primary outcome. Thus, HRQoL data may change the study's interpretation. Even in situations where HRQoL measurement does not alter the clinical interpretation of a trial, important methodologic advances can be made. A classification of the added value of HRQoL information is provided, which may assist in choosing trials for which measurement of HRQoL outcomes will be beneficial. PMID:20384559

Au, Heather-Jane; Ringash, Jolie; Brundage, Michael; Palmer, Michael; Richardson, Harriet; Meyer, Ralph M



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


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

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



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

SciTech Connect

The goal of the study was to evaluate the first CR digital mammography system ( registered Konica-Minolta) in Mexico in clinical routine for cancer detection in a screening population and to determine if high resolution CR digital imaging is equivalent to state-of-the-art screen-film imaging. The mammograms were evaluated by two observers with cytological or histological confirmation for BIRADS 3, 4 and 5. Contrast, exposure and artifacts of the images were evaluated. Different details like skin, retromamillary space and parenchymal structures were judged. The detectability of microcalcifications and lesions were compared and correlated to histology. The difference in sensitivity of CR Mammography (CRM) and Screen Film Mammography (SFM) was not statistically significant. However, CRM had a significantly lower recall rate, and the lesion detection was equal or superior to conventional images. There is no significant difference in the number of microcalcifications and highly suspicious calcifications were equally detected on both film-screen and digital images. Different anatomical regions were better detectable in digital than in conventional mammography.

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



Integration and Extension  

NSDL National Science Digital Library

Activities in the field provide students with opportunities to be creative in the classroom. Integrating these experiences into the whole curriculum allows an interdisciplinary approach to education. Section IV, "Integration and Extension," provides some ideas with which to begin this process with your students. The areas addressed in this section are creative writing, art, social studies, and extended science activities. In addition, we encourage writing activities of all kinds in response to any of the activities you undertake.

Galle, Janet R.; Warren, Patricia A.



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.

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



A computer-controlled contracture correction device with low-load and continuous torque: an animal experiment and prototype design for clinical use.  


The purpose of this study was to clarify the relationship between mechanical stress and tissue response of the contracted knee joint in rats and to propose a new design of contracture correction device for clinical use. Wistar rats were operated on to immobilize their knee joints with a procedure causing periarticular bleeding and were kept in flexed position for 40 days. At day 40, the immobilizing wire was removed, and after day 43, the contracted knee joint had been treated with tunable corrective devices secured by an external fixation method to the rear limb. These devices consisted of four types of motor-driving system which provided several different low-load and continuous stretch torques. Measuring the angle of maximum knee extension, its effectiveness was assessed comparing with a lower load and control group of natural recovery course. The device also had a cyclic joint movement within the acquired range of motion and an oval cam mechanism producing a small distraction force to the joint along its long axis. The results showed that an appropriate range of low-load continuous torque was more effective to correct joint contracture. On the basis of the animal experiment, a new computer-controlled, gas-driven contracture correction device was developed for clinical trial. It was concluded that mechanical application in a condition with low and continuous torque is a useful treatment for fixed joint contracture. PMID:17520489

Akai, M; Usuba, M; Sekiguchi, H; Hong, B; Iwashita, K; Shirasaki, Y



Clinical Experience with Intraurethral Alprostadil (MUSE®) in the Treatment of Men with Erectile Dysfunction  

Microsoft Academic Search

Objective: The Food and Drug Administration (USA) approved the transurethral administration of prostaglandin (alprostadil in January 1997), which had an efficacy of approximately 50% in clinical trials. We studied its effectiveness in clinical practice.Methods: Patient and partner education was followed by an initial office trial of a medicated urethral system for erection (MUSE®) after other medical risk factors were corrected

André T. Guay; Jesús B. Perez; Ernesto Velásquez; Robert A. Newton; Jerilynn P. Jacobson



Enrollment onto breast cancer therapeutic clinical trials: A tertiary cancer center experience |

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.


