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Genotypic and phenotypic characterization of Brazilian patients with GM1 gangliosidosis.  


GM1 gangliosidosis is a lysosomal disorder caused by ?-galactosidase deficiency due to mutations in the GLB1 gene. It is a rare neurodegenerative disorder with an incidence of about 1:100,000-1:200,000 live births worldwide. Here we review GLB1 mutations and clinical features from 65 Brazilian GM1 gangliosidosis patients. Molecular analysis showed 17 different mutations and c.1622-1627insG was the most frequent, accounting for 50% of the alleles. Cognitive impairment was the main clinical sign, observed in 82% of patients, followed by hepatosplenomegaly observed in 56% of patients. It was possible to establish a significant correlation between age at onset of symptoms preceding the first year of life and the presence of the mutation c.1622-1627insG (p=0.03). Overall our findings differ from literature and represent the exclusive genotypic profile found in Brazilian GM1 gangliosidosis patients. PMID:23046582

Sperb, Fernanda; Vairo, Filippo; Burin, Maira; Mayer, Fabiana Quoos; Matte, Ursula; Giugliani, Roberto



Genetics Home Reference: GM1 gangliosidosis  


... Patients and Families Resources for Health Professionals What glossary definitions help with understanding GM1 gangliosidosis? autosomal ; autosomal ... many other terms in the Genetics Home Reference Glossary . See also Understanding Medical Terminology . References (6 links) ...


GM1 gangliosidosis and Morquio B disease: an update on genetic alterations and clinical findings  

PubMed Central

GM1 gangliosidosis and Morquio B syndrome, both arising from beta-galactosidase (GLB1) deficiency, are very rare lysosomal storage diseases with an incidence of about 1:100,000– 1:200,000 live births worldwide. Here we report the beta-galactosidase gene (GLB1) mutation analysis of 21 unrelated GM1 gangliosidosis patients, and of 4 Morquio B patients, of whom two are brothers. Clinical features of the patients were collected and compared with those in literature. In silico analyses were performed by standard alignments tools and by an improved version of GLB1 three-dimensional models. The analysed cohort includes remarkable cases. One patient with GM1 gangliosidosis had a triple X syndrome. One patient with juvenile GM1 gangliosidosis was homozygous for a mutation previously identified in Morquio type B. A patient with infantile GM1 gangliosidosis carried a complex GLB1 allele harbouring two genetic variants leading to p.R68W and p.R109W amino acid changes, in trans with the known p.R148C mutation. Molecular analysis showed 27 mutations, 9 of which are new: 5 missense, 3 microdeletions and a nonsense mutation. We also identified four new genetic variants with a predicted polymorphic nature that was further investigated by in silico analyses. Three-dimensional structural analysis of GLB1 homology models including the new missense mutations and the p.R68W and p.R109W amino acid changes, showed that all the amino acids replacements affected the resulting protein structures in different ways, from changes in polarity to folding alterations. Genetic and clinical associations led us to undertake a critical review of the classifications of late-onset GM1 gangliosidosis and Morquio B disease. PMID:21497194

Caciotti, Anna; Garman, Scott C; Rivera-Colón, Yadilette; Procopio, Elena; Catarzi, Serena; Ferri, Lorenzo; Guido, Carmen; Martelli, Paola; Parini, Rossella; Antuzzi, Daniela; Battini, Roberta; Sibilio, Michela; Simonati, Alessandro; Fontana, Elena; Salviati, Alessandro; Akinci, Gulcin; Cereda, Cristina; Dionisi-Vici, Carlo; Deodato, Francesca; d’Amico, Adele; d’Azzo, Alessandra; Bertini, Enrico; Filocamo, Mirella; Scarpa, Maurizio; di Rocco, Maja; Tifft, Cynthia J; Ciani, Federica; Gasperini, Serena; Pasquini, Elisabetta; Guerrini, Renzo; Donati, Maria Alice; Morrone, Amelia



Myelin Abnormalities in the Optic and Sciatic Nerves in Mice With GM1-Gangliosidosis.  


GM1-gangliosidosis is a glycosphingolipid lysosomal storage disease involving accumulation of GM1 and its asialo form (GA1) primarily in the brain. Thin-layer chromatography and X-ray diffraction were used to analyze the lipid content/composition and the myelin structure of the optic and sciatic nerves from 7- and 10-month old ?-galactosidase (?-gal) +/? and ?-gal -/- mice, a model of GM1gangliosidosis. Optic nerve weight was lower in the ?-gal -/- mice than in unaffected ?-gal +/? mice, but no difference was seen in sciatic nerve weight. The levels of GM1 and GA1 were significantly increased in both the optic nerve and sciatic nerve of the ?-gal -/- mice. The content of myelin-enriched cerebrosides, sulfatides, and plasmalogen ethanolamines was significantly lower in optic nerve of ?-gal -/- mice than in ?-gal +/? mice; however, cholesteryl esters were enriched in the ?-gal -/- mice. No major abnormalities in these lipids were detected in the sciatic nerve of the ?-gal -/- mice. The abnormalities in GM1 and myelin lipids in optic nerve of ?-gal -/- mice correlated with a reduction in the relative amount of myelin and periodicity in fresh nerve. By contrast, the relative amount of myelin and periodicity in the sciatic nerves from control and ?-gal -/- mice were indistinguishable, suggesting minimal pathological involvement in sciatic nerve. Our results indicate that the greater neurochemical pathology observed in the optic nerve than in the sciatic nerve of ?-gal -/- mice is likely due to the greater glycolipid storage in optic nerve. PMID:25694553

Heinecke, Karie A; Luoma, Adrienne; d'Azzo, Alessandra; Kirschner, Daniel A; Seyfried, Thomas N



GM1-gangliosidosis in American black bears: clinical, pathological, biochemical and molecular genetic characterization.  


G(M1)-gangliosidosis is a rare progressive neurodegenerative disorder due to an autosomal recessively inherited deficiency of lysosomal ?-galactosidase. We have identified seven American black bears (Ursus americanus) found in the Northeast United States suffering from G(M1)-gangliosidosis. This report describes the clinical features, brain MRI, and morphologic, biochemical and molecular genetic findings in the affected bears. Brain lipids were compared with those in the brain of a G(M1)-mouse. The bears presented at ages 10-14 months in poor clinical condition, lethargic, tremulous and ataxic. They continued to decline and were humanely euthanized. The T(2)-weighted MR images of the brain of one bear disclosed white matter hyperintensity. Morphological studies of the brain from five of the bears revealed enlarged neurons with foamy cytoplasm containing granules. Axonal spheroids were present in white matter. Electron microscopic examination revealed lamellated membrane structures within neurons. Cytoplasmic vacuoles were found in the liver, kidneys and chondrocytes and foamy macrophages within the lungs. Acid ?-galactosidase activity in cultured skin fibroblasts was only 1-2% of control values. In the brain, ganglioside-bound sialic acid was increased more than 2-fold with G(M1)-ganglioside predominating. G(A1) content was also increased whereas cerebrosides and sulfatides were markedly decreased. The distribution of gangliosides was similar to that in the G(M1)-mouse brain, but the loss of myelin lipids was greater in the brain of the affected bear than in the brain of the G(M1) mouse. Isolated full-length cDNA of the black bear GLB1 gene revealed 86% homology to its human counterpart in nucleotide sequence and 82% in amino acid sequence. GLB1 cDNA from liver tissue of an affected bear contained a homozygous recessive T(1042) to C transition inducing a Tyr348 to His mutation (Y348H) within a highly conserved region of the GLB1 gene. The coincidence of several black bears with G(M1)-gangliosidosis in the same geographic area suggests increased frequency of a founder mutation in this animal population. PMID:24581871

Muthupalani, Sureshkumar; Torres, Paola A; Wang, Betty C; Zeng, Bai Jin; Eaton, Samuel; Erdelyi, Ildiko; Ducore, Rebecca; Maganti, Rajanikarath; Keating, John; Perry, Bain J; Tseng, Florina S; Waliszewski, Nicole; Pokras, Mark; Causey, Robert; Seger, Rita; March, Philip; Tidwell, Amy; Pfannl, Rolf; Seyfried, Thomas; Kolodny, Edwin H; Alroy, Joseph



Evaluation of N-nonyl-deoxygalactonojirimycin as a pharmacological chaperone for human GM1 gangliosidosis leads to identification of a feline model suitable for testing enzyme enhancement therapy  

PubMed Central

Deficiencies of lysosomal ?-D-galactosidase can result in GM1 gangliosidosis, a severe neurodegenerative disease characterized by massive neuronal storage of GM1 ganglioside in the brain. Currently there are no available therapies that can even slow the progression of this disease. Enzyme enhancement therapy utilizes small molecules that can often cross the blood brain barrier, but are also often competitive inhibitors of their target enzyme. It is a promising new approach for treating diseases, often caused by missense mutations, associated with dramatically reduced levels of functionally folded enzyme. Despite a number of positive reports based on assays performed with patient cells, skepticism persists that an inhibitor-based treatment can increase mutant enzyme activity in vivo. To date no appropriate animal model, i.e., one that recapitulates a responsive human genotype and clinical phenotype, has been reported that could be used to validate enzyme enhancement therapy. In this report, we identify a novel enzyme enhancement-agent, N-nonyl-deoxygalactonojirimycin, that enhances the mutant ?-galactosidase activity in the lysosomes of a number of patient cell lines containing a variety of missense mutations. We then demonstrate that treatment of cells from a previously described, naturally occurring feline model (that biochemically, clinically and molecularly closely mimics GM1 gangliosidosis in humans) with this molecule, results in a robust enhancement of their mutant lysosomal ?-galactosidase activity. These data indicate that the feline model could be used to validate this therapeutic approach and determine the relationship between the disease stage at which this therapy is initiated and the maximum clinical benefits obtainable. PMID:22784478

Rigat, Brigitte A.; Tropak, Michael B.; Buttner, Justin; Crushell, Ellen; Benedict, Daphne; Callahan, John W.; Martin, Douglas R.; Mahuran, Don J.



A fluorescent probe for GM1 gangliosidosis related ?-galactosidase: N-(dansylamino)hexylaminocarbonylpentyl-1,5-dideoxy-1,5-imino-D-galactitol.  


N-(Dansylamino)hexylaminocarbonylpentyl-1,5-dideoxy-1,5-imino-D-galactitol, a strong competitive inhibitor of ?-galactosidase, enhances residual ?-galactosidase activities in fibroblasts and serves as lead en route to diagnostic compounds for tracking the fate of mutant ?-gal as well as aberrant GM1 gangliosides by live cell imaging. PMID:21974950

Fröhlich, Richard F G; Fantur, Katrin; Furneaux, Richard H; Paschke, Eduard; Stütz, Arnold E; Wicki, Jacqueline; Withers, Stephen G; Wrodnigg, Tanja M



Subclass of IgG antibody to GM1 epitope-bearing lipopolysaccharide of Campylobacter jejuni in patients with Guillain-Barré syndrome  

Microsoft Academic Search

Sera of patients who develop Guillain-Barré syndrome (GBS) subsequent to Campylobacter jejuni enteritis frequently have IgG anti-GM1 antibody. Lipopolysaccharide (LPS) of C. jejuni isolated from a GBS patient has a GM1 ganglioside-like structure. IgG subclass distribution of the anti-GM1 antibody in GBS patients is mainly restricted to IgGl and IgG3. Since IgG antibodies to bacterial polysaccharide generally are restricted to

Nobuhiro Yuki; Yasuo Ichihashi; Takao Taki



Human monoclonal IgM with autoantibody activity against two gangliosides (GM1 and GD1b) in a patient with motor neuron syndrome.  

PubMed Central

Small amounts of oligoclonal immunoglobulins were detected by Western blotting in the serum from a patient with motor neuron syndrome. The prominent one, a monoclonal IgM lambda, reacted strongly with the gangliosides GM1 and GD1b and more weakly with asialo GM1, as shown by immunoenzymatic staining of thin-layer chromatograms of gangliosides, ELISA on purified glycolipid coats and immunoadsorption with purified GM1. Affinity-chromatography with purified GM1 resulted in the purification of monoclonal IgM lambda. This purified IgM and its Fab fragments showed the same pattern of reactivity with gangliosides as that observed with whole serum. Such monoclonal IgM could be responsible for motor neuron diseases in some patients with overt or barely detectable monoclonal gammopathies. Images Fig. 2 Fig. 3 PMID:2357844

Jauberteau, M O; Gualde, N; Preud'Homme, J L; Rigaud, M; Gil, R; Vallat, J M; Baumann, N



Molecular analysis of a GM2-activator deficiency in two patients with GM2-gangliosidosis AB variant.  

PubMed Central

Lysosomal degradation of ganglioside GM2 by beta-hexosaminidase A (hex A) requires the presence of the GM2 activator protein (GM2AP) as an essential cofactor. A deficiency of the GM2 activator causes the AB variant of GM2 gangliosidosis, a recessively inherited disorder characterized by excessive neuronal accumulation of GM2 and related glycolipids. Two novel mutations in the GM2 activator gene (GM2A) have been identified by the reverse-transcriptase-PCR method--a three-base deletion, AAG262-264, resulting in a deletion of Lys88, and a single-base deletion, A410, that causes a frameshift. The latter results in substitution of 33 amino acids and the loss of another 24 amino acid residues. Both patients are homoallelic for their respective mutations inherited from their parents, who are heteroallelic at the GM2A locus. Although the cultured fibroblasts of both patients produce normal levels of activator mRNA, they lack a lysosomal form of GM2AP. Pulse/chase labeling of cultured fibroblasts of the patients, in presence and absence of brefeldin A, indicates a premature degradation of both--mutant and truncated--GM2APs in the endoplasmic reticulum or Golgi. These results were supported by in vitro translation experiments and expression of the mutated proteins. When the mutated GM2APs were expressed in Escherichia coli, both mature GM2AP forms turned proved to exhibit only residual activities in an in vitro assay. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 PMID:8900233

Schepers, U.; Glombitza, G.; Lemm, T.; Hoffmann, A.; Chabas, A.; Ozand, P.; Sandhoff, K.



Genetics Home Reference: GM2-gangliosidosis, AB variant  


... Patients and Families Resources for Health Professionals What glossary definitions help with understanding GM2-gangliosidosis, AB variant? ... many other terms in the Genetics Home Reference Glossary . See also Understanding Medical Terminology . References (4 links) ...


Biochemical and molecular characterization of novel mutations in GLB1 and NEU1 in patient cells with lysosomal storage disorders.  


Lysosomes are cytoplasmic compartments that contain many acid hydrolases and play critical roles in the metabolism of a wide range of macromolecules. Deficiencies in lysosomal enzyme activities cause genetic diseases, called lysosomal storage disorders (LSDs). Many mutations have been identified in the genes responsible for LSDs, and the identification of mutations is required for the accurate molecular diagnoses. Here, we analyzed cell lines that were derived from two different LSDs, GM1 gangliosidosis and sialidosis. GM1 gangliosidosis is caused by mutations in the GLB1 gene that encodes ?-galactosidase. A lack of ?-galactosidase activity leads to the massive accumulation of GM1 ganglioside, which results in neurodegenerative pathology. Mutations in the NEU1 gene that encodes lysosomal sialidase cause sialidosis. Insufficient activity of lysosomal sialidase progressively increases the accumulation of sialylated molecules, and various clinical symptoms, including mental retardation, appear. We sequenced the entire coding regions of GLB1 and NEU1 in GM1 gangliosidosis and sialidosis patient cells, respectively. We found the novel mutations p.E186A in GLB1 and p.R347Q in NEU1, as well as many other mutations that have been previously reported. We also demonstrated that patient cells containing the novel mutations showed the molecular phenotypes of the corresponding disease. Further structural analysis suggested that these novel mutation sites are highly conserved and important for enzyme activity. PMID:25600812

Kwak, Jae Eun; Son, Mi-Young; Son, Ye Seul; Son, Myung Jin; Cho, Yee Sook



Lysosomal acid hydrolases in established lymphoblastoid cell lines, transformed by Epstein-Barr virus, from patients with genetic lysosomal storage diseases  

Microsoft Academic Search

Lysosomal acid hydrolases were determined in established lymphoblastoid cell lines, transformed in vitro by Epstein-Barr virus (EBV) from lymphocyte-rich cell populations isolated from the peripheral blood of patients with genetic lysosomal storage diseases—Hurler syndrome, Scheie syndrome, GM1-gangliosidosis type 1 and type 2, Tay-Sachs disease, and I-cell disease—and from obligate heterozygotes for these diseases.

R. Minami; Y. Watanabe; T. Kudoh; M. Suzuki; K. Oyanagi; T. Orii; T. Nakao



NSOM/QD-based visualization of GM1 serving as platforms for TCR/CD3 mediated T-cell activation.  


Direct molecular imaging of nanoscale relationship between T-cell receptor complexes (TCR/CD3) and gangliosidosis GM1 before and after T-cell activation has not been reported. In this study, we made use of our expertise of near-field scanning optical microscopy(NSOM)/immune-labeling quantum dots- (QD-)based dual-color imaging system to visualize nanoscale profiles for distribution and organization of TCR/CD3, GM1, as well as their nanospatial relationship and their correlation with PKC ? signaling cascade during T-cell activation. Interestingly, after anti-CD3/anti-CD28 Ab co-stimulation, both TCR/CD3 and GM1 were clustered to form nanodomains; moreover, all of TCR/CD3 nanodomains were colocalized with GM1 nanodomains, indicating that the formation of GM1 nanodomains was greatly correlated with TCR/CD3 mediated signaling. Specially, while T-cells were pretreated with PKC ? signaling inhibitor rottlerin to suppress IL-2 cytokine production, no visible TCR/CD3 nanodomains appeared while a lot of GM1 nanodomains were still observed. However, while T-cells are pretreated with PKC? ? signaling inhibitor GÖ6976 to suppress calcium-dependent manner, all of TCR/CD3 nanodomains were still colocalized with GM1 nanodomains. These findings possibly support the notion that the formation of GM1 nanodomains indeed serves as platforms for the recruitment of TCR/CD3 nanodomains, and TCR/CD3 nanodomains are required for PKC? signaling cascades and T-cell activation. PMID:24288672

Zhong, Liyun; Zhang, Zhun; Lu, Xiaoxu; Liu, Shengde; Chen, Crystal Y; Chen, Zheng W



NSOM/QD-Based Visualization of GM1 Serving as Platforms for TCR/CD3 Mediated T-Cell Activation  

PubMed Central

Direct molecular imaging of nanoscale relationship between T-cell receptor complexes (TCR/CD3) and gangliosidosis GM1 before and after T-cell activation has not been reported. In this study, we made use of our expertise of near-field scanning optical microscopy(NSOM)/immune-labeling quantum dots- (QD-)based dual-color imaging system to visualize nanoscale profiles for distribution and organization of TCR/CD3, GM1, as well as their nanospatial relationship and their correlation with PKC? signaling cascade during T-cell activation. Interestingly, after anti-CD3/anti-CD28 Ab co-stimulation, both TCR/CD3 and GM1 were clustered to form nanodomains; moreover, all of TCR/CD3 nanodomains were colocalized with GM1 nanodomains, indicating that the formation of GM1 nanodomains was greatly correlated with TCR/CD3 mediated signaling. Specially, while T-cells were pretreated with PKC? signaling inhibitor rottlerin to suppress IL-2 cytokine production, no visible TCR/CD3 nanodomains appeared while a lot of GM1 nanodomains were still observed. However, while T-cells are pretreated with PKC?? signaling inhibitor GÖ6976 to suppress calcium-dependent manner, all of TCR/CD3 nanodomains were still colocalized with GM1 nanodomains. These findings possibly support the notion that the formation of GM1 nanodomains indeed serves as platforms for the recruitment of TCR/CD3 nanodomains, and TCR/CD3 nanodomains are required for PKC? signaling cascades and T-cell activation PMID:24288672

Zhang, Zhun; Lu, Xiaoxu; Liu, Shengde; Chen, Crystal Y.; Chen, Zheng W.



