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1

Clinical decision making on extensive molar restorations.  

PubMed

SUMMARY Extensive loss of posterior tooth substance, which traditionally was restored with amalgam or indirect restorations, is more commonly being restored with resin-based composite restorations. Using a questionnaire, we aimed to survey dentists' clinical decision making when restoring extensive defects in posterior molar teeth. The questionnaire, which included questions on background information from the dentists, clinical cases with treatment options, and general questions about restoring extensive posterior defects, was sent to 476 dentists. The response rate was 59%. Multiple logistic regressions were used to investigate the different associations. Most of the respondents preferred a direct composite restoration when one cusp was missing, while indirect restorations were most preferred when replacing three or four cusps. Younger dentists and dentists working in the private sector had a greater tendency to choose an indirect technique compared with older colleagues. Generally, the most important influencing factor in clinical decision making was the amount of remaining tooth substance. Factors that appeared to be less important were dental advertisements, use of fluoride, and dietary habits. Female dentists perceived factors such as oral hygiene, patient requests, and economy to be more important than did their male colleagues. PMID:24828135

Laegreid, T; Gjerdet, Nr; Johansson, A; Johansson, A-K

2014-01-01

2

Developing Effective Extension Agents: Experience Concerns.  

ERIC Educational Resources Information Center

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

Goddu, Roland

3

Vardenafil Clinical Trials Experience  

Microsoft Academic Search

There can be little doubt that the introduction into clinical practice of oral phosphodiesterase type 5 (PDE5) inhibitors\\u000a has had a major and positive impact on the quality of life in men with erectile dysfunction (ED) of various causes. PDE5 inhibitors\\u000a have largely supplanted less subjectively appealing local treatments for ED, such as vacuum constriction devices, penile self-injection\\u000a therapy, transurethral

Ajay Nehra

4

Clinical experience with bemiparin.  

PubMed

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

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

2010-12-14

5

Semirigid Cantilever Extension System for Splinting Implants: A Clinical Report  

PubMed Central

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

Machado, Raissa Micaella Marcello; Pinto, Luciana de Rezende; Chagas Junior, Otacilio Luiz

2014-01-01

6

Clinical teachers’ experiences of nursing and teaching.  

E-print Network

??Doctor of Philosophy (PhD)%%%Abstract Clinical teachers’ experiences of nursing and teaching Clinical nurse teachers’ experiences of nursing and teaching undergraduate nursing students on clinical placement… (more)

Forbes, Helen

2007-01-01

7

Outline Motivation Statistical Learning Feature Selection Experiments Extensions Comparing different strategies for variable  

E-print Network

Outline Motivation Statistical Learning Feature Selection Experiments Extensions Comparing Motivation Statistical Learning Feature Selection Experiments Extensions Outline Motivation. Statistical Motivation Statistical Learning Feature Selection Experiments Extensions Motivation We would like to learn

Gent, Universiteit

8

Student Perceptions of Early Clinical Field Experiences.  

ERIC Educational Resources Information Center

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

Bischoff, Judith; And Others

1988-01-01

9

Clinical Experiences with Dental Implants  

Microsoft Academic Search

The clinical utilization of dental impants has accelerated in recent years, and new applications continue to emerge. Concomitantly, alternative implant systems have introduced conceptually different approaches to treatment using altered protocols. The purpose of this paper is to address some of the background issues pertinent to the long-term success, survival, safety, and effectiveness of these devices. The requirements for clinical

Patrick J. Henry

1999-01-01

10

Vardenafil: update on clinical experience  

Microsoft Academic Search

Vardenafil, a potent and selective phosphodiesterase 5 inhibitor, has entered phase 3 clinical trials. Pharmacodynamic studies showed that the maximum plasma concentration after oral administration of 20–40 mg of vardenafil occurred in 0.7–0.9 h, the half-life was 4–5 h, and negligible amounts remained in the circulation after 24 h. The efficacy of vardenafil compared with placebo was shown in RigiScan

J Pryor

2002-01-01

11

Extensive air shower experiment at Kolar Gold Fields  

NASA Astrophysics Data System (ADS)

An experiment to determine the nature of primary cosmic rays of energy > 10 14 eV by studying high energy (> 220 GeV) muons and their correlations with other parameters of extensive air showers generated by them, was carried out at Kolar Gold Fields, India (atmospheric depth of 920 g cm -2). An accurate estimate of shower parameters in showers as small as 10 4 particles was achieved by means of a closely packed array of large area detectors and by employing special methods of analysis. In this paper, the details of the array, the data recording system, the procedure of data analysis and error estimates are described.

Acharya, B. S.; Naranan, S.; Rao, M. V. S.; Sivaprasad, K.; Sreekantan, B. V.; Rao, Srikantha

1988-07-01

12

Clinical experience with persistent cloaca  

PubMed Central

Purpose Persistent cloaca is one of the most severe types of anorectal malformation. Appropriate initial drainage is difficult due to their various malformations and hydrocolpos or dilated urinary bladder. Corrective surgery also differs among individual patients. We describe our experiences with the surgical management of children with persistent cloaca. Methods We retrospectively reviewed 16 children diagnosed with persistent cloaca at Asan Medical Center. Results Sixteen patients were managed in their neonatal period. Twelve patients had enlarged bladder or vagina at birth. Three patients, who did not undergo cystostomy or vaginostomy at first operation, had earlier complications after surgery or required drainage tube insertion. One patient who did not undergo hydrocolpos drainage died of sepsis and complications. Nine patients underwent corrective surgery; posterior sagittal anorectovaginourethroplasty using the Pena method. Three patients required additional operations due to complications after surgery. Conclusion Patients found to have anatomical malformations before colostomy, as well as hydrocolpos and bladder enlargement, require a vaginostomy with or without a cystostomy to reduce complications. Follow-up is required in patients with hydrocolpos and bladder enlargement to determine whether vaginal drainage improves dilated bladder. Continuous long-term follow-up examination is required to determine the long-term results of corrective surgery. PMID:22066071

Cho, Min-Jeng; Kim, Tae-Hoon; Kim, Dae-Yeon; Kim, In-Koo

2011-01-01

13

Gender variations in clinical pain experience  

Microsoft Academic Search

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

Anita M. Unruh

1996-01-01

14

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

PubMed

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

Laschober, Tanja C; Eby, Lillian T

2013-01-01

15

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

PubMed Central

Managing vast datasets collected throughout multiple clinical imaging communities has become critical with the ever increasing and diverse nature of datasets. Development of data management infrastructure is further complicated by technical and experimental advances that drive modifications to existing protocols and acquisition of new types of research data to be incorporated into existing data management systems. In this paper, an extensible data management system for clinical neuroimaging studies is introduced: The Human Clinical Imaging Database (HID) and Toolkit. The database schema is constructed to support the storage of new data types without changes to the underlying schema. The complex infrastructure allows management of experiment data, such as image protocol and behavioral task parameters, as well as subject-specific data, including demographics, clinical assessments, and behavioral task performance metrics. Of significant interest, embedded clinical data entry and management tools enhance both consistency of data reporting and automatic entry of data into the database. The Clinical Assessment Layout Manager (CALM) allows users to create on-line data entry forms for use within and across sites, through which data is pulled into the underlying database via the generic clinical assessment management engine (GAME). Importantly, the system is designed to operate in a distributed environment, serving both human users and client applications in a service-oriented manner. Querying capabilities use a built-in multi-database parallel query builder/result combiner, allowing web-accessible queries within and across multiple federated databases. The system along with its documentation is open-source and available from the Neuroimaging Informatics Tools and Resource Clearinghouse (NITRC) site. PMID:20567938

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

2010-01-01

16

Shared-Learning Experience During a Clinical Pharmacy Practice Experience  

PubMed Central

Objective To implement a shared learning approach through fourth-year students’ mentorship of third-year students and to assess the perceptions of the mentored students on the value of their shared learning experience. Design We introduced the shared learning experience in clinical pharmacy and pharmacotherapeutic practice experiences involving 87 third-year and 51 fourth-year students. Both student groups undertook the practice experiences together, with third-year students working in smaller groups mentored by fourth-year students. Assessment A majority of the students (> 75%) believed that they learned to work as a team during their practice experiences and that the shared learning approach provided an opportunity to practice their communication skills. Similarly, most respondents (> 70%) agreed that the new approach would help them become effective members of the healthcare team and would facilitate their professional relationships in future practice. Almost two-thirds of the students believed that the shared learning enhanced their ability to understand clinical problems. However, about 31% of the pharmacy students felt that they could have learned clinical problem-solving skills equally well working only with peers from their own student group. Conclusions The pharmacy students in the current study generally believed that the shared-learning approach enhanced their ability to understand clinical problems and improved their communication and teamwork skills. Both groups of students were positive that they had acquired some skills through the shared-learning approach. PMID:21769151

Awaisu, Ahmed

2011-01-01

17

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

Microsoft Academic Search

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

Howard R. Hernandez

2012-01-01

18

First detection of extensive air showers with the EEE experiment  

NASA Astrophysics Data System (ADS)

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

Moro, R.

2011-03-01

19

Extension of Experiment 756 into the Next Running Period  

SciTech Connect

Prior to E756, no one had ever produced a polarized {Omega}{sup -} beam. Thus the authors first proposed to try the 'standard method'. If the {Omega}{sup -}s were polarized, the experiment was designed to yield an error of less than 0.1 n.m. for the magnetic moment. They proposed to carry out a polarization analysis while data was being taken to determine the course of the experiment. If protons did not produce polarized {Omega}{sup -}s, they had devised alternative methods to produce the desired polarized sample. During the 1987-88 fixed target run, the experiment proceeded as outlined in the proposal. Using a minimal statistically significant sample, they found the polarization of {Omega}{sup -}'s produced directly by protons to be insufficient to accomplish the measurement. This result is in itself a major contribution to the understanding of the phenomena of inclusive hyperon polarization. In addition to the polarization results, this period of the experiment will yield the best measurement of the cascade minus magnetic moment (better than 1%), the best measurement of the weak decay parameter, {alpha}, for both the {Omega}{sup -} and the {Xi}{sup -}, and the best measurement of the lifetime of both the {Omega}{sup -} and the {Xi}{sup -}. From their previous experiments, they knew that a neutral beam produced at an angle was rich in polarized {Lambda}'s and {Xi}{sup 0}'s. Therefore they believed they could produce polarized {Omega}{sup -} via spin transfer from a targeted polarized neutral hyperon beam. They had the flexibility of installing another targeting area and a neutral channel just upstream of their charged hyperon channel. Their neutral beam was the first targeted polarized beam at the Tevatron and one of the few polarized high energy beams anywhere in the world. For the remainder of the fixed target run, about three calendar months, they collected about 20,000 {Omega}{sup -}'s, enough to discover that the {Omega}{sup -}'s were polarized and make the first statistically significant measurement of {mu}{sub {Omega}{sup -}} ({+-}0.2 n.m.). In adidition, measurement sof the {Omega}{sup -} and {Xi}{sup -} spin transfer from the polarized neutral hyperon beam will provide new information for particle production models. The stage is now set to accomplish the primary goal of the E756 proposal, a precise measurement of {mu}{sup {Omega}{sup -}}.

Johns, Kenneth A.; Rameika, Regina A.

1988-01-01

20

Transhiatal Esophagectomy: Clinical Experience and Refinements  

PubMed Central

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

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

1999-01-01

21

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

ERIC Educational Resources Information Center

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

Cooksey, Yan Zhang; Cole, Bryan R.

2012-01-01

22

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

ERIC Educational Resources Information Center

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

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

2006-01-01

23

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

Microsoft Academic Search

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

Mikaela von Bonsdorff

2003-01-01

24

Experiments on the Automated Selection of Patients for Clinical Trials  

E-print Network

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

Fink, Eugene

25

Experiments on the Automated Selection of Patients for Clinical Trials  

E-print Network

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

Fink, Eugene

26

Online hemodiafiltration: 4 years of clinical experience.  

PubMed

Online hemodiafiltration (online HDF) is a new hemodialysis technique combining convection and diffusion and thus also enabling the purification of large molecules. As yet, only a small number of clinical experiences have been published about the effectiveness and safety of online HDF. We present a prospective and observational study conducted on 31 patients treated with online HDF in our center in the last 4 years. The purpose of the study is to compare the evolution of the following aspects before and after starting online HDF: dose of dialysis, purification of medium-sized/large molecules, inflammation, nutrition, Ca-P metabolism, anemia, and intradialytic complications. Online HDF increased Kt/V to 31.0% (p > 0.001) and reduced postdialysis beta(2)-M to 66.4% (p > 0.001). The rest of the parameters analyzed did not vary significantly. During online HDF, episodes of symptomatic hypotension fell by 45% in relation to conventional hemodialysis, and no relevant complication occurred. Online HDF is very useful in patients in whom we need to increase replacement therapy, such as patients with a large body surface, those in whom we suspect a residual syndrome or those who have been receiving dialysis for a long time and for whom we wish to prevent amyloidosis. Online HDF is safe and better tolerated than conventional hemodialysis. PMID:16441865

Muñoz, Rosa; Gallardo, Isabel; Valladares, Evandro; Saracho, Ramón; Martínez, Isabel; Ocharan, Julen; Montenegro, Jesús

2006-01-01

27

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

Microsoft Academic Search

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

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

2007-01-01

28

Combining creativity and community partnership in mental health clinical experiences.  

PubMed

Lack of parity for mental health treatment, coupled with the trend toward more community-based care, has challenged nurse faculty to identify quality, creative psychiatric clinical sites. The purpose of this article is to educate nurse faculty on practical, creative ways to identify nontraditional community psychiatric clinical experiences. Service learning, community partnerships, and group interaction are emphasized. Literature regarding recent health care initiatives and widely accepted criteria for quality nursing education are discussed as foundations for creating alternative mental health clinical experiences. The authors' experiences implementing these concepts are discussed. Community partnerships and alternative clinical sites/experiences benefit students, faculty, institutions, and the community. PMID:18459625

Pharez, Marye C; Walls, Noretta D; Roussel, Linda A; Broome, Barbara A

2008-01-01

29

Perceptions of nursing student clinical placement experiences.  

PubMed

There is an unprecedented shortage of registered nurses (RNs) in the United States of America. Efforts to educate more RNs have been limited by a shortage of both clinical placements and preceptors for nursing students. The purpose of this study was to examine nursing education issues associated with student clinical placement as experienced by hospital personnel who coordinate the placements with various schools of nursing. A qualitative study involving 15 state-wide participants directly associated with clinical placement of nursing students was conducted. Emergent themes from the data included lack of consistent terminology and definition of student and preceptor roles, preference of clinical scholars, process of site placements, rewards for supervision of students, dis-satisfiers to the supervision of students and suggested strategies for change. Recommendations which developed from the research are summarized and discussed. PMID:17049044

Leners, Debra; Sitzman, Kathleen; Hessler, Karen L

2006-01-01

30

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

ERIC Educational Resources Information Center

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

Zeanah, Charles H.

2009-01-01

31

A 4-year clinical evaluation of extensive amalgam restorations--description of the failures.  

PubMed

The 4-year evaluation of a randomized controlled clinical trial to the functioning of Extensive Amalgam Restorations (EAR) is reported. In this trial 300 EAR were made by three operators on molar teeth. Five different auxiliary retention methods were used to retain these restorations. In the evaluation a differentiation in 'absolute' and 'relative' failures was made. After 4 years seven absolute failures (EAR dislodged or removed) were encountered (2%). When relative failures (endodontic treatment or restoration at margin) are also taken into account the number of failures increased to 31 (10%). Due to the low number of failures, no significant influences from experimental variables (c.q. retention method or operator) could be detected. It may be concluded that the results of this interim analysis of the clinical functioning of EAR are promising. It is thought that careful evaluation of cusp strength and reducing weak cusps diminishes clinical failure and as a result, it is not necessary to protect an EAR with a cast restoration in the first 4 years of its clinical life. PMID:10412478

Plasmans, P J; van 't Hof, M A

1993-11-01

32

Clinical experience with trisomies 18 and 13.  

PubMed Central

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 and the syndromes compared with each other and summaries found in the literature. Images PMID:637922

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

1978-01-01

33

Overview of clinical experience with ciprofloxacin  

Microsoft Academic Search

Ciprofloxacin is a new 4-quinolone antibacterial agent with an extended antibacterial spectrum, enhanced potency and the ability to produce therapeutic serum, tissue and urine concentrations after oral administration. Unlike earlier 4-quinolones, it is active against gram-positive cocci and opportunistic organisms such asPseudomonas aeruginosa. This overview demonstrates that the oral formulation has been shown to be clinically effective in a broad

A. P. Ball

1986-01-01

34

Odontogenic keratocyst: a clinical experience in Singapore.  

PubMed

The odontogenic keratocyst has been well documented and extensively studied. It is of particular interest because of its high recurrence rate and aggressive nature. The material for this study consisted of 70 cases of odontogenic keratocysts in predominantly ethnic Chinese patients who were treated from 1981 to 1996. The cases were retrospectively studied to compare characteristics of the lesion in this population with those in previous reports. Most of the patients in this series were 21 to 30 years of age. Association with an impacted mandibular third molar was found in more than 50% of the cases. The recurrence rate was 20% for 35 patients with a follow-up period of at least 5 years. The follow-up period for the whole series ranged from 1 to 16 years. Treatment was surgical enucleation with peripheral ostectomy. There were no significant differences in characteristics with respect to presentation and prognosis between this series and those described in previous publications. PMID:9830650

Chow, H T

1998-11-01

35

Motivation Problem Solution Experiments Extensions Summary Learning Multi-View Neighborhood Preserving  

E-print Network

Wisdom: Keep your friends (read: matching samples) close and your enemies (read: non-matching samples) close and your enemies (read: non-matching samples) XXXcloser far far away; · Turning Wisdom Experiments Extensions Summary Back to the Objective Function Recall: · Objective = Enemies term + Friends

Ghahramani, Zoubin

36

Korean Supervisors' Experiences in Clinical Supervision  

ERIC Educational Resources Information Center

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

Bang, Keeyeon; Park, Jeeseon

2009-01-01

37

Centralization of a regional clinical microbiology service: The Calgary experience  

PubMed Central

Diagnostic laboratory services in Alberta have been dramatically restructured over the past five years. In 1994, Alberta Health embarked on an aggressive laboratory restructuring that cut back approximately 30% of the overall monies previously paid to the laboratory service sector in Calgary. A unique service delivery model consolidated all institutional and community-based diagnostic testing in a company called Calgary Laboratory Services (CLS) in late 1996. CLS was formed by a public/private partnership between the Calgary Regional Health Care Authority (CRHA) and MDS-Kasper Laboratories. By virtue of its customer service base and scope of testing, CLS provides comprehensive regional laboratory services to the entire populace. Regional microbiology services within CLS have been successfully consolidated over the past three years into a centralized high volume laboratory (HVL). Because the HVL is not located in a hospital, rapid response laboratories (RRLs) are operated at each acute care site. Although the initial principle behind the proposed test menus for the RRLs was that only procedures requiring a clinical turnaround time of more than 2 h stay on-site, many other principles had to be used to develop and implement an efficient and clinically relevant RRL model for microbiology. From these guiding principles, a detailed assessment of the needs of each institution and extensive networking with user groups, the functions of the microbiology RRLs were established and a detailed implementation plan drawn up. The experience at CLS with regards to restructuring a regional microbiology service is described herein. A post-hoc analysis provides the pros and cons of directing and operating a regionalized microbiology service. PMID:22346397

Church, Deirdre L; Hall, Paula

1999-01-01

38

Clinical Experience with Treatment of Angioleiomyoma  

PubMed Central

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

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

2014-01-01

39

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

ERIC Educational Resources Information Center

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

Schilling, Jim

2011-01-01

40

Public Schools as a Clinical Experience for Nursing Students.  

ERIC Educational Resources Information Center

In a clinical experience program, each nursing student was to select one school-age client with a chronic impairment and develop a nursing care plan. Both the teaching staff and nursing students found the program to be beneficial. (JN)

Schmidt, Cheryl Klouzal

1981-01-01

41

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

PubMed Central

Much work has been done in the area of web-based clinical practice guidelines. Issues such as representation, description, architectures, and implementation have been explored previously. Most if not all of these web-based applications rely exclusively on HTML, the HyperText Markup Language. In the process of prototyping a guideline service to be used in a diabetes operations improvement project, we developed a model for a guideline engine that makes use of the Extensible Markup Language (XML), both as an interface to the engine and as a vehicle for delivering structured guideline content. We feel that XML may offer advantages in implementing guideline services that are difficult (if not impossible) to accomplish with HTML alone. PMID:9929316

Dubey, A. K.; Chueh, H.

1998-01-01

42

Our clinical experience in low-energy laser medical treatments  

Microsoft Academic Search

In clinical research the efficiency of low-energy laser (LEL) therapy remains controversial. We present here some of the most important results of our clinical experience in this field. We summarize our opinions about the LEL effects in rheumatic diseases, in chronic pelvic inflammatory disorders, in the treatment of some dermatological disorders, and in the recovery of the distal forearm nerve

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

1996-01-01

43

Tinnitus: clinical experience of the psychosomatic connection  

PubMed Central

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

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

2014-01-01

44

Enhancing nursing students' clinical experiences using aesthetics.  

PubMed

Traditional nursing education is based strongly in empiric knowledge. However, just as important as empiric knowledge is aesthetic knowledge. Nursing involves multiple ways of knowing, and as such, educational institutions have a responsibility to assist students in gaining knowledge in nontraditonal ways. This article describes an assignment implemented in a pediatric course in a baccalaureate nursing program. Books and movies were used in a an undergraduate nursing course to help students gain insight into illness and disability from the client and family perspective. The students in the course were required to reflect on the meaning of the movie/book and the influence the book/movie had on the student. Based on student responses, this assignment was successful in meeting the objectives originally proposed. The books and movies provided a beginning introduction to, and an appreciation for, client and family experiences. Students were helped to understand illness, abuse, disability, and/or death from the client and/or family perspective. PMID:15682163

Northington, Ladonna; Wilkerson, Robin; Fisher, Wanda; Schenk, Laura

2005-01-01

45

Postgraduate clinical education--the Canadian experience.  

PubMed

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

Mueller, C B; Ames, F

1974-10-19

46

Clinical experience with sorbinil--an aldose reductase inhibitor.  

PubMed

A considerable volume of animal pharmacologic data support the view that increased flux through the polyol pathway provides a unifying hypothesis for the major complications of diabetes. An extensive clinical program has been established to verify the extrapolation of the animal pharmacologic findings to man. Clinical data accumulated to date confirm the biochemical and electrophysiologic effects, and encouraging evidence of a drug effect in diabetic neuropathy and retinopathy has already been observed. In the large, controlled safety data base already available, the long-term clinical use of sorbinil is devoid of significant adverse effects in terms of both subjective side effects and laboratory parameters. The only clinically important adverse reaction reported to date has been a hypersensitivity reaction in the early weeks of therapy, which is similar to that seen with other hydantoins. PMID:3083213

Pitts, N E; Vreeland, F; Shaw, G L; Peterson, M J; Mehta, D J; Collier, J; Gundersen, K

1986-04-01

47

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

PubMed Central

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

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

2013-01-01

48

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

ERIC Educational Resources Information Center

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

Patterson, Robert K.; Kass, Susan H.

49

Experiences from an interprofessional student-assisted chronic disease clinic.  

PubMed

Abstract Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice. PMID:24841001

Frakes, Kerrie-Anne; Brownie, Sharon; Davies, Lauren; Thomas, Janelle; Miller, Mary-Ellen; Tyack, Zephanie

2014-11-01

50

COMBINING IMAGING AND CLINICAL DATA IN MANIFOLD LEARNING: DISTANCE-BASED AND GRAPH-BASED EXTENSIONS OF LAPLACIAN EIGENMAPS  

E-print Network

from manifold learning It has been shown that the space of brain images in RM can be described by a nonCOMBINING IMAGING AND CLINICAL DATA IN MANIFOLD LEARNING: DISTANCE-BASED AND GRAPH-BASED EXTENSIONS ABSTRACT Manifold learning techniques have been widely used to pro- duce low-dimensional representations

Cohen, Laurent

51

The Student Trainer Clinical Experience at Lock Haven State College.  

ERIC Educational Resources Information Center

An integral part of the clinical experience for athletic trainers at Lock Haven State College (Pennsylvania) is training in first aid and learning to evaluate not only sport-related injuries but all injuries. Thorough knowledge is expected of athletic trainers in the areas of cardiopulmonary resuscitation, first aid, and treatment of…

Tomasi, David

52

Designing Nursing Simulation Clinical Experiences to Promote Critical Inquiry  

ERIC Educational Resources Information Center

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

Beattie, Bev; Koroll, Donna; Price, Susan

2010-01-01

53

Time Keeps on Ticking: The Experience of Clinical Judgment  

ERIC Educational Resources Information Center

The reactions by Ridley and Shaw-Ridley (EJ832451) and Lichtenberg (EJ832452) to the authors' meta-analysis on the effects of experience on judgment accuracy add positively to what is hoped will become an ever more focused discourse on this most basic question: How can mental health clinical decision making be improved? In this rejoinder, the…

Spengler, Paul M.; White, Michael J.; Aegisdottir, Stefania; Maugherman, Alan S.

2009-01-01

54

Teachers' Clinical Experiences and Attitudes toward Technology Inclusion  

ERIC Educational Resources Information Center

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

Paganelli, Andrea Lynch

2010-01-01

55

Creation of a virtual health system for leadership clinical experiences.  

PubMed

Students had difficulty integrating leadership and outcomes management skills into their burgeoning novice practice. Further, the Baccalaureate Completion Program for RNs, an online program, expanded student enrollment, which created difficulty in finding enough clinical placements in agencies with staff experienced in leading teams and conducting performance improvement projects. The Leadership and Outcomes Management course was changed from a live clinical agency placement course to a virtual clinical agency experience. Students worked in teams on a virtual quality care delivery case within a virtual health care system. Students selected the case and where they worked within our full-service virtual health system. The virtual health system required interactions with staff, and faculty assumed several roles within the virtual health system as they guided the students through leadership skill development and the creation of a performance improvement system process. It also eliminated the need for live clinical agency placements. [J Nurs Educ. 2014;53(12):714-718.]. PMID:25406844

Ross, Amy Miner; Crusoe, Kristen L

2014-12-01

56

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

PubMed Central

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

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

2014-01-01

57

[Clinical experience in using tents in oxygen-drug inhalation].  