Initial Experience of an Objective Structured Clinical Examination in Evaluating Urology Residents  

Microsoft Academic Search

Objectives: Objective Structured Clinical Examination (OSCE) is now generally considered as the new gold standard for evaluating clinical competence. The objective of this study was to assess the feasibility of OSCE in evaluating urology residents.Material and Methods: 20 urology residents rotated through a circuit of five standardized patient–based OSCE stations of 10 min duration. The selection of problems was based

Louis Sibert; Paul Grand’Maison; Jean Doucet; Jacques Weber; Philippe Grise



Experiences of clinical tutors with English as an additional language (EAL) students.  


Clinical tutors, referred to in the international literature as clinical supervisors, facilitators, mentors or instructors, are responsible for providing and supervising workplace learning opportunities for groups of Bachelor of Nursing (BN) students. They also play a key role in assessing students. The role modeling and support provided by both clinical tutors and registered nurses (RN) or nurse preceptors helps students become familiar with the language in which nursing work is realised. As BN student cohorts in New Zealand have become more diverse in terms of cultures, ethnicities and language backgrounds, clinical tutors have to directly facilitate the development of context-specific and client-focused communication skills for students who speak English as an additional language. We undertook a study which looked at the perceptions of new nursing graduates with English as an additional language (EAL) on the development of spoken language skills for the clinical workplace. As well as interviewing graduates, we spoke to four clinical tutors in order to elicit their views on the language development of EAL students in previous cohorts. This article reports on the themes which emerged from the interviews with the tutors. These include goal setting for communication, integrating students into nursing work, making assessment less stressful, and endorsing independent learning strategies. Based on their observations and on other published research we make some suggestions about ways both clinical tutors and EAL students within their teaching groups could be supported in the development of communication skills for clinical practice. PMID:23421011

Lu, Hongyan; Maithus, Caroline



Dose-finding clinical trial design for ordinal toxicity grades using the continuation ratio model: an extension of the continual reassessment method  

Microsoft Academic Search

Background Various dose-finding clinical trial designs, including the continual reassessment method (CRM), dichotomize toxicity outcomes based on prespecified dose-limiting toxicity (DLT) criteria. This loss of toxicity information is particularly inefficient due to the small sample sizes in phase I trials, especially when Common Terminology Criteria for Adverse Events (CTCAE v4.0) are an established ordinal toxicity grading classification already used in

Emily M Van Meter; Elizabeth Garrett-Mayer; Dipankar Bandyopadhyay



Using clinical risk management as a means of enhancing patient safety: the Irish experience.  


This paper outlines the process and context in which the Clinical Risk Modification Project at Sligo Hospital, Ireland was established and focuses on the issues encountered from conception to implementation. The project is based in the emergency and orthopaedic departments and is of two years duration. The stated aim of this project is to design and test a framework incorporating the core components of a workable Clinical Risk Modification programme in the context of an Irish general hospital. This involved making an explicit commitment to the principles of a learning organisation including blame free risk reporting, providing education and awareness training to promote understanding of clinical risk management locally, and developing a clinical incident/near miss reporting system to address clinical risk in both a proactive and reactive way. PMID:12870248

McElhinney, John; Heffernan, Orla



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


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



A Comparison of Students' Clinical Experience in Family Medicine and Traditional Clerkships.  

ERIC Educational Resources Information Center

Experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships was compared with the experience on a family medicine clerkship. The family medicine clerkship offered the most experience with circulatory, respiratory, digestive, neurological, musculoskeletal, and skin problems and with…

Parkerson, George R., Jr.; And Others



[Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL].  


We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected. PMID:3177119

Tanda, H; Kato, S; Ohnishi, S; Nakajima, H; Mori, K



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: [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)



XCEDE: An Extensible Schema For Biomedical Data  

PubMed Central

The XCEDE (XML-based Clinical and Experimental Data Exchange) XML schema, developed by members of the BIRN (Biomedical Informatics Research Network), provides an extensive metadata hierarchy for storing, describing and documenting the data generated by scientific studies. Currently at version 2.0, the XCEDE schema serves as a specification for the exchange of scientific data between databases, analysis tools, and web services. It provides a structured metadata hierarchy, storing information relevant to various aspects of an experiment (project, subject, protocol, etc.). Each hierarchy level also provides for the storage of data provenance information allowing for a traceable record of processing and/or changes to the underlying data. The schema is extensible to support the needs of various data modalities and to express types of data not originally envisioned by the developers. The latest version of the XCEDE schema and manual are available from

Gadde, Syam; Aucoin, Nicole; Grethe, Jeffrey S.; Keator, David B.; Marcus, Daniel S.; Pieper, Steve



Use of accelerating clinical improvement in reorganization of care: the Dartmouth-Hitchcock Medical Center experience.  


Accelerating clinical improvement is a unique strategic method for accelerating the rate and effectiveness of improvements in strategically important clinical services. It promotes real reduction in the cost of service while preserving the quality and value within the system. Based on the components of process, value, benchmarking, change, and learning, the method can be used in any system or setting to produce value-driven change. Accelerating clinical improvement is being used within the Obstetrical Department of Dartmouth-Hitchcock Medical Center to decrease postpartum length of stay for families with spontaneous vaginal delivery. Familiarity with the method led to additional and ongoing improvements in the system. This method is important for nurses because it is continuous, multidisciplinary, addresses values of concern to families and providers, and is easily incorporated by nurse providers in any clinical setting. PMID:9170598

Kobokovich, L J



Recruitment experience in clinical trials: literature summary and annotated bibliography. |

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.


Reflective Practice in Clinical Teaching: The Experience of Two Nurse Academics.  

ERIC Educational Resources Information Center

Two beginning nurse educators used reflective practice to shape ideas about clinical teaching. Techniques such as journal writing, audiotaped debriefing, and a "critical friend" helped support and inform their reflection and improve teaching and learning. (SK)

Stockhausen, Lynette



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

NASA Astrophysics Data System (ADS)

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

Veldkamp, Ruth B.


What to learn about sildenafil in the treatment of erectile dysfunction from 3-year clinical experience  

Microsoft Academic Search

We retrospectively assessed the clinical uses and results of sildenafil in the treatment of erectile dysfunction (ED) in daily clinical practice from a cohort of 1658 subjects at a multispeciality medical center from 1999 to 2001 through a chart review, mailed questionnaire and telephone interview. The overall follow-up rate was 77.8% (1290\\/1658). The mean age was 63.8 y and ED

B-P Jiann; C-C Yu; J-Y Tsai; TT Wu; Y-H Lee; J-K Huang



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


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



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



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


Mental health pre-registration nursing students' experiences of group clinical supervision: a UK longitudinal qualitative study.  


There is widespread international interest in the use of clinical supervision in nursing as well as recognition of the need to introduce nursing students to its concepts and value. This article reports on a three-year longitudinal qualitative focus group study which explored students' views and experiences of a group clinical supervision initiative. Students attended supervision groups facilitated by teaching staff over their three year pre-registration mental health nursing course, with a main aim of developing skills, knowledge and attitudes as supervisees. The findings showed that students derived benefit from the experience, gained greater awareness of the nature of supervision and became active supervisees within their groups. These benefits took time to emerge and were not universal however. While the findings support the value of exposing students to the experience of group clinical supervision educators wishing to implement such a programme need to address a host of issues. These include; the preparation of students, structural and resource concerns, and issues relating to group dynamics. PMID:24219985

Carver, Neil; Clibbens, Nicola; Ashmore, Russell; Sheldon, Julie



A transdisciplinary approach to developing a web-based nursing experiential log system for advanced practice nursing clinical experiences.  


This article describes a transdisciplinary project between the computer information systems department and the graduate nursing department of a higher education institution. The project is the planning, development, and implementation of a Web-based nursing experiential log system for advanced practice nursing clinical experiences, which was funded by a Nursing Education Practice and Retention grant from the Health Resources and Services Administration. The article explains the concept and benefits of the transdisciplinary nature of the project. The design team, project leadership, and roles within the team are reviewed, including the role of end-user faculty in the design process. The article describes the focus and scope of the Web-based experiential log system database that is used to document and track advanced practice nursing student clinical experiences, as well as a summary of the design process used to develop the log system and the specific functionality of the database system. The implementation process, including end-user training, pilot implementation, and modifications, lessons learned, and future directions of the project are addressed. The article concludes with the benefits to the clinical experience and graduate nursing program that have been noted since the implementation of the system. PMID:21697707

Olson, Brandon D; Fauchald, Sally K



Natalizumab treatment in multiple sclerosis patients: a multicenter experience in clinical practice in Italy.  


We evaluated efficacy of natalizumab in relapsing-remitting multiple sclerosis patients in a clinical practice setting. We report data on the first consecutive 343 patients receiving natalizumab in 12 multiple sclerosis (MS) Italian centers enrolled between April 2007 and November 2010. The main efficacy endpoints were the proportion of patients free from relapses, disease progression, combined clinical activity, defined as presence of relapse or disease progression, from MRI activity, and from any disease activity defined as the absence of any single or combined activity. At the end of follow-up, the cumulative proportion of patients free from relapses was 68%; the proportion of patients free from Expanded Disability Status Scale (EDSS) progression was 93%; the proportion of patients free from combined clinical activity was 65%; the proportion of patients free from MRI activity was 77%; and the proportion of patients free from any disease activity was 53%. Natalizumab was effective in reducing clinical and neuroradiological disease activity. Its effectiveness in clinical practice is higher than that reported in pivotal trials and was maintained over time. PMID:25004826

Totaro, R; Lugaresi, A; Bellantonio, P; Danni, M; Costantino, G; Gasperini, C; Florio, C; Pucci, E; Maddestra, M; Spitaleri, D; Lus, G; Ardito, B; Farina, D; Rossi, M; Di Carmine, C; Altobelli, E; Maccarone, B; Casalena, A; De Luca, G; Travaglini, D; Di Ioia, M; Di Tommaso, V; Fantozzi, R; Ruggieri, S; Provinciali, L; De Riso, S; Mundi, C; Fuiani, A; Galgani, S; Ruggieri, S; Maniscalco, G T; Giuliani, G; Cartechini, E; Petretta, V; Fratta, M; Alfieri, G; Gatto, M; Carolei, A



Teaching style in clinical nursing education: a qualitative study of Iranian nursing teachers' experiences.  


There are many studies about nursing clinical settings and their problems, but the teaching style as a whole has not been widely studied. Therefore, this study aimed to explore nursing teachers' perceptions about teaching style in the clinical settings in Iran. A grounded theory approach was used to conduct this study. Fifteen nursing teachers were interviewed individually, 2006-2007. The interviews were tape-recorded and later transcribed verbatim. The transcriptions were analyzed using Strauss and Corbin's method. Three main and 12 sub themes emerged from data and these could explain the nature of the teaching style in clinical education of the Mashhad Faculty of Nursing and probably others in Iran. The main themes included: multiplicity in teaching style, nature of clinical teaching, and control and adaptation in education atmosphere. Multiplicity in teaching style was the dominant concept in this study. Each educator had a personal and individualized style which was flexible according to the situation, type of the skill (course content), education environment and facilities, and level of the learner. This study can guide nurse educators to know more about teaching styles and use them appropriately in the clinical settings. Further research into the themes of this study are recommended. PMID:19251481

Hossein, Karimi Moonaghi; Fatemeh, Dabbaghi; Fatemeh, Oskouie Seid; Katri, Vehviläinen-Julkunen; Tahereh, Binaghi



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

PubMed Central

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



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



Diurnal variation in clinical depression and accessibility of memories of positive and negative experiences  

Microsoft Academic Search

Each of 12 depressed patients with diurnal mood variation was seen at 2 different times during the day. On one of these occasions they were substantially more depressed than on the other. On each occasion they recalled life experiences associated to stimulus words. At the end of the 2nd occasion they rated these experiences for happiness or unhappiness at the

David M. Clark; John D. Teasdale



Parents' experiences of receiving their child's genetic diagnosis: A qualitative study to inform clinical genetics practice.  


Little is currently known about how parents experience the medical genetics appointment at which their child receives a genetic diagnosis. We conducted semi-structured in-person interviews with 13 parents of 10 index children to explore their experience in the medical genetics appointment in which they received their child's genetic diagnosis. Guided by grounded theory, we used a constant comparative approach to data analysis. Transcribed interviews were coded and sorted, and thematic categories identified. Sixty-one and a half percent of parents experienced the diagnosis session as negative, 23% felt the experience was positive, and 15.5% were ambivalent. Receiving emotional support, an outline of the follow-up plans, and messages of hope and perspective during the session seemed to positively influence parents' experience, while feeling that their role was as a passive receiver of information and the use of difficult medical terminology negatively influenced parents' overall experience. Parental preparedness for the information, and the parents' emotional reaction to the diagnosis were also factors that influenced the parental experience. Few participants understood the role of the genetic counselor. Our results provide in-depth insight into the parental experience of the pediatric medical genetics diagnosis session. We propose a mechanism through which parental experience shapes their perception of the medical genetics session. © 2014 Wiley Periodicals, Inc. PMID:24706543

Ashtiani, Setareh; Makela, Nancy; Carrion, Prescilla; Austin, Jehannine



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

PubMed Central

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

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



Locally enhanced chemotherapy by electroporation: clinical experiences and perspective of use of electrochemotherapy.  


Electroporation is used to enhance drug diffusion and gene delivery into the cytosol. The combination of electroporation and cytotoxic drugs, electrochemotherapy (ECT), is used to treat metastatic tumor nodules located at the skin and subcutaneous tissue. The objective response rate following a single session of treatment exceeds 80%, with minimal toxicity for the patients. The efficacy of ECT in the bone and visceral metastasis is currently investigated, and Phase II studies have been completed. ECT has been used to treat skin primary tumors, except melanoma, and is under investigation for locally advanced pancreatic cancer. Early evidence suggests that treatment of tumor nodules with ECT recruits components of the immune system and eliciting a systemic immune response against cancer is a challenging clinical perspective. Considering the proven safety in several different clinical applications electroporation should be viewed as a clinical platform technology with wide perspectives for use in ECT, gene therapy and DNA vaccination. PMID:24799067

Cadossi, Ruggero; Ronchetti, Mattia; Cadossi, Matteo



Experience and challenges from clinical trials with malaria vaccines in Africa  

PubMed Central

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



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


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



The role of the nurse teacher in clinical practice: an empirical study of Finnish student nurse experiences.  


This paper focuses on the role of the nurse teacher (NT) in supporting student nurse education in clinical practice. The paper draws on the outcomes of a study aimed at exploring student nurse experiences of the pedagogical relationship with NTs during their clinical placements. The participants (N=549) were student nurses studying on pre-registration nursing programmes in Finland. Data were analysed using descriptive statistics, cross-tabulation and ANOVA. The study showed that the core aspect of NTs work in clinical practice revolved around the relationship between student, mentor and NT. Higher levels of satisfaction were experienced in direct proportion to the number of meetings held between the student and NT. However, whilst the importance of this relationship has been reported elsewhere, an additional aspect of this relationship emerged in the data analysis. Those NT who facilitated good face to face contact also used other methods to enhance the relationship, particularly e-mail, virtual learning environment and texting. This outcome suggests that NT's interpersonal and communicative skills are as important as their clinical knowledge and skills in promoting effective learning in the clinical practice area. The paper argues for such approaches to be utilised within the emergent opportunities afforded by new communication and educational technologies. PMID:19232789

Saarikoski, Mikko; Warne, Tony; Kaila, Päivi; Leino-Kilpi, Helena



Mass mailing and staff experience in a total recruitment program for a clinical trial: the SHEP experience. Systolic Hypertension in the Elderly Program. Cooperative Research Group.  


The Systolic Hypertension in the Elderly Program (SHEP) staff contacted 447,921 screenees, of whom 11,919 (2.7%) were originally eligible and 4,736 (1.1%) maintained eligibility and were randomized. The total number of participants enrolled at the 16 clinical centers ranged from 133 to 559. The low yield of screenees to randomizations resulted from the study design, not from low levels of agreement to participate, and required the employment of a variety of recruitment strategies in a prudent overall plan. SHEP was one of the first clinical trials to use mass mailing as a primary strategy of recruitment. The study used mailing lists from seven generic sources. More than 3.4 million letters of invitation were mailed; they yielded an overall response rate of 4.3%. Motor vehicle and voter registration lists provided the greatest numbers of names. Mailings to members of health maintenance organizations (HMOs) and registrants of the Health Care Finance Administration (HCFA) provided the greatest response rates. Considerable variability in response rates existed among clinical centers using generically similar mailing lists. Generally, the number of hours spent on recruitment showed a positive, but not statistically significant, association with randomization yields. The recruitment yield was statistically significantly higher in clinics with experienced recruitment coordinators than in clinics with inexperienced ones (p = 0.0008). From these findings we conclude that mass mailing is an important strategy in an overall recruitment program, that the involvement of experienced recruitment staff is important, and that although the total time spent by staff on recruitment may also improve results, it matters less than the staff's level of recruiting experience. PMID:10227414

Cosgrove, N; Borhani, N O; Bailey, G; Borhani, P; Levin, J; Hoffmeier, M; Krieger, S; Lovato, L C; Petrovitch, H; Vogt, T; Wilson, A C; Breeson, V; Probstfield, J L



Students learn systems-based care and facilitate system change as stakeholders in a free clinic experience.  


Systems-based practice (SBP) is rarely taught or evaluated during medical school, yet is one of the required competencies once students enter residency. We believe Texas A&M College of Medicine students learn about systems issues informally, as they care for patients at a free clinic in Temple, TX. The mandatory free clinic rotation is part of the Internal Medicine clerkship and does not include formal instruction in SBP. During 2008-2009, a sample of students (n = 31) on the IMED clerkship's free clinic rotation participated in a program evaluation/study regarding their experiences. Focus groups (M = 5 students/group) were held at the end of each outpatient rotation. Students were asked: "Are you aware of any system issues which can affect either the delivery of or access to care at the free clinic?" Data saturation was reached after six focus groups, when investigators noted a repetition of responses. Based upon investigator consensus opinion, data collection was discontinued. Based upon a content analysis, six themes were identified: access to specialists, including OB-GYN, was limited; cost containment; lack of resources affects delivery of care; delays in care due to lack of insurance; understanding of larger healthcare system and free clinic role; and delays in tests due to language barriers. Medical students were able to learn about SBP issues during free clinic rotations. Students experienced how SBP issues affected the health care of uninsured individuals. We believe these findings may be transferable to medical schools with mandatory free clinic rotations. PMID:20039122

Colbert, Colleen Y; Ogden, Paul E; Lowe, Darla; Moffitt, Michael J



A treatment protocol for restoring occlusal vertical dimension using an overlay removable partial denture as an alternative to extensive fixed restorations: a clinical report.  


Treatment options for patients with severe attrition resulting in reduced occlusal vertical dimension are often limited to fixed prosthesis to reestablish proper occlusal vertical dimension and functional occlusion. In some cases such as when there are limited finances, minimal esthetic concerns, and medical considerations fixed prosthesis may not be the ideal treatment option. Overlay removable partial dentures (ORPDs) can be used as a provisional or interim prosthesis as well as permanent prosthesis in these cases. While ORPDs can provide a reversible and relatively inexpensive treatment for patients with a significantly compromised dental status, there is not much scientific evidence in the literature on ORPDs. Most studies published on ORPDs to date are primarily reviews and clinical reports. In this article, literatures on ORPDs are summarized and a patient treated with interim and permanent ORPDs is presented. This article reviews previously published literatures on the use of ORPDs. Indications, advantages and disadvantages are discussed. Treatment protocol with an example of the prosthodontic treatment of a patient with severely worn dentition with an interim ORPD and later a permanent ORPD are discussed in details. PMID:19915723

Patel, Mit B; Bencharit, Sompop



Predictive value of direct nitrate reductase assay and its clinical performance in the detection of multi- and extensively drug-resistant tuberculosis.  


Conventional culture and drug susceptibility testing (DST) methods for Mycobacterium tuberculosis are laborious and time consuming. For this reason alternative rapid culture and DST techniques are urgently needed to shorten the time for drug-resistance detection. A total of 222 smear-positive sputum samples were evaluated by the direct nitrate reductase assay (D-NRA) on Lowenstein-Jensen medium, for the rapid and simultaneous detection of resistance to isoniazid, rifampicin, kanamycin and ofloxacin. p-Nitrobenzoic acid was also included for identification of the M. tuberculosis complex. Results were compared with the BACTEC MGIT 960 as gold standard. The general performance of the D-NRA was very good, reaching a global value of 97?%. D-NRA had a turn-around time of 16.9 days to obtain results while that of the indirect MGIT 960 system was 29 days. D-NRA is a low-cost technology, easy to set up in clinical laboratories and suitable to be used for DST of M. tuberculosis in all smear-positive samples. PMID:24445510

Imperiale, Belén R; Morcillo, Nora S; Palomino, Juan C; Vandamme, Peter; Martin, Anandi



Genomic biomarkers for a binary clinical outcome in early drug development microarray experiments.  


In this article, we discuss methods to select three different types of genes (treatment related, response related, or both) and investigate whether they can serve as biomarkers for a binary outcome variable. We consider an extension of the joint model introduced by Lin et al. (2010) and Tilahun et al. (2010) for a continuous response. As the model has certain drawbacks in a binary setting, we also present a way to use classical selection methods to identify subgroups of genes, which are treatment and/or response related. We evaluate their potential to serve as biomarkers by applying DLDA to predict the response level. PMID:22204528

Van Sanden, Suzy; Shkedy, Ziv; Burzykowski, Tomasz; Göhlmann, Hinrich W H; Talloen, Willem; Bijnens, Luc



Dentists' comfort in treating underserved populations after participating in community-based clinical experiences as a student.  


The purpose of this project was to determine new dentists' comfort levels in treating traditionally underserved populations after participating in two consecutive five-week community-based clinical experiences while in dental school. A written survey was mailed to all known University of Iowa alumni (1992-2002; N=745). Respondents were asked to rank their comfort levels in treating twelve underserved populations on a five-point Likert type scale (5=no problem; 1=will not). Bivariate and logistic regression model analyses were performed to examine associations (p<0.05) among comfort and six predictor variables. Alumni (n=372) were most comfortable treating other ethnic, low-income, non-English-speaking, and HIV+/AIDS populations and least comfortable treating incarcerated and homebound populations. The following variables were significantly associated with comfort: 1) perception that the community experiences had great/much value; 2) practice located in larger communities; 3) non-solo practitioners; and 4) dentist's gender. As more dental schools utilize community-based clinical experiences to increase students' exposure to underserved populations, it is important that these experiences provide exposure to a variety of populations. Additionally, dental schools should continuously monitor the short- and long-term value of these programs for their students and recent graduates. PMID:18381848

McQuistan, Michelle R; Kuthy, Raymond A; Heller, Keith E; Qian, Fang; Riniker, Katharine J



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

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.


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.



Teaching Advanced Psychopathology: A Method that Promotes Basic Undergraduate Clinical and Research Experience  

ERIC Educational Resources Information Center

Students in advanced psychopathology courses can learn key concepts by administering semistructured interviews designed to identify specific mental disorders. Such an active learning approach potentially can help students gain fundamental knowledge about psychopathology and begin to develop clinical and research skills. To explore the value of…

Balsis, Steve; Eaton, Nicholas R.; Zona, Denise Martin; Oltmanns, Thomas F.



The Process Approach to Clinical Pharmacy Orientation--Four Years' Experience.  

ERIC Educational Resources Information Center

The process approach is an effective method of teaching clinical pharmacy clerkship orientation, the major advantage of which is increased student participation based on improved early identification of predetermined learning outcomes. The primary disadvantage is the difficulty of implementation. A lesson plan is appended. (MLW)

Moleski, Ronald J.; Snodgrass, Gary L.



Clinical Profile of Measles in Adults: A 2 -year Period, San Lazaro Hospital Experience  

Microsoft Academic Search

Measles is an acute infection caused by the rubeola virus. It is a highly contagious disease usually seen in children. Recovery from illness is the rule but serious complications of the respiratory and central nervous system may occur. This study aims 1) to determine the clinical profile of measles in adults, 2) to determine the common complications seen in adult

Ronaldo E. Lapitan; Joseph Deperdee; B. Ugalde; Australia Perth


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

PubMed Central

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

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



Clinical Pharmacokinetic\\/Pharmacodynamic and Physiologically based Pharmacokinetic Modeling in New Drug Development: The Capecitabine Experience  

Microsoft Academic Search

Preclinical studies, along with Phase I, II, and III clinical trials demonstrate the pharmacokinetics, pharmacodynamics, safety and efficacy of a new drug under well controlled circumstances in relatively homogeneous populations. However, these types of studies generally do not answer important questions about variability in specific factors that predict pharmacokinetic and pharmacodynamic (PKPD) activity, in turn affecting safety and efficacy. Semi-physiological

Karen S. Blesch; Ronald Gieschke; Yuko Tsukamoto; Bruno G. Reigner; Hans U. Burger; Jean-Louis Steimer



The Mental Health Walk-In Clinic: The University of Massachusetts Experience  

Microsoft Academic Search

A mental health walk-in clinic was introduced at the University of Massachusetts at Amherst in 1978 and was successful in maintaining accessible and early intervention services. Over the last few years, serious questions arose about the quality of service provided and the amount of stress on staff based on the volume of people needing to be seen during the walk-in

Jeffrey B. Hersch; Catherine Lathan



Seven years of experience of preimplantation HLA typing: a clinical overview of 327 cycles  

Microsoft Academic Search

Preimplantation human leukocyte antigen (HLA) typing allows the birth of healthy children who are potential donors of stem cells for their affected siblings. This technique can be used for acquired diseases such as leukaemia or can be used for single-gene disorders such as thalassaemia. This retrospective study presents clinical data obtained from 171 couples who had undergone 327 preimplantation HLA

Semra Kahraman; Cagri Beyazyurek; Cumhur Gokhan Ekmekci



13 Communication and Experience in Clinical Psychology and Neurorehabilitation: The Use of Virtual Reality Driving Simulators  

Microsoft Academic Search

Virtual reality (VR) driving simulators may be used as an aid to traditional cognitive-behavioral therapy in the treatment of a variety of driving- related disorders. In recent years there has been a heightened interest among researchers and clinicians in using VR technology to address a wide range of driving-related issues. Clinical applications include specific driving phobias, driving phobias related to



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



Dementia in Urban Black Outpatients: Initial Experience at the Emory Satellite Clinics.  

ERIC Educational Resources Information Center

Describes the demographic features and clinical diagnoses in a sample of 58 demented urban black outpatients. Results indicate that probable Alzheimer's disease was the most common cause of dementia whereas probable vascular dementia was uncommon. A multiple etiology dementia was identified in more than one-third of the patients. (RJM)

Auchus, Alexander P.



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

PubMed Central

Background The usefulness of antithrombotic prophylaxis in management of Assisted Reproductive Te