GM2 gangliosidosis in British Jacob sheep.  


GM2 gangliosidosis (Tay-Sachs disease) was diagnosed in 6- to 8-month-old pedigree Jacob lambs from two unrelated flocks presenting clinically with progressive neurological dysfunction of 10 day's to 8 week's duration. Clinical signs included hindlimb ataxia and weakness, recumbency and proprioceptive defects. Histopathological examination of the nervous system identified extensive neuronal cytoplasmic accumulation of material that stained with periodic acid--Schiff and Luxol fast blue. Electron microscopy identified membranous cytoplasmic bodies within the nervous system. Serum biochemistry detected a marked decrease in hexosaminidase A activity in the one lamb tested, when compared with the concentration in age matched controls and genetic analysis identified a mutation in the sheep hexa allele G444R consistent with Tay-Sachs disease in Jacob sheep in North America. The identification of Tay-Sachs disease in British Jacob sheep supports previous evidence that the mutation in North American Jacob sheep originated from imported UK stock. PMID:24309906

Wessels, M E; Holmes, J P; Jeffrey, M; Jackson, M; Mackintosh, A; Kolodny, E H; Zeng, B J; Wang, C B; Scholes, S F E



GM1 antibodies in post-polio syndrome and previous paralytic polio.  


We studied the relationship between post-polio syndrome (PPS) and GM1 antibodies, since such antibodies have been associated with PPS and motor neuron disorders. Sera from 144 patients with previous poliomyelitis (105 paralytic, 22 nonparalytic and 17 PPS), 60 with previous Guillain-Barré syndrome, 44 with amyotrophic lateral sclerosis (ALS) and 22 healthy blood donors were analyzed with ELISA for GM1 IgM, IgG and IgA antibodies. GM1 antibodies were present in 14% of the PPS patients, but the prevalence did not differ significantly from that of the other groups. Our study does not support the hypothesis that GM1 antibodies are involved in the pathogenesis of PPS. PMID:12799031

Farbu, E; Rekand, T; Tysnes, O-B; Aarli, J A; Gilhus, N E; Vedeler, C A



Immunoglobulin allotype Gm(1,2;21) in ankylosing spondylitis with peripheral arthritis.  

PubMed Central

Frequencies of immunoglobulin G (Gm) allotypes were determined in 240 patients with ankylosing spondylitis (AS). The uncommon phenotype Gm(1,2;21) was increased in frequency in 55 patients with AS and peripheral arthritis (14.5% v 3.5% of healthy blood donors; p less than 0.05). In 16 patients with arthritis only of wrist/hand or ankle/forefoot, or both, the Gm(1,2;21) frequency was even higher (31.3%; p less than 0.0005). Patients with AS negative for the HLA antigen B27 (n = 28) differed from the B27 positive patients (n = 205) with regard to the frequency of the Gm(1,2,3;5,21) phenotype (39.3% v 9.3%; p less than 0.0005). These findings support the notion of genetic heterogeneity among patients with AS. PMID:3264692

Mierau, R; von Mühlen, C A; Zarnowski, H; Genth, E; Hartl, P W



A case of GM2 gangliosidosis of late onset  

Microsoft Academic Search

A case of GM2-gangliosidosis commencing by the age of 5 years is described, in which hyperacusis, dementia, and fits were prominent clinical features. In addition to the typical ganglioside pattern on thin layer chromatography and the presence of membranous bodies in electron microscopic studies and characteristic histology and histochemistry, there was biochemical evidence of a gross reduction in heat-labile hexosaminidase

P. Buxton; J. N. Cumings; R. B. Ellis; B. D. Lake; W. G. P. Mair; J. R. Roberts; E. P. Young



GM2-Gangliosidosis (Sandhoff and Tay Sachs disease): Diagnosis and Neuroimaging Findings (An Iranian Pediatric Case Series)  

PubMed Central

Objective GM2-Gangliosidosis disease is a rare autosomal recessive genetic disorder that includes two disorders (Tay–Sachs and Sandhoff disease).These disorders cause a progressive deterioration of nerve cells and inherited deficiency in creating hexosaminidases A, B, and AB. Materials & Methods Patients who were diagnosed withGM2-Gangliosidosis in the Neurology Department of Mofid Children’s Hospital in Tehran, Iran from October 2009 to February 2014were included in our study. The disorder was confirmed by neurometabolic and enzyme level detection of hexosaminidases A, B, and AB in reference to Wagnester Laboratory in Germany. We assessed age, gender, past medical history, developmental status, clinical manifestations, and neuroimaging findings of 9 patients with Sandhoff disease and 9 with Tay Sachs disease. Results 83% of our patients were the offspring of consanguineous marriages. All of them had a developmental disorder as a chief complaint. 38%of patients had a history of developmental delay or regression and 22% had seizures. The patients with Sandhoff and Tay Sachs disease were followed for approximately 5 years and the follow-up showed all patients were bedridden or had expired due to refractory seizures, pneumonia aspiration, or swallowing disorders. Neuro-imaging findings included bilateral thalamic involvement, brain atrophy, and hypo myelination in near half of our patients (48%). Conclusion According to the results of this study, we suggest that cherry-red spots, hyperacusis, refractory seizures, and relative parents in children with developmental delay and/or regression should be considered for assessment of GM2-Gangliosidosis disease. PMID:25143775

KARIMZADEH, Parvaneh; JAFARI, Narjes; NEJAD BIGLARI, Habibeh; JABBEH DARI, Sayena; AHMAD ABADI, Farzad; ALAEE, Mohammad-Reza; NEMATI, Hamid; SAKET, Sasan; TONEKABONI, Seyed Hasan; TAGHDIRI, Mohammad-Mahdi; GHOFRANI, Mohammad



Properties of ganglioside GM1 in phosphatidylcholine bilayer membranes.  

PubMed Central

Gangliosides have been shown to function as cell surface receptors, as well as participating in cell growth, differentiation, and transformation. In spite of their multiple biological functions, relatively little is known about their structure and physical properties in membrane systems. The thermotropic and structural properties of ganglioside GM1 alone and in a binary system with 1,2-dipalmitoyl phosphatidylcholine (DPPC) have been investigated by differential scanning calorimetry (DSC) and x-ray diffraction. By DSC hydrated GM1 undergoes a broad endothermic transition TM = 26 degrees C (delta H = 1.7 kcal/mol GM1). X-ray diffraction below (-2 degrees C) and above (51 degrees C) this transition indicates a micellar structure with changes occurring only in the wide angle region of the diffraction pattern (relatively sharp reflection at 1/4.12 A-1 at -2 degrees C; more diffuse reflection at 1/4.41 A-1 at 51 degrees C). In hydrated binary mixtures with DPPC, incorporation of GM1 (0-30 mol%; zone 1) decreases the enthalpy of the DPPC pretransition at low molar compositions while increasing the TM of both the pre- and main transitions (limiting values, 39 and 44 degrees C, respectively). X-ray diffraction studies indicate the presence of a single bilayer gel phase in zone 1 that can undergo chain melting to an L alpha bilayer phase. A detailed hydration study of GM1 (5.7 mol %)/DPPC indicated a conversion of the DPPC bilayer gel phase to an infinite swelling system in zone 1 due to the presence of the negatively charged sialic acid moiety of GM1. At 30-61 mol % GM1 (zone 2), two calorimetric transitions are observed at 44 and 47 degrees C, suggesting the presence of two phases. The lower transition reflects the bilayer gel --> L alpha transition (zone 1), whereas the upper transition appears to be a consequence of the formation of a nonbilayer, micellar or hexagonal phase, although the structure of this phase has not been defined by x-ray diffraction. At > 61 mol % GM1 (zone 3) the calorimetric and phase behavior is dominated by the micelle-forming properties of GM1; the presence of mixed GM1/DPPC micellar phases is predicted. Images FIGURE 2 FIGURE 4 PMID:8785291

Reed, R A; Shipley, G G



Lo/Ld phase coexistence modulation induced by GM1.  


Lipid rafts are assumed to undergo biologically important size-modulations from nanorafts to microrafts. Due to the complexity of cellular membranes, model systems become important tools, especially for the investigation of the factors affecting "raft-like" Lo domain size and the search for Lo nanodomains as precursors in Lo microdomain formation. Because lipid compositional change is the primary mechanism by which a cell can alter membrane phase behavior, we studied the effect of the ganglioside GM1 concentration on the Lo/Ld lateral phase separation in PC/SM/Chol/GM1 bilayers. GM1 above 1mol % abolishes the formation of the micrometer-scale Lo domains observed in GUVs. However, the apparently homogeneous phase observed in optical microscopy corresponds in fact, within a certain temperature range, to a Lo/Ld lateral phase separation taking place below the optical resolution. This nanoscale phase separation is revealed by fluorescence spectroscopy, including C12NBD-PC self-quenching and Laurdan GP measurements, and is supported by Gaussian spectral decomposition analysis. The temperature of formation of nanoscale Lo phase domains over an Ld phase is determined, and is shifted to higher values when the GM1 content increases. A "morphological" phase diagram could be made, and it displays three regions corresponding respectively to Lo/Ld micrometric phase separation, Lo/Ld nanometric phase separation, and a homogeneous Ld phase. We therefore show that a lipid only-based mechanism is able to control the existence and the sizes of phase-separated membrane domains. GM1 could act on the line tension, "arresting" domain growth and thereby stabilizing Lo nanodomains. PMID:24835016

Puff, Nicolas; Watanabe, Chiho; Seigneuret, Michel; Angelova, Miglena I; Staneva, Galya



Galleria mellonella native and analogue peptides Gm1 and ?Gm1. II) anti-bacterial and anti-endotoxic effects.  


Antimicrobial peptides (AMPs) are important components of the innate immune system of animals, plants, fungi and bacteria and are recently under discussion as promising alternatives to conventional antibiotics. We have investigated two cecropin-like synthetic peptides, Gm1, which corresponds to the natural overall uncharged Galleria mellonella native peptide and ?Gm1, a modified overall positively charged Gm1 variant. We have analysed these peptides for their potential to inhibit the endotoxin-induced secretion of tumour necrosis factor-? (TNF-?) from human mononuclear cells. Furthermore, in a conventional microbiological assay, the ability of these peptides to inhibit the growth of the rough mutant bacteria Salmonella enterica Minnesota R60 and the polymyxin B-resistant Proteus mirabilis R45 was investigated and atomic force microscopy (AFM) measurements were performed to characterize the morphology of the bacteria treated by the two peptides. We have also studied their cytotoxic properties in a haemolysis assay to clarify potential toxic effects. Our data revealed for both peptides minor anti-inflammatory (anti-endotoxin) activity, but demonstrated antimicrobial activity with differences depending on the endotoxin composition of the respective bacteria. In accordance with the antimicrobial assay, AFM data revealed a stronger morphology change of the R45 bacteria than for the R60. Furthermore, Gm1 had a stronger effect on the bacteria than ?Gm1, leading to a different morphology regarding indentations and coalescing of bacterial structures. The findings verify the biophysical measurements with the peptides on model systems. Both peptides lack any haemolytic activity up to an amount of 100?g/ml, making them suitable as new anti-infective agents. PMID:25016054

Correa, Wilmar; Manrique-Moreno, Marcela; Behrends, Jochen; Patińo, Edwin; Marella, Chakravarthy; Peláez-Jaramillo, Carlos; Garidel, Patrick; Gutsmann, Thomas; Brandenburg, Klaus; Heinbockel, Lena



Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody  

Microsoft Academic Search

OBJECTIVESTo investigate the incidence of hyperreflexia in patients with Guillain-Barré syndrome (GBS), and its relation with electrodiagnosis of acute motor axonal neuropathy (AMAN), antiganglioside GM1 antibody, and Campylobacter jejuni infection. It was reported that patients with AMAN in northern China often had hyperreflexia in the recovery phase.METHODSIn 54 consecutive Japanese patients with GBS, sequential findings of tendon reflexes were reviewed.

Satoshi Kuwabara; Kazue Ogawara; Michiaki Koga; Masahiro Mori; Takamichi Hattori; Nobuhiro Yuki



Adult-onset GM2 gangliosidosis diagnosed in a fetus.  


Amniocentesis and subsequent tests are reported on a fetus conceived of a rare mating type: its mother has an intermediate level of beta hexosaminidase A (HEX A), characteristic of carriers of Tay-Sachs disease (TSD), while the father suffers from an adult-onset GM2 gangliosidosis (AOG) with severe HEX A deficiency. Activity of HEX A in the cultured fetal cells was very low when measured by the heat-inactivation method, thus showing the typical biochemical phenotype of TSD fetuses. However, upon separation of HEX isozymes by ion exchange chromatography, residual HEX A (17 per cent of total HEX) was demonstrated. Also in contrast to TSD fetuses, this fetus' fibroblasts were able to synthesize the precursor of alpha chains of HEX, and ultrastructural examination of its brain revealed few atypical lamellar bodies, unlike those found in TSD fetuses of the same gestational age. It is therefore concluded that the fetus was not affected with TSD, but rather with AOG. PMID:2941730

Navon, R; Sandbank, U; Frisch, A; Baram, D; Adam, A



Heat-Labile Enterotoxin: Beyond GM1 Binding  

PubMed Central

Enterotoxigenic Escherichia coli (ETEC) is a significant source of morbidity and mortality worldwide. One major virulence factor released by ETEC is the heat-labile enterotoxin LT, which is structurally and functionally similar to cholera toxin. LT consists of five B subunits carrying a single catalytically active A subunit. LTB binds the monosialoganglioside GM1, the toxin’s host receptor, but interactions with A-type blood sugars and E. coli lipopolysaccharide have also been identified within the past decade. Here, we review the regulation, assembly, and binding properties of the LT B-subunit pentamer and discuss the possible roles of its numerous molecular interactions. PMID:22069646

Mudrak, Benjamin; Kuehn, Meta J.



Colocalization of the Ganglioside GM1 and Cholesterol Detected by Secondary Ion Mass Spectrometry  

E-print Network

phase separation of the ganglioside GM1 into nano- and microscale assemblies in a canonical lipid raft). Orthogonal isotopic labeling of every lipid bilayer component and monofluorination of GM1 allowed generation of molecule specific images using a NanoSIMS. Simultaneous detection of six different ion species in SIMS

Boxer, Steven G.


Occurrence of glycosylation and deglycosylation of exogenously administered ganglioside GM1 in mouse liver.  

PubMed Central

Ganglioside GM1, 3H-labelled at the level of terminal galactose or of sphingosine, was intravenously injected into Swiss albino mice and some steps in its metabolic fate in the liver were investigated. After administration of [3H]sphingosine-labelled GM1 all major liver gangliosides [GM3, GM2, GM1, GD1a-(NeuAc,NeuGl)] became radioactive, the radioactivity residing in all cases on the sphingosine moiety. The specific radioactivity was highest in GM1, which carried about 53% of the radioactivity incorporated into gangliosides, followed by GM2, with 34.5% of incorporated radioactivity, GM3 and GD1a-(NeuAc,NeuGl), both with about 5% of incorporated radioactivity. After administration of [3H]galactose-labelled GM1 the only radioactive gangliosides present in the liver were GM1 and GD1a-(NeuAc,NeuGl), the former carrying about 95% of the total ganglioside-incorporated radioactivity, the latter about 3%. Both gangliosides were radioactive exclusively in the terminal galactose residue. According to these results exogenously administered GM1, after being taken up by the liver, is mainly degraded to GM2 and GM3, a part being, however, sialylated to GD1a-(NeuAc,NeuGl). All this suggests that exogenous GM1 may be involved in the metabolic routes of endogenous liver gangliosides. Images Fig. 1. Fig. 2. Fig. 5. PMID:6615438

Ghidoni, R; Sonnino, S; Chigorno, V; Venerando, B; Tettamanti, G



Recovery from Experimental Parkinsonism in Primates with GM1 Ganglioside Treatment  

NASA Astrophysics Data System (ADS)

A parkinsonian syndrome can be produced in nonhuman primates by administration of the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Parkinsonian-like symptoms induced acutely by MPTP were ameliorated after treatment with GM1 ganglioside, a substance shown to have neurotrophic effects on the damaged dopamine system in rodents. Treatment with GM1 ganglioside also increased striatal dopamine and metabolite levels and enhanced the dopaminergic innervation of the striatum as demonstrated by tyrosine hydroxylase immunohistochemistry. These results suggest that GM1 ganglioside may hold promise as a therapeutic agent for the treatment of Parkinson's disease.

Schneider, J. S.; Pope, Anne; Simpson, Kimberly; Taggart, James; Smith, M. G.; Distefano, L.



Recovery from Experimental Parkinsonism in Primates with GM1 Ganglioside Treatment  

Microsoft Academic Search

A parkinsonian syndrome can be produced in nonhuman primates by administration of the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Parkinsonian-like symptoms induced acutely by MPTP were ameliorated after treatment with GM1 ganglioside, a substance shown to have neurotrophic effects on the damaged dopamine system in rodents. Treatment with GM1 ganglioside also increased striatal dopamine and metabolite levels and enhanced the dopaminergic innervation of

J. S. Schneider; Anne Pope; Kimberly Simpson; James Taggart; M. G. Smith; L. Distefano



Efficient biotransformation of polysialogangliosides for preparation of GM1 by Cellulosimicrobium sp. 21.  


A new ganglioside transformed strain isolated from soil was identified as Cellulosimicrobium sp. 21. It produced a sialidase which transformed polysialo-gangliosides GD1 and GT1 into a monosialoterahexosylganglioside, i.e., ganglioside GM1. The sialidase had both NeuAc-?-2,3- and NeuAc-?-2,8-sialidase activity without producing asiolo-GM1. The optimum conditions were evaluated and it was found that the transformation was optimally performed at 30 °C and pH 7.0. The substrate should be added at the beginning of the reaction and the concentration of substrate was 3% (w/v). Under these optimum conditions, Cellulosimicrobium sp. 21 converted GD1 and GT1 into GM1 in inorganic medium in a 5 L bioreactor with the recovery rate of 69.3%. The product contained 50.3% GM1 and was purified on silica to give the product with 95% of GM1 with a recovery rate of 30.5%. Therefore, Cellulosimicrobium sp. 21 has potential to be applied in the production of GM1 in the pharmaceutical industry. PMID:25299818

Zheng, Yan; Ji, Li; Leng, Jiayi; Yuan, Ye; Chen, Honglei; Gou, Dongxia; Gao, Yufei; Zhou, Yifa



Galleria mellonella native and analogue peptides Gm1 and ?Gm1. I) biophysical characterization of the interaction mechanisms with bacterial model membranes.  