PubMed

The contributors display their experience in the clinical application of tents for oxygen-drug therapy, aerosol prophylaxis and treatment purposes, and advocate the evident advantages of the method: a combined therapeutic action of oxygen and aerosols, the healing properties of the sprayer-produced negative ions, portability and easiness in handling the tent, possibility of its ready-to-use prophylactic and therapeutic purposes. Clinical trials were made in 2 groups of patients with respiratory and cardio-vascular disorders, which proved both therapeutic and technical effectiveness of the method to be recommended for wide use in medical posts of enterprises. PMID:2394408

Parpale?, I A; Plenov, N N; Gul'ko, S N; Pikul'skaia, A F; Parliuk, A F

1990-01-01

58

Dynamics of diachronous back-arc extension: insights from 3D thermo-mechanical analogue experiments  

NASA Astrophysics Data System (ADS)

Subduction of an old, dense oceanic lithosphere can lead to rifting and extension of the magmatic arc. Such subduction systems are inherently three-dimensional with significant along-strike variations in the timing and style of deformation and magmatism. Geodynamic models used to explain such variations and associated trench curvature generally ignore the role of the overriding plate and its deformation. 3D thermo-mechanical analogue experiments are used to investigate the kinematics and dynamics of diachronous arc rifting and back-arc basin opening. In the models, horizontal tension increases in the upper plate until the magmatic arc lithosphere fails and back-arc opening occurs via slab rollback. This result corresponds well to previous 2D models of arc rifting and subsequent back-arc opening via trench rollback and the mechanics of retreating slabs in fluid dynamic experiments. However, in our experiments arc failure occurs diachronously, initiating near the model edge due to locally higher temperatures and lower strength and then propagating along strike, producing an arcuate plate boundary. The experiments demonstrate that trench rollback rate is limited by the propagation rate of arc failure. Conversely, slab rollback generates additional horizontal tension in the adjacent magmatic arc lithosphere, which drives along-strike propagation of arc failure. Feedback between the rates of trench rollback and arc failure propagation dictates the geometry of the back-arc basin in plan-view. The shape of the back-arc basin obtained in models fits remarkably well with that of the Mariana basin in the western Pacific. Experiments where the strength of the magmatic arc, or forearc varies along strike or where the negative buoyancy of the subducting plate varies along strike explore further the role of the slab edge and the trench-parallel tensile strength of the retreating forearc block.

Boutelier, D. A.; Cruden, A. R.

2013-12-01

59

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

PubMed

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

Bezecny, Pavel

2014-06-01

60

Laboratory and clinical experience with neodymium:YAG laser prostatectomy  

NASA Astrophysics Data System (ADS)

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

Kabalin, John N.

1996-05-01

61

Vitamin B12 extensive thoracic myelopathy: clinical, radiological and prognostic aspects. Two cases report and literature review.  

PubMed

The myelopathy caused by vitamin B12 deficiency is known as subacute combined degeneration. It is rare, but a well known cause of demyelination of the dorsal columns of the spinal cord. The magnetic resonance imaging is characterized by an increased signal on T2-weighted images involving the posterior columns of cervical and thoracic cord. There have been few cases in literature with extensive lesions (more than seven levels) of the thoracic spinal cord. The clinical and radiological improvements are possible if the replacement of vitamin B12 is initiated precocious. We present two rare cases of extensive thoracic myelopathy due to vitamin B12 deficiency. The first is a young woman with complete clinical recovery and important radiologic improvement after early treatment. In addition, the second case is an older man with partial response to the treatment. Those cases illustrate the importance of considering vitamin B12 deficiency in any patient, who presents with myelopathy. PMID:23468407

de Medeiros, Frederico Carvalho; de Albuquerque, Lucas Alverne Freitas; de Souza, Renata Brant; Gomes Neto, Antonio Pereira; Christo, Paulo Pereira

2013-10-01

62

Systematic review of new medics' clinical task experience by country  

PubMed Central

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

2014-01-01

63

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

Microsoft Academic Search

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

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

1999-01-01

64

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

NASA Astrophysics Data System (ADS)

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

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

2004-12-01

65

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

PubMed Central

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

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

2014-01-01

66

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

PubMed Central

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

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

2013-01-01

67

Mutuality: clinical and metapsychological potentials of a failed experiment.  

PubMed

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

Castillo Mendoza, Carlos Alberto

2012-03-01

68

Integrated clinical experience: University of Nebraska Medical Center.  

PubMed

The Integrated Clinical Experience (ICE) at the University of Nebraska College of Medicine is a required, two-year course of study for first- and second-year students. It provides early clinical experiences in primary care settings in metropolitan and rural areas, and related instruction in the social, behavioral, and ethical foundations of medicine. The authors describe the course goals, teaching format, topics, and evaluation of students and faculty. ICE is based on the assumptions that medicine is an applied behavioral science as well as an applied biological science, that critical reflection is important in professional education, and that early exposure to primary care will promote interest in primary care careers. The authors also describe some of the challenges associated with the implementation of this new course of study. These include student dissatisfaction with behavioral and ethical topics, resistance to critical reflection about their personal attitudes and values, and discomfort with "subjective" grading. ICE has also been controversial with some basic science faculty who feel they have had to sacrifice curriculum time to make room for this new program. Also, recruiting the large number of faculty, particularly physicians, needed to run the program has been difficult. Finally, the organization of the curriculum, with basic sciences in the morning and the ICE in the afternoon, may inadvertently reinforce the conceptual split between the biomedical and psychosocial dimensions of medicine. Efforts are under way to address this problem by exploring ways to intergrate the curriculum better. PMID:9447200

Steele, D J; Susman, J L

1998-01-01

69

General Practitioners' responses to global climate change - lessons from clinical experience and the clinical method  

PubMed Central

Background Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action. Discussion We contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism. Summary General practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change. PMID:22873633

2012-01-01

70

Artificial Pancreas: Model Predictive Control Design from Clinical Experience  

PubMed Central

Background The objective of this research is to develop a new artificial pancreas that takes into account the experience accumulated during more than 5000 h of closed-loop control in several clinical research centers. The main objective is to reduce the mean glucose value without exacerbating hypo phenomena. Controller design and in silico testing were performed on a new virtual population of the University of Virginia/Padova simulator. Methods A new sensor model was developed based on the Comparison of Two Artificial Pancreas Systems for Closed-Loop Blood Glucose Control versus Open-Loop Control in Patients with Type 1 Diabetes trial AP@home data. The Kalman filter incorporated in the controller has been tuned using plasma and pump insulin as well as plasma and continuous glucose monitoring measures collected in clinical research centers. New constraints describing clinical knowledge not incorporated in the simulator but very critical in real patients (e.g., pump shutoff) have been introduced. The proposed model predictive control (MPC) is characterized by a low computational burden and memory requirements, and it is ready for an embedded implementation. Results The new MPC was tested with an intensive simulation study on the University of Virginia/Padova simulator equipped with a new virtual population. It was also used in some preliminary outpatient pilot trials. The obtained results are very promising in terms of mean glucose and number of patients in the critical zone of the control variability grid analysis. Conclusions The proposed MPC improves on the performance of a previous controller already tested in several experiments in the AP@home and JDRF projects. This algorithm complemented with a safety supervision module is a significant step toward deploying artificial pancreases into outpatient environments for extended periods of time. J Diabetes Sci Technol 2013;7(6):1470-1483 PMID:24351173

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

2013-01-01

71

Internet in clinical research based on a pilot experience.  

PubMed

Computing has become an integral part of many disciplines nowadays, turning it into an evermore necessary working tool. Internet provides a fast and easy way to collect scientific data and is becoming a more and more effective and safe way to transmit data. It is also an efficient means for interaction and information sharing within a work group that provides the necessary flexibility. A pilot project was conducted replacing the traditional hardcopy version of the case report form for an electronic one (e-CRF) and with access to Internet within the Naturalistic Randomized Clinical Trial of the Effectiveness of Olanzapine and Risperidone in the Treatment of Schizophrenia. Carrying out this pilot project has given us the opportunity to determine the advantages electronic data collection (EDC) by Internet has to offer both researchers and sponsors. The results have optimized time management, since it is easier to work in real time; data quality is improved, since intermediates are eliminated, and it facilitates communication amongst the different parties involved in the project. The use of this technology requires updated Internet connections and adequate personal computers, since the possibilities offered by the computer system and high-speed connection are critical in conducting the project. Obviously, this may involve a higher initial investment, but the results have revealed to us that these start-up costs are later offset by lowering personnel costs or by decreasing the number of monitoring visits. On the basis of our experience and that of the participating investigators, certain recommendations for future clinical trials using e-CRF can be made. We will go into these recommendations in greater depth throughout this paper. In short, EDC can dramatically improve the clinical trial process, opening the door to new technologies in the world of clinical research, not only for sponsors, but also for clinicians. PMID:15837443

López-Carrero, Carmen; Arriaza, Elena; Bolaños, Elena; Ciudad, Antonio; Municio, Marco; Ramos, José; Hesen, Wout

2005-04-01

72

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

PubMed

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

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

2014-11-01

73

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

PubMed Central

Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially for early stage clinician managers. PMID:23173953

2012-01-01

74

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

ERIC Educational Resources Information Center

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

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

2009-01-01

75

An Experiment to Transform the Orientation of an Urban Youth Service: A Case Study. Extension Studies 59.  

ERIC Educational Resources Information Center

This study investigates an experiment undertaken by the Cooperative Extension Service of The Pennsylvania State University and the Christian Street Urban 4H Center in Philadelphia to transform the "provider" orientation of a youth service. The "provider' orientation addresses needs as they are perceived and defined by the providers of services. It…

Stephenson, Paul L.; Harris, J. John, III

76

Dabigatran in Secondary Stroke Prevention: Clinical Experience with 106 Patients  

PubMed Central

Introduction. Our aim was to analyze our clinical experience with dabigatran etexilate in secondary stroke prevention. Methods. We retrospectively included patients starting dabigatran etexilate for secondary stroke prevention from March 2010 to December 2012. Efficacy and safety variables were registered. Results. 106 patients were included, median follow-up of 12 months (range 1–31). Fifty-six females (52.8%), mean age 76.4 (range 50–95, SD 9.8), median CHADS2 4 (range 2–6), CHA2DS2-VASc 5 (range 2–9), and HAS-BLED 2 (range 1–5). Indication for dabigatran etexilate was ischemic stroke in 101 patients and acute cerebral hemorrhage (CH) due to warfarin in 5 (4.7%). Dabigatran etexilate 110?mg bid was prescribed in 71 cases (67%) and 150?mg bid was prescribed in the remaining. Seventeen patients (16%) suffered 20 complications during follow-up. Ischemic complications (10) were 6 transient ischemic attacks (TIA), 3 ischemic strokes, and 1 acute coronary syndrome. Hemorrhagic complications (10) were CH (1), gastrointestinal bleeding (6), mild hematuria (2), and mild metrorrhagia (1), leading to dabigatran etexilate discontinuation in 3 patients. Patients with previous CH remained uneventful. Three patients died (pneumonia, congestive heart failure, and acute cholecystitis) and 9 were lost during follow-up. Conclusions. Dabigatran etexilate was safe and effective in secondary stroke prevention in clinical practice, including a small number of patients with previous history of CH. PMID:25133166

DeFelipe-Mimbrera, Alicia; Canovas, Araceli Alonso; Guillan, Marta; Matute, Consuelo; Cruz, Antonio; Vera, Rocio; Masjuan, Jaime

2014-01-01

77

Medical academia clinical experiences of Ward Round Teaching curriculum  

PubMed Central

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

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

2014-01-01

78

Extensive genetic diversity among clinical isolates of Streptococcus pyogenes serotype M5.  

PubMed

The genetic diversity of clinical isolates of Streptococcus pyogenes serotype M5 has been characterized. Strain genotypes were defined by macrorestriction profile, 16S ribotype, emm gene subtype, insertion element IS1239 profile, and exotoxin gene determinant. By these criteria, clinical isolates of M5 constituted a multiplicity of strain clusters rather than a homogeneous population as found for certain serotypes. Distance matrices and an unrooted tree were constructed from macrorestriction data with three rarely cutting endonucleases, determined by PFGE. A single IS1239 profile was common to 85% of isolates but there was great diversity of both ribotype and macrorestriction profile, and 18 different emm gene subtypes were detected by PCR-RFLP. DNA sequence analysis of the antigen-coding 5' (hypervariable) region of emm gene amplicons (about 240 bp) showed that 14/18 exhibited up to 6% divergence. Four amplicons had highly divergent sequences--corresponding to those previously determined for emm6, emm11, emm18 and emm77. Further serological and hybridization studies were used to analyse the discrepancy between the Lancefield serotype of these strains (M5) and their emm genotype. Overall, this study shows a high degree of genetic diversity in serotype M5, with implications for the Lancefield scheme itself, for the epidemiology of group A streptococci, and for recombinant DNA strategies for M protein-based vaccine development. PMID:9534234

Desai, M; Tanna, A; Efstratiou, A; George, R; Clewley, J; Stanley, J

1998-03-01

79

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

PubMed Central

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

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

2014-01-01

80

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

Federal Register 2010, 2011, 2012, 2013

...one-year extension with funds for the Black Lung/Coal Miner Clinics Program awards to the current grantees (included in attached chart), in amounts between $299,000 and $1.5 million over the one-year extension project period. Correction In the...

2013-05-07

81

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

E-print Network

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...

Zhang, Yan

2010-10-12

82

Rutgers New Jersey Agricultural Experiment Station Cooperative Extension of Somerset County  

E-print Network

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

Goodman, Robert M.

83

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

ERIC Educational Resources Information Center

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

Furrer, Stephanie D.; Younger, Barbara A.

2008-01-01

84

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

ERIC Educational Resources Information Center

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

Robb, Thomas; Kano, Makimi

2013-01-01

85

PARENTS' EXPERIENCES WITH PEDIATRIC CARE AT RETAIL CLINICS  

PubMed Central

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

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

2014-01-01

86

Students' experiences of learning manual clinical skills through simulation.  

PubMed

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

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

2013-03-01

87

Initial experiences with PACS in a clinical and research environment  

NASA Astrophysics Data System (ADS)

The installation of a local area network of microcomputers, workstations, archival storage devices, and digital acquisition modalities is the first step taken by the Radiology Department at the University of Florida toward a comprehensive picture archival and communications system (PACS). The system meets the following requirements, identified during the initial planning and design stage: (1) It allows the connection of heterogeneous equipment from multiple vendors. (2) It is modular and can be extended and modified. (3) It uses current technology with the option to upgrade when improved methodologies are available. (4) It maintains a database of all patient studies/images archived, including those on optical disks not currently mounted in a disk drive. (5) The database can be customized to match specific requirements. (6) ACR-NEMA commands and headers combined with TCP/IP protocols allow access to images by different types of workstations for display and evaluation. In addition to the clinical operation, the network allows communication among microcomputers and research workstations, allowing extended access to images on the archive. The authors discuss their early experience with the system, including design requirements and performance measures.

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

1991-07-01

88

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

PubMed Central

Background There is a lack of information on the clinical characteristics of multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR) TB in the Jiangxi Province of China; furthermore, data have not been reported on the utility of mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analyses in genotyping Mycobacterium tuberculosis strains isolated from this region. The aim of this study was to analyse the clinical features of patients with MDR and XDR TB from Jiangxi Province and to evaluate the discriminatory power of the 15-loci MIRU-VNTR method. Methods A retrospective study was conducted on patients diagnosed with MDR and XDR TB at the Jiangxi Chest Hospital from July 2010 to June 2011. The RD105 deletion-targeted multiplex PCR (DTM-PCR) and the 15-loci MIRU-VNTR method were used to determine the genetic background of the identified MDR and XDR M. tuberculosis clinical isolates. Results Of 804?M. tuberculosis clinical isolates, 159 (159/804, 19.8%) of the isolates were identified as MDR with first-line drug susceptibility testing. Of the 123 available MDR isolates, 13 (13/123, 10.6%) were XDR. The RD105 deletion-targeted multiplex PCR method identified 85 (85/110, 77.3%) MDR and 12 (12/13, 92.3%) XDR isolates as the Beijing genotype. MIRU-VNTR cluster analysis demonstrated that 101 MDR and 13 XDR strains had unique genotype patterns; the remaining 9 MDR strains were in 4 clusters, namely 1 cluster with 3 strains and 3 clusters with 2 strains, resulting in a low clustering rate (4.06%). The Hunter-Gaston discriminatory index (HGDI) of the 15-loci MIRU-VNTR method was as high as 0.992. In addition, clinical surveys showed that 87 (87/110, 79.1%) MDR TB patients and 10 (10/13, 76.9%) XDR TB patients had been previously treated. Diabetes mellitus was the most common comorbidity in both MDR TB (16/110, 14.5%) and XDR TB (2/13, 15.4%) patients. Conclusions Based on our preliminary data, the MDR and XDR M. tuberculosis clinical isolates identified at the Jiangxi Chest Hospital were genetically diverse and clustered at a low frequency. The 15-loci MIRU-VNTR method showed high discriminatory power and may be used as a first-line genotyping tool in investigating the molecular epidemiology of M. tuberculosis in Jiangxi, China. Decisive measures are urgently needed to effectively prevent and manage MDR and XDR tuberculosis in this province. PMID:23849244

2013-01-01

89

Time structure of the extensive air shower muon component measured by the KASCADE experiment  

Microsoft Academic Search

The temporal structure of the extensive air shower (EAS) muon component (Ethres=2.4 GeV) is studied at sea level by measurements of the muon arrival time distributions using the muon detection facilities of the KASCADE central detector. Data have been analysed for EAS core distances up to 110 m for primary energies around the knee region. The time structure of the

T. Antoni; W. D. Apel; A. F. Badea; K. Bekk; K. Bernlöhr; H. Blümer; E. Bollmann; H. Bozdog; I. M. Brancus; A. Chilingarian; K. Daumiller; P. Doll; J. Engler; F. Feßler; H. J. Gils; R. Glasstetter; R. Haeusler; W. Hafemann; A. Haungs; D. Heck; T. Holst; J. R. Hörandel; K. H. Kampert; J. Kempa; H. O. Klages; J. Knapp; D. Martello; H. J. Mathes; H. J. Mayer; H. J. Mayer; D. Mühlenberg; J. Oehlschläger; M. Petcu; H. Rebel; M. Risse; G. Schatz; F. K. Schmidt; T. Thouw; H. Ulrich; A. Vardanyan; B. Vulpescu; J. H. Weber; J. Wentz; T. Wiegert; J. Wochele; J. Zabierowski; S. Zagromski

2001-01-01

90

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

SciTech Connect

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

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

2011-08-01

91

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

E-print Network

Behavioral Health Services � Neuropsychological & Psychological Assessment Services � Substance Internship in Clinical & Community Psychology The Yale Experience will change you professionally internships in clinical and community psychology, developing the next generation

Johnson, Marcia K.

92

A nurse-led palpitations clinic: a 2-year experience  

Microsoft Academic Search

ObjectiveTo investigate the role of a nurse-led clinic in the assessment of patients with palpitations.DesignProspective descriptive study.SettingNurse-led palpitations clinic in a UK district general hospital.ParticipantsPatients referred from primary care or the emergency department with palpitations.MethodsReferral letters were screened, and only patients without high-risk features or a documented arrhythmia were diverted to the palpitations clinic. Patients were evaluated using a protocol.

P. A. Scott; P. Appleford; T. G. Farrell; N. P. Andrews

2010-01-01

93

Differences in Clinical Experiences of ADN and BSN Students.  

ERIC Educational Resources Information Center

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

Oermann, Marilyn H.

1998-01-01

94

Femtosecond laser eye surgery: the first clinical experience  

NASA Astrophysics Data System (ADS)

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

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

2002-04-01

95

Epidemiology, Clinical Characteristics and Outcomes of Extensively Drug-Resistant Acinetobacter baumannii Infections among Solid Organ Transplant Recipients  

PubMed Central

Background Extensively drug-resistant Acinetobacter baumannii (XDR-Ab) has emerged as a major nosocomial pathogen, but optimal treatment regimens are unknown. Although solid organ transplant (SOT) recipients are particularly susceptible to XDR-Ab infections, studies in this population are limited. Our objectives were to determine the epidemiology, clinical characteristics and outcomes of XDR-Ab infections among SOT patients. Methods A retrospective study of SOT recipients at our center who were colonized or infected with XDR-Ab between November 2006 and December 2011 was conducted. Among infected patients, the primary outcome was survival at 28 days. Secondary outcomes included survival at 90 days and clinical success at 28 days, and XDR-Ab infection recurrence. Results XDR-Ab was isolated from 69 SOT patients, of whom 41% (28) and 59% (41) were colonized and infected, respectively. Infections were significantly more common among cardiothoracic than abdominal transplant recipients (p?=?0.0004). Ninety-eight percent (40/41) of patients had respiratory tract infections, most commonly ventilator-associated pneumonia (VAP; 88% [36/41]). Survival rates at 28 and 90 days were 54% (22/41) and 46% (19/41), respectively. Treatment with a colistin-carbapenem regimen was an independent predictor of 28-day survival (p?=?0.01; odds ratio?=?7.88 [95% CI: 1.60–38.76]). Clinical success at 28 days was achieved in 49% (18/37) of patients who received antimicrobial therapy, but 44% (8/18) of successes were associated with infection recurrence within 3 months. Colistin resistance emerged in 18% (2/11) and 100% (3/3) of patients treated with colistin-carbapenem and colistin-tigecycline, respectively (p?=?0.03). Conclusions XDR-Ab causes VAP and other respiratory infections following SOT that are associated with significant recurrence and mortality rates. Cardiothoracic transplant recipients are at greatest risk. Results from this retrospective study suggest that colistin-carbapenem combinations may result in improved clinical responses and survival compared to other regimens and may also limit the emergence of colistin resistance. PMID:23285002

Shields, Ryan K.; Clancy, Cornelius J.; Gillis, Louise M.; Kwak, Eun J.; Silveira, Fernanda P.; Massih, Rima C. Abdel; Eschenauer, Gregory A.; Potoski, Brian A.; Nguyen, M. Hong

2012-01-01

96

Extension Agricola, (Agricultural Extension),  

National Technical Information Service (NTIS)

The Agricultural Extension Manual is a how-to manual covering techniques of extension work and community organization. It is written for extension workers. Also it promotes recommended agricultural practices, training of counterparts and a host of other r...

M. J. Gibbons, R. Schroeder

1987-01-01

97

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

PubMed

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

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

2012-06-01

98

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

Microsoft Academic Search

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

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

2010-01-01

99

Clinical approaches to the out-of-body experience  

Microsoft Academic Search

The author reviews aspects of the out-of-body experience (OBE) related to psychic experiences and personality traits, and describes a continuum of experiences of altered mind\\/body perception, from the prototypical OBE on the healthy end to schizophrenia and organic brain syndromes on the other end. The impact of the OBE on the individual's life is described, with suggestions for a psychoeducational

Stuart W. Twemlow

1989-01-01

100

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

E-print Network

The CancerGrid Experience: Metadata-Based Model-Driven Engineering for Clinical Trials Jim Davies Abstract The CancerGrid approach to software support for clinical trials is based on two principles significant. From a software point of view, a clinical trial is largely an exercise in data management

Oxford, University of

101

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

ERIC Educational Resources Information Center

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…

Duxbury, Mark

2004-01-01

102

Review of clinical experience with ion beam radiotherapy  

PubMed Central

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

Jensen, A D; Münter, M W; Debus, J

2011-01-01

103

Review of clinical experience with ion beam radiotherapy.  

PubMed

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

Jensen, A D; Münter, M W; Debus, J

2011-12-01

104

Improving biological relevancy of transcriptional biomarkers experiments by applying the MIQE guidelines to pre-clinical and clinical trials.  

PubMed

The "Minimum Information for the Publication of qPCR Experiments" (MIQE [3]) guidelines are very much targeted at basic research experiments and have to our knowledge not been applied to qPCR assays carried out in the context of clinical trials. This report details the use of the MIQE qPCR app for iPhone (App Store, Apple) to assess the MIQE compliance of one clinical and five pre-clinical trials. This resulted in the need to include 14 modifications that make the guidelines more relevant for the assessment of this special type of application. We also discuss the need for flexibility, since while some parameters increase experimental quality, they also require more reagents and more time, which is not always feasible in a clinical setting. PMID:22910527

Dooms, M; Chango, A; Barbour, E; Pouillart, P; Abdel Nour, A M

2013-01-01

105

The drug discovery by nanomedicine and its clinical experience.  

PubMed

It is expected that the incidence of various adverse effects of anticancer agents maybe decreased owing to the reduced drug distribution in normal tissue. Anticancer agent incorporating nanoparticles including micelles and liposomes can evade non-specific capture by the reticuloendothelial system because the outer shell of the nanoparticles is covered with polyethylene glycol. Consequently, the micellar and liposomal carrier can be delivered selectively to a tumor by utilizing the enhanced permeability and retention effect. Presently, several anticancer agent-incorporating nano-carrier systems are under preclinical and clinical evaluation. Several drug delivery system formulations have been approved worldwide. Regarding a pipeline of clinical development of anticancer agent incorporating micelle carrier system, several clinical trials are now underway not only in Japan but also in other countries. A Phase 3 trial of NK105, a paclitaxel incorporating micelle is now underway. In this paper, preclinical and clinical studies of NK105, NC-6004, cisplatin incorporating micelle, NC-6300, epirubicin incorporating micelle and the concept of cancer stromal targeting therapy using nanoparticles and monoclonal antibodies against cancer related stromal components are reviewed. PMID:24755547

Matsumura, Yasuhiro

2014-06-01

106

The Clinical/Practicum Experience in Professional Preparation: Preliminary Findings  

ERIC Educational Resources Information Center

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

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

2008-01-01

107

Cleveland Clinic experience with interstitial laser coagulation of the prostate  

NASA Astrophysics Data System (ADS)

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

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

2000-05-01

108

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

SciTech Connect

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.

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

2007-03-19

109

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

NASA Astrophysics Data System (ADS)

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

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

2008-01-01

110

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

E-print Network

The interpretation of extensive air shower (EAS) measurements is strongly dependent on the hadronic interaction models used for simulating reference showers. We study the importance of low-energy hadronic interactions in simulated air showers, generated with the simulation package CORSIKA, for the observed characteristics of extensive air showers. In particular we investigate in detail the energy and the phase space regions of secondary particle production which are most important for muon production. This phase space region is covered by fixed target experiments at CERN. In the second part of this work we present preliminary momentum spectra of secondary 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.

Christine Meurer; J. Bluemer; R. Engel; A. Haungs; M. Roth; the HARP collaboration

2006-12-06

111

Journal of Clinical Sleep Medicine Supplement to Vol.5, No. 2, 2009S20 The functions of sleep have been extensively studied and  

E-print Network

Journal of Clinical Sleep Medicine Supplement to Vol.5, No. 2, 2009S20 The functions of sleep have been extensively studied and debated, but remain largely unknown. However, evidence has demonstrated the necessity of sleep; sleep is tightly regu- lated, it has a restorative nature and, if eliminated completely

Walker, Matthew P.

112

The ethics of nursing student international clinical experiences.  

PubMed

This article explores the motivations for offering international nursing student experiences and the reasons students choose to participate. Students should prepare by learning cultural humility rather than cultural competency, and they should be oriented to the ethical responsibility implicit in caring for those in developing countries. Programs that provide these experiences need to be developed with an eye to sustainability so the lives of those receiving care will be enriched after the students go home. PMID:19208054

Levi, Amy

2009-01-01

113

Clinical Experience and Management of Cervico-Thoracic Epidural Hematoma  

PubMed Central

Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient's recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention. PMID:20539799

Ahn, Sang-Soak

2010-01-01

114

Clinical experience in cell-based therapeutics: intervention and outcome  

Microsoft Academic Search

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

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

2006-01-01

115

Digital Mammography Clinical Trials: The North American Experience  

Microsoft Academic Search

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

John M. Lewin

116

Initial experience with a rapid access blackouts triage clinic.  

PubMed

Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. The majority of patients had syncope, and very few had epilepsy. A high proportion had an abnormal ECG. A specialist-nurse-led rapid access blackouts triage clinic (RABTC) provided rapid effective triage for risk, a comprehensive assessment format, direct treatment for many patients, and otherwise a prompt appropriate onward referral. Rapid assessment through a RABTC reduced re-admissions with blackouts. Widespread use of the web-based blackouts tool could provide the NHS with a performance map. The U.K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate. PMID:21404775

Petkar, S; Bell, W; Rice, N; Iddon, P; Cooper, P; McKee, D; Curtis, N; Hanley, M; Stuart, J; Mackway Jones, K; Fitzpatrick, A P

2011-02-01

117

[50 years of clinical chemistry, first hand experience].  

PubMed

Approximately since 1945, progress in the field of photometric analysis also found its way into the laboratories of clinical chemistry. These techniques almost completely replaced the then prevailing gravimetric and titrimetric methods. At the same epoch, many of the biochemical reagents which up to then had to be prepared by the clinical laboratories themselves with great expenditure of work became commercially available. The increasing number of analytical orders could only be mastered thanks to the newly developed analyzers. Novel microliter techniques made it possible to diminish drastically the volumes of samples and reagents necessary. The radioimmunoassay opened up new analytical dimensions, the limits of detection and of quantification were expanded downwards to the picomol range. Soon afterwards, enzymes and/or fluorochromes were used as markers in immunoassays. The development of monoclonal antibodies constituted further important progress in this field. The latest revolutionary invention is doubtlessly the polymerase chain reaction (PCR), and related techniques. These methods are bound to bring about fundamental change not only in clinical chemistry but in the medical laboratory diagnostics in general. PMID:7770813

Keller, H

1995-05-01

118

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

PubMed Central

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

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

2012-01-01

119

Students' Experiences of Learning Manual Clinical Skills through Simulation  

ERIC Educational Resources Information Center

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

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

2013-01-01

120

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

PubMed

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

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

2014-08-01

121

Experience of a Clinic for Afghan Refugees in Pakistan  

PubMed Central

Since the Soviets invaded Afghanistan in 1979, 3.5 to 4 million refugees have moved into Pakistan and Iran. Even before the war, the health status of the Afghans was extremely poor and the medical personnel limited. Various international efforts are attempting to cope with the health care needs of the refugees. Economic, language, and cultural problems hamper the projects. One clinic found the most common problems were of the gastrointestinal tract, then the respiratory tract, with a problem ranking similar to that of pre-war Afghanistan. Many of the health problems are linked to deficiencies in sanitation and nutrition. PMID:3247740

Morgan, Walter A.

1988-01-01

122

Clinical experiences in fungal keratitis caused by Acremonium  

PubMed Central

Purpose To report the predisposing risk factors, clinical presentation, management, and therapeutic outcomes of fungal keratitis caused by Acremonium. Methods This is a retrospective study of cases with Acremonium fungal keratitis that presented to our tertiary referral center between January 2006 and August 2012. Patient demographic and clinical details were determined and reported. Results Five cases of fungal keratitis from Acremonium species were identified in five patients (three males, two females). The mean age of the patients was of 73.4±5.46 years, with a mean follow-up time of 124±72 days. All patients had a history of corneal trauma with vegetable matter. Four cases were unresponsive to initial treatment (0.2% fluconazole, 0.15% amphotericin B) and required topical 5% natamycin, and, in two out of five cases, topical 1% voriconazole. Conclusion The most common risk factors for Acremonium fungal keratitis was ocular trauma. When a corneal lesion is found to be unresponsive to the initial treatment, we should consider adding or substituting topical natamycin or voriconazole for treatment. PMID:24492439

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

2014-01-01

123

Contact allergy to colophony. Chemical identifications of allergens, sensitization experiments and clinical experiences.  

PubMed

Colophony (rosin) is a widespread material which is obtained from species of the family Pinaceae. It has a complex chemical composition, which differs depending mainly on the recovery process. The global production is about one million tons a year and the largest single consumption is in the sizing of paper and paper board. Rosin is a common cause of contact allergy and is included in the standard tray for patch testing at dermatological clinics. Unmodified gum rosin is the material mainly used in the routine series. It is desirable to test with identified allergens in order to make the testing and diagnosis more reliable and establish a strategy for prevention. The principal aims of the present study were to compare the allergenicity of rosin of different origins, to isolate and identify some of the allergens in unmodified gum rosin, and to attempt to diminish the allergenic potential of rosin preparations. Tall oil rosin and different types of gum rosin were tested in guinea pigs and in man. The test reactivity corresponded well when comparing gum rosin from different sources, while tall oil rosin showed a lower reactivity. However, testing with more than one rosin preparation in the routine series detected additional cases. A clear dose-response relationship was obtained by patch testing with gum rosin, implying that a concentration of 10% in petrolatum is well worth considering for routine testing. Unmodified Portuguese gum rosin was fractionated by chromatographic methods. Isolated fractions and components were tested for eliciting activity in guinea pigs sensitive to gum rosin. Pure compounds were also tested in patients with known allergy to gum rosin. The structures of the isolated allergens were elucidated using spectroscopic methods. Abietic acid, the classical colophony allergen, was found not to be allergenic, while oxidation products of abietic acid and dehydroabietic acid were identified as allergens. The isolated allergens showed a pattern of cross-reactivity in the animal experiments as well as among patients with known allergy to gum rosin. 15-Hydroperoxyabietic acid was identified as one of the main allergens, apparently formed by air oxidation of abietic acid. Gum rosin was hydrogenated in order to minimize the content of easily oxidized acids of the abietic type. The hydrogenated gum rosin showed a reduced allergenic activity compared to unmodified rosin both in animal experiments and patch testing in man. PMID:3188806

Karlberg, A T

1988-01-01

124

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

PubMed

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

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

2014-04-01

125

The Clinical Presentation of Celiac Disease: Experiences from Northeastern Iran  

PubMed Central

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

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

2014-01-01

126

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

PubMed

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

Allan, Helen

2007-06-01

127

Experience in international clinical research: the HIV Prevention Trials Network  

PubMed Central

The HIV Prevention Trials Network (HPTN) is supported by the NIH to conduct randomized clinical trials to assess the efficacy of HIV prevention strategies and technologies to reduce HIV transmission between adults. A special focus of attention is on the use of antiretroviral drugs to prevent HIV transmission, both by reducing infectiousness among HIV-infected persons taking combination antiretroviral therapy (cART) and also by reducing susceptibility among HIV-uninfected persons taking antiretrovirals for pre-exposure prophylaxis. Studies may be developmental in nature to assess novel ideas for interventions or for assessing trial feasibility. However, pivotal efficacy trials to test HIV-specific prevention strategies and technologies are the main HPTN priority. Examples include a major protocol investigating the impact of expanded testing and linkage to care on HIV surveillance indicators in the USA (HPTN 065). Another protocol is addressing similar issues while also investigating how combinations of prevention approaches are best deployed to make a community-level impact in southern Africa (HPTN 071). HPTN 068 is evaluating a novel conditional cash transfer structural intervention to increase school completion rates in young girls and thereby reduce their HIV risk. Studies outside the US address the epidemic in most at-risk populations and include an assessment of opiate agonist therapy to reduce risk of HIV seroconversion among injection drug users (HTPN 058), methods to increase HIV testing rates (HTPN 043), as well as methods for reducing high-risk behaviors, and increasing adherence to cART in HIV-infected individuals (HPTN 062 and HPTN 063, respectively). The recent HPTN 052 study demonstrated that a 96% reduction in HIV transmission could be achieved between serodiscordant sexual partners by providing the infected partners with cART at a CD4+ cell count (350–550/µl) above the level that would usually qualify them for therapy in low- and middle-income countries. The immediate relevance to public health policy showcased in these trials is a paradigm for the HPTN: design and conduct of clinical trials using available licensed tools that can be rapidly translated for implementation (‘Prevention NOW!’). PMID:22348195

Sista, Nirupama Deshmane; Abdool Karim, Quarraisha; Hinson, Kathy; Donnell, Deborah; Eshleman, Susan H; Vermund, Sten H

2012-01-01

128

Reliable Clinical Monitoring using Wireless Sensor Networks: Experiences in a Step-down Hospital Unit  

E-print Network

Reliable Clinical Monitoring using Wireless Sensor Networks: Experiences in a Step-down Hospital and oxygen saturation readings from patients. The pri- mary contribution of this paper is an in-depth clinical trial that assesses the feasibility of wireless sensor networks for patient monitoring in general

Lu, Chenyang

129

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

Microsoft Academic Search

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

Carol A. Nolan

1998-01-01

130

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

ERIC Educational Resources Information Center

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

Gordon, Michael; Russo, Kate

2009-01-01

131

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

ERIC Educational Resources Information Center

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

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

2013-01-01

132

Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity?  

Microsoft Academic Search

In a recent article, Weisz, Weiss, and Donenberg (1992) compared the effects of child and adolescent psychotherapy in experimental studies and in studies of clinic practice. Here we update that report with new information and we explore 10 possible reasons why, to date, therapy in experiments appears to have shown larger effect sizes than therapy in clinics. We find that

John R. Weisz; Geri R. Doneffberg; Susan S. Han; Danika Kauneckis I

1995-01-01

133

Clinical Experience of an Iontophoresis Based Glucose Measuring System  

PubMed Central

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45±52.99 mg/dL with a mean absolute relative error of 20±15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p<0.05)) and this correlation was independent of time of data collection. However, after excluding confounding variables this correlation coefficient exhibited a tendency to increase. 98.9% of the results were clinically acceptable by Clarke error grid analysis. We concluded that RIGMD does not have the reliability and accuracy required to wholly replace conventional methods. However, further technical advancements that reduce its shortcomings would make this device useful for the management of diabetes. PMID:17297254

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

2007-01-01

134

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

Microsoft Academic Search

RNumerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance,

Álvaro I. Langer; Adolfo J. Cangas; Mark Serper

2011-01-01

135

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

PubMed Central

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

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

136

Microwave imaging for neoadjuvant chemotherapy monitoring: initial clinical experience  

PubMed Central

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

2013-01-01

137

Clinical course of ectopic pregnancy: A single-center experience  

PubMed Central

OBJECTIVES: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP) in a general hospital. MATERIALS AND METHODS: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007). RESULTS: Out of total 7564 pregnancies, 44 (0.58%) patients were diagnosed as EP. Out of 44, 22 (50%) patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%), and 21 (48%) had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%), abdominal pain (39, 88.6%), and tenderness (38, 86%). Previous pelvic surgery (13, 29.5%), infertility treatment (11, 25%), and pelvic inflammatory disease (10, 22.7%) were the common predisposing factors. Twenty-five (57%) presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%). No mortality was observed. CONCLUSION: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes. PMID:23869156

Ayaz, Aqueela; Emam, Sameh; Farooq, Mian Usman

2013-01-01

138

Clinical experiences of bixalomer usage at our hospital.  

PubMed

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

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

2014-06-01

139

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

PubMed Central

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

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

2014-01-01

140

Three years of clinical experiences on excimer laser angioplasty  

NASA Astrophysics Data System (ADS)

We report here the experience of our multidisciplinary group that has been working since 1986 on excimer laser angioplasty. After having selected the excimer laser between the available sources because of the negligible lesions left on the residual tissue, we had the purpose to develop a suitable laser and catheter system. Neglecting here all the preliminary studies, we outline only a typical phenomenon related to the energy delivery and useful for the comprehension of the recanalization process. The energy emitted by every single fiber determines, under a certain threshold, independent recanalized channels in the plaque with residual flaps. At a higher energy level the overposition of the lobes, due to the intrinsic divergence, up to the recanalization in a single large channel. In our opinion this condition is crucial in the design of the catheters to obtain an optical instead of a mechanical recanalization. The biological experimentation conducted during the preliminary tests on human hearts obtained from transplants or cadavers, convinced us that the correct goal to pursue was unique laser angioplasty without the need for further balloon dilation.

Viligiardi, Riccardo; Galiberti, Sandra; Pini, Roberto; Salimbeni, Renzo

1992-03-01

141

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

PubMed

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

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

1998-03-01

142

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

PubMed Central

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

Doyle, Cathal; Lennox, Laura; Bell, Derek

2013-01-01

143

PURDUE EXTENSION Purdue Extension  

E-print Network

PURDUE EXTENSION Purdue Extension 1-888-EXT-INFO Preparing for Asian Soybean Rust Preparing for Asian Soybean Rust Preparing for Asian Soybean Rust ID-324ID-324 #12;2 What is Asian soybean rust? Asian soybean rust was first discovered in the continental United States in November 2004. This foliar disease

144

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

PubMed

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

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

2014-09-01

145

The electromagnetic bio-field: clinical experiments and interferences  

PubMed Central

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

Burnei, G; Hodorogea, D; Georgescu, I; Gavriliu, S; Draghici, I; Dan, D; Vlad, C; Draghici, L

2012-01-01

146

[Anastomotic pseudoaneurysms of the femoral bifurcation. Clinical experience].  

PubMed

The authors report their experience of the treatment of anastomotic pseudoaneurysms of the femoral tripod. The paper analyses 231 cases treated over the past 8 years by the Division of Vascular Surgery using an alloplastic prosthetic implant in correspondence with the femoral tripod. Pseudoaneurysms were observed in 23 patients (9.8%) and emergency corrective surgery was required in 10 cases (43%) and elective surgery in 13 (56.5%). A total of 6 trans-obturator by-passes, 2 femoro-femoral by-passes using the saphena vein, 2 axillo-popliteal by-passes, 8 resections and re-implants, and 5 ligatures were performed. Immediate permeability was obtained in 15 patients, whereas 5 were amputated at the thigh and the remaining patient undergoing ligature preserved the limb but with chronic ischemic symptoms; 2 patients died. In the long-term follow-up of those patients who were permeable on discharge, permeability had persisted in 5 (83%) treated with trans-obturator by-pass and in 7 (87%) who had undergone resection and re-implant. The remaining axillo-popliteal by-pass had thrombosed after 6 months but the patient had not lost the limb. The authors underline the unpredictability of this pathology and analyse the causes which may provoke the development of this complication which inevitably leads to thrombosis or hemorrhage. However, suture materials (continuing pseudoaneurysm in spite of not using silk), the infective etiology (the extreme difficulty of obtaining a positive bacteriological culture) and the inguinal region (onset of pseudoaneurysm during aorto-femoral by-pass but hardly ever during femoro-popliteal by-pass) may be contributory causes but not decisive factors.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8506036

Bonelli, U; Patrone, P; Cerruti, R

1993-03-15

147

Nursing students' evaluation of clinical experiences in a rural differentiated-practice setting.  

PubMed

This article describes nursing students' evaluations of clinical experiences in a rural nursing center that uses a differentiated practice model. The center provides clinical experiences for associate degree, baccalaureate degree, and master's degree nursing students. Learning objectives and student roles are differentiated according to educational level and reflect the practice model used by the nursing center. Student evaluations showed high levels of satisfaction for all three groups and indicated that experience at the center increased students' knowledge of rural health. Findings also showed that autonomy, independence, and a supportive staff are valued characteristics of this practice setting. PMID:12016659

Robertson, J F; Anderko, L; Uscian, M

2000-01-01

148

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

PubMed Central

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.

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

2014-01-01

149

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

PubMed

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

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

150

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

PubMed Central

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

2014-01-01

151

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

PubMed Central

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

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

2014-01-01

152

Clinical application of split skin graft from scar tissue for plastic reconstruction in post-extensive burn patients  

Microsoft Academic Search

We evaluated the use of autologous split-thickness skin taken from scars on the backs of patients with extensive burns, without sufficient normal donor skin. Between 1998 and 2008, a total of 15 patients underwent 47 operations using split-thickness skin grafts from scar tissue. Split-thickness skin was harvested from scars on the patient's back. In each operation, two thirds of donor

Jie Xin Zheng; Qin Zhang; Yi Wen Niu; Jian Liu

2010-01-01

153

Randomized Clinical Trial of a Brief and Extensive Dyadic Intervention for Advanced Cancer Patients and Their Family Caregivers  

PubMed Central

Objective Few intervention programs assist patients and their family caregivers to manage advanced cancer and maintain their quality of life (QOL). This study examined: 1) whether patient-caregiver dyads (i.e., pairs) randomly assigned to a Brief or Extensive dyadic intervention (the FOCUS Program) had better outcomes than dyads randomly assigned to usual care, and 2) if patients' risk for distress (RFD) and other factors moderated the effect of the Brief or Extensive Program on outcomes. Methods Advanced cancer patients and their caregivers (N=484 dyads) were stratified by patients' baseline risk for distress (high versus low), cancer type (lung, colorectal, breast, prostate), and research site, and then randomly assigned to a Brief (3-session) or Extensive (6-session) intervention or Control. The interventions offered dyads information and support. Intermediary outcomes were: appraisals (i.e., appraisal of illness/caregiving, uncertainty, hopelessness) and resources (i.e., coping, interpersonal relationships, and self-efficacy). The primary outcome was QOL. Data were collected prior to intervention and post-intervention (3 and 6 months from baseline). The final sample was 302 dyads. Repeated Measures MANOVA was used to evaluate outcomes. Results Significant Group by Time interactions showed there was improvement in dyads' coping (p<.05), self-efficacy (p<.05), and social QOL (p<.01), and in caregivers' emotional QOL (p<.05). Effects varied by intervention dose. Most effects were found at 3 months only. Risk for distress accounted for very few moderation effects. Conclusions Both Brief and Extensive programs had positive outcomes for patient-caregiver dyads, but few sustained effects. Patient-caregiver dyads benefit when viewed as the “unit of care.” PMID:22290823

Northouse, Laurel L.; Mood, Darlene W.; Schafenacker, Ann; Kalemkerian, Gregory; Zalupski, Mark; LoRusso, Patricia; Hayes, Daniel F.; Hussain, Maha; Ruckdeschel, John; Fendrick, A. Mark; Trask, Peter C.; Ronis, David L.; Kershaw, Trace

2012-01-01

154

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

SciTech Connect

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

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

2013-02-15

155

Providing premedical students with quality clinical and research experience: the Tobacco Science Scholars Program.  

PubMed

Undergraduate premedical students face a formidable decision as they work to determine whether to pursue a profession in medicine. Exposure to clinical medicine and research is essential to inform students what it might be like to be a physician. Undergraduates, however, face a number of obstacles to obtaining the kind of quality clinical and research experience needed to make an informed decision. Growing regulations designed to protect patient confidentiality, though undeniably important, pose a barrier to students seeking patient contact. Traditional passive physician shadowing often does not provide ample opportunities for one-on-one patient interaction or problem solving. Finally, research opportunities available to students typically are not associated with clinical work and therefore do not provide an experiential model of how empirical evidence informs medical practice. This report describes the University of Wisconsin School of Medicine and Public Health's Tobacco Science Scholars Program, a pilot program designed to address some of these barriers. While fulfilling institutional requirements for patient contact, the program provides students with an active model of clinical patient interaction and problem solving, with a research experience integrated into these clinical experiences so that undergraduates better understand how research informs clinical medicine. PMID:24734413

Davis, James M; Anderson, Maggie C; Stankevitz, Kristin A; Manley, Alison R

2013-10-01

156

An exploration of the clinical learning experience of nursing students in nine European countries.  

PubMed

The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship. PMID:20409620

Warne, Tony; Johansson, Unn-Britt; Papastavrou, Evridiki; Tichelaar, Erna; Tomietto, Marco; Van den Bossche, Koen; Moreno, Maria Flores Vizcaya; Saarikoski, Mikko

2010-11-01

157

"Virtual" clinical trials: case control experiments utilizing a health services research workstation.  

PubMed Central

We created an interface to a growing repository of clinical and administrative information to facilitate the design and execution of case-control experiments. The system enables knowledgeable users to generate and test hypotheses regarding associations among diseases and outcomes. The intuitive interface allows the user to specify criteria for selecting cases and defining putative risks. The repository contains comprehensive administrative and selected clinical information on all ambulatory and emergency department visits as well as hospital admissions since 1994. We tested the workstation's ability to determine relationships between outpatient diagnoses including hypertension, osteoarthritis and hypercholesterolemia with the occurrence of admissions for stroke and myocardial infarction and achieved results consistent with published studies. Successful implementation of this Health Services Research Workstation will allow "virtual" clinical trials to validate the results of formal clinical trials on a local population and may provide meaningful analyses of data when formal clinical trials are not feasible. PMID:9929230

Weiner, M. G.; Hillman, A. L.

1998-01-01

158

Clinical correlates of the caregiving experience for Chinese caregivers of patients with schizophrenia  

Microsoft Academic Search

Objective  To assess the correlation between clinical characteristics and the caregiving experience of caregivers of patients with schizophrenia.\\u000a \\u000a \\u000a \\u000a Patients and methods  Two hundred and one patients with schizophrenia and their caregivers were recruited from a psychiatric clinic. The involvement\\u000a evaluation questionnaire (IEQ) and the general health questionnaire (GHQ) were administered to the caregivers. The patients\\u000a were assessed by the Structured Clinical Interview,

Victoria Wing Kay Tang; Siu Kau Leung; Linda Chiu-Wa Lam

2008-01-01

159

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

PubMed Central

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

Wankowicz, Zofia

2013-01-01

160

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

E-print Network

involved, who have different technical and medical background. In the past, different guideline- agement in order to improve the quality and consistency in healthcare reducing costs where possible. EBM also influenced the development of clinical practice guidelines (CPGs) ­ also known as medical

161

Clinical application of split skin graft from scar tissue for plastic reconstruction in post-extensive burn patients.  

PubMed

We evaluated the use of autologous split-thickness skin taken from scars on the backs of patients with extensive burns, without sufficient normal donor skin. Between 1998 and 2008, a total of 15 patients underwent 47 operations using split-thickness skin grafts from scar tissue. Split-thickness skin was harvested from scars on the patient's back. In each operation, two thirds of donor skin was used at the recipient site and the remaining part was used to cover the donor site. All skin grafts survived. The skin function and appearance at the reconstruction site was improved in all cases, and reconstruction had therapeutic effects similar to those achieved by graft procedures using normal autologous split skin. Moreover, 6 months later, the skin graft procedure could be repeated at the donor site. Therefore, we concluded that split-thickness skin from scars on patients' backs is a valuable source of skin graft material that can be used repeatedly for plastic reconstruction in extensively burned patients. PMID:20971386

Zheng, Jie Xin; Zhang, Qin; Niu, Yi Wen; Liu, Jian

2010-12-01

162

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

PubMed Central

Background Hand-held dynamometry is a portable and inexpensive method to quantify muscle strength. To determine if muscle strength has changed, an examiner must know what part of the difference between a patient's pre-treatment and post-treatment measurements is attributable to real change, and what part is due to measurement error. This study aimed to determine the relative and absolute reliability of intra and inter-observer strength measurements with a hand-held dynamometer (HHD). Methods Two observers performed maximum voluntary peak torque measurements (MVPT) for isometric knee extension in 24 patients with haematological malignancies. For each patient, the measurements were carried out on the same day. The main outcome measures were the intraclass correlation coefficient (ICC ± 95%CI), the standard error of measurement (SEM), the smallest detectable difference (SDD), the relative values as % of the grand mean of the SEM and SDD, and the limits of agreement for the intra- and inter-observer '3 repetition average' and the 'highest value of 3 MVPT' knee extension strength measures. Results The intra-observer ICCs were 0.94 for the average of 3 MVPT (95%CI: 0.86–0.97) and 0.86 for the highest value of 3 MVPT (95%CI: 0.71–0.94). The ICCs for the inter-observer measurements were 0.89 for the average of 3 MVPT (95%CI: 0.75–0.95) and 0.77 for the highest value of 3 MVPT (95%CI: 0.54–0.90). The SEMs for the intra-observer measurements were 6.22 Nm (3.98% of the grand mean (GM) and 9.83 Nm (5.88% of GM). For the inter-observer measurements, the SEMs were 9.65 Nm (6.65% of GM) and 11.41 Nm (6.73% of GM). The SDDs for the generated parameters varied from 17.23 Nm (11.04% of GM) to 27.26 Nm (17.09% of GM) for intra-observer measurements, and 26.76 Nm (16.77% of GM) to 31.62 Nm (18.66% of GM) for inter-observer measurements, with similar results for the limits of agreement. Conclusion The results indicate that there is acceptable relative reliability for evaluating knee strength with a HHD, while the measurement error observed was modest. The HHD may be useful in detecting changes in knee extension strength at the individual patient level. PMID:19272149

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

2009-01-01

163

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

E-print Network

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

Paris-Sud XI, Université de

164

Systemic Mastocytosis: Retrospective Review of a Decade's Clinical Experience at the Brigham and Women's Hospital  

Microsoft Academic Search

The clinical experience with a group of 21 patients with systemic mastocytosis followed at our institution is summarized. Cutaneous and gastrointestinal symptoms and findings were the most prominent chronic manifestations; episodic vascular collapse was the most dramatic acute event. All patients had indolent mastocytosis. There was no mortality.

Richard F. Horan; K. Frank Austen

1991-01-01

165

Foreign bodies causing asphyxiation in children: the experience of the Buenos Aires Pediatric ORL Clinic  

Microsoft Academic Search

Rationale and aimThe inhalation\\/aspiration, of a foreign body (FB) is a relatively frequent event in young children. Size, shape, type and site of arrest of the FB are responsible of an important variability on clinical picture, therefore, the possibility to know details regarding object characteristics and traumatic event dynamics have a key role. In the present paper, experience coming from

A Chinski; F Foltran; D Passali; L Bellussi; D Gregori

2010-01-01

166

Clinical experience with the saphena loop arteriovenous fistula on the thigh  

Microsoft Academic Search

The increasing number of patients on regular dialysis treatment (RDT) for many years produces a number of problems, one of which is the vascular access procedure. When the internal subcutaneous fistula cannot be used either as the first procedure or after some years of treatment, alternative methods are necessary. We present here clinical experience with the saphenous vein arteriovenous fistula

F. Lynggaard; J. Nordling; R. Iversen Hansen

1981-01-01

167

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

Microsoft Academic Search

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

Sarah H. Ailey; Marilyn E. ORourke

2008-01-01

168

The First Experience of a Global Clinical Examination at the National University of Cuyo Medical School  

Microsoft Academic Search

Started in 1997, the new medical program of the National University of Cuyo, requires that students pass a Global Clinical Exam before graduation, in order to determine if they are able to approach and solve health problems in each of the major medical specialties. This report describes the first experience with this type of exam held at the Medical School

Ana María; Reta de De Rosas; Celia Bordín; Norma Carrasco; Francisco Eduardo Gago; Carlos Alberto López Vernengo; Bernardo Odoriz; Eduardo Reta; Ana Lía Vargas; María José López

169

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.

170

[Proton beam therapy: clinical indications and summary of the Swiss experience].  

PubMed

Compared to conventional radiotherapy, proton beam therapy provides a superior distribution of radiation dose due to the physical characteristics of protons. Protons administer a uniform dose across the target and then virtually zero deep to the target and lower dose proximal to the target (for non-superficial lesions). The result is a smaller treatment volume, and therefore a lower incidence and frequency of treatment-related morbidity. Moreover, the reduction in treatment volume permits a higher dose to the tumor. This means an improved local control probability and lower normal tissue complication probability. Evidence-based medicine has demonstrated that clinical gains have been realized in the treatment of patient with uveal melanoma, skull-base or spinal sarcoma and prostate cancer. In the future, more extensive prospective studies are required to assess more completely the potential clinical benefit of proton beam therapy in many anatomical sites in children and adults. PMID:17878101

Weber, Damien Charles; Mirimanoff, René-Olivier; Miralbell, Raymond

2007-09-01

171

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

NASA Astrophysics Data System (ADS)

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.

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

2011-03-01

172

Hearing distressing voices clinical simulation: "life changing" experiences of psychiatric-mental health nursing students.  

PubMed

The purpose of the current qualitative study was to investigate the experience of baccalaureate nursing (BSN) students with the clinical simulation of hearing distressing voices and derive themes from the written reflective data of students' evaluative statements. A purposive convenience sample of BSN students (N = 74) was recruited from two nursing cohorts at a private, religiously affiliated university BSN program in the northeastern United States. Student reflections on three evaluation questions of the simulation experience were analyzed using constant comparison as per naturalistic inquiry methodology. Themes emerged from each of the three questions related to students' experiences of hearing the simulated voices. Findings support the value of this simulation as a means to promote both active and affective learning in BSN students as they enter psychiatric-mental health clinical rotations. [Journal of Psychosocial Nursing and Mental Health Services, 52(10), 42-51.]. PMID:25291728

Wieland, Diane; Levine, Ciara; Smith, Janet

2014-10-01

173

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

PubMed Central

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

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

2012-01-01

174

Patients' experiences of a nurse-led rheumatology clinic in Sweden: a qualitative study.  

PubMed

In this study, patients' experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme "the nurse-led rheumatology clinic provided added value to patient care". The participants' experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care, making it more complete. Nurses and rheumatologists complemented each other, as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients in rheumatology units. PMID:23186524

Larsson, Ingrid; Bergman, Stefan; Fridlund, Bengt; Arvidsson, Barbro

2012-12-01

175

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

PubMed

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

Baw, Bandar; Chan, Teresa; Upadhye, Suneel

2014-11-01

176

Consent Timing and Experience: Modifiable Factors That May Influence Interest in Clinical Research  

PubMed Central

Purpose: Low rates of participation in cancer clinical trials have been attributed to patient, institutional, and study characteristics. However, few studies have examined factors related to the consent process. We therefore evaluated the impact of consent timing and experience on markers of patient interest in research. Methods: We performed a retrospective analysis of patients enrolled in a cancer center tissue repository. During enrollment, patients were asked if they were willing to be contacted in the future to provide medical follow-up information and/or to participate in other clinical research. We analyzed the association between patient responses to these questions and consent process factors using univariate analysis and multivariate logistic regression. Results: Of 922 patients evaluated, 85% agreed to be contacted to provide follow-up information, and 83% agreed to be contacted to participate in future research studies. In univariate analysis, willingness to be contacted for future research was associated with consenter experience (P = .01) and had a trend toward association with the timing of enrollment in relation to diagnosis (P = .08), but it was not associated with patient sex, race, or diagnosis. In multivariate analysis, responses remained associated with consenter experience (P = .02). Conclusion: Factors related to the consent process, including consenter experience and timing of study enrollment, are significantly associated with or have a trend toward association with markers of patient interest in clinical research. These understudied and potentially modifiable variables warrant further evaluation. PMID:23077435

Gerber, David E.; Rasco, Drew W.; Skinner, Celette Sugg; Dowell, Jonathan E.; Yan, Jingsheng; Sayne, Jennifer R.; Xie, Yang

2012-01-01

177

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

PubMed Central

A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40?kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart. PMID:21876780

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

2011-01-01

178

Recruitment and Retention of Diverse Populations in Antiretroviral Clinical Trials: Practical Applications from the Gender, Race And Clinical Experience Study  

PubMed Central

Abstract Background Women, particularly women of color, remain underrepresented in antiretroviral (ARV) clinical trials. To evaluate sex-based differences in darunavir/ritonavir-based therapy, the Gender, Race And Clinical Experience (GRACE) study was designed to enroll and retain a high proportion of women representative of the racial/ethnic demographics of women with HIV/AIDS in the United States. The recruitment and retention strategies used in GRACE are described in this article. Methods Recruitment and retention strategies targeting women included selecting study sites that focused on women, involving community consultants, site-specific enrollment plans, access to other ARV drugs, study branding, site and patient toolkits, targeted public relations, site grants for patient support, and subsidized child care and transportation. Results The recruitment strategies were successful; 287 (67%) women were enrolled, primarily women of color (black, n=191 [67%], Hispanic, n=60 [21%]). Despite the focus on retention, a greater proportion of women (32.8%) discontinued compared with men (23.2%). Conclusions The successes of GRACE in enrolling a representative population of women were rooted in pretrial preparation, engagement of community advisors, enrollment quotas, choice of study sites and site support. Lessons learned from GRACE may be applied to future study design. Further focus on factors that influence discontinuation is warranted. PMID:21663416

Bridge, Dawn Averitt; Currier, Judith; Squires, Kathleen; Hagins, Debbie; Schaible, Deborah; Ryan, Robert; Mrus, Joseph

2011-01-01

179

Lessons from new experiences in extension in West Africa: Management advice for family farms and farmers' governance  

Microsoft Academic Search

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

Guy Faure; Paul Kleene

2004-01-01

180

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

ERIC Educational Resources Information Center

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

Faure, Guy; Kleene, Paul

2004-01-01

181

Technical experiences of implementing a wireless tracking and facial biometric verification system for a clinical environment  

NASA Astrophysics Data System (ADS)

By implementing a tracking and verification system, clinical facilities can effectively monitor workflow and heighten information security in today's growing demand towards digital imaging informatics. This paper presents the technical design and implementation experiences encountered during the development of a Location Tracking and Verification System (LTVS) for a clinical environment. LTVS integrates facial biometrics with wireless tracking so that administrators can manage and monitor patient and staff through a web-based application. Implementation challenges fall into three main areas: 1) Development and Integration, 2) Calibration and Optimization of Wi-Fi Tracking System, and 3) Clinical Implementation. An initial prototype LTVS has been implemented within USC's Healthcare Consultation Center II Outpatient Facility, which currently has a fully digital imaging department environment with integrated HIS/RIS/PACS/VR (Voice Recognition).

Liu, Brent; Lee, Jasper; Documet, Jorge; Guo, Bing; King, Nelson; Huang, H. K.

2006-03-01

182

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

PubMed Central

Alexander of Tralles, writing in the late sixth century, combined his wide-ranging practical knowledge with earlier medical theories. This article shows how clinical experience is used in Alexander’s works by concentrating on his therapeutic advice on epilepsy and, in particular, on pharmacology and the group of so-called natural remedies. I argue that clinical testing is used not only for the introduction of new medicines but also as an instrument for checking the therapeutic effect of popular healing practices. On another level, this article discusses Alexander’s role as the author of a medical compendium; it suggests that by marking the cases of clinical testing with a set of recurrent expressions, Alexander leads his audience to reflect on his medical authority and personal contribution. PMID:25045178

Bouras-vallianatos, Petros

2014-01-01

183

Peroral small-intestinal biopsy: experience with the hydraulic multiple biopsy instrument in routine clinical practice.  

PubMed Central

Experience of the peroral, hydraulic, multiple, small-bowel biopsy instrument is recorded and compared with reported experience of other peroral biopsy instruments. It is concluded that, in routine clinical practice, there is no particular danger associated with this instrument despite warnings to the contrary. Furthermore, biopsies are obtained at least as quickly as with other instruments and with great reliability. Since this instrument also enables multiple, precisely located biopsies to be taken from various levels of the small intestine, it could be considered the instrument of choice for peroral jejunal biopsy. PMID:1086269

Scott, B B; Losowsky, M S

1976-01-01

184

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

PubMed Central

Background Clinical guidelines can improve health-care delivery, but there are a number of challenges in adopting and implementing the current practice guidelines for depression. The aim of this study was to determine clinical experiences and perceived barriers to the implementation of these guidelines in psychiatric care. Methods A web-based survey was conducted with 386 psychiatric specialists to inquire about experiences and attitudes related to the depression guidelines and barriers influencing the use of the guidelines. Quantitative data were analyzed, and qualitative data were transcribed and coded manually. Results Almost three quarters of the psychiatrists (74.6%) were aware of the clinical guidelines for depression, and over half of participants (55.7%) had had clinical experiences with the guidelines in practice. The main reported advantages of the guidelines were that they helped in clinical decision making and provided informative resources for the patients and their caregivers. Despite this, some psychiatrists were making treatment decisions that were not in accordance with the depression guidelines. Lack of knowledge was the main obstacle to the implementation of guidelines assessed by the psychiatrists. Other complaints addressed difficulties in accessing the guidelines, lack of support for mental health services, and general attitudes toward guideline necessity. Overall, the responses suggested that adding a summary booklet, providing teaching sessions, and improving guidance delivery systems could be effective tools for increasing depression guideline usage. Conclusion Individual barriers, such as lack of awareness and lack of familiarity, and external barriers, such as the supplying system, can affect whether physicians’ implement the guidelines for the treatment of depression in Korea. These findings suggest that further medical education to disseminate guidelines contents could improve public health for depression. PMID:23705908

2013-01-01

185

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

PubMed

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

Auerswald, G; Kreuz, W

2008-11-01

186

Enhancing Prostate Cancer Care Through the Multidisciplinary Clinic Approach: A 15-Year Experience  

PubMed Central

Purpose: To report on the 15-year prostate cancer experience of our multidisciplinary genitourinary cancer clinic established in 1996 at the National Cancer Institute (NCI) –designated Jefferson Kimmel Cancer Center. Patients with genitourinary cancers were evaluated weekly by multiple specialists at a single site, and we focus on the 83% of patients with prostate cancer. To our knowledge, our multidisciplinary genitourinary cancer clinic is the longest continuously operating center of its kind at an NCI Cancer Center in the United States. Methods: Data from Jefferson's Oncology Data Services were compared to SEER prostate cancer outcomes. Data on treatment changes in localized disease, patient satisfaction, and related parameters were also assessed. Results: Ten-year survival data approach 100% in stage I and II prostate cancer. Ten-year data for stage III (T3 N0M0) and stage IV (T4 N0M0) disease show that our institutional survival rate exceeds SEER. There is a shift toward robotically assisted laparoscopic radical prostatectomy and a slight decrease in brachytherapy relative to external beam radiation therapy in localized disease. Patient satisfaction is high as measured by survey instruments. Conclusion: Our long-term experience suggests a benefit of the multidisciplinary clinic approach to prostate cancer, most pronounced for high-risk, locally advanced disease. A high level of satisfaction with this patient-centered model is seen. The multidisciplinary clinic approach to prostate cancer may enhance outcomes and possibly reduce treatment regret through a coordinated presentation of all therapeutic options. This clinic model serves as an interdisciplinary educational tool for patients, their families, and our trainees and supports clinical trial participation. PMID:21358951

Gomella, Leonard G.; Lin, Jianqing; Hoffman-Censits, Jean; Dugan, Patricia; Guiles, Fran; Lallas, Costas D.; Singh, Jaspreet; McCue, Peter; Showalter, Timothy; Valicenti, Richard K.; Dicker, Adam; Trabulsi, Edouard J.

2010-01-01

187

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

Microsoft Academic Search

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

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

188

Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease.  

PubMed

Interstitial lung disease is the most common complication and cause of death among patients with scleroderma. Scleroderma-related interstitial lung disease has usually been treated with cyclophosphamide; however, its effect was evaluated to be modest and long-term administration of this drug is associated with adverse effects. Herein, we report our clinical experience of administering pirfenidone, which is an antifibrotic agent, in five patients with scleroderma-related interstitial lung disease. All patients demonstrated an increase in vital capacity. PMID:25363224

Miura, Yukiko; Saito, Takefumi; Fujita, Kazutaka; Tanaka, Toru; Tsunoda, Yoshiya; Azuma, Arata; Nei, Takahito; Yatagai, Yohei; Rin, Shigen; Sekine, Akimasa; Hayashihara, Kenji

2014-01-01

189

Transurethral needle ablation of the prostate for treatment of benign prostatic hyperplasia: Early clinical experience  

Microsoft Academic Search

Objectives.Many attempts have been made to develop a method for treatment of benign prostatic hyperplasia (BPH) that is minimally invasive, efficacious, and low-cost. Transurethral needle ablation (TUNA) is a new, fast outpatient anesthesia-free procedure, using interstitial low-level radio frequency energy to produce a temperature above 100°C. We describe our early clinical experience with TUNA as an outpatient procedure.

Claude C. Schulman; Alexandre R. Zlotta

1995-01-01

190

Clinical experience with two physiologic bicarbonate\\/lactate peritoneal dialysis solutions in automated peritoneal dialysis  

Microsoft Academic Search

Clinical experience with two physiologic bicarbonate\\/lactate peritoneal dialysis solutions in automated peritoneal dialysis.Background. Patients on automated peritoneal dialysis (APD) usually receive larger volumes of dialysis solution and more frequent, shorter exchanges than patients on continuous ambulatory peritoneal dialysis (CAPD), and therefore are likely to derive greater benefit from more physiologic solutions.MethodsPeritoneal dialysis solutions containing 25 mmol\\/L bicarbonate and either 10

MAX DRATWA; MARTIN WILKIE; JEAN-PHILIPPE RYCKELYNCK; PM TER WEE; PETER RUTHERFORD; CATHERINE MICHEL; ALEXANDRA HOPWOOD; LYNNE CURTIS; NICOLAS DENYS; Jose C. Divino Filho; DIRK FAICT

2003-01-01

191

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

PubMed

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

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

2012-08-01

192

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

ERIC Educational Resources Information Center

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…

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

2010-01-01

193

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

NASA Astrophysics Data System (ADS)

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

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

2014-05-01

194

Australian Football League clinics promoting health, hygiene and trachoma elimination: the Northern Territory experience.  

PubMed

Australia is the only developed country to suffer trachoma and it is only found in remote Indigenous communities. In 2009, trachoma prevalence was 14%, but through screening, treatment and health promotion, rates had fallen to 4% in 2012. More work needs to be done to sustain these declining rates. In 2012, 25% of screened communities still had endemic trachoma and 8% had hyperendemic trachoma. In addition, only 58% of communities had reached clean face targets in children aged 5-9 years. Australian Football League (AFL) players are highly influential role models and the community love of football provides a platform to engage and strengthen community participation in health promotion. The University of Melbourne has partnered with Melbourne Football Club since 2010 to run trachoma football hygiene clinics in the Northern Territory (NT) to raise awareness of the importance of clean faces in order to reduce the spread of trachoma. This activity supports Federal and state government trachoma screening and treatment programs. Between 2010 and 2013, 12 football clinics were held in major towns and remote communities in the NT. Almost 2000 children and adults attended football clinics run by 16 partner organisations. Awareness of the football clinics has grown and has become a media feature in the NT trachoma elimination campaign. The hygiene station featured within the football clinic could be adapted for other events hosted in remote NT community events to add value to the experience and reinforce good holistic health and hygiene messages, as well as encourage interagency collaboration. PMID:25282385

Atkinson, Josie R; Boudville, Andrea I; Stanford, Emma E; Lange, Fiona D; Anjou, Mitchell D

2014-10-01

195

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

PubMed Central

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

Lundquist, Lisa M.

2014-01-01

196

Programas de Extension (Extension Programs).  

National Technical Information Service (NTIS)

The greater number of techniques a worker uses, the greater the impact he or she can have by reaching more people. The following titles cover the programming development of rural extension. Guide for Village Extension Workers: Extension Methods. The more ...

1968-01-01

197

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

PubMed Central

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

Miller, Michael G.; Berry, Leisha M.

2004-01-01

198

Developing more positive attitudes towards mental health nursing in undergraduate students: part 2--The impact of theory and clinical experience.  

PubMed

Previous research examining the impact of education on nursing students' attitudes towards mental health nursing as a career has highlighted clinical experience as the primary influencing factor and generally has not considered the impact of theory. The current study compared a cohort of second-year and a cohort of third-year nursing students from the same university. Second-year students had received more theory and clinical experience than their counterparts. Questionnaires were distributed to the total population of students before commencement of, and after completion of clinical placement. This paper examines students' perceived preparedness for and satisfaction with clinical experience, attitudes towards people with mental illness, and attitudes towards mental health nursing as a career option following the completion of differing amounts of theory and clinical experience. The results demonstrate some statistically significant differences with increased amounts of theory and clinical experience in the second-year cohort being positively influential. The findings suggest that an increased component of theoretical and clinical experience in psychiatric/mental health nursing is likely to produce more positive attitudes towards people with mental illness and psychiatric/mental health nursing. However, little difference in perceived preparedness for and satisfaction with clinical experience was noted between the two cohorts. PMID:18768004

Happell, B; Robins, A; Gough, K

2008-09-01

199

Concepts in local treatment of extensive paediatric burns  

PubMed Central

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

Ungureanu, M

2014-01-01

200

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

PubMed

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

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

2014-01-01

201

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

PubMed Central

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

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

2012-01-01

202

The 10-year experience of an academically affiliated occupational and environmental medicine clinic.  

PubMed Central

Occupational and environmental diseases are underrecognized. Among the barriers to the successful diagnosis, treatment, and prevention of these conditions are inadequate consultative and information resources. We describe the 10-year clinical and training experiences of an academically affiliated referral center that has as its primary goal the identification of work-related and other environmental diseases. The University of Washington Occupational and Environmental Medicine Program has evaluated 6,048 patients in its diagnostic and screening clinics. Among the 2,841 seen in the diagnostic clinics, 1,553 (55%) had a work-related condition. The most prevalent diagnoses included asbestos-related lung disease (n = 603), toxic encephalopathy (n = 160), asthma (n = 119), other specific respiratory conditions (n = 197), carpal tunnel syndrome (n = 86), and dermatitis (n = 82). The clinics serve as a training site for fellows in the specialty training program, primary care internal medicine residents, residents from other medical specialties, and students in industrial hygiene, toxicology, and occupational health nursing. The program serves two additional important functions: providing consultative services to community physicians and training specialists and other physicians in this underserved area of medicine. PMID:1462536

Rosenstock, L; Daniell, W; Barnhart, S; Stover, B; Castorina, J; Mason, S E; Heyer, N J; Hubbard, R; Kaufman, J D; Brodkin, C A

1992-01-01

203

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

PubMed Central

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

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

2014-01-01

204

Transesophageal echocardiography using cypress-miniaturized echocardiogram unit: initial clinical experience.  

PubMed

Transesophageal echocardiography (TEE) was introduced clinically in the United States in 1987. Recent technologic advances have resulted in the creation of a small portable hand-carried ultrasound (HCU) device that can be easily carried throughout the hospital with greater flexibility for cardiac imaging. These HCU devices have harmonic, color, and spectral Doppler (continuous/pulsed wave). Siemens Medical Solutions USA, Inc. has incorporated a TEE connector, which connects to its Cypress (highly miniaturized echocardiogram unit) and allows the performance of a TEE with this unit, which is mildly heavier than a typical HCU. We describe our initial clinical experience with this unit. The image quality is comparable to routine TEEs, with the advantages of shorter duration, portability, affordable cost, avoiding the use of high-end machine from the echo lab, availability of non-HCU units for other studies, and preventing the need for an echo technician to be involved in the procedure. PMID:16343162

Herzog, Eyal; Pudpud, Danny; Chaudhry, Farooq A

2005-11-01

205

A Pilot Common Reading Experience to Integrate Basic and Clinical Sciences in Pharmacy Education  

PubMed Central

Objective. To use a common reading experience that engages students in academic discourse both before and during a PharmD degree program and introduces students to basic science and ethical foundations in health care. Design. First-year (P1) pharmacy students were assigned a nonfiction text to read during the summer prior to admission to be followed by facilitated discussions. Activities using the text were integrated into the first-year curriculum. Pre-experience and post-experience student and faculty survey instruments were administered. Assessment. Students and faculty members reported that 3 first-year courses used the text. Students noted that the text's historical perspective enhanced their understanding of both healthcare delivery and clinical research. Most students (78%) recommended continuation of the common reading experience activity. Conclusion. Students and participating faculty members found the common reading experience, which provided a hub for discussion around issues such as health literacy and ethical treatment of patients, to be a positive addition to the curriculum. Future intentions for this project include expansion across all healthcare colleges at the university. PMID:22438597

Policastri, Anne; Garces, Helen; Gokun, Yevgeniya; Romanelli, Frank

2012-01-01

206

African American Patient Experiences with a Rapid HIV Testing Program in an Urban Public Clinic  

PubMed Central

Background Of 1,174 new HIV cases diagnosed in Philadelphia in 2008, 771 (66%) were among African Americans. In 2007, Philadelphia introduced a citywide rapid HIV testing program in public clinics. Methods We conducted a prospective qualitative study among 60 African Americans undergoing rapid HIV testing in one of Philadelphia’s public clinics located in a zipcode with high HIV incidence. Employing grounded theory, we used semi-structured interviews to assess patients’ motivations, perceptions and clinical experiences with rapid HIV testing. Interviews were transcribed and coded; 20% were double coded to enhance reliability. Results Primary motivations for undergoing rapid HIV testing included: testing during routine clinical care, presenting for care with symptomatic STIs or opportunistic infections, knowing someone living with HIV/AIDS, and perceiving oneself at risk for HIV. Most patients reported positive experiences with rapid testing and preferred it to conventional testing because it eliminated the need for return visits and decreased anxiety; however, many expressed concerns about accuracy of rapid HIV testing. Barriers to HIV testing among this population included low self-perceived risk, HIV stigma and reported homophobia in respondents’ communities. Conclusion This rapid testing program was acceptable, convenient, and preferred over conventional HIV testing. Providing educational information about rapid and confirmatory HIV testing may further enhance acceptability of rapid HIV testing in this population. Nationwide expansion of rapid HIV testing in public health centers is an important and acceptable means of achieving President Obama’s National AIDS Strategy goals of reducing racial disparities in HIV infection and HIV/AIDS treatment services. PMID:22708242

Nunn, Amy; Eng, Whitney; Cornwall, Alexandra; Beckwith, Curt; Dickman, Samuel; Flanigan, Timothy; Kwakwa, Helena

2014-01-01

207

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

PubMed Central

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

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

2009-01-01

208

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

PubMed Central

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

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

2012-01-01

209

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

PubMed Central

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

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

2013-01-01

210

Steam piping monitoring system -- A key to power station life extension-experience at Anllares power plant  

SciTech Connect

During inspections conducted in connection with a life-extension assessment, the hot reheat steam piping was observed to have a negative slope. Thirty weight transducers were placed in each piping support to obtain actual measurements under real operating conditions. Thereafter, further flexibility analyses were run, recording piping system performance under specific operating conditions such as turbine start-up, shutdown or tripping. Several options were proposed in pursuit of the most favorable approach: (A) Traumatic solutions including cutting the piping. (B) Non-traumatic solutions: reinforcing the piping support system. (C) Combined solutions: cutting piping and reinforcing the support system. Solution C was chosen and implemented in a major overhaul performed in 1996. Several supports were replaced, a new support was incorporated and three cuts were made in the piping in order to correct slopes and relieve stress. One cut was made in the horizontal stretch of the main piping prior to the bifurcation near the turbine inlets. The other two cuts were made in each piping downstream of the bifurcation. A subsequent flexibility analysis was conducted to verify that the solution implemented was effective. Piping monitoring made it possible to relieve stress, adjust slopes and prevent condensate stagnancy.

Barreiro, J.C.; Bertet, J.S.

1998-07-01

211

Prognostic significance of soft tissue extension, international prognostic index, and multifocality in primary bone lymphoma: a single institutional experience.  

PubMed

Primary bone lymphoma (PBL) is a rare disease. The literature is inconsistent in regard to definition, stage and prognostic factors. We examined the PBL cases seen at the Moffitt Cancer Center between 1998 and 2013 using the 2013 World Health Organization criteria for bone/soft tissue tumours. Seventy PBL patients were included, of whom 53 (75.7%) patients were histologically classified as primary bone diffuse large B-cell lymphoma (PB-DLBCL). Femur was the most commonly involved site in PBLs with unifocal bone lesions, whereas PBLs with multifocal bone lesions most frequently presented with spine disease. Further analysis of the PB-DLBCL subgroup showed that these patients had 3- and 5-year progression-free survival (PFS) of 61.2% and 46.9%, respectively and 5- and 10-year overall survival (OS) of 81.1% and 74.7%, respectively. Multivariate analysis identified soft tissue extension and International Prognostic Index (IPI) score as the most important unfavourable prognostic factors for both PFS and OS. Multifocality was also highly significantly associated with a worse PFS (P = 0.002) and OS (P < 0.001), although it was not identified in multivariate analysis due to its incorporation into the IPI. The results warrant further investigation regarding whether PBL with multifocal bone lesions could be considered as a systemic and more aggressive disease rather than a conventional PBL. PMID:24673481

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

2014-07-01

212

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

PubMed Central

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

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

2012-01-01

213

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

PubMed Central

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

Siemionow, Maria; Klimczak, Aleksandra

2013-01-01

214

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

PubMed

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

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

2014-01-01

215

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

PubMed

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

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

2014-08-01

216

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

PubMed Central

Purpose To assess the safety and efficacy of the serotonin–norepinephrine reuptake inhibitor desvenlafaxine in adults with painful diabetic peripheral neuropathy (DPN). ClinicalTrials.gov identifiers NCT00283842, NCT01050218. Patients and methods This was a 13-week, randomized, double-blind, placebo-controlled, fixed-dose study of desvenlafaxine in adults with painful DPN. The primary efficacy endpoint was change from baseline in numeric rating scale (NRS) score. Patients who completed the 13-week trial could continue in a 9-month open-label, flexible-dose extension study. Results A total of 412 patients were randomized to treatment with placebo or desvenlafaxine 50, 100, 200, or 400 mg/day. Of those, 240 patients continued in the extension study. After a planned interim analysis, conducted when the first 225 patients had completed 6 weeks of treatment in the short-term study, randomization to the 50 mg or 400 mg doses was stopped. At week 13, the mean change from baseline in NRS score was significantly greater compared with placebo in the desvenlafaxine 200 mg (difference [95% confidence interval {CI}]: 1.10 [0.50 to 1.70]; P<0.001) and 400 mg groups (0.91 [95% CI: 0.23 to 1.59]; P=0.027); differences from placebo were not statistically significant for the 50 mg (0.58 [95% CI: ?0.08 to 1.25]) and 100 mg (0.59 [95% CI: –0.03 to 1.21]) groups. Nausea and dizziness were the most common treatment-emergent adverse events reported in the short-term study, and the most common adverse events leading to discontinuation in the short-term study and the extension. Adverse events rates were dose-dependent in the short-term studies. Conclusion Desvenlafaxine was effective in relieving pain associated with DPN at doses of 200 and 400 mg/day, and improved activity impairment at all doses assessed. Desvenlafaxine was generally well-tolerated in the short-term and long-term studies. PMID:25018648

Allen, Rob; Sharma, Uma; Barlas, Suna

2014-01-01

217

Assessing decentering: validation, psychometric properties, and clinical usefulness of the experiences questionnaire in a spanish sample.  

PubMed

Decentering is defined as the ability to observe one's thoughts and feelings in a detached manner. The Experiences Questionnaire (EQ) is a self-report instrument that originally assessed decentering and rumination. The purpose of this study was to evaluate the psychometric properties of the Spanish version of EQ-Decentering and to explore its clinical usefulness. The 11-item EQ-Decentering subscale was translated into Spanish and psychometric properties were examined in a sample of 921 adult individuals, 231 with psychiatric disorders and 690 without. The subsample of nonpsychiatric participants was also split according to their previous meditative experience (meditative participants, n=341; and nonmeditative participants, n=349). Additionally, differences among these three subgroups were explored to determine clinical validity of the scale. Finally, EQ-Decentering was administered twice in a group of borderline personality disorder, before and after a 10-week mindfulness intervention. Confirmatory factor analysis indicated acceptable model fit, sb?(2)=243.8836 (p<.001), CFI=.939, GFI=.936, SRMR=.040, and RMSEA=.06 (.060-.077), and psychometric properties were found to be satisfactory (reliability: Cronbach's ?=.893; convergent validity: r>.46; and divergent validity: r<-.35). The scale detected changes in decentering after a 10-session intervention in mindfulness (t=-4.692, p<.00001). Differences among groups were significant (F=134.8, p<.000001), where psychiatric participants showed the lowest scores compared to nonpsychiatric meditative and nonmeditative participants. The Spanish version of the EQ-Decentering is a valid and reliable instrument to assess decentering either in clinical and nonclinical samples. In addition, the findings show that EQ-Decentering seems an adequate outcome instrument to detect changes after mindfulness-based interventions. PMID:25311294

Soler, Joaquim; Franquesa, Alba; Feliu-Soler, Albert; Cebolla, Ausias; García-Campayo, Javier; Tejedor, Rosa; Demarzo, Marcelo; Baños, Rosa; Pascual, Juan Carlos; Portella, Maria J

2014-11-01

218

Correlation of quantity of dental students' clinical experiences with faculty evaluation of overall clinical competence: a twenty-two-year retrospective investigation.  

PubMed

The purpose of this study was to investigate the correlation between the quantity of a student's clinical experiences in the final year of dental school and the student's overall clinical competence at graduation, as evaluated by faculty at the University of Iowa College of Dentistry. Further, the authors sought to determine whether this correlation changed over time, as new generations of students come to dental school. Information including year of graduation, age at graduation, final grade in the course Clinical Competencies in Comprehensive Care, and final total Clinical Experience Units (CEUs) earned by each student in the D4 Family Dentistry Clinic was collected for 1987-2008 graduates of the University of Iowa College of Dentistry. Spearman's rank correlation coefficient (r(s)) was computed for the association of final clinical course grade and final CEU total for each graduation year. The correlation between final course grade and final CEU total was variable, ranging from moderately strong (r(s)=0.614, Class of 1991) to negligible (r(s)=-0.013, Class of 2008). This correlation generally tended to become weaker over time. The results of this study suggest that the terminal quality of a dental student's work is not solely a function of repetitions of prescribed procedures and that repetition of procedures may have even less influence on the quality of clinical performance for the new generation of dental students. PMID:19056625

Spector, Michael; Holmes, David C; Doering, John V

2008-12-01

219

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

SciTech Connect

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

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

2011-09-22

220

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

PubMed Central

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

Cafiero, Madeline

2013-01-01

221

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

PubMed

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

Cafiero, Madeline

2013-01-01

222

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

PubMed Central

Background Single incision thoracoscopic surgery (SITS) is recognized as a difficult procedure and surgeons hesitate to perform this technique. We describe our experience of SITS and determine whether SITS can be a routine approach in minimally invasive surgery. Methods From May 2011 to April 2013, a single operator attempted SITS for 264 cases. Their medical records were retrospectively reviewed with regard to age, sex, diagnosis, operation time, hospital stay, need of additional incision, morbidity, and early outcome. Results A number of thoracic diseases and procedures were attempted with SITS including primary (n?=?172) or secondary (n?=?22) spontaneous pneumothorax, biopsy for lung (n?=?29), pleura (n?=?3), and mediastinal lymph node (n?=?3), mediastinal mass excision (n?=?11), empyema decortication (n?=?11), lobectomy (n?=?6), pulmonary metastasectomy (n?=?3), pericardial window formation (n?=?3), and hematoma evacuation (n?=?1). Of these, 237 cases underwent SITS successfully. However, additional incision was needed in 10.2% (n?=?27). Reasons for conversions were as follows: extensive pleural adhesion (n?=?14), difficulty in endoscopic stapling (n?=?11), bleeding (n?=?1), and intolerance of one lung ventilation (n?=?1). Conversion rate of empyema was 54.5%, which was the most difficult for SITS. In contrast, the conversion rate of PSP was 4.7%, which means PSP was the most applicable for SITS. Postoperative complications included air leak (?3 days) (n?=?1), wound problem (n?=?4), delayed pleural effusion (n?=?1), and postoperative bleeding (n?=?1). Conclusions SITS can be a routine approach from simple to more complicated diseases. However, we still have difficulties in cases with extensive pleural adhesion or location of lesion with difficult accessibility for endoscopic stapling. PMID:24607000

2014-01-01

223

Extension maps  

E-print Network

We define extension maps as maps that extend a system (through adding ancillary systems) without changing the state in the original system. We show, using extension maps, why a completely positive operation on an initially entangled system results in a non positive mapping of a subsystem. We also show that any trace preserving map, either positive or negative, can be decomposed in terms of an extension map and a completely positive map.

Aik-meng Kuah; E. C. G. Sudarshan

2005-03-12

224

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

ERIC Educational Resources Information Center

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

Collings, Mary Louise; Gassie, Edward W.

225

Clinical response and tolerability to abatacept in patients with rheumatoid arthritis previously treated with infliximab or abatacept: open-label extension of the ATTEST Study  

PubMed Central

Objective To assess the efficacy and safety of abatacept in biological-naive patients with rheumatoid arthritis and an inadequate response to methotrexate treated in the long-term extension (LTE) of the ATTEST trial. Methods Patients randomly assigned to abatacept, placebo or infliximab completing the 1-year double-blind period were eligible to receive abatacept ?10 mg/kg in the open-label LTE. Efficacy to year 2 is presented for patients randomly assigned to abatacept or infliximab who switched to open-label abatacept. Safety data are presented for all patients entering LTE regardless of double-blind treatment. Results Of 431 patients randomly assigned, 79.8% remained on abatacept at year 2. At years 1 and 2, 19.7% and 26.1% of abatacept and 13.3% and 28.6% of infliximab-to-abatacept patients achieved disease activity score 28-defined remission (<2.6). Safety with abatacept during the cumulative study period was consistent with the double-blind experience, with no increase in adverse event incidence following the switch to abatacept. Conclusion In methotrexate-inadequate responders, abatacept efficacy was maintained over 2 years. For infliximab-to-abatacept patients, efficacy improvements were seen in year 2 after patients switched to abatacept. Switching directly from infliximab to abatacept was well tolerated. These data demonstrate that abatacept provides sustained responses and consistent safety, suggesting that switching from infliximab to abatacept is a viable treatment option. PMID:21914628

Schiff, Michael; Keiserman, Mauro; Codding, Christine; Songcharoen, Suthin; Berman, Alberto; Nayiager, Sauithree; Saldate, Cristina; Aranda, Richard; Becker, Jean-Claude; Nys, Marleen; le Bars, Manuela; Reed, Diane Moniz; Poncet, Coralie; Dougados, Maxime

2011-01-01

226

The Effect of Nursing Faculty Presence on Students' Level of Anxiety, Self-Confidence, and Clinical Performance During a Clinical Simulation Experience  

E-print Network

evaluation of a clinical simulation experience. Data were collected for the quasi-experimental two group pretest-posttest study from a total of 91 participants during the Fall 2011 and Spring 2012 semesters at a large university in the north central region...

Horsley, Trisha Leann

2012-05-31

227

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

PubMed

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

Javaid, Mahvesh Rana

2013-01-01

228

Allegations of children's involvement in ritual sexual abuse: clinical experience of 20 cases.  

PubMed

Twenty cases were evaluated in which allegations had been made of children being involved in ritual sexual abuse (RSA). A selection of case histories are presented together with a summary of the salient points in the other cases. Using a standard format developed for assessing the validity of allegations in sexual abuse cases, it was concluded that false allegations of ritual sexual abuse occurred in three-quarters of the cases and true allegations only in one-quarter. This high rate of false allegations is unlike the author's clinical experience in other cases of child sexual abuse where the rate of false allegations is much lower and similar to other published series. Reasons for the high rate of false allegations are discussed. PMID:7606526

Weir, I K; Wheatcroft, M S

1995-04-01

229

Early Traumatic Experiences in those at Clinical High Risk for Psychosis  

PubMed Central

Aim Several lines of evidence suggest a possible association between a history of trauma in childhood and later psychosis or psychotic-like-experiences. The purpose of this study was to determine the extent of childhood trauma and bullying in young people at clinical high risk (CHR) of developing psychosis. Methods The sample consisted of 360 individuals who were at CHR of developing psychosis and 180 age and gender matched healthy controls. All participants were assessed on past trauma and bullying. The CHR participants were also assessed on a range of psychopathology and functioning. Results Individuals at CHR reported significantly more trauma and bullying than healthy controls. Those who had experienced past trauma and bullying were more likely to have increased levels of depression and anxiety and a poorer sense of self. Conclusions These results offer preliminary support for an association between a history of trauma and later subthreshold symptoms. PMID:23343384

Addington, Jean; Stowkowy, Jacqueline; Cadenhead, Kristin S.; Cornblatt, Barbara A.; McGlashan, Thomas H.; Perkins, Diana O.; Seidman, Larry J.; Tsuang, Ming T.; Walker, Elaine F.; Woods, Scott W.; Cannon, Tyrone D.

2012-01-01

230

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

PubMed

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

Karussis, Dimitrios; Petrou, Panayiota; Kassis, Ibrahim

2013-01-15

231

Migrating toward a next-generation clinical decision support application: the BJC HealthCare experience.  

PubMed

The next-generation model outlined in the AMIA Roadmap for National Action on Clinical Decision Support (CDS) is aimed to optimize the effectiveness of CDS interventions, and to achieve widespread adoption. BJC HealthCare re-engineered its existing CDS system in alignment with the AMIA roadmap and plans to use it for guidance on further enhancements. We present our experience and discuss an incremental approach to migrate towards the next generation of CDS applications from the viewpoint of a healthcare institution. Specifically, a CDS rule engine service with a standards-based rule representation format was built to simplify maintenance and deployment. Rules were separated from execution code and made customizable for multi-facility deployment. Those changes resulted in system improvement in the short term while aligning with long-term strategic objectives. PMID:18693855

Huang, Yan; Noirot, Laura A; Heard, Kevin M; Reichley, Richard M; Dunagan, Wm Claiborne; Bailey, Thomas C

2007-01-01

232

Regulatory approvals in a large multinational clinical trial: the ESPRIT experience.  

PubMed

While accepted as serving an important function to safeguard human subjects, the process of obtaining regulatory approvals to conduct clinical trials is generally regarded as cumbersome and time-consuming. For large multinational trials, U.S. federally sponsored human subject research abroad involves specific U.S. regulatory requirements, in addition to those of the host country, that act as further hurdles. These requirements may include obtaining an Assurance of Protection for Human Subjects from the Office of Human Research Protection of the U.S. Department of Health and Human Services, maintaining specific Ethics Committee/Institutional Review Board (EC/IRB) composition, and incorporating mandated elements in informed consents, all of which may differ from local policies and guidelines. Specific examples of issues that led to delays in regulatory approvals for sites participating in the multinational clinical trial entitled Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT) are presented here. While the goal of these requirements is to protect the rights and welfare of human subjects, they may create substantial delays and engender resentment over the notion of lack of respect for individual country sovereignty. Substudies within ESPRIT have been undertaken to obtain feedback from EC/IRB chairpersons, site personnel responsible for processing the required assurances, ESPRIT investigators, and study participants regarding aspects of current U.S. regulatory requirements related to human subject protection and ethical issues in multinational research. The purpose of these substudies is to compare the attitudes and experiences across countries regarding important ethical issues associated with conducting ESPRIT. One objective of the substudies is to gather additional insight to the impact of U.S. regulatory processes. Another is to help to inform the debate about how to best maximize the rights and welfare of clinical trial participants without delaying the initiation of research, while respecting the importance of national sensitivities. PMID:11852166

McNay, Laura A; Tavel, Jorge A; Oseekey, Karen; McDermott, Cathy M; Mollerup, David; Bebchuk, Judith D

2002-02-01

233

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

PubMed Central

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

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

2014-01-01

234

Clinical outcome of rhabdomyosarcoma in adolescent and adult patients: single center experience from Turkey.  

PubMed

Rhabdomyosarcoma (RMS) is rare disease in adults (age >or= 16 years). The data from randomized prospective trials are scarce; the clinical outcome of these patients seems poor with the currently available treatment strategies. In this study, we report a single institution's experience in the treatment of adult RMS. We reviewed the medical records of patients with RMS who were >or= 16 years and have been treated in our institution between 1988 and 2003 retrospectively. We analyzed the survival outcome of these patients and the prognostic impact of clinical/pathological factors on their survival. In total, 23 patients with RMS were identified. Median age was 26 years (range, 16-72 years). Majority of patients were male (n: 17, 73.9%), and had large tumors (>or= 5 cm, n: 13, 56.5%), localized disease (N0, M0, n: 12, 52.2%), and embryonal histology (n: 10, 43.5%). Median overall survival was 31.3 months, and the 3-year progression-free survival and overall survival rates were 19.9% and 34.94%, respectively. Patients with smaller tumors (< 5 cm) (p < 0.04), local disease (p < 0.01), and normal lactic dehydrogenase (LDH) level (p < 0.01) at the time of diagnosis were found to have better survival outcome. The tumor size, serum LDH level, and metastatic disease at the time of diagnosis are potential predictors of outcome in patients with adult RMS. Adult RMS is an aggressive disease with poor survival despite treatment. The data from prospective, randomized multicenter trials are necessary in order to improve the clinical outcome of adult RMS patients. PMID:17984619

Ustuner, Zeki; Basaran, Mert; Dizdar, Yavuz; Agaoglu, Fulya Yaman; Bilgic, Bilge; Sakar, Burak; Basaran, Gul Atalay; Darendeliler, Emin; Ozger, Harzem; Onat, Haluk; Bavbek, Sevil

2007-11-01

235

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

PubMed Central

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

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

2005-01-01

236

Clinical routine operation of a filmless radiology department: three years experience  

NASA Astrophysics Data System (ADS)

This paper communicates the operational implementation of filmless digital radiology in clinical routine, its feasibility and its effect on the radiology profession, based on the three years clinical experience from the filmless digital radiology department of the Danube Hospital, a major teaching hospital in Vienna, Austria, with currently 850 acute-care beds. Since April 1992 all radiological modalities are reported from the monitors of 16 reporting consoles in the radiology department. Images and reports are distributed by the hospital-wide network (Sienet, Siemens Medical Systems, Erlangen), and can be viewed on 60 display consoles throughout the hospital. Filmless radiology primarily is an efficient hospital-wide infrastructure to deliver radiological services along with other medical information, providing safe and fast access to this information anytime and anywhere, necessary for the conduct of the diagnostic and therapeutic task of patient care. In a comparative study of the Danube Hospital with the film based Rudolfstiftung Hospital in Vienna, we found a significant decrease of the mean patient length of hospital stay (1.99 to 3.72 days) that partially might be attributed to the implementation of filmless radiology.

Mosser, Hans M.; Paertan, Gerald; Hruby, Walter

1995-05-01

237

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

PubMed Central

Background To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology. Methods During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45Gy and 69.96Gy in 33 fractions (group A); 54.45Gy and 66Gy in 33 fractions (group B) and 55Gy in 25 fractions (group C). Results Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition. Conclusions These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities. PMID:20950429

2010-01-01

238

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

SciTech Connect

Purpose: Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of pituitary adenomas. However, there have been few published data on the short- and long-term outcomes of this treatment. This is the initial report of Cleveland Clinic's experience. Methods and Materials: Between February 1998 and December 2003, 34 patients with pituitary adenomas were treated with IMRT. A retrospective chart review was conducted for data analysis. Results: With a median follow-up of 42.5 months, the treatment has proven to be well tolerated, with performance status remaining stable in 90% of patients. Radiographic local control was 89%, and among patients with secretory tumors, 100% had a biochemical response. Only 1 patient required salvage surgery for progressive disease, giving a clinical progression free survival of 97%. The only patient who received more than 46 Gy experienced optic neuropathy 8 months after radiation. Smaller tumor volume significantly correlated with subjective improvements in nonvisual neurologic complaints (p = 0.03), and larger tumor volume significantly correlated with subjective worsening of visual symptoms (p = 0.05). New hormonal supplementation was required for 40% of patients. Younger patients were significantly more likely to require hormonal supplementation (p 0.03). Conclusions: Intensity-modulated radiation therapy is a safe and effective treatment for pituitary adenomas over the short term. Longer follow-up is necessary to determine if IMRT confers any advantage with respect to either tumor control or toxicity over conventional radiation modalities.

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

2007-01-01

239

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

SciTech Connect

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

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

2006-12-15

240

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

PubMed Central

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

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

2010-01-01

241

Early clinical experience with high-field 1.5 Tesla magnetic resonance imaging.  

PubMed

Despite early concerns regarding potential tissue attenuation of signal and lack of inherent contrast, magnetic resonance imaging at 1.5 Tesla has proved to be a valuable extension of magnetic resonance imaging. In this report, we review our initial experience in imaging of the central nervous system, abdomen, chest and pelvis. In the central nervous system, exquisite morphologic detail has been demonstrated. This has added both in terms of sensitivity and specificity to neuroradiologic diagnosis. In the chest and abdomen, despite problems with respiratory and cardiac motion, good morphologic detail can be obtained. In the thorax, our work has demonstrated the ability of magnetic resonance imaging to clearly define the relationship of masses to the hilum and mediastinum. Imaging of the great vessels with magnetic resonance imaging has also proved useful. In the abdomen, magnetic resonance imaging has been useful in looking at the extent of masses identified, in characterizing focal liver masses, and in staging a variety of neoplasms. The high contrast resolution and the ability to image in a variety of planes is particularly helpful in the pelvis. In the male pelvis our work has primarily dealt with staging extracapsular prostatic carcinoma. In the female pelvis, ascertaining the nature of adnexal masses and defining staging primary carcinomas and their response to therapy has been the major thrust of our efforts. Surface coils and other technical improvements will undoubtedly extend the range of application at high field. PMID:3562885

Kressel, H Y

1986-01-01

242

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

PubMed

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

Begley, Thelma

2007-07-01

243

Professional socialisation of nursing students as an outcome of a senior clinical preceptorship experience.  

PubMed

The study purpose was to examine the effects of a senior clinical preceptorship experience on the professional socialisation of nursing students. Corwin's (1961) conception of the professional nursing role and literature on professional socialisation provided the model for the study. A three-group, pre- and post-test design was used. The voluntary, non-randomised sample was drawn from 242 senior community college, baccalaureate and RN-BScN nursing students. Instruments were the Lawler-Corwin (1988) Nursing Role Conception Scale and the Lawler-Stone (1988) Health Care Professional Attitude Inventory. Demographic data were collected. One-way ANOVA was used to compare the mean scores among the three groups. For statistically significant (p < 0.05) F tests, Student-Newman-Keuls multiple comparison tests were used to determine which pairs of groups were different. Pre-post scores were compared using paired t-tests. Following the preceptorship, on the Lawler-Stone subscales, the groups became more professional and more similar in attitude. On Corwin's three role conceptions, the total group reported less role conflict, with the community college students having the least and the RN-BScN students the most amount of conflict. The mixed results emphasise that professional socialization requires further research, especially as an outcome of a preceptorship experience for RN-BScN students. PMID:8455537

Goldenberg, D; Iwasiw, C

1993-02-01

244

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

PubMed

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

Pozzilli, Carlo

2013-12-01

245

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

PubMed Central

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

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

2014-01-01

246

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

PubMed Central

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

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

2013-01-01

247

Preliminary Clinical Experience with a Bifurcated Y-Graft Fontan Procedure--A Feasibility Study  

PubMed Central

OBJECTIVE Optimizing flow and diminishing power loss in the Fontan circuit can improve hemodynamic efficiency potentially improving long-term outcomes. Computerized modeling has predicted improved energetics with a Y-graft Fontan. METHODS From August to December, 2010, six consecutive children had a completion Fontan (n=3) or a Fontan revision (n=3) using a bifurcated polytetrafluoroethylene Y-graft (18×9×9 mm in 2, 20×10×10 mm in 4) connecting the inferior vena cava (IVC) to the right and left pulmonary arteries (PAs) with separate graft limbs. Patents were imaged by magnetic resonance imaging (MRI; n-5) or computerized tomography (n=1). Computational fluid dynamics (CFD) assessed Fontan hemodynamics, power loss, and IVC flow splits to the branch PAs. Clinical parameters were compared with 12 patients immediately preceding this series who had a lateral Fontan procedure. RESULTS Despite longer crossclamp and bypass times (not statistically significant), the Y-graft Fontan patients had postoperative courses similar to the conventional Fontan patients. Other than two early readmissions for pleural effusions managed with diuretics, on 6–12 months follow-up (mean 8 months), all six patients have done well. Postoperative flow modeling demonstrated balanced distribution of IVC flow to both PAs with minimal flow disturbance. Improvements in hemodynamics and efficiency were noted when the Y-graft branches were anastomosed distally and aligned tangentially with the branch PAs. CONCLUSIONS This preliminary surgical experience demonstrates clinical feasibility of the bifurcated Y-graft Fontan. CFD shows acceptable hemodynamics with low calculated power losses and balanced distribution of IVC flow to the PAs as long as the branch grafts are anastomosed distally. PMID:22698555

Kanter, Kirk R.; Haggerty, Christopher M.; Restrepo, Maria; de Zelicourt, Diane A.; Rossignac, Jarek; Parks, W. James; Yoganathan, Ajit P.

2012-01-01

248

Extension Service Agricultural Experiment Station  

E-print Network

Song Farm and Dairy, attended in 2012 and wrote: "My pen was madly writing everything from slug control to green- house styles; kale varieties to planting dates to running a full- diet, year-around CSA. Totally

Tullos, Desiree

249

Extension Service Agricultural Experiment Station  

E-print Network

, 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

Tullos, Desiree

250

Clinical experience with linezolid in the treatment of resistant gram-positive infections.  

PubMed Central

This study presents our clinical experience with linezolid in 19 patients with serious resistant gram-positive infections enrolled as part of the compassionate study. In this prospective, non-randomized, noncomparative study, 19 patients were enrolled as part of the National Compassionate Study Protocol conducted by Pharmacia-Upjohn. At the time of this writing, these patients had not been published in the literature. All of the patients had to have documented evidence of serious gram-positive infections in normally sterile sites and should have been unable to tolerate available antimicrobial therapy or be unresponsive to available drugs. Clinical characteristics, laboratory values, and pharmacokinetic and pharmacodynamic parameters were obtained. Patients were followed both short-term and long-term after completion of therapy. Nineteen patients were enrolled: 13 females and 6 males. The average age was 63 years. The average length of therapy with linezolid was 22 days. Methicillin-resistant Staphylococcus aureus (MRSA) was treated in eight patients, methicillin-resistant Staphylococcus epidermidis (MRSE) in two patients, vancomycin-resistant Enterococcus faecium (VREF) in eight patients, and coagulase-negative Staphylococcus in two patients. Co-infecting organisms include Enterococcus species colonization in six patients, Pseudomonas species in one patient, Serratia marcenens in one patient, and Candida albicans in one patient. Sterile sites that were infected included bone and joint (wounds and septic joints) in six patients, gastrointestinal system (hepatobiliary, liver abscess, Crohn's) in five patients, genitourinary (kidney and urine) in two patients, blood in five patients, respiratory in one patient, and aortic valve in 1 patient. Linezolid was given at 600 mg IV every 12 hours with a mean length of therapy of 22 days. Surgical drainage was used in combination with linezolid in 11 of the patients. Seventy nine percent of these patients achieved clinical and microbiologic cure, and none of the deaths reported in this series were related to the drug. Adverse events included skin rash in one patient, mild bone marrow suppression in two patients, and mild elevation in liver function tests in two patients. No life-threatening adverse events were noted. It appears that linezolid, along with surgical intervention (when necessary), appears to be an effective treatment option for resistant gram-positive infections. Long-term studies evaluating the possible resistance rates are necessary. PMID:11688919

Antony, S. J.; Diaz-Vasquez, E.; Stratton, C.

2001-01-01

251

Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis  

PubMed Central

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

2012-01-01

252

[Professor Li Shi-zhen's clinical experiences on compatibility application of hegu (LI 4)].  

PubMed

The present paper introduces professor LI Shi-zhen's clinical experiences on compatibility application of Hegu (LI 4). Hegu (LI 4) is mostly used to treat acute pyreticosis, exterior syndrome of exogenous diseases, mind diseases and deficiency of vital energy. Acupuncture at this acupoint by using reducing method can dispel wind to relieve exterior syndrome, clear away heat to disperse lung. Powerful stimulation by needle can dredge stagnant meridian, open orifice to activate spirit. Acupuncture at this acupoint by using reinforcing method can invigorate qi to strengthen superficies and replenish qi to prevent collapse. Based on this method, reinforcing Zusanli (ST 36) and Baihui (GV 20) can strengthen middle energizer to nourish qi, which show the same benefits as Buzhong Yiqi Decoction; reinforcing Sanyinjiao (SP 6) can nourish both qi and blood, which show the same benefits as Decoction of Eight Ingredients; reducing Neiting (ST 44) can clear away evil heat of qifen in yangming meridians, which show the same benefits as Baihu Decoction. PMID:20214075

Li, Chuan-qi

2010-02-01

253

Clinical Outcomes of Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: 12-Year Experience  

PubMed Central

Background We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as functional class III or IV based on the New York Heart Association (NYHA) classification. Seven patients had a history of inferior vena cava filter insertion, and 5 patients showed coagulation disorders. Pulmonary thromboendarterectomy was performed during total circulatory arrest with deep hypothermia in 14 patients. Results In-hospital mortality and late death occurred in 2 patients (12.5%) and 1 patient (6.3%), respectively. Extracorporeal membrane oxygenation support was required in 4 patients who developed severe hypoxemia after surgery. Thirteen of the 14 survivors have been followed up for 54 months (range, 2 to 141 months). The pulmonary arterial systolic pressure and cardiothoracic ratio on chest radiography was significantly decreased after surgery (76±26 mmHg vs. 41±17 mmHg, p=0.001; 55%±8% vs. 48%±3%, p=0.003). Tricuspid regurgitation was reduced from 2.1±1.1 to 0.7±0.6 (p=0.007), and the NYHA functional class was also improved to I or II in 13 patients (81%). These symptomatic and hemodynamic improvements maintained during the late follow-up period. Conclusion Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension shows good clinical outcomes with acceptable early and long term mortality. PMID:23423163

Oh, Se Jin; Bok, Jin San; Hwang, Ho Young; Kim, Ki Bong; Ahn, Hyuk

2013-01-01

254

[Clinical supervision--experience of 10 nurses of a 2-year process-oriented supervision].  

PubMed

Many patients in swedish hospital care today are older, more physically and mentally ill and in need of much care. Despite this there is a strong urge for higher cost-effectiveness and shorter hospital stays. Both these trends are often reported to be important sources of stress and burn-out among nurses. One way of reducing such effects among nurses could be clinical supervision. The present study is a result of one two-year long process-oriented supervision programme for nurses, led by the authors. The method in this study consisted of semi-structured interviews of 10 nurses joining the programme. The main questions in the interviews concerned; a) what knowledge they had acquired through the programme; b) if the programme had contributed to their understanding of others' feelings and reactions and; c) whether the programme had influenced their cooperation with others. The main conclusion from the interviews was that the programme had given them more courage and a more pronounced experience of support from colleagues. It was also found that the programme had improved their sense of professionalism and their self-image. These results point to the value of offering nurses possibilities for supervision, giving opportunities for both personal and professional development and thus preventing burn-outs. PMID:9393122

Elmcrona, M; Winroth, M K

1997-01-01

255

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

PubMed

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

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

2012-11-01

256

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

PubMed

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

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

2012-12-01

257

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

PubMed

The aim of this paper is the presentation of a new version of the anesthesia documentation software, NarkoData, that has been used in routine clinical work in our department as part of an anesthesia information management system (AIMS) since 1995. The performance of this software is presented along with requirements for future development of such a system. The originally used version, NarkoData 3.0, is an online anesthesia documentation software established by the software company ProLogic GmbH. It was primarily developed as a disk-based system for the MacOS operating system (Apple Computer Inc.). Based on our routine experience with the system, a catalogue of requirements was developed that concentrated on improvement in the sequence of work, administration and data management. In 1996, the concepts developed in our department, in close co-operation with medical personnel and the software company, led to a considerable enlargement of the program functions and the subsequent release of a new version of NarkoData. Since 1997, more than 20 000 anesthesia procedures have been recorded annually with this new version at 115 decentralized work stations at our university hospital. PMID:10961571

Benson, M; Junger, A; Quinzio, L; Fuchs, C; Sciuk, G; Michel, A; Marquardt, K; Hempelmann, G

2000-07-01

258

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

PubMed Central

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

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

2012-01-01

259

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

PubMed

Named entity recognition is a crucial component of biomedical natural language processing, enabling information extraction and ultimately reasoning over and knowledge discovery from text. Much progress has been made in the design of rule-based and supervised tools, but they are often genre and task dependent. As such, adapting them to different genres of text or identifying new types of entities requires major effort in re-annotation or rule development. In this paper, we propose an unsupervised approach to extracting named entities from biomedical text. We describe a stepwise solution to tackle the challenges of entity boundary detection and entity type classification without relying on any handcrafted rules, heuristics, or annotated data. A noun phrase chunker followed by a filter based on inverse document frequency extracts candidate entities from free text. Classification of candidate entities into categories of interest is carried out by leveraging principles from distributional semantics. Experiments show that our system, especially the entity classification step, yields competitive results on two popular biomedical datasets of clinical notes and biological literature, and outperforms a baseline dictionary match approach. Detailed error analysis provides a road map for future work. PMID:23954592

Zhang, Shaodian; Elhadad, Noémie

2013-12-01

260

Prostaglandin synthetase inhibitors and dysmenorrhea. A survey and personal clinical experience.  

PubMed

A survey of earlier published studies on treatment of dysmenorrhea with prostaglandin synthetase inhibitors is given and personal clinical experiences are presented. The time when treatment should start in relation to the onset of bleeding is also discussed. A survey of studies published in English and Scandinavian literature yielded 532 patients. Pain relief was experienced in 64 to 100 per cent of the patients in these studies. The incidence of side-effects has generally been low but in a few studies a high incidence was reported. In the current study 34 patients with prinary dysmenorrhea completed the douule-blind, placebo controlled study on naproxen. The patients were treated for two cycles, 16 with naproxen and 18 with placebo. The mean relief score indicated a "slight to good" pain relief in the naproxen group and "no alleviation" in the placebo group. The difference is statistically significant (p = 0.003). Supplementary medication was much more used in the placebo group compared to the naproxen group (p = 0.01). In the placebo group no change whatsoever was demonstrated in alleviation of interference with every-day life, whereas there was a statistically significant improvement in the naproxen group. No major side-effect was registered. Thus none of the subjects withdrew from the study. PMID:111467

Jacobson, J; Cavalli-Björkman, K; Lundström, V; Nilsson, B; Norbeck, M

1979-01-01

261

Clinical implementation of dynamic intensity-modulated radiotherapy: Dosimetric aspects and initial experience  

PubMed Central

This paper describes the initial experience of quality assurance (QA) tests performed on the millennium multi-leaf collimator (mMLC) for clinical implementation of intensity-modulated radiotherapy (IMRT) using sliding window technique. The various QA tests verified the mechanical and dosimetric stability of the mMLC of linear accelerator when operated in dynamic mode (dMLC). The mechanical QA tests also verified the positional accuracy and kinetic properties of the dMLC. The stability of dMLC was analyzed qualitatively and quantitatively using radiographic film and Omnipro IMRT software. The output stability, variation in output for different sweeping gap widths, and dosimetric leaf separation were measured. Dose delivery with IMRT was verified against the dose computed by the treatment planning system (TPS). Monitor units (MUs) calculated by the planning system for the IMRT were cross-checked with independent commercial dose management software. Visual inspection and qualitative analysis showed that the leaf positioning accuracy was well within the acceptable limits. Dosimetric QA tests confirmed the dosimetric stability of the mMLC in dynamic mode. The verification of MUs using commercial software confirmed the reliability of the IMRT planning system for dose computation. The dosimetric measurements validated the fractional dose delivery. PMID:19893693

Sivakumar, S. S.; Krishnamurthy, K.; Davis, C. A.; Ravichandran, R.; Kannadhasan, S.; Biunkumar, J. P.; El Ghamrawy, Kamal

2008-01-01

262

Clinical implementation of dynamic intensity-modulated radiotherapy: Dosimetric aspects and initial experience.  

PubMed

This paper describes the initial experience of quality assurance (QA) tests performed on the millennium multi-leaf collimator (mMLC) for clinical implementation of intensity-modulated radiotherapy (IMRT) using sliding window technique. The various QA tests verified the mechanical and dosimetric stability of the mMLC of linear accelerator when operated in dynamic mode (dMLC). The mechanical QA tests also verified the positional accuracy and kinetic properties of the dMLC. The stability of dMLC was analyzed qualitatively and quantitatively using radiographic film and Omnipro IMRT software. The output stability, variation in output for different sweeping gap widths, and dosimetric leaf separation were measured. Dose delivery with IMRT was verified against the dose computed by the treatment planning system (TPS). Monitor units (MUs) calculated by the planning system for the IMRT were cross-checked with independent commercial dose management software. Visual inspection and qualitative analysis showed that the leaf positioning accuracy was well within the acceptable limits. Dosimetric QA tests confirmed the dosimetric stability of the mMLC in dynamic mode. The verification of MUs using commercial software confirmed the reliability of the IMRT planning system for dose computation. The dosimetric measurements validated the fractional dose delivery. PMID:19893693

Sivakumar, S S; Krishnamurthy, K; Davis, C A; Ravichandran, R; Kannadhasan, S; Biunkumar, J P; El Ghamrawy, Kamal

2008-04-01

263

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

PubMed Central

Purpose: The purpose of this study is to report the clinical and functional outcomes of patients, treated between 2004 and 2009, with high-risk popliteal vascular injuries due to compound fractures about the knee. Patients and methods: A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%), primary anastomosis in 20 (32.3%), and lateral repair in 3 (4.8%) patients. The patients were divided into 2 study groups: limb salvage group (group 1) and amputation group (group 2). Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage. Results: In the entire cohort of patients, 60 patients (97%) were male and 2 were female (3%); the mean age was 34.1 years (16–49 years). The overall amputation rate in this study was 37.1% (23 amputations). Significant (P < 0.05) independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions. Conclusion: Expeditious recognition of vascular injury, transport to repair, and repair of associated venous injury when possible are necessary to optimize limb salvage. The importance of a high level of suspicion and low threshold for timely amputation has been emphasized when limb salvage was deemed impossible to prevent life-threatening complication. Delays in surgery, extensive soft tissue defect, compound tibia–fibula fracture, and other factors are associated with high amputation rate following popliteal artery injury. PMID:20730017

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

2010-01-01

264

Survival of 1,181 Patients in a Phase I Clinic: The MD Anderson Clinical Center for Targeted Therapy Experience  

PubMed Central

Background In order to determine if the Royal Marsden Hospital (RMH) prognostic score for phase I patients can be validated in a large group of individuals seen in a different center, and if other prognostic variables are also relevant, we present an analysis of 1,181 patients treated in the MD Anderson Cancer Center (MDACC) Phase I clinic. Methods Medical records of 1,181 consecutive patients who were treated on at least one trial in the Phase I clinic were reviewed. Results The median age was 58 years and 50% were women. The median number of prior therapies was four; median survival, 10 months (95% CI-9.1 to 10.9 months). Independent factors that predicted shorter survival in a multivariate Cox model and could be internally validated included: RMH score >1 (p<0.0001) (albumin <3.5 mg/dL, LDH >upper limit of normal, and >2 sites of metastases); gastrointestinal tumor type (p<0.0001); and, ECOG performance status ?1 (p=0.0004). The median survival was 24.0, 15.2, 8.4, 6.2 and 4.1 months for patients with 0, 1, 2, 3, and 4 or 5 of the above risk factors respectively. Conclusion The RMH score was validated in a large group of patients at MDACC. Internal validation of the independent prognostic factors for survival led to the development of the MDACC prognostic score, a modification of the RMH score that strengthens it. PMID:22452943

Wheler, Jennifer; Tsimberidou, Apostolia M.; Hong, David; Naing, Aung; Falchook, Gerald; Piha-Paul, Sarina; Fu, Siqing; Moulder, Stacy; Stephen, Bettzy; Wen, Sijin; Kurzrock, Razelle

2014-01-01

265

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

Cancer.gov

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

266

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

PubMed Central

Background There is limited evidence of the unmet needs and experiences of adults with Attention Deficit Hyperactivity Disorder (ADHD) in the published scientific literature. This study aimed to explore the experiences of adults in England with ADHD regarding access to diagnostic and treatment services, ADHD-related impairment and to compare experiences between patients diagnosed during adulthood and childhood. Methods In this qualitative study, 30 adults with ADHD were recruited through an ADHD charity (n?=?17) and two hospital outpatient clinics for adults with ADHD in England (n?=?13). Half of the participants were diagnosed with ADHD during childhood or adolescence and the remainder during adulthood. Semi-structured interviews were conducted and data was analysed using a thematic approach based on Grounded Theory principles. Results Analysis revealed five core themes: ‘An uphill struggle’: the challenge of accessing services, ‘Accumulated Psychosocial Burden and the Impact of ADHD’, ‘Weighing up Costs vs. Benefits of ADHD Pharmacological Treatment’, ‘Value of Non-pharmacological Treatment’ and ‘Barriers to Treatment Adherence’. Accessing services and the challenges associated with securing a definitive diagnosis of ADHD in adulthood was an ‘uphill struggle’, often due to sceptical and negative attitudes towards ADHD by healthcare professionals. ADHD-related impairment had an overwhelmingly chaotic impact on every aspect of patients’ lives and many felt ill equipped to cope. A persistent sense of failure and missed potential from living with the impact of ADHD impairment had led to an accumulated psychosocial burden, especially among those diagnosed from late adolescence onwards. In contrast, positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many felt strongly that by itself, it was inadequate. Additional support in the form of psychological therapies or psycho-education was strongly desired. However, few patients had access to non-pharmacological treatment. In some, medication use was often inadequately monitored with little or no follow-up by healthcare professionals, leading to poor adherence and a sense of abandonment from the healthcare system. Conclusion The findings suggest that the unmet needs of adults with ADHD are substantial and that there is a wide gap between policy and current practice in England. PMID:23692803

2013-01-01

267

A new alternative for bony chest wall reconstruction using biomaterial artificial rib and pleura: animal experiment and clinical application  

Microsoft Academic Search

Objective: To evaluate a new method for chest wall reconstruction using porcine-derived artificial rib and pleura in an animal experiment. Further, the clinical application was performed in five patients with large defects in the chest wall as a preliminary observation. Methods: In animal experiments, a full-thickness chest wall defect of 7cm×8cm was created in 12 adult mongrel dogs. Six dogs

Lan-jun Zhang; Wu-ping Wang; Wei-yang Li; Chong-li Hao; Zhe Li; Qiu-liang Wu; Rao-pan Wu; Tie-hua Rong

2011-01-01

268

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

PubMed Central

Background To report about initial clinical experience in radiation treatment of carcinoma of prostate with volumetric modulated arcs with the RapidArc (RA) technology. Methods Forty-five patients with a median age of 72 ± 3, affected by prostate carcinoma (T1c: 22 patients, T2a-b: 17 patients, T3a-b: 6 patients. N0: 43 patients, N1-Nx: 2 patients, all M0), with initial PSA of 10.0 ± 3.0 ng/mL, were treated with RapidArc in a feasibility study. All patients were treated with single arc using 6MV photons. Dose prescription ranged between 76 (7 patients) and 78 Gy (38 patients) in 2Gy/fraction. Plan quality was assessed by means of Dose Volume Histogram (DVH) analysis. Technical parameters of arcs and pre-treatment quality assurance results (Gamma Agreement Index, GAI) are reported to describe delivery features. Early toxicity was scored (according to the Common Terminology Criteria of Adverse Effects scale, CTCAE, scale) at the end of treatment together with biochemical outcome (PSA). Results From DVH data, target coverage was fulfilling planning objectives: V95% was in average higher than 98% and V107%~0.0% (D2%~104.0% in average). Homogeneity D5%-D95% ranged between 6.2 ± 1.0% to 6.7 ± 1.3%. For rectum, all planning objectives were largely met (e.g. V70Gy = 10.7 ± 5.5% against an objective of < 25%) similarly for bladder (e.g. D2% = 79.4 ± 1.2Gy against an objective of 80.0Gy). Maximum dose to femurs was D2% = 36.7 ± 5.4Gy against an objective of 47Gy. Monitor Units resulted: MU/Gy = 239 ± 37. Average beam on time was 1.24 ± 0.0 minutes. Pre-treatment GAI resulted in 98.1 ± 1.1%. Clinical data were recorded as PSA at 6 weeks after RT, with median values of 0.4 ± 0.4 ng/mL. Concerning acute toxicity, no patient showed grade 2-3 rectal toxicity; 5/42 (12%) patients experienced grade 2 dysuria; 18/41 (44%) patients preserved complete or partial erectile function. Conclusion RapidArc proved to be a safe, qualitative and advantageous treatment modality for prostate cancer. PMID:20550722

2010-01-01

269

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

PubMed Central

Background Many women experience breastfeeding difficulties. Sometimes these difficulties lead to breastfeeding cessation. Breastfeeding clinics provide support for women facing such problems. This study aims to describe the breastfeeding experience of women, particularly those who use the services of the breastfeeding clinic located in the Greater Quebec City area. Methods This is a descriptive study based on information gathered through telephone questionnaires that were administered in 2006 to a sample of 86 women and semi-structured interviews conducted with 12 of these women. Results Painful nipples/breasts, low milk supply and latching difficulties were the three most frequent major breastfeeding problems identified by women. Their personal characteristics as well as the moral and physical support provided by family and friends and by health professional and clinicians at the breastfeeding clinic were the factors identified most often as having a positive influence on the breastfeeding experience. Conclusion The results suggest that breastfeeding clinics have a critical role to play in improving the breastfeeding experience of women with major difficulties. PMID:18680602

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

2008-01-01

270

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

PubMed Central

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

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

2013-01-01

271

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

NASA Astrophysics Data System (ADS)

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

Gaona, Enrique; Alfonso, Beatriz Y. Álvarez; Castellanos, Gustavo Casian; Enríquez, Jesús Gabriel Franco

2008-08-01

272

Clinical experience in ovarian squamous cell carcinoma arising from mature cystic teratoma: A rare entity  

PubMed Central

Objective We sought to investigate the clinicopathologic features of ovarian squamous cell carcinomas arising from mature cystic teratomas (MCT) and to report our clinical experience and lessons learned. Methods From January 1993 to November 2012, a total of 6,260 women with ovarian MCT were surgically treated at Cheil General Hospital and Women's Healthcare Center. Among them, the cases with malignant transformation to squamous cell carcinoma were included in this analysis. Patient demographic characteristics, surgical findings, and prognosis were evaluated retrospectively. Results Of the 6,260 ovarian MCT patients, four (0.06%) had ovarian squamous cell carcinoma arising from MCT. The mean patient age was 43 years (range, 35-51 years), and the mean tumor size was 12 cm (range, 9-16 cm), with two patients in the International Federation of Gynecology and Obstetrics stage I and the other two in stage III. Upon preoperative imaging, all cases were expected to be benign ovarian tumors, but the preoperative squamous cell carcinoma antigen level was elevated from 1.5 ng/mL in stage Ia to 11.3 ng/mL in stage IIIc, suggesting malignancy, while the CA-125 level was normal in two of the three patients who received the test. Optimal debulking surgery was performed and adjuvant chemotherapy was used in all patients, but death from the recurrence of disease occurred in one patient, whose overall survival was 10 months. Conclusion Ovarian squamous cell carcinoma arising from MCT is extremely rare, and it is rarely diagnosed preoperatively on imaging workups. Measuring the squamous cell carcinoma antigen level might be a useful diagnostic clue, and it might also be predictive of the tumor stage. An adequate staging surgery should be included in the standard treatment, but multicenter studies are needed to confirm this. PMID:25105100

Choi, Eun-Jeong; Koo, Yu-Jin; Jeon, Ji-Hyun; Kim, Tae-Jin; Lee, Ki-Heon

2014-01-01

273

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

PubMed Central

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

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

2009-01-01

274

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

PubMed Central

Robotic pancreatic surgery offers technical advantages, and has been applied across many surgical specialties. We report an initial experience of 12 distal pancreatic resections for benign tumors from an established pancreatic center with previous general and biliary laparoscopic experience. Of a total of 12 patients, 7 were women; the mean age was 55.5 years, and the lesions included 8 distal intraductal papillary mucinous tumors, 1 insulinoma and in 3 a non-functioning neuroendocrine tumor. All operations were performed in between 90 and 180 minutes, and blood loss and hospital stay were minimal. PMID:23866984

2013-01-01

275

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.

276

[Clinical experiences with percutaneous digitoxin therapy in pregnant women with varicose veins].  

PubMed

It is reported on the clinical recommendations in a cutaneous treatment with "Digitoxinpasta" in varicose veins of pregnant women. The patients' arrangement in groups and the valuation of the result of the treatment was done after clinical aspects. The rate of failures (12%) ranges in tolerable limits. Neither a "Digitoxinbradycardy" or signs of overdosage were found in the electrocardiogram. PMID:1007697

Jorde, A; Hamann, B

1976-01-01

277

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

Microsoft Academic Search

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

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

2010-01-01

278

Clinical Utility of the Anti-CCP Assay: Experiences with 700 Patients  

Microsoft Academic Search

Our objective was to determine the frequency of antibodies to cyclic citrullinated peptides (CCPs) in a series of patients with a variety of rheumatic diseases. Seven hundred consecutive serum samples from patients at an outpatient clinic were tested for the presence of rheumatoid factor (RF) and anti-CCP. Clinical diagnosis, radiographic information, and other laboratory data were taken from patients' charts.

Ulrich Sauerland; Heidemarie Becker; Matthias Seidel; Heiko Schotte; Peter Willeke; Annette Schorat; Bernhard Schlüter; Wolfram Domschke; Markus Gaubitz

2005-01-01

279

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

Cancer.gov

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

280

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

Microsoft Academic Search

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

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

1981-01-01

281

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

PubMed

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

McElhinney, John; Heffernan, Orla

2003-01-01

282

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

PubMed Central

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

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

2012-01-01

283

Strategic infarcts in vascular dementia. A clinical and brain imaging experience.  

PubMed

The mechanisms of dementia resulting from small deep infarctions are incompletely understood. The thesis underlying the concept of "multi-infarct dementia" is that multiple lesions have a synergistic effect on mental functions, resulting in dementia irrespective of specific location or volume. In this report, we summarize our experience with six patients reported previously along with additional patients examined subsequently, whose clinical features and brain imaging findings allow an alternative formulation for dementia resulting from lacunar stroke. The six initial patients presented with an abrupt change in behavior after acute infarction involving the inferior genu of the internal capsule documented by computed tomography (CT) and magnetic resonance imaging (MRI). The acute syndrome featured fluctuating alertness, inattention, memory loss, apathy, abulia, and psychomotor retardation suggesting frontal lobe dysfunction. Contralateral hemiparesis and dysarthria were generally mild, except when the infarct extended into the posterior limb. Neuropsychological testing in five patients with left-sided infarcts revealed severe verbal memory loss. Additional cognitive deficits consistent with dementia were evident in four patients. A right-sided infarct caused transient impairment in visuospatial memory. Functional brain imaging in three patients using 133xenon regional cerebral blood flow (rCBF) and single photon emission computed tomography (SPECT) showed focal reduction in hemispheric perfusion most prominent in the ipsilateral inferior and medial frontal cortex. Perfusion was also defective in the medial and laterial temporal cortex. Important pathways of the limbic system traverse the inferior capsule in the region of the genu. Corticothalamic and thalamocortical fibers form the thalamic peduncles which detach from the internal capsule and enter the thalamus at its rostral and caudal poles and along its dorsal surface. The anterior thalamic peduncle, conveys reciprocal connections between the dorsomedial nucleus and the cingulate gyrus, as well as the prefrontal and orbitofrontal cortex. The inferior thalamic peduncle carries fibers which connect the thalamus with orbitofrontal, insular, and temporal cortex, as well as the amygdala via the ansa peduncularis to the ventral amygdalofugal pathway. Thus, damage to one or both white-matter tracts may occur with infarctions in the region of the inferior genu, causing striking frontal behavioral effects and memory loss in our patients associated with functional deactivation of the ipsilateral frontal and temporal cortex.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7763329

Tatemichi, T K; Desmond, D W; Prohovnik, I

1995-03-01

284

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

SciTech Connect

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

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

2011-10-01

285

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

ERIC Educational Resources Information Center

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

Parkerson, George R., Jr.; And Others

1984-01-01

286

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

PubMed

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

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

2014-02-01

287

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

E-print Network

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

Espitia, Noberto Francisco

2009-05-15

288

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

Code of Federal Regulations, 2012 CFR

...multivisceral transplants performed at the center. (3) A pancreas transplant center is not required to comply with the clinical...outcome requirements in paragraph (c) of this section for pancreas transplants performed at the center. (4) A center...

2012-10-01

289

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

Code of Federal Regulations, 2011 CFR

...multivisceral transplants performed at the center. (3) A pancreas transplant center is not required to comply with the clinical...outcome requirements in paragraph (c) of this section for pancreas transplants performed at the center. (4) A center...

2011-10-01

290

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

Code of Federal Regulations, 2010 CFR

...multivisceral transplants performed at the center. (3) A pancreas transplant center is not required to comply with the clinical...outcome requirements in paragraph (c) of this section for pancreas transplants performed at the center. (4) A center...

2010-10-01

291

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

Code of Federal Regulations, 2013 CFR

...multivisceral transplants performed at the center. (3) A pancreas transplant center is not required to comply with the clinical...outcome requirements in paragraph (c) of this section for pancreas transplants performed at the center. (4) A center...

2013-10-01

292

Computer-aided navigation in dental implantology: 7 years of clinical experience  

Microsoft Academic Search

PurposeThis long-term study gives a review over 7 years of research, development, and routine clinical application of computer-aided navigation technology in dental implantology. Benefits and disadvantages of up-to-date technologies are discussed.

Rolf Ewers; Kurt Schicho; Michael Truppe; Rudolf Seemann; Astrid Reichwein; Michael Figl; Arne Wagner

2004-01-01

293

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

Cancer.gov

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

294

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

Microsoft Academic Search

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

Dale Alexander

2003-01-01

295

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

PubMed Central

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

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

2014-01-01

296

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

PubMed Central

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

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

2012-01-01

297

In vitro quinolone-gentamicin antagonism demonstrated by time-kill and combination experiments with clinical isolates of Enterococcus  

Microsoft Academic Search

Bacteriostatic and bactericidal activites of amoxicillin, pefloxacin, ofloxacin, ciprofloxacin, sparfloxacin, vancomycin,\\u000a alone or associated with gentamicin, were evaluated over 22 months using time-kill and combination experiments, on 20 clinicalEnterococcus isolates (6E. faecium and 14E. faecalis) selected in a French district hospital. Sparfloxacin or ciprofloxacin were more frequently bacteriostatic or bactericidal\\u000a than pefloxacin or ofloxacin but, unlike amoxicillin or vancomycin, the

Joseph Watine; Bruno Seigneuric; Jean-Christophe Charet

1997-01-01

298

Implementation of high-resolution SNP arrays in the investigation of fetuses with ultrasound malformations: 5?years of clinical experience.  

PubMed

Chromosome microarray analysis (CMA) has proven to be a powerful tool in postnatal patients with intellectual disabilities, and it is increasingly used in prenatal diagnosis. However, its diagnostic capabilities in prenatal diagnosis vary, and clinical experiences have failed to establish a consensus regarding CMA indications, the design and resolution of microarrays, and the notification and interpretation of copy number variations (CNVs). We present our 5?years of clinical experience using whole-genome high-resolution single nucleotide polymorphism (SNP) arrays to investigate 446 fetuses that had structural malformations detected with ultrasound but for which standard karyotyping analysis showed normal karyotypes. CMA revealed genomic CNVs in 323 (72.4%) cases and clinically significant CNVs in 11.4% of the fetuses (51/446), including 2 cases of uniparental disomy (UPD) as well as 1 case of cryptic mosaic monosomy of chromosome X. Variants of unknown significance (VOUS) existed in 2.0% of the tested fetuses (9/446). Our results demonstrate the value of whole-genome high-resolution SNP arrays in fetuses with congenital malformations and give a higher detection rate of clinically significant genomic imbalance, especially for detecting UPD. Sufficient communication between technicians and genetic counselors, along with parental testing and comparison with data from in-house or international sources, can significantly reduce VOUS. PMID:24000829

Liao, C; Fu, F; Li, R; Xie, G-E; Zhang, Y-L; Li, J; Li, D-Z

2014-09-01

299

A model for selection and assessment of community-based sites for dental students' extramural clinical experiences.  

PubMed

As a recipient of the Robert Wood Johnson's Pipeline, Profession, and Practice: Community-Based Dental Education grant, the Extramural Education Program (EEP) at the University of Illinois at Chicago College of Dentistry was charged with developing partnerships with community-based oral health programs throughout Illinois. These programs are to be used for clinical service-learning rotations for fourth-year dental students, relying on the utilization of the dentists employed at the community site as preceptors for the students. Because the College of Dentistry had essentially no community-based service-learning experiences prior to the Robert Wood Johnson grant, procedures and protocols needed to be developed to standardize a process for site and preceptor selection. An administrative process was developed to engage, recruit, and partner with community-based oral health programs that provided direct clinical services. This article will discuss the development of criteria used to select sites and preceptors for extramural clinical rotations; the development of a set of standardized assessment instruments; and the credentialing process for community-based adjunct faculty that leads to the affiliation agreements. These community-based rotations have been integrated into the College of Dentistry curriculum as a required extramural service-learning course referred to as Extramural Clinical Experience (DADM 325). PMID:18250395

Hryhorczuk, Christine; Bolden, Aljernon J; Knight, G William; Punwani, Indru; Mulvihill, Daniel M; Noorullah, Khatija; Evans, Caswell A

2008-02-01

300

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

SciTech Connect

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

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

1983-05-01

301

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

Federal Register 2010, 2011, 2012, 2013

...funding for the Black Lung/Coal Miner Clinics Program grants...indicates that the prevalence of coal workers' pneumoconiosis (CWP...fact, a recent study of 2,000 coal miners from Utah to Pennsylvania...premature mortality. In addition, data from the U.S. Department...

2013-04-12

302

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

ERIC Educational Resources Information Center

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

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

2014-01-01

303

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

PubMed

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

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

2014-03-01

304

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

PubMed Central

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

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

2014-01-01

305

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

PubMed

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

Miller, Wendy

2014-01-01

306

The University of Maryland experience in integrating preventive medicine into the clinical medicine curriculum.  

PubMed Central

Lifestyle risk factors play a major role in the etiology of premature mortality, morbidity, and disability in the United States. Numerous professional groups as well as the Surgeon General of the Public Health Service have recommended that increased attention be devoted to training medical students and physicians to improve their knowledge and skills in health promotion and disease prevention. Such training is critical for attaining many of the "Healthy People 2000" objectives. For a variety of reasons, however, most medical schools have had difficulty in successfully integrating preventive medicine into their clinical curriculums. This article describes the critical elements that allowed the faculty at the University of Maryland School of Medicine to accomplish this goal through its fourth year clinical preventive medicine course. The strategies employed in this course may serve as a model for other institutions to achieve the integration of preventive medicine into their clinical curriculums. PMID:8497571

Havas, S; Rixey, S; Sherwin, R; Zimmerman, S I; Anderson, S

1993-01-01

307

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

PubMed

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

Mwangoka, Grace; Ogutu, Bernhards; Msambichaka, Beverly; Mzee, Tutu; Salim, Nahya; Kafuruki, Shubis; Mpina, Maxmillian; Shekalaghe, Seif; Tanner, Marcel; Abdulla, Salim

2013-01-01

308

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

ERIC Educational Resources Information Center

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)

Chan, Sally; Cheng, Bing-shu

2001-01-01

309

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

ERIC Educational Resources Information Center

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

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

2006-01-01

310

Interventional and intraoperative MR: review and update of techniques and clinical experience  

Microsoft Academic Search

The concept of interventional magnetic resonance imaging (MRI) is based on the integration of diagnostic and therapeutic procedures, favored by the combination of the excellent morphological and functional imaging characteristics of MRI. The spectrum of MRI-assisted interventions ranges from biopsies and intraoperative guidance to thermal ablation modalities and vascular interventions. The most relevant recently published experimental and clinical results are

Thomas Schulz; Silvia Puccini; Jens-Peter Schneider; Thomas Kahn

2004-01-01

311

Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years’ clinical experience  

Microsoft Academic Search

Purpose: To report on the clinical outcome of LINAC-based stereotactic radiotherapy (SRT) of uveal melanomas. Additionally, a new prototype (hardware and software) for automated eye monitoring and gated SRT using a noninvasive eye fixation technique is described. Patients and Methods: Between June 1997 and March 2004, 158 patients suffering from uveal melanoma were treated at a LINAC with 6 MV

Karin. Dieckmann; Dietmar Georg; Joachim Bogner; Martin Zehetmayer; Bernhard Petersch; Martin Chorvat; Hajo Weitmann; Richard Poetter

2006-01-01

312

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

Microsoft Academic Search

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

Iram Khursheed; Yaseen Usman; Jawaid Usman

313

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

PubMed

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

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

2013-01-01

314

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

PubMed Central

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

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

2013-01-01

315

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

Microsoft Academic Search

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

Brenda K. WIEDERHOLD; Mark D. WIEDERHOLD

316

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

ERIC Educational Resources Information Center

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

Lee, Kyungjae

2014-01-01

317

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

ERIC Educational Resources Information Center

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

Feil, Philip; Meeske, Jessica; Fortman, Jared

1999-01-01

318

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

NASA Astrophysics Data System (ADS)

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

Kuzmak, Peter M.; Dayhoff, Ruth E.

2004-04-01

319

From Research to Clinic and Beyond—NRC Experience in Commercialization\\/Technology Transfer  

Microsoft Academic Search

Medical imaging technologists operate some of the most advanced health care equipment on the market and understand the constant evolution of new hardware, new techniques, and new applications that various manufacturers introduce each year. Before appearing as a new product offering, there is usually a long history beginning with identifying a clinical need, coming up with an idea to solve

Lawrence Ryner; Paul D. Wiebe

2009-01-01

320

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

Microsoft Academic Search

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

Joseph Spahn; Ronina Covar; David A. Stempel

2002-01-01

321

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

PubMed

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

Melis, G B

1990-01-01

322

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

Microsoft Academic Search

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

A. A. Ivanov; O. V. Smirnova; A. M. Ulanova

1993-01-01

323

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

NASA Technical Reports Server (NTRS)

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

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

1982-01-01

324

South Asian patients’ views and experiences of clinical trial participation. | accrualnet.cancer.gov  

Cancer.gov

Among South Asians in Great Britain, factors associated with willingness to participate in clinical trials are similar to those among the majority population—altruism, health benefits, and availability of clear and concise information. Factors associated with lack of willingness to participate include language barriers, perceptions of discriminatory practices, and female modesty.

325

The effect of clinical experience, judgment task difficulty and time pressure on nurses' confidence calibration in a high fidelity clinical simulation  

PubMed Central

Background Misplaced or poorly calibrated confidence in healthcare professionals’ judgments compromises the quality of health care. Using higher fidelity clinical simulations to elicit clinicians’ confidence 'calibration' (i.e. overconfidence or underconfidence) in more realistic settings is a promising but underutilized tactic. In this study we examine nurses’ calibration of confidence with judgment accuracy for critical event risk assessment judgments in a high fidelity simulated clinical environment. The study also explores the effects of clinical experience, task difficulty and time pressure on the relationship between confidence and accuracy. Methods 63 student and 34 experienced nurses made dichotomous risk assessments on 25 scenarios simulated in a high fidelity clinical environment. Each nurse also assigned a score (0–100) reflecting the level of confidence in their judgments. Scenarios were derived from real patient cases and classified as easy or difficult judgment tasks. Nurses made half of their judgments under time pressure. Confidence calibration statistics were calculated and calibration curves generated. Results Nurse students were underconfident (mean over/underconfidence score ?1.05) and experienced nurses overconfident (mean over/underconfidence score 6.56), P?=?0.01. No significant differences in calibration and resolution were found between the two groups (P?=?0.80 and P?=?0.51, respectively). There was a significant interaction between time pressure and task difficulty on confidence (P?=?0.008); time pressure increased confidence in easy cases but reduced confidence in difficult cases. Time pressure had no effect on confidence or accuracy. Judgment task difficulty impacted significantly on nurses’ judgmental accuracy and confidence. A 'hard-easy' effect was observed: nurses were overconfident in difficult judgments and underconfident in easy judgments. Conclusion Nurses were poorly calibrated when making risk assessment judgments in a high fidelity simulated setting. Nurses with more experience tended toward overconfidence. Whilst time pressure had little effect on calibration, nurses’ over/underconfidence varied significantly with the degree of task difficulty. More research is required to identify strategies to minimize such cognitive biases. PMID:23034048

2012-01-01

326

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

PubMed

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

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

2013-10-01

327

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

PubMed Central

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

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

2010-01-01

328

Cancer genetic testing panels for inherited cancer susceptibility: the clinical experience of a large adult genetics practice.  

PubMed

Next-generation sequencing genetic testing panels for cancer susceptibility (cancer panels) have recently become clinically available. At present, clinical utility is unknown and there are no set criteria or guidelines established for whom to offer such testing. Although it may be a cost-effective method to test multiple cancer susceptibility genes concurrently, the rate of finding variants of unknown significance (VUS) may be high and testing may yield mutations in genes with no established management recommendations. We describe our Center's experience over a 14-month period (April 2012-June 2013) for patient interest and uptake in cancer panel testing and whether there were predictors of pursuing testing or identifying mutations. Using a clinical ranking system, patients' family histories were ranked from 0 to 3 (low likelihood to high likelihood for underlying genetic susceptibility). The clinical ranking system was assessed to determine its predictability of finding mutations. Of the 689 patients who met inclusion criteria, the option of pursuing a cancer panel was discussed with 357 patients; 63 (17.6 %) patients pursued testing. Those who pursued testing were more likely to be older, male, affected with cancer, affected with multiple primary cancers, and had a higher clinical rank than non-pursuers. There were no significant predictors of finding a mutation on panel testing. Of the 61 patients who have received results, there was a 6.6 % mutation rate and 19.7 % VUS rate. The yield of cancer panels in clinical practice is low and the strength of family history alone may not predict likelihood of finding a mutation. PMID:25117502

Selkirk, Christina G; Vogel, Kristen J; Newlin, Anna C; Weissman, Scott M; Weiss, Shelly M; Wang, Chi-Hsiung; Hulick, Peter J

2014-12-01

329

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

SciTech Connect

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

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

2007-11-01

330

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)

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.

Attanasi, F.; Knopf, A.; Parodi, K.; Paganetti, H.; Bortfeld, T.; Rosso, V.; Del Guerra, A.

2011-08-01

331

Clinical Experience for the Graduate Student in Pathology and Medical Bacteriology  

E-print Network

instruction. As a result (and we are not overstating the case) the general practitioner at the present time makes but little use of the clinical laboratory as an aid to diag- nosis, prognosis, and the efficiency of treatment• - 2 - Tfce writer has met a... bear this in mind, especially in such frequent cases as septicaemia, tuberculosis, diphtheria and typhoid. Blood-cultures should never be reported negative under twelve hours; eighteen is preferable, and unless the case is acute- ly and rapidly...

Fraser, Roy

1914-05-01

332

Pathogenesis of the Acute Coronary Syndromes: Hypotheses Generated from Clinical Experience  

Microsoft Academic Search

The acute coronary syndromes include unstable angina, myocardial infarction (both non-Q-wave and Q-wave), and sudden ischemic\\u000a death. Common to all these syndromes, in a majority of cases, is the event of plaque disruption. Thrombus generated as a result\\u000a of plaque disruption is clinically manifested as one of the acute coronary syndromes. Hence, there is considerable overlap\\u000a amongst the syndromes, and

Narinder P. Bhalla; John A. Ambrose

333

[Experience with a clinical parasitological examination in a clonorchiasis focus in the Amur River region].  

PubMed

The clinical manifestations of clonorchiasis were studied in 190 patients in the Amur River region. The severity of the disease correlated with the excretion rates of Clonorchis eggs. The peculiarity of the region is a rather low egg excretion; 66.8% of patients excreted as many as 100 eggs/g, 27.3%, up to 1000 eggs/g. Most examinees (94.3%) suffered from chronic gastroduodenitis and functional disorders of the biliary system. PMID:9445987

Dyk, L M; Posokhov, P S; Dobrykh, V A; Markina, L G; Kozyreva, T G

1997-01-01

334

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

Microsoft Academic Search

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

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

335

Clinical Presentation and Treatment of Wilson’s Disease: A Single-Centre Experience  

Microsoft Academic Search

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

M. T. Pellecchia; C. Criscuolo; K. Longo; G. Campanella; A. Filla; P. Barone

2003-01-01

336

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

Microsoft Academic Search

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

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

2000-01-01

337

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

Microsoft Academic Search

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

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

2005-01-01

338

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

PubMed Central

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

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

1983-01-01

339

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

PubMed

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

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

2014-05-01

340

Strategic planning in healthcare: the experience of the University of Wisconsin Hospital and Clinics.  

PubMed

In 1999, after 25 years of stable leadership from a single CEO, the University of Wisconsin Hospital and Clinics (UWHC) Authority Board named a new CEO. The 471-bed academic medical center had recently experienced significant change and challenges. In 1996, it had emerged as a public authority, a statutory designation by the state of Wisconsin that moved the hospital and clinics from the University of Wisconsin and the state of Wisconsin, and created it as a quasi-public entity with its own board. In 1999, when the new CEO was named, the hospital was experiencing a loss of revenue and market share, operating deficits, a 22 percent nurse vacancy rate, and patient satisfaction scores below the 40th percentile. The first task assigned to the new CEO by the board was the development of a new strategic plan that would reverse these trends and position UWHC as a premier academic hospital. The CEO began a strategic planning process that involved leaders, physicians, and staff from throughout the hospital and clinics, its affiliated medical school, and the physician practice plan. This article describes the collaborative, integrative, and communicative strategic planning process UWHC used; details the organization of the process; describes the results achieved by UWHC; and lists the lessons learned along the way. PMID:17310807

Sollenberger, Donna K

2006-01-01

341

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

PubMed Central

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

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

1999-01-01

342

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

PubMed

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

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

2014-09-01

343

Clinical characterization and NPHP1 mutations in nephronophthisis and associated ciliopathies: a single center experience.  

PubMed

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 confirming the diagnosis of type-1 NPHP. Moreover, our findings confirm that NPHP1 deletions can indeed be responsible for JSRD. PMID:22982934

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

2012-09-01

344

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

NASA Astrophysics Data System (ADS)

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

Kanou, Naoyuki; Sakuma, Kenji; Nakashima, Kenji

345

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

PubMed

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

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

2014-08-01

346

[Study of the interaction between mood and music experience under its musical and clinical psychological aspects].  

PubMed

An exploratory, non-hypothesis-based experiment set out to discover to what extent the assessment of music is influenced by the basic mood (hypomanic versus depressive) of the listener. Distinct differences became apparent on all four dimensions extracted from a polarity list, independent of the structural nature of the piece of music assessed. This result was discussed primarily with regard to the necessity of making the construct "experience of music" empirically accessible to non-aesthetic lines of inquiry, for example in music therapy. PMID:7445635

Schaub, S

1980-01-01

347

Integration and Extension  

NSDL National Science Digital Library

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

Galle, Janet R.; Warren, Patricia A.

2005-01-01

348

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

SciTech Connect

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

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

2013-07-01

349

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

PubMed Central

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

North, Barbara B.

2011-01-01

350

[Recanalization of the peripheral arteries by laser thermal balloon angioplasty. 2 years of clinical experience].  

PubMed

Laser angioplasty represents an attractive alternative to overcome the limitations of balloon angioplasty. We describe our results with laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans in the lower limbs after two years clinical follow up. We also analyse the influence of lesion characteristics on immediate results. Thirty seven patients (34 men), whose mean age was 58 +/- 9 years, were included in this study. Occlusive arterial disease (Fontaine stage II-IV), with 39 significant haemodynamic arterial lesions were present in all of them. Ankle/brachial Doppler index was O,51 +/- 0,17. Eighteen lesions were located in the iliac area (13 stenoses 2,3 +/- 1 cm of length and 5 occlusions 4,2 +/- 3 cm) and 21 lesions in femoro-popliteal area (5 stenoses 2,6 +/- 2 cm and 16 occlusions 5,7 +/- 3 cm). A percutaneous procedure was used in 38 cases and only in one case a femoral dissection was necessary. The laser source was argon in 26 cases and Nd-YAG in 13. The overall immediate angiographic and clinical success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0,01) and/or calcium (p less than O,05) influenced negatively the immediate results. No major complications were observed. Seven (17%) minor complications occurred, but no emergency surgery was necessary. The ankle/brachial Doppler index after treatment was 0,82 +/- 0,21. Cumulative clinical patency was 91% for successfully treated patients after two years follow up. We conclude that LTBA represents an effective and less aggressive way to treat atherosclerosis obliterans.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1952251

Riambau Alonso, V; Masotti Centol, M; Latorre Vilallonga, J; Viver Manresa, E; Crexells Figueres, C; Oriol Palou, A

1991-01-01

351

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

ERIC Educational Resources Information Center

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

Hathorn, Donna; Machtmes, Krisanna; Tillman, Ken

2009-01-01

352

A Collaborative Model of Clinical Preparation: A Move toward Interprofessional Field Experience  

ERIC Educational Resources Information Center

This article proposes a model for interprofessional collaboration within the context and process of field experiences in public schools. The model evolved out of a collaborative venture between the schools of social work and education at Boston College. The placement of pairs of social work and education interns in urban schools provided an…

Tourse, Robbie Welch Christler; Mooney, Jean F.; Kline, Paul; Davoren, Jeanne

2005-01-01

353

Experiences with an End-To-End Wireless Clinical Monitoring System  

E-print Network

spanning multiple hospital floors, and integration into the hospital Electronic Medical Record (EMR hospital wards of Barnes-Jewish Hospital in St. Louis, Missouri. Our experiences show the feasibil- ity of achieving reliable vital sign collection, using a wireless sensor network integrated with hospital

Lu, Chenyang

354

An evaluation of the integration of pharmacokinetic and pharmacodynamic principles in clinical drug development. Experience within Hoffmann La Roche.  

PubMed

The integration of pharmacokinetic and pharmacodynamic principles into drug development has been proposed as a way of making it more rational and efficient. The use of these principles in drug development to make scientific and strategic decisions is defined as the 'pharmacokinetic-pharmacodynamic guided approach to drug development'. The objectives of this survey were: (i) to assess the extent the pharmacokinetic-pharmacodynamic guided approach to drug development has been used in a large multinational pharmaceutical company: (ii) to evaluate the impact of pharmacokinetic and/or pharmacodynamic results on clinical drug development; and (iii) to identify factors which prevented the full application of the pharmacokinetic-pharmacodynamic guided approach. This was done by looking at 18 projects in the current development portfolio at Hoffman La Roche and evaluating the use of this approach by interviewing the responsible clinical pharmacologist using a standardised questionnaire. (i) Benefits from using the pharmacokinetic-pharmacodynamic guided approach were reported in every project, independent of development phase and therapeutic area. This approach was more extensively used in the recent projects. The selection of dosages in clinical studies was found to be the most important application of pharmacokinetic-pharmacodynamic results in terms of an impact on drug development. (ii) Time savings, up to several months, could be quantified in 8 projects during the entry-into-man studies and in 6 projects during the phase II or III studies. In 4 projects, 1 clinical study was avoided. (iii) The most important scientific factor preventing the full application of the approach was the lack of knowledge on the predictive value of the pharmacodynamic or surrogate marker for effect (6 projects). The results of the survey have shown that the use of the pharmacokinetic-pharmacodynamic guided approach has contributed to making clinical drug development more rational and more efficient. Opportunities to apply the pharmacokinetic-pharmacodynamic approach should be identified in each project and a project specific strategy for the pharmacokinetic-pharmacodynamic guided approach should be defined during phase 0 of drug development. PMID:9260036

Reigner, B G; Williams, P E; Patel, I H; Steimer, J L; Peck, C; van Brummelen, P

1997-08-01

355

Clinical experience with nimotuzumab in cuban pediatric patients with brain tumors, 2005 to 2007.  

PubMed

Introduction Nimotuzumab, developed in Cuba, is a humanized monoclonal antibody that targets the epidermal growth factor receptor (EGFR). It has been evaluated in malignant brain tumors in adults and children, and shown to be therapeutically safe and effective in terms of increased survival and improved quality of life. Objective Describe nimotuzumab's safety profile and clinical benefits in terms of disease control and survival in pediatric patients with progressive or recurrent primary brain tumors who were included in an expanded access program. Methods An open, prospective clinical study was designed. Between December 2005 and December 2007, 22 patients were included, all of whom had an histological and/or radiological diagnosis of progressive or recurrent primary brain tumor, classified as high-grade malignant glioblastoma (n=6), diffuse brain stem glioma (n=6), ependymoblastoma (n=5), low-grade glioma (n=4), or thalamic tumor (n=1); life expectancy of at least 4 weeks; and a Karnofsky or Lansky Performance Status score of ?50. Nimotuzumab was administered on a 100 mg weekly intravenous infusion schedule for 6 to 8 weeks, followed by a bi-weekly maintenance phase, as long as there was no deterioration in the patient's functional capacity. Therapeutic protocols were followed for administration as monotherapy or in combination with chemotherapy and/or radiotherapy. All patients received clinical and imaging follow-up. Results Nimotuzumab was well tolerated in all therapeutic modalities, even with prolonged exposure. A minority of patients reported slight or moderate adverse events, such as vomiting, mucositis and chills, as classified by the Common Terminology Criteria for Adverse Events (CTCAE). The disease was controlled in 64% (14/22) of patients; 6-month and 1-year survival rates were 82% and 64%, respectively; average survival was 20.3 months and median survival, 19 months. Recovery of neurological functions and improvement in general status were notable in patients who attained control of the disease. Conclusions As used in this study, nimotuzumab demonstrated a broad safety profile, making it acceptable for chronic use, and implied clinical benefits in terms of increased survival and improved functional status in these patients, compared to findings described in the literature. These results indicate further studies of this product are warranted. PMID:21483304

Saurez, Giselle; Cabanas, Ricardo; Zaldívar, Melba; Garnier, Tania; Iglesias, Bárbara; Piedra, Patricia; Castillo, Martha Ríos; Longchong, Martha; Iznaga, Normando; Lage, Agustín

2009-07-01

356

Developing a clinical research network: the Northern Region Endoscopy Group experience.  

PubMed

Research is central to the National Health Service. Clinical trial recruitment has been aided by the National Institute for Health Research's Comprehensive Research Network but these networks do not support development of research. The Northern Region Endoscopy Group (NREG) was founded in 2007, encompasses 17 endoscopy units and has become a highly successful collaborative research network. The network is now a major contributor to UK trials, has published over 20 papers (>60 abstracts) and holds grants totalling more than £1.5 million. The NREG provides an exemplar model of how collaborative working can contribute significantly to biomedical research. PMID:24715118

Rajasekhar, Praveen; Rees, Colin; Rutter, Matthew; Hungin, Pali

2014-04-01

357

Medical specialty considerations by medical students early in their clinical experience  

PubMed Central

Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83%) questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in a large university medical center. Only 5% considered it important to do their residency in the country's peripheral areas, while 30% reported interest in a residency in the country's center. Conclusions The fifth year of a six-year medical school is an opportune time to provide students with information and guidance on the various specialties and selecting a residency program as they begin to solidify their perceptions and ideas about the various specialties. This study serves as an impetus to medical educators and healthcare leaders to become interested in students' career selection. PMID:22913658

2012-01-01

358

Frameless stereotactic guided neurosurgery: Clinical experience with an infrared based pointer device navigation system  

Microsoft Academic Search

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

K. Roessler; K. Ungersboeck; W. Dietrich; M. Aichholzer; K. Hittmeir; Ch. Matula; Th. Czech; W. Th. Koos

1997-01-01

359

1NH Agricultural Experiment Station -COLLEGE OF LIFE SCIENCES & AGRICULTURE http://extension.unh.edu/Agric | http://www.colsa.unh.edu/aes  

E-print Network

(Brassica juncea) Ruby Streaks Finely serrated maroon vor is more pungent when grown at higher tempera HAMPSHIRE Cooperative Extension Arugula Lobed light green leaves Medium growth Medium yields Kales (Brassica (Brassica rapa) Tokyo Bekana on thick white stems. Adds weight and bulk to salad mixes. Fast growth Heavy

New Hampshire, University of

360

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

E-print Network

://extension.unh.edu/Agric3 3 3 3 3 http://www.colsa.unh.edu/aes/3 Winter Sprouting Broccoli: A new crop for high tunnels Broccoli? Sprouting broccoli is a traditional English crop for fresh market and home gardeners. Sprouting broccoli produces many small shoots, rather than a single head. Many varieties require a cold treatment

New Hampshire, University of

361

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

Microsoft Academic Search

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

Bertil Lundberg; Lars Hansson; Elisabeth Wentz; Tommy Björkman

2007-01-01

362

Noninvasive imaging of the coronary arteries using a 64-row multidetector CT scanner: initial clinical experience and radiation dose concerns  

Microsoft Academic Search

Purpose.  We present our initial clinical experience with a recently introduced 64-detector computed tomography (64-MDCT) scanner that\\u000a makes use of a periodic motion of the focal spot in the longitudinal direction (z-flying focal spot), which enables it to\\u000a reach a final spatial resolution of 0.40.40.4 mm3 and a temporal resolution of 83 ms.\\u000a \\u000a \\u000a \\u000a Materials and methods.  A total of 114 patients (108

M. Francone; A. Napoli; I. Carbone; M. Cavacece; P. G. Nardis; K. Lanciotti; S. Visconti; L. Bertoletti; E. Di Castro; C. Catalano; R. Passariello

2007-01-01

363

Pathotropic nanoparticles for cancer gene therapy Rexin-G IV: three-year clinical experience.  

PubMed

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

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

364

Clinical Analysis and Surgical Considerations of Atherosclerotic Cerebral Aneurysms: Experience of a Single Center  

PubMed Central

Objective Atherosclerotic cerebral aneurysms are known to increase occurrence of thromboembolic events and occlusion of perforator vessels intraoperatively due to pathological changes in the vessels themselves. In the current study, we analyzed the points to be considered during surgery for atherosclerotic cerebral aneurysms and the postoperative results. Materials and Methods We retrospectively reviewed the medical records, radiological results, and surgical records, including intraoperative video recordings and photographs, of 262 patients who underwent cerebral aneurysm surgery. We then performed a detailed analysis of aneurysm features, surgical methods, and clinical outcomes. Results Among 278 aneurysms in 262 patients, 73 aneurysms in 67 patients showed atherosclerotic features (atherosclerotic group, AG), and 205 aneurysms in 195 patients showed no evidence of atherosclerosis (non-atherosclerotic group, NAG). In the AG, clipping with multiple permanent clips was performed in 14 aneurysms, and clip slippage was found in four cases. Six AG cases had a remnant neck after clipping, which was significantly more frequent than in the NAG (p < 0.05). Clinical outcomes and surgery-related complications did not differ significantly between the two groups. Conclusion In the surgical repair of aneurysms, the incidence of ischemia, which is irreversible or severe, might be greater in atherosclerotic than in non-atherosclerotic aneurysms. In addition, multiple clips might be applied to atherosclerotic aneurysms for effective obliteration and an aneurysm neck might be left to avoid a region of atheroma. PMID:25340027

Park, Chang Kyu; Choi, Seok Keun; Lee, Seung Hwan; Koh, Jun Seok

2014-01-01

365

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

PubMed

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

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

2014-09-01

366

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

PubMed

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

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

2014-12-01

367

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

PubMed

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. © 2014 Wiley Periodicals, Inc. PMID:25255904

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

2014-12-01

368

Haemate P von Willebrand factor/factor VIII concentrate: 25 years of clinical experience.  

PubMed

Although von Willebrand disease (VWD) has a very long history, our understanding and treatment of the bleeding disorder has only evolved during the past 50 years or so. It was not until the 1920s that VWD was first recognized as a disease separate from that of classical haemophilia. It then took another 30 years before the first effective treatment was developed. Since then, the medical management of VWD has evolved considerably, but not without its ups and downs. One of the key milestones in the evolution of the treatment of VWD was the development of Haemate P/Humate-P (CSL Behring) - the first virus-inactivated factor VIII plasma product. For 25 years, this concentrate has demonstrated excellent clinical efficacy and safety for patients with VWD and for those with haemophilia. This article provides an historical overview of the early landmark efforts to ensure a safe plasma-derived replacement product and outlines the clinical evolution in the use of Haemate P. PMID:18786006

Schramm, W

2008-11-01

369

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

NASA Astrophysics Data System (ADS)

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

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

2006-05-01

370

Er:YAG clinical experience in Japan: a review of scientific investigations  

NASA Astrophysics Data System (ADS)

An Er:YAG laser apparatus with a contact fiberoptic delivery system has been newly developed in Japan and its clinical use was approved by the Ministry of Health and Welfare in 1995. Previous investigations using the laser apparatus and its prototype showed that the Er:YAG laser was able to effectively ablate dental hard and soft tissues without major thermal damage, and that the influence on the tooth pulp was minimal. The degree of damage to the surrounding tissues caused by the inadvertent irradiation has also been evaluated. Bactericidal effect of the Er:YAG laser has been shown. The utility and safety of the Er:YAG laser treatment for caries removal and cavity preparation, soft tissue minor surgery, and scaling have been revealed by several clinical studies. Reports describing the usefulness of the Er:YAG laser are increasing. However, further studies are required in order to clarify the advantages and limitations of the Er:YAG laser treatment and to establish a reliable procedure.

Aoki, Akira; Watanabe, Hisashi; Ishikawa, Isao

1998-04-01

371

Contrast-enhanced digital mammography (CEDM): phantom experiment and first clinical results  

NASA Astrophysics Data System (ADS)

The introduction of the Full Field Digital Mammography (FFDM) opens the way to a large range of future advanced applications. Among them, Contrast Enhanced Digital Mammography (CEDM) could be a fast and less expensive alternative to Magnetic Resonance Imaging (MRI) for breast lesion characterization. In this work, we have investigated, first on phantom then on patients, the capability of a modified FFDM system to show the contrast enhancement of lesions after intra-venous injection of iodine. The uptake has been estimated from the difference between pre- and post-contrast images. Phantom results showed that 1) detectability thresholds of the contrast media were compatible with clinical conditions; 2) breast radiological thickness has a low impact on uptake detectability; 3) spatial and temporal analysis showed delayed margin contrast uptake of the simulated lesion and slow increase of contrast in the background. Preliminary results on patients have confirmed the phantom results and have shown a contrast uptake in all malignant lesions despite the observed patient motion artifacts, and some moderate signal variability. This study demonstrated the feasibility of the Contrast Enhanced Digital Mammography technique. Further investigations and clinical validations will have to be completed before it can be widely used in a daily routine practice.

Marx, Christiane; Facius, Mirijam; Muller, Serge L.; Benali, Karim; Malich, Ansgar; Kaiser, Werner

2002-05-01

372

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

PubMed Central

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

Wirth, Thomas

2011-01-01

373

First clinical experience with TRV027: pharmacokinetics and pharmacodynamics in healthy volunteers.  

PubMed

TRV027 is a novel ?-arrestin biased peptide ligand of the angiotensin II type 1 receptor (AT1R). The compound antagonizes G protein coupling while simultaneously stimulating ?-arrestin-mediated signaling. In preclinical studies, TRV027 reversibly reduced blood pressure while preserving renal function in a dog tachypaced heart failure model and stimulating cardiomyocyte contractility in vitro. This profile suggests that TRV027 may have unique benefits in acute heart failure, a condition associated with renin-angiotensin system activation. A first-time-in-human study was conducted with ascending doses of TRV027 to explore its tolerability, pharmacokinetics and pharmacodynamics in healthy volunteers. Subjects' salt intake was restricted to stimulate RAS activation. In this study TRV027 was safe and well tolerated with a short-half-life (ranging between 2.4 and 13.2?minutes) and dose-proportional increases in systemic exposure. Consistent with the pre-clinical findings, TRV027 reduced blood pressure to a greater degree in subjects with RAS activation, measured as elevated plasma renin activity, than in those with normal PRA levels. This study in sodium-restricted healthy subjects suggests that TRV027 will successfully target a core mechanism of acute heart failure pathophysiology. Further clinical studies with TRV027 in patients with heart failure are underway. PMID:23813302

Soergel, David G; Subach, Ruth Ann; Cowan, Conrad L; Violin, Jonathan D; Lark, Michael W

2013-09-01

374

Clinical Experience With Berlin Heart Excor in Pediatric Patients in Argentina: 1373 days of Cardiac Support  

Microsoft Academic Search

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

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

375

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

Microsoft Academic Search

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

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

2004-01-01

376

[Clinical experiences of professor WU Bing-Huang on emergency treatment with acupressure].  

PubMed

The key points of acupoint selection and manipulations of Professor WU Bing-huang's experiences on emergency treatment with acupressure are introduced. It includes emergency treatment on coma (collapse, faint, faint at the sight of blood, faint during acupuncture, faint during moxibustion, shock, etc.), and pain, cough as well as asthma relieving with acupressure (include abdominal pain, vomiting, diarrhea, headache, toothache, dysmenorrhea, lumbago, neck stiffness after sleep, cough, asthma, etc.). At the same time, typical cases are given as examples. PMID:21644319

Hong, Kun-Da; Wan, Tian; Wang, Lin-Lin; Wu, Ming-Xia

2011-03-01

377

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

Microsoft Academic Search

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

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

378

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

Microsoft Academic Search

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

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

2008-01-01

379

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

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

Patel, Mit B; Bencharit, Sompop

2009-01-01

380

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

PubMed

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

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

2014-04-01

381

Building capacity for clinical research in developing countries: the INDOX cancer research network experience  

PubMed Central

Transnational Organisations increasingly prioritise the need to support local research capacity in low and middle income countries in order that local priorities are addressed with due consideration of contextual issues. There remains limited evidence on the best way in which this should be done or the ways in which external agencies can support this process. We present an analysis of the learning from the INDOX Research Network, established in 2005 as a partnership between the Institute of Cancer Medicine at the University of Oxford and India's top nine comprehensive cancer centres. INDOX aims to enable Indian centres to conduct clinical research to the highest international standards; to ensure that trials are developed to address the specific needs of Indian patients by involving Indian investigators from the outset; and to provide the training to enable them to design and conduct their own studies. We report on the implementation, outputs and challenges of simultaneously trying to build capacity and deliver meaningful research output. PMID:22566788

Ali, Raghib; Finlayson, Alexander; on behalf of the INDOX Cancer Research Network

2012-01-01

382

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

E-print Network

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 ...

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

383

Understanding and Improving Management of Inpatient Diabetes Mellitus: The Mayo Clinic Arizona Experience  

PubMed Central

We present an overview of strategies our institution has taken to understand the state of its inpatient diabetes management. We first describe how we utilized information systems to assess inpatient glycemic control and insulin management in noncritically ill patients and discuss our findings regarding mean bedside glucose levels, the prevalence and frequency hypoglycemic and hyperglycemic events, the patterns of insulin therapy, and evidence of inpatient clinical inertia. We also review the development of a survey to determine practitioner attitudes and beliefs about inpatient diabetes. Results of this survey study found that, in general, practitioners believed in the importance of controlling hyperglycemia but were not comfortable with many aspects of inpatient diabetes care, particularly with the use of insulin. Finally, we suggest steps to follow in developing a quality-improvement program for hospitals. PMID:19885281

Cook, Curtiss B.; Zimmerman, Richard S.; Gauthier, Susanne M.; Castro, Janna C.; Jameson, Kimberly A.; Littman, Stephanie D.; Magallanez, Janice M.

2008-01-01

384

A new left ventricular assist device: clinical experience in two patients.  

PubMed

A permanent parallel aortic pump (PAP), essentially a permanent intra-aortic balloon pump or modified dynamic aortic patch, has been designed to support failing left ventricles The PAP is a counterpulsation system in which an external energy source delivers a pulsatile wave into the central circulation during cardiac diastole and relaxes during cardiac systole. Clinical improvement occurred in two patients after PAP implantation. The initial regimen of continuous pumping evolved to intermittent left ventricular assistance, and the patients were able to be periodically disconnected from the pump and ambulated. The patients expired 39 and 34 days after implantation due to gastrointestinal bleeding and complications of chronic emphysema and tracheostomy. Autopsy revealed that surgery for both devices had entirely healed. PMID:6450314

Phillips, S J; Kongtahworn, C; Zeff, R H; Iannone, L A; Brown, T M; Kreamer, R; Gordon, D F

1980-01-01

385

The Strategy of Combining Antidepressants in the Treatment of Major Depression: Clinical Experience in Spanish Outpatients  

PubMed Central

Introduction. The combination of antidepressants is a useful tool in the treatment of major depression, especially in cases where there is a partial response to antidepressant monotherapy. However, the use of this strategy is a matter of controversy, and its frequency of use in clinical practice is not clear. The aim of our study is to assess the use of antidepressants combination in Spain by reviewing three databases used between 1997 and 2001. Methods. Databases pertain to patients who are study subjects of major depression treatment. These databases are a result of studies performed in Spain and in which 550 psychiatrists participated. The total studied sample was comprised of N = 2, 842 patients, aged over 18, fitting DSM-IV criteria for Major Depressive Episode. The percentage of patients who received more than one antidepressant and the types of combinations used was described. Subsequently, a comparative study between the group which received a combination of antidepressants (N = 64) and the group which received antidepressant monotherapy (N = 775) was performed. Results. 27.1% of patients were on antidepressive monotherapy treatment, and 2.2% were on combination therapy. In the comparison of patients on combination therapy and monotherapy, there were significant differences only in episode duration (P = 0.001). The most frequent combinations are SSRIs and tricyclic antidepressants. The active principle most widely combined is fluoxetine. Conclusions. The prevalence of use of antidepressant combination therapy is 2.2% of the global sample and 8.3% of treated patients. Other than duration of the depressive episode, no clinical characteristics exclusive to patients who received combination rather than monotherapy were found. Our study found that the most frequent combination is SSRIs + TCAs, also being the most studied. PMID:21738865

Martin-Lopez, Luis M.; Rojo, Jose E.; Gibert, Karina; Martin, Juan Carlos; Sperry, Lyli; Duno, Lurdes; Bulbena, Antonio; Vallejo, Julio

2011-01-01

386

Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience  

PubMed Central

Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years) who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8%) girls and 64 (51.2%) boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60%) patients, followed by fever in 35 (28%). Erythema (33.6%), esophageal ulcer (11.2%), and whitish patch (8.0%) were the most common endoscopic findings, while reflux esophagitis (32.8%), chronic (6.4%) and acute esophagitis (5.6%), and candida esophagitis (5.6%) were the most common histological diagnoses. Only one (0.8%) patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression. PMID:24031107

Zahmatkeshan, Mozhgan; Najib, Khadijesadat; Geramizadeh, Bita; Fallahzadeh, Ebrahim; Haghighat, Mahmood; Imanieh, Mohammad Hadi

2013-01-01

387

Clinical evaluation of natural history of Peyronie's disease: our experience, old myths and new certainties.  

PubMed

Several studies describing the "natural history" of Peyronie's disease (PD) (Chronic Inflammation of the Tunica Albuginea-CITA) showed that untreated patients with PD seem to have spontaneous improvement. Because of these articles many physicians found to have a non-therapeutic behavior in case of PD. This paper tries to define the natural history of PD using penile dynamic duplex ultrasound evaluation in function of factors able to elicit fibrosis of the penis. Eighty-two patients have been studied, the mean time being between PD onset and diagnosis was 9.6 ± 3.8 months, mean age was 52.6 ± 10.69. Each patient underwent to two clinical assessments for PD, with a time-lag of 18.08 ± 9.2 months. Each assessment comprises: measurement of: plaque volume in cm(3) (with dynamic echocolor Doppler ultrasonography), penile curvature in degrees (with Kelami method), pain (with Pain Intensity Numerical Rating Scale/PINRS) and sexual function (with IIEF15 scale). The following clinical and laboratory assessments were carried out on each patient: body-mass index (BMI), blood pressure measurement, blood count, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, blood sugar, glycated haemoglobin and total testosterone. We assessed whether PD plaque volume, penile deformity, pain and modify by time, in function of risk factors of fibrosis (aging, smoking habit, erectile failure, number of comorbidities, BMI, radical prostatectomy) and/or of the severity of symptoms (plaque area, penile deformity and calcifications). Qualitative-quantitative non parametric multivariate analysis has been used as statistical test. The analysis indicated that PD symptoms increase by time in the majority of the patients, and that the increase is not linked to the severity of symptoms, but to the risk factors for developing fibrosis, with the exception of age that is inversely related. PD is a progressive disease, whose progression is linked to young age and to risk factors of fibrosis. PMID:23909888

Paulis, Gianni; Cavallini, Giorgio

2013-10-01

388

Coordination and management of multicenter clinical studies in trauma: Experience from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study  

PubMed Central

Aim Early death due to hemorrhage is a major consequence of traumatic injury. Transfusion practices differ among hospitals and it is unknown which transfusion practices improve survival. This report describes the experience of the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) Study Data Coordination Center in designing and coordinating a study to examine transfusion practices at ten Level 1 trauma centers in the U.S. Methods PROMMTT was a multisite prospective observational study of severely injured transfused trauma patients. The clinical sites collected real-time information on the timing and amounts of blood product infusions as well as colloids and crystalloids, vital signs, initial diagnostic and clinical laboratory tests, life saving interventions and other clinical care data. Results Between July 2009 and October 2010, PROMMTT screened 12,561 trauma admissions and enrolled 1,245 patients who received one or more blood transfusions within 6 hours of ED admission. A total of 297 massive transfusions were observed over the course of the study at a combined rate of 5.0 massive transfusion patients/week. Conclusion PROMMTT is the first multisite study to collect real-time prospective data on trauma patients requiring transfusion. Support from the Department of Defense and collaborative expertise from the ten participating centers helped to demonstrate the feasibility of prospective trauma transfusion studies. The observational data collected from this study will be an invaluable resource for research in trauma surgery and it will guide the design and conduct of future randomized trials. PMID:22001613

Rahbar, Mohammad H.; Fox, Erin E.; del Junco, Deborah J.; Cotton, Bryan A.; Podbielski, Jeanette M.; Matijevic, Nena; Cohen, Mitchell J.; Schreiber, Martin A.; Zhang, Jiajie; Mirhaji, Parsa; Duran, Sarah; Reynolds, Robert J.; Benjamin-Garner, Ruby; Holcomb, John B.

2011-01-01

389

Uncovering pain in critically ill non-verbal children: nurses' clinical experiences in the paediatric intensive care unit.  

PubMed

Critically ill paediatric patients are frequently exposed to pain that is required to be assessed and treated effectively. The most reliable resource for assessing pain is the child itself, but children in the paediatric intensive care unit (PICU) are commonly unable to communicate their needs, requiring professional caregivers to uncover and interpret pain. However, nurses and paediatricians do not have sufficient knowledge of how critical illness affects childrens' signs of pain. The aim of this study was to illuminate clinical experiences of pain in the PICU; describing nurses' perceptions of expressions of pain in non-verbal, critically ill 2-6 year old children. The participants were 17 experienced PICU nurses. Data were analysed according to the phenomenographic method and three qualitatively different main categories, gained from clinical experience, emerged: changes in the measurable parameters; perceived muscular tension; and, altered behaviour. Furthermore, contrasting the categories revealed two diverse perspectives to focus pain: measure-oriented and patient-oriented. Subtle expressions of pain were recognised when focus was patient-oriented. These findings support the necessity of actively looking for pain deriving from various perspectives and considering diverse caring needs when doing so. Acknowledging pain makes pain visible. PMID:21828165

Mattsson, Janet Yvonne; Forsner, Maria; Arman, Maria

2011-09-01

390

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

PubMed

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

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

2014-03-01

391

Experience with Under Fives' Clinic in Malavani, a slum area near Bombay.  

PubMed

3 models of Under Fives Clinics were tried successively at the Malavani Health Center beginning in 1978. Malavani is a village with a population of abourt 70,000 near the city of Bombay (India). In each model mothers were given a Road to Health Card for each child. Model I was a center-based model. The venue was the same center where outpatient departments were located for the convenience of the mothers. The staff comprised 1 pediatrician from the staff of the K.E.M. Hospital and rotating interns posted for 1 month at a time. Enrollment and follow-up of the children were done in the outpatient department. Model II, a subcenter-based model established in 1980, 5 satellite subcenters located in the community were established. The permanent staff consisted of a medical officer, a medico-social worker, and a records assistan. A detailed record of each child was maintained at the subcenter. The medico-social worker held group discussions with the attending mothers and an attempt was made to understand their views and beliefs about child care before trying to educate them. Model III, a community-based model, was established in April 1983. The staff was partly permanent (a medico-social worker, a student nurse, and local community health volunteer) and partly temporary (rotating interns). The staff visited different areas of Malavani village by rotation. An attempt was made to visit each area at least once in 2 months. Detailed recors were maintained as in Model II. In all models, the children were weighed at each visit. They were given oral polio and triple vaccines. Mothers were advised on foods to feed the children to improve nutrition and were given simple recipes and cooking demonstrations. An attempt was made to evaluate the regularity of attendance, weight gain in children, and immuniation coverage. With Model I 450 babies were registered in 6 months but only 48 of them were brought for further follow-up; only 21 of them completed primary immunization. 2034 babies were registered under Model II over a 2-year period. Of these, 1280 attended the clinic regularly for follow-up and completed the course of primary immunization. A striking feature was the weight gain in 1011 children. The number of family planning users increased significantly from 237 at the time of clinic registration to 384 after a few months. 856 babies were registered in 6 months under Model III and 764 attended regularly for follow-up. 613 of the 764 children gained weight and all 764 completed the primary course of immunization. The deficiencies of the center-based model, Model I, are evident. Models II and III proved effective in improving the care of children under 5. PMID:6716303

Kowli, S S; Kumar, R; Trivedi, M J; Bhalerao, V R

1984-01-01

392

Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience  

SciTech Connect

Purpose: To report on the clinical outcome of LINAC-based stereotactic radiotherapy (SRT) of uveal melanomas. Additionally, a new prototype (hardware and software) for automated eye monitoring and gated SRT using a noninvasive eye fixation technique is described. Patients and Methods: Between June 1997 and March 2004, 158 patients suffering from uveal melanoma were treated at a LINAC with 6 MV (5 x 14 Gy; 5 x 12 Gy prescribed to 80% isodose) photon beams. To guarantee identical patient setup during treatment planning (CT and MRI) and treatment delivery, patients were immobilized with a BrainLAB thermoplastic mask. Eye immobilization was achieved by instructing the patient to fixate on a light source integrated into the mask system. A mini-video camera was used to provide on-line information about the eye and pupil position, respectively. A new CT and magnetic resonance (MR) compatible prototype, based on head-and-neck fixation and the infrared tracking system ExacTrac, has been developed and evaluated since 2002. This system records maximum temporal and angular deviations during treatment and, based on tolerance limits, a feedback signal to the LINAC enables gated SRT. Results: After a median follow-up of 33.4 months (range, 3-85 months), local control was achieved in 98%. Fifteen patients (9.0%) developed metastases. Secondary enucleation was performed in 23 patients (13.8%). Long-term side effects were retinopathy (n = 70; 44%), cataract (n = 30; 23%), optic neuropathy (n = 65; 41%), and secondary neovascular glaucoma (n = 23; 13.8%). Typical situations when preset deviation criteria were exceeded were slow drifts (fatigue), large sudden eye movements (irritation), or eye closing (fatigue). In these cases, radiation was reliably interrupted by the gating system. In our clinical setup, the novel system for computer-controlled gated SRT of uveal melanoma was well tolerated by about 30 of the patients treated with this system so far. Conclusion: LINAC-based SRT of uveal melanomas provides good local control. The new prototype system improves the quality of treatment and offers the possibility of movement-gated treatments. In an ongoing study, treatment-related side effects are correlated with dose levels. Such correlations can be used to further optimize linac-based SRT of uveal melanoma.

Dieckmann, Karin [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria)]. E-mail: Karin.Dieckmann@akhwien.at; Georg, Dietmar [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Bogner, Joachim [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Zehetmayer, Martin [Department of Ophthalmology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Petersch, Bernhard [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Chorvat, Martin [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Weitmann, Hajo [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria); Poetter, Richard [Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria)

2006-11-15

393

Self-Ratings of Confidence in Clinical and Critical Thinking Problem-Solving as a Function of Post-Qualification Experience. A Study of Radiation Therapists  

Microsoft Academic Search

Recognising one’s abilities and limits in clinical tasks is a valuable part of professionalism. This study investigated the self-ratings of problem-solving confidence of radiation therapists in two domains: clinical scenarios and critical thinking items. We divided the sixty participants into three groups based on post-qualification experience (PQE), and found that greater PQE was linked with higher self-rated confidence on clinical

Helena Ferris; Kenneth McKenzie; Kevin Thomas

2007-01-01

394

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

Cancer.gov

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

395

Clinical experience with power-injectable PICCs in intensive care patients  

PubMed Central

Introduction In the ICU, peripherally inserted central catheters (PICCs) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome with the use of power-injectable catheters. Methods We retrospectively reviewed all of the power-injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We collected 89 power-injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related bloodstream infection. Non-infective complications during management were not clinically significant. There was one episode of symptomatic thrombosis during the stay in the ICU and one episode after transfer of a patient to a non-intensive ward. Conclusion Power-injectable PICCs have many advantages in the ICU: they can be used as multipurpose central lines for any type of infusion including high-flow infusion, for hemodynamic monitoring, and for high-pressure injection of contrast media during radiological procedures. Their insertion is successful in 100% of cases and is not associated with significant risks, even in patients with coagulation disorders. Their maintenance is associated with an extremely low rate of infective and non-infective complications. PMID:22305301

2012-01-01

396

Clinical experiences using everolimus-eluting stents in patients with coronary artery disease.  

PubMed

Despite the growing use of drug-eluting stents, restenosis remains to occur especially in high risk subgroups like patients with diffuse in-stent restenosis. This observation is supporting the search for new and potentially even more effective drug eluting stent systems. Everolimus has been used in conjunction with a new bioabsorbable polymer and gave promising results in initial clinical studies. In FUTURE I, a single-center, single-blinded randomized safety and feasibility study enrolling 15 patients with bare metal stents and 27 patients with everolimus-coated stents, 30-day MACE rate was 0% in both groups. In-stent late loss at six months was 0.83 mm in the control group and 0.10 mm in the everolimus group (p < 0.0001). In FUTURE II, a randomized multi-center study, a total of 64 patients were enrolled confirming safety and feasibility. After 6 months late loss was 0.85 mm in the control group and 0.12 mm in the everolimus group (p < 0.001). PMID:15546290

Störger, Hans; Grube, Eberhard; Hofmann, Manfred; Schwarz, Franz; Haase, Jürgen

2004-12-01

397

Clinical findings in MuSK-antibody positive myasthenia gravis: a U.S. experience.  

PubMed

We performed a retrospective chart review on 53 muscle-specific kinase antibody (MuSK-Ab)-positive myasthenia gravis (MG) patients at nine university-based centers in the U.S. Of these, 66% were Caucasian, 85% were women, and age of onset was 9-79 years. Twenty-seven patients were nonresponsive to anticholinesterase therapy. Myasthenia Gravis Foundation of America improvement status was achieved in 53% patients on corticosteroids, 51% with plasma exchange, and in 20% on intravenous immunoglobulin (IVIG). Thymectomy was beneficial in 7/18 patients at 3 years. Long-term (> or =3 years) outcome was very favorable in 58% of patients who achieved remission and/or minimal manifestation status. Overall, 73% improved. There was one MG-related death. This survey reinforces several cardinal features of MuSK-Ab-positive MG, including prominent bulbar involvement and anticholinesterase nonresponsiveness. Facial or tongue atrophy was rare. Most patients respond favorably to immunotherapy. The best clinical response was to corticosteroids and plasma exchange, and the poorest response was to IVIG. Long-term outcome is favorable in about 60% of cases. PMID:19882635

Pasnoor, Mamatha; Wolfe, Gil I; Nations, Sharon; Trivedi, Jaya; Barohn, Richard J; Herbelin, Laura; McVey, April; Dimachkie, Mazen; Kissel, John; Walsh, Ronan; Amato, Anthony; Mozaffar, Tahseen; Hungs, Marcel; Chui, Luis; Goldstein, Jonathan; Novella, Steven; Burns, Ted; Phillips, Lawrence; Claussen, Gwendolyn; Young, Angela; Bertorini, Tulio; Oh, Shin

2010-03-01

398

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

PubMed Central

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

Ruza, Ieva; Mirfakhraee, Sasan; Orwoll, Eric

2013-01-01

399

Imaging breast lesions using the Twente photoacoustic mammoscope: ongoing clinical experience  

NASA Astrophysics Data System (ADS)

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.

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

400

Nursing process documentation systems in clinical routine--prerequisites and experiences.  

PubMed

Documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality and high writing efforts, are reported. However, it is still unclear if computer-based documentation systems can reduce these problems. At the Heidelberg University Medical Center, computer-based nursing process documentation projects began in 1998. A computer-based nursing documentation system has now been successfully introduced on four wards of three different departments, supporting all six phases of the nursing process. The introduction of the new documentation system was accompanied by systematic evaluations of prerequisites and consequences. In this paper, we present preliminary results of this evaluation, focusing on prerequisites of computer-based nursing process documentation. We will discuss in detail the creation and use of predefined nursing care plans as one important prerequisite for computer-based nursing documentation. We will also focus on acceptance issues and on organizational and technical issues. PMID:11734385

Ammenwerth, E; Kutscha, U; Kutscha, A; Mahler, C; Eichstädter, R; Haux, R

2001-12-01