Sample records for extensive clinical experience

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

    PubMed Central

    2013-01-01

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

  2. Extension Service Agricultural Experiment Station

    E-print Network

    Tullos, Desiree

    products' quality and are free of BPA chemical Oregon Sea Grant Extension at Oregon State University bisphenol A (BPA), unlike some aluminum cans. Sea Grant helped Oregon Seafoods in Coos Bay set up a pouch-processing operation and later helped it develop a line of albacore tuna that included four flavors that were tested

  3. Farmer Experience of Pluralistic Agricultural Extension, Malawi

    ERIC Educational Resources Information Center

    Chowa, Clodina; Garforth, Chris; Cardey, Sarah

    2013-01-01

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

  4. Nontraditional Preservice Teacher Development: The Value of Clinical Experience.

    ERIC Educational Resources Information Center

    Metcalf, Kim K.; Kahlich, Pamela A.

    1998-01-01

    Examined the professional growth and development of nontraditional preservice teachers during a 12-month teacher certification program that included extensive on-campus clinical experience. Student interviews and guided written reflections indicated that their development was similar to that of traditional students, though it progressed more…

  5. Bladder autoaugmentation: early clinical experience.

    PubMed

    Cartwright, P C; Snow, B W

    1989-08-01

    A surgical technique is described in which detrusor muscle over the entire dome of the bladder is excised while leaving the bladder epithelium intact. A large epithelial bulge is created, which functions to augment the storage properties of the bladder without using bowel, and it is referred to as "autoaugmentation". Seven patients have undergone autoaugmentation of whom 5 have excellent clinical results while 1 has modest improvement. The remaining patient was a technical failure. Postoperative urodynamics in 5 patients demonstrated improved bladder capacity in 3 and markedly improved bladder storage pressures in 4 compared to preoperative studies. The technical aspects of the procedure and patient management are discussed. Autoaugmentation offers potential advantages over enterocystoplasty, is simple to perform, does not preclude future enterocystoplasty if needed and may be a reasonable alternative to conventional augmentation in selected patients. PMID:2746767

  6. Clinical Experience With Mammary Ductoscopy

    Microsoft Academic Search

    Edna K. Valdes; Susan K. Boolbol; Jean-Marc Cohen; Ronald Balassanian; Sheldon M. Feldman

    Background  Most breast cancers begin in the ductal epithelium with normal cells and progress to atypia and finally to carcinoma. Mammary\\u000a ductoscopy enables one to directly visualize and sample the ductal epithelium and, therefore, identify early changes cytologically.\\u000a This article describes our initial experience with mammary ductoscopy at Beth Israel Medical Center.\\u000a \\u000a \\u000a \\u000a Methods  A prospective review of all patients who underwent ductoscopy

  7. Clinical experience with the Pierre Robin sequence

    Microsoft Academic Search

    M. Hamdi; J. P. Brutus; A. De Mey

    2004-01-01

    The Pierre Robin sequence manifests itself in the neonatal period with symptoms of respiratory distress and feeding difficulties. We report our experience in the clinical management of this entity over 14 years and present an appraisal of risk factors for the surgical treatment of the cleft lip\\/palate and late outcome. Between 1986 and 1999, out of a series of 159 consecutive

  8. Decontamination and decorporation: the clinical experience

    Microsoft Academic Search

    Poda

    1979-01-01

    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. Stubborn cases are treated with sodium hypochlorite followed by rinsing, and emery cloth is used on more stubborn nail or finger pad contamination. If inhaled, the usual skin

  9. The ethics of simulated nursing clinical experiences

    Microsoft Academic Search

    Janeen Berndt

    2010-01-01

    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

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

    PubMed

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

    2015-01-01

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

  11. Nurses’ experiences of humour in clinical settings

    PubMed Central

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

    2015-01-01

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

  12. Experience with fingolimod in clinical practice.

    PubMed

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

    2014-10-29

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

  13. Economics of Paid Extension: Lessons from Experience in Nicaragua

    Microsoft Academic Search

    Ariel Dinar; Gabriel Keynan

    2001-01-01

    Public Agricultural Extension (Extension) faces major changes and challenges, resulting from less available public resources and from changes in demand for extension. Structural changes in extension provision and financing alternatives have been one type of response to the changes in conditions under which extension operates. Some new mechanisms, all modifications to traditional public exten- sion, include: private extension, commercial- ized

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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

  15. Fetal thrombotic vasculopathy: The clinical significance of extensive avascular villi

    Microsoft Academic Search

    Raymond W Redline; Amy Pappin

    1995-01-01

    Thrombosis of large fetal vessels in the placenta leads to regions of downstream avascular villi (AV). Avascular villi have been associated with adverse outcomes in anecdotal reports, but no controlled study of their significance has been done. We prospectively gathered cases of extensive AV (n = 29) occurring over a 2-year period at the Institute of Pathology at Case Western

  16. Clinical experience with ureteral metal stents

    PubMed Central

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

    2010-01-01

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

  17. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

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

  18. Clinical training experience in district general hospitals

    PubMed Central

    MacFaul, R.; Jones, S.; Werneke, U.

    2000-01-01

    AIMS—To estimate the nature and quantity of clinical experience available for trainees in paediatrics or general practice in acute general hospitals of differing sizes in the UK. To discuss implications for training and service configuration taking account of current Royal College recommendations (a minimum of 1800 acute contacts each year and ideally covering a population of 450 000 to 500 000 people).?METHODS—Observed frequencies of diagnoses in Pinderfields Hospital, Wakefield were compared with those in five other hospitals in Yorkshire and four in the South of England, and with expected frequencies from a review of selected marker conditions using national routine and epidemiological data. Based on the Pinderfields data, we modelled expected frequencies of a wider range of diagnoses for different sized hospitals.?RESULTS—Small units (1800 or less acute referrals a year) provide adequate exposure to common conditions such as gastroenteritis (157per annum) and asthma (171 per annum) but encounter serious or unusual disease rarely. When modelled for units serving larger populations, numbers of such disorders remain small. For example, about 0.5% of admissions require intensive care to the level of ventilatory support. Medium size units offer a wide range of experience but differ little from those serving the population of 500 000 proposed as being optimal for training. This standard is not justified by the evidence in this review. Closing or amalgamating units on the scale necessary to achieve this ideal would be impractical as only five hospitals in England have a paediatric workload equivalent to this population; it would also raise issues of access and equity.?? PMID:10868998

  19. Clinical experiences with a new tourniquet device.

    PubMed

    Orbay, Hakan; Unlü, Ramazan Erkin; Kerem, Metin; Sensöz, Omer

    2006-06-01

    Cessation of blood flow to the extremity improves the comfort of the surgeon. So pneumatic tourniquets are commonly used to obtain a bloodless field during upper- and lower-extremity surgery despite the several problems that tourniquet pressure may lead to. In this paper, we present our clinical experiences with a new tourniquet device called S-MART (OHK Medical Devices, Haifa, Israel) and compared the device with the traditional pneumatic tourniquet in terms of efficacy and complications. A total of 30 patients were included in the study. Preoperative systolic blood pressure measurements were obtained, and patients with a systolic blood pressure >190 mm Hg were excluded. S-MART was used in stead of pneumatic tourniquet in half of the patients in group 1. Pneumatic tourniquet was applied to the patients in group 2. The patient groups were compared. No major complications were observed in either group. But it was observed that S-MART was unsuccessful to maintain a bloodless field during the whole operative procedure in some of the cases. In conclusion, application of S-MART is practical, provides bloodless field for a certain time, and does not increase the complication rate related with the pressure applied to underlying tissues, but it is not a suitable tourniquet device for long surgical procedures. PMID:16721073

  20. Classification of Adults with Problematic Internet Experiences: Linking Internet and Conventional Problems from a Clinical Perspective

    Microsoft Academic Search

    Kimberly J. Mitchell; David Finkelhor; Kathryn A. Becker-Blease

    2007-01-01

    This article utilizes data from clinical reports of 929 adults to examine whether various prob- lematic Internet experiences are distinctly different from or extensions of conventional prob- lems. A TwoStep Cluster Analysis identified three mutually exclusive groups of adults, those with (1) online relationship problems and victimization; (2) online and offline problems; and (3) marital discord. Results suggest some initial

  1. A Simulated Interprofessional Rounding Experience in a Clinical Assessment Course

    PubMed Central

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

    2011-01-01

    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. PMID:21769137

  2. Clinical experience with trisomies 18 and 13

    Microsoft Academic Search

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

    1978-01-01

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

  3. Montana State University College of Agriculture/Agricultural Experiment Station/Extension Service

    E-print Network

    Maxwell, Bruce D.

    Montana State University College of Agriculture/Agricultural Experiment Station/Extension Service/Agricultural Experiment Station/Extension Service Department of Plant Sciences ROLE, SCOPE, CRITERIA, STANDARDS for the review of faculty members. The role and scope statement of each college identifies how each department

  4. Preservice Clinical Experiences: Using Controlled and Natural Settings for Practice.

    ERIC Educational Resources Information Center

    Everhart, Brett; Turner, Ed

    1996-01-01

    This paper describes a successful preservice program that incorporates early teaching experience for preservice physical educators. Prior to student teaching, students must complete multiple clinical teaching experiences in a natural setting. Two of the experiences are peer teaching opportunities, and the others take place at public schools. (SM)

  5. Clinical Engineering: Experiences of assisted professional practices

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

  6. Toward Quality Field Experiences: The Role of Clinical Faculty.

    ERIC Educational Resources Information Center

    Losee, Suzanne

    The clinical faculty role is a new role for supervising or cooperating teachers that has evolved in the Division of Teacher Education at Western New Mexico University, producing dramatic changes in the design of the student teaching field experience. Clinical faculty are master teachers who supervise student teachers during their field…

  7. ECG devices interoperability in hospital environment: clinical experience

    Microsoft Academic Search

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

    2004-01-01

    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

  8. Clinical experience with peripheral excimer laser angioplasty

    NASA Astrophysics Data System (ADS)

    Visona, Adriana; Cecchetti, Walter; Liessi, Guido; Miserocchi, Luigi; Bonanome, Andrea; Lusiani, Luigi; Mayellaro, Valeria; Pagnan, Antonio

    1993-06-01

    We used an excimer laser system (xenon-chloride at the wavelength of 308 nm) to treat totally occluded peripheral vessels in 71 patients. Energy was delivered through a multifiber catheter, which combines 12 (7F) or 18 (9F) fibers (260 (mu) diameter each), concentrically arranged. Balloon dilatation was associated to complete the procedure in 84% of the cases. The immediate success rate was 97%. The cumulative patency rate was 49% at one year. The major problems with this system were that the stiff multifiber tips caused dissections, and spasm; dead space/active space ratio of the catheter was unfavorable, allowing mechanical `dottering;' the maximum lumen obtained was considered inadequate. After this three year period, the goal of our clinical laser program is to develop a stand alone laser technique by employing a multifiber catheter which combines 130 - 150 fibers 100 (mu) diameter each, and features a quartz coated distal tip.

  9. Clinical experience with the fourth generation cephalosporins.

    PubMed

    Giamarellou, H

    1996-02-01

    The author reviews the comparative and non-comparative studies of cefepime and cefpirome, from which it is evident that both cephalosporins are extremely effective both clinically and bacteriologically. Success rates of about 90% have been reported for both drugs as therapy for complicated urinary tract infections, lower respiratory tract infections of the community as well as of nosocomial origin, including a large number of penicillin-resistant Streptococcus pneumoniae infections, skin and soft-tissue infections, surgical infections, as well as therapy for infections in neutropenic hosts. Cure rates are similar to or better than those obtained with ceftazidime, cefotaxime and ceftriaxone. The author also points out the various precautions necessary in utilizing these two antimicrobial agents. PMID:8738851

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

    Microsoft Academic Search

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

    2011-01-01

    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

  11. Terazosin, doxazosin, and prazosin: current clinical experience.

    PubMed

    Akduman, B; Crawford, E D

    2001-12-01

    Lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction are common in aging men. Nearly 25% of men >40 years of age have LUTS. Medical therapy with alpha-blockade is the most common method of medical therapy for benign prostatic obstruction. Multiple methods of minimally invasive surgical therapies have been introduced in the last decade. These methods include balloon dilatation, temporary and permanent urethral stents, various laser techniques, microwave thermotherapy, transurethral needle ablation, electrovaporization, and high-intensity focused ultrasound. alpha-Receptor blockers to reduce the sympathetic tone of the prostate are considered as first-line therapy to relieve the symptoms of benign prostatic hyperplasia. Selective alpha(1)-receptor blockers relax prostatic smooth muscle, relieve bladder outlet obstruction, and enhance urine flow with fewer side effects. In addition, it was determined that treating patients with alpha-blockers increases prostatic apoptosis. Pharmacokinetic activity, mode of action, clinical efficacy, and side effects of the selective alpha(1)-receptor blockers terazosin, doxazosin, and prazosin are reviewed. PMID:11750252

  12. O. R. Clinical Experience: Catalyst For Student Learning

    ERIC Educational Resources Information Center

    Nolan, Mary Gill

    1976-01-01

    Active participation in a 12-hour operating room experience seemed to provide one group of medical-surgical nursing students with a broad range of clinical nursing experiences leading to rapid, integrated learning of knowledge and skills and increased self-confidence. (Author)

  13. Dedicated Breast CT: Initial Clinical Experience1

    PubMed Central

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

    2008-01-01

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

  14. Clinical experience and applications of oocyte cryopreservation.

    PubMed

    Porcu, E; Fabbri, R; Damiano, G; Giunchi, S; Fratto, R; Ciotti, P M; Venturoli, S; Flamigni, C

    2000-11-27

    Oocyte cryopreservation is a viable solution for the ethical problems related to embryo storage, and the only available technique for preservation of fertility in women who have to undergo chemo- or radiotherapy. The main problems with oocyte cryopreservation are concerned with the survival rate and the fertilization rate. Recently the introduction of the intracytoplasmic sperm injection (ICSI) led to an increase in the fertilization rate. The success achieved with the first case treated encouraged us to set up a clinical trial on human oocyte cryopreservation. In the first stage of the study, 23 women with tubal infertility were enrolled. Superovulation was induced and 375 oocytes were retrieved; of these 338 oocytes were frozen. The survival rate was 59.5% and was independant of the duration of cryopreservation or the presence of cumulus. The normal fertilization rate was 64.4%, and only 7.5% of fertilizations were abnormal. A total of 90.8% of fertilized oocytes cleaved. A mean of 3.1+/-1.3 embryos per patient were transferred. Three pregnancies were achieved. In the second stage of our investigation, more patients were enrolled and similar results were observed. Sixteen pregnancies were achieved. A further stage of the investigation involved the fertilization of frozen oocytes with frozen sperm and even these resulted in a pregnancy. Our study demonstrated that pregnancies can also be achieved when frozen eggs are fertilized by testicular and epididymal sperm. As a consequence of the success of our investigations, a program of oocyte cryopreservation for oncological patients has been initiated in our centre. In our opinion, oocyte cryopreservation is, at present, a safe and efficient technique as documented by the birth of several healthy children. PMID:11155951

  15. Asymmetric lithospheric extension: The role of frictional plastic strain softening inferred from numerical experiments

    Microsoft Academic Search

    Ritske S. Huismans; Christopher Beaumont

    2002-01-01

    Plane-strain thermomechanical finite element model experiments of lithospheric extension are used to investigate the effects of strain softening in the frictional plastic regime on the asymmetry of extension. Strain softening is considered in cases where the crust is either strongly or weakly coupled to the mantle, and as the extension velocity varies from 0.3 to 30 cm\\/yr. In the absence

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

    ERIC Educational Resources Information Center

    Cooksey, Yan Zhang; Cole, Bryan R.

    2012-01-01

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

  17. Clinical Environment as a Learning Environment: Student Nurses' Perceptions Concerning Clinical Learning Experiences.

    ERIC Educational Resources Information Center

    Papp, Inkeri; Markkanen, Marjatta; von Bonsdorff, Mikaela

    2003-01-01

    Finnish student nurses (n=16) described their clinical learning experiences. Several themes were identified: feeling appreciated and supported, the quality of mentoring and patient care, and self-directedness. School and clinical staff cooperation helped create a good learning environment in which theory and practice complemented each other.…

  18. Designing for Extensibility and Planning for Conflict: Experiments in Web-Browser Design

    E-print Network

    Anderson, Richard

    , that implement both an application's user interface and its functionality, web apps by contrast are writtenDesigning for Extensibility and Planning for Conflict: Experiments in Web-Browser Design Benjamin S microform." Signature Date #12;#12;University of Washington Abstract Designing for Extensibility

  19. Extension of drop experiments with the MIKROBA balloon drop facility

    NASA Astrophysics Data System (ADS)

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

    1992-12-01

    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.

  20. Laparoscopic aortofemoral bypass grafting: Human cadaveric and initial clinical experiences

    Microsoft Academic Search

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

    1999-01-01

    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

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

    PubMed Central

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

    2013-01-01

    We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as “virtual” clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but for increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

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

    PubMed Central

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

    2014-01-01

    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

  3. Intermittent Androgen Deprivation for Clinically Localized Prostate Cancer: Initial Experience

    Microsoft Academic Search

    Gary D Grossfeld; Eric J Small; Peter R Carroll

    1998-01-01

    Objectives. To evaluate the use of intermittent androgen deprivation (IAD) in the treatment of selected patients with clinically localized prostate cancer.Methods. We report our initial experience with 47 patients (aged 50 to 92 years) treated with IAD for clinically localized prostate cancer (Stage T1c in 3 patients, T2 in 21, T3 in 21, T4 in 1, and unknown in 1).

  4. Teachers' Clinical Experiences and Attitudes toward Technology Inclusion

    ERIC Educational Resources Information Center

    Paganelli, Andrea Lynch

    2010-01-01

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

  5. Electrochemotherapy with Cisplatin: Clinical Experience in Malignant Melanoma Patients1

    E-print Network

    Ljubljana, University of

    Electrochemotherapy with Cisplatin: Clinical Experience in Malignant Melanoma Patients1 Gregor cisplatin adminis- tration on cutaneous tumor nodules in malignant melanoma patients. In 10 patients, 133 that electrochemotherapy with cisplatin is a highly effective approach for treatment of cutaneous malignant melanoma

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

    PubMed

    Ross, Amy Miner; Crusoe, Kristen L

    2014-12-01

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

  7. Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?

    Microsoft Academic Search

    K. Kenneth Chao; Neal S. Goldstein; Di Yan; Carlos E. Vargas; Michel I. Ghilezan; Howard J. Korman; Kenneth M. Kernen; Jay B. Hollander; Jose A. Gonzalez; Alvaro A. Martinez; Frank A. Vicini; Larry L.. Kestin

    2006-01-01

    Purpose: We performed a complete pathologic analysis examining extracapsular extension (ECE) and microscopic spread of malignant cells beyond the prostate capsule to determine whether and when clinical target volume (CTV) expansion should be performed. Methods and Materials: A detailed pathologic analysis was performed for 371 prostatectomy specimens. All slides from each case were reviewed by a single pathologist (N.S.G.). The

  8. Experience of 2 dental clinics registered to ISO 9002.

    PubMed

    Casas, Michael J; Kenny, David J; Johnston, Douglas H

    2003-04-01

    This paper describes the 3-year experience of managing 2 hospital-based dental clinics registered to ISO 9002:1994; it also examines the revision of previous quality management standards in 2 separate institutions to prepare for registration under the new ISO 9001:2000 standard. Daily equipment and process checks, combined with internal audits, were the backbone of the quality system at both locations. Corrective and protective actions had been underused, because of the partial duplication produced by 2 different institutionally mandated risk management and incident reporting systems. ISO 9002 registration provided both dental clinics with responsive quality systems, emphasizing patient satisfaction and providing measurable continuous quality improvement. PMID:12662459

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

    PubMed

    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

    2012-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2015-03-01

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

  12. Clinical experience with CD64-directed immunotherapy. An overview

    Microsoft Academic Search

    Randall T. Curnow

    1997-01-01

    The class I IgG receptor (Fc?RI or CD64 receptor), which is present on key cytotoxic effector cells, has been shown to initiate\\u000a the destruction of tumor cells in vitro and has been hypothesized to play a role in the destruction of antibody-coated cells\\u000a such as platelets in idiopathic thrombocytopenia purpura (ITP). This overview summarizes the clinical experience with CD64-directed\\u000a immunotherapy

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

    PubMed Central

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

    1976-01-01

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

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

    PubMed

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

    2014-11-01

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

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

    PubMed Central

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

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

  16. Topiramate in clinical practice: first year’s postlicensing experience in a specialist epilepsy clinic

    Microsoft Academic Search

    Mark W Kellett; David F Smith; Paul A Stockton; David W Chadwick

    1999-01-01

    OBJECTIVETopiramate became available for use in October 1995. Meta-analysis of its randomised controlled data suggested that it may be the most potent of the new antiepileptic drugs. The aim of this study was to assess the first year’s postlicensing experience in a specialist regional epilepsy clinic.METHODSThe case notes of 174 of 178 patients who were prescribed topiramate in the 12

  17. Extension of nano-confined DNA: quantitative comparison between experiment and theory

    E-print Network

    Iarko, V; Nyberg, L K; Müller, V; Fritzsche, J; Ambjörnsson, T; Beech, J P; Tegenfeldt, J O; Mehlig, K; Westerlund, F; Mehlig, B

    2015-01-01

    The extension of DNA confined to nanochannels has been studied intensively and in detail. Yet quantitative comparisons between experiments and model calculations are difficult because most theoretical predictions involve undetermined prefactors, and because the model parameters (contour length, Kuhn length, and effective width) are difficult to compute reliably, leading to a substantial uncertainties. Here we use a recent asymptotically exact theory for the DNA extension in the "extended de Gennes regime" that allows to determine the model parameters by comparing experimental results with theory. We obtained new experimental results for this purpose, for the mean DNA extension and its standard deviation, varying the channel geometry, dye intercalation ratio, and ionic buffer strength. The experimental results agree very well with theory at high ionic strengths, indicating that the model parameters are reliable. At low ionic strengths the agreement is less good. We discuss possible reasons. Our approach allows...

  18. Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology

    PubMed Central

    Buch, Maya H; Silva-Fernandez, Lucia; Carmona, Loreto; Aletaha, Daniel; Christensen, Robin; Combe, Bernard; Emery, Paul; Ferraccioli, Gianfranco; Guillemin, Francis; Kvien, Tore K; Landewe, Robert; Pavelka, Karel; Saag, Kenneth; Smolen, Josef S; Symmons, Deborah; van der Heijde, Désirée; Welling, Joep; Wells, George; Westhovens, Rene; Zink, Angela; Boers, Maarten

    2015-01-01

    Objectives Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports. Methods We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A ‘0–10’ agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance. Results Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations. Conclusions This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes. PMID:24827533

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

    PubMed

    Castillo Mendoza, Carlos Alberto

    2012-03-01

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

  20. Early experience with tedizolid: clinical efficacy, pharmacodynamics, and resistance.

    PubMed

    Rybak, Jeffrey M; Marx, Kayleigh; Martin, Craig A

    2014-11-01

    Antimicrobial resistance among gram-positive organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) continues to limit therapeutic options. The oxazolidinones are a synthetic class of agents now commonly relied on for the treatment of serious MRSA and VRE infections. With increasing utilization of linezolid, resistant pathogens have once again begun to emerge. Tedizolid, a next-generation oxazolidinone, possesses a spectrum of activity including MRSA and VRE, with significantly enhanced potency also against linezolid-resistant strains. Preclinical and early clinical studies have reported positive results, demonstrating a favorable pharmacokinetic profile in combination with key potential safety advantages. In two phase III clinical trials, tedizolid was found noninferior to linezolid in the treatment of acute bacterial skin and skin structure infections. Investigations for treatment of ventilator-acquired and health care-associated pneumonia are currently underway. Tedizolid has been subjected to pharmacodynamics studies throughout its development that have highlighted properties unique to this agent. Considerable accumulations in epithelial lining fluid and antimicrobial activity greatly augmented by the presence of granulocytes suggest that slow but bactericidal activity may be possible in some clinical scenarios. Structural distinctions between tedizolid and linezolid suggest that tedizolid has decreased vulnerability to oxazolidinone resistance mechanisms. Tedizolid minimum inhibitory concentrations are essentially unchanged in organisms possessing the chloramphenicol-florfenicol resistance gene, a horizontally transferable linezolid resistance mechanism. Although the clinical experience with tedizolid remains limited, early data suggest a potential role in the treatment of serious infections due to multidrug-resistant gram-positive pathogens. PMID:25266820

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

    ERIC Educational Resources Information Center

    Cole, Beverley; Wessel, Jean

    2008-01-01

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

  2. The effect of alternative clinical teaching experience on preservice science teachers' self-efficacy

    NASA Astrophysics Data System (ADS)

    Klett, Mitchell Dean

    The purpose of this study was to compare different methods of alternative clinical experience; family science nights and Saturday science (authentic teaching) against micro-teaching (peer teaching) in terms of self-efficacy in science teaching and teaching self-efficacy. The independent variable, or cause, is teaching experiences (clinical vs. peer teaching); the dependent variable, or effect, is two levels of self-efficacy. This study was conducted at the University of Idaho's main campus in Moscow and extension campus in Coeur d'Alene. Four sections of science methods were exposed to the same science methods curriculum and will have opportunities to teach. However, each of the four sections were exposed to different levels or types of clinical experience. One section of preservice teachers worked with students in a Saturday science program. Another section worked with students during family science nights. The third worked with children at both the Saturday science program and family science nights. The last section did not have a clinical experience with children, instead they taught in their peer groups and acted as a control group. A pre-test was given at the beginning of the semester to measure their content knowledge, teaching self-efficacy and self-efficacy in science teaching. A post-test was given at the end of the semester to see if there was any change in self-efficacy or science teaching self-efficacy. Throughout the semester participants kept journals about their experiences and were interviewed after their alternative clinical teaching experiences. These responses were categorized into three groups; gains in efficacy, no change in efficacy, and drop in efficacy. There was a rise in teaching efficacy for all groups. The mean scores for personal teaching efficacy dropped for the Monday-Wednesday and Tuesday-Thursday group while the both Coeur D'Alene groups remained nearly unchanged. There was no significant change in the overall means for science teaching efficacy for any of the groups. Finally, the mean scores for all groups dropped for personal science teaching efficacy.

  3. Improving the Output of Agricultural Extension and Research through Participatory Innovation Development and Extension; Experiences from Zimbabwe.

    ERIC Educational Resources Information Center

    Hagmann, J.; And Others

    1994-01-01

    In Zimbabwe, agricultural extension agents took a participatory approach involving farmers in experimentation and research. The attitude changes required for participatory approaches were highly dependent upon personalities and required major changes in planning, training, monitoring, and evaluating. (SK)

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

    PubMed Central

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

    2014-01-01

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

  5. Clinical experience with heat sterilization for reprocessing dialyzers.

    PubMed

    Kaufman, A M; Frinak, S; Godmere, R O; Levin, N W

    1992-01-01

    Use of heat sterilization for dialysis reprocessing offers significant advantages over chemical germicides. Polysulfone dialyzers (Fresenius 60M or 80M) can be sterilized by heating to 105 degrees C for 20 hr, thus permitting clinical trials of this method. One hundred eighty patients received 9,000 treatments. Pyrogenic reactions, sepsis, and subjective symptoms have not occurred. In vitro clearances (Qb 500 ml/min, Qd 800 ml/min) at baseline and after 2-8 uses did not differ (340 +/- 29 vs. 352 +/- 4 ml/min, respectively). KoA determined in vivo did not decrease (baseline 709 +/- 131 vs. 7th use 632 +/- 50 ml/min). Kt/V for urea was not different in 18 patients treated with heat sterilized dialyzers over 6 months when compared with a baseline period with formaldehyde sterilized dialyzers (1.37 +/- 0.12 vs. 1.32 +/- 0.11 at similar time and blood flows). Mean use number was 7.4 (dialyzers limited to 11 uses). Of discarded dialyzers, 44% failed a bedside integrity test (blood side pressurized at > 400 mmHg for 1 min), 36% failed automated fiber bundle or pressure holding tests, 8% had a blood leak, and 12% reached 11 uses. Clinical blood leaks occur in < 0.5% of treatments. Heat sterilization is a safe and effective method of dialysis reprocessing, but quality control of the process is essential. Based on initial clinical experience, heat sterilization of dialyzers for reuse is a promising alternative to chemical disinfection. PMID:1457877

  6. Extensive video-game experience alters cortical networks for complex visuomotor transformations.

    PubMed

    Granek, Joshua A; Gorbet, Diana J; Sergio, Lauren E

    2010-10-01

    Using event-related functional magnetic resonance imaging (fMRI), we examined the effect of video-game experience on the neural control of increasingly complex visuomotor tasks. Previously, skilled individuals have demonstrated the use of a more efficient movement control brain network, including the prefrontal, premotor, primary sensorimotor and parietal cortices. Our results extend and generalize this finding by documenting additional prefrontal cortex activity in experienced video gamers planning for complex eye-hand coordination tasks that are distinct from actual video-game play. These changes in activation between non-gamers and extensive gamers are putatively related to the increased online control and spatial attention required for complex visually guided reaching. These data suggest that the basic cortical network for processing complex visually guided reaching is altered by extensive video-game play. PMID:20060111

  7. Consistency of softcopy and hardcopy: preliminary experiences with the new DICOM extensions for image display

    NASA Astrophysics Data System (ADS)

    Eichelberg, Marco; Riesmeier, Joerg; Kleber, Klaus; Holstein, Joerg; Oosterwijk, Herman J.; Jensch, Peter F.

    2000-05-01

    The DICOM standard defines in detail how medical images can be transmitted and stored. However, there have been no precise rules on how to interpret the parameters contained in a DICOM image which deal with the image presentation. As a result, the same image frequently looks different when displayed on different workstations or printed on a film from various printers. Three new DICOM extensions attempt to close this gap by defining a comprehensive model for the display of images on softcopy and hardcopy devices: Grayscale Standard Display Function, Grayscale Softcopy Presentation State and Presentation Look Up Table. A prototype implementation of these extensions has been shown at the 1999 annual tradeshow of the Radiological Society of North America (RSNA) as part of the scientific exhibit (infoRAD). This demonstrated a simulated radiological workflow in which images were created, interpreted at a diagnostic workstation and later reviewed on a clinical workstation. Images could also be printed using DICOM Print. The prototype shows a proof of concept, i.e. that image integrity and consistency over a variety of display and print devices can be achieved and in addition, that the new DICOM extensions can be implemented relatively easily, without a significant performance penalty. The extensions allow to store all parameters defining how an image is displayed or printed in a separate DICOM object that can be managed with the existing DICOM database services. In particular, this satisfies the user's need to view images at different locations in a consistent manner, and to document the image appearance on which a diagnosis is made in softcopy environments.

  8. 78 FR 26638 - Non-Competitive One-Year Extension With Funds for Black Lung/Coal Miner Clinics Program (H37...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-07

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

  9. Initial Clinical Experience with Contrast-Enhanced Digital Breast Tomosynthesis

    PubMed Central

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

    2007-01-01

    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. PMID:17236995

  10. Extension of nano-confined DNA: quantitative comparison between experiment and theory

    E-print Network

    V. Iarko; E. Werner; L. K. Nyberg; V. Müller; J. Fritzsche; T. Ambjörnsson; J. P. Beech; J. O. Tegenfeldt; K. Mehlig; F. Westerlund; B. Mehlig

    2015-06-07

    The extension of DNA confined to nanochannels has been studied intensively and in detail. Yet quantitative comparisons between experiments and model calculations are difficult because most theoretical predictions involve undetermined prefactors, and because the model parameters (contour length, Kuhn length, and effective width) are difficult to compute reliably, leading to a substantial uncertainties. Here we use a recent asymptotically exact theory for the DNA extension in the "extended de Gennes regime" that allows to determine the model parameters by comparing experimental results with theory. We obtained new experimental results for this purpose, for the mean DNA extension and its standard deviation, varying the channel geometry, dye intercalation ratio, and ionic buffer strength. The experimental results agree very well with theory at high ionic strengths, indicating that the model parameters are reliable. At low ionic strengths the agreement is less good. We discuss possible reasons. Our approach allows, in principle, to measure the Kuhn length and effective width of a single DNA molecule and more generally of semiflexible polymers in solution.

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

    ERIC Educational Resources Information Center

    Karbasioun, Mostafa; Mulder, Martin; Biemans, Harm

    2007-01-01

    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,…

  12. Management of laryngeal radionecrosis: Animal and clinical experience

    SciTech Connect

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

    1989-05-01

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

  13. Normothermic donor heart perfusion: current clinical experience and the future.

    PubMed

    Messer, Simon; Ardehali, Abbas; Tsui, Steven

    2015-06-01

    Following the first successful heart transplant in 1967, more than 100 000 heart transplants have been carried out worldwide. These procedures have mostly relied on cold ischaemic preservation of the donor heart because this simple technique is inexpensive and relatively reliable. However, the well-known limitations of cold ischaemic preservation imposes significant logistical challenges to heart transplantation which put a ceiling on the immediate success on this life-saving therapy, and limits the number of donor hearts that can be safely transplanted annually. Although the theoretical advantages of normothermic donor heart perfusion have been recognised for over a century, the technology to transport donor hearts in this state has only been developed within the last decade. The Organ Care System (OCS) which is designed and manufactured by TransMedics Inc. is currently the only commercially available device with this capability. This article reviews the history of normothermic heart perfusion and the clinical experience with the TransMedics OCS to date. We have also attempted to speculate on the future possibilities of this innovative and exciting technology. PMID:24853906

  14. [Ethic review on clinical experiments of medical devices in medical institutions].

    PubMed

    Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

    2011-07-01

    Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed. PMID:22097752

  15. Surgical Management of Substernal Goiters: Clinical Experience of 170 Cases

    Microsoft Academic Search

    Yesim Erbil; Alp Bozbora; Umut Barbaros; Selcuk Özarma?an; Adil Azezli; Senay Molvalilar

    2004-01-01

    Purpose To discuss the presentation, diagnosis, treatment, histopathological findings, and complications of patients who underwent thyroidectomy for substernal goiter in our surgical clinic. Methods We retrospectively analyzed 170 patients with substernal goiters among 2650 patients undergoing surgical treatment for various thyroid diseases between 1990 and 2003. We evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative

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

    Microsoft Academic Search

    Karen Wotton; Judy Gonda

    1999-01-01

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

  17. Managing Medical Images and Clinical Information: InCor's Experience

    Microsoft Academic Search

    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

    2007-01-01

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

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

    E-print Network

    Oxford, University of

    The CancerGrid Experience: Metadata-Based Model-Driven Engineering for Clinical Trials Jim Davies Abstract The CancerGrid approach to software support for clinical trials is based on two principles: careful curation of semantic metadata about clinical observations, to enable subsequent data integration

  19. [Clinical analysis of anaerobic septicemia in 26 patients with extensive burn].

    PubMed

    Huang, X; Ma, E; Gong, L

    1995-12-01

    To understand the incidence and importance of anaerobic infection, the aerobic and anaerobic blood culture were carried out simultaneously in 127 patients with extensive burns (TBSA > 50%). Among 39 patients with positive culture, 26 had anaerob growth in blood culture. The total incidence rate of anaerobic septicemia was 20.4%. 61 strains (9 species) of anaerobes were isolated from blood specimens. The predominant anaerobes were Peptococcus (37.7%) and B. fragilis (36.1%). 20 (76.9%) were mixed infection of aerobes and anaerobes. The others thers suffered from combined infection of B. Fragilis and peptococcus combined infection. Finally, 19 patients survived and 7 died (26.9%). The sensitive tests showed that the effective drugs were metronidazot, chloramycin, and lincomycin. These data suggested that the septicemia of extensive burn patients is often caused by anaerobes. Therefore, anaerobe plays an important role in burn infection. PMID:8762556

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

    ERIC Educational Resources Information Center

    Duxbury, Mark

    2004-01-01

    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  1. Conflict of Interest and Student Clinical Experiences1 20-05.10 (Procedures)

    E-print Network

    Chapman, Michael S.

    Conflict of Interest and Student Clinical Experiences1 20-05.10 (Procedures) Applies to: All OHSU of Interest and Student Clinical Experiences will be monitored. 2.0 DEFINITIONS Not applicable 3.0 RESPONSIBILITIES Campus Associate Deans and Program Directors are responsible for ensuring compliance

  2. The extension of controlled source experiments through the use of broadband instrumentation

    NASA Astrophysics Data System (ADS)

    Brisbourne, A.; Denton, P.; Seis-Uk

    2003-04-01

    Two recent controlled source experiments in Ethiopia and New Zealand have been extended by the use of significant numbers of broadband seismometers. The deployment of Guralp CMG-6TD instruments along the profiles for periods significantly longer than the duration of the controlled source experiment deployment has allowed the acquisition of significant volumes of earthquake data. These data will supplement the controlled source data recorded along the respective profiles and should significantly enhance the results and any models derived. In 2001/2 SEIS-UK acquired 152 Guralp CMG-6TD seismometers for use on both passive and controlled source seismic experiments. The initial experiments have been concluded and the instrument pool is now fully commissioned. The CMG-6TD instrument consists of a 3-component 30s-100Hz sensor with integral 24bit digitiser and 3-4Gbyte of solid-state memory. The instrument can be deployed on bedrock in a similar way to a conventional broadband seismometer, or may simply be buried like a geophone. A breakout-box and firewire-lead are left at the surface for communication and rapid data download, respectively. The SEIS-UK instruments are supplied with optional dry-cell batteries and 24W solar panels with integral stands. Without the solar panel the instrument can be deployed completely buried for the duration of a controlled source experiment to enhance the conventional array, or may be deployed with the solar panel for significantly longer periods to record passive events. Although deployment of the broadband sensor is of course more involved than deployment of a geophone, the design of the instrument and its peripheral components makes deployment of a significant number of these instruments a realisable extension to a standard controlled source deployment. Controlled source and passive seismic experiments have been undertaken to image the crust and upper mantle just prior to break-up in the northern Ethiopian Rift where the transition from continental rifting to incipient spreading is captured. The controlled source aspect of the experiment consisted of two perpendicular lines of 4Hz geophones, along and across the rift, with a significant number of instruments also deployed around the junction of the lines. For a number of months either side of the controlled source experiment, around 50 CMG-6TD instruments were deployed in the rift in an array focused around the intersection of the lines. A further 100 broadband instruments were deployed along the cross-rift line at 4km intervals for the 2 months leading up to and including the shots. Similarly, following the NIGHT experiment in New Zealand, twenty CMG-6TD instruments were deployed along the length of the line. In both these experiments, the large numbers of earthquakes recorded will allow methods such as receiver function analysis, shear-wave splitting and tomography to be applied to the data to significantly extend the scope of the experiments.

  3. [Axis I "illness experience and treatment preconditions" of operational psychodynamic diagnosis (OPD). Experiences in clinical practice].

    PubMed

    Schneider, W; Klauer, T; Freyberger, H J; Hake, K; von Wietersheim, J

    2000-12-01

    In a selective survey, results on psychometric properties and aspects of application of the axis I, "illness experience and treatment preconditions" of the Operational Psychodynamic Diagnoses (OPD) are described. Following remarks on the role of defense and coping theories in the conceptualisation of the axis, its structure and contents are outlined. After a brief summary of findings on its interrater reliability, several aspects of validity are discussed. Results on discriminative validity show that axis I items are useful in the statistical discrimination of subsamples differing in age, clinical diagnoses, and diagnostic setting (psychotherapy outpatient vs. psychosomatic consultation-liasion services). The contribution of axis I items to prediction of treatment outcomes, moreover, reveals high degree of predictive or treatment validity. After an integrative discussion of these findings, implications of patient personality and coping behaviour for axis I ratings are highlighted as important objectives for future OPD research. PMID:11199108

  4. Extended Followup of the Influence of Wide Excision of the Neurovascular Bundle(s) on Prognosis in Men with Clinically Localized Prostate Cancer and Extensive Capsular Perforation

    Microsoft Academic Search

    Robert C. Smith; Alan W. Partin; Jonathan I. Epstein; Charles B. Brendler

    1996-01-01

    PurposeThe effect of wide excision of the neurovascular bundles on disease-free survival was determined in men with clinically localized prostate cancer and pathological evidence of extensive capsular perforation in the region of the neurovascular bundle.

  5. Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?

    SciTech Connect

    Chao, K. Kenneth [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Goldstein, Neal S. [Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI (United States); Yan Di [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vargas, Carlos E. [Department of Radiation Oncology, University of Florida, Jacksonville, FL (United States); Ghilezan, Michel I. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Korman, Howard J. [Department of Urology, William Beaumont Hospital, Royal Oak, MI (United States); Kernen, Kenneth M. [Department of Urology, William Beaumont Hospital, Royal Oak, MI (United States); Hollander, Jay B. [Department of Urology, William Beaumont Hospital, Royal Oak, MI (United States); Gonzalez, Jose A. [Department of Urology, William Beaumont Hospital, Royal Oak, MI (United States); Martinez, Alvaro A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Kestin, Larry L. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)]. E-mail: lkestin@beaumont.edu

    2006-07-15

    Purpose: We performed a complete pathologic analysis examining extracapsular extension (ECE) and microscopic spread of malignant cells beyond the prostate capsule to determine whether and when clinical target volume (CTV) expansion should be performed. Methods and Materials: A detailed pathologic analysis was performed for 371 prostatectomy specimens. All slides from each case were reviewed by a single pathologist (N.S.G.). The ECE status and ECE distance, defined as the maximal linear radial distance of malignant cells beyond the capsule, were recorded. Results: A total of 121 patients (33%) were found to have ECE (68 unilateral, 53 bilateral). Median ECE distance = 2.4 mm [range: 0.05-7.0 mm]. The 90th-percentile distance = 5.0 mm. Of the 121 cases with ECE, 55% had ECE distance {>=}2 mm, 19% {>=}4 mm, and 6% {>=}6 mm. ECE occurred primarily posterolaterally along the neurovascular bundle in all cases. Pretreatment prostrate-specific antigen (PSA), biopsy Gleason, pathologic Gleason, clinical stage, bilateral involvement, positive margins, percentage of gland involved, and maximal tumor dimension were associated with presence of ECE. Both PSA and Gleason score were associated with ECE distance. In all 371 patients, for those with either pretreatment PSA {>=}10 or biopsy Gleason score {>=}7, 21% had ECE {>=}2 mm and 5% {>=}4 mm beyond the capsule. For patients with both of these risk factors, 49% had ECE {>=}2 mm and 21% {>=}4 mm. Conclusions: For prostate cancer with ECE, the median linear distance of ECE was 2.4 mm and occurred primarily posterolaterally. Although only 5% of patients demonstrate ECE >4 to 5 mm beyond the capsule, this risk may exceed 20% in patients with PSA {>=}10 ng/ml and biopsy Gleason score {>=}7. As imaging techniques improve for prostate capsule delineation and as radiotherapy delivery techniques increase in accuracy, a posterolateral CTV expansion should be considered for patients at high risk.

  6. Experimental and clinical experience with toxiferine (alkaloid of calabash curare)

    Microsoft Academic Search

    R. Frey; R. Seeger

    1961-01-01

    Summary  The Calabash alkaioid Toxiferine is, the most potent and long-acting relaxant of the curare group available to the clinic.\\u000a As little as 2 mg. produces sufficient relaxation for all operative interventions in adults, of a marked degree for 30 minutes\\u000a and slowly wearing off during the next 30 minutes.\\u000a \\u000a As shown in 30 auto-investigations and 100 clinical cases, the drug

  7. Unusual extensive physiologic melanin pigmentation of the oral cavity: a clinical presentation.

    PubMed

    Mallikarjuna, K; Gupta, S; Shukla, S; Chaurasia, S

    2013-01-01

    Pigmented lesions are commonly found in the oral cavity. Oral pigmentations may be physiological or pathological in nature. It may represent as a localized anomaly of limited significance or the presentation of potentially life threatening multisystem disease. Oral pigmentation has a multifactorial etiology. Most of the oral pigmentations are physiologic. Evaluation of a patient with pigmented lesions should include a full medical and dental history, extraoral and intraoral examinations. In this article, we report a case of extensive physiologic pigmentation of the oral cavity in a 12 year old female patient, posing a diagnostic challenge. PMID:23886725

  8. Plasmodium knowlesi Genome Sequences from Clinical Isolates Reveal Extensive Genomic Dimorphism

    PubMed Central

    Millar, Scott B.; Sanderson, Theo; Otto, Thomas D.; Lu, Woon Chan; Krishna, Sanjeev; Rayner, Julian C.; Cox-Singh, Janet

    2015-01-01

    Plasmodium knowlesi is a newly described zoonosis that causes malaria in the human population that can be severe and fatal. The study of P. knowlesi parasites from human clinical isolates is relatively new and, in order to obtain maximum information from patient sample collections, we explored the possibility of generating P. knowlesi genome sequences from archived clinical isolates. Our patient sample collection consisted of frozen whole blood samples that contained excessive human DNA contamination and, in that form, were not suitable for parasite genome sequencing. We developed a method to reduce the amount of human DNA in the thawed blood samples in preparation for high throughput parasite genome sequencing using Illumina HiSeq and MiSeq sequencing platforms. Seven of fifteen samples processed had sufficiently pure P. knowlesi DNA for whole genome sequencing. The reads were mapped to the P. knowlesi H strain reference genome and an average mapping of 90% was obtained. Genes with low coverage were removed leaving 4623 genes for subsequent analyses. Previously we identified a DNA sequence dimorphism on a small fragment of the P. knowlesi normocyte binding protein xa gene on chromosome 14. We used the genome data to assemble full-length Pknbpxa sequences and discovered that the dimorphism extended along the gene. An in-house algorithm was developed to detect SNP sites co-associating with the dimorphism. More than half of the P. knowlesi genome was dimorphic, involving genes on all chromosomes and suggesting that two distinct types of P. knowlesi infect the human population in Sarawak, Malaysian Borneo. We use P. knowlesi clinical samples to demonstrate that Plasmodium DNA from archived patient samples can produce high quality genome data. We show that analyses, of even small numbers of difficult clinical malaria isolates, can generate comprehensive genomic information that will improve our understanding of malaria parasite diversity and pathobiology. PMID:25830531

  9. Plasmodium knowlesi genome sequences from clinical isolates reveal extensive genomic dimorphism.

    PubMed

    Pinheiro, Miguel M; Ahmed, Md Atique; Millar, Scott B; Sanderson, Theo; Otto, Thomas D; Lu, Woon Chan; Krishna, Sanjeev; Rayner, Julian C; Cox-Singh, Janet

    2015-01-01

    Plasmodium knowlesi is a newly described zoonosis that causes malaria in the human population that can be severe and fatal. The study of P. knowlesi parasites from human clinical isolates is relatively new and, in order to obtain maximum information from patient sample collections, we explored the possibility of generating P. knowlesi genome sequences from archived clinical isolates. Our patient sample collection consisted of frozen whole blood samples that contained excessive human DNA contamination and, in that form, were not suitable for parasite genome sequencing. We developed a method to reduce the amount of human DNA in the thawed blood samples in preparation for high throughput parasite genome sequencing using Illumina HiSeq and MiSeq sequencing platforms. Seven of fifteen samples processed had sufficiently pure P. knowlesi DNA for whole genome sequencing. The reads were mapped to the P. knowlesi H strain reference genome and an average mapping of 90% was obtained. Genes with low coverage were removed leaving 4623 genes for subsequent analyses. Previously we identified a DNA sequence dimorphism on a small fragment of the P. knowlesi normocyte binding protein xa gene on chromosome 14. We used the genome data to assemble full-length Pknbpxa sequences and discovered that the dimorphism extended along the gene. An in-house algorithm was developed to detect SNP sites co-associating with the dimorphism. More than half of the P. knowlesi genome was dimorphic, involving genes on all chromosomes and suggesting that two distinct types of P. knowlesi infect the human population in Sarawak, Malaysian Borneo. We use P. knowlesi clinical samples to demonstrate that Plasmodium DNA from archived patient samples can produce high quality genome data. We show that analyses, of even small numbers of difficult clinical malaria isolates, can generate comprehensive genomic information that will improve our understanding of malaria parasite diversity and pathobiology. PMID:25830531

  10. Extension of the clinical range of facioscapulohumeral dystrophy: report of six cases.

    PubMed

    van der Kooi, A J; Visser, M C; Rosenberg, N; van den Berg-Vos, R; Wokke, J H; Bakker, E; de Visser, M

    2000-07-01

    Consensual diagnostic criteria for facioscapulohumeral dystrophy (FSHD) include onset of the disease in facial or shoulder girdle muscles, facial weakness in more than 50% of affected family members, autosomal dominant inheritance in familial cases, and evidence of myopathic disease in at least one affected member without biopsy features specific to alternative diagnoses. Six patients did not meet most of these criteria but were diagnosed as FSHD by DNA testing, which showed small EcoRI fragments on chromosome 4q. Their clinical signs and symptoms and results of auxiliary investigations are reported. The patients presented with foot extensor, thigh, or calf muscle weakness. None of them had apparent facial weakness, only one complained of weakness in the shoulders, none had a positive family history. Expert physical examination, however, showed a typical facial expression, an abnormal shoulder configuration on lifting the arms, or scapular winging. This raised the suspicion of FSHD, whereupon DNA analysis was done. In conclusion, the clinical expression of FSHD is much broader than indicated by the nomenclature. The possibility to perform DNA tests is likely to greatly expand the clinical range of FSHD. PMID:10864616

  11. Review of clinical experience with ion beam radiotherapy

    PubMed Central

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

    2011-01-01

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

  12. [Clinical experience with silastic middle-ear prostheses].

    PubMed

    Zelený, M; Voldrich, Z

    1989-01-01

    The authors made clinical tests of silastic prostheses of the middle ear, type PORP, TORP and piston. They used 29 X PORP, 26 X TORP and 21 pistons. They did not reveal any signs of tissue intolerance to Silastic MDX 44-516, which is used for making prostheses. They achieved satisfactory anatomical and functional results. They recorded an auditory gain in more than half the patients (early: PORP 97%, TORP 73%, piston 52%; plasty transplants of ossicles obtained from subjects who died accidentally? For preserfic Council of the Ministry of Health, Czech Socialist Republic, recommended, based on the clinical tests, the manufacture of silastic prostheses of the middle ear. PMID:2540918

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

    ERIC Educational Resources Information Center

    Chenail, Ronald J.

    2011-01-01

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

  14. I ST HE'TECHNICAL EXPERT' ROLE OF FARM FORESTRY EXTENSION AGENTS FADING ?R ECENT EXPERIENCES FROM AFRICA AND IMPLICATIONS FOR FUTURE EXTENSION PROGRAMS

    Microsoft Academic Search

    Alice A. Kaudia; L. M. A. Omoro

    The conventional meaning of extension has been changing to accommodate challenges presented by changes in extension policies and dwindling extension resources. Staffing rationalization programs have led to drastic reductions in number of extension staff. Financial resources for extension have dwindled to halting levels. The emerging trend is that institutional arrangements for extension services are being founded on facilitation, participatory and

  15. Febrile neutropenia and Fusobacterium bacteremia: clinical experience with 13 cases

    Microsoft Academic Search

    P. Fanourgiakis; M. Vekemans; A. Georgala; D. Daneau; A. Vandermies; P. Grenier; M. Aoun

    2003-01-01

    Objectives. To assess the disease spectrum of Fusobacterium bacteremia in our neutropenic patients and review the literature. Methods. This was a 6.5-year retrospective study in which all the records of neutropenic patients with Fusobacterium bacteremia were analyzed. Results. Fusobacterium bacteremia was found in 13 neutropenic patients, 10 with hematological malignancies and 3 with solid tumors. The standard clinical presentation was

  16. Current clinical experience with staphylokinase in arterial thrombosis

    Microsoft Academic Search

    Steven Vanderschueren; Désiré Collen; Frans Werf

    1996-01-01

    Sak, a profibrinolytic agent produced by S. aureus that is now readily available by recombinant DNA technology, induces efficient and rapid recanalization in patients with occlusive arterial thrombosis. Its fibrin specificity at clinically effective doses by far exceeds that of any commercially available plasminogen activator. Likewise, the speed and rate of clot lysis compare favorably with established agents, but definition

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  18. Clinical gait analysis by neural networks: issues and experiences

    Microsoft Academic Search

    Monika Köhle; Dieter Merkl; Josef Kastner

    1997-01-01

    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

  19. Monitoring clinical research: report of one hospital's experience

    Microsoft Academic Search

    Jane McCusker; Zita Kruszewski; Belaine Lacey; Benjamin Schiff

    2001-01-01

    MONITORING OF RESEARCH BY RESEARCH ETHICS BOARDS HAS BEEN RECOMMENDED by vari- ous organizations that fund clinical studies and by other groups. However, little ev- idence has been reported on the processes, costs and outcomes of these activities, information that would be helpful to guide the boards in their current work and fu- ture policies. We report here 3 years

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    1991-02-28

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

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

    PubMed Central

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

    2014-01-01

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

  3. Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience

    Microsoft Academic Search

    HV Schaff; JA Dearani; RC Daly; TA Orszulak; GK Danielson

    2000-01-01

    The Cox-Maze procedure corrects atrial fibrillation in 90% of patients, and successful operation restores sinus rhythm, thereby reducing risks of thromboembolism and anticoagulant-associated hemorrhage. Symptoms such as palpitation and fatigability also improve with restoration of atrioventricular synchrony. At the Mayo Clinic, 221 Cox-Maze procedures were performed from March 1993 through March 1999. Over 75% of patients had associated cardiac disease

  4. Navigating a guide wire through total occlusions: clinical experience

    NASA Astrophysics Data System (ADS)

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

    2000-05-01

    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.

  5. Extensive mixed vascular malformation clinically imitating multiple sclerosis--case report.

    PubMed

    Rafalowska, J; Dziewulska, D; Podlecka, A; Zakrzewska-Pniewska, B

    2006-01-01

    Vascular malformations usually develop as a result of influence of teratogenic factor(s) acting in the defined embryonic/fetal period. However, in the case examined by us, various types of vascular malformations formed in different periods of the ontogenic development were found. They were seen in all parts of the central nervous system and clinically mimicked multiple sclerosis. On the background of generalized ischemic lesions of the CNS, certain kinds of vascular malformations were seen: cavernous or fetallike vessels within meninges, superficially located capillary angioma penetrating into the brain and spinal cord white matter, and arterio-venous pathological conglomerates forming meningeal angiomatosis. In pathological vessels, immunocytochemical assessment of vascular endothelium with antibodies against antigens CD31, CD34, von Willebrand factor and lectin Ulex europaeus was normal but examination of the vascular basal membrane compounds revealed poor immunoreactivity to laminin and fibronectin. There were no disturbances in expression of angiopoietin, platelet-derived growth factor, transforming growth factor beta and vascular endothelial growth factor receptors Tie-1/2, PDGFR-alpha/beta, endoglin and Flk-1, respectively. The presence of various types of pathological vessels originating from different ontogenic periods indicates remittent or prolonged influence of teratogenic factor(s) in all periods of fetal vessel development. PMID:17007447

  6. Clinical experience with generic levetiracetam in people with epilepsy

    PubMed Central

    Chaluvadi, Siresha; Chiang, Sharon; Tran, Larry; Goldsmith, Corey E.; Friedman, David E.

    2015-01-01

    SUMMARY Purpose To describe the clinical outcomes of a compulsory switch from branded to generic levetiracetam (LEV) among people with epilepsy (PWE) in an outpatient setting. Methods We conducted a retrospective chart review of 760 unduplicated consecutive adult patients attending a tertiary care epilepsy clinic at Ben Taub General Hospital. On November 1, 2008 hospital policy required all patients receiving branded LEV to be automatically switched to generic LEV. We calculated the proportion of patients switching back to branded LEV and reasons for the switch back. Key Findings Of the 260 patients (34%) being prescribed LEV (generic and brand name) during the study period, 105 (42.9%) were switched back to brand name LEV by their treating physicians. Reasons for switch back included increase in seizure frequency (19.6% vs. 1.6%; p < 0.0001) and adverse effects (AEs) (3.3%). AEs included headache, fatigue, and aggression. Patient age was associated with switchback when controlling for gender, epilepsy classification, and treatment characteristics [relative risk (RR) 2.44; 95% confidence interval (CI) 2.09–2.84; p < 0.05)]. An increase in seizure frequency subsequent to generic substitution was associated with polytherapy compared to monotherapy (3.225; 1.512–6.880; p < 0.05). Significance A significant proportion of patients in our cohort on generic LEV required switch back to the branded drug. Careful monitoring is imperative because a compulsory switch from branded to generic LEV may lead to poor clinical outcomes, with risk of AEs and increased seizure frequency. PMID:21426334

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

    PubMed Central

    2013-01-01

    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. PMID:23849244

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

    Microsoft Academic Search

    Jie Hu; Susan Andreatta; Liping Yu; Sijian Li

    2010-01-01

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

  9. Co-Learning: Maximizing Learning in Clinical Experiences

    ERIC Educational Resources Information Center

    Merk, Hillary; Waggoner, Jacqueline; Carroll, James

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Neill, Jane; Taylor, Kerry

    2002-01-01

    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…

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Nelson, Lori A.

    2011-01-01

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

  15. Use of Handheld Computer Technology to Monitor General Practice Residents' Clinical Experiences

    Microsoft Academic Search

    Marc D. Dyer; Emory A. Presler; Ted P. Raybould; Cindy Burklow; Timothy A. Smith

    The Commission on Dental Accreditation (CODA) requires that General Practice Residency (GPR) programs report a summary of each resident's clinical experiences. The goal of this study was to determine the effectiveness of handheld computer technology in tracking residents' clinical procedures. In the academic years 2004-05 and 2005-06, University of Kentucky GPR residents were provided a Palm M130 ® with customized

  16. Monitoring clinical quality in rare disease services – experience in England

    PubMed Central

    Kenny, Thomas D; Jessop, Edmund G; Gutteridge, William H

    2008-01-01

    After some well-publicised problems with paediatric cardiac surgery, there has been great interest in England in monitoring clinical quality in specialised medical services. The National Commissioning Group plans, funds and monitors a set of highly specialised services for the National Health Service in England. We have developed systems for monitoring clinical quality that perform two interrelated but distinct functions: performance measurement and performance improvement. The aim is to collect information on all patients seen during each year – a 100% consecutive case series. Generally, there is no conceptual difficulty identifying an appropriate outcome for surgical interventions: the indication for surgery usually defines the outcome to monitor. This is not so for the medical and psychiatric services, where the relevant outcome to monitor is sometimes not obvious. There are a number of problems in interpreting, and acting on, outcome data for rare conditions and treatments. These problems include statistical problems due to small numbers, the need to risk adjust data and coding problems. PMID:18793435

  17. Tc-NGA imaging in liver transplantation: preliminary clinical experience

    SciTech Connect

    Woodle, E.S.; Ward, R.E.; Stadalnik, R.C.; Vera, D.R.

    1989-03-01

    Technetium-99m galactosyl-neoglycoalbumin (Tc-NGA) is a new liver imaging agent that binds to hepatic-binding protein, a hepatocyte-specific membrane receptor. The purpose of this study was to determine the potential of Tc-NGA imaging in clinical liver transplantation. A total of 25 studies were performed in nine patients. Imaging studies performed in the early posttransplant period in patients with good hepatic allograft function revealed diffuse patchiness in tracer distribution, a manifestation of preservation damage. Left lobar infarction was demonstrated within a few hours of ischemic injury. Right posterior segmental infarction was seen in another patient. Comparison of kinetic, clinical, and biochemical data revealed good correlation between hepatic allograft function and Tc-NGA kinetics. Major kinetic alterations were noted during periods of preservation injury, hepatic infarction, and acute rejection. These studies indicate: (1) major alterations in Tc-NGA kinetics occur during preservation injury, hepatic infarction, and acute rejection, and (2) Tc-NGA kinetic data appear to provide an accurate reflection of hepatic allograft function. Tc-NGA imaging has the advantages of being noninvasive and of utilizing standard nuclear medicine instrumentation, including portable imaging devices. In conclusion, Tc-NGA imaging provides a promising noninvasive approach for evaluation of liver function in patients undergoing hepatic transplantation.

  18. [First clinical experiences with ceramic ball attachments for overdentures].

    PubMed

    Büttel, Adrian E; Schmidli, Fredy; Marinello, Carlo P; Lüthy, Heinz

    2008-01-01

    In this prospective clinical study on 40 patients with similar clinical conditions (edentulous jaw with 2 interforaminal implants) commercially available ceramic ball attachments (ruby) were compared to commercial titanium ball attachments. The primary aim of the study was to measure the wear of the ball attachments after being 1 year in function. However, in the course of the study already after 7 to 12 months multiple failures with ceramic ball attachments occurred. Twelve (28%) of 43 ceramic ball attachments had to be replaced, mostly because of fractures (8) of the ceramic ball. It seems that ceramic ball attachments of the investigated design are not able to withstand normal intraoral stresses. The short-term susceptibility to fractures didn't allow to examine the ceramic-inherent features such as compressive strength and wear resistance. Furthermore, a secure connection between a titan base and a ceramic ball seems to be challenging. Based on these results, in implant-retained removable prosthesis the use of metal-based retainers is still recommended, although during maintenance a higher wear has to be expected. This wear can be compensated by either activating or changing the matrix or the patrix. PMID:18293602

  19. Clinical spectrum of infective endocarditis: 15 years experience.

    PubMed

    Jalal, S; Khan, K A; Alai, M S; Jan, V; Iqbal, K; Tramboo, N A; Rather, H A; Lone, N A; Dar, M A

    1998-01-01

    Four hundred and sixty-six patients (277 males, 189 females; mean age 23.2 years) diagnosed as cases of infective endocarditis during the past 15 years were retrospectively analysed. Two-thirds of patients belonged to the 15 to 35 years age group. The most common predisposing cardiac lesion was rheumatic heart disease seen in 73.4 percent patients. Mitral valve prolapse and right-sided endocarditis were infrequent, seen in four patients each. Blood culture positivity was 28.7 percent in adults and 61 percent in children. Commonest organism isolated was staphylococcus aureus in adults (39.3%) and streptococcus viridans in children (48%). Salmonella typhi was detected in 17 patients and showed excellent response to ciprofloxacin and gentamycin. Overall mortality was 13.9 percent and resistant heart failure was the leading cause of death. Our study presents the clinical spectrum of infective endocarditis and highlights the comparison with western studies. PMID:10052275

  20. Japanese experience with clinical trails of fast neutrons

    SciTech Connect

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

    1982-12-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Doyle, Cathal; Lennox, Laura; Bell, Derek

    2013-01-01

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

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

    Microsoft Academic Search

    TIM BETTS; HELEN YARROW; LYN GREENHILL; MARY BARRETT

    2003-01-01

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

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

    PubMed Central

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

    2013-01-01

    Introduction Participants’ perceptions of their research experiences provide valuable measures of ethical treatment, yet no validated instruments exist to measure these experiences. We conducted focus groups of research participants and professionals as the initial step in developing a validated instrument. Methods Research participants enrolled in twelve focus groups, consisting of: 1) individuals with disorders undergoing interventions or 2) in natural history studies; or 3) healthy volunteers. Research professionals participated in six separate groups of 1) IRB members, ethicists, Research Subject Advocates, 2) research nurses/coordinators, or 3) investigators. Focus groups used standard methodologies. Results 85 participants and 29 professionals enrolled at 8 academic centers. Altruism and personal relevance of the research were commonly identified motivators; financial compensation was less commonly mentioned. Participants were satisfied with informed consent processes but disappointed if not provided test results, or study outcomes. Positive relationships with research teams were valued highly. Research professionals were concerned about risks, undue influence, and informed consent. Conclusions Participants join studies for varied, complex reasons, notably altruism and personal relevance. They value staff relationships, health gains, new knowledge, and compensation, and expect professionalism and good organization. Based on these insights, we propose specific actions to enhance participant recruitment, retention and satisfaction. PMID:22212221

  5. Clinical experience with subcutaneous implantable cardioverter-defibrillators.

    PubMed

    Lewis, Geoffrey F; Gold, Michael R

    2015-07-01

    The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a novel technology for the treatment of sudden cardiac death. The system consists of a pulse generator implanted in the left axillary position and a single subcutaneous lead for detection and delivery of therapy. Initial clinical trials of S-ICDs demonstrated improved safety and efficacy when compared to transvenous ICD systems, leading to their widespread approval. The main advantage of the S-ICD is the avoidance of vascular access and the complications associated with transvenous leads. Owing to limitations of S-ICDs, patients who require pacing support or antitachycardia pacing are not candidates for the device; instead, this system is currently used most commonly in young patients with previous lead malfunction, limited vascular access, or low risk for subsequent bradycardia or antitachycardia pacing. Findings from device trials support S-ICDs as a viable alternative to transvenous ICDs in certain patients, and the current limitations associated with S-ICDs are likely to be addressed in future iterations of the device, extending its indications and target patient populations. PMID:25898263

  6. Congenital adrenal hyperplasia: experience at intersex clinic, AIIMS.

    PubMed

    Menon, P S; Virmani, A; Sethi, A K; Verma, I C; Rohatgi, M; Gupta, D K; Gupta, A K

    1992-01-01

    During 1981-88, 63 cases of female pseudohermaphroditism (FPH) were seen at the Intersex clinic at AIIMS, of whom 34 (54%) were diagnosed as due to congenital adrenal hyperplasia (CAH). Though ambiguity was present at birth in most cases, only one child was brought immediately after birth, while 14 presented after one year. Family history of affected siblings and fetal wastage was present in 10. Salt wasting symptoms were present in 13 (38.2%), evidence of early virilization in 10 (29.4%) and generalised hyperpigmentation in 7 (20.6%). Clitoromegaly was present in 30 children with labial fusion in 10 and scrotalisation of labia in 6. The urogenital opening was single in 25 (73.5%). Buccal smear was positive for sex chromatin in 19. Chromosomal pattern showed 46 XX in 33. Dyselectrolytemia was present in 16 children. Bone age was advanced in all. Adrenal hyperplasia could be documented in 3 on CT scan. All the girls were put on hydrocortisone or prednisolone, and fluodrocortisone was given only to children with salt wasting CAH. Children with CAH are being brought to medical attention much too late and investigative and therapeutic facilities are grossly inadequate. There is a need to educate primary care physicians for early case detection and provide minimum diagnostic and therapeutic facilities in regional centres. PMID:1452272

  7. Clinical Experience of an Iontophoresis Based Glucose Measuring System

    PubMed Central

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

    2007-01-01

    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. PMID:17297254

  8. Initial Clinical Experience Using the Amplatzer Vascular Plug

    SciTech Connect

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

    2007-07-15

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

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

    PubMed

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

    2004-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  11. The Clinical Experience: A New Component of Urban Teacher Education Models.

    ERIC Educational Resources Information Center

    Smith, Calvert Hayes

    Recent developments indicate that future urban teacher education models will have as one of their basic components a clinical experience program. This experience should constitute a direct involvement in the activities and way of life of a given group of people in an urban community. The legitimacy of urban sub-cultures must be recognized, and the…

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2013-01-01

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

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

    SciTech Connect

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

    2010-10-01

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

  15. Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients?

    PubMed Central

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

    2008-01-01

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

  16. Clinical experiences of bixalomer usage at our hospital.

    PubMed

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

    2014-06-01

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

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

    SciTech Connect

    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: jychang@mdanderson.org

    2008-02-01

    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.

  18. What students really learn: contrasting medical and nursing students' experiences of the clinical learning environment.

    PubMed

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

    2015-08-01

    This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a framework of 'before', 'during' and 'after' clinical placements. Three major themes emerged from the analysis, contrasting the medical and nursing students' experiences of the clinical learning environment: (1) expectations of the placement; (2) relationship with the supervisor; and (3) focus of learning. The findings offer an increased understanding of how medical and nursing students learn in the clinical setting; they also show that the clinical learning environment contributes to the socialisation process of students not only into their future profession, but also into their role as learners. Differences between the two professions should be taken into consideration when designing interprofessional learning activities. Also, the findings can be used as a tool for clinical supervisors in the reflection on how student learning in the clinical learning environment can be improved. PMID:25312745

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

    E-print Network

    Zhang, Yan

    2010-10-12

    Whereas research related to the experience of faculty of color is increasing, little attention has been focused on Chinese faculty's career experience in the United States. The purpose of this study was: (1) to identify and describe factors which...

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

    E-print Network

    Zhang, Yan

    2010-10-12

    Whereas research related to the experience of faculty of color is increasing, little attention has been focused on Chinese faculty's career experience in the United States. The purpose of this study was: (1) to identify ...

  1. In vivo creep and stress relaxation experiments to determine the wall extensibility and yield threshold for the sporangiophores of phycomyces

    PubMed Central

    Ortega, Joseph K. E.; Zehr, Edwin G.; Keanini, Russell G.

    1989-01-01

    The pressure probe was used to conduct in vivo creep and in vivo stress relaxation experiments on the sporangiophores of Phycomyces blakesleeanus. The in vivo creep and in vivo stress relaxation methods are compared with respect to their utility for determining the irreversible wall extensibility and the yield threshold. The results of the in vivo stress relaxation experiments demonstrate that the growth usually does not cease when the external water supply is removed, and the turgor pressure does not decay for hours afterwards. A successful stress relaxation experiment requires that the cell enlargement rate (growth rate) be zero during the turgor pressure decay. In a few experiments, the growth rate was zero during the turgor pressure decay. However, in general only the yield threshold could be determined. In vivo creep experiments proved to be easier to conduct and more useful in determining values for both the irreversible wall extensibility and the yield threshold. The results of the in vivo creep experiments demonstrate that small steps-up in turgor pressure, generally <0.02 MPa, elicit increases in growth rate as predicted by the growth equations and the augmented growth equations. The irreversible wall extensibility and the yield threshold were determined from these results. The results also demonstrate that steps-up in turgor pressure larger than 0.02 MPa, produce a different response; a decrease in growth rate. The decreased growth rate behavior is related to the magnitude of the step-up, and in general, larger steps-up in turgor pressure produce larger decreases in growth rate and longer periods of decreased growth rate. Qualitatively, this growth behavior is very similar to the “stretch response” previously reported by Dennison and Roth (1967). PMID:19431745

  2. Emergence and Molecular Characterization of Extensively Drug-Resistant Mycobacterium tuberculosis Clinical Isolates from the Delhi Region in India?

    PubMed Central

    Khanna, Alka; Raj, V. Samuel; Tarai, Bansidhar; Sood, Ruchi; Pareek, Pawan Kumar; Upadhyay, Dilip J.; Sharma, Pawan; Rattan, Ashok; Saini, Kulvinder Singh; Singh, Harpal

    2010-01-01

    We screened 194 Mycobacterium tuberculosis strains isolated from tuberculosis (TB) patients in Delhi and neighboring regions in India to identify the prevalence of extensive drug resistance (XDR) in clinical isolates. Among these, 104 isolates were found to be multidrug resistant (MDR), and 6 were identified as XDR isolates, which was later confirmed by antimicrobial susceptibility testing against the respective drug screening panel. Genotyping was carried out by amplifying and sequencing the following genes: rpoB (rifampin), katG (isoniazid), gyrA (fluoroquinolones), and rrs (amikacin, kanamycin, and capreomycin). Our analyses indicated that mutations at the hot spots of these genes were positively correlated with drug resistance in clinical isolates. The key mutation observed for rpoB was in the codon for amino acid position 531 (S531L), and other mutations were seen in the hot spot, including those encoding Q510P, L511H, D516V, and H526Y mutations. We identified S315T and R463L substitutions encoded in the katG locus. An S95T substitution encoded in the gyrA locus was the most common mutation observed in fluoroquinolone-resistant isolates. In addition, we saw D94G and D94N mutations encoded in the QRDR region. The 16S rRNA (rrs) gene encoded mainly the A1401G mutation and an additional mutation, G1484T, resulting in ribosomal modifications. Taken together, the data in this report clearly establish the presence of phenotypically distinct XDR strains in India by molecular profiling and further identify specific mutational hot spots within key genes of XDR-TB strains. PMID:20713679

  3. Clinical needs finding: developing the virtual experience-a case study.

    PubMed

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

    2013-09-01

    We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as "virtual" clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but also increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

  4. Use of handheld computer technology to monitor general practice residents' clinical experiences.

    PubMed

    Dyer, Marc D; Presler, Emory A; Raybould, Ted P; Burklow, Cindy; Smith, Timothy A

    2006-12-01

    The Commission on Dental Accreditation (CODA) requires that General Practice Residency (GPR) programs report a summary of each resident's clinical experiences. The goal of this study was to determine the effectiveness of handheld computer technology in tracking residents' clinical procedures. In the academic years 2004-05 and 2005-06, University of Kentucky GPR residents were provided a Palm M130 with customized forms. These menu-driven forms allowed residents to record procedures. Residents synchronized the data to a centralized database. A separate reporting system interfaced with the database to allow administrators to produce detailed reports on each resident. At the end of the academic year, data were tabulated, clinical procedures were correlated with respective costs, and annual production was determined. Data from fourteen residents were analyzed. Types and frequencies of various clinical experiences were tabulated, financial production summaries assessed, and percentage distribution of procedures by discipline was examined. Palm technology has proven to be an effective tool in monitoring each resident's clinical experiences. This methodology was beneficial to residency directors by allowing the examination of the experience distribution of each discipline in dentistry to determine the range of experiences that residents achieved. PMID:17170324

  5. Cell therapy for human ischemic heart diseases: critical review and summary of the clinical experiences.

    PubMed

    Pavo, Noemi; Charwat, Silvia; Nyolczas, Noemi; Jakab, András; Murlasits, Zsolt; Bergler-Klein, Jutta; Nikfardjam, Mariam; Benedek, Imre; Benedek, Teodora; Pavo, Imre J; Gersh, Bernard J; Huber, Kurt; Maurer, Gerald; Gyöngyösi, Mariann

    2014-10-01

    A decade ago, stem or progenitor cells held the promise of tissue regeneration in human myocardium, with the expectation that these therapies could rescue ischemic myocyte damage, enhance vascular density and rebuild injured myocardium. The accumulated evidence in 2014 indicates, however, that the therapeutic success of these cells is modest and the tissue regeneration involves much more complex processes than cell-related biologics. As the quest for the ideal cell or combination of cells continues, alternative cell types, such as resident cardiac cells, adipose-derived or phenotypic modified stem or progenitor cells have also been applied, with the objective of increasing both the number and the retention of the reparative cells in the myocardium. Two main delivery routes (intracoronary and percutaneous intramyocardial) of stem cells are currently used preferably for patients with recent acute myocardial infarction or ischemic cardiomyopathy. Other delivery modes, such as surgical or intravenous via peripheral veins or coronary sinus have also been utilized with less success. Due to the difficult recruitment of patients within conceivable timeframe into cardiac regenerative trials, meta-analyses of human cardiac cell-based studies have tried to gather sufficient number of subjects to present a statistical compelling statement, reporting modest success with a mean increase of 0.9-6.1% in left ventricular global ejection fraction. Additionally, nearly half of the long-term studies reported the disappearance of the initial benefit of this treatment. Beside further extensive efforts to increase the efficacy of currently available methods, pre-clinical experiments using new techniques such as tissue engineering or exploiting paracrine effect hold promise to regenerate injured human cardiac tissue. PMID:24998410

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

    ERIC Educational Resources Information Center

    Furrer, Stephanie D.; Younger, Barbara A.

    2008-01-01

    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

  7. Rutgers New Jersey Agricultural Experiment Station Cooperative Extension of Somerset County

    E-print Network

    Goodman, Robert M.

    Floriculture Greenhouses, Cook Campus New Brunswick, New Jersey Dr. George Wulster, Rutgers Cooperative Extension Specialist in Floriculture has announced his annual production and variety trial open house. More between the hours of 9:00 a.m. to 3:00 p.m. at the Floriculture Greenhouses that are located behind Blake

  8. The extension of controlled source experiments through the use of broadband instrumentation

    Microsoft Academic Search

    A. Brisbourne; P. Denton; Seis-Uk

    2003-01-01

    Two recent controlled source experiments in Ethiopia and New Zealand have been extended by the use of significant numbers of broadband seismometers. The deployment of Guralp CMG-6TD instruments along the profiles for periods significantly longer than the duration of the controlled source experiment deployment has allowed the acquisition of significant volumes of earthquake data. These data will supplement the controlled

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

    PubMed

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

    2015-03-30

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

  10. The Experience of a Department of Medicine with a Clinical Medical Library Service.

    ERIC Educational Resources Information Center

    Miller, Naomi; Kaye, Donald

    1985-01-01

    Five years of experience using the services of a clinical medical librarian at the Hospital of the Medical College of Pennsylvania are reviewed. There were increases in the use of the librarian for patient-related queries, research, and oral presentations. (Author/MLW)

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  12. Population Health Clinical Experiences at an Agency Serving Individuals With Developmental Disabilities

    Microsoft Academic Search

    Sarah H. Ailey; Marilyn E. ORourke

    2008-01-01

    The American Association of Colleges of Nursing's (AACN) Essentials of baccalaureate and master's degree education require teaching population health skills in nursing programs. Clinical site placement for learning population health skills is hoped to be beneficial for both students and the agencies. This article reports on the experience of placing undergraduate and graduate student groups at an agency serving adults

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

    E-print Network

    Paris-Sud XI, Université de

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

  14. Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early Chinese clinical experience

    Microsoft Academic Search

    Feng Wu; Zhi-Biao Wang; Wen-Zhi Chen; Jian-Zhong Zou; Jin Bai; Hui Zhu; Ke-Quan Li; Fang-Lin Xie; Cheng-Bing Jin; Hai-Bing Su; Gen-Wu Gao

    2004-01-01

    The objective of this article is to introduce the early Chinese clinical experience of using extracorporeal focused ultrasound (US) surgery (FUS) for the treatment of solid tumors. From December 1997 to October 2001, a total of 1038 patients with solid tumors underwent FUS ablation in 10 Chinese hospitals. The tumors included primary and metastatic liver cancer, malignant bone tumors, breast

  15. Fetoscopic Endotracheal Occlusion for Severe Isolated Diaphragmatic Hernia: Initial Experience from a Single Clinic in Brazil

    Microsoft Academic Search

    Cleisson Fábio Andrioli Peralta; Lourenço Sbragia; João Renato Bennini; Angélica de Fátima Assunção Braga; Monique Sampaio Rousselet; Izilda Rodrigues Machado Rosa; Ricardo Barini

    2011-01-01

    Objective: To report on the initial experience in a single Brazilian university clinic of the use of fetoscopic endotracheal occlusion (FETO) to treat severe isolated congenital diaphragmatic hernia (CDH). Methods: The inclusion criteria for FETO for this prospective study were isolated CDH and intrathoracic herniation of the liver, as well as the lung area to head circumference ratio (LHR) <1.0.

  16. MD Summer Experience at Emory (MD-SEE): Clinical Neurology Study

    E-print Network

    Rowley, Clarence W.

    MD Summer Experience at Emory (MD-SEE): Clinical Neurology Study A Joint Program Sponsored by the Emory College Neuroscience & Behavioral Biology Program (NBB) and the Department of Neurology of the Emory School of Medicine May 19 ­ June 27, 2014 Undergraduates, Explore Neurology at Emory this Summer

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

    Cancer.gov

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

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

    ERIC Educational Resources Information Center

    LaFauci, Frances F.

    2009-01-01

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

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

    PubMed

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

    2014-11-28

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

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

    Human observer performance experiments (HOPE) are frequently carried out in controlled environments in order to maximize the influence of the performance parameter under study. As an example, the amount of ambient reading variables can be kept as low as possible during HOPE. This is contrasting with the dynamic nature of a clinical reading environment that may therefore be suboptimal for the majority of the experiments. The aim of current work was to extend our previously developed software platform Sara² to cope with the influences of the reading environment on HOPE experiments. Generic modules for ROC, LROC, FROC, MAFC and visual grading analysis/image quality criteria (VGA/IQC) experiments were developed for 2D and 3D input images. Additional modules were included in the platform for finding unexpected interruptions due to clinical emergencies by means of idle time and for mouse trajectory monitoring. Also a generic approach towards the inclusion of reading questionnaires and a RFID enabled secured login system was added. Next, we created a sensor network consisting of off-the-shelf components which continuously monitor ambient reading conditions like: temperature, ambient lighting, humidity, ambient noise levels and observer reading distance. These measured parameters can be synchronized with the reading findings. Finally we included a link to incorporate the use of specialized 3rd party PACS viewers in our software framework. Using the proposed software and hardware solution, we could simplify the setup and the performing of HOPE in clinical reading environments and we can now properly control our reading experiments.

  2. Classroom Experiences in an Engineering Design Graphics Course with a CAD/CAM Extension.

    ERIC Educational Resources Information Center

    Barr, Ronald E.; Juricic, Davor

    1997-01-01

    Reports on the development of a new CAD/CAM laboratory experience for an Engineering Design Graphics (EDG) course. The EDG curriculum included freehand sketching, introduction to Computer-Aided Design and Drafting (CADD), and emphasized 3-D solid modeling. Reviews the project and reports on the testing of the new laboratory components which were…

  3. The Functional Genomics Experiment model (FuGE): an extensible framework for standards in functional genomics

    Microsoft Academic Search

    Andrew R Jones; Michael Miller; Ruedi Aebersold; Rolf Apweiler; Catherine A Ball; Alvis Brazma; James DeGreef; Nigel Hardy; Henning Hermjakob; Simon J Hubbard; Peter Hussey; Mark Igra; Helen Jenkins; Randall K Julian; Kent Laursen; Stephen G Oliver; Norman W Paton; Susanna-Assunta Sansone; Ugis Sarkans; Christian J Stoeckert; Chris F Taylor; Patricia L Whetzel; Joseph A White; Paul Spellman; Angel Pizarro

    2007-01-01

    The Functional Genomics Experiment data model (FuGE) has been developed to facilitate convergence of data standards for high-throughput, comprehensive analyses in biology. FuGE models the components of an experimental activity that are common across different technologies, including protocols, samples and data. FuGE provides a foundation for describing entire laboratory workflows and for the development of new data formats. The Microarray

  4. Direct measurement of single-molecule visco-elasticity in atomic force microscope force-extension experiments.

    PubMed

    Bippes, Christian A; Humphris, Andrew D L; Stark, Martin; Müller, Daniel J; Janovjak, Harald

    2006-02-01

    Measuring the visco-elastic properties of biological macromolecules constitutes an important step towards the understanding of dynamic biological processes, such as cell adhesion, muscle function, or plant cell wall stability. Force spectroscopy techniques based on the atomic force microscope (AFM) are increasingly used to study the complex visco-elastic response of (bio-)molecules on a single-molecule level. These experiments either require that the AFM cantilever is actively oscillated or that the molecule is clamped at constant force to monitor thermal cantilever motion. Here we demonstrate that the visco-elasticity of single bio-molecules can readily be extracted from the Brownian cantilever motion during conventional force-extension measurements. It is shown that the characteristics of the cantilever determine the signal-to-noise (S/N) ratio and time resolution. Using a small cantilever, the visco-elastic properties of single dextran molecules were resolved with a time resolution of 8.3 ms. The presented approach can be directly applied to probe the dynamic response of complex bio-molecular systems or proteins in force-extension experiments. PMID:16237549

  5. The muon component in extensive air showers and new p+C data in fixed target experiments

    SciTech Connect

    Meurer, C.; Bluemer, J.; Engel, R.; Haungs, A.; Roth, M. [Institut fuer Kernphysik, Forschungszentrum Karlsruhe GmbH, Postfach 3640, 76021 Karlsruhe (Germany)

    2007-03-19

    One of the most promising approaches to determine the energy spectrum and composition of the cosmic rays with energies above 1015 eV is the measurement of the number of electrons and muons produced in extensive air showers (EAS). Therefore simulation of air showers using electromagnetic and hadronic interaction models are necessary. These simulations show uncertainties which come mainly from hadronic interaction models. One aim of this work is to specify the low energy hadronic interactions which are important for the muon production in EAS. Therefore we simulate extensive air showers with a modified version of the simulation package CORSIKA. 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 {pi}+ and {pi}- 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.

  6. The Stanford experience with combined procarbazine, Alkeran and vinblastine (PAVe) and radiotherapy for locally extensive and advanced stage Hodgkin's disease.

    PubMed

    Horning, S J; Ang, P T; Hoppe, R T; Rosenberg, S A

    1992-11-01

    This report describes the efficacy and toxicity of PAVe (procarbazine, Alkeran, vinblastine) and irradiation (RT) in the management of 159 patients with locally extensive or advanced stage Hodgkin's disease (HD) at Stanford University. Patients received six courses of chemotherapy alternating with RT. The extent of RT and the schedule of treatment varied according to the stage of disease. About 2/3 of patients received PAVe/RT in the setting of prospective, randomized clinical trials. The rate of complete response was 93%. With a median follow-up of seven years (range 2-17), the 15 year actuarial freedom from progression (FFP) is 78% and overall survival is 75%. Ten-year FFP by stage is: 80% for locally extensive stage II, 90% for stage IIIA and 70% for stage IIIB. Excellent and equal results were attained with PAVe/RT vs. MOP(P) (mustard, Oncovin, procarbazine with or without prednisone)/RT in the randomized combined modality studies. Progression or recurrence was documented in 30 patients and was more common in irradiated sites. PAVe was well tolerated acutely. There were no treatment related fatalities. Twenty-three (14%) patients were admitted to the hospital for neutropenic fever. Five second malignancies have occurred after PAVe/RT only: one myelodysplastic syndrome, one acute myelogenous leukemia, one non-Hodgkin's lymphoma and two solid tumors including a case of non-small cell lung cancer and an in situ carcinoma of the cervix. Three patients died from myocardial infarction several years after the completion of treatment. These mature data show that PAVe/RT is effective and well-tolerated therapy for locally extensive stage II and IIIA/B HD.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1450064

  7. An exploration of student midwives' experiences of the Objective Structured Clinical Examination assessment process.

    PubMed

    Barry, Maebh; Noonan, Maria; Bradshaw, Carmel; Murphy-Tighe, Sylvia

    2012-08-01

    This paper reports on a qualitative descriptive study that explored student midwives' experiences of the Objective Structured Clinical Examination assessment process for obstetric emergencies within a university setting. The development of fundamental clinical skills is an important component in preparing students to meet the responsibilities of a midwife. There is an international concern that the transfer of midwifery education into universities may impact on the development of midwifery clinical skills. Objective Structured Clinical Examinations (OSCEs) have the potential to promote integration and consolidation of skills prior to clinical placement. Twenty six students (n=36) from two midwifery programmes (BSc and Higher Diploma) participated in four focus groups and Burnard's (2006) framework was used for data analysis. Three main themes emerged following analysis: preparation for the OSCE assessment, the OSCE process and learning through simulating practice. Preparation for the OSCE's which included lectures, demonstrations, and practice of OSCE's facilitated by lecturers and by the students themselves, was considered central to the process. Learning via OSCEs was perceived to be more effective in comparison to other forms of assessment and prepared students for clinical practice. Positive aspects of the process and areas for improvement were identified. Using OSCE's increased the depth of learning for the students with the steps taken in preparation for the OSCE's proving to be a valuable learning tool. This study adds to the evidence on the use of OSCE's in midwifery education. PMID:21999901

  8. Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes

    SciTech Connect

    Apisarnthanarax, Smith [Department of Experimental Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Elliott, Danielle D. [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); El-Naggar, Adel K. [Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Asper, Joshua A. P.A. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Blanco, Angel [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Ang, K. Kian [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Morrison, William H. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Rosenthal, David [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Weber, Randal S. [Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Chao, K.S. Clifford [Department of Experimental Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States) and Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: cchao@mdanderson.org

    2006-03-01

    Purpose: To determine the optimal clinical target volume margins around the gross nodal tumor volume in head-and-neck cancer by assessing microscopic tumor extension beyond cervical lymph node capsules. Methods and Materials: Histologic sections of 96 dissected cervical lymph nodes with extracapsular extension (ECE) from 48 patients with head-and-neck squamous cell carcinoma were examined. The maximum linear distance from the external capsule border to the farthest extent of the tumor or tumoral reaction was measured. The trends of ECE as a function of the distance from the capsule and lymph node size were analyzed. Results: The median diameter of all lymph nodes was 11.0 mm (range: 3.0-30.0 mm). The mean and median ECE extent was 2.2 mm and 1.6 mm, respectively (range: 0.4-9.0 mm). The ECE was <5 mm from the capsule in 96% of the nodes. As the distance from the capsule increased, the probability of tumor extension declined. No significant difference between the extent of ECE and lymph node size was observed. Conclusion: For N1 nodes that are at high risk for ECE but not grossly infiltrating musculature, 1 cm clinical target volume margins around the nodal gross tumor volume are recommended to cover microscopic nodal extension in head-and-neck cancer.

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

    Microsoft Academic Search

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

    2009-01-01

    Background: Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials.Purpose: This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials

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

    ERIC Educational Resources Information Center

    Flowers, Claudia

    2006-01-01

    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…

  11. Peer Experiences of Anxious and Socially Withdrawn Youth: An Integrative Review of the Developmental and Clinical Literature

    ERIC Educational Resources Information Center

    Kingery, Julie Newman; Erdley, Cynthia A.; Marshall, Katherine C.; Whitaker, Kyle G.; Reuter, Tyson R.

    2010-01-01

    Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental…

  12. Clinical experiences with cartilage repair techniques: outcomes, indications, contraindications and rehabilitation.

    PubMed

    Berta, Á; Duska, Zsofia; Tóth, Ferenc; Hangody, Laszlo

    2015-08-01

    Untreated articular cartilage defects may lead to chronic joint degeneration and functional disability. In the past decade, several cartilage repair techniques have emerged for the treatment of cartilage lesions. Among these techniques, mosaicplasty was introduced by the senior author into the clinical practice in 1992. This article does not intend to give a review or a comparison of currently existing surgical techniques which aim to repair symptomatic focal defects; however, it focuses on the procedures used in the everyday practice in the authors' institute, namely microfracture, mosaicplasty, autologous chondrocyte implantation (ACI), osteochondral allograft transplantation and biodegradable osteochondral scaffolds. It gives a brief summary of these well-described techniques, summarizes the authors' clinical experience and available data on the clinical outcome, and the rehabilitation protocol following different procedures, with a special emphasis on mosaicplasty. PMID:26165712

  13. [Interferon-?1b in multiple sclerosis therapy: more than 20 years clinical experience].

    PubMed

    Hartung, H-P; Haas, J; Meergans, M; Tracik, F; Ortler, S

    2013-06-01

    The introduction of interferon-?1b in 1993 in the USA and 2 years later in Europe made it possible for the first time to alter the course of the disease in patients with relapsing-remitting multiple sclerosis (MS). Subsequently, interferon-?1b was approved for the treatment of patients with active secondary progressive MS (1999) and early relapsing-remitting MS following a first demyelinating event (clinically isolated syndrome, CIS) (2006). Here we provide an overview of the clinical experience gathered during more than 20 years of interferon-? use focusing on long-term efficacy and safety and the impact of early initiation of treatment. Furthermore, the following aspects will be discussed: putative mechanisms of action of interferon-?, indications for a disease-modifying therapy, clinical relevance of neutralizing antibodies, importance of adherence in MS therapy, high versus low frequency therapy, combination therapies with interferon-? and safety of interferon-? in children and adolescents with MS and during pregnancy. PMID:23669866

  14. Seven-Year Clinical Experience With the Extracardiac Pedicled Pericardial Fontan Operation

    Microsoft Academic Search

    Minoo N. Kavarana; Sebastian Pagni; Michael R. Recto; Walter L. Sobczyk; Thomas Yeh Jr; Michael Mitchell; Erle H. Austin III

    2005-01-01

    Background. Although improved perioperative out- comes with growth potential of the extracardiac pedicled pericardial Fontan (EPPF) operation have been sug- gested, no advantage has been demonstrated. Methods. We retrospectively reviewed our institutional experience of 54 consecutive patients undergoing EPPF between June 1996 and August 2003. Clinical and echo- cardiographic follow-up was obtained yearly with a mean follow-up of 2.8 2.0

  15. Multiple Clinical Presentations of Lymphoproliferative Disorders in Pediatric Liver Transplant Recipients: A Single-Center Experience

    Microsoft Academic Search

    M. L. Pinho-Apezzato; U. Tannuri; A. C. A. Tannuri; E. S. Mello; F. Lima; N. E. Gibelli; M. M. Santos; A. A. Ayoub; J. G. Maksoud-Filho; M. C. Velhote; M. M. Silva; W. C. Andrade; H. T. Miyatani

    2010-01-01

    Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation that has been linked to Epstein-Barr virus (EBV) infection. The aim of this article was to describe a single-center experience with the multiplicity of clinical presentations of PTLD. Among 350 liver transplantations performed in 303 children, 13 survivor children displayed a histological diagnosis of PTLD (13\\/242 survivors; 5.4%).

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

    Microsoft Academic Search

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

    1975-01-01

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

  17. First Report of an Extensively Drug-Resistant VIM-2 Metallo-?-Lactamase-Producing Brevundimonas diminuta Clinical Isolate

    PubMed Central

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

    2012-01-01

    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

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

    E-print Network

    .-Karl-Dorrek-Strae 30, 3500 Krems, Austria silvia.miksch@donau-uni.ac.at Abstract Transforming a text-based clinical and utility for the various users. 1. Introduction The evidence-based medicine/healthcare (EBM) [11] movement also influenced the development of clinical practice guidelines (CPGs) ­ also known as medical

  19. [Primary anti-phospholipid syndrome. Clinical experience at the Ignacio Chávez National Institute of Cardiology].

    PubMed

    León, S; Amigo, M C; Casanova, J M; Reyes, P A

    1991-01-01

    This paper describes 15 patients who had elevated IgG antibodies reactive with cardiolipin. Outstanding clinical features were: recurrent venous and/or arterial thrombosis--often extensive and severe--in 9 cases. Thrombocytopenia, in 11 cases and spontaneous recurrent fetal loss in 8 out of 10 females with marital life. In addition there were vasospastic/thrombotic features such as livedo reticularis, Raynaud's phenomenon and leg ulcers. Involvement of central and/or peripheral nervous system was present in 10 cases. Valvular heart disease was conspicuous, 10 out of 15 patients (66%) had organic lesions in both sides of the heart. There were also laboratory abnormalities such as prolonged partial thromboplastin time, false positive V.D.R.L., plasmatic anticoagulant activity and low incidence of antinuclear antibodies and rheumatoid factors. The clinical syndrome seems to be related to the presence of antibodies reactive with anionic phospholipids, although there is not formal proof of a direct cause effects relationship. Recognition of these distinct clinical entity is important, the use of simple anti aggregating agents like aspirine and careful anticoagulant therapy may modify the course of this newly recognized autoimmune condition. PMID:1854230

  20. Peer Experiences of Anxious and Socially Withdrawn Youth: An Integrative Review of the Developmental and Clinical Literature

    Microsoft Academic Search

    Julie Newman Kingery; Cynthia A. Erdley; Katherine C. Marshall; Kyle G. Whitaker; Tyson R. Reuter

    2010-01-01

    Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties\\u000a in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined\\u000a how anxiety relates to peer experiences using normative and clinically anxious samples, developmental psychologists have focused\\u000a primarily on the peer experiences of shy and withdrawn children. Research

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

    PubMed

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

    2015-02-01

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

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

    PubMed

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

    2014-09-01

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

  3. Reflective impressions of a precepted clinical experience caring for people with disabilities.

    PubMed

    Karl, Renee; McGuigan, Denise; Withiam-Leitch, Matthew L; Akl, Elie A; Symons, Andrew B

    2013-08-01

    There is evidence that early and frequent encounters with people with disabilities can improve medical students' knowledge, skills, and attitudes about disability. As part of a 4-year integrated curriculum in caring for patients with disabilities, third-year medical students (n = 144) in a Family Medicine clerkship participated in a day-long precepted clinical experience at a medical facility serving people with disabilities, predominantly developmental disabilities, where they met patients and worked with clinicians. At the conclusion of the program, students completed a reflective survey about their experience. These data were analyzed qualitatively using a constructivist grounded-theory approach. Students' responses indicated that the experience improved their comfort levels in working with people with disabilities and increased their awareness of attitudinal factors that influence patient care. Responses also demonstrated that students achieved an awareness of technical accommodations and organizational adaptations that improve patient care. PMID:23909585

  4. Quantitative and qualitative assessment of women's experience of a one-stop menstrual clinic in comparison with traditional gynaecology clinics

    Microsoft Academic Search

    Jafaru I Abu; Marwan A Habiba; Richard Baker; Aidan W. F Halligan; Nicholas J Naftalin; Ronald Hsu; Nicholas Taub

    2001-01-01

    Objective A quantitative and qualitative evaluation of the views of patients attending two types of clinics for menstrual disorders.Methods Semi-structured qualitative interview and quantitative questionnaire.Setting Five traditional general gynaecology clinics and a one-stop menstrual clinic, where investigations are performed and results given to patients on the same day.Participants Two hundred and thirty-nine women (126 from the gynaecology clinic and 113

  5. Ethnographic experiences of HIV-positive nurses in managing stigma at a clinic in rural Uganda.

    PubMed

    Kyakuwa, Margaret

    2009-09-01

    This paper explores the workplace experiences of HIV-positive nurses and their attempts to manage HIV/AIDS stigma. An HIV diagnosis can have a major impact on an individual's psychological and emotional wellbeing. Moreover, caring for those suffering from chronic HIV-related illnesses comes with additional stress, which makes providing care more complex. Stigma-reduction and assisting with psychosocial support and wellbeing is an integral part of ensuring that care providers who are HIV-positive have good outcomes both for themselves and their patients. An ethnographic study with HIV-positive nurses was conducted from August 2005 to December 2007 at a Health Centre IV HIV clinic in rural Luweero district, Uganda. Data were gathered through clinical participant observation, informal conversations, recorded life histories, open-ended in-depth interviews and topical focus group discussions. Nurses are in a position to help people through negative life events, yet they may personally experience the same types of negative life events. In the absence of a system to provide support for HIV and AIDS clinical care providers, a group of HIV-positive nurses initiated a support process by creating safe spaces for interacting and seeking psychosocial support among themselves in a relatively secretive way. This process provided the nurses with a solid foundation for developing interventions to assist them through difficult times. PMID:25864551

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

    PubMed

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

    2009-03-01

    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

  7. Clinical-radiological improvement following low-tech surgical treatment of an extensive cervical-medullary idiopathic syringomyelia in a low-resource African neurosurgical practice.

    PubMed

    Adeleye, Amos O; Ogbole, Godwin I

    2015-07-01

    Surgical intervention is not so commonly deployed for idiopathic syringomyelia, even the symptomatic ones; is only undertaken, in the current era, after thorough clinical evaluation and extensive high-resolution neuroimaging; and is more assuredly performed, high-tech, in health facilities in the developed world with cutting edge logistic supports. In the practice environment of a low-resource African developing country, a 41-year-old young man recently presented in severe clinical-neurological deficit, Nurick grade 5, with an extensive cervical-medullary idiopathic syringomyelia. In spite of severe preoperative and intraoperative resource limitations, he successfully underwent spinal surgical decompression, fenestration of syrinx, and expansile duraplasty. He improved clinically postoperatively and achieved mobility, Nurick grade 3, before hospital discharge. He sustained this improvement, Nurick grade 3 to 2, 20 months post-op. He is now independent, needing only a walking stick to aid ambulation, and an MRI at this time showed only minimal focal post-op changes but total disappearance of the syrinx. PMID:25697142

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

    NASA Astrophysics Data System (ADS)

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

    2012-04-01

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

  9. Clinical experience of frame ring utilization in applying interintestinal anastomoses in urgent surgery.

    PubMed

    Khodjimukhamedova, Nigora; Khadjibaev, Farhad; Shukurov, Bobur

    2014-08-01

    The problem of restoration of intestinal integrity preserves its importance as the intestinal suture is a basis for digestive tract surgery. Tightness failure in the intestinal suture during gastrointestinal surgery is a threatening and, unfortunately, frequent complication, and it gets especial importance in emergency patients and those with severe concomitant pathologies. The research is carried out on utilization of a metal frame ring in applying interintestinal anastomoses. Clinical utilization of the method developed was preceded with a series of experiments on animals with morphological researches with the use of the device. Seventy operations were performed with utilization of a frame metal ring during application of interintestinal anastomoses. After performing an operation, intestinal peristalsis restored faster. In the postoperative period, all patients undertook study of abdominal exudates to determine for early diagnostics of development of intestinal suture failure. In clinical practice, utilization of a frame ring is indicated in applying primary interintestinal anastomoses in adverse conditions, namely, peritonitis and intestinal obstruction. PMID:25278650

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

    PubMed Central

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

    2014-01-01

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

  11. Psychotic experiences as indicators of suicidal ideation in a non-clinical college sample.

    PubMed

    DeVylder, Jordan E; Thompson, Elizabeth; Reeves, Gloria; Schiffman, Jason

    2015-04-30

    Suicide is a leading cause of preventable death. Epidemiological studies have shown strong associations between sub-threshold psychotic experiences and risk for suicidal ideation and behavior. Screens designed to assess psychotic experiences may have clinical utility in improving suicide prevention efforts. In the current study, we hypothesized that the Prodromal Questionnaire-Brief (PQ-B) would reliably distinguish levels of suicidal ideation within a sample of college students (n=376). As predicted, PQ-B scores varied significantly across levels of suicidal ideation, both when treated as a raw count of sub-threshold psychotic experiences and when taking into account subjective distress associated with those symptoms. In addition, we explored the feasibility of developing a short screen based on the most discriminating items, finding that a six-item version of the PQ-B yielded higher accuracy for detecting elevated suicidal ideation over the full measure. The PQ-B has the potential for clinical utility in detecting groups that might be at increased risk for suicidal ideation. PMID:25746171

  12. Accuracy of Reporting the Hyperdense Middle Cerebral Artery Sign as a Function of Clinical Experience

    PubMed Central

    Aouad, Patrick; Hughes, Andrew; Neeman, Terry; Lueck, Christian J.

    2015-01-01

    Background/Aim The hyperdense middle cerebral artery sign (HMCAS) is a useful clinical sign in the management of acute stroke and may alter time-critical decisions within an emergency setting. Though gold standards have been published, these are rarely used in clinical practice and scans tend to be reported subjectively. It is therefore possible that the level of experience of the doctor reporting the scan may impact on the accuracy of the reporting and hence patient management. This study was designed to evaluate the accuracy in detecting HMCAS across doctors with varying levels of experience. Methods Forty doctors were recruited into four categories of experience. Each subject received a brief computer-based tutorial on how to identify an HMCAS and was then asked to report on the presence or absence of an HMCAS in 19 pre-prepared CT scans using a standardised viewing template. Results The mean (±SE) percentage correct scores increased with experience from 76.8 ± 3.69 among interns and residents to 90.1 ± 2.23 (neurologists and radiologists; p < 0.01). Sensitivity and specificity as well as positive and negative predictive values all increased with experience. In addition, more experienced clinicians were better able to distinguish scans which met the radiological criteria for HMCAS from those which only just failed to do so. Conclusions Experienced neurologists and radiologists consistently and accurately reported the presence or absence of HMCAS, whereas less experienced clinicians tended to over-report the presence of HMCAS. This may have implications for the acute management of thromboembolic stroke. PMID:25759709

  13. Renal oncocytoma: experience of Clinical Urology A, Urology Department, CHU Ibn Sina, Rabat, Morocco and literature review

    PubMed Central

    Benatiya, Marwane Andaloussi; Rais, Ghizlane; Tahri, Mounir; Barki, Ali; El Sayegh, Hachem; Iken, Ali; Nouini, Yassine; Lachkar, Azzouz; Benslimane, Lounis; Errihani, Hassan; Faik, Mohammed

    2012-01-01

    Renal oncocytoma is a rare and benign renal tumor. Only few cases have been reported in Moroccan populations. In the present study, we report our experiences in the diagnosis, management and follow-up of this disease. We report on six cases of renal oncocytoma indentified between 1990 and 2008 in the urology department of “CHU Ibn Sina” in Rabat. These six cases are listed among 130 kidney tumors reported during the study period. We assess the clinical, radiological and therapeutic features of the patients and we review literature. Six cases of renal oncocytoma, representing 4.6% of all primitive kidney tumors treated in our institution during the study period. The mean age was 53 ±9.7 years (range 34 to 61 years). One patient was asymptomatic at presentation, five patients (83%) had flank pain and two (33%) had macroscopic hematuria. The tumor was right sided in 4 cases (66%) and left sided in 2 cases (33%). All patients underwent CT scan which showed, in three cases, a centrally located stellate area of low attenuation. The clinical suspicion of oncocytoma was made preoperatively in only 3 patients by imaging studies, but the suspicion of renal cell carcinoma persist and all patients were treated with radical nephrectomy. Definitive diagnosis was made in all cases postoperatively. All the tumors were well circumscribed but unencapsulated. The mean tumor size was 8,75±2,04 cm. Four patients were classified at stage pT2 and two at stage p T1. Most of the pathological features in our patients were typical of this entity. Predominant cell type was a typical oncocytoma with general low mitotic activity. No extension to peri-nephric fat tissue or lymphovascular invasion was observed. After a mean follow-up of 36 months (range 26-62 months), there was neither recurrence nor death from oncocytoma. Accordingly, the disease-specific survival was 100%. Renal oncocytoma has a benign clinical course with excellent long-term outcomes. In our series, it happened mostly in females and is more frequently symptomatic. Although radical nephrectomy is the usual treatment, a conservative approach should be considered whenever there are signs of clinical and radiological presumptions. PMID:23077705

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

    PubMed Central

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

    2014-01-01

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

  15. Clinical experiences on the effect of scrambler therapy for patients with postherpetic neuralgia.

    PubMed

    Ko, Young Kwon; Lee, Ho Young; Lee, Wang Yong

    2013-01-01

    Postherpetic neuralgia (PHN) is a debilitating complication of herpes zoster, especially in elderly and comorbid patients. Unfortunately, the currently available treatments have shown limited efficacy and some adverse events that are poorly tolerated in elderly patients. Scrambler Therapy, proposed as an alternative treatment for chronic neuropathic pain recently, is a noninvasive approach to relieve pain by changing pain perception at the brain level. Here, we report our clinical experiences on the effect of Scrambler Therapy for three patients with PHN refractory to conventional treatment. PMID:23342218

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

    PubMed Central

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

    1997-01-01

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

  17. Experiences of and perspectives on genetic testing for breast\\/ovarian cancer in and outside of the customary clinical setting

    Microsoft Academic Search

    A. M. Buckmaster; P. Gallagher

    2010-01-01

    Recently, genetic testing has begun to move from the customary clinical setting (with restrictive entry criteria) into the offices of GPs and the homes of consumers (Williams-Jones, 2003). This research aimed to look at participants’ experiences of genetic testing for hereditary breast and ovarian cancer in a clinical environment, and subsequently ascertain potential psychosocial issues associated with genetic testing outside

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

    PubMed

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

    2013-06-01

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

  19. The disclosure of dyslexia in clinical practice: experiences of student nurses in the United Kingdom.

    PubMed

    Morris, David K; Turnbull, Patricia A

    2007-01-01

    Heightened awareness and increasingly sophisticated psychological tests have seen a dramatic rise in the numbers of people diagnosed with dyslexia. Accordingly, there is a reported increase in the numbers of students with dyslexia entering Higher Education (HE) in the United Kingdom (UK) [Singleton, C.H., Chair, 1999. Dyslexia in higher education: policy, provision and practice. Report of the national working party on dyslexia in higher education. University of Hull on behalf of the Higher Education Funding Councils of England and Scotland, Hull], [Higher Education Statistics Agency. HESA. Available from: (accessed 21.12.05)]. Studies researching the effects of dyslexia on the clinical practice of nurses are almost non-existent. This paper reports part of a UK study exploring the clinical experiences of student nurses with dyslexia. In depth interviewing of 18 adult branch student nurses revealed a range of difficulties encountered and a variety of coping mechanisms to manage these. Other than in exceptional circumstances there is no legal requirement to disclose a dyslexia diagnosis. The decision to conceal or disclose their dyslexia was particularly prominent and contentious for these participants. This related to the attitudes of co-workers, concerns for patient safety, expectations of support, confidentiality issues and potential discrimination. Dyslexia continues to attract an unwarranted stigma and can adversely affect the learning experience. The need for disability awareness training in the workplace and improved education/service partnerships to support these students is considered crucial. PMID:16624451

  20. Clinical experiences in conducting cognitive-behavioral therapy for social phobia.

    PubMed

    McAleavey, Andrew A; Castonguay, Louis G; Goldfried, Marvin R

    2014-01-01

    Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here. PMID:24411111

  1. Use of lumbar extension, slump test, physical and neurological examination in the evaluation of patients with suspected herniated nucleus pulposus. A prospective clinical study.

    PubMed

    Stankovic, R; Johnell, O; Maly, P; Willner, S

    1999-02-01

    This prospective and consecutive study was designed to evaluate the validity of different clinical tests, e.g. lumbar extension in lying and slump test for patients with suspected herniated nucleus pulposus, in comparison with findings on computed tomography (CT) and/or magnetic resonance imaging (MRI) scan. There were 105 patients who were seen and examined by the senior author (for the sake of the study) at the Orthopaedic Physiotherapy Department, on an average of 5.5 days (range 0-21 days) before CT and/or MRI examination were carried out. There were 36 women and 69 men with an average age of 42.7 +/- 9.8 (range 19-64) years. According to the radiological findings on CT and/or MRI, the patients were divided into three groups: 52 patients with disc hernia, 41 patients with bulging discs and 12 patients without positive findings. The mean values with standard deviations of 25 variables of three diagnostic groups were studied. Multiple comparison adjustment according to Bonferroni showed significant differences for three variables that were of diagnostic value (lumbar range of motion for forward flexion, left side-bending in standing, and pain distribution during extension in standing). The agreement between clinical and radiological findings for type and level of diagnosis of disc herniation was accurate in 72 patients (69%). The diagnostic sensitivity for disc herniation was 82.6% and the specificity 54.7%. PMID:10463018

  2. Medicare, Medicaid and CLIA programs; extension of certain effective dates for clinical laboratory requirements and personnel requirements for cytologists--HCFA. Final rule with comment period.

    PubMed

    1994-12-01

    This final rule extends certain effective dates for clinical laboratory requirements in regulations published on February 28, 1992, which implemented provisions of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and announces our approval of a certifying organization for qualifying cytotechnologists. This rule extends the date by which an individual must enroll in an HCFA-approved cytology proficiency testing (PT) program and the date by which an individual with a doctoral degree must possess board certification to qualify as a director of a laboratory that performs high complexity testing. In addition, we are extending the phase-in of the quality control requirements applicable to unmodified, moderate complexity tests cleared for commercial distribution by the Food and Drug Administration (FDA). We are extending the date to meet applicable CLIA QC requirements for laboratories using commercial, nonmodified tests to fulfill certain quality control (QC) requirements. These effective date extensions do not reduce the current requirements for quality test performance. The date extensions are necessary due to the limited number and scope of currently operating cytology PT programs, resource constraints that have prevented commencement of the substantial number of quality control reviews, and inability of many laboratory directors to complete certification requirements within the time period originally specified. PMID:10138980

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

    PubMed

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

    2012-02-01

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

  4. Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates

    PubMed Central

    Doherty, Jane; Conco, Daphney; Couper, Ian; Fonn, Sharon

    2013-01-01

    Background Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008. Objective We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker. Methods We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed. Results Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards. Conclusions This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives. PMID:23364079

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

    PubMed

    Lindop, E; Cannon, S

    2001-06-01

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

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

    PubMed Central

    Cafiero, Madeline

    2013-01-01

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

  7. [The experience with the application of dynamic electroneurostimulation in clinical medicine. A multicenter study].

    PubMed

    Chernysh, I M; Ulashchik, V S

    2014-01-01

    The ever growing occurrence of iatrogenic pathologies under present conditions is responsible for the high percentage of adverse reactions associated with medicamental therapy. It emphasizes the necessity of the more extensive application of non-pharmacological products and physiotherapeutic methods free of this disadvantage. Dynamic electroneurostimulation (DENS) is one of the up-to-date promising therapeutic and prophylactic modality for this purpose by virtue of its broad spectrum of action. This approach is based on the principle of monitoring skin surface impedance. The present study was designed to estimate the effectiveness of DENS for the treatment of the patients presenting with chronic diseases, such as nervous disorders, dysfunction of the locomotor system, gastrointestinal and urogenital pathologies. This multicenter study in the form of a randomized clinical trial included 1,198 outpatients and 814 inpatients. It was shown that the application of dynamic electroneurostimulation provides a highly efficacious tool for the management of nervous, internal, and other diseases. It can be recommended for use as a promising non-medicamnetal therapeutic modality for the combined treatment and rehabilitation of the patients presenting with the diseases of various etiology. PMID:24864484

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

    PubMed

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

    1976-02-01

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

  9. Concepts in local treatment of extensive paediatric burns

    PubMed Central

    Ungureanu, M

    2014-01-01

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

  10. Influence of an extensive inquiry-based field experience on pre-service elementary student teachers' science teaching beliefs

    NASA Astrophysics Data System (ADS)

    Bhattacharyya, Sumita

    This study examined the effects of an extensive inquiry-based field experience on pre-service elementary teachers' personal agency beliefs (PAB) about teaching science and their ability to effectively implement science instruction. The research combined quantitative and qualitative approaches within an ethnographic research tradition. A comparison was made between the pre and posttest scores for two groups. The experimental group utilized the inquiry method; the control group did not. The experimental group had the stronger PAB pattern. The field experience caused no significant differences to the context beliefs of either groups, but did to the capability beliefs. The number of college science courses taken by pre-service elementary teachers' was positively related to their post capability belief (p = .0209). Qualitative information was collected through case studies which included observation of classrooms, assessment of lesson plans and open-ended, extended interviews of the participants about their beliefs in their teaching abilities (efficacy beliefs), and in teaching environments (context beliefs). The interview data were analyzed by the analytic induction method to look for themes. The emerging themes were then grouped under several attributes. Following a review of the attributes a number of hypotheses were formulated. Each hypothesis was then tested across all the cases by the constant comparative method. The pattern of relationship that emerged from the hypotheses testing clearly suggests a new hypothesis that there is a spiral relationship among the ability to establish communicative relationship with students, desire for personal growth and improvement, and greater content knowledge. The study concluded that inquiry based student teaching should be encouraged to train school science teachers. But the meaning and the practice of the inquiry method should be clearly delineated to ensure its correct implementation in the classroom. A survey should be undertaken to ascertain the extent to which what is currently being practiced, as the inquiry method is indeed the inquiry method. Practicing the inquiry method is greatly more demanding than traditional methods of teacher training. A widespread adoption of the method will require considerable changes in these factors.

  11. Agomelatine: clinical experience and adherence to EMA recommendations for a novel antidepressant.

    PubMed

    Sinnott, C; Morris, M

    2013-02-01

    In 2009, the European Medicines Agency (EMA) granted marketing authorisation for the novel antidepressant agomelatine, with the recommendation that liver function tests (LFTs) are checked before, and 6, 12 and 24 weeks after, commencing the drug. This paper describes early clinical experience with agomelatine and audits physician adherence to EMA recommendations. A retrospective review of patients attending general adult psychiatry services in Carlow /Kilkenny (catchment population 120,000) over one year was performed. 62 patients were prescribed agomelatine. 32 patients (52%) had unipolar depression, and 43 (73%) were already established on antidepressant medication. 60 patients (97%) had LFTs measured before starting treatment with agomelatine, but half of patients (47%) did not have further LFTs as recommended. To increase adherence to EMA recommendations and ensure optimal patient safety, existing barriers to effective monitoring must be addressed. PMID:23472387

  12. [Experience with clinical administration of new drug Thrombovasim® in vascular surgery].

    PubMed

    Madonov, P G; Kinsht, D N; Ershov, K I; Shilova, M A; Solov'ev, O N

    2015-01-01

    Recent years have witnessed an increased worldwide interest in medical use of unique naturally occurring enzymes - subtilisins possessing pronounced fibrinolytic and anti-inflammatory properties. The article deals with experience in clinical administration in vascular surgery of new therapeutic agent Thrombovasim® containing pegylated subtilisin as an active substance. Thrombovasim® has a favourable profile of safety, good tolerance and causes no severe haemorrhagic complications. The pharmacological action of Thrombovasim® consists in combination of the targeted effect on the fibrin carcass of the thrombus without participation of the own system of haemostasis and anti-inflammatory effect. In the Russian Federation Thrombovasim® has been used for 6 years predominantly in vascular pathology of lower limbs accompanied by the development of chronic venous insufficiency. PMID:25757172

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

    SciTech Connect

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

    1984-08-01

    Magnetic resonance imaging (MRI) was performed in 20 patients before and after intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Twelve of the patients had clinical and histologic diagnoses of cerebral tumor, six had hepatic tumors, one had hepatic cysts, and one had transitional cell carcinoma of the bladder. Contrast enhancement was seen with all tumors, but not with the hepatic cysts. The degree of enhancement was greater than that seen with computed tomography (CT) in 13 cases, equal to it in six, and less in one. No short-term side effects were encountered and no significant change was seen in urea, creatinine, electrolytes, liver function tests, blood coagulation, or urine testing after injection of Gd-DTPA. Although much more work will be required to evaluate this contrast agent, these initial experiences are very promising.

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

    PubMed Central

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

    2014-01-01

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

  15. Formative Evaluation of Clinician Experience with Integrating Family History-Based Clinical Decision Support into Clinical Practice

    PubMed Central

    Doerr, Megan; Edelman, Emily; Gabitzsch, Emily; Eng, Charis; Teng, Kathryn

    2014-01-01

    Family health history is a leading predictor of disease risk. Nonetheless, it is underutilized to guide care and, therefore, is ripe for health information technology intervention. To fill the family health history practice gap, Cleveland Clinic has developed a family health history collection and clinical decision support tool, MyFamily. This report describes the impact and process of implementing MyFamily into primary care, cancer survivorship and cancer genetics clinics. Ten providers participated in semi-structured interviews that were analyzed to identify opportunities for process improvement. Participants universally noted positive effects on patient care, including increases in quality, personalization of care and patient engagement. The impact on clinical workflow varied by practice setting, with differences observed in the ease of integration and the use of specific report elements. Tension between the length of the report and desired detail was appreciated. Barriers and facilitators to the process of implementation were noted, dominated by the theme of increased integration with the electronic medical record. These results fed real-time improvement cycles to reinforce clinician use. This model will be applied in future institutional efforts to integrate clinical genomic applications into practice and may be useful for other institutions considering the implementation of tools for personalizing medical management. PMID:25563219

  16. The Depressive Experiences Questionnaire: validity and psychological correlates in a clinical sample.

    PubMed

    Riley, W T; McCranie, E W

    1990-01-01

    This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-Critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ, the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-Criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes. PMID:2348339

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

    SciTech Connect

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

    2006-12-15

    Purpose. To describe the preliminary clinical experience with a new embolization microcoil. Methods. The microcoil was made of a platinum coil spring, and consisted of firm and flexible segments. The firm segment functioned as an anchor and the flexible segment was well compacted to occlude the arteries. No Dacron fiber was attached. Seventy-one new microcoils were placed via microcatheters in 28 visceral arteries of 17 patients. Two other types of microcoils with Dacron fibers were used together in 8 arteries. Results. Sixty-nine new microcoils were placed and compacted successfully. Two coils were misplaced; one was retrieved and the other was left in the migrated artery, which remained patent 5 months later. All 28 arteries were occluded, and the goals of intervention were achieved successfully in all 17 cases. Conclusion. The new microcoils anchored and compacted well in the arteries. The clinical feasibility of this coil design was confirmed. The additional use of other types of microcoils with Dacron fiber was necessary to obtain rapid occlusion in some cases.

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

    PubMed

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

    2013-12-01

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

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

    PubMed Central

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

    2005-01-01

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

  20. Extensions, Validation, and Clinical Applications of a Feedback Control System Simulator of the Hypothalamo-Pituitary-Thyroid Axis

    PubMed Central

    Samuels, Mary; DiStefano, Joseph J.

    2008-01-01

    Background We upgraded our recent feedback control system (FBCS) simulation model of human thyroid hormone (TH) regulation to include explicit representation of hypothalamic and pituitary dynamics, and updated TH distribution and elimination (D&E) parameters. This new model greatly expands the range of clinical and basic science scenarios explorable by computer simulation. Methods We quantified the model from pharmacokinetic (PK) and physiological human data and validated it comparatively against several independent clinical data sets. We then explored three contemporary clinical issues with the new model: combined triiodothyronine (T3)/thyroxine (T4) versus T4-only treatment, parenteral levothyroxine (L-T4) administration, and central hypothyroidism. Results Combined T3/T4 therapy—In thyroidectomized patients, the L-T4–only replacement doses needed to normalize plasma T3 or average tissue T3 were 145 ?g L-T4/day or 165 ?gL-T4/day, respectively. The combined T4 + T3 dosing needed to normalize both plasma and tissue T3 levels was 105 ?g L-T4 + 9 ?gT3 per day. For all three regimens, simulated mean steady-state plasma thyroid-stimulating hormone (TSH), T3, and T4 was within normal ranges (TSH: 0.5–5 mU/L; T4: 5–12 ?g/dL; T3: 0.8–1.9 ng/mL). Parenteral T4 administration—800 ?g weekly or 400 ?g twice weekly normalized average tissue T3 levels both for subcutaneous (SC) and intramuscular (IM) routes of administration. TSH, T3, and T4 levels were maintained within normal ranges for all four of these dosing schemes (1× vs. 2× weekly, SC vs. IM). Central hypothyroidism—We simulated steady-state plasma T3,T4, and TSH concentrations in response to varying degrees of central hypothyroidism, reducing TSH secretion from 50% down to 0.1% of normal. Surprisingly, TSH, T3, and T4 plasma concentrations remained within normal ranges for TSH secretion as low as 25% of normal. Conclusions Combined T3/T4 treatment—Simulated standard L-T4–only therapy was sufficient to renormalize average tissue T3 levels and maintain normal TSH, T3, and T4 plasma levels, supporting adequacy of standard L-T4–only treatment. Parenteral T4 administration—TSH, T3, and T4 levels were maintained within normal ranges for all four of these dosing schemes (1× vs. 2× weekly, SC vs. IM), supporting these therapeutic alternatives for patients with compromised L-T4 gut absorption. Central hypothyroidism—These results highlight how highly nonlinear feedback in the hypothalamic-pituitary-thyroid axis acts to maintain normal hormone levels, even with severely reduced TSH secretion. PMID:18844475

  1. 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)

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

    2014-05-01

    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.

  2. Emergency Medical Service Providers' Attitudes and Experiences Regarding Enrolling Patients in Clinical Research Trials

    PubMed Central

    Schmidt, Terri A.; Nelson, Maria; Daya, Mohamud; Delorio, Nicole M.; Griffiths, Denise; Rosteck, Pontine

    2010-01-01

    Objective The purpose of this study was to evaluate Emergency Medical Services (EMS) providers' attitudes and experiences about enrolling patients in clinical research trials utilizing the federal rules for exception from informed consent. We hypothesized that Emergency Medical Technicians (EMTs) would have varied attitudes about research using an exception from informed consent which could have an impact on the research. Methods and setting Since January 2007, the EMS system has been participating in a randomized, multicenter interventional trial in which out-of-hospital providers enroll critically injured trauma patients using exception from informed consent. A voluntary, anonymous, written survey was administered to EMS providers during an in-service. The survey included demographics and Likert-type questions about their experiences with and attitudes towards research in general, and research using an exception from informed consent for an out-of-hospital clinical trial. Results The response rate was 79.3% (844/1067). Most respondents, 93.3%, agreed that “research in EMS care is important.” However, 38.5% also agreed that individual EMTs/paramedics should maintain the personal right of refusal to enroll patients in EMS trials. Fifty-four percent of respondents agreed with the statement that “the right of research subjects to make their own choices is more important than the interests of the general community.” In response to statements about the current study, 11.3% agreed that “the study is unethical because the patient cannot consent” and 69.2% responded that they would personally be willing to be enrolled in the study before they were able to give consent if they were seriously injured. Those who had not enrolled a patient into the study (681 respondents) were asked their reasons: 76.8% had not encountered an eligible patient or did not work for an agency that carried the fluid; 4.3% did not have time; 4.1% forgot and 1.1% stated that they were opposed to enrolling patients in studies without their consent. Conclusion The majority of EMS personnel in one community support EMS research and this specific out-of-hospital clinical trial being conducted under an exception from informed consent. Potential barriers to enrollment were identified. Further study in other systems is warranted to better understand EMS provider perspectives about exception from informed consent research. PMID:19291551

  3. Advances in the management of multiple sclerosis spasticity: experiences from recent studies and everyday clinical practice.

    PubMed

    Pozzilli, Carlo

    2013-12-01

    Although spasticity of varying severity affects up to 80% of patients with multiple sclerosis (MS) during the course of their disease, the symptom is often overlooked and undertreated. Despite the availability of oral antispasticity treatments (baclofen, tizanidine and others), approximately one-third of MS patients in Europe and the USA experience moderate or severe nonfocalized spasticity. At present, a thorough clinical evaluation of MS-related spasticity that takes into account the patient's own perception of spasms, spasticity-related pain and other associated symptoms is not common in daily neurological practice. Some of the usual spasticity scales, such as the Ashworth and modified Ashworth scales, reflect the observer's measurement of spasticity at a particular point in time. Herbal (smoked) cannabis has long been recognized as a possible option for relief of spasticity and neuropathic pain, but pertinent concerns about psychoactive effects and addiction risk have prevented its common use. An innovative method of benefiting from the mode of action of cannabinoids while limiting their drawbacks is to reduce peak plasma levels of 9-delta-tetrahydrocannabinol and counteract psychoactivity with higher than naturally occurring proportions of a second cannabinoid, cannabidiol. Sativex® oromucosal spray (1:1 ratio of 9-delta-tetrahydrocannabinol/cannabidiol) has recently been approved in a number of EU countries and elsewhere for use in patients with MS-related spasticity who are resistant to treatment with other antispasticity medications. In clinical trials, Sativex provided initial relief of spasticity symptoms within the first 4 weeks of treatment (trial period) in up to about half of patients resistant to other available oral antispasticity medications and demonstrated clinically significant improvement in spasticity (30% or higher reduction from baseline) in three-quarters of the initial responders. Adverse events were limited mainly to mild or moderate cases of somnolence and dizziness. Under everyday clinical practice conditions, Sativex at a mean daily dose of <7 sprays/day, was shown to relieve spasticity in about 70% of patients previously resistant to treatment. Clear improvements were also noted in associated symptoms such as sleep disturbances, bladder problems, loss of mobility and cramps. In large observational studies, >80% of patients reported no adverse events with the use of Sativex and interim data from safety registries in the UK and Spain indicate a low risk for serious adverse drug reactions. Follow-up studies in Sativex responders support continued benefit without the need to increase doses for at least 1 year. Sativex appears to be a promising solution for a meaningful proportion of patients with MS-related spasticity who have inadequate response to current antispasticity medications. PMID:24289844

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

    PubMed Central

    Maes, Evelyne; Valkenborg, Dirk; Baggerman, Geert; Willems, Hanny; Landuyt, Bart; Schoofs, Liliane; Mertens, Inge

    2015-01-01

    In quantitative shotgun proteomic analyses by liquid chromatography and mass spectrometry, a rigid study design is necessary in order to obtain statistically relevant results. Hypothesis testing, sample size calculation and power estimation are fundamental concepts that require consideration upon designing an experiment. For this reason, the reproducibility and variability of the proteomic platform needs to be assessed. In this study, we evaluate the technical (sample preparation), labeling (isobaric labels), and total (biological + technical + labeling + experimental) variability and reproducibility of a workflow that employs a shotgun LC-MS/MS approach in combination with TMT peptide labeling for the quantification of peripheral blood mononuclear cell (PBMC) proteome. We illustrate that the variability induced by TMT labeling is small when compared to the technical variation. The latter is also responsible for a substantial part of the total variation. Prior knowledge about the experimental variability allows for a correct design, a prerequisite for the detection of biologically significant disease-specific differential proteins in clinical proteomics experiments. PMID:25775046

  5. Posterior spinal fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: clinical outcomes and predictive radiological factors for extension of fusion distal to caudal end vertebra.

    PubMed

    Roberts, S B; Tsirikos, A I; Subramanian, A S

    2014-08-01

    Clinical, radiological, and Scoliosis Research Society-22 questionnaire data were reviewed pre-operatively and two years post-operatively for patients with thoracolumbar/lumbar adolescent idiopathic scoliosis treated by posterior spinal fusion using a unilateral convex segmental pedicle screw technique. A total of 72 patients were included (67 female, 5 male; mean age at surgery 16.7 years (13 to 23)) and divided into groups: group 1 included 53 patients who underwent fusion between the vertebrae at the limit of the curve (proximal and distal end vertebrae); group 2 included 19 patients who underwent extension of the fusion distally beyond the caudal end vertebra. A mean scoliosis correction of 80% (45% to 100%) was achieved. The mean post-operative lowest instrumented vertebra angle, apical vertebra translation and trunk shift were less than in previous studies. A total of five pre-operative radiological parameters differed significantly between the groups and correlated with the extension of the fusion distally: the size of the thoracolumbar/lumbar curve, the lowest instrumented vertebra angle, apical vertebra translation, the Cobb angle on lumbar convex bending and the size of the compensatory thoracic curve. Regression analysis allowed an equation incorporating these parameters to be developed which had a positive predictive value of 81% in determining whether the lowest instrumented vertebra should be at the caudal end vertebra or one or two levels more distal. There were no differences in the Scoliosis Research Society-22 outcome scores between the two groups (p = 0.17). In conclusion, thoracolumbar/lumbar curves in patients with adolescent idiopathic scoliosis may be effectively treated by posterior spinal fusion using a unilateral segmental pedicle screw technique. Five radiological parameters correlate with the need for distal extension of the fusion, and an equation incorporating these parameters reliably informs selection of the lowest instrumented vertebra. PMID:25086125

  6. Use of Shell-Vial Cell Culture Assay for Isolation of Bacteria from Clinical Specimens: 13 Years of Experience

    Microsoft Academic Search

    Frederique Gouriet; Florence Fenollar; Jean-Yves Patrice; Michel Drancourt; Didier Raoult

    2005-01-01

    The shell-vial culture assay is performed routinely in our laboratory. Recently we revisited our experience of using the shell-vial culture assay for the isolation of microorganisms from various clinical samples. Over a 13-year period, we have isolated 580 bacterial strains (5%) from 11,083 clinical samples tested. Over the same period, 285 isolates of rickettsiae, bartonellae, or Coxiella burnetii were cultured

  7. Predictive power of individual factors and clinical learning experience on academic success: findings from a longitudinal study.

    PubMed

    Dante, Angelo; Fabris, Stefano; Palese, Alvisa

    2015-01-01

    Academic failure is the inability of a nursing student to graduate or to complete the nursing degree on time. This longitudinal cohort study, involving 2 Italian universities, documents the effects of selected individual variables and the quality of the clinical learning experience as perceived by students on academic success. Factors related to the clinical learning experience were the quality of the supervisory relationship, pedagogical atmosphere, and commitment of the ward related to the level of personalized nursing care delivered and clarity of nursing documentation. PMID:25643319

  8. Expanded clinical experience with 4DDome(R) composite prosthesis in elective open inguinal herniorrhaphy.

    PubMed

    Mutter, Didier; Callari, Cosimo; D Agostino, Jacopo; Cahill, Ronan A; Forgione, Antonello; Vix, Michel; Leroy, Joël; Marescaux, Jacques

    2010-04-01

    Prosthetic material composition is implicated in the phenomenon of postoperative chronic groin pain that has undermined elective open inguinal herniorrhaphy. Reported herein are our 'all-comers' experiences with a novel dual component mesh (4DDome(R)). A prospective cohort (Phase II) study was performed that involved all patients undergoing elective open inguinal herniorrhaphy during a four-year period. Conventional operative technique was used except for choice of prosthesis. The 4DDome mesh comprises a molded dome-shaped composite (10% polypropylene, 90% poly-L-lactic acid) with a lightweight polypropylene mesh overlay. Short- (1 week) and intermediate-term (18 months) clinical follow-up with examination and symptom questionnaire judged outcome while surgeons rated their approval using a visual analogue scale. One hundred ninety-six patients (mean age, 65.5 years; Mean BMI, 25.5; Mean ASA, 1.8, 178 males) underwent repair of 201 inguinal hernias by six surgeons (three residents). The majority of patients had an indirect hernia (n=119) 93 being combined with a posterior wall defect [Nyhus IIIa], whereas 66 had a direct hernia [Nyhus IIIb], and 11 had a recurrent hernia.) Mean operative time was 44.6 minutes with 92 patients being operated under local anesthesia. Ten patients developed seromas and two had hematomas early postoperatively. Median intermediate-term follow-up is currently 19 (range: 3-72) months for the 147 (75%) patients still available for contact. The incidence of chronic groin pain is 8.8%, whereas there has been one hernia recurrence. Surgeon satisfaction and confidence were high. The 4DDome provides appropriate clinical results and, therefore, appears valid for use in routine practice. PMID:20437353

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

    PubMed Central

    Steinke, Wolfgang; Zellweger, René

    2000-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    2012-01-01

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

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

    PubMed

    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

    2009-08-01

    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

  13. Clinical translation of genotyping and haplotyping data: implementation of in vivo pharmacology experience leading drug prescription to pharmacotyping.

    PubMed

    Vizirianakis, Ioannis S

    2007-01-01

    The completion of the Human Genome Project has raised expectations for the translation of genomic knowledge into clinical forms that would lead to improved diagnosis of diseases and identification of new drug targets. Such an opportunity is quite challenging within science and society, although there is still uncertainty regarding its outcomes in new drug development and healthcare. Undoubtedly, however, the recent approval by the US FDA of the first two pharmacogenomic tests for genotyping drug-metabolising enzymes is expected to empower and eventually lead to general applicability of various genetic diagnostic tools to improve pharmacotherapy outcomes in the post-genomic era. To this end, the application of genomic knowledge and technologies in everyday clinical practice leads personalised medicine concepts towards the achievement of individualised drug selection and dosage profiling (i.e. pharmacotyping) for ensuring maximum drug effectiveness and safety. Within this framework, pharmacogenomic information can implement the existing clinical pharmacology experience in clinical diagnosis and drug delivery. The latter can be further advanced through the development of workflow information-based operating systems in healthcare to support the utilisation, assessment and outcome of engaged clinical and genomic information. Such a direction may help to suitably revise and adjust clinical regulatory guidelines as well as clinical pharmacology guidelines. This will further facilitate better designing of clinical trials for new drug development as well as pharmacovigilance registries and evaluation of these data. To critically describe the existing environment, this article comprehensively discusses scientific efforts aimed at making clinical translation of genotyping and haplotyping data more efficient and productive in forms that are readily applicable in everyday healthcare. In addition, specific and systematic pharmacogenomic and clinical attempts related to the development of new molecularly targeted drugs, as well as improvement of the efficacy and safety of commonly prescribed drugs, are presented. To this end, the clinical pharmacogenomic experience gained thus far in the use of tyrosine kinase inhibitors in oncology, as well as the process of empowerment through the use of genomic knowledge of the cardiac safety of drugs modulating the function of the human ether-à-go-go-related gene (HERG) potassium channel, represent examples of how the implementation of clinical experience with genomic information guides the development of new drugs and the improvement of pharmacotherapy outcomes. PMID:17854232

  14. Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

    PubMed

    Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

    2013-01-01

    Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome. PMID:24217830

  15. [Lumbar spinal stenosis syndrome in the experience of a rheumatologic-geriatric clinic].

    PubMed

    Stevanovic, L; Hacohen, H; Six, P

    1989-02-25

    In the geriatric patient differential diagnosis of low back pain with sciatica includes degenerative lumbar spinal stenosis, affecting the central canal, the lateral recesses or both. Symptoms usually begin in the sixth decade, but may occur earlier if spinal degeneration is superimposed on congenital stenosis. In the elderly early diagnosis is more difficult to establish, because of the bewildering medical problems and the multiple symptoms rooted in the polypathy and polymorbidity of old age. Typical symptoms include low back pain, claudicatory pains, and paraesthesias of the legs, typically aggravated by standing and relieved by rest. In our series they were present in 100%, 94% and 56% respectively. In our series, the most important clinical investigations confirming diagnosis were pain provocation by reclining and pain relief by inclination (present in 69% of patients) and combined radiographic examination including plain films, computed tomography and myelography. In our experience myelography proved the best single method for early diagnosis. In our elderly patients lateral stenosis was predominant, and therefore lateral decompression by foraminotomy, generally combined with flavectomy, was the most important surgical procedure. In cases with combined lateral and central stenosis, hemilaminectomy or facetectomy was also performed. In follow-up 1 to 5 years after the operation the success rate, determined by very restrictive criteria, was 87%. Therefore, and because failure to establish early diagnosis potentially leads to definitive invalidity, degenerative lumbar spinal stenosis should be considered more frequently in the differential diagnosis of low back pain of the elderly.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2522677

  16. Clinical judgment and decision making in wound assessment and management: is experience enough?

    PubMed

    Logan, Gemma

    2015-03-01

    The assessment and management of wounds forms a large proportion of community nurses' workload, often requiring judgment and decision-making in complex, challenging and uncertain circumstances. The processes through which nurses form judgments and make decisions within this context are reviewed in this article against existing theories on these on these subjects. There is variability in wound assessment and management practice which may be attributed to uncertainties within the context, a lack of knowledge in appropriate treatment choices and the inability to correctly value the importance of the clinical information presented. Nurses may be required to draw on intuition to guide their judgments and decision-making by association with experience and expertise. In addition, a step-by-step analytical approach underpinned by an evidence base may be required to ensure accuracy in practice. Developing an understanding of the different theories of judgment and decision-making may facilitate nurses' abilities to reflect on their own decision tasks, thereby enhancing the care provided. PMID:25790510

  17. Clinical judgment and decision-making in wound assessment and management: is experience enough?

    PubMed

    Logan, Gemma

    2015-03-01

    The assessment and management of wounds forms a large proportion of community nurses' workload, often requiring judgment and decision-making in complex, challenging and uncertain circumstances. The processes through which nurses form judgments and make decisions within this context are reviewed in this article against existing theories on these subjects. There is variability in wound assessment and management practice which may be attributed to uncertainties within the context, a lack of knowledge in appropriate treatment choices and the inability to correctly value the importance of the clinical information presented. Nurses may be required to draw on intuition to guide their judgments and decision-making by association with experience and expertise. In addition, a step-by-step analytical approach underpinned by an evidence base may be required to ensure accuracy in practice. Developing an understanding of the different theories of judgment and decision-making may facilitate nurses' abilities to reflect on their own decision tasks, thereby enhancing the care provided. PMID:25882591

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

    PubMed

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

    1984-08-01

    Magnetic resonance imaging (MRI) was performed in 20 patients before and after intravenous administration of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) in a dose of 0.1 mmol/kg. Twelve of the patients had clinical and histologic diagnoses of cerebral tumor, six had hepatic tumors, one had hepatic cysts, and one had transitional cell carcinoma of the bladder. Contrast enhancement was seen with all tumors, but not with the hepatic cysts. The degree of enhancement was greater than that seen with computed tomography (CT) in 13 cases, equal to it in six, and less in one. Contrast enhancement was detectable as long as 18 hr after injection of Gd-DTPA in one case of cerebral tumor. The margin between cerebral tumor and peritumoral edema could be delineated with contrast-enhanced MRI to the degree possible with contrast-enhanced CT. In the liver isointense enhancement was seen with saturation-recovery (SR), inversion-recovery (IR), and spin-echo (SE) sequences although not with all three sequences simultaneously. In general IR sequences were most sensitive for display of the contrast agent, but the enhancement often decreased the difference between abnormal and normal tissue. No short-term side effects were encountered and no significant change was seen in urea, creatinine, electrolytes, liver function tests, blood coagulation, or urine testing after injection of Gd-DTPA. Although much more work will be required to evaluate this contrast agent, these initial experiences are very promising. PMID:6611046

  19. A class experiment in clinical pharmacology using beta-adrenoceptor antagonist drugs.

    PubMed Central

    Kumana, C R; Ogle, C W

    1985-01-01

    Cardiac beta-adrenoceptor blocking activity was evaluated in a between-subject study carried out as a class experiment with pre-clinical medical students participating in a practical pharmacology course. From each of 10 groups of students, three healthy male volunteers, took oral propranolol 80 mg, pindolol 10 mg or placebo, according to a double-blind randomised protocol. Pre-treatment, and 45-60 min (1 h) and 105-120 min (2 h) post-treatment heart rate (HR) was determined electrocardiographically in the last 15 s during periods of rest (sitting for 5 min), isometric exercise (applying a standardized hand grip to a rolled sphygmomanometer cuff to elevate pressure from 50 to 150 mm Hg; 2 min) and dynamic exercise (bicycle ergometry with a load of 150 W for 3 min). Reductions from pre-treatment HR yielded statistically significant differences during exercise (isometric and dynamic) between all corresponding changes on placebo and active drugs (P less than 0.05-0.01), except with the 1 h post-propranolol hand grip HR. At rest, only the difference between 2 h HR changes on placebo and propranolol achieved statistical significance (P = 0.05); presumably, the partial agonist activity of pindolol overcame any minimal HR slowing liable to occur at rest. Cardiac beta-adrenoceptor blocking activity as judged by reductions in HR from pretreatment values, was more evident during cycling than during hand grip; and during hand grip than at rest. PMID:2859042

  20. A class experiment in clinical pharmacology using beta-adrenoceptor antagonist drugs.

    PubMed

    Kumana, C R; Ogle, C W

    1985-02-01

    Cardiac beta-adrenoceptor blocking activity was evaluated in a between-subject study carried out as a class experiment with pre-clinical medical students participating in a practical pharmacology course. From each of 10 groups of students, three healthy male volunteers, took oral propranolol 80 mg, pindolol 10 mg or placebo, according to a double-blind randomised protocol. Pre-treatment, and 45-60 min (1 h) and 105-120 min (2 h) post-treatment heart rate (HR) was determined electrocardiographically in the last 15 s during periods of rest (sitting for 5 min), isometric exercise (applying a standardized hand grip to a rolled sphygmomanometer cuff to elevate pressure from 50 to 150 mm Hg; 2 min) and dynamic exercise (bicycle ergometry with a load of 150 W for 3 min). Reductions from pre-treatment HR yielded statistically significant differences during exercise (isometric and dynamic) between all corresponding changes on placebo and active drugs (P less than 0.05-0.01), except with the 1 h post-propranolol hand grip HR. At rest, only the difference between 2 h HR changes on placebo and propranolol achieved statistical significance (P = 0.05); presumably, the partial agonist activity of pindolol overcame any minimal HR slowing liable to occur at rest. Cardiac beta-adrenoceptor blocking activity as judged by reductions in HR from pretreatment values, was more evident during cycling than during hand grip; and during hand grip than at rest. PMID:2859042

  1. Determining optimal clinical target volume margins on the basis of microscopic extracapsular extension of metastatic nodes in patients with non-small-cell lung cancer

    SciTech Connect

    Yuan Shuanghu [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China); Meng Xue [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China); Yu Jinming [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China)]. E-mail: fishtigers@yahoo.com.cn; Mu Dianbin [Department of Pathology, Shandong Cancer Hospital and Institute, Jinan (China); Chao, K.S. Clifford [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Zhang Jiandong [Department of Radiation Oncology, Qianfoshan Hospital, Jinan (China); Zhong Weixia [Department of Pathology, Shandong Cancer Hospital and Institute, Jinan (China); Yu Yonghua [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China); Wang Jialin [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China); Sun Xindong [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China); Yang Guoren [Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan (China); Wang Yongzheng [Department of Radiology, Second Hospital of Shandong University, Jinan (China)

    2007-03-01

    Purpose: To determine the optimal clinical target volume (CTV) margins around the nodal gross tumor volume (GTV) in non-small-cell lung cancer (NSCLC) patients by assessing microscopic tumor extension beyond regional lymph node capsules. Methods and Materials: The incidence of nodal extracapsular extension (ECE) and relationship with nodal size were reviewed in 243 patients. Histologic sections of dissected regional lymph nodes up to 30 mm in size were examined to measure the extent of microscopic ECE. We determined the distribution of cases according to extent of ECE and the relationships between ECE extent and lymph node size, regional nodal disease extent, histologic type, and degree of differentiation. Results: The nodal ECE was seen in 41.6% of patients (101/243) and 33.4% of lymph nodes (214/640), and the incidence correlated to larger lymph node size positively. The extent of ECE was 0.7 mm in mean (range, 0-12.0 mm) and {<=}3 mm in 95% of the nodes. Positive correlations were found between extent of ECE and larger lymph node size ({>=}20 mm vs. 10-19 mm or <10 mm, p = 0.005), advanced nodal stage (N2 vs. N1, p = 0.046), and moderate or poor (vs. good or unknown) nodal differentiation (p = 0.002). ECE did not differ significantly by histologic type or nodal station. Conclusions: The incidence of ECE related to lymph node size, and ECE extent related to lymph node size, stage, and differentiation. It may be reasonable to recommend 3-mm CTV margins for pathologic lymph nodes <20 mm and more generous margins for lymph nodes {>=}20 mm.

  2. Events and Experiences Impacting the Development of Clinical Self Confidence: A Study of the First Year of Client Contact

    ERIC Educational Resources Information Center

    Bischoff, Richard J.; Barton, Marci; Thober, Jody; Hawley, Rachel

    2002-01-01

    Research was conducted to identify the events and experiences influencing the development of clinical self-confidence during the first year of client contact for beginning marriage and family therapists. Thirty-nine recent graduates of a master's degree training program participated in a semistructured interview in which they were asked to…

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

    PubMed

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

    2014-11-10

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

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

    Microsoft Academic Search

    2008-01-01

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

  5. Peer experiences of anxious and socially withdrawn youth: an integrative review of the developmental and clinical literature.

    PubMed

    Kingery, Julie Newman; Erdley, Cynthia A; Marshall, Katherine C; Whitaker, Kyle G; Reuter, Tyson R

    2010-03-01

    Prior research indicates that both anxious youth and socially withdrawn youth tend to experience challenges and difficulties in various aspects of their peer relationships and social functioning. While clinical psychology researchers have examined how anxiety relates to peer experiences using normative and clinically anxious samples, developmental psychologists have focused primarily on the peer experiences of shy and withdrawn children. Research from these two fields has progressed on related yet separate paths, producing similar results despite using different terminology and assessment techniques. The purpose of this review is to bring together the developmental and clinical bodies of literature on the peer experiences of anxious and socially withdrawn youth by identifying common themes and unique contributions of each discipline. Studies reviewed focus specifically on the peer constructs of acceptance, friendship, peer victimization, social skills, and social-cognitive processes. Limitations including methodological inconsistencies and insufficient examination of age-, gender-, and ethnicity-related issues are identified. Recommendations for future collaborations between developmental and clinical researchers as well as implications for interventions targeting the peer relations of anxious and withdrawn youth are discussed. PMID:20069362

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

    PubMed

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

    2014-04-01

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

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

    PubMed

    Huk, W J; Gademann, G

    1984-01-01

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

  8. Bleeding with dabigatran, rivaroxaban, apixaban. No antidote, and little clinical experience.

    PubMed

    2013-06-01

    Dabigatran, rivaroxaban and apixaban are oral anticoagulants used to prevent or treat thrombosis in a variety of situations. Like all anticoagulants, these drugs can provoke bleeding. How should patients be managed if bleeding occurs during dabigatran, rivaroxaban or apixaban therapy? How can the risk of bleeding be reduced in patients who require surgery or other invasive procedures? To answer these questions, we reviewed the available literature, using the standard Prescrire methodology. In clinical trials, warfarin, enoxaparin, dabigatran, rivaroxaban and apixaban were associated with a similar frequency of severe bleeding. Numerous reports of severe bleeding associated with dabigatran have been recorded since this drug was first marketed. Some situations are associated with a particularly high bleeding risk, including: even mild renal failure, advanced age, extremes in body weight and drug-drug interactions, particularly with antiplatelet agents (including aspirin), nonsteroidal antiinflammatory drugs, and many drugs used in cardiovascular indications. In patients treated with dabigatran, rivaroxaban or apixaban, changes in the INR (international normalised ratio) and activated partial thromboplastin time (aPTT) do not correlate with the dose. In early 2013, there is still no routine coagulation test suitable for monitoring these patients; specific tests are only available in specialised laboratories. In early 2013 there is no antidote for dabigatran, rivaroxaban or apixaban, nor any specific treatment with proven efficacy for severe bleeding linked to these drugs. Recommendations on the management of bleeding in this setting are based mainly on pharmacological parameters and on scarce experimen-Haemodialysis reduces the plasma concentration of dabigatran, while rivaroxaban and apixaban cannot be eliminated by dialysis. Prothrombin complex concentrates and recombinant activated factor VII seem to have little or no efficacy, and they carry a poorly documented risk of thrombosis. For patients undergoing surgery or other invasive procedures, clinical practice guidelines are primarily based on pharmacokinetic parameters and on extrapolation of data on vitamin K antagonists. The decision on whether or not to discontinue anticoagulation before the procedure mainly depends on the likely risk of bleeding. In patients at high risk of thrombosis, heparin can be proposed when the anticoagulant is withdrawn. In early 2013, difficulties in the management of bleeding and of situations in which there is a risk of bleeding weigh heavily in the balance of potential harm versus potential benefit of dabigatran, rivaroxaban and apixaban. When an oral anticoagulant is required, it is best to choose warfarin, a vitamin K antagonist, and the drug with which we have the most experience, except in those rare situations in which the INR cannot be maintained within the therapeutic range. PMID:23866358

  9. Validation for clinical use of, and initial clinical experience with, a novel approach to population-based carrier screening using high-throughput, next-generation DNA sequencing.

    PubMed

    Hallam, Stephanie; Nelson, Heather; Greger, Valerie; Perreault-Micale, Cynthia; Davie, Jocelyn; Faulkner, Nicole; Neitzel, Dana; Casey, Kristie; Umbarger, Mark A; Chennagiri, Niru; Kramer, Alexander C; Porreca, Gregory J; Kennedy, Caleb J

    2014-03-01

    Traditional carrier screening assays are designed to look for only the most common mutations within a gene owing to cost considerations. Although this can yield high detection rates in specific populations for specific genes (such as cystic fibrosis in Caucasians), they are suboptimal for other ethnicities or for patients of mixed or unknown ethnic background. Next-generation DNA sequencing provides an opportunity to provide carrier screening using more comprehensive mutation panels that are limited primarily by information about the clinical impact of detected sequence changes. We describe a next-generation DNA sequencing-based assay capable of reliably screening patient samples in a timely and comprehensive manner. The analytic accuracy in a research setting has been documented. Here, we describe the additional studies performed to ensure the accuracy (analytic validity) and robustness of our assay for use in clinical practice and provide data from our experience offering this testing. Our clinical experience using this approach to screen 11,691 in vitro fertilization patients has identified 449 mutant alleles: 447 in carriers and 2 in an affected individual. In total, we found 87 distinct mutations in 14 different genes. Approximately one quarter of the mutations found are not included in traditional, limited, mutation panels, including 16 known mutations unique to our panel, and novel truncating mutations in several genes. PMID:24374108

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

    SciTech Connect

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

    2008-08-11

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

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

    NASA Astrophysics Data System (ADS)

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

    2015-01-01

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

  12. Staff nurses' experiences as co-investigators in a clinical research project.

    PubMed

    Welch, J A; Dye, J S; Games, C; Ellett, M L; Beckstrand, J K

    1990-01-01

    This article discusses the development of a clinical research project that was initiated by staff nurses and ultimately received funding from the Center for Nursing Research, National Institutes of Health (NIH) in 1988. Staff nurses from a large children's hospital in the midwest generated the clinical question and worked through the maze and mechanics of developing and implementing a team research project in the clinical setting. PMID:2392345

  13. Obstacles and approaches to clinical database research: experience at the University of California, San Francisco.

    PubMed Central

    Newman, T. B.; Brown, A.; Easterling, M. J.

    1994-01-01

    With increasing availability of clinical data in machine-readable form, and decreasing cost of storing and manipulating that data, retrospective research using clinical databases has become more feasible. Nonetheless, much of the potential for clinical research using these data remains unrealized. Obstacles to clinical database research include difficulty accessing data, difficulty using retrospective data to draw valid inferences about medical tests and treatments, and a shortage of investigators trained and interested in using a clinical database to answer their questions. At the University of California, San Francisco, we have developed a Clinical Database Research Program (CDRP) to try to overcome these obstacles. The CDRP maintains a relational database of patient data obtained from diverse sources and a small staff dedicated to providing such data to researchers. The CDRP staff also provides support for design and analysis of studies using the database--the development of methods for such studies is our primary research interest. Finally, to increase the number of investigators using the database for research, we are integrating training in clinical epidemiology and clinical research methods into residency and fellowship training, and offering an elective in clinical database research for trainees who wish to undertake a specific project. PMID:7949992

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

    PubMed Central

    2013-01-01

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

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

    PubMed

    Schulze, Scott M; Tursi, James P

    2014-12-01

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

  16. 'You don't do it for nothing': women's experiences of volunteering in two community WELL WOMAN CLINICS.

    PubMed

    Merrell, Joy

    2000-01-01

    Despite the fact that approximately 11.5 million women each year participate in formal voluntary activity, little is known about their experiences of volunteering in the National Health Service (NHS) and in particular, their experiences of working together with paid workers in direct client care. Arguably, this is because of the sensitive nature of voluntarism and concerns regarding the potential for exploitation. Much of women's voluntary activity is within the health and personal social services. Recently, volunteering in the NHS has been promoted as providing an added dimension to professional care. The study reported here seeks to bring to public attention women's experiences of volunteering and their relationships with paid workers within two community WELL WOMAN CLINICS. The findings are based on an 18-month period of participant observation which included in-depth interviews with 26 volunteer and paid workers and a review of the clinics' operational policy documents. Applying the concepts of balanced reciprocity and equity theory, the relationships between the volunteers and between the volunteers and paid workers are illuminated. Volunteers gain from their participation in the clinics as well as giving of their time and effort. However, in order for volunteers to view their volunteering positively and to sustain their interest there needs to be a balance between giving and taking. Within the context of the clinics, volunteering need not necessarily be exploitative and can be empowering for some women. PMID:11560672

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

    PubMed

    Lu, Hongyan; Maithus, Caroline

    2012-11-01

    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

  18. Improving the child's experience of healthcare: the implementation of clinical governance

    Microsoft Academic Search

    L Donaldson; A Halligan; D Wall

    2003-01-01

    The concept of clinical governance and the philosophy of quality-centred care is being implemented throughout the National Health Service. Clinical governance integrates the activities necessary to ensure high-quality care for patients. It is about identifying standards, robust systems of inspection, local innovation and enabling patient empowerment; all themes that build on the lessons of the inquiry into children's heart surgery

  19. Quality assurance in a large clinical trials consortium: The experience of the Tuberculosis Trials Consortium

    Microsoft Academic Search

    Laurie Sandman; Ann Mosher; Awal Khan; Jan Tapy; Rany Condos; Scott Ferrell; Andrew Vernon

    2006-01-01

    Quality assurance (QA) is essential for data accuracy and proper evaluation of study objectives in clinical trials. The Tuberculosis Trials Consortium (TBTC)–a collaboration of 28 clinical sites and the Centers for Disease Control and Prevention–has developed a comprehensive QA program that provides quantitative assessments of performance based on clearly defined standards that are communicated to data collectors through a feedback

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

    Microsoft Academic Search

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

    2000-01-01

    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

  1. Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use

    PubMed Central

    Jean-François, Kaux; Pierre, Drion; Jean-Louis, Croisier; Jean-Michel, Crielaard

    2015-01-01

    Objectives: The restorative properties of platelets, through the local release of growth factors, are used in various medical areas. This article reviews fundamental and clinical research relating to platelet-rich plasma applied to tendinous lesions. Materials and method: Articles in French and English, published between 1 January 2012 and 31 December 2014. dealing with PRP and tendons were searched for using the Medline and Scopus data bases. Results: Forty-seven articles were identified which addressed pre-clinical and clinical studies: 27 relating to in vitro and in vivo animal studies and 20 relating to human studies. Of these, five addressed lateral epicondylitis, two addressed rotator cuff tendinopathies, ten dealt with patellar tendinopathies and three looked at Achilles tendinopathies. Conclusions: The majority of pre-clinical studies show that PRP stimulates the tendon’s healing process. However, clinical series remain more controversial and level 1, controlled, randomised studies are still needed. PMID:26195890

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

    PubMed Central

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

    2012-01-01

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

  3. Clinical experience with pericardiocentesis and extended drainage in a population with a high prevalence of HIV

    PubMed Central

    Louw, V.J.; Reuter, H.; Smedema, J.P.; Katjitae, I.; Burgess, L.J.; Doubell, A.F.

    2002-01-01

    Background The data presented were generated in a prospective study on the immunopathogenesis and management of tuberculous (TB) pericarditis at Tygerberg Hospital in Cape Town. We report our experience with 2D echocardiographically guided pericardiocentesis in 170 consecutive patients who presented to us with large pericardial effusions since 1995. Methods All patients referred to our department with echocardiographically confirmed large pericardial effusions underwent a clinical assessment followed by pericardiocentesis and drainage by an indwelling pigtail catheter. The appearance and amount of drained effusion were noted and fluid was sent for diagnostic assessment. The pigtail catheter was kept in place and fluid was aspirated once daily until the aspirate was less than 100 ml, at which stage the catheter was removed. Results A chest wall puncture site was chosen in 165 of the 170 patients (97%), while the subcostal approach was only used in five patients. Echocardiographic signs of tamponade were seen in 88% of cases. In the majority of patients (68.2%) a diagnosis of TB could be established and of these 46.6% were HIV positive. TB could not be proven in only three HIV-positive patients (1.8% of all patients). Neither hospital stay nor complications were increased in the HIV-positive group when compared with the HIV-negative group and no patient developed intrapericardial sepsis. No death could be attributed with certainty to the procedure. One patient developed non-fatal tamponade within 24 hours after the tap and in another patient a left ventricular thrombus was noted on echo after 16 days. Twenty-four patients underwent a pericardial window procedure according to protocol for diagnostic purposes. In another four patients a window was performed for therapeutic reasons. The most common minor complication was local pain at the site of catheter insertion. Repeat drainage was necessary in only six (3.5%) cases. Conclusions 2D echocardiographically directed pericardiocentesis with extended catheter drainage has an excellent profile in terms of simplicity, safety and efficacy, even in a population with a very high prevalence of HIV. PMID:25696035

  4. How can student experience enhance the development of a model of interprofessional clinical skills education in the practice placement setting?

    PubMed

    O'Carroll, Veronica; Braid, Margaret; Ker, Jean; Jackson, Cathy

    2012-11-01

    The practice placement setting offers opportunities and challenges for engaging students in high-quality interprofessional learning. The Fife Interprofessional Clinical Skills Model for Education was established to develop structured interprofessional learning opportunities for students during their clinical attachments in NHS Fife. This short report describes the delivery and evaluation of the model, which was piloted with students from the nursing, medicine and allied health professions. Scheduled workshops were delivered within primary and secondary care locations. The learning activities involved exploring and comparing their professional identities, discussing roles and responsibilities within the healthcare team and practicing nontechnical clinical skills. Students who participated in the workshops reported that they developed a better understanding of each other's roles and responsibilities and also identified that this would be transferable knowledge to their future practice. Exploring the student experience has assisted in developing relevant and accessible interprofessional learning opportunities within the practice placement setting. PMID:22866817

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

    PubMed Central

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Parkerson, George R., Jr.; And Others

    1984-01-01

    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…

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

    PubMed

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

    2013-01-01

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

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

    E-print Network

    Espitia, Noberto Francisco

    2009-05-15

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

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

    E-print Network

    Espitia, Noberto Francisco

    2009-05-15

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

  10. What are the primary concerns of nursing students as they prepare for and contemplate their first clinical placement experience?

    PubMed

    Levett-Jones, Tracy; Pitt, Victoria; Courtney-Pratt, Helen; Harbrow, Gwyneth; Rossiter, Rachel

    2015-07-01

    Nursing students' first clinical placement experience can be a critical turning point -reinforcing professional aspirations for some, and for others, a time of emotional turbulence. There is a paucity of research focusing on students' perceptions and concerns prior to their first placement experience. Thus, the aim of this study was to explore the concerns of first year bachelor of nursing students from one Australian university as they prepared for their first clinical placement. Participants completed an online 'readiness for practice' survey consisting of 22 items. This paper focuses on participants' responses to the one open ended question: 'Please comment on any concerns that you have in relation to being prepared for your first clinical placement'. Summative qualitative content analysis was used for analysis. 144 students (55%) responded to the open ended question. Responses were categorised into six themes including: Not prepared for placement; feeling nervous, anxious and worried; bullying and belonging; practicalities; patient safety and making mistakes; and working outside of my scope of practice. It appears that activities designed to equip students with the capacity to manage the inherent challenges of undertaking a clinical placement may sometimes have a paradoxical effect by increasing students' level of stress and anxiety. An enhanced understanding of students' concerns may help educators implement appropriate support strategies. PMID:25862609

  11. Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience

    Microsoft Academic Search

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

    2004-01-01

    In October 2002, the U.S. Food and Drug Administration approved buprenorphine-naloxone (Suboxone) sublingual tablets as an opioid dependence treatment available for use outside traditionally licensed opioid treatment programs. The NIDA Center for Clinical Trials Network (CTN) sponsored two clinical trials assessing buprenorphine-naloxone for short-term opioid detoxification. These trials provided an unprecedented field test of its use in twelve diverse community-based

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

    Microsoft Academic Search

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

    2003-01-01

    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

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

    Microsoft Academic Search

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

    2003-01-01

    Improvements in the specificity of radiopharmaceutical compounds have been paralleled by an upsurge of interest in developing small detectors to assist surgeons in localizing tumour tissue during surgery. This study reports the main technical features and physical characteristics of a new hand-held gamma camera dedicated to accurate and real-time intra-operative imaging. First clinical experience is also reported. The POCI (Per-operative

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

    Microsoft Academic Search

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

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

  15. Post-marketing survey on clinical response to interferon beta in relapsing multiple sclerosis: the Roman experience

    Microsoft Academic Search

    C. Pozzilli; L. Prosperini; E. Sbardella; L. De Giglio; E. Onesti; V. Tomassini

    2005-01-01

    Safety, tolerability and efficacy profiles of interferon beta (IFN?) therapy in relapsing multiple sclerosis (MS) has been\\u000a widely verified both in trial settings and in daily clinical practice. However, for a variable percentage of treated patients,\\u000a it remains only partially effective. In this study, we reported the post-marketing experience of the efficacy of IFN? therapy\\u000a for a large cohort of

  16. [Experiences and recommendations of the German Federal Institute for Drugs and Medical Devices (BfArM) concerning clinical investigation of medical devices and the evaluation of serious adverse events (SAE)].

    PubMed

    Renisch, B; Lauer, W

    2014-12-01

    An integral part of the conformity assessment process for medical devices is a clinical evaluation based on clinical data. Particularly in the case of implantable devices and products of risk class III clinical trials must be performed. Since March 2010 applications for the authorization of clinical trials as well as for the waiver of the authorization requirement must be submitted centrally in Germany to the appropriate federal authority, the Federal Institute for Drugs and Medical Devices (BfArM) or the Paul Ehrlich Institute (PEI). In addition to authorization, approval by the responsible ethics committee is also required under law in order to begin clinical testing of medical devices in Germany. In this paper, the legal framework for the clinical testing of medical devices as well as those involved and possible procedures including evaluation criteria for the initial application of a trial and subsequent amendments are presented in detail. In addition, the reporting requirements for serious adverse events (SAEs) are explained and possible consequences of the evaluation are presented. Finally, a summary of application and registration numbers for all areas of extensive experience of the BfArM as well as requests and guidance for applicants are presented. PMID:25376539

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

    ERIC Educational Resources Information Center

    Collings, Mary Louise; Gassie, Edward W.

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

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

    PubMed

    Miller, Wendy

    2014-01-01

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

  19. A semantic normal form for clinical drugs in the UMLS: early experiences with the VANDF.

    PubMed Central

    Nelson, Stuart J.; Brown, Steven H.; Erlbaum, Mark S.; Olson, Nels; Powell, Tammy; Carlsen, Brian; Carter, John; Tuttle, Mark S.; Hole, William T.

    2002-01-01

    A semantic normal form (SNF) for a clinical drug, designed to represent the meaning of an expression typically seen in a practitioner's medication order, has been developed and is being created in the UMLS Metathesaurus. The long term goal is to establish a relationship for every concept in the Metathesaurus with semantic type "clinical drug" with one or more of these semantic normal forms. First steps have been taken using the Veterans Administration National Drug File (VANDF). 70% of the entries in the VANDF could be parsed algorithmically into the SNF. Next steps include parsing other drug vocabularies included in the UMLS Metathesaurus and performing human review of the parsed vocabularies. After machine parsed forms have been merged in the Metathesaurus Information Database (MID), editors will be able to edit matched SNFs for accuracy and establish relationships and relationship attributes with other clinical drug concepts PMID:12463886

  20. [Ten years of clinical experiences with canine parvovirus infection CPV-2 infection)].

    PubMed

    Baatz, G

    1992-02-01

    Clinical and laboratory data of 205 dogs with acute canine parvovirus infection were collected. Seventy-six of these dogs underwent 179 clinical reexaminations. Parvovirus infection can be clinically diagnosed if there are typical gastrointestinal symptoms (vomiting, diarrhoea) in combination with a leucopenia of under 4000 cells/microliters and/or a rise in antibody titer of two degrees or more. In typical parvovirus infection a distinct hyperthermia often precedes vomiting and diarrhoea. The characteristic fall in leucocyte concentration is rapid and most marked between the 3rd and 5th day of the disease. In some cases virus-induced encephalitis and moderate coincident involvement of the cardiac muscle were seen. Secondary bacterial infections of subcutaneous tissue and lungs as well as invaginations are important complications. Surviving dogs will not necessarily have digestive problems later. Therapeutical considerations are discussed. PMID:1324535

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

    PubMed Central

    2013-01-01

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

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

    E-print Network

    Fraser, Roy

    1914-05-01

    of three reasons:- - 3 - (1) The laboratory of to-day must in many cases bear the burdens of class instruction and research in addition to the applied work of clinical diagnosis. 12) The laboratory worker is frequently deficient in actual clinical... for clean slides, discovering his reagent and staining-bottles empty, finding nothing but dirty test tubes etc., ad consternatum. It should be as humiliating to the.laboratory worker to find his Gram's iodine bottle empty in time of need, as it would...

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

    PubMed

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

    2013-04-01

    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

  4. Critical Factors in On-Campus Clinical Experiences: Perceptions of Preservice Teachers.

    ERIC Educational Resources Information Center

    Metcalf, Kim K.

    1993-01-01

    Indiana University's Teacher Education Laboratory replaces and supplements portions of the preservice program previously provided through field placements in area schools. This article describes the initial field test of a laboratory experience for secondary education majors. Surveys rating students' attitudes about the experience indicated…

  5. Influence of examiner experience on clinical performance of visual inspection in detecting and assessing the activity status of caries lesions.

    PubMed

    Gimenez, T; Bittar, D G; Piovesan, C; Guglielmi, C A B; Fujimoto, K Y; Matos, R; Novaes, T F; Braga, M M; Mendes, F M

    2013-01-01

    Our hypothesis was that a method of caries activity evaluation based on the clinical features of the lesions would be less time consuming but more influenced by the examiner's experience than the scoring system used in association with the International Caries Detection and Assessment System (ICDAS). Thus, the aim of this study was to evaluate the performance of three groups of examiners with different levels of experience using two different methods to assess the activity status of caries lesions by visual inspection. A cross-sectional study in a dental office setting was performed selecting 18 children, aged three to eight years, who had sought dental treatment at a dental school. Examinations to detect caries lesions were performed using visual inspection by six examiners with different levels of experience: two undergraduate dental students, two specialists in pediatric dentistry, and two graduate students. The examiners used ICDAS and two different methods to assess caries activity: using an additional score system or considering the examination of clinical features. Two benchmark examiners examined the children in a joint session, and their consensus was considered to be the reference standard. The sensitivity, specificity, and reproducibility were calculated for different thresholds: all, cavitated, and active caries lesions. Multilevel analyses were performed to compare the different methods and examiners. No differences were observed among the examiners, either in detecting all lesions and cavitated lesions or regarding the activity assessment. The methods of assessing activity status performed similarly, but the time spent on examinations was shorter for the method evaluating clinical features. In conclusion, the experience of examiners does not significantly influence the performance of visual inspection, and both methods of assessing activity status result in similar diagnostic accuracy. PMID:23617691

  6. Experiences in Rural Mental Health. V: Creating Alternatives to Clinical Care.

    ERIC Educational Resources Information Center

    Hollister, William G.; And Others

    Based on a North Carolina feasibility study (1967-73) which focused on development of a pattern for providing comprehensive mental health services to rural people, this guide deals with the process of creating alternatives to clinical care in Vance and Franklin counties. Specifically, this booklet details the chronological development of the…

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

    ERIC Educational Resources Information Center

    Chan, Sally; Cheng, Bing-shu

    2001-01-01

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

  8. A Semantic Normal Form for Clinical Drugs in the UMLS: Early Experiences with the VANDF

    Microsoft Academic Search

    Stuart J. Nelson; Steven H. Brown; Mark S. Erlbaum; Tammy Powell; John Carter; Mark S. Tuttle; William T. Hole

    A semantic normal form (SNF) for a clinical drug, designed to represent the meaning of an expression typically seen in a practitioner's medication order, has been developed and is being created in the UMLS Metathesaurus. The long term goal is to establish a relationship for every concept in the Metathesaurus with semantic type \\

  9. University-School Partnerships for Clinical Experiences: Design, Implementation, Assessment, and Data Collection

    ERIC Educational Resources Information Center

    Sivakumaran, Thillainatarajan; Holland, Glenda; Clark, Leonard; Heyning, Katharina; Wishart, William; Flowers-Gibson, Beverly

    2011-01-01

    University teacher education programs establish partnerships with P-12 schools, in part to place their teacher education candidates in a learning environment that allows candidates to work with a diverse population of learners. The purpose of this study was to examine three universities in regard to the partnerships utilized for field and clinical

  10. Asthma: Addressing consistency in results from basic science, clinical trials, and observational experience

    Microsoft Academic Search

    Joseph Spahn; Ronina Covar; David A. Stempel

    2002-01-01

    The basic science understanding of the pathophysiology of a disease often serves as the basis for clinical investigations. This knowledge is used to propose new directions in care and confirm initial concepts. The basic science of asthma demonstrates that the most comprehensive management of inflammation appears to be associated with the use of inhaled corticosteroids and proposes a mechanism for

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

    Microsoft Academic Search

    Bjørg Hjerkinn; Morten Lindbæk; Elin Olaug Rosvold

    2007-01-01

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

  12. Overdiagnosis of TIA and minor stroke: experience at a regional neurovascular clinic

    Microsoft Academic Search

    P. J. MARTIN; G. YOUNG; T. P. ENEVOLDSON; P. R. D. HUMPHREY

    1997-01-01

    Summary We compared the referral diagnoses of TIAs and minor strokes made by non-specialists with those of two consultant neurologists, in 565 consecutive cer- ebrovascular clinic patients, of whom 508 (90%) were referred with a diagnosis of any TIA or stroke. In 373 (73%), the neurologists felt the diagnosis of a cerebrovascular event to be correct. Agreement with the vascular

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

    PubMed

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

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    2004-04-01

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

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

    ERIC Educational Resources Information Center

    Lee, Kyungjae

    2014-01-01

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

  16. Students' feedback of Objectively Structured Clinical Examination: a private med- ical college experience

    Microsoft Academic Search

    Iram Khursheed; Yaseen Usman; Jawaid Usman

    The aim of the study was to evaluate undergraduate stu- dents' perceptions regarding Objectively Structured Clinical Examination (OSCE) to be used as a feedback to improve the assessment technique. At the end of OSCE, students were provided with a feedback questionnaire related to OSCE to obtain their views and comments. The feedback was obtained from two consecutive batches of third

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

    Microsoft Academic Search

    Zenya Yamazaki; Yasuo Idezuki; Tetsu Nemoto; Tatsuo Togawa

    1988-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

    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…

  19. Recruitment of Black Elderly for Clinical Research Studies of Dementia: The CERAD Experience.

    ERIC Educational Resources Information Center

    Ballard, Edna L.; And Others

    1993-01-01

    Surveyed nine Consortium to Establish a Registry for Alzheimer's Disease (CERAD) sites to identify barriers to recruiting African-American subjects. Major cited obstacles were expenses, transportation difficulties, and especially lack of rapport with clinic staff. CERAD efforts to increase community awareness of Alzheimer's disease and staff…

  20. Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan.

    PubMed

    Nakajima, Kenichi; Nakata, Tomoaki

    2015-06-01

    Cardiac neuroimaging with (123)I-metaiodobenzylguanidine ((123)I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac (123)I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of (123)I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac (123)I-MIBG parameter, the heart-to-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6-1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on (123)I-MIBG studies had a good long-term prognosis. Future investigations of cardiac (123)I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of cost-effective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice. PMID:26033897

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

    PubMed

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

    2003-12-01

    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 multispecialty 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 duration was 3.4 y, and 44.6% of them had one or more concomitant conditions. The mean score of the International Index of Erectile Function erectile function domain was 12.7 in 314 nonselective subjects, and 75% of them had moderate to severe ED. The average number of purchase-visits and tablets of sildenafil purchased was 2.27 and 10.8 per person, respectively, and the prescription refill rate was 58.6%. Urology accounts for 91.4% of the specialties of prescribers. The response rate was 72.0%, which was significantly lower in subjects with diabetes, ischemic heart disease and following radical pelvic surgery than those without. Subjects with psychogenic etiology had the highest response rate, while those following radical pelvic surgery the lowest. Of the nonresponders, 67% did not try the maximum dose of 100 mg and 71.1% bought no more than four tablets. Adverse events were reported in 20.1% of the subjects. No one discontinued the treatment because of the adverse events. Mortality occurred in 17 subjects and none was considered related to sildenafil use. In conclusion, sildenafil was effective and safe in the treatment of ED in clinical practice. Compared with clinical trials or prospective clinical practice based studies, lack of dose titration, less follow-up visits and inadequate attempts before giving up were the main shortfalls in daily practice. PMID:14671659

  2. The Appalachian Tri-State Node Experiences with the National Institute on Drug Abuse Clinical Trials Network

    PubMed Central

    Kelly, Thomas M; Daley, Dennis C; Byrne, Mimmie; DeMarzo, Larry; Smith, Doris; Madl, Stephanie

    2011-01-01

    The National Institute on Drug Abuse (NIDA)-sponsored Clinical Trial Network (CTN) recently celebrated 10 years of conducting “real world” research into the treatment of addiction. This article reviews the history and results of the most recent CTN studies and describes the experiences of one of the 13 participating research affiliates, the Appalachian Tri-State (ATS) Node. We discuss our “bidirectional” collaboration with multiple community treatment programs (CTPs) on research and dissemination activities and include their experiences as a member of our ATS Node. Results of CTN clinical trials have found unexpectedly that treatment as usual (TAU) is often almost as good as evidence-based interventions such as Motivational Interviewing (MI), possibly due to the difficulty in implementing evidence-based practices most effectively among divergent treatment sites and heterogeneous clinical populations. Some expected findings from the reviewed research are that severity of addiction and comorbidity moderate treatment outcomes and must be accounted for in future CTN-sponsored studies. Notwithstanding these results, much has been learned and recommendations are suggested for changes in CTN research designs that will address methodological limitations and increase treatment effectiveness in future CTN studies. PMID:22102966

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

    SciTech Connect

    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)

    2011-09-22

    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.

  4. EARLY CLINICAL EXPERIENCE WITH 5-AMINOLEVULINIC ACID FOR THE PHOTODYNAMIC THERAPY OF UPPER TRACT UROTHELIAL TUMORS

    Microsoft Academic Search

    Raphaela Waidelich; Alfons Hofstetter; Herbert Stepp; Reinhold Baumgartner; Ernst Weninger; Martin Kriegmair

    1998-01-01

    PurposePhotodynamic therapy is effective in the treatment of superficial urothelial cancer of the bladder. We report our experience with photodynamic therapy for the treatment of upper urinary tract transitional cell carcinoma.

  5. Fully liquid DTaP-IPV-Hib pediatric combination vaccine (Pediacel): a review of 18 years of clinical experience.

    PubMed

    Reynolds, Donna L; Vidor, Emmanuel

    2014-08-01

    Safe and effective combination pediatric vaccines are necessary to simplify complex immunization schedules and to improve coverage and protection for children worldwide. We provide an overview of the 18 years of clinical and worldwide experience with DTaP-IPV-Hib (Pediacel(®)), a unique fully liquid pentavalent vaccine (diphtheria [D], tetanus [T], acellular pertussis, inactivated poliovirus [IPV], Haemophilus influenzae type b [Hib]). Pediacel has demonstrated good and lasting immunogenicity in many populations, with differing primary series and booster schedules, and with a variety of coadministered vaccines. The acellular pertussis antigens have proven efficacy and real-world effectiveness. Clinical and post-marketing studies confirm the safety of Pediacel. Pediacel can be used for primary series and toddler booster doses, as well as in mixed pediatric vaccine schedules. PMID:24985159

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

    PubMed

    Reske, S N

    1994-01-01

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

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

    PubMed

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

    2008-02-01

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

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

    PubMed

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

    2015-02-01

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

  9. Clinical experience with temsirolimus in the treatment of advanced renal cell carcinoma

    PubMed Central

    Zanardi, Elisa; Verzoni, Elena; Grassi, Paolo; Necchi, Andrea; Giannatempo, Patrizia; Raggi, Daniele; De Braud, Filippo

    2015-01-01

    Temsirolimus is an inhibitor of the mammalian target of rapamycin (mTOR) kinase, a protein that has been shown to be particularly active in metastatic renal cell carcinoma (mRCC) with poor prognosis. Therefore, temsirolimus should be considered as the first-line treatment indicated in mRCC patients classified as poor risk. The benefits of temsirolimus are not limited to an increased survival but are also related to a better quality of life, which is certainly one of the most important aspects in the clinical management of these frail patients. Temsirolimus is a well-tolerated treatment, and the most frequent adverse events are manageable with supportive care. To this end, the identification of predictive factors of response to temsirolimus could help us to better select patients and obtain a more tailored clinical management of mRCC.

  10. Mass Mailing and Staff Experience in a Total Recruitment Program for a Clinical Trial

    Microsoft Academic Search

    Nora Cosgrove; Nemat O Borhani; Geri Bailey; Patty Borhani; Julie Levin; Mary Hoffmeier; Susan Krieger; Laura C Lovato; Helen Petrovitch; Thomas Vogt; Alan C Wilson; Vincent Breeson; Jeffrey L Probstfield

    1999-01-01

    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

  11. Sexually transmitted diseases in northern Nigeria. Five years' experience in a university teaching hospital clinic.

    PubMed Central

    Bello, C S; Elegba, O Y; Dada, J D

    1983-01-01

    Between 1977 and 1981, 3089 patients attended the sexually transmitted diseases (STD) clinic in Zaria, northern Nigeria. The male-to-female ratio of attenders was 6:1. Postpubertal gonorrhoea accounted for 28.1% of cases, non-specific genital infections for 22.4%, and syphilis for 1.2%. Illiteracy, polygamy, the purdah system, widespread prostitution, and inadequate facilities are factors aiding the spread of these diseases in northern Nigeria. PMID:6687822

  12. Use of branched chain amino acids for treating hepatic encephalopathy: clinical experiences

    Microsoft Academic Search

    F Rossi Fanelli; C Cangiano; L Capocaccia; A Cascino; F Ceci; M Muscaritoli; G Giunchi

    1986-01-01

    The efficacy of branched chain amino acids in two consecutive clinical studies in patients with severe hepatic encephalopathy was tested. In the preliminary uncontrolled study 19 patients with grade 3-4 hepatic encephalopathy were given an intravenous solution containing leucine 11 g\\/l, isoleucine 9 g\\/l, and valine 8.4 g\\/l in 20% dextrose. A complete recovery of mental state was obtained in

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

    PubMed

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

    2014-05-01

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

  14. Clinical Experience with One-Stage, Non-Submerged Dental Implants

    Microsoft Academic Search

    Daniel Buser; Regina Mericske-Stern; Karl Dula; Niklaus P. Lang

    1999-01-01

    This review article describes the scientific documentation of one-stage, non-submerged dental implants. In the past 25 years, numerous in vivo studies have demonstrated that non-submerged titanium implants achieve osseointegration as predictable as that of submerged titanium implants. This observation was confirmed in prospective clinical studies, mostly done with the ITI® Dental Implant System. ITI implants have been widely documented for

  15. The influence of modern nuclear technologies on immune status in clinic and experiment

    SciTech Connect

    Ivanov, A.A.; Smirnova, O.V.; Ulanova, A.M. [and others

    1993-12-31

    It is known that the immune system is extremly sensitive to ionizing radiation. This report described results of investigations pertaining to experimental and clinical data on the character and dynamics of changes in the immune system as under external radiation influence (x-rays, gamma-irradiation, neutrons) as in the result of radionuclides entering an organism. The influence of ionizing radiation on man was studied by data from nuclear accidents such as from people exposed from the Chernobyl accident.

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

    Microsoft Academic Search

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

    2005-01-01

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

  17. Macrophage activation syndrome in children with systemic onset juvenile idiopathic arthritis: clinical experience from northwest India

    Microsoft Academic Search

    Surjit Singh; Shanmuganathan Chandrakasan; Jasmina Ahluwalia; Deepti Suri; Amit Rawat; Nishath Ahmed; Reena Das; Neelam Varma

    The objective of this study is to describe the clinical and laboratory features of macrophage activation syndrome (MAS) in\\u000a systemic onset juvenile idiopathic arthritis (SOJIA) at a tertiary care center in northwest India. Review of medical records\\u000a of all children with SOJIA admitted during the period January 1995–December 2008 in Pediatric Allergy and Immunology Unit,\\u000a Advanced Pediatrics Centre, Postgraduate Institute

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

    PubMed Central

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

    2015-01-01

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

  19. Presentation and Treatment of Subfertile Men with Balanced Translocations: The Cleveland Clinic Experience

    Microsoft Academic Search

    Christina B. Ching; Edmund Ko; Bryan Hecht; Marissa Smith; Edmund Sabanegh

    2012-01-01

    Introduction: Balanced chromosomal translocations are a relatively common (2–7%) finding among infertile couples. We report clinical features of males with translocations at our institution. Materials and Methods: Data was collected on men presenting for infertility evaluation between July 2006 March 2010, including presentation, medical history, and infertility treatments. Criteria for genetic evaluation, consisting of karyotype and Y-linked microdeletion assay, included

  20. Transference in Everyday Experience: Implications of Experimental Research for Relevant Clinical Phenomena

    Microsoft Academic Search

    Susan M. Andersen; Michele S. Berk

    1998-01-01

    Experimental research examining the clinical concept of transference (S. Freud, 1912\\/1958; H. S. Sullivan, 1953) using a social–cognitive model has demonstrated that mental representations of significant others are stored in memory and can be activated and applied in new social encounters, with consequences for cognition, evaluation, affect, motivation, expectancies, and self-evaluations (S. M. Andersen & N. S. Glassman, 1996; S.

  1. Selective alpha 1-adrenoceptor antagonists in benign prostatic hyperplasia: rationale and clinical experience.

    PubMed

    Chapple, C R

    1996-01-01

    Symptomatic benign prostatic hyperplasia (BPH) is a common condition in older men and has a significant impact on their daily lives. Transurethral resection of the prostate is currently the most effective remedy for BPH but is not suitable for all patients. There is now clear evidence for the efficacy of alpha-adrenoceptor antagonists, particularly selective alpha 1-adrenoceptor antagonists, in the treatment of BPH. Inhibition of alpha-adrenoceptors significantly increases urinary flow and improves symptoms in BPH. alpha 1-Adrenoceptor antagonists have a place in the management of BPH patients with mild to moderate disease, who are bothered by their symptoms, or for those awaiting or wishing to delay surgery. Treatment with selective alpha 1-adrenoceptor antagonists is generally better tolerated than nonselective-alpha-blockers. alpha 1-Selective adrenoceptor antagonists with a long half-life such as terazosin, doxazosin and tamsulosin, as a modified release formulation, permit once-daily dosing. Tamsulosin is the first subtype-specific (cloned alpha 1c/functional alpha 1A) adrenoceptor antagonist in clinical practice. Initial reports suggest that it gives no clinically relevant lowering of blood pressure and that its (vasodilatory) side effect profile is minimal. The scientific rationale behind the therapeutic use of alpha-adrenergic blockade as treatment for BPH and the trials data relating to the various agents which are available for clinical use are reviewed in the context of the contemporary literature. PMID:8647139

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

    PubMed

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

    2014-09-01

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

  3. The hazard of software updates to clinical workstations: a natural experiment.

    PubMed

    Landman, Adam B; Takhar, Sukhjit S; Wang, Samuel L; Cardoso, Anabela; Kosowsky, Joshua M; Raja, Ali S; Khorasani, Ramin; Poon, Eric G

    2013-06-01

    Emergency department (ED) electronic tracking boards provide a snapshot view of patient status and a quick link to other clinical applications, such as a web-based image viewer client to view current and previous radiology images from the picture archiving and communication systems (PACS). We describe a case where an update to Microsoft Internet Explorer severed the link between the ED tracking board and web-based image viewer. The loss of this link resulted in decreased web-based image viewer access rates for ED patients during the 10 days of the incident (2.8 views/study) compared with image review rates for a similar 10-day period preceding this event (3.8 views/study, p<0.001). Single-click user interfaces that transfer user and patient contexts are efficient mechanisms to link disparate clinical systems. Maintaining hazard analyses and rigorously testing all software updates to clinical workstations, including seemingly minor web-browser updates, are important to minimize the risk of unintended consequences. PMID:23492594

  4. Video Rating in Neurodegenerative Disease Clinical Trials: The Experience of PRION-1

    PubMed Central

    Carswell, Christopher; Rañopa, Michael; Pal, Suvankar; MacFarlane, Rebecca; Siddique, Durre; Thomas, Dafydd; Webb, Tom; Wroe, Steve; Walker, Sarah; Darbyshire, Janet; Collinge, John; Mead, Simon; Rudge, Peter

    2012-01-01

    Background/Aims Large clinical trials including patients with uncommon diseases involve assessors in different geographical locations, resulting in considerable inter-rater variability in assessment scores. As video recordings of examinations, which can be individually rated, may eliminate such variability, we measured the agreement between a single video rater and multiple examining physicians in the context of PRION-1, a clinical trial of the antimalarial drug quinacrine in human prion diseases. Methods We analysed a 43-component neurocognitive assessment battery, on 101 patients with Creutzfeldt-Jakob disease, focusing on the correlation and agreement between examining physicians and a single video rater. Results In total, 335 videos of examinations of 101 patients who were video-recorded over the 4-year trial period were assessed. For neurocognitive examination, inter-observer concordance was generally excellent. Highly visual neurological examination domains (e.g. finger-nose-finger assessment of ataxia) had good inter-rater correlation, whereas those dependent on non-visual clues (e.g. power or reflexes) correlated poorly. Some non-visual neurological domains were surprisingly concordant, such as limb muscle tone. Conclusion Cognitive assessments and selected neurological domains can be practically and accurately recorded in a clinical trial using video rating. Video recording of examinations is a valuable addition to any trial provided appropriate selection of assessment instruments is used and rigorous training of assessors is undertaken. PMID:22962552

  5. Clinical Characterization and NPHP1 Mutations in Nephronophthisis and Associated Ciliopathies: A Single Center Experience

    PubMed Central

    Soliman, Neveen A.; Hildebrandt, Friedhelm; Otto, Edgar A.; Nabhan, Marwa M.; Allen, Susan J.; Badr, Ahmed M.; Sheba, Maha; Fadda, Sawsan; Gawdat, Ghada; El-Kiky, Hassan

    2014-01-01

    Nephronophthisis (NPHP) is a recessive disorder of the kidney that is the leading genetic cause of end-stage renal failure in children. Egypt is a country with a high rate of consanguineous marriages; yet, only a few studies have investigated the clinical and molecular characteristics of NPHP and related ciliopathies in the Egyptian population. We studied 20 children, from 17 independent families, fulfilling the clinical and the ultrasonographic criteria of NPHP. Analysis for a homozygous deletion of the NPHP1 gene was performed by polymerase chain reaction on the genomic DNA of all patients. Patients were best categorized as 75% juvenile NPHP, 5% infantile NPHP, and 20% Joubert syndrome-related disorders (JSRD). The mean age at diagnosis was 87.5 + 45.4 months, which was significantly late as compared with the age at onset of symptoms, 43.8 ± 29.7 months (P <0.01). Homozygous NPHP1 deletions were detected in six patients from five of 17 (29.4%) studied families. Our study demonstrates the clinical phenotype of NPHP and related disorders in Egyptian children. Also, we report that homozygous NPHP1 deletions account for 29.4% of NPHP in the studied families in this cohort, thereby confir-ming the diagnosis of type-1 NPHP. Moreover, our findings confirm that NPHP1 deletions can indeed be responsible for JSRD. PMID:22982934

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

    PubMed Central

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

    2006-01-01

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

  7. Using clinical video excerpts to prompt music therapy majors' recall of related experiences and self-attributions of comfort and skill.

    PubMed

    Gregory, Dianne

    2009-01-01

    This study was designed to develop a method for collecting music therapy majors' hypothesized self-attributions of comfort and skill in diverse clinical scenarios and relating their attributions to recall and perceptions of similar personal and clinical experience. Fifty eight music therapy majors, from freshmen to graduate (board-certified) students, watched 10 brief video excerpts. After each excerpt participants moved 2 Continuous Response Digital Interface (CRDI) dials, one labeled "comfort" and the other labeled "skill," to indicate their feelings about themselves as therapist with the client(s) in the excerpt. At the end of viewing all excerpts, participants completed an open-ended total recall paper/pencil form requesting estimation of personal and clinical experience with any population represented in the excerpts. Participants recalled more personal experience compared to clinical experience. A strong positive correlation was found between personal and clinical experience estimates. A strong positive correlation was also found between comfort and skill scores. Personal experience estimates were not related to self-attributions of comfort or skill. Clinical excerpts prompted neutral self-attributions of comfort and skill with comfort being slightly higher than skill self-attributions. Clinical experience estimates, although not related to self-attributions of comfort; were positively related to self-attributions of skill. Exploratory comparisons with small groups within the total sample suggest a highly positive impact of specific music therapy clinical experience, particularly the post-coursework internship, on skill self-attributions. Results are discussed within the context of using the assessment to investigate the predictive value of self-attributes as clinical indicators of persistence for recruitment and retention of potentially successful music therapy students and young professionals. PMID:20394131

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

    Microsoft Academic Search

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

    2008-01-01

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

  9. Unlocking Data for Clinical Research – The German i2b2 Experience

    PubMed Central

    Ganslandt, T.; Mate, S.; Helbing, K; Sax, U.; Prokosch, H.U.

    2011-01-01

    Objective Data from clinical care is increasingly being used for research purposes. The i2b2 platform has been introduced in some US research communities as a tool for data integration and querying by clinical users. The purpose of this project was to assess the applicability of i2b2 in Germany regarding use cases, functionality and integration with privacy enhancing tools. Methods A set of four research usage scenarios was chosen, including the transformation and import of ontology and fact data from existing clinical data collections into i2b2 v1.4 instances. Query performance was measured in comparison to native SQL queries. A setup and administration tool for i2b2 was developed. An extraction tool for CDISC ODM data was programmed. Interfaces for the TMF privacy enhancing tools (PID Generator, Pseudonymization Service) were implemented. Results Data could be imported in all tested scenarios from various source systems, including the generation of i2b2 ontology definitions. The integration of TMF privacy enhancing tools was possible without modification of the platform. Limitations were found regarding query performance in comparison to native SQL and certain temporal queries. Conclusions i2b2 is a viable platform for data query tasks in use cases typical for networked medical research in Germany. The integration of privacy enhancing tools facilitates the use of i2b2 within established data protection concepts. Entry barriers should be lowered by providing tools for simplified setup and import of medical standard formats like CDISC ODM. PMID:23616864

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

    PubMed

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

    2015-04-01

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

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

    SciTech Connect

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

    2013-07-01

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

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

    PubMed

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

    2015-02-01

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

  13. Frameless stereotactic guided neurosurgery: Clinical experience with an infrared based pointer device navigation system

    Microsoft Academic Search

    K. Roessler; K. Ungersboeck; W. Dietrich; M. Aichholzer; K. Hittmeir; Ch. Matula; Th. Czech; W. Th. Koos

    1997-01-01

    Summary  An infrared based frameless stereotactic navigation device (Easy Guide Neuro) was investigated for its clinical applicability,\\u000a registration\\/application accuracy and limitations in a standard operating room set-up.\\u000a \\u000a In a five-month period 40 frameless stereotactic procedures (23 female, 17 male, mean age 46.4, yrs range 10–83) including\\u000a 36 craniotomies and 4 spinal surgery procedures were performed. Image registration, data transfer and operation

  14. Clinical experience with preimplantation diagnosis of sex by dual fluorescent in situ hybridization

    Microsoft Academic Search

    Darren K. Griffin; Alan H. Handyside; Joyce C. Harper; Leeanda J. Wilton; Glenn Atkinson; Iakovos Soussis; Dagan Wells; Elena Kontogianni; Juan Tarin; Selmo Geber; Asangla Ao; Robert M. L. Winston; Joy D. A. Delhanty

    1994-01-01

    Purpose  \\u000a Our purpose was to assess the clinical application of dual fluorescent in situhybridization (FISH) for the diagnosis of sex in the human preimplantation embryo.\\u000a \\u000a \\u000a \\u000a Results  \\u000a Over a 2-year period, 18 couples at risk of transmitting X-linked recessive disorders underwent preimplantation diagnosis\\u000a of embryo sex by dual FISH with X and Y chromosome-specific DNA probes. A total of 27 in

  15. Pediatric nephrology patients are overweight: 20 years' experience in a single Canadian tertiary pediatric nephrology clinic

    Microsoft Academic Search

    Guido Filler; Sílvia Mansur Reimão; Anusha Kathiravelu; Joanne Grimmer; Janusz Feber; Alfred Drukker

    2007-01-01

    Background  Obesity is an independent risk factor for chronic kidney disease (CKD). We compared the body composition of pediatric nephrology\\u000a patients with that of the general child population over 2 decades.\\u000a \\u000a \\u000a \\u000a Methods  About 4,959 patients above 2 years of age (mean: 9.6 ± 4.5) were referred to a tertiary pediatric nephrology clinic from 1985\\u000a to 2006. In 3,422 patients (69.0% with the same mean age)

  16. Healthcare professional experiences and attitudes on unlicensed\\/off-label paediatric prescribing and paediatric clinical trials

    Microsoft Academic Search

    Tareq Mukattash; Ahmed F. Hawwa; Karen Trew; James C. McElnay

    2011-01-01

    Objectives  To investigate the knowledge and views of a range of healthcare professionals (consultant paediatricians, general practitioners\\u000a (GPs), community pharmacists and paediatric nurses) regarding the use of unlicensed\\/off-label medicines in children and the\\u000a participation of children in clinical trials.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A regional study in which a survey instrument with 39 items was issued to 500 randomly selected GPs, all community pharmacists\\u000a (n?=?512),

  17. Single center experience of five diffuse panbronchiolitis patients clinically presenting as severe asthma.

    PubMed

    Park, Kyung Hee; Park, Hye Jung; Lee, Jae-Hyun; Park, Jung-Won

    2015-06-01

    Diffuse panbronchiolitis (DPB) is a bronchiolitis affecting the whole lung fields which can be treated by macrolide. Especially East Asian patients are more susceptible to diffuse panbronchiolitis. As asthma and DPB both can cause airway obstruction, differential diagnosis is important for the 2 diseases. Here we report 5 patients with DPB clinically presenting as severe asthma in Korea, who were well treated by macrolide. Among the 5 patients, 2 could stop their asthma inhalers and the other 3 could reduce asthma medications after diagnosis and treatment of DPB. In conclusion, considering DPB as differential diagnosis for asthmatics in Asian ethnic groups is important. PMID:26028938

  18. Results of a multicenter study of the retrievable Tulip vena cava filter: Early clinical experience

    Microsoft Academic Search

    Jiirg M. Neuerburg; Rolf W. Giinther; Dierk Vorwerk; Robert F. Dondelinger; Horst Jiiger; Klaus J. Lackner; Hans H. Schild; Graham R. Plant; Francis G. Joffre; Pierre A. Schneider; Johan H. A. Janssen

    1997-01-01

    Purpose  To evaluate clinically a new, retrievable vena caval filter in a multicenter study.\\u000a \\u000a \\u000a \\u000a Methods  The Tulip filter is a stainless steel half-basket that is suitable for antegrade or retrograde insertion via an 8.5 Fr introducer\\u000a sheath. The filter can be retrieved via the jugular approach using an 11 Fr coaxial retrieval system. Forty-eight filters\\u000a were implanted via the femoral approach and

  19. A model-based cluster analysis of social experiences in clinically anxious youth: links to emotional functioning.

    PubMed

    Suveg, Cynthia; Jacob, Marni L; Whitehead, Monica; Jones, Anna; Kingery, Julie Newman

    2014-01-01

    Social difficulties are commonly associated with anxiety disorders in youth, yet are not well specified in the literature. The aim of this study was to identify patterns of social experiences in clinically anxious children and examine the associations with indices of emotional functioning. A model-based cluster analysis was conducted on parent-, teacher-, and child-reports of social experiences with 64 children, ages 7-12 years (M = 8.86 years, SD = 1.59 years; 60.3% boys; 85.7% Caucasian) with a primary diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Follow-up analyses examined cluster differences on indices of emotional functioning. Findings yielded three clusters of social experiences that were unrelated to diagnosis: (1) Unaware Children (elevated scores on parent- and teacher-reports of social difficulties but relatively low scores on child-reports, n = 12), (2) Average Functioning (relatively average scores across all informants, n = 44), and (3) Victimized and Lonely (elevated child-reports of overt and relational victimization and loneliness and relatively low scores on parent- and teacher-reports of social difficulties, n = 8). Youth in the Unaware Children cluster were rated as more emotionally dysregulated by teachers and had a greater number of diagnoses than youth in the Average Functioning group. In contrast, the Victimized and Lonely group self-reported greater frequency of negative affect and reluctance to share emotional experiences than the Average Functioning cluster. Overall, this study demonstrates that social maladjustment in clinically anxious children can manifest in a variety of ways and assessment should include multiple informants and methods. PMID:24506348

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

    ERIC Educational Resources Information Center

    Hathorn, Donna; Machtmes, Krisanna; Tillman, Ken

    2009-01-01

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

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

    Microsoft Academic Search

    Edward Lindop; Sue Cannon

    2001-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2014-12-01

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

  6. Radiotherapy with heavy ions: radiobiology, clinical indications and experience at GSI, Darmstadt.

    PubMed

    Kraft, G

    1998-01-01

    In the history of external beam radiotherapy, the trend for a better conformation as well as for a higher biological efficiency has been the driving force for the improvement of clinical results. However, these two goals had to be followed with separate types of radiation, i.e. photons and neutrons, and could not be combined. For the first time being, beams of heavy ions like carbon offer the possibility to combine both advantageous properties: better targeting and higher biological efficiency. Particle beams have an inverse depth dose profile, with a maximum dose in the deep seated tumor, a finite range, small lateral scattering, and a drastically increased biological efficiency in the tumor. These properties maximize the deletion effects on tumor cells. In addition, particle beams can be directed precisely in the limit of one or two millimeters, and can be monitored using positron emission tomography (PET) with the same precision. In the following paper the conditions are given that are necessary to translate these properties into clinical routine. PMID:9620245

  7. Clinical observation of atrial threshold monitoring algorithm: a single center experience

    PubMed Central

    She, Jianqing; Zhou, Jing; Hu, Zhan; Xia, Yulong

    2015-01-01

    Objective: To observe the atrial capture management in an atrial threshold monitoring algorithm. By calculating the enabling rate of the atrial threshold monitoring algorithm and comparing atrial thresholds measured automatically and manually, we evaluate its safety, reliability and applicability in clinical practice. Methods and results: Data were collected at implant, start of atrial threshold monitoring, visits scheduled 1 month, 2 months and 4 months thereafter, and upon notification of adverse events. Atrial threshold monitoring algorithm was enabled in 94 patients, while in 38 not, indicating an enabling rate of 71.2%. Causes of the unsuccessful attempts to enable automatic atrial threshold include tachycardia (2, 5.3%), and atrial safety margin not met (36, 94.7%). A total of 88 pairs of atrial thresholds measured automatically and manually were gained. The auto threshold was 0.528 ± 0.270 V, and the manual threshold was 0.580 ± 0.223 V. There is a strict correlation between the automatic measurements and those conducted manually by the physician with a P < 0.05. No significant differences were observed during the 1-month, 2-month and 4-month follow-up. Conclusion: Atrial threshold monitoring algorithm is safe, reliable and applicable over time. Atrial threshold monitoring tested atrial threshold was demonstrated to be clinically equivalent to the manual atrial threshold test. The addition of atrial threshold monitoring will benefit the patients by reducing energy cost and enhancing pacemaker safety. PMID:26131207

  8. Pathotropic nanoparticles for cancer gene therapy Rexin-G IV: three-year clinical experience.

    PubMed

    Gordon, Erlinda M; Lopez, Francisco F; Cornelio, Gerardo H; Lorenzo, Conrado C; Levy, John P; Reed, Rebecca A; Liu, Liqiong; Bruckner, Howard W; Hall, Frederick L

    2006-11-01

    Metastatic cancer is a life-threatening illness with a predictably fatal outcome, thereby representing a major unmet medical need. In 2003, Rexin-G became the world's first targeted injectable vector approved for clinical trials in the treatment of intractable metastatic disease. Uniquely suited, by design, to function within the context of the human circulatory system, Rexin-G is a pathotropic (disease-seeking) gene delivery system bearing a designer killer gene; in essence, a targeted nanoparticle that seeks out and selectively accumulates in metastatic sites upon intravenous infusion. The targeted delivery of the cytocidal gene to primary tumors and metastatic foci, in effective local concentrations, compels both cancer cells and tumor-associated neovasculature to self-destruct, without causing untoward collateral damage to non-target organs. In this study: i) we report the results of three distinctive clinical studies which demonstrate the initial proofs of concept, safety, and efficacy of Rexin-G when used as a single agent for advanced or metastatic cancer, ii) we introduce the quantitative foundations of an innovative personalized treatment regimen, designated the 'Calculus of Parity', based on a patient's calculated tumor burden, iii) we propose a refinement of surrogate end-points commonly used for defining success in cancer therapy, and iv) we map out a strategic plan for the accelerated approval of Rexin-G based on the oncologic Threshold of Credibility paradigm being developed by the Food and Drug Administration. PMID:17016635

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

    PubMed Central

    Wirth, Thomas

    2011-01-01

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

  10. Sentinel lymph node biopsy in melanoma: Our 8-year clinical experience in a single French institute (2002–2009)

    PubMed Central

    2012-01-01

    Background Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma. Methods A single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness?>?1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation. Results The SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5–97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p?=?0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p?=?0.0006 and p?=?0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients. Conclusion Our data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated. PMID:23228015

  11. Profile of patients seen at a psychosexual clinic in a gynaecological teaching hospital--the Singapore experience.

    PubMed

    Yeong, C T; Atputharajah, V

    1999-03-01

    Ignorance is not bliss when it comes to sexuality. Psychosexual problems lead to shame, fumbling, needless fears, low-self esteem and even subfertility. The demands for help appears to be increasing; as the general population become more aware of its presence and the treatment options available through the mass media and better health education. Sex therapy has traditionally been the realm of the psychiatrist but with the gynaecologist as the first contact for most women, the number of women seeking advice directly from their doctors will only increase with time. A total of 243 new cases of sexual dysfunction were treated at the sexual problem clinic in Kandang Kerbau Hospital between January 1994 and November 1996; majority of which were self-referrals (48.5%). The patient pool consisted of more males than females although the clinical setting is in an obstetrics and gynaecology teaching institute. Vaginismus and erectile problems constituted the main complaints. Erectile problems are more common in the patients above 40 years old (p < 0.001). We report here our experience of such a sexual problem clinic and hope to provide insight into this area of medicine from the perspective of a practising gynaecologist. PMID:10972009

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

    PubMed

    Toker, S M; Canadinc, D

    2014-07-01

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

  13. A clinical teacher's experience with the Open University MA in Education.

    PubMed

    Cabot, L B

    1999-04-24

    In this article, I outline my experience of undertaking the Open University Master of Arts Degree in Education Management. A brief overview of the structure of this modular degree is presented. I then assess the benefits that I have gained during this course of study; I also consider the relevance of this primarily mainstream education higher qualification to those in dental education, in particular those who teach at undergraduate level and in general dental practice. PMID:10365463

  14. Optimal Experiment Design in Clinical Medicine: A Computer Program and Applications to Compartmental Models

    PubMed Central

    Cobelli, C.; DiStefano, J.J.; Ruggeri, A.

    1984-01-01

    This paper describes a program which computes exact D-optimal sampling schedules (OSS) for experiments with multi-input multi-output time-invariant linear/nonlinear differential equation models. Theoretical fundamentals on the algorithm are given. Two case studies which show practical application of the software are presented, respectively on OSS for the identification of a model of ketone body kinetics and of glucose-insulin interactions.

  15. Clinical Experience With Berlin Heart Excor in Pediatric Patients in Argentina: 1373 days of Cardiac Support

    Microsoft Academic Search

    Guillermo E. Moreno; Alberto Charroqui; María L. Pilán; Ricardo H. Magliola; Mariela P. Krynski; María Althabe; Luis M. Landry; Gabriela Sciuccati; Alejandra Villa; Horacio Vogelfang

    2011-01-01

    The objective of this study was to describe our experience (1373 days of support) with the Berlin Heart Excor (BH) ventricular-assist\\u000a device (VAD) as bridging to cardiac transplantation in pediatric patients with end-stage cardiomyopathy. This study involved\\u000a a retrospective observational cohort. Records of patients supported with the BH VAD were reviewed. Data regarding age, sex,\\u000a weight, diagnosis, preoperative condition, single versus

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

    E-print Network

    Long, Jean-Alexandre; Lanchon, Cecilia; Voros, Sandrine; Medici, Maud; Descotes, Jean-Luc; Troccaz, Jocelyne; Cinquin, Philippe; Rambeaud, Jean-Jacques; Moreau-Gaudry, Alexandre

    2012-01-01

    Purpose: To report the feasibility and the safety of a surgeon-controlled robotic endoscope holder in laparoscopic surgery. Materials and methods: From March 2010 to September 2010, 20 patients were enrolled prospectively to undergo a laparoscopic surgery using an innovative robotic endoscope holder. Two surgeons performed 6 adrenalectomies, 4 sacrocolpopexies, 5 pyeloplasties, 4 radical prostatectomies and 1 radical nephrectomy. Demographic data, overall set-up time, operative time, number of assistants needed were reviewed. Surgeon's satisfaction regarding the ergonomics was assessed using a ten point scale. Postoperative clinical outcomes were reviewed at day 1 and 1 month postoperatively. Results: The per-protocol analysis was performed on 17 patients for whom the robot was effectively used for surgery. Median age was 63 years, 10 patients were female (59%). Median BMI was 26.8. Surgical procedures were completed with the robot in 12 cases (71 %). Median number of surgical assistant was 0. Overall set-up ...

  17. Etiological Analysis of Neurodevelopmental Disabilities: Single-Center Eight-Year Clinical Experience in South China

    PubMed Central

    Guo, Li; Li, Bing-Xiao; Deng, Mei; Wen, Fang; Jiang, Jian-Hui; Tan, Yue-Qiu; Song, Yuan-Zong; Liu, Zhen-Huan; Zhang, Chun-Hua; Kobayashi, Keiko; Wang, Zi-Neng

    2011-01-01

    Etiology determination of neurodevelopmental disabilities (NDDs) currently remains a worldwide common challenge on child health. We herein reported the etiology distribution feature in a cohort of 285 Chinese patients with NDDs. Although concrete NDD etiologies in 48.4% of the total patients could not be identified, genetic diseases (with the proportion of 35.8% in the total cases) including inborn errors of metabolism (IEM) and congenital dysmorphic diseases, constituted the commonest etiology category for NDDs in this study. The two key experimental technologies in pediatric metabolomics, gas chromatography-mass spectrometry (GC-MS), and tandem mass spectrometry (MS-MS), proved to be substantially helpful for the exploration of the NDD etiologies in this clinical investigation. The findings in this paper provided latest epidemiologic information on the etiology distribution of NDDs in Chinese, and the syndromic NDDs caused by citrin deficiency and the novel chromosomal karyotype, respectively, further expanded the etiology spectrum of NDDs. PMID:20936111

  18. [First clinical experience of radio-endovascular functional thyroidectomy in the treatment of diffuse toxic goiter].

    PubMed

    Galkin, E V; Grakov, B S; Protopopov, A V

    1994-01-01

    To suppress Thyroid pathologic activity in diffuse toxic goitre the authors have for the first time resorted to roentgenoendovascular functional thyroiedctomy. This method consists in vascular isolation of the thyroid by superselective catheterization of the left and right thyroid arteries followed by their material occlusion. For embolization a wide spectrum of nonlyzed synthetic, organic, and inorganic materials were used. The operation was carried out in 32 patients with stages III-IV diffuse toxic gotre. The advantages of this technique over subtotal thyroidectomy are emphasized. A stable clinical and hormonal remission and reduction of thyroid size to first degree were observed in all the patients for more tham 1.5 years after roentgenoendovascular intervention. PMID:7985368

  19. Ethics application protocols for multicentre clinical studies in Canada: A paediatric rheumatology experience

    PubMed Central

    Matheson, Loren A; Huber, Adam M; Warner, Aleasha; Rosenberg, Alan M

    2012-01-01

    INTRODUCTION: Individual institutions govern research ethics applications and each must administer and regulate their own protocols. Variations in ethics review procedures and expectations among centres impose impediments to efficiently conducting multicentre studies. METHODS: Observations relating to preparing multisite ethics documents for a study conducted by Canadian paediatric rheumatology investigators are described. Research ethics applications from the 12 participating centres were compared. RESULTS: Although the applications were similar in their content, they differed in their formatting. All applications shared a commitment to ensuring that the study conformed to exemplary ethical standards. CONCLUSIONS: There is wide variation in the multicentre clinical study ethics application process at the institutional level. Considering the common fundamental elements required by all ethics review boards, the present study conceptualized introducing a discipline-specific uniform ethics application process acceptable to all Canadian research ethics boards. This may be a more efficient strategy that could help lessen the burden of collaborative research. PMID:23730169

  20. Clinical neurological examination vs electrophysiological studies: Reflections from experiences in occupational medicine

    PubMed Central

    Jepsen, Jørgen Riis

    2015-01-01

    Seventy-five percent of upper limb disorders that are related to work are regarded as diagnostically unclassifiable and therefore challenging to the clinician. Therefore it has been generally less successfully to prevent and treat these common and frequently disabling disorders. To reach a diagnosis requires the identification of the responsible pathology and the involved tissues and structures. Consequently, improved diagnostic approaches are needed. This editorial discusses the potentials of using the clinical neurologic examination in patients with upper limb complaints related to work. It is argued that a simple but systematic physical approach permits the examiner to frequently identify patterns of neurological findings that suggest nerve afflictions and their locations, and that electrophysiological studies are less likely to identify pathology. A diagnostic algorithm for the physical assessment is provided to assist the clinician. Failure to include representative neurological items in the physical examination may result in patients being misinterpreted, misdiagnosed and mistreated. PMID:26140269

  1. Idiopathic Systemic Capillary Leak Syndrome (Clarkson's Disease): The Mayo Clinic Experience

    PubMed Central

    Kapoor, Prashant; Greipp, Patricia T.; Schaefer, Eric W.; Mandrekar, Sumithra J.; Kamal, Arif H.; Gonzalez-Paz, Natalia C.; Kumar, Shaji; Greipp, Philip R.

    2010-01-01

    OBJECTIVE: To determine clinical features, natural history, and outcome of a well-defined cohort of 25 consecutive patients with idiopathic systemic capillary leak syndrome (SCLS) evaluated at a tertiary care center. PATIENTS AND METHODS: Records of patients diagnosed as having SCLS from November 1, 1981, through April 30, 2008, were reviewed. Descriptive statistics were used to analyze patient demographics, clinical features, complications, and therapeutic interventions. RESULTS: Of the 34 patients whose records were reviewed, 25 fulfilled all diagnostic criteria for SCLS. The median age at diagnosis of SCLS was 44 years. Median follow-up of surviving patients was 4.9 years, and median time to diagnosis from symptom onset was 1.1 years (interquartile range, 0.5-4.1 years). Flulike illness or myalgia was reported by 14 patients (56%) at onset of an acute attack of SCLS, and rhabdomyolysis developed in 9 patients (36%). Patients with a greater decrease in albumin level had a higher likelihood of developing rhabdomyolysis (p=.03). Monoclonal gammopathy, predominantly of the IgG-? type, was found in 19 patients (76%). The progression rate to multiple myeloma was 0.7% per person-year of follow-up. The overall response rate to the different therapies was 76%, and 24% of patients sustained durable (>2 years) complete remission. The estimated 5-year overall survival rate was 76% (95% confidence interval, 59%-97%). CONCLUSION: Systemic capillary leak syndrome, a rare disease that occurs in those of middle age, is usually diagnosed after a considerable delay from onset of symptoms. The degree of albumin decrement during an attack correlates with development of rhabdomyolysis. A reduction in the frequency and/or the severity of attacks was seen in nearly three-fourths of patients who were offered empirical therapies. The rate of progression to multiple myeloma appears to be comparable to that of monoclonal gammopathy of undetermined significance. PMID:20634497

  2. MRI experience with multiple sclerosis - Comparison to CT and clinical status

    SciTech Connect

    Reese, L.; Carr, T.; Nicholson, R.L.

    1985-05-01

    A Multiple Sclerosis (M.S.) Protocol was set--SEB (1000/60) volume acquisition and selected single slices SEC (1000/120) and IR (1500/450). Single slices SE 500/30, 1500/30 and 1530/60 were obtained for T1 and T2 calculation. New software and coils permitted multi-slice multi-echo acquisition so the Protocol was changed to multi-slice multi-echo transaxial SE 2120/60-120, and the T1 and T2 sets. The study consisted of 62 known M.S. patients and 35 controls. Of the 62 M.S. patients, 58 (94%) were positive on NMR. Thirty-two of these patients had CT scans of which 17 (53%) were positive. Of the 35 controls, 2 were positive on NMR for a false positive rate of 6%. The relative sensitivity of NMR, Double Dose Delayed CT(DDD) and contrast CT in the clinically early progressive group is 87%, 60% and 45% respectively. In the chronic stable group, the sensitivity is 100% for NMR and 55% for DDD. The NMR lesions were graded on a scale of 1 - 4 and the authors found poor correlation with either duration of disease or Kurtzke Functional Scale. The T1, T2 values showed good differentiation between white matter and lesions, although differentiation between lesions and grey matter was poor. White matter has T1 of 328 +- 28 and T2 of 85 +- 22, grey matter T1 of 515 +- 37 and T2 of 96 +- 32 and lesions T1 of 530 +- 76 and T2 of 106 +- 27. They conclude that multi-slice SE 2120/60-120 NMR imaging has proven to be a valuable tool in the clinical diagnosis of Multiple Sclerosis. Most of the lesions seen are asymptomatic and the number, size and distribution of lesions have little correlation with severity or acuity of the disease.

  3. Adaptive Planning in Intensity-Modulated Radiation Therapy for Head and Neck Cancers: Single-Institution Experience and Clinical Implications

    SciTech Connect

    Ahn, Peter H.; Chen, Chin-Cheng [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Ahn, Andrew I. [Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Hong, Linda; Scripes, Paola G.; Shen Jin; Lee, Chen-Chiao; Miller, Ekeni; Kalnicki, Shalom [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Garg, Madhur K., E-mail: mgarg@montefiore.org [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States)

    2011-07-01

    Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

  4. Radioactive colloidal gold in the treatment of endometrial cancer: Mayo Clinic experience, 1952-1976

    SciTech Connect

    Fountain, K.S.; Malkasian, G.D. Jr.

    1981-05-15

    A review of 1670 patients with endometrial cancer who were treated between 1952 and 1976 revealed that 15 patients had received radioactive colloidal gold as an adjunct to surgery. Most of the patients had follow-up more than ten years, and all had microscopic tumor contamination of the peritoneal cavity. Of the 15 patients, 13 had biopsy of peritoneal metastases and underwent resection of gross metastatic lesions that were more than 2 mm in diameter. The other two patients had direct extension of the tumor through the uterus into the peritoneal cavity without visible metastasis. The radiogold was inserted from 4-37 days after the initial surgical procedure. The dosage ranged from 100-140 mCi. At follow-up, from 11 years seven months to 24 years two months after treatment, seven patients were alive without evidence of disease. Three died of intercurrent disease, 16 years, and 14 years, and 14 years two months after treatment. Five patients died of cancer, two with local recurrence and three with distant metastases to lung or bone (or both).

  5. Comparing fourth-year dental student productivity and experiences in a dental school with community-based clinical education.

    PubMed

    Bean, Canise Y; Rowland, Michael L; Soller, Hilary; Casamassimo, Paul; Van Sickle, Rachel; Levings, Kevin; Agunga, Rachel

    2007-08-01

    Reports and articles by the Institute of Medicine, the American Dental Education Association (ADEA) Commission on Change and Innovation in Dental Education (CCI), and the Macy Foundation have examined the challenges confronting dental education and reached the conclusion that U.S. dental education is on the brink of major change. A recent "case for change" article by the CCI makes the argument that dental education, as currently structured, is quickly becoming obsolete, overpriced, and lacking in its ability to provide the education that future practitioners will need. The Ohio State University College of Dentistry (OSUCOD) began a major reorganization of its clinical education program upon receipt of a Robert Wood Johnson Foundation-sponsored Pipeline, Profession, and Practice grant. In our fourth year of the five-year grant program, known as the OHIO Project (Oral Health Improvement through Outreach), our fourth-year dental students approached the sixty-day target of time spent in community-based clinical education. The purpose of this report is to describe the productivity of students and the characteristics of the patient pool they care for in community-based sites as compared to our school-based clinics during that final year. This report reflects the activity of 102 students in the graduating class of 2006. Attendance (clinic utilization) was estimated to be 94 percent at OSUCOD and 99 percent at OHIO Project sites. In the aggregate, the OHIO Project-based students treated a total of 11,808 unique patients and completed 26,882 procedures in the community during their 41.9-day community experience. This translates into 116 unduplicated patients and 264 procedures per student in the community-based sites for the period studied. In comparison, the same students treated 19,344 unique patients and completed 28,680 procedures during ninety-three clinic days at the school. Each student treated 190 patients and completed 281 procedures. Fourth-year dental students completed as many procedures and generated similar revenue-equivalents in community sites as they did in a dental school clinic in half the time. PMID:17687084

  6. Teaching Resident Physicians Chronic Disease Management: Simulating a 10-Year Longitudinal Clinical Experience With a Standardized Dementia Patient and Caregiver

    PubMed Central

    Schlaudecker, Jeffrey D.; Lewis, Timothy J.; Moore, Irene; Pallerla, Harini; Stecher, Anna M.; Wiebracht, Nathan D.; Warshaw, Gregg A.

    2013-01-01

    Background Education for all physicians should include specialty-specific geriatrics-related and chronic disease-related topics. Objective We describe the development, implementation, and evaluation of a chronic disease/geriatric medicine curriculum designed to teach Accreditation Council for Graduate Medical Education core competencies and geriatric medicine competencies to residents by using longitudinal encounters with a standardized dementia patient and her caregiver daughter. Intervention Over 3 half-day sessions, the unfolding standardized patient (SP) case portrays the progressive course of dementia and simulates a 10-year longitudinal clinical experience between residents and a patient with dementia and her daughter. A total of 134 residents participated in the University of Cincinnati-based curriculum during 2007–2010, 72% of whom were from internal medicine (79) or family medicine (17) residency programs. Seventy-five percent of participants (100) said they intended to provide primary care to older adults in future practice, yet 54% (73) had little or no experience providing medical care to older adults with dementia. Results Significant improvements in resident proficiency were observed for all self-reported skill items. SPs' evaluations revealed that residents' use of patient-centered language and professionalism significantly improved over the 3 weekly visits. Nearly all participants agreed that the experience enhanced clinical competency in the care of older adults and rated the program as “excellent” or “above average” compared to other learning activities. Conclusions Residents found this SP-based curriculum using a longitudinal dementia case realistic and valuable. Residents improved in both self-perceived knowledge of dementia and the use of patient-centered language and professionalism. PMID:24404312

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

    SciTech Connect

    Zhou, Y

    2006-08-21

    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, we caution that 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 we introduce the concept of a minimum state as the lowest Reynolds number turbulent flow that a time-dependent mixing transition must achieve to fulfill this objective. Later in the paper we show that the Reynolds number of the minimum state may be determined as 1.6 x 10{sup 5}. Our efforts here can be viewed as a unification and extension of the concepts of both similarity scaling and transient mixing transition concepts. At the last 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 can be devised so that more and more spectral range dynamic structures and their statistical influences on evolving astrophysical flows can be progressively extended in laboratory investigations.

  8. Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis

    Microsoft Academic Search

    Udo Nagele; Markus A. Kuczyk; Marcus Horstmann; Jörg Hennenlotter; Karl-Dietrich Sievert; David Schilling; Ute Walcher; Arnulf Stenzl; Aristotelis G. Anastasiadis

    2008-01-01

    Objectives  Long-term ureteral stenting is used to ensure urinary drainage if a reconstructive approach or a release of an extrinsic obstruction\\u000a is not possible. In this contribution, a long-term experience with a new full-length, metal indwelling stent is presented.\\u000a \\u000a \\u000a \\u000a Methods  Fourteen patients with ureteral obstruction received full metal indwelling stents in 18 collecting systems (benign disease\\u000a in 5 and malignant disease in

  9. Clinical experience with EPID dosimetry for prostate IMRT pre-treatment dose verification

    SciTech Connect

    McDermott, L. N.; Wendling, M.; Asselen, B. van; Stroom, J.; Sonke, J.-J.; Herk, M. van; Mijnheer, B. J. [Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)

    2006-10-15

    The aim of this study was to demonstrate how dosimetry with an amorphous silicon electronic portal imaging device (a-Si EPID) replaced film and ionization chamber measurements for routine pre-treatment dosimetry in our clinic. Furthermore, we described how EPID dosimetry was used to solve a clinical problem. IMRT prostate plans were delivered to a homogeneous slab phantom. EPID transit images were acquired for each segment. A previously developed in-house back-projection algorithm was used to reconstruct the dose distribution in the phantom mid-plane (intersecting the isocenter). Segment dose images were summed to obtain an EPID mid-plane dose image for each field. Fields were compared using profiles and in two dimensions with the {gamma} evaluation (criteria: 3%/3 mm). To quantify results, the average {gamma} ({gamma}{sub avg}), maximum {gamma} ({gamma}{sub max}), and the percentage of points with {gamma}<1(P{sub {gamma}}{sub lt1}) were calculated within the 20% isodose line of each field. For 10 patient plans, all fields were measured with EPID and film at gantry set to 0 deg. . The film was located in the phantom coronal mid-plane (10 cm depth), and compared with the back-projected EPID mid-plane absolute dose. EPID and film measurements agreed well for all 50 fields, with <{gamma}{sub avg}>=0.16, <{gamma}{sub max}>=1.00, and =100%. Based on these results, film measurements were discontinued for verification of prostate IMRT plans. For 20 patient plans, the dose distribution was re-calculated with the phantom CT scan and delivered to the phantom with the original gantry angles. The planned isocenter dose (plan{sub iso}) was verified with the EPID (EPID{sub iso}) and an ionization chamber (IC{sub iso}). The average ratio, , was 1.00 (0.01 SD). Both measurements were systematically lower than planned, with and =0.99 (0.01 SD). EPID mid-plane dose images for each field were also compared with the corresponding plane derived from the three dimensional (3D) dose grid calculated with the phantom CT scan. Comparisons of 100 fields yielded <{gamma}{sub avg}>=0.39, {gamma}{sub max}=2.52, and =98.7%. Seven plans revealed under-dosage in individual fields ranging from 5% to 16%, occurring at small regions of overlapping segments or along the junction of abutting segments (tongue-and-groove side). Test fields were designed to simulate errors and gave similar results. The agreement was improved after adjusting an incorrectly set tongue-and-groove width parameter in the treatment planning system (TPS), reducing <{gamma}{sub max}> from 2.19 to 0.80 for the test field. Mid-plane dose distributions determined with the EPID were consistent with film measurements in a slab phantom for all IMRT fields. Isocenter doses of the total plan measured with an EPID and an ionization chamber also agreed. The EPID can therefore replace these dosimetry devices for field-by-field and isocenter IMRT pre-treatment verification. Systematic errors were detected using EPID dosimetry, resulting in the adjustment of a TPS parameter and alteration of two clinical patient plans. One set of EPID measurements (i.e., one open and transit image acquired for each segment of the plan) is sufficient to check each IMRT plan field-by-field and at the isocenter, making it a useful, efficient, and accurate dosimetric tool.

  10. The Effect of Level of Patient Acuity, Critical Care Experience, and ACLS Certification on Clinical Decision Making: Implications for Computer Decision Support Systems

    PubMed Central

    Henry, Suzanne Bakken

    1990-01-01

    This study examined the effect of patient acuity, critical care experience, and ACLS certification on clinical decision making. Each subject (N=68) completed two computerized clinical simulations. Ventricular tachycardia (VT) represented the high acuity situation and atrial flutter (AF) the lower acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure/die), and amount of data collected. In the AF simulation, proficiency scores were higher (p=.000), more dysrhythmias were cured (p<.005), and more data were collected (p=.040) than in the VT simulation. Experienced and inexperienced nurses did not differ on proficiency score, however, inexperienced nurses collected more data (p=.048) and cured fewer atrial flutter simulations (p=.04). ACLS certified nurses had higher proficiency scores (p=.033) and collected less data (p=.048). Clinical decision making on two simulations was affected by patient acuity, critical care experience, and ACLS certification. These findings have implications for the design and implementation of clinical decision support systems.

  11. Interviewing to develop Patient-Reported Outcome (PRO) measures for clinical research: eliciting patients' experience.

    PubMed

    Brédart, Anne; Marrel, Alexia; Abetz-Webb, Linda; Lasch, Kathy; Acquadro, Catherine

    2014-01-01

    Patient-reported outcome (PRO) measures must provide evidence that their development followed a rigorous process for ensuring their content validity. To this end, the collection of data is performed through qualitative interviews that allow for the elicitation of in-depth spontaneous reports of the patients' experiences with their condition and/or its treatment. This paper provides a review of qualitative research applied to PRO measure development. A clear definition of what is a qualitative research interview is given as well as information about the form and content of qualitative interviews required for developing PRO measures. Particular attention is paid to the description of interviewing approaches (e.g., semi-structured and in-depth interviews, individual vs. focus group interviews). Information about how to get prepared for a qualitative interview is provided with the description of how to develop discussion guides for exploratory or cognitive interviews. Interviewing patients to obtain knowledge regarding their illness experience requires interpersonal and communication skills to facilitate patients' expression. Those skills are described in details, as well as the skills needed to facilitate focus groups and to interview children, adolescents and the elderly. Special attention is also given to quality assurance and interview training. The paper ends on ethical considerations since interviewing for the development of PROs is performed in a context of illness and vulnerability. Therefore, it is all the more important that, in addition to soliciting informed consent, respectful interactions be ensured throughout the interview process. PMID:24499454

  12. [Two years' experience teaching medical ethics in a hospital clinic course].

    PubMed

    Mantz, J M; Bastian, B

    1991-11-01

    Ethics problems arise from conflict of values: a physician has to take charge of his patients, but advances of sciences and technics make such conflicts more and more frequent. Their solution cannot be left to a mere improvization. Medical ethics have to be taught. In Strasbourg, we have elected to teach compulsory medical ethics in the course of compulsory hospital training, for five mornings running, to groups of ten fifth-year medical students, the place being different each day. Fifteen departments including five specialties, internal medicine, intensive care, pediatrics, gynecology-obstetrics, geriatrics, are involved in this experience. The training takes place near the patient bed in the presence of a medical teacher. Communication and multi-disciplinarity are the characteristics. The teaching is done with the purpose of bringing about reflection in the students, of proposing methods for the discovering and the approach of ethics problems, of leading the students up to the enlightenment of their own scale of evaluation. A few previous lectures about history of ethics through different philosophical systems, about social, economical and cultural implications, are given for basic formation of the students. This teaching experience interests students and teachers greatly. The first ones have the opportunity to perceive a new dimension of medical responsibility, the second ones appreciate this form of recovered fellowship. PMID:1809494

  13. Extension Service Agricultural Experiment Station

    E-print Network

    Tullos, Desiree

    use. The plans use integrated pest management (IPM), which employs chemicals as a last resort ­ a condition that 10 percent of all Oregon children have. As part of the law, each school district must school districts in 2012. Backers say IPM will reduce costs. The Anne Arundel district in Maryland

  14. Extension Service Agricultural Experiment Station

    E-print Network

    Tullos, Desiree

    , abundant soy- bean flour into a superior adhesive for bonding wood composite panels such as plywood economy Revolutionary adhesive developed at the FRL creates jobs and reduces hazardous emissions. The environmentally friendly, cost-competitive adhesive in- spired by the way mussels cling tightly to rocks

  15. The effect of the photobiomodulation in the treatment of Bell's palsy: clinical experience

    NASA Astrophysics Data System (ADS)

    Colombo, Fabio; Marques, Aparecida Maria C.; Carvalho, Carolina M.; Paraguassu, Gardenia M.; de Sousa, José A. C.; Magalhaes, Edival; Cangussu, Maria Cristina T.; de A. Reis, Silvia Regina; Pinheiro, Antonio Luiz B.

    2012-03-01

    The Bell's palsy (G51) consists of a unilateral face paralysis that sudden begins with unknown cause and can result in complete mimic loss or partial paralysis of the face. Damage to the VII cranial nerve can be found in the pathology, promoting mussel's inactivity. The light Photobiomodulation (LPBM) has presented ability of rush the tissue repair, favoring the regeneration of neural structures. The present study aimed to assess the effectiveness use of the 780nm laser and 850nm LED (light-emitting diode) in the treatment of the face paralysis. Were evaluated 14 patients that suffer of Bell's palsy whom were submitted to the light administration, on the Laser Clinic of the UFBA between 2005 and 2010. The treatment was performed by infrared Laser in 11 patients (78.57%), and by LED in 3 patients (21.42%). At the end of the 12 sections, 11 patients (78.57%) had presented themselves cure or with substantial improvement of the initial picture, however 3 patients (21.42%) dealt with infra-red Laser ?780nm had not evolution. The light presented as an effective method for the treatment of Bell's palsy, but the association with the physiotherapy and medications is important.

  16. Clinical experience of lomitapide therapy in patients with homozygous familial hypercholesterolaemia.

    PubMed

    Cuchel, Marina; Blom, Dirk J; Averna, Maurizio R

    2014-09-01

    The microsomal triglyceride transfer protein (MTP) inhibitor lomitapide is a licenced adjunct to a low-fat diet and other lipid-lowering medication, with or without low-density lipoprotein apheresis, for the treatment of adults with homozygous familial hypercholesterolaemia (HoFH). In a recently published phase 3 study, patients with HoFH received lomitapide in addition to maximally tolerated lipid-lowering therapy. Treatment with lomitapide resulted in a mean approximate 50% reduction in LDL-C levels after 26 weeks compared with baseline levels (p < 0.0001). This decrease in LDL-C was maintained at Weeks 56 and 78 (44% [p < 0.0001] and 38% [p = 0.0001], respectively). This paper offers clinical perspectives based on selected case histories of patients participating in the phase 3 lomitapide study. These cases provide illustrative examples of the efficacy of lomitapide, with or without apheresis, and show that the effective management of adverse effects can enable patients to remain on effective treatment. PMID:25257075

  17. Initial Clinical Experience Performing Patient Treatment Verification With an Electronic Portal Imaging Device Transit Dosimeter

    SciTech Connect

    Berry, Sean L., E-mail: BerryS@MSKCC.org [Department of Applied Physics and Applied Mathematics, Columbia University, New York, New York (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Polvorosa, Cynthia; Cheng, Simon; Deutsch, Israel; Chao, K. S. Clifford; Wuu, Cheng-Shie [Department of Radiation Oncology, Columbia University, New York, New York (United States)

    2014-01-01

    Purpose: To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry. Methods and Materials: Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm ? criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm ? criterion. Results: There were 288 transit images analyzed. The overall ? pass rate was 89.1% ± 9.8% (average ± 1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the ? pass rate was 95.7% ± 2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment. Conclusions: The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.

  18. Perioperative ketamine for acute postoperative analgesia: the mayo clinic-Florida experience.

    PubMed

    Porter, Steven B; McClain, Robert L; Howe, Bonnie L; Ardon, Albert E; Mazer, Laura S; Knestrick, Brittany M; Clendenen, Anna M

    2015-06-01

    Many common elective surgeries are associated with moderate-to-severe postoperative pain. These common surgeries include total knee and total hip arthroplasty, thoracotomy, and multilevel lumbar spine surgery. Unfortunately, many patients requiring these surgeries are already in moderate-to-severe pain, necessitating high doses of oral or transdermal opioids preoperatively. This is an established risk factor for difficult-to-control postoperative pain.(1,2) Opioid-sparing interventions are important elements in these patients to promote convalescence and reduce common opioid side effects such as constipation, confusion, pruritus, nausea, vomiting, and urinary retention. Potential interventions to reduce postoperative pain can include nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin, and even invasive therapies such as epidural or peripheral nerve blockade. Ketamine is a well-known anesthetic agent that has opioid-sparing analgesic properties, is noninvasive, and in analgesic doses, has few contraindications. This article will review the basic science behind ketamine, some of the evidence supporting its perioperative use, and the logistics of how the Department of Anesthesia at Mayo Clinic in Jacksonville, Florida rolled out a hospital-wide ketamine infusion protocol. PMID:26003764

  19. Clinical presentation and treatment of Wilson's disease: a single-centre experience.

    PubMed

    Pellecchia, M T; Criscuolo, C; Longo, K; Campanella, G; Filla, A; Barone, P

    2003-01-01

    Thirty patients with Wilson's disease (WD) were observed at a movement disorder clinic between 1970 and 2000. Disease onset was at the mean age (SD) of 14.5 (+/-5.9) years. Presentation with hepatic disease occurred in 12 of 30 patients and with neurologic disease in 15. Three patients were asymptomatic at the time of diagnosis. The mean (SD) delay to diagnosis was 5.9 (+/-5.7) years. Five patients diagnosed in an advanced stage of disease died before initiating treatment. Eighteen patients were followed and treated with D-penicillamine alone or in combination with zinc sulphate. Treatment improved most of neurological symptoms. Dystonic postures, behavioural disturbances and dysarthria were the most resistant neurological signs. 'Pseudo-sclerotic' neurologic involvement predicted a good outcome, whereas hepatic onset and 'classic' neurologic involvement were associated with a poorer prognosis. Two of the 18 treated patients died of hepatic failure due to voluntary discontinuation of therapy. Both D-penicillamine and zinc sulphate were well tolerated. No teratogenic effect of D-penicillamine was observed throughout 5 pregnancies. Our results suggest that D-penicillamine or a combination of D-penicillamine and zinc sulphate is a safe and effective long-term treatment in patients with WD. PMID:12824712

  20. A clinical algorithm for the management of abnormal mammograms. A community hospital's experience.

    PubMed Central

    Gist, D; Llorente, J; Mayer, J

    1997-01-01

    Mammography is an important tool in the early detection of breast cancer, but its use has been criticized for stimulating the performance of unnecessary breast biopsies. We retrospectively reviewed the results of breast biopsies preceded by abnormal mammograms at a community hospital for three 5-month periods--baseline, postintervention, and follow-up--to determine the effectiveness of algorithm-based care for patients with an abnormal mammogram. Cases in which there was a definite or implied recommendation for biopsy by a radiologist revealed a baseline positive predictive value of 4% (2/45), a postintervention positive predictive value of 21% (9/42), and a follow-up phase positive predictive value of 18% (5/28). A Fisher's exact test of the preintervention and postintervention positive predictive values after an abnormal mammogram with a "recommendation for biopsy" was significant (n = 87, P = .023). A Kruskal-Wallis analysis of variance to determine if there had been an increase in the mean lesion size of breast cancers detected over the 3 study periods was not significant. The results of this study suggest that developing a clinical algorithm under the leadership of an opinion leader combined with continuing medical education efforts may be efficacious in reducing the incidence of unnecessary surgical procedures. PMID:9074335

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

    PubMed

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

    2014-03-01

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

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

    SciTech Connect

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

    2013-08-01

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

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

    PubMed Central

    Ruza, Ieva; Mirfakhraee, Sasan; Orwoll, Eric

    2013-01-01

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

  4. Supratentorial extradural hematoma in children: An institutional clinical experience of 65 cases

    PubMed Central

    Nath, Pratap Chandra; Mishra, Sudhansu Sekhar; Das, Srikant; Deo, Rama Chandra

    2015-01-01

    Aim and Objective: To survey the epidemiology, management, and severity of extradural hematoma (EDH) in children. Materials and Methods: All patients of EDH (n = 65) in the age group of 0–16 years admitted to our department during the period of August 13 and July 14 were analyzed retrospectively from the hospital records. In all patients, age, sex, mode of injury, clinical presentation, site of EDH, management, duration of hospitalization, and outcome were evaluated. Observation and Results: Of 65 patients, males were 70.76% with a male to female ratio of 2.4:1, most of the victims (47.69%) were in the age group of 11–16 years. Mean duration of hospitalization was 4.32 days. The most common mode of injury was fall from height in 29 cases (44.61%) followed by road traffic accident (RTA) in 23 cases (35.35%). Temporoparietal EDH was the most common computed tomography finding present in 22 (33.84%) patients. 67.69% patients presented to casualty with minor head injury having Glasgow coma scale (GCS) between 14 and 15. Most common presenting feature was vomiting in 52 cases (80%) and next to it was altered sensorium. The mortality rate was 7.69% (n = 5). Conclusion: Extradural hematoma is a life-threatening entity encountered in pediatric head injury. Timely intervention and diagnosis decrease mortality to a great degree. Most of the mortality is encountered in patients who presented late at the neurosurgical unit with low GCS.

  5. Clinical experience with parotid gland enlargement in HIV infection: a report of five cases in Nigeria.

    PubMed

    Owotade, Foluso J; Fatusi, Olawunmi A; Adebiyi, Kehinde E; Ajike, Sunday O; Folayan, Morenike O

    2005-02-15

    A changing picture of oral lesions associated with HIV/AIDS has been documented. With the use of antiretroviral therapy, salivary gland swellings and other less common conditions associated with HIV/AIDS are now becoming more common. Our review of the literature showed the presence of parotid swelling in HIV-1 infection has increased from a range of 5-10% to 20% in AIDS. However, to the best of our knowledge, none from sub-Saharan Africa, which is the epicenter of the HIV infection and where access to antiretroviral therapy is poorest, has been primarily reported in literature. This report documents five cases of bilateral parotid gland enlargement as the presenting clinical manifestation of HIV/AIDS. The combination of a fine needle aspiration (FNA) biopsy, ultrasound imaging, and histological diagnosis increased the accuracy of diagnosis. While two patients had access to antiretroviral therapy, other modes of management were cystic aspiration and parotidectomy. One of the patients treated with parotidectomy had facial nerve injury, and the short-term aesthetic outcome between surgical treatment and antiretroviral therapy did not appear different. However, all our patients were lost to follow-up within a 2-year period. For a resource-constrained environment like Nigeria where stigma and discrimination is high and access to antiretroviral therapy is limited, there is a need to understand how best to manage a lymphoepithelial lesion in HIV/AIDS patients. PMID:15719085

  6. Clinical experience with atypical antipsychotics in an acute inpatient unit: focus on quetiapine.

    PubMed

    Keks, Nicholas A; Tonso, Michael; Tabone, Kelly; McHugh, Mary; Thomas, Rajan; Tune, Phil; Gelman, Mat

    2006-01-01

    Objective. To evaluate dosing and time to efficacy of atypical antipsychotics in an acute inpatient unit. Methods. Admissions during 2001 were reviewed. Patients primarily treated with an atypical antipsychotic (including those simultaneously commenced on a mood stabiliser and/or antidepressant or receiving benzodiazepines) were evaluated. Non-acute patients, those without medical records or transferred to other hospitals were excluded. Medication details were noted. Results. A total of 137 patients were evaluated; 56 (41%) had received risperidone, 38 (28%) olanzapine, and 37 (27%) quetiapine. Mean doses (mg/day) at discharge were risperidone 4.1±2.3, olanzapine 22.5±10.2, quetiapine 576±472. Dose ranges (mg/day) were risperidone 0.5-12, olanzapine 5-40, quetiapine 50-1800. No differences between atypicals in time to efficacy/concomitant anticholinergics/mood stabilisers were observed. Benzodiazepine use was more frequent with risperidone and olanzapine than quetiapine. No serious side effects with any drug were noted. Quetiapine was rapidly titrated in 20 patients (up to 400 mg on Day 1). In 18 of these, acute disturbance was controlled. Two patients were switched for lack of efficacy, one due to persistent tachycardia, and five for concern about early postural hypotension. Conclusion. These data provide further evidence concerning dose and dose range of atypicals required for optimal clinical outcome. More rapid initiation with quetiapine may be of benefit to some patients in the acute inpatient setting. PMID:24940964

  7. Imaging breast lesions using the Twente photoacoustic mammoscope: ongoing clinical experience

    NASA Astrophysics Data System (ADS)

    Heijblom, M.; Piras, D.; Xia, W.; van Hespen, J. C. G.; van den Engh, F. M.; Klaase, J. M.; van Leeuwen, T. G.; Steenbergen, W.; Manohar, S.

    2012-02-01

    Current imaging modalities are often not able to detect early stages of breast cancer with high imaging contrast. Visualizing malignancy-associated increased hemoglobin concentrations might improve breast cancer diagnosis. Photoacoustic imaging can visualize hemoglobin in tissue with optical contrast and ultrasound resolution, which makes it potentially ideal for breast imaging. The Twente Photoacoustic Mammoscope (PAM) has been designed specifically for this purpose. Based on a successful pilot study in 2007, a large clinical study using PAM has been started in December 2010. PAM uses a pulsed Q-switched Nd:YAG laser at 1064 nm to illuminate a region of interest on the breast. Photoacoustic signals are detected with a 1MHz, unfocused ultrasound detector array. Three dimensional data are reconstructed using an acoustic backprojection algorithm. Those reconstructed images are compared with conventional imaging and histopathology. In the first phase of the study, the goal was to optimize the visualization of malignancies. We performed sixteen technically acceptable measurements on confined breast malignancies. In the reconstructed volumes of all malignancies, a confined high contrast region could be identified at the expected lesion depth. After ten successful measurements, the illumination area was increased and the fluence was substantially decreased. This caused a further significant increase in PAM lesion contrast.

  8. [HOX genes and the limb development in the clinical praxis and in the experiment].

    PubMed

    Snajdr, Pavel; Grim, Milos; Liska, Frantisek

    2010-01-01

    In human, congenital malformations of the limbs are ranked among the most prevalent of all congenital birth defects. Substantial portion of these defects has genetic origin. Increasing knowledge about the particular mutations responsible for limb malformations in human results in the increasing availability of DNA diagnostic procedures for confirmation of clinical diagnosis and family counselling. Increasing understanding of the underlying developmental processes revealed by studying limb defects both in human and animal models may offer better therapeutic options in the future. This review concentrates on the role of Hox genes in limb development. Man, as well as other mammals, has 39 HOX genes, divided into 4 complexes (clusters). HOX genes play a major role in body plan layout and development of many organ systems. Experimental data show that during the limb development, HOX genes influence patterning along the proximodistal and anteroposterior (thumb-little finger) axis of the limb bud. In human, limb malformation was described in patients with mutations in HOXA11, HOXA13, HOXD10, and HOXD13 genes. Most frequent among these malformations are hand-foot-genital syndrome caused by HOXA13 gene mutation, and synpolydactyly caused by HOXD13 mutation. Severity of the phenotype manifestation of these diseases is variable, and depends on the particular mutation type, where point mutations, polyalanine expansions and deletions can take part. PMID:20662453

  9. Preimplantation embryo metabolism and culture systems: experience from domestic animals and clinical implications.

    PubMed

    Absalón-Medina, V A; Butler, W R; Gilbert, R O

    2014-04-01

    Despite advantages of in vitro embryo production in many species, widespread use of this technology is limited by generally lower developmental competence of in vitro derived embryos compared to in vivo counterparts. Regardless, in vivo or in vitro gametes and embryos face and must adjust to multiple microenvironments especially at preimplantation stages. Moreover, the embryo has to be able to further adapt to environmental cues in utero to result in the birth of live and healthy offspring. Enormous strides have been made in understanding and meeting stage-specific requirements of preimplantation embryos, but interpretation of the data is made difficult due to the complexity of the wide array of culture systems and the remarkable plasticity of developing embryos that seem able to develop under a variety of conditions. Nevertheless, a primary objective remains meeting, as closely as possible, the preimplantation embryo requirements as provided in vivo. In general, oocytes and embryos develop more satisfactorily when cultured in groups. However, optimization of individual culture of oocytes and embryos is an important goal and area of intensive current research for both animal and human clinical application. Successful culture of individual embryos is of primary importance in order to avoid ovarian superstimulation and the associated physiological and psychological disadvantages for patients. This review emphasizes stage specific shifts in embryo metabolism and requirements and research to optimize in vitro embryo culture conditions and supplementation, with a view to optimizing embryo culture in general, and culture of single embryos in particular. PMID:24682781

  10. New titanium spacer for cervical laminoplasty: initial clinical experience. Technical note.

    PubMed

    Tani, Satoshi; Suetsua, Futoshi; Mizuno, Junichi; Uchikado, Hisaaki; Nagashima, Hiroyasu; Akiyama, Masahiko; Isoshima, Akira; Ohashi, Hiroki; Hirano, Yoshitaka; Abe, Toshiaki

    2010-01-01

    Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty. PMID:21206196

  11. Quadrilateral space syndrome: the Mayo Clinic experience with a new classification system and case series.

    PubMed

    Brown, Sherry-Ann N; Doolittle, Derrick A; Bohanon, Carol J; Jayaraj, Arjun; Naidu, Sailendra G; Huettl, Eric A; Renfree, Kevin J; Oderich, Gustavo S; Bjarnason, Haraldur; Gloviczki, Peter; Wysokinski, Waldemar E; McPhail, Ian R

    2015-03-01

    Quadrilateral space syndrome (QSS) arises from compression or mechanical injury to the axillary nerve or the posterior circumflex humeral artery (PCHA) as they pass through the quadrilateral space (QS). Quadrilateral space syndrome is an uncommon cause of paresthesia and an underdiagnosed cause of digital ischemia in overhead athletes. Quadrilateral space syndrome can present with neurogenic symptoms (pain and weakness) secondary to axillary nerve compression. In addition, repeated abduction and external rotation of the arm is felt to lead to injury of the PCHA within the QSS. This often results in PCHA thrombosis and aneurysm formation, with distal emboli. Because of relative infrequency, QSS is rarely diagnosed on evaluation of athletes with such symptoms. We report on 9 patients who presented at Mayo Clinic with QSS. Differential diagnosis, a new classification system, and the management of QSS are discussed, with a comprehensive literature review. The following search terms were used on PubMed: axillary nerve, posterior circumflex humeral artery, quadrilateral space, and quadrangular space. Articles were selected if they described patients with symptoms from axillary nerve entrapment or PCHA thrombosis, or if related screening or imaging methods were assessed. References available within the obtained articles were also pursued. There was no date or language restriction for article inclusion; 5 studies in languages besides English were reported in German, French, Spanish, Turkish, and Chinese. PMID:25649966

  12. Teacher Candidates and Latina/o English Learners at Fenton Elementary School: The Role of Early Clinical Experiences in Urban Teacher Education

    ERIC Educational Resources Information Center

    Nasir, Ambareen; Heineke, Amy J.

    2014-01-01

    This study investigates how early clinical experiences impact teacher candidates' learning and experiences with Latina/o English learners in a field-based program housed in a multilingual, urban elementary school. We draw on multiple-case study design and use discourse analysis to explore cases of three candidates. Findings reveal exploration of…

  13. [Expenses and risk of artificial knee joint: a look backward to a 20-year clinical experience].

    PubMed

    Kieser, C; Räber, D

    1996-06-15

    Costs and risks of implantation of prosthetic knee joints are analyzed in this retrospective study. From 1974-1993 514 primary and 34 revision arthroplasties were done in this hospital, all by the same surgeon. 98% of the patient protocols were available and analyzed, but no systematic follow-up was attempted. 82% of the patients were female; mean age at operation was 74 years. Joint destruction was caused by osteoarthritis in 75%, aseptic osteonecrosis in 10%, rheumatoid arthritis in 9% and posttraumatic arthritis in 3.5%. 75% of the patients were obese and had a body mass index > 25 kg/m2. Non-constrained unicompartmental type prostheses were used in 66%, the non-constrained multicompartmental type in 10% and the constrained total rotation knee (Engelbrecht) in 24%. Hospital mortality rate was 0.55% due to myocardial infarction and pulmonary embolism. 3 patients died of septic prosthetic joint infections 5, 7 and 71/2 years after surgery. Perioperative morbidity, typical of the age group above 70 years, was mainly due to cardiovascular and thromboembolic events and gastrointestinal bleeding. Early infection during the first postoperative year was encountered in 3 constrained total knees, but none in nonconstrained type. The calculated operative infection rate was 2.4% for the constrained type, zero for the non-constrained type, and 0.5% for the whole series. Late prosthetic infections occurred in 8 patients up to 12 years after surgery. In comparing non-constrained unicondylar and hinged types of joint replacement, the non-constrained sledge prosthesis involves considerably lower costs in terms of duration of surgery, hospital stay, blood loss, price of the implant, infection rate and difficulties of revision arthroplasty. Lower costs and risks favour the smaller unicondylar implant for use in localized degenerative or necrotic destruction, particularly of the medial compartment of the knee. Semi-constrained total condylar systems are used for more extensive degeneration without evident instability. The indication for hinged endoprostheses is restricted to revision arthroplasty and grossly unstable knees. PMID:8701242

  14. [Experience with the clinical use of laser surgery in the nasal cavity].

    PubMed

    György, S; Ottó, R; Lajos, G; Gábor, E; Andor, H

    1996-02-01

    The authors treated nasal bleedings of various origin, lower turbinate hypertrophy, nasal polyps and rhinolithiasis using different, kinds of surgical lasers for the first time in Hungary. According to their experiences the modern CO2 and Nd-Yag laser with advanced optics are applicable for the purposes of endonasal laser surgery. The use of CO2 laser is indicated for vaporization and cutting of small haemorrhagic areas without strong bleeding, Nd-Yag laser is more suitable for coagulation and vaporization of highly vascularised tissue masses. The, fiber optic introducible into the endoscope makes the Nd-Yag laser useful for almost every endoscopic nasal and paranasal surgery, making simultaneous video-documentation possible. Using lasers combined with endoscopes (in itself or as an independent step of operation) is a method with minimal operational stress and invasivity, which makes effective surgery possible, in many cases as one-day surgery. PMID:8882442

  15. Photodynamic diagnosis following intravesical instillation of aminolevulinic acid (ALA): first clinical experiences in urology

    NASA Astrophysics Data System (ADS)

    Baumgartner, Reinhold; Kriegmair, M.; Stepp, Herbert G.; Lumper, W.; Heil, Peter; Riesenberg, Rainer; Stocker, Susanne; Hofstetter, Alfons G.

    1993-06-01

    Delta Aminolevulinic acid (ALA), a precursor of Protoporphyrin IX (PP IX) in hem biosynthesis has been topically applied in urinary bladders in order to study its potential as fluorescent tumor marker. Preclinical experiments have been performed on chemically induced tumors in rats, revealing a ratio of PP IX-fluorescence intensity up to 20:1 in tumors as compared to healthy urothelium. Synthesis of PP IX has been stimulated in 56 patients by intravesical instillation of a pH-neutral ALA-solution. After an incubation time of two to four hours strong red fluorescence was endoscopically observed even in tiny superficial tumors. Brightness and contrast allows visualization of early stage urothelial diseases with naked eyes and without the necessity suppressing background fluorescence or violet excitation light.

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

    PubMed

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

    2015-01-01

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

  17. Technical experience from clinical studies with INPRES and a concept for a miniature augmented reality system

    NASA Astrophysics Data System (ADS)

    Sudra, Gunther; Marmulla, Ruediger; Salb, Tobias; Gockel, Tilo; Eggers, Georg; Giesler, Bjoern; Ghanai, Sassan; Fritz, Dominik; Dillmann, Ruediger; Muehling, Joachim

    2005-04-01

    This paper is going to present a summary of our technical experience with the INPRES System -- an augmented reality system based upon a tracked see-through head-mounted display. With INPRES a complete augmented reality solution has been developed that has crucial advantages when compared with previous navigation systems. Using these techniques the surgeon does not need to turn his head from the patient to the computer monitor and vice versa. The system's purpose is to display virtual objects, e.g. cutting trajectories, tumours and risk-areas from computer-based surgical planning systems directly in the surgical site. The INPRES system was evaluated in several patient experiments in craniofacial surgery at the Department of Oral and Maxillofacial Surgery/University of Heidelberg. We will discuss the technical advantages as well as the limitations of INPRES and present two strategies as a result. On the one hand we will improve the existing and successful INPRES system with new hardware and a new calibration method to compensate for the stated disadvantage. On the other hand we will focus on miniaturized augmented reality systems and present a new concept based on fibre optics. This new system should be easily adaptable at surgical instruments and capable of projecting small structures. It consists of a source of light, a miniature TFT display, a fibre optic cable and a tool grip. Compared to established projection systems it has the capability of projecting into areas that are only accessible by a narrow path. No wide surgical exposure of the region is necessary for the use of augmented reality.

  18. [Anterior cervical fusion on the lower cervical spine: own clinical experience].

    PubMed

    Pazdernyik, Szilárd; Sándor, László; Elek, Péter; Barzó, Pál

    2010-01-30

    Both acute and chronic instability of the cervical spine can be succesfully treated by anterior crevical fusion. The main goal is to create a spondylodesis through which the instable motion segments are fixed in the position defined by the surgeon. The spondylodesis is realised by the bone healing of the intervertebral space. The consolidation itself is facilitated by the operative stabilisation of the segments involved, and also by the implantation/transplantation of the osteoproductive/osteoinductive materials. The sooner consolidation is achieved, the more likely it is to be able to avoid the material dependent complications and/or that of dislocation. So as to support this theory a retrospective clinical/radiological study was performed. During this the length and the safety of the consolidation was measured by applying various anterior cervical plating systems. A total of 485 patients having cervical injuries or degenerative disc disease were treated by anterior cervical plating. For bone transplantation partly pure autolog spongious partly autolog cortico-spongious morsalised bone chips, furthermore autolog tricortical bone block were applied. A standard protocoll was used for data collection, evaluation and also follow-up. The patients treated with plate systems were divided into 3 groups: Group 1: Non-locked H-plate system with autogeneous cancellous bone (155 trauma patients, for a total of 210 cervical motion segments, 1.35 segments/patients). Group 2: Non-locked H-plate system with tricortical autograft (167 patients, for a total of 290 cervical motion segments, 1.73 segments/patients). Group 3: Locked cervical plate system with tricortical autograft (73 patients, for a total of 110 cervical motion segments, 1.5 segments/patients). Patients treated with standalone cage belong to group 4. These cages were filled with autogenous cortico-spongiosus bone chips (90 patients, for a total of 90 cervical motion segments, 1.0 segments/patients). Evaluations included postoperative clinical, X-ray and CT examination, and follow-ups at 6, 16, 52, and 104 weeks. We established three grades, and classified the degree of bony fusion between the graft and vertebra: not-yet-fused, fused or non-union. When evaluating the results the following statements/observations were made: a) There is a fast and safe consolidation in the case of those patients that underwent dinamic disc osteosynthesis (p = 0.00001). b) Whereas performing fixation with non-locked or locked screw plate systems and strutgrafted with tricortical autograft created prolonged healing requiring months and developed non-unions more often (non-locked screw-plate system versus locked screw-plate system) (p > 0.05). c) Using locked screw-plate fixation systems non-union rate in our study was 21%, suggesting that this form of fixation has only a limited use. d) In our study complete consolidation without pseudoarthrosis was achieved by using standalone cages filled with autolog cortico-spongiosus bone chips, but bony healing was delayed due to cage coating and the substitution of pure autogenous spongiosa for cortico-spongiosus bone chips. It is recommended to treat acute/chronic instability of the cervical spine both by using non-fixed plate system with autolog cancellosus bone and by standalone cage filled with cortico-spongiosus bone chips as well. It is worth keeping in mind that by applying this lattest an extra surgery to harvest the graft will be avoided. PMID:20420121

  19. Clinical experience with a new modified transanal endorectal pull-through for Hirschsprung's disease.

    PubMed

    Dutta, Hemonta Kr

    2010-07-01

    Single-stage transanal endorectal pull-through (TEPT) procedure is now widely used for rectosigmoid Hirschsprung's disease (HD). However, this procedure is associated with some common complications like stricture, enterocolitis, constipation, anastomotic dehiscence and perianal excoriation. The aim of this study was to evaluate the clinical outcomes of a modified TEPT operation in the management of rectosigmoid HD. 45 patients with rectosigmoid HD admitted between August, 2004 and July, 2008 were included in this study. Pre-operative barium enema was done in all of them. Patients in whom the transition zone was well delineated were included in the study. Frozen section biopsy was done to confirm the presence of ganglion cells in the pull-through bowel. All odd number patients were included in group A, where conventional TEPT procedure was performed. All even number patients and the last five patients of the series were in group B. In this group, a modified transanal endorectal procedure was done. The initial part of submucosal dissection and mobilization of aganglionic rectum was the same as in the conventional procedure. The anorectal mucosa was anastomosed end-to-side to the seromuscular coat of the ganglionic bowel. Mobilized bowel was divided at about 2 cm distal to the anastomosis. Six hitching stitches were applied from the free edge of the bowel to the perianal skin so that the anastomosis remains outside the anal verge. The distal redundant bowel was excised on eighth post-operative day. Pre-operative bowel preparation was done in all patients in group A. The bowel preparation was not mandatory in group B patients. Post-operative results of both these groups were compared and analyzed using the Mann-Whitney U test. Mean operative time in group A was 86 min (range 75-95 min) versus 90 min (range 70-100 min) in group B. Average length of the bowel resected was 20 cm (range 10-26 cm) in group A and 22 cm (12-40 cm) in group B. Post-operative feeding was started after 48 h in group A and after 6 h in group B. Average hospital stay was about 8 days in both the groups. Median follow-up was 36 months in group A (range 14-54 months) and 32 months (range 12-52 months) in group B. Anastomotic stricture or stenosis was noted in two patients in group A and none in group B (p < 0.01). Partial anastomotic dehiscence was noted in two patients in group A and none in group B (p < 0.01). Average bowel movement in group A was 6-8 per day at 1 month and 2-6 per day at 6 months. In group B, it was 8-10 at 1 month and 2-8 at 6 months. Cuff narrowing causing constipation was noted in two patients in group A and none in group B (p < 0.01). Enterocolitis following pull-through was noted in two patients in group A and three patients in group B. Four patients in group A and one patient in group B had post-operative constipation. All of them responded to bowel management program: only one of them (group A) required enema; soiling was noted in one patient each in both the groups. Modified TEPT procedure is associated with excellent clinical outcome with fewer complications, and permits early post-operative feeding. Operating time, hospital stay and post-operative bowel movement were comparable with the conventional technique. PMID:20532528

  20. Evaluation of Analytical Errors in a Clinical Chemistry Laboratory: A 3 Year Experience

    PubMed Central

    Sakyi, AS; Laing, EF; Ephraim, RK; Asibey, OF; Sadique, OK

    2015-01-01

    Background: Proficient laboratory service is the cornerstone of modern healthcare systems and has an impact on over 70% of medical decisions on admission, discharge, and medications. In recent years, there is an increasing awareness of the importance of errors in laboratory practice and their possible negative impact on patient outcomes. Aim: We retrospectively analyzed data spanning a period of 3 years on analytical errors observed in our laboratory. The data covered errors over the whole testing cycle including pre-, intra-, and post-analytical phases and discussed strategies pertinent to our settings to minimize their occurrence. Materials and Methods: We described the occurrence of pre-analytical, analytical and post-analytical errors observed at the Komfo Anokye Teaching Hospital clinical biochemistry laboratory during a 3-year period from January, 2010 to December, 2012. Data were analyzed with Graph Pad Prism 5(GraphPad Software Inc. CA USA). Results: A total of 589,510 tests was performed on 188,503 outpatients and hospitalized patients. The overall error rate for the 3 years was 4.7% (27,520/58,950). Pre-analytical, analytical and post-analytical errors contributed 3.7% (2210/58,950), 0.1% (108/58,950), and 0.9% (512/58,950), respectively. The number of tests reduced significantly over the 3-year period, but this did not correspond with a reduction in the overall error rate (P = 0.90) along with the years. Conclusion: Analytical errors are embedded within our total process setup especially pre-analytical and post-analytical phases. Strategic measures including quality assessment programs for staff involved in pre-analytical processes should be intensified. PMID:25745569

  1. Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy

    PubMed Central

    Kimura, Tomoki; Doi, Yoshiko; Nakashima, Takeo; Imano, Nobuki; Katsuta, Tsuyoshi; Takahashi, Shigeo; Kenjo, Masahiro; Ozawa, Shuichi; Murakami, Yuji; Nagata, Yasushi

    2015-01-01

    The purpose of this study was to evaluate the efficacy and safety of volumetric modulated arc therapy (VMAT) after extrapleural pneumonectomy (EPP) in patients with malignant pleural mesothelioma (MPM). A total of 15 patients who received VMAT after EPP were enrolled. All patients were males, and the median age was 67 years (Stage IB in two, II in six, and III in seven patients). The clinical target volume (CTV) included the entire preoperative ipsilateral hemithorax and involved nodal stations. The CTV was generally expanded by 10–15 mm beyond the planning target volume (PTV). The dose prescription was designed to cover 95% of the PTV with 54 Gy in 30 fractions. The median follow-up period was 11 months. Treatment-related toxicities were evaluated by Common Terminology Criteria for Adverse Events (CTCAE) ver. 4. One-year local control, disease-free survival, and overall survival rates were 55.7% [95% confidence interval (CI): 25.6–85.8%], 29.3% (95% CI: 5.3–53.3%), and 43.1% (95% CI: 17.1–69.0%), respectively. According to the histological analysis, the one-year LC rate was significantly worse in patients with non-epithelial type (biphasic and sarcomatoid types) than in patients with epithelial type [epithelial type: 83.3% (95% CI, 53.5–100%), non-epithelial type: 0% (95% CI, 0%), P = 0.0011]. Grade 3 pneumonitis after VMAT was observed in three patients (20.0%); however, no patients died of pulmonary toxicity. VMAT appears to be relatively safe for patients with MPM after EPP because of the low pulmonary dose. PMID:25599996

  2. Clinical features and outcomes of systemic amyloidosis with gastrointestinal involvement: a single-center experience

    PubMed Central

    Lim, A Young; Lee, Ji Hyeon; Jung, Ki Sun; Gwag, Hye Bin; Kim, Do Hee; Kim, Seok Jin; Lee, Ga Yeon; Kim, Jung Sun; Kim, Hee-Jin; Lee, Soo-Youn; Lee, Jung Eun; Jeon, Eun-Seok

    2015-01-01

    Background/Aims The gastrointestinal (GI) tract often becomes involved in patients with systemic amyloidosis. As few GI amyloidosis data have been reported, we describe the clinical features and outcomes of patients with pathologically proven GI amyloidosis. Methods We identified 155 patients diagnosed with systemic amyloidosis between April 1995 and April 2013. Twenty-four patients (15.5%) were diagnosed with GI amyloidosis using associated symptoms, and the diagnoses were confirmed by direct biopsy. Results Among the 24 patients, 20 (83.3%) had amyloidosis light chain (AL), three (12.5%) had amyloid A, and one (4.2%) had transthyretin-related type amyloidosis. Their median age was 57 years (range, 37 to 72), and 10 patients were female (41.7%). The most common symptoms of GI amyloidosis were diarrhea (11 patients, 45.8%), followed by anorexia (nine patients, 37.5%), weight loss, and nausea and/or vomiting (seven patients, 29.2%). The histologically confirmed GI tract site in AL amyloidosis was the stomach in 11 patients (55.0%), the colon in nine (45.0%), the rectum in seven (35.0%), and the small bowel in one (5.0%). Patients with GI involvement had a greater frequency of organ involvement (p = 0.014). Median overall survival (OS) in patients with GI involvement was shorter (7.95 months; range, 0.3 to 40.54) than in those without GI involvement (15.84 months; range, 0.0 to 114.53; p = 0.069) in a univariate analysis. A multivariate analysis of prognostic factors for AL amyloidosis revealed that GI involvement was not a significant predictor of OS (p = 0.447). Conclusions The prognosis of patients with AL amyloidosis and GI involvement was poorer than those without GI involvement, and they presented with more organ involvement and more advanced disease than those without organ involvement. PMID:26161016

  3. Clinical experience with radio-, chemo- and hyperthermotherapy combined trimodality on locally advanced esophageal cancer

    PubMed Central

    ZHU, HAIWEN; HUO, XUDONG; CHEN, LONGYUN; WANG, HANHUA; YU, HONGLIANG

    2013-01-01

    Esophageal cancer is a highly malignant and lethal disease with a low 5-year survival rate. Therefore, an effective treatment modality is required. To investigate the treatment efficacy and toxicity of radio-, chemo- and hyper-thermotherapy combined trimodality on locally advanced esophageal cancer, the medical records of 78 patients with pathologically confirmed esophageal cancer treated with chemoradiotherapy plus hyperthemia at our institution were retrospectively investigated and the 3-year outcome was carefully assessed. All 78 patients received intensity-modulated radiation therapy at a total dose of 60–66 Gy, in a conventional schedule of 1.8–2.1 Gy/fraction, 5 fractions/week. They also received 4–6 courses of chemotherapy, consisting of 450 mg/m2 5-fluorouracil for 1–5 days and 25 mg/m2 cisplatin for 1–5 days, in addition to 6–12 sessions of hyperthermia, performed twice a week. Out of the 78 cases, complete remission of the primary tumor was observed in 31 (39.7%), partial remission in 44 (56.4%) and no change in 3 (3.9%) cases. The treatment response rate was 96.1%. The overall survival (OS) rate at 1, 2 and 3 years was 67.9, 41.0 and 33.3%, respectively. No significant difference in adverse effects was observed between this treatment regimen and other similar studies. Our preliminary results demonstrated that the chemo-, radio- and hyperthermotherapy combined trimodality exhibited excellent short-term clinical outcomes as regards tumor response rate and a sound long-term OS, with endurable adverse events. This trimodal treatment requires further investigation to establish its beneficial role in the treatment of patients with locally advanced esophageal cancer. PMID:24649285

  4. Clinical experience of uterine tumors resembling ovarian sex cord tumors: a clinicopathological analysis of 6 cases

    PubMed Central

    Liu, Cai-Yan; Shen, Yan; Zhao, Jian-Guo; Qu, Peng-Peng

    2015-01-01

    Objective: To compare the clinicopathological features, diagnosis, treatment, and prognosis of two types of uterine sex cord-like tumors. Methods: The clinicopathological features of four uterine tumors resembling ovarian sex cord tumors (UTROSCTs) and two endometrial stromal tumors with sex cord-like elements (ESTSCLEs) were analyzed retrospectively. Results: All patients were premenopausal women. The most common clinical presentation was vaginal bleeding (four cases). Total hysterectomy with or without bilateral adnexectomy was the most common treatment pattern (five cases). A patient with UTROSCTs, presenting with recurrence 10 months after transvaginal submucous myomectomy, underwent a total hysterectomy (case 2). All tumors were polypoid or intramural masses, usually located in the uterine fundus or submucosa. The majority of UTROSCTs were positive for cytokeratin (4/4 cases), one was positive for Wilms tumor protein, and of two cases with smooth muscle actin immunoreactivity, two were positive for desmin. UTROSCTs were positive for two or more sex cord markers, whereas sex cord markers were less frequently detected in ESTSCLEs. CD10 was variably positive in two UTROSCT patients and strongly positive in all ESTSCLE patients. Three UTROSCTs and one ESTSCLE were positive for both estrogen and progesterone receptors. All patients with UTROSCTs were alive without evidence of recurrence. One patient with ESTSCLEs underwent postoperative chemotherapy after total vaginal hysterectomy but developed recurrence at the vaginal stump (case 5). The other patient with ESTSCLEs was lost to follow-up. Conclusion: These UTROSCTs are polymorphic neoplasms with true sex cord differentiation and uncertain malignant potential, which possess a distinct biology from ESTSCLEs.

  5. A New Rotational Thrombectomy Catheter: System Design and First Clinical Experiences

    SciTech Connect

    Schmitt, Hans-Erich [Department of Diagnostic Radiology, University Hospital Basel, Kantonsspital, CH-4031 Basel (Switzerland); Jaeger, Kurt A. [Department of Medicine, Division of Angiology, University Hospital Basel, Kantonsspital, CH-4031 Basel (Switzerland); Jacob, Augustinus L. [Department of Diagnostic Radiology, University Hospital Basel, Kantonsspital, CH-4031 Basel (Switzerland); Mohr, Helmuth [Straub Medical, Straubstrasse, CH-7323 Wangs (Switzerland); Labs, Karl-Heinz [Department of Medicine, Division of Angiology, University Hospital Basel, Kantonsspital, CH-4031 Basel (Switzerland); Steinbrich, Wolfgang [Department of Diagnostic Radiology, University Hospital Basel, Kantonsspital, CH-4031 Basel (Switzerland)

    1999-11-15

    Purpose: To describe a new catheter for the percutaneous mechanical removal of fresh and organized thrombi, and to assess its efficacy and safety in vitro and in vivo. Methods: The catheter consists of a coated stainless steel spiral that rotates at 40,000 rpm over a guidewire inside the whole length of an 8 Fr, single-lumen, polyurethane catheter, driving a dual-blade cutting crown. Abraded occlusion material is sucked into the catheter head through distal side holes and transported by the spiral into a reservoir at the proximal end. The efficacy of the device was tested in arterial models and fresh bovine carotid arteries (n = 72). In a clinical pilot study 10 patients (8 women, 2 men; mean age 70.6 {+-} 10.1 years) with occlusions of the superficial femoral artery (2-12 cm, mean 5.8 cm), not older than 4 weeks, underwent thrombectomy with the new catheter. Results: In arterial models and bovine cadaver arteries the catheter completely removed fresh thrombi. Occlusion material of higher consistency was cut into particles of 100-500 {mu}m and transported outside. Thrombectomy was successful and vessel patency restored in all 10 patients. The ankle/brachial pressure index significantly (p < 0.0005) increased from 0.41 {+-} 0.18 before intervention to 0.88 {+-} 0.15 after 48 hr and to 0.84 {+-} 0.20 after 3 months. Two reocclusions occurred within 14 days after the intervention. Conclusion: Thrombectomy with the new device appears to be feasible and safe in patients with acute and subacute occlusions of the femoropopliteal artery.

  6. Carbon Ion Radiation Therapy for Primary Renal Cell Carcinoma: Initial Clinical Experience

    SciTech Connect

    Nomiya, Takuma [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS), Chiba (Japan)], E-mail: t.nomiya@med.id.yamagata-u.ac.jp; Tsuji, Hiroshi; Hirasawa, Naoki; Kato, Hiroyuki; Kamada, Tadashi; Mizoe, Junetsu [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS), Chiba (Japan); Kishi, Hirohisa [Department of Pathology, Narita Red Cross Hospital, Chiba (Japan); Kamura, Koichi [Department of Urology, National Hospital Organization Chiba-East Hospital, Chiba (Japan); Wada, Hitoshi; Nemoto, Kenji [Department of Radiation Oncology, Yamagata University Hospital, Yamagata (Japan); Tsujii, Hirohiko [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences (NIRS), Chiba (Japan)

    2008-11-01

    Purpose: Renal cell carcinoma (RCC) is known as a radioresistant tumor, and there are few reports on radiotherapy for primary RCC. We evaluated the efficacy of carbon ion radiotherapy (CIRT) for patients with RCC. Methods and Materials: Data for patients with RCC who received CIRT were analyzed. A median total dose of 72 GyE (gray equivalents) in 16 fractions was administered without any additional treatment. Clinical stage was determined based on TNM classification by the International Union Against Cancer (UICC). Local recurrence was defined as definite tumor regrowth after treatment. Results: Data for 10 patients were included in the analyses, including 7 patients with Stage I and 3 patients with Stage IV (T4NxM0 or TxN2M0) disease. The median maximum diameter of the tumor was 43 mm (24-120 mm). The median follow-up for surviving patients was 57.5 months (9-111 months). The 5-year local control rate, progression-free survival rate, cause-specific survival rate, and overall survival rates were 100%, 100%, 100%, and 74%, respectively. Interestingly, treated tumors showed very slow shrinkage, and the tumor in 1 case has been shrinking for 9 years. One patient with muscular invasion (T4 tumor) developed Grade 4 skin toxicity, but no other toxicity greater than Grade 2 was observed. Conclusions: This is one of the few reports on curative radiotherapy for primary RCC. The response of the tumor to treatment was uncommon. However despite inclusion of T4 and massive tumors, favorable local controllability has been shown. The results indicate the possibility of radical CIRT, as well as surgery, for RCC.

  7. Results of a multicenter study of the retrievable Tulip vena cava filter: Early clinical experience

    SciTech Connect

    Neuerburg, Joerg M.; Guenther, Rolf W.; Vorwerk, Dierk [University of Technology Aachen, Department of Diagnostic Radiology (Germany); Dondelinger, Robert F. [University Hospital Liege, Department of Radiology (Belgium); Jaeger, Horst [Staedt. Kliniken Dortmund, Department of Radiology (Germany); Lackner, Klaus J. [University Hospital Cologne, Department of Diagnostic Radiology (Germany); Schild, Hans H. [University Hospital Bonn, Department of Radiology (Germany); Plant, Graham R. [Basingstoke District Hospital, Department of Diagnostic Radiology (United Kingdom); Joffre, Francis G. [Centre Hospitalier Universitaire de Rangueil, Department of Diagnostic Radiology (France); Schneider, Pierre A. [Hopital Cantonal Universitaire, Department of Radiology (Switzerland); Janssen, Johan H. A. [University of Limburg, Department of Cardiology, Academisch Ziekenhuis Maastricht (Netherlands)

    1997-01-15

    Purpose. To evaluate clinically a new, retrievable vena caval filter in a multicenter study. Methods. The Tulip filter is a stainless steel half-basket that is suitable for antegrade or retrograde insertion via an 8.5 Fr introducer sheath. The filter can be retrieved via the jugular approach using an 11 Fr coaxial retrieval system. Forty-eight filters were implanted via the femoral approach and 38 via the jugular approach in 83 patients. Follow-up examinations (plain films, colorcoded duplex sonography) were performed up to 3 years after filter insertion (mean 136 days) in 75 patients. Twenty-seven patients were screened by colorcoded duplex sonography for insertion site thrombosis. Results. An appropriate filter position was achieved in all cases. Insertion problems occurred in 3 cases; these were not due to the filter design but to an imperfect prototype insertion mechanism that has now been modified (n=2) or a manipulation error (n=1). In 2 of these cases the filters were replaced percutaneously; 1 patient required venotomy for filter removal. No further complications due to filter insertion occurred. Two filters were used as temporary devices and were successfully removed after 6 and 11 days, respectively. There was 1 fatal recurrent pulmonary embolism (PE) and 2 non-fatal PE, 5 complete and 3 partial caval occlusions, and 3 caudal migrations of the filter. Insertion site venous thrombosis was not seen in the 27 patients monitored for this complication. Conclusion. Precise placement of the Tulip filter is feasible by either access route and the device appears mechanically stable. Further observations are needed to confirm that safe filter removal is practical up to 10 days after its insertion.

  8. Cost-effective organization of an institutional human cancer biobank in a clinical setting: CRO-Biobank experience toward harmonization.

    PubMed

    Cervo, Silvia; De Paoli, Paolo; Perin, Tiziana; Canzonieri, Vincenzo; Steffan, Agostino

    2015-01-01

    This report describes the organization of the Biobank of the CRO Aviano National Cancer Institute, Aviano (CRO- Biobank), Italy, implemented as a structured facility dedicated to collecting human biological samples. It describes a particular disease-specific biobank and the integration of a research biobank in a clinical setting. The CRO-Biobank's mission is rooted in supporting and implementing cancer research, with its main focus on optimizing technical and quality processes, while also investigating ethical, legal and IT topics.The CRO-Biobank has implemented processes aimed at guaranteeing the safety of the providers, protecting patient privacy and ensuring both the traceability and quality of its samples. Our 8 years of experience allow us to offer insights and useful suggestions that may solve theoretical and practical issues that can arise when starting up new biobanks or developing existing biobanks further. PMID:25744364

  9. Patient flow improvement for an ophthalmic specialist outpatient clinic with aid of discrete event simulation and design of experiment.

    PubMed

    Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon

    2015-06-01

    Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported. PMID:25012400

  10. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models.

    PubMed

    White, Carl W; Martin, James G

    2010-07-01

    Humans can come into contact with chlorine gas during short-term, high-level exposures due to traffic or rail accidents, spills, or other disasters. By contrast, workplace and public (swimming pools, etc.) exposures are more frequently long-term, low-level exposures, occasionally punctuated by unintentional transient increases. Acute exposures can result in symptoms of acute airway obstruction including wheezing, cough, chest tightness, and/or dyspnea. These findings are fairly nonspecific, and might be present after exposures to a number of inhaled chemical irritants. Clinical signs, including hypoxemia, wheezes, rales, and/or abnormal chest radiographs may be present. More severely affected individuals may suffer acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS). Up to 1% of exposed individuals die. Humidified oxygen and inhaled beta-adrenergic agents are appropriate therapies for victims with respiratory symptoms while assessments are underway. Inhaled bicarbonate and systemic or inhaled glucocorticoids also have been reported anecdotally to be beneficial. Chronic sequelae may include increased airways reactivity, which tends to diminish over time. Airways hyperreactivity may be more of a problem among those survivors that are older, have smoked, and/or have pre-existing chronic lung disease. Individuals suffering from irritant-induced asthma (IIA) due to workplace exposures to chlorine also tend to have similar characteristics, such as airways hyperresponsiveness to methacholine, and to be older and to have smoked. Other workplace studies, however, have indicated that workers exposed to chlorine dioxide/sulfur dioxide have tended to have increased risk for chronic bronchitis and/or recurrent wheezing attacks (one or more episodes) but not asthma, while those exposed to ozone have a greater incidence of asthma. Specific biomarkers for acute and chronic exposures to chlorine gas are currently lacking. Animal models for chlorine gas inhalation have demonstrated evidence of oxidative injury and inflammation. Early epithelial injury, airways hyperresponsiveness, and airway remodeling, likely diminishing over time, have been shown. As in humans, ALI/ARDS can occur, becoming more likely when the upper airways are bypassed. Inhalation models of chlorine toxicity provide unique opportunities for testing potential pharmacologic rescue agents. PMID:20601629

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

    PubMed Central

    2014-01-01

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

  12. VP-16 and carboplatin in previously untreated patients with extensive small cell lung cancer: a study of the National Cancer Institute of Canada Clinical Trials Group

    Microsoft Academic Search

    WK Evans; E Eisenhauer; P Hughes; JA Maroun; J Ayoub; FA Shepherd; R Feld

    1988-01-01

    Thirty-four previously untreated patients with extensive small cell lung cancer were treated with a combination of carboplatin 300 mg m-2 i.v. on day 1 and etoposide 100 mg m-2 i.v. on days 1, 2 and 3 every 28 days. Thirty-two patients were assessable for response. Eighteen patients (56%) achieved an objective response (95% confidence limits 38%-73%). Five (16%) had a

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

    Cancer.gov

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

  14. The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters

    PubMed Central

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

    2014-01-01

    Continuous peripheral nerve blocks (CPNB) are commonly used for intraoperative and postoperative analgesia. Our study aimed at describing our experience with ambulatory peripheral nerve catheters. After Institutional Review Board approval, records for all patients discharged with supraclavicular or popliteal catheters between January 1, 2009 and December 31, 2011 were reviewed. A licensed practitioner provided verbal and written instructions to the patients prior to discharge. Daily follow-up phone calls were conducted. Patients either removed their catheters at home with real-time simultaneous telephone guidance by a member of the Acute Pain Service or had them removed by the surgeon during a regular office visit. The primary outcome of this analysis was the incidence of complications, categorized as pharmacologic, infectious, or other. The secondary outcome measure was the average daily pain score. Our study included a total of 1059 patients with ambulatory catheters (769 supraclavicular, 290 popliteal). The median infusion duration was 5 days for both groups. Forty-two possible complications were identified: 13 infectious, 23 pharmacologic, and 6 labeled as other. Two patients had retained catheters, 2 had catheter leakage, and 2 had shortness of breath. Our study showed that prolonged use of ambulatory catheters for a median period of 5 days did not lead to an increased incidence of complications. PMID:25535627

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

    NASA Astrophysics Data System (ADS)

    Gerzer, Rupert

    2014-11-01

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

  16. Clinical Experience of Interferon Alfa-2a Treatment for Refractory Uveitis in Behçet's Disease.

    PubMed

    Park, Ji Youn; Chung, Yoo Ri; Lee, Kihwang; Song, Ji Hun; Lee, Eun So

    2015-07-01

    Behçet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behçet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behçet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients. PMID:26069144

  17. Testing for Hereditary Breast Cancer: Panel or Targeted Testing? Experience from a Clinical Cancer Genetics Practice.

    PubMed

    Doherty, Jennifer; Bonadies, Danielle C; Matloff, Ellen T

    2014-12-01

    Approaches to hereditary breast cancer testing are shifting as multi-gene panels become more widely available. This paper describes our center's experience and outcomes of a 6-gene panel test as a first-tier approach in patients who were candidates for BRCA testing. Between July and December 2013, a 6-gene panel test was ordered for patients meeting criteria for BRCA testing. A retrospective review detailed the mutation and variant of uncertain significance (VUS) rates for the genes analyzed. The mutation rate was 5.2 % (n?=?7) and the VUS rate was 6.7 % (n?=?9). A subsequent review determined the number of BRCA-negative patients who would have been offered additional single gene testing had BRCA, only, been their first-tier test. Applying consensus criteria revealed 7.1 % (n?=?9) cases that met criteria for additional testing. Pedigree analysis by a certified genetic counselor revealed 26.8 % (n?=?34) cases that would have been offered additional testing based on personal and/or family history. Our results suggest that this panel may be warranted as a first-tier test for a small subset of patients, but likely represents over testing for the majority of patients who are candidates for BRCA testing. The genes selected for panels, the extra costs per patient and the chance of VUS must be considered before we uniformly switch from BRCA to full panel testing on all patients. PMID:25475920

  18. Clinical Experience of Interferon Alfa-2a Treatment for Refractory Uveitis in Behçet's Disease

    PubMed Central

    Park, Ji-Youn; Chung, Yoo-Ri; Lee, Kihwang; Song, Ji Hun

    2015-01-01

    Behçet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behçet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behçet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients. PMID:26069144

  19. A review of medication reconciliation issues and experiences with clinical staff and information systems.

    PubMed

    Porcelli, P J; Waitman, L R; Brown, S H

    2010-01-01

    Medication reconciliation was developed to reduce medical mistakes and injuries through a process of creating and comparing a current medication list from independent patient information sources, and resolving discrepancies. The structure and clinician assignments of medication reconciliation varies between institutions, but usually includes physicians, nurses and pharmacists. The Joint Commission has recognized the value of medication reconciliation and mandated implementation in 2006; however, a variety of issues have prevented simple, easy, and universal implementation. This review references issues related to the development and the implementation of medication reconciliation including: - the need of a system or standard for accurate drug identification to create a definitive 'gold standard' patient medication list, - identifying stakeholders of medication reconciliation within the institution and contrasting staff interest and participation with institutional resources, - observations and opportunities of integrating medication reconciliation with the electronic patient health record, and - summarizing a series of institutions experiences developing and implementing medication reconciliation. Last, as medication reconciliation becomes a regular process within medical centers, key concepts for effective implementation are discussed. PMID:23616853

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

    SciTech Connect

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

    2007-02-01

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

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

    PubMed Central

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

    2013-01-01

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

  2. Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment

    PubMed Central

    2012-01-01

    Background Health facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. Methods We investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes. Results Data were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary, facility quality and manager support, relative to other attributes. For medical and laboratory students, tuition support for future training was also important, while pharmacy students valued opportunities for dual practice. Conclusions In Uganda, financial and non-financial incentives may be effective in attracting health workers to underserved areas. Our findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work. Better quality facilities and supportive managers were important to all students. Similarities in preferences for these factors suggest that team-based, facility-level strategies for attracting health workers may be appropriate. Improving facility quality and training managers to be more supportive of facility staff may be particularly cost-effective, as investments are borne once while benefits accrue to a range of health workers at the facility. PMID:22824497

  3. The Influence of Serial Sections, Immunohistochemistry, and Extension of Pelvic Lymph Node Dissection on the Lymph Node Status in Clinically Localized Prostate Cancer

    Microsoft Academic Search

    Friedhelm Wawroschek; Theodor Wagner; Michael Hamm; Dorothea Weckermann; Harry Vogt; Bruno Märkl; Ronald Gordijn; Rolf Harzmann

    2003-01-01

    Objectives: Pelvic lymph node metastases indicate a poor prognosis for patients with clinically localized prostate cancer. The aim of the study was to investigate the value of extended histopathological techniques considering the extent of pelvic lymphadenectomy and preoperative risk factors.Methods: Total of 194 patients with prostate cancer were examined. At first all patients had a sampling of the sentinel lymph

  4. Clinical development of a failure detection-based online repositioning strategy for prostate IMRT--Experiments, simulation, and dosimetry study

    SciTech Connect

    Liu Wu; Qian Jianguo; Hancock, Steven L.; Xing, Lei; Luxton, Gary [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305-5847 (United States) and Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510 (United States); Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305-5847 (United States)

    2010-10-15

    Purpose: To implement and evaluate clinic-ready adaptive imaging protocols for online patient repositioning (motion tracking) during prostate IMRT using treatment beam imaging supplemented by minimal, as-needed use of on-board kV. Methods: The authors examine the two-step decision-making strategy: (1) Use cine-MV imaging and online-updated characterization of prostate motion to detect target motion that is potentially beyond a predefined threshold and (2) use paired MV-kV 3D localization to determine overthreshold displacement and, if needed, reposition the patient. Two levels of clinical implementation were evaluated: (1) Field-by-field based motion correction for present-day linacs and (2) instantaneous repositioning for new-generation linacs with capabilities of simultaneous MV-kV imaging and remote automatic couch control during treatment delivery. Experiments were performed on a Varian Trilogy linac in clinical mode using a 4D motion phantom programed with prostate motion trajectories taken from patient data. Dosimetric impact was examined using a 2D ion chamber array. Simulations were done for 536 trajectories from 17 patients. Results: Despite the loss of marker detection efficiency caused by the MLC leaves sometimes obscuring the field at the marker's projected position on the MV imager, the field-by-field correction halved (from 23% to 10%) the mean percentage of time that target displacement exceeded a 3 mm threshold, as compared to no intervention. This was achieved at minimal cost in additional imaging (average of one MV-kV pair per two to three treatment fractions) and with a very small number of repositionings (once every four to five fractions). Also with low kV usage ({approx}2/fraction), the instantaneous repositioning approach reduced overthreshold time by more than 75% (23% to 5%) even with severe MLC blockage as often encountered in current IMRT and could reduce the overthreshold time tenfold (to <2%) if the MLC blockage problem were relieved. The information acquired for repositioning using combined MV-kV images was found to have submillimeter accuracy. Conclusions: This work demonstrated with a current clinical setup that substantial reduction of adverse targeting effects of intrafraction prostate motion can be realized. The proposed adaptive imaging strategy incurs minimal imaging dose to the patient as compared to other stereoscopic imaging techniques.

  5. The Effect of Nursing Faculty Presence on Students' Level of Anxiety, Self-Confidence, and Clinical Performance during a Clinical Simulation Experience

    ERIC Educational Resources Information Center

    Horsley, Trisha Leann

    2012-01-01

    Nursing schools design their clinical simulation labs based upon faculty's perception of the optimal environment to meet the students' learning needs, other programs' success with integrating high-tech clinical simulation, and the funds available. No research has been conducted on nursing faculty presence during a summative…

  6. Developing an interactive web-based learning program on skin cancer: the learning experiences of clinical educators.

    PubMed

    Shaikh, Waqas R; Geller, Alan; Alexander, Gwen; Asgari, Maryam M; Chanange, Gunther J; Dusza, Stephen; Eide, Melody J; Fletcher, Suzanne W; Goulart, Jacqueline M; Halpern, Allan C; Landow, Shoshana; Marghoob, Ashfaq A; Quigley, Elizabeth A; Weinstock, Martin A

    2012-12-01

    Web-based learning in medical education is rapidly growing. However, there are few firsthand accounts on the rationale for and development of web-based learning programs. We present the experience of clinical educators who developed an interactive online skin cancer detection and management course in a time-efficient and cost-efficient manner without any prior skills in computer programming or technical construction of web-based learning programs. We review the current state of web-based learning including its general advantages and disadvantages as well as its specific utility in dermatology. We then detail our experience in developing an interactive online skin cancer curriculum for primary care clinicians. Finally, we describe the main challenges faced and lessons learned during the process. This report may serve medical educators who possess minimal computer programming and web design skills but want to employ the many strengths of web-based learning without the huge costs associated with hiring a professional development team. PMID:22614576

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

    PubMed Central

    2013-01-01

    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 http://www.bioconductor.org. PMID:23965047

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

    SciTech Connect

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

    1983-05-01

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

  9. Long-term efficacy and safety of rabeprazole in patients taking low-dose aspirin with a history of peptic ulcers: a phase 2/3, randomized, parallel-group, multicenter, extension clinical trial

    PubMed Central

    Fujishiro, Mitsuhiro; Higuchi, Kazuhide; Kato, Mototsugu; Kinoshita, Yoshikazu; Iwakiri, Ryuichi; Watanabe, Toshio; Takeuchi, Toshihisa; Sugisaki, Nobuyuki; Okada, Yasushi; Ogawa, Hisao; Arakawa, Tetsuo; Fujimoto, Kazuma

    2015-01-01

    A 24-week, double-blind, clinical trial of rabeprazole for the prevention of recurrent peptic ulcers caused by low-dose aspirin (LDA) has been reported, but trials for longer than 24 weeks have not been reported. The aim of this study is to assess the long-term efficacy and safety of rabeprazole for preventing peptic ulcer recurrence on LDA therapy. Eligible patients had a history of peptic ulcers on long-term LDA (81 or 100 mg/day) therapy. Patients with no recurrence of peptic ulcers at the end of the 24-week double-blind phase with rabeprazole (10- or 5-mg once daily) or teprenone (50 mg three times daily) entered the extension phase. Rabeprazole doses were maintained for a maximum of 76 weeks, including the double-blind 24-week period and the extension phase period (long-term rabeprazole 10- and 5-mg groups). Teprenone was randomly switched to rabeprazole 10 or 5 mg for a maximum of 52 weeks in the extension phase (newly-initiated rabeprazole 10- and 5-mg groups). The full analysis set consisted of 151 and 150 subjects in the long-term rabeprazole 10- and 5-mg groups, respectively, and the cumulative recurrence rates of peptic ulcers were 2.2 and 3.7%, respectively. Recurrent peptic ulcers were not observed in the newly-initiated rabeprazole 10- and 5-mg groups. No bleeding ulcers were reported. No clinically significant safety findings, including cardiovascular events, emerged. The use of long-term rabeprazole 10- and 5-mg once daily prevents the recurrence of peptic ulcers in subjects on low-dose aspirin therapy, and both were well-tolerated.

  10. Clinical and pathological characteristics of adrenal lymphangioma treated by laparoscopy via a retroperitoneal approach: experience and analysis of 7 cases

    PubMed Central

    Gao, Liang; Zhang, Shu; Wang, Huan; Qiu, Yan; Yang, Lu; Yuan, Jiuhong; Wei, Qiang; Han, Ping

    2015-01-01

    To describe the clinical and pathological characteristics of adrenal lymphangioma (AL) and share our experiences of the treatment of AL with retroperitoneal laparoscopic surgery. All patients pathologically diagnosed with AL were examined. The clinical and pathological characteristics, process of diagnosis, and preparation and treatment of all patients, especially patients treated with laparoscopic surgery, were summarized and retrospectively analyzed. From January 2008 to May 2014, 8 patients underwent adrenalectomies and were diagnosed with AL in our hospital. The median age was 45.5 years. All of these patients experienced a smooth adrenalectomy: 7 performed by laparoscopy via a retroperitoneal approach and 1 performed by open surgery. Five were female and the other 3 were male. These patients had unilateral adrenal lesions. Four were located on the right which to be same as the contralateral. In addition, 1 specimen was assayed by immunohistochemistry (IHC), which revealed positive results for CD31, CD34, Factor VIII-related antigen and D2-40, and negative results for cytokeratin AE1/AE3. During a brief follow up, all patients exhibited favorable results without discomfort. AL is a benign lesion with mild bio-behavior and patients are generally asymptomatic. The use of computerized tomography (CT) combined with enhanced CT has a superior advantage in diagnosis. Laparoscopic adrenalectomies that are performed via a retroperitoneal approach would be a very safe and efficient choice for AL treatment. D2-40 can be considered as a specific IHC marker in the pathological diagnosis of AL. However, pheochromocytoma and adrenal tuberculosis should be ruled out before and during the operation.

  11. Extension and validation of an analytical model for in vivo PET verification of proton therapy—a phantom and clinical study

    NASA Astrophysics Data System (ADS)

    Attanasi, F.; Knopf, A.; Parodi, K.; Paganetti, H.; Bortfeld, T.; Rosso, V.; Del Guerra, A.

    2011-08-01

    The interest in positron emission tomography (PET) as a tool for treatment verification in proton therapy has become widespread in recent years, and several research groups worldwide are currently investigating the clinical implementation. After the first off-line investigation with a PET/CT scanner at MGH (Boston, USA), attention is now focused on an in-room PET application immediately after treatment in order to also detect shorter-lived isotopes, such as O15 and N13, minimizing isotope washout and avoiding patient repositioning errors. Clinical trials are being conducted by means of commercially available PET systems, and other tests are planned using application-dedicated tomographs. Parallel to the experimental investigation and new hardware development, great interest has been shown in the development of fast procedures to provide feedback regarding the delivered dose from reconstructed PET images. Since the thresholds of inelastic nuclear reactions leading to tissue ?+-activation fall within the energy range of 15-20 MeV, the distal activity fall-off is correlated, but not directly matched, to the distal fall-off of the dose distribution. Moreover, the physical interactions leading to ?+-activation and energy deposition are of a different nature. All these facts make it essential to further develop accurate and fast methodologies capable of predicting, on the basis of the planned dose distribution, expected PET images to be compared with actual PET measurements, thus providing clinical feedback on the correctness of the dose delivery and of the irradiation field position. The aim of this study has been to validate an analytical model and to implement and evaluate it in a fast and flexible framework able to locally predict such activity distributions directly taking the reference planning CT and planned dose as inputs. The results achieved in this study for phantoms and clinical cases highlighted the potential of the implemented method to predict expected activity distributions with great accuracy. Thus, the analytical model can be used as a powerful substitute method to the sensitive and time-consuming Monte Carlo approach.

  12. Hypophosphatasia: validation and expansion of the clinical nosology for children from 25 years experience with 173 pediatric patients.

    PubMed

    Whyte, Michael P; Zhang, Fan; Wenkert, Deborah; McAlister, William H; Mack, Karen E; Benigno, Marci C; Coburn, Stephen P; Wagy, Susan; Griffin, Donna M; Ericson, Karen L; Mumm, Steven

    2015-06-01

    Hypophosphatasia (HPP) is caused by loss-of-function mutation(s) within the gene TNSALP that encodes the "tissue-nonspecific" isoenzyme of alkaline phosphatase (TNSALP). In HPP, inorganic pyrophosphate, an inhibitor of mineralization and substrate for TNSALP, accumulates extracellularly often leading to rickets or osteomalacia and tooth loss, and sometimes to craniosynostosis and calcium crystal arthropathies. HPP's remarkably broad-ranging expressivity spans stillbirth from profound skeletal hypomineralization to adult-onset dental problems or arthropathies without bone disease, which is largely explained by autosomal recessive versus autosomal dominant transmission from among several hundred, usually missense, TNSALP mutations. For clinical purposes, this expressivity has been codified according to absence or presence of skeletal disease and then patient age at presentation and diagnosis. Pediatric patients are reported principally with "odonto", "childhood", "infantile", or "perinatal" HPP. However, this nosology has not been tested using a cohort of patients, and the ranges of the clinical and laboratory findings have not been defined and contrasted among these patient groups. To evaluate the extant nosology for HPP in children, we assessed our 25 years experience with 173 pediatric HPP patients. Data were exclusively from inpatient studies. The childhood form of HPP was further designated "mild" or "severe". Here, we focused on demographic, clinical, and dual-energy X-ray absorptiometry parameters compared to data from healthy American children. The 173-patient cohort comprised 64 individuals with odonto HPP, 38 with mild childhood HPP, 58 with severe childhood HPP, and 13 with infantile HPP. None was a survivor of perinatal HPP. TNSALP analysis revealed a mutation(s) in all 105 probands tested. Thirteen mutations were unique. Most patients represented autosomal dominant inheritance of HPP. Mutant allele dosage generally indicated the disorder's severity. Gender discordance was found for severe childhood HPP; 42 boys versus 16 girls (p=0.006), perhaps reflecting parental concern about stature and strength. Key disease parameters (e.g., height, weight, numbers of teeth lost prematurely, grip strength, spine and hip bone mineral density) were increasingly compromised as HPP was designated more severe. Although data overlapped successively between the four patient groups, body size (height and weight) differed significantly. Thus, our expanded nosology for HPP in children organizes the disorder's broad-ranging expressivity and should improve understanding of HPP presentation, natural history, complications, and prognosis. PMID:25731960

  13. Clinical experience with recombinant tissue plasminogen activator in the management of intracardiac and arterial thrombosis in children.

    PubMed

    Olgun, Hasim; Buyukavci, Mustafa; Ceviz, Naci; Sahin, Irfan Oguz; Yildirim, Zuhal Keskin; Colak, Abdurrahim; Tekgunduz, Kadir Serafettin; Caner, Ibrahim

    2014-10-01

    Thrombotic events may complicate the clinical course of many pediatric diseases. Drugs for therapeutic thrombolysis include streptokinase, urokinase and tissue plasminogen activator (t-PA). There is less experience with recombinant t-PA (rt-PA) in children. We aimed to present our experiences with rt-PA in children with intracardiac or peripheral arterial thrombus. We retrospectively reviewed the children who received rt-PA for thrombus. Twenty-two children (13 boys, 9 girls; age range: 1 day-17 years) with intracardiac (n?=?5), prosthetic heart valve (n?=?2) and peripheral arterial (n?=?15) thrombus were evaluated. Twelve (54%) had congenital heart disease, two (9%) had rheumatic heart disease, three (14%) had leukemia and five (23%) had documented sepsis, prematurity or meconium aspiration syndrome. Ten of the 15 peripheral arterial thromboses were observed following cardiac catheterization. Three of the five intracardiac thrombi were detected in children with leukemia. All children received low-molecular-weight heparin. rt-PA (alteplase) infusion (at a dose of 0.01-0.5?mg/kg per h) was administered for different time periods (3-66?h). Ten of 11 patients with peripheral arterial occlusion and three of five patients with intracardiac thrombus showed full recovery. However, there was no response in two patients with intracardiac thrombus and in two patients with heart valve thrombus. Nose bleeding, melena and decreased serum fibrinogen concentration were observed in seven patients during the rt-PA infusion. All bleedings stopped after cessation of rt-PA infusion, and no blood transfusion was required in any patient. We conclude that rt-PA infusion seems effective and well tolerated in children for the treatment of peripheral arterial and intracardiac thrombus. PMID:24806322

  14. Patience, Persistence and Pragmatism: Experiences and Lessons Learnt from the Implementation of Clinically Integrated Teaching and Learning of Evidence-Based Health Care – A Qualitative Study

    PubMed Central

    Young, Taryn; Rohwer, Anke; van Schalkwyk, Susan; Volmink, Jimmy; Clarke, Mike

    2015-01-01

    Background Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes. Methods and Findings We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling. Conclusions Implementing clinically integrated EBHC curricula requires institutional support, a critical mass of the right teachers and role models in the clinical setting combined with patience, persistence and pragmatism on the part of teachers. PMID:26110641

  15. Can complementary and alternative medicine clinical cancer research be successfully accomplished? The Mayo Clinic-North Central Cancer Treatment Group experience.

    PubMed

    Barton, Debra L; Loprinzi, Charles; Jatoi, Aminah; Vincent, Ann; Limburg, Paul; Bauer, Brent; Sood, Amit; Good, Marge; Bearden, James D; Kelaghan, Joseph; Sloan, Jeff

    2006-01-01

    Some critics question whether research on complementary and alternative modalities for patients with cancer can be done efficiently in traditional clinical settings. This article reviews a program of complementary medicine research that has been done in a traditional clinical setting over the past 30 years. Trials using complementary therapies for both symptom management and cancer treatment done by the Mayo Clinic and the North Central Cancer Treatment Group are reviewed. Twenty-seven studies have been developed using complementary therapies, addressing such issues as mucosal and epidermal toxicity, hot flashes, lymphedema, anorexia and cachexia, insomnia, cognitive dysfunction, fatigue, and cancer treatment. Nineteen of them have been completed and have had results published in peer-reviewed clinical journals, whereas two manuscripts are in press. Two other trials have recently completed accrual, and the data are being analyzed so that manuscripts can be prepared. In addition, four clinical trials are actively accruing patients. The data presented in this article demonstrate that complementary and alternative medicine research can be done in a scientifically sound manner. Well-designed and adequately powered studies can be implemented, and large numbers of patients can be accrued. The resulting research evaluations can be published in peer-reviewed medical journals. PMID:17022922

  16. The Role of Retroperitoneal Lymphadenectomy in Clinical Stage B Testis Cancer: The Indiana University Experience (1965 to 1989)

    Microsoft Academic Search

    John P. Donohue; John A. Thornhill; Richard S. Foster; Richard Bihrle; Randall G. Rowland; Lawrence H. Einhorn; Jerome P. Richie

    1995-01-01

    Between 1965 and 1989, 1,180 patients underwent retroperitoneal lymph node dissection for nonseminomatous germ cell testis cancer (638 underwent primary dissection). Of these patients, 174 were considered to have clinical stage B disease preoperatively (suspected retroperitoneal node metastases by clinical staging). Surgery revealed that 41 patients (23%) actually had pathological stage A disease (no cancerous nodes). This nonspecificity in clinical

  17. XCEDE: An Extensible Schema For Biomedical Data

    PubMed Central

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

    2013-01-01

    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 http://www.xcede.org/ PMID:21479735

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

    PubMed Central

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

    2013-01-01

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

  19. Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice – the Frankfurt Experience

    PubMed Central

    Fischer, Dania P.; Zacharowski, Kai D.; Müller, Markus M.; Geisen, Christof; Seifried, Erhard; Müller, Heiko; Meybohm, Patrick

    2015-01-01

    Introduction A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program. PMID:26019704

  20. The Effect of Preservice Laserdisc Presentation of Question Types and Wait-Time Use on Questioning and Wait-Time Use in Clinical Experiences.

    ERIC Educational Resources Information Center

    Wallace, Stephen R.; And Others

    This study explored whether the addition of visual examples through laser disc instruction influenced the learning and application of convergent and divergent questioning techniques and wait-time by preservice elementary education teachers during their clinical experience. The study compared the difference in the frequency of convergent and…

  1. Ten year experience with induction therapy in locally advanced non-small cell lung cancer (NSCLC): is clinical re-staging predictive of pathological staging?q

    Microsoft Academic Search

    Stefano Margaritora; Alfredo Cesario; Domenico Galetta; Antonio D'Andrilli; Giuseppe Macis; Giovanna Mantini; Lucio Trodella; Pierluigi Granone

    Objective: To verify if in our experience with 'induction therapy' in non-small cell lung cancer (NSCLC) the clinical re-staging is really predictive of pathological staging. Materials and methods: From January 1990 to February 2000, 136 patients with locally advanced NSCLC underwent a protocol of induction therapy according to three different treatment plans: Carboplatin 1 radiotherapy - study A; Cisplatin 1

  2. Psychiatric Residents' Attitudes toward and Experiences with the Clinical-Skills Verification Process: A Pilot Study on U.S. and International Medical Graduates

    ERIC Educational Resources Information Center

    Rao, Nyapati R.; Kodali, Rahul; Mian, Ayesha; Ramtekkar, Ujjwal; Kamarajan, Chella; Jibson, Michael D.

    2012-01-01

    Objective: The authors report on a pilot study of the experiences and perceptions of foreign international medical graduate (F-IMG), United States international medical graduate (US-IMG), and United States medical graduate (USMG) psychiatric residents with the newly mandated Clinical Skills Verification (CSV) process. The goal was to identify and…

  3. Mapping clinical phenotype data elements to standardized metadata repositories and controlled terminologies: the eMERGE Network experience

    PubMed Central

    Wang, Janey; Kashyap, Sudha; Basford, Melissa; Li, Rongling; Masys, Daniel R; Chute, Christopher G

    2011-01-01

    Background Systematic study of clinical phenotypes is important for a better understanding of the genetic basis of human diseases and more effective gene-based disease management. A key aspect in facilitating such studies requires standardized representation of the phenotype data using common data elements (CDEs) and controlled biomedical vocabularies. In this study, the authors analyzed how a limited subset of phenotypic data is amenable to common definition and standardized collection, as well as how their adoption in large-scale epidemiological and genome-wide studies can significantly facilitate cross-study analysis. Methods The authors mapped phenotype data dictionaries from five different eMERGE (Electronic Medical Records and Genomics) Network sites studying multiple diseases such as peripheral arterial disease and type 2 diabetes. For mapping, standardized terminological and metadata repository resources, such as the caDSR (Cancer Data Standards Registry and Repository) and SNOMED CT (Systematized Nomenclature of Medicine), were used. The mapping process comprised both lexical (via searching for relevant pre-coordinated concepts and data elements) and semantic (via post-coordination) techniques. Where feasible, new data elements were curated to enhance the coverage during mapping. A web-based application was also developed to uniformly represent and query the mapped data elements from different eMERGE studies. Results Approximately 60% of the target data elements (95 out of 157) could be mapped using simple lexical analysis techniques on pre-coordinated terms and concepts before any additional curation of terminology and metadata resources was initiated by eMERGE investigators. After curation of 54 new caDSR CDEs and nine new NCI thesaurus concepts and using post-coordination, the authors were able to map the remaining 40% of data elements to caDSR and SNOMED CT. A web-based tool was also implemented to assist in semi-automatic mapping of data elements. Conclusion This study emphasizes the requirement for standardized representation of clinical research data using existing metadata and terminology resources and provides simple techniques and software for data element mapping using experiences from the eMERGE Network. PMID:21597104

  4. A Treatment Protocol for Restoring Occlusal Vertical Dimension Using an Overlay Removable Partial Denture as an Alternative to Extensive Fixed Restorations: A Clinical Report

    PubMed Central

    Patel, Mit B; Bencharit, Sompop

    2009-01-01

    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

  5. Extension 720

    NSDL National Science Digital Library

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

  6. SU-E-T-68: Clinical Implementation of Total Skin Electron Beam Therapy: A New- York Presbyterian Hospital Experience

    SciTech Connect

    Afghan, M; Shih, R; Chen, H [New York Presbyterian/Columbia Hospital, NY, NY (United States); Kulidzhanov, F; Sabbas, A [New York Presbyterian Hospital/Cornell, NY, NY (United States)

    2014-06-01

    Purpose: Total skin electron beam therapy (TSET) is used in the treatment of rare skin diseases such as mycosis fungoides, the most common type of cutaneous T-cell lymphoma. We report our experience with clinical implementation of TSET. Methods: A modified six-dual-field irradiation technique was chosen to deliver TSET. A Varian Trilogy linear accelerator with a nominal 6 MeV beam using high dose rate total skin electron mode (HDTSe) was employed. The recommendations of AAPM task group report 23 were followed for the commissioning. An acrylic plate (energy degrader) of 3.2 mm depth was mounted on the HDTSe applicator. The nominal source to skin distance was set at 450 cm. The optimum tilt angle of the gantry was determined using NACP-02 ionization chamber embedded in certified therapy grade solid water. Percent depth dose measurements were performed using ionization chamber and radiochromic films embedded in solid water and anthropomorphic phantom. For absolute dose measurements, TG-51 formalism was employed. The dose distribution on the entire skin was measured by irradiating the anthropomorphic phantom, with TLDs attached, mimicking the real treatment. Results: The 3.2 mm acrylic plate mounted on the HDTSe applicator degraded the energy of the electron beam to 4.1 MeV in the treatment plane, located at an SSD of 450 cm. The optimum tilt angle was found to be ±20°. A single-dual field had a longitudinal uniformity, measured at a depth of dose maximum, of ±7% over a length of about 200 cm. For the entire treatment the multiplication factor was found to be 2.86. On the surface of the phantom, the dose varied from 108% to 93% of the prescription dose. Conclusion: We have successfully commissioned TSET meeting the guidelines of the TG report 23, and treated our first patient on February 25, 2014.

  7. The core of mentorship: medical students' experiences of one-to-one mentoring in a clinical environment.

    PubMed

    Kalén, Susanne; Ponzer, Sari; Silén, Charlotte

    2012-08-01

    Mentoring has been used in different health care educational programmes, but the core of mentorship, i.e., facilitating the development of medical students' professional competence, has not been explored in depth in the literature. In order to create effective and meaningful mentoring programmes, there is a need for deeper knowledge of the meaning of formal mentorship and, for this, the students' experiences are important. A mentoring program was set up where all medical students were offered a mentor during their first clinical courses; years 3-4. The mentors were physicians and their role as mentors was to support the students and act as sounding-boards, not to teach or assess knowledge. This study aimed to get a deeper understanding of the meaning of mentorship seen from the perspective of undergraduate medical students. A qualitative approach with individual interviews (N = 12) and inductive content analysis was chosen to investigate and interpret the meaning of mentorship. The results comprise three overarching themes: Space, Belief in the future and Transition. Having a mentor gave a sense of security and constituted a 'free zone' alongside the undergraduate programme. It gave hope about the future and increased motivation. The students were introduced to a new community and began to identify themselves as doctors. We would argue that one-to-one mentoring can create conditions for medical students to start to develop some parts of the professional competences that are more elusive in medical education programmes, such as reflective capacity, emotional competence and the feeling of belonging to a community. PMID:21792708

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

    Microsoft Academic Search

    James S. Kahn; Joan F. Hilton; T. Van Nunnery; Skip Leasure; Kelly M. Bryant; C. Bradley Hare; David H. Thom

    2010-01-01

    Personal health records (PHRs) are information repositories; however, PHRs may be less available to persons in the safety net setting. We deployed a free, secure, internet-based PHR for persons receiving care at the AIDS\\/HIV clinic at San Francisco General Hospital. In our initial rollout, 221 persons registered for the PHR. Compared to the entire clinic, these initial users were more

  9. The safety profile of infliximab in patients with Crohn’s disease: The Mayo Clinic experience in 500 patients

    Microsoft Academic Search

    Jean-Frederic Colombel; Edward V. Loftus; William J. Tremaine; Laurence J. Egan; W. Scott Harmsen; Cathy D. Schleck; Alan R. Zinsmeister; William J. Sandborn

    2004-01-01

    Background & Aims: The aim of this study was to evaluate the short- and long-term safety of infliximab in patients with Crohn’s disease in clinical practice. Methods: The medical records of 500 consecutive patients treated with infliximab at the Mayo Clinic were reviewed and abstracted for demographic features and adverse events. The likelihood of a causal relationship to infliximab for

  10. A Light at the End of the Tunnel: The Impact of Early Clinical Experiences on Medical Students.

    ERIC Educational Resources Information Center

    Mann, Mary Pat

    This paper describes the impact of early clinical contact (ECC) on medical students. The concepts emerged from a grounded theory analysis of interviews with students and faculty in the ECC program at Ohio University College of Osteopathic Medicine, which places first-year and second-year students in a variety of clinical settings in ambulatory…

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

    E-print Network

    Liskiewicz, Maciej

    industry, Extension specialists are developing protocols for best management practices to recycle- cultural products. nDevelop and deliver programs to enhance agricultural literacy. nInterpret policy resources to address urban/rural interface issues. nProvide education to conserve and protect Virginia

  12. Best Practice Irrigation Management and Extension in Peri-Urban Landscapes--Experiences and Insights from the Hawkesbury-Nepean Catchment, Australia

    ERIC Educational Resources Information Center

    Maheshwari, B. L.; Plunkett, M.

    2015-01-01

    Purpose: The aim of this article to examine key irrigation management issues and their implications for future research and extension developments. Design/Methodology/Approach: Peri-urban landscapes are important as they supply fresh fruit, vegetables, turf, ornamental plants and other farm products to the cities. In this study, the…

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

    E-print Network

    New Hampshire, University of

    centers on raised beds covered with Biotelo biodegradable black plastic mulch. One application of carbaryl; teardrop-shaped golden fruit. Goldprize (R) - - 6 - 4 - 1 Tapered, fairly smooth yellow fruits. Slick Pik & AGRICULTURE http://extension.unh.edu/Agric http://www.colsa.unh.edu/aes/ Slick PikZephyr Leaf yellowing

  14. A review of clinical experience with the prandial glucose regulator, repaglinide, in the treatment of type 2 diabetes.

    PubMed

    Moses, R

    2000-12-01

    Repaglinide is a novel insulin secretagogue that was developed as a prandial glucose regulator for the treatment of people with Type 2 diabetes mellitus. It is used flexibly, taken prior to meals, in order to limit subsequent postprandial blood glucose excursions as well as the dependent basal blood glucose concentration. In theory, the pharmacological profile of repaglinide is well suited for this role. Taken at mealtimes, its relatively rapid-onset and short-duration of action counteract a fundamental pathophysiological aspect of this disease: attenuation of the prandial insulin response. The predominantly hepatic elimination profile and a lack of drug-drug interactions with repaglinide are also properties well suited for patients with Type 2 diabetes. Importantly, the pharmacokinetic properties of repaglinide, are expected to reduce the risk of hypoglycaemia in comparison to the conventional insulin secretagogues (sulphonylureas). A reduced risk of hypoglycaemia carries the advantage that patients are not obliged to consume meals at regular intervals supplemented by snacks, so caloric restriction is feasible and lifestyle not compromised. These theoretical advantages have now been largely borne-out by clinical studies and empirical experience. Placebo-controlled studies have consistently demonstrated the antidiabetic efficacy of repaglinide, with improvements having been shown in all indicators of glycaemic control. Double-blind, active-comparator studies have shown repaglinide to have an antidiabetic efficacy that is at least equivalent to sulphonylureas, even when food intake and dosing intervals were controlled according to the requirements of sulphonylureas. Pooled data from these studies have shown that the risk of severe hypoglycaemia is reduced by 60% (p = 0.03) when repaglinide is used in preference to sulphonylureas. There is also evidence that the blood glucose threshold at which symptoms of hypoglycaemia are perceived by patients may be better preserved during treatment with repaglinide than with sulphonylureas. Studies examining flexible prandial dosing with repaglinide have shown that good glycaemic control and a low risk of hypoglycaemia are achievable goals that are independent of the meal (and, hence, dosing) pattern chosen by the patient. Furthermore, when used in this way, repaglinide has not been associated with weight gain. In combination therapy, repaglinide has been shown to act in synergy with both metformin and troglitazone. The possibility of a 'new' basal-bolus regimen combining repaglinide and exogenous (neutral protamine hagedorn) NPH insulin strategy has also been investigated. PMID:11249478

  15. First experience in pulsed YAG-laser clinical applications in endoscopic surgery for gallstone destruction and operations on peripapillary zone

    NASA Astrophysics Data System (ADS)

    Yurchenko, S. V.; Manevich, V. D.; Meshkov, Vladimir M.; Kornilov, Yu. M.; Manenkov, Alexander A.; Upyrev, A. V.; Ryabykh, V. I.; Denisov, N. N.; Bagdasarov, V. H.; Starkovsky, A. N.

    1990-09-01

    1. Central Clinical Hospital No 1, the USSR Ministry of Communications, Moscow 2. II Surgery Department, Central Institute for Advanced Medical Training, Moscow 3. Central Clinical Hospital No 4, the USSR Ministry of Communications, Moscow 4. Central Clinical Hospital of the RSFSR Ministry of Health, Moscow 5. General Physics Institute of the USSR Academy of Sciences, Moscow Progress in biliferous system surgery is to a considerable extent associated with realization of endosurgery methods on gallbladder and main biliary tracts. Radical alterations in the treatment tactics and the up-date developments of this trend put forward new technical and methodical tasks. The problem of safe disintegration of gallstones.is one of them. Introduction into clinical practice of endoscopic draining operations on the distal section of hepaticocholedoch eliminating such complications as wedging into it of the stone remains and recurrent lithogenesis, inevitably puts forward the problem of lithotripsy which is often of top priority as determining the radical effect of endosurgical interference.

  16. The Relationship Between Academic Achievement, Nursing Experience, Self Concept, And The Accuracy Of Nursing Student Self-Evaluation Of Clinical Performance

    Microsoft Academic Search

    Daryl Tua Nagel

    1981-01-01

    The major premise of this study was that accurate self-evaluation of clinical performance in the nursing student would directly enhance the development of self-direction as a professional. It was expected that knowledge of the relationships between professional experience, academic achievement, and self concept with accuracy of self-evaluation could be utilized in a structured manner to enrich self-direction. One hundred and

  17. Ten year experience with induction therapy in locally advanced non-small cell lung cancer (NSCLC): is clinical re-staging predictive of pathological staging?

    Microsoft Academic Search

    Stefano Margaritora; Alfredo Cesario; Domenico Galetta; Antonio D'Andrilli; Giuseppe Macis; Giovanna Mantini; Lucio Trodella; Pierluigi Granone

    2001-01-01

    Objective: To verify if in our experience with ‘induction therapy’ in non-small cell lung cancer (NSCLC) the clinical re-staging is really predictive of pathological staging. Materials and methods: From January 1990 to February 2000, 136 patients with locally advanced NSCLC underwent a protocol of induction therapy according to three different treatment plans: Carboplatin+radiotherapy – study A; Cisplatin+5-Fluorouracil+radiotherapy – study B;

  18. The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects

    Microsoft Academic Search

    Vincenzo Giuliano; Concetta Giuliano; Fabio Pinto; Mariano Scaglione

    2002-01-01

    .   The purpose of this study was to determine the value of flexion and extension MR in traumatized cervical spines following\\u000a rear low-impact acceleration–deceleration injury. The cervical spines of 100 consecutive uninjured normal asymptomatic adults\\u000a and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI.\\u000a Subjects were matched for age but not gender.

  19. On experiences of i2b2 (Informatics for integrating biology and the bedside) database with Japanese clinical patients’ data

    PubMed Central

    Takai-Igarashi, Takako; Akasaka, Ryo; Suzuki, Kenji; Furukawa, Takahisa; Yoshida, Makiko; Inoue, Keisuke; Maruyama, Tomohisa; Maejima, Toshimasa; Bando, Masahiro; Takasaki, Masakazu; Sakota, Miki; Eguchi, Maki; Konagaya, Akihiko; Matsuura, Hiroya; Suzumura, Toyotaro; Tanaka, Hiroshi

    2011-01-01

    Informatics for Integrating Biology and the Bedside (i2b2) is a database system to facilitate sharing and reuse of clinical patients' data collected in individual hospitals. The i2b2 provides an ontology based object-oriented database system with highly simple and flexible database schema which enables us to integrate clinical patients' data from different laboratories and different hospitals. 392 patients' data including carcinoma and non-carcinoma specimens from cancer patients are transported from the Integrated Clinical Omics Database (iCOD) to the i2b2 database for a feasibility study to check applicability of i2b2 ontology and database schema on Japanese clinical patients’ data. No modification is required for the i2b2 data model to deal with Japanese characters. Some modification of ontology is required to integrate biomedical information extracted from the cancer patients’ data. We believe that the i2b2 system will be practical infrastructure to integrate Japanese clinical databases if appropriate disease ontology for Japanese patients is provided. PMID:21544172

  20. Patients who return to care after tracking remain at high risk of attrition: experience from a large HIV clinic, Uganda.

    PubMed

    Nakiwogga-Muwanga, A; Musaazi, J; Katabira, E; Worodria, W; Talisuna, S Alamo; Colebunders, R

    2015-01-01

    We determined the retention rate of patients infected with HIV who resumed care after being tracked at the Infectious Diseases Clinic (IDC) in Kampala, Uganda. Between April 2011 and September 2013, patients who missed their clinic appointment for 8-90 days were tracked, and those who returned to the clinic within 120 days were followed up. The proportion of patients retained among tracked patients, and those who resumed care before tracking started was compared. At 18 months of follow up, 33 (39%) of the tracked patients and 72 (61%) of those who had resumed care before tracking started were retained in care. The most important cause of attrition among the traceable was self-transfer to another clinic (38 [73%] patients), whereas among those who resumed care before tracking was loss to follow up (LTFU) (32 [71%] patients). Tracked patients who resume care following a missed appointment are at high risk of attrition. To increase retention, antiretroviral therapy clinics need to adopt a chronic care model which takes into consideration patients' changing needs and their preference for self-management. PMID:24648320

  1. Gender-Specific Differences in Clinical Profile and Biochemical Parameters in Patients with Cushing's Disease: A Single Center Experience

    PubMed Central

    Zhu, Xiaoming; Zeng, Meifang; Zhuang, Yan; Zhou, Yiting; Zhang, Zhaoyun; Yang, Yehong; Wang, Yongfei; Ye, Hongying; Li, Yiming

    2015-01-01

    Cushing's disease (CD) is remarkably prevalent among females; however, more severe clinical presentation and adverse outcomes have been found in males. The purpose of this study was to investigate the overall clinical profile and biochemical parameters in patients with CD to identify the gender differences. Here we describe our series of CD patients referred to our medical center during 2012-2013. Among 73 cases, females presented a marked preponderance compared to males. Males had significantly higher ACTH, BMI, HbA1c, systolic blood pressure, and hemoglobin than females. For the first time, the incidence of fatty liver and hepatic function was also shown to be elevated in males. Multiple linear regression analysis was performed to further investigate the correlation of risk factors with hypokalemia, HbA1c, and systolic blood pressure. Gender and serum cortisol were associated with hypokalemia. Age, gender, and serum cortisol were significantly associated with HbA1c. Additionally, only gender was significantly associated with systolic blood pressure. Regarding clinical presentation, purple striae seemed to occur more frequently in males than in females. Thus, more severe clinical presentation, biochemical parameters, and complications were found in males than in females. Clinical professionals should pay more attention to the diagnosis and management of males with CD.

  2. Twenty years of experience with a clinical ladder: a tool for professional growth, evidence-based practice, recruitment, and retention.

    PubMed

    Pierson, Margaret A; Liggett, Charlotte; Moore, Kim S

    2010-01-01

    A clinical ladder program was introduced in a 257-bed facility 20 years ago. The program, developed by nurses for nurses, has evolved as integral to the facility's recruitment and retention, professional development, and evidence-based practice initiatives. This clinical ladder program has been used to encourage staff nurses to reach outside of their comfort zone to develop new skills. In this way, it has served as a means to identify leadership potential as a tool toward succession planning. The program provided evidence for the institution's Magnet designation (2004) and again for its bid for redesignation in 2008. PMID:20102141

  3. Clinical acupuncture research in the West.

    PubMed

    Meng, Xianze; Xu, Shifen; Lao, Lixing

    2011-06-01

    In recent years, acupuncture has rapidly become part of mainstream medicine in the West, where new developments in acupuncture clinical research show extensive progress in evaluating the efficacy and safety of the modality in many categories of disease, especially in pain conditions. Although challenges and difficulties remain, the acupuncture research community has matured and its past experience may lead to even better methods and more innovative research. PMID:21695617

  4. Validation, Revision, and Evaluation of a Clinical Experience Using Ambulatory Care Facilities as Learning Sites for Student Nurses.

    ERIC Educational Resources Information Center

    Gregory, Faye M.

    A study confirmed the need for an ambulatory nursing experience as part of the vocational nursing (VN) program at the Long Beach City College (LBCC). Information on which to base the revision of the ambulatory care (AC) experience was obtained from a literature review and interviews with the following: AC administrators, California Board of…

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

    PubMed Central

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

    2014-01-01

    Purpose Little is currently known about how parents experience the medical genetics appointment at which their child receives a genetic diagnosis. Methods 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, and the transcribed interviews were coded and sorted, and thematic categories identified. Results 61.5% 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 using 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. Conclusion 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. PMID:24706543

  6. Survivors' Experiences of Dysphagia-Related Services Following Head and Neck Cancer: Implications for Clinical Practice

    ERIC Educational Resources Information Center

    Nund, Rebecca L.; Ward, Elizabeth C.; Scarinci, Nerina A.; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V.

    2014-01-01

    Background: It is known that people with dysphagia experience a number of negative consequences as a result of their swallowing difficulties following head and neck cancer management (HNC). However their perceptions and experiences of adjusting to dysphagia in the post-treatment phase, and the services received to assist this process, has not been…

  7. Electrical Stimulation for Wound Healing: A Review of Evidence From In Vitro Studies, Animal Experiments, and Clinical Trials

    Microsoft Academic Search

    Luther C. Kloth

    2005-01-01

    This article reviews theories linked to endogenous bioelectric currents and the role they may play in wound repair with further appraisal of in vitro and in vivo research related to the effects of clinically applicable electrical currents on protein synthesis, cell migration, and antibacterial outcomes. In addition, studies on the effects of electrical stimulation (ES) on skin grafts, donor sites,

  8. Assessing the Consistency and Educational Benefits of Students' Clinical Experiences during an Ambulatory Care Internal Medicine Rotation.

    ERIC Educational Resources Information Center

    Gruppen, Larry D.; And Others

    1993-01-01

    Analysis of the internal medicine clinical rotations of 43 University of Michigan medical students revealed that students saw many kinds of medical problems but few instances of each and that there were wide gaps in exposure to some typical ambulatory care problems. Student skill gains did not correlate with problem types encountered. (MSE)

  9. Clinical guidelines in early detection of oral squamous cell carcinoma arising in oral lichen planus: a 5-year experience

    Microsoft Academic Search

    M. D. Mignogna; L. Lo Muzio; L. Lo Russo; S. Fedele; E. Ruoppo; E. Bucci

    2001-01-01

    In recent years, studies on the malignant potential of oral lichen planus (OLP) provided clinical evidence that patients affected by OLP have an increased risk to develop oral squamous cell carcinoma (OSCC); nevertheless, controversies still exist as to whether OLP has inherent predisposition to become malignant, or not. We believe extremely careful management of OLP patient is mandatory, and the

  10. Radiologic Pulmonary Findings, Clinical Manifestations and Serious Complications in Scrub Typhus: Experiences From A Teaching Hospital in Eastern Taiwan

    Microsoft Academic Search

    Kun-Ming Wu; Zhe-Wei Wu; Guo-Quan Peng; Jian Liang Wu; Shih-Yi Lee

    2009-01-01

    SUMMARY Background: Scrub typhus (tsutsugamushi disease) is an endemic infectious disease in eastern Taiwan caused by Orientia tsutsugamushi. Methods: A total of 136 cases of scrub typhus were diagnosed from patients' blood samples. Medical records were reviewed and clinical manifestations and chest X-rays were analyzed. Results: Scrub typhus was diagnosed in 136 patients, with a mean age of 40.7 ±

  11. Interprofessional Education in Gross Anatomy: Experience with First-Year Medical and Physical Therapy Students at Mayo Clinic

    ERIC Educational Resources Information Center

    Hamilton, Steven S.; Yuan, Brandon J.; Lachman, Nirusha; Hellyer, Nathan J.; Krause, David A.; Hollman, John H.; Youdas, James W.; Pawlina, Wojciech

    2008-01-01

    Interprofessional education (IPE) in clinical practice is believed to improve outcomes in health care delivery. Integrating teaching and learning objectives through cross discipline student interaction in basic sciences has the potential to initiate interprofessional collaboration at the early stages of health care education. Student attitudes and…

  12. The Benefits of Multidisciplinary Learning in Clinical Practice for Law, Finance, and Social Work Students: An Australian Experience

    ERIC Educational Resources Information Center

    Hyams, Ross; Brown, Grace; Foster, Richard

    2013-01-01

    In July 2010, the faculties of Law, Business and Economics, and Medicine at Monash University, Australia commenced placing law, finance, and social work students in a multidisciplinary clinic at a community legal service operated by the University. Students from the three disciplines began seeing legal service clients at the same time as a team.…

  13. A chance to stop and breathe: participants’ experiences in the North American Opiate Medication Initiative clinical trial

    PubMed Central

    2014-01-01

    Background The North American Opiate Medication Initiative (NAOMI) clinical trial compared the effectiveness of injectable diacetylmorphine (DAM) or hydromorphone (HDM) to oral methadone maintenance treatment (MMT). This study aimed to determine participants’ perceptions of treatment delivered in NAOMI. Methods A qualitative sub-study was conducted with 29 participants (12 female): 18 (62.1%) received injectable DAM or HDM and 11 (37.9%) received MMT. A phenomenological theoretical framework was used. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis was used over successive phases and was driven by the semantic meanings of the data. Results Participants receiving injectable medications suggested that the supervised delivery model was stringent but provided valuable stability to their lives. Females discussed the adjustment required for the clinical setting, while males focused on the challenging clinic schedule and its impact on employment abilities. Participants receiving MMT described disappointment with being randomized to this treatment; however, positive aspects, including the quick titration time and availability of auxiliary services, were also discussed. Conclusion Treatment with injectable DAM (or HDM) is preferred by participants and considered effective in reducing the burden of opioid dependency. Engaging patients in research regarding their perceptions of treatment provides a comprehensive assessment of treatment needs and barriers. Clinical trial registration NCT00175357 PMID:25262567

  14. An Experimental Study of High Intensity Focused Ultrasound on Pig's Pancreas and the Early Clinical Experience on Pancreatic Cancer

    Microsoft Academic Search

    Liulin Xiong; Xiaobo Huang; Songsen Yao; Jinsheng Yu; Jooha Hwang; Xingbo Fei; Qiuhong Yu; Weicheng Xue; Zhuying Zheng; Xiaofeng Wang

    2007-01-01

    Objective: To investigate the feasibility and safety of high intensity focused ultrasound (HIFU) treatment of in vivo pig pancreases, and to evaluate the safety and efficacy of HIFU in the clinical treatment of pancreatic cancer in humans. Methods: HIFU was performed in 12 domestic pig pancreases in vivo with varying acoustic energies. The safety of HIFU treatments was assessed by

  15. Efficacy of Heparinoid PSS in Treating Cardiovascular Diseases and Beyond-A Review of 27 Years Clinical Experiences in China.

    PubMed

    Zeng, Yangyang; Yang, Desheng; Qiu, Peiju; Han, Zhangrun; Zeng, Pengjiao; He, Yanli; Guo, Zhihua; Xu, Lingling; Cui, Yidi; Zhou, Zijing; Zhang, Meng; Hao, Jiejie; Zhang, Lijuan

    2014-09-25

    Propylene glycol alginate sodium sulfate (PSS) is the world's first oral heparinoid approved by Chinese Food and Drug Administration in 1987. Propylene glycol alginate sodium sulfate is produced by modifying partially hydrolyzed alginate, one of the most abundant marine polysaccharides isolated from brown algae, by epoxypropane esterification and by chemical sulfation. It is used for treating and preventing cardiovascular-related diseases. The low cost (US$1.29/100 tablets, ~4 tablets/day), remarkable clinical effects, and convenient oral administration make PSS an ideal long-term prevention drug. Propylene glycol alginate sodium sulfate is available in most drug stores in China, and millions of patients take PSS routinely during the past 27 years. The 22 784 reported clinical cases as well as the structure, preparation, clinical efficacy, adverse reactions, pharmacokinetics, pharmacodynamics, and future perspectives of PSS based on the results of peer-reviewed publications will be discussed. This review should bring the knowledge of PSS gained in China to the world to stimulate in depth academic and clinical studies of PSS. PMID:25258421

  16. Tardive Syndromes are Rarely Reversible after Discontinuing Dopamine Receptor Blocking Agents: Experience from a University-based Movement Disorder Clinic

    PubMed Central

    Zutshi, Deepti; Cloud, Leslie J.; Factor, Stewart A.

    2014-01-01

    Background Several studies have examined reversibility of tardive syndromes (TS), primarily in psychotic patients who are maintained on dopamine receptor blocking drugs. The results have varied widely. However, few have assessed remission rates after discontinuing the offending agents. This study evaluated reversibility of TS in patients who permanently withdrew the causative agent(s). We also examined for any possible clinical predictors of reversibility. Methods A retrospective cohort of 108 TS patients was studied. Most of the patients were not psychotic; most patients were being treated either for a mood disorder with atypical antipsychotics or for a gastrointestinal disturbance with metoclopramide. Patients were stratified on the basis of reversibility, and statistical tests were used for subgroup comparisons of relevant clinical variables. Logistic regression was undertaken to identify clinical variables predictive of reversibility. Results Only 13% of the cohort experienced reversibility of the TS, 2% without medical intervention. When stratified by reversibility, there were no significant differences in any study variables between subgroups. None of the study variables predicted reversibility in the logistic regression. Discussion Our study demonstrated a low remission rate for TS in a cohort of psychiatric and non-psychiatric patients seen in a movement disorder clinic after the offending agents were completely withdrawn. Such a finding has significant prognostic implications. It is possible that limitations of the retrospective design may have resulted in an underestimation. There is a clear need for prospective, multicenter, clinical trials in populations that can be safely withdrawn from dopamine receptor blocking agents so that true remission rates can be measured. PMID:25374768

  17. Preservice Teachers' Reflections on Their Home-School Clinical Teaching Experience: Evidence to Support an Alternative Field Experience for Teacher Educators

    ERIC Educational Resources Information Center

    Everhart, Brett; McKethan, Robert

    2004-01-01

    Teacher education programs continue to search for alternative field experiences for preservice teachers. Whether the public schools are overloaded with interns or a break from certain schools is recommended for various reasons, it is important to identify appropriate alternative practice teaching opportunities prior to student teaching. With the…

  18. The experience of the clinical photographer, when working in both large and small medical illustration departments in the UK.

    PubMed

    Grice, Katherine; Treen, Nicola

    2010-06-16

    Working in a large department with an assorted staff of photographers, managers, graphic designers and administrators numbering thirty-plus is a radically different experience from working in a department that numbers two or three. The authors of this paper have both worked in large and small departments and were quite surprised by the similarities and differences between these two working experiences. Their impressions are shared here. PMID:20557162

  19. Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions.

    PubMed

    Gega, Lina; Marks, Isaac; Mataix-Cols, David

    2004-02-01

    This article describes a broad-spectrum, computer-aided self-help clinic that raised the throughput of anxious/depressed patients per clinician and lowered per-patient time with a clinician without impairing effectiveness. Many sufferers improved by using one of four computer-aided systems of cognitive behavior therapy (CBT) self-help for phobia/panic, depression, obsessive-compulsive disorder, and general anxiety. The systems are accessible at home, two by phone and two by the Web. Initial brief screening by a clinician can be done by phone, and if patients get stuck they can obtain brief live advice from a therapist on a phone helpline. Such clinician-extender systems offer hope for enhancing the convenience and confidentiality of guided self-help, reducing the per-patient cost of CBT, and lessening stigma. The case examples illustrate the clinical process and outcomes of the computer-aided system. PMID:14724922

  20. Genotypic identification of mycobacteria by nucleic acid sequence determination: report of a 2-year experience in a clinical laboratory.

    PubMed Central

    Kirschner, P; Springer, B; Vogel, U; Meier, A; Wrede, A; Kiekenbeck, M; Bange, F C; Böttger, E C

    1993-01-01

    Clinical isolates of Mycobacterium spp. were identified by direct sequence determination of 16S rRNA gene fragments amplified by polymerase chain reaction. Identification was based on a hypervariable region within the 16S rRNA gene in which mycobacterial species are characterized by species-specific nucleotide sequences. A manually aligned data base including the signature sequences of 52 species of mycobacteria easily allowed rapid and correct identification. The results of this study demonstrate that polymerase chain reaction-mediated direct sequence determination can be used as a rapid and reliable method for the identification of mycobacteria in the clinical laboratory. In addition, the prompt recognition of previously undescribed species is now feasible. PMID:7505291

  1. Clinical experience and outcomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital

    Microsoft Academic Search

    G. P. Maguire; A. D. Arthur; P. J. Boustead; B. Dwyer; B. J. Currie

    1998-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized cause of hospital-acquired sepsis. We reviewed the clinical features of a new variant of community-acquired MRSA originally described from the Kimberley region of northern Western Australia (WA MRSA). This strain has become an increasing cause of community- and hospital-acquired sepsis at Royal Darwin Hospital (RDH) in the Northern Territory, especially in Aboriginal Australians

  2. The IFN? treatment of multiple sclerosis (MS) in clinical practice: the experience at the MS Center of Bari, Italy

    Microsoft Academic Search

    M. Trojano; D. Paolicelli; G. B. Zimatore; F. De Robertis; A. Fuiani; E. Di Monte; P. Livrea

    2005-01-01

    Abstract This independent, population-based surveillance study monitored, in clinical practice, the efficacy of interferon\\u000a beta (IFN?) products in 1173 patients with multiple sclerosis (MS) from the Department of Neurological and Psychiatric Sciences,\\u000a University of Bari, Italy. Relapses and Expanded Disability Status Scale (EDSS) scores were evaluated for up to 6 years for\\u000a Avonex, Betaferon and Rebif 22 groups, and for

  3. Clinical experience with VIE-PNN, a knowledge-based system for planning the parenteral nutrition of newborn infants

    Microsoft Academic Search

    Kirchner L; Popow C; Horn W; Dobner M; Seyfang A; Miksch S

    Background: Knowledge-based systems are rarely used in the clinical routine. VIE-PNN, an interactive knowledge-based system, has been integrated in the local network of our patient data management system and used at the bedside since more than two years. Objective: To evaluate the performance and acceptance of a routinely used knowledge- based system. Methodology: Based on a few input data and

  4. Middle Managers' Experiences and Role in Implementing an Interactive Tailored Patient Assessment eHealth Intervention in Clinical Practice.

    PubMed

    Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Børøsund, Elin; Ruland, Cornelia M

    2015-06-01

    The role of nurse and physician managers is considered crucial for implementing eHealth interventions in clinical practice, but few studies have explored this. The aim of the current study was to examine the perceptions of nurse and physician managers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physician managers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice. PMID:25988851

  5. Treatment Extension of Pegylated Interferon Alpha and Ribavirin Does Not Improve SVR in Patients with Genotypes 2/3 without Rapid Virological Response (OPTEX Trial): A Prospective, Randomized, Two-Arm, Multicentre Phase IV Clinical Trial

    PubMed Central

    Heidrich, Benjamin; Cordes, Hans-Jörg; Klinker, Hartwig; Möller, Bernd; Naumann, Uwe; Rössle, Martin; Kraus, Michael R.; Böker, Klaus H.; Roggel, Christoph; Schuchmann, Marcus; Stoehr, Albrecht; Trein, Andreas; Hardtke, Svenja; Gonnermann, Andrea; Koch, Armin; Wedemeyer, Heiner; Manns, Michael P.; Cornberg, Markus

    2015-01-01

    Although sofosbuvir has been approved for patients with genotypes 2/3 (G2/3), many parts of the world still consider pegylated Interferon alpha (P) and ribavirin (R) as standard of care for G2/3. Patients with rapid virological response (RVR) show response rates >80%. However, SVR (sustained virological response) in non-RVR patients is not satisfactory. Longer treatment duration may be required but evidence from prospective trials are lacking. A total of 1006 chronic HCV genotype 2/3 patients treated with P/R were recruited into a German HepNet multicenter screening registry. Of those, only 226 patients were still HCV RNA positive at week 4 (non-RVR). Non-RVR patients with ongoing response after 24 weeks P-2b/R qualified for OPTEX, a randomized trial investigating treatment extension of additional 24 weeks (total 48 weeks, Group A) or additional 12 weeks (total 36 weeks, group B) of 1.5 ?g/kg P-2b and 800-1400 mg R. Due to the low number of patients without RVR, the number of 150 anticipated study patients was not met and only 99 non-RVR patients (n=50 Group A, n=49 Group B) could be enrolled into the OPTEX trial. Baseline factors did not differ between groups. Sixteen patients had G2 and 83 patients G3. Based on the ITT (intention-to-treat) analysis, 68% [55%; 81%] in Group A and 57% [43%; 71%] in Group B achieved SVR (p= 0.31). The primary endpoint of better SVR rates in Group A compared to a historical control group (SVR 70%) was not met. In conclusion, approximately 23% of G2/3 patients did not achieve RVR in a real world setting. However, subsequent recruitment in a treatment-extension study was difficult. Prolonged therapy beyond 24 weeks did not result in higher SVR compared to a historical control group. Trial Registration ClinicalTrials.gov NCT00803309 PMID:26057627

  6. Consumer evaluation of technology-based vertical brand extension

    Microsoft Academic Search

    Hongwei He; Yan Li

    2010-01-01

    Purpose – Little research on brand extension observes the role of technological levels between parent brand and brand extension on consumers' attitudes toward brand extension. The present study aims to explore how consumers evaluate technology-based brand extension and how technologic direction interacts with brand loyalty and fit in affecting brand extension evaluation. Design\\/methodology\\/approach – A field experiment (n=200) was conducted.

  7. Clinical relevance of positive voltage-gated potassium channel (VGKC)-complex antibodies: experience from a tertiary referral centre

    PubMed Central

    Paterson, Ross W; Zandi, Michael S; Armstrong, Richard; Vincent, Angela; Schott, Jonathan M

    2014-01-01

    Background Voltage-gated potassium channel (VGKC)-complex antibodies can be associated with a range of immunotherapy-responsive clinical presentations including limbic encephalitis, Morvan's syndrome and acquired neuromyotonia. However, there are patients with positive levels in whom the significance is uncertain. Objective To evaluate the clinical significance associated with positive (>100?pM) VGKC-complex antibodies. Methods Over a 4-year period, 1053 samples were sent for testing of which 55 were positive. The clinical presentations, final diagnoses and responses to immunotherapies, when given, were assessed retrospectively and the likelihood of autoimmunity was categorised as definite, possible, unlikely or undetermined (modified from Zuliani et al 2012). Results Only 4 of the 32 patients with low-positive (100–400?pM) levels were considered definitely autoimmune, 3 with peripheral nerve hyperexcitability and 1 with a thymoma; 3 were given immunotherapies. Of the remaining 28 with low-positive levels, 13 (3 of whom had tumours) were considered possibly autoimmune, and 15 were unlikely or undetermined; 1 was given immunotherapy unsuccessfully. Of the 23 patients with high-positive (>400?pM) levels, 12 were given immunotherapies, 11 of whom showed a good response. 11 were considered definitely autoimmune, 10 with limbic encephalitis (antibody specificity: 5 LGI1, 1 contactin2, 2 negative, 2 untested) and 1 with a tumour. In the remaining 12, autoimmunity was considered possible (n=9; most had not received immunotherapies), or unlikely (n=3). Conclusions As antibody testing becomes more widely available, and many samples are referred from patients with less clear-cut diagnoses, it is important to assess the utility of the results. VGKC-complex antibodies in the range of 100–400?pM (0.1–0.4?nM) were considered clinically relevant in rare conditions with peripheral nerve hyperexcitability and appeared to associate with tumours (12.5%). By contrast high-positive (>400?pM; >0.4?nM) levels were considered definitely (38%) or possibly (49%) clinically relevant, but not all patients had a ‘classical’ limbic encephalitis and some did not receive immunotherapies. PMID:23757422

  8. Should trainee doctors use the developing world to gain clinical experience? The annual Varsity Medical Debate - London, Friday 20th January, 2012.

    PubMed

    Gilbert, Barnabas J; Miller, Calum; Corrick, Fenella; Watson, Robert A

    2013-01-01

    The 2012 Varsity Medical Debate between Oxford University and Cambridge University provided a stage for representatives from these famous institutions to debate the motion "This house believes that trainee doctors should be able to use the developing world to gain clinical experience." This article brings together many of the arguments put forward during the debate, centring around three major points of contention: the potential intrinsic wrong of 'using' patients in developing countries; the effects on the elective participant; and the effects on the host community. The article goes on to critically appraise overseas elective programmes, offering a number of solutions that would help optimise their effectiveness in the developing world. PMID:23433035

  9. Parental Experiences of Having a Child with Obsessive-Compulsive Disorder: Associations with Clinical Characteristics and Caregiver Adjustment

    Microsoft Academic Search

    Eric A. Storch; Heather Lehmkuhl; Steven L. Pence Jr; Gary R. Geffken; Emily Ricketts; Jill F. Storch; Tanya K. Murphy

    2009-01-01

    We examined parental experience of having a child with obsessive-compulsive disorder (OCD) in 62 parent–child dyads. Youth\\u000a with a primary diagnosis of OCD and their parent(s) were administered the CY-BOCS jointly by a trained clinician. Parents\\u000a completed several measures about their child’s OCD-related impairment and accommodation, emotional and behavioral functioning,\\u000a parental distress, caregiver stress, and parental experiences of having a

  10. Combining the roles of clinical nurse specialist and neonatal nurse practitioner: the experience in one academic tertiary care setting.

    PubMed

    Ditzenberger, G R; Collins, S D; Banta-Wright, S A

    1995-12-01

    The roles of clinical nurse specialist (CNS) neonatal nurse practitioner (NNP) have originated and evolved to meet specific needs in the nursing and medical community. The CNS role was developed in response to the perception that patient care needed to be improved; the NNP role resulted from an acute shortage of physicians to provide neonatal medical management. While on the surface these two roles may appear to be vastly different, many facets of each may be effectively interfaced. The NNP-CNS practice at Doernbecher Neonatal Care Center is an example of successful convergence of the two roles. The implementation of the combined practice is described in this article. PMID:8699360

  11. Micro HTA as a tool for clinical governance: the experience of the Breast Unit in “Santa Maria” Terni Hospital

    PubMed Central

    SANGUINETTI, A.; LUCCHINI, R.; TRIOLA, R.; AVENIA, S.; BISTONI, G.; CONTI, C.; SANTOPRETE, S.; AVENIA, N.

    2013-01-01

    Summary The last decade has witnessed the affirmation of the paradigm Health Technology Assessment (HTA) as a tool for government innovation technology in health care. As is known, this is an approach of evaluation oriented policy making that, in addition to provide for the disclosure of its results, it is proposed to consider simultaneously the clinical, economic, organizational, ethical and social issues arising from the introduction or disposal of a health technology, understood in the broadest sense of the term. In order to reconstruct a realistic picture of its level of implementation we have reproduced a micro HTA which served to assess the Harmonic Focus® device usefulness in breast surgery. PMID:24342156

  12. Experiences with experimental clinical evaluation of a computerized drug delivery system for regulation of mean arterial blood pressure

    Microsoft Academic Search

    K. Ezra Kwok; S. L. Shah; B. A. Finegan; G. K. Kwong

    1999-01-01

    A number of closed-loop control systems have been investigated and developed for the regulation of physiological variables by automatic administration of therapeutic agents. This paper reflects on several years of practical experience, by the authors, in this area including the development of an adaptive computerized drug delivery system. A computerized adaptive drug delivery system has been designed and tested for

  13. Family Experience with Eating Disorders Scale: Exploring Reliability and Validity and Evaluating the Clinical Utility of its Use in Treatment

    Microsoft Academic Search

    Kathleen M. Hoff

    2008-01-01

    The family plays a significant role in the development and maintenance of eating disorders, and may be equally influential in recovery. The deliberate use of an instrument that addresses the perceived family environment is useful in engaging the family in treatment and enhancing treatment outcomes. The Family Experience with Eating Disorders Scale (FEEDS) was used in this study because it

  14. Learning from Multiple Cases: A New Paradigm for Investigating the Effects of Clinical Experience on Knowledge Restructuring and Knowledge Acquisition.

    ERIC Educational Resources Information Center

    Boshuizen, Henny P. A.; Bongaerts, Maureen Machiels; van de Wiel, Margaretha W. J.; Schmidt, Henk G.

    The effects of experience with a series of similar cases on the knowledge restructuring and learning from text were studied in a longitudinal design. Two groups of fourth-year medical students were confronted with a series of cases, part of them having the same underlying disease. The cases were interspersed with fillers, and each set of cases had…

  15. International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results

    Microsoft Academic Search

    Christoph Herrmann

    1997-01-01

    More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and

  16. Page 300 Courses: Education: Reading and Language (EDRL) Sonoma State University 2010-2011 Catalog edrl 527A CliniCAl field experienCe in reAdinG And lAnGuAGe

    E-print Network

    Ravikumar, B.

    the supervision of and in collaboration with clinical faculty and Reading and Language Arts Specialist CredentialPage 300 Courses: Education: Reading and Language (EDRL) Sonoma State University 2010-2011 Catalog edrl 527A CliniCAl field experienCe in reAdinG And lAnGuAGe ArtS (3-6) Supervised practicum

  17. Clinical and laboratory experience of vorinostat (suberoylanilide hydroxamic acid) in the treatment of cutaneous T-cell lymphoma

    PubMed Central

    Duvic, M; Zhang, C

    2006-01-01

    The most common cutaneous T-cell lymphomas (CTCLs) – mycosis fungoides (MF) and Sézary Syndrome – are characterised by the presence of clonally expanded, skin-homing helper-memory T cells exhibiting abnormal apoptotic control mechanisms. Epigenetic modulation of genes that induce apoptosis and differentiation of malignant T cells may therefore represent an attractive new strategy for targeted therapy for T-cell lymphomas. In vitro studies show that vorinostat (suberoylanilide hydroxamic acid or SAHA), an oral inhibitor of class I and II histone deacetylases, induces selective apoptosis of malignant CTCL cell lines and peripheral blood lymphocytes from CTCL patients at clinically achievable doses. In a Phase IIa clinical trial, vorinostat therapy achieved a meaningful partial response (>50% reduction in disease burden) in eight out of 33 (24%) patients with heavily pretreated, advanced refractory CTCL. The most common major toxicities of oral vorinostat therapy were fatigue and gastrointestinal symptoms (diarrhoea, altered taste, nausea, and dehydration from not eating). Thrombocytopenia was dose limiting in patients receiving oral vorinostat at the higher dose induction levels of 300?mg twice daily for 14 days. These studies suggest that vorinostat represents a promising new agent in the treatment of CTCL patients. Additional studies are underway to define the exact mechanism (s) of by which vorinostat induces selective apoptosis in CTCL cells and to further evaluate the antitumour efficacy of vorinostat in a Phase IIb study in CTCL patients.

  18. Clinical Characteristics of Cerebral Venous Sinus Thrombosis in Patients with Systemic Lupus Erythematosus: A Single-Centre Experience in China

    PubMed Central

    Wang, Li; Chen, Hua; Zhang, Yao; Liu, Wanli; Zheng, Wenjie; Zhang, Xuan; Zhang, Fengchun

    2015-01-01

    Clinical characteristics of systemic lupus erythematosus (SLE) patients complicated with cerebral venous sinus thrombosis (CVST) between 2000 and 2013 were analyzed through this retrospective, single-centre study. Of 4747 hospitalized SLE patients, 17 (0.36%, 12 females, average age 30) had CVST. Headache (88.2%) was the most common neurological symptom followed by nausea or vomiting (47.1%), conscious disturbance (41.2%), edema of eyelids or conjunctiva (35.3%), blurred vision or diplopia (35.3%), and seizure (35.3%). Increased intracranial pressure (ICP) occurred in 13 cases (76.5%). Magnetic resonance venography (MRV) detected thrombosis in the transverse (82.4%), sigmoid (52.9%), and sagittal (35.3%) sinuses, with frequent (70.6%) multiple sinus occlusions. Compared to SLE patients without CVST, SLE patients with CVST had a higher prevalence of thrombocytopenia and positive antiphospholipid antibodies and a higher SLE disease activity index (SLEDAI) score. 13 patients achieved improvement following glucocorticoids and immunosuppressants treatment, as well as anticoagulants, while 3 patients died at the hospital. CVST is relatively rare in SLE and tends to occur in active lupus patients. Intracranial hypertension is common but nonspecific clinical feature, so MRV evaluation is necessary to establish a diagnosis. Aggressive treatment for the rapid control of SLE activity combined with anticoagulants can improve the prognosis. PMID:26090493

  19. Management of leg ulcers in patients with chronic venous insufficiency: the experience of a Dermatology Clinic in Bucharest, Romania.

    PubMed

    Salavastru, C M; Nedelcu, L E; Tiplica, G-S

    2012-01-01

    Venous ulcers are the most severe skin manifestation of chronic venous insufficiency. Treatment is complex and it is performed according to the stage of the disease. It includes changes of lifestyle, compressive therapy, phlebotropic medication, topical therapy of the ulcer, antibiotic therapy (topical and systemic), sclerotherapy, and surgical treatment. Patients with venous leg ulcers that attend the Second Dermatology Clinic of Colentina Clinical Hospital, are treated both as inpatients and as outpatients. They benefit from topical treatment and bandaging performed by specialized medical personnel in separate treatment room with strictly monitored conditions of asepsis and antisepsis. A follow-up study of these patients was made from January 1, 2009 to December 31, 2011. The average age of patients was 65.9 years (± 14.2), most of them being in the eight decade of life (31.9%). In almost half of the cases (44.2%), the patients spent more than 1 week in the hospital. Bacteriological investigations from the ulcers were performed in 55.1% of patients and the most frequent infectious agents were found to be Staphylococcus aureus (26.3%) and Enterobacter spp. (17.2%). Treatment of leg ulcer patients proves to be a long and complex one, a systematic and organized approach being needed in order to obtain healing of the wound. PMID:22950557

  20. Non-extensive radiobiology

    SciTech Connect

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

    2011-03-14

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