Natural occurring antimicrobial peptides (AMPs) are important components of the innate immune system of animals and plants. They are considered to be promising alternatives to conventional antibiotics. Here we present a comparative study of two synthetic peptides: Gm1, corresponding to the natural overall uncharged peptide from Galleria mellonella (Gm) and ?Gm1, a modified overall positively charged Gm1 variant. We have studied the interaction of the peptides with lipid membranes composed of different kinds of lipopolysaccharides (LPS) and dimyristoylphosphatidylglycerol (DMPG), in some cases also dimyristoylphosphatidylethanolamine (DMPE) as representative lipid components of Gram-negative bacterial membranes, by applying Fourier-transform infrared spectroscopy (FTIR), Förster resonance energy transfer spectroscopy (FRET), differential scanning calorimetry (DSC) and isothermal titration calorimetry (ITC). Gm1 generates a destabilizing effect on the gel to liquid crystalline phase transition of the acyl chains of the lipids, as deduced from a decrease in the phase transition temperature and enthalpy, suggesting a fluidization, whereas ?Gm1 led to the opposite behavior. Further, FTIR analysis of the functional groups of the lipids participating in the interaction with the peptides indicated a shift in the band position and intensity of the asymmetric PO2(-) stretching vibration originating from the lipid phosphate groups, a consequence of the sterical changes in the head group region. Interestingly, FRET spectroscopy showed a similar intercalation of both peptides into the DMPG and LPS, but much less into the DMPE membrane systems. These results are discussed in the light of a possible use of the peptides as antimicrobial and anti-endotoxin drugs. PMID:25017800

Correa, Wilmar; Manrique-Moreno, Marcela; Patińo, Edwin; Peláez-Jaramillo, Carlos; Kaconis, Yani; Gutsmann, Thomas; Garidel, Patrick; Heinbockel, Lena; Brandenburg, Klaus



Does exogenous GM1 ganglioside enhance the effects of electrical stimulation in ameliorating degeneration after neonatal deafness?  


This study examined the combined effects of administration of exogenous GM1 ganglioside and electrical stimulation on the cochlear nucleus (CN) of cats deafened neonatally by ototoxic drugs. Five normal hearing adult cats served as controls. Another 12 cats were deafened bilaterally by daily injections of neomycin sulfate (60 mg/kg) for 17-21 days after birth until auditory brainstem testing demonstrated profound hearing loss. Six of the deaf animals comprised the GM1 group, which received daily injections of GM1 ganglioside (30 mg/kg) for 28-38 days during the period after profound deafness was confirmed, and prior to receiving a cochlear implant. The non-GM1 group (n=6) received no treatment during this interim period. All the deafened animals underwent unilateral cochlear implantation at 6-9 weeks postnatal and received several months (mean duration, 32 weeks) of chronic electrical stimulation (4 h/day, 5 days/week). Stimulation was delivered by intracochlear bipolar electrodes, using electrical signals that were designed to be temporally challenging to the central auditory system. Results showed that in the neonatally deafened animals, both the GM1 and non-GM1 groups, the volume of the CN was markedly reduced (to 76% of normal), but there was no difference between the animals that received GM1 and those that did not. The cross sectional areas of spherical cell somata in both GM1 and non-GM1 groups also showed a highly significant reduction in size, to < or =75% of normal after neonatal deafening. Moreover, in both the GM1 and non-GM1 groups, the spherical cells in the CN ipsilateral to the implanted cochlea were significantly larger (6%) than cells in the control, unstimulated CN. Again, however, there was no significant difference between the GM1 group and the non-GM1 group in spherical cell size. These results contrast sharply with previous reports that exogenous GM1 prevents CN degeneration after neonatal conductive hearing loss and partially prevents spiral ganglion cell degeneration when administered immediately after ototoxic drug deafening in adult animals. Taken together, findings to date suggest that GM1 may be effective in preventing degeneration only if the GM1 is administered immediately at the time hearing loss occurs. PMID:11520632

Osofsky, M R; Moore, C M; Leake, P A



Prediction of international crude oil futures price based on GM(1,1)  

Microsoft Academic Search

Grey prediction method is characterized by small amount data, simple calculation and accurate prediction. On the basis of WTI crude oil futures monthly price of New York Mercantile Exchange (NYMEX) from June 2008 to Feb 2009, this paper gives a grey prediction model of intentional crude oil prices. The results show that the model of GM (1,1) is suitable for

Aimei Lin



Condensing and Fluidizing Effects of Ganglioside GM1 on Phospholipid Films  

E-print Network

; and { Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark ABSTRACT Mixed monolayers expanded or fluid-like. After deposition onto a solid substrate, atomic force microscopy imaging isotherms were obtained with molecules modeling the backbone or headgroup portions of the GM1 molecule

Lee, Ka Yee C.


GM1 Clustering Inhibits Cholera Toxin Binding in Supported Phospholipid Membranes  

E-print Network

GM1 Clustering Inhibits Cholera Toxin Binding in Supported Phospholipid Membranes Jinjun Shi ligand-receptor interactions between pentameric cholera toxin B subunits (CTB) and the corresponding-pathogen interactions3-5 are associated with multiva- lent ligand-receptor binding. The recognition of cholera toxin (CT


Interaction of liposomes composed of phospholipids, GM1 ganglioside and cholesterol with human keratinocytes in culture.  


We studied the possibility of supplementing human keratinocytes with exogenous lipids (phospholipids, sphingolipids and cholesterol) and evaluated their influence on cell proliferation, using cells cultured in vitro. Experiments carried out with liposomes composed of cholesterol/GM1 ganglioside and different phospholipids (5:1.5:10, M/M/M), showed that liposomes associated with cells more efficiently when they contained soya lecithin. The treatment with liposomes made of the ternary mixture did not modify the rate of cell proliferation, as assessed by the incorporation of [3H]-thymidine. In contrast, the proliferation rate strongly decreased (65% with respect to the control) using the same liposomes without GM1. Experiments carried out with GM1 alone showed a strong stimulation of the proliferation rate (144% with respect to the control). Fluorescence dequenching experiments, carried out with the probe octadecyl rhodamine B chloride, showed that fusion was the main mechanism of liposome-cell interaction. Metabolic studies established that exogenously administered GM1--either embedded in liposomes or as a pure glycolipid dispersion--led to the production of several products, including ceramide. Altogether, these results show that different, opposing effects can be exerted on cell proliferation by the administration of lipids, separately or in mixtures, to human keratinocytes, and indicate the importance of a correct formulation for supplementing human keratinocytes with exogenous lipids. PMID:10335921

Pitto, M; Palestini, P; Ferraretto, A; Marazzi, M; Donati, V; Falcone, L; Masserini, M



Heterogeneity of detergent-insoluble membranes from human intestine containing caveolin-1 and ganglioside GM1  

PubMed Central

In intestinal epithelia, cholera and related toxins elicit a cAMP-dependent chloride secretory response fundamental to the pathogenesis of toxigenic diarrhea. We recently proposed that specificity of cholera toxin (CT) action in model intestinal epithelia may depend on the toxin's cell surface receptor ganglioside GM1. Binding GM1 enabled the toxin to elicit a response, but forcing the toxin to enter the cell by binding the closely related ganglioside GD1a rendered the toxin inactive. The specificity of ganglioside function correlated with the ability of GM1 to partition CT into detergent-insoluble glycosphingolipid-rich membranes (DIGs). To test the biological plausibility of these hypotheses, we examined native human intestinal epithelia. We show that human small intestinal epithelia contain DIGs that distinguish between toxin bound to GM1 and GD1a, thus providing a possible mechanism for enterotoxicity associated with CT. We find direct evidence for the presence of caveolin-1 in DIGs from human intestinal epithelia but find that these membranes are heterogeneous and that caveolin-1 is not a structural component of apical membrane DIGs that contain CT. PMID:10859219




Co-localization of the Ganglioside GM1 and Cholesterol Detected by Secondary Ion Mass Spectrometry  

PubMed Central

The characterization of the lateral organization of components in biological membranes and the evolution of this arrangement in response to external triggers remains a major challenge. The concept of lipid rafts is widely invoked, however, direct evidence of the existence of these ephemeral entities remains elusive. We report here the use of Secondary Ion Mass Spectrometry (SIMS) to image the cholesterol-dependent cohesive phase separation of the ganglioside GM1 into nano and micro-scale assemblies in a canonical lipid raft composition of lipids. This assembly of domains was interrogated in a model membrane system composed of palmitoyl sphingomyelin (PSM), cholesterol, and an unsaturated lipid (dioleoylphosphatidylcholine, DOPC). Orthogonal isotopic labeling of every lipid bilayer component and monofluorination of GM1 allowed generation of molecule specific images using a NanoSIMS. Simultaneous detection of six different ion species in SIMS, including secondary electrons, was used to generate ion ratio images whose signal intensity values could be correlated to composition through the use of calibration curves from standard samples. Images of this system provide the first direct, molecule specific, visual evidence for the co-localization of cholesterol and GM1 in supported lipid bilayers and further indicate the presence of three compositionally distinct phases: (1) the interdomain region; (2) micrometer-scale domains (d>3 ?m); and, (3) nanometer-scale domains (d=100 nm ? 1 ?m) localized within the micrometer-scale domains and the interdomain region. PSM-rich, nanometer-scale domains prefer to partition within the more ordered, cholesterol-rich/DOPC-poor/GM1-rich micrometer-scale phase, while GM1-rich, nanometer-scale domains prefer to partition within the surrounding, disordered, cholesterol-poor/PSM-rich/DOPC-rich interdomain phase. PMID:23514537

Lozano, Mónica M.; Liu, Zhao; Sunnick, Eva; Janshoff, Andreas; Kumar, Krishna; Boxer, Steven G.



Cholera Toxin Assault on Lipid Monolayers Containing Ganglioside GM1 C. E. Miller,* J. Majewski,y  

E-print Network

Cholera Toxin Assault on Lipid Monolayers Containing Ganglioside GM1 C. E. Miller,* J. Majewski,y R DPPE:GM1 lipid monolayers before and during the binding of cholera toxin (CTAB5) or its B-subunit (CTB5 through specific interactions with membrane compo- nents. One such example is cholera toxin (CTAB5

Kuhl, Tonya L.


Using a set of GM(1,1) models to predict values of diagnostic symptoms  

NASA Astrophysics Data System (ADS)

The main purpose of this study is to develop a methodology of predicting values of vibration symptoms of fan mills in a combined heat and power (CHP) plant. The study was based on grey system theory and GM(1,1) prognostic models with different window sizes for estimating model parameters. Such models have a number of features that are desirable from the point of view of data characteristics collected by the diagnostic system. When using moving window, GM(1,1) models tend to be adaptive. However, selecting an inappropriate window size can result in excessive forecast errors. The present study proposes three possible methods that can be used in automated diagnostic systems to counteract the excessive increase in the forecast error. A comparative analysis of their performance was conducted using data from fan mills in order to select the method which minimises the forecast error.

Tabaszewski, Maciej; Cempel, Czeslaw



Relative Roles of GM1 Ganglioside, N-Acylneuraminic Acids, and ?2?1 Integrin in Mediating Rotavirus Infection  

PubMed Central

ABSTRACT N-acetyl- and N-glycolylneuraminic acids (Sia) and ?2?1 integrin are frequently used by rotaviruses as cellular receptors through recognition by virion spike protein VP4. The VP4 subunit VP8*, derived from Wa rotavirus, binds the internal N-acetylneuraminic acid on ganglioside GM1. Wa infection is increased by enhanced internal Sia access following terminal Sia removal from main glycan chains with sialidase. The GM1 ligand cholera toxin B (CTB) reduces Wa infectivity. Here, we found sialidase treatment increased cellular GM1 availability and the infectivity of several other human (including RV-3) and animal rotaviruses, typically rendering them susceptible to methyl ?-d-N-acetylneuraminide treatment, but did not alter ?2?1 usage. CTB reduced the infectivity of these viruses. Aceramido-GM1 inhibited Wa and RV-3 infectivity in untreated and sialidase-treated cells, and GM1 supplementation increased their infectivity, demonstrating the importance of GM1 for infection. Wa recognition of ?2?1 and internal Sia were at least partially independent. Rotavirus usage of GM1 was mapped to VP4 using virus reassortants, and RV-3 VP8* bound aceramido-GM1 by saturation transfer difference nuclear magnetic resonance (STD NMR). Most rotaviruses recognizing terminal Sia did not use GM1, including RRV. RRV VP8* interacted minimally with aceramido-GM1 by STD NMR. Unusually, TFR-41 rotavirus infectivity depended upon terminal Sia and GM1. Competition of CTB, Sia, and/or aceramido-GM1 with cell binding by VP8* from representative rotaviruses showed that rotavirus Sia and GM1 preferences resulted from VP8*-cell binding. Our major finding is that infection by human rotaviruses of commonly occurring VP4 serotypes involves VP8* binding to cell surface GM1 glycan, typically including the internal N-acetylneuraminic acid. IMPORTANCE Rotaviruses, the major cause of severe infantile gastroenteritis, recognize cell surface receptors through virus spike protein VP4. Several animal rotaviruses are known to bind sialic acids at the termini of main carbohydrate chains. Conversely, only a single human rotavirus is known to bind sialic acid. Interestingly, VP4 of this rotavirus bound to sialic acid that forms a branch on the main carbohydrate chain of the GM1 ganglioside. Here, we use several techniques to demonstrate that other human rotaviruses exhibit similar GM1 usage properties. Furthermore, binding by VP4 to cell surface GM1, involving branched sialic acid recognition, is shown to facilitate infection. In contrast, most animal rotaviruses that bind terminal sialic acids did not utilize GM1 for VP4 cell binding or infection. These studies support a significant role for GM1 in mediating host cell invasion by human rotaviruses. PMID:24501414

Fleming, Fiona E.; Böhm, Raphael; Dang, Vi T.; Holloway, Gavan; Haselhorst, Thomas; Madge, Paul D.; Deveryshetty, Jaigeeth; Yu, Xing; Blanchard, Helen; von Itzstein, Mark



Insights into Binding of Cholera Toxin to GM1 Containing Membrane.  


Interactions of cholera toxin (CT) with membrane are associated with the massive secretory diarrhea seen in Asiatic cholera. Ganglioside GM1 has been shown to be responsible for the binding of the B subunit of cholera toxin (CT-B), which then helps CT to pass through the membrane, but the exact mechanism remains to be explored. In this work, we have carried out atomistic scale molecular dynamics simulation to investigate the structural changes of CT upon membrane binding and alteration in membrane structure and dynamics. Starting from the initial structure where the five units of B subunit bind with five GM1, only three of five units remain bound and the whole CT is tilted such that the three binding units are deeper in the membrane. The lipids that are in contact with those units of the CT-B behave differently from the rest of the lipids. Altogether, our results demonstrate the atomistic interaction of CT with GM1 containing lipid membrane and provide a probable mechanism of the early stage alteration of lipid structure and dynamics, which can make a passage for penetration of CT on membrane surface. PMID:25425333

Basu, Ipsita; Mukhopadhyay, Chaitali



Attenuated Endocytosis and Toxicity of a Mutant Cholera Toxin with Decreased Ability To Cluster Ganglioside GM1 Molecules?  

PubMed Central

Cholera toxin (CT) moves from the plasma membrane (PM) of host cells to the endoplasmic reticulum (ER) by binding to the lipid raft ganglioside GM1. The homopentomeric B-subunit of the toxin can bind up to five GM1 molecules at once. Here, we examined the role of polyvalent binding of GM1 in CT action by producing chimeric CTs that had B-subunits with only one or two normal binding pockets for GM1. The chimeric toxins had attenuated affinity for binding to host cell PM, as expected. Nevertheless, like wild-type (wt) CT, the CT chimeras induced toxicity, fractionated with detergent-resistant membranes extracted from toxin-treated cells, displayed restricted diffusion in the plane of the PM in intact cells, and remained bound to GM1 when they were immunoprecipitated. Thus, binding normally to two or perhaps only one GM1 molecule is sufficient for association with lipid rafts in the PM and toxin action. The chimeric toxins, however, were much less potent than wt toxin, and they entered the cell by endocytosis more slowly, suggesting that clustering of GM1 molecules by the B-subunit enhances the efficiency of toxin uptake and perhaps also trafficking to the ER. PMID:18212085

Wolf, Anne A.; Jobling, Michael G.; Saslowsky, David E.; Kern, Eli; Drake, Kimberly R.; Kenworthy, Anne K.; Holmes, Randall K.; Lencer, Wayne I.



Polycystic Kidneys and GM2 Gangliosidosis-Like Disease in Neonatal Springboks (Antidorcas marsupialis).  


Clinical, gross, histopathologic, electron microscopic findings and enzymatic analysis of 4 captive, juvenile springboks (Antidorcas marsupialis) showing both polycystic kidneys and a storage disease are described. Springbok offspring (4 of 34; 12%) were affected by either one or both disorders in a German zoo within a period of 5 years (2008-2013). Macroscopic findings included bilaterally severely enlarged kidneys displaying numerous cysts in 4 animals and superior brachygnathism in 2 animals. Histopathologically, kidneys of 4 animals displayed cystic dilation of the renal tubules. In addition, abundant cytoplasmic vacuoles with a diameter ranging from 2 to 10 ?m in neurons of the central and peripheral nervous system, hepatocytes, thyroid follicular epithelial cells, pancreatic islets of Langerhans and renal tubular cells were found in 2 springbok neonates indicative of an additional storage disease. Ultrastructurally, round electron-lucent vacuoles, up to 4 ?m in diameter, were present in neurons. Enzymatic analysis of liver and kidney tissue of 1 affected springbok revealed a reduced activity of total hexosaminidase (Hex) with relatively increased HexA activity at the same level of total Hex, suggesting a hexosaminidase defect. Pedigree analysis suggested a monogenic autosomal recessive inheritance for both diseases. In summary, related springboks showed 2 different changes resembling both polycystic kidney and a GM2 gangliosidosis similar to the human Sandhoff disease. Whether the simultaneous occurrence of these 2 entities represents an incidental finding or has a genetic link needs to be investigated in future studies. PMID:25232033

Herder, V; Kummrow, M; Leeb, T; Sewell, A C; Hansmann, F; Lehmbecker, A; Wohlsein, P; Baumgärtner, W



Association to HeLa cells and surface behavior of exogenous gangliosides studied with a fluorescent derivative of GM1  

SciTech Connect

Cultured HeLa cells were incubated with pyrene-GM1/{sup 3}H-radiolabeled GM1 ganglioside (1:4 M/M) mixtures for various times. The process of association of pyrene-GM1 with cells was qualitatively and quantitatively the same as that of {sup 3}H-GM1. The pyrene-GM1 and {sup 3}H-GM1 proportions in the various forms of association with cells were similar to that of the starting ganglioside mixture. After 2-h incubation, the association of ganglioside with cells was well established whereas almost no metabolic processing had occurred. During a 24-h incubation, pyrene- and {sup 3}H-GM1 underwent similar metabolic processing and gave rise to catabolic (GM2 and GM3) and anabolic (GDla) derivatives. Fluorescence spectroscopy experiments carried out with the excimer formation technique on subcellular fractions containing plasma membranes showed that exogenous ganglioside was, in part, associated with the cells in a micellar form removable by trypsin treatment, and in part inserted in a seemingly molecular dispersion. Addition of Ca{sup 2+} salts caused aggregation of the ganglioside, as indicated by the increase of the excimer:monomer fluorescence ratio. The phenomenon was Ca{sup 2+} concentration dependent (maximum at 10 mM), and subsequent addition of EDTA has no effect. The saccharide portion of exogenously incorporated pyrene-GM1 was available to interact with external ligands, as shown by its ability to bind cholera toxin whose addition reduced the collision rate among the ganglioside lipid moieties.

