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Sample records for genitourinary medicine clinics

  1. Workloads in genitourinary medicine clinics in England.

    PubMed

    Thin, R N

    1989-12-01

    Work loads in venereal disease--sexually transmitted disease (STD)--genitourinary medicine (GUM) clinics have risen greatly in recent years. The increase in viral infections which are more difficult and time consuming to manage than those caused by bacteria and the higher expectations and demands of patients have combined to increase workloads more than the case figures indicate. This prompted the Department of Health and Social Security in 1988 to set up a survey of clinics in England with the following terms of reference: "To examine current and forecast workloads on GUM clinics, taking account of AIDS and other STDs, and to recommend any action which may need to be taken on manpower (including nursing manpower), training, resources and accommodation". The team concluded that the GUM service was ill equipped to meet the demands for its services, and made 36 recommendations. The priority recommendations included: the need to provide more resources; government ministers should give a lead in developing the service; all health districts should provide care for STD and HIV infection; all new patients should be seen on the day of presentation or failing that on the next occasion the clinic was open. Other recommendations included: location of all GUM clinics in the general outpatient department of general hospitals; accommodation of the same standard as other outpatient departments; review of the distribution of clinics; review of staffing levels and roles; and coordination of care of HIV infection. Many of these recommendations have already led to action including a lead from government ministers and provision of more funds. Many of the problems and recommendations will apply in other countries. PMID:2613217

  2. Testicular self-examination amongst genitourinary medicine clinic attendees.

    PubMed

    Kennett, Alexandra; Shaw, Jonathan W; Woolley, Paul D

    2014-10-01

    Advancements in the diagnosis and treatment of testicular cancer now give a five-year survival rate of 97.2%. Delayed presentation remains the primary cause of poor outcome and recommendations have stressed that men, particularly those with risk factors, should undertake regular testicular self-examination. This study aimed to determine testicular self-examination knowledge and practices amongst 740 unselected men attending a genitourinary medicine clinic via questionnaire survey. Of respondents, 75.8% of men had heard of testicular cancer, and 79.9% had heard of testicular self-examination. Of these, 41% of men had been taught testicular self-examination; 73.9% of them by a doctor or nurse. Importantly, 79.2% had previously performed testicular self-examination. The most common reason for not performing testicular self-examination was 'Don't really know what to look for' (59.5%). Men previously taught testicular self-examination were 11.5 times more likely to perform the practice than those untaught. Of respondents, 74.1% wanted more information regarding testicular self-examination whilst attending the clinic. This study shows an increased level of testicular self-examination amongst genitourinary medicine attendees than has been previously demonstrated in other patient groups. There remains room for improvement via further health promotion and research on the effectiveness of testicular self-examination. PMID:24516080

  3. Candida species and C. albicans biotypes in women attending clinics in genitourinary medicine.

    PubMed

    Odds, F C; Webster, C E; Fisk, P G; Riley, V C; Mayuranathan, P; Simmons, P D

    1989-05-01

    Yeasts were isolated from two or more anatomical sites in 198 women attending genitourinary clinics on at least two occasions. The yeast biotypes isolated concurrently from the vagina and urethra were the same in 138 (99%) of 140 instances, and 94% of 124 concurrent genital and anal isolates were of matching types, whereas only 75% of concurrent genital and oral isolates were of the same type. Mixtures of Candida spp. or C. albicans biotypes were encountered only five times among 545 yeast-positive samples. In instances where Candida spp. were isolated at successive times from the same site in a patient, the same yeast type was encountered on 97 (87%) of 112 occasions when the interval between samples was less than 15 weeks, and on 19 (66%) of 29 occasions when the interval was 15 weeks or more. These data indicate a tendency to carriage of phenotypically consistent types of Candida among most women attending genitourinary clinics. PMID:2657069

  4. Improving access to genitourinary medicine by satellite clinics: an evaluation of the use of pump-priming funding.

    PubMed

    Challenor, Rachel; Pinsent, Susan; Baker, Debbie

    2005-01-01

    Pump-priming funding was used to implement a three-month pilot project of two satellite clinics. We conducted a review to determine the impact of the satellite clinics on the local genitourinary (GU) medicine service and the level of success with reference to priorities in the National Strategy for Sexual Health and HIV. A total of 140 patients attended a university clinic and 52 attended a market town clinic. In all, 14% of university clinic and 15% of market town patients were chlamydia positive. Targets for offering/uptake of HIV testing (as outlined in the National Strategy) for 2004 were all met, and those for 2007 were all met except for one. Both satellites were judged successful. After effective implementation of a satellite service, staffing could be transferred to general practitioners with special interest in GU medicine/nurse specialists. This could allow additional satellites to be developed without compromising the main service, helping to improve access to local GU medicine services and promoting local clinical networks. PMID:15705273

  5. Applications of nuclear medicine in genitourinary imaging

    SciTech Connect

    Blaufox, M.D.; Kalika, V.; Scharf, S.; Milstein, D.

    1982-01-01

    Major advances in nuclear medicine instrumentation and radiopharmaceuticals for renal studies have occurred during the last decade. Current nuclear medicine methodology can be applied for accurate evaluation of renal function and for renal imaging in a wide variety of clinical situations. Total renal function can be estimated from the plasma clearance of agents excreted by glomerular filtration or tubular secretion, and individual function can be estimated by imaging combined with renography. A major area of radionuclide application is in the evaluation of obstructive uropathy. The introduction of diuretic renography and the use of computer-generated regions of interest offer the clinician added useful data which may aid in diagnosis and management. Imaging is of proven value also in trauma, renovascular hypertension, and acute and chronic renal failure. Methods for the evaluation of residual urine, vesicoureteral reflux, and testicular torsion have achieved increasing clinical use. These many procedures assure a meaningful and useful role for the application of nuclear medicine in genitourinary imaging.

  6. The need for innovative sexually transmitted infection screening initiatives for young men: evidence from genitourinary medicine clinics across England.

    PubMed

    Dave, S S; French, R S; Jungmann, E; Brook, G; Cassell, J A; Mercer, C H

    2011-10-01

    The study objectives were to ascertain behavioural, access-related, health-seeking factors and sexually transmitted infection (STI) prevalence in young men (<25 years) attending genitourinary (GU) medicine clinics and compare them with older men (≥ 25 years) and young women (<25 years). Between October 2004 and March 2005, 4600 new attendees at seven sociodemographically and geographically contrasting GU medicine clinics across England completed questionnaires, which were linked to routine clinical data. Young men waited significantly less time to be seen in clinic compared with older men and young women. They were less likely to report symptoms than older men (P = 0.021) yet more likely to be diagnosed with chlamydia (P = 0.001) and gonorrhoea (P = 0.007). They were also more likely to be diagnosed with an acute STI relative to young women (P = 0.007). Our data confirm the need to make comprehensive STI screening readily available for young men and to develop effective and innovative screening strategies in different settings. PMID:21998183

  7. Factors associated with travel to non-local genitourinary medicine clinics for gonorrhoea: an analysis of patients diagnosed in London, 2009-10.

    PubMed

    Le Polain de Waroux, Olivier; Hughes, Gwenda; Maguire, Helen; Crook, Paul D

    2014-03-01

    We analysed factors associated with travelling to non-local genitourinary medicine clinics for gonorrhoea care in London. We used surveillance data on London residents attending genitourinary medicine clinics in 2009-10 and calculated distances between patients' areas of residence and both the nearest genitourinary medicine clinic and the clinic attended. Non-local clinics were attended by 5408 (46.7%) patients. Men having sex with men attended non-local services more than heterosexuals (OR 3.83, p < 0.001). Among heterosexual men, black Africans and black Caribbeans were more likely, and South Asians less likely, to attend non-local services compared to whites (OR [95%CI] 1.33 [1.04-1.72], 1.36 [1.11-1.67] and 0.46 [0.31-0.70] respectively). Similar associations, although not statistically significant, were found in women. People were more likely to attend local services if their local clinic provided walk-in and young people's services, weekend consultations and long opening hours. These findings could help design services meeting local population needs and facilitate prompt and equitable access to care. PMID:23970635

  8. The sexual health of male sex workers in England: analysis of cross-sectional data from genitourinary medicine clinics

    PubMed Central

    Mc Grath-Lone, Louise; Marsh, Kimberly; Hughes, Gwenda; Ward, Helen

    2014-01-01

    Objectives Male sex workers (MSW) are thought to be at increased risk of sexually transmitted infections (STI), however, limited comparative data with other groups are available. Disparities among MSWs by migrant status may also exist. Using newly available, cross-sectional surveillance data, the characteristics of MSWs and other male genitourinary medicine (GUM) clinic attendees can be investigated. Methods Demographic characteristics, STI prevalence and service usage among MSWs and other male attendees between 1 January and 31 December 2011 were compared using logistic regression. Results In 2011, 627 780 men attended GUM clinics; 488 (0.08%) were identified as MSWs. MSWs used a variety of services, however, one in seven had no HIV test at presentation. Adjusting for demographic factors and self-reported sexual orientation, MSWs had increased risk of some STIs and reinfection compared to other male attendees (eg, ORadj of gonorrhoea infection: 2.21, 95% CI 1.61 to 3.01, p<0.001, 14.1% vs 4.8% reinfected in 2011, p=0.005). Service usage did not vary between migrant and UK-born MSWs, but migrant MSWs were twice as likely to be diagnosed with chlamydia. Conclusions Some STIs are more prevalent and some reinfections more common among MSWs than other male attendees. A minority of MSWs do not appear to access STI/HIV testing through GUM clinics, and targeted interventions to improve uptake of testing in MSWs should be developed. Service usage and sexual health of MSWs does not appear to vary greatly by migrant status, though the increased risk of chlamydia infection among migrant MSWs should be investigated further. PMID:24273126

  9. Improving surveillance of sexually transmitted infections using mandatory electronic clinical reporting: the genitourinary medicine clinic activity dataset, England, 2009 to 2013.

    PubMed

    Savage, E J; Mohammed, H; Leong, G; Duffell, S; Hughes, G

    2014-01-01

    A new electronic surveillance system for sexually transmitted infections (STIs) was introduced in England in 2009. The genitourinary medicine clinic activity dataset (GUMCAD) is a mandatory, disaggregated, pseudo-anonymised data return submitted by all STI clinics across England. The dataset includes information on all STI diagnoses made and services provided alongside demographic characteristics for every patient attendance at a clinic. The new system enables the timely analysis and publication of routine STI data, detailed analyses of risk groups and longitudinal analyses of clinic attendees. The system offers flexibility so new codes can be introduced to help monitor outbreaks or unusual STI activity. From January 2009 to December 2013 inclusive, over twenty-five million records from a total of 6,668,648 patients of STI clinics have been submitted. This article describes the successful implementation of this new surveillance system and the types of epidemiological outputs and analyses that GUMCAD enables. The challenges faced are discussed and forthcoming developments in STI surveillance in England are described. PMID:25496573

  10. Providing a genitourinary medicine colposcopy service.

    PubMed

    Sonnex, C

    2014-02-01

    Between 15 and 30 years ago, the management of women with abnormal cervical cytology fell within the remit of GU Medicine. This involved performing colposcopy. With the introduction of certification for colposcopists in 1998, most GU Medicine clinicians stopped providing a colposcopy service. As certification is not required for using the colposcope to diagnose and manage other ano-genital conditions, a GU Medicine-based colposcopy service was introduced at Addenbrooke's Hospital, Cambridge, UK, to assess young women with post-coital bleeding (PCB). One of the objectives of this study was to review this service. In 2011, local guidelines were implemented advising referral to the department of GU Medicine for women under the age of 40 years presenting with PCB with or without inter-menstrual bleeding (IMB) and with no history of previous cervical pathology. A case note review was undertaken for 357 consecutive patients to document clinical findings and management and to determine whether this was an appropriate route of referral. Cervical pathology was found to be uncommon and easily treated within the GU Medicine setting. The provision of a colposcopy service by GU Medicine nurse practitioners or doctors is achievable but requires appropriate training. Importantly, once obtained, these skills can be easily and usefully transferred to examining the vulva, penis, anus and anal canal. PMID:23893915

  11. The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics

    PubMed Central

    Mc Grath-Lone, Louise; Marsh, Kimberly; Hughes, Gwenda; Ward, Helen

    2014-01-01

    Background While female sex workers (FSWs) are assumed to be at increased risk of sexually transmitted infections (STIs), there are limited comparative data with other population groups available. Using routine STI surveillance data, we investigated differences in sexual health between FSWs and other female attendees at genitourinary medicine (GUM) clinics in England. Methods Demographic characteristics, STI prevalence and service usage among FSWs and other attendees in 2011 were compared using logistic regression. Results In 2011, 2704 FSWs made 8411 recorded visits to 131/208 GUM clinics, (primarily large, FSW-specialist centres in London). FSWs used a variety of services, however, 10% did not have an STI/HIV test at presentation. By comparison with other female attendees, FSWs travelled further for their care and had increased risk of certain STIs (eg, gonorrhoea ORadj: 2.76, 95% CI 2.16 to 3.54, p<0.001). Migrant FSWs had better sexual health outcomes than UK-born FSWs (eg, period prevalence of chlamydia among those tested: 8.5% vs 13.5%, p<0.001) but were more likely to experience non-STI outcomes (eg, pelvic inflammatory disease ORadj: 2.92, 95% CI 1.57 to 5.41, p<0.001). Conclusions FSWs in England have access to high-quality care through the GUM clinic network, but there is evidence of geographical inequality in access to these services. A minority do not appear to access STI/HIV testing through clinics, and some STIs are more prevalent among FSWs than other female attendees. Targeted interventions aimed at improving uptake of testing in FSWs should be developed, and need to be culturally sensitive to the needs of this predominantly migrant population. PMID:24493858

  12. Referral patterns between primary care and genitourinary medicine.

    PubMed

    Champion, J K; Ross, J D

    1999-02-01

    Many patients attending genitourinary medicine (GUM) clinics are self referred, but some patients initially present to their general practitioner (GP). The aim of this study was to describe the referral pattern of GPs in the Lothian region of Scotland to the local GUM clinic. A questionnaire was completed by all patients referred by their GP and a case note review supplied further diagnostic and demographic information. Of 1140 (23%) patients, 965 were available for study and were referred by their GP. There was a wide variability in referral rates from different practices and from different partners within a practice. The median referral rate per 100,000 practice population was 22.4/year (range 0-586). A referral letter accompanied the patient in 797/965 (83%) cases. The detection of cases of chlamydia and gonorrhoea in patients in primary care subsequently referred to the GUM clinic was low and poor diagnostic acumen for herpes simplex virus (HSV) was notable. No consistent practice for investigation or treatment prior to referral was found and there was marked failure of the investigations initiated in primary care to achieve diagnosis. Despite this, 24% of patients were already on treatment at the time of their GUM consultation. Few STDs were diagnosed in primary care and subsequently referred to the GUM clinic suggesting either failure to diagnose infections or reluctance to refer on for confirmation, treatment, test of cure and health education. PMID:10215118

  13. Identifying hidden capacity through modernization of genitourinary medicine services.

    PubMed

    Ahmed-Jushuf, I; Griffiths, V

    2007-05-01

    Rates of sexually transmitted infections have continued to rise in recent years throughout the UK. Poor access to genitourinary medicine clinics has been highlighted as a major factor contributing to this increase. Despite a lack of investment in sexual health services, capacity for new patients has almost doubled over the past decade. However, a significant amount of unreleased capacity is still available within the service. This 'Six Sigma' study group was formed in 2003 to explore whether capacity could be enhanced by further reducing the ratio of follow-up to new-case patient visits. Following implementation of recommended changes, the mean follow-up to new-case ratio reduced from 0.82 (range 0.29-1.69) to 0.62 (range: 0.19-1.40). Crucially, this increase in capacity was achieved without adversely affecting quality of care. The Six Sigma group have developed the tools to release capacity in a controlled and validated way and are keen to help other clinics achieve similar results. PMID:17524186

  14. Genitourinary medicine and The Internet No. 4.

    PubMed

    Lau, R K

    1997-02-01

    The Internet provides a rapid facility for accessing a large amount of information which, once found, can be manipulated in a variety of ways. For example, with the authors' permission, Web pages can be retrieved, converted into text files and edited to produce patient leaflets of sexually-transmitted conditions, prescribing information leaflets, clinical guidelines and protocols, etc. Collections of relevant Web sites placed in bookmarks on a Web browser for students to refer to could also form the basis for self-directed learning, and tutorials and small group teaching on specific subjects. PMID:9155562

  15. Child sexual abuse--the interface with genitourinary medicine.

    PubMed Central

    Rogers, D J; Roberts, R E

    1995-01-01

    Whenever a child is seen in a genitourinary clinic the possibility that the child is the victim of child sexual abuse must be considered. This article considers the definition and postulated prevalence of child sexual abuse in England and Wales. A proposed management plan is then detailed with a review of the significance of the medical findings. Finally consideration is given to the ethical dilemmas which such cases pose. Images PMID:7750955

  16. Genitourinary cancer: Basic and clinical aspects

    SciTech Connect

    Ratliff, T.L.; Catalona, W.J.

    1987-01-01

    This book contains 12 chapters. Some of the chapter titles are: Isoenzymes in Prostate Cancer; Growth Facgors in Urology; Methods of Detecting Prostatic Tumors; Oncogenes and Genitourinary Neoplasia; BCG Immunotherapy for Superficial Bladder Cancer; and the Role of Flow Cytometry in Urologic Oncology.

  17. Supply and demand: estimating the real need for care while meeting the 48 hour waiting time target in a genitourinary medicine clinic by a closed appointment system

    PubMed Central

    Clarke, J; Christodoulides, H; Taylor, Y

    2006-01-01

    Aim To attempt to assess demand for access to sexual health services in a community where a “closed” appointment system operates in the local genitourinary medicine (GUM) clinic. Setting A large GUM clinic serving a provincial city in England. Appointments for new episodes are available only 1 or 2 days ahead. Service user complaints about repeated difficulty in getting through to book a visit prompted a review of all methods of access. Methods A prospective review of all calls received in the departmental telephone booking service was performed. Temporary extra staff manned a cascade sequence of telephone lines and recorded all calls and caller characteristics such as age and declaration of symptoms. All attempts to book an appointment in person, by written referral, or by telephone in a period of 5 working days were also logged. This total demand was compared with the actual capacity and maximum theoretical capacity of the clinic during the same time period. Results 626 appointments would be required in the working week to accommodate all patients within 48 hours of requesting to be seen. 84% of all calls requested a new appointment, and 77% all new appointment requests were by phone. There were 181 new appointments available; 72% of those requesting an appointment could not be seen. The clinic was working at 103% capacity. To accommodate demand at this quiet time of the academic year, the GUM service would need to increase capacity by 3–4‐fold. Conclusions Closed appointment systems in GUM services may produce an apparent “improvement” in waiting times to 48 hours, but many callers are not able to book an appointment at all. Demand for GUM services outstrips capacity to an extent that internal efficiency savings cannot hope to address. PMID:16461602

  18. Genitourinary tuberculosis in North America: A rare clinical entity

    PubMed Central

    Sourial, Michael W.; Brimo, Fadi; Horn, Ruth; Andonian, Sero

    2015-01-01

    Introduction: Although tuberculosis (TB) is the most common cause of mortality from infectious diseases worldwide, genitourinary TB in North America is rare. We review 3 cases of genitourinary TB diagnosed within the last 5 years. Cases: The first case is that of a 76-year-old African-Canadian woman who was referred for percutaneous nephrolithotomy of right lower pole renal stones. Although renal TB was suspected, her initial urinary TB culture was negative. On follow-up imaging, she developed bilateral ureteral thickening and ureteroscopic biopsy confirmed necrotizing granulomata. Repeat urine cultures were positive for M. tuberculosis. The second case is a 73-year-old Italian-Canadian woman who was referred for ureteroscopic biopsy of left thickened ureter to rule out urothelial carcinoma. Initial urine TB cultures were negative, despite biopsies confirming granulomatous inflammation. She was closely followed with urine cytologies and TB cultures. Repeat urine culture was positive for M. tuberculosis. Both patients were treated with a course of anti-tuberculous agents and indwelling ureteral stents to relieve ureteral obstruction. The third case is a 70-year-old Cree woman who was referred for percutaneous nephrolithotomy of a left “staghorn stone” in an atrophic left kidney. Thirty years earlier she had been treated for pulmonary TB in addition to ileocystoplasty for a “thimble” bladder. A computed tomography scan showed autonephrectomized left kidney. Her urine TB cultures were negative. She was placed on prophylactic antibiotics for her recurrent bacterial urinary tract infections. Conclusion: Genitourinary TB may present in various subtle ways, and the astute clinician must have a high index of suspicion for this disease in patients with atypical clinical and radiologic findings. In addition, TB urine cultures should be repeated when there is high index of suspicion. PMID:26279721

  19. Domestic violence in a genitourinary medicine setting--an anonymous prevalence study in women.

    PubMed

    Loke, W C; Torres, C; Bacchus, L; Fox, E

    2008-11-01

    Domestic violence (DV) affects around one in four women in the UK. This study aimed to determine the prevalence of DV and the associations with sociodemographic and sexual behaviour variables in female attendees of an inner-city genitourinary (GU) medicine clinic. In this cross-sectional survey, 177 of 380 women (46.6%) disclosed a history of abuse and 17.4% reported DV in the preceding 12 months. Women with a history of a sexually transmitted infection (STI) were more likely to have experienced DV at some point in their lives (odds ratio [OR]=2.39; 95% confidence interval [CI]: 1.58-3.63). Logistic regression analysis revealed that being black compared with white, (OR=1.7; 95% CI: 2.4-12.5) current cohabitation with a partner (OR=2.24; 95% CI: 1.06-4.75), increasing number of sexual partners in the last year (OR=1.24; 95% CI: 1.01-1.5) and consumption of illicit drugs (OR=2.05; 95% CI: 1.02-4.11) were significantly associated with DV in the last 12 months but age, current occupation, history of STIs, age of coitarche and condom use were not. DV was common in this GU medicine clinic population and associated with STIs. We recommend that health practitioners undergo training to increase awareness of the links between partner violence and sexual health problems. PMID:18931267

  20. Reducing follow-ups: an opportunity to increase the capacity of genitourinary medicine services across the UK.

    PubMed

    Ahmed-Jushuf, I; Griffiths, V

    2007-05-01

    Significant increases in genitourinary (GU) medicine clinic workloads throughout the UK have resulted in an unmet demand for appointments, and increased waiting times. In order to meet the government target of a 48-hour maximum waiting time for all patients, many clinics are modernising current practices to increase capacity and improve access to services. The 'Six Sigma' study group of 12 GU medicine clinics which was formed in 2003 to investigate means of enhancing capacity of GU medicine services, has demonstrated that there is a significant amount of unreleased capacity within UK clinics. In this article, the Six Sigma group present potential actions which other GU medicine clinics in the UK may be able to apply and thereby release additional capacity. Example case studies from the Six Sigma study are also presented, illustrating the applicability of this model throughout the UK. The findings of the Six Sigma project offer GU medicine clinics across the UK the opportunity to increase capacity, without adversely affecting quality of care. PMID:17524188

  1. Genitourinary Medicine trainees' experience and training needs in the management of patients disclosing sexual violence.

    PubMed

    Sacks, Rachel; Emerson, Carol

    2014-04-01

    The British Association for Sexual Health and HIV (BASHH) Sexual Violence group assessed the level of confidence of Genitourinary Medicine (GUM) trainees in managing patients disclosing sexual violence using an online survey. Twenty-eight percent of current UK GUM trainees responded. The results demonstrated wide variation in trainees' experience and confidence in managing these patients, which was dependent on the patient type, as well as the gender of the trainee and the number of years' experience the trainee had in the specialty. There were also differences in the reported availability of training in this specialist area. Regular accessible training in identification and management of patients disclosing sexual violence is recommended for GUM trainees. PMID:24100285

  2. Inside the 2016 American Society of Clinical Oncology Genitourinary Cancers Symposium: part 2 - prostate and bladder cancer.

    PubMed

    Buti, Sebastiano; Ciccarese, Chiara; Iacovelli, Roberto; Bersanelli, Melissa; Scarpelli, Marina; Lopez-Beltran, Antonio; Cheng, Liang; Montironi, Rodolfo; Tortora, Giampaolo; Massari, Francesco

    2016-09-01

    The American Society of Clinical Oncology Genitourinary Cancers Symposium, Moscone West Building, San Francisco, CA, USA, 7-9 January 2016 The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, held in San Francisco (CA, USA), from 7 to 9 January 2016, focused on 'patient-centric care: translating research to results'. Every year, this meeting is a must for anyone studying genitourinary tumors to keep abreast of the most recent innovations in this field, exchange views on behaviors customarily adopted in daily clinical practice and discuss future topics of scientific research. This two-part report highlights the key themes presented at the 2016 ASCO Genitourinary Cancers Symposium, with part 1 reporting the main novelties of kidney cancer and part 2 discussing the most relevant issues which have emerged for bladder and prostate tumors. PMID:27312584

  3. Prior sexual assault reported by male attenders at a department of genitourinary medicine.

    PubMed

    Keane, F E; Young, S M; Boyle, H M; Curry, K M

    1995-01-01

    One-hundred-and-fifty male patients who attended the department of genitourinary medicine (GUM) completed a questionnaire which enquired into a past history of sexual assault and asked certain details about the assault and various sequelae of such an experience. Twenty-one men gave a history of sexual assault, 11 of whom had been abused before the age of 16, 7 afterwards and 3 in both age groups. Victims of such an assault were more likely to be homosexual or bisexual than heterosexual. The substantial majority i.e. 104 (81%) of the 129 patients who had not been assaulted in the past had been brought up by both natural parents. However, of the 21 males who reported a history of previous sexual abuse only 11 (52%) had been raised by both natural parents alone and 9 of the remaining 10 who divulged such information had been brought up in other circumstances. The association between not being raised entirely by both natural parents and a history of previous sexual assault was significant (P < 0.01). Overall, physical contact of a sexual nature was the most commonly reported type of abuse, followed by anal and then by oral penetration. All of the perpetrators of assault were male except in one instance. Only 3 cases of assault were reported to the police or other agencies. Those who had been abused as minors were more likely to acknowledge subsequent psychological difficulties and to have obtained professional counselling. This problem is a significant one which goes largely undetected in GUM departments and elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7779938

  4. Clinical nuclear medicine. [Handbook

    SciTech Connect

    Matin, P.

    1981-01-01

    ''Clinical Nuclear Medicine'' is an update to the author's ''Handbook of Clinical Nuclear Medicine.'' Sections on placental imaging, bone marrow imaging, biliary tract imaging and scintigraphy are included in the volume. (JMT)

  5. Profile of patients with genitourinary anomalies treated in a clinical genetics service in the Brazilian unified health system

    PubMed Central

    Gazzaneo, Ilanna Fragoso Peixoto; de Queiroz, Camila Maia Costa; Goes, Larissa Clara Vieira; Lessa, Victor José Correia; de Omena, Reinaldo Luna; do Nascimento, Diogo Lucas Lima; Petroli, Reginaldo José; Zanotti, Susane Vasconcelos; Monlleó, Isabella Lopes

    2016-01-01

    Abstract Objective: To describe the profile of patients with genitourinary abnormalities treated at a tertiary hospital genetics service. Methods: Cross-sectional study of 1068 medical records of patients treated between April/2008 and August/2014. A total of 115 cases suggestive of genitourinary anomalies were selected, regardless of age. A standardized clinical protocol was used, as well as karyotype, hormone levels and genitourinary ultrasound for basic evaluation. Laparoscopy, gonadal biopsy and molecular studies were performed in specific cases. Patients with genitourinary malformations were classified as genitourinary anomalies (GUA), whereas the others, as Disorders of Sex Differentiation (DSD). Chi-square, Fisher and Kruskal–Wallis tests were used for statistical analysis and comparison between groups. Results: 80 subjects met the inclusion criteria, 91% with DSD and 9% with isolated/syndromic GUA. The age was younger in the GUA group (p<0.02), but these groups did not differ regarding external and internal genitalia, as well as karyotype. Karyotype 46,XY was verified in 55% and chromosomal aberrations in 17.5% of cases. Ambiguous genitalia occurred in 45%, predominantly in 46,XX patients (p<0.006). Disorders of Gonadal Differentiation accounted for 25% and congenital adrenal hyperplasia, for 17.5% of the sample. Consanguinity occurred in 16%, recurrence in 12%, lack of birth certificate in 20% and interrupted follow-up in 31% of cases. Conclusions: Patients with DSD predominated. Ambiguous genitalia and abnormal sexual differentiation were more frequent among infants and prepubertal individuals. Congenital adrenal hyperplasia was the most prevalent nosology. Younger patients were more common in the GUA group. Abandonment and lower frequency of birth certificate occurred in patients with ambiguous or malformed genitalia. These characteristics corroborate the literature and show the biopsychosocial impact of genitourinary anomalies. PMID:26522823

  6. Preventing congenital syphilis - a regional audit of syphilis in pregnant women seen in Genitourinary Medicine services.

    PubMed

    Hussey, J; Mitchell, L; Hew, Y; Foster, K; Waldram, A

    2014-05-01

    Genitourinary case records of 42 pregnant women with syphilis were reviewed as part of a regional audit following the re-emergence of congenital syphilis in the north east of England. National standards, from the British Association of Sexual Health and HIV guidelines on managing syphilis in pregnancy, were met in the majority of cases with 69% being treated according to national guidance and all cases completing treatment. Locally developed standards on multidisciplinary working and communication were met less well, with particular issues regarding the documentation of pregnancy outcomes in GUM records and communication between specialities being highlighted. A regional good practice guide has been developed and implemented to address standards not met, reduce adverse outcomes and prevent future cases of congenital syphilis. PMID:24285598

  7. Genitourinary radiology

    SciTech Connect

    McClennan, B.L.

    1982-01-01

    A literature review of genitourinary radiology highlights new findings in the field that have occurred in the past year. The physiology of contrast media, and the occasional life-threatening contrast medial reaction are discussed. Common urologic problems such as stones, infection, and obstruction are examined in order to interpret static radiographs in a more meaningful way. The field of interventional uroradiology continues to expand, with new procedures being tried and new indications for old procedures being developed. (KRM)

  8. Survey of genitourinary medicine specialist registrars in the United Kingdom regarding genital dermatology training.

    PubMed

    Hartley, A; Bates, C M; Sashidharan, P N

    2016-07-01

    The British Association for Sexual Health and HIV Genital Dermatology Special Interest Group (SIG) conducted a survey of specialist registrar training in genital dermatology (GD) to inform future training provision provided by the group and other services. The survey shows that training in GD is variable with most trainees receiving GD training through formal lectures or ad hoc clinical teaching, with fewer trainees having access to specialist GD clinics. There is mixed confidence in diagnosis and use of topical steroids, and few trainees are independent in GD practical procedures. Many trainees feel training could be improved with requests for a formalised attachment, formal qualification and greater training in practical procedures. The GD SIG, in liaison with British Association for Sexual Health and HIV (BASHH), aims to optimise GD training for registrars. Plans for improved resources are in progress, including a practical skills course and e-learning. It is hoped this survey will also inform GD training at both local and national levels. PMID:26394999

  9. Phenotypic Detection of Genitourinary Candidiasis among Sexually Transmitted Disease Clinic Attendees in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

    PubMed Central

    Obisesan, Oluranti J.; Olowe, Olugbenga A.; Taiwo, Samuel S.

    2015-01-01

    The management of genitourinary candidiasis (GC) is fraught with challenges, especially, in an era of increasing antifungal resistance. This descriptive cross-sectional study conducted between May 2013 and January 2014 determined the prevalence and characteristics of GC and the species of Candida among 369 attendees of a Sexually Transmitted Disease (STD) clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Appropriate urogenital specimen collected from each attendee was examined by microscopy and culture for Candida, with preliminary species identification by CHROMAgar Candida and confirmation by Analytical Profile Index (API) 20C AUX. The age range of attendees was 1-80 years, mean age was 36.32 ± 11.34 years, and male to female ratio was 1 to 3. The prevalence of genitourinary candidiasis was 47.4%, with 4.9% in males and 42.5% in females (p < 0.0001). The age groups 31–45 and 16–30 have the highest prevalence of 23.3% and 16.8%, respectively. The species of Candida recovered include Candida glabrata 46.9%, Candida albicans 33.7%, Candida dubliniensis 9.7%, Candida tropicalis 5.7%, Candida krusei 1.7%, Candida lusitaniae 1.7%, and Candida utilis 0.6%. This study reported non-C. albicans Candida, especially C. glabrata, as the most frequently isolated species in GC, contrary to previous studies in this environment and elsewhere. PMID:26064140

  10. Phenotypic Detection of Genitourinary Candidiasis among Sexually Transmitted Disease Clinic Attendees in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria.

    PubMed

    Obisesan, Oluranti J; Olowe, Olugbenga A; Taiwo, Samuel S

    2015-01-01

    The management of genitourinary candidiasis (GC) is fraught with challenges, especially, in an era of increasing antifungal resistance. This descriptive cross-sectional study conducted between May 2013 and January 2014 determined the prevalence and characteristics of GC and the species of Candida among 369 attendees of a Sexually Transmitted Disease (STD) clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria. Appropriate urogenital specimen collected from each attendee was examined by microscopy and culture for Candida, with preliminary species identification by CHROMAgar Candida and confirmation by Analytical Profile Index (API) 20C AUX. The age range of attendees was 1-80 years, mean age was 36.32 ± 11.34 years, and male to female ratio was 1 to 3. The prevalence of genitourinary candidiasis was 47.4%, with 4.9% in males and 42.5% in females (p < 0.0001). The age groups 31-45 and 16-30 have the highest prevalence of 23.3% and 16.8%, respectively. The species of Candida recovered include Candida glabrata 46.9%, Candida albicans 33.7%, Candida dubliniensis 9.7%, Candida tropicalis 5.7%, Candida krusei 1.7%, Candida lusitaniae 1.7%, and Candida utilis 0.6%. This study reported non-C. albicans Candida, especially C. glabrata, as the most frequently isolated species in GC, contrary to previous studies in this environment and elsewhere. PMID:26064140

  11. Genitourinary tuberculosis masquerading as a ureteral calculus

    PubMed Central

    Wong, Nathan; Hoag, Nathan A.; Jones, Edward C.; Rowley, Allen; McLoughlin, Martin G.; Paterson, Ryan F.

    2013-01-01

    The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis. PMID:23766841

  12. Candida Infections of the Genitourinary Tract

    PubMed Central

    Achkar, Jacqueline M.; Fries, Bettina C.

    2010-01-01

    Summary: All humans are colonized with Candida species, mostly Candida albicans, yet some develop diseases due to Candida, among which genitourinary manifestations are extremely common. The forms of genitourinary candidiasis are distinct from each other and affect different populations. While vulvovaginal candidiasis affects mostly healthy women, candiduria occurs typically in elderly, hospitalized, or immunocompromised patients and in neonates. Despite its high incidence and clinical relevance, genitourinary candidiasis is understudied, and therefore, important questions about pathogenesis and treatment guidelines remain to be resolved. In this review, we summarize the current knowledge about genitourinary candidiasis. PMID:20375352

  13. Clinical Space Medicine Panel

    NASA Technical Reports Server (NTRS)

    Baisden, Denise L.; Billica, Roger (Technical Monitor)

    2000-01-01

    The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.

  14. [Scientific concepts in clinical medicine].

    PubMed

    Rogler, G

    2003-11-28

    The understanding of the scientific basis and the theory of knowledge are surprisingly heterogeneous in practical and clinical medicine. It is frequently influenced or based on the philosophical theory of critical rationalism founded by Sir Karl Popper. Because the theory of knowledge and the understanding of scientific truth is the central basis for cautious and good clinical practise it is necessary to discuss both points to avoid unscientific auto-immunisation against critique in a type of medicine that regards herself as science-based. Evidence-based medicine would not be possible without interpretation and explanation of existing data into the individual treatment context. Besides an inductive or deductive logic the historical and situative side-conditions of the gathering of knowledge and of experiments are of central importance for their interpretation and their relevance in clinical practice. This historical and situative context warrants reflection but must also be paid attention to in the reflections on medical ethics. PMID:14648440

  15. Clinical trials and gender medicine.

    PubMed

    Cassese, Mariarita; Zuber, Veronica

    2011-01-01

    Women use more medicines than men because they fall ill more often and suffer more from chronic diseases, but also because women pay more attention to their health and have more consciousness and care about themselves. Although medicines can have different effects on women and men, women still represent a small percentage in the first phases of trials (22%) which are essential to verify drugs dosage, side effects, and safety. Even though women are more present in trials, studies results are not presented with a gender approach. This situation is due to educational, social, ethical and economical factors. The scientific research must increase feminine presence in clinical trials in order to be equal and correct, and all the key stakeholder should be involved in this process. We still have a long way to cover and it doesn't concern only women but also children and old people. The aim is to have a medicine not only illness-focused but patient-focused: a medicine able to take into consideration all the patient characteristics and so to produce a really personalized therapy. What above described is part of the reasons why in 2005 was founded the National Observatory for Women's Health (Osservatorio Nazionale sulla Salute della Donna, ONDa) which promotes a gender health awareness and culture in Italy, at all the levels of the civil and scientific society. PMID:21430348

  16. The epidemiology of genital infection with herpes simplex virus types 1 and 2 in genitourinary medicine attendees in inner London

    PubMed Central

    Ramaswamy, M; McDonald, C; Sabin, C; Tenant-Flowers, M; Smith, M; Geretti, A

    2005-01-01

    Methods: Genital swabs (n = 186) were tested by real time polymerase chain reaction (PCR) and serum samples (n = 70) by HSV-2 specific enzyme linked immunoassay (ELISA). Results: Among 186 patients (median age 29 years), 104/186 (56%) were male and 176/186 (95%) heterosexual; ethnicity was predominantly black Caribbean (76/186, 41%), white (65/186, 35%), or black-African (41/186, 22%). The most common lesion sites were penis (85/104 men, 82%) and vulva (63/82 women, 77%); 114/186 (61%) patients were diagnosed clinically with first episode disease. Women were more likely to present <5 days of onset (p = 0.008). Black Caribbean patients were more likely to present ⩾5 days (p = 0.04) and decline HIV testing (p = 0.03). By PCR, 108/186 (58%) swabs tested positive for HSV-1 (7/108, 6.5%) or HSV-2 (101/108, 93.5%). Independent predictors of a positive PCR were heterosexual group, <5 days of onset, and visible genital ulceration on examination. HSV-2 was associated with black Caribbean and black African ethnicity; HSV-1 with white ethnicity (p = 0.006). By HSV-2 specific serology, 16/42 (38%) first episodes caused by HSV-2 were recurrent infections, and 7/19 (37%) patients with recurrent genital disease but negative PCR had genital herpes. Conclusions: Epidemiological trends in genital HSV-1 and HSV-2 infection appear to vary between ethnic groups in the United Kingdom. HSV-2 specific serology improves diagnostic accuracy in GUM populations where most genital infections are caused by HSV-2. PMID:16061536

  17. Graduate Program Organization in Clinical Veterinary Medicine.

    ERIC Educational Resources Information Center

    Horne, R. D.

    1979-01-01

    Graduate training in clinical veterinary medicine is discussed. The options available to the student and problems that must be dealt with are presented, along with the requirements to accomplish a finely structured program that satisfies the needs of both the trainee and clinical veterinary medicine. (Author/MLW)

  18. Clinical imaging in regenerative medicine

    PubMed Central

    Naumova, Anna V; Modo, Michel; Moore, Anna; Murry, Charles E; Frank, Joseph A

    2014-01-01

    In regenerative medicine, clinical imaging is indispensable for characterizing damaged tissue and for measuring the safety and efficacy of therapy. However, the ability to track the fate and function of transplanted cells with current technologies is limited. Exogenous contrast labels such as nanoparticles give a strong signal in the short term but are unreliable long term. Genetically encoded labels are good both short- and long-term in animals, but in the human setting they raise regulatory issues related to the safety of genomic integration and potential immunogenicity of reporter proteins. Imaging studies in brain, heart and islets share a common set of challenges, including developing novel labeling approaches to improve detection thresholds and early delineation of toxicity and function. Key areas for future research include addressing safety concerns associated with genetic labels and developing methods to follow cell survival, differentiation and integration with host tissue. Imaging may bridge the gap between cell therapies and health outcomes by elucidating mechanisms of action through longitudinal monitoring. PMID:25093889

  19. Genitourinary cancers: Summary of Indian data.

    PubMed

    Yuvaraja, T B; Waigankar, Santosh; Bakshi, Ganesh; Prakash, Gagan

    2016-01-01

    Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice. The associated morbidity and mortality and the significant proportion of affected middle-age individuals have a major bearing on the death-adjusted life years compared to other malignancies. Genitourinary system tumors encompass a very broad spectrum with regard to age, location, histology, and clinical outcomes. Advances in diagnostic imaging, surgical techniques, radiotherapy equipment, and generation of newer chemotherapeutic and targeted agents over the past few years have helped improving treatment outcome. Several focused groups within India have been working on a range of topics related to genitourinary system tumors, and a significant body of work from India in the recent years is being increasingly recognized throughout the world. The present article summarizes the key published work related to the epidemiology of genitourinary system tumors in the Indian setting. A PubMed search was made for locating and selecting articles relevant to the topic. PMID:27606296

  20. Genitourinary cancers: Summary of Indian data

    PubMed Central

    Yuvaraja, T. B.; Waigankar, Santosh; Bakshi, Ganesh; Prakash, Gagan

    2016-01-01

    Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice. The associated morbidity and mortality and the significant proportion of affected middle-age individuals have a major bearing on the death-adjusted life years compared to other malignancies. Genitourinary system tumors encompass a very broad spectrum with regard to age, location, histology, and clinical outcomes. Advances in diagnostic imaging, surgical techniques, radiotherapy equipment, and generation of newer chemotherapeutic and targeted agents over the past few years have helped improving treatment outcome. Several focused groups within India have been working on a range of topics related to genitourinary system tumors, and a significant body of work from India in the recent years is being increasingly recognized throughout the world. The present article summarizes the key published work related to the epidemiology of genitourinary system tumors in the Indian setting. A PubMed search was made for locating and selecting articles relevant to the topic. PMID:27606296

  1. [Design of a Curriculum Clinical Social Medicine].

    PubMed

    Gostomzyk, J G; Simoes, E; Mittelstaedt, G V

    2015-09-01

    The economic transformation of health care systems, which is supported by both the economic and the political sector, is in demand of constant humane correction. Legal regulations of social systems securing health corresponding to the code of social law are guard rails for a responsible use of limited resources and are subject to constant development. All doctors caring for patients should be in a position to reflect the real life context of their patients as both causal and modifying influence for health and disease from a social medical perspective, apart from their specific medical field of expertise.Accordingly 3 parts of sub-specialization training are suggested: clinical tasks of social medicine as detailed in the code of social law, clinical social medicine in health care according to the 5(th) book of the code of social law and social medicine in clinical social medicine/participation. Higher level-of-care hospitals, as well as rehabilitation clinics, should offer sub-specialization in social medicine without interruption of employment contracts. Corresponding criteria for the regulation on further education should be formulated by the German Society of Social Medicine and Prevention (DGSMP) as the competent scientific association and presented to the committee on further education of the Federal Medical Association. This aims at strengthening social medicine in clinical care. PMID:26154260

  2. Personalized medicine: ethics for clinical trials.

    PubMed

    Sharrer, G Terry

    2012-01-01

    Modern ethical codes in medicine were developed following World War II to provide respect for persons, beneficence, and justice in clinical research. Clinical trial medicine involves greater scrutiny than most research activities. In every instance, clinical trials have institutional review boards to ensure the medical procedure under study complies with regulatory requirements, privacy, informed consent, good practices, safety monitoring, adverse events reporting, and is free of conflicting interests. Mandatory training in medical ethics for all clinical staff is becoming more common, and at some institutions, knowledgeable patient advocates play a watchdog role. In personalized medicine, each patient becomes a clinical trial of one, based on the uniqueness of the person's illness and the relatively tailored treatment. These features imply a shared responsibility between the patient and the researchers because uncertainty exists over the outcome for each individual patient. This chapter introduces ethical considerations using case studies, with historical context, and describes general ethical guidelines for initiating a clinical trial. PMID:22081337

  3. Evaluating Clinical Teaching in Medicine.

    ERIC Educational Resources Information Center

    Irby, David; Rakestraw, Philip

    1981-01-01

    Medical students have been rating clinical teaching in an obstetrics and gynecology clerkship at the University of Washington using an assessment form designed to reflect six factors of clinical teaching effectiveness. High interrater reliability and the utility of the data for faculty development and advancement are discussed. (Author/JMD)

  4. Personalizing medicine with clinical pharmacogenetics

    PubMed Central

    Scott, Stuart A.

    2012-01-01

    Clinical genetic testing has grown substantially over the past 30 years as the causative mutations for Mendelian diseases have been identified, particularly aided in part by the recent advances in molecular-based technologies. Importantly, the adoption of new tests and testing strategies (e.g., diagnostic confirmation, prenatal testing, and population-based carrier screening) has often been met with caution and careful consideration before clinical implementation, which facilitates the appropriate use of new genetic tests. Although the field of pharmacogenetics was established in the 1950s, clinical testing for constitutional pharmacogenetic variants implicated in interindividual drug response variability has only recently become available to help clinicians guide pharmacotherapy, in part due to US Food and Drug Administration-mediated product insert revisions that include pharmacogenetic information for selected drugs. However, despite pharmacogenetic associations with adverse outcomes, physician uptake of clinical pharmacogenetic testing has been slow. Compared with testing for Mendelian diseases, pharmacogenetic testing for certain indications can have a lower positive predictive value, which is one reason for underutilization. A number of other barriers remain with implementing clinical pharmacogenetics, including clinical utility, professional education, and regulatory and reimbursement issues, among others. This review presents some of the current opportunities and challenges with implementing clinical pharmacogenetic testing. PMID:22095251

  5. Medicine and clinical skills laboratories.

    PubMed

    Al-Elq, Abdulmohsen H

    2007-05-01

    The main objective of the medical curriculum is to provide medical students with knowledge, skills and attitudes required for their practice. A decade ago, the UK Medical Council issued a report called "Tomorrow's Doctors"(1) which called for the reduction in the factual content of the medical course with the promotion of problem-based and self-dedicated learning. This report was the basis for a move toward an extensive reform of the medical and nursing curricula. The new reformed curricula enhanced the integrated medical teaching and emphasized the teaching and learning of clinical skills. However, there were still concerns about the standards and appropriateness of the skills of new medical graduates.(2)The changes in the teaching and learning methods, the radical changes in the health care delivery and the rapid growth of technology challenged the traditional way of clinical skills development and led to the emergence of clinical skills laboratories (CSLs) in the medical education of many medical and nursing schools. With the proliferation of the CSLs, it is important to evaluate and introduce the reader to their applications, bearing in mind the paucity of information on this subject particularly over the last couple of years. This article is based on literature review. PMID:23012147

  6. Narrative medicine in clinical genetics practice.

    PubMed

    Nowaczyk, Małgorzata J M

    2012-08-01

    Over the last 30 years medicine has undergone a significant paradigm shift. Due to the tremendous advances of modern medicine more and more people are living longer with their illnesses. These people have stories to tell, and they want these stories to be heard: They are reclaiming their voices. As clinical geneticists we need to hear what these voices are telling us, especially so in our area of clinical care where cures are rare, and disease states can be permanent. Narrative medicine is an important new skill set that hones abilities to do just that.This article highlights how integral narrative medicine is to clinical genetics practice, how geneticists already employ many of its tools and how they practice it diligently every day. I will show how geneticists can further improve their abilities to hear and honor patients' stories by writing and sharing stories with patients and with each other as doctors, counselors, and nurses, social workers and chaplains. The review presents the skills of close reading and how they improve patient care and illustrates how geneticists can, by using reflective writing, reshape their emotions in order to understand them, to let them go, and to make room for more. It presents the major types of illness narratives whose recognition allows us to hear and understand patients' stories. When used, the tools of narrative medicine can result in better patient care. PMID:22753050

  7. Personalized medicine and the clinical laboratory

    PubMed Central

    Pinho, João Renato Rebello; Sitnik, Roberta; Mangueira, Cristóvão Luis Pitangueira

    2014-01-01

    Personalized medicine is the use of biomarkers, most of them molecular markers, for detection of specific genetic traits to guide various approaches for preventing and treating different conditions. The identification of several genes related to heredity, oncology and infectious diseases lead to the detection of genetic polymorphisms that are involved not only in different clinical progression of these diseases but also in variations in treatment response. Currently, it is possible to detect these polymorphisms using several methodologies: detection of single nucleotide polymorphisms using polymerase chain reaction methods; nucleic acid microarray detection; and nucleic acid sequencing with automatized DNA sequencers using Sanger-derived methods and new generation sequencing. Personalized medicine assays are directed towards detecting genetic variations that alter interactions of drugs with targets or the metabolic pathways of drugs (upstream and downstream) and can be utilized for the selection of drug formulations and detect different immunogenicities of the drug. Personalized medicine applications have already been described in different areas of Medicine and allow specific treatment approaches to be applied to each patient and pathology according to the results of these assays. The application of such a protocol demands an increasing interaction between the clinical laboratory and the clinical staff. For its implementation, a coordinated team composed of basic researchers and physicians highly specialized in their areas supported by a highly specialized team of clinical analysts particularly trained in molecular biology assays is necessary. PMID:25295459

  8. Hyaluronan and hyaluronidase in genitourinary tumors

    PubMed Central

    Simpson, Melanie A.; Lokeshwar, Vinata B.

    2008-01-01

    Genitourinary cancers are the most frequently diagnosed cancers in men and the fifth most common in women. Management of disease through accurate and cost effective early diagnostic markers, as well as identification of valid prognostic indicators, has contributed significantly to improved treatment outcomes. In this review, we will discuss the function, regulation and clinical utility of hyaluronan (HA), genes encoding its metabolic enzymes and receptors that mediate its cellular effects. Specific HA synthase (HAS) and hyaluronidase (HAase) genes encode the enzymes that produce HA polymers and oligosaccharides, respectively. Differential effects of these enzymes in progression of genitourinary tumors are determined by the relative balance between HAS and HAase levels, as well as the distribution of receptors. The genes are regulated in a complex fashion at the transcriptional and post-translational levels, but also by epigenetic events, alternative mRNA splicing, and subcellular localization. Importantly, the major tumor-derived HAase enzyme, HYAL-1, either alone or together with HA, is an accurate diagnostic and prognostic marker for genitourinary tumors. PMID:18508614

  9. Routine fetal genitourinary tract screening.

    PubMed

    Arger, P H; Coleman, B G; Mintz, M C; Snyder, H P; Camardese, T; Arenson, R L; Gabbe, S G; Aquino, L

    1985-08-01

    To evaluate routine fetal genitourinary tract obstetrical ultrasound screening, and to determine what size renal pelvis is indicative of significant renal disease, we reviewed 4,832 examinations, which had been performed over 2 years, of 3,530 consecutive obstetrical patients. Any fetus that had a renal pelvis greater than 5 mm or a definable cystic area was identified for follow-up. The fetuses of 39 patients (1.1%) who underwent 112 examinations fulfilled these criteria and constitute the basis of this report. A variety of examination criteria were recorded and analyzed in relationship to the follow-up, which ranged from 2-3 days to 21 months. The fetuses of the 39 patients were grouped into three categories: those with renal pelves between 5 and 9 mm in size; those with renal pelves larger than 10 mm; and those with cystic abnormalities. Those with renal pelves larger than 10 mm had either an obstructing lesion or exceptional extrarenal pelves. The clinical and pathologic aspects of these three groups are detailed, discussed, and analyzed. Criteria for significant fetal renal hydronephrosis and aspects of a loculated appearance are given. PMID:3892578

  10. [Challenges for pathologists in clinical laboratory medicine].

    PubMed

    Tezuka, F

    2001-06-01

    The number of pathologists in hospitals has been increasing and they are responsible for both surgical pathology and clinical laboratory medicine. In the future they will also play important roles in the modernized reform of the central laboratory as it establishes its own importance in improving the quality and safety of medical activities. As a pathologist, the author reports on challenges faced since assuming the present directorship of the department of laboratory medicine in 1995 including (a) establishing a decision-making system in collaboration with technologists, (b) improving expertise in the department through joining a variety of seminars, conferences and research activities, (c) publishing an annual department report, and (d) introducing both internal and external quality assessment. In the future, for young pathologists training in both pathology and laboratory medicine will be essential. PMID:11452548

  11. Assessment of the impact of the London Olympics 2012 on selected non-genitourinary medicine clinic sexual health services.

    PubMed

    Hartley, A; Foster, R; Brook, M G; Cassell, J A; Mercer, C H; Coyne, K; Hughes, G; Crook, P

    2015-04-01

    With minimal information on sexual health provision during mass-gathering events, our aim was to describe the use of sexual health, contraceptive, sex worker and sexual assault services during the London 2012 Olympics. We analysed data from five sources. One contraceptive service provider reported a 10% increase in attendance during the main Games, while emergency contraception prescriptions rose during the main Olympics, compared to the week before, but were similar or lower than at the beginning and end of the summer period. A health telephone advice line reported a 16% fall in sexual health-related calls during the main Olympics, but a 33% increase subsequently. London sexual assault referral centres reported that 1.8% of sexual assaults were Olympics-linked. A service for sex workers reported that 16% started working in the sex industry and 7% moved to London to work during the Olympics. Fifty-eight per cent and 45% of sex workers reported fewer clients and an increase in police crack-downs, respectively. Our results show a change in activity across these services during the 2012 summer, which may be associated with the Olympics. Our data are a guide to other services when anticipating changes in service activity and planning staffing for mass-gathering events. PMID:24894726

  12. The effect of electronic patient records on hepatitis B vaccination completion rates at a genitourinary medicine clinic.

    PubMed

    Kuria, Patrick; Brook, Gary; McSorley, John

    2016-05-01

    The study was conducted to assess whether the introduction of an electronic patient records-based system affected hepatitis B vaccination completion rates and post-vaccination return rates, when compared to a paper-based system. Data were gathered for three groups of patients: those commencing vaccination (a) when paper records were in use (paper records group), (b) after electronic patient records were introduced (basic electronic patient records group) and (c) after electronic patient records were enhanced with recall (enhanced electronic patient records group). Compared to the paper records group, the third dose completion rates for patients managed using electronic patient records did not differ significantly: 74/119 (62.2%) paper vs. 58/98 (59.2%) basic electronic patient records, p = 0.652 and 89/130 (68.5%) enhanced electronic patient records, p = 0.298. On sub-group analysis, completion rates in patients of black ethnicity in the enhanced electronic patient records group were significantly higher than those in the paper records group: 16/19 (84.2%) enhanced electronic patient records vs. 11/23 (47.8%) paper, p = 0.014. Patients in the enhanced electronic patient records group were more likely than those in the paper records group to attend for measurement of hepatitis B surface antibody levels: 61/130 (46.9%) vs. 39/119 (32.8%), p = 0.023. PMID:26085502

  13. Development of autophagy inducers in clinical medicine

    PubMed Central

    Levine, Beth; Packer, Milton; Codogno, Patrice

    2015-01-01

    Defects in autophagy have been linked to a wide range of medical illnesses, including cancer as well as infectious, neurodegenerative, inflammatory, and metabolic diseases. These observations have led to the hypothesis that autophagy inducers may prevent or treat certain clinical conditions. Lifestyle and nutritional factors, such as exercise and caloric restriction, may exert their known health benefits through the autophagy pathway. Several currently available FDA-approved drugs have been shown to enhance autophagy, and this autophagy-enhancing action may be repurposed for use in novel clinical indications. The development of new drugs that are designed to be more selective inducers of autophagy function in target organs is expected to maximize clinical benefits while minimizing toxicity. This Review summarizes the rationale and current approaches for developing autophagy inducers in medicine, the factors to be considered in defining disease targets for such therapy, and the potential benefits of such treatment for human health. PMID:25654546

  14. Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

    PubMed Central

    Cofield, Stacey; Conwit, Robin; Barsan, William; Quinn, James

    2010-01-01

    The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in emergency medicine clinical trials. PMID:21040112

  15. Pediatric Genitourinary Oncology

    PubMed Central

    Dénes, Francisco Tibor; Duarte, Ricardo Jordão; Cristófani, Lílian Maria; Lopes, Roberto Iglesias

    2013-01-01

    Tumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management. PMID:24400293

  16. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

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

  17. Genitourinary dysfunction in Parkinson's disease.

    PubMed

    Sakakibara, Ryuji; Uchiyama, Tomoyuki; Yamanishi, Tomonori; Kishi, Masahiko

    2010-01-15

    Bladder dysfunction (urinary urgency/frequency) and sexual dysfunction (erectile dysfunction) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, genitourinary autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the genitourinary dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. PMID:20077468

  18. Current Epidemiology of Genitourinary Trauma

    PubMed Central

    McGeady, James B.; Breyer, Benjamin N.

    2013-01-01

    Synopsis This article reviews recent publications evaluating the current epidemiology of urologic trauma. It begins by providing a brief explanation of databases that have been recently used to study this patient population, then proceeds to discuss each genitourinary organ individually, discussing the most relevant and up to date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic. PMID:23905930

  19. Review of clinical medicine and religious practice.

    PubMed

    Stewart, William C; Adams, Michelle P; Stewart, Jeanette A; Nelson, Lindsay A

    2013-03-01

    The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states. PMID:23484213

  20. Advance modern medicine with clinical case reports

    PubMed Central

    2014-01-01

    Randomized clinical trial (RCT) can fail to demonstrate the richness of individual patient characteristics. Given the unpredictable nature of medicine, a patient may present in an unusual way, have a strange new pathology, or react to a medical intervention in a manner not seen before. The publication of these novelties as case reports is a fundamental way of conveying medical knowledge. Throughout history there have been famous case studies that shaped the way we view health and disease. Case reports can have the following functions: (I) descriptions of new diseases; (II) study of mechanisms; (III) discovery new therapies; (IV) recognition of side effects; and (V) education. Before submitting a case report, it is worthwhile to refer to the Case Report Check Sheet described by Green and Johnson [2006]. PMID:25525572

  1. Computational Medicine: Translating Models to Clinical Care

    PubMed Central

    Winslow, Raimond L.; Trayanova, Natalia; Geman, Donald; Miller, Michael I.

    2013-01-01

    Because of the inherent complexity of coupled nonlinear biological systems, the development of computational models is necessary for achieving a quantitative understanding of their structure and function in health and disease. Statistical learning is applied to high-dimensional biomolecular data to create models that describe relationships between molecules and networks. Multiscale modeling links networks to cells, organs, and organ systems. Computational approaches are used to characterize anatomic shape and its variations in health and disease. In each case, the purposes of modeling are to capture all that we know about disease and to develop improved therapies tailored to the needs of individuals. We discuss advances in computational medicine, with specific examples in the fields of cancer, diabetes, cardiology, and neurology. Advances in translating these computational methods to the clinic are described, as well as challenges in applying models for improving patient health. PMID:23115356

  2. Evidence-based integrative medicine in clinical veterinary oncology.

    PubMed

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. PMID:25174902

  3. A Review of the Clinical Education in Podiatric Medicine.

    ERIC Educational Resources Information Center

    Baerg, Richard H.

    1979-01-01

    Contemporary clinical educational programs at five colleges of podiatric medicine are reviewed. Both classroom contact hours and clinical experience are examined and compared among institutions. Course offerings in podiatric medicine, radiology, surgery, othopedics, community health, etc., are listed by college. (MLW)

  4. Imaging of Extranodal Genitourinary Lymphoma.

    PubMed

    Rohena-Quinquilla, Iván R; Lattin, Grant E; Wolfman, Darcy

    2016-07-01

    The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed. PMID:27265606

  5. Genitourinary cancer in the elderly.

    PubMed

    Raghavan, Derek; Skinner, Eila

    2004-04-01

    Genitourinary malignancy comprises nearly half of the cancers diagnosed in men, and the incidence of this group of cancers increases with age. The key to successful management is to define appropriate goals (cure v palliation) based on the natural history and extent of disease, physiology and life expectancy of the patients, and cost-benefit ratio of treatment options. Of particular importance, the chance for cure should not be sacrificed because of age-based considerations in early-stage cancers of the prostate or kidney nor in the early stage of locally advanced urothelial malignancy. PMID:15112154

  6. Cytokine medicines in clinical practice: current issues.

    PubMed

    Barnes, Theresa; Moots, Robert J; Goodacre, John

    2005-10-21

    Cytokine medicines have been licensed for the treatment of rheumatoid arthritis since 2000. The rheumatology community has accrued a large amount of experience in the use of these medications. This experience has led to the development of guidelines for their use that include ongoing vigilance for long term adverse events and efficacy using the Biologics Register. Delivery of these expensive therapies has prompted extensive system developments within rheumatology. The cytokine medicines have provided important tools to probe the pathogenesis of rheumatoid and other inflammatory diseases. Further cytokine medicines, in various stages of development, are on the horizon and continue to stimulate excitement within this fast expanding field. PMID:16188452

  7. Clinical Next Generation Sequencing for Precision Medicine in Cancer

    PubMed Central

    Dong, Ling; Wang, Wanheng; Li, Alvin; Kansal, Rina; Chen, Yuhan; Chen, Hong; Li, Xinmin

    2015-01-01

    Rapid adoption of next generation sequencing (NGS) in genomic medicine has been driven by low cost, high throughput sequencing and rapid advances in our understanding of the genetic bases of human diseases. Today, the NGS method has dominated sequencing space in genomic research, and quickly entered clinical practice. Because unique features of NGS perfectly meet the clinical reality (need to do more with less), the NGS technology is becoming a driving force to realize the dream of precision medicine. This article describes the strengths of NGS, NGS panels used in precision medicine, current applications of NGS in cytology, and its challenges and future directions for routine clinical use. PMID:27006629

  8. Clinical Next Generation Sequencing for Precision Medicine in Cancer.

    PubMed

    Dong, Ling; Wang, Wanheng; Li, Alvin; Kansal, Rina; Chen, Yuhan; Chen, Hong; Li, Xinmin

    2015-08-01

    Rapid adoption of next generation sequencing (NGS) in genomic medicine has been driven by low cost, high throughput sequencing and rapid advances in our understanding of the genetic bases of human diseases. Today, the NGS method has dominated sequencing space in genomic research, and quickly entered clinical practice. Because unique features of NGS perfectly meet the clinical reality (need to do more with less), the NGS technology is becoming a driving force to realize the dream of precision medicine. This article describes the strengths of NGS, NGS panels used in precision medicine, current applications of NGS in cytology, and its challenges and future directions for routine clinical use. PMID:27006629

  9. Clinical Evaluation in a Family Medicine Residency.

    ERIC Educational Resources Information Center

    Herman, James M.; And Others

    1985-01-01

    A study assessed (1) the validity of the Bowman Gray School of Medicine evaluation instrument regarding the occurrence of halo effects and (2) possible relationships between the faculty's evaluations of the residents and the residents' cognitive knowledge and productivity. (MLW)

  10. Genitourinary mast cells and survival.

    PubMed

    Theoharides, Theoharis C; Stewart, Julia M

    2015-10-01

    Mast cells (MCs) are ubiquitous in the body, but they have historically been associated with allergies, and most recently with regulation of immunity and inflammation. However, it remains a puzzle why so many MCs are located in the diencephalon, which regulates emotions and in the genitourinary tract, including the bladder, prostate, penis, vagina and uterus that hardly ever get allergic reactions. A number of papers have reported that MCs have estrogen, gonadotropin and corticotropin-releasing hormone (CRH) receptors. Moreover, animal experiments have shown that diencephalic MCs increase in number during courting in doves. We had reported that allergic stimulation of nasal MCs leads to hypothalamic-pituitary adrenal (HPA) activation. Interestingly, anecdotal information indicates that female patients with mastocytosis or mast cell activation syndrome may have increased libido. Preliminary evidence also suggests that MCs may have olfactory receptors. MCs may, therefore, have been retained phylogenetically not only to "smell danger", but to promote survival and procreation. PMID:26813805

  11. Genitourinary mast cells and survival

    PubMed Central

    Stewart, Julia M.

    2015-01-01

    Mast cells (MCs) are ubiquitous in the body, but they have historically been associated with allergies, and most recently with regulation of immunity and inflammation. However, it remains a puzzle why so many MCs are located in the diencephalon, which regulates emotions and in the genitourinary tract, including the bladder, prostate, penis, vagina and uterus that hardly ever get allergic reactions. A number of papers have reported that MCs have estrogen, gonadotropin and corticotropin-releasing hormone (CRH) receptors. Moreover, animal experiments have shown that diencephalic MCs increase in number during courting in doves. We had reported that allergic stimulation of nasal MCs leads to hypothalamic-pituitary adrenal (HPA) activation. Interestingly, anecdotal information indicates that female patients with mastocytosis or mast cell activation syndrome may have increased libido. Preliminary evidence also suggests that MCs may have olfactory receptors. MCs may, therefore, have been retained phylogenetically not only to “smell danger”, but to promote survival and procreation. PMID:26813805

  12. Complementary and Alternative Medicine Cancer Clinical Trials

    MedlinePlus

    ... patients. Currently, what cancer clinical trials are the NCI and medical community sponsoring involving CAM modalities? Cancer CAM clinical trials are listed in NCI’s PDQ ® (Physician Data Query) computer database of clinical ...

  13. Complementary and Alternative Medicine Cancer Clinical Trials

    MedlinePlus

    ... patients. Currently, what cancer clinical trials are the NCI and medical community sponsoring involving CAM modalities? Cancer CAM clinical trials are listed in NCI's PDQ ® (Physician Data Query) computer database of clinical ...

  14. Urolithiasis and Genitourinary Systems Issues for Spaceflight

    NASA Astrophysics Data System (ADS)

    Jones, Jeffrey A.; Sargsyan, Ashot; Pietryzk, Robert; Sams, C.; Stepaniak, Phillip; Whitson, P.

    2008-09-01

    Genitourinary medical events have shown to be an issue for both short duration and long duration spaceflight, and are anticipated to also be a potential issue for future exploration missions as well. This is based on actual historical pre-, in- and post-flight medical events, as well as assessment of what future flight challenges lay ahead. For this study, retrospective record review, as well as prospective studies of ultrasound and contingency management procedure development, and oral urinary stone prophylaxis were conducted. Results showed that the incidence of prior urinary calculi in- and post-flight was a risk driver for development of on-orbit countermeasures, as well as diagnostic and therapeutic methods for a possible in-flight calculus contingency. Oral potassium citrate and bisphosphonate preparations show promise for prophylaxis in spaceflight risk reduction. We conclude that a properly developed approach of selection, monitoring, and preventive medicine with effective countermeasures, along with early imaging diagnosis and minimally-invasive contingency intervention, should prevent issues such as urinary calculi from having a significant mission impact for exploration-class spaceflight.

  15. Clinical practice of traditional Chinese medicines for chronic heart failure

    PubMed Central

    Fu, Shufei; Zhang, Junhua; Gao, Xiumei; Xia, Ye; Ferrelli, Rita; Fauci, Alice; Guerra, Ranieri; Hu, Limin

    2010-01-01

    Background Chinese medicines have been used for chronic heart failure (CHF) for thousands of years; however, the status of traditional Chinese medicines (TCMs) used for CHF has not been reported. This review was carried out in the framework of a joint Sino-Italian Laboratory. Objective To investigate the baseline of clinical practice of TCMs for CHF, and to provide valuable information for research and clinical practice. Methods The authors included articles about the use of TCMs for the treatment of CHF by searching the Chinese Journal Full-text Database (1994 to November 2007). Results In all, 1029 papers were included, with 239 herbs retrieved from these. The most commonly used herbs included Huangqi (Radix Astragali), Fuling (Poria), Danshen (Radix Salviae Miltiorrhiae), Fuzi (Radix Aconiti Lateralis Preparata) and Tinglizi (Semen Lepidii). Modern Chinese patent medicines (produced by pharmaceutical companies) and traditional prescriptions (comprising several herbs) are the application forms of these drugs. Shenmai, Shengmai and Astragalus injections were the most commonly used Chinese patent medicines. Some classic prescriptions (including Zhenwu decoction, Shengmai powder and Lingguizhugan decoction) were also frequently used. The effectiveness and safety of the TCMs were both satisfactory, and the traditional Chinese medicine and western medicine therapy could significantly improve the clinical effectiveness and reduce some of the adverse reactions from western medicines used alone. Conclusion The authors have acquired overall information about the clinical application of TCMs for CHF. Modern pharmacology has provided limited evidence for the rationality of this clinical use. Further research is needed to provide more evidence. PMID:27325938

  16. Literature and medicine: contributions to clinical practice.

    PubMed

    Charon, R; Banks, J T; Connelly, J E; Hawkins, A H; Hunter, K M; Jones, A H; Montello, M; Poirer, S

    1995-04-15

    Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine. PMID:7887555

  17. [Discussion on Clinical and Diagnosis Program of Integrative Medicine].

    PubMed

    Zeng, Yi-di; Cao, Ze-biao; Du, Jia; Tao, Jing-jie; Zhou, Xiao-qing

    2016-05-01

    Facing current situation of integrative medicine (IM), authors put forward that clinical and diagnosis program of IM could be carried out from clinical path, pathogenesis, treatment theory and philosophy, and so on, but with different integration degrees. Meanwhile, formulation of concrete program should be disease-targetedly set up, and adjusted from person to person, from place to place, from time to time. As for settled IM program , authors could evaluate it from whether Chinese medicine and Western medicine have formed complementary, synergistic, excitatory actions, and toxicity attenuation; whether more problems could be solved in efficacy, safety, practicability, and economy than previous single mode. PMID:27386638

  18. International differences in sport medicine access and clinical management

    PubMed Central

    Heron, Neil; Malliaropoulos, Nikolaos G.

    2012-01-01

    Summary I undertook the 2012 ECOSEP travelling fellowship, sponsored by Bauerfeind, between May and August 2012, which involved visiting 5 European sport medicine centres and spending approximately one week in each centre. The 5 centres included: National Track and Field Centre, SEGAS, Thessaloniki, Greece; Professional School in Sport & Exercise Medicine, University of Barcelona, Spain; Sport Medicine Frankfurt Institute, Germany; Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy, and Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, England. Throughout the fellowship, the clinical cases which were routinely encountered were documented. The following sections detail my experiences throughout the fellowship, the sports of the athletes and the injuries which were treated at each of the sport medicine centres during the fellowship visit and the different forms of management employed. PMID:23738305

  19. An Overview of Emerging Immunotargets of Genitourinary Tumors.

    PubMed

    Montironi, Rodolfo; Santoni, Matteo; Cheng, Liang; Lopez-Beltran, Antonio; Massari, Francesco; Matrana, Marc R; Moch, Holger; Scarpelli, Marina

    2016-01-01

    Emerging immunotherapies targeting immune checkpoints and tumor associated antigens are leading to important clinical advances and providing a new weapon in patients with prostate (PCa) and bladder cancer (BC) and, in particular, with renal cell carcinoma (RCC). The possibility to integrate these agents in the current therapeutic scenario or genitourinary tumors, both in sequential or combined approaches, relies on a more profound comprehension of the protumorigenic activity of the immune system and of the mechanisms of cancer-related immunosuppression. In this regards, neutrophils, T and B lymphocytes and tumor-associated macrophages (TAMs) are implicated in the pathogenesis, progression and development of drug resistance in genitourinary tumors. This review is an overview on the recent insights concerning the role of immune cells in this context. PMID:26648079

  20. Biomarkers for immunotherapy in genitourinary malignancies.

    PubMed

    Slovin, Susan F

    2016-04-01

    Immunotherapy for genitourinary malignancies such as prostate, renal, and bladder cancers has experienced a resurgence since the development of 3 novel strategies: the autologous cellular product therapy, Sipuleucel-T for prostate cancer, the checkpoint inhibitors, anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4), anti-programmed cell death ligand 1 (anti-PD1), and anti-programmed cell death ligand 1), respectively. These agents have led to strikingly durable responses in several of these solid tumors, but their efficacy has been inconsistent. Why all solid tumors are not equal in their response to these therapies is unclear. More importantly, changes in humoral or cellular responses which may reflect changes in a tumor's biology have been limited due to differences in immune monitoring and lack of consistency in established reliable immunologic endpoints. How to design immunologic end points that reflect a meaningful effect on the cancer remains a challenge for clinical trial development. The issues faced by clinical investigators and the current state of immune monitoring are discussed. PMID:25791754

  1. [Computer technology in clinical preventive medicine].

    PubMed

    Okada, M

    1990-12-01

    Predicting who will suffer from diseases in the future is basically mathematical work. Current computer technology will accelerate the progress of preventive medicine. In this respect, there are two useful tools for the research. First, long-term archiving of health-care information is valuable in a retrospective study, such as, determination of diagnostic criteria for the prediction. Health-care information here includes past history, laboratory data, and dietary habits. Using such criteria, potential patients can be discriminated from truly healthy persons. Second, prediction is successfully carried out on the basis of mathematical equations which represent the relationship between disease status and health-care information. In conclusion, technology for database management and mathematical modelling is essential for the basic study in preventive medicine. PMID:2082030

  2. Clinical holistic medicine: when biomedicine is inadequate.

    PubMed

    Ventegodt, Søren; Morad, Mohammed; Hyam, Eytan; Merrick, Joav

    2004-05-19

    The modern physician is using pharmaceuticals as his prime tool. Unfortunately, this tool is much less efficient than you might expect from the biochemical theory. The belief in drugs as the solution to the health problems of mankind, overlooking important existing knowledge on quality of life, personal development, and holistic healing seems to be one good reason why approximately every second citizen of our modern society is chronically ill. The biomedical paradigm and the drugs are certainly useful, because in many situations we could not do without the drugs (like antibiotics), but curing infections or diseases in young age is not without consequences, as the way we perceive health and medicine is influenced by such experiences. When we get a more severe disease in midlife, we also believe drugs will make us healthy again. But at this age, the drugs do not work efficiently anymore, because we have turned older and lost much of the biological coherence that made us heal easily when we were younger. Now we need to assume responsibility, take learning, and improve our quality of life. We need a more holistic medicine that can help us back to life by allowing us to access our hidden resources. The modern physician cannot rely solely on drugs, but must also have holistic tools in his medical toolbox. This is the only way we can improve the general health of our populations. Whenever NNT (Number Needed to Treat) is 2 or higher, the likelihood of the drug to cure the patient is less than 50%, which is not satisfying to any physician. In this case, he must ethically try something more in order to cure his patients, which is the crossroads where both traditional manual medicine and the tools of a scientific holistic medicine are helpful. PMID:15175832

  3. Cutaneous manifestations of genitourinary malignancy.

    PubMed

    Raghavan, Derek

    2016-06-01

    Genitourinary cancers are associated with a range of cutaneous syndromes, which can reflect direct metastatic spread, non-metastatic manifestations of malignancy or the consequences of treatment. More than 220,000 new cases of prostate cancer occur each year in the United States, and thus the associations with cutaneous involvement are quite well documented-rare metastatic spread, vasculitic and hemorrhagic syndromes. Cancers of the bladder and kidney may be associated with direct cutaneous metastases, vasculitic syndromes, hereditary leiomyomatosis, and other familial syndromes. Testicular cancer occasionally metastasizes to the skin but more commonly is associated with the dysplastic nevus (multiple atypical nevus) syndrome. A structured approach to history-taking, examination, and investigation is essential for optimal management, especially when these syndromes precede the diagnosis of a known malignancy. A brief review of the more common iatrogenic cutaneous complications is provided, and includes Raynaud's phenomenon, purpura, rash, hand-foot syndrome, the consequences of marrow failure, and bleomycin-induced pigmentation. PMID:27178687

  4. Immunobiology and immunotherapy in genitourinary malignancies.

    PubMed

    Tsiatas, Marinos; Grivas, Petros

    2016-07-01

    Immunotherapy has traditionally been a critical component of the cancer treatment armamentarium in genitourinary (GU) cancers. It has an established role in the management of carefully selected patients with metastatic renal cell carcinoma (RCC) [e.g., high dose interleukin-2 (IL-2)] and non-muscle invasive bladder cancer (NMIBC) [e.g., intravesical Bacillus Calmette-Guérin (BCG)]. In 2010, the sipuleucel-T vaccine was approved by the FDA for the management of metastatic castration-resistant prostate cancer (mCRPC), based on a phase III trial showing overall survival (OS) benefit compared to placebo. The immune checkpoint inhibitor nivolumab (anti-PD-1) recently received FDA approval for the management of patients with advanced RCC patients previously treated with anti-angiogenic therapy, based on OS benefit compared to everolimus. Recently, large clinical trials demonstrated meaningful clinical benefit, including durable responses, as well as a good tolerability/safety profile with the use of immune checkpoint inhibitors in advanced RCC and chemotherapy-resistant advanced urothelial carcinoma (UC), while FDA just approved atezolizumab for platinum-treated advanced UC. Numerous interesting trials in different cancers are ongoing. Several combinations of immune checkpoint blockade with chemotherapeutics, vaccines, targeted tyrosine kinase inhibitors & monoclonal antibodies, epigenetic modifiers, anti-angiogenic agents, tumor microenvironment & myeloid cell targeting therapies, metabolic modification strategies, radiation, and others, are being tested in clinical trials. Comprehensive understanding of the factors underlying antitumor immune responses in physiologically relevant animal models and humans will refine further the clinical benefit of immunotherapy. Discovery and validation of appropriate molecular biomarkers via coordinated translational research efforts, rational clinical trial designs with suitable endpoints and well-defined eligibility criteria

  5. Immunobiology and immunotherapy in genitourinary malignancies

    PubMed Central

    Grivas, Petros

    2016-01-01

    Immunotherapy has traditionally been a critical component of the cancer treatment armamentarium in genitourinary (GU) cancers. It has an established role in the management of carefully selected patients with metastatic renal cell carcinoma (RCC) [e.g., high dose interleukin-2 (IL-2)] and non-muscle invasive bladder cancer (NMIBC) [e.g., intravesical Bacillus Calmette-Guérin (BCG)]. In 2010, the sipuleucel-T vaccine was approved by the FDA for the management of metastatic castration-resistant prostate cancer (mCRPC), based on a phase III trial showing overall survival (OS) benefit compared to placebo. The immune checkpoint inhibitor nivolumab (anti-PD-1) recently received FDA approval for the management of patients with advanced RCC patients previously treated with anti-angiogenic therapy, based on OS benefit compared to everolimus. Recently, large clinical trials demonstrated meaningful clinical benefit, including durable responses, as well as a good tolerability/safety profile with the use of immune checkpoint inhibitors in advanced RCC and chemotherapy-resistant advanced urothelial carcinoma (UC), while FDA just approved atezolizumab for platinum-treated advanced UC. Numerous interesting trials in different cancers are ongoing. Several combinations of immune checkpoint blockade with chemotherapeutics, vaccines, targeted tyrosine kinase inhibitors & monoclonal antibodies, epigenetic modifiers, anti-angiogenic agents, tumor microenvironment & myeloid cell targeting therapies, metabolic modification strategies, radiation, and others, are being tested in clinical trials. Comprehensive understanding of the factors underlying antitumor immune responses in physiologically relevant animal models and humans will refine further the clinical benefit of immunotherapy. Discovery and validation of appropriate molecular biomarkers via coordinated translational research efforts, rational clinical trial designs with suitable endpoints and well-defined eligibility criteria

  6. Placebos used in clinical trials for Chinese herbal medicine.

    PubMed

    Qi, Guan D; We, Ding A; Chung, Leung P; Fai, Cheng K

    2008-06-01

    One of the important components in randomized Controlled Trial (RCT) is blinding. The gold standard of clinical trials is to achieve a double blind design. However, only a small number of randomized controlled trials in traditional Chinese medicine have been reported, most of them are of poor quality in methodology including placebo preparation and verification. The purpose of the article is to review the validity of placebo used in blinded clinical trials for Chinese herbal medicine (CHM) in recent years and related patents. We searched the Wanfang Database (total of 827 Chinese journals of medicine and/or pharmacy, from 1999 to 2005) and 598 full-length articles related to placebo clinical trials were found. 77 placebo blinded clinical trials for Chinese medicine were extracted by manual search from the 598 articles. After reviewing the 77 full-length articles, we found that nearly half of the clinical trials did not pay attention to the physical quality of the testing drug and placebo and whether they were of comparable physical quality. The rest provided very limited placebo information so that blinding assurance could not be assumed. Only 2 articles (2.6%) specifically validated the comparability between the testing drug and the placebo. Researchers in Chinese medicine commonly ignored the quality of the placebo in comparison to the test drug. This may be causing bias in the clinical trials. Quality specifications and evaluation of the placebo should deserve special attention to reduce bias in randomized controlled trials in TCM study. PMID:19076001

  7. Ultrasound imaging in research and clinical medicine.

    PubMed

    Schellpfeffer, Michael A

    2013-06-01

    The use of ultrasound imaging in clinical obstetrics continues to grow at an almost exponential rate. Ultrasound imaging in developmental biology has only begun to be used to enhance the traditional methodologies to study the developing embryo/fetus. The various modalities of ultrasound imaging are reviewed as they apply to current uses in clinical obstetrics and developmental biologic research. New modalities are also discussed in both clinical obstetrics and developmental biologic research as well as the current limitations of ultrasound imaging faced in both of these fields. PMID:23897593

  8. Application and Exploration of Big Data Mining in Clinical Medicine

    PubMed Central

    Zhang, Yue; Guo, Shu-Li; Han, Li-Na; Li, Tie-Ling

    2016-01-01

    Objective: To review theories and technologies of big data mining and their application in clinical medicine. Data Sources: Literatures published in English or Chinese regarding theories and technologies of big data mining and the concrete applications of data mining technology in clinical medicine were obtained from PubMed and Chinese Hospital Knowledge Database from 1975 to 2015. Study Selection: Original articles regarding big data mining theory/technology and big data mining's application in the medical field were selected. Results: This review characterized the basic theories and technologies of big data mining including fuzzy theory, rough set theory, cloud theory, Dempster–Shafer theory, artificial neural network, genetic algorithm, inductive learning theory, Bayesian network, decision tree, pattern recognition, high-performance computing, and statistical analysis. The application of big data mining in clinical medicine was analyzed in the fields of disease risk assessment, clinical decision support, prediction of disease development, guidance of rational use of drugs, medical management, and evidence-based medicine. Conclusion: Big data mining has the potential to play an important role in clinical medicine. PMID:26960378

  9. Capacity for Clinical Research on Herbal Medicines in Africa

    PubMed Central

    Siegfried, Nandi; Johnson, Quinton

    2012-01-01

    Abstract An electronic survey was used to assess the training needs of clinical and public health researchers who have been involved, and/or plan to become involved, in clinical trials of herbal medicines in Africa. Over 90 researchers were contacted through pre-existing networks, of whom 58 (64%) responded, from 35 institutions in 14 African countries. Over half (57%) had already been involved in a clinical trial of an herbal medicine, and gave information about a total of 23 trials that have already been completed. Of these, only five had been published, and only one had resulted in a licensed product. Fifty-four (54) of the researchers were planning to conduct a clinical trial of an herbal medicine in the future, and gave information about 54 possible trials. Respondents outlined the following most commonly encountered difficulties when conducting clinical trials: resource constraints (including lack of funding, equipment, staff, and infrastructure); social acceptance of the clinical trial (including difficulty recruiting enough patients, poor rapport with traditional healers, and willingness of biomedical staff to be involved); herbal medicine supply (including insufficient cultivation, production, and quality control); lack of trained staff; and logistical issues in conducting trials. The topics in which researchers were least confident were Intellectual Property Rights issues, statistical issues, and issues related to Good Clinical Practice guidelines. PMID:22784350

  10. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    SciTech Connect

    Not Available

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  11. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    SciTech Connect

    Not Available

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not? by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  12. [Clinical and health economic challenges of personalized medicine].

    PubMed

    Brüggenjürgen, B; Kornbluth, L; Ferrara, J V; Willich, S N

    2012-05-01

    Healthcare systems across the globe are currently challenged by aging populations, increases in chronic diseases and the difficult task of managing a healthcare budget. In this health economic climate, personalized medicine promises not only an improvement in healthcare delivery but also the possibility of more cost-effective therapies. It is important to remember, however, that personalized medicine has the potential to both increase and decrease costs. Each targeted therapy must be evaluated individually. However, standard clinical trial design is not suitable for personalized therapies. Therefore, both scientists and regulatory authorities will need to accept innovative study designs in order to validate personalized therapies. Hence correct economic evaluations are difficult to carry out due to lack of clear clinical evidence, longitudinal accounting and experience with patient/clinician behavior in the context of personalized medicine. In terms of reimbursement, payers, pharmaceutical companies and companion diagnostic manufacturers will also need to explore creative risk-sharing concepts. Germany is no exception to the challenges that face personalized medicine and for personalized medicine to really become the future of medicine many health economic challenges first need to be overcome. The health economic implications of personalized medicine remain unclear but it is certain that the expansion of targeted therapies in current healthcare systems will create a host of challenges. PMID:22526860

  13. Clinical decision making-a functional medicine perspective.

    PubMed

    Pizzorno, Joseph E

    2012-09-01

    As 21st century health care moves from a disease-based approach to a more patient-centric system that can address biochemical individuality to improve health and function, clinical decision making becomes more complex. Accentuating the problem is the lack of a clear standard for this more complex functional medicine approach. While there is relatively broad agreement in Western medicine for what constitutes competent assessment of disease and identification of related treatment approaches, the complex functional medicine model posits multiple and individualized diagnostic and therapeutic approaches, most or many of which have reasonable underlying science and principles, but which have not been rigorously tested in a research or clinical setting. This has led to non-rigorous thinking and sometimes to uncritical acceptance of both poorly documented diagnostic procedures and ineffective therapies, resulting in less than optimal clinical care. PMID:24278827

  14. Treatment of the genitourinary syndrome of menopause.

    PubMed

    Palacios, S; Mejía, A; Neyro, J L

    2015-10-01

    The vagina, vulva, vestibule, labia majora/minora, and bladder trigone have a high concentration of estrogen receptors; therefore, they are a sensitive biological indicator of serum levels of these hormones in women. The estrogen loss in postmenopausal women produces a dysfunction called genitourinary syndrome of menopause. The principal therapeutic goal in the genitourinary syndrome of menopause is to relieve symptoms. Treatment options, as well as local and systemic hormonal treatment are changes in lifestyle and non-hormonal treatments mainly based on the use of moisturizers and lubricants. New treatments that have recently appeared are ospemifeme, the first selective hormone receptor modulator for dyspareunia and vulvovaginal atrophy treatment, and the use of vaginal laser. This review has been written with the intention of giving recommendations on the prevention and treatment of genitourinary syndrome of menopause. PMID:26366797

  15. [Clinical and medicine characteristics of patients with Parkinson's syndrome].

    PubMed

    Liu, Huan; Xie, Yan-Ming; Yi, Dan-Hui; Wang, Yong-Yan

    2014-09-01

    This study analyze the characteristics and clinical medicine in 17 hospitals all over China, based on hospital information system diagnostic information database, including 4 497 cases of hospitalized patients with Parkinson's syndrome. Results indicate, the most common comorbidities are infarction, hypertension, coronary heart disease, diabetes and lung infections, including cerebral infarction, the combined incidence of hypertension in men reached 33.46% and 30.05%, respectively, it is slightly lower in the females. Men with coronary heart disease are more than women, women with diabetes and bone disease are more than men. Combined incidence of the disease increases with age, vascular factors occupy an important position. The most common combined diseases in patients with 90 years of age or older are coronary heart disease, lung infection, and often accompanied by metabolic disorders and nutritional emergency, critical care. Constipation, depression, anxiety, sleep disorders, cognitive impairment are common non-motor symptoms. The drug categories associated with Parkinson's core symptoms treatment are about 20% to 30% of clinical medicine, the others are associated with the treatment of combined disease, clinical medicine and disease spectrum consistent. Blood circulation topped Chinese agents applied frequency, reaching 44.52%; laxative drugs accounted for 11.66%; detoxification agent representing 9.46%. The first twenty Chinese medicine of the applying frequency reached 56.07% of the total utilization, including 12 kinds of traditional Chinese medicine injections, accounting for 60%. Therefore, in the diagnosis and treatment of Parkinsons syndrome, the treatment of comorbidities is very important, more attentions should be paid to vascular factors of the disease, Chinese medicine should be more concerned to improve the non-motor symptoms, give full play to the pharmaceutical multi-target, the overall regulation of advantages, integrative medicine, and improve

  16. The oral-systemic personalized medicine model at Marshfield Clinic.

    PubMed

    Glurich, I; Acharya, A; Shukla, S K; Nycz, G R; Brilliant, M H

    2013-01-01

    Periodontal disease and diabetes, two diseases that have achieved epidemic status, share a bidirectional relationship driven by micro-inflammatory processes. The present review frames the current understanding of the pathological processes that appear to link these diseases and advances the hypothesis that reversal of the epidemic is possible through application of interdisciplinary intervention and advancement of oral-systemic personalized medicine. An overview of how Marshfield Clinic's unique clinical, informatics and bio-repository resources and infrastructures are being aligned to advance oral-systemic personalized medicine is presented as an interventional model with the potential to reverse the epidemic trends seen for these two chronic diseases over the past several decades. The overall vision is to engineer a transformational shift in paradigm from 'personalized medicine' to 'personalized health'. PMID:22458294

  17. Toward clinical genomics in everyday medicine: perspectives and recommendations.

    PubMed

    Delaney, Susan K; Hultner, Michael L; Jacob, Howard J; Ledbetter, David H; McCarthy, Jeanette J; Ball, Michael; Beckman, Kenneth B; Belmont, John W; Bloss, Cinnamon S; Christman, Michael F; Cosgrove, Andy; Damiani, Stephen A; Danis, Timothy; Delledonne, Massimo; Dougherty, Michael J; Dudley, Joel T; Faucett, W Andrew; Friedman, Jennifer R; Haase, David H; Hays, Tom S; Heilsberg, Stu; Huber, Jeff; Kaminsky, Leah; Ledbetter, Nikki; Lee, Warren H; Levin, Elissa; Libiger, Ondrej; Linderman, Michael; Love, Richard L; Magnus, David C; Martland, AnneMarie; McClure, Susan L; Megill, Scott E; Messier, Helen; Nussbaum, Robert L; Palaniappan, Latha; Patay, Bradley A; Popovich, Bradley W; Quackenbush, John; Savant, Mark J; Su, Michael M; Terry, Sharon F; Tucker, Steven; Wong, William T; Green, Robert C

    2016-01-01

    Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine. PMID:26810587

  18. Toward clinical genomics in everyday medicine: perspectives and recommendations

    PubMed Central

    Delaney, Susan K.; Hultner, Michael L.; Jacob, Howard J.; Ledbetter, David H.; McCarthy, Jeanette J.; Ball, Michael; Beckman, Kenneth B.; Belmont, John W.; Bloss, Cinnamon S.; Christman, Michael F.; Cosgrove, Andy; Damiani, Stephen A.; Danis, Timothy; Delledonne, Massimo; Dougherty, Michael J.; Dudley, Joel T.; Faucett, W. Andrew; Friedman, Jennifer R.; Haase, David H.; Hays, Tom S.; Heilsberg, Stu; Huber, Jeff; Kaminsky, Leah; Ledbetter, Nikki; Lee, Warren H.; Levin, Elissa; Libiger, Ondrej; Linderman, Michael; Love, Richard L.; Magnus, David C.; Martland, AnneMarie; McClure, Susan L.; Megill, Scott E.; Messier, Helen; Nussbaum, Robert L.; Palaniappan, Latha; Patay, Bradley A.; Popovich, Bradley W.; Quackenbush, John; Savant, Mark J.; Su, Michael M.; Terry, Sharon F.; Tucker, Steven; Wong, William T.; Green, Robert C.

    2016-01-01

    ABSTRACT Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine. PMID:26810587

  19. The future for clinical scientists in laboratory medicine.

    PubMed

    Hallworth, M; Hyde, K; Cumming, A; Peake, I

    2002-08-01

    Clinical science in the UK has been presented with a range of opportunities and new initiatives in recent years. This review summarizes the contribution of clinical scientists to the changing face of laboratory medicine, and describes some recent UK Government initiatives to modernize the scientific service and develop the people who work in it. Recent changes in the regulation of professional practice and the need for maintenance of professional competence are also discussed. PMID:12181021

  20. Sports Medicine. Clinical Rotation. Instructor's Packet and Student Study Packet.

    ERIC Educational Resources Information Center

    Texas Univ., Austin. Extension Instruction and Materials Center.

    The materials in this packet are for a course designed to provide individualized classroom study for a specific area of clinical rotation--sports medicine. The instructor's manual describes the learning objectives together with a list of reference materials that should be provided for completion of the student worksheets, and lists suggested…

  1. Methodology guideline for clinical studies investigating traditional Chinese medicine and integrative medicine: executive summary.

    PubMed

    Liu, Jian-Ping; Chen, Ke-Ji

    2015-10-01

    This guideline aims to provide a methodological guidance for clinical studies in TCM and integrative medicine in terms of study design, execution, and reporting. The commonly used methods including experimental and observational methods were introduced in this guideline such as randomized clinical trials, cohort study, case-control study, case series, and qualitative method which can be incorporated into above quantitative methods. The guideline can be used for the evaluation of therapeutic effect of TCM therapies or their combination with conventional therapy. TCM therapy refers to one of the followings or their combination: herbal medicine, acupuncture, moxibustion, cupping, Taichi/Qigong, and Guasha,Tuina (therapeutic massage). It is also suitable for research and development of ethnopharmaceuticals or folk medicine. PMID:26615617

  2. Review of splanchnic oximetry in clinical medicine.

    PubMed

    Bailey, Sean M; Mally, Pradeep V

    2016-09-01

    Global tissue perfusion and oxygenation are important indicators of physiologic function in humans. The monitoring of splanchnic oximetry through the use of near-infrared spectroscopy (NIRS) is an emerging method used to assess tissue oxygenation status. Splanchnic tissue oxygenation (SrSO2) is thought to be potentially of high value in critically ill patients because gastrointestinal organs can often be the first to suffer ischemic injury. During conditions of hypovolemia, cardiac dysfunction, or decreased oxygen-carrying capacity, blood flow is diverted toward vital organs, such as the brain and the heart at the expense of the splanchnic circulation. While monitoring SrSO2 has great potential benefit, there are limitations to the technology and techniques. SrSO2 has been found to have a relatively high degree of variability that can potentially make it difficult to interpret. In addition, because splanchnic organs only lie near the skin surface in children and infants, and energy from currently available sensors only penetrates a few centimeters deep, it can be difficult to use clinically in a noninvasive manner in adults. Research thus far is showing that splanchnic oximetry holds great promise in the ability to monitor patient oxygenation status and detect disease states in humans, especially in pediatric populations. PMID:27165703

  3. An eMERGE Clinical Center at Partners Personalized Medicine

    PubMed Central

    Smoller, Jordan W.; Karlson, Elizabeth W.; Green, Robert C.; Kathiresan, Sekar; MacArthur, Daniel G.; Talkowski, Michael E.; Murphy, Shawn N.; Weiss, Scott T.

    2016-01-01

    The integration of electronic medical records (EMRs) and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE) network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM) is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians. PMID:26805891

  4. Traditional Chinese medicine: potential for clinical treatment of rheumatoid arthritis.

    PubMed

    Moudgil, Kamal D; Berman, Brian M

    2014-07-01

    Rheumatoid arthritis (RA) is a chronic debilitating autoimmune disease affecting people worldwide. Increasing numbers of RA patients in the west are resorting to various complementary and alternative medicine modalities for relief of symptoms and well-being. Herbal products and acupuncture representing traditional Chinese medicine (TCM) are two of the most commonly used forms of complementary and alternative medicine. Frequently, their efficacy against RA and safety have been inferred from anecdotal experience or pilot testing on a relatively small number of patients following inadequate study designs. Accordingly, significant efforts need to be invested in objectively testing TCM in clinical trials that are sufficiently powered, randomized, blinded, possess appropriate controls and follow standard criteria for assessment of the outcomes. In addition, the mechanisms underlying the immunomodulatory and other antiarthritic activities of TCM modalities need to be better defined. These efforts would help validate the scientific rationale for the use of TCM for the management of RA. PMID:24820012

  5. The development of precision medicine in clinical practice.

    PubMed

    He, Mingyan; Xia, Jinglin; Shehab, Mohamed; Wang, Xiangdong

    2015-12-01

    Precision medicine allows a dramatic expansion of biological data, while there is still an urgent need to understand and insight the exact meaning of those data to human health and disease. This has led to an increasing wealth of data unanalyzed. The concept of precision medicine is about the customization of healthcare, with decisions and practices tailored to an individual patient based on their intrinsic biology in addition to clinical "signs and symptoms". Construction of a standardized model for the integration of data from various platforms is the central mission of the 'New Disease Management Model'. The model is helpful for the development of new taxonomy of diseases and subtypes, to personalize therapy based on patient genetic profiles. A rapid progression of precision therapy has been made recently. Clinical trials have shown the therapeutic efficacy of discovered and developed therapeutic agents has improved. However, next-generation drugs would be designed for disease subtypes with more specificity, efficacy and lower toxicity. PMID:26302883

  6. The Challenges of Clinical Researches in Iranian Traditional Medicine (ITM)

    PubMed Central

    Tabarrai, Malihe; Qaraaty, Marzie; Aliasl, Jale

    2016-01-01

    Background: Traditional medicine is one of the medical schools, which has been considered in recent years. Achieving reliable and valid research in ITM is very important to introduce this line of medicine into the healthcare organizations. The aim of this study was to investigate clinical research issues in ITM. Methods: This study is a qualitative research. We formed an expert panel and, after identifying the content, the study findings were divided into two main categories. Results: Challenges of clinical research studies are divided into two major categories in ITM, the problems of clinical trial processes and the difficulties in publishing research results. Lack of standard data collection instruments and questionnaires, limited sample size, lack of study models designed for distemperament treatment, unawareness, and non-compliance of ethics committees in facilities approved by WHO for clinical research of TM, and even rigidity beyond conventional medicine studies are some of the previously mentioned issues. Some difficulties in the publication of research results include lack of specialized journals especially at high academic levels, lack of familiarity with editorial board and difficulty in publishing the results of studies that are designed with combined products. A few proposals for these problems include: Conducting codification questionnaire workshops (approved by a thesis assistant with a subject of research tools)Introducing appropriate methods of multi-intervention research in ITMCreating the database of similarly performed research available for researchersDesigning multicenter researchCollaborations between academic centersLinking two or more thesis assistants or research projects in the form of a joint proposal with larger sample sizesEstablishing joint meeting between researchers, the heads of TM research centers and ethics committeesDedicated TM journal Conclusion: Considering a history of several thousand years, the Iranian traditional medicine

  7. Extracting terms from clinical records of traditional Chinese medicine.

    PubMed

    Cao, Cungen; Sun, Meng; Wang, Shi

    2014-09-01

    Health records of traditional Chinese medicine contain valuable clinical information which can be used for improvement of disease treatment and for medical research. In this paper, we present a practical iterative extraction method for extracting terms from the records. The method is based on a set of extraction rules, the Mesh, and the likelihood ratio technique, and achieved a precision rate of 88.18% and a recall rate of 94.21%. PMID:25159995

  8. Vaginal Estrogen for Genitourinary Syndrome of Menopause

    PubMed Central

    Rahn, David D.; Carberry, Cassandra; Sanses, Tatiana V.; Mamik, Mamta M.; Ward, Renée M.; Meriwether, Kate V.; Olivera, Cedric K.; Abed, Husam; Balk, Ethan M.; Murphy, Miles

    2016-01-01

    OBJECTIVE To comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines. DATA SOURCES MEDLINE and Cochrane databases were searched from inception to April 2013. We included randomized controlled trials and prospective comparative studies. Interventions and comparators included all commercially available vaginal estrogen products. Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators. METHODS OF STUDY SELECTION We double-screened 1,805 abstracts, identifying 44 eligible studies. Discrepancies were adjudicated by a third reviewer. Studies were individually and collectively assessed for methodologic quality and strength of evidence. TABULATION, INTEGRATION, AND RESULTS Studies were extracted for participant, intervention, comparator, and outcomes data, including patient-reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events. Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Urinary tract infection rates decreased. The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high-dose conjugated equine estrogen cream. Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen. Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar

  9. [Examples of the use of music in clinical medicine].

    PubMed

    Myskja, A; Lindbaek, M

    2000-04-10

    Music has been an element in medical practice throughout history. There is growing interest in music as a therapeutic tool. Since there is no generally accepted standard for how, when and where music should be applied within a medical framework, this literature study endeavours to present an overview of central areas of application of music in medicine. It further attempts to find tentative conclusions that may be drawn from existing clinical research on the efficacy of music as a medical tool. Traditionally, music has been linked to the treatment of mental illness, and has been used successfully to treat anxiety and depression and improve function in schizophrenia and autism. In clinical medicine several studies have shown analgetic and anxiolytic properties that have been used in intensive care units, both in diagnostic procedures like gastroscopy and in larger operations, in preoperative as well as postoperative phases, reducing the need for medication in several studies. The combination of music with guided imagery and deep relaxation has shown reduction of symptoms and increased well-being in chronic pain syndromes, whether from cancer or rheumatic origin. Music has been used as support in pregnancy and gestation, in internal medicine, oncology, paediatrics and other related fields. The use of music with geriatric patients could prove to be especially fruitful, both in its receptive and its active aspect. Studies have shown that music can improve function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, Alzheimer's disease and other forms of dementia. The role of music in medicine is primarily supportive and palliative. The supportive role of music has a natural field of application in palliative medicine and terminal care. Music is well tolerated, inexpensive, with good compliance and few side effects. PMID:10863351

  10. Interprofessional primary care in academic family medicine clinics

    PubMed Central

    Drummond, Neil; Abbott, Karen; Williamson, Tyler; Somji, Behnaz

    2012-01-01

    Abstract Objective To explore the status and processes of interprofessional work environments and the implications for interprofessional education in a sample of family medicine teaching clinics. Design Focus group interviews using a purposive sampling procedure. Setting Four academic family medicine clinics in Alberta. Participants Seven family physicians, 9 registered nurses, 5 licensed practical nurses, 2 residents, 1 psychologist, 1 informatics specialist, 1 pharmacist, 1 dietitian, 1 nurse practitioner, 1 receptionist, and 1 respiratory therapist. Methods Assessment of clinic status and performance in relation to established principles of interprofessional work and education was explored using semistructured focus group interviews. Main findings Our data supported the D’Amour and Oandasan model of successful interprofessional collaborative practice in terms of the model’s main “factors” (ie, shared goals and vision, sense of belonging, governance, and the structuring of clinical care) and their constituent “elements.” It is reasonable to conclude that the extent to which these factors and elements are both present and positively oriented in academic clinic settings is an important contributory factor to the establishment of interprofessional collaborative practice in primary care. Using this model, 2 of the 4 clinics were rated as expressing substantial progress in relation to interprofessional work, while the other 2 clinics were rated as less successful on that dimension. None of the clinics was identified as having a clear and explicit focus on providing interprofessional education. Conclusion The key factor in relation to the implementation of interprofessional work in primary care appears to be the existence of clear and explicit leadership in that direction. Substantial scope exists for improvement in the organization, conduct, and promotion of interprofessional education for Canadian primary care. PMID:22893347

  11. Is traditional Chinese medicine recommended in Western medicine clinical practice guidelines in China? A systematic analysis

    PubMed Central

    Ren, Jun; Li, Xun; Sun, Jin; Han, Mei; Yang, Guo-Yan; Li, Wen-Yuan; Robinson, Nicola; Lewith, George; Liu, Jian-Ping

    2015-01-01

    Background Evidence-based medicine promotes and relies on the use of evidence in developing clinical practice guidelines (CPGs). The Chinese healthcare system includes both traditional Chinese medicine (TCM) and Western medicine, which are expected to be equally reflected in Chinese CPGs. Objective To evaluate the inclusion of TCM-related information in Western medicine CPGs developed in China and the adoption of high level evidence. Methods All CPGs were identified from the China Guideline Clearinghouse (CGC), which is the main Chinese organisation maintaining the guidelines issued by the Ministry of Health of China, the Chinese Medical Association and the Chinese Medical Doctors’ Association. TCM-related contents were extracted from all the CPGs identified. Extracted information comprised the institution issuing the guideline, date of issue, disease, recommendations relating to TCM, evidence level of the recommended content and references supporting the recommendations. Results A total of 604 CPGs were identified, only a small number of which (74/604; 12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. The 74 CPGs involved 13 disease systems according to the International Classification of Diseases 10th edition. TCM was mainly recommended in the treatment part of the guidelines (73/74, 99%), and more than half of the recommendations (43/74, 58%) were related to Chinese herbal medicine (single herbs or herbal treatment based on syndrome differentiation). Conclusions Few Chinese Western medicine CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendation. We suggest that future guideline development should be based on systematic searches for evidence to support CPG recommendations and involve a multidisciplinary approach including TCM expertise. PMID:26041487

  12. Formal errors in non-pharmaceutical medicine (CAM): clinical medicine, mind-body medicine, body-psychotherapy, holistic medicine, clinical holistic medicine and sexology.

    PubMed

    Ventegodt, Søren; Andersen, Niels Jørgen; Kandel, Isack; Merrick, Joav

    2009-01-01

    This paper identifies five formal errors in non-drug medicine including most types of complementary and alternative medicine (CAM). These are based on five central principles of healing from the curriculum of the EU master in complementary, psychosocial and integrated health sciences (EU-MSc-CAM) from the Interuniversity College in Graz, Austria. An error is defined, as a therapeutic intervention that judged from established scientific knowledge should have been done differently. We found formal errors regarding: 1) The principle of salutogenesis, 2) The principle of similarity, 3) The principle that healing happens in surplus of resources, 4) The principle of using as little force as possible (primum non nocere), 5) The Hering's law of cure (you will get well in the opposite order of the way you got ill). From the primary errors secondary errors can be identified: A) Focusing on the patient's consciousness instead of the patient's unconscious, B) Wasting time on taking anamnesis and giving diagnoses, C) To ignore that the therapy does not help, D) Not to refer a patient that you know cannot be helped by you, E) Not to observe that a close relationship does not develop between therapist and patient, F) To work on a patient that you are not competent to help, G) Not to support the development of the patient into an independent person, H) Not letting go of the patient. None of the errors caused harm to the patient but slowed down healing. The presented list of errors is ideal for training and supervision. PMID:19702195

  13. Clinical research of traditional Chinese medicine in big data era.

    PubMed

    Zhang, Junhua; Zhang, Boli

    2014-09-01

    With the advent of big data era, our thinking, technology and methodology are being transformed. Data-intensive scientific discovery based on big data, named "The Fourth Paradigm," has become a new paradigm of scientific research. Along with the development and application of the Internet information technology in the field of healthcare, individual health records, clinical data of diagnosis and treatment, and genomic data have been accumulated dramatically, which generates big data in medical field for clinical research and assessment. With the support of big data, the defects and weakness may be overcome in the methodology of the conventional clinical evaluation based on sampling. Our research target shifts from the "causality inference" to "correlativity analysis." This not only facilitates the evaluation of individualized treatment, disease prediction, prevention and prognosis, but also is suitable for the practice of preventive healthcare and symptom pattern differentiation for treatment in terms of traditional Chinese medicine (TCM), and for the post-marketing evaluation of Chinese patent medicines. To conduct clinical studies involved in big data in TCM domain, top level design is needed and should be performed orderly. The fundamental construction and innovation studies should be strengthened in the sections of data platform creation, data analysis technology and big-data professionals fostering and training. PMID:25217972

  14. Protected clinical teaching time and a bedside clinical evaluation instrument in an emergency medicine training program.

    PubMed

    Shayne, Philip; Heilpern, Katherine; Ander, Douglas; Palmer-Smith, Victoria

    2002-11-01

    In a process that has evolved over the last four years, the Emory University Emergency Medicine Education Committee has developed an "academic attending" teaching shift incorporating a formatted lecture series with a clinical evaluation exercise (CEE). The program structures the approach to clinical teaching at the bedside, provides an objective clinical evaluation tool specific to emergency medicine residents, and provides targeted learning for medical students and residents rotating in the emergency department (ED). The CEE instrument was designed to be quick and efficient, satisfy requirements of assessment of the Accreditation Council for Graduate Medical Education (ACGME) general competencies, and incorporate the language of the "Model of the Clinical Practice of Emergency Medicine." The original program called for unstructured bedside teaching three days a week, by faculty freed from clinical duties, combined with a limited series of introductory emergency medicine lectures. The program proved more successful when concentrated in a once weekly structured educational program. The prepared, repeating lecture series has been expanded to include many of the most common ED presenting chief complaints and has significantly advanced a curriculum for medical students and visiting interns. A CEE was developed to evaluate and provide immediate feedback to residents on many of the core ACGME competencies. The CEE has been successfully used to structure the bedside educational encounter. This dedicated non-clinical "teaching" shift appears effective in meeting the educational goals of the authors' academic ED. This is a description of the program and its evolution; the program has not been formally evaluated. PMID:12414493

  15. Echocardiography as a Research and Clinical Tool in Veterinary Medicine

    PubMed Central

    Allen, D. G.

    1982-01-01

    Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of anesthetic effects on ventricular function and clinically in the diagnosis of congestive cardiomyopathy in a cat, ventricular septal defect in a calf, and pericardial effusion in a dog. Echocardiography is now an important adjunct to the field of veterinary cardiology. ImagesFigure 7.Figure 8.Figure 9.Figure 10. PMID:17422196

  16. Nutritional interventions for Alzheimer's prevention: a clinical precision medicine approach.

    PubMed

    Schelke, Matthew W; Hackett, Katherine; Chen, Jaclyn L; Shih, Chiashin; Shum, Jessica; Montgomery, Mary E; Chiang, Gloria C; Berkowitz, Cara; Seifan, Alon; Krikorian, Robert; Isaacson, Richard Scott

    2016-03-01

    Alzheimer's disease (AD) is a major source of morbidity and mortality, with the disease burden expected to rise as the population ages. No disease-modifying agent is currently available, but recent research suggests that nutritional and lifestyle modifications can delay or prevent the onset of AD. However, preventive nutritional interventions are not universally applicable and depend on the clinical profile of the individual patient. This article reviews existing nutritional modalities for AD prevention that act through improvement of insulin resistance, correction of dyslipidemia, and reduction of oxidative stress, and discusses how they may be modified on the basis of individual biomarkers, genetics, and behavior. In addition, we report preliminary results of clinical application of these personalized interventions at the first AD prevention clinic in the United States. The use of these personalized interventions represents an important application of precision medicine techniques for the prevention of AD that can be adopted by clinicians across disciplines. PMID:27116241

  17. Parasexuality in genitourinary investigations: a qualitative study

    PubMed Central

    2014-01-01

    Background Genitourinary investigations are performed on a large proportion of middle-aged and older men and the majority undergo investigations for prostate issues. The effects that genitourinary disease can have on men depend on the type of problem, investigations required and treatment including impotence, gynaecomastia and urinary incontinence that have lasting devastating physical, social and psychological effects. The aim was to explore older men’s experience and views of intimate and intrusive genitourinary investigations and specifically to develop hypotheses and theories concerning gender and sexuality issues in intimate genitourinary investigations. Methods Written informed consent was obtained for this qualitative study. Data were collected through one-off, semi-structured interviews involving 15 men in the first year following patient’s last urological procedure. Initially, multiple themes were identified and when analysed further concepts were repeatedly present. As the urological investigations were limited to men, gender and sexuality became prominent issues in the data. Results On analysis, the term parasexuality appeared to explain the dynamic of the situation. Parasexuality is a modified form of sexuality which is channelled and limited to maintain propriety. This was not expressed as sexuality in its overt, explicit sense, but instead a type of covert sexuality where professional boundaries are maintained but nonetheless undercurrents remain. This managed version of sexuality created a common currency by which interactions between staff and patients could take place safely. Feeding into parasexuality were gender role stereotypes and for some of the participants this reflected their own experience, context, historical and cultural norms. Intimate contact in the form of exposure and handling of the participants' genitalia during the investigations particularly challenged the boundaries of parasexuality. In order to remain parasexual, many of

  18. [Gender medicine. Sex- and gender-specific aspects of clinical medicine].

    PubMed

    Kautzky-Willer, A

    2014-09-01

    Gender medicine studies sex- and gender-based differences in the development and prevention of diseases, the awareness and presentation of symptoms, and the effectiveness of therapy. Gender medicine is part of personalized medicine, considering differences in biological and psychosocial factors individually. There are differences in genes, chromosomes, hormones, and metabolism as well as differences in culture, environment, and society. Lifelong interactions between physical and psychosocial factors will influence the health and ill-health of men and women in different ways. Epigenetic modifications provide evidence of the impact of environment and lifestyle during vulnerable phases on biological processes, effecting future generations. Maternal lifestyle and environmental factors during pregnancy can impact the health of offspring in later life already in utero in a sex-specific way. Pain, stress, and coping styles differ between men and women. Women experience more dramatic physical changes during their lifetime, which are associated with specific burdens and psychosocial alterations. Women with multiple roles and responsibilities suffering from stress develop depression more frequently. However, men are often not diagnosed and treated appropriately in cases of depression or osteoporosis, diseases that are typically considered "female." There are prominent differences between men and women in medicine regarding the immune system, inflammation, and noncommunicable diseases such as obesity, type 2 diabetes, hypertension, and cardiovascular disease. Women experience more often autoimmune diseases and suffer more frequently from (chronic) pain, neurodegenerative changes, and functional disabilities. Men have shorter life expectancy but relatively more healthy years of life, which is in greater part ascribed to psychosocial determinants. State-of-the-art clinical medicine comprises individual risk factors based on sex- and gender-sensitive health programs in order to

  19. The human genome project: Prospects and implications for clinical medicine

    SciTech Connect

    Green, E.D.; Waterston, R.H. )

    1991-10-09

    The recently initiated human genome project is a large international effort to elucidate the genetic architecture of the genomes of man and several model organisms. The initial phases of this endeavor involve the establishment of rough blueprints (maps) of the genetic landscape of these genomes, with the long-term goal of determining their precise nucleotide sequences and identifying the genes. The knowledge gained by these studies will provide a vital tool for the study of many biologic processes and will have a profound impact on clinical medicine.

  20. Anthroposophical medicine: a systematic review of randomised clinical trials.

    PubMed

    Ernst, Edzard

    2004-02-28

    The aim of this systematic review was to summarise and critically evaluate all randomised clinical trials testing the effectiveness of the whole system of anthroposophical medicine either as a sole or as an adjunctive form of treatment. Seven independent literature searches were conducted to locate all such studies. Trials of single remedies within the wider anthroposophical approach were excluded. No language restrictions were applied. Unfortunately not a single study was located which met the inclusion/exclusion criteria. It was therefore concluded that, at present, the question whether the anthroposophical concept of healing generates more good than harm cannot be answered. PMID:15038403

  1. Cannabinoid-based medicines for neurological disorders--clinical evidence.

    PubMed

    Wright, Stephen

    2007-08-01

    Whereas the cannabis plant has a long history of medicinal use, it is only in recent years that a sufficient understanding of the pharmacology of the main plant constituents has allowed for a better understanding of the most rational therapeutic targets. The distribution of cannabinoid receptors, both within the nervous system and without, and the development of pharmacological tools to investigate their function has lead to a substantial increase in efforts to develop cannabinoids as therapeutic agents. Concomitant with these efforts, the understanding of the pharmacology of plant cannabinoids at receptor and other systems distinct from the cannabinoid receptors suggests that the therapeutic applications of plant-derived cannabinoids (and presumably their synthetic derivatives also) may be diverse. This review aims to discuss the clinical evidence investigating the use of medicines derived, directly or indirectly, from plant cannabinoids with special reference to neurological disorders. Published studies suggest that the oral administration of cannabinoids may not be the preferred route of administration and that plant extracts show greater evidence of efficacy than synthetic compounds. One of these, Sativex (GW Pharmaceuticals), was approved as a prescription medicine in Canada in 2005 and is currently under regulatory review in the EU. PMID:17952657

  2. Clinical intuition versus statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine.

    PubMed

    Braude, Hillel D

    2009-01-01

    Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine's epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi's theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine. PMID:19548116

  3. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    PubMed Central

    2015-01-01

    Purpose: Smartphone technology offers a multitude of applications (apps) that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100%) were calculated to assess the frequency of their use of general features (email, text) and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%). The average score for using general features, 14.4/20 (72.2%) was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001). The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1%) than year 1–2 residents, 14.1/20 (70.5%, P=0.035), and for internal medicine residents, 14.9/20 (74.6%) in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001). The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5%) than for year 1–2 residents, 13.7/44 (31.1%; P=0.044). Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones. PMID:26582632

  4. Syndromes that Link the Endocrine System and Genitourinary Tract.

    PubMed

    Özlük, Yasemin; Kılıçaslan, Işın

    2015-01-01

    The endocrine system and genitourinary tract unite in various syndromes. Genitourinary malignancies may cause paraneoplastic endocrine syndromes by secreting hormonal substances. These entities include Cushing`s syndrome, hypercalcemia, hyperglycemia, polycythemia, hypertension, and inappropriate ADH or HCG production. The most important syndromic scenarios that links these two systems are hereditary renal cancer syndromes with specific genotype/phenotype correlation. There are also some very rare entities in which endocrine and genitourinary systems are involved such as Carney complex, congenital adrenal hyperplasia and Beckwith-Wiedemann syndrome. We will review all the syndromes regarding manifestations present in endocrine and genitourinary organs. PMID:26177325

  5. The emergence of trust in clinics of alternative medicine.

    PubMed

    Pedersen, Inge Kryger; Hansen, Vibeke Holm; Grünenberg, Kristina

    2016-01-01

    Demands for alternative medicine have increased since the 1970s in nations in which western scientific evidence has become the basis for health care. This paradox has been the impetus to examine how trust emerges in clinics of alternative medicine. Alternative practitioners are self-regulated and the clients pay out of their own pockets to attend non-authorised treatments with very limited scientific evidence of their effects. Trust is a key issue in this context. However, only a few studies have dealt with the ways in which alternative practitioners win their clients' trust. Drawing on three qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients' susceptibility and practitioners' individual skill development and strategies, as well as from objects, place and space. Trust is developed on relational and bodily as well as material grounds. It is argued that the dynamics and elements of trust identified do not only minimalise uncertainties but sometimes convert these uncertainties into productive new ways for clients to address their ailments, life circumstances and perspectives. PMID:26403077

  6. Ethical Diversity and the Role of Conscience in Clinical Medicine

    PubMed Central

    Genuis, Stephen J.; Lipp, Chris

    2013-01-01

    In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. PMID:24455248

  7. New advances in genitourinary cancer: evidence gathered in 2014.

    PubMed

    Suárez, C; Puente, J; Gallardo, E; Méndez-Vidal, M J; Climent, M A; León, L; Olmos, D; García del Muro, X; González-Billalabeitia, E; Grande, E; Bellmunt, J; Mellado, B; Maroto, P; González del Alba, A

    2015-09-01

    This review provides updated information published in 2014 regarding advances and major achievements in genitourinary cancer. Sections include the best in prostate cancer, renal cancer, bladder cancer, and germ cell tumors. In the field of prostate cancer, data related to treatment approach of hormone-sensitive disease, castrate-resistant prostate cancer, mechanisms of resistance, new drugs, and molecular research are presented. In relation to renal cancer, relevant aspects in the treatment of advanced renal cell carcinoma, immunotherapy, and molecular research, including angiogenesis and von Hippel-Lindau gene, molecular biology of non-clear cell histologies, and epigenetics of clear renal cell cancer are described. New strategies in the management of muscle-invasive localized bladder cancer and metastatic disease are reported as well as salient findings of biomolecular research in urothelial cancer. Some approaches intended to improve outcomes in poor prognosis patients with metastatic germ cell cancer are also reported. Results of clinical trials in these areas are discussed. PMID:26227584

  8. Genitourinary issues during spaceflight: a review.

    PubMed

    Jones, J A; Jennings, R; Pietryzk, R; Ciftcioglu, N; Stepaniak, P

    2005-12-01

    The genitourinary (GU) system is not uncommonly affected during previous spaceflights. GU issues that have been observed during spaceflight include urinary calculi, infections, retention, waste management, and reproductive. In-flight countermeasures for each of these issues are being developed to reduce the likelihood of adverse sequelae, due to GU issues during exploration-class spaceflight, to begin in 2018 with flights back to the Moon and on to Mars, according to the February 2004 Presendent's Vision for US Space Exploration. With implementation of a robust countermeasures program, GU issues should not have a significant threat for mission impact during future spaceflights. PMID:16391546

  9. Clinical tumor sequencing: opportunities and challenges for precision cancer medicine.

    PubMed

    Damodaran, Senthilkumar; Berger, Michael F; Roychowdhury, Sameek

    2015-01-01

    Advances in tumor genome sequencing have enabled discovery of actionable alterations leading to novel therapies. Currently, there are approved targeted therapies across various tumors that can be matched to genomic alterations, such as point mutations, gene amplification, and translocations. Tools to detect these genomic alterations have emerged as a result of decreasing costs and improved throughput enabled by next-generation sequencing (NGS) technologies. NGS has been successfully utilized for developing biomarkers to assess susceptibility, diagnosis, prognosis, and treatment of cancers. However, clinical application presents some potential challenges in terms of tumor specimen acquisition, analysis, privacy, interpretation, and drug development in rare cancer subsets. Although whole-genome sequencing offers the most complete strategy for tumor analysis, its present utility in clinical care is limited. Consequently, targeted gene capture panels are more commonly employed by academic institutions and commercial vendors for clinical grade cancer genomic testing to assess molecular eligibility for matching therapies, whereas whole-exome and transcriptome (RNASeq) sequencing are being utilized for discovery research. This review discusses the strategies, clinical challenges, and opportunities associated with the application of cancer genomic testing for precision cancer medicine. PMID:25993170

  10. Development and promotion in translational medicine: perspectives from 2012 sino-american symposium on clinical and translational medicine

    PubMed Central

    2012-01-01

    Background Clinical translational medicine (CTM) is an emerging area comprising multidisciplinary research from basic science to medical applications and entails a close collaboration among hospital, academia and industry. Findings This Session focused discussing on new models for project development and promotion in translational medicine. The conference stimulated the scientific and commercial communication of project development between academies and companies, shared the advanced knowledge and expertise of clinical applications, and created the environment for collaborations. Conclusions Although strategic collaborations between corporate and academic institutions have resulted in a state of resurgence in the market, new cooperation models still need time to tell whether they will improve the translational medicine process. PMID:23369198

  11. Pharmacology and Clinical Drug Candidates in Redox Medicine

    PubMed Central

    Casas, Ana I.; Maghzal, Ghassan J.; Seredenina, Tamara; Kaludercic, Nina; Robledinos-Anton, Natalia; Di Lisa, Fabio; Stocker, Roland; Ghezzi, Pietro; Jaquet, Vincent; Cuadrado, Antonio

    2015-01-01

    Abstract Significance: Oxidative stress is suggested to be a disease mechanism common to a wide range of disorders affecting human health. However, so far, the pharmacotherapeutic exploitation of this, for example, based on chemical scavenging of pro-oxidant molecules, has been unsuccessful. Recent Advances: An alternative emerging approach is to target the enzymatic sources of disease-relevant oxidative stress. Several such enzymes and isoforms have been identified and linked to different pathologies. For some targets, the respective pharmacology is quite advanced, that is, up to late-stage clinical development or even on the market; for others, drugs are already in clinical use, although not for indications based on oxidative stress, and repurposing seems to be a viable option. Critical Issues: For all other targets, reliable preclinical validation and drug ability are key factors for any translation into the clinic. In this study, specific pharmacological agents with optimal pharmacokinetic profiles are still lacking. Moreover, these enzymes also serve largely unknown physiological functions and their inhibition may lead to unwanted side effects. Future Directions: The current promising data based on new targets, drugs, and drug repurposing are mainly a result of academic efforts. With the availability of optimized compounds and coordinated efforts from academia and industry scientists, unambiguous validation and translation into proof-of-principle studies seem achievable in the very near future, possibly leading towards a new era of redox medicine. Antioxid. Redox Signal. 23, 1113–1129. PMID:26415051

  12. Monitoring medicines use: the role of the clinical pharmacologist.

    PubMed

    Williams, David

    2012-10-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs. PMID:22554404

  13. Monitoring medicines use: the role of the clinical pharmacologist

    PubMed Central

    Williams, David

    2012-01-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs. PMID:22554404

  14. Implementing genomic medicine in the clinic: the future is here

    PubMed Central

    Manolio, Teri A.; Chisholm, Rex L.; Ozenberger, Brad; Roden, Dan M.; Williams, Marc S.; Wilson, Richard; Bick, David; Bottinger, Erwin P.; Brilliant, Murray H.; Eng, Charis; Frazer, Kelly A.; Korf, Bruce; Ledbetter, David H.; Lupski, James R.; Marsh, Clay; Mrazek, David; Murray, Michael F.; O'Donnell, Peter H.; Rader, Daniel J.; Relling, Mary V.; Shuldiner, Alan R.; Valle, David; Weinshilboum, Richard; Green, Eric D.; Ginsburg, Geoffrey S.

    2013-01-01

    Although the potential for genomics to contribute to clinical care has long been anticipated, the pace of defining the risks and benefits of incorporating genomic findings into medical practice has been relatively slow. Several institutions have recently begun genomic medicine programs, encountering many of the same obstacles and developing the same solutions, often independently. Recognizing that successful early experiences can inform subsequent efforts, the National Human Genome Research Institute brought together a number of these groups to describe their ongoing projects and challenges, identify common infrastructure and research needs, and outline an implementation framework for investigating and introducing similar programs elsewhere. Chief among the challenges were limited evidence and consensus on which genomic variants were medically relevant; lack of reimbursement for genomically driven interventions; and burden to patients and clinicians of assaying, reporting, intervening, and following up genomic findings. Key infrastructure needs included an openly accessible knowledge base capturing sequence variants and their phenotypic associations and a framework for defining and cataloging clinically actionable variants. Multiple institutions are actively engaged in using genomic information in clinical care. Much of this work is being done in isolation and would benefit from more structured collaboration and sharing of best practices. Genet Med 2013:15(4):258–267 PMID:23306799

  15. Epigenetic therapies - a new direction in clinical medicine.

    PubMed

    Stein, R A

    2014-07-01

    A major biomedical advance from recent years was the finding that gene expression and phenotypic traits may be shaped by potentially reversible and heritable modifications that occur without altering the sequence of the nucleotides, and became known as epigenetic changes. The term 'epigenetics' dates back to the 1940s, when it was first used in context of cellular differentiation decisions that are made during development. Since then, our understanding of epigenetic modifications that govern development and disease expanded considerably. The contribution of epigenetic changes to shaping phenotypes brings at least two major clinically relevant benefits. One of these, stemming from the reversibility of epigenetic changes, involves the possibility to therapeutically revert epigenetic marks to re-establish prior gene expression patterns. The strength and the potential of this strategy are illustrated by the first four epigenetic drugs that were approved in recent years and by the additional candidates that are at various stages in preclinical studies and clinical trials. The second particularity is the finding that epigenetic changes precede the appearance of histopathological modifications. This has the potential to facilitate the emergence of epigenetic biomarkers, some of which already entered the clinical arena, catalysing a major shift in prophylactic and therapeutic strategies, and promising to fill a decades-old gap in preventive medicine. PMID:24845064

  16. Exploring the methodology and application of clinical pathway in evidence-based Chinese medicine.

    PubMed

    Wang, Sicheng; Yu, He; Liu, Jianping; Liu, Baoyan

    2011-06-01

    At present, clinical pathway has become one of the most important health care reform measures in many countries. In this study, the authors introduced basic concepts and explored the application of the clinical pathway of evidence-based Chinese medicine incorporated with the methodology from the concepts of management, evidence-based medicine, operational research and health economics. Such concepts provide examples and experiences, on which the application of clinical pathway in Chinese medicine practice in China can be based. PMID:21695620

  17. Developing clinical practice guidelines for spinal cord medicine. Lessons learned.

    PubMed

    Biddle, A K; Fraher, E P

    2000-02-01

    This article describes the process used by the Consortium for Spinal Cord Medicine to develop evidence-based clinical practice guidelines for managing and treating individuals with spinal cord injury and provides important information on lessons learned and the potential problems to avoid. Issues to consider during the guideline development process include topic selection and explication, methods for selecting the panel chair and panel members, the writing of recommendations and supporting scientific rationales, peer-reviewing guidelines, and the process for disseminating, implementing, and evaluating guidelines. The applicability, advantages, and disadvantages of available evidence and guideline recommendation grading systems and issues arising from the lack of scientific evidence supporting particular recommendations are also discussed. PMID:10680167

  18. Clinical Year in Review 2014: Critical Care Medicine

    PubMed Central

    Lee, Jeong Moon

    2014-01-01

    Severe sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units. In 2002, the guideline titled "Surviving Sepsis Campaign" was published by American and European Critical Care Medicine to decrease the mortality of severe sepsis and septic shock patients, which has been the basis of the treatment for those patients. After the first revised guidelines were published on 2008, the most current version was published in 2013 based on the updated literature of until fall 2012. Other important revised guidelines in critical care field such as 'Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit' were revised in 2013. This article will review the revised guidelines and several additional interesting published papers of until March 2014, including the part of ventilator-induced lung injury and the preventive strategies. PMID:25114697

  19. Patients presenting to an outpatient sport medicine clinic with concussion

    PubMed Central

    Ouellet, Jérôme; Boisvert, Leslie; Fischer, Lisa

    2016-01-01

    Abstract Objective To describe the characteristics of patients who presented to outpatient sport and exercise medicine clinics with concussion. Design Retrospective chart review of electronic medical records. Setting Three specialized sport and exercise medicine clinics in London, Ont. Participants A total of 283 patients presenting with concussion. Main outcome measures Data collected included demographic variables (age and sex), sport participation at the time of injury, previous medical history (including history of concussion), Post-Concussion Symptom Scale (PCSS) scores, and return-to-play (RTP) variables (delay and outcome). Results The mean age of patients presenting for care was 17.6 years; 70.9% of patients were younger than 18 years of age (considered pediatric patients); 58.8% of patients were male; and 31.7% of patients had a previous history of concussion. The main sports associated with injury were hockey (40.0%), soccer (12.6%), and football (11.7%). Return to play was granted to 50.9% of patients before the 3-week mark and 80.2% of patients before 8 weeks. Total PCSS scores (maximum score was 132) and neck scores (part of the PCSS, maximum score was 6) were significantly higher in adults compared with pediatric patients (36.2 vs 27.6, P = .02, and 1.8 vs 1.2, P = .02, respectively). A significant difference was seen in RTP, with pediatric patients returning earlier than adults did (P = .04). This difference was not seen when comparing males with females (P = .07). Longer duration of follow-up did not influence RTP outcomes. Previous history of concussion was associated with restriction from contact or collision sports (P < .001). Conclusion Given the age and sex variability found in this study, as well as in previous published reports, it is important to manage each patient individually using current best available practice strategies to optimize long-term outcomes.

  20. Observations on Genito-urinary Tuberculosis

    PubMed Central

    Carver, James

    1937-01-01

    Early and reliable diagnosis is obtained by cultural methods. Pyelographic evidence of renal destruction is necessary as a rule to supplement the positive laboratory findings before resorting to nephrectomy. Bilateral renal tuberculosis should not be diagnosed on the findings of cystoscopy alone. Nephro-ureterectomy is the ideal operation. It prevents the prolongation of the bladder symptoms and the breaking-down of the operation wound and the risk of another operation for the removal of the ureter, not forgetting the danger of infection of the other kidney. Bad results are probably due, in the case of poor patients, to economic and sociological factors which interfere with restoration to health after operation. Genito-urinary tuberculosis is to be regarded not as a localized disorder but as a manifestation of a generalized disease, a fact which necessitates a guarded prognosis and prolonged after-treatment. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:19991279

  1. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials

    PubMed Central

    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher

    2016-01-01

    Objective Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. Methods We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Results Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. Conclusion No failure risk rate per development phase is available for ATMPs. The discontinuation rate may

  2. The telemedicine and teleconsultation system application in clinical medicine.

    PubMed

    Chang, T; Lee, J; Wu, S

    2004-01-01

    Telemedicine and teleconsultation are the application and development of the telecommunication networks. Health experts can solve problems by using the electronic and communication technologies without distance limitation. In this study, we try to develop the telemedicine and teleconsultation system between local site and consulting expert site. Two applications of this system in clinical medicine are discussed. The system at each site has a workstation including a cable modem or ADSL connection, a monitor, a web camera, speakers, a microphone for communication, and NetMeeting application software. The first application in this study is to develop a school-based intervention program by using this system for high-risk school-age children in one of the earthquake-struck areas. The preliminary result of this study is that the telemedicine and teleconsultation system is more effective than traditional consultation and supervision. Moreover, we can apply this system in training local volunteers, educators, and welfare workers. Meanwhile, we can save lots of cost and time since we don't need to travel between the local site and the expert site. In the end of this study, the second application of this system in SARS case treatment was also discussed. PMID:17271012

  3. Clinical holistic medicine: the patient with multiple diseases.

    PubMed

    Ventegodt, Søren; Merrick, Joav

    2005-04-12

    In clinical practice, patients can present with many different diseases, often both somatic and mental. Holistic medicine will try to see the diseases as a whole, as symptoms of a more fundamental imbalance in the state of being. The holistic physician must help the patient to recover existence and a good relationship with self. According to the life mission theory, theory of character, and holistic process theory of healing, recovering the purpose of life (the life mission) is essential for the patient to regain life, love, and trust in order to find happiness and realize the true purpose of life. We illustrate the power of the holistic medical approach with a case study of an invalidated female artist, aged 42 years, who suffered from multiple severe health problems, many of which had been chronic for years. She had a combination of neurological disturbances (tinnitus, migraine, minor hallucinations), immunological disturbances (recurrent herpes simplex, phlegm in the throat, fungal infection in the crotch), hormonal disturbances (14 days of menstruation in each cycle), muscle disturbances (neck tensions), mental disturbances (tendency to cry, inferiority feeling, mild depression, desolation, anxiety), abdominal complaints, hemorrhoids, and more. The treatment was a combined strategy of improving the general quality of life, recovering her human character and purpose of life ("renewing the patients life energy", "balancing her global information system"), and processing the local blockages, thus healing most of her many different diseases in a treatment using 30 h of intense holistic therapy over a period of 18 months. PMID:15962199

  4. Portable gamma camera for clinical use in nuclear medicine

    SciTech Connect

    Pani, R.; Pellegrini, R.; Scopinaro, F.

    1996-12-31

    Up today Hamamatsu R3292 is the Position Sensitive Photo Multiplier Tube (PSPMT) with the largest sensitive area (10 cm of diameter). At the same time it has the minimum size for clinical application in Nuclear Medicine. A portable gamma camera was realized, based on 5 inches PSPMT coupled to a scintillating array. The head has a light weight (15 Kg.) spatial resolution resulted better than that of Anger Camera with good linearity response, good energy resolution and FOV coincident with intrinsic one of PSPMT. To optimize gamma camera response two different scintillating arrays were tested: YAP:Ce and CsI (Tl). Their overall size cover all photochatode active area, and crystal pixel size was 2 mm x 2 mm. The detection efficiency resulted comparable to that of Anger Camera. The best result was obtained by CsI (Tl) scintillating: an intrinsic spatial resolution of 1.6 mm FWHM and a relative energy resolution of 17% FWHM. With a standard general purpose collimator a spatial resolution of about 2 mm resulted. Some preliminary results were also obtained in breast scintigraphy.

  5. Personalized medicine. Closing the gap between knowledge and clinical practice.

    PubMed

    Anaya, Juan-Manuel; Duarte-Rey, Carolina; Sarmiento-Monroy, Juan C; Bardey, David; Castiblanco, John; Rojas-Villarraga, Adriana

    2016-08-01

    Personalized medicine encompasses a broad and evolving field informed by a patient distinctive information and biomarker profile. Although terminology is evolving and some semantic interpretations exist (e.g., personalized, individualized, precision), in a broad sense personalized medicine can be coined as: "To practice medicine as it once used to be in the past using the current biotechnological tools." A humanized approach to personalized medicine would offer the possibility of exploiting systems biology and its concept of P5 medicine, where predictive factors for developing a disease should be examined within populations in order to establish preventive measures on at-risk individuals, for whom healthcare should be personalized and participatory. Herein, the process of personalized medicine is presented together with the options that can be offered in health care systems with limited resources for diseases like rheumatoid arthritis and type 1 diabetes. PMID:27302209

  6. Clinical trials with herbal medicinal products in children: a literature analysis.

    PubMed

    Marquardt, Peter; Kaft, Karin; Nieber, Karen

    2015-06-01

    Herbal medicinal products have been used since several decades for the health care of children. Nevertheless, well-controlled clinical studies with herbal medicinal products for children are rare. The authors' objective therefore was to evaluate clinical trials with herbal medicinal products in children, based on a literature search in PubMed and Web of Science. A total of 133 trials were identified. 90 studies were randomized, 32.2% were randomized and double-blinded. Most studies were performed in China, in the age group 6-12 years, and in children with respiratory diseases, most often herbal medicinal products with Hedera helix were tested. The analysis revealed that studies on herbal medicinal products were feasible in children. Although clinical trials have been found, this literature search have limitations and did not cover all studies performed. However, only few clinical trials of high quality were identified. Further studies therefore are urgently needed to support the good empirical findings. PMID:26183729

  7. Evidence-based medicine and values-based medicine: partners in clinical education as well as in clinical practice

    PubMed Central

    2013-01-01

    The best clinical decisions are based on both evidence and values in what is known as the 'two-feet principle'. Anecdotally, educationalists find teaching clinicians to become more evidence based is relatively simple in comparison to encouraging them to become more values based. One reason is likely to be the importance of values awareness. As values-based practice is premised on a mutual respect for the diversity of values, clinicians need to develop the skills to ascertain patient values and to get in touch with their own beliefs and preferences in order to understand those at play in any consultation. Only then can shared decision-making processes take place within a shared framework of values. In a research article published in BMC Medicine, Altamirano-Bustamante and colleagues highlight difficulties that clinicians face in getting in touch with their own values. Despite finding that healthcare personnel's core values were honesty and respect, autonomy was initially low ranked by participants. One significant aspect of this work is that this group has demonstrated that the extent to which clinicians value 'autonomy' and 'openness to change' can both be positively influenced by well designed education. PMID:23414247

  8. Translational medicine as a permanent glue and force of clinical medicine and public health: perspectives (1) from 2012 Sino-American symposium on clinical and translational medicine.

    PubMed

    Zhou, Jiebai; Wu, Duojiao; Liu, Xinqing; Yuan, Shuoqi; Yang, Xiaoqiu; Wang, Xiangdong

    2012-01-01

    Health systems globally face challenges and opportunities in balancing quality, access, and cost, where clinical and translational medicine (CTM) should play more important and powerful roles in the identification, development and validation of solutions and strategies. Strategic collaboration can gather global strengths and resources and improve health systems, care delivery, regulations and policies. CTM-driven innovation and development has the potential to achieve step-change improvements across three dimensions. Thus, we have the reasons to believe that CTM will play even more roles in the development of new diagnostics, therapies, healthcare, and policies and SAS-CTM will become more and more important platform to obtain the latest development in CTM internationally and explore new opportunities in the international collaborations. PMID:23369646

  9. Translational medicine as a permanent glue and force of clinical medicine and public health: perspectives (1) from 2012 Sino-American symposium on clinical and translational medicine

    PubMed Central

    2012-01-01

    Abstracts Health systems globally face challenges and opportunities in balancing quality, access, and cost, where clinical and translational medicine (CTM) should play more important and powerful roles in the identification, development and validation of solutions and strategies. Strategic collaboration can gather global strengths and resources and improve health systems, care delivery, regulations and policies. CTM-driven innovation and development has the potential to achieve step-change improvements across three dimensions. Thus, we have the reasons to believe that CTM will play even more roles in the development of new diagnostics, therapies, healthcare, and policies and SAS-CTM will become more and more important platform to obtain the latest development in CTM internationally and explore new opportunities in the international collaborations. PMID:23369646

  10. Current Situation and Perspectives of Clinical Study in Integrative Medicine in China

    PubMed Central

    Wang, Jie; Xiong, Xingjiang

    2012-01-01

    Integrative medicine is not only an innovative China model in clinical practice, but also the bridge for TCM toward the world. In the past thirty years, great achievements have been made in integrative medicine researches, especially in clinical practice. The clinical achievements mainly include the following three: innovating methodology of disease-syndrome combination, excavating the classical theory in traditional Chinese medicine (TCM), preventing and curing refractory diseases. The development ideas and strategies of integrative medicine for future mainly include (a) standing on frontier field of international medicine and improving the capability of preventing and curing refractory diseases; (b) moving prevention and control strategy forward and improving the curative effect of common and frequent disease; (c) excavating the classical theory of TCM and broadening the treatment system of modern medicine; (d) improving the innovation level of new high effective drugs on the basis of classical prescriptions and herbs in TCM; (e) rerecognizing the theory of formula corresponding to syndrome in TCM and enhancing the level of clinical research evidence based on evidence-based medicine. Integrative medicine will do obtain greater achievements in creating new medicine and pharmacology and make more tremendous contributions for the great rejuvenation of the Chinese nation and human health care. PMID:22550539

  11. Regulatory acceptance of animal models of disease to support clinical trials of medicines and advanced therapy medicinal products.

    PubMed

    Cavagnaro, Joy; Silva Lima, Beatriz

    2015-07-15

    The utility of animal models of disease for assessing the safety of novel therapeutic modalities has become an increasingly important topic of discussion as research and development efforts focus on improving the predictive value of animal studies to support accelerated clinical development. Medicines are approved for marketing based upon a determination that their benefits outweigh foreseeable risks in specific indications, specific populations, and at specific dosages and regimens. No medicine is 100% safe. A medicine is less safe if the actual risks are greater than the predicted risks. The purpose of preclinical safety assessment is to understand the potential risks to aid clinical decision-making. Ideally preclinical studies should identify potential adverse effects and design clinical studies that will minimize their occurrence. Most regulatory documents delineate the utilization of conventional "normal" animal species to evaluate the safety risk of new medicines (i.e., new chemical entities and new biological entities). Animal models of human disease are commonly utilized to gain insight into the pathogenesis of disease and to evaluate efficacy but less frequently utilized in preclinical safety assessment. An understanding of the limitations of the animal disease models together with a better understanding of the disease and how toxicity may be impacted by the disease condition should allow for a better prediction of risk in the intended patient population. Importantly, regulatory authorities are becoming more willing to accept and even recommend data from experimental animal disease models that combine efficacy and safety to support clinical development. PMID:25814257

  12. Probability and uncertainty in clinical and forensic medicine

    PubMed Central

    2015-01-01

    In medicine, and in life in general, uncertainty is unavoidable. Throughout history, man has tried to bring order to a chaotic world by predicting future events based on past experiences. However, physicians in training are often surprised by the subjectivity and lack of certainty involved in the practice of medicine. Helpful advice is available—and Sir William Osler had much to say about this problem. This article reviews some of Osler's writings regarding medical uncertainty, provides an outline of the classification currently used by the courts to evaluate medical testimony, and offers some historical notes on probability theory and evidence-based medicine.

  13. [Technical specifications for rational clinical use of parenterally administered Chinese medicine (draft version for comments)].

    PubMed

    Xie, Yan-Ming; Li, Ming-Quan; Zhang, Yun-Ling; Ma, Rong; Xian, Shao-Xiang; Liu, Jian; Li, Su-Yun; Zhao, Yu-Bin

    2013-09-01

    The regulations on basic clinical use of parenterally administered Chinese medicine, issued jointly in 2008, by the ministry of health (MOH), China food and drug administration (SFDA) and the state administration of traditional Chinese medicine (SATCM). Integrating actual clinical practice, these presented doctors and nurses with detailed specifications for the safe use of parenterally administered Chinese medicine. The regulations emphasize the use of Chinese medicine pattern differentiation, use in strict accordance with instructions, and they prohibit use combined with other medicines. The emphasis of the regulations are practicality and operability, and provide meaningful guidance to doctors and nurses for the rational and safe use of parenterally administered Chinese medicine, to reduce adverse reactions/adverse events caused by improper use. PMID:24471306

  14. Clinical holistic medicine: tools for a medical science based on consciousness.

    PubMed

    Ventegodt, Søren; Morad, Mohammed; Andersen, Niels Jørgen; Merrick, Joav

    2004-05-26

    Biomedicine focuses on the biochemistry of the body, while consciousness-based medicine--holistic medicine--focuses on the individual"s experiences and conscious whole (Greek: holos, whole). Biomedicine perceives diseases as mechanical errors at the micro level, while consciousness-based medicine perceives diseases as disturbances in attitudes, perceptions, and experiences at the macro level--in the organism as a whole. Thus, consciousness-based medicine is based on the whole individual, while biomedicine is based on its smallest parts, the molecules. These two completely different points of departure make the two forms of medicine very different; they represent two different mind sets and two different frames of reference or medical paradigms. This paper explains the basic tools of clinical holistic medicine based on the life mission theory and holistic process theory, with examples of holistic healing from the holistic medical clinic. PMID:15175833

  15. Review of the regulations for clinical research in herbal medicines in USA.

    PubMed

    Tang, Tony Yuqi; Li, Fang-Zhou; Afseth, Janyne

    2014-12-01

    In 2012, USA Food and Drug Administration (FDA) approved 39 new drugs, however, there are only two botanical drugs (one topical and one oral) approved by FDA since the publication of the FDA's industry guidelines for the botanical drug product in June 2004. The approval shows the Western guideline can be used for herbal medicines, authors investigate current regulation on herbal medicine clinical research, identify challenges conducting clinical trials, and seek to produce some guidance for potential investigators and sponsors considering a clinical trial in this area. Key words were formulated for searching on Medline and FDA website to locate relevant regulations for clinical research in herbal medicines to understand current environment for herbal medicine usage and examine the barriers affecting herbal medicine in clinical trials. Authors critically explore case study of the 1st FDA approved botanical drugs, Veregen (sinecatechins), green tea leaves extract, a topical cream for perianal and genital condyloma. In consideration of current regulation environment in USA, based on the findings and analysis through the literature review and Veregen case study, authors produce and propose a Checklist for New Drug Application of Herbal Medicines for potential investigators and sponsors considering in a herbal medicine clinical trial. PMID:25428336

  16. The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives

    PubMed Central

    2016-01-01

    Background Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal–known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists’ perspectives. Therefore the aim of this study was to explore pharmacists’ views about medicinal cannabis; its legalisation and supply in pharmacy. Methods Semi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software. Results Emergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients. Discussion This study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which

  17. Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

    PubMed

    Rosenzweig, B A; Pushkin, S; Blumenfeld, D; Bhatia, N N

    1992-04-01

    Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results. PMID:1553172

  18. LGR4/GPR48 Inactivation Leads to Aniridia-Genitourinary Anomalies-Mental Retardation Syndrome Defects*

    PubMed Central

    Yi, Tingfang; Weng, Jinsheng; Siwko, Stefan; Luo, Jian; Li, Dali; Liu, Mingyao

    2014-01-01

    AGR syndrome (the clinical triad of aniridia, genitourinary anomalies, and mental retardation, a subgroup of WAGR syndrome for Wilm's tumor, aniridia, genitourinary anomalies, and mental retardation) is a rare syndrome caused by a contiguous gene deletion in the 11p13–14 region. However, the mechanisms of WAGR syndrome pathogenesis are elusive. In this study we provide evidence that LGR4 (also named GPR48), the only G-protein-coupled receptor gene in the human chromosome 11p12–11p14.4 fragment, is the key gene responsible for the diseases of AGR syndrome. Deletion of Lgr4 in mouse led to aniridia, polycystic kidney disease, genitourinary anomalies, and mental retardation, similar to the pathological defects of AGR syndrome. Furthermore, Lgr4 inactivation significantly increased cell apoptosis and decreased the expression of multiple important genes involved in the development of WAGR syndrome related organs. Specifically, deletion of Lgr4 down-regulated the expression of histone demethylases Jmjd2a and Fbxl10 through cAMP-CREB signaling pathways both in mouse embryonic fibroblast cells and in urinary and reproductive system mouse tissues. Our data suggest that Lgr4, which regulates eye, kidney, testis, ovary, and uterine organ development as well as mental development through genetic and epigenetic surveillance, is a novel candidate gene for the pathogenesis of AGR syndrome. PMID:24519938

  19. Multidisciplinary Overview of Vaginal Atrophy and Associated Genitourinary Symptoms in Postmenopausal Women

    PubMed Central

    Goldstein, Irwin; Dicks, Brian; Kim, Noel N; Hartzell, Rose

    2013-01-01

    Introduction Vaginal atrophy, which may affect up to 45% of postmenopausal women, is often associated with one or more urinary symptoms, including urgency, increased frequency, nocturia, dysuria, incontinence, and recurrent urinary tract infection. Aims To provide an overview of the current literature regarding cellular and clinical aspects of vaginal atrophy and response to treatment with local vaginal estrogen therapy. Methods PubMed searches through February 2012 were conducted using the terms “vaginal atrophy,” “atrophic vaginitis,” and “vulvovaginal atrophy.” Expert opinion was based on review of the relevant scientific and medical literature. Main Outcome Measure Genitourinary symptoms and treatment of vaginal atrophy from peer-reviewed published literature. Results Typically, a diagnosis of vaginal atrophy is made based on patient-reported symptoms, including genitourinary symptoms, and an examination that reveals signs of the disorder; however, many women are hesitant to report vaginal-related symptoms, primarily because of embarrassment. Conclusions Physicians in various disciplines are encouraged to initiate open discussions about vulvovaginal health with postmenopausal women, including recommended treatment options. Goldstein I, Dicks B, Kim NN, and Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med 2013;1:44–53. PMID:25356287

  20. Prevalence of Polyherbacy in Ambulatory Visits to Traditional Chinese Medicine Clinics in Taiwan

    PubMed Central

    Lin, Ming-Hwai; Chang, Hsiao-Ting; Tu, Chun-Yi; Chen, Tzeng-Ji; Hwang, Shinn-Jang

    2015-01-01

    Patients with a polyherbal prescription are more likely to receive duplicate medications and thus suffer from adverse drug reactions. We conducted a population-based retrospective study to examine the items of Chinese herbal medicine (CHM) per prescription in the ambulatory care of traditional Chinese medicine (TCM) in Taiwan. We retrieved complete TCM ambulatory visit datasets for 2010 from the National Health Insurance database in Taiwan. A total of 59,790 patients who received 313,482 CHM prescriptions were analyzed. Drug prescriptions containing more than five drugs were classified as polyherbal prescriptions; 41.6% of patients were given a polyherbal prescription. There were on average 5.2 ± 2.5 CHMs: 2.3 ± 1.1 compound herbal formula items, and 3.0 ± 2.5 single Chinese herb items in a single prescription. Approximately 4.6% of patients were prescribed 10 CHMs or more. Men had a lower odds ratio (OR) among polyherbal prescriptions (OR = 0.96, 95% confidence interval [CI] 0.92–0.99), and middle-aged patients (35–49 years) had the highest frequency of polyherbal prescription (OR = 1.19, 95% CI = 1.13–1.26). Patients with neoplasm, skin and subcutaneous tissue disease, or genitourinary system disease were more likely to have a polyherbal prescription; OR = 2.20 (1.81–2.67), 1.65 (1.50–1.80), and 1.52 (1.40–1.64), respectively. Polyherbal prescription is widespread in TCM in Taiwan. Potential herb interactions and iatrogenic risks associated with polyherbal prescriptions should be monitored. PMID:26287228

  1. The management of genitourinary fistula in the third millennium

    PubMed Central

    Ghoniem, Gamal M.; Warda, Hussein A.

    2014-01-01

    Background A vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and vagina, causing continuous loss of urine via the vagina. VVF is a relatively uncommon condition, but there is a drastically higher prevalence in the developing world. Furthermore, iatrogenic postoperative VVF is most common in developed countries, compared to mainly obstetric trauma in developing countries. In this review we focus on the development of current management techniques for VVF. Methods Medline was searched to identify articles related to urogenital fistulae, including VVF. Based on these reports we focus on the aetiology, clinical presentation, diagnosis and management of VVF. This in-depth review includes the optimal surgical timing, different surgical approaches (including minimally invasive techniques such as laparoscopic and robotic surgery), recommendations for postoperative care, surgical complications, and the need for further research in the use of robotic surgery to treat this condition. Results In all, 60 articles were identified and included in this review; eight were related to the aetiology, 12 to diagnosis, and 40 to the management of VVF. A thorough evaluation of VVF is imperative for planning the repair. Although the surgeonís experience typically influences the surgical approach, special situations will dictate the best approach. Conclusion The treatment of genitourinary fistulae with robotic assistance continues to develop, but further research is necessary to fully understand the use of this technology. PMID:26019933

  2. Correlative Medicine--Bridging the Gap between Basic Science and Clinical Studies.

    ERIC Educational Resources Information Center

    Hudson, Edward B.; Smart, Marian

    1980-01-01

    Greater flexibility in clinical instruction in the veterinary field through the introduction of a course in Correlative Medicine at the Western College of Veterinary Medicine is described. The changes in the course over the past 10 years are described and the course's original objectives are assessed. (Author/MLW)

  3. Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine.

    PubMed

    Barbato, Emanuele; Barton, Paul J; Bartunek, Jozef; Huber, Sally; Ibanez, Borja; Judge, Daniel P; Lara-Pezzi, Enrique; Stolen, Craig M; Taylor, Angela; Hall, Jennifer L

    2015-11-01

    The goal of this paper is to provide an updated review for scientists and clinicians on the major areas in cardiovascular medicine published in the Journal. Leading topics in regenerative and personalized medicine are presented along with a critical overview of the field. New standards in large preclinical animal models of pulmonary hypertension and left bundle branch block are highlighted. Finally, clinical care in the areas of atherosclerosis, the aortic valve, platelet biology, and myocarditis is discussed as well as autonomic modulation therapies. PMID:26453460

  4. Hippocrates of Kos, the father of clinical medicine, and Asclepiades of Bithynia, the father of molecular medicine. Review.

    PubMed

    Yapijakis, Christos

    2009-01-01

    Hippocrates of Kos (460-377 Before Common Era, BCE) is universally recognized as the father of modern medicine, which is based on observation of clinical signs and rational conclusions, and does not rely on religious or magical beliefs. Hippocratic medicine was influenced by the Pythagorean theory that Nature was made of four elements (water, earth, wind and fire), and therefore, in an analogous way, the body consisted of four fluids or 'humors' (black bile, yellow bile, phlegm and blood). The physician had to reinstate the healthy balance of these humors by facilitating the healing work of 'benevolent Nature'. The Hippocratic Oath contains the Pythagorean duties of justice, secrecy, respect for teachers and solidarity with peers. The clinical and ethical basics of medical practice as well as most clinical terms used even today have their origins in Hippocrates. His contribution in clinical medicine is immense. Asclepiades of Bithynia (124-40 BCE) was the first physician who established Greek medicine in Rome. Influenced by the Epicurean philosophy, he adhered to atomic theory, chance and evolution, and did not accept the theory of a 'benevolent Nature'. He suggested that the human body is composed of molecules and void spaces, and that diseases are caused by alteration of form or position of a patient's molecules. Asclepiades favored naturalistic therapeutic methods such as a healthy diet, massage and physical exercise. Above all, he introduced the friendly, sympathetic, pleasing and painless treatment of patients into medical practice, influenced by the teachings of Epicurus on pleasure and friendship. He was the first who made the highly important division of diseases into acute and chronic ones and to perform an elective non-emergency tracheotomy. As the founder of the Methodic School, Asclepiades was the first known physician who spoke about what is known today as molecular medicine. PMID:19567383

  5. Historical thinking in clinical medicine: lessons from R.G. Collingwood's philosophy of history.

    PubMed

    Chin-Yee, Benjamin H; Upshur, Ross E G

    2015-06-01

    The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R.G. Collingwood (1889-1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re-centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine. Furthermore, we examine how Collingwood's historical thinking offers a patient-centred epistemology and a more pluralistic concept of evidence that includes the qualitative, narrative evidence necessary for human understanding. We suggest that clinical medicine can benefit from Collingwood's historical thinking, and, more generally, illustrates how a philosophy of medicine that draws on diverse sources from the humanities offers a richer, more empathetic clinical practice. PMID:25850886

  6. Changing the Face of Veterinary Medicine: Research and Clinical Developments at AAVMC Institutions.

    PubMed

    Smith, Donald F; Hagstrom, Melena R

    2015-01-01

    This paper provides a 50-year overview of research and clinical advances in AAVMC member colleges in four representative fields of veterinary medicine: oncology, vaccine development, production medicine, and public health. Though emphasis is on the progress since the mid-1960s, the salient background and associated personnel in each field are also identified to the extent that their description informs more recent events. Advances in board certification and post-graduate clinical and research educational opportunities are also described. PMID:26673211

  7. Systems medicine: a new approach to clinical practice.

    PubMed

    Cardinal-Fernández, Pablo; Nin, Nicolás; Ruíz-Cabello, Jesús; Lorente, José A

    2014-10-01

    Most respiratory diseases are considered complex diseases as their susceptibility and outcomes are determined by the interaction between host-dependent factors (genetic factors, comorbidities, etc.) and environmental factors (exposure to microorganisms or allergens, treatments received, etc.) The reductionist approach in the study of diseases has been of fundamental importance for the understanding of the different components of a system. Systems biology or systems medicine is a complementary approach aimed at analyzing the interactions between the different components within one organizational level (genome, transcriptome, proteome), and then between the different levels. Systems medicine is currently used for the interpretation and understanding of the pathogenesis and pathophysiology of different diseases, biomarker discovery, design of innovative therapeutic targets, and the drawing up of computational models for different biological processes. In this review we discuss the most relevant concepts of the theory underlying systems medicine, as well as its applications in the various biological processes in humans. PMID:24397963

  8. Another Fine MeSH: Clinical Medicine Meets Information Science.

    ERIC Educational Resources Information Center

    O'Rourke, Alan; Booth, Andrew; Ford, Nigel

    1999-01-01

    Discusses evidence-based medicine (EBM) and the need for systematic use of databases like MEDLINE with more sophisticated search strategies to optimize the retrieval of relevant papers. Describes an empirical study of hospital libraries that examined requests for information and search strategies using both structured and unstructured forms.…

  9. The medical ethos and social responsibility in clinical medicine.

    PubMed Central

    Francis, C. K.

    2001-01-01

    The medical profession will face many challenges in the new millennium. As medicine looks forward to advances in molecular genetics and the prospect of unprecedented understanding of the causes and cures of human disease, clinicians, scientists and bioethicists may benefit from reflection upon the origins of the medical ethos and its relevance to postmodern medicine. Past distortions of the medical ethos, such as Nazism and the Tuskegee Syphilis Study, as well as more recent experience with the ethical challenges of employer-based market driven managed care, provide important lessons as medicine contemplates the future. Racial and ethnic disparities in health status and access to care serve as a reminders that the racial doctrines that fostered the horrors of the Holocaust and the Tuskegee Syphilis Study have not been completely removed from contemporary thinking. Inequalities in health status based on race and ethnicity, as well as socioeconomic status, attest to the inescapable reality of racism in America. When viewed against a background of historical distortions and disregard for the traditional tenets of the medical ethos, persistent racial and ethnic disparities and health and the prospect of genetic engineering raise the specter of discrimination because of genotype, a postmodern version of "racist medicine" or of a "new eugenics." There is a need to balance medicine's devotion to the wellbeing of the patient and the primacy of the patient-physician relationship against with the need to meet the health care needs of society. The challenge facing the medical profession in the new millennium is to establish an equilibrium between the responsibility to assure quality health care for the individual patient while affecting societal changes to achieve "health for all." PMID:11405593

  10. Tissue engineering and regenerative medicine: concepts for clinical application.

    PubMed

    Atala, Anthony

    2004-01-01

    Patients suffering from diseased and injured organs may be treated with transplanted organs. However, there is a severe shortage of donor organs that is worsening yearly given the aging population. Scientists in the field of regenerative medicine and tissue engineering apply the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that will restore and maintain normal function in diseased and injured tissues. Therapeutic cloning, where the nucleus from a donor cell is transferred into an enucleated oocyte in order to extract pluripotent embryonic stem cells, offers a potentially limitless source of cells for tissue engineering applications. The stem cell field is also advancing rapidly, opening new options for therapy. This paper reviews recent advances that have occurred in regenerative medicine and describes applications of these new technologies that may offer novel therapies for patients with end-stage organ failure. PMID:15256042

  11. AYURVEDIC APPROACH TO CLINICAL MEDICINE (PART-I)

    PubMed Central

    Mishra, S.K.

    1982-01-01

    The general status of clinical approach regarding the applications of clinical methodology has been reviewed under the spectacles of author's points. Also the subject of MANAHPARIKSANA has been critically analysed through the lenses of CARAKA and CAKRAPANIDATTA and its utility in present day clinical practices has been underlined. An appeal has been projected to the fellow Ayur-dists to shed of prejudices and hypocritical practices with an information and promise from our side to join hands PMID:22556949

  12. Mechanisms of Progranulin Action and Regulation in Genitourinary Cancers

    PubMed Central

    Tanimoto, Ryuta; Lu, Kuojung G.; Xu, Shi-Qiong; Buraschi, Simone; Belfiore, Antonino; Iozzo, Renato V.; Morrione, Andrea

    2016-01-01

    The growth factor progranulin has emerged in recent years as a critical regulator of transformation in several cancer models, including breast cancer, glioblastomas, leukemias, and hepatocellular carcinomas. Several laboratories, including ours, have also demonstrated an important role of progranulin in several genitourinary cancers, including ovarian, endometrial, cervical, prostate, and bladder tumors, where progranulin acts as an autocrine growth factor thereby modulating motility and invasion of transformed cells. In this review, we will focus on the mechanisms of action and regulation of progranulin signaling in genitourinary cancers with a special emphasis on prostate and bladder tumors. PMID:27512385

  13. Chronic renal failure and macrogenitalia associated with genitourinary neurofibromatosis.

    PubMed

    Dündar, Bumin Nuri; Oktem, Faruk; Armağan, Abdullah; Dündar, Nihal Olgaç; Bircan, Sema; Yesildag, Ahmet

    2010-02-01

    Neurofibromatosis (NF) is a genetic disorder of the nervous system that primarily affects the development and growth of neural cell tissues. This disorder is characterized by the development of various tumors, including neurofibromas, neuroniomas, malignant and benign peripheral nerve sheath tumors, and meningiomas. Accompanying skin changes and bone deformities are also common in NF. However, genitourinary involvement in NF is a rare condition, and penile enlargement has been reported only in a few males with plexiform NF. We report a 6-year-old boy with chronic renal failure associated with plexiform neurofibromas of the bladder and prostatic urethra which led to urinary obstruction and macrogenitalia due to genitourinary NF. PMID:19826840

  14. Integrating Genomics into Clinical Oncology: Ethical and Social Challenges from Proponents of Personalized Medicine

    PubMed Central

    Settersten, Richard A.; Juengst, Eric T.; Fishman, Jennifer R.

    2013-01-01

    Summary The use of molecular tools to individualize health care, predict appropriate therapies and prevent adverse health outcomes has gained significant traction in the field of oncology, under the banner of “personalized medicine.” Enthusiasm for personalized medicine in oncology has been fueled by success stories of targeted treatments for a variety of cancers based on their molecular profiles. Though these are clear indications of optimism for personalized medicine, little is known about the ethical and social implications of personalized approaches in clinical oncology. The objective of this study is to assess how a range of stakeholders engaged in promoting, monitoring, and providing personalized medicine understand the challenges of integrating genomic testing and targeted therapies into clinical oncology. The study involved the analysis of in-depth interviews with 117 basic scientists, clinician-researchers, clinicians in private practice, health professional educators, representatives of funding agencies, medical journal editors, entrepreneurs, and insurers whose experiences and perspectives on personalized medicine span a wide variety of institutional and professional settings. Despite considerable enthusiasm for this shift, promoters, monitors and providers of personalized medicine identified four domains which will still provoke heightened ethical and social concerns: (1) informed consent for cancer genomic testing, (2) privacy, confidentiality, and disclosure of genomic test results, (3) access to genomic testing and targeted therapies in oncology, and (4) the costs of scaling up pharmacogenomic testing and targeted cancer therapies. These specific concerns are not unique to oncology, or even genomics. However, those most invested in the success of personalized medicine view oncologists’ responses to these challenges as precedent-setting because oncology is farther along the path of clinical integration of genomic technologies than other fields

  15. Diagnostic imaging of the lower genitourinary tract

    SciTech Connect

    Rifkin, M.D.

    1985-01-01

    Dr. Rifkin analyzes the relative merits of ultrasound, computed tomography, magnetic resonance imaging, nuclear medicine, and radiography. He correlates ultrasound findings with those of computed tomography, radiography, and nuclear medicine and assesses the potential benefits of magnetic resonance imaging as compared with ultrasound and other imaging modalities. Each imaging modality is discussed in terms of its role as the primary, secondary, or complementary study for diagnoses involving the urinary bladder and perivesical spaces, the prostate and seminal vesicles, the urethra and penis, and the scrotal sac.

  16. Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

    ERIC Educational Resources Information Center

    Whitley, Heather P.

    2011-01-01

    Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  18. Methodologic standards for interpreting clinical decision rules in emergency medicine: 2014 update.

    PubMed

    Green, Steven M; Schriger, David L; Yealy, Donald M

    2014-09-01

    Clinical decision rules are increasingly prominent in medicine, particularly in emergency care. The quality, use, and impact of current published decision rules widely vary, requiring clinicians to be critical consumers. We present an approach to assist in the appraisal of clinical decision rules and in judging when to use such rules. PMID:24530108

  19. [Construction of Research-Oriented State Key Clinical Department by Highlighting the Characteris- tics and Advantages of Chinese Medicine].

    PubMed

    Ma, Shi-yu; Guo, Li-heng; Han, Yun; Li, Jian; Zhang, Min-zhou

    2016-04-01

    As the largest research-oriented specialty department in national traditional Chinese medicine hospitals, the Department of Critical Care Medicine in Guangdong Provincial Hospital of Chinese Medicine insists on the development mode combined with clinical medicine and scientific research. By taking clinical and basic researches for integrative medicine preventing and treating acute myocardial in-farction and sepsis as a breakthrough, authors explored key problems of Chinese medicine in improving the prognosis related diseases and patients' quality of life. In recent 3 years our department has successively become the principal unit of the national key specialties cooperative group of critical care medicine (awarded by State Administration of Traditional Chinese Medicine), the key clinical specialties (awarded by National Health and Family Planning Commission), and Guangzhou key laboratory construction unit, and achieved overall lap in clinical medical treatment, personnel training, scientific research, and social service. PMID:27323605

  20. Interpretation of biomonitoring data in clinical medicine and the exposure sciences

    SciTech Connect

    Williams, Bryan L. Barr, Dana B.; Wright, J. Michael; Buckley, Brian; Magsumbol, Melina S.

    2008-11-15

    Biomonitoring has become a fundamental tool in both exposure science and clinical medicine. Despite significant analytical advances, the clinical use of environmental biomarkers remains in its infancy. Clinical use of environmental biomarkers poses some complex scientific and ethical challenges. The purpose of this paper is compare how the clinical and exposure sciences differ with respect to their interpretation and use of biological data. Additionally, the clinical use of environmental biomonitoring data is discussed. A case study is used to illustrate the complexities of conducting biomonitoring research on highly vulnerable populations in a clinical setting.

  1. Precision manufacturing for clinical-quality regenerative medicines.

    PubMed

    Williams, David J; Thomas, Robert J; Hourd, Paul C; Chandra, Amit; Ratcliffe, Elizabeth; Liu, Yang; Rayment, Erin A; Archer, J Richard

    2012-08-28

    Innovations in engineering applied to healthcare make a significant difference to people's lives. Market growth is guaranteed by demographics. Regulation and requirements for good manufacturing practice-extreme levels of repeatability and reliability-demand high-precision process and measurement solutions. Emerging technologies using living biological materials add complexity. This paper presents some results of work demonstrating the precision automated manufacture of living materials, particularly the expansion of populations of human stem cells for therapeutic use as regenerative medicines. The paper also describes quality engineering techniques for precision process design and improvement, and identifies the requirements for manufacturing technology and measurement systems evolution for such therapies. PMID:22802496

  2. The Cleveland Clinic: a distinctive model of American medicine

    PubMed Central

    2014-01-01

    The Cleveland Clinic is a large healthcare system based in Cleveland, Ohio (USA) with an extensive American (throughout Northeast Ohio; Weston, Florida; and Las Vegas, Nevada) and global presence (in Abu Dhabi, UAE; and with training alumni in >70 countries). Cleveland Clinic was founded in 1921 as a distinctive medical model with a tripartite mission of “better care of the sick, investigation of their problems, and more teaching of those who serve” which has been vibrantly maintained. Distinctive aspects of the Clinic include its being a closed staff, salaried, group practice which is physician-led and which features 1-year faculty appointments and a vigorous annual review process for all physicians and leaders. Regarding its tripartite mission, the Clinic has demonstrated longstanding clinical excellence, e.g., with consistent ranking as first in cardiovascular care in U.S. News and World Report and top-10 rankings in at least 12 other specialties. A longstanding tradition of research has contributed landmark discoveries, including performance of the first coronary revascularization procedure, the first intra-coronary angiogram, the world’s third face transplant, ongoing development of a breast cancer vaccine, etc. Regarding education, the Clinic serves many educational audiences excellently through its Education Institute. These audiences include medical students, graduate medical trainees, faculty physicians, nurses, and allied health providers (both within the Cleveland Clinic and from other institutions worldwide), and patients. The Education Institute also includes the Cleveland Clinic Academy, which offers training in leadership competencies to physicians, nurses, and healthcare administrators both within the Cleveland Clinic and to visitors from abroad (through the Executive Visitors Program and the Samson Global Leadership Academy for Healthcare Executives). The latter program is an intensive 2-week residential leadership development course for

  3. [Construction and implementation of quality control index for clinical safety of Chinese medicine injection].

    PubMed

    Jiang, Jun-jie; Xie, Yan-ming

    2015-12-01

    In order to ensure the authenticity and accuracy of traditional Chinese medicine injection safety monitoring data, Chinese medicine injection safety monitoring quality control indicators, including the monitoring center, monitoring personnel, hardware conditions, monitoring progress and the number of patients into the group, original documents and archives management, electronic data, adverse events, quality management were constructed. Its application in the creation of major new drugs technology major projects, 10 kinds of traditional Chinese medicine injections clinical safety monitoring quality control work, found the missing case surveillance, not reported adverse events, only reported adverse reactions, electronic data reporting lag, lack of level of efforts to control the problem, and corrected, the traditional Chinese medicine injection safety monitoring of quality control and quality assurance, and subsequent Chinese medicine safety monitoring quality control to provide the reference. PMID:27245020

  4. A Pilot Whole Systems Clinical Trial of Traditional Chinese Medicine and Naturopathic Medicine for the Treatment of Temporomandibular Disorders

    PubMed Central

    Hammerschlag, Richard; Calabrese, Carlo; Mist, Scott; Aickin, Mikel; Sutherland, Elizabeth; Leben, Joseph; DeBAR, Lynn; Elder, Charles; Dworkin, Samuel F.

    2008-01-01

    Abstract Objectives To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. Design A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). Setting/location Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. Subjects One hundred and sixty (160) women 25–55 years of age attending a KPNW TMD specialty clinic. Interventions Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. Outcome measures TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 0–10 where 10 is worst). Results Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement, = −1.11 ± 0.43, p = 0.010 and −1.02 ± 0.45, p = 0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (−1.07 ± 0.51, p = 0.037 and −1.27 ± 0.54, p = 0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference

  5. Clinical holistic medicine: developing from asthma, allergy, and eczema.

    PubMed

    Ventegodt, Søren; Morad, Mohammed; Merrick, Joav

    2004-01-01

    This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. Consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child. PMID:15526074

  6. Essentials of Pediatric Emergency Medicine Fellowship: Part 4: Beyond Clinical Education.

    PubMed

    Wolff, Margaret; Carney, Michele; Eldridge, Charles; Zaveri, Pavan; Kou, Maybelle

    2016-08-01

    This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the skills beyond clinical training required of pediatric emergency medicine physicians including teaching, leadership, teamwork, and communication. PMID:27490731

  7. Essentials of Pediatric Emergency Medicine Fellowship: Part 3: Clinical Education and Experience.

    PubMed

    Mittiga, Matthew R; Nagler, Joshua; Eldridge, Charles D; Ishimine, Paul; Zuckerbraun, Noel S; McAneney, Constance M

    2016-07-01

    This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the clinical aspects of fellowship training including the impact of the clinical environment, modalities for teaching and evaluation, and threats and opportunities in clinical education. PMID:27380607

  8. [Sample size calculation in clinical post-marketing evaluation of traditional Chinese medicine].

    PubMed

    Fu, Yingkun; Xie, Yanming

    2011-10-01

    In recent years, as the Chinese government and people pay more attention on the post-marketing research of Chinese Medicine, part of traditional Chinese medicine breed has or is about to begin after the listing of post-marketing evaluation study. In the post-marketing evaluation design, sample size calculation plays a decisive role. It not only ensures the accuracy and reliability of post-marketing evaluation. but also assures that the intended trials will have a desired power for correctly detecting a clinically meaningful difference of different medicine under study if such a difference truly exists. Up to now, there is no systemic method of sample size calculation in view of the traditional Chinese medicine. In this paper, according to the basic method of sample size calculation and the characteristic of the traditional Chinese medicine clinical evaluation, the sample size calculation methods of the Chinese medicine efficacy and safety are discussed respectively. We hope the paper would be beneficial to medical researchers, and pharmaceutical scientists who are engaged in the areas of Chinese medicine research. PMID:22292397

  9. The current clinical practice of herbal medicine in psychiatry in mainland China: a review of literature.

    PubMed

    Saku, M

    1991-12-01

    The current clinical psychiatric practice of herbal medicine in the People's Republic of China was explored by reviewing the literature. The results found in many of the articles were lacking methodological strictness. Some reliable articles reported that certain herbal medicines were effective for psychiatric conditions, and that a combination treatment of modern drugs with herbs was useful for the enhancement of the efficacy and the reduction of both recovery time and side effects. It is suggested that more sophisticated investigations are necessary to corroborate any conclusions concerning the value for herbal medicine in the psychiatric field. PMID:1813678

  10. Spectrum of retroperitoneal and genitourinary paraganglioma: Experience at a North Indian tertiary care center

    PubMed Central

    Choudhary, Gautam Ram; Singh, Shivanshu; Prasad, Seema; Singh, Shrawan Kumar; Bhansali, Anil; Bhadada, Sanjay; Dutta, Pinaki

    2015-01-01

    Introduction Genitourinary and retroperitoneal paragangliomas are infrequent tumors with bizarre presentation. A high index of suspicion is required to make a diagnosis in young hypertensive individuals. Our aim is to study the varied clinical presentations and management of these paragangliomas. Herein, we share our experience of clinical presentation, diagnosis, and management of these paragangliomas. Material and methods Seventeen consecutive patients who underwent surgery for paraganglioma at our institute from August 2009 to July 2014 were included. Demographic, peri-operative, surgical, and follow up data were collected and analyzed. Results Mean age of presentation was 34.8 years with female predominance. The majority of the tumors were located in the retroperitoneum and urinary bladder. Most of them presented with classical symptoms of catecholamine excess and hypertension. Complete surgical resection could be performed in 13 cases. At a median follow up of two years, cases with R0 resection (no microscopic malignant cells) did not show recurrence. Among patients on chemotherapy, one died, another had partial response, and yet another had progressive disease. Conclusions Genitourinary and retroperitoneal paragangliomas are a disease of a young age group with variable clinical features at presentation. Appropriate pre-operative optimization and complete surgical resection provide the best chance of cure. PMID:26855794

  11. Trend and impact of international collaboration in clinical medicine papers published in Malaysia.

    PubMed

    Low, Wah Yun; Ng, Kwan Hoong; Kabir, M A; Koh, Ai Peng; Sinnasamy, Janaki

    2014-01-01

    Research collaboration is the way forward in order to improve quality and impact of its research findings. International research collaboration has resulted in international co-authorship in scientific communications and publications. This study highlights the collaborating research and authorship trend in clinical medicine in Malaysia from 2001 to 2010. Malaysian-based author affiliation in the Web of Science (Science Citation Index Expanded) and clinical medicine journals (n = 999) and articles (n = 3951) as of 30th Oct 2011 were downloaded. Types of document analyzed were articles and reviews, and impact factors (IF) in the 2010 Journal Citation Report Science Edition were taken to access the quality of the articles. The number of publications in clinical medicine increased from 4.5 % (n = 178) in 2001 to 23.9 % (n = 944) in 2010. The top three contributors in the subject categories are Pharmacology and Pharmacy (13.9 %), General and Internal Medicine (13.6 %) and Tropical Medicine (7.3 %). By journal tier system: Tier 1 (18.7 %, n = 738), Tier 2 (22.5 %, n = 888), Tier 3 (29.6 %, n = 1170), Tier 4 (27.2 %, n = 1074), and journals without IF (2.1 %, n = 81). University of Malaya was the most productive. Local collaborators accounted for 60.3 % and international collaborations 39.7 %. Articles with international collaborations appeared in journals with higher journal IFs than those without international collaboration. They were also cited more significantly than articles without international collaborations. Citations, impact factor and journal tiers were significantly associated with international collaboration in Malaysia's clinical medicine publications. Malaysia has achieved a significant number of ISI publications in clinical medicine participation in international collaboration. PMID:24465065

  12. [Clinical practice of integrative medicine in the United States and its development in primary care].

    PubMed

    Zhang, Wei-jun; Hui, Ka-kit

    2015-04-01

    The field of integrative medicine (IM) has grown tremendously in the United States over last two decades, in terms of clinical practice, research, and education. Its growing popularity among patients has led to increased need for physicians with appropriate counseling skills and a knowledge base of the efficacy and safety of complementary and alternative medicine (CAM) therapies. Family medicine is the first specialty as a whole to embrace IM, which encounters similar ailing conditions and emphasizes similar core values-person centered, evidence based, proactive, and continuous in nature. As integrative family medicine emerges, family medicine educators have developed suggested curriculum guidelines and approved measurable competencies to implement the best of evidence-based CAM and principles of IM. There are currently over 40 family medicine residencies that officially advertise CAM/IM in their programs. Meanwhile, IM centers have also been developing their own primary care programs based on their unique characteristics. This physician-led IM workforce is similar to that of China's IM in the early 1960s. As the Chinese government embarks on repeating its efforts to educate more Western medicine trained physicians in Chinese medicine in primary care training programs, the process and insights related to implementation of their practice in the United States would provide useful food for thought. PMID:26043559

  13. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod.

    PubMed

    Correale, Jorge; Chiquete, Erwin; Boyko, Alexey; Beran, Roy G; Strauch, Jorge Barahona; Milojevic, Snezana; Frider, Nadina

    2016-01-01

    Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic) medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans), they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of each ingredient in each capsule/tablet) and lower quality. Substandard, nonproprietary copies of medicines that are immunomodulatory or immunosuppressive are of concern to patients due to their possible untoward safety and lack of efficacy events. This article reviews the potential risks associated with nonproprietary medicines that do not meet the regulatory requirements of the United States Food and Drug Administration, the European Medicines Agency, or the World Health Organization. The clinical implications for patients are described. This article focuses on nonproprietary medicines for multiple sclerosis, particularly fingolimod, that are not identical to proprietary versions and could thus fail to meet efficacy expectations or have different impact on the safety of patients with multiple sclerosis. PMID:27418809

  14. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod

    PubMed Central

    Correale, Jorge; Chiquete, Erwin; Boyko, Alexey; Beran, Roy G; Strauch, Jorge Barahona; Milojevic, Snezana; Frider, Nadina

    2016-01-01

    Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic) medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans), they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of each ingredient in each capsule/tablet) and lower quality. Substandard, nonproprietary copies of medicines that are immunomodulatory or immunosuppressive are of concern to patients due to their possible untoward safety and lack of efficacy events. This article reviews the potential risks associated with nonproprietary medicines that do not meet the regulatory requirements of the United States Food and Drug Administration, the European Medicines Agency, or the World Health Organization. The clinical implications for patients are described. This article focuses on nonproprietary medicines for multiple sclerosis, particularly fingolimod, that are not identical to proprietary versions and could thus fail to meet efficacy expectations or have different impact on the safety of patients with multiple sclerosis. PMID:27418809

  15. The SickKids Genome Clinic: developing and evaluating a pediatric model for individualized genomic medicine.

    PubMed

    Bowdin, S C; Hayeems, R Z; Monfared, N; Cohn, R D; Meyn, M S

    2016-01-01

    Our increasing knowledge of how genomic variants affect human health and the falling costs of whole-genome sequencing are driving the development of individualized genomic medicine. This new clinical paradigm uses knowledge of an individual's genomic variants to anticipate, diagnose and manage disease. While individualized genetic medicine offers the promise of transformative change in health care, it forces us to reconsider existing ethical, scientific and clinical paradigms. The potential benefits of pre-symptomatic identification of at-risk individuals, improved diagnostics, individualized therapy, accurate prognosis and avoidance of adverse drug reactions coexist with the potential risks of uninterpretable results, psychological harm, outmoded counseling models and increased health care costs. Here we review the challenges, opportunities and limits of integrating genomic analysis into pediatric clinical practice and describe a model for implementing individualized genomic medicine. Our multidisciplinary team of bioinformaticians, health economists, health services and policy researchers, ethicists, geneticists, genetic counselors and clinicians has designed a 'Genome Clinic' research project that addresses multiple challenges in pediatric genomic medicine--ranging from development of bioinformatics tools for the clinical assessment of genomic variants and the discovery of disease genes to health policy inquiries, assessment of clinical care models, patient preference and the ethics of consent. PMID:25813238

  16. [Establish research model of post-marketing clinical safety evaluation for Chinese patent medicine].

    PubMed

    Zheng, Wen-ke; Liu, Zhi; Lei, Xiang; Tian, Ran; Zheng, Rui; Li, Nan; Ren, Jing-tian; Du, Xiao-xi; Shang, Hong-cai

    2015-09-01

    The safety of Chinese patent medicine has become a focus of social. It is necessary to carry out work on post-marketing clinical safety evaluation for Chinese patent medicine. However, there have no criterions to guide the related research, it is urgent to set up a model and method to guide the practice for related research. According to a series of clinical research, we put forward some views, which contained clear and definite the objective and content of clinical safety evaluation, the work flow should be determined, make a list of items for safety evaluation project, and put forward the three level classification of risk control. We set up a model of post-marketing clinical safety evaluation for Chinese patent medicine. Based this model, the list of items can be used for ranking medicine risks, and then take steps for different risks, aims to lower the app:ds:risksrisk level. At last, the medicine can be managed by five steps in sequence. The five steps are, collect risk signal, risk recognition, risk assessment, risk management, and aftereffect assessment. We hope to provide new ideas for the future research. PMID:26983223

  17. Whole-exome sequencing and clinical interpretation of FFPE tumor samples to guide precision cancer medicine

    PubMed Central

    Allen, Eliezer M. Van; Wagle, Nikhil; Stojanov, Petar; Perrin, Danielle L.; Cibulskis, Kristian; Marlow, Sara; Jane-Valbuena, Judit; Friedrich, Dennis C.; Kryukov, Gregory; Carter, Scott L.; McKenna, Aaron; Sivachenko, Andrey; Rosenberg, Mara; Kiezun, Adam; Voet, Douglas; Lawrence, Michael; Lichtenstein, Lee T.; Gentry, Jeff G.; Huang, Franklin W.; Fostel, Jennifer; Farlow, Deborah; Barbie, David; Gandhi, Leena; Lander, Eric S.; Gray, Stacy W.; Joffe, Steven; Janne, Pasi; Garber, Judy; MacConaill, Laura; Lindeman, Neal; Rollins, Barrett; Kantoff, Philip; Fisher, Sheila A.; Gabriel, Stacey; Getz, Gad; Garraway, Levi A.

    2013-01-01

    Translating whole exome sequencing (WES) for prospective clinical use may impact the care of cancer patients; however, multiple innovations are necessary for clinical implementation. These include: (1) rapid and robust WES from formalin-fixed paraffin embedded (FFPE) tumor tissue, (2) analytical output similar to data from frozen samples, and (3) clinical interpretation of WES data for prospective use. Here, we describe a prospective clinical WES platform for archival FFPE tumor samples. The platform employs computational methods for effective clinical analysis and interpretation of WES data. When applied retrospectively to 511 exomes, the interpretative framework revealed a “long tail” of somatic alterations in clinically important genes. Prospective application of this approach identified clinically relevant alterations in 15/16 patients. In one patient, previously undetected findings guided clinical trial enrollment leading to an objective clinical response. Overall, this methodology may inform the widespread implementation of precision cancer medicine. PMID:24836576

  18. Spina Bifida Clinic Directory

    MedlinePlus

    ... genitourinary-reconstruction Cleveland Clinic (pediatric) 9500 Euclid Avenue S-60 Cleveland, OH 44195 Phone: 216-445-5579 Fax: ... for Adults Adult Spina Bifida Clinic (adult only) 60 Township Line Rd. Elkins Park, PA 19027 (215) ...

  19. Clinically Available Medicines Demonstrating Anti-Toxoplasma Activity

    PubMed Central

    Neville, Andrew J.; Zach, Sydney J.; Wang, Xiaofang; Larson, Joshua J.; Judge, Abigail K.; Davis, Lisa A.; Vennerstrom, Jonathan L.

    2015-01-01

    Toxoplasma gondii is an apicomplexan parasite of humans and other mammals, including livestock and companion animals. While chemotherapeutic regimens, including pyrimethamine and sulfadiazine regimens, ameliorate acute or recrudescent disease such as toxoplasmic encephalitis or ocular toxoplasmosis, these drugs are often toxic to the host. Moreover, no approved options are available to treat infected women who are pregnant. Lastly, no drug regimen has shown the ability to eradicate the chronic stage of infection, which is characterized by chemoresistant intracellular cysts that persist for the life of the host. In an effort to promote additional chemotherapeutic options, we now evaluate clinically available drugs that have shown efficacy in disease models but which lack clinical case reports. Ideally, less-toxic treatments for the acute disease can be identified and developed, with an additional goal of cyst clearance from human and animal hosts. PMID:26392504

  20. Meeting the urgency for document delivery in clinical medicine.

    PubMed

    Broering, N C; King, E

    1993-01-01

    A Document Delivery library project was designed to improve delivery of information to health professionals in the Washington DC/Baltimore area. The project goals were to enhance delivery of full text documents and accelerate interlibrary loan services. The aim was to provide direct library services in the clinical arena by facilitating access to the articles needed by practitioners and clinical investigators. The objectives were to (1) design, develop and implement a comprehensive Document Delivery System (DDS) for the Library Information System (LIS) which included interlibrary loan, photocopy services and facsimile transmission capabilities; (2) establish a multi-university Library Knowledge Network for resource sharing; and (3) evaluate the project. The DDS and facsimile service are described and project data and outcomes are reported. Today, the participating libraries can use electronic means to share interlibrary loans. Georgetown users have responded favorably to the DDS and Fax services. PMID:8130539

  1. Early evolution of the thermometer and application to clinical medicine.

    PubMed

    Wright, William F

    2016-02-01

    By the time of Hippocrates and Galen the notion of fevers and temperature were known. Through ensuing centuries, ancient Greek, Roman, and medieval savants and physicians made additional contributions to the understanding of fever, temperature, and thermometry. By the end of that era, there was a working definition of what constitutes a rationale temperature scale, the distinction between fever as a symptom and fever as a disease, an elaborate classification scheme for temperature, hypotheses as to the causes of fever, and methods for measuring fevers. Based on the definition of fever at that time, the 16th century scientist Galileo promulgated production of thermometric instruments hundreds of years before they were routinely used in the clinical setting. In this work we examine the history of fever and clinical thermometry in the ancient world through the end of the eighteenth century with descriptions of instruments for its measure and human relationship to fever. PMID:26857973

  2. Clinically Available Medicines Demonstrating Anti-Toxoplasma Activity.

    PubMed

    Neville, Andrew J; Zach, Sydney J; Wang, Xiaofang; Larson, Joshua J; Judge, Abigail K; Davis, Lisa A; Vennerstrom, Jonathan L; Davis, Paul H

    2015-12-01

    Toxoplasma gondii is an apicomplexan parasite of humans and other mammals, including livestock and companion animals. While chemotherapeutic regimens, including pyrimethamine and sulfadiazine regimens, ameliorate acute or recrudescent disease such as toxoplasmic encephalitis or ocular toxoplasmosis, these drugs are often toxic to the host. Moreover, no approved options are available to treat infected women who are pregnant. Lastly, no drug regimen has shown the ability to eradicate the chronic stage of infection, which is characterized by chemoresistant intracellular cysts that persist for the life of the host. In an effort to promote additional chemotherapeutic options, we now evaluate clinically available drugs that have shown efficacy in disease models but which lack clinical case reports. Ideally, less-toxic treatments for the acute disease can be identified and developed, with an additional goal of cyst clearance from human and animal hosts. PMID:26392504

  3. Atomic spectrometry and trends in clinical laboratory medicine

    NASA Astrophysics Data System (ADS)

    Parsons, Patrick J.; Barbosa, Fernando

    2007-09-01

    Increasing numbers of clinical laboratories are transitioning away from flame and electrothermal AAS methods to those based on ICP-MS. Still, for many laboratories, the choice of instrumentation is based upon (a) the element(s) to be determined, (b) the matrix/matrices to be analyzed, and (c) the expected concentration(s) of the analytes in the matrix. Most clinical laboratories specialize in measuring Se, Zn, Cu, and Al in serum, and/or Pb, Cd, Hg, As, and Cr in blood and/or urine, while other trace elements (e.g., Pt, Au etc.) are measured for therapeutic purposes. Quantitative measurement of elemental species is becoming more widely accepted for nutritional and/or toxicological screening purposes, and ICP-MS interfaced with separation techniques, such as liquid chromatography or capillary electrophoresis, offers the advantage of on-line species determination coupled with very low detection limits. Polyatomic interferences for some key elements such as Se, As, and Cr require instrumentation equipped with dynamic reaction cell or collision cell technologies, or might even necessitate the use of sector field ICP-MS, to assure accurate results. Nonetheless, whatever analytical method is selected for the task, careful consideration must be given both to specimen collection procedures and to the control of pre-analytical variables. Finally, all methods benefit from access to reliable certified reference materials (CRMs). While a variety of reference materials (RMs) are available for trace element measurements in clinical matrices, not all can be classified as CRMs. The major metrological organizations (e.g., NIST, IRMM, NIES) provide a limited number of clinical CRMs, however, secondary reference materials are readily available from commercial organizations and organizers of external quality assessment schemes.

  4. Carcinoma of the Uterine Cervix Involving the Genitourinary Tract: A Potential Diagnostic Dilemma.

    PubMed

    Schwartz, Lauren E; Khani, Francesca; Bishop, Justin A; Vang, Russell; Epstein, Jonathan I

    2016-01-01

    Uterine cervical carcinoma secondarily involving the genitourinary tract is rarely documented histologically. These tumors present a unique diagnostic challenge as they can appear morphologically similar to urothelial carcinoma as well as primary squamous cell carcinoma and primary adenocarcinoma of the bladder. Genitourinary consult cases at the Johns Hopkins Hospital from 1984 to the present were searched for cases in which the differential diagnosis was primary bladder carcinoma versus secondary involvement by cervical carcinoma. We identified 10 cases that met these criteria and evaluated them by immunohistochemistry for p16 and GATA3 and in situ hybridization for human papillomavirus (HPV). Six cases were received with a gynecologic history. Four cases had been misdiagnosed as urothelial carcinoma, and 1 case was favored to be cystitis cystica et glandularis by the submitting institutions. Morphologically, the majority of cases showed basaloid nests of tumor cells infiltrating muscle bundles, with several having foci that mimicked urothelial carcinoma in situ. Six tumors were found to be diffusely positive with p16, 1 tumor was patchy, 1 was weak, and 2 were negative. GATA3 staining was negative in 6 cases, and 4 showed weak to strong positivity. Eight cases were positive for high-risk HPV (6 were positive for HPV 16, and 1 was positive for HPV 18). In the 2 cases that were negative for HPV by in situ hybridization, characteristic morphologic features of HPV-unrelated type of endocervical adenocarcinoma were present. On the basis of our findings we advocate a multifaceted approach, combining morphologic evaluation with ancillary studies including immunohistochemistry and in situ hybridization in the evaluation of genitourinary specimens for secondary involvement by cervical carcinoma. Furthermore, gynecologic clinical history is absolutely critical and most important to the evaluation and diagnosis of these specimens, as these ancillary studies are not

  5. What does «integrative medicine» provide to daily scientific clinical care?

    PubMed

    Bataller-Sifre, R; Bataller-Alberola, A

    2015-11-01

    Integrative medicine is an ambitious and noble-minded attempt to address the shortcomings of the current public health systems in our Western societies, which is restricted by the limited time available, especially in outpatient clinics. Integrative medicine also does not limit the possibilities of useful therapies that have been tested over the centuries (from China, India, etc.) or of certain resources that do not achieve the level of desired scientific credibility but that present certain therapeutic support in specific cases (homeopathy, acupuncture, etc.) but still require a scientific approach. Finally, the resource of botanical products (phytotherapy) constitutes a wide range of possibilities that universities can (and do) make progress on by providing drug brands for these products through the use of the scientific method and evidence-based medical criteria. This approach will help avoid the irrationality of the daily struggle between conventional scientific medicine (which we apply to the immense majority of patients) and the other diagnostic-therapeutic «guidelines» (natural medicine, alternative medicine, complementary medicine, patient-focused medicine and others). PMID:26159787

  6. A systematic review of randomised clinical trials of individualised herbal medicine in any indication

    PubMed Central

    Guo, R; Canter, P H; Ernst, E

    2007-01-01

    Aim To summarise and critically evaluate the evidence from randomised clinical trials for the effectiveness of individualised herbal medicine in any indication. Methods Search of electronic databases and approaches to experts in the field to identify randomised, controlled clinical trials of individualised herbal medicine in any indication. Independent data extraction and assessment of methodological quality by two authors and best evidence synthesis. Results Three randomised clinical trials of individualised herbal medicine were identified. Statistically non‐significant trends favouring active over placebo treatment in osteoarthritis of the knee probably result from large baseline differences and regression to the mean. Individualised treatment was superior to placebo in four of five outcome measures in the treatment of irritable bowel syndrome, but was inferior to standardised herbal treatment in all outcomes. Individualised herbal treatment was no better than placebo in the prevention of chemotherapy‐induced toxicity. Conclusions There is a sparsity of evidence regarding the effectiveness of individualised herbal medicine and no convincing evidence to support the use of individualised herbal medicine in any indication. PMID:17916871

  7. Clinical application of somatosensory amplification in psychosomatic medicine

    PubMed Central

    Nakao, Mutsuhiro; Barsky, Arthur J

    2007-01-01

    Many patients with somatoform disorders are frequently encountered in psychosomatic clinics as well as in primary care clinics. To assess such patients objectively, the concept of somatosensory amplification may be useful. Somatosensory amplification refers to the tendency to experience a somatic sensation as intense, noxious, and disturbing. It may have a role in a variety of medical conditions characterized by somatic symptoms that are disproportionate to demonstrable organ pathology. It may also explain some of the variability in somatic symptomatology found among different patients with the same serious medical disorder. It has been assessed with a self-report questionnaire, the Somatosensory Amplification Scale. This instrument was developed in a clinical setting in the U.S., and the reliability and validity of the Japanese and Turkish versions have been confirmed as well. Many studies have attempted to clarify the specific role of somatosensory amplification as a pathogenic mechanism in somatization. It has been reported that somatosensory amplification does not correlate with heightened sensitivity to bodily sensations and that emotional reactivity exerts its influence on somatization via a negatively biased reporting style. According to our recent electroencephalographic study, somatosensory amplification appears to reflect some aspects of long-latency cognitive processing rather than short-latency interoceptive sensitivity. The concept of somatosensory amplification can be useful as an indicator of somatization in the therapy of a broad range of disorders, from impaired self-awareness to various psychiatric disorders. It also provides useful information for choosing appropriate pharmacological or psychological therapy. While somatosensory amplification has a role in the presentation of somatic symptoms, it is closely associated with other factors, namely, anxiety, depression, and alexithymia that may also influence the same. The specific role of

  8. The thinking doctor: clinical decision making in contemporary medicine.

    PubMed

    Trimble, Michael; Hamilton, Paul

    2016-08-01

    Diagnostic errors are responsible for a significant number of adverse events. Logical reasoning and good decision-making skills are key factors in reducing such errors, but little emphasis has traditionally been placed on how these thought processes occur, and how errors could be minimised. In this article, we explore key cognitive ideas that underpin clinical decision making and suggest that by employing some simple strategies, physicians might be better able to understand how they make decisions and how the process might be optimised. PMID:27481378

  9. Medicines

    MedlinePlus

    ... better. In the United States, the Food and Drug Administration is in charge of assuring the safety ... prescription and over-the-counter medicines. Even safe drugs can cause unwanted side effects or interactions with ...

  10. Medicines

    MedlinePlus

    ... you get better. In the United States, the Food and Drug Administration is in charge of assuring ... can cause unwanted side effects or interactions with food or other medicines you may be taking. They ...

  11. Clinical outcome research in complementary and alternative medicine: an overview of experimental design and analysis.

    PubMed

    Gatchel, R J; Maddrey, A M

    1998-09-01

    This article serves as a primer for those beginning clinical research in complementary and alternative medicine. The authors provide a basic overview of important experimental design and statistical issues, of which clinical researchers in the area of complementary and alternative medicine must be aware when attempting to demonstrate the effectiveness of particular treatment modalities. As the article suggests, science is an inferential process, and experimental investigations can vary greatly in methodological integrity. Key concepts in clinical outcome research such as internal validity, statistical conclusion validity, and the appropriate measurement and operational definitions of outcomes are discussed. New scientific approaches that are evolving because of paradigm shifts in science (e.g., chaos theory) are also reviewed. Suggestions are provided to further develop an understanding of clinical outcome research methodology. PMID:9737030

  12. Monitoring of radiation dose rates around a clinical nuclear medicine site

    NASA Astrophysics Data System (ADS)

    Shao, Chia-Ho; Lu, Cheng-Chang; Chen, Tou-Rong; Weng, Jui-Hung; Kao, Pan-Fu; Dong, Shang-Lung; Chou, Ming-Jen

    2014-11-01

    The monitoring of radiation dose around the nuclear medicine site is an important study issue. In this study, TLD-100H radiation dosimeters were used to measure the ambient radiation dose rates around a clinical nuclear medicine site in order to investigate the latent hot zones of radiation exposure. Results of this study showed that the radiation doses measured from all piping and storage systems were comparable to the background dose. A relatively high dose was observed at the single bend point of waste water piping of the PET/CT. Another important finding was the unexpected high dose rates observed at the non-restricted waiting area (NRWA) of SPECT. To conclude, this study provides useful information for further determination of an appropriate dose reduction strategy to achieve the ALARA principle in a clinical nuclear medicine site.

  13. [Clinical and organizational way of innovative development of regenerative medicine in security agencies].

    PubMed

    Ryzhman, N N; Maksimov, A G; Tyrenko, V V; Karamullin, M A; Yurkin, A K; Golota, A S; Lisovets, D G; Sarana, A M; Barsevich, O V

    2015-03-01

    The article covers organizational aspects of development of innovative technologies in the field of regenerative medicine. It is shown that for the effective design and implementation into medical practice of regenerative medicine requires a united complex of military health care, military medical research and education. The main goal is to formate a biological insurance of personnel to treat different consequences of radiological incidents, burn disease, identification of the remains of the victims; the maximum returning to action after disturbed as a result of health services. Proposes the creation of "Interdepartmental Clinical Research and Education Center for Regenerative Medicine", combining research, clinical, industrial and educational potential of the leading institutions of various departments that will enhance the national security of the Russian Federation. PMID:26454924

  14. Placebo preparation for the proper clinical trial of herbal medicine--requirements, verification and quality control.

    PubMed

    Fai, Cheng K; Qi, Guan De; Wei, Ding A; Chung, Leung P

    2011-05-01

    Randomized controlled trials (RCT) have been recognized as the gold standard for interventional clinical trials. In many clinical trials of herbal medicine, it is very difficult to create a quality placebo. To achieve the purpose of blinding, the characteristics of the real drug and placebo should be identical in color, appearance, smell and taste. The quality placebo should be identical to the real drug in physical form, sensory perception, packaging, and labeling, and it should have no pharmaceutical activity. The aim of this study was to evaluate a placebo capsule and its matching herbal medicine D&G capsule in physical form, chemical nature, appearance, packaging and labeling. The assessment results suggested that the placebo was satisfactory in these aspects. The results demonstrated that a placebo could be created for a RCT involving herbal medicine. This report also discusses the means to acquire patent. PMID:21457134

  15. Clinical holistic health: advanced tools for holistic medicine.

    PubMed

    Ventegodt, Søren; Clausen, Birgitte; Nielsen, May Lyck; Merrick, Joav

    2006-01-01

    According to holistic medical theory, the patient will heal when old painful moments, the traumatic events of life that are often called "gestalts", are integrated in the present "now". The advanced holistic physician's expanded toolbox has many different tools to induce this healing, some that are more dangerous and potentially traumatic than others. The more intense the therapeutic technique, the more emotional energy will be released and contained in the session, but the higher also is the risk for the therapist to lose control of the session and lose the patient to his or her own dark side. To avoid harming the patient must be the highest priority in holistic existential therapy, making sufficient education and training an issue of highest importance. The concept of "stepping up" the therapy by using more and more "dramatic" methods to get access to repressed emotions and events has led us to a "therapeutic staircase" with ten steps: (1) establishing the relationship; (2) establishing intimacy, trust, and confidentiality; (3) giving support and holding; (4) taking the patient into the process of physical, emotional, and mental healing; (5) social healing of being in the family; (6) spiritual healing--returning to the abstract wholeness of the soul; (7) healing the informational layer of the body; (8) healing the three fundamental dimensions of existence: love, power, and sexuality in a direct way using, among other techniques, "controlled violence" and "acupressure through the vagina"; (9) mind-expanding and consciousness-transformative techniques like psychotropic drugs; and (10) techniques transgressing the patient's borders and, therefore, often traumatizing (for instance, the use of force against the will of the patient). We believe that the systematic use of the staircase will greatly improve the power and efficiency of holistic medicine for the patient and we invite a broad cooperation in scientifically testing the efficiency of the advanced holistic

  16. [Summary and analysis of safety warning on clinical application of anti-cold Chinese patent medicine preparations].

    PubMed

    Lai, Xiao-xiao; Lin, Hua; Luo, Yi-ni; Wang, Ying-yan; Duan, Xiao-hong; Wang, Lin; Luo, Rui; Chen, Yan-hong

    2015-04-01

    In China, many surveys have shown that most people do not have a correct understanding about cold and administration of anti-cold Chinese patent medicine preparations. The author conducted a systematic summary and analysis on the actual application of anti-cold Chinese patent medicine preparations as well as the warning on safe application of anti-cold Chinese patent medicine preparations in Clinical Medication Information of China Pharmacopoeia, in the expectation of reducing the blind application of anti-cold Chinese patent medicine preparations and providing traditional Chinese medicine pharmacists new ideas in monitoring the safe application of exterior syndrome-relieving Chinese patent medicine preparations. PMID:26281605

  17. A review of clinical trials of lithium in medicine.

    PubMed

    Yung, C Y

    1984-01-01

    Since the approval of lithium use in treatment of acute mania, there have been numerous clinical trials of lithium in medical and psychiatric disorders. This paper gives a brief review of the literature on lithium trials in approximately fourteen medical conditions. These are: hyperthyroidism, metabolizing thyroid cancer, syndrome of inappropriate secretion of antidiuretic hormone, premenstrual tension syndrome, anorexia nervosa, Felty's syndrome, chemotherapy-induced neutropenia, aplastic anemia, seborrheic dermatitis, eczematoid dermatitis, cyclic vomiting, diabetes mellitus and asthma. Most of the case reports cited showed the efficacy of the side effects from lithium salt in the management of the symptoms and signs of these disorders, however, well-designed and controlled studies give negative results. The positive results are reported in the group of disorders having an underlying subdromal affective syndrome such as premenstrual tension syndrome and anorexia nervosa. Other encouraging reports include the effect of lithium to induce leucocytosis in Felty's syndrome and chemotherapy-induced neutropenia. PMID:6395135

  18. Human pharmacology for addiction medicine: From evidence to clinical recommendations.

    PubMed

    Quednow, Boris B; Herdener, Marcus

    2016-01-01

    Substance use disorders (SUD) are complex and often chronic diseases with negative health outcomes and social consequences. Pharmacological treatment options for SUD can be separated in medications for (i) intoxication, (ii) withdrawal, and (iii) reduction of use together with relapse prevention. This chapter will focus on approved or clinically established pharmacological strategies suited to manage symptoms of withdrawal, and to reduce substance use or to promote abstinence. Hereby SUD involving alcohol, nicotine, stimulants, and opioids are primarily discussed as these substances are considered most harmful for both the individual and the society. Moreover, the pharmacotherapy of SUD related to the use of cannabis, benzodiazepines, and gamma-hydroxybutyrate is also briefly reviewed. Since most approved pharmacological treatment options show only moderate effect sizes especially in the long term, the development of new treatment strategies including new drugs, new combinations of available compounds, and biomarkers for response prediction is still warranted. PMID:26822361

  19. Alternative Blood Products and Clinical Needs in Transfusion Medicine

    PubMed Central

    Whitsett, Carolyn; Vaglio, Stefania; Grazzini, Giuliano

    2012-01-01

    The primary focus of national blood programs is the provision of a safe and adequate blood supply. This goal is dependent on regular voluntary donations and a regulatory infrastructure that establishes and enforces standards for blood safety. Progress in ex vivo expansion of blood cells from cell sources including peripheral blood, cord blood, induced pluripotent stem cells, and human embryonic stem cell lines will likely make alternative transfusion products available for clinical use in the near future. Initially, alloimmunized patients and individuals with rare blood types are most likely to benefit from alternative products. However, in developed nations voluntary blood donations are projected to be inadequate in the future as blood usage by individuals 60 years and older increases. In developing nations economic and political challenges may impede progress in attaining self-sufficiency. Under these circumstances, ex vivo generated red cells may be needed to supplement the general blood supply. PMID:22567025

  20. The International Certification of Addiction Medicine: Validating Clinical Knowledge across Borders

    ERIC Educational Resources Information Center

    el-Guebaly, Nady; Violato, Claudio

    2011-01-01

    The experience of the International Society of Addiction Medicine in setting up the first international certification of clinical knowledge is reported. The steps followed and the results of a psychometric analysis of the tests from the first 65 candidates are reported. Lessons learned in the first 5 years and challenges for the future are…

  1. THE EFFECTIVENESS OF THE TELEVISED CLINICAL SEMINARS OF THE NEW YORK ACADEMY OF MEDICINE.

    ERIC Educational Resources Information Center

    MENZEL, HERBERT; AND OTHERS

    IN 1963 THE NEW YORK ACADEMY OF MEDICINE, WITH THE NEW YORK CITY MUNICIPAL BROADCASTING SYSTEM, INAUGURATED AN EXPERIMENTAL PROGRAM OF WEEKLY ONE-HOUR TELEVISED CLINICAL SCIENCE SEMINARS TO EXPLORE THE ACCEPTABILITY AND EFFECTIVENESS OF OPEN-CIRCUIT TELEVISION AS AN ADDITIONAL MEDIUM OF CONTINUING MEDICAL EDUCATION IN A LARGE METROPOLITAN AREA.…

  2. Testicular Self Examination--Knowledge of Men Attending a Large Genito Urinary Medicine Clinic

    ERIC Educational Resources Information Center

    Handy, Pauline; Sankar, K. Nathan

    2008-01-01

    Objective: To elicit the level of knowledge, training and preferences of men in relation to Testicular Self Examination (TSE). Setting: The Genito Urinary Medicine (GUM) department of a large teaching hospital in the North East of England. The open access clinic serves patients from Newcastle upon Tyne, Northumberland, Gateshead and surrounding…

  3. Translational medicine as a new clinical tool and application which improves metabolic diseases: perspectives from 2012 Sino-American symposium on clinical and translational medicine.

    PubMed

    Shi, Lin; López Villar, Elena; Chen, Chengshui

    2014-01-01

    Because of the economic growth and changes in lifestyle, metabolic diseases have become a major public health problem, which impose heavy economic burdens on individuals, families and health systems. However, its precise mediators and mechanisms remain to be fully understood. Clinical translational medicine (CTM) is an emerging area comprising multidisciplinary research from basic science to medical applications and as a new tool to improve human health by reducing disease incidence, morbidity and mortality. It can bridge knowledge of metabolic diseases processes, gained by in vitro and experimental animal models, with the disease pathways found in humans, further to identify their susceptibility genes and enable patients to achieve personalized medicament treatment. Thus, we have the reasons to believe that CTM will play even more roles in the development of new diagnostics, therapies, healthcare, and policies and the Sino-American Symposium on Clinical and Translational Medicine (SAS-CTM) will become a more and more important platform for exchanging ideas on clinical and translational research and entails a close collaboration among hospital, academia and industry. PMID:24512772

  4. Translational medicine as a new clinical tool and application which improves metabolic diseases: perspectives from 2012 Sino-American symposium on clinical and translational medicine

    PubMed Central

    2014-01-01

    Because of the economic growth and changes in lifestyle, metabolic diseases have become a major public health problem, which impose heavy economic burdens on individuals, families and health systems. However, its precise mediators and mechanisms remain to be fully understood. Clinical translational medicine (CTM) is an emerging area comprising multidisciplinary research from basic science to medical applications and as a new tool to improve human health by reducing disease incidence, morbidity and mortality. It can bridge knowledge of metabolic diseases processes, gained by in vitro and experimental animal models, with the disease pathways found in humans, further to identify their susceptibility genes and enable patients to achieve personalized medicament treatment. Thus, we have the reasons to believe that CTM will play even more roles in the development of new diagnostics, therapies, healthcare, and policies and the Sino-American Symposium on Clinical and Translational Medicine (SAS-CTM) will become a more and more important platform for exchanging ideas on clinical and translational research and entails a close collaboration among hospital, academia and industry. PMID:24512772

  5. Genitourinary Considerations in Reoperative and Complex Colorectal Surgery.

    PubMed

    Althumairi, Azah A; Efron, Jonathan E

    2016-06-01

    Genitourinary structures are at risk of injury during colorectal surgery. The incidence of injury is low; however, the risk is higher in cases involving severe inflammatory or infectious processes, locally advanced or recurrent cancer, previous radiation, and reoperation. Consideration of the anatomical relationship between the genitourinary system, and the colon and rectum is crucial to avoid injuries. Intraoperative diagnostic techniques such as intravenous pyelogram (IVP), fluoroscopic cystogram, or retrograde urethrogram can aid in identifying suspected injuries. Early recognition and repair of injuries decrease the morbidity of an injury. Repair of injuries depends on the location and extent of the injury. Simple injuries may be repaired primarily, while complex injuries may require more advanced repairs such as a flap reconstruction. PMID:27247540

  6. Solitary lesions on bone scan in genitourinary malignancy

    SciTech Connect

    Robey, E.L.; Schellhammer, P.F.

    1984-11-01

    Solitary lesions on bone scans obtained as part of metastatic diagnostic studies for genitourinary malignancy require identification as to whether they represent nonneoplastic or neoplastic disease and, if neoplastic, whether metastatic genitourinary cancer or another primary is present. Such definition requires at least plain film tomograms of the area as well as computerized tomography (for inaccessible lesions) and/or biopsy of lesions still in doubt after tomography. Of the 9 patients in our study 4 had true positive scans for metastatic disease, 3 had false positive scans, 1 had a true positive scan for a second bone primary and 1 is indeterminate, since a negative biopsy of a positive area on a bone scan was followed rapidly by the appearance of other widespread metastases.

  7. Genitourinary syndrome of menopause and the use of laser therapy.

    PubMed

    Hutchinson-Colas, Juana; Segal, Saya

    2015-12-01

    Genitourinary syndrome of menopause is a common condition that left untreated can progress and negatively affect quality of life and sexual function. Laser therapy has a therapeutic role for several gynecologic conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM). The laser is well tolerated and may increase thickness of the squamous epithelium and improve vascularity of the vagina. These morphological changes presumably alleviate symptoms of dryness, dyspareunia, and irritation. However, the duration of therapeutic effects and safety of repeated applications at this point is not clear. Further research is needed in the form of controlled studies of the laser and other non-hormonal GSM therapies. The objective of this paper is to review the existing literature describing laser therapy for GSM. PMID:26323234

  8. The GUDMAP database – an online resource for genitourinary research

    PubMed Central

    Harding, Simon D.; Armit, Chris; Armstrong, Jane; Brennan, Jane; Cheng, Ying; Haggarty, Bernard; Houghton, Derek; Lloyd-MacGilp, Sue; Pi, Xingjun; Roochun, Yogmatee; Sharghi, Mehran; Tindal, Christopher; McMahon, Andrew P.; Gottesman, Brian; Little, Melissa H.; Georgas, Kylie; Aronow, Bruce J.; Potter, S. Steven; Brunskill, Eric W.; Southard-Smith, E. Michelle; Mendelsohn, Cathy; Baldock, Richard A.; Davies, Jamie A.; Davidson, Duncan

    2011-01-01

    The GenitoUrinary Development Molecular Anatomy Project (GUDMAP) is an international consortium working to generate gene expression data and transgenic mice. GUDMAP includes data from large-scale in situ hybridisation screens (wholemount and section) and microarray gene expression data of microdissected, laser-captured and FACS-sorted components of the developing mouse genitourinary (GU) system. These expression data are annotated using a high-resolution anatomy ontology specific to the developing murine GU system. GUDMAP data are freely accessible at www.gudmap.org via easy-to-use interfaces. This curated, high-resolution dataset serves as a powerful resource for biologists, clinicians and bioinformaticians interested in the developing urogenital system. This paper gives examples of how the data have been used to address problems in developmental biology and provides a primer for those wishing to use the database in their own research. PMID:21652655

  9. The GUDMAP database--an online resource for genitourinary research.

    PubMed

    Harding, Simon D; Armit, Chris; Armstrong, Jane; Brennan, Jane; Cheng, Ying; Haggarty, Bernard; Houghton, Derek; Lloyd-MacGilp, Sue; Pi, Xingjun; Roochun, Yogmatee; Sharghi, Mehran; Tindal, Christopher; McMahon, Andrew P; Gottesman, Brian; Little, Melissa H; Georgas, Kylie; Aronow, Bruce J; Potter, S Steven; Brunskill, Eric W; Southard-Smith, E Michelle; Mendelsohn, Cathy; Baldock, Richard A; Davies, Jamie A; Davidson, Duncan

    2011-07-01

    The GenitoUrinary Development Molecular Anatomy Project (GUDMAP) is an international consortium working to generate gene expression data and transgenic mice. GUDMAP includes data from large-scale in situ hybridisation screens (wholemount and section) and microarray gene expression data of microdissected, laser-captured and FACS-sorted components of the developing mouse genitourinary (GU) system. These expression data are annotated using a high-resolution anatomy ontology specific to the developing murine GU system. GUDMAP data are freely accessible at www.gudmap.org via easy-to-use interfaces. This curated, high-resolution dataset serves as a powerful resource for biologists, clinicians and bioinformaticians interested in the developing urogenital system. This paper gives examples of how the data have been used to address problems in developmental biology and provides a primer for those wishing to use the database in their own research. PMID:21652655

  10. Particle shedding and migration from silicone genitourinary prosthetic devices

    SciTech Connect

    Barrett, D.M.; O'Sullivan, D.C.; Malizia, A.A.; Reiman, H.M.; Abell-Aleff, P.C. )

    1991-08-01

    Of 26 patients undergoing revision of genitourinary prostheses the surrounding reactive fibrous capsule was biopsied in 25 and the draining lymph nodes also were biopsied in 4. The prostheses included 16 inflatable and 14 flexible penile devices, and 10 artificial urinary sphincters. Tissue was examined by light and transmission electron microscopy. X-ray microanalysis was done on intracellular and extracellular foreign material from each specimen. Silicone was found in 18 of the 25 periprosthetic specimens and in all 4 lymph nodes. Foreign body granulomas were identified in 14 of these 29 specimens. Examination of new and explanted versions of each prosthesis by scanning electron microscopy revealed free particles of silicone or silicates on the surface of most devices. Pitting and microfissuring were seen on a few of the new devices and on nearly all of the used ones. Thus, genitourinary prostheses shed silicone particles that can be found in the fibrous capsule and draining lymph nodes.

  11. Vasopressin receptor antagonists and their role in clinical medicine

    PubMed Central

    Narayen, Girish; Mandal, Surya Narayan

    2012-01-01

    Hyponatremia is the most common electrolyte abnormality in hospitalized patients. Its treatment is based not only on extracellular fluid volume status of patients but also on its pathogenetic mechanisms. Conventional treatment of hyponatremia like fluid restriction, which is useful in euvolemic and hypervolemic hyponatremia, has very poor patient compliance over long term. Vasopressin receptor antagonists (Vaptans) are a new group of nonpeptide drugs which have been used in various clinical conditions with limited success. Whereas conivaptan is to be administered intravenously, the other vaptans like tolvaptan, lixivaptan, and satavaptan are effective as oral medication. They produce aquaresis by their action on vasopressin type 2 (V2R) receptors in the collecting duct and thus increase solute free water excretion. Vaptans are being used as an alternative to fluid restriction in euvolemic and hypervolemic hyponatremic patients. Efficacy of vaptans is now well accepted for management of correction of hyponatremia over a short period. However, its efficacy in improving the long-term morbidity and mortality in patients with chronic hyponatremia due to cirrhosis and heart failure is yet to be established. Vaptans have not become the mainstay treatment of hyponatremia yet. PMID:22470853

  12. High Resolution Melting Applications for Clinical Laboratory Medicine

    PubMed Central

    Erali, Maria; Voelkerding, Karl V.; Wittwer, Carl T.

    2008-01-01

    Separation of the two strands of DNA with heat (melting) is a fundamental property of DNA that is conveniently monitored with fluorescence. Conventional melting is performed after PCR on any real-time instrument to monitor product purity (dsDNA dyes) and sequence (hybridization probes). Recent advances include high-resolution instruments and saturating DNA dyes that distinguish many different species. For example, mutation scanning (identifying heterozygotes) by melting is closed-tube and has similar or superior sensitivity and specificity compared to methods that require physical separation. With high resolution melting, SNPs can be genotyped without probes and more complex regions can be typed with unlabeled hybridization probes. Highly polymorphic HLA loci can be melted to establish sequence identity for transplantation matching. Simultaneous genotyping with one or more unlabeled probes and mutation scanning of the entire amplicon can be performed at the same time in the same tube, vastly decreasing or eliminating the need for re-sequencing in genetic analysis. High-resolution PCR product melting is homogeneous, closed-tube, rapid (1–5 min), non-destructive and does not require covalently-labeled fluorescent probes. In the clinical laboratory, it is an ideal format for in-house testing, with minimal cost and time requirements for new assay development. PMID:18502416

  13. Chinese Herbal Medicine for Functional Abdominal Pain Syndrome: From Clinical Findings to Basic Understandings

    PubMed Central

    Liu, Tao; Wang, Ning

    2016-01-01

    Functional abdominal pain syndrome (FAPS) is one of the less common functional gastrointestinal disorders. Conventional therapy has unsatisfactory response to it so people turn to Chinese medicine for help. Currently, we reviewed the whole picture of Chinese herbal medicine (CHM) clinical and basic application in the treatment of FAPS, especially the traditional Chinese medicine (TCM) syndrome, the single herb, and Chinese medicine formulae, thus to provide a solid base to further develop evidence-based study for this common gastrointestinal complaint in the future. We developed the search strategy and set the inclusion and exclusion criteria for article search. From the included articles, we totally retrieved 586 records according to our searching criteria, of which 16 were duplicate records and 291 were excluded for reasons of irrelevance. The full text of 279 articles was retrieved for detailed assessment, of which 123 were excluded for various reasons. The number one used single herb is Radix Ginseng. The most common syndrome was liver qi depression. The most frequently used classic formula was Si-Mo-Tang. This reflected the true situation of clinical practice of Chinese medicine practitioners and could be further systematically synthesized as key points of the therapeutic research for FAPS. PMID:27366194

  14. Hyperoxaluria and Genitourinary Disorders in Children Ingesting Almond Milk Products.

    PubMed

    Ellis, Demetrius; Lieb, Jessica

    2015-11-01

    We describe 3 children presenting with hematuria, dysuria or kidney stones, and hyperoxaluria believed to be related to ingestion of excessive amounts of almond milk products. Our investigation of the oxalate content of several popular plant-based milk substitutes indicates that almond milk products are a particularly rich source of dietary oxalate. All genitourinary and urinary metabolic disturbances resolved after discontinuation of almond milk ingestion. Therefore, pediatricians should be aware of this potential link. PMID:26382627

  15. New conceptual model of EMR implementation in interprofessional academic family medicine clinics

    PubMed Central

    Halas, Gayle; Singer, Alexander; Styles, Carol; Katz, Alan

    2015-01-01

    Abstract Objective To capture users’ experiences with a newly implemented electronic medical record (EMR) in family medicine academic teaching clinics and to explore their perceptions of its use in clinical and teaching processes. Design Qualitative study using focus group discussions guided by semistructured questions. Setting Three family medicine academic teaching clinics in Winnipeg, Man. Participants Faculty, residents, and support staff. Methods Focus group discussions were audiorecorded and transcribed. Data were analyzed by open coding, followed by development of consensus on a final coding strategy. We used this to independently code the data and analyze them to identify salient events and emergent themes. Main findings We developed a conceptual model to reflect and summarize key themes that we identified from participant comments regarding EMR implementation and use in an academic setting. These included training and support, system design, information management, work flow, communication, and continuity. Conclusion This is the first specific analysis of user experience with a newly implemented EMR in urban family medicine teaching clinics in Canada. The experiences of our participants with EMR implementation were similar to those reported in earlier investigations, but highlight organizational influences and integration strategies. Learning how to use and transitioning to EMRs has implications for clinical learners. This points to the need for further research to gain a more in-depth understanding of the effects of EMRs on the learning environment. PMID:26167563

  16. Bioinformatics Workflow for Clinical Whole Genome Sequencing at Partners HealthCare Personalized Medicine

    PubMed Central

    Tsai, Ellen A.; Shakbatyan, Rimma; Evans, Jason; Rossetti, Peter; Graham, Chet; Sharma, Himanshu; Lin, Chiao-Feng; Lebo, Matthew S.

    2016-01-01

    Effective implementation of precision medicine will be enhanced by a thorough understanding of each patient’s genetic composition to better treat his or her presenting symptoms or mitigate the onset of disease. This ideally includes the sequence information of a complete genome for each individual. At Partners HealthCare Personalized Medicine, we have developed a clinical process for whole genome sequencing (WGS) with application in both healthy individuals and those with disease. In this manuscript, we will describe our bioinformatics strategy to efficiently process and deliver genomic data to geneticists for clinical interpretation. We describe the handling of data from FASTQ to the final variant list for clinical review for the final report. We will also discuss our methodology for validating this workflow and the cost implications of running WGS. PMID:26927186

  17. [Ginkgo preparations of Chinese medicine and treatment of diabetes: mechanisms and clinical applications].

    PubMed

    Xin, Qi-Qi; Liu, Yue; Yang, Lin; Fu, Chang-Geng; Chen, Ke-Ji

    2014-12-01

    Ginkgo is one of the most successful cases of botanical drugs developed by modern science and technology during the past fifty years all over the world. At present ginkgo has been applied to the prevention and treatment of cardiovascular disease widely, and has good clinical efficacy. Type 2 diabetes has been proved to be the risk equivalents of cardiovascular disease, therefore it has an important scientific significance for looking for more effective drugs of prevention and control of diabetes. To seek more efficient and safe drug from the plant medicine which has the function of regulate blood sugar and improve insulin resistance becomes a hotspot at home and abroad. Basic and clinical studies have shown the ginkgo preparations of Chinese medicine have certain regulation effect on blood sugar and insulin resistance. In this paper, we review the mechanisms and clinical applications of ginkgo preparations on diabetes and its applications during the past 10 years. PMID:25911792

  18. Clinical medicine, public health and ecological health: a new basis for education and prevention?

    PubMed Central

    Schaller, Bernhard; Sandu, Nora

    2011-01-01

    In contrast to public health and the resolution to further increase the health care of the whole community in regions worldwide, current clinical medicine has its limits. Further improvement in public health – rather than individual diseases – can only be achieved by integrating new views into treatment. Some years ago, the concept of biopsychosocial medicine was integrated into patient treatment and is now generally accepted. Therefore the author describes here a new dimension to treatment and presents substantial evidence to include ecological health in this already existing concept. The problem of community education is discussed. PMID:22291784

  19. Clinical Research of Traditional Chinese Medicine Needs to Develop Its Own System of Core Outcome Sets

    PubMed Central

    Zhang, Li; Zhang, Junhua; Chen, Jing; Xing, Dongmei; Wang, Jiaying

    2013-01-01

    Currently, quality issues concerning clinical research of traditional Chinese medicine (TCM) have come into the spotlight. It has been recognized that poorly-devised research methodology largely restricted the development of clinical research in TCM. The choice of appropriate outcome measurements is key to the success of clinical research; however, the current procedure for outcomes selection in clinical research of TCM is problematic due to the underdevelopment of clinical methodology. Under this circumstance, we propose the introduction to the concept of Core Outcome Set (COS) and discuss the feasibility of developing a COS system that caters for clinical studies in TCM, in the hope that the outcome evaluation system could be up to international standards. PMID:24312133

  20. Helen Flanders Dunbar, John Dewey, and clinical pragmatism: reflections on method in psychosomatic medicine and bioethics.

    PubMed

    Hart, Curtis W

    2002-01-01

    This article outlines the method utilized by physicians and major figures in the founding of Clinical Pastoral Education, Helen Flanders Dunbar, in her work of 1943, Psychosomatic Diagnosis, and relates it to the currently evolving approach in bioethics known as clinical pragmatism. It assesses Dewey's influence on both Dunbar in psychosomatic medicine and clinical pragmatism in bioethics, and illustrates the breadth of influence of the school of philosophical thought known as pragmatism with which Dewey's name and those of William James and Charles Sanders Pierce are most often identified. PMID:12385140

  1. Identifying low-value clinical practices in critical care medicine: protocol for a scoping review

    PubMed Central

    Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R; Jeffs, Lianne P; Stelfox, Henry T

    2015-01-01

    Introduction Reducing unnecessary, low-value clinical practice (ie, de-adoption) is key to improving value for money in healthcare, especially among patients admitted to intensive care units (ICUs) where resource consumption exceeds other medical and surgical populations. Research suggests that low-value clinical practices are common in medicine, however systematically and objectively identifying them is a widely cited barrier to de-adoption. We will conduct a scoping review to identify low-value clinical practices in adult critical care medicine that are candidates for de-adoption. Methods and analysis We will systematically search the literature to identify all randomised controlled trials or systematic reviews that focus on diagnostic or therapeutic interventions in adult patients admitted to medical, surgical or specialty ICUs, and are published in 3 general medical journals with the highest impact factor (New England Journal of Medicine, The Lancet, Journal of the American Medical Association). 2 investigators will independently screen abstracts and full-text articles against inclusion criteria, and extract data from included citations. Included citations will be classified according to whether or not they represent a repeat examination of the given research question (ie, replication research), and whether the results are similar or contradictory to the original study. Studies with contradictory results will determine clinical practices that are candidates for de-adoption. Ethics and dissemination Our scoping review will use robust methodology to systematically identify a list of clinical practices in adult critical care medicine with evidence supporting their de-adoption. In addition to adding to advancing the study of de-adoption, this review may also serve as the launching point for clinicians and researchers in critical care to begin reducing the number of low-value clinical practices. Dissemination of these results to relevant stakeholders will include

  2. 3D Reconstruction from X-ray Fluoroscopy for Clinical Veterinary Medicine using Differential Volume Rendering

    NASA Astrophysics Data System (ADS)

    Khongsomboon, Khamphong; Hamamoto, Kazuhiko; Kondo, Shozo

    3D reconstruction from ordinary X-ray equipment which is not CT or MRI is required in clinical veterinary medicine. Authors have already proposed a 3D reconstruction technique from X-ray photograph to present bone structure. Although the reconstruction is useful for veterinary medicine, the thechnique has two problems. One is about exposure of X-ray and the other is about data acquisition process. An x-ray equipment which is not special one but can solve the problems is X-ray fluoroscopy. Therefore, in this paper, we propose a method for 3D-reconstruction from X-ray fluoroscopy for clinical veterinary medicine. Fluoroscopy is usually used to observe a movement of organ or to identify a position of organ for surgery by weak X-ray intensity. Since fluoroscopy can output a observed result as movie, the previous two problems which are caused by use of X-ray photograph can be solved. However, a new problem arises due to weak X-ray intensity. Although fluoroscopy can present information of not only bone structure but soft tissues, the contrast is very low and it is very difficult to recognize some soft tissues. It is very useful to be able to observe not only bone structure but soft tissues clearly by ordinary X-ray equipment in the field of clinical veterinary medicine. To solve this problem, this paper proposes a new method to determine opacity in volume rendering process. The opacity is determined according to 3D differential coefficient of 3D reconstruction. This differential volume rendering can present a 3D structure image of multiple organs volumetrically and clearly for clinical veterinary medicine. This paper shows results of simulation and experimental investigation of small dog and evaluation by veterinarians.

  3. Identification of possible adverse drug reactions in clinical notes: The case of glucose-lowering medicines

    PubMed Central

    Warrer, Pernille; Jensen, Peter Bjødstrup; Aagaard, Lise; Jensen, Lars Juhl; Brunak, Søren; Krag, Malene Hammer; Rossing, Peter; Almdal, Thomas; Andersen, Henrik Ullits; Hansen, Ebba Holme

    2015-01-01

    Objective: Through manual review of clinical notes for patients with type 2 diabetes mellitus attending a Danish diabetes center, the aim of the study was to identify adverse drug reactions (ADRs) associated with three classes of glucose-lowering medicines: “Combinations of oral blood-glucose lowering medicines” (A10BD), “dipeptidyl peptidase-4 (DDP-4) inhibitors” (A10BH), and “other blood glucose lowering medicines” (A10BX). Specifically, we aimed to describe the potential of clinical notes to identify new ADRs and to evaluate if sufficient information can be obtained for causality assessment. Methods: For observed adverse events (AEs) we extracted time to onset, outcome, and suspected medicine(s). AEs were assessed according to World Health Organization-Uppsala Monitoring Centre causality criteria and analyzed with respect to suspected medicines, type of ADR (system organ class), seriousness and labeling status. Findings: A total of 207 patients were included in the study leading to the identification of 163 AEs. 14% were categorized as certain, 60% as probable/likely, and 26% as possible. 15 (9%) ADRs were unlabeled of which two were serious: peripheral edema associated with sitagliptin and stomach ulcer associated with liraglutide. Of the unlabeled ADRs, 13 (87%) were associated with “other blood glucose lowering medications,” the remaining 2 (13%) with “DDP-4 inhibitors.” Conclusion: Clinical notes could potentially reveal unlabeled ADRs associated with prescribed medicines and sufficient information is generally available for causality assessment. However, manual review of clinical notes is too time-consuming for routine use and hence there is a need for developing information technology (IT) tools for automatic screening of patient records with the purpose to detect information about potentially serious and unlabeled ADRs. PMID:25984543

  4. Clinical Poems and Clinical Conversations: Some Thoughts on Working with Family Medicine Residents

    ERIC Educational Resources Information Center

    Stein, Howard F.

    2006-01-01

    This paper describes an experiment in which Family Medicine residents composed, read, and discussed their poems as a way of bringing to life their often complex relationships with patients. It argues that this approach mobilizes the physicians' own creativity in the service of reflective practice and improved doctor-patient relationships. This…

  5. [93 YEARS OF CLINICAL EMPATHY, STATE-OF-THE-ART MEDICINE AND RESEARCH EXCELLENCE].

    PubMed

    Kessel, Aharon; Odeh, Majed; Rofe, Amnon

    2015-12-01

    This issue of Harefuah is devoted to articles and reviews written by the medical staff of Bnai Zion Medical Center in Haifa. Celebrating 93 years since its inception, Bnai Zion Medical Center is home to the oldest public hospital in Haifa, and a founding affiliate of the Technion's Faculty of Medicine. Known for its centers of excellence and the impactful clinical and basic research developed, the hospital has a reputation for state-of-the-art medicine, both conventional and complementary. Bnai Zion prides itself as an innovation leader in medical and nursing education, with its staff's empathetic and personalized approach to patient care, and the center's dedication to applying emotional intelligence to medicine. PMID:26897773

  6. Guidelines for ethical behavior relating to clinical practice issues in neuromuscular and electrodiagnostic medicine.

    PubMed

    Abel, Naomi A; De Sousa, Eduardo A; Govindarajan, Raghav; Mayer, Matthew P; Simpson, David A

    2015-12-01

    The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) developed guidelines to formalize the ethical standards that neuromuscular and electrodiagnostic (EDx) physicians should observe in their clinical and scientific activities. Neuromuscular and EDx medicine is a subspecialty of medicine that focuses on evaluation, diagnosis, and comprehensive medical management, including rehabilitation of individuals with neuromuscular disorders. Physicians working in this subspecialty focus on disorders of the motor unit, including muscle, neuromuscular junction, axon, plexus, nerve root, anterior horn cell, and the peripheral nerves (motor and sensory). The neuromuscular and EDx physician's goal is to diagnose and treat these conditions to mitigate their impact and improve the patient's quality of life. The guidelines are consistent with the Principles of Medical Ethics adopted by the American Medical Association and represent a revision of previous AANEM guidelines. PMID:26372720

  7. The clinical benefits, ethics, and economics of stratified medicine and companion diagnostics.

    PubMed

    Trusheim, Mark R; Berndt, Ernst R

    2015-12-01

    The stratified medicine companion diagnostic (CDx) cut-off decision integrates scientific, clinical, ethical, and commercial considerations, and determines its value to developers, providers, payers, and patients. Competition already sharpens these issues in oncology, and might soon do the same for emerging stratified medicines in autoimmune, cardiovascular, neurodegenerative, respiratory, and other conditions. Of 53 oncology targets with a launched therapeutic, 44 have competing therapeutics. Only 12 of 141 Phase III candidates addressing new targets face no competition. CDx choices might alter competitive positions and reimbursement. Under current diagnostic incentives, payers see novel stratified medicines that improve public health and increase costs, but do not observe companion diagnostics for legacy treatments that would reduce costs. It would be in the interests of payers to rediscover their heritage of direct investment in diagnostic development. PMID:26542060

  8. Herbal Medicines for Asthmatic Inflammation: From Basic Researches to Clinical Applications

    PubMed Central

    Xuan, Nan-Xia; Ying, Song-Min; Li, Wen

    2016-01-01

    Asthma is one of the most common chronic inflammatory disorders, associated with reversible airflow obstruction, airway hyperresponsiveness, and airway remodeling. This disease has a significant impact on individuals, their families, and society. Standardized therapeutics such as inhaled corticosteroid in combination with long acting β2 agonist have been applied for asthma control; however, complementary and alternative medicines, especially herbal medicines, are still widely used all over the world. A growing body of literature suggests that various herbals or related products might be effective in inhibiting asthmatic inflammation. In this review, we summarize recent advances about the mechanistic studies of herbal medicines on allergic airway inflammation in animal models and their potential application into clinic for asthma control. PMID:27478309

  9. Anticandidal activity of medicinal plants and Pseudomonas aeruginosa strains of clinical specimens.

    PubMed

    Bora, Limpon

    2016-04-01

    This study was designed to investigate the in vitro anticandidal activity of some medicinal plants and Pseudomonas aeruginosa strains against Candida species. The antifungal activity of methanolic extracts of five medicinal plants, namely, Cinnamomum porrectum, Lippia nudiflora, Cestrum nocturnum, Trachyspermum ammi, and Sida carpinifolia were studied. The medicinal characteristics of these plants were compared with commercially used antibiotics. The antimicrobial assay was done by agar well diffusion and the broth dilution method. Among the plants used, T. ammi and C. nocturnum were found to be more potent than the others. Twenty P. aeruginosa strains were isolated from various clinical specimens. The total inhibitions obtained were found to be 47%, 38%, and 36% in blood agar, whereas in Sabouraud dextrose agar (SDA) the inhibitions were 57%, 48%, and 37%, respectively. PMID:25592881

  10. Education and training for medicines development, regulation, and clinical research in emerging countries

    PubMed Central

    Kerpel-Fronius, Sandor; Rosenkranz, Bernd; Allen, Elizabeth; Bass, Rolf; Mainard, Jacques D.; Dodoo, Alex; Dubois, Dominique J.; Hela, Mandisa; Kern, Steven; Massud, Joao; Silva, Honorio; Whitty, Jeremy

    2015-01-01

    The aim of this satellite workshop held at the 17th World Congress of Basic and Clinical Pharmacology (WCP2014) was to discuss the needs, optimal methods and practical approaches for extending education and teaching of medicines development, regulation, and clinical research to Low and Middle Income Countries (LMICs). It was generally agreed that, for efficiently treating the rapidly growing number of patients suffering from non-communicable diseases, modern drug therapy has to become available more widely and with a shorter time lag in these countries. To achieve this goal many additional experts working in medicines development, regulation, and clinical research have to be trained in parallel. The competence-oriented educational programs designed within the framework of the European Innovative Medicine Initiative-PharmaTrain (IMI-PhT) project were developed with the purpose to cover these interconnected fields. In addition, the programs can be easily adapted to the various local needs, primarily due to their modular architecture and well defined learning outcomes. Furthermore, the program is accompanied by stringent quality assurance standards which are essential for providing internationally accepted certificates. Effective cooperation between international and local experts and organizations, the involvement of the industry, health care centers and governments is essential for successful education. The initiative should also support the development of professional networks able to manage complex health care strategies. In addition it should help establish cooperation between neighboring countries for jointly managing clinical trials, as well as complex regulatory and ethical issues. PMID:25926798

  11. Pilot Program Using Medical Simulation in Clinical Decision-Making Training for Internal Medicine Interns

    PubMed Central

    Miloslavsky, Eli M.; Hayden, Emily M.; Currier, Paul F.; Mathai, Susan K.; Contreras-Valdes, Fernando; Gordon, James A.

    2012-01-01

    Background The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored. Objective To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills. Methods Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators. Results A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as “excellent,” 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills. Conclusions Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective. PMID:24294427

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

    PubMed Central

    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

    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

  13. Education and training for medicines development, regulation, and clinical research in emerging countries.

    PubMed

    Kerpel-Fronius, Sandor; Rosenkranz, Bernd; Allen, Elizabeth; Bass, Rolf; Mainard, Jacques D; Dodoo, Alex; Dubois, Dominique J; Hela, Mandisa; Kern, Steven; Massud, Joao; Silva, Honorio; Whitty, Jeremy

    2015-01-01

    The aim of this satellite workshop held at the 17th World Congress of Basic and Clinical Pharmacology (WCP2014) was to discuss the needs, optimal methods and practical approaches for extending education and teaching of medicines development, regulation, and clinical research to Low and Middle Income Countries (LMICs). It was generally agreed that, for efficiently treating the rapidly growing number of patients suffering from non-communicable diseases, modern drug therapy has to become available more widely and with a shorter time lag in these countries. To achieve this goal many additional experts working in medicines development, regulation, and clinical research have to be trained in parallel. The competence-oriented educational programs designed within the framework of the European Innovative Medicine Initiative-PharmaTrain (IMI-PhT) project were developed with the purpose to cover these interconnected fields. In addition, the programs can be easily adapted to the various local needs, primarily due to their modular architecture and well defined learning outcomes. Furthermore, the program is accompanied by stringent quality assurance standards which are essential for providing internationally accepted certificates. Effective cooperation between international and local experts and organizations, the involvement of the industry, health care centers and governments is essential for successful education. The initiative should also support the development of professional networks able to manage complex health care strategies. In addition it should help establish cooperation between neighboring countries for jointly managing clinical trials, as well as complex regulatory and ethical issues. PMID:25926798

  14. Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

    PubMed Central

    Francis, Maureen D.; Wieland, Mark L.; Drake, Sean; Gwisdalla, Keri Lyn; Julian, Katherine A.; Nabors, Christopher; Pereira, Anne; Rosenblum, Michael; Smith, Amy; Sweet, David; Thomas, Kris; Varney, Andrew; Warm, Eric; Wininger, David; Francis, Mark L.

    2015-01-01

    Background Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear. Methods This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity. Results UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY. Conclusions Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model. PMID:26217420

  15. Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice.

    PubMed

    Miles, Andrew

    2013-01-01

    The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities

  16. Apparent Ruvalcaba syndrome with genitourinary abnormalities.

    PubMed

    Bialer, M G; Wilson, W G; Kelly, T E

    1989-07-01

    The Ruvalcaba syndrome is a rare malformation syndrome characterized by skeletal dysplasia, facial anomalies, and mental retardation. We report on a 22-year-old woman with severe growth and mental retardation and numerous manifestations characteristic of the Ruvalcaba syndrome. In addition, she has several anomalies not previously described in the Ruvalcaba syndrome, including upslanting palpebral fissures, torus palatinus, hiatal hernia with gastroesophageal reflux, recurrent respiratory infections, pectus excavatum, equinovarous deformity, hypotonia, unilateral renal hypoplasia, an accessory ovary, and atretic fallopian tube. Review of published reports of Ruvalcaba syndrome confirms variability of the clinical and radiographic changes. Findings present in at least 50% of reported patients include mental retardation, short stature, pubertal delay, an abnormal nose (usually beaked) with hypoplastic nasal alae, microstomia with narrow maxilla, thin upper lip vermilion, broad hips, small hands, joint limitation, short fingers and toes, and vertebral abnormalities. Because 5 of the reported patients had renal abnormalities, a renal ultrasound or contrast study is indicated in the evaluation of these patients. Additional reports, particular from multiplex families, will be important to better characterize this syndrome. PMID:2679089

  17. Strategies to overcome clinical, regulatory, and financial challenges in the implementation of personalized medicine.

    PubMed

    Tsimberidou, Apostolia M; Ringborg, Ulrik; Schilsky, Richard L

    2013-01-01

    This article highlights major developments over the last decade in personalized medicine in cancer. Emerging data from clinical studies demonstrate that the use of targeted agents in patients with targetable molecular aberrations improves clinical outcomes. Despite a surge of studies, however, significant gaps in knowledge remain, especially in identifying driver molecular aberrations in patients with multiple aberrations, understanding molecular networks that control carcinogenesis and metastasis, and most importantly, discovering effective targeted agents. Implementation of personalized medicine requires continued scientific and technological breakthroughs; standardization of tumor tissue acquisition and molecular testing; changes in oncology practice and regulatory standards for drug and device access and approval; modification of reimbursement policies by health care payers; and innovative ways to collect and analyze electronic patient information that are linked to prospective clinical registries and rapid learning systems. Informatics systems that integrate clinical, laboratory, radiologic, molecular, and economic data will improve clinical care and will provide infrastructure to enable clinical research. The initiative of the EurocanPlatform aims to overcome the challenges of implementing personalized medicine in Europe by sharing patients, biologic materials, and technological resources across borders. The EurocanPlatform establishes a complete translational cancer research program covering the drug development process and strengthening collaborations among academic centers, pharmaceutical companies, regulatory authorities, health technology assessment organizations, and health care systems. The CancerLinQ rapid learning system being developed by ASCO has the potential to revolutionize how all stakeholders in the cancer community assemble and use information obtained from patients treated in real-world settings to guide clinical practice, regulatory

  18. HIV in (and out of) the clinic: Biomedicine, traditional medicine and spiritual healing in Harare

    PubMed Central

    O'Brien, Stephen; Broom, Alex

    2014-01-01

    Abstract Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative interviews with 60 people from poor urban areas in Harare, we explore the experiences of people living with and affected by HIV. Specifically, we sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. Second, we observe the dramatic and overwhelmingly beneficial impact of Antiretroviral Therapy and conclude through Zimbabwean's own stories that limitations around delivery and wider structural inequalities impede its potential. Lastly, we explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert contestation. This paper aimed to add to our knowledge of the relationships between traditional medicine and spiritual healing in connection with biomedicine and how this may influence HIV treatment and prevention. PMID:25017937

  19. The Theoretical Construction of a Classification of Clinical Somatic Symptoms in Psychosomatic Medicine Theory

    PubMed Central

    Zeng, Fanmin; Sun, Xueli; Yang, Bangxiang; Shen, Hong; Liu, Ling

    2016-01-01

    Objective This article adopts the perspective of psychosomatic medicine to present and test a theoretical model of the classification of clinical somatic symptoms. The theoretical model consists of four dimensions: emotional somatic symptoms, biological somatic symptoms, imaginative somatic symptoms, and cognitive somatic symptoms. Method A clinical somatic symptom classification scale was developed according to the theoretical model. A total of 542 participants completed the clinical somatic symptoms classification scale. The data were analyzed using exploratory and confirmatory factor analyses. Results The results confirmed the theoretical model. The analyses found that the proposed theoretical structure of the scale was good, as indicated by factor loadings and fit indices, and that the scale had good reliability and construct validity. Conclusions Based on the interpretation of the clinical symptoms of psychosomatic medicine, the treatment of chronic non-infectious diseases includes at least three dimensions: the first is the etiological treatment, the second is the pathophysiological and pathopsychological dimension, and the third is symptomatic treatment. The unified psychosomatic point of view and diverse clinical thinking modes are aimed at identifying different classes of somatic symptoms and important prerequisites for the treatment of these symptoms. We registered the study with the Chinese Clinical Trial Registry and it was approved by the West China Hospital, Sichuan University ethics committee. Trial registration: The registration number is ChiCTR-OCS-14004632 (time: 2014-05-12). PMID:27525701

  20. Teamwork, Clinical Research, and the Development of Scientific Medicines in Interwar Britain:

    PubMed Central

    Hull, Andrew J.

    2007-01-01

    Summary This article argues that historians of medicine have, until very recently, misinterpreted the relationship of “science” and “the clinic” in the early twentieth century. It follows recent historiographic developments in focusing on the relationship in practice as exemplified by the development of a specific variety of collaborative clinical research using laboratory methods, ca. 1919–37, in a major British medical school. It suggests that it is such working hybrids that should be studied in order to understand fully the development of scientific medicines in the United Kingdom in this period. In Glasgow, it was the local medical culture’s characteristic local subservience to clinical priorities that facilitated, in a particular kind of academic unit, a certain type of hierarchical teamwork between clinicians and laboratory workers; the paper reveals how and why this teamwork became, over time, more of an equal partnership. PMID:17873452

  1. A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application.

    PubMed

    Garland, Megan; Yim, Joshua J; Bogyo, Matthew

    2016-01-21

    The Precision Medicine Initiative aims to use advances in basic and clinical research to develop therapeutics that selectively target and kill cancer cells. Under the same doctrine of precision medicine, there is an equally important need to visualize these diseased cells to enable diagnosis, facilitate surgical resection, and monitor therapeutic response. Therefore, there is a great opportunity for chemists to develop chemically tractable probes that can image cancer in vivo. This review focuses on recent advances in the development of optical probes, as well as their current and future applications in the clinical management of cancer. The progress in probe development described here suggests that optical imaging is an important and rapidly developing field of study that encourages continued collaboration among chemists, biologists, and clinicians to further refine these tools for interventional surgical imaging, as well as for diagnostic and therapeutic applications. PMID:26933740

  2. Penile dermatoses: a clinical and histopathological study.

    PubMed Central

    Hillman, R J; Walker, M M; Harris, J R; Taylor-Robinson, D

    1992-01-01

    OBJECTIVE--To assess the spectrum of genital dermatological conditions affecting men and compare the clinical and histopathological diagnoses. DESIGN--Prospective study over a one year period. SETTING--A central London teaching hospital. PATIENTS--Seventy one patients with unresponsive penile dermatoses attending a specific internal referral clinic within the department of genitourinary medicine and 36 patients undergoing penile biopsy following attendance at other departments within the same hospital. METHODS--Full dermatological assessment of patients attending the specific clinic. Standard histopathological methods were used in the diagnosis of biopsy specimens. OUTCOME MEASURED--Clinico-pathological diagnosis of cutaneous penile abnormalities. RESULTS--Description of the range and relative frequency of penile dermatological conditions. The most common histopathological diagnosis was of non specific dermatitis. Twenty seven percent (16 of 61) of patients attending the specific clinic and 33% (12 of 36) of men attending other departments had conditions requiring long term follow up. CONCLUSIONS--The ranges of penile dermatoses presenting to the different departments were broadly similar. Penile biopsy was shown to be a safe and clinically informative procedure. In the genitourinary clinic setting, clinical diagnosis prior to biopsy was found frequently to be inaccurate. Images PMID:1607192

  3. Training in clinical forensic medicine in the UK--perceptions of current regulatory standards.

    PubMed

    Stark, Margaret M; Norfolk, Guy A

    2011-08-01

    As clinical forensic medicine (CFM) is not currently recognised as a speciality in the UK there are no nationally agreed mandatory standards for training forensic physicians in either general forensic (GFM) or sexual offence medicine (SOM). The General Medical Council (GMC), the medical regulator in the UK, has issued clear standards for training in all specialities recommending that "trainees must be supported to acquire the necessary skills and experience through induction, effective educational supervision, an appropriate workload and time to learn". In order to evaluate the current situation in the field of clinical forensic medicine, doctors who have recently (within the last two years) started working in the field "trainees" (n = 38), and trainers (n = 61) with responsibility for clinical and educational supervision of new trainees, were surveyed by questionnaire to gather their perceptions of how the relevant GMC standards are being met in initial on-the-job training. Telephone interviews were performed with eleven doctors working as clinical or medical directors to determine their views. It is clear that currently the quality of training in CFM is sub-standard and inconsistent and that the published standards, as to the minimum requirement for training that must be met by post-graduate medical and training providers at all levels, are not being met. The Faculty of Forensic and Legal Medicine (FFLM) needs to set explicit minimum standards which will comply with the regulator and work to pilot credentialing for forensic physicians. A number of recommendations are made for urgent FFLM development. PMID:21771557

  4. Systems Medicine: from molecular features and models to the clinic in COPD

    PubMed Central

    2014-01-01

    Background and hypothesis Chronic Obstructive Pulmonary Disease (COPD) patients are characterized by heterogeneous clinical manifestations and patterns of disease progression. Two major factors that can be used to identify COPD subtypes are muscle dysfunction/wasting and co-morbidity patterns. We hypothesized that COPD heterogeneity is in part the result of complex interactions between several genes and pathways. We explored the possibility of using a Systems Medicine approach to identify such pathways, as well as to generate predictive computational models that may be used in clinic practice. Objective and method Our overarching goal is to generate clinically applicable predictive models that characterize COPD heterogeneity through a Systems Medicine approach. To this end we have developed a general framework, consisting of three steps/objectives: (1) feature identification, (2) model generation and statistical validation, and (3) application and validation of the predictive models in the clinical scenario. We used muscle dysfunction and co-morbidity as test cases for this framework. Results In the study of muscle wasting we identified relevant features (genes) by a network analysis and generated predictive models that integrate mechanistic and probabilistic models. This allowed us to characterize muscle wasting as a general de-regulation of pathway interactions. In the co-morbidity analysis we identified relevant features (genes/pathways) by the integration of gene-disease and disease-disease associations. We further present a detailed characterization of co-morbidities in COPD patients that was implemented into a predictive model. In both use cases we were able to achieve predictive modeling but we also identified several key challenges, the most pressing being the validation and implementation into actual clinical practice. Conclusions The results confirm the potential of the Systems Medicine approach to study complex diseases and generate clinically relevant

  5. Regulatory requirements for clinical trial and marketing authorisation application for cell-based medicinal products.

    PubMed

    Salmikangas, P; Flory, E; Reinhardt, J; Hinz, T; Maciulaitis, R

    2010-01-01

    The new era of regenerative medicine has led to rapid development of new innovative therapies especially for diseases and tissue/organ defects for which traditional therapies and medicinal products have not provided satisfactory outcome. Although the clinical use and developments of cell-based medicinal products (CBMPs) could be witnessed already for a decade, robust scientific and regulatory provisions for these products have only recently been enacted. The new Regulation for Advanced Therapies (EC) 1394/2007 together with the revised Annex I, Part IV of Directive 2001/83/EC provides the new legal framework for CBMPs. The wide variety of cell-based products and the foreseen limitations (small sample sizes, short shelf life) vs. particular risks (microbiological purity, variability, immunogenicity, tumourigenicity) associated with CBMPs have called for a flexible, case-by-case regulatory approach for these products. Consequently, a risk-based approach has been developed to allow definition of the amount of scientific data needed for a Marketing Authorisation Application (MAA) of each CBMP. The article provides further insight into the initial risk evaluation, as well as to the quality, non-clinical, and clinical requirements of CBMPs. Special somatic cell therapies designed for active immunotherapy are also addressed. PMID:19940964

  6. Lollipops in the Clinic: Information Dense Mutation Plots for Precision Medicine

    PubMed Central

    Brouwer, Cory

    2016-01-01

    Introduction Concise visualization is critical to present large amounts of information in a minimal space that can be interpreted quickly. Clinical applications in precision medicine present an important use case due to the time dependent nature of the interpretations, although visualization is increasingly necessary across the life sciences. In this paper we describe the Lollipops software for the presentation of panel or exome sequencing results. Source code and binaries are freely available at https://github.com/pbnjay/lollipops. Although other software and web resources exist to produce lollipop diagrams, these packages are less suited to clinical applications. The demands of precision medicine require the ability to easily fit into a workflow and incorporate external information without manual intervention. Results The Lollipops software provides a simple command line interface that only requires an official gene symbol and mutation list making it easily scriptable. External information is integrated using the publicly available Uniprot and Pfam resources. Heuristics are used to select the most informative components and condense them for a concise plot. The output is a flexible Scalable Vector Graphic (SVG) diagram that can be displayed in a web page or graphic illustration tool. Conclusion The Lollipops software creates information-dense, publication-quality mutation plots for automated pipelines and high-throughput workflows in precision medicine. The automatic data integration enables clinical data security, and visualization heuristics concisely present knowledge with minimal user configuration. PMID:27490490

  7. Rational use of medicines in older adults: Can we do better during clinical development?

    PubMed

    Saeed, M A; Vlasakakis, G; Della Pasqua, O

    2015-05-01

    There is an evidence gap to ensuring safe/effective use of medicines in older adults. Generating clinical data in these patients poses ethical and operational challenges, yielding results that may not be generalizable to the overall population. Modeling and simulation (M&S) is proposed as a basis for assessing the impact of age-related changes and their clinical implications. M&S can be used in conjunction with bridging and extrapolation to ensure the selection of appropriate dose(s)/regimen(s) in this population. PMID:25676612

  8. Basic science and clinical application of stem cells in veterinary medicine.

    PubMed

    Ribitsch, I; Burk, J; Delling, U; Geißler, C; Gittel, C; Jülke, H; Brehm, W

    2010-01-01

    Stem cells play an important role in veterinary medicine in different ways. Currently several stem cell therapies for animal patients are being developed and some, like the treatment of equine tendinopathies with mesenchymal stem cells (MSCs), have already successfully entered the market. Moreover, animal models are widely used to study the properties and potential of stem cells for possible future applications in human medicine. Therefore, in the young and emerging field of stem cell research, human and veterinary medicine are intrinsically tied to one another. Many of the pioneering innovations in the field of stem cell research are achieved by cooperating teams of human and veterinary medical scientists.Embryonic stem (ES) cell research, for instance, is mainly performed in animals. Key feature of ES cells is their potential to contribute to any tissue type of the body (Reed and Johnson, J Cell Physiol 215:329-336, 2008). ES cells are capable of self-renewal and thus have the inherent potential for exceptionally prolonged culture (up to 1-2 years). So far, ES cells have been recovered and maintained from non-human primate, mouse (Fortier, Vet Surg 34:415-423, 2005) and horse blastocysts (Guest and Allen, Stem Cells Dev 16:789-796, 2007). In addition, bovine ES cells have been grown in primary culture and there are several reports of ES cells derived from mink, rat, rabbit, chicken and pigs (Fortier, Vet Surg 34:415-423, 2005). However, clinical applications of ES cells are not possible yet, due to their in vivo teratogenic degeneration. The potential to form a teratoma consisting of tissues from all three germ lines even serves as a definitive in vivo test for ES cells.Stem cells obtained from any postnatal organism are defined as adult stem cells. Adult haematopoietic and MSCs, which can easily be recovered from extra embryonic or adult tissues, possess a more limited plasticity than their embryonic counterparts (Reed and Johnson, J Cell Physiol 215

  9. Challenges in the clinical development requirements for the marketing authorization of new medicines in southeast Asia.

    PubMed

    Kudrin, Alex

    2009-03-01

    A rapid growth of investment into clinical research and new drug development has manifested itself by an exponential increase of new products coming onto the worldwide market. The emerging pharmaceutical and biotech markets in Southeast Asia are believed to be extremely promising from a commercial point of view in the next decade. The unique position of the Asian market and the diversity in clinical research initiatives are linked with diverse regulatory requirements for clinical development and registration of new medicines. Some of these differences have an impact on timelines for marketing authorizations in South Korea, China, Thailand, Japan, Singapore, and other countries. One of the approaches to streamlining regulatory strategy in different countries is the initiation of multicountry international clinical trials trying to address requirements and allowing registration in several regional countries simultaneously. Increasing cooperation between South Asian countries in relation to regulatory requirements and clinical development will facilitate the registration of innovative medicines in this rapidly developing region of the world and enable improved cohesiveness between countries in a drug safety framework. PMID:19168433

  10. Integrating Personalized Medicine in the Canadian Environment: Efforts Facilitating Oncology Clinical Research.

    PubMed

    Syme, Rachel; Carleton, Bruce; Leyens, Lada; Richer, Etienne

    2015-01-01

    There is currently a rapid evolution of clinical practices based on the introduction of patient stratification and molecular diagnosis that is likely to improve health outcomes. Building on a strong research base, complemented by strong support from clinicians and health authorities, the oncology field is at the forefront of this evolution. Yet, clinical research is still facing many challenges that need to be addressed in order to conduct necessary studies and effectively translate medical breakthroughs based on personalized medicine into standards of care. Leveraging its universal health care system and on resources developed to support oncology clinical research, Canada is well positioned to join the international efforts deployed to address these challenges. Available resources include a broad range of structures and funding mechanisms, ranging from direct clinical trial support to post-marketing surveillance. Here, we propose a clinical model for the introduction of innovation for precision medicine in oncology that starts with patients' and clinicians' unmet needs to initiate a cycle of discovery, validation, translation and sustainability development. PMID:26565702

  11. Developing knowledge resources to support precision medicine: principles from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

    PubMed

    Hoffman, James M; Dunnenberger, Henry M; Kevin Hicks, J; Caudle, Kelly E; Whirl Carrillo, Michelle; Freimuth, Robert R; Williams, Marc S; Klein, Teri E; Peterson, Josh F

    2016-07-01

    To move beyond a select few genes/drugs, the successful adoption of pharmacogenomics into routine clinical care requires a curated and machine-readable database of pharmacogenomic knowledge suitable for use in an electronic health record (EHR) with clinical decision support (CDS). Recognizing that EHR vendors do not yet provide a standard set of CDS functions for pharmacogenetics, the Clinical Pharmacogenetics Implementation Consortium (CPIC) Informatics Working Group is developing and systematically incorporating a set of EHR-agnostic implementation resources into all CPIC guidelines. These resources illustrate how to integrate pharmacogenomic test results in clinical information systems with CDS to facilitate the use of patient genomic data at the point of care. Based on our collective experience creating existing CPIC resources and implementing pharmacogenomics at our practice sites, we outline principles to define the key features of future knowledge bases and discuss the importance of these knowledge resources for pharmacogenomics and ultimately precision medicine. PMID:27026620

  12. Dandy–Walker Malformation, Genitourinary Abnormalities, and Intellectual Disability in Two Families

    PubMed Central

    Gregor, Anne; Gleeson, Joseph G.; Rosti, Rasim Ozgur

    2016-01-01

    We report on two families, each with documented consanguinity and two affected with overlapping features of Dandy-Walker malformation, genitourinary abnormalities, intellectual disability, and hearing deficit. This phenotype shares similar findings with many well-known syndromes. However, the clinical findings of this syndrome categorize this as a new syndrome as compared with the phenotype of already established syndromes. Due to parental consanguinity, occurrence in siblings of both genders and the absence of manifestations in obligate carrier parents, an autosomal recessive pattern of inheritance is more likely. The authors believe that these families suggest a novel autosomal recessive cerebello–genital syndrome. Array CGH analyses of an affected did not show pathological deletions or duplications. PMID:26109232

  13. Genitourinary Prosthetics: A Primer for the Non-urologic Surgeon.

    PubMed

    Lavien, Garjae; Zaid, Uwais; Peterson, Andrew C

    2016-06-01

    Genitourinary prosthetics are used for correction of functional deficits and to improve the quality of lives of affected patients. General surgeons must evaluate patients scheduled for nonurologic surgery with urologic devices that can impact their perioperative management. Lack of recognition of these prosthetics preoperatively can lead to unnecessary morbidity for the patient and have legal implications for the surgeon. Close consultation with a urologist may avoid common complications associated with these devices and allows for surgical assistance when operative misadventures do occur. This article reviews 3 common urologic prosthetics: testicular prosthesis, artificial urinary sphincter, and penile prosthesis. PMID:27261793

  14. Importance of Selected Athletic Trainer Employment Characteristics in Collegiate, Sports Medicine Clinic, and High School Settings

    PubMed Central

    Arnold, Brent L.; Gansneder, Bruce M.; Van Lunen, Bonnie L.; Szczerba, Joseph E.; Mattacola, Carl G.; Perrin, David H.

    1998-01-01

    Objective: We examined employer importance ratings of 35 employee characteristics in the collegiate, sports medicine clinic, and high school settings and made comparisons among these settings. Design and Setting: All prospective employers were sent a survey. Of the 472 surveys mailed, 282 (60%) were returned, with a sample error rate of 1.9%. Subjects: All prospective employers listed on the NATA position vacancy notices from January 1, 1994 to October 1, 1994. Measurements: Employers were asked to rate 35 employee characteristics as “not important” “ minimally important,” “ important.” or “very important.” Additionally, employers chose 1 of 15 job descriptors that best identified their position vacancy. These 15 descriptors were then categorized into collegiate, sports medicine clinic, and high school settings. Discriminant analysis and analysis of variance procedures were used to determine if the 35 employee characteristics differed across the 3 settings. Results: The discriminant analysis produced 2 significant discriminant functions (P < .05) with 23 of the original 35 characteristics remaining in the analysis. The first function discriminated between the collegiate setting and the other settings, with the collegiate setting scoring the highest. The second function discriminated among all 3 groups, with the sports medicine clinic and high school settings scoring the highest and lowest, respectively. Additionally, the analyses of variance (ANOVAs) revealed that 21 of the characteristics remaining in the discriminant analysis differed across the 3 settings. Conclusions: Employers from all 3 settings rated educational program reputation, written recommendations, job interview performance, and NATA-BOC certification eligibility as important to very important. For the collegiate setting, 7 characteristics were rated above important and included such characteristics as possession of a master's degree and collegiate experience. For the sports medicine

  15. Congenital pouch colon in girls: Genitourinary abnormalities and their management

    PubMed Central

    Chadha, Rajiv; Khan, Niyaz Ahmed; Shah, Shalu; Pant, Nitin; Gupta, Amit; Choudhury, Subhasis Roy; Debnath, Pinaki Ranjan; Puri, Archana

    2015-01-01

    Aims: To discuss the assessment and management of genitourinary (GU) tract abnormalities in 21 girls with Types I-III congenital pouch colon (CPC), studied over a period of 10 years. Materials and Methods: Assessment included clinical and radiological assessment, examination under anesthesia (EUA), endoscopy of the lower GU tract, and evaluation of the surgical findings, operative procedures for the GU anomalies, and the results of management. Results: Initial examination of the external genitalia showed a “clover-leaf” appearance (n = 6) and a single perineal opening (n = 6). In 9 patients, the openings of the urethra and double vagina were seen, of which a vestibular fistula was seen in 5 and an anterior perineal fistula in 1. Seventeen patients (81%) had urinary incontinence (UI) - partial in 10, and complete in 7. Renal function tests, X-ray sacrum, and abdominal US were normal in all patients. Micturating cystourethrogram (n = 9) showed a wide, bladder neck incompetence (BNI) with reduced bladder capacity in seven patients. EUA and endoscopy revealed a septate vagina in all patients and the urethral opening at a “high” position (n = 14) or at a relatively normal or “low” position (n = 7). In 8 patients, the intervaginal septum was thick and fleshy. Endoscopy showed a short, wide urethra, an open incompetent bladder neck, poorly developed trigone, and reduced bladder capacity in the patients with UI. The fistula from the colonic pouch opened in the proximal urethra (n = 4), high in the vestibule (n = 3), low in the vestibule (n = 8), perineum just posterior to the vestibule (n = 1), and undetermined (n = 5). Vaginoscopy (n = 8) showed normal cervices in all and cervical mucus in 4 patients. The subtypes of CPC were Type I CPC (n = 4), Type II CPC (n = 16), and Type III CPC (n = 1). All 21 patients had uterus didelphys. In four patients with UI, during tubular colorraphy, a segment of the colonic pouch was preserved for later bladder augmentation if

  16. Prognostic value of caveolin-1 in genitourinary cancer: a meta-analysis

    PubMed Central

    Liu, Jia-Ming; Cheng, Si-Hang; Liu, Xiao-Xiao; Xia, Chao; Wang, Wei-Wen; Ma, Xue-Lei

    2015-01-01

    We aimed to obtain the most comprehensive picture to date of the prognostic value of caveolin-1 (Cav-1) in genitourinary carcinoma by meta-analyzing all eligible studies in PubMed and EMBASE. Data on patient clinical characteristics, cancer-specific survival (CSS) and recurrence-free survival (RFS) were extracted. The meta-analysis included 6 articles on prostate cancer, 5 on renal cancer, 1 on bladder cancer and 1 on transition cell carcinoma of the upper urinary tract. Two studies examining the association of ELISA-measured Cav-1 levels in serum with RFS in 621 patients with prostate cancer gave a combined hazard ratio (HR) of 1.25 (95% CI 0.36 to 4.36). The other 4 studies on prostate cancer examined the association of immunohistochemically determined Cav-1 levels in cancerous tissue with RFS and gave a combined HR of 1.83 (95% CI 1.36 to 2.47). Three studies on renal cancer examining the association of Cav-1 levels with CSS gave a multivariate HR of 1.98 (95% CI 1.35 to 2.90). The single studies on bladder carcinoma and upper urinary tract carcinoma gave, respectively, a multivariate HR of 2.28 (95% CI 1.09 to 4.74) for the relationship of Cav-1 levels to DFS, and a multivariate HR of 5.08 (95% CI 1.799 to 14.342) for the relationship of Cav-1 levels to CSS. This meta-analysis of available evidence suggests that elevated Cav-1 levels in serum can predict poor survival in patients with genitourinary cancer, which may help identify high-risk patients earlier and guide clinical decision-making. PMID:26884999

  17. Factors associated with medical student clinical reasoning and evidence based medicine practice

    PubMed Central

    Kamei, Robert; Chan, Kenneth; Goh, Sok-Hong; Ngee, Lek

    2015-01-01

    Objectives To identify the factors associated with medical students’ clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. Methods Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students’ EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors’ value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students’ CR and EBM clinical use. Results Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students’ CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students’ EBM clinical use (p=0.03). Clinical teaching culture was not associated with students’ CR and EBM clinical use. Conclusions Our study found that medical students’ classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice. PMID:26547924

  18. Misunderstanding as therapy: doctors, patients and medicines in a rural clinic in Sri Lanka.

    PubMed

    Sachs, L

    1989-09-01

    In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through - rather than despite - "misunderstandings" based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems. PMID:2776468

  19. Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine.

    PubMed

    Green, Robert C; Goddard, Katrina A B; Jarvik, Gail P; Amendola, Laura M; Appelbaum, Paul S; Berg, Jonathan S; Bernhardt, Barbara A; Biesecker, Leslie G; Biswas, Sawona; Blout, Carrie L; Bowling, Kevin M; Brothers, Kyle B; Burke, Wylie; Caga-Anan, Charlisse F; Chinnaiyan, Arul M; Chung, Wendy K; Clayton, Ellen W; Cooper, Gregory M; East, Kelly; Evans, James P; Fullerton, Stephanie M; Garraway, Levi A; Garrett, Jeremy R; Gray, Stacy W; Henderson, Gail E; Hindorff, Lucia A; Holm, Ingrid A; Lewis, Michelle Huckaby; Hutter, Carolyn M; Janne, Pasi A; Joffe, Steven; Kaufman, David; Knoppers, Bartha M; Koenig, Barbara A; Krantz, Ian D; Manolio, Teri A; McCullough, Laurence; McEwen, Jean; McGuire, Amy; Muzny, Donna; Myers, Richard M; Nickerson, Deborah A; Ou, Jeffrey; Parsons, Donald W; Petersen, Gloria M; Plon, Sharon E; Rehm, Heidi L; Roberts, J Scott; Robinson, Dan; Salama, Joseph S; Scollon, Sarah; Sharp, Richard R; Shirts, Brian; Spinner, Nancy B; Tabor, Holly K; Tarczy-Hornoch, Peter; Veenstra, David L; Wagle, Nikhil; Weck, Karen; Wilfond, Benjamin S; Wilhelmsen, Kirk; Wolf, Susan M; Wynn, Julia; Yu, Joon-Ho

    2016-06-01

    Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine. PMID:27181682

  20. [Acupuncture clinical studies and evidence-based medicine--an update].

    PubMed

    Lao, Li-xing

    2008-02-01

    Acupuncture has been widely used in the West in recent years and demand has been growing for scientific evaluation of its clinical efficacy. The practice of evidence-based medicine has brought new challenges in the design of acupuncture research, and publication of randomized clinical trials on acupuncture has significantly increased. While systematic reviews of these trials have advanced our current knowledge, they have exposed deficiencies in research design and revealed that one design can not answer all research questions. Few clinical studies conducted in China have been published in the West, and most published in Chinese suffer from methodological design flaws that render the results unreliable and unconvincing. Such flaws include inadequate or no randomization, inadequate control, unsatisfactory outcome measurements, lack of proper concealment, insufficient follow-up, and improper statistical analysis. To foster high quality acupuncture clinical research in China, we must cultivate innovation and creativity in research design. It is unwise to simply follow or copy the research methodology of Western pharmaceutical studies. Acupuncture and traditional Chinese medicine (TCM) must be evaluated using rigorous scientific methods that preserve the essence of TCM concepts, so that acupuncture and TCM, these ancient healing arts, can continue to play an important role in the health care systems of modern societies. PMID:18386647

  1. Tibetan Medicine: A Systematic Review of the Clinical Research Available in the West

    PubMed Central

    Reuter, K. Philip; Weißhuhn, Thorolf E. R.; Witt, Claudia M.

    2013-01-01

    Background. Little is known about Tibetan medicine (TM), in Western industrialized countries. Objectives. To provide a systematic review of the clinical studies on TM available in the West. Data Sources. Seven literature databases, published literature lists, citation tracking, and contacts to experts and institutions. Study Eligibility Criteria. Studies in English, German, French, or Spanish presenting clinical trial results. Participants. All patients of the included studies. Interventions. Tibetan medicine treatment. Study Appraisal and Synthesis Methods. Included studies were described quantitatively; their quality was assessed with the DIMDI HTA checklist; for RCTs the Jadad score was used. Results. 40 studies from 39 publications were included. They were very heterogeneous regarding study type and size, treated conditions, treatments, measured outcomes, and quality. Limitations. No Russian, Tibetan, or Chinese publications were included. Possible publication bias. Conclusions. The number of clinical trials on TM available in the West is small; methods and results are heterogeneous. Implications of Key Findings. Higher quality larger trials are needed, as is a general overview of traditional usage to inform future clinical trials. Systematic Review Registration Number. None. PMID:23662117

  2. Tibetan medicine: a systematic review of the clinical research available in the west.

    PubMed

    Reuter, K Philip; Weißhuhn, Thorolf E R; Witt, Claudia M

    2013-01-01

    Background. Little is known about Tibetan medicine (TM), in Western industrialized countries. Objectives. To provide a systematic review of the clinical studies on TM available in the West. Data Sources. Seven literature databases, published literature lists, citation tracking, and contacts to experts and institutions. Study Eligibility Criteria. Studies in English, German, French, or Spanish presenting clinical trial results. Participants. All patients of the included studies. Interventions. Tibetan medicine treatment. Study Appraisal and Synthesis Methods. Included studies were described quantitatively; their quality was assessed with the DIMDI HTA checklist; for RCTs the Jadad score was used. Results. 40 studies from 39 publications were included. They were very heterogeneous regarding study type and size, treated conditions, treatments, measured outcomes, and quality. Limitations. No Russian, Tibetan, or Chinese publications were included. Possible publication bias. Conclusions. The number of clinical trials on TM available in the West is small; methods and results are heterogeneous. Implications of Key Findings. Higher quality larger trials are needed, as is a general overview of traditional usage to inform future clinical trials. Systematic Review Registration Number. None. PMID:23662117

  3. Clinical complexity in medicine: A measurement model of task and patient complexity

    PubMed Central

    Islam, R.; Weir, C.; Fiol, G. Del

    2016-01-01

    Summary Background Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. Objective The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on infectious disease domain. The measurement model was adapted and modified to healthcare domain. Methods Three clinical Infectious Disease teams were observed, audio-recorded and transcribed. Each team included an Infectious Diseases expert, one Infectious Diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding process and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen’s kappa. Results The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. Conclusion The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare. PMID:26404626

  4. Consensus Recommendations of Pediatric Transfusion Medicine Objectives for Clinical Pathology Residency Training Programs

    PubMed Central

    Sanchez, Rosa; Sloan, Steven R.; Josephson, Cassandra D.; Ambruso, Daniel R.; Hillyer, Christopher D.; O’Sullivan, Patricia

    2010-01-01

    BACKGROUND Pediatric transfusion medicine (PTM) is a subspecialty of transfusion medicine (TM) with no formal training program and few specialists. The Pediatric Transfusion Medicine Academic Awardees (PedsTMAA) group surveyed PTM content experts to identify relevant objectives for the first formal PTM curriculum. STUDY DESIGN AND METHODS Eight North American PTM experts were invited to participate in a two-step consensus process. PTM-related objectives compiled from a review of existing training documents were organized into a survey. Experts were asked to rate each objective for relevancy for a clinical pathology trainee. Content validity indices (CVIs) and asymmetric confidence intervals (ACIs) of expert ratings and analysis of respondents’ comments were used to identify relevant objectives. RESULTS Six experts participated and reviewed 117 objectives. Based on content validity criteria (CVI ≥ 0.83 and lower-limit 95% ACI ≥ 3), a total of 65 objectives were considered relevant. Twenty-three objectives were rated “very relevant” by all the experts while some proposed objectives were determined to be not relevant, out-of-date, or inappropriate for a resident trainee level. CONCLUSION The PedsTMAA group identified 65 objectives for a PTM curriculum. Twenty-three represent a clear core set of objectives and should be considered for clinical pathology training. The next step is to consider the teaching strategies and evaluation methods that will be employed to best deliver this content addressing competency in medical knowledge. PMID:20051052

  5. Bryophyllum pinnatum and Related Species Used in Anthroposophic Medicine: Constituents, Pharmacological Activities, and Clinical Efficacy.

    PubMed

    Fürer, Karin; Simões-Wüst, Ana Paula; von Mandach, Ursula; Hamburger, Matthias; Potterat, Olivier

    2016-07-01

    Bryophyllum pinnatum (syn. Kalanchoe pinnata) is a succulent perennial plant native to Madagascar that was introduced in anthroposophic medicine in the early 20th century. In recent years, we conducted a large collaborative project to provide reliable data on the chemical composition, pharmacological properties, and clinical efficacy of Bryophyllum. Here, we comprehensively review the phytochemistry, as well as the pharmacological and clinical data. As to the pharmacology, special emphasis is given to properties related to the use in anthroposophic medicine as a treatment for "hyperactivity diseases", such as preterm labor, restlessness, and sleep disorders. Studies suggesting that B. pinnatum may become a new treatment option for overactive bladder syndrome are also reviewed. Tolerability is addressed, and toxicological data are discussed in conjunction with the presence of potentially toxic bufadienolides in Bryophyllum species. The few data available on two related species with medicinal uses, Bryophyllum daigremontianum and Bryophyllum delagoense, have also been included. Taken together, current data support the use of B. pinnatum for the mentioned indications, but further studies are needed to fully understand the modes of action, and to identify the pharmacologically active constituents. PMID:27220081

  6. Clinical Experiences of Korean Medicine Treatment against Urinary Bladder Cancer in General Practice

    PubMed Central

    Park, Taeyeol; Lee, Sanghun

    2016-01-01

    Urinary bladder cancer (UBC) is one of the most common cancers, with 1 out of every 26 men and 1 out of every 80 women worldwide developing the disease during their lifetime. Moreover, it is a disease that predominantly affects the elderly and is becoming a major health problem as the elderly population continues to rapidly increase. In spite of the rapid development of medical science, the 5-year survival rate has remained around 75% since the 1990s, and the FDA has approved no new drugs for UBC over the last 10 years. In addition, most patients experience frequent recurrence and poor quality of life after diagnosis. Therefore, in order to solve unmet needs by alternative methods, we present our clinical cases of UBC where we observed outstanding results including regression and recurrence prevention exclusively through Traditional Korean Medicine such as (1) herbal therapy, (2) acupuncture, (3) pharmacopuncture and needle-embedding therapy, (4) moxibustion, and (5) cupping therapy. From our experience, it appears that multimodal strategies for synergistic efficiency are more effective than single Korean Medicine treatment. We hope this will encourage investigation of the efficacy of Korean Medicine treatment in clinical trials for UBC patients. PMID:27190532

  7. A systems medicine clinical platform for understanding and managing non- communicable diseases.

    PubMed

    Cesario, Alfredo; Auffray, Charles; Agusti, Alvar; Apolone, Giovanni; Balling, Rudi; Barbanti, Piero; Bellia, Alfonso; Boccia, Stefania; Bousquet, Jean; Cardaci, Vittorio; Cazzola, Mario; Dall'Armi, Valentina; Daraselia, Nikolai; Ros, Lucio Da; Bufalo, Alessandra Del; Ducci, Giuseppe; Ferri, Luigi; Fini, Massimo; Fossati, Chiara; Gensini, Gianfranco; Granone, Pierluigi Maria; Kinross, James; Lauro, Davide; Cascio, Gerland Lo; Lococo, Filippo; Lococo, Achille; Maier, Dieter; Marcus, Frederick; Margaritora, Stefano; Marra, Camillo; Minati, Gianfranco; Neri, Monica; Pasqua, Franco; Pison, Christophe; Pristipino, Christian; Roca, Joseph; Rosano, Giuseppe; Rossini, Paolo Maria; Russo, Patrizia; Salinaro, Gianluca; Shenhar, Shani; Soreq, Hermona; Sterk, Peter J; Stocchi, Fabrizio; Torti, Margherita; Volterrani, Maurizio; Wouters, Emiel F M; Frustaci, Alessandra; Bonassi, Stefano

    2014-01-01

    Non-Communicable Diseases (NCDs) are among the most pressing global health problems of the twenty-first century. Their rising incidence and prevalence is linked to severe morbidity and mortality, and they are putting economic and managerial pressure on healthcare systems around the world. Moreover, NCDs are impeding healthy aging by negatively affecting the quality of life of a growing number of the global population. NCDs result from the interaction of various genetic, environmental and habitual factors, and cluster in complex ways, making the complex identification of resulting phenotypes not only difficult, but also a top research priority. The degree of complexity required to interpret large patient datasets generated by advanced high-throughput functional genomics assays has now increased to the point that novel computational biology approaches are essential to extract information that is relevant to the clinical decision-making process. Consequently, system-level models that interpret the interactions between extensive tissues, cellular and molecular measurements and clinical features are also being created to identify new disease phenotypes, so that disease definition and treatment are optimized, and novel therapeutic targets discovered. Likewise, Systems Medicine (SM) platforms applied to extensively-characterized patients provide a basis for more targeted clinical trials, and represent a promising tool to achieve better prevention and patient care, thereby promoting healthy aging globally. The present paper: (1) reviews the novel systems approaches to NCDs; (2) discusses how to move efficiently from Systems Biology to Systems Medicine; and (3) presents the scientific and clinical background of the San Raffaele Systems Medicine Platform. PMID:24641232

  8. Hypertension and Subsequent Genitourinary and Gynecologic Cancers Risk

    PubMed Central

    Sun, Li-Min; Kuo, Huang-Tsung; Jeng, Long-Bin; Lin, Cheng-Li; Liang, Ji-An; Kao, Chia-Hung

    2015-01-01

    Abstract Although a relationship between hypertension and the development of renal cancer and other types of cancer have been proposed for decades, the results of epidemiologic studies remain inconclusive. This study was conducted to evaluate the association between hypertension and genitourinary and gynecologic cancers in Taiwan. In this study, we conducted a populated-based retrospective cohort study by using data from the Taiwanese National Health Insurance program. The study period was from 2000 to 2011, and the cohort comprised 111,704 insurants: 57,961 patients with hypertension and 53,743 patients without hypertension. A Cox proportional hazard regression analysis was performed to estimate the effects of hypertension on genitourinary and gynecologic cancers risk. Among the patients with hypertension, the risks of developing renal and uterine corpus cancers were significantly higher in the hypertension group than they were in the nonhypertension group. Further stratified analyses by sex, age, and hypertension duration revealed distinct cancer-specific patterns. Higher cancer risk appears to be more obvious among younger hypertensive patients with longer follow-up time. The results of this study indicate that Taiwanese patients with hypertension have higher risks for some types of cancer, and cancer-specific patterns vary by sex, age, and hypertension duration. PMID:25906108

  9. Medicine.

    ERIC Educational Resources Information Center

    Ingelfinger, Franz J.

    1980-01-01

    Selected for discussion are certain advances in basic research and technologic innovation which shape the past, present, and future of medical care. Included are infectious diseases, especially hepatitis, immunology, clinical disorders of the immune system and the histocompatability system. (Author/SA)

  10. Current Status and Clinical Studies of Oriental Herbs in Sexual Medicine in Korea

    PubMed Central

    Shin, Yu Seob; Zhao, Chen; Zhang, Li Tao

    2015-01-01

    Erectile dysfunction (ED) is one of the most common diseases among aging men. Although previous studies have shown that type 5 phosphodiesterase inhibitors (PDE5-Is) are very effective for the treatment of ED, many researchers are currently attempting to identify therapeutic agents from natural sources with comparable or better effects than PDE5-Is. Herbal medicine is thought to be advantageous because it is natural; moreover, it not only treats isolated symptoms, but also maintains general well-being. Furthermore, since newly created chemical compound libraries have limited structural diversity with regard to pharmaceutical agents, more attention has recently been paid to the ability of oriental herbs to enhance physical health, including sexual function. Herein, we review the current status of Korean preclinical or clinical studies of the application of oriental herbs to sexual medicine. PMID:26331122

  11. Design, clinical translation and immunological response of biomaterials in regenerative medicine

    NASA Astrophysics Data System (ADS)

    Sadtler, Kaitlyn; Singh, Anirudha; Wolf, Matthew T.; Wang, Xiaokun; Pardoll, Drew M.; Elisseeff, Jennifer H.

    2016-07-01

    The field of regenerative medicine aims to replace tissues lost as a consequence of disease, trauma or congenital abnormalities. Biomaterials serve as scaffolds for regenerative medicine to deliver cells, provide biological signals and physical support, and mobilize endogenous cells to repair tissues. Sophisticated chemistries are used to synthesize materials that mimic and modulate native tissue microenvironments, to replace form and to elucidate structure–function relationships of cell–material interactions. The therapeutic relevance of these biomaterial properties can only be studied after clinical translation, whereby key parameters for efficacy can be defined and then used for future design. In this Review, we present the development and translation of biomaterials for two tissue engineering targets, cartilage and cornea, both of which lack the ability to self-repair. Finally, looking to the future, we discuss the role of the immune system in regeneration and the potential for biomaterial scaffolds to modulate immune signalling to create a pro-regenerative environment.

  12. Integrating genomic and clinical medicine: Searching for susceptibility genes in complex lung diseases

    PubMed Central

    DESAI, ANKIT A.; HYSI, PIRRO; GARCIA, JOE G. N.

    2011-01-01

    The integration of molecular, genomic, and clinical medicine in the post-genome era provides the promise of novel information on genetic variation and pathophysiologic cascades. The current challenge is to translate these discoveries rapidly into viable biomarkers that identify susceptible populations and into the development of precisely targeted therapies. In this article, we describe the application of comparative genomics, microarray platforms, genetic epidemiology, statistical genetics, and bioinformatic approaches within examples of complex pulmonary pathobiology. Our search for candidate genes, which are gene variations that drive susceptibility to and severity of enigmatic acute and chronic lung disorders, provides a logical framework to understand better the evolution of genomic medicine. The dissection of the genetic basis of complex diseases and the development of highly individualized therapies remain lofty but achievable goals. PMID:18355765

  13. MD-CTS: An integrated terminology reference of clinical and translational medicine.

    PubMed

    Ray, Will; Finamore, Joe; Rastegar-Mojarad, Majid; Kadolph, Chris; Ye, Zhan; Bohne, Jacquie; Xu, Yin; Burish, Dan; Sondelski, Joshua; Easker, Melissa; Finnegan, Brian; Bartkowiak, Barbara; Smith, Catherine Arnott; Tachinardi, Umberto; Mendonca, Eneida A; Weichelt, Bryan; Lin, Simon M

    2016-01-01

    New vocabularies are rapidly evolving in the literature relative to the practice of clinical medicine and translational research. To provide integrated access to new terms, we developed a mobile and desktop online reference-Marshfield Dictionary of Clinical and Translational Science (MD-CTS). It is the first public resource that comprehensively integrates Wiktionary (word definition), BioPortal (ontology), Wiki (image reference), and Medline abstract (word usage) information. MD-CTS is accessible at http://spellchecker.mfldclin.edu/. The website provides a broadened capacity for the wider clinical and translational science community to keep pace with newly emerging scientific vocabulary. An initial evaluation using 63 randomly selected biomedical words suggests that online references generally provided better coverage (73%-95%) than paper-based dictionaries (57-71%). PMID:27069559

  14. Precision Medicine for Molecularly Targeted Agents and Immunotherapies in Early-Phase Clinical Trials

    PubMed Central

    Lopez, Juanita; Harris, Sam; Roda, Desam; Yap, Timothy A

    2015-01-01

    Precision medicine in oncology promises the matching of genomic, molecular, and clinical data with underlying mechanisms of a range of novel anticancer therapeutics to develop more rational and effective antitumor strategies in a timely manner. However, despite the remarkable progress made in the understanding of novel drivers of different oncogenic processes, success rates for the approval of oncology drugs remain low with substantial fiscal consequences. In this article, we focus on how recent rapid innovations in technology have brought greater clarity to the biological and clinical complexities of different cancers and advanced the development of molecularly targeted agents and immunotherapies in clinical trials. We discuss the key challenges of identifying and validating predictive biomarkers of response and resistance using both tumor and surrogate tissues, as well as the hurdles associated with intratumor heterogeneity. Finally, we outline evolving strategies employed in early-phase trial designs that incorporate omics-based technologies. PMID:26609214

  15. Complementary and alternative medicine usage by patients of a dental school clinic.

    PubMed

    Spector, Michael L; Fischer, Mark; Dawson, Deborah V; Holmes, David C; Kummet, Colleen; Nisly, Nicole L; Baker, Karen A K

    2012-01-01

    This pilot study investigated the prevalence and specific reasons for usage of complementary and alternative medicine (CAM) among patients of a dental school clinic. Four hundred and two patients completed a 30-page survey on CAM usage. A higher rate of CAM usage was found in this dental school clinic population than rates previously reported in a general population. More than three-quarters (76.1%) of the respondents reported using at least one CAM treatment in the past 12 months; 93.3% reported using at least one CAM treatment at some time in their lives. High rates of chiropractic use were found in this population. Tooth pain was the most frequently reported dental condition motivating CAM use. About 10% of dental school clinic patients use topical oral herbal and/or natural products to treat dental conditions, most frequently for preventive/oral health reasons or for tooth pain. PMID:22943769

  16. On art and science: an epistemic framework for integrating social science and clinical medicine.

    PubMed

    Wasserman, Jason Adam

    2014-06-01

    Calls for incorporating social science into patient care typically have accounted for neither the logistic constraints of medical training nor the methodological fallacies of utilizing aggregate "social facts" in clinical practice. By elucidating the different epistemic approaches of artistic and scientific practices, this paper illustrates an integrative artistic pedagogy that allows clinical practitioners to generate social scientific insights from actual patient encounters. Although there is no shortage of calls to bring social science into medicine, the more fundamental processes of thinking by which art and science proceed have not been addressed to this end. As such, the art of medical practice is conceptualized as an innate gift, and thus little is done to cultivate it. Yet doing so is more important than ever because uncertainty in diagnosing and treating chronic illnesses, the most significant contemporary mortality risks, suggests a re-expanding role for clinical judgment. PMID:24776979

  17. MD-CTS: An integrated terminology reference of clinical and translational medicine

    PubMed Central

    Ray, Will; Finamore, Joe; Rastegar-Mojarad, Majid; Kadolph, Chris; Ye, Zhan; Bohne, Jacquie; Xu, Yin; Burish, Dan; Sondelski, Joshua; Easker, Melissa; Finnegan, Brian; Bartkowiak, Barbara; Smith, Catherine Arnott; Tachinardi, Umberto; Mendonca, Eneida A.; Weichelt, Bryan; Lin, Simon M.

    2016-01-01

    New vocabularies are rapidly evolving in the literature relative to the practice of clinical medicine and translational research. To provide integrated access to new terms, we developed a mobile and desktop online reference—Marshfield Dictionary of Clinical and Translational Science (MD-CTS). It is the first public resource that comprehensively integrates Wiktionary (word definition), BioPortal (ontology), Wiki (image reference), and Medline abstract (word usage) information. MD-CTS is accessible at http://spellchecker.mfldclin.edu/. The website provides a broadened capacity for the wider clinical and translational science community to keep pace with newly emerging scientific vocabulary. An initial evaluation using 63 randomly selected biomedical words suggests that online references generally provided better coverage (73%-95%) than paper-based dictionaries (57–71%). PMID:27069559

  18. Clinical implementation of genetic testing in medicine: a US regulatory science perspective.

    PubMed

    Lesko, Lawrence J; Schmidt, Stephan

    2014-04-01

    Heterogeneity of treatment effects in unselected patient populations has stimulated various strategic approaches to reduce variability and uncertainty and improve individualization of drug selection and dosing. The rapid growth of DNA sequencing and related technologies has ramped up progress in interpreting germline and somatic mutations and has begun to reshape medicine, especially in oncology. Over the past decade, regulatory agencies realized that they needed to be proactive and not reactive if personalized medicine was to become a reality. The US Food and Drug Administration, in particular, took steps to nurture the field through peer-reviewed publications, co-sponsoring public workshops and issuing guidance for industry. The following two major approaches to personalized medicine were taken: (i) encouragement of de novo co-development of drug-genetic test combinations by industry; and (ii) retrospective assessment of legacy genetic data for the purpose of updating drug labels. The former strategy has been more successful in getting new targeted therapies to the marketplace with successful adoption, while the latter, as evidenced by the low adoption rate of pharmacogenetic testing, has been less successful. This reflection piece makes clear that several important things need to happen to make personalized medicine diffuse in more geographical areas and among more therapeutic specialties. The debate over clinical utility of genetic tests needs to be resolved with consensus on evidentiary standards. Physicians, as gatekeepers of prescription medicines, need to increase their knowledge of genetics and the application of the information to patient care. An infrastructure needs to be developed to make access to genetic tests and decision-support tools available to primary practitioners and specialists outside major medical centres and metropolitan areas. PMID:24286486

  19. [Histological view of ethics in medicine and handling of residual samples in clinical laboratories].

    PubMed

    Yoshida, Hiroshi

    2004-03-01

    One of the important ethical issues in clinical laboratory medicine is whether organs and/or specimens should belong to the examinees. Tracing back to ancient Greece, an episode of the death of Asklepios, killed by Zeus to revive the dead, and the great contribution of Hippocrates to medicine including the vow and ethics of medicine, have been described. In the relationship between doctors and patients, the former had been superior to the latter for more than 2400 years, however, the situation has been changing from that to the same position since 1960th, along with the development of bioethics from medical ethics. For the promotion of bioethics, world medical associations have contributed declarations and continuous discussion. The declarations are based on the avoidance of actions detrimental to the life, health, privacy or dignity of examinees. On the medical use of human organs and specimens in relation to human rights, the mind and the body, discussion has continued, however, a consensus on the details has not been reached. A view on the use of residual samples for methodological study, teaching and research in the clinical laboratory was proposed by the Japanese Society of Laboratory Medicine in 2002. Briefly, it included confidentiality of the laboratory staff, responsibility of the laboratory director, the absence of a necessity to obtain consent for the use of residual samples for methodological study when they are made anonymous or pooled, and the recommendation to obtain a judgement by an ethics committee for research use. The background and discussion for the proposal and the current situation on how to obtain consent from patients in Japan are mentioned. PMID:15137321

  20. Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine.

    PubMed

    Chapman, Dane M; Hayden, Stephen; Sanders, Arthur B; Binder, Louis S; Chinnis, Ann; Corrigan, Kelly; LaDuca, Tony; Dyne, Pam; Perina, Debra G; Smith-Coggins, Rebecca; Sulton, Larry; Swing, Susan

    2004-06-01

    In response to public pressure for greater accountability from the medical profession, a transformation is occurring in the approach to medical education and assessment of physician competency. Over the past 5 years, the Accreditation Council for Graduate Medical Education (ACGME) has implemented the Outcomes and General Competencies projects to better ensure that physicians are appropriately trained in the knowledge and skills of their specialties. Concurrently, the American Board of Medical Specialties, including the American Board of Emergency Medicine (ABEM), has embraced the competency concept. The core competencies have been integral in ABEM's development of Emergency Medicine Continuous Certification and the development of the Model of Clinical Practice of Emergency Medicine (Model). ABEM has used the Model as a significant part of its blueprint for the written and oral certification examinations in emergency medicine and is fully supportive of the effort to more fully define and integrate the ACGME core competencies into training emergency medicine specialists. To incorporate these competencies into our specialty, an Emergency Medicine Competency Taskforce (Taskforce) was formed by the Residency Review Committee-Emergency Medicine to determine how these general competencies fit in the Model. This article represents a consensus of the Taskforce with the input of multiple organizations in emergency medicine. It provides a framework for organizations such as the Council of Emergency Medicine Residency Directors (CORD) and the Society for Academic Emergency Medicine to develop a curriculum in emergency medicine and program requirement revisions by the Residency Review Committee-Emergency Medicine. In this report, we describe the approach taken by the Taskforce to integrate the ACGME core competencies into the Model. Ultimately, as competency-based assessment is implemented in emergency medicine training, program directors, governing bodies such as the ACGME

  1. Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine.

    PubMed

    Castaneda, Christian; Nalley, Kip; Mannion, Ciaran; Bhattacharyya, Pritish; Blake, Patrick; Pecora, Andrew; Goy, Andre; Suh, K Stephen

    2015-01-01

    As research laboratories and clinics collaborate to achieve precision medicine, both communities are required to understand mandated electronic health/medical record (EHR/EMR) initiatives that will be fully implemented in all clinics in the United States by 2015. Stakeholders will need to evaluate current record keeping practices and optimize and standardize methodologies to capture nearly all information in digital format. Collaborative efforts from academic and industry sectors are crucial to achieving higher efficacy in patient care while minimizing costs. Currently existing digitized data and information are present in multiple formats and are largely unstructured. In the absence of a universally accepted management system, departments and institutions continue to generate silos of information. As a result, invaluable and newly discovered knowledge is difficult to access. To accelerate biomedical research and reduce healthcare costs, clinical and bioinformatics systems must employ common data elements to create structured annotation forms enabling laboratories and clinics to capture sharable data in real time. Conversion of these datasets to knowable information should be a routine institutionalized process. New scientific knowledge and clinical discoveries can be shared via integrated knowledge environments defined by flexible data models and extensive use of standards, ontologies, vocabularies, and thesauri. In the clinical setting, aggregated knowledge must be displayed in user-friendly formats so that physicians, non-technical laboratory personnel, nurses, data/research coordinators, and end-users can enter data, access information, and understand the output. The effort to connect astronomical numbers of data points, including '-omics'-based molecular data, individual genome sequences, experimental data, patient clinical phenotypes, and follow-up data is a monumental task. Roadblocks to this vision of integration and interoperability include ethical, legal

  2. [Clinical implication of urinary protein markers in diabetic nephropathy and interventional effects of Chinese herbal medicine].

    PubMed

    Shi, Xi-Miao; Meng, Xian-Jie; Wan, Yi-Gang; Shen, Shan-Mei; Luo, Xun-Yang; Gu, Liu-Bao; Yao, Jian

    2014-07-01

    In clinic, some urinary protein makers can dynamically and noninvasively reflect the degree of renal tubular injury in patients with diabetic nephropathy (DN). These urinary biomarkers of tubular damage are broadly divided into two categories. One is newfound, including kidney injury molecule-1 (Kim-1), neutrophil getatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP) and cystatin C (CysC); the other one is classical, including beta2 microglobulin (beta2-MG), retinal binding protein (RBP) and N-acetyl-beta-D-glucosaminidase (NAG). It is reported that, the increases in urinary protein markers are not only closely related to the damage of tubular epithelial cells in DN patients, but also can be ameliorated by the treatment with Chinese herbal compound preparations or Chinese herbal medicine. Recently, although urinary proteomics are used in the protein separation and identification, the traditional associated detection of urinary protein markers is more practical in clinic. At present, it is possible that the associated detection of urinary biomarkers of glomerular and tubular damages may be a feasible measure to reveal the clinical significance of urinary protein markers in DN patients and the interventional effects of Chinese herbal medicine. PMID:25272479

  3. The dental region constitutes a major blind spot in clinical medicine.

    PubMed

    Eidelman, David

    2006-01-01

    Headache, fatigue, and vertigo are collectively the commonest symptoms encountered in clinical medicine, yet in many cases their true aetiopathogenesis is unknown or unclear. It is postulated that an important reason why little significant progress is being made towards discovering the true aetiology of these symptoms is because physicians, almost universally, are failing to examine a large part of the head for common, readily observable intraosseous pathology which could conceivably cause these symptoms. The region not examined comprises the mandible, maxillae, and their appendages, and the intraosseous pathology not examined for includes impacted teeth, devitalized teeth, and residual infection, amongst others. The non-examination for pathology which could cause these symptoms has thus created a major blind spot in clinical medicine. It is conservatively estimated that more than 50 million people on the American and European continents may thereby be denied a proper clinical examination for the aetiology of these symptoms. Readily testable data, indicating the extent to which the medical profession as a whole has overlooked this pathology, is provided. PMID:16413687

  4. Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

    PubMed Central

    Johnson, Emilie K.; Logvinenko, Tanya; Chow, Jeanne S.

    2014-01-01

    BACKGROUND: The 2011 American Academy of Pediatrics guidelines state that renal and bladder ultrasound (RBUS) should be performed after initial febrile urinary tract infection (UTI) in a young child, with voiding cystourethrogram (VCUG) performed only if RBUS shows abnormalities. We sought to determine test characteristics and predictive values of RBUS for VCUG findings in this setting. METHODS: We analyzed 3995 clinical encounters from January 1, 2006 to December 31, 2010 during which VCUG and RBUS were performed for history of UTI. Patients who had previous postnatal genitourinary imaging or history of prenatal hydronephrosis were excluded. Sensitivity, specificity, and predictive values of RBUS for VCUG abnormalities were determined. RESULTS: We identified 2259 patients age <60 months who had UTI as the indication for imaging. RBUS was reported as “normal” in 75%. On VCUG, any vesicoureteral reflux (VUR) was identified in 41.7%, VUR grade >II in 20.9%, and VUR grade >III in 2.8%. Sensitivity of RBUS for any abnormal findings on VCUG ranged from 5% (specificity: 97%) to 28% (specificity: 77%). Sensitivity for VUR grade >III ranged from 18% (specificity: 97%) to 55% (specificity: 77%). Among the 1203 children aged 2 to 24 months imaged after a first febrile UTI, positive predictive value of RBUS was 37% to 47% for VUR grade >II (13% to 24% for VUR grade >III); negative predictive value was 72% to 74% for VUR grade >II (95% to 96% for VUR grade >III). CONCLUSIONS: RBUS is a poor screening test for genitourinary abnormalities. RBUS and VCUG should be considered complementary as they provide important, but different, information. PMID:24515519

  5. Assessing research impact in academic clinical medicine: a study using Research Excellence Framework pilot impact indicators

    PubMed Central

    2012-01-01

    Background Funders of medical research the world over are increasingly seeking, in research assessment, to complement traditional output measures of scientific publications with more outcome-based indicators of societal and economic impact. In the United Kingdom, the Higher Education Funding Council for England (HEFCE) developed proposals for the Research Excellence Framework (REF) to allocate public research funding to higher education institutions, inter alia, on the basis of the social and economic impact of their research. In 2010, it conducted a pilot exercise to test these proposals and refine impact indicators and criteria. Methods The impact indicators proposed in the 2010 REF impact pilot exercise are critically reviewed and appraised using insights from the relevant literature and empirical data collected for the University of Oxford’s REF pilot submission in clinical medicine. The empirical data were gathered from existing administrative sources and an online administrative survey carried out by the university’s Medical Sciences Division among 289 clinical medicine faculty members (48.1% response rate). Results The feasibility and scope of measuring research impact in clinical medicine in a given university are assessed. Twenty impact indicators from seven categories proposed by HEFCE are presented; their strengths and limitations are discussed using insights from the relevant biomedical and research policy literature. Conclusions While the 2010 pilot exercise has confirmed that the majority of the proposed indicators have some validity, there are significant challenges in operationalising and measuring these indicators reliably, as well as in comparing evidence of research impact across different cases in a standardised manner. It is suggested that the public funding agencies, medical research charities, universities, and the wider medical research community work together to develop more robust methodologies for capturing and describing impact

  6. Laboratory Medicine in the Clinical Decision Support for Treatment of Hypercholesterolemia: Pharmacogenetics of Statins.

    PubMed

    Ruaño, Gualberto; Seip, Richard; Windemuth, Andreas; Wu, Alan H B; Thompson, Paul D

    2016-09-01

    Statin responsiveness is an area of great research interest given the success of the drug class in the treatment of hypercholesterolemia and in primary and secondary prevention of cardiovascular disease. Interrogation of the patient's genome for gene variants will eventually guide anti-hyperlipidemic intervention. In this review, we discuss methodological approaches to discover genetic markers predictive of class-wide and drug-specific statin efficacy and safety. Notable pharmacogenetic findings are summarized from hypothesis-free genome wide and hypothesis-led candidate gene association studies. Physiogenomic models and clinical decision support systems will be required for DNA-guided statin therapy to reach practical use in medicine. PMID:27514463

  7. The Role of Clinical Records in Narrative Medicine: A Discourse of Message

    PubMed Central

    Murphy, John W; Choi, Jung Min; Cadeiras, Martin

    2016-01-01

    This article is designed to unite theory and practice. The focus of attention is the impact of narrative medicine on clinical records. Specifically important is that records are created through dialogue, whereby patients are able to grow the record through their ability to offer critiques and alternative explanations. Merely allowing patients to peruse their records, through advances in technology, is not sufficient to facilitate this aim. Various theoretical and practical considerations are discussed that may facilitate patient involvement and the creation of more accurate and relevant patient records. PMID:26918897

  8. [World level of competitiveness of national researches in the field of clinical medicine].

    PubMed

    Starodubov, V I; Kuznetsov, S L; Kurakova, N G; Tsvetkova, L A; Aref'ev, P G

    2012-01-01

    There is proposed formalization of concepts ,world research levelb and "leading scientific technological directions" of global science used in program documents which define main trends of reformation of Russian science. Use of bibliographic index as an example of "normalized citation in related area" for analyzing various subject areas for Russian clinic medicine it was shown that there is a different correlation of some areas of some national subject areas to their world levels. It was noted that it's necessary to develop national methodology of Russian science audit considering its national aspect which is a real problem while application world-acclaimed methods. PMID:22988746

  9. Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part two

    PubMed Central

    Malick, Sadia; Das, Kausik; Khan, Khalid S

    2008-01-01

    Summary Evidence-based medicine (EBM) is the clinical use of current best available evidence from relevant, valid research. Provision of evidence-based healthcare is the most ethical way to practise as it integrates up-to-date patient-oriented research into the clinical decision-making to improve patients' outcomes. This article provides tips for teachers to teach clinical trainees the final two steps of EBM: integrating evidence with clinical judgement and bringing about change. PMID:19029354

  10. Changing health care quality paradigms: the rise of clinical guidelines and quality measures in American medicine.

    PubMed

    Nigam, Amit

    2012-12-01

    Clinical guidelines and quality measures are important new paradigms for conceptualizing and managing quality in the United States. Researchers have proposed that professional elites-including members of academic medicine-were an important cause of the shift to guidelines and measures. This paper draws on content analysis of abstracts focused on quality in major American medical journals between 1975 and 2009 to empirically assess whether and how paradigms for managing quality changed in academic medicine. The content analysis shows that guidelines- and measures-based approaches to quality increased in prominence. Individual expertise-based approaches to quality, however, remain important. Concurrent with changing paradigms in academic medicine, there was a reorientation of policy toward increased use of guidelines and measures the late 1980s and early 1990s in the United States. This policy reorientation was informed by earlier work by medical researchers proposing new approaches to quality. The policy reorientation was followed by an increase in the prominence of guidelines and measures in medical research. PMID:22920278

  11. [Study of clinical character and medicinal therapy of viral hepatitis in hospital based on real world].

    PubMed

    Li, Yun-ru; Wang, Lian-xin; Xie, Yan-ming; Yang, Wei; Wang, Zhuo-yue; Yi, Dan-hui; Wang, Yong-yan

    2014-09-01

    Viral hepatitis was the most common infectious disease in china. But the diagnosis and treatment were varied because the viral hepatitis patients were hospitalized in different kinds of hospital such as infectious disease hospital, general hospital and Chinese medical hospital. It was necessary to know clinical characters and information of viral hepatitis patients in different hospitals. The general information, subtype distribution, prognosis, complication, medication and relations of onset with solar term from 41 180 viral hepatitis patients based on HIS data were analyzed. It was found that the age of patients between 18 to 59 years old was most; most patients were males. The national basic medical insurance was the most type of payment. The outcome of viral hepatitis in the youth and female were better than that in the old and male. Acute hepatitis was easer to restore than chronic hepatitis. Liver cirrhosis and hepatocellular carcinoma were the two most complications. The peak of onset was during summer solstice, slight heat and great heat. The most common Chinese medicine was Diammonium glycyrrhizinate and the most common western medicine was reduced glutathione. The combination of D. glycyrrhizinate with reduced glutathione, polyene phosphatidylcholine and thymosin was the main pattern. But It was not knew if the combination of western and Chinese medicine was the most effective therapy to protect liver function. It was necessary to take deeply research of the relationship between the combination therapy and their effectiveness. PMID:25532376

  12. Cardiovascular medicine at face value: a qualitative pilot study on clinical axiology

    PubMed Central

    2013-01-01

    Introduction Cardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter. Results We point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education. Conclusion We establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. PMID:23531271

  13. In vitro antimicrobial activity of ten medicinal plants against clinical isolates of oral cancer cases

    PubMed Central

    2011-01-01

    Background Suppression of immune system in treated cancer patients may lead to secondary infections that obviate the need of antibiotics. In the present study, an attempt was made to understand the occurrence of secondary infections in immuno-suppressed patients along with herbal control of these infections with the following objectives to: (a) isolate the microbial species from the treated oral cancer patients along with the estimation of absolute neutrophile counts of patients (b) assess the in vitro antimicrobial activity medicinal plants against the above clinical isolates. Methods Blood and oral swab cultures were taken from 40 oral cancer patients undergoing treatment in the radiotherapy unit of Regional Cancer Institute, Pt. B.D.S. Health University, Rohtak, Haryana. Clinical isolates were identified by following general microbiological, staining and biochemical methods. The absolute neutrophile counts were done by following the standard methods. The medicinal plants selected for antimicrobial activity analysis were Asphodelus tenuifolius Cav., Asparagus racemosus Willd., Balanites aegyptiaca L., Cestrum diurnum L., Cordia dichotoma G. Forst, Eclipta alba L., Murraya koenigii (L.) Spreng. , Pedalium murex L., Ricinus communis L. and Trigonella foenum graecum L. The antimicrobial efficacy of medicinal plants was evaluated by modified Kirby-Bauer disc diffusion method. MIC and MFC were investigated by serial two fold microbroth dilution method. Results Prevalent bacterial pathogens isolated were Staphylococcus aureus (23.2%), Escherichia coli (15.62%), Staphylococcus epidermidis (12.5%), Pseudomonas aeruginosa (9.37%), Klebsiella pneumonia (7.81%), Proteus mirabilis (3.6%), Proteus vulgaris (4.2%) and the fungal pathogens were Candida albicans (14.6%), Aspergillus fumigatus (9.37%). Out of 40 cases, 35 (87.5%) were observed as neutropenic. Eight medicinal plants (A. tenuifolius, A. racemosus, B. aegyptiaca, E. alba, M. koenigii, P. murex R. communis and T

  14. Missed opportunities for identifying primary HIV within genitourinary medical/HIV services.

    PubMed

    Sharrocks, K; Jones, C B; Naftalin, C; Darling, D; Fisher, M; Fidler, S; Fox, J

    2012-08-01

    To assess the ability of three genitourinary medical centres to clinically identify primary HIV infection (PHI). Cases of recently acquired HIV infection, identified using the Health Protection Agency (HPA) avidity assay on all HIV diagnoses from January to August 2009, were investigated by case-note review. Sixty-four individuals were identified as PHI using the HPA avidity assay. Of 64 individuals, 31 (48%) were identified clinically. Imperial College identified 8/26 (31%), Guys and St Thomas' 15/27 (56%) and Brighton 8/11 (73%). Clinical suspicion of PHI was associated with reported unprotected anal intercourse (P = 0.017), seroconversion symptoms (P = 0.0004), a negative HIV test within six months (P = 0.024) and avidity assay result availability (P = 0.0169). Seventy percent of PHI cases missed had a documented risk factor. Thirty-five percent of those clinically identified with PHI were documented as informed of the associated enhanced infectivity. Suspicion of PHI was low despite documented risk factors and recent HIV-negative antibody tests. Counselling to prevent onward transmission was suboptimal. PMID:22930288

  15. Prevalence and factors associated with use of herbal medicine among women attending an infertility clinic in Uganda

    PubMed Central

    2014-01-01

    Background Infertility is a public health problem associated with devastating psychosocial consequences. In countries where infertility care is difficult to access, women turn to herbal medicines to achieve parenthood. The aim of this study was to determine the prevalence and factors associated with herbal medicine use by women attending the infertility clinic. Methods This was a cross-sectional study of 260 women attending the infertility clinic at Mulago hospital. The interviewer administered questionnaire comprised socio-demographic characteristics, infertility-related aspects and information on herbal medicine use. The main outcome measure was herbal medicines use for infertility treatment. Determinants of herbal medicine use were assessed using multivariable logistic regression. Results The majority (76.2%) of respondents had used herbal medicines for infertility treatment. The mean age of the participants was 28.3 years ± 5.5. Over 80% were married, 59.6% had secondary infertility and 2/3 of the married participants were in monogamous unions. In a multivariable model, the variables that were independently associated with increased use of herbal medicine among infertile patients were being married (OR 2.55, CI 1.24-5.24), never conceived (OR 4.08 CI 1.86-8.96) and infertility for less than 3 years (OR 3.52 CI 1.51-8.821). Factors that were associated with less use of herbal medicine among infertile women were being aged 30 years or less (OR 0.18 CI 0.07-0.46), primary and no education (OR 0.12 CI 0.05-0.46) and living with partner for less than three years (OR 0.39 CI 0.16-0.93). Conclusions The prevalence of herbal medicine use among women attending the infertility clinic was 76.2%. Herbal medicine use was associated with the participants’ age, level of education, marital status, infertility duration, nulliparity, and duration of marriage. Medical care was often delayed and the majority of the participants did not disclose use of herbal medicines to

  16. Potential Clinical Utility of Copeptin (C-terminal provasopressin) measurements in clinical medicine.

    PubMed

    Lewandowski, K C; Brabant, G

    2016-03-01

    Copeptin is a 39-amino-acids containing glycosylated peptide derived from the C-terminal part of the arginine vasopressin (AVP) precursor. In the process of proteolysis the AVP precursor is processed to AVP, neurophysin II, and copeptin in equimolar amounts. In contrast to AVP, copeptin remains stable for several days at room temperature in serum or plasma. Hence, copeptin serves as a bona fide biomarker of AVP release. We briefly summarise clinical utility of copeptin in the diagnosis of diabetes insipidus. We also discuss potential applications of copeptin measurements in hyponatraemic states, assessment of an anterior pituitary function, as well as a wide range of several acute and chronic medical conditions, such as myocardial infarction, stroke or diabetes mellitus. PMID:27008633

  17. A clinical study of integrating acupuncture and Western medicine in treating patients with Parkinson's disease.

    PubMed

    Chen, Fang-Pey; Chang, Ching-Mao; Shiu, Jing-Huei; Chiu, Jen-Hwey; Wu, Ta-Peng; Yang, Jen-Lin; Kung, Yen-Ying; Chen, Fun-Jou; Chern, Chang-Ming; Hwang, Shinn-Jang

    2015-01-01

    Complementary therapy with acupuncture for Parkinson's disease (PD) has been studied for quite a long time, but the effectiveness of the treatment still remains unclear. The aim of this study is to evaluate the integrated effects of acupuncture treatment in PD patients who received western medicine. In the short-term acupuncture treatment study, 20 patients received acupuncture therapy twice a week in acupoints DU 20, GB 20, LI 11, LI 10, LI 4, GB 31, ST 32, GB 34 and GB 38 along with western medicine for 18 weeks, and 20 controlled patients received western medicine only. In the long-term acupuncture treatment, 13 patients received acupuncture treatment twice a week for 36 weeks. The outcome parameters include Unified Parkinson's disease rating scale (UPDRS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-Version 2 (BDI-II), and WHO quality of life (WHOQOL). In the short-term clinical trial, a higher percentage of patients in the acupuncture group had score improvement in UPDRS total scores (55% vs. 15%, p = 0.019), sub-score of mind, behavior and mood (85% vs. 25%, p < 0.001), activity of daily living (65% vs. 15%, p = 0.003), mobility (40% vs. 15%, p = 0.155) and complication of treatment (75% vs. 15%, p < 0.001), BDI-II score (85% vs. 35%, p = 0.003), and WHOQOL score (65% vs. 15%, p = 0.003) when compared to control group at the end of the 18 weeks' follow up. After 36 weeks of long-term acupuncture treatment, the mean UPDRS total scores and sub-score of mentation, behavior and mood, sub-score of complications of therapy and BDI-II score decreased significantly when compared to the pretreatment baseline. In conclusion, acupuncture treatment had integrated effects in reducing symptoms and signs of mind, behavior, mood, complications of therapy and depression in PD patients who received Western medicine. PMID:25967661

  18. Proposed roadmap to stepwise integration of genetics in family medicine and clinical research

    PubMed Central

    2013-01-01

    We propose A step-by-step roadmap to integrate genetics in the Electronic Patient Record in Family Medicine and clinical research. This could make urgent operationalization of readily available genetic knowledge feasible in clinical research and consequently improved medical care. Improving genomic literacy by training and education is needed first. The second step is the improvement of the possibilities to register the family history in such a way that queries can identify patients at risk. Adding codes to the ICPC chapters “A21 Personal/family history of malignancy” and “A99 Disease carrier not described further” is proposed. Multidisciplinary guidelines for referral must be unambiguous. Electronical patient records need possibilities to add (new) family history information, including links between individuals who are family members. Automatic alerts should help general practitioners to recognize patients at risk who satisfy referral criteria. We present a familial breast cancer case with a BRCA1 mutation as an example. PMID:23415259

  19. Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine.

    PubMed

    Wan, S H

    2015-10-01

    The script concordance test is a relatively new format of written assessment that is used to assess higher-order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate's decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script concordance questions, using expert panellists to score the items and set the passing score standard, and the challenges in the practical implementation (including pitfalls to avoid) of the written assessment. PMID:26314569

  20. [Clinical and experimental studies on membranous pulp-capping agent with Chinese medicinal herbs].

    PubMed

    Wang, Z P; Li, Z R; Li, S L

    1993-06-01

    A membranous pulp-capping agent of Chinese medicinal herbs was made by ourselves prescription, and was filled in capsules for medication. Direct pulp-capping and pulpotomy were performed on 102 permanent teeth. During the observation period of more than one year, the successful rate was 82.4%. Under light microscope, the artificial exposed sites of normal sheep teeth were fully sealed after capping for 45 days. There were calcification under the exposed sites. The inner lines were preparative dentins. Experiments on dogs' teeth revealed that the pulps were normal after two month's direct pulp-capping, and the new dentins appeared. The bacteria culture test was made before and after the pulp-capping agent was used on ten deep carious teeth. It revealed that the bacteria all converted negative after medication of two weeks. Clinical and experimental studies indicated that the pulp-capping agent is valuable in clinical treatment. PMID:8257838

  1. Ethical Considerations for Acupuncture and Chinese Herbal Medicine Clinical Trials: A Cross-cultural Perspective.

    PubMed

    Zaslawski, Christopher

    2010-09-01

    MANY ETHICAL CONCERNS REVOLVE AROUND THE FOUR BASIC PRINCIPLES OF RESEARCH: merit and integrity, respect for human beings, weighting of risk-benefit and justice. These principles form the basis for any discussion concerning human research ethics and are applicable to all areas of research including acupuncture and Chinese herbal medicine. World Health Organisation document, Guidelines for Clinical Research on Acupuncture, states that 'consideration should be given to the different value systems that are involved in human rights such as social, cultural and historical issues' and that 'further studies should be conducted in relation to ethical issues involved in clinical research on acupuncture'. In addition to outlining the four basic principles, this paper will also examine the effect of Asian culture on Western human research ethics and how this may impact upon issues such as informed consent and weighting of risk-benefit. PMID:18955359

  2. Academy of Medicine-Ministry of Health clinical practice guidelines: attention deficit hyperactivity disorder.

    PubMed

    Fung, Daniel S S; Lim, Choon Guan; Wong, John Chee Meng; Ng, Koon Hock; Cheok, Christopher Cheng Soon; Kiing, Jennifer Sie Hee; Chong, Shang Chee; Lou, June; Daniel, Mary Lourdes; Ong, Desmond; Low, Charity; Aljunied, Sharifah Mariam; Choi, Pui Meng; Mehrotra, Kala; Kee, Carolyn; Leung, Ivy; Yen, Lee Chen; Wong, Geraldine; Lee, Poh Yin; Chin, Bella; Ng, Hwee Chien

    2014-08-01

    The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:25189301

  3. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Attention Deficit Hyperactivity Disorder

    PubMed Central

    Fung, Daniel SS; Lim, Choon Guan; Wong, John Chee Meng; Ng, Koon Hock; Cheok, Christopher Cheng Soon; Kiing, Jennifer Sie Hee; Chong, Shang Chee; Lou, June; Daniel, Mary Lourdes; Ong, Desmond; Low, Charity; Aljunied, Sharifah Mariam; Choi, Pui Meng; Mehrotra, Kala; Kee, Carolyn; Leung, Ivy; Yen, Lee Chen; Wong, Geraldine; Lee, Poh Yin; Chin, Bella; Ng, Hwee Chien

    2014-01-01

    The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:25189301

  4. Stereoroentgenographic System With Portable Calibration Cage For Use In Clinical Medicine

    NASA Astrophysics Data System (ADS)

    Moffitt, Francis; Baumrind, Sheldon; Chafetz, Neil; Curry, Sean

    1983-07-01

    For the past five years, we have been accumulating information on the performance of a stereoroentgenographic system developed for use in clinical medicine and first reported at the NATO Symposium on the Application of Human Biostereometrics. This system represents an adaptation of normal case coplanar stereometry and involves the use of a single emitter which is displaced in a controlled fashion between exposures. The system has been used primarily for the detection of applicance loosening and settling following the placement of total hip protheses and also for the detection of pseudorthosis following lumbo-sacral fusion. One major goal has been the development of a data acquisition and analysis system suitable for general hospital use which can be operated by technicians without specialized photogrammetric training. This report will focus on system design and on the delineation of technical problems encountered during routine clinical use of the system.

  5. Dendritic cells and macrophages in the genitourinary tract

    PubMed Central

    Iijima, N; Thompson, JM; Iwasaki, A

    2009-01-01

    Dendritic cells (DCs) and macrophages are antigen-presenting cells (APCs) that are important in innate immune defense as well as in the generation and regulation of adaptive immunity against a wide array of pathogens. The genitourinary (GU) tract, which serves an important reproductive function, is constantly exposed to numerous agents of sexually transmitted infections (STIs). To combat these STIs, several subsets of DCs and macrophages are strategically localized within the GU tract. In the female genital mucosa, recruitment and function of these APCs are uniquely governed by sex hormones. This review summarizes the latest advances in our understanding of DCs and macrophages in the GU tract with respect to their subsets, lineage, and function. In addition, we discuss the divergent roles of these cells in immune defense against STIs as well as in maternal tolerance to the fetus. PMID:19079212

  6. The Recent Review of the Genitourinary Syndrome of Menopause

    PubMed Central

    Kim, Hyun-Kyung; Kang, So-Yeon; Chung, Youn-Jee; Kim, Jang-Heub

    2015-01-01

    The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital symptoms (dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function, but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections). The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used until recently, had a limitation because they did not cover the full spectrum of symptoms and did not imply that the symptoms are related to a decreased estrogen level in menopause. Since the GSM may have a profound negative impact on the quality of life of postmenopausal women, women should be made aware of these problems and treated with an appropriate effective therapy. Thus, in this review we introduce new terminology and discuss the importance of comprehension of GSM and the necessity of active treatment of this syndrome in postmenopausal women. PMID:26357643

  7. The Recent Review of the Genitourinary Syndrome of Menopause.

    PubMed

    Kim, Hyun-Kyung; Kang, So-Yeon; Chung, Youn-Jee; Kim, Jang-Heub; Kim, Mee-Ran

    2015-08-01

    The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital symptoms (dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function, but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections). The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used until recently, had a limitation because they did not cover the full spectrum of symptoms and did not imply that the symptoms are related to a decreased estrogen level in menopause. Since the GSM may have a profound negative impact on the quality of life of postmenopausal women, women should be made aware of these problems and treated with an appropriate effective therapy. Thus, in this review we introduce new terminology and discuss the importance of comprehension of GSM and the necessity of active treatment of this syndrome in postmenopausal women. PMID:26357643

  8. Child Rights and Clinical Bioethics: Historical Reflections on Modern Medicine and Ethics.

    PubMed

    Brosco, Jeffrey P

    2016-01-01

    Why might pediatric bioethicists in the United States reject the U.N. Convention on the Rights of the Child (CRC) as a framework for resolving ethical issues? The essays in this issue present arguments and counterarguments regarding the usefulness of the CRC in various clinical and research cases. But underlying this debate are two historical factors that help explain the seeming paradox of pediatric bioethicists' arguing against child's rights. First, the profession of clinical bioethics emerged in the 1970s as one component of modern medicine's focus on improving health through the application of technologically sophisticated treatments. The everyday work of U.S. bioethicists thus usually involves emerging technologies or practices in clinical or laboratory settings; the articles of the CRC, in contrast, seem better suited to addressing broad policy issues that affect the social determinants of health. Second, U.S. child health policy veered away from a more communitarian approach in the early 20th century for reasons of demography that were reinforced by ideology and concerns about immigration. The divide between clinical medicine and public health in the United States, as well as the relatively meager social safety net, are not based on a failure to recognize the rights of children. Indeed, there is some historical evidence to suggest that "rights language" has hindered progress on child health and well-being in the United States. In today's political climate, efforts to ensure that governments pledge to treat children in accordance with their status as human beings (a child right's perspective) are less likely to improve child health than robust advocacy on behalf of children's unique needs, especially as novel models of health-care financing emerge. PMID:27157355

  9. Self-assessment of current knowledge in nuclear medicine (second edition)

    SciTech Connect

    Selby, J.B.; Frey, G.D.; Cooper, J.F.; Klobukoski, C.J.

    1981-01-01

    In this updated second edition, the order of contents of the textbook has been reorganized. It has been divided into main parts: Basic Science and Clinical Nuclear Medicine. Basic Science, Part I, encompasses basic physics, radiation protection, interaction of radiation with matter and radiation detection, imaging, nuclear pharmacy, and radiation biology. Part II, Clinical Nuclear Medicine, covers the central nervous system, bone, gastroenterology (liver/spleen), cardiovascular system, pulmonary system, genitourinary system, thyroid and endocrine systems, gallium studies, radioassay, hematology, and therapy. The total number of pages of the current edition is increased to 250 from the 213 of the first edition but there are fewer questions because those in the basic science area have been carefully selected to 60 of the original 98 questions. Compared with the previous edition, there are two advantages in the current one: (1) the addition of explanatory answers; and (2) the inclusion of up-to-date scintiphotos replacing rectilinear scan illustrations.

  10. Cold Atmospheric Plasma for Medicine: State of Research and Clinical Application

    NASA Astrophysics Data System (ADS)

    von Woedtke, Thomas

    2015-09-01

    Basic research in plasma medicine has made excellent progress and resulted in the fundamental insights that biological effects of cold atmospheric plasmas (CAP) are significantly caused by changes of the liquid environment of cells, and are dominated by redox-active species. First CAP sources are CE-certified as medical devices. Main focus of plasma application is on wound healing and treatment of infective skin diseases. Clinical applications in this field confirm the supportive effect of cold plasma treatment in acceleration of healing of chronic wounds above all in cases where conventional treatment fails. Cancer treatment is another actual and emerging field of CAP application. The ability of CAP to kill cancer cells by induction of apoptosis has been proved in vitro. First clinical applications of CAP in palliative care of cancer are realized. In collaboration with Hans-Robert Metelmann, University Medicine Greifswald; Helmut Uhlemann, Klinikum Altenburger Land GmbH Altenburg; Anke Schmidt and Kai Masur, Leibniz Institute for Plasma Science and Technology (INP Greifswald); Renate Schönebeck, Neoplas Tools GmbH Greifswald; and Klaus-Dieter Weltmann, Leibniz Institute for Plasma Science and Technology (INP Greifswald).

  11. Safe composition levels of transgenic crops assessed via a clinical medicine model

    PubMed Central

    Herman, Rod A; Scherer, Peter N; Phillips, Amy M; Storer, Nicholas P; Krieger, Mark

    2010-01-01

    Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. Substantial equivalence has become established as a foundation concept in the safety evaluation of transgenic crops. In the case of a food and feed crop, no single variety is considered the standard for safety or nutrition, so the substantial equivalence of transgenic crops is investigated relative to the array of commercial crop varieties with a history of safe consumption. Although used extensively in clinical medicine to compare new generic drugs with brand-name drugs, equivalence limits are shown to be a poor model for comparing transgenic crops with an array of reference crop varieties. We suggest an alternate model, also analogous to that used in clinical medicine, where reference intervals are constructed for a healthy heterogeneous population. Specifically, we advocate the use of distribution-free tolerance intervals calculated across a large amount of publicly available compositional data such as is found in the International Life Sciences Institute Crop Composition Database. PMID:20084639

  12. [Painting realism and medicine: the two surgical clinics of Thomas Eakins].

    PubMed

    Cabello, Felipe

    2015-06-01

    Realism is a painting style that began with Millet and Courbet in politically convulsed France in the middle of the nineteenth century. In the second half of that century, the pragmatic and democratic tradition of the United States fostered the careers of many realist painters, including that of Thomas Eakins. Eakins, trained in France, developed his career completely associated with Philadelphia at a time when this city was in the vanguard of American emerging industry, culture and medicine. Eakins "The clinic of Dr. Gross" and the "The clinic of Dr. Agnew" are icons of these developments and symbolize a perfect union of art and medicine. Both paintings permit the viewer to appreciate the artist's mastery, originality and Americanism while simultaneously tracking the progress of surgery as evidenced by the introduction of asepsis, anesthesia and nursing. Eakins mastery is revealed by its use of some European Old Masters approaches to portray medical professionals undertaking their daily duties in their work environments with critical and unadorned vision. This combination of vision and skills led Eakins to create a highly original yet analytical art. Unfortunately, his representations were far ahead of his time and resulted in under appreciation of his paintings and a censorious reaction to their content. His contemporaries rejection of Eakins work negatively affected his career as a painter, as a teacher and even his private life. This judgment was overturned in subsequent years and by the twentieth century Eakins was recognized as an American master without parallel. PMID:26230562

  13. Thoracic sonography for pneumothorax: The clinical evaluation of an operational space medicine spin-off

    NASA Astrophysics Data System (ADS)

    Kirkpatrick, Andrew W.; Nicolaou, Savvas; Rowan, Kevin; Liu, David; Cunningham, Johan; Sargsyan, Ashot E.; Hamilton, Douglas; Dulchavsky, Scott A.

    2005-05-01

    The recent interest in the use of ultrasound (US) to detect pneumothoraces after acute trauma in North America was initially driven by an operational space medicine concern. Astronauts aboard the International Space Station (ISS) are at risk for pneumothoraces, and US is the only potential medical imaging available. Pneumothoraces are common following trauma, and are a preventable cause of death, as most are treatable with relatively simple interventions. While pneumothoraces are optimally diagnosed clinically, they are more often inapparent even on supine chest radiographs (CXR) with recent series reporting a greater than 50% rate of occult pneumothoraces. In the course of basic scientific investigations in a conventional and parabolic flight laboratory, investigators familiarized themselves with the sonographic features of both pneumothoraces and normal pulmonary ventilation. By examining the visceral-parietal pleural interface (VPPI) with US, investigators became confident in diagnosing pneumothoraces. This knowledge was subsequently translated into practice at an American and a Canadian trauma center. The sonographic examination was found to be more accurate and sensitive than CXR (US 96% and 100% versus US 74% and 36%) in specific circumstances. Initial studies have also suggested that detecting the US features of pleural pulmonary ventilation in the left lung field may offer the ability to exclude serious endotracheal tube malpositions such as right mainstem and esophageal intubations. Applied thoracic US is an example of a clinically useful space medicine spin-off that is improving health care on earth.

  14. Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns

    PubMed Central

    Esch, Lindsay M.; Bird, Amber-Nicole; Oyler, Julie L.; Lee, Wei Wei; Shah, Sachin D.; Pincavage, Amber T.

    2015-01-01

    Introduction Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns’ ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. Methods During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. Results Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (p<0.001). All interns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. Conclusions The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered. PMID:26609962

  15. Racial and ethnic disparities in the clinical practice of emergency medicine.

    PubMed

    Richardson, Lynne D; Babcock Irvin, Charlene; Tamayo-Sarver, Joshua H

    2003-11-01

    There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as-yet-undocumented disparities in clinical emergency practice. Racial and ethnic disparities may arise in decisions made by out-of-hospital personnel regarding ambulance destination, triage assessments made by nursing personnel, diagnostic testing ordered by physicians or physician-extenders, and in disposition decisions. The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence-based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs. PMID:14597493

  16. How should clinical psychologists approach complementary and alternative medicine? Empirical, epistemological, and ethical considerations.

    PubMed

    Hughes, Brian M

    2008-04-01

    As complementary and alternative medicine (CAM) practices are often recommended for mental health problems, many clients in clinical psychology will be in receipt of such treatments from other practitioners. Some psychologists have argued that CAM and psychology are natural bedfellows, given their sharing of philosophies (e.g., holism), professional orientations (e.g., person-centeredness), and theoretical positions (e.g., mind-body connectionism). It has specifically been argued that the practices of CAM could productively be appropriated, or at least promoted, by clinical psychologists. However, other commentators have criticized CAM for comprising therapies that, by definition, are both intrinsically unscientific and lacking in empirical evidence. This article examines the current standing of CAM from empirical, epistemological, and ethical perspectives. CAM treatments are found to be based on heterogeneous epistemologies and to suffer from poor records in empirical efficacy research. Attention is given to possible psychological explanations for CAM's popularity in the face of poor evidence for efficacy. It is argued that, given the likely incompatibility of CAM with clinical psychology's positivist scientific ethos, CAM practices should not be integrated into clinical psychology at this time. PMID:17996344

  17. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine?

    PubMed Central

    Lillie, Elizabeth O; Patay, Bradley; Diamant, Joel; Issell, Brian; Topol, Eric J; Schork, Nicholas J

    2011-01-01

    N-of-1 or single subject clinical trials consider an individual patient as the sole unit of observation in a study investigating the efficacy or side-effect profiles of different interventions. The ultimate goal of an n-of-1 trial is to determine the optimal or best intervention for an individual patient using objective data-driven criteria. Such trials can leverage study design and statistical techniques associated with standard population-based clinical trials, including randomization, washout and crossover periods, as well as placebo controls. Despite their obvious appeal and wide use in educational settings, n-of-1 trials have been used sparingly in medical and general clinical settings. We briefly review the history, motivation and design of n-of-1 trials and emphasize the great utility of modern wireless medical monitoring devices in their execution. We ultimately argue that n-of-1 trials demand serious attention among the health research and clinical care communities given the contemporary focus on individualized medicine. PMID:21695041

  18. Translating personalized medicine using new genetic technologies in clinical practice: the ethical issues

    PubMed Central

    Ormond, Kelly E; Cho, Mildred K

    2014-01-01

    The integration of new genetic technologies into clinical practice holds great promise for the personalization of medical care, particularly the use of large-scale DNA sequencing for genome-wide genetic testing. However, these technologies also yield unprecedented amounts of information whose clinical implications are not fully understood, and we are still developing technical standards for measuring sequence accuracy. These technical and clinical challenges raise ethical issues that are similar to but qualitatively different from those that we are accustomed to dealing with for traditional medical genetics. The sheer amount of information afforded by genome sequencing requires rethinking of how to implement core ethical principles including, but not limited to: informed consent, privacy and data ownership and sharing, technology regulation, issues of access, particularly as new technology is integrated into clinical practice, and issues of potential stigma and impact on perceptions of disability. In this article, we will review the issues of informed consent, privacy, data ownership and technology regulation as they relate to the emerging field of personalized medicine and genomics. PMID:25221608

  19. Clinical application of kampo medicine (rikkunshito) for common and/or intractable symptoms of the gastrointestinal tract.

    PubMed

    Tominaga, Kazunari; Arakawa, Tetsuo

    2015-01-01

    Gastroenterological reflux disease and functional dyspepsia are usually treatable using Western medical practices. Nonetheless, some cases present with intractable symptoms that are not amenable to these therapies. Treatment with kampo, a traditional Japanese medicine, recently has been proposed as an alternative therapy for use in combination with the Western practices. In general, traditional Japanese medicines have been used empirically for intractable symptoms correctively designated as "general malaises." Accumulating lines of evidence, including basic and clinical researches, have demonstrate detailed mechanisms where traditional Japanese medicines exert pharmacological action to improve symptoms. Therefore, traditional Japanese medicines have been gaining use by various medical doctors as the specific modes of pharmacological action are recognized. This review covers both the pharmacological functions and the clinical efficacies of rikkunshito for use in treating disorders of the gastrointestinal tract. PMID:25688209

  20. Application of diet-derived taste active components for clinical nutrition: perspectives from ancient Ayurvedic medical science, space medicine, and modern clinical nutrition.

    PubMed

    Kulkarni, Anil D; Sundaresan, Alamelu; Rashid, Muhammad J; Yamamoto, Shigeru; Karkow, Francisco

    2014-01-01

    The principal objective of this paper is to demonstrate the role of taste and flavor in health from the ancient science of Ayurveda to modern medicine; specifically their mechanisms and roles in space medicine and their clinical relevance in modern heath care. It also describes the brief history of the use of the monosodium glutamate or flavor enhancers ("Umami substance") that improve the quality of food intake by stimulating chemosensory perception. In addition, the dietary nucleotides are known to be the components of "Umami substance" and the benefit of their use has been proposed in various types of patients with cancer, radiation therapy, organ transplantation, and for application in space medicine. PMID:23886389

  1. Precision medicine: Clarity for the clinical and biological complexity of Alzheimer’s and Parkinson’s diseases

    PubMed Central

    2015-01-01

    The goal of precision medicine is to deliver optimally targeted and timed interventions tailored to an individual’s molecular drivers of disease. This concept has wide currency in cancer care and in some diseases caused by monogenetic mutations, such as cystic fibrosis, and recently has been endorsed by the White House Office of Science and Technology for more widespread application in medicine. Here we describe our vision of how precision medicine can bring greater clarity to the clinical and biological complexity of the two most common neurodegenerative diseases, Alzheimer’s disease and Parkinson’s disease. PMID:25941321

  2. Personalized Medicine: how to Switch from the Concept to the Integration into the Clinical Development Plan to Obtain Marketing Authorization.

    PubMed

    Becquemont, Laurent; Bordet, Régis; Cellier, Dominic

    2012-01-01

    One of the challenges of the coming years is to personalize medicine in order to provide each patient with an individualized treatment plan. The three objectives of personalized medicine are to refine diagnosis, rationalize treatment and engage patients in a preventive approach. Personalization can be characterized by various descriptors whether related to the field, biology, imaging, type of lesion of the entity to be treated, comorbidity factors, coprescriptions or the environment As part of personalized medicine focused on biological markers including genetics or genomics, the integration of the clinical development plan to obtain marketing authorization may be segmented in 3 stages with a known descriptor identified before clinical development, a known descriptor discovered during clinical development or a known descriptor known after clinical development. For each stage, it is important to clearly define the technical optimization elements, to specify the expectations and objectives, to examine the methodological aspects of each clinical development phase and finally to consider the fast changing regulatory requirements in view of the few registered therapeutics complying with the definition of personalized medicine as well as the significant technological breakthroughs according to the screened and selected biomarkers. These considerations should be integrated in view of the time required for clinical development from early phase to MA, i.e. more than 10 years. Moreover, business models related to the economic environment should be taken into account when deciding whether or not to retain a biomarker allowing the selection of target populations in a general population. PMID:23110835

  3. Assessing medical student empathy in a family medicine clinical test: validity of the CARE measure

    PubMed Central

    Chen, Julie Y.; Chin, Weng Y.; Fung, Colman S. C.; Wong, Carlos K. H.; Tsang, Joyce P. Y.

    2015-01-01

    Introduction The Consultation and Relational Empathy (CARE) measure developed and validated in primary care settings and used for general practitioner appraisal is a 10-item instrument used by patients to assess doctors’ empathy. The aim of this study is to investigate the validity of the CARE measure in assessing medical students’ empathy during a formative family medicine clinical test. Method All 158 final-year medical students were assessed by trained simulated patients (SPs) – who completed the CARE measure, the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a global rating score to assess students’ empathy and history-taking ability. Results Exploratory and confirmatory factor analysis identified a unidimensional structure. The CARE measure strongly correlated with both convergent measures: global rating (ρ=0.79 and <0.001) and JSPPPE (ρ=0.77 and <0.001) and weakly correlated with the divergent measure: history-taking score (ρ=0.28 and <0.001). Internal consistency was excellent (Cronbach’s α=0.94). Conclusion The CARE measure had strong construct and internal reliability in a formative, undergraduate family medicine examination. Its role in higher stakes examinations and other educational settings should be explored. PMID:26154863

  4. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

    PubMed

    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies. PMID:22450181

  5. Clinical holistic medicine: avoiding the Freudian trap of sexual transference and countertransference in psychodynamic therapy.

    PubMed

    Ventegodt, Søren; Kandel, Isack; Merrick, Joav

    2008-01-01

    Sexual transference and countertransference can make therapy slow and inefficient when libidinous gratification becomes more important for both the patient and the therapist than real therapeutic progress. Sexual transference is normal when working with a patient's repressed sexuality, but the therapeutic rule of not touching often hinders the integration of sexual traumas, as this needs physical holding. So the patient is often left with sexual, Oedipal energies projected onto the therapist as an "idealized father" figure. The strong and lasting sexual desire for the therapist without any healing taking place can prolong therapy for many years, as it often does in psychodynamic psychotherapy and psychoanalysis. We call this problem "Freud's Trap". Freud used intimate bodywork, such as massage, in the beginning of his career, but stopped, presumably for moral and political reasons. In the tradition of psychoanalysis, touch is therefore not allowed. Recent research in clinical holistic medicine (CHM), salutogenesis, and sexual healing has shown that touch and bodywork (an integral part of medicine since Hippocrates) are as important for healing as conversational therapy. CHM allows the patient to regress spontaneously to early sexual and emotional traumas, and to heal the deep wounds on body, soul, and sexual character from arrested psychosexual development. CHM treats sexuality in therapy more as the patient's internal affair (i.e., energy work) and less as a thing going on between the patient and the therapist (i.e., transference). This accelerates healing, and reduces sexual transference and the need for mourning at the end of therapy. PMID:18454245

  6. Clinically-relevant chemotherapy interactions with complementary and alternative medicines in patients with cancer.

    PubMed

    Yap, Kevin Yi-Lwern; See, Cheng Shang; Chan, Alexandre

    2010-01-01

    Complementary and alternative medicines (CAMs), in particular herbal medicines, are commonly used by cancer patients in conjunction with chemotherapy treatment for their anticancer properties and supportive care. However, the effects of many of these herbs are not well-documented due to limited studies done on them. Severe herb-drug interactions (HDIs) have been recorded in some cases, and failure to recognize these harmful HDIs can lead to dire consequences in cancer patients. This study discusses clinically-relevant interactions between anticancer drugs (ACDs) and herbs classified into 7 categories: cancer treatment and prevention, immune-system-related, alopecia, nausea and vomiting, peripheral neuropathy and pain, inflammation, and fatigue. Some promising patents which contain these herbs and thus may manifest these interactions are also presented in this article. Pharmacokinetic interactions involved mainly induction or inhibition of the cytochrome P450 isozymes and p-glycoprotein, while pharmacodynamic interactions were related to increased risks of central nervous system-related effects, hepatotoxicity and bleeding, among others. Clinicians should be vigilant when treating cancer patients who take CAMs with concurrent chemotherapy since they face a high risk of HDIs. These HDIs can be minimized or avoided by selecting herb-drug pairs which are less likely to interact. Furthermore, close monitoring of pharmacological effects and plasma drug levels should be carried out to avoid toxicity and ensure adequate chemotherapeutic coverage in patients with cancer. PMID:20653549

  7. Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine

    PubMed Central

    Castelnuovo, Gianluca; Zoppis, Italo; Santoro, Eugenio; Ceccarini, Martina; Pietrabissa, Giada; Manzoni, Gian Mauro; Corti, Stefania; Borrello, Maria; Giusti, Emanuele Maria; Cattivelli, Roberto; Melesi, Anna; Mauri, Giancarlo; Molinari, Enrico; Sicurello, Francesco

    2015-01-01

    Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of eHealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the “chronic care management” challenge in both traditional and mHealth settings. PMID:25926801

  8. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

    PubMed Central

    Bäckryd, Emmanuel

    2015-01-01

    Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. “opioid epidemic” is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of “noci-marker” is presented as an alternative to “pain biomarker”, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science. PMID:26854144

  9. Chemokine Receptor CCR5 Antagonist Maraviroc: Medicinal Chemistry and Clinical Applications

    PubMed Central

    Xu, Guoyan G.; Guo, Jia; Wu, Yuntao

    2015-01-01

    The human immunodeficiency virus (HIV) causes acquired immumodeficiency syndrome (AIDS), one of the worst global pandemic. The virus infects human CD4 T cells and macrophages, and causes CD4 depletion. HIV enters target cells through the binding of the viral envelope glycoprotein to CD4 and the chemokine coreceptor, CXCR4 or CCR5. In particular, the CCR5-utilizing viruses predominate in the blood during the disease course. CCR5 is expressed on the surface of various immune cells including macrophages, monocytes, microglia, dendric cells, and active memory CD4 T cells. In the human population, the CCR5 genomic mutation, CCR5Δ32, is associated with relative resistance to HIV. These findings paved the way for the discovery and development of CCR5 inhibitors to block HIV transmission and replication. Maraviroc, discovered as a CCR5 antagonist, is the only CCR5 inhibitor that has been approved by both US FDA and the European Medicines Agency (EMA) for treating HIV/AIDS patients. In this review, we summarize the medicinal chemistry and clinical studies of Maraviroc. PMID:25159165

  10. Radiologists’ perspectives about evidence-based medicine and their clinical practice: a semistructured interview study

    PubMed Central

    Tong, Allison; Mahady, Suzanne E; Craig, Jonathan C; Lau, Gabes; Peduto, Anthony J; Loy, Clement

    2014-01-01

    Objectives To describe radiologist's attitudes and perspectives on evidence-based medicine (EBM) and their practice. Design Face-to-face semistructured interviews, thematic analysis. Setting 24 institutions across six Australian states and New Zealand. Transcripts were imported into HyperRESEARCH software and thematically analysed. Participants 25 radiologists. Results Six themes were identified: legitimising decisions (validated justification, prioritising patient preferences, reinforcing protocols), optimising outcomes (ensuring patient safety, maximising efficiency), availability of access (requiring immediacy, inadequacy of evidence, time constraints, proximity of peer networks, grasping information dispersion), over-riding pragmatism (perceptibly applicability, preserving the art of medicine, technical demands), limited confidence (conceptual obscurity, reputation-based trust, demands constant practice, suspicion and cynicism), and competing powers (hierarchical conflict, prevailing commercial interests). Conclusions Radiologists believe EBM can support clinical decision-making for optimal patient outcomes and service efficiency but feel limited in their capacities to assimilate and apply EBM in practice. Improving access to evidence, providing ongoing education and training supplemented with practical tools for appraising evidence; and developing evidence-based guidelines and protocols may enhance feasibility and promote the confidence and skills among radiologists in applying EBM in radiology practice for better patient care. PMID:25500161

  11. Acellular approaches for regenerative medicine: on the verge of clinical trials with extracellular membrane vesicles?

    PubMed

    Fuster-Matanzo, Almudena; Gessler, Florian; Leonardi, Tommaso; Iraci, Nunzio; Pluchino, Stefano

    2015-01-01

    Extracellular vesicles (EVs) are a heterogeneous population of naturally occurring secreted small vesicles, with distinct biophysical properties and different functions both in physiology and under pathological conditions. In recent years, a number of studies have demonstrated that EVs might hold remarkable potential in regenerative medicine by acting as therapeutically promising nanodrugs. Understanding their final impact on the biology of specific target cells as well as clarification of their overall therapeutic impact remains a matter of intense debate. Here we review the key principles of EVs in physiological and pathological conditions with a specific highlight on the most recently described mechanisms regulating some of the EV-mediated effects. First, we describe the current debates and the upcoming research on EVs as potential novel therapeutics in regenerative medicine, either as unmodified agents or as functionalized small carriers for targeted drug delivery. Moreover, we address a number of safety aspects and regulatory limitations related to the novel nature of EV-mediated therapeutic applications. Despite the emerging possibilities of EV treatments, these issues need to be overcome in order to allow their safe and successful application in future explorative clinical studies. PMID:26631254

  12. [Education of clinical laboratory medicine in the premedical course of Fukushima Medical University].

    PubMed

    Yoshida, Hiroshi

    2003-11-01

    Education of clinical laboratory medicine in the medical course of Fukushima Medical University School of Medicine is described. It include lectures (90 min, 15 times) for the 4th grade students and practices for the 5th grade students (one week/2 w, 16 times) and for the 6th grade students (one week/2 w, 4-5 times). In the practice course of 5th grade students, subjects concerning preanalytical issues have been employed to understand the importance. Specimens for practices are taken from every student, which include urines for urinalysis, feces for occult blood test, bloods for Wright-Giemsa staining and cell morphology and coagulation tests, and pharyngeal fluids for Gram staining. In the 6th grade course, residual specimens from anonymous patients are used, and ECG examination is performed by the permission of patients. Through the experiences of sample collections and practices of elementary laboratory tests, students are expected to realize anxiety and pain of patients, to understand the importance of preanalytical variables and to master fundamental laboratory techniques as physicians. PMID:14679797

  13. The portfolio approach to competency-based assessment at the Cleveland Clinic Lerner College of Medicine.

    PubMed

    Dannefer, Elaine F; Henson, Lindsey C

    2007-05-01

    Despite the rapid expansion of interest in competency-based assessment, few descriptions of assessment systems specifically designed for a competency-based curriculum have been reported. The purpose of this article is to describe the design of a portfolio approach to a comprehensive, competency-based assessment system that is fully integrated with the curriculum to foster an educational environment focused on learning. The educational design goal of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University was to create an integrated educational program-curriculum and instructional methods, student assessment processes, and learning environment-to prepare medical students for success in careers as physician investigators. The first class in the five-year program matriculated in 2004. To graduate, a student must demonstrate mastery of nine competencies: research, medical knowledge, communication, professionalism, clinical skills, clinical reasoning, health care systems, personal development, and reflective practice. The portfolio provides a tool for collecting and managing multiple types of assessment evidence from multiple contexts and sources within the curriculum to document competence and promote reflective practice skills. This article describes how the portfolio was developed to provide both formative and summative assessment of student achievement in relation to the program's nine competencies. PMID:17457074

  14. Vitamin D, Essential Minerals, and Toxic Elements: Exploring Interactions between Nutrients and Toxicants in Clinical Medicine.

    PubMed

    Schwalfenberg, Gerry K; Genuis, Stephen J

    2015-01-01

    In clinical medicine, increasing attention is being directed towards the important areas of nutritional biochemistry and toxicant bioaccumulation as they relate to human health and chronic disease. Optimal nutritional status, including healthy levels of vitamin D and essential minerals, is requisite for proper physiological function; conversely, accrual of toxic elements has the potential to impair normal physiology. It is evident that vitamin D intake can facilitate the absorption and assimilation of essential inorganic elements (such as calcium, magnesium, copper, zinc, iron, and selenium) but also the uptake of toxic elements (such as lead, arsenic, aluminum, cobalt, and strontium). Furthermore, sufficiency of essential minerals appears to resist the uptake of toxic metals. This paper explores the literature to determine a suitable clinical approach with regard to vitamin D and essential mineral intake to achieve optimal biological function and to avoid harm in order to prevent and overcome illness. It appears preferable to secure essential mineral status in conjunction with adequate vitamin D, as intake of vitamin D in the absence of mineral sufficiency may result in facilitation of toxic element absorption with potential adverse clinical outcomes. PMID:26347061

  15. Vitamin D, Essential Minerals, and Toxic Elements: Exploring Interactions between Nutrients and Toxicants in Clinical Medicine

    PubMed Central

    Schwalfenberg, Gerry K.; Genuis, Stephen J.

    2015-01-01

    In clinical medicine, increasing attention is being directed towards the important areas of nutritional biochemistry and toxicant bioaccumulation as they relate to human health and chronic disease. Optimal nutritional status, including healthy levels of vitamin D and essential minerals, is requisite for proper physiological function; conversely, accrual of toxic elements has the potential to impair normal physiology. It is evident that vitamin D intake can facilitate the absorption and assimilation of essential inorganic elements (such as calcium, magnesium, copper, zinc, iron, and selenium) but also the uptake of toxic elements (such as lead, arsenic, aluminum, cobalt, and strontium). Furthermore, sufficiency of essential minerals appears to resist the uptake of toxic metals. This paper explores the literature to determine a suitable clinical approach with regard to vitamin D and essential mineral intake to achieve optimal biological function and to avoid harm in order to prevent and overcome illness. It appears preferable to secure essential mineral status in conjunction with adequate vitamin D, as intake of vitamin D in the absence of mineral sufficiency may result in facilitation of toxic element absorption with potential adverse clinical outcomes. PMID:26347061

  16. Protein kinase small molecule inhibitors for rheumatoid arthritis: Medicinal chemistry/clinical perspectives

    PubMed Central

    Malemud, Charles J; Blumenthal, David E

    2014-01-01

    Medicinal chemistry strategies have contributed to the development, experimental study of and clinical trials assessment of the first type of protein kinase small molecule inhibitor to target the Janus kinase/Signal Transducers and Activators of Transcription (JAK/STAT) signaling pathway. The orally administered small molecule inhibitor, tofacitinib, is the first drug to target the JAK/STAT pathway for entry into the armamentarium of the medical therapy of rheumatoid arthritis. The introduction of tofacitinib into general rheumatologic practice coupled with increasing understanding that additional cellular signal transduction pathways including the mitogen-activated protein kinase and phosphatidylinositide-3-kinase/Akt/mammalian target of rapamycin pathways as well as spleen tyrosine kinase also contribute to immune-mediated inflammatory in rheumatoid arthritis makes it likely that further development of orally administered protein kinase small molecule inhibitors for rheumatoid arthritis will occur in the near future. PMID:25232525

  17. Relationship between Chinese medicine pattern types, clinical severity, and prognosis in patients with acute cerebral infarct.

    PubMed

    Jhong, Mao-chi; Tang, Nou-Ying; Liu, Chung-Hsiang; Huang, Wei-Hsih; Hsu, Yi-Ting; Liu, Yen-Liang; Li, Tsai-Chung; Hsieh, Ching-Liang

    2013-01-01

    We investigated the relationship between Chinese medicine pattern (CMP) types, their severity, and prognosis in patients (n = 187) with acute cerebral infarct (ACI). Six CMPs (wind, phlegm, fire-heat, blood stasis, qi deficiency, and yin deficiency and yang hyperactivity) were evaluated according to inspection, listening and smelling, inquiry, and palpitation. The severity and prognosis of each pattern type was determined according to the Glasgow Coma Scale (GCS), Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Functional Independence Measure (FIM), recorded at stroke onset and 12 weeks after stroke onset. The phlegm pattern (PP) patients displayed lower GCS, BI, and FIM scales scores, and higher MRS and NIHSS scales scores, than the nonphlegm pattern (N-PP) patients at, and 12 weeks after stroke onset, suggesting the clinical severity is greater and the prognosis is worse in PP patients with ACI than in non-PP patients with ACI. PMID:23906101

  18. 3-D Reconstruction From 2-D Radiographic Images and Its Application to Clinical Veterinary Medicine

    NASA Astrophysics Data System (ADS)

    Hamamoto, Kazuhiko; Sato, Motoyoshi

    3D imaging technique is very important and indispensable in diagnosis. The main stream of the technique is one in which 3D image is reconstructed from a set of slice images, such as X-ray CT and MRI. However, these systems require large space and high costs. On the other hand, a low cost and small size 3D imaging system is needed in clinical veterinary medicine, for example, in the case of diagnosis in X-ray car or pasture area. We propose a novel 3D imaging technique using 2-D X-ray radiographic images. This system can be realized by cheaper system than X-ray CT and enables to get 3D image in X-ray car or portable X-ray equipment. In this paper, a 3D visualization technique from 2-D radiographic images is proposed and several reconstructions are shown. These reconstructions are evaluated by veterinarians.

  19. Moral Expertise in the Clinic: Lessons Learned from Medicine and Science.

    PubMed

    McClimans, Leah; Slowther, Anne

    2016-08-01

    Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. PMID:27302969

  20. Virtual anthropology: useful radiological tools for age assessment in clinical forensic medicine and thanatology.

    PubMed

    Dedouit, Fabrice; Saint-Martin, Pauline; Mokrane, Fatima-Zohra; Savall, Frédéric; Rousseau, Hervé; Crubézy, Eric; Rougé, Daniel; Telmon, Norbert

    2015-09-01

    Virtual anthropology consists of the introduction of modern slice imaging to biological and forensic anthropology. Thanks to this non-invasive scientific revolution, some classifications and staging systems, first based on dry bone analysis, can be applied to cadavers with no need for specific preparation, as well as to living persons. Estimation of bone and dental age is one of the possibilities offered by radiology. Biological age can be estimated in clinical forensic medicine as well as in living persons. Virtual anthropology may also help the forensic pathologist to estimate a deceased person's age at death, which together with sex, geographical origin and stature, is one of the important features determining a biological profile used in reconstructive identification. For this forensic purpose, the radiological tools used are multislice computed tomography and, more recently, X-ray free imaging techniques such as magnetic resonance imaging and ultrasound investigations. We present and discuss the value of these investigations for age estimation in anthropology. PMID:25735613

  1. Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence.

    PubMed

    Sarris, Jerome; Panossian, Alexander; Schweitzer, Isaac; Stough, Con; Scholey, Andrew

    2011-12-01

    Research in the area of herbal psychopharmacology has increased markedly over the past decades. To date however, a comprehensive review of herbal antidepressant, anxiolytic and hypnotic psychopharmacology and applications in depression, anxiety and insomnia has been absent. A search of MEDLINE (PubMed), CINAHL, PsycINFO, and the Cochrane Library databases was conducted (up to February 21st 2011) on commonly used psychotropic herbal medicines. A review of the literature was conducted to ascertain mechanisms of action of these botanicals, in addition to a systematic review of controlled clinical trials for treatment of mood, anxiety and sleep disorders, which are common comorbid psychiatric disorders. Specific emphasis was given to emerging phytomedicines. Analysis of evidence levels was conducted, as were effect sizes (Cohen's d) where data were available. Results provided evidence of a range of neurochemical, endocrinological, and epigenetic effects for 21 individual phytomedicines, which are detailed in this paper. Sixty six controlled studies were located involving eleven phytomedicines. Several of these provide a high level of evidence, such as Hypericum perforatum for major depression, and Piper methysticum for anxiety disorders. Several human clinical trials provide preliminary positive evidence of antidepressant effects (Echium amoenum, Crocus sativus, and Rhodiola rosea) and anxiolytic activity (Matricaria recutita, Ginkgo biloba, Passiflora incanata, E. amoenum, and Scutellaria lateriflora). Caution should however be taken when interpreting the results as many studies have not been replicated. Several herbal medicines with in vitro and in vivo evidence are currently unexplored in human studies, and along with use of emerging genetic technologies "herbomics", are areas of potential future research. PMID:21601431

  2. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement.

    PubMed

    Thornton, Tim

    2006-01-01

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit.Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values. PMID:16759426

  3. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement

    PubMed Central

    Thornton, Tim

    2006-01-01

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit. Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values. PMID:16759426

  4. Clinical holistic medicine: teaching orgasm for females with chronic anorgasmia using the Betty Dodson method.

    PubMed

    Struck, Pia; Ventegodt, Søren

    2008-01-01

    The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis) through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM). The patients received 3 "e 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP) and complementary medicine (CAM bodywork, manual sexology similar to the inverted exclamation mark section signsexological examination inverted exclamation mark ). The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years) with chronic anorgasmia (for 12 years on average) who were participating in the inverted exclamation mark section signorgasm course for anorgasmic women inverted exclamation mark ; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 < NNT < 1.12, NNH > 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient. PMID:18836654

  5. Infectious disease following travel to developed regions: a snapshot of presentations to an Australian travel medicine clinic.

    PubMed

    Drewett, George; Leder, Karin

    2016-06-01

    Much of the travel medicine literature focuses on travel to 'developing' regions by travellers from 'developed' regions; however literature about travel to developed regions is scarce. This article examines presentations to a travel medicine clinic over a 17-year period with illnesses resulting from travel to developed regions. From a cohort of general presentations to the clinic of 1077 patients, 85 patients acquired infections due to travel to developed regions, with a total of 99 infectious diagnoses made. This serves to highlight the risk of infectious disease even among travel to only developed regions, and the importance of travel advice in these situations. PMID:27496541

  6. Ocular medicines in children: the regulatory situation related to clinical research

    PubMed Central

    2012-01-01

    Background Many ocular medications are prescribed for paediatric patients, but the evidence for their rational use is very scant. This study was planned to compare the availability and the licensing status of ocular medications marketed in Italy, the United Kingdom (UK), and the United States of America (USA) related to the amount of published and un-published RCTs testing these drugs in the paediatric population. Methods A quantitative analysis was performed to evaluate the number of ocular medications with a paediatric license in Italy, the UK, and the USA. A literature search was also performed in MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) on ophthalmic pharmacological therapy in children aged < 18 years, published up to December 2010. A search in the international clinical trial registries, the list of paediatric investigation plans (PIPs) approved by European Medicines Agency (EMA), and the table of medicines with new paediatric information approved by Food and Drug Administration (FDA) was also performed. Results In all, of 197 drugs identified, 68 (35%) single drugs are licensed for paediatric use at least in one considered country, while 23 (12%) were marketed in all three countries. More specifically, in Italy 43 single drugs (48% of those marketed) had a paediatric license, while 39 (64%) did in the UK and 22 (54%) did in the USA. Only 13 drugs were marketed with a paediatric license in all countries. The percentage of drugs licensed for paediatric use and for which at least one RCT had been performed ranged between 51% in Italy and 55% in the USA. No published RCTs were found for 11 (48%) drugs licensed for paediatric use in all three countries. In all, 74 (35%) of the retrieved RCTs involved mydriatic/cycloplegic medications. A total of 62 RCTs (56% completed) on 46 drugs were found in the international clinical trial registries. Cyclosporin and bevacizumab were being studied in many

  7. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.

    PubMed

    Frykholm, P; Pikwer, A; Hammarskjöld, F; Larsson, A T; Lindgren, S; Lindwall, R; Taxbro, K; Oberg, F; Acosta, S; Akeson, J

    2014-05-01

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should

  8. 1986 yearbook of nuclear medicine

    SciTech Connect

    Hoffer, P.B.; Gore, J.C.; Zaret, B.L.; Gottschalk, A.; Sostman, D.

    1986-01-01

    This year's edition summarizes recent published articles about nuclear medicine in major medical journals. The book starts with a review on quantitative analysis of thallium-201 scintigraphy. Chapters then follow on magnetic resonance imaging, the cardiovascular system, peripheral vasculature, the pulmonary system, physics and instrumentation, radiochemistry, and radiopharmacology, health physics and radiation biology, oncology, infection, bone, joints and muscles, the endocrine system, the genitourinary system, the gastrointestinal tract, hemotology, and the central nervous system.

  9. Automatic symptom name normalization in clinical records of traditional Chinese medicine

    PubMed Central

    2010-01-01

    Background In recent years, Data Mining technology has been applied more than ever before in the field of traditional Chinese medicine (TCM) to discover regularities from the experience accumulated in the past thousands of years in China. Electronic medical records (or clinical records) of TCM, containing larger amount of information than well-structured data of prescriptions extracted manually from TCM literature such as information related to medical treatment process, could be an important source for discovering valuable regularities of TCM. However, they are collected by TCM doctors on a day to day basis without the support of authoritative editorial board, and owing to different experience and background of TCM doctors, the same concept might be described in several different terms. Therefore, clinical records of TCM cannot be used directly to Data Mining and Knowledge Discovery. This paper focuses its attention on the phenomena of "one symptom with different names" and investigates a series of metrics for automatically normalizing symptom names in clinical records of TCM. Results A series of extensive experiments were performed to validate the metrics proposed, and they have shown that the hybrid similarity metrics integrating literal similarity and remedy-based similarity are more accurate than the others which are based on literal similarity or remedy-based similarity alone, and the highest F-Measure (65.62%) of all the metrics is achieved by hybrid similarity metric VSM+TFIDF+SWD. Conclusions Automatic symptom name normalization is an essential task for discovering knowledge from clinical data of TCM. The problem is introduced for the first time by this paper. The results have verified that the investigated metrics are reasonable and accurate, and the hybrid similarity metrics are much better than the metrics based on literal similarity or remedy-based similarity alone. PMID:20089162

  10. The sexual and reproductive consequences of congenital genitourinary anomalies.

    PubMed

    Woodhouse, C R

    1994-08-01

    The major congenital anomalies of the genitourinary tract may result in disturbances of sexual and reproductive function. In general the children grow up with the same aspirations as their more normal peers, which are to marry, have intercourse and produce children. Some achieve this despite the deformities and in others specific reconstructive surgery may be needed. In exstrophy the vagina lies parallel to the floor when the girl is standing and the introitus is seen on the lower abdominal wall rather than in the perineum. Episiotomy is required in 34% and formal vaginoplasty in 23% of the cases. The exstrophy penis has a tight dorsal chordee that must be corrected to allow intercourse. The neurological and social consequences of myelomeningocele do not prevent patients from having an interest in sex. Those who are able to walk are likely to have normal sexual function compared to about 50% of those who are wheelchair bound. The recurrence risk for neural tube defects in their offspring is 1:50 for sons and 1:13 for daughters regardless of the sex of the affected parent. The physiological consequences of posterior urethral valves result in weak ejaculation in 50% and highly viscous and alkaline semen in 50% of the cases. Of male patients with ambiguous genitalia or micropenis 75% have normal intercourse. PMID:8021989

  11. Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students

    PubMed Central

    Leung, Gabriel M; Johnston, Janice M; Tin, Keith Y K; Wong, Irene O L; Ho, Lai-Ming; Lam, Wendy W T; Lam, Tai-Hing

    2003-01-01

    Objective To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. Design Randomised controlled trial. Setting University of Hong Kong, 2001. Participants 169 fourth year medical students. Main outcome measures Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. Results The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. Conclusions Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making. PMID:14604933

  12. Clinical chemistry and laboratory medicine in Croatia: regulation of the profession.

    PubMed

    Simundic, Ana-Maria; Topic, Elizabeta; Cvoriscec, Dubravka; Cepelak, Ivana

    2011-01-01

    Heterogeneity exists across Europe in the definition of the profession of clinical chemistry and laboratory medicine and also in academic background of specialists in this discipline. This article provides an overview of the standards of education and training of laboratory professionals and quality regulations in Croatia. Clinical chemistry in Croatia is almost exclusively practiced by medical biochemists. Although term Medical biochemist often relates to medical doctors in other European countries, in Croatia medical biochemists are not medical doctors, but university degree professionals who are qualified scientifically. Practicing the medical biochemistry is regulated by The Health Care Law, The Law of the Medical Biochemistry Profession and The Law of the State and Private Health Insurance. According to the law, only medical biochemists are entitled to run and work in the medical biochemistry laboratory. University degree is earned after the 5 years of the studies. Register for medical biochemists is kept by the Croatian Chamber of Medical Biochemists. Licensing is mandatory, valid for 6 years and regulated by the government (Law on the Health Care, 1993). Vocational training for medical biochemists lasts 44 months and is regulated by the national regulatory document issued by the Ministry of Health. Accreditation is not mandatory and is provided by an independent, non-commercial national accreditation body. The profession has interdisciplinary character and a level of required competence and skills comparable to other European countries. PMID:22141201

  13. Impact of GPCRs in clinical medicine: genetic variants and drug targets

    PubMed Central

    Insel, Paul A.; Tang, Chih-Min; Hahntow, Ines; Michel, Martin C.

    2007-01-01

    Summary By virtue of their large number, widespread distribution and important roles in cell physiology and biochemistry, G-protein-coupled receptors (GPCR) play multiple important roles in clinical medicine. Here, we focus on 3 areas that subsume much of the recent work in this aspect of GPCR biology: 1) Monogenic diseases of GPCR; 2) Genetic variants of GPCR; and 3) Clinically useful pharmacological agonists and antagonists of GPCR. Diseases involving mutations of GPCR are rare, occurring in <1/1000 people, but disorders in which antibodies are directed against GPCR are more common. Genetic variants, especially single nucleotide polymorphisms (SNP), show substantial heterogeneity in frequency among different GPCRs but have not been evaluated for some GPCR. Many therapeutic agonists and antagonists target GPCR and show inter-subject variability in terms of efficacy and toxicity. For most of those agents, it remains an open question whether genetic variation in primary sequence of the GPCR is an important contributor to such inter-subject variability, although this is an active area of investigation. PMID:17081496

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

    PubMed

    Giordano, James; Engebretson, Joan

    2006-05-01

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

  15. From P0 to P6 medicine, a model of highly participatory, narrative, interactive, and “augmented” medicine: some considerations on Salvatore Iaconesi’s clinical story

    PubMed Central

    Bragazzi, Nicola Luigi

    2013-01-01

    Salvatore Iaconesi was recently diagnosed with a brain tumor. He decided to share his clinical records not only with doctors but with everybody who wishes to find him a cure. “Because cure is not unique,” he emphasizes “there are cures for the body and cures for the soul, and everyone, from a painter to a musician, can find me a cure. Please, feel free to take my clinical history for example and let it become a game, a video, a music, a picture, whatever you like.” The emblematic hallmark of the changing times, Salvatore Iaconesi’s case is an example of how many profound revolutions and steps medicine has undertaken during the past few centuries. Stemming from a form of remote medical paternalism and arriving at the concept of a therapeutic alliance, medicine nowadays faces challenges and opportunities at a level before unforeseeable and unimaginable. The new concept of P6 medicine (personalized, predictive, preventive, participatory, psychocognitive, and public) is discussed, together with its profound implications. PMID:23650443

  16. Does the Concept of the “Flipped Classroom” Extend to the Emergency Medicine Clinical Clerkship?

    PubMed Central

    Heitz, Corey; Prusakowski, Melanie; Willis, George; Franck, Christopher

    2015-01-01

    Introduction Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a “flipped classroom” model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning. Methods Students at two institutions were randomized to complete two of four selected EM clerkship topics in a “flipped fashion,” and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students’ discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus. Results Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol. Conclusion Preparation for a clinical shift with pre-assigned, web-based learning modules followed by an

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

    ERIC Educational Resources Information Center

    Parkerson, George R., Jr.; And Others

    1984-01-01

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

  18. The Exploration and Practice of the Comprehensive Reform in Graduate Education on Professional Degree of Clinical Medicine

    ERIC Educational Resources Information Center

    Xu, Ling-Xiao; Yu, Fang; Ma, Zhen-Qiu; Zhou, Tian-Hua; Geng, Xiao-Bei; Huang, He

    2014-01-01

    The comprehensive reform in graduate education of Zhejiang University for a professional degree in clinical medicine accommodates the demand of both the Ministry of Education and Ministry of Health of China for educational reform by putting forward a "5+3" pattern, an innovative training pattern for this degree. The pattern focuses on…

  19. Cleveland Clinic's summer research program in reproductive medicine: an inside look at the class of 2014

    PubMed Central

    Durairajanayagam, Damayanthi; Kashou, Anthony H; Tatagari, Sindhuja; Vitale, Joseph; Cirenza, Caroline; Agarwal, Ashok

    2015-01-01

    Background The American Center for Reproductive Medicine's summer internship course in reproductive medicine and research at Cleveland Clinic is a rigorous, results-oriented annual program that began in 2008 to train both local and international students in the fundamentals of scientific research and writing. The foremost goal of the program is to encourage premedical and medical students to aspire toward a career as a physician–scientist. The internship provides participants with an opportunity to engage in original bench research and scientific writing while developing theoretical knowledge and soft skills. This study describes selected survey responses from interns who participated in the 2014 internship program. The objective of these surveys was to elicit the interns' perspective on the internship program, its strengths and weaknesses, and to obtain insight into potential areas for improvement. Methods Questionnaires were structured around the five fundamental aspects of the program: 1) theoretical knowledge, 2) bench research, 3) scientific writing, 4) mentorship, and 5) soft skills. In addition, an exit survey gathered information on factors that attracted the interns to the program, communication with mentors, and overall impression of the research program. Results The opportunity to experience hands-on bench research and scientific writing, personalized mentorship, and the reputation of the institution were appreciated and ranked highly among the interns. Nearly 90% of the interns responded that the program was beneficial and well worth the time and effort invested by both interns and faculty. Conclusion The outcomes portrayed in this study will be useful in the implementation of new programs or refinement of existing medical research training programs. PMID:26563960

  20. Anterior Cruciate Ligament Injuries in Pediatric Athletes Presenting to Sports Medicine Clinic

    PubMed Central

    Stracciolini, Andrea; Stein, Cynthia J.; Zurakowski, David; Meehan, William P.; Myer, Gregory D.; Micheli, Lyle J.

    2015-01-01

    Background: Limited data exist regarding the effect of the growth process on anterior cruciate ligament (ACL) injury risk in male versus female children. Hypothesis: The proportion of ACL injuries/sports injuries presenting to clinic will vary by age, sex, and body mass index (BMI). Study Design: Cross-sectional epidemiologic study. Level of Evidence: Level 3. Methods: The study group consisted of a randomly selected 5% probability sample of all children 5 to 17 years of age presenting to a sports medicine clinic from January 1, 2000 to December 31, 2009; 2133 charts were reviewed. Data collected included demographics, height and weight, injury mechanism, diagnosis, treatment, previous injury, and organized sports. Results: A total of 206 ACL tears were analyzed (104 girls, 102 boys). Girls were slightly older than boys (15.1 ± 1.7 vs 14.3 ± 2.1 years; P < 0.01). Male-female comparison of ACL injury/total injury by age revealed that girls had a steeper increase by age than boys. Among 5- to 12-year-olds, boys had a higher ACL injury/total injury ratio than girls (all P < 0.01). Children 13 to 17 years of age showed no significant difference for sex in ACL injury/total injury ratio. As age advanced, the proportion of ACL injuries/total injuries increased for both girls (P < 0.01) and boys (P = 0.04). BMI was independently associated with an ACL injury (P < 0.01). Conclusion: The proportion of ACL injuries/total injuries was similar for boys and girls aged 13 to 17 years. Girls showed a significantly steeper increase in ACL injury proportion versus boys through puberty. Clinical Relevance: This study will increase clinician awareness of ACL injury occurrence in young male and female athletes 5 to 12 years of age. Injury prevention efforts should target young girls before the onset of puberty and before injury occurs. PMID:25984258

  1. Next generation sequencing in clinical medicine: Challenges and lessons for pathology and biomedical informatics

    PubMed Central

    Gullapalli, Rama R.; Desai, Ketaki V.; Santana-Santos, Lucas; Kant, Jeffrey A.; Becich, Michael J.

    2012-01-01

    The Human Genome Project (HGP) provided the initial draft of mankind's DNA sequence in 2001. The HGP was produced by 23 collaborating laboratories using Sanger sequencing of mapped regions as well as shotgun sequencing techniques in a process that occupied 13 years at a cost of ~$3 billion. Today, Next Generation Sequencing (NGS) techniques represent the next phase in the evolution of DNA sequencing technology at dramatically reduced cost compared to traditional Sanger sequencing. A single laboratory today can sequence the entire human genome in a few days for a few thousand dollars in reagents and staff time. Routine whole exome or even whole genome sequencing of clinical patients is well within the realm of affordability for many academic institutions across the country. This paper reviews current sequencing technology methods and upcoming advancements in sequencing technology as well as challenges associated with data generation, data manipulation and data storage. Implementation of routine NGS data in cancer genomics is discussed along with potential pitfalls in the interpretation of the NGS data. The overarching importance of bioinformatics in the clinical implementation of NGS is emphasized.[7] We also review the issue of physician education which also is an important consideration for the successful implementation of NGS in the clinical workplace. NGS technologies represent a golden opportunity for the next generation of pathologists to be at the leading edge of the personalized medicine approaches coming our way. Often under-emphasized issues of data access and control as well as potential ethical implications of whole genome NGS sequencing are also discussed. Despite some challenges, it's hard not to be optimistic about the future of personalized genome sequencing and its potential impact on patient care and the advancement of knowledge of human biology and disease in the near future. PMID:23248761

  2. Availability and affordability of new medicines in Latin American countries where pivotal clinical trials were conducted

    PubMed Central

    Ugalde, Antonio

    2015-01-01

    Abstract Objective To assess whether new pharmaceutical products approved by the United States Food and Drug Administration (FDA) in 2011 and 2012 were registered, commercialized and sold at affordable prices in the Latin American countries where they were tested. Methods We obtained a list of new molecular entities (new pharmaceutical products) approved by the FDA in 2011 and 2012. FDA medical reviews indicated the countries where pivotal clinical trials had been conducted. The registration status of the products was obtained from pharmaceutical registers; pharmaceutical companies confirmed their availability in national markets and local pricing observatories provided the price of medicines in retail pharmacies. Affordability was assessed as the cost of a course of treatment as a proportion of monthly income. Information on safety and efficacy was gathered from independent drug bulletins. Findings Of an expected 114 registrations, if the 33 products had been registered in all the countries where tested, only 68 (60%) were completed. Eight products were registered and commercialized in all countries but 10 had not been registered in any of the countries. With one exception, products for which we obtained pricing information (n = 18) cost more than the monthly minimum wage in all countries and 12 products cost at least five times the monthly minimum wage. Conclusion Many pharmaceutical products tested in Latin America are unavailable and/or unaffordable to most of the population. Ethical review committees should consider the local affordability and therapeutic relevance of new products as additional criteria for the approval of clinical trials. Finally, clinical trials have opportunity costs that need to be assessed. PMID:26600609

  3. The Genitourinary System [and] Instructor's Guide: The Genitourinary System. Health Occupations Education Module: Instructional Materials in Anatomy and Physiology for Pennsylvania Health Occupations Programs.

    ERIC Educational Resources Information Center

    National Evaluation Systems, Inc., Amherst, MA.

    This module on the genitourinary system is one of 17 modules designed for individualized instruction in health occupations education programs at both the secondary and postsecondary levels. It is part of an eight-unit miniseries on anatomy and physiology within the series of 17 modules. Following a preface which explains to the student how to use…

  4. Clinical forensic medicine and its main fields of activity from the foundation of the German Society of Legal Medicine until today.

    PubMed

    Pollak, S

    2004-09-10

    The fields mainly covered by clinical forensic medicine are subject to time-related changes which are described on the basis of the German literature of the 20th century. Some fields of forensic sexual medicine (diagnosis of virginity, proof of criminal abortion, potentia coeundi, potentia generandi, potentia concipiendi) have become less important in the daily work of medicolegal institutes, whereas victims of rape and sexual abuse continue to form a major part of the forensic examination material in the German-speaking countries. The evaluation of suspected physical child abuse has grown in importance since the 60s, and it is essentially the merit of Elisabeth Trube-Becker that this problem is now dealt with also in scientific medicine. More recently, medicolegal experts are increasingly confronted with further groups of persons: victims of domestic violence, abused/neglected seniors, refugees from countries where torture is used. A new special field, which established itself only in the 90s, is the estimation of age with regard to the criminal responsibility of suspects who have no identity papers or pretend to have none. A phenomenon frequently observed in the last two decades is the non-accidental self-infliction of injuries. Whereas in the first half of the 20th century the motive for self-mutilation was typically to evade military service, this category of injury was later mainly seen in the context of insurance fraud; more recently most forensically relevant self-inflicted injuries refer to simulated offenses (fictitious sexual offenses and robbery, attacks allegedly having a political background). One of the traditional fields of clinical forensic medicine continues to be the evaluation of victims and suspects following bodily harm and attempted homicides. In the field of civil law medicolegal experts are particularly often concerned with controversial consequences of traffic accidents (e.g. alleged whiplash injuries after rear-end collisions at low

  5. Community-based clinical education increases motivation of medical students to medicine of remote area: comparison between lecture and practice.

    PubMed

    Tani, Kenji; Yamaguchi, Harutaka; Tada, Saaya; Kondo, Saki; Tabata, Ryo; Yuasa, Shino; Kawaminami, Shingo; Nakanishi, Yoshinori; Ito, Jun; Shimizu, Nobuhiko; Obata, Fumiaki; Shin, Teruki; Bando, Hiroyasu; Kohno, Mitsuhiro

    2014-01-01

    In this study, we administered a questionnaire to medical students to evaluate the effect of community-based clinical education on their attitudes to community medicine and medicine in remote area. Questionnaires were given 4 times to all the students from first-year to sixth-year. Of 95 students, 65 students (68.4%) who completed all questionnaires, were used in this study. The intensity of students' attitudes was estimated by using visual analogue scale. The intensity of interest, a sense of fulfillment and passion in medicine of remote area was significantly increased after the community-based practice. On the other hand, the level of understanding in medicine in remote area was increased by the lecture not by the practice. The intensity of desire both to become a generalist and a specialist was significantly increased when the grade went up. Most of sixth-year students desired to have abilities of a generalist and a specialist simultaneously. This study shows that the community-based practice is more meaningful in increasing motivation in medicine in remote area than the lecture, and suggests that it is important to prepare more courses to experience community medicine to increase the number of physicians who desire to work in remote area. PMID:24705761

  6. Ultrasound in sports medicine: relevance of emerging techniques to clinical care of athletes.

    PubMed

    Yim, Eugene Sun; Corrado, Gianmichael

    2012-08-01

    The applications of ultrasound in managing the clinical care of athletes have been expanding over the past decade. This review provides an analysis of the research that has been published regarding the use of ultrasound in athletes and focuses on how these emerging techniques can impact the clinical management of athletes by sports medicine physicians. Electronic database literature searches were performed using the subject terms 'ultrasound' and 'athletes' from the years 2003 to 2012. The following databases were searched: PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus™. The search produced 617 articles in total, with a predominance of articles focused on cardiac and musculoskeletal ultrasound. 266 of the studies involved application of ultrasound in evaluating the cardiovascular properties of athletes, and 151 studies involved musculoskeletal ultrasound. Other applications of ultrasound included abdominal, vascular, bone density and volume status. New techniques in echocardiography have made significant contributions to the understanding of the physiological changes that occur in the athlete's heart in response to the haemodynamic stress associated with different types of activity. The likely application of these techniques will be in managing athletes with hypertrophic cardiomyopathy, and the techniques are near ready for application into clinical practice. These techniques are highly specialized, however, and will require referral to dedicated laboratories to influence the clinical management of athletes. Investigation of aortic root pathology and pulmonary vascular haemodynamics are also emerging, but will require additional studies with larger numbers and outcomes analysis to validate their clinical utility. Some of these techniques are relatively simple, and thus hold the potential to enter clinical management in a point-of-care fashion. Musculoskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques

  7. OncDRS: An integrative clinical and genomic data platform for enabling translational research and precision medicine

    PubMed Central

    Orechia, John; Pathak, Ameet; Shi, Yunling; Nawani, Aniket; Belozerov, Andrey; Fontes, Caitlin; Lakhiani, Camille; Jawale, Chetan; Patel, Chetansharan; Quinn, Daniel; Botvinnik, Dmitry; Mei, Eddie; Cotter, Elizabeth; Byleckie, James; Ullman-Cullere, Mollie; Chhetri, Padam; Chalasani, Poornima; Karnam, Purushotham; Beaudoin, Ronald; Sahu, Sandeep; Belozerova, Yelena; Mathew, Jomol P.

    2015-01-01

    We live in the genomic era of medicine, where a patient's genomic/molecular data is becoming increasingly important for disease diagnosis, identification of targeted therapy, and risk assessment for adverse reactions. However, decoding the genomic test results and integrating it with clinical data for retrospective studies and cohort identification for prospective clinical trials is still a challenging task. In order to overcome these barriers, we developed an overarching enterprise informatics framework for translational research and personalized medicine called Synergistic Patient and Research Knowledge Systems (SPARKS) and a suite of tools called Oncology Data Retrieval Systems (OncDRS). OncDRS enables seamless data integration, secure and self-navigated query and extraction of clinical and genomic data from heterogeneous sources. Within a year of release, the system has facilitated more than 1500 research queries and has delivered data for more than 50 research studies. PMID:27054074

  8. Level of control among patients with type 2 diabetes mellitus attending diabetic clinic under family medicine compared to diabetic clinic under endocrinology

    PubMed Central

    AlHabdan, Mohammed A; AlAteeq, Mohammed A; AlJurbou, Fiasal I

    2016-01-01

    Objectives To assess and compare level of control among patients with type 2 diabetes mellitus attending diabetic clinic under family medicine service and patients attending diabetic clinics under endocrinology service, and to explore the effect of different variables on the level of control in both groups. Methods Retrospective cross-sectional study by reviewing medical records of patients with type 2 diabetes mellitus and laboratory studies from Hospital Information System at King Abdul-Aziz Medical City, National Guard, Riyadh – Saudi Arabia using predesigned sheet for data collection. Results Among 352 patients enrolled in the study, 176 (50%) patients were from the family medicine setting and 176 (50%) patients were from the hospital setting. The mean glycosylated hemoglobin for the whole study population was 8.97±1.87. There was no significant difference between the two groups in regard to level of control (9.01±1.75 in the family medicine setting compared to 8.93±1.98 in the hospital setting). No significant correlation was found between level of control and age, duration of disease and number of follow-up visits in both settings. Conclusion Patients with type 2 diabetes mellitus in this study were found to be poorly controlled in both the settings, diabetic clinic under family medicine and diabetic clinic under endocrinology. More research should be done to explore quality of care in a family medicine setting for patients with type 2 diabetes mellitus, as such a setting is expected to be more accessible, more convenient, and more cost effective to patients. PMID:27143944

  9. National Cancer Institute's Precision Medicine Initiatives for the new National Clinical Trials Network.

    PubMed

    Abrams, Jeffrey; Conley, Barbara; Mooney, Margaret; Zwiebel, James; Chen, Alice; Welch, John J; Takebe, Naoko; Malik, Shakun; McShane, Lisa; Korn, Edward; Williams, Mickey; Staudt, Louis; Doroshow, James

    2014-01-01

    The promise of precision medicine will only be fully realized if the research community can adapt its clinical trials methodology to study molecularly characterized tumors instead of the traditional histologic classification. Such trials will depend on adequate tissue collection, availability of quality controlled, high throughput molecular assays, and the ability to screen large numbers of tumors to find those with the desired molecular alterations. The National Cancer Institute's (NCI) new National Clinical Trials Network (NCTN) is well positioned to conduct such trials. The NCTN has the ability to seamlessly perform ethics review, register patients, manage data, and deliver investigational drugs across its many sites including both in cities and rural communities, academic centers, and private practices. The initial set of trials will focus on different questions: (1) Exceptional Responders Initiative-why do a minority of patients with solid tumors or lymphoma respond very well to some drugs even if the majority do not?; (2) NCI MATCH trial-can molecular markers predict response to targeted therapies in patients with advanced cancer resistant to standard treatment?; (3) ALCHEMIST trial-will targeted epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors improve survival for adenocarcinoma of the lung in the adjuvant setting?; and (4) Lung Cancer Master Protocol trial for advanced squamous cell lung cancer-is there an advantage to developing drugs for small subsets of molecularly characterized tumors in a single, multiarm trial design? These studies will hopefully spawn a new era of treatment trials that will carefully select the tumors that may respond best to investigational therapy. PMID:24857062

  10. Publishing history does not correlate with clinical performance among internal medicine residents.

    PubMed

    Cavalcanti, Rodrigo B; Detsky, Allan S

    2010-05-01

    OBJECTIVES Selection criteria for applicants to the internal medicine programme at the University of Toronto have included the number and quality of scholarly items published. We sought to determine whether previous publishing record correlated with resident performance as measured by in-training evaluation reports (ITERs) and global impressions of clinical competency by site programme directors and senior educators (global impression). METHODS Data on the total number, quality and type of items published, as well as the timing of publishing with regard to pre-MD training, were abstracted from the curricula vitae of individuals who applied for residency during 2001-2005. These were correlated with overall, Expert and Scholar role ITER scores, and with global impression, using Spearman rank correlation scores. RESULTS We gathered publishing history data on 181 residents, for 162 of whom ITER data were available. Overall, 68.5% of residents had published, but only 14.9% had published during medical school. There was a weak correlation of borderline significance (rho = 0.15, P = 0.055) between overall ITER score and number of items published. No such correlation was found with CanMEDS Medical Expert and Scholar role scores. Global impression classified 33.9% of residents as top-rated. More top-rated residents had published (76.7% versus 65.1%; P = 0.07), but the number of items published during medical school were similar between top-rated and non-top-rated residents (16.1% versus 12.3%; P = 0.46). CONCLUSIONS Our results do not support publishing record as a predictor of residents' clinical performance. Surprisingly, the correlation between publishing record and Scholar role scores was also weak, possibly indicating an inability of the ITER to capture this competency. Further research is needed to identify predictors and measures of performance in scholarly activities. PMID:20345694

  11. Bioinformatics for precision medicine in oncology: principles and application to the SHIVA clinical trial

    PubMed Central

    Servant, Nicolas; Roméjon, Julien; Gestraud, Pierre; La Rosa, Philippe; Lucotte, Georges; Lair, Séverine; Bernard, Virginie; Zeitouni, Bruno; Coffin, Fanny; Jules-Clément, Gérôme; Yvon, Florent; Lermine, Alban; Poullet, Patrick; Liva, Stéphane; Pook, Stuart; Popova, Tatiana; Barette, Camille; Prud’homme, François; Dick, Jean-Gabriel; Kamal, Maud; Le Tourneau, Christophe; Barillot, Emmanuel; Hupé, Philippe

    2014-01-01

    Precision medicine (PM) requires the delivery of individually adapted medical care based on the genetic characteristics of each patient and his/her tumor. The last decade witnessed the development of high-throughput technologies such as microarrays and next-generation sequencing which paved the way to PM in the field of oncology. While the cost of these technologies decreases, we are facing an exponential increase in the amount of data produced. Our ability to use this information in daily practice relies strongly on the availability of an efficient bioinformatics system that assists in the translation of knowledge from the bench towards molecular targeting and diagnosis. Clinical trials and routine diagnoses constitute different approaches, both requiring a strong bioinformatics environment capable of (i) warranting the integration and the traceability of data, (ii) ensuring the correct processing and analyses of genomic data, and (iii) applying well-defined and reproducible procedures for workflow management and decision-making. To address the issues, a seamless information system was developed at Institut Curie which facilitates the data integration and tracks in real-time the processing of individual samples. Moreover, computational pipelines were developed to identify reliably genomic alterations and mutations from the molecular profiles of each patient. After a rigorous quality control, a meaningful report is delivered to the clinicians and biologists for the therapeutic decision. The complete bioinformatics environment and the key points of its implementation are presented in the context of the SHIVA clinical trial, a multicentric randomized phase II trial comparing targeted therapy based on tumor molecular profiling versus conventional therapy in patients with refractory cancer. The numerous challenges faced in practice during the setting up and the conduct of this trial are discussed as an illustration of PM application. PMID:24910641

  12. Electronic Cigarettes and Vaping: A New Challenge in Clinical Medicine and Public Health. A Literature Review

    PubMed Central

    Palazzolo, Dominic L.

    2013-01-01

    Electronic cigarette (e-cigarette) use, or vaping, in the United States and worldwide is increasing. Their use is highly controversial from scientific, political, financial, psychological, and sociological ideologies. Given the controversial nature of e-cigarettes and vaping, how should medical care providers advise their patients? To effectively face this new challenge, health care professionals need to become more familiar with the existing literature concerning e-cigarettes and vaping, especially the scientific literature. Thus, the aim of this article is to present a review of the scientific evidence-based primary literature concerning electronic cigarettes and vaping. A search of the most current literature using the pubmed database dating back to 2008, and using electronic cigarette(s) or e-cigarette(s) as key words, yielded a total of 66 highly relevant articles. These articles primarily deal with (1) consumer-based surveys regarding personal views on vaping, (2) chemical analysis of e-cigarette cartridges, solutions, and mist, (3) nicotine content, delivery, and pharmacokinetics, and (4) clinical and physiological studies investigating the effects of acute vaping. When compared to the effects of smoking, the scant available literature suggests that vaping could be a “harm reduction” alternative to smoking and a possible means for smoking cessation, at least to the same degree as other Food and Drug Administration-approved nicotine replacement therapies. However, it is unclear if vaping e-cigarettes will reduce or increase nicotine addiction. It is obvious that more rigorous investigations of the acute and long-term health effects of vaping are required to establish the safety and efficacy of these devices; especially parallel experiments comparing the cardiopulmonary effects of vaping to smoking. Only then will the medical community be able to adequately meet the new challenge e-cigarettes and vaping present to clinical medicine and public health. PMID

  13. Regulation (EU) No 536/2014 on clinical trials on medicinal products for human use: an overview.

    PubMed

    Petrini, Carlo

    2014-01-01

    For the 28 member states of the European Union, Regulation (EU) No 536/2014 on clinical trials on medicinal products for human use, which repeals Directive 2001/20/EC, represents a substantial innovation in the procedures for authorising clinical trials and for handling all the subsequent stages. It introduces a single authorisation that will be valid for all EU member states, as well as a single portal through which all data concerning all clinical trials performed throughout the EU will pass. The present article offers an overview of the general aspects of the new procedures. It does not address the specific issues involved, each of which merits separate examination. PMID:25522070

  14. Precision medicine at Memorial Sloan Kettering Cancer Center: clinical next-generation sequencing enabling next-generation targeted therapy trials.

    PubMed

    Hyman, David M; Solit, David B; Arcila, Maria E; Cheng, Donavan T; Sabbatini, Paul; Baselga, Jose; Berger, Michael F; Ladanyi, Marc

    2015-12-01

    Implementing a center-wide precision medicine strategy at a major cancer center is a true multidisciplinary effort and requires comprehensive alignment of a broad screening strategy with a clinical research enterprise that can use these data to accelerate development of new treatments. Here, we describe the genomic screening approach at Memorial Sloan Kettering Cancer Center, a hybridization capture-based next-generation sequencing clinical assay for solid tumor molecular oncology designated MSK-IMPACT, and how it enables and supports a large clinical trial portfolio enriched for multi-histology, biomarker-selected, 'basket' studies of targeted therapies. PMID:26320725

  15. Good publication practices in clinical pharmacology: transparency, evidence-based medicine and the 7-D assessment*

    PubMed Central

    Woodcock, Barry G.; Luger, Veronika

    2015-01-01

    Transparency and evidence-based medicine are cornerstones of good publication practices (GPP), and concern publishers, editors, research investigators, and reviewers alike. Methods for implementing these principles within the framework of GPP are described. The main aspects include obtaining a Manuscript Agreement Contract, a Statement on Transparency of Authorship and a Declaration of Conflicts of Interest from the authors. Assessing whether a manuscript meets the requirements of EBM is demonstrated using the “7-D assessment”. The main purpose of this tool is to established that the (1) right Design, (2) right Diagnosis, (3) right Drug molecule, (4) right Dosage, (5) right Data, (6) right Deductions, and (7) right Documentation have been implemented in order to meet the objectives of the investigation. If the findings from any one of these assessments is questionable, the compliance of the research with EBM principles will be weakened and the reviewers and editors will make recommendations to the publisher accordingly. The guidelines described will help to provide a fair and transparent process of scientific publication and foster the freedom of clinical pharmacological research. PMID:26329349

  16. Training international medical graduate clinical fellows: the challenges and opportunities for adolescent medicine programs.

    PubMed

    Goldberg, Eudice

    2016-08-01

    Adolescent medicine achieved accreditation status first in the United States in 1994 and then in Canada in 2008 and even if it is not an accredited subspecialty in most other Western nations, it has still become firmly established as a distinct discipline. This has not necessarily been the case in some developing countries, where even the recognition of adolescence as a unique stage of human development is not always acknowledged. The program at SickKids in Toronto has prided itself in treating its international medical graduates (IMG) clinical fellows the same as their Canadian subspecialty residents by integrating them seamlessly into the training program. Although this approach has been laudable to a great extent, it may have fallen short in formally acknowledging and addressing the challenges that the IMG trainees have had to overcome. Moving forward, faculty must be trained and supports instituted that are geared specifically towards these challenges. This must be done on a formal basis to ensure both the success of the trainees as well as the overall enrichment of the fellowship training programs. PMID:26115499

  17. Observations from the Mayo Clinic National Conference on Medicine and the Media.

    PubMed

    Lantz, Jane C; Lanier, William L

    2002-12-01

    In September 2002, the Mayo Clinic National Conference on Medicine and the Media convened to consider the accurate, timely, and responsible reporting of medical news to the public. The more than 500 participants included medical and health journalists, scientific journal editors, physicians and other health care professionals, industry representatives, government officials, institutional public information officers, public relations professionals, patients, and representatives of patient advocacy groups. The goal of the conference was to bring together all facets of the medical news dissemination process with the hope of identifying ways to serve the public more effectively. Several key observations emerged: Medical news reports may be confusing because the underlying scientific issues are unresolved and open to multiple interpretations. People who are ill have different information needs than the rest of the public. Journalists' primary concern is accurate, clear reporting, with secondary concern for a story's consequences. Journalists consider themselves primarily reporters rather than educators, but the public expects reporting to contain an educational element. Financial and other more subtle interests may influence the quality and content of scientific news releases, presentations in scientific journals, and stories covered by print and broadcast news media. Full disclosure of commercial support and affiliations, peer review of study reports, and formal guidelines for conduct may limit inappropriate financial influence. PMID:12479517

  18. Nonadherence to antihypertensive medications and associated factors in general medicine clinics

    PubMed Central

    Al Ghobain, Mohammed; Alhashemi, H; Aljama, A; Bin Salih, S; Assiri, Z; Alsomali, A; Mohamed, Gamal

    2016-01-01

    Objectives Nonadherence to antihypertensive medications has not been assessed in the Saudi population. The aim of this study was to address and evaluate the magnitude of nonadherence among hypertensive patients and the risk factors associated with it. Methods A cross-sectional survey was conducted on hypertensive patients who attended the general internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a questionnaire that was modified after reviewing the literature. Hypertensive patients were labeled as nonadherent if they missed their medications for a total of 7 days during the previous month. Results A total of 302 patients participated in the study, of whom 63% were females with a mean age of 64 years, and 64% were illiterate. The prevalence of nonadherence to medications among hypertensive patients was found to be 12.3%. Poor disease knowledge was reported in 80% of patients, while 66% of the patients had poor monitoring of their disease. Younger age (≤65 years), poor monitoring, and uncontrolled blood pressure (BP ≥140/90 mmHg) were the predictor factors associated with nonadherence (odds ratio [OR] =2.04, P=0.025; OR=2.39, P=0.004; and OR=2.86, P=0.003, respectively). Conclusion Nonadherence to antihypertensive medications is lower than that previously reported in the literature. Younger age, uncontrolled BP, and poor monitoring are the main risk factors associated with nonadherence. PMID:27536073

  19. Ambient intelligence for monitoring and research in clinical neurophysiology and medicine: the MIMERICA* project and prototype.

    PubMed

    Pignolo, L; Riganello, F; Dolce, G; Sannita, W G

    2013-04-01

    Ambient Intelligence (AmI) provides extended but unobtrusive sensing and computing devices and ubiquitous networking for human/environment interaction. It is a new paradigm in information technology compliant with the international Integrating Healthcare Enterprise board (IHE) and eHealth HL7 technological standards in the functional integration of biomedical domotics and informatics in hospital and home care. AmI allows real-time automatic recording of biological/medical information and environmental data. It is extensively applicable to patient monitoring, medicine and neuroscience research, which require large biomedical data sets; for example, in the study of spontaneous or condition-dependent variability or chronobiology. In this respect, AML is equivalent to a traditional laboratory for data collection and processing, with minimal dedicated equipment, staff, and costs; it benefits from the integration of artificial intelligence technology with traditional/innovative sensors to monitor clinical or functional parameters. A prototype AmI platform (MIMERICA*) has been implemented and is operated in a semi-intensive unit for the vegetative and minimally conscious states, to investigate the spontaneous or environment-related fluctuations of physiological parameters in these conditions. PMID:23545248

  20. Clinical manifestations, disability and use of folk medicine in dracunculus infection in Nigeria.

    PubMed

    Ilegbodu, V A; Ilegbodu, A E; Wise, R A; Christensen, B L; Kale, O O

    1991-02-01

    A cross-sectional survey of households was carried out in a dracunculiasis endemic village in Oyo state Nigeria. Data were collected on history of dracunculiasis, occupational and domestic sources of drinking water, clinical manifestations, disability, use of folk medicine, and incorporation of previous dracunculiasis control programmes. The findings indicated that dracunculiasis patients were usually unaware of their infection 3-5 days before the appearance of a bleb; that religious affiliation appeared to be positively related to increasing morbidity; and that ulcers were predominantly in the ankles and feet, particularly among young children. Severe disability was related to age, site and number of ulcers, and the form of selected treatment. Indigenous remedy was the treatment of choice, although traditional healers in the community indicated no knowledge of any efficacious remedy. Mortality from secondary tetanus infection was associated with outbreak of dracunculiasis. The impact of dracunculiasis on agricultural, economic and recreational activities was considerable, with the infected farmers being unable to attend to their farms at the critical farming period. Sixty-one per cent of the residents were opposed on religious and aesthetic grounds to the treatment of the local surface water which contained cyclops species. Sixty-three per cent regarded the boiling and filtration of portions of their domestic water as an additional burden, cumbersome and impracticable.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1825339

  1. Psoriatic arthritis in Japan: difference in clinical features and approach to precision medicine.

    PubMed

    Tanaka, Yoshiya

    2016-01-01

    Psoriatic arthritis (PsA) is a chronic and progressive inflammatory arthritis that is common among patients with psoriasis, often resulting in permanent damage of joints and spines. Recent report indicates that the prevalence of PsA among Japanese patients with psoriasis is 14.3%, which is similar or slightly less than that of PsA in Caucasian, 6-42%. Skin disorders precede arthritis in 60-80% of Japanese patients with PsA and oligoarthritis or polyarthritis is the dominant pattern of them. The genotypic backgrounds appear different among Japanese and Caucasians. Biological DMARDs (bDMARDs) targeting cytokines IL-12/IL-23, TNF and IL-17 involved in the pathogenesis of PsA, have been emerging for the treatment. Although background characteristics are various among studies, anti-IL-17 seemed to be slightly better in Japanese than in global, whereas anti-IL-12/23 and anti-TNF tended to be better in global than in Japanese. Because PsA is a clinically heterogeneous disorder, we have tried to classify PsA by phenotypic differences of peripheral lymphocyte using 8-color flow cytometry and found that PsA can be divided to four types, activated Th17-dominant, Th1-dominant, both of them and neither of them. We currently try to treat patients with different bDMARDs based on the difference of lymphocyte phenotype, which may lead to precision medicine of PsA. PMID:27586804

  2. Integrating precision medicine in the study and clinical treatment of a severely mentally ill person

    PubMed Central

    O’Rawe, Jason A.; Fang, Han; Rynearson, Shawn; Robison, Reid; Kiruluta, Edward S.; Higgins, Gerald; Eilbeck, Karen; Reese, Martin G.

    2013-01-01

    .Glu429Ala allele in methylenetetrahydrofolate reductase (MTHFR) and the p.Asp7Asn allele in ChAT, encoding choline O-acetyltransferase, with both alleles having been shown to confer an elevated susceptibility to psychoses. We have found thousands of other variants in his genome, including pharmacogenetic and copy number variants. This information has been archived and offered to this person alongside the clinical sequencing data, so that he and others can re-analyze his genome for years to come. Conclusions. To our knowledge, this is the first study in the clinical neurosciences that integrates detailed neuropsychiatric phenotyping, deep brain stimulation for OCD and clinical-grade WGS with management of genetic results in the medical treatment of one person with severe mental illness. We offer this as an example of precision medicine in neuropsychiatry including brain-implantable devices and genomics-guided preventive health care. PMID:24109560

  3. Integrating precision medicine in the study and clinical treatment of a severely mentally ill person.

    PubMed

    O'Rawe, Jason A; Fang, Han; Rynearson, Shawn; Robison, Reid; Kiruluta, Edward S; Higgins, Gerald; Eilbeck, Karen; Reese, Martin G; Lyon, Gholson J

    2013-01-01

    .Glu429Ala allele in methylenetetrahydrofolate reductase (MTHFR) and the p.Asp7Asn allele in ChAT, encoding choline O-acetyltransferase, with both alleles having been shown to confer an elevated susceptibility to psychoses. We have found thousands of other variants in his genome, including pharmacogenetic and copy number variants. This information has been archived and offered to this person alongside the clinical sequencing data, so that he and others can re-analyze his genome for years to come. Conclusions. To our knowledge, this is the first study in the clinical neurosciences that integrates detailed neuropsychiatric phenotyping, deep brain stimulation for OCD and clinical-grade WGS with management of genetic results in the medical treatment of one person with severe mental illness. We offer this as an example of precision medicine in neuropsychiatry including brain-implantable devices and genomics-guided preventive health care. PMID:24109560

  4. Alternative therapies and medical science: designing clinical trials of alternative/complementary medicines--is evidence-based traditional Chinese medicine attainable?

    PubMed

    Critchley, J A; Zhang, Y; Suthisisang, C C; Chan, T Y; Tomlinson, B

    2000-05-01

    Evidence-based traditional Chinese medicine is attainable. With good planning and a positive attitude, the remedies used in traditional Chinese medicine (TCM) and Chinese proprietary medicines can be studied at a standard acceptable to modern science. The identification of an active principal should not delay the search for effective remedies from the TCM pharmacopoeia. Herbal mixtures can be validly tested to establish their efficacy. Problems with potential batch-to-batch variation can be circumvented by appropriate randomization. Subsequent independent screening and randomization to treatment and placebo arms can allow for the individualization of treatments by TCM practitioners. However, clearly defined treatments are required and should be recorded in a manner that enables other suitably trained researchers to reproduce them reliably (e.g., using prescriptions in Chinese). Quality control of TCM is a prerequisite of credible clinical trials. Correct natural ingredients must be used without adulteration or erroneous substitution. Evidence of safety in man is essential, and in lieu of data from formal toxicity studies, clear, convincing, and impartial evidence of safety is needed based on their long-term use in mainstream TCM practice backed up by publications in the Chinese medical/scientific literature. PMID:10806598

  5. Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons' medical practice and on health service.

    PubMed

    Pellino, Italia Maria; Pellino, Gianluca

    2015-12-01

    Increased knowledge in disease causes and progression, along with technological and technical advancements in their diagnosis and treatment, have led to increased expectations from physicians by patients and their relatives. The condition of "second victim" is known to affect caregivers that commit an error, and seriously impairs private life and subsequent practice. Besides, a condition has been described, the clinical-judicial syndrome, affecting caregivers at any moment during a medical litigation. In this scenario, physicians have started to practice "defensive medicine", aimed at protect themselves from liability rather than actually advancing care of patients. This paper represents the first review on defensive medicine with specific focus on surgery in an Italian setting. We reviewed the literature on the topic, with particular focus on surgeons and Italian current status, and provide the readers with a snapshot on these relevant issues, proposing strategies to prevent and reduce the practice of defensive medicine, and to support patients and physicians suffering from medical errors. PMID:26650202

  6. Rationale for the combination of nuclear medicine with magnetic resonance for pre-clinical imaging.

    PubMed

    Wagenaar, Douglas J; Kapusta, Maciej; Li, Junqiang; Patt, Bradley E

    2006-08-01

    Multi-modality combinations of SPECT/CT and PET/CT have proven to be highly successful in the clinic and small animal SPECT/CT and PET/CT are becoming the norm in the research and drug development setting. However, the use of ionizing radiation from a high-resolution CT scanner is undesirable in any setting and particularly in small animal imaging (SAI), in laboratory experiments where it can result in radiation doses of sufficient magnitude that the experimental results can be influenced by the organism's response to radiation. The alternative use of magnetic resonance (MR) would offer a high-resolution, non-ionizing method for anatomical imaging of laboratory animals. MR brings considerably more than its 3D anatomical capability, especially regarding the imaging of laboratory animals. Dynamic MR imaging techniques can facilitate studies of perfusion, oxygenation, and diffusion amongst others. Further, MR spectroscopy can provide images that can be related to the concentration of endogenous molecules in vivo. MR imaging of injected contrast agents extends MR into the domain of molecular imaging. In combination with nuclear medicine (NM) SPECT and PET modalities in small animal imaging, MR would facilitate studies of dynamic processes such as biodistribution, pharmacokinetics, and pharmacodynamics. However, the detectors for nearly all PET and SPECT systems are still based on vacuum tube technology, namely: photomultiplier tubes (PMT's) in which the signal is generated by transporting electrons over a substantial distance within an evacuated glass tube, making them inoperable in even small magnetic fields. Thus the combination of SPECT or PET with MR has not been practical until the recent availability of semiconductor detectors such as silicon avalanche photodiodes (APD's) for PET and CdZnTe (CZT) detectors for SPECT coupled with the availability of high-density low noise ASIC electronics to read out the semiconductor detectors. The strong advantage of these

  7. Clinical features and management of recurrent balanitis; association with atopy and genital washing.

    PubMed Central

    Birley, H D; Walker, M M; Luzzi, G A; Bell, R; Taylor-Robinson, D; Byrne, M; Renton, A M

    1993-01-01

    OBJECTIVE--To evaluate clinical features and diagnostic investigations in patients with recurrent or unresponsive balanitis in order to institute rational management. DESIGN--Forty-three patients presenting to a genitourinary medicine clinic with recurrent or persistent balanitis were studied. All patients were asked whether they had a history of atopic illness and about their practice of genital washing. All patients were investigated by taking a swab specimen from the preputial area for bacterial and viral culture and 30 underwent biopsy of the affected skin. Follow-up was between three and six months. SETTING--Outpatient genitourinary medicine clinic, St Mary's Hospital, London, UK. RESULTS--In 31 (72%) of the patients a diagnosis of irritant dermatitis was made. In comparison with the remaining patients, they had a greater lifetime incidence of atopic illness and more frequent daily genital washing with soap. For 28 (90%) of these patients, use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily. For the remaining 12 patients, a variety of diagnoses were made. Biopsy proved a well tolerated and diagnostic investigation, but the isolation of microbial pathogens from preputial swabs was irrelevant to management. CONCLUSION--A history of atopic illness and of the practice of penile washing are important aspects in the evaluation of patients with recurrent balanitis. Biopsy is an important investigation in the condition when it does not seem to be caused by irritant dermatitis. PMID:8244363

  8. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence.

    PubMed

    Sarris, Jerome; McIntyre, Erica; Camfield, David A

    2013-04-01

    Research in the area of herbal psychopharmacology has revealed a variety of promising medicines that may provide benefit in the treatment of general anxiety and specific anxiety disorders. However, a comprehensive review of plant-based anxiolytics has been absent to date. Thus, our aim was to provide a comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity. We present the article in two parts. In part one, we reviewed herbal medicines for which only preclinical investigations for anxiolytic activity have been performed. In this current article (part two), we review herbal medicines for which there have been both preclinical and clinical investigations of anxiolytic activity. A search of MEDLINE (PubMed), CINAHL, Scopus and the Cochrane Library databases was conducted (up to 28 October 2012) for English language papers using the search terms 'anxiety' OR 'anxiety disorder' OR 'generalized anxiety disorder' OR 'social phobia' OR 'post-traumatic stress disorder' OR 'panic disorder' OR 'agoraphobia' OR 'obsessive compulsive disorder' in combination with the search terms 'Herb*' OR 'Medicinal Plants' OR 'Botanical Medicine' OR 'Chinese herb*', in addition to individual herbal medicines. This search of the literature revealed 1,525 papers, of which 53 plants were included in the review (having at least one study using the whole plant extract). Of these plants, 21 had human clinical trial evidence (reviewed here in part two), with the other 32 having solely preclinical evidence (reviewed in part one). Support for efficacy was found for chronic use (i.e. greater than one day) of the following herbs in treating a range of anxiety disorders in human clinical trials: Piper methysticum, Matricaria recutita, Ginkgo biloba, Scutellaria lateriflora, Silybum marianum, Passiflora incarnata, Withania somniferum, Galphimia glauca, Centella asiatica, Rhodiola rosea, Echinacea spp., Melissa officinalis and Echium

  9. Ethical standards for clinical trials conducted in third countries: the new strategy of the European Medicines Agency.

    PubMed

    Altavilla, Annagrazia

    2011-01-01

    Clinical trials increasingly occur on a global scale as industry and government sponsors in wealthy countries move trials to low- and middle-income countries. The globalization of clinical research raises important questions about the economical and ethical aspects of clinical research and the translation of trial results to clinical practice: which ethical standards are applied? Are trials results accurate and valid, and can they be extrapolated to other settings? This article provides an overview of the strategy approved by the European Medicines Agency (EMA) to clarify ethical standards for clinical research conducted outside the European Economic Area (EEA) and included in Marketing Authorization Applications. Reference to the EMA Reflection paper is made. PMID:21409974

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

    PubMed

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

    2014-09-01

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

  11. Active Student Participation May Enhance Patient Centeredness: Patients' Assessments of the Clinical Education Ward for Integrative Medicine

    PubMed Central

    Tauschel, Diethard; Neumann, Melanie; Lutz, Gabriele; Valk-Draad, Maria

    2013-01-01

    Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM), where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG). General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction. PMID:23573149

  12. The "Bantu Clinic": a genealogy of the African patient as object and effect of South African clinical medicine, 1930-1990.

    PubMed

    Butchart, A

    1997-12-01

    This paper is about power, medicine and the identity of the African as a patient of western medicine. From a conventional perspective and as encoded in the current "quest for wholeness" that characterises South African biomedical discourse, the African patient--like any other patient--has always existed as an authentic and subjectified being, whose true attributes and experiences have been denied by the "mechanistic," "reductionistic" and "ethnocentric" practices of clinical medicine. Against this liberal humanist perspective on the body as ontologically independent of power, this paper offers a Foucaultian reading of the African patient as-like any other patient--contingent upon the force relations immanent within and relayed through the clinical practices of biomedicine. A quintessential form of disciplinary micro-power, these fabricate the most intimate recesses of the human body as manageable objects of medical knowledge and social consciousness to make possible the great control strategies of repression, segmentation and liberation that are the usual focus of conventional investigations into the place and function of medicine in society. Since the 1930s when the African body first emerged as a discrete object of a secular clinical knowledge, these have repeatedly transformed the attributes and identity of the African patient, and the paper traces this archaeology of South African clinical perception from then until the 1990s to show how its "quest for wholeness" is not an end point of "discovery" or "liberation," but merely another ephemeral crystallization of socio-medical knowledge in a constantly changing force field of disciplinary power. PMID:9492973

  13. Comparison of residents’ approaches to clinical decisions before and after the implementation of Evidence Based Medicine course

    PubMed Central

    KARIMIAN, ZAHRA; KOJURI, JAVAD; SAGHEB, MOHAMMAD MAHDI; MAHBOUDI, ALI; SABER, MAHBOOBEH; AMINI, MITRA; DEHGHANI, MOHAMMAD REZA

    2014-01-01

    Introduction: It has been found that the decision-making process in medicine is affected, to a large extent, by one’s experience, individual mentality, previous models, and common habitual approaches, in addition to scientific principles. Evidence-based medicine is an approach attempting to reinforce scientific, systematic and critical thinking in physicians and provide the ground for optimal decision making. In this connection, the purpose of the present study is to find out to what extent the education of evidence based medicine affects clinical decision making. Methods: The present quasi-experimental study was carried out on 110 clinical residents, who started their education in September, 2012 and finally 62 residents filled out the questionnaires. The instrument used was a researcher-made questionnaire containing items on four decision-making approaches. The questionnaire was used both as a pre-test and a post-test to assess the residents’ viewpoints on decision making approaches. The validity of the questionnaire was determined using medical education and clinical professionals’ viewpoints, and the reliability was calculated through Chronbach alpha; it was found to be 0.93. The results were analyzed by paired t-test using SPSS, version 14. Results: The results demonstrated that evidence-based medicine workshop significantly affected the residents’ decision-making approaches (p<0.001). The pre-test showed that principles-based, reference-based and routine model-based approaches were more preferred before the program (p<0.001). However, after the implementation of the program, the dominant approaches used by the residents in their decision making were evidence-based ones.  Conclusion: To develop the evidence-based approach, it is necessary for educational programs to continue steadily and goal-orientedly. In addition, the equipment infrastructure such as the Internet, access to data bases, scientific data, and clinical guides should develop more in the

  14. Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay

    PubMed Central

    Juma, Salina; Taabazuing, Mary-Margaret; Montero-Odasso, Manuel

    2016-01-01

    Background Frailty is characterized by increased vulnerability to external stressors. When frail older adults are admitted to hospital, they are at increased risk of adverse events including falls, delirium, and disability. The Clinical Frailty Scale (CFS) is a practical and efficient tool for assessing frailty; however, its ability to predict outcomes has not been well studied within the acute medical service. Objective To examine the CFS in elderly patients admitted to the acute medical ward and its association with length of stay. Design Prospective cohort study in an acute care university hospital in London, Ontario, Canada, involving 75 patients over age 65, admitted to the general internal medicine clinical teaching units (CTU). Measurements Patient demographics were collected through chart review, and CFS score was assigned to each patient after brief clinician assessment. The CFS ranges from 1 (very fit) to 9 (terminally ill) based on descriptors and pictographs of activity and functional status. The CFS was collapsed into three categories: non-frail (CFS 1–4), mild-to-moderately frail (CFS 5–6), and severely frail (CFS 7–8). Outcomes of length of stay and 90-day readmission were gathered through the LHSC electronic patient record. Results Severe frailty was associated with longer lengths of stay (Mean = 12.6 ± 12.7 days) compared to mild-to-moderate frailty (mean = 11.2 ± 10.8 days), and non-frailty (mean = 4.1 ± 2.1 days, p = .014). This finding was significant after adjusting for age, sex, and number of medications. Participants with higher frailty scores showed higher readmission rates when compared with those with no frailty (31.2% for severely frail, vs. 34.2% for mild-to-moderately frail vs. 19% for non-frail) although there was no significant difference in the adjusted analysis. Conclusion The CFS helped identify patients that are more likely to have prolonged hospital stays on the acute medical ward. The CFS is an easy to use tool which

  15. Everyday ethics in internal medicine resident clinic: an opportunity to teach

    PubMed Central

    Carrese, Joseph A; McDonald, Erin L; Moon, Margaret; Taylor, Holly A; Khaira, Kiran; Beach, Mary Catherine; Hughes, Mark T

    2011-01-01

    OBJECTIVES Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during faculty preceptor–resident interactions. METHODS This study involved a multi-method qualitative research design combining observation of preceptor-resident discussions with preceptor interviews. The study was conducted in two different internal medicine training programme clinics over a 2-week period in June 2007. Fifty-three residents and 19 preceptors were observed, and 10 preceptors were interviewed. Transcripts of observer field notes and faculty interviews were carefully analysed. The analysis identified several themes of everyday ethics issues and determined whether preceptors identified and taught about these issues. RESULTS Everyday ethics content was considered present in 109 (81%) of the 135 observed case presentations. Three major thematic domains and associated sub-themes related to everyday ethics issues were identified, concerning: (i) the Doctor–Patient Interaction (relationships; communication; shared decision making); (ii) the Resident as Learner (developmental issues; challenges and conflicts associated with training; relationships with colleagues and mentors; interactions with the preceptor), and; (iii) the Doctor–System Interaction (financial issues; doctor–system issues; external influences; doctor frustration related to system issues). Everyday ethics issues were explicitly identified by preceptors (without teaching) in 18 of 109 cases (17%); explicit identification and teaching occurred in only 13 cases (12%). CONCLUSIONS In this study a variety of everyday ethics issues were frequently encountered as residents cared for patients. Yet, faculty preceptors infrequently explicitly

  16. Adverse Events Associated with Metal Contamination of Traditional Chinese Medicines in Korea: A Clinical Review

    PubMed Central

    Kim, Hyunah; Hawes, Emily M.

    2014-01-01

    This study was performed to review studies carried out in Korea reporting toxic reactions to traditional Chinese medicines (TCMs) as a result of heavy metal contamination. PubMed (1966-August 2013) and International Pharmaceutical Abstracts (1965-August 2013) were searched using the medical subject heading terms of "Medicine, Chinese Traditional," "Medicine, Korean Traditional," "Medicine, Traditional," "Metals, Heavy," and "Drug Contamination". For Korean literature, Korea Med (http://www.koreamed.org), the Korean Medical Database (http://kmbase.medric.or.kr), National Discovery for Science Leaders (www.ndsl.kr), Research Information Sharing Service (http://www.riss.kr), and Google Scholar were searched using the terms "Chinese medicine," "Korean medicine," "herbal medicine," and "metallic contamination" in Korean. Bibliographies of case reports and case series, identified using secondary resources, were also utilized. Only literature describing cases or studies performed in Korea were included. Case reports identified clear issues with heavy metal, particularly lead, contamination of TCMs utilized in Korea. No international standardization guidelines for processing, manufacturing and marketing of herbal products exist. Unacceptably high levels of toxic metals can be present in TCM preparations. Health care providers and patients should be educated on the potential risks associated with TCMs. International advocacy for stricter standardization procedures for production of TCMs is warranted. PMID:25048473

  17. Induction of clinical response and remission of inflammatory bowel disease by use of herbal medicines: A meta-analysis

    PubMed Central

    Rahimi, Roja; Nikfar, Shekoufeh; Abdollahi, Mohammad

    2013-01-01

    AIM: To evaluate the efficacy and tolerability of herbal medicines in inflammatory bowel disease (IBD) by conducting a meta-analysis. METHODS: Electronic databases were searched for studies investigating efficacy and/or tolerability of herbal medicines in the management of different types of IBD. The search terms were: “herb” or “plant” or “herbal” and “inflammatory bowel disease”. Data were collected from 1966 to 2013 (up to Feb). The “clinical response”, “clinical remission”, “endoscopic response”, “endoscopic remission”, “histological response”, “histological remission”, “relapse”, “any adverse events”, and “serious adverse events” were the key outcomes of interest. We used the Mantel-Haenszel, Rothman-Boice method for fixed effects and DerSimonian-Laird method for random-effects. For subgroup analyses, we separated the studies by type of IBD and type of herbal medicine to determine confounding factors and reliability. RESULTS: Seven placebo controlled clinical trials met our criteria and were included (474 patients). Comparison of herbal medicine with placebo yielded a significant RR of 2.07 (95%CI: 1.41-3.03, P = 0.0002) for clinical remission; a significant RR of 2.59 (95%CI: 1.24-5.42, P = 0.01) for clinical response; a non-significant RR of 1.33 (95%CI: 0.93-1.9, P = 0.12) for endoscopic remission; a non-significant RR of 1.69 (95%CI: 0.69-5.04) for endoscopic response; a non-significant RR of 0.64 (95%CI: 0.25-1.81) for histological remission; a non-significant RR of 0.86 (95%CI: 0.55-1.55) for histological response; a non-significant RR of 0.95 (95%CI: 0.52-1.73) for relapse; a non-significant RR of 0.89 (95%CI: 0.75-1.06, P = 0.2) for any adverse events; and a non-significant RR of 0.97 (95%CI: 0.37-2.56, P = 0.96) for serious adverse events. CONCLUSION: The results showed that herbal medicines may safely induce clinical response and remission in patients with IBD without significant effects on

  18. Providing guidance to the NHS: The Scottish Medicines Consortium and the National Institute for Clinical Excellence compared.

    PubMed

    Cairns, John

    2006-04-01

    There is wide acceptance that cost-effectiveness is a relevant consideration when deciding which treatments to make available in publicly funded health services. An unresolved issue concerns the timing and the extent of such evaluations. The United Kingdom provides examples of two distinct approaches. The Scottish Medicines Consortium (SMC) provides guidance to the NHS in Scotland based on a rapid early review of the evidence. The National Institute for Health and Clinical Excellence (NICE) provides guidance to the NHS in England and Wales based on a later, more extensive review of the evidence. This paper explores how the difference in approach affects the role of the pharmaceutical industry, clinical experts and other stakeholders. It compares the guidance produced when both bodies have evaluated the same medicines. It addresses the general question of when to assess the cost-effectiveness of medicines. It concludes that there are important differences between the approaches of SMC and NICE, relating primarily to the timing of the review of evidence on clinical and cost-effectiveness. The difference in timing means that the activities of the two bodies are to a large extent complementary. PMID:15982779

  19. Clarifying Evidence-Based Medicine in Educational and Therapeutic Experiences of Clinical Faculty Members: A Qualitative Study in Iran

    PubMed Central

    Safari, Yahya

    2015-01-01

    Introduction: Although evidence-based medicine has been a significant part of recent research efforts to reform the health care system, it requires an assessment of real life community and patient. The present study strives to clarify the concept of evidence-based medicine in educational and therapeutic experiences of clinical faculty members of Kermanshah University of Medical Sciences (2014). Materials and Methods: It was a qualitative study of phenomenology. The population consists of 12 clinical faculty members of Kermanshah University Medical Sciences. Sampling was carried out using a purposeful method. Sample volume was determined using adequacy of samples’ law. Data gathering occurred through semi-structured interviews. Collaizzi pattern was employed for data interpretation concurrent with data gathering. Results: interpreting the data, three main themes were extracted. They include: 1. Unawareness and disuse (unaware of the concept, disuse, referral to colleagues, experiment prescription) 2. Conscious or unconscious use (using journals and scientific websites, aware of the process). 3. Beliefs (belief or disbelief in necessity). Conclusion: It sounds essential to change the behavior of clinical faculty members from passive to active with respect to employing evidence-based medicine as well as to alter negative attitudes into positive ones. In so doing, systematic training program aiming at behavior changing is necessary. Also, providing dissent facilities and infrastructures and removing barriers to the use of EBM can be effective. PMID:26153205

  20. Basic Science and Clinical Application of Stem Cells in Veterinary Medicine

    NASA Astrophysics Data System (ADS)

    Ribitsch, I.; Burk, J.; Delling, U.; Geißler, C.; Gittel, C.; Jülke, H.; Brehm, W.

    Stem cells play an important role in veterinary medicine in different ways. Currently several stem cell therapies for animal patients are being developed and some, like the treatment of equine tendinopathies with mesenchymal stem cells (MSCs), have already successfully entered the market. Moreover, animal models are widely used to study the properties and potential of stem cells for possible future applications in human medicine. Therefore, in the young and emerging field of stem cell research, human and veterinary medicine are intrinsically tied to one another. Many of the pioneering innovations in the field of stem cell research are achieved by cooperating teams of human and veterinary medical scientists.

  1. Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one

    PubMed Central

    Das, Kausik; Malick, Sadia; Khan, Khalid S

    2008-01-01

    Summary Evidence-based medicine (EBM) is an indispensable tool in clinical practice. Teaching and training of EBM to trainee clinicians is patchy and fragmented at its best. Clinically integrated teaching of EBM is more likely to bring about changes in skills, attitudes and behaviour. Provision of evidence-based health care is the most ethical way to practice, as it integrates up-to-date, patient-oriented research into the clinical decision making process, thus improving patients' outcomes. In this article, we aim to dispel the myth that EBM is an academic and statistical exercise removed from practice by providing practical tips for teaching the minimum skills required to ask questions and critically identify and appraise the evidence and presenting an approach to teaching EBM within the existing clinical and educational training infrastructure. PMID:18840865

  2. Bringing regenerative medicines to the clinic: the future for regulation and reimbursement.

    PubMed

    Bubela, Tania; McCabe, Christopher; Archibald, Peter; Atkins, Harold; Bradshaw, Steven E; Kefalas, Panos; Mujoomdar, Michelle; Packer, Claire; Piret, James; Raxworthy, Mike; Soares, Marta; Viswanathan, Sowmya

    2015-01-01

    Significant investments in regenerative medicine necessitate discussion to align evidentiary requirements and decision-making considerations from regulatory, health system payer and developer perspectives. Only with coordinated efforts will the potential of regenerative medicine be realized. We report on discussions from two workshops sponsored by NICE, University of Alberta, Cell Therapy Catapult and Centre for Commercialization of Regenerative Medicine. We discuss methods to support the assessment of value for regenerative medicine products and services and the synergies that exist between market authorization and reimbursement regulations and practices. We discuss the convergence in novel adaptive licensing practices that may promote the development and adoption of novel therapeutics that meet the needs of healthcare payers. PMID:26565607

  3. Routine Quality Control of Clinical Nuclear Medicine Instrumentation: A Brief Review*

    PubMed Central

    Zanzonico, Pat

    2009-01-01

    This article reviews routine quality-control (QC) procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ (“thyroid”) uptake probe, γ-camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. The procedures described and their respective frequencies are presented only as general guidelines. PMID:18587088

  4. Structure of a Protozoan Virus from the Human Genitourinary Parasite Trichomonas vaginalis

    PubMed Central

    Parent, Kristin N.; Takagi, Yuko; Cardone, Giovanni; Olson, Norman H.; Ericsson, Maria; Yang, May; Lee, Yujin; Asara, John M.; Fichorova, Raina N.; Baker, Timothy S.; Nibert, Max L.

    2013-01-01

    ABSTRACT The flagellated protozoan Trichomonas vaginalis is an obligate human genitourinary parasite and the most frequent cause of sexually transmitted disease worldwide. Most clinical isolates of T. vaginalis are persistently infected with one or more double-stranded RNA (dsRNA) viruses from the genus Trichomonasvirus, family Totiviridae, which appear to influence not only protozoan biology but also human disease. Here we describe the three-dimensional structure of Trichomonas vaginalis virus 1 (TVV1) virions, as determined by electron cryomicroscopy and icosahedral image reconstruction. The structure reveals a T = 1 capsid comprising 120 subunits, 60 in each of two nonequivalent positions, designated A and B, as previously observed for fungal Totiviridae family members. The putative protomer is identified as an asymmetric AB dimer consistent with either decamer or tetramer assembly intermediates. The capsid surface is notable for raised plateaus around the icosahedral 5-fold axes, with canyons connecting the 2- and 3-fold axes. Capsid-spanning channels at the 5-fold axes are unusually wide and may facilitate release of the viral genome, promoting dsRNA-dependent immunoinflammatory responses, as recently shown upon the exposure of human cervicovaginal epithelial cells to either TVV-infected T. vaginalis or purified TVV1 virions. Despite extensive sequence divergence, conservative features of the capsid reveal a helix-rich fold probably derived from an ancestor shared with fungal Totiviridae family members. Also notable are mass spectrometry results assessing the virion proteins as a complement to structure determination, which suggest that translation of the TVV1 RNA-dependent RNA polymerase in fusion with its capsid protein involves −2, and not +1, ribosomal frameshifting, an uncommonly found mechanism to date. PMID:23549915

  5. Effect of Combining Therapy with Traditional Chinese Medicine-Based Psychotherapy and Herbal Medicines in Women with Menopausal Syndrome: A Randomized Controlled Clinical Trial

    PubMed Central

    Yang, Hongyan; Yang, Jing; Wen, Zehuai; Zha, Qinglin; Nie, Guangning; Huang, Xuchun; Zhang, Chunlin; Lu, Aiping; Jiang, Miao; Wang, Xiaoyun

    2012-01-01

    This multicenter, randomized, controlled clinical study was designed to address the effectiveness of combined traditional-Chinese-medicine- (TCM-) based psychotherapy and Chinese herbal medicine (CHM) in the treatment of menopausal syndrome. Altogether 424 eligible women diagnosed as menopausal syndrome and categorized as Kidney-Yin/Kidney-Yang deficiency pattern in TCM were randomly assigned into 4 groups and accepted TCM-based psychotherapy (PSY), CHM, PSY + CHM, or placebo therapies, respectively, for 12 weeks, and another 12 weeks were taken as the followup. Kupperman Index (KI) and the Menopause-Specific Quality of Life (MENQOL) with its four subscales (vasomotor, physical, psychosocial, and sexual) were employed for efficacy assessment. Results showed that 400 participants completed 12-week treatment, of which 380 finished the record of KI and MENQOF at week 24. The average adjusted number of KI score decreased between baseline and 12 weeks in all groups. Statistically significant differences were detected in the average adjusted change between the PSY + CHM group and placebo at overall time points (P < 0.05). No severe adverse events occurred in each group and no significant differences were indicated between any of the three groups and placebo in adverse event proportion. We concluded that TCM psychotherapy combined with CHM has a favorable outcome in treating menopausal syndrome. PMID:23304198

  6. IMPACT - Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model

    PubMed Central

    2014-01-01

    Background Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM. Methods/Design This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n = 500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n = 180) and clinic personnel (n = 15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n = 8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works. Discussion The US health care

  7. [Post-marketing reevaluation for potential quality risk and quality control in clinical application of traditional Chinese medicines].

    PubMed

    Li, Hong-jiao; He, Li-yun; Liu, Bao-yan

    2015-06-01

    The effective quality control in clinical practices is an effective guarantee for the authenticity and scientificity of the findings. The post-marketing reevaluation for traditional Chinese medicines (TCM) focuses on the efficacy, adverse reaction, combined medication and effective dose of drugs in the market by expanded clinical trials, and requires a larger sample size and a wider range of patients. Therefore, this increases the difficulty of quality control in clinical practices. With the experience in quality control in clinical practices for the post-marketing reevaluation for Kangbingdu oral for cold, researchers in this study reviewed the study purpose, project, scheme design and clinical practice process from an overall point of view, analyzed the study characteristics of the post-marketing reevaluation for TCMs and the quality control risks, designed the quality control contents with quality impacting factors, defined key review contents and summarized the precautions in clinical practices, with the aim to improve the efficiency of quality control of clinical practices. This study can provide reference to clinical units and quality control-related personnel in the post-marketing reevaluation for TCMs. PMID:26591543

  8. New Paradigm in Training of Undergraduate Clinical Skills: the NEPTUNE-CS project at the Split University School of Medicine

    PubMed Central

    Šimunović, Vladimir J.; Hozo, Izet; Rakić, Mladen; Jukić, Marko; Tomić, Snježana; Kokić, Slaven; Ljutić, Dragan; Družijanić, Nikica; Grković, Ivica; Šimunović, Filip; Marasović, Dujomir

    2010-01-01

    Clinical skills’ training is arguably the weakest point in medical schools’ curriculum. This study briefly describes how we at the Split University School of Medicine cope with this problem. We consider that, over the last decades, a considerable advancement in teaching methodologies, tools, and assessment of students has been made. However, there are many unresolved issues, most notably: (i) the institutional value system, impeding the motivation of the teaching staff; (ii) lack of a strong mentoring system; (iii) organization, timing, and placement of training in the curriculum; (iv) lack of publications pertinent to training; and (v) unwillingness of patients to participate in student training. To improve the existing training models we suggest increased institutional awareness of obstacles, as well as willingness to develop mechanisms for increasing the motivation of faculty. It is necessary to introduce changes in the structure and timing of training and to complement it with a catalog, practicum, and portfolio of clinical skills. At Split University School of Medicine, we developed a new paradigm aimed to improve the teaching of clinical skills called “Neptune-CSS,” which stands for New Paradigm in Training of Undergraduate Clinical Skills in Split. PMID:20960586

  9. 75 FR 82428 - VASRD Improvement Forum-Updating Disability Criteria for the Genitourinary System, Digestive...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ...The Veterans Benefits Administration (VBA) and Veterans Health Administration (VHA) will co-host the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD) Improvement Forum-- Updating Disability Criteria for the Genitourinary System, Digestive System, Dental Conditions, and Infectious Diseases, Immune Disorders and Nutritional Deficiencies. The purpose of the VASRD......

  10. Are Maternal Genitourinary Infection and Pre-Eclampsia Associated with ADHD in School-Aged Children?

    ERIC Educational Resources Information Center

    Mann, Joshua R.; McDermott, Suzanne

    2011-01-01

    Objective: To investigate the hypothesis that maternal genitourinary infection (GU) infection is associated with increased risk of ADHD. Method: The authors obtained linked Medicaid billing data for pregnant women and their children in South Carolina, with births from 1996 through 2002 and follow-up data through 2008. Maternal GU infections and…

  11. 77 FR 32397 - Servicemembers' Group Life Insurance Traumatic Injury Protection Program-Genitourinary Losses

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-01

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO20 Servicemembers' Group Life Insurance Traumatic Injury Protection Program--Genitourinary Losses AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: The... Servicemembers' Group Life Insurance Traumatic Injury Protection (TSGLI) program by adding certain...

  12. Update in Cancer Chemotherapy: Genitourinary Tract Cancer, Part 6: Cancer of the Uterus and Vulva

    PubMed Central

    Wright, Jane C.

    1988-01-01

    An update of the state of the art of cancer chemotherapeutic treatment of genitourinary tract cancer is described in this multi-part series: included are cancers of the kidney, bladder, prostate, testicle, ovary, uterus, vulva, and gestational trophoblastic neoplasms. Part 6 is a review of treatment for cancers of the uterus and vulva. PMID:3292776

  13. Phytomedicine 101: plant taxonomy for preclinical and clinical medicinal plant researchers.

    PubMed

    Bennett, Bradley C; Balick, Michael J

    2008-01-01

    Plants are the primary source of medicine for most of the world. The most fundamental step in the scientific study of medicinal plants is establishing their botanical identity. Many studies lack voucher specimens, which serve as permanent records of scientific investigations. This omission makes positive identification impossible and hinders reproducibility. Even when vouchers are cited, scientific names are often mishandled. A random survey of titles and abstracts of 100 publications revealed 20 with taxonomic errors. Mistakes included a lack of author citations, misspellings, and use of older synonyms instead of currently accepted names. A seemingly minor orthographic error makes it impossible to search electronic databases for information about a species. Medicinal plant manuscripts and National Institutes of Health proposals commonly lack scientific rigor in dealing with botanical names and documentation. This article examines common taxonomic problems relevant to medicinal plant research and provides a basic guide to plant taxonomy for medicinal plant researchers. Voucher specimens and their preparation, plant identification, and botanical nomenclature are discussed. References and other resources to assist investigators are cited. PMID:19134447

  14. The role of family therapists in veterinary medicine: opportunities for clinical services, education, and research.

    PubMed

    Hafen, McArthur; Rush, Bonnie R; Reisbig, Allison M J; McDaniel, Kara Z; White, Mark B

    2007-04-01

    Marriage and family therapists (MFTs) are applying their specific skill set in a variety of arenas. A new area for collaboration is veterinary medicine. The veterinary medical profession is emphasizing the importance of non-biomedical skills such as communication skills, acknowledging that human clientele are likely to view their pets as family members, and discussing veterinarian personal well-being. Each of these trends has clear application for intervention by MFTs. A discussion of how MFTs may be uniquely positioned to assist veterinary medicine is presented. An example of collaboration between MFT and veterinary medicine at Kansas State University is highlighted. Recommendations are made for development of effective educational relationships and possible private sector collaborations. PMID:17437457

  15. The first center for evidence-based medicine in Lithuania: an opportunity to change culture and improve clinical practice.

    PubMed

    Beinortas, Tumas; Bauza, Karolis; Howick, Jeremy; Nunan, David; Mahtani, Kamal Ram

    2015-05-01

    In post-Soviet countries, where medical practice largely relies on experience alone, the incorporation of the best research evidence in clinical practice is limited. In order to promote the awareness and utilization of evidence-based medicine (EBM) among Lithuanian doctors, we organized EBM conferences in each of the two Lithuanian medical schools. More than 500 medical professionals and students attended the conferences in Vilnius (2013) and Kaunas (2014) demonstrating that there is a high demand for formal EBM teaching. Building on the success of these seminal conferences, and to start addressing the lack of EBM practice in the country, the first Lithuanian Centre for Evidence-Based Medicine was established at Vilnius University Medical Faculty in 2014. The Centre will focus on the implementation of EBM teaching in medical school curriculum, formulating management guidelines, writing systematic reviews and supporting Lithuanian authors in doing so. PMID:25955430

  16. [Analysis Methods of Short-term Non-linear Heart Rate Variability and Their Application in Clinical Medicine].

    PubMed

    Chi, Xianglin; Zhou, Jianhua; Shi, Ping; Liu, Chengyu

    2016-02-01

    The linear analysis for heart rate variability (HRV), including time domain method, frequency domain method and time-frequency analysis, has reached a lot of consensus. The non-linear analysis has also been widely applied in biomedical and clinical researches. However, for non-linear HRV analysis, especially for short-term non-linear HRV analysis, controversy still exists, and a unified standard and conclusion has not been formed. This paper reviews and discusses three short-term non-linear HRV analysis methods (fractal dimension, entropy and complexity) and their principles, progresses and problems in clinical application in detail, in order to provide a reference for accurate application in clinical medicine. PMID:27382764

  17. The use of oral herbal medicine by women attending antenatal clinics in urban and rural Tanga District in Tanzania.

    PubMed

    Mbura, J S; Mgaya, H N; Heggenhougen, H K

    1985-08-01

    A prospective study on the use of oral herbal medicine was conducted on 214 pregnant women attending antenatal clinics in urban and rural Tanga district, which is well-known for traditional healers. There is a perception that traditional healers are very respected locally, and should be cooperated with. However herb effects range from therapeutic to dangerous. The overall prevalence rate of use of herbal medicine was 42%. The prevalence in urban and rural areas was 43.3% and 40.2% respectively. The highest use rate was towards the end of the 1st trimester and during labor, for a total of 87.7%. Of the users, 54% did so to relieve pregnancy-associated symptoms, while the rest used it as a consequence of beliefs, possibly superstitious, circumstantial constraints, and combinations of these. Significant differences were found between women delivering at home (55% used herbal medicine) and in a modern health facility (38.8%), P=0.038, between Moslems (44.4%) and Christians (32.2%), P=0.22, and among tribes. It seems that oral herbal medicines are commonly used in pregnancies and childbirth in Tanga, as well as in other areas, Bagamoyo being an example. Fear of the health facility eivironment as being a place for dying is an interesting factor. A form of Koranic medicine known as Kombe, which included the use of Quranic inscriptions, was used widely. It is recommended that immediate and long-term outcomes of herb-tested pregnancies be evaluated. Phytochemical, toxicological, and pharmacological studies are necessary to enable health workers to warn against inappropriate and dangerous usage. PMID:4054028

  18. Personalised Medicine Possible With Real-Time Integration of Genomic and Clinical Data To Inform Clinical Decision-Making.

    PubMed

    Martin-Sanchez, Fernando; Turner, Maureen; Johnstone, Alice; Heffer, Leon; Rafael, Naomi; Bakker, Tim; Thorne, Natalie; Macciocca, Ivan; Gaff, Clara

    2015-01-01

    Despite widespread use of genomic sequencing in research, there are gaps in our understanding of the performance and provision of genomic sequencing in clinical practice. The Melbourne Genomics Health Alliance (the Alliance), has been established to determine the feasibility, performance and impact of using genomic sequencing as a diagnostic tool. The Alliance has partnered with BioGrid Australia to enable the linkage of genomic sequencing, clinical treatment and outcome data for this project. This integrated dataset of genetic, clinical and patient sourced information will be used by the Alliance to evaluate the potential diagnostic value of genomic sequencing in routine clinical practice. This project will allow the Alliance to provide recommendations to facilitate the integration of genomic sequencing into clinical practice to enable personalised disease treatment. PMID:26262351

  19. Value of non-clinical cardiac repolarization assays in supporting the discovery and development of safer medicines.

    PubMed

    Valentin, Jean-Pierre; Pollard, Chris; Lainée, Pierre; Hammond, Tim

    2010-01-01

    Non-clinical QT-related assays aligned to the pharmaceutical drug discovery and development phases are used in several ways. During the early discovery phases, assays are used for hazard identification and wherever possible for hazard elimination. The data generated enable us to: (i) establish structure-activity relationships and thereby; (ii) influence the medicinal chemistry design and provide tools for effective decision making; and provide structure-activity data for in silico predictive databases; (iii) solve problems earlier; (iv) provide reassurance for compound or project to progress; and (v) refine strategies as scientific and technical knowledge grows. For compounds progressing into pre-clinical development, the 'core battery' QT-related data enable an integrated risk assessment to: (i) fulfil regulatory requirements; (ii) assess the safety and risk-benefit for compound progression to man; (iii) contribute to defining the starting dose during the phase I clinical trials; (iv) influence the design of the phase I clinical trials; (v) identify clinically relevant safety biomarkers; and (vi) contribute to the patient risk management plan. Once a compound progresses into clinical development, QT-related data can be applied in the context of risk management and risk mitigation. The data from 'follow-up' studies can be used to: (i) support regulatory approval; (ii) investigate discrepancies that may have emerged within and/or between non-clinical and clinical data; (iii) understand the mechanism of an undesirable pharmacodynamic effect; (iv) provide reassurance for progression into multiple dosing in humans and/or large-scale clinical trials; and (v) assess drug-drug interactions. Based on emerging data, the integrated risk assessment is then reviewed in this article, and the benefit-risk for compound progression was re-assessed. Project examples are provided to illustrate the impact of non-clinical data to support compound progression throughout the drug

  20. The Clinical Education of Medical Students: A Perspective from Internal Medicine.

    ERIC Educational Resources Information Center

    Tierney, Lawrence M., Jr.

    1986-01-01

    A summary of what is generally thought to be taught well in internal medicine and what is taught less effectively is presented. The roles of medical students are considered in that context. Teaching contributions, evaluation of teaching, problems on clerkships, and opportunities for change are discussed. (MLW)

  1. Complementary medicine.

    PubMed

    Ernst, E

    2003-03-01

    Complementary medicine has become an important subject for rheumatologists, not least because many patients try complementary treatments. Recent clinical trials yield promising results. In particular, evidence suggests that several herbal medicines and dietary supplements can alleviate the pain of osteoarthritis and rheumatoid arthritis. Clearly, rigorous testing of complementary treatments is possible, and considering their popularity, should be encouraged. PMID:12598804

  2. Evaluating clinical teaching in the medicine clerkship: relationship of instructor experience and training setting to ratings of teaching effectiveness.

    PubMed

    Ramsey, P G; Gillmore, G M; Irby, D M

    1988-01-01

    A clinical teaching assessment form was used to evaluate the teaching by faculty and residents in the required third-year medicine clerkship over a two-year period. Data from 1,627 forms were analyzed for differences between groups of teachers at different experience levels and for comparison of teaching programs at different training sites. The level of involvement of instructor with student correlated with ratings by the students. Among groups of instructors, chief medical residents received the highest overall ratings. Faculty were rated higher than first-, second-, and third-year residents when degree of involvement of instructor with student was high. Ratings among faculty of different academic ranks were not significantly different. Analysis of data from different clinical settings showed that the teaching efforts by clinical faculty members in the ambulatory setting received the highest ratings from students. Although increased involvement of instructors with students or other factors may have led to the higher ratings in the ambulatory setting, the results are encouraging for the use of ambulatory teaching sites for the basic medicine clerkship. PMID:3404296

  3. Is “modular” the way to go for small group learning in community medicine in undergraduate clinical postings?

    PubMed Central

    Chavda, Paragkumar; Pandya, Chandresh; Solanki, Dipak; Dindod, Sonal

    2016-01-01

    Context: There is a need to shift from the didactic lecture-based instruction to more student-centered active learning methods for undergraduate teaching in community medicine. Aims: To compare didactic and modular method of learning on Level 1 and 2 on Kirkpatrick’s training evaluation model. Settings and Design: This was a two-arm educational intervention study for a small group of the 2nd year MBBS students in their 4th semester during clinical posting in the subject of community medicine. Subjects and Methods: The topic chosen was “rabies prophylaxis” in the 2nd clinical posting during 4th semester. With permission from Institutional Ethics Committee, first batch of 17 students was taught this topic by didactic method. Next batch of 22 students was taught by the modular method. A self-reading module was prepared for this study and validated by three teachers. What was different in modular teaching was a circular sitting arrangement, module reading by students, video presentation, and exercise using case vignettes. Statistical Analysis Used: Student’s t-test was used for pre- and post-test score comparison and Mann–Whitney U-test for students' responses on Likert scale. Results: The mean gain in obtained marks after modular learning (7.9/15) was significantly higher as compared to gain after didactic teaching (5.9/15) (P = 0.0038); more students asserted to be confident to manage a case in modular group compared to the didactic group (P < 0.05) indicating a higher level of learning through modular teaching. Conclusions: Modular teaching fares better than didactic method and hence should be used more frequently in community medicine clinical posting. PMID:27563590

  4. A new approach in training pre-clinical medical undergraduates in community medicine in Pondicherry, South India.

    PubMed

    Rotti, S B; Soudarssanane, M B; Srinivasa, D K; Kumar, V S; Premarajan, K C; Pradhan, P

    1992-01-01

    Pre-clinical medical undergraduates are taught Community Medicine using a variety of teaching methods keeping the didactic lectures to the minimum in conformity with the latest recommendations of Medical Council of India. Five of the total twelve topics were taught using group discussion during 1988-89. The present paper gives the details of lesson plans for two topics. Evaluation was done based on the results of the written test, opinions expressed by the students and on the spot observation by the faculty members. Suggestions given by the students to improve the sessions have also been highlighted. PMID:1293466

  5. Future directions in risk stratification and therapy for advanced pediatric genitourinary rhabdomyosarcoma.

    PubMed

    Harel, Miriam; Ferrer, Fernando A; Shapiro, Linda H; Makari, John H

    2016-02-01

    Rhabdomyosarcoma (RMS) represents the most common soft tissue sarcoma in infants and children and the third most common pediatric solid tumor, accounting for 5% to 15% of all childhood solid tumors. Of these, 15% to 20% arise from the genitourinary tract, with the most common sites originating from the prostate, bladder, and paratesticular regions, followed by the vagina and uterus. Although upfront radical surgery was used at the initiation of Intergroup RMS Study-I (1972-1978), the treatment paradigm has shifted to include initial biopsy with the goal of organ preservation, systemic chemotherapy for all patients, and local control involving surgical resection with or without radiation therapy for most patients. Collaborative group clinical trials have led to dramatic improvement in survival rates from 1960 to 1996 among patients with low- or intermediate-risk disease; however, outcomes appear to have plateaued in more recent years, and the prognosis for patients with metastatic or relapsed/refractory disease remains poor. Current management goals include minimizing toxicity while maintaining the excellent outcomes in low-risk disease, as well as improving outcomes in patients with intermediate- and high-risk disease. Advances in genetic analysis have allowed further refinement in risk stratification of patients. Perhaps the most significant recent development in RMS research was the discovery of an association of alveolar RMS (ARMS) with translocations t(2;13) and t(1;13). Translocation fusion-positive tumors comprise 80% of ARMS and are more aggressive. Fusion-negative ARMS may have a clinical course similar to embryonal RMS. Future Children's Oncology Group sarcoma studies will likely incorporate fusion status into risk stratification and treatment allocation. Newer radiotherapy modalities hold promise for providing local control of disease while minimizing morbidity. The addition of traditional cytotoxic chemotherapeutic agents does not seem to improve

  6. An International Comparison of Attitudes Toward Traditional and Modern Medicine in a Chinese and an American Clinic Setting

    PubMed Central

    Burke, Adam; Kuo, Tony; Harvey, Rick; Wang, Jun

    2011-01-01

    Introduction. International comparative research on traditional medicine (TM) offers a useful method for examining differences in patient characteristics and can provide insight into: (i) more universal characteristics which may cross cultures and international borders; (ii) unique characteristics influenced by regional/national factors; and (iii) cultural values of immigrant populations. To explore these issues TM patients from the United States and China were compared. Methods. Data collection took place at two TM college clinics. A convenience sample of 128 patients in China and 127 patients in the United States completed a 28-item questionnaire. Results. There was a marked similarity between the two patient groups in terms of the biological characteristics of age and gender. Musculoskeletal issues were the most common presenting complaints in the United States; while in China TM was used for a more diverse array of conditions. The majority of patients in both countries had initially used allopathic medicine (AM); significantly, more of the United States respondents stopped allopathic treatment after beginning traditional treatment. In comparing the two countries, patients in China were significantly more satisfied with AM and American patients significantly more satisfied with TM. In comparing the two medicines, the patient samples in both countries were significantly more satisfied with TM than AM. Discussion. Although treatment often originated with allopathic providers, many patients sought alternatives presumably to find the best solution to their problems. This tendency toward self-assignment suggests that a pluralistic healthcare system may provide the greatest satisfaction resulting from personal choice and improved outcomes. PMID:18955368

  7. Evaluation of the UCLA department of medicine Malawi global health clinical elective: lessons from the first five years.

    PubMed

    Shull, Hannah; Tymchuk, Chris; Grogan, Tristan; Hamilton, John; Friedman, Jodi; Hoffman, Risa M

    2014-11-01

    In 2008, the UCLA Department of Medicine established a three-week clinical elective in Malawi, Africa, for Medicine and Medicine/Pediatrics residents. We sought to determine whether the elective resulted in improved medical knowledge, alterations in career trajectory, and whether the opportunity for the elective influenced selection of UCLA for residency. A 29-question survey was distributed to all graduates of the elective from 2009-2013. Surveys were distributed to 40 individuals, with 33 responses (82.5%). Thirty-one participants (93.9%) reported increased medical knowledge and 24 participants (72.7%) reported the rotation altered their career trajectory. Among the 23 residents who came to UCLA after the elective was established, 13 (56.5%) stated it had an influential role in their selection of UCLA for residency. The Malawi elective resulted in self-reported increases in medical knowledge, alterations in career trajectory, and has played an important role in attracting individuals to UCLA for residency. PMID:25223939

  8. GMP facilities for manufacturing of advanced therapy medicinal products for clinical trials: an overview for clinical researchers.

    PubMed

    Alici, Evren; Blomberg, Pontus

    2010-12-01

    To be able to produce advanced therapy medicinal products, compliance with regulatory standards while maintaining flexibility is mandatory. For this purpose, careful planning is vital in the design or upgrade of a facility. Similarly, extensive foresight is elemental to anticipate upcoming needs and requirements. Failing this may lead to the facility's in-ability to meet the demands. In this chapter we aimed to outline the current issues with regards to the European Union Directives (EUD) and the proposal for Advanced Therapies, which are of importance to cellular and gene therapy facilities in Europe. This chapter is an attempt to elucidate what the minimum requirements for GMP facilities for cell and gene therapy products are and what is considered necessary to comply with the regulations in Europe. PMID:21054243

  9. [History of the University of Chile Faculty of Medicine and clinical hospital location].

    PubMed

    Osorio A, Carlos G

    2015-02-01

    The history of the location of the University of Chile Faculty of Medicine North Campus is derived from a farm of Pedro de Valdivia founder of the city of Santiago de la Nueva Extremadura and governor of the “Reyno de Chile”. This work narrates succinctly the history of this particular location from the Spanish Conquest period to present days. PMID:25860368

  10. Practical clinical skills assessment for a cohort of 680 2nd year human medicine students. Is it feasible?

    PubMed

    Wagner-Menghin, Michaela; Preusche, Ingrid; Schmidts, Michael

    2015-03-01

    In clinical skills training objective structured clinical examinations (OSCEs) are the method of choice to foster learning. Hence, implementing them is challenging and expensive. Thus it is investigated how an alternative procedure that keeps OSCE's essential elements, but assigns less stations to each student, works in terms of validity and justifiability.Data of n = 694 students, each taking five tasks drawn semi-randomized out of a pool of 26 tasks, strictly aligned with learning objectives, are analyzed. Despite unsurprisingly low overall reliability, a justifiable pass/fail decision is possible for 480 students (69 %). The remaining group (n = 210, 30 %) is indeed larger than with longer OSCEs, and would need ongoing assessment. The tasks' psychometric quality contributes to exams construct validity. Resource preserving short practical skills assessment is educationally valid and feasible with MedUniVienna's human medicine cohorts of n = 680. PMID:25724462

  11. Academy of Medicine-Ministry of Health Clinical Practice Guidelines: Assessment and Management of Infertility at Primary Healthcare Level

    PubMed Central

    Loh, Seong Feei; Agarwal, Rachna; Chan, Jerry; Chia, Sing Joo; Cho, Li Wei; Lim, Lean Huat; Lau, Matthew Sie Kuei; Loh, Sheila Kia Ee; Hendricks, Marianne Sybille; Nair, Suresh; Quah, Joanne Hui Min; Tan, Heng Hao; Wong, PC; Yeong, Cheng Toh; Yu, Su Ling

    2014-01-01

    The Academy of Medicine (AMS) and Ministry of Health (MOH) have developed the clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level to provide doctors and patients in Singapore with evidence-based treatment for infertility. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Assessment and Management of Infertility at Primary Healthcare Level, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_ medical/2013/cpgmed_infertility.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:24570313

  12. Academy of Medicine Singapore-Ministry of Health clinical practice guidelines: Autism Spectrum Disorders in pre-school children.

    PubMed

    2010-03-01

    The Academy of Medicine Singapore (AMS) and the Ministry of Health (MOH) publish clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the AMS-MOH clinical practice guidelines on Autism Spectrum Disorders (ASD), for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh. gov.sg/mohcorp/publications.aspx?id=24048). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:20428749

  13. Comparison of 4-Dimensional Computed Tomography Ventilation With Nuclear Medicine Ventilation-Perfusion Imaging: A Clinical Validation Study

    PubMed Central

    Vinogradskiy, Yevgeniy; Koo, Phillip J.; Castillo, Richard; Castillo, Edward; Guerrero, Thomas; Gaspar, Laurie E.; Miften, Moyed; Kavanagh, Brian D.

    2014-01-01

    Purpose Four-dimensional computed tomography (4DCT) ventilation imaging provides lung function information for lung cancer patients undergoing radiation therapy. Before 4DCT-ventilation can be implemented clinically it needs to be validated against an established imaging modality. The purpose of this work was to compare 4DCT-ventilation to nuclear medicine ventilation, using clinically relevant global metrics and radiologist observations. Methods and Materials Fifteen lung cancer patients with 16 sets of 4DCT and nuclear medicine ventilation-perfusion (VQ) images were used for the study. The VQ-ventilation images were acquired in planar mode using Tc-99m-labeled diethylenetriamine-pentaacetic acid aerosol inhalation. 4DCT data, spatial registration, and a density-change-based model were used to compute a 4DCT-based ventilation map for each patient. The percent ventilation was calculated in each lung and each lung third for both the 4DCT and VQ-ventilation scans. A nuclear medicine radiologist assessed the VQ and 4DCT scans for the presence of ventilation defects. The VQ and 4DCT-based images were compared using regional percent ventilation and radiologist clinical observations. Results Individual patient examples demonstrate good qualitative agreement between the 4DCT and VQ-ventilation scans. The correlation coefficients were 0.68 and 0.45, using the percent ventilation in each individual lung and lung third, respectively. Using radiologist-noted presence of ventilation defects and receiver operating characteristic analysis, the sensitivity, specificity, and accuracy of the 4DCT-ventilation were 90%, 64%, and 81%, respectively. Conclusions The current work compared 4DCT with VQ-based ventilation using clinically relevant global metrics and radiologist observations. We found good agreement between the radiologist’s assessment of the 4DCT and VQ-ventilation images as well as the percent ventilation in each lung. The agreement lessened when the data were analyzed

  14. Comparison of 4-Dimensional Computed Tomography Ventilation With Nuclear Medicine Ventilation-Perfusion Imaging: A Clinical Validation Study

    SciTech Connect

    Vinogradskiy, Yevgeniy; Koo, Phillip J.; Castillo, Richard; Castillo, Edward; Guerrero, Thomas; Gaspar, Laurie E.; Miften, Moyed; Kavanagh, Brian D.

    2014-05-01

    Purpose: Four-dimensional computed tomography (4DCT) ventilation imaging provides lung function information for lung cancer patients undergoing radiation therapy. Before 4DCT-ventilation can be implemented clinically it needs to be validated against an established imaging modality. The purpose of this work was to compare 4DCT-ventilation to nuclear medicine ventilation, using clinically relevant global metrics and radiologist observations. Methods and Materials: Fifteen lung cancer patients with 16 sets of 4DCT and nuclear medicine ventilation-perfusion (VQ) images were used for the study. The VQ-ventilation images were acquired in planar mode using Tc-99m-labeled diethylenetriamine-pentaacetic acid aerosol inhalation. 4DCT data, spatial registration, and a density-change-based model were used to compute a 4DCT-based ventilation map for each patient. The percent ventilation was calculated in each lung and each lung third for both the 4DCT and VQ-ventilation scans. A nuclear medicine radiologist assessed the VQ and 4DCT scans for the presence of ventilation defects. The VQ and 4DCT-based images were compared using regional percent ventilation and radiologist clinical observations. Results: Individual patient examples demonstrate good qualitative agreement between the 4DCT and VQ-ventilation scans. The correlation coefficients were 0.68 and 0.45, using the percent ventilation in each individual lung and lung third, respectively. Using radiologist-noted presence of ventilation defects and receiver operating characteristic analysis, the sensitivity, specificity, and accuracy of the 4DCT-ventilation were 90%, 64%, and 81%, respectively. Conclusions: The current work compared 4DCT with VQ-based ventilation using clinically relevant global metrics and radiologist observations. We found good agreement between the radiologist's assessment of the 4DCT and VQ-ventilation images as well as the percent ventilation in each lung. The agreement lessened when the data were analyzed

  15. Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

    PubMed Central

    Francis, Maureen D.; Warm, Eric; Julian, Katherine A.; Rosenblum, Michael; Thomas, Kris; Drake, Sean; Gwisdalla, Keri Lyn; Langan, Michael; Nabors, Christopher; Pereira, Anne; Smith, Amy; Sweet, David; Varney, Andrew; Francis, Mark L.

    2014-01-01

    Background Many internal medicine programs have reorganized their resident continuity clinics to improve the ambulatory care experience for residents. The effect of this redesign on patient satisfaction is largely unknown. Methods Our multi-institutional, cross-sectional study included 569 internal medicine residents from 11 programs participating in the Educational Innovations Project Ambulatory Collaborative. An 11-item patient satisfaction survey from the Consumer Assessment of Healthcare Providers and Systems was used to assess patient satisfaction, comparing patient satisfaction in traditional models of weekly continuity clinic with 2 new clinic models. We then examined the relationship between patient satisfaction and other practice variables. Results Patient satisfaction responses related to resident listening and communication skills, knowledge of medical history, perception of adequate visit time, overall rating, and willingness to refer to family and friends were significantly better in the traditional and block continuity models than the combination model. Higher ambulatory workload was associated with reduced patient perception of respect shown by the physician. The percentage of diabetic patients with glycated hemoglobin < 8% was positively correlated with number of visits, knowledge of medical history, perception of respect, and higher scores for recommending the physician to others. The percentage of diabetic patients with low density lipoprotein < 100 mg/dL was positively correlated with the physician showing respect. Conclusions Patient satisfaction was similar in programs using block design and traditional models for continuity clinic, and both outperformed the combination model programs. There was a delicate balance between workload and patient perception of the physician showing respect. Care outcome measures for diabetic patients were associated with aspects of patient satisfaction. PMID:26279771

  16. Better Management of Cardiovascular Diseases by Pulse Wave Velocity: Combining Clinical Practice with Clinical Research using Evidence-Based Medicine

    PubMed Central

    Khoshdel, Ali R.; Carney, Shane L.; Nair, Balakrishnan R.; Gillies, Alastair

    2007-01-01

    Arterial stiffness measured by pulse wave velocity (PWV) is an accepted strong, independent predictor of cardiovascular events and mortality. However, lack of a reliable reference range has limited its use in clinical practice. In this evidence-based review, we applied published data to develop a PWV risk stratification model and demonstrated its impact on the management of common clinical scenarios. After reviewing 97 studies where PWV was measured, 5 end-stage renal disease patients, 5 hypertensives, 2 diabetics, and 2 elderly studies were selected. Pooling the data by the “fixed-effect model” demonstrated that the mortality and cardiovascular event risk ratio for one level increment in PWV was 2.41 (1.81–3.20) or 1.69 (1.35–2.11), respectively. There was a significant difference in PWV between survived and deceased groups, both in the low and high risk populations. Furthermore, risk comparison demonstrated that 1 standard deviation increment in PWV is equivalent to 10 years of aging, or 1.5 to 2 times the risk of a 10 mmHg increase in systolic blood pressure. Evidence shows that PWV can be beneficially used in clinical practice for cardiovascular risk stratification. Furthermore, the above risk estimates could be incorporated into currently used cardiac risk scores to improve their predictive power and facilitate the clinical application of PWV. PMID:17456834

  17. Treatment of Idiopathic Parkinson's Disease with Traditional Chinese Herbal Medicine: A Randomized Placebo-Controlled Pilot Clinical Study

    PubMed Central

    Kum, Wan Fung; Durairajan, Siva Sundara Kumar; Bian, Zhao Xiang; Man, Sui Cheung; Lam, Yuen Chi; Xie, Li Xia; Lu, Jia Hong; Wang, Yan; Huang, Xian Zhang; Li, Min

    2011-01-01

    The objective of this clinical study is to examine the effects of a Chinese herbal medicine formula (Jia Wei Liu Jun Zi Tang: JWLJZT) on motor and non-motor symptoms, and on complications of conventional therapy in idiopathic Parkinson's disease (PD), using an add-on design. Fifty-five patients with PD were randomly allocated to receive either Chinese herbal medicine or placebo for 24 weeks. Primary outcome measure was the 39-item Parkinson's Disease Questionnaire (PDQ-39). Secondary outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Short-Form-36 Health Survey (SF-36), Geriatric Depression Scale (GDS), home diaries, and a range of category rating scales. JWLJZT resulted in a significant improvement in the UPDRS IVC when compared with placebo at 12 weeks (P = .039) and 24 weeks (P = .034). In addition, patients in the Chinese herbal medicine group also showed significant improvement in PDQ-39 communication scores at 12 weeks (P = .024) and 24 weeks (P = .047) when compared with the placebo group. There were no significant differences between treatment and control groups for SF-36 variables, GDS score or the mean daily “on-off” time. One case of mild diarrhea was noted in the treatment group. The findings suggest that JWLJZT can relieve some non-motor complications of conventional therapy and improve the communication ability in patients with PD. The results of this pilot study warrant larger multi-center clinical studies to assess long-term efficacy and tolerability of JWLJZT, and to elucidate the mechanisms by which it affects PD function. PMID:19692449

  18. Clinical trials of medicines in neonates: the influence of ethical and practical issues on design and conduct

    PubMed Central

    Turner, Mark A

    2015-01-01

    In the past, there has been a perception that ethical and practical problems limit the opportunities for research in neonates. This perception is no longer appropriate. It is now clear that research about the medicines used in neonates is an ethical requirement. It is possible to conduct high quality research in neonates if the research team adapt to the characteristics of this population. Good practice involves respecting the specific needs of newborn babies and their families by adopting relevant approaches to study design, recruitment, pharmacokinetic studies and safety assessment. Neonatal units have a unique culture that requires careful development in a research setting. Clinical investigators need to recognize the clinical and ethical imperative to conduct rigorous research. Industry needs to engage with neonatal networks early in the process of drug development, preferably before contacting regulatory agencies. Follow-up over 3–5 years is essential for the evaluation of medicines in neonates and explicit funding for this is required for the assessment of the benefit and risk of treatments given to sick newborn babies. The views of parents must be central to the development of studies and the research agenda. Ethical and practical problems are no longer barriers to research in neonates. The current challenges are to disseminate good practice and maximize capacity in order to meet the need for research among newborn babies. PMID:25041601

  19. Is the Information about a Test Important? Applying the Methods of Evidence-Based Medicine to the Clinical Examination of Swallowing

    ERIC Educational Resources Information Center

    Rosenbek, John C.; McCullough, Gary H.; Wertz, Robert T.

    2004-01-01

    A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report.…

  20. A First-Year, Student-Managed Course to Correlate Basic Sciences with Clinical Medicine.

    ERIC Educational Resources Information Center

    Saffran, Murray; Yeasting, Richard A.

    1985-01-01

    A course, designed to illustrate the correlation of the biochemistry and physiology content of the curriculum with clinical applications, is described. The entire presentation, from introduction and interview of the patient to the correlation of the clinical application with the basic sciences, was managed by the students. (Author/MLW)

  1. Enrollment of racial/ethnic minorities and women with HIV in clinical research studies of HIV medicines.

    PubMed Central

    Sullivan, Patrick S.; McNaghten, A. D.; Begley, Elin; Hutchinson, Angela; Cargill, Victoria A.

    2007-01-01

    PURPOSE: Inclusion of women and racial/ethnic minorities is a requirement for federally supported clinical research, but data on clinical research participation from women and racial/ethnic minorities with HIV are few. To describe participation in clinical research of HIV medicines among women and racial/ethnic minorities, and associated factors, we used data from a cross-sectional behavioral surveillance interview project conducted in 15 U.S. states. METHODS: Data were from 6,892 persons living with HIV infection, recruited in facilities in seven U.S. states and using population-based methods in eight other states, between 2000-2004. We calculated self-reported participation in a clinical research study of HIV medicines, factors associated with self-reported study participation among men and women, and reasons for not participating in a study among nonparticipants. MAIN FINDINGS: Overall, 17% of respondents had ever participated in a clinical research study. For men, the odds of participation were lower for black or Hispanic men (versus white men) and were higher for men whose risk for HIV infection was male-male sex (versus men with male-female sex risk) and for men with AIDS. For men who had not participated in a study, black men were more likely than white men to report not participating in a study because they were unaware of available studies or were not offered enrollment (75% vs. 69%), and because they did not want to be a "guinea pig" (11% vs. 8%). Among women, participation was not associated with race/ethnicity or risk for HIV infection but was associated with living in an area with an NIH- or CDC- supported clinical research network. HIV-infected women were more likely than HIV-infected men with comparable modes of HIV acquisition to have participated in a study. CONCLUSIONS: Among persons with HIV interviewed in these 15 states, self-reported participation in clinical research studies was higher among women than men, but racial/ethnic minority men were

  2. Genitourinary malignancy presenting as an ocular metastasis: A case report and review of the literature

    PubMed Central

    Lefresne, Shilo; Fairchild, Alysa; Johnson, Royce; Deschenes, Jean; Russell, Laurie; Pederson, John

    2012-01-01

    Metastases to the eye or orbit as the initial presentation of genitourinary malignancy are unusual and can be a diagnostic challenge. We report an 81-year-old man who presented with pain and proptosis in an eye that had been blind for 50 years. Radiologic investigations identified a mass involving the left globe and orbit. Histology of the enucleation specimen was consistent with a metastatic poorly differentiated carcinoma suggestive of a prostate primary. With the constellation of obstructive urinary symptoms, an abnormal digital rectal examination, elevated prostate-specific antigen and a positive bone scan, androgen deprivation therapy was initiated for metastatic prostate cancer. After an initial response to treatment, the patient’s disease progressed in a manner atypical for prostate cancer. After describing our case, we review the literature on ocular and orbital metastases and their relation to genitourinary malignancies. PMID:22511437

  3. Supernumerary nipple and seminoma: case report and review of polythelia and genitourinary cancers.

    PubMed

    Grimshaw, Emily C; Cohen, Philip R

    2013-01-01

    The presence of supernumerary nipples, known as polythelia, is the most common presentation of accessory breast tissue. It is usually considered to be a benign congenital anomaly. However, polythelia may warrant attention for more than mere cosmetic concern because supernumerary nipples have been shown to be associated with an increased risk of genitourinary malignancies. We describe a 53-year-old man with an accessory nipple on the left chest who presented with stage IIA testicular seminoma at the age of 47. Published reports of patients with polythelia and genitourinary malignancies, as well as other neoplasms, are reviewed. Because patients with accessory nipples have a predisposition to develop visceral cancers, polythelia should be considered as a genodermatosis with malignant potential. PMID:23374946

  4. Lab Plays Central Role in Groundbreaking National Clinical Trial in Precision Medicine | Poster

    Cancer.gov

    The Molecular Characterization Laboratory lies at the heart of an ambitious new approach for testing cancer drugs that will use the newest tools of precision medicine to select the best treatment for individual patients based on the genetic makeup of their tumors. The protocol, called NCI-Molecular Analysis for Therapy Choice (NCI-MATCH), will start with tumor biopsies from as many as 3,000 patients to see if they have genetic defects for which a targeted cancer drug is available. Cancers will be treated based on their genetic profiles rather than by their location in the body, which is the conventional approach.

  5. [Eye tracking and desire: new scientific and clinical perspectives in sexual medicine].

    PubMed

    Bolmont, Mylène; Bianchi-Demicheli, Francesco

    2016-03-16

    There is a growing interest in the field of neurobiology of sexual function. With the advent of advanced technologies such as fMRI or EEG, it was possible to investigate the neuronal and psychobiological bases of the various phases of sexual response and sexual desire. Recently, a new technique debuted in sexual medicine, eye tracking. Thus through this article, we will leave the definition of sexual desire, through various neuropsychological studies in this field to finish on the unique and very recent eye tracking study that highlighted the visual patterns of desire sexual. PMID:27149718

  6. Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

    PubMed Central

    2011-01-01

    Background Consumer use of herbal and natural products (H/NP) is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants) (n = 532) in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7%) on the first survey and 87 of 535 (16.3%) clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81%) indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P < 0.0001), boosted their knowledge of H/NP (p < 0.0001), and increased their confidence in providing accurate H/NP answers to patients and colleagues (P < 0.0001). Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and

  7. A high-resolution anatomical ontology of the developing murine genitourinary tract

    PubMed Central

    Little, Melissa H.; Brennan, Jane; Georgas, Kylie; Davies, Jamie A.; Davidson, Duncan R.; Baldock, Richard A.; Beverdam, Annemiek; Bertram, John F.; Capel, Blanche; Chiu, Han Sheng; Clements, Dave; Cullen-McEwen, Luise; Fleming, Jean; Gilbert, Thierry; Houghton, Derek; Kaufman, Matt H.; Kleymenova, Elena; Koopman, Peter A.; Lewis, Alfor G.; McMahon, Andrew P.; Mendelsohn, Cathy L.; Mitchell, Eleanor K.; Rumballe, Bree A.; Sweeney, Derina E.; Valerius, M. Todd; Yamada, Gen; Yang, Yiya; Yu., Jing

    2007-01-01

    Cataloguing gene expression during development of the genitourinary tract will increase our understanding not only of this process but also of congenital defects and disease affecting this organ system. We have developed a high-resolution ontology with which to describe the subcompartments of the developing murine genitourinary tract. This ontology incorporates what can be defined histologically and begins to encompass other structures and cell types already identified at the molecular level. The ontology is being used to annotate in situ hybridisation data generated as part of the Genitourinary Development Molecular Anatomy Project (GUDMAP), a publicly available data resource on gene and protein expression during genitourinary development. The GUDMAP ontology encompasses Theiler stage (TS) 17 to 27 of development as well as the sexually mature adult. It has been written as a partonomic, text-based, hierarchical ontology that, for the embryological stages, has been developed as a high-resolution expansion of the existing Edinburgh Mouse Atlas Project (EMAP) ontology. It also includes group terms for well-characterised structural and/or functional units comprising several sub-structures, such as the nephron and juxtaglomerular complex. Each term has been assigned a unique identification number. Synonyms have been used to improve the success of query searching and maintain wherever possible existing EMAP terms relating to this organ system. We describe here the principles and structure of the ontology and provide representative diagrammatic, histological, and whole mount and section RNA in situ hybridisation images to clarify the terms used within the ontology. Visual examples of how terms appear in different specimen types are also provided. PMID:17452023

  8. Genitourinary syndrome of menopause: A new name for an old condition.

    PubMed

    Ward, Katherine; Deneris, Angela

    2016-06-16

    Genitourinary syndrome of menopause (GSM) is the new name for the conditions that formerly included vulvovaginal atrophy and atrophic vaginitis. GSM better describes the range of conditions associated with low estrogen levels in menopause and invites patient discussion without the use of words that might be uncomfortable to say. This article discusses the physiology of GSM and reviews both hormonal and nonhormonal treatment options. PMID:27327425

  9. Non-oncologic applications of diffusion-weighted imaging (DWI) in the genitourinary system.

    PubMed

    Dunn, Dell P; Kelsey, Nathan R; Lee, Karen S; Smith, Martin P; Mortele, Koenraad J

    2015-08-01

    Diffusion-weighted imaging (DWI) has become an increasingly used tool in abdominal and pelvic magnetic resonance imaging (MRI), primarily in the oncologic setting. DWI sequences are being added to routine MRI protocols at many institutions, and as its use has spread, more non-oncologic applications have been explored. The purpose of this article is to provide a review of DWI applications in inflammatory, infectious, autoimmune-mediated, and ischemic processes affecting the genitourinary system. PMID:26109511

  10. Effective Communication Barriers in Clinical Teaching among Malaysian Medical Students in Zagazig Faculty of Medicine (Egypt)

    PubMed Central

    Abass, Marwa Ahmed; Said, Nagwa Samy; Zahed, Eman Salah EL; Hussein, Wafaa Fawzy; Hamid, Omaima Ibrahim Abdel

    2015-01-01

    Introduction effective communication in a clinical environment plays a vital role in patient assessment and treatment. The aim of this study was to understand the experiences of Malaysian medical students concerning communication barriers during clinical practice. The goal was to provide answers for three important research questions, i.e., 1) Are communication barriers an impediment to Malaysian students during clinical teaching? 2) What is the nature of the language barriers that the students encounter? and 3) What are the best ways of reducing these barriers during clinical teaching? Methods The qualitative method was used to conduct the research, and open-ended questionnaires were used to collect the data. The study was conducted on 95 fourth-, fifth-, and sixth-year students, 80% of whom completed the study. Results Medical students from Malaysia who have limited knowledge of the Arabic language experience some difficulties in communicating with staff members, patients, and nurses during their clinical practices. Conclusion Successful orientation of students to the language used in the clinical environment will help the students overcome the communication barriers they encounter during their clinical practices. PMID:26816591

  11. Congenital anomalies of the genitourinary system can help in diagnosis of the primary site of metastatic cancer: a case report and a review of the literature

    PubMed Central

    Deptala, Andrzej; Romanowicz, Agnieszka; Czerw, Aleksandra; Walecki, Jerzy; Rogowski, Wojciech; Nasierowska-Guttmejer, Anna

    2016-01-01

    Objective To analyze whether the presence of congenital anomalies of the genitourinary system that are accompanied by specific types of cancer and predispose patients to many complications, including infection, obstruction, stasis, calculus formation, and impaired renal function, could help in the diagnosis of the primary site of a metastatic tumor. Case presentation We report a case of a 58-year-old man with metastatic adenocarcinoma, in whom congenital anomalies of the genitourinary system proved helpful for the diagnosis of the primary site of cancer originating in the seminal vesicles. Conclusion We report an extremely rare case of primary adenocarcinoma arising probably from the left seminal vesicle associated with ipsilateral renal agenesis. The lesion was detected on ultrasound and contrast-enhanced computed tomography and confirmed histologically with ultrasound-guided biopsy. Serum markers, ie, CA19-9 and CA125, were elevated, while prostate-specific antigen and carcinoembryonic antigen were within normal limits. Such a constellation of markers strengthened the diagnosis. Our patient unfortunately presented very late in the course of the disease. Hence, we decided to initiate antiandrogen therapy and best supportive care in a hospice setting. Only early detection seems to be the key factor that may result in improved cure rates for cancer of the seminal vesicles. We also performed a literature search for current concepts related to the diagnosis and clinical management of primary adenocarcinoma of seminal vesicles. PMID:27499637

  12. The perception, beliefs and practices toward genitourinary schistosomiasis by inhabitants of selected endemic areas (Edo/Delta States) in south-eastern Nigeria.

    PubMed

    Ukwandu, Nnamdi Callistus D; Nmorsi, O P G

    2004-01-01

    Well-structured questionnaire on the perception, impression and response to genitourinary bilharziasis (Genitourinary schistosomiasis) was administered and explained in local languages: 'Igbo' 'Esan' 'Ezon' Itshekiri and Bini to 33815 inhabitants of selected endemic areas in south-eastern Nigeria from January, 1999 to December, 2001. Out of this number, 3815 (11.3%) were properly filled and returned. About 42.0% of the inhabitants admitted knowledge of the disease, while 14 (0.4%) knew about the aetiologic agent. About 181 (5.0%) who responded, admitted procuring treatment, while 100 (5.0%) declined to seek treatment of any sort. The relationships between water-bodies and human activities, and infection were well discussed. Amongst those who admitted knowledge of the disease but no knowledge of its etiologic agent, declined seeking treatment of any kind, but believe the disease is a natural phenomenon in ones developmental stage and therefore of no morbidity and mortality. Laboratory analysis of urine, faeces, semen and HVS was employed to assess questionnaire responses, and in some cases, physical examination was utilized to augment laboratory analysis in confirming urinal diagnosis. Haematuria was only directly related to egg count in the early part of life. Females were significantly haematuric and excreted more ova than males (p < 0.05). Headache (43.0%) and fever (31.0%) were major clinical signs while sexual pains (22.0%) were the least. PMID:15361973

  13. American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: quality assurance for clinical radiotherapy treatment planning.

    PubMed

    Fraass, B; Doppke, K; Hunt, M; Kutcher, G; Starkschall, G; Stern, R; Van Dyke, J

    1998-10-01

    In recent years, the sophistication and complexity of clinical treatment planning and treatment planning systems has increased significantly, particularly including three-dimensional (3D) treatment planning systems, and the use of conformal treatment planning and delivery techniques. This has led to the need for a comprehensive set of quality assurance (QA) guidelines that can be applied to clinical treatment planning. This document is the report of Task Group 53 of the Radiation Therapy Committee of the American Association of Physicists in Medicine. The purpose of this report is to guide and assist the clinical medical physicist in developing and implementing a comprehensive but viable program of quality assurance for modern radiotherapy treatment planning. The scope of the QA needs for treatment planning is quite broad, encompassing image-based definition of patient anatomy, 3D beam descriptions for complex beams including multileaf collimator apertures, 3D dose calculation algorithms, and complex plan evaluation tools including dose volume histograms. The Task Group recommends an organizational framework for the task of creating a QA program which is individualized to the needs of each institution and addresses the issues of acceptance testing, commissioning the planning system and planning process, routine quality assurance, and ongoing QA of the planning process. This report, while not prescribing specific QA tests, provides the framework and guidance to allow radiation oncology physicists to design comprehensive and practical treatment planning QA programs for their clinics. PMID:9800687

  14. Intermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma.

    PubMed

    Biardeau, X; Corcos, J

    2016-04-01

    Intermittent catheterization is considered the standard of care in most neurologic patients with lower urinary tract disorders. However, in this context, genitourinary tract infection and urethral trauma represent specific challenges. Such conditions have been found to significantly deteriorate quality of life and complicate subsequent treatments. Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management. Here, we discuss the diagnosis and therapeutic and preventive approaches associated with genitourinary tract infection and urethral trauma in this specific population. This "state-of-the-art" article results from a literature review (MEDLINE articles and scientific society guidelines) and the authors' experience. It was structured in a didactic way to facilitate comprehension and promote the implementation of advice and recommendations in daily practice. Genitourinary tract infection and urethral trauma associated with intermittent catheterization in neurologic patients should be managed with a global approach, including patient and caregiver education, optimal catheterization with hydrophilic-coated or pre-lubricated catheters and adequate use of antibiotic therapy. PMID:27053002

  15. Clinical Space Medicine Products as Developed by the Medical Operations Support Team (MOST)

    NASA Technical Reports Server (NTRS)

    Polk, James D.; Doerr, Harold K.; Hurst, Victor W., IV; Schmid, Josef

    2007-01-01

    Medical Operations Support Team (MOST) is introducing/integrating teaching practices associated with high fidelity human patient simulation into the NASA culture, in particular, into medical training sessions and medical procedure evaluations. Current/Future Products iclude: a) Development of Sub-optimal Airway Protocols for the International Space Station (ISS) using the ILMA; b) Clinical Core Competency Training for NASA Flight Surgeons (FS); c) Post-Soyuz Landing Clinical Training for NASA FS; d) Experimental Integrated Training for Astronaut Crew Medical Officers and NASA FS; and e) Private Clinical Refresher Training.

  16. Precision Medicine in NCI’s National Clinical Trials Network: Progress and Lessons Learned

    Cancer.gov

    NCI’s Jeff Abrams, M.D., Acting Director for Clinical Research in the Division of Cancer Treatment and Diagnosis (DCTD) and Associate Director of the Cancer Therapy Evaluation Program (CTEP) and Nita Seibel, M.D., Head of the Pediatric Solid Tumor Therapeutics in the Clinical Investigations Branch of CTEP, DCTD will host a Google Hangout on Air. The discussion will be moderated by Andrea Denicoff, R.N., N.P, Head, NCTN Clinical Trials Operations in the Investigational Drug Branch of CTEP, DCTD.

  17. Pictorial review of SPECT/CT imaging applications in clinical nuclear medicine

    PubMed Central

    Bhargava, Peeyush; He, Guocheng; Samarghandi, Amin; Delpassand, Ebrahim S

    2012-01-01

    Integrated SPECT/CT scanners are gaining popularity as hybrid molecular imaging devices which can acquire SPECT and CT in a single exam. CT can be a low dose non-contrast enhanced scan for attenuation correction and anatomical localization, or a contrast enhanced diagnostic quality scan for additional anatomical characterization. We present a pictorial review highlighting the usefulness of this emerging technology. We present SPECT/CT images of 13 patients where additional information was provided by the co-registered low dose non-contrast enhanced CT scan. They belong to 12 male and 1 female patients with age ranging from 28 to 76 yrs, who were referred to the Nuclear Medicine Department for various indications. We describe these cases under in the following categories: bone scintigraphy (2), leukocyte scintigraphy (2), nuclear oncology (5), nuclear cardiology (1), and general nuclear medicine (3). Additional information provided by the co-registered low dose CT improves the diagnostic confidence in image interpretation of SPECT imaging. PMID:23133813

  18. The practical application of narrative medicine at Mayo Clinic: imagining the scaffold of a worthy house.

    PubMed

    Rian, Johanna; Hammer, Rachel

    2013-12-01

    American health care institutions increasingly recognize narrative medicine as a means to developing quality patient care. More commonly applied in health care professional development settings, narrative medicine is less overtly employed with patient populations. In this article, we describe the application of various narrative practices in the patient care and medical education programs of a major health care center in Minnesota. We discuss the impact of these programs on their participants in relation to the evidence based in current scholarship. Further, we examine narrative externalization of illness in Katherine Butler Hathaway's disability memoir "The Little Locksmith," a text which implicates the work of metaphor-making as a transformative step in healing. While several reports demonstrate that patients can find creative writing during times of illness to be therapeutic, there are many for whom the practice is problematic or unattractive, obstacles to practice implementation that the authors discuss. However, based on the experience of our institution, for health care institutions seeking to build a legacy of leadership in empathic patient care, narrative--employed in mentoring physicians in training and in establishing strong, dialogic relationships with patients and colleagues--should serve as a central strategy, or scaffold. PMID:24130048

  19. The Learners' Perceptions Survey—Primary Care: Assessing Resident Perceptions of Internal Medicine Continuity Clinics and Patient-Centered Care

    PubMed Central

    Byrne, John M.; Chang, Barbara K.; Gilman, Stuart C.; Keitz, Sheri A.; Kaminetzky, Catherine P.; Aron, David C.; Baz, Sam; Cannon, Grant W.; Zeiss, Robert A.; Holland, Gloria J.; Kashner, T. Michael

    2013-01-01

    Background In 2010, the Department of Veterans Affairs (VA) implemented a national patient-centered care initiative that organized primary care into interdisciplinary teams of health care professionals to provide patient-centered, continuous, and coordinated care. Objective We assessed the discriminate validity of the Learners' Perceptions Survey—Primary Care (LPS-PC), a tool designed to measure residents' perceptions about their primary and patient-centered care experiences. Methods Between October 2010 and June 2011, the LPS-PC was administered to Loma Linda University Medical Center internal medicine residents assigned to continuity clinics at the VA Loma Linda Healthcare System (VALLHCS), a university setting, or the county hospital. Adjusted differences in satisfaction ratings across settings and over domains (patient- and family-centered care, faculty and preceptors, learning, clinical, work and physical environments, and personal experience) were computed using a generalized linear model. Results Our response rate was 86% (77 of 90). Residents were more satisfied with patient- and family-centered care at the VALLHCS than at either the university or county (P < .001). However, faculty and preceptors (odds ratio [OR]  =  1.53), physical (OR  =  1.29), and learning (OR  =  1.28) environments had more impact on overall resident satisfaction than patient- and family-centered care (OR  =  1.08). Conclusions The LPS-PC demonstrated discriminate validity to assess residents' perceptions of their patient-centered clinical training experience across outpatient primary care settings at an internal medicine residency program. The largest difference in scores was the patient- and family-centered care domain, in which residents rated the VALLHCS much higher than the university or county sites. PMID:24455006

  20. Report: Clinical curative effect of traditional Chinese medicine combined with doxycycline in the treatment of genital Chlamydia trachomatis and Urea plasma urealyticum infections.

    PubMed

    Ruan, Yueqin; Han, Zhaodong; Han, Xiaotong

    2015-07-01

    This paper aims to study clinical curative effect of traditional Chinese medicine combined with doxycycline in treating genital Chlamydia trachomatis (Ct) and Urea plasma urealyticum (Uu) infections. The observed subjects in this paper were 60 patients who had been randomly divided into two groups, among which the control group was treated with doxycycline and the treatment group with Chinese medicine combined with doxycycline. Results showed that the curative effect of the treatment group was much better than that of the control. So it is proved that Chinese medicine combined with doxycycline is worth promoting because it is a convenient and safe way, which does not easily produce drug-resistant strain. PMID:26431666

  1. [Genitourinary fistulae at the National Institute of Perinatology].

    PubMed

    Villagrán-Cervantes, R; Rodríguez-Colorado, S; Delgado-Urdapilleta, J; Kunhardt-R, J

    1996-07-01

    Evaluation of the characteristics of urogenital fistula with a retrospective study at the clinic of Urology Ginecologica in the Instituto Nacional de Perinatologia between March 1992 to June 1995, information of the location, etiopathogenesis of the disease, urinary tract infection and surgical treatment were obtained form de patients records in the clinic. The etiophatogenesis of the disease was surgical gynecological procedures in 51.1%, and obstetric cause 48.5%; the location were 14 (66.6%) vesicovaginal, 5 (23.5% 0 ureterovaginal and 2 (urethrovaginal). The abdominal approach were in 8 patients and vaginal route in 9, no surgical treatment were 2. Successfully repair fistula were in 80.9%. Urinary tract infections before treatment agreed on the obstetric etiology was 47.6%, and for surgical gynecological procedures 52.2%. There is an increase in the incident of obstetric vesicovaginal fistula, we believe it depends on the patients that we have in de Instituto Nacional de Perinatologia, most of them are obstetric patients. PMID:8756196

  2. How Current Clinical Practice Guidelines for Low Back Pain Reflect Traditional Medicine in East Asian Countries: A Systematic Review of Clinical Practice Guidelines and Systematic Reviews

    PubMed Central

    Cho, Hyun-Woo; Hwang, Eui-Hyoung; Lim, Byungmook; Heo, Kwang-Ho; Liu, Jian-Ping; Tsutani, Kiichiro; Lee, Myeong Soo; Shin, Byung-Cheul

    2014-01-01

    Objectives The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. Methods We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. Results Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. Conclusions The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system. PMID:24505363

  3. One-year clinical experience with a fully digitized nuclear medicine department: organizational and economical aspects

    NASA Astrophysics Data System (ADS)

    Anema, P. C.; de Graaf, C. N.; Wilmink, J. B.; Hall, David R.; Hoekstra, A. G.; van Rijk, P. P.; Van Isselt, J. W.; Viergever, Max A.

    1991-07-01

    At the department of nuclear medicine of the University Hospital Utrecht a single-modality PACS has been operational since mid-1990. After one year of operation the functionality, the organizational and economical consequences, and the acceptability of the PACS were evaluated. The functional aspects reviewed were: viewing facilities, patient data management, connectivity, reporting facilities, archiving, privacy, and security. It was concluded that the improved quality of diagnostic viewing and the potential integration with diagnosis, reporting, and archiving are highly appreciated. The many problems that have occurred during the transition period, however, greatly influence the appreciation and acceptability of the PACS. Overall, it is felt that in the long term there will be a positive effect on the quality and efficiency of the work.

  4. Subcutaneous electrical stimulation (acupuncture) in the clinical practice of physical medicine.

    PubMed

    Waylonis, G W

    1976-04-01

    There has been a rapid growth in both interest and concern over the value of acupuncture in this country during the last three years. Initially it was regarded with doubt, then with overwhelming interest, but only recently have any research data appeared as to its true value and applicability to western medicine. An acupuncture research project was initiated in November 1972 by the author to assess the immediate and long-range benefits of acupuncture in a group of 179 patients with various neuromuscular-skeletal pain and mobility problems. A total of 1,112 treatments have been administered. A follow-up survey of these patients was completed in October 1974 with 126 (70%) of the patients responding to a subjective questionnaire. In 49% of the patients the initial response to acupuncture treatments was some reduction of symptoms and in a significant percentage there was persistence of beneficial response for greater than three months. PMID:1083724

  5. The spectrum of expert reports on clinical biochemical toxicology and medicine from an Irish practice.

    PubMed

    Tormey, William P

    2015-12-01

    The compounds which generated an expert opinion report in the area of medical toxicology in the period 1999 to 2015 are presented from the toxicological case files of a specialist in chemical pathology and general internal medicine. There were 132 different compounds from 86 cases. Alcohol was involved in 43%, drugs of abuse in 18.6%, volatile carbon compounds in 17.4%, metals in 9.3%, and carbon monoxide in 4.6%. Many compounds appeared once. The duty of the medical expert witness to provide an objective report for the court irrespective of the payer is stated. The addition of references from peer reviewed literature to substantiate the pros and cons of each case is recommended as a standard operating procedure in completing each report. PMID:26424478

  6. Selenium, copper and iron in veterinary medicine-From clinical implications to scientific models.

    PubMed

    Humann-Ziehank, Esther

    2016-09-01

    Diseases related to copper, selenium or iron overload or deficiency are common and well-described in large animal veterinary medicine. Some of them certainly have the potential to serve as useful animal models for ongoing research in the field of trace elements. Obvious advantages of large animal models compared to laboratory animal models like rats and mice are the option of long-term, consecutive examinations of progressive deficient or toxic stages and the opportunity to collect various, high volume samples for repeated measurements. Nevertheless, close cooperation between scientific disciplines is necessary as scientists using high sophisticated analytical methods and equipment are not regularly in touch with scientists working with large animal diseases. This review will give an introduction into some typical animal diseases related to trace elements and will present approaches where the animal diseases were used already as a model for interdisciplinary research. PMID:27316591

  7. [Surrogate end points for clinical trials on chronic kidney disease and research of Chinese medicine].

    PubMed

    Rao, Xiang-rong; Wang, Li; Dai, Xi-wen

    2008-08-01

    Chronic kidney disease is a kind of disease with the condition always worsening over time passing through a sequence of stages, and the evaluation on its clinical treatment is mainly by observing the speed of renal function deteriorating and the time of terminal renal failure occurrence. In order to conduct the trial go on wheels, the authors proposed that the "surrogate end points (SEP)" should be introduced. It is the biologic mark for substitute the clinical terminal point (event), formed depending upon the scientific evidences of epidemiology, pathophysiology, drug-therapy and other scientific evidence, which could be used for predicting the efficacy or damage of a certain measure, present or absent. This article aimed to explain the definition of SEP and to discuss the usable SEP for clinical trial on chronic kidney disease, such as proteinuria, declination of glomerular filtration rate and its slope coefficient as well as the time of terminal occurrence. Moreover, through analyzing the existent problems in clinical researches concerning TCM treatment of chronic kidney disease, the authors suggested that some improvements, chiefly the utilization of SEP for efficacy evaluation, are necessary in the clinical observation methodologies for chronic kidney disease. PMID:18928108

  8. [Breast cancer pathogenesis of stagnation of phlegm, poison and blood stasis: rationale and clinical application in traditional Chinese medicine].

    PubMed

    Liu, Sheng; Hua, Yong-qiang; Sun, Zhen-ping; Tan, Song; Lu, De-ming

    2007-03-01

    Breast cancer is called "Ruyan" in literature of traditional Chinese medicine. We synthesized the ancient and contemporary discussions and raised the theory that "Duxie" (poisonous pathogenic factor) is the etiological factor and pathologic product through the whole course of breast cancer. "Liuyin Fudu" (latent poison of six exogenous pathogenic factors) and "Qiqing Yudu" (stagnant poison of seven emotions) are the main etiological factors affecting the breast cancer occurrence. "Aidu Neisheng" (internal product of cancer poison) is the essential change in breast cancer occurrence. "Tandu Yujie" (stagnation of phlegm, poison and blood stasis) is the essential pathogenesis of the breast cancer's development. "Yudu Weiqing" (vestigial poison) is the main pathogenesis of breast cancer after operation. "Yudu Pangcuan" (vestigial poison invasion elsewhere) is the key pathogenesis of recurrence and metastasis after operation. "Sanjie Jiedu" (dispersing accumulation and detoxification) is an important therapeutic principle in breast cancer's treatment after operation. The "Tandu Yujie" pathogenesis theory and "Sanjie Jiedu" therapeutic principle developed the theory about breast cancer in traditional Chinese medicine, and have some clinical application value. PMID:17352863

  9. Consumption of medicinal plants by patients with heart diseases at a pharmacist-managed anticoagulation clinic in Brazil.

    PubMed

    Leite, Paula Mendonça; Castilho, Rachel Oliveira; Ribeiro, Antonio Luiz Pinho; Martins, Maria Auxiliadora Parreiras

    2016-04-01

    Background Medicinal plants (MP) have been used for many years with the purpose of feeding and curing. Several MP may interfere in drug response and are not always considered as potential drug-interactors in clinical practice. Objective To investigate the consumption of MP by outpatients during a one-year follow-up. Method Patients with cardiopathy diagnosis and indication(s) for long-term use of warfarin were recruited at a pharmacist-managed anticoagulation clinic of a Brazilian public hospital. This research employed a descriptive method. The consumption of MP was examined regarding the type, frequency and forms of use. Results A total of 280 patients were studied. Most patients were female (54.6 %) with an average age of 56.8 ± 13.1 years. The consumption of MP was reported by 46 (16.4 %) patients, totalizing 59 occurrences. Lemon, lemon balm and plantain were the most common MP. The main pharmacological uses involved the digestive, urinary, and respiratory tracts. Tea was the predominant form of consumption (87 %). Twelve (33.3 %) plants presented potential herb-warfarin interactions according to the literature. Conclusion We described the consumption of MP among outpatients characterized by their complex disease status, propensity for adverse events, and socioeconomic limitations. These results may guide pharmacist interventions and procedures to prevent clinical complications. PMID:26941093

  10. Whole-exome sequencing and clinical interpretation of formalin-fixed, paraffin-embedded tumor samples to guide precision cancer medicine.

    PubMed

    Van Allen, Eliezer M; Wagle, Nikhil; Stojanov, Petar; Perrin, Danielle L; Cibulskis, Kristian; Marlow, Sara; Jane-Valbuena, Judit; Friedrich, Dennis C; Kryukov, Gregory; Carter, Scott L; McKenna, Aaron; Sivachenko, Andrey; Rosenberg, Mara; Kiezun, Adam; Voet, Douglas; Lawrence, Michael; Lichtenstein, Lee T; Gentry, Jeff G; Huang, Franklin W; Fostel, Jennifer; Farlow, Deborah; Barbie, David; Gandhi, Leena; Lander, Eric S; Gray, Stacy W; Joffe, Steven; Janne, Pasi; Garber, Judy; MacConaill, Laura; Lindeman, Neal; Rollins, Barrett; Kantoff, Philip; Fisher, Sheila A; Gabriel, Stacey; Getz, Gad; Garraway, Levi A

    2014-06-01

    Translating whole-exome sequencing (WES) for prospective clinical use may have an impact on the care of patients with cancer; however, multiple innovations are necessary for clinical implementation. These include rapid and robust WES of DNA derived from formalin-fixed, paraffin-embedded tumor tissue, analytical output similar to data from frozen samples and clinical interpretation of WES data for prospective use. Here, we describe a prospective clinical WES platform for archival formalin-fixed, paraffin-embedded tumor samples. The platform employs computational methods for effective clinical analysis and interpretation of WES data. When applied retrospectively to 511 exomes, the interpretative framework revealed a 'long tail' of somatic alterations in clinically important genes. Prospective application of this approach identified clinically relevant alterations in 15 out of 16 patients. In one patient, previously undetected findings guided clinical trial enrollment, leading to an objective clinical response. Overall, this methodology may inform the widespread implementation of precision cancer medicine. PMID:24836576

  11. Standardized nursing language in the systematized nomenclature of medicine clinical terms: A cross-mapping validation method.

    PubMed

    Lu, Der-Fa F; Eichmann, David; Konicek, Debra; Park, Hyun Tae; Ucharattana, Prangtip; Delaney, Connie

    2006-01-01

    Many standardized healthcare languages have been mapped to the Systematized Nomenclature of Medicine Clinical Terms known as SNOMED CT, which was developed by the College of American Pathologists. This study describes a methodology for detecting misassigned concepts from source systems to SNOMED CT and presents the results of applying this methodology to a subset of concepts from two standardized nursing languages, the Nursing Interventions Classification and the Nursing Outcomes Classification. The methodology is based on comparing the knowledge representations of a set of nursing concepts between source systems (nursing languages) and SNOMED CT. If any nursing concept differs in knowledge representation in the target system compared with the source system, editorial misassignment of the concept was declared and recommendations for target system developers were made. In a total of 75 nursing concepts used to test this method, five misassigned concepts(6.6%) were found in SNOMED CT. This method can be used to validate other healthcare languages. PMID:16980782

  12. Enhanced Evidence-Based Chinese Medicine Clinical Practice Guidelines in Hong Kong: A Study Protocol for Three Common Diseases

    PubMed Central

    Shi, Nannan; Zhong, Linda L. D.; Han, XueJie; Ng, Bacon; Bian, Zhaoxiang; Lu, Aiping

    2015-01-01

    We presented a study protocol of developing Chinese medicine clinical practice guidelines for three common diseases in Hong Kong, including insomnia, chronic gastritis, and cerebral infarction. This research project will be conducted in three phases. First phase is the preparation stage which consists of the establishment of steering committee and panel. Second phase involves 6 steps, which are searching and identifying evidence, text mining process, Delphi survey, synthesizing of data, consensus conference, and drafting guidelines. In this phase, text mining technique, evidence-based method, and formal consensus method are combined to get consolidated supporting data as the source of CM CPGs. The final phase comprised external reviews, dissemination, and updating. The outputs from this project will provide three CM CPGs for insomnia, chronic gastritis, and cerebral infarction for Hong Kong local use. PMID:25815035

  13. Determination of Clinically Relevant Content for a Musculoskeletal Anatomy Curriculum for Physical Medicine and Rehabilitation Residents

    ERIC Educational Resources Information Center

    Lisk, Kristina; Flannery, John F.; Loh, Eldon Y.; Richardson, Denyse; Agur, Anne M. R.; Woods, Nicole N.

    2014-01-01

    To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi…

  14. Lung-MAP Launches: First Precision Medicine Trial From National Clinical Trials Network

    Cancer.gov

    A unique public-private collaboration today announced the initiation of the Lung Cancer Master Protocol (Lung-MAP) trial, a multi-drug, multi-arm, biomarker-driven clinical trial for patients with advanced squamous cell lung cancer. Squamous cell carcinom

  15. Systems medicine in colorectal cancer: from a mathematical model toward a new type of clinical trial.

    PubMed

    Castagnino, Nicoletta; Maffei, Massimo; Tortolina, Lorenzo; Zoppoli, Gabriele; Piras, Daniela; Nencioni, Alessio; Moran, Eva; Ballestrero, Alberto; Patrone, Franco; Parodi, Silvio

    2016-07-01

    Current colorectal cancer (CRC) treatment guidelines are primarily based on clinical features, such as cancer stage and grade. However, outcomes may be improved using molecular treatment guidelines. Potentially useful biomarkers include driver mutations and somatically inherited alterations, signaling proteins (their expression levels and (post) translational modifications), mRNAs, micro-RNAs and long noncoding RNAs. Moving to an integrated system is potentially very relevant. To implement such an integrated system: we focus on an important region of the signaling network, immediately above the G1-S restriction point, and discuss the reconstruction of a Molecular Interaction Map and interrogating it with a dynamic mathematical model. Extensive model pretraining achieved satisfactory, validated, performance. The model helps to propose future target combination priorities, and restricts drastically the number of drugs to be finally tested at a cellular, in vivo, and clinical-trial level. Our model allows for the inclusion of the unique molecular profiles of each individual patient's tumor. While existing clinical guidelines are well established, dynamic modeling may be used for future targeted combination therapies, which may progressively become part of clinical practice within the near future. WIREs Syst Biol Med 2016, 8:314-336. doi: 10.1002/wsbm.1342 For further resources related to this article, please visit the WIREs website. PMID:27240214

  16. Process improvement of pap smear tracking in a women's medicine center clinic in residency training.

    PubMed

    Calhoun, Byron C; Goode, Jeff; Simmons, Kathy

    2011-11-01

    Application of Six-Sigma methodology and Change Acceleration Process (CAP)/Work Out (WO) tools to track pap smear results in an outpatient clinic in a hospital-based residency-training program. Observational study of impact of changes obtained through application of Six-Sigma principles in clinic process with particular attention to prevention of sentinel events. Using cohort analysis and applying Six-Sigma principles to an interactive electronic medical record Soarian workflow engine, we designed a system of timely accession and reporting of pap smear and pathology results. We compared manual processes from January 1, 2007 to February 28, 2008 to automated processes from March 1, 2008 to December 31, 2009. Using the Six-Sigma principles, CAP/WO tools, including "voice of the customer" and team focused approach, no outlier events went untracked. Applying the Soarian workflow engine to track prescribed 7 day turnaround time for completion, we identified 148 pap results in 3,936, 3 non-gynecological results in 15, and 41 surgical results in 246. We applied Six-Sigma principles to an outpatient clinic facilitating an interdisciplinary team approach to improve the clinic's reporting system. Through focused problem assessment, verification of process, and validation of outcomes, we improved patient care for pap smears and critical pathology. PMID:22103702

  17. A Web-Based Compendium of Clinical Questions and Medical Evidence To Educate Internal Medicine Residents.

    ERIC Educational Resources Information Center

    Crowley, Steven H.; Owens, Thomas A.; Schardt, Connie M.; Wardell, Sarah I.; Peterson, Josh; Garrison, Scott; Keitz, Sheri A.

    2003-01-01

    Describes an electronic database of clinical questions (CQs) and medical evidence, the Critical Appraisal Resource (CAR). Evaluation of ten months of use found that medical residents did engage the medical literature on behalf of their patients, which influenced approximately half of their patient-care decisions. (EV)

  18. Nanoparticle-Based Medicines: A Review of FDA-Approved Materials and Clinical Trials to Date.

    PubMed

    Bobo, Daniel; Robinson, Kye J; Islam, Jiaul; Thurecht, Kristofer J; Corrie, Simon R

    2016-10-01

    In this review we provide an up to date snapshot of nanomedicines either currently approved by the US FDA, or in the FDA clinical trials process. We define nanomedicines as therapeutic or imaging agents which comprise a nanoparticle in order to control the biodistribution, enhance the efficacy, or otherwise reduce toxicity of a drug or biologic. We identified 51 FDA-approved nanomedicines that met this definition and 77 products in clinical trials, with ~40% of trials listed in clinicaltrials.gov started in 2014 or 2015. While FDA approved materials are heavily weighted to polymeric, liposomal, and nanocrystal formulations, there is a trend towards the development of more complex materials comprising micelles, protein-based NPs, and also the emergence of a variety of inorganic and metallic particles in clinical trials. We then provide an overview of the different material categories represented in our search, highlighting nanomedicines that have either been recently approved, or are already in clinical trials. We conclude with some comments on future perspectives for nanomedicines, which we expect to include more actively-targeted materials, multi-functional materials ("theranostics") and more complicated materials that blur the boundaries of traditional material categories. A key challenge for researchers, industry, and regulators is how to classify new materials and what additional testing (e.g. safety and toxicity) is required before products become available. PMID:27299311

  19. Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach.

    PubMed

    Ziemssen, Tjalf; Kern, Raimar; Thomas, Katja

    2016-01-01

    Multiple sclerosis (MS) is a highly heterogeneous disease as it can present inter-individually as well as intra-individually, with different disease phenotypes emerging during different stages in the long-term disease course. In addition to advanced immunological, genetic and magnetic resonance imaging (MRI) profiling of the patient, the clinical profiling of MS patients needs to be widely implemented in clinical practice and improved by including a greater range of relevant parameters as patient-reported outcomes. It is crucial to implement a high standard of clinical characterization of individual patients as this is key to effective long-term observation and evaluation.To generate reliable real-world data, individual clinical data should be collected in specific MS registries and/or using intelligent software instruments as the Multiple Sclerosis Documentation System 3D. Computational analysis of biological processes will play a key role in the transition to personalized MS treatment. Major breakthroughs in the areas of bioinformatics and computational systems biology will be required to process this complex information to enable improved personalization of treatment for MS patients. PMID:27484848

  20. Jumping on the Train of Personalized Medicine: A Primer for Non- Geneticist Clinicians: Part 3. Clinical Applications in the Personalized Medicine Area

    PubMed Central

    Li, Aihua; Meyre, David

    2014-01-01

    The rapid decline of sequencing costs brings hope that personal genome sequencing will become a common feature of medical practice. This series of three reviews aim to help non-geneticist clinicians to jump into the fast-moving field of personalized genetic medicine. In the first two articles, we covered the fundamental concepts of molecular genetics and the methodologies used in genetic epidemiology. In this third article, we discuss the evolution of personalized medicine and illustrate the most recent success in the fields of Mendelian and complex human diseases. We also address the challenges that currently limit the use of personalized medicine to its full potential. PMID:25598768