Masserini, M.; Giuliani, A.; Palestini, P.; Acquotti, D.; Pitto, M.; Chigorno, V.; Tettamanti, G. (Univ. of Milan (Italy))



Interaction of liposomes composed of phospholipids, GM1 ganglioside and cholesterol with human keratinocytes in culture  

Microsoft Academic Search

\\u000a Abstract We studied the possibility of supplementing human keratinocytes with exogenous lipids (phospholipids, sphingolipids and cholesterol)\\u000a and evaluated their influence on cell proliferation, using cells cultured in vitro. Experiments carried out with liposomes\\u000a composed of cholesterol\\/GM1 ganglioside and different phospholipids (5:1.5:10, M\\/M\\/M), showed that liposomes associated with cells more efficiently when they contained soya lecithin. The treatment with liposomes\\u000a made

M. Pitto; P. Palestini; A. Ferraretto; M. Marazzi; V. Donati; L. Falcone; M. Masserini



Segregation of GM1 and GM3 clusters in the cell membrane depends on the intact actin cytoskeleton.  


Gangliosides have been implicated in exerting multiple physiological functions, and it is important to understand how their distribution is regulated in the cell membrane. By using freeze-fracture immunolabeling electron microscopy, we showed that GM1 and GM3 make independent clusters that are significantly reduced by cholesterol depletion. In the present study, we examined the effects of actin depolymerization/polymerization and Src-family kinase inhibition on the GM1 and GM3 clusters. Both GM1 and GM3 clustering was reduced when the actin cytoskeleton was perturbed by latrunculin A or jasplakinolide, but the decrease was less significant than that induced by cholesterol depletion. On the other hand, inhibition of Src-family kinases decreased GM3 clustering more drastically than did cholesterol depletion, whereas its effect on GM1 clustering was less significant. GM1 and GM3 were segregated from each other in unperturbed cells, but co-clustering increased significantly after actin depolymerization. Our results indicate that the GM1 and GM3 clusters in the cell membrane are regulated in different ways and that segregation of the two gangliosides depends on the intact actin cytoskeleton. PMID:19830910

Fujita, Akikazu; Cheng, Jinglei; Fujimoto, Toyoshi



Improving the detection of IgM antibodies against glycolipids complexes of GM1 and Galactocerebroside in Multifocal Motor Neuropathy using glycoarray and ELISA assays.  


Antibodies against complexes of GM1:GalC are detected in multifocal motor neuropathy. Previous studies used different techniques, explaining disparities in the results. Antibodies against GM1 and GM1:GalC with different proportions of GalC were measured with both glycoarray and ELISA in 20 multifocal motor neuropathies, and 45 controls. The 1:5 ratio and the 1:1 ratio of GM1:GalC (weight ratio) were respectively the most effective for glycoarray and for ELISA. Testing for anti-GM1:GalC antibodies increased the sensitivity from 40% with anti-GM1 antibodies to 65% with array and 60% with ELISA without loss in specificity (above 91%). Anti-GM1:GalC antibodies are effective biological tools to diagnose multifocal motor neuropathy. PMID:25468269

Delmont, Emilien; Halstead, Susan; Galban-Horcajo, Francesc; Yao, Denggao; Desnuelle, Claude; Willison, Hugh



Orientation of the GM1 ganglioside in Langmuir-Blodgett monolayers: a PM IRRAS and computational study.  


The GM1 ganglioside in the monolayer at the air/water interface shows a liquid expanded-liquid condensed phase transition. Due to a combination of the PM IRRAS results with quantum chemical calculations the structure and orientation of the GM1 molecule in the monolayer on the sub-molecular level is provided. The PM IRRAS studies of GM1 monolayers demonstrate that the phase transition is accompanied by a reorientation of sugar residues with simultaneous changes in the network of hydrogen bonds. The calculation of the IR spectrum of the GM1 molecule allowed us to describe individual nu(as)(COC) modes in sugar residues of the GM1 pentasaccharide. The visualization of the dipole moment vector of each analyzed nu(as)(COC) band allowed us to discuss the orientation of the polar head group of the GM1 in the monolayer. In the liquid expanded state the planes of two sugar residues: beta-Gal-(1-3)-betaGlc-(1-1)-Cer of the GM1 molecule are tilted by ca. 55 degrees with respect to the surface normal. The plane of the beta1,4-GalNAc sugar ring is inclined by 70 degrees towards the gold surface. The phase transition to the liquid condensed state causes simultaneous reduction (by approximately 10 degrees) of the tilt of planes of sugar residues. The plane of the alpha2,3-Nue5Ac residue (sialic acid) has a nearly perpendicular orientation to the gold surface. Upon the transition to the liquid condensed state the strength of hydrogen bonds formed by the carboxylate group in the alpha2,3-Nue5Ac residue decreases. In parallel, the strength of hydrogen bonds formed by N atoms of amide groups of the GM1 molecule increases. These events may be explained by loosening and/or breaking of hydrogen bonds between the carboxylate and hydroxyl groups in the alpha2,3-Nue5Ac residue in a densely packed monolayer, due to steric hindrances. The ceramide group coupling the polar head group with the hydrophobic hydrocarbon chains, forms strong hydrogen bonds. The C=O bond of the amide group is almost perpendicular to the gold surface orientation. The hydrocarbon chains of the GM1 exist in a liquid disordered state and their physical state and orientation are not affected by the phase transition. PMID:19865770

Röefzaad, Melanie; Klüner, Thorsten; Brand, Izabella



Measuring Positive Cooperativity Using the Direct ESI-MS Assay. Cholera Toxin B Subunit Homopentamer Binding to GM1 Pentasaccharide  

NASA Astrophysics Data System (ADS)

Direct electrospray ionization mass spectrometry (ESI-MS) assay was used to investigate the stepwise binding of the GM1 pentasaccharide ?- D-Gal p-(1?3)-?-D-Gal pNAc-(1?4)[?-D-Neu5Ac-(2?3)]-?- D-Gal p-(1?4)-?-D-Glc p (GM1os) to the cholera toxin B subunit homopentamer (CTB5) and to establish conclusively whether GM1os binding is cooperative. Apparent association constants were measured for the stepwise addition of one to five GM1os to CTB5 at pH 6.9 and 22 °C. The intrinsic association constant, which was established from the apparent association constant for the addition of a single GM1os to CTB5, was found to be (3.2 ± 0.2) × 106 M-1. This is in reasonable agreement with the reported value of (6.4 ± 0.3) × 106 M-1, which was measured at pH 7.4 and 25 °C using isothermal titration calorimetry (ITC). Analysis of the apparent association constants provides direct and unambiguous evidence that GM1os binding exhibits small positive cooperativity. Binding was found to be sensitive to the number of ligand-bound nearest neighbor subunits, with the affinities enhanced by a factor of 1.7 and 2.9 when binding occurs next to one or two ligand-bound subunits, respectively. These findings, which provide quantitative support for the binding model proposed by Homans and coworkers [14], highlight the unique strengths of the direct ESI-MS assay for measuring cooperative ligand binding.

Lin, Hong; Kitova, Elena N.; Klassen, John S.



Differential uPAR recruitment in caveolar-lipid rafts by GM1 and GM3 gangliosides regulates endothelial progenitor cells angiogenesis.  


Gangliosides and the urokinase plasminogen activator receptor (uPAR) tipically partition in specialized membrane microdomains called lipid-rafts. uPAR becomes functionally important in fostering angiogenesis in endothelial progenitor cells (EPCs) upon recruitment in caveolar-lipid rafts. Moreover, cell membrane enrichment with exogenous GM1 ganglioside is pro-angiogenic and opposite to the activity of GM3 ganglioside. On these basis, we first checked the interaction of uPAR with membrane models enriched with GM1 or GM3, relying on the adoption of solid-supported mobile bilayer lipid membranes with raft-like composition formed onto solid hydrophilic surfaces, and evaluated by surface plasmon resonance (SPR) the extent of uPAR recruitment. We estimated the apparent dissociation constants of uPAR-GM1/GM3 complexes. These preliminary observations, indicating that uPAR binds preferentially to GM1-enriched biomimetic membranes, were validated by identifying a pro-angiogenic activity of GM1-enriched EPCs, based on GM1-dependent uPAR recruitment in caveolar rafts. We have observed that addition of GM1 to EPCs culture medium promotes matrigel invasion and capillary morphogenesis, as opposed to the anti-angiogenesis activity of GM3. Moreover, GM1 also stimulates MAPKinases signalling pathways, typically associated with an angiogenesis program. Caveolar-raft isolation and Western blotting of uPAR showed that GM1 promotes caveolar-raft partitioning of uPAR, as opposed to control and GM3-challenged EPCs. By confocal microscopy, we have shown that in EPCs uPAR is present on the surface in at least three compartments, respectively, associated to GM1, GM3 and caveolar rafts. Following GM1 exogenous addition, the GM3 compartment is depleted of uPAR which is recruited within caveolar rafts thereby triggering angiogenesis. PMID:25313007

Margheri, Francesca; Papucci, Laura; Schiavone, Nicola; D'Agostino, Riccardo; Trigari, Silvana; Serratě, Simona; Laurenzana, Anna; Biagioni, Alessio; Luciani, Cristina; Chillŕ, Anastasia; Andreucci, Elena; Del Rosso, Tommaso; Margheri, Giancarlo; Del Rosso, Mario; Fibbi, Gabriella



Differential uPAR recruitment in caveolar-lipid rafts by GM1 and GM3 gangliosides regulates endothelial progenitor cells angiogenesis  

PubMed Central

Gangliosides and the urokinase plasminogen activator receptor (uPAR) tipically partition in specialized membrane microdomains called lipid-rafts. uPAR becomes functionally important in fostering angiogenesis in endothelial progenitor cells (EPCs) upon recruitment in caveolar-lipid rafts. Moreover, cell membrane enrichment with exogenous GM1 ganglioside is pro-angiogenic and opposite to the activity of GM3 ganglioside. On these basis, we first checked the interaction of uPAR with membrane models enriched with GM1 or GM3, relying on the adoption of solid-supported mobile bilayer lipid membranes with raft-like composition formed onto solid hydrophilic surfaces, and evaluated by surface plasmon resonance (SPR) the extent of uPAR recruitment. We estimated the apparent dissociation constants of uPAR-GM1/GM3 complexes. These preliminary observations, indicating that uPAR binds preferentially to GM1-enriched biomimetic membranes, were validated by identifying a pro-angiogenic activity of GM1-enriched EPCs, based on GM1-dependent uPAR recruitment in caveolar rafts. We have observed that addition of GM1 to EPCs culture medium promotes matrigel invasion and capillary morphogenesis, as opposed to the anti-angiogenesis activity of GM3. Moreover, GM1 also stimulates MAPKinases signalling pathways, typically associated with an angiogenesis program. Caveolar-raft isolation and Western blotting of uPAR showed that GM1 promotes caveolar-raft partitioning of uPAR, as opposed to control and GM3-challenged EPCs. By confocal microscopy, we have shown that in EPCs uPAR is present on the surface in at least three compartments, respectively, associated to GM1, GM3 and caveolar rafts. Following GM1 exogenous addition, the GM3 compartment is depleted of uPAR which is recruited within caveolar rafts thereby triggering angiogenesis. PMID:25313007

Margheri, Francesca; Papucci, Laura; Schiavone, Nicola; D'Agostino, Riccardo; Trigari, Silvana; Serratě, Simona; Laurenzana, Anna; Biagioni, Alessio; Luciani, Cristina; Chillŕ, Anastasia; Andreucci, Elena; Del Rosso, Tommaso; Margheri, Giancarlo; Del Rosso, Mario; Fibbi, Gabriella



Gangliosides GM1 and GM3 in the Living Cell Membrane Form Clusters Susceptible to Cholesterol Depletion and Chilling  

Microsoft Academic Search

Presence of microdomains has been postulated in the cell membrane, but two-dimensional distribution of lipid molecules has been difficult to determine in the submicrometer scale. In the present paper, we examined the distribution of gangliosides GM1 and GM3, putative raft molecules in the cell membrane, by immunoelectron microscopy using quick-frozen and freeze-fractured specimens. This method physically immobilized molecules in situ

Akikazu Fujita; Jinglei Cheng; Minako Hirakawa; Koichi Furukawa; Susumu Kusunoki; Toyoshi Fujimoto



Busy period analysis for M\\/G\\/1 and G\\/M\\/1 type queues with restricted accessibility  

Microsoft Academic Search

We consider two models of M\\/G\\/1 and G\\/M\\/1 type queueing systems with restricted accessibility. Let (V(t))t?0 be the virtual waiting time process, let Sn be the time required for a full service of the nth customer and let ?n be his arrival time. In both models there is a capacity bound v??(0,?). In Model I the amount of service given

David Perry; Wolfgang Stadje; S. Zacks



Asymmetric Structural Features in Single Supported Lipid Bilayers Containing Cholesterol and GM1 Resolved with Synchrotron X-Ray Reflectivity  

PubMed Central

The cell membrane comprises numerous protein and lipid molecules capable of asymmetric organization between leaflets and liquid-liquid phase separation. We use single supported lipid bilayers (SLBs) to model cell membranes, and study how cholesterol and asymmetrically oriented ganglioside receptor GM1 affect membrane structure using synchrotron x-ray reflectivity. Using mixtures of cholesterol, sphingomyelin, and 1,2-dioleoyl-sn-glycero-3-phosphocholine, we characterize the structure of liquid-ordered and liquid-disordered SLBs in terms of acyl-chain density, headgroup size, and leaflet thickness. SLBs modeling the liquid-ordered phase are 10 Ĺ thicker and have a higher acyl-chain electron density (??chain? = 0.33 e?/Ĺ3) compared to SLBs modeling the liquid-disordered phase, or pure phosphatidylcholine SLBs (??chain? = 0.28 e?/Ĺ3). Incorporating GM1 into the distal bilayer leaflet results in membrane asymmetry and thickening of the leaflet of 4–9 Ĺ. The structural effect of GM1 is more complex in SLBs of cholesterol/sphingomyelin/1,2-dioleoyl-sn-glycero-3-phosphocholine, where the distal chains show a high electron density (??chain? = 0.33 e?/Ĺ3) and the lipid diffusion constant is reduced by ?50%, as measured by fluorescence microscopy. These results give quantitative information about the leaflet asymmetry and electron density changes induced by receptor molecules that penetrate a single lipid bilayer. PMID:18375517

Reich, Christian; Horton, Margaret R.; Krause, Bärbel; Gast, Alice P.; Rädler, Joachim O.; Nickel, Bert



Monomer of the B subunit of heat-labile enterotoxin from enterotoxigenic Escherichia coli has little ability to bind to GM1 ganglioside compared to its coligenoid.  


Coligenoid, composed of the B subunit of heat-labile enterotoxin from enterotoxigenic Escherichia coli, was separated into monomers in the presence of 2% propionic acid containing 6 M urea (pH 3.8). Monomers equilibrated against 0.75% or 0.5% propionic acid containing 3 M urea (pH 3.8) did not reassemble into coligenoid. Complexes of GM1 ganglioside and coligenoid in these buffers were detected by SDS-polyacrylamide gel electrophoresis, but those of the GM1 ganglioside and monomers were not. The binding ability of monomer to GM1 ganglioside in these buffers was about 1% of that of normal coligenoid by GM1-enzyme-linked immunosorbent assay. Moreover, monomers in these buffers reassembled into coligenoid by buffering against original TEAN buffer, and the binding ability of the resulting coligenoid to GM1 ganglioside was identical to that of native coligenoid. These data suggest that although coligenoid formation is important for the receptor binding of the B subunit, little binding ability to GM1 ganglioside remains in monomer of the B subunit. PMID:8577273

Tsuji, T; Watanabe, K; Miyama, A



Neurotropin promotes NGF signaling through interaction of GM1 ganglioside with Trk neurotrophin receptor in PC12 cells.  


Activation of the high-affinity nerve growth factor (NGF) receptor Trk occurs through multiple processes consisted of translocation and clustering within the plasma membrane lipid rafts, dimerization and autophosphorylation. Here we found that a nonprotein extract of inflamed rabbit skin inoculated with vaccinia virus (Neurotropin(®)) enhanced efficiency of NGF signaling. In rat pheochromocytoma PC12 cells overexpressing Trk (PCtrk cells), Neurotropin augmented insufficient neurite outgrowth observed at suboptimal concentration of NGF (2ng/mL) in a manner depending on Trk kinase activity. Cellular exposure to Neurotropin resulted in an accumulation of Trk-GM1 complexes without affecting dimerization or phosphorylation states of Trk. Following NGF stimulation, Neurotropin significantly facilitated the time course of NGF-induced Trk autophosphorylation. These observations provide a unique mechanism controlling efficiency of NGF signaling, and raise the therapeutic potential of Neurotropin for various neurological conditions associated with neurotrophin dysfunction. PMID:25454796

Fukuda, Yu; Fukui, Takao; Hikichi, Chika; Ishikawa, Tomomasa; Murate, Kenichiro; Adachi, Takeshi; Imai, Hideki; Fukuhara, Koki; Ueda, Akihiro; Kaplan, Allen P; Mutoh, Tatsuro



Stem Cell Transplant for Inborn Errors of Metabolism

Adrenoleukodystrophy; Metachromatic Leukodystrophy; Globoid Cell Leukodystrophy; Gaucher's Disease; Fucosidosis; Wolman Disease; Niemann-Pick Disease; Batten Disease; GM1 Gangliosidosis; Tay Sachs Disease; Sandhoff Disease



Chaperone therapy for GM2 gangliosidosis: effects of pyrimethamine on ?-hexosaminidase activity in Sandhoff fibroblasts.  


Sphingolipidoses are inherited genetic diseases due to mutations in genes encoding proteins involved in the lysosomal catabolism of sphingolipids. Despite a low incidence of each individual disease, altogether, the number of patients involved is relatively high and resolutive approaches for treatment are still lacking. The chaperone therapy is one of the latest pharmacological approaches to these storage diseases. This therapy allows the mutated protein to escape its natural removal and to increase its quantity in lysosomes, thus partially restoring the metabolic functions. Sandhoff disease is an autosomal recessive inherited disorder resulting from ?-hexosaminidase deficiency and characterized by large accumulation of GM2 ganglioside in brain. No enzymatic replacement therapy is currently available, and the use of inhibitors of glycosphingolipid biosynthesis for substrate reduction therapy, although very promising, is associated with serious side effects. The chaperone pyrimethamine has been proposed as a very promising drug in those cases characterized by a residual enzyme activity. In this review, we report the effect of pyrimethamine on the recovery of ?-hexosaminidase activity in cultured fibroblasts from Sandhoff patients. PMID:24356898

Chiricozzi, Elena; Niemir, Natalia; Aureli, Massimo; Magini, Alessandro; Loberto, Nicoletta; Prinetti, Alessandro; Bassi, Rosaria; Polchi, Alice; Emiliani, Carla; Caillaud, Catherine; Sonnino, Sandro



Midazolam inhibits the formation of amyloid fibrils and GM1 ganglioside-rich microdomains in presynaptic membranes through the gamma-aminobutyric acid A receptor.  


Recent studies have suggested that a positive correlation exists between surgical interventions performed under general anesthesia and the risk of developing Alzheimer's disease (AD) in the late postoperative period. It has been reported that amyloid ?-protein (??) fibrillogenesis, which is closely related to AD, is accelerated by exposure to anesthetics. However, the mechanisms underlying these effects remain uncertain. This study was designed to investigate whether the anesthetic midazolam affects ?? fibrillogenesis, and if so, whether it acts through GM1 ganglioside (GM1) on the neuronal surface. Midazolam treatment decreased GM1 expression in the detergent-resistant membrane microdomains of neurons, and these effects were regulated by the gamma-aminobutyric acid-A receptor. Midazolam inhibited ?? fibril formation from soluble ?? on the neuronal surface. In addition, midazolam suppressed GM1-induced fibril formation in a cell-free system. Moreover, midazolam inhibited the formation of ?? assemblies in synaptosomes isolated from aged mouse brains. These finding suggested that midazolam has direct and indirect inhibitory effects on ?? fibrillogenesis. PMID:25600806

Yamamoto, Naoki; Arima, Hajime; Sugiura, Takeshi; Hirate, Hiroyuki; Kusama, Nobuyoshi; Suzuki, Kenji; Sobue, Kazuya



Mutational Analysis of Ganglioside GM1-Binding Ability, Pentamer Formation, and Epitopes of Cholera Toxin B (CTB) Subunits and CTB/Heat-Labile Enterotoxin B Subunit Chimeras  

PubMed Central

Variants of cholera toxin B subunit (CTB) were made by bisulfite- and oligonucleotide-directed mutagenesis of the ctxB gene. Variants were screened by a radial passive immune hemolysis assay (RPIHA) for loss of binding to sheep erythrocytes (SRBC). Variant CTBs were characterized for the formation of immunoreactive pentamers, the ability to bind ganglioside GM1 in vitro, and reactivity with a panel of monoclonal anti-CTB antibodies. Substitutions at eight positions (i.e., positions 22, 29, 36, 45, 64, 86, 93, and 100) greatly reduced the yield of immunoreactive CTB. RPIHA-negative substitution variants that formed immunoreactive pentamers were obtained for residues 12, 33, 36, 51, 52 + 54, 91, and 95. Tyrosine-12 was identified as a novel residue important for GM1 binding since, among all of the novel variants isolated with altered RPIHA phenotypes, only CTB with aspartate substituted for tyrosine at position 12 failed to bind significantly to ganglioside GM1 in vitro. In contrast, CTB variants with single substitutions for several other residues (Glu-51, Lys-91, and Ala-95) that participate in GM1 binding, based on the crystal structure of CTB and the oligosaccharide of GM1, were not appreciably altered in their ability to bind GM1 in vitro, even though they showed altered RPIHA phenotypes and did not bind to SRBC. Hybrid B genes made by fusing ctxB and the related Escherichia coli heat-labile enterotoxin eltB genes at codon 56 produced CTB variants that had 7 or 12 heat-labile enterotoxin B residue substitutions in the amino or carboxyl halves of the monomer, respectively, each of which which also bound GM1 as well as wild-type CTB. This collection of variant CTBs in which 47 of the 103 residues were substituted was used to map the epitopes of nine anti-CTB monoclonal antibodies (MAbs). Each MAb had a unique pattern of reactivity with the panel of CTB variants. Although no two of the epitopes recognized by different MAbs were identical, most of the single amino acid substitutions that altered the immunoreactivity of CTB affected more that one epitope. The tertiary structures of the epitopes of these anti-CTB MAbs are highly conformational and may involve structural elements both within and between CTB monomers. Substitution of valine for alanine at positions 10 and 46 had dramatic effects on the immunoreactivity of CTB, affecting epitopes recognized by eight or six MAbs, respectively. PMID:11854209

Jobling, Michael G.; Holmes, Randall K.



Selection of GM2, fucosyl GM1, globo H and polysialic acid as targets on small cell lung cancers for antibody mediated immunotherapy  

Microsoft Academic Search

Glycolipids GM2, GD2, GD3, fucosyl GM1, sialyl Lewis a (sLea) and globo H, and polysialic acid on embryonal NCAM, are cell-surface antigens expressed on small cell lung cancer (SCLC) biopsy specimens. They are all candidates for inclusion in a polyvalent, antibody-inducing vaccine or for adoptive therapy with monoclonal antibodies (mAbs) against SCLC. To identify the minimum optimal combination of target

P. O. Livingston; C. Hood; L. M. Krug; N. Warren; M. G. Kris; T. Brezicka; G. Ragupathi



On the Emerging Role of Chemistry in the Fashioning of Biologics: Synthesis of a Bidomainal Fucosyl GM1-Based Vaccine, for the Treatment of Small Cell Lung Cancer  

PubMed Central

The synthesis of the novel Small Cell Lung Cancer (SCLC) Fucosyl GM1-based vaccine construct, featuring insertion of the HLA-DR binding 15 amino acid sequence derived from Plasmodium Falciparum, is described. The resultant glycopeptide has been synthesized in an efficient manner. Finally, successful conjugation of the glycopeptide to the Keyhole Limpet Hemocyanin (KLH) carrier protein completed the preparation of the vaccine. PMID:19555091

Nagorny, Pavel; Kim, Woo Han; Wan, Qian; Lee, Dongjoo; Danishefsky, Samuel J.



On the emerging role of chemistry in the fashioning of biologics: synthesis of a bidomainal fucosyl GM1-based vaccine for the treatment of small cell lung cancer.  


The synthesis of the novel small cell lung cancer (SCLC) fucosyl GM1-based vaccine construct, featuring insertion of the HLA-DR binding 15 amino acid sequence derived from Plasmodium falciparum, is described. The resultant glycopeptide has been synthesized in an efficient manner. Finally, successful conjugation of the glycopeptide to the keyhole limpet hemocyanin (KLH) carrier protein completed the preparation of the vaccine. PMID:19555091

Nagorny, Pavel; Kim, Woo Han; Wan, Qian; Lee, Dongjoo; Danishefsky, Samuel J



GM1 controlled lateral segregation of tyrosine kinase Lck predispose T-cells to cell-derived galectin-1-induced apoptosis.  


One prominent immunoregulatory function of galectin-1 (Gal-1), a ?-galactoside binding mammalian lectin, is induction of apoptosis in activated T-cells by a process depending on the activity of Src family tyrosine kinase, Lck. Although the requirement for Lck in Gal-1 induced T-cell death and the ability of Gal-1 to affect the membrane localization of extracellular Gal-1-binding proteins have been well documented, the consequence of the complex and related reorganization of extra- and intracellular signaling components upon Gal-1 treatment of T-cells has not yet been revealed. Therefore, we have analyzed the plasma membrane movement of Lck upon Gal-1 triggered signaling, and the significance of this event in Gal-1 induced T-cell death. Non-receptor tyrosine kinase, Lck primarily localized in the synapse of tumor cell-T-cell during 15 min of the established direct cell contact. Later, after 30 min, a lateral segregation of Lck from the cell synapse was observed. The migration of Lck to the opposite of the cell contact apparently depended on the expression and cell surface presentation of Gal-1 on the effector (tumor) cells and was accompanied by phosphorylation on the negative regulatory tyrosine residue, Tyr505. Receptor tyrosine phosphatase, CD45 played crucial role in this event since CD45 deficiency or inhibition of its phosphatase activity resulted in the failure of Lck membrane movement. Level of the Gal-1-binding glycolipid GM1 ganglioside also essentially regulated Lck localization. Segregation of Lck and Gal-1 induced apoptosis was diminished in T-cells with low GM1 expression compared to T-cells with high GM1. Our results show that spatial regulation of Lck by CD45 and GM1 ganglioside determines the outcome of apoptotic response to Gal-1 and this local regulation may occur only upon intimate effector (Gal-1 expressing) cell-T-cell attachment. PMID:24231767

Novák, Julianna; Kriston-Pál, Éva; Czibula, Ágnes; Deák, Magdolna; Kovács, László; Monostori, Éva; Fajka-Boja, Roberta



GM1 and GD1a gangliosides modulate toxic and inflammatory effects of E. coli lipopolysaccharide by preventing TLR4 translocation into lipid rafts.  


Exogenous gangliosides are known to inhibit the effects of Escherichia coli lipopolysaccharide (LPS) in different cells exhibiting a nti-inflammatory and immunosuppressive activities. The mechanisms underlying ganglioside action are not fully understood. Because LPS recognition and receptor complex formation occur in lipid rafts, and gangliosides play a key role in their maintenance, we hypothesize that protective effects of exogenous gangliosides would depend on inhibition of LPS signaling via prevention of TLR4 translocation into lipid rafts. The effect of GM1 and GD1a gangliosides on LPS-induced toxic and inflammatory reactions in PC12 cells, and in epithelial cells isolated from the frog urinary bladder, was studied. In PC12 cells, GD1a and GM1 significantly reduced the effect of LPS on the decrease of cell survival and on stimulation of reactive oxygen species production. In epithelial cells, gangliosides decreased LPS-stimulated iNOS expression, NO, and PGE2 production. Subcellular fractionation, in combination with immunoblotting, showed that pretreatment of cells with GM1, GD1a, or methyl-?-cyclodextrin, completely eliminated the effect of LPS on translocation of TLR4 into lipid rafts. The results are consistent with the hypothesis that ganglioside-induced prevention of TLR4 translocation into lipid rafts could be a mechanism of protection against LPS in various cells. PMID:25499607

Nikolaeva, Svetlana; Bayunova, Lubov; Sokolova, Tatyana; Vlasova, Yulia; Bachteeva, Vera; Avrova, Natalia; Parnova, Rimma



Reduced GM1 ganglioside in CFTR-deficient human airway cells results in decreased ?1-integrin signaling and delayed wound repair.  


Loss of cystic fibrosis transmembrane conductance regulator (CFTR) function reduces chloride secretion and increases sodium uptake, but it is not clear why CFTR mutation also results in progressive lung inflammation and infection. We previously demonstrated that CFTR-silenced airway cells migrate more slowly during wound repair than CFTR-expressing controls. In addition, CFTR-deficient cells and mouse models have been reported to have altered sphingolipid levels. Here, we investigated the hypothesis that reduced migration in CFTR-deficient airway epithelial cells results from altered sphingolipid composition. We used cell lines derived from a human airway epithelial cell line (Calu-3) stably transfected with CFTR short hairpin RNA (CFTR-silenced) or nontargeting short hairpin RNA (controls). Cell migration was measured by electric cell substrate impedance sensing (ECIS). Lipid analyses, addition of exogenous glycosphingolipids, and immunoblotting were performed. We found that levels of the glycosphingolipid, GM1 ganglioside, were ~60% lower in CFTR-silenced cells than in controls. CFTR-silenced cells exhibited reduced levels of activated ?1-integrin, phosphorylated tyrosine 576 of focal adhesion kinase (pFAK), and phosphorylation of Crk-associated substrate (pCAS). Addition of GM1 (but not GM3) ganglioside to CFTR-silenced cells restored activated ?1-integrin, pFAK, and pCAS to near control levels and partially restored (~40%) cell migration. Our results suggest that decreased GM1 in CFTR-silenced cells depresses ?1-integrin signaling, which contributes to the delayed wound repair observed in these cells. These findings have implications for the pathology of cystic fibrosis, where altered sphingolipid levels in airway epithelial cells could result in a diminished capacity for wound repair after injury. PMID:24500283

Itokazu, Yutaka; Pagano, Richard E; Schroeder, Andreas S; O'Grady, Scott M; Limper, Andrew H; Marks, David L



Galectin-3 protein regulates mobility of N-cadherin and GM1 ganglioside at cell-cell junctions of mammary carcinoma cells.  


Galectin-3 binding to cell surface glycoproteins, including branched N-glycans generated by N-acetylglucosaminyltransferase V (Mgat5) activity, forms a multivalent, heterogeneous, and dynamic lattice. This lattice has been shown to regulate integrin and receptor tyrosine kinase signaling promoting tumor cell migration. N-cadherin is a homotypic cell-cell adhesion receptor commonly overexpressed in tumor cells that contributes to cell motility. Here we show that galectin-3 and N-cadherin interact and colocalize with the lipid raft marker GM1 ganglioside in cell-cell junctions of mammary epithelial cancer cells. Disruption of the lattice by deletion of Mgat5, siRNA depletion of galectin-3, or competitive inhibition with lactose stabilizes cell-cell junctions. It also reduces, in a p120-catenin-dependent manner, the dynamic pool of junctional N-cadherin. Proteomic analysis of detergent-resistant membranes (DRMs) revealed that the galectin lattice opposes entry of many proteins into DRM rafts. N-cadherin and catenins are present in DRMs; however, their DRM distribution is not significantly affected by lattice disruption. Galectin lattice integrity increases the mobile fraction of the raft marker, GM1 ganglioside binding cholera toxin B subunit Ctb, at cell-cell contacts in a p120-catenin-independent manner, but does not affect the mobility of either Ctb-labeled GM1 or GFP-coupled N-cadherin in nonjunctional regions. Our results suggest that the galectin lattice independently enhances lateral molecular diffusion by direct interaction with specific glycoconjugates within the adherens junction. By promoting exchange between raft and non-raft microdomains as well as molecular dynamics within junction-specific raft microdomains, the lattice may enhance turnover of N-cadherin and other glycoconjugates that determine junctional stability and rates of cell migration. PMID:22846995

Boscher, Cécile; Zheng, Yu Zi; Lakshminarayan, Ramya; Johannes, Ludger; Dennis, James W; Foster, Leonard J; Nabi, Ivan R



Galectin-3 Protein Regulates Mobility of N-cadherin and GM1 Ganglioside at Cell-Cell Junctions of Mammary Carcinoma Cells*  

PubMed Central

Galectin-3 binding to cell surface glycoproteins, including branched N-glycans generated by N-acetylglucosaminyltransferase V (Mgat5) activity, forms a multivalent, heterogeneous, and dynamic lattice. This lattice has been shown to regulate integrin and receptor tyrosine kinase signaling promoting tumor cell migration. N-cadherin is a homotypic cell-cell adhesion receptor commonly overexpressed in tumor cells that contributes to cell motility. Here we show that galectin-3 and N-cadherin interact and colocalize with the lipid raft marker GM1 ganglioside in cell-cell junctions of mammary epithelial cancer cells. Disruption of the lattice by deletion of Mgat5, siRNA depletion of galectin-3, or competitive inhibition with lactose stabilizes cell-cell junctions. It also reduces, in a p120-catenin-dependent manner, the dynamic pool of junctional N-cadherin. Proteomic analysis of detergent-resistant membranes (DRMs) revealed that the galectin lattice opposes entry of many proteins into DRM rafts. N-cadherin and catenins are present in DRMs; however, their DRM distribution is not significantly affected by lattice disruption. Galectin lattice integrity increases the mobile fraction of the raft marker, GM1 ganglioside binding cholera toxin B subunit Ctb, at cell-cell contacts in a p120-catenin-independent manner, but does not affect the mobility of either Ctb-labeled GM1 or GFP-coupled N-cadherin in nonjunctional regions. Our results suggest that the galectin lattice independently enhances lateral molecular diffusion by direct interaction with specific glycoconjugates within the adherens junction. By promoting exchange between raft and non-raft microdomains as well as molecular dynamics within junction-specific raft microdomains, the lattice may enhance turnover of N-cadherin and other glycoconjugates that determine junctional stability and rates of cell migration. PMID:22846995

Boscher, Cécile; Zheng, Yu Zi; Lakshminarayan, Ramya; Johannes, Ludger; Dennis, James W.; Foster, Leonard J.; Nabi, Ivan R.



Differential interactions of two local anesthetics with phospholipid membrane and nonerythroid spectrin: Localization in presence of cholesterol and ganglioside, GM1.  


Interactions of two local anesthetics, dibucaine and tetracaine have been studied with phospholipid vesicles containing cholesterol and/or monosialogangliosides (GM1) using fluorescence spectroscopy. The fluorescence intensity of tetracaine showed a marked increase with the increasing molar ratio of the phospholipid to tetracaine, while that of dibucaine showed opposite effects. Steady state anisotropy and the wavelength of maximum emission (?max) decreased with the increasing phospholipids to tetracaine ratio. The extent of such changes in anisotropy and ?max in the presence and absence of two important components of neuronal membranes, cholesterol and GM1 indicated differential membrane localization of the two local anesthetics. To understand the intercellular mode of action of local anesthetics, we have also studied the interactions of dibucaine and tetracaine with brain spectrin which indicate differential spectrin interactions with similar binding strength. Thermodynamic parameters associated with such binding reveal that binding is favored by entropy. Tetracaine brings about distinct structural changes in spectrin compared to dibucaine, as reflected in the tryptophan mean lifetime and far-UV CD spectra. Tetracaine also exhibits a detergent-like property inducing concentration dependent decrease in spectrin anisotropy, further indicating structural changes in brain spectrin with probable implications in its anesthetic potential. PMID:25482358

Chakrabarti, Abhijit; Patra, Malay



Chaperone Therapy for Neuronopathic Lysosomal Diseases: Competitive Inhibitors as Chemical Chaperones for Enhancement of Mutant Enzyme Activities  

PubMed Central

Chaperone therapy is a newly developed molecular approach to lysosomal diseases, a group of human genetic diseases causing severe brain damage. We found two valienamine derivatives, N-octyl-4-epi-?-valienamine (NOEV) and N-octyl-?-valienamine (NOV), as promising therapeutic agents for human ?-galactosidase deficiency disorders (mainly GM1-gangliosidosis) and ?-glucosidase deficiency disorders (Gaucher disease), respectively. We briefly reviewed the historical background of research in carbasugar glycosidase inhibitors. Originally NOEV and NOV had been discovered as competitive inhibitors, and then their paradoxical bioactivities as chaperones were confirmed in cultured fibroblasts from patients with these disorders. Subsequently GM1-gangliosidosis model mice were developed and useful for experimental studies. Orally administered NOEV entered the brain through the blood-brain barrier, enhanced ?-galactosidase activity, reduced substrate storage, and improved neurological deterioration clinically. Furthermore, we executed computational analysis for prediction of molecular interactions between ?-galactosidase and NOEV. Some preliminary results of computational analysis of molecular interaction mechanism are presented in this article. NOV also showed the chaperone effect toward several ?-glucosidase gene mutations in Gaucher disease. We hope chaperone therapy will become available for some patients with GM1-gangliosidosis, Gaucher disease, and potentially other lysosomal storage diseases with central nervous system involvement. PMID:19812739

Suzuki, Yoshiyuki; Ogawa, Seiichiro; Sakakibara, Yasubumi



Meningoencephalitis-like onset of post-infectious AQP4-IgG-positive optic neuritis complicated by GM1-IgG-positive acute polyneuropathy.  


Fifteen days after a respiratory infection, a 45-year-old woman presented with paresthesias in the hands and feet, bilateral loss of vision, fever, headache, and impairment of consciousness. Magnetic resonance imaging (MRI) showed predominant lesions in the optic tracts, optic chiasm, and hypothalamus. Cerebrospinal fluid analysis revealed elevated protein level, and lymphocytic pleocytosis. Neurophysiological studies disclosed a demyelinating sensorimotor polyneuropathy. Serum anti-Mycoplasma pneumoniae immunoglobulin (Ig)M, anti-GM1 IgG, and anti-AQP4 IgG were positive. This case, which is remarkable for post-infectious meningoencephalitis-like onset, MRI picture, and dysimmunity to central and peripheral nervous system autoantigens, underpins the pivotal diagnostic role of anti-AQP4-IgG, and expands the list of clinico-pathological findings that can associate with neuromyelitis optica spectrum disorders. PMID:24557856

Benedetti, Luana; Franciotta, Diego; Beronio, Alessandro; Delucchi, Stefano; Capellini, Cesare; Sette, Massimo Del



Lending a helping hand, screening chemical libraries for compounds that enhance ?-hexosaminidase A activity in GM2 gangliosidosis cells  

PubMed Central

Enzyme enhancement therapy is an emerging therapeutic approach that has the potential to treat many genetic diseases. Candidate diseases are those associated with a mutant protein that has difficulty folding and/or assembling into active oligomers in the endoplasmic reticulum. Many lysosomal storage diseases are candidates for enzyme enhancement therapy and have the additional advantage of requiring only 5–10% of normal enzyme levels to reduce and/or prevent substrate accumulation. Our long experience in working with the ?-hexosaminidase (EC isozymes system and its associated deficiencies (Tay-Sachs and Sandhoff disease) lead us to search for possible enzyme enhancement therapy-agents that could treat the chronic forms of these diseases which express 2–5% residual activity. Pharmacological chaperones are enzyme enhancement therapy-agents that are competitive inhibitors of the target enzyme. Each of the known ?-hexosaminidase inhibitors (low ?M IC50) increased mutant enzyme levels to ? 10% in chronic Tay-Sachs fibroblasts and also attenuated the thermo-denaturation of ?-hexosaminidase. To expand the repertoire of pharmacological chaperones to more ‘drug-like’ compounds, we screened the Maybridge library of 50 000 compounds using a real-time assay for non-carbohydrate-based ?-hexosaminidase inhibitors and identified several that functioned as pharmacological chaperones in patient cells. Two of these inhibitors had derivatives that had been tested in humans for other purposes. These observations lead us to screen the NINDS library of 1040 Food and Drug Administration approved compounds for pharmacological chaperones. Pyrimethamine, an antimalarial drug with well documented pharmacokinetics, was confirmed as a ?-hexosaminidase pharmacological chaperone and compared favorably with our best carbohydrate-based pharmacological chaperone in patient cells with various mutant genotypes. PMID:17894780

Tropak, Michael B.; Mahuran, Don



Carbohydrate-to-carbohydrate interactions between ?2,3-linked sialic acids on ?2 integrin subunits and asialo-GM1 underlie the bone metastatic behaviour of LNCAP-derivative C4-2B prostate cancer cells  

PubMed Central

Complex interplays among proteins, lipids and carbohydrates can alter the phenotype and are suggested to have a crucial role in tumour metastasis. Our previous studies indicated that a complex of the GSLs (glycosphingolipids), AsGM1 (asialo-GM1), which lacks ?2,3-linked sialic acid, and ?2?1 integrin receptors is responsible for the metastatic behaviour of C4-2B prostate cancer cells. Herein, we identified and addressed the functional significance of changes in sialylation during prostate cancer progression. We observed an increase in ?2,3-linked sialic acid residues on ?2 subunits of ?2?1 integrin receptors, correlating with increased gene expression of ?2,3-STs (sialyltransferases), particularly ST3GAL3. Cell surface ?2,3-sialylation of ?2 subunits was required for the integrin ?2?1-dependent cell adhesion to collagen type I and the same ?2,3-linked sialic acid residues on the integrin receptor were responsible for the interaction with the carbohydrate moiety of AsGM1, explaining the complex formation between AsGM1 and ?2?1 integrin receptors. These results provide novel insights into the role of sialic acids in the organization and function of important membrane components in invasion and metastatic processes. PMID:25137483

Van Slambrouck, Séverine; Groux-Degroote, Sophie; Krzewinski-Recchi, Marie-Ange; Cazet, Aurélie; Delannoy, Philippe; Steelant, Wim F. A.




EPA Science Inventory

Adult, male Fischer-344 rats were given bilateral injections of 2.5 microgram colchicine or artificial cerebrospinal fluid into caudal and rostral sites of the dentate gyrus of the hippocampus. One group of rats received 21 consecutive daily injections of 20 mg/kg GM1 ganglioside...


Ganglioside-like epitopes of lipopolysaccharides from Campylobacter jejuni (PEN 19) in three isolates from patients with Guillain-Barré syndrome  

Microsoft Academic Search

Sera from patients with Guillain-Barré syndrome (GBS) frequently have anti-GM1 antibody. We earlier showed that an lipopolysaccharides (LPS) from Campylobacter jejuni (PEN 19) isolated from a GBS patient has a GM1 ganglioside-like structure. Aspinall et al. (Biochemistry, 61 (1994) 335–337) reported that OH 4382 has an LPS that bears a GD3 ganglioside-like structure and that OH 4384 has an LPS

Nobuhiro Yuki; Shizuo Handa; Tadashi Tai; Masaki Takahashi; Kahiko Saito; Yoshihiro Tsujino; Takao Taki



An in vitro model for abnormal skeletal development in the lysosomal storage diseases  

Microsoft Academic Search

Lysosomal storage diseases such as GM1-gangliosidosis are associated with skeletal abnormalities. Radiological and histological studies, both in human and corresponding animal models, indicate retarded bone formation. Since cartilage maturation leads to bone formation, we developed an in vitro system to study and compare the biological features of cartilage from dogs affected with GM1-gangliosidosis with age-matched controls. Costochondral chondrocytes were grown

Amy Lynn Aulthouse; Joseph Alroy



Recombinant GM2Activator Protein Stimulates In Vivo Degradation of GA2 in GM2 Gangliosidosis AB Variant Fibroblasts But Exhibits No Detectable Binding of GA2 in an In Vitro Assay  

Microsoft Academic Search

The interaction between glycosphingolipids and recombinant human GM2-activator was studied in a microwell binding assay. A-series gangliosides like GM3, GM2 and GM1 were strongly bound by the recombinant human GM2 activator. A weak binding was observed to GD1b and sulfatide, while neutral glycolipids were not bound. Optimal binding occurred at pH 4.2 and was inhibited by increasing concentrations of citrate

Uwe Bierfreund; Thorsten Lemm; Alexander Hoffmann; Gunther Uhlhorn-Dierks; Robert A. Childs; Chun-Ting Yuen; Ten Feizi; Konrad Sandhoff



Magnetic resonance imaging pattern recognition in hypomyelinating disorders  

PubMed Central

Hypomyelination is observed in the context of a growing number of genetic disorders that share clinical characteristics. The aim of this study was to determine the possible role of magnetic resonance imaging pattern recognition in distinguishing different hypomyelinating disorders, which would facilitate the diagnostic process. Only patients with hypomyelination of known cause were included in this retrospective study. A total of 112 patients with Pelizaeus–Merzbacher disease, hypomyelination with congenital cataract, hypomyelination with hypogonadotropic hypogonadism and hypodontia, Pelizaeus–Merzbacher-like disease, infantile GM1 and GM2 gangliosidosis, Salla disease and fucosidosis were included. The brain scans were rated using a standard scoring list; the raters were blinded to the diagnoses. Grouping of the patients was based on cluster analysis. Ten clusters of patients with similar magnetic resonance imaging abnormalities were identified. The most important discriminating items were early cerebellar atrophy, homogeneity of the white matter signal on T2-weighted images, abnormal signal intensity of the basal ganglia, signal abnormalities in the pons and additional T2 lesions in the deep white matter. Eight clusters each represented mainly a single disorder (i.e. Pelizaeus–Merzbacher disease, hypomyelination with congenital cataract, hypomyelination with hypogonadotropic hypogonadism and hypodontia, infantile GM1 and GM2 gangliosidosis, Pelizaeus–Merzbacher-like disease and fucosidosis); only two clusters contained multiple diseases. Pelizaeus–Merzbacher-like disease was divided between two clusters and Salla disease did not cluster at all. This study shows that it is possible to separate patients with hypomyelination disorders of known cause in clusters based on magnetic resonance imaging abnormalities alone. In most cases of Pelizaeus–Merzbacher disease, hypomyelination with congenital cataract, hypomyelination with hypogonadotropic hypogonadism and hypodontia, Pelizaeus–Merzbacher-like disease, infantile GM1 and GM2 gangliosidosis and fucosidosis, the imaging pattern gives clues for the diagnosis. PMID:20881161

Steenweg, Marjan E.; Vanderver, Adeline; Blaser, Susan; Bizzi, Alberto; de Koning, Tom J.; Mancini, Grazia M. S.; van Wieringen, Wessel N.; Barkhof, Frederik; Wolf, Nicole I.



Antibody to Ga1NAc-GD1a and Ga1NAc-GM1b in Guillain—Barré syndrome subsequent to Campylobacter jejuni enteritis  

Microsoft Academic Search

N-Acetylgalactosaminyl GD1a (Ga1NAc-GD1a) is a proposed target molecule for serum antibody in some patients with Guillain-Barré syndrome (GBS) (Kusunoki et al., 1994). We examined autoantibody to Ga1NAc-GD1a in sera from 58 GBS patients. Eight GBS patients had high IgG anti-Ga1NAc-GD1a antibody titers, 3 of whom also had high IgM anti-Ga1NAc-GD1a antibody titers. These 8 patients had experienced gastrointestinal infection before

Nobuhiro Yuki; Takao Taki; Shizuo Handa



Increase in asialoganglioside- and monosialoganglioside-reactive antibodies in chronic Chagas' disease patients.  


Antibodies reactive with the core glycan of asialoganglioside (GA1), monosialoganglioside (GM1), and disialoganglioside (GD1a) were studied in human sera. In healthy individuals, GA1-, GM1-, and GD1a-reactive antibodies were mainly of the IgM class, but also of the IgA and IgG classes, and were present at low titers in the serum of 68%, 79%, and 91% of the individuals studied, respectively. Levels of anti-GA1 and anti-GM1 antibodies, mainly of the IgA and IgG classes, were significantly elevated (P < 0.001) in 62% and 72% of subjects, respectively, chronically infected with Trypanosoma cruzi, with no association found with the degree of myocardial damage. No significant increase in anti-GA1 and anti-GM1 antibodies was found in dilated cardiomyopathy patients. The level of anti-GD1a antibody was not significantly different between healthy controls and chronic chagasic or dilatatory cardiomyopathy patients. Since the peripheral nervous system is very rich in gangliosides, it is possible that the increases in GA1- and GM1-specific antibodies that develop during chronic T. cruzi infection are involved in the pathology of peripheral neuropathy in Chagas' disease. PMID:9546415

Avila, J L; Rojas, M; Avila, A



Diagnostic Approach to Childhood-onset Cerebellar Atrophy: A 10-Year Retrospective Study of 300 Patients  

PubMed Central

Hereditary ataxias associated with cerebellar atrophy are a heterogeneous group of disorders. Selection of appropriate clinical and genetic tests for patients with cerebellar atrophy poses a diagnostic challenge. Neuroimaging is a crucial initial investigation in the diagnostic evaluation of ataxia in childhood, and the presence of cerebellar atrophy helps guide further investigations. We performed a detailed review of 300 patients with confirmed cerebellar atrophy on magnetic resonance imaging over a 10-year period. A diagnosis was established in 47% of patients: Mitochondrial disorders were most common, followed by the neuronal ceroid lipofuscinoses, ataxia telangectasia, and late GM2-gangliosidosis. We review the common causes of cerebellar atrophy in childhood and propose a diagnostic approach based on correlating specific neuroimaging patterns with clinical and genetic diagnoses. PMID:22764178

Al-Maawali, Almundher; Blaser, Susan; Yoon, Grace



Carbohydrate chain of ganglioside GM1 as a ligand: identification of the binding strategies of three 15 mer peptides and their divergence from the binding modes of growth-regulatory galectin-1 and cholera toxin.  


The branched pentasaccharide chain of ganglioside GM1 is a prominent cell surface ligand, for example, for cholera toxin or tumor growth-regulatory homodimeric galectins. This activity profile via protein recognition prompted us to examine the binding properties of peptides with this specificity. Our study provides insights into the mechanism of molecular interaction of this thus far unexplored size limit of the protein part. We used three pentadecapeptides in a combined approach of mass spectrometry, NMR spectroscopy and molecular modelling to analyze the ligand binding in solution. Availability of charged and hydrophobic functionalities affected the intramolecular flexibility of the peptides differently. Backfolding led to restrictions in two cases; the flexibility was not reduced significantly by association of the ligand in its energetically privileged conformations. Major contributions to the interaction energy arise from the sialic acid moiety contacting Arg/Lys residues and the N-terminal charge. Considerable involvement of stacking between the monovalent ligand and aromatic rings could not be detected. This carbohydrate binding strategy is similar to how an adenoviral fiber knob targets sialylated glycans. Rational manipulation for an affinity enhancement can now be directed to reduce the flexibility, exploit the potential for stacking and acquire the cross-linking capacity of the natural lectins by peptide attachment to a suitable scaffold. PMID:16267866

Siebert, Hans-Christian; Born, Karin; André, Sabine; Frank, Martin; Kaltner, Herbert; von der Lieth, Claus-Wilhelm; Heck, Albert J R; Jiménez-Barbero, Jesús; Kopitz, Jürgen; Gabius, Hans-Joachim



Structural basis of pharmacological chaperoning for human ?-galactosidase.  


GM1 gangliosidosis and Morquio B disease are autosomal recessive diseases caused by the defect in the lysosomal ?-galactosidase (?-Gal), frequently related to misfolding and subsequent endoplasmic reticulum-associated degradation. Pharmacological chaperone (PC) therapy is a newly developed molecular therapeutic approach by using small molecule ligands of the mutant enzyme that are able to promote the correct folding and prevent endoplasmic reticulum-associated degradation and promote trafficking to the lysosome. In this report, we describe the enzymological properties of purified recombinant human ?-Gal(WT) and two representative mutations in GM1 gangliosidosis Japanese patients, ?-Gal(R201C) and ?-Gal(I51T). We have also evaluated the PC effect of two competitive inhibitors of ?-Gal. Moreover, we provide a detailed atomic view of the recognition mechanism of these compounds in comparison with two structurally related analogues. All compounds bind to the active site of ?-Gal with the sugar-mimicking moiety making hydrogen bonds to active site residues. Moreover, the binding affinity, the enzyme selectivity, and the PC potential are strongly affected by the mono- or bicyclic structure of the core as well as the orientation, nature, and length of the exocyclic substituent. These results provide understanding on the mechanism of action of ?-Gal selective chaperoning by newly developed PC compounds. PMID:24737316

Suzuki, Hironori; Ohto, Umeharu; Higaki, Katsumi; Mena-Barragán, Teresa; Aguilar-Moncayo, Matilde; Ortiz Mellet, Carmen; Nanba, Eiji; Garcia Fernandez, Jose M; Suzuki, Yoshiyuki; Shimizu, Toshiyuki



RESEARCH Open Access Fast urinary screening of oligosaccharidoses by  

E-print Network

to the lysosomal storage diseases, are inherited metabolic disorders due to the absence or the loss of function- somal storage disorders resulting in deficient activity of one of the lysosomal hydrolases involved fucosidosis, aspartylglucosaminuria, GM1 gangliosidosis, Sandhoff disease, -mannosidosis, sialidosis

Paris-Sud XI, Université de


Clinical phenotype of patients with neuropathy associated with monoclonal gammopathy: a comparative study and a review of the literature.  


The objective of this study was to investigate if the clinical and electrophysiological phenotype of patients with polyneuropathy associated with IgM monoclonal gammopathy (IgM-PNP) is related to the presence of antibodies against gangliosides or myelin-associated glycoprotein (MAG). We compared clinical and nerve conduction study (NCS) characteristics of 11 IgM-PNP patients with antibodies against asialo-GM1 or gangliosides (GM1, GD1a, GD1b, GM2 or GQ1b) to 11 consecutive IgM-PNP patients with anti-MAG neuropathy and to 9 IgM-PNP patients without antibodies against either MAG or gangliosides. Patients with anti-ganglioside antibodies could not be differentiated from those with anti-MAG antibodies based on clinical characteristics. However, within the group of anti-ganglioside antibody positive patients, antibodies against GD1b and GQ1b were associated with a purely sensory neuropathy (p = 0.002), while asymmetric weakness with symmetric sensory loss was associated with anti-asialo-GM1 antibodies. In conclusion, polyneuropathy associated with IgM monoclonal gammopathy and anti-ganglioside antibodies clinically resembles anti-MAG neuropathy. Pure sensory neuropathy and marked asymmetry may suggest the presence of anti-ganglioside rather than anti-MAG antibodies. PMID:24781837

Stork, Abraham C J; van der Pol, W-Ludo; Franssen, Hessel; Jacobs, Bart C; Notermans, Nicolette C



Sustained normalization of neurological disease after intracranial gene therapy in a feline model.  


Progressive debilitating neurological defects characterize feline G(M1) gangliosidosis, a lysosomal storage disease caused by deficiency of lysosomal ?-galactosidase. No effective therapy exists for affected children, who often die before age 5 years. An adeno-associated viral vector carrying the therapeutic gene was injected bilaterally into two brain targets (thalamus and deep cerebellar nuclei) of a feline model of G(M1) gangliosidosis. Gene therapy normalized ?-galactosidase activity and storage throughout the brain and spinal cord. The mean survival of 12 treated G(M1) animals was >38 months, compared to 8 months for untreated animals. Seven of the eight treated animals remaining alive demonstrated normalization of disease, with abrogation of many symptoms including gait deficits and postural imbalance. Sustained correction of the G(M1) gangliosidosis disease phenotype after limited intracranial targeting by gene therapy in a large animal model suggests that this approach may be useful for treating the human version of this lysosomal storage disorder. PMID:24718858

McCurdy, Victoria J; Johnson, Aime K; Gray-Edwards, Heather L; Randle, Ashley N; Brunson, Brandon L; Morrison, Nancy E; Salibi, Nouha; Johnson, Jacob A; Hwang, Misako; Beyers, Ronald J; Leroy, Stanley G; Maitland, Stacy; Denney, Thomas S; Cox, Nancy R; Baker, Henry J; Sena-Esteves, Miguel; Martin, Douglas R



G M1 Gangliosidosis Type 2 in Two Siblings  

Microsoft Academic Search

A sister and brother, now aged 7 and 9 years, presented with developmental arrest, gait disturbance, dementia, and a progressive myoclonic epilepsy syndrome with hyperacusis in the second year of life. Then, spastic quadriparesis led to a decerebrate state. In the absence of macular or retinal degeneration, organomegaly, and somatic-facial features suggesting mucopolysaccharidosis, the presence of hyperacusis together with sea-blue

Generoso G. Gascon; Pinar T. Ozand; Robert E. Erwin



Magnetic Resonance Findings of the Corpus Callosum in Canine and Feline Lysosomal Storage Diseases  

PubMed Central

Several reports have described magnetic resonance (MR) findings in canine and feline lysosomal storage diseases such as gangliosidoses and neuronal ceroid lipofuscinosis. Although most of those studies described the signal intensities of white matter in the cerebrum, findings of the corpus callosum were not described in detail. A retrospective study was conducted on MR findings of the corpus callosum as well as the rostral commissure and the fornix in 18 cases of canine and feline lysosomal storage diseases. This included 6 Shiba Inu dogs and 2 domestic shorthair cats with GM1 gangliosidosis; 2 domestic shorthair cats, 2 familial toy poodles, and a golden retriever with GM2 gangliosidosis; and 2 border collies and 3 chihuahuas with neuronal ceroid lipofuscinoses, to determine whether changes of the corpus callosum is an imaging indicator of those diseases. The corpus callosum and the rostral commissure were difficult to recognize in all cases of juvenile-onset gangliosidoses (GM1 gangliosidosis in Shiba Inu dogs and domestic shorthair cats and GM2 gangliosidosis in domestic shorthair cats) and GM2 gangliosidosis in toy poodles with late juvenile-onset. In contrast, the corpus callosum and the rostral commissure were confirmed in cases of GM2 gangliosidosis in a golden retriever and canine neuronal ceroid lipofuscinoses with late juvenile- to early adult-onset, but were extremely thin. Abnormal findings of the corpus callosum on midline sagittal images may be a useful imaging indicator for suspecting lysosomal storage diseases, especially hypoplasia (underdevelopment) of the corpus callosum in juvenile-onset gangliosidoses. PMID:24386203

Hasegawa, Daisuke; Tamura, Shinji; Nakamoto, Yuya; Matsuki, Naoaki; Takahashi, Kimimasa; Fujita, Michio; Uchida, Kazuyuki; Yamato, Osamu



Comparison of the canine and human acid {beta}-galactosidase gene  

SciTech Connect

Several canine cDNA libraries were screened with human {beta}-galactosidase cDNA as probe. Seven positive clones were isolated and sequenced yielding a partial (2060 bp) canine {beta}-galactosidase cDNA with 86% identity to the human {beta}-galactosidase cDNA. Preliminary analysis of a canine genomic library indicated conservation of exon number and size. Analysis by Northern blotting disclosed a single mRNA of 2.4 kb in fibroblasts and liver from normal dogs and dogs affected with GM1 gangliosidosis. Although incomplete, these results indicate canine GM1 gangliosidosis is a suitable animal model of the human disease and should further efforts to devise a gene therapy strategy for its treatment. 20 refs., 2 figs., 1 tab.

Ahern-Rindell, A.J. [Weber State Univ., Ogden, UT (United States)] [Weber State Univ., Ogden, UT (United States); Kretz, K.A. [Recombinant BioCatalysis, Inc., La Jolla, CA (United States)] [Recombinant BioCatalysis, Inc., La Jolla, CA (United States); O`Brien, J.S. [Univ. of California at San Diego, La Jolla, CA (United States)] [Univ. of California at San Diego, La Jolla, CA (United States)



A capillary electrophoresis procedure for the screening of oligosaccharidoses and related diseases.  


The most widely used method for the biochemical screening of oligosaccharidoses is the analysis of the urinary oligosaccharide pattern by thin-layer chromatography on silica gel plates. However, this method is not always sensitive enough, and it is extremely time-consuming and laborious. In this work, the analysis of the urine oligosaccharide pattern was standardized for the first time by using capillary electrophoresis with laser-induced fluorescence (CE-LIF) detection (Beckman P/ACE MDQ) with a 488-nm argon ion laser module. All of the analyses were conducted using the Carbohydrate Labeling and Analysis Kit (Beckman-Coulter), which derivatizes samples with 8-aminopyrene-1,3,6-trisulfonate. Urine samples from 40 control subjects (age range, 1 week to 16 years) and from ten patients diagnosed with eight different lysosomal diseases (six of them included in the Educational Oligosaccharide Kit from ERNDIM EQA schemes) were analyzed. Two oligosaccharide excretion patterns were established in our control population according to age (younger or older than 1 year of age). Abnormal peaks with slower migration times than the tetrasaccharide position were observed for fucosidosis, ?-mannosidosis, GM1 gangliosidosis, GM2 gangliosidosis variant 0, Pompe disease, and glycogen storage disease type 3. In conclusion, the first CE-LIF method to screen for oligosaccharidoses and related diseases, which also present oligosacchariduria, has been standardized. In all of the cases, the urine oligosaccharide analysis was strongly informative and showed abnormal patterns that were not present in any of the urine samples from the control subjects. Only urine from patients with aspartylglucosaminuria and Schindler disease displayed normal results. PMID:24788891

Casado, Mercedes; Altimira, Laura; Montero, Raquel; Castejón, Esperanza; Nascimento, Andrés; Pérez-Dueńas, Belén; Ormazabal, Aida; Artuch, Rafael



Normalizing glycosphingolipids restores function in CD4+ T cells from lupus patients.  


Patients with the autoimmune rheumatic disease systemic lupus erythematosus (SLE) have multiple defects in lymphocyte signaling and function that contribute to disease pathogenesis. Such defects could be attributed to alterations in metabolic processes, including abnormal control of lipid biosynthesis pathways. Here, we reveal that CD4+ T cells from SLE patients displayed an altered profile of lipid raft-associated glycosphingolipids (GSLs) compared with that of healthy controls. In particular, lactosylceramide, globotriaosylceramide (Gb3), and monosialotetrahexosylganglioside (GM1) levels were markedly increased. Elevated GSLs in SLE patients were associated with increased expression of liver X receptor ? (LXR?), a nuclear receptor that controls cellular lipid metabolism and trafficking and influences acquired immune responses. Stimulation of CD4+ T cells isolated from healthy donors with synthetic and endogenous LXR agonists promoted GSL expression, which was blocked by an LXR antagonist. Increased GSL expression in CD4+ T cells was associated with intracellular accumulation and accelerated trafficking of GSL, reminiscent of cells from patients with glycolipid storage diseases. Inhibition of GSL biosynthesis in vitro with a clinically approved inhibitor (N-butyldeoxynojirimycin) normalized GSL metabolism, corrected CD4+ T cell signaling and functional defects, and decreased anti-dsDNA antibody production by autologous B cells in SLE patients. Our data demonstrate that lipid metabolism defects contribute to SLE pathogenesis and suggest that targeting GSL biosynthesis restores T cell function in SLE. PMID:24463447

McDonald, Georgia; Deepak, Shantal; Miguel, Laura; Hall, Cleo J; Isenberg, David A; Magee, Anthony I; Butters, Terry; Jury, Elizabeth C



Clostridium perfringens Alpha-toxin Recognizes the GM1a-TrkA Complex*S  

E-print Network

and sphingomy- elin are important virulence factors in the pathogenesis of diseases caused by Listeria monocytogenes, Pseudomonas aeruginosa, and several Clostridium spp. (3­5). Clostridium perfringens

Gleeson, Joseph G.


Carbohydrate mimicry between human ganglioside GM1 and Campylobacter jejuni lipooligosaccharide causes Guillain-Barré syndrome  

Microsoft Academic Search

Molecular mimicry between microbial and self-components is postulated as the mechanism that accounts for the antigen and tissue specificity of immune responses in postinfectious autoimmune diseases. Little direct evidence exists, and research in this area has focused principally on T cell-mediated, antipeptide responses, rather than on humoral responses to carbohydrate structures. Guillain-Barré syndrome, the most frequent cause of acute neuromuscular

Nobuhiro Yuki; Keiichiro Susuki; Michiaki Koga; Yukihiro Nishimoto; Masaaki Odaka; Koichi Hirata; Kyoji Taguchi; Tadashi Miyatake; Koichi Furukawa; Tetsuji Kobata; Mitsunori Yamada



GM2-gangliosidosis variant 0 (Sandhoff-like disease) in a family of Japanese domestic cats  

Microsoft Academic Search

A five-month-old, female Japanese domestic shorthair cat with proportionate dwarfism developed neurological disorders, including ataxia, decreased postural responses and generalised body and head tremors, at between two and five months of age. Leucocytosis due to lymphocytosis with abnormal cytoplasmic vacuolations was observed. The concentration of GM2-ganglioside in its cerebrospinal fluid was markedly higher than in normal cats, and the activities

O. Yamato; H. Satoh; T. Shoda; M. Yamasaki; Y. Maede; S. Matsunaga; K. Takata; K. Uetsuka; Y. Baba; A. Yasoshima; K. Kato; H. Nakayama; K. Doi; H. Ogawa; K. Takahashi



Gene Transfer Corrects Acute GM2 Gangliosidosis—Potential Therapeutic Contribution of Perivascular Enzyme Flow  

PubMed Central

The GM2 gangliosidoses are fatal lysosomal storage diseases principally affecting the brain. Absence of ?-hexosaminidase A and B activities in the Sandhoff mouse causes neurological dysfunction and recapitulates the acute Tay–Sachs (TSD) and Sandhoff diseases (SD) in infants. Intracranial coinjection of recombinant adeno-associated viral vectors (rAAV), serotype 2/1, expressing human ?-hexosaminidase ? (HEXA) and ? (HEXB) subunits into 1-month-old Sandhoff mice gave unprecedented survival to 2 years and prevented disease throughout the brain and spinal cord. Classical manifestations of disease, including spasticity—as opposed to tremor-ataxia—were resolved by localized gene transfer to the striatum or cerebellum, respectively. Abundant biosynthesis of ?-hexosaminidase isozymes and their global distribution via axonal, perivascular, and cerebrospinal fluid (CSF) spaces, as well as diffusion, account for the sustained phenotypic rescue—long-term protein expression by transduced brain parenchyma, choroid plexus epithelium, and dorsal root ganglia neurons supplies the corrective enzyme. Prolonged survival permitted expression of cryptic disease in organs not accessed by intracranial vector delivery. We contend that infusion of rAAV into CSF space and intraparenchymal administration by convection-enhanced delivery at a few strategic sites will optimally treat neurodegeneration in many diseases affecting the nervous system. PMID:22453766

Cachón-González, M Begońa; Wang, Susan Z; McNair, Rosamund; Bradley, Josephine; Lunn, David; Ziegler, Robin; Cheng, Seng H; Cox, Timothy M



Patient Advocacy

CPTAC recognizes the important role that patients, patient advocates, and other members outside of the traditional science community play in advancing cancer research, and is actively involved in dialogue with such communities.  To this end the consortium


BEN Patient  

USGS Multimedia Gallery

Balkan endemic nephropathy (BEN) patient from a BEN village in Romania. The photo was taken at a dialysis clinic in Romania where the patient traveled every 2 to 3 days to receive dialysis, the principal treatment option for people with BEN. This patient died from complications of BEN within a year ...



Patient Corner

Biospecimens contain an extraordinary amount of biological information, written in the language of cells, genes and proteins. Each biospecimen is also defined by a clinical context - the age, gender, race, diet, and various aspects of the environment the patient has been exposed to during his life. The personal and clinical information comes from interviews at the time the specimen is donated, from medical records patients consent to provide, and from clinical trials that patients volunteer to join.


Carrier Rates of Four Single-Gene Disorders in Croatian Bayash Roma  

PubMed Central

To assess how specific population history, different migration routes, isolation, and endogamy practices contributed to the distribution of several rare diseases found in specific Roma groups, we conducted a population-based research study of rare disease mutations in Croatian Vlax Roma. We tested a total of 427 subjects from Baranja and Me?imurje for the presence of four mutations causing hereditary motor and sensory neuropathy type Lom (HMSNL), GM1 gangliosidosis (GM1), congenital cataracts, facial dysmorphism and neuropathy (CCFDN), and limb girdle muscle dystrophy type 2C (LGMD2C), using the RFLP-PCR method to estimate carrier frequencies. We identified a total of four individuals heterozygous for the mutation causing HMSNL in the Baranja population, with a carrier rate amounting to 1.5%. Carriers for other three mutations causing GM1, CCFDN, and LGMD2C were not found in our sample. The carrier rate for the HMSNL mutation in Baranja is lower than in other Vlax Roma groups. In addition, distinct differences in carrier rates between the Croatian Vlax groups point to different genetic history, despite their belonging to the same Roma migration category and subgroup. The difference in carrier rates is either the result of admixture or the reflection of a greater extent of genetic drift since recent founding, maintained by a high degree of endogamy. PMID:24180318

Bareši?, Ana



Patient empowerment: the young patient.  


The responsibilities that doctors have for their patients often transcend the obvious. When orthodontists begin treatment relationships with young people, they should understand that preadolescent and adolescent patients are very impressionable and educable. This creates the possibility for extraordinary positive experiences during the period of therapy that may be unexpected by the doctor, the professional office staff, the patient, and the patients' families. In the present day climate created by OSHA and barrier techniques, recognition of our potential role is more important than ever. Children will be exposed over an extended time interval to the work of well-trained orthodontists and orthodontic staff. Role modeling and mentoring may occur that could benefit these patients throughout their entire life. New responsibilities that can create a sense of accomplishment and build self-confidence are introduced and accepted. The genesis of this article was the result of a conversation that developed between Mrs. Burnes and me after she had commented about the positive influence that her children's orthodontic therapy had on their general character development. Noting her area of professional expertise, and combining that with my general interest in the subject of personal character development, we decided to commit our thoughts to paper. Our goal was to identify some of the mutually satisfying interactions that can occur between the orthodontist, staff, patient, and parent. PMID:8480702

Tayer, B H; Burnes, H



Patient Monitoring  

NASA Technical Reports Server (NTRS)

In photo above, the electrocardiogram of a hospitalized patient is being transmitted by telemetry. Widely employed in space operations, telemetry is a process wherein instrument data is converted to electrical signals and sent to a receiver where the signals are reconverted to usable information. In this instance, heart readings are picked up by the electrode attached to the patient's body and delivered by wire to the small box shown, which is a telemetry transmitter. The signals are relayed wirelessly to the console in the background, which converts them to EKG data. The data is displayed visually and recorded on a printout; at the same time, it is transmitted to a central control station (upper photo) where a nurse can monitor the condition of several patients simultaneously. The Patient Monitoring System was developed by SCI Systems, Inc., Huntsville, Alabama, in conjunction with Abbott Medical Electronics, Houston, Texas. In developing the system, SCI drew upon its extensive experience as a NASA contractor. The company applied telemetry technology developed for the Saturn launch vehicle and the Apollo spacecraft; instrumentation technology developed for heart, blood pressure and sleep monitoring of astronauts aboard NASA's Skylab long duration space station; and communications technology developed for the Space Shuttle.



Patient Empowerment  


... American Cancer Society at 1-800-ACS-2345. The U.S. Centers for Disease Control & Prevention website ( www.cdc. ... physical health.” But do not expect tumors to just disappear because you have engaged in “imaging” or some mind technique. The best organizations have ongoing information programs for patients. ...


Patient Corner

Biospecimens are materials taken from the human body, such as tissue, blood, plasma, and urine that can be used for cancer diagnosis and analysis. When patients have a biopsy, surgery, or other procedure, often a small amount of the specimen removed can be stored and used for later research. Once these samples have been properly processed and stored they are known as human biospecimens.


Patient Corner

As a patient scheduled for a biopsy or surgery, you may be asked before the procedure if you would consider donating a biospecimen for research. You will receive a brochure describing how the process works, as well as a consent form to review.


Communicating with patients  


... Ask your patients about their outlooks, attitudes, and motivations. Learn the patient's perspective. Talk to the patient ... beliefs. This will help you understand the patient's motivation and let you plan the best ways to ...


[Patient advice].  


In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material. PMID:24998084

Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Gutiérrez Pérez, M Isabel; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez



National Patient Safety Foundation  


... Joint Commission Journal Focus Archive Stand Up for Patient Safety Welcome Stand Up Members Stand Up e-News ... PLS Webcast Archives Stand Up Templates and Logos Patient Safety Coalition Patient Safety Coalition Members Partnership Compact Stand ...


Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy + G-CSF in patients with chronic myelogenous leukemia in first chronic phase.  


The aim of the study was to investigate the feasibility of mobilizing Philadelphia chromosome negative (Ph-) blood stem cells (BSC) with intensive chemotherapy and lenograstim (G-CSF) in patients with CML in first chronic phase (CP1). During 1994-1999 12 centers included 37 patients <56 years. All patients received 6 months' IFN, stopping at median 36 (1-290) days prior to the mobilization chemotherapy. All received one cycle of daunorubicin 50 mg/m2 and 1 hour infusion on days 1-3, and cytarabine (ara-C) 200 mg/m2 24 hours' i.v. infusion on days 1-7 (DA) followed by G-CSF 526 microg s.c. once daily from day 8 after the start of chemotherapy. Leukaphereses were initiated when the number of CD 34+ cells was >5/microl blood. Patients mobilizing poorly could receive a 4-day cycle of chemotherapy with mitoxantrone 12 mg/m2/day and 1 hour i.v infusion, etoposide 100 mg/m2/day and 1 hour i.v. infusion and ara-C 1 g/m2/twice a day with 2 hours' i.v infusion (MEA) or a second DA, followed by G-CSF 526 microg s.c once daily from day 8 after the start of chemotherapy. Twenty-seven patients received one cycle of chemotherapy and G-CSF, whereas 10 were mobilized twice. Twenty-three patients (62%) were successfully (MNC >3.5 x 10(8)/kg, CFU-GM >1.0 x 10(4)/kg, CD34+ cells >2.0 x 10(6)/kg and no Ph+ cells in the apheresis product) [n = 16] or partially successfully (as defined above but 1-34% Ph+ cells in the apheresis product) [n = 7] mobilized. There was no mortality during the mobilization procedure. Twenty-one/23 patients subsequently underwent auto-SCT. The time with PMN <0.5 x 10(9)/l was 10 (range 7-49) and with platelets <20 x 10(9)/l was also 10 (2-173) days. There was no transplant related mortality. The estimated 5-year overall survival after auto-SCT was 68% (95% CI 47 - 90%), with a median follow-up time of 5.2 years.We conclude that in a significant proportion of patients with CML in CP 1, intensive chemotherapy combined with G-CSF mobilizes Ph- BSC sufficient for use in auto-SCT. PMID:17064986

Olsson-Strömberg, Ulla; Höglund, Martin; Björkholm, Magnus; Braide, Inger; Carlson, Karin; Gahrton, Gösta; Grimfors, Gunnar; Hast, Robert; Lerner, Rickard; Linder, Olle; Ljungman, Per; Löfvenberg, Eva; Malm, Claes; Nilsson, Per-Gunnar; Paul, Christer; Rödjer, Stig; Stenke, Leif; Tidefeldt, Ulf; Turesson, Ingemar; Uden, Ann-Marie; Wahlin, Anders; Vilen, Lars; Winqvist, Ingemar; Zettervall, Olle; Oberg, Gunnar; Simonsson, Bengt



The Prevalence of Nine Genetic Disorders in a Dog Population from Belgium, the Netherlands and Germany  

PubMed Central

The objective of this study was to screen a dog population from Belgium, the Netherlands and Germany for the presence of mutant alleles associated with hip dysplasia (HD), degenerative myelopathy (DM), exercise-induced collapse (EIC), neuronal ceroid lipofuscinosis 4A (NCL), centronuclear myopathy (HMLR), mucopolysaccharidosis VII (MPS VII), myotonia congenita (MG), gangliosidosis (GM1) and muscular dystrophy (Duchenne type) (GRMD). Blood samples (K3EDTA) were collected for genotyping with Kompetitive Allele Specific PCR (n?=?476). Allele and genotype frequencies were calculated in those breeds with at least 12 samples (n?=?8). Hardy-Weinberg equilibrium was tested. Genetic variation was identified for 4 out of 9 disorders: mutant alleles were found in 49, 15, 3 and 2 breeds for HD, DM, EIC and NCL respectively. Additionally, mutant alleles were identified in crossbreeds for both HD and EIC. For HD, DM, EIC and NCL mutant alleles were newly discovered in 43, 13, 2 and 1 breed(s), respectively. In 9, 2 and 1 breed(s) for DM, EIC and NCL respectively, the mutant allele was detected, but the respective disorder has not been reported in those breeds. For 5 disorders (HMLR, MPS VII, MG, GM1, GRMD), the mutant allele could not be identified in our population. For the other 4 disorders (HD, DM, EIC, NCL), prevalence of associated mutant alleles seems strongly breed dependent. Surprisingly, mutant alleles were found in many breeds where the disorder has not been reported to date. PMID:24069350

Broeckx, Bart J. G.; Coopman, Frank; Verhoeven, Geert E. C.; Van Haeringen, Wim; van de Goor, Leanne; Bosmans, Tim; Gielen, Ingrid; Saunders, Jimmy H.; Soetaert, Sandra S. A.; Van Bree, Henri; Van Neste, Christophe; Van Nieuwerburgh, Filip; Van Ryssen, Bernadette; Verelst, Elien; Van Steendam, Katleen; Deforce, Dieter



Repositioning the Patient:  

PubMed Central

Summary This article explores how and why the patient came to be repositioned as a political actor within British health care during the 1960s and 1970s. Focusing on the role played by patient organizations, it is suggested that the repositioning of the patient needs to be seen in the light of growing demands for greater patient autonomy and the application of consumerist principles to health. Examining the activities of two patient groups—the National Association for the Welfare of Children in Hospital (NAWCH) and the Patients Association (PA)—indicates that while such groups undoubtedly placed more emphasis on individual autonomy, collective concerns did not entirely fall away. The voices of patients, as well as the patient, continued to matter within British health care. PMID:23811711

Mold, Alex



CRCHD - Patient Navigation Concept

Patient Navigation is an intervention that addresses barriers to quality standard care by providing individualized assistance to patients, survivors, and families. The NCI is conducting several research programs to test the effectiveness of this approach.


Induction for Radiology Patients  

NASA Astrophysics Data System (ADS)

This paper represents the implementation of an inductive learning algorithm for patients of Radiology Department in Hacettepe University hospitals to discover the relationship between patient demographics information and time that patients spend during a specific radiology exam. ILA has been used for the implementation which generates rules and the results are evaluated by evaluation metrics. According to generated rules, some patients in different age groups or birthplaces may spend more time for the same radiology exam than the others.

Y?ld?r?m, P?nar; Tolun, Mehmet R.


The chronically ill patient  

Microsoft Academic Search

Psychiatry's renewed interest in its identity as a medical specialty and its increased therapeutic armamentarium make its involvement with chronically medically ill patients more feasible than ever before. These patients face problems which include economic ones, conflicts between independency and dependency, those connected with self-image, intra-family stresses including sexual ones, social isolation and the threat of death. Patients respond to

Norman B. Levy



Student Clinic Patient Benefits  

E-print Network

oral health care rehabilitation at the LSUHSC School of Dentistry. In addition to services offered patients have treatment needs which are beyond the capabilities of an undergraduate dental student of treatment, patients must find a private dentist for future dental needs. · Patients must keep the dental


The quantified patient: a patient participatory culture.  


Abstract The Quantified Self Movement, which aims to improve various aspects of life and health through recording and reviewing daily activities and biometrics, is a new and upcoming practice of self monitoring that holds much promise. Now, the most underutilized resource in ambulatory health care, the patient, can participate like never before, and the patient's Quantified Self can be directly monitored and remotely accessed by health care professionals. PMID:25118077

Appelboom, Geoff; LoPresti, Melissa; Reginster, Jean-Yves; Sander Connolly, E; Dumont, Emmanuel P L



Patient-Centered Research  

PubMed Central

PURPOSE A prospective cohort study was conducted to test our ability to identify chronically ill patients at near term risk of death by asking their primary care physician (PCP) the question, "Would you be surprised if this patient died within the next year of CHF or COPD?" METHODS Patients were eligible for inclusion if 1) their clinic chart problem list carried a diagnosis of CHF or COPD, 2) they had been hospitalized within the past two years with primary or secondary diagnosis of CHF or COPD, or 3) direct identification by their PCP. Chart review was used to exclude patients erroneously carrying these diagnoses (e.g. coding errors), inactive patients (deceased or changed providers) and those patients with normal ejection fractions or not requiring scheduled ?-2 agonist and anticholinergic bronchodialator therapy. Patients were then stratified on the basis of their PCP's response to the question, "Would you be surprised if this patient died in the next year from CHF or COPD?" All patients screened and stratified by the question were followed for the primary endpoint of death. RESULTS The initial data query identified 190 patients with CHF and/or COPD. A chart review excluded eight inactive patients and thirty-one patients who did not meet inclusion criteria or did meet exclusion criteria for significant disease. Of the remaining 151 patients, there were 72 whose PCP answered that he/she would not be surprised if the patient died from CHF and/or COPD in the next year. Within nine months, nine of these patients have died from complications of their CHF or COPD. There have been no deaths in the 79 patients whose PCP answered that they would be surprised if their patient died in the next year from CHF or COPD. (p-value < 0.01) CONCLUSION Patients with CHF and/or COPD at risk of near term death can be differentiated from those who are not at high risk by the PCPs'response to the question, "Would you be surprised if this patient died within the next year of their CHF and/or COPD?" Such screening may be useful to more efficiently target palliative services and end of life care planning to patients with advanced CHF and/or COPD.

Weiche, RE; Mundy, BJ; Skokan, L; Shivers, C; Simmons, A; Gordon, SG



[Patient safety in Sweden].  


This article describes the patient safety work in Sweden and the cooperation between the Nordic countries in the area of patient safety. It depicts the national infrastructure, methods and partners in patient safety work as well as the development in key areas. Since 2000, the interest in patient safety and quality issues has significantly increased. A national study (2009) showed that more than 100,000 patients (8.6?%) experienced preventable harm in hospitals. Since 2007, all Swedish counties and regions work on the "National commitment for increased patient safety" to systematically minimize adverse events in the healthcare system. Also, a national strategy for patient safety has been proposed based on a new law regulating the responsibility for patient safety (2011) and a zero vision in terms of preventable harm and adverse events. The Nordic collaboration in this field currently focuses on the development of indicators and quality measurement with respect to nosocomial infections, harm in inpatient somatic care, patient safety culture, hospital mortality and polypharmacy in the elderly. The Nordic collaboration is driven by the development, exchange and documentation of experiences and evidence on patient safety indicators. The work presented in this article is only a part of the Swedish and the Nordic efforts related to patient safety and provides an interesting insight into how this work can be carried out. PMID:25430735

Rutberg, H; Eckhardt, M; Biermann, O



[Communication with patients].  


A survey on patients' opinions about and needs for communication is reported. Most patients consider communication as an important part of nursing and recovery. Not only information is demanded, but also a discussion of problems and distress. Nurses are well requested to play a part herein. While most patients indicate that their communication demands are well cared for, there are also deficits. A considerable minority of patients has notable problems with solitude and lack of communication, they want personal help to cope with disease and help for better social integration. Special demands for more communication are indicated by younger patients and by women. Patients who feel severely ill and patients who suffer from pain, depression or fright say they need more communication about their feelings and fears. Frequent, long-term or immobile patients are less convinced that doctors and nurses know what is good for them. Patients with reduced mobility tend to express less interest in communication. A field for improvement may also be found within clinics: Quality of relationships between nurses and patients differ between clinics with a clear impact on quality of nursing and wellbeing of the patients. PMID:9456780

Kolleck, B; Huber, A; Breitmann, A; Barth, I; Kirchgässner, R



Respiratory syncytial virus assembly occurs in GM1-rich regions of the host-cell membrane and alters the cellular distribution of tyrosine phosphorylated caveolin-1  

Microsoft Academic Search

We have previously shown that respiratory syncytial virus (RSV) assembly occurs within regions of the host-cell surface membrane that are enriched in the protein caveolin-1 (cav-1). In this report, we have employed immunofluorescence microscopy to further examine the RSV assembly process. Our results show that RSV matures at regions of the cell surface that, in addition to cav-1, are enriched

Gaie Brown; Richard J. Sugrue


GM1 ganglioside treatment protects against long-term neurotoxic effects of neonatal X-irradiation on cerebellar cortex cytoarchitecture and motor function  

Microsoft Academic Search

Exposure of neonatal rats to a 5 Gy dose of X-irradiation induces permanent abnormalities in cerebellar cortex cytoarchitecture (disarrangement of Purkinje cells, reduction of thickness of granular cortex) and neurochemistry (late increase in noradrenaline levels), and motor function (ataxic gait). The neuroprotective effects of gangliosides have been demonstrated using a variety of CNS injuries, including mechanical, electrolytic, neurotoxic, ischemic, and

Laura Ruth Guelman; Mar??a Aurelia Zorrilla Zubilete; Hugo R??os; Alejandro Mario Dopico; Luis Mar??a Zieher



Ganglioside GM1-Mediated Amyloid-beta Fibrillogenesis and Membrane Disruption Eva Y. Chi, Shelli L. Frey, and Ka Yee C. Lee*  

E-print Network

prevalent neurodegenerative diseases, such as Parkinson's, Huntington's and prion diseases, as well's disease amyloid- peptide (A ). Using lipid monolayers and vesicles as model membranes, we measured's disease (AD1) is a neurodegenerative disease in which the normally soluble amyloid- peptide (A

Lee, Ka Yee C.


A model to evaluate the consequences of GM and non-GM1 segregation scenarios on GM crop placement in the landscape and2  

E-print Network

(genetically modified) if more than10 0.9% of one of its ingredients originates from GM material. During consumers is reluctant to eat GM foods (Eurobarometer, 2006), there is a demand for more29 stringent purity and c).35 Within the food-processing industry, traceability of GM products has to be implemented36

Boyer, Edmond


Patient-centered Communication  

PubMed Central

OBJECTIVE To investigate patient preferences for a patient-centered or a biomedical communication style. DESIGN Randomized study. SETTING Urgent care and ambulatory medicine clinics in an academic medical center. PARTICIPANTS We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. INTERVENTION Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. MEASUREMENTS AND MAIN RESULTS Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82%[51/62] for age < 30; 68%[100/148] for ages 30–59; 55%[21/38] for age > 59; P < .03), more educated (76%[54/71] for postcollege education; 73%[94/128] for some college; 49%[23/47] for high school only; P = .003), use CAM (75%[140/188] vs. 55%[33/60] for nonusers; P = .006), and have a patient-centered physician (88%[74/84] vs. 30%[16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a “doctor's interest in you as a person” as “very important.” CONCLUSIONS Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication. PMID:15566435

Swenson, Sara L; Buell, Stephanie; Zettler, Patti; White, Martha; Ruston, Delaney C; Lo, Bernard



Patient Safety Threat - Syringe Reuse  


... About . Injection Safety Share Compartir A Patient Safety Threat – Syringe Reuse Important Information! Please read this ... References Information for Patients FAQs for Patients A Patient Safety Threat - Syringe Reuse Preventing Unsafe Injection Practices Safe ...


The agitated patient.  


Caring for an agitated patient can be a daunting task for the tactical emergency medical support (TEMS) or Special Operations Forces (SOF) medic. The cause, degree, and duration of agitation can vary among such individuals. These patients create a high-stress and disruptive environment, needing numerous people involved to control. One agitated patient can disrupt an entire tactical team or casualty evacuation. The patient?s history and physical examination can give important clues to the cause, thereby directing treatment and leading to a quick and safe resolution. The variety of treatments for the agitated patient are just as numerous as the causes and range from verbal deescalation to medications and physical restraint, all of which have a risk-benefit profile to consider. PMID:24048996

Goldstein, Scott



Multicenter Patient Records Research  

PubMed Central

The expanding health information infrastructure offers the promise of new medical knowledge drawn from patient records. Such promise will never be fulfilled, however, unless researchers first address policy issues regarding the rights and interests of both the patients and the institutions who hold their records. In this article, the authors analyze the interests of patients and institutions in light of public policy and institutional needs. They conclude that the multicenter study, with Institutional Review Board approval of each study at each site, protects the interests of both. “Anonymity” is no panacea, since patient records are so rich in information that they can never be truly anonymous. Researchers must earn and respect the trust of the public, as responsible stewards of facts about patients' lives. The authors find that computer security tools are needed to administer multicenter patient records studies and describe simple approaches that can be implemented using commercial database products. PMID:10579601

Behlen, Fred M.; Johnson, Stephen B.



Hyperkalemia in hemodialysis patients.  


Hyperkalemia contributes significantly to high mortality among ESRD patients. Excess intake and inadequate removal are the most common etiologies in HD patients. Although dialysis is the definitive treatment, classical medical therapy must be employed as a temporizing measure to acutely lower serum potassium. Reducing potassium intake through dietetic/nutritional support is critical to reducing the K+ load in ESRD patients and preventing this condition. PMID:25039770

Pani, Antonello; Floris, Matteo; Rosner, Mitchell H; Ronco, Claudio



Patient-physician communication.  


Extensive research has shown that no matter how knowledgeable the physician might be, if he/she is not able to open good communication channels with the patient, he/she may be of no help to the latter Despite this known fact and the fact that a patient-physician consultation is the most widely performed 'procedure' in a physician's professional lifetime, effective communication with the patient has been found to be sadly lacking. This review article seeks to discuss 'the what', 'the why' and 'the how' of doctor-patient communication. PMID:20099777

Asnani, M R



Patient Education in Thyrotoxicosis.  

ERIC Educational Resources Information Center

Study aims to assess the need for a thyrotoxicosis patient education programs and evaluates a group education session. Patients with thyrotoxicosis were surveyed to assess their needs. Determined that people with thyrotoxicosis had limited knowledge about their condition. The offer of a group education program has little effect on that knowledge…

Lincoln, N. B.; Sturrock, N. D. C.; Sowter, H.; Abbott-Harland, S.; Nichols, E.; Jeffcoate, W. J.



Building lifelong patient relationships.  


In theory there is really only one reason why a dentist should lose a patient--and that is when the patient dies. I appreciate that this is a little simplistic. Of course, there are other reasons for a patient to leave a practice. In the majority of cases, the reason patients choose to leave a dentist/practice is because they experienced something that upset them. In my seminars, I ask attendees to raise their hands if they have patients coming in from other parts of the state, the country and/or the world. It is genuinely thrilling to see that so many practices draw their patient base from such a wide area, so when I hear a staff member say that they lose patients because patients tell them, "I'm moving a few exits further down the highway from your office, so please forward my X-rays to my new dentist, who is closer to my new home," I know that reason is most likely an excuse. PMID:23513347

de St Georges, Jennifer



Mimivirus in Pneumonia Patients  

PubMed Central

Mimivirus, the largest virus known to date, is an amebal pathogen like Legionella spp. When mimivirus was used as an antigen in a migration inhibition factor assay, seroconversion was found in patients with both community- and hospital-acquired pneumonia. Mimivirus DNA was found in respiratory samples of patients with hospital-acquired pneumonia. PMID:15757563

La Scola, Bernard; Marrie, Thomas J.; Auffray, Jean-Pierre



Authorization Patient Information  

E-print Network

Authorization Patient Information Student Health Center 501 Student Health Irvine, CA 92697-5200 949-824-5302 Fax 949-824-3033 Authorization for Disclosure of HIV Test Results Student ID No.: Date Fax Patient hereby authorizes UCI Student Health Center to release the results of the blood test

Rose, Michael R.


Swimming for laryngectomy patients.  


We describe how to start up and run a swimming club for laryngectomy patients. We detail the precautions required, and present the benefits to patients. This paper is based on the experience acquired through contact with the Sunderland Laryngectomy Swimming Club. PMID:9276565

Nigam, A; Samuel, P



Patient Advocate Steering Committee

The Patient Advocate Steering Committee (PASC) works to ensure that advocates involved with the Disease-Specific Steering Committees (DSSC) and their task forces are effectively and consistently integrated with the development, implementation, and monitoring of clinical trials within those groups. PASC membership is composed of the patient advocate members of the DSSC.


Do patients have duties?  

PubMed Central

The notion of patients' duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients' duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient is always liable to be an opportunity cost (however justifiable) in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one's own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights?based approaches, and that a preferable alternative might be sought through the (here unexplored) notion of a “virtuous patient” contributing to a problem?solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. PMID:18055897

Evans, H M



JAMA Patient Page: Delirium  


... effects of and need for all medications the patient is receiving should be assessed. • Replacement of vitamin B should be considered for persons with alcoholism or who are malnourished. ... • If no other treatments are effective and the patient is at clear risk of harm to self ...


Threading together patient expertise.  


Patients are valuable sources of expertise for other patients in similar situations, but little is understood about the nature of this expertise. To address this knowledge gap, we investigated informational support as a mechanism for peers to help one another learn to cope with the breast cancer experience. We analyzed the types of problems discussed and recommendations offered by correspondents in three online breast cancer communities. Informational support was prevalent and directed towards problems in which correspondents were planning for future events or coping with emergent situations. Peers shared a wealth of patient expertise, including action strategies, recommended knowledge, suggested approaches, and information resources for dealing with problems. Our results highlight how peers are helping one another to learn. These findings bring insight to new support we could provide to patients for developing and sharing patient expertise, such as problem-based information organization and functionality for collaborative problem solving. PMID:18693814

Civan, Andrea; Pratt, Wanda



Approach to bleeding patient  

PubMed Central

Managing a bleeding patient is very challenging for the perioperative physician. Bleeding in a patient would be due to inherited or acquired disorders of haemostasis. Identifying the patients at risk of bleeding and utilising prophylactic treatment protocols has good outcomes. Along with clinical signs, trends in monitoring coagulation parameters and analysing blood picture are necessary. Management of patients in the postoperative period and in intensive care unit should be focused on normalization of coagulation profile as early as possible with available blood and its products. Available recombinant factors should be given priority as per the approved indications. Exploring the surgical site should be considered for persistent bleeding because haemodynamic compromise, excessive transfusion of fluids, blood and its products and more inotropic support may have a negative impact on the patient outcome.

Gopinath, Ramachandran; Sreekanth, Y.; Yadav, Monu



Respecting patient confidentiality.  


Nurses face a particular challenge in respecting the confidentiality of patients in a world where information is quickly shared and where information about illness can be sensitive. We have a duty of care towards patients. That duty includes maintaining privacy (protecting them from undue intrusion), and confidentiality (by the discreet management of information about themselves that they share with us). Legislation on confidentiality comes from different sources and should be interpreted in the clinical setting. This article summarises the principal requirements set out in the legislation and directs readers to questions and tools designed to help them explore the extent to which patient confidentiality is respected where they work. PMID:25627535

Price, Bob



A nursing challenge: adult-onset Tay-Sachs disease.  


Adult-onset GM2 gangliosidosis (AOG), also labelled Adult-Onset Tay-Sachs disease, is a slowly progressing disease caused by a gradual accumulation of the GM2 ganglioside in neurons due to defective hexosaminidase A. Recent research findings and clinical experiences suggest that AOG may be more widespread than previously believed. Moreover, the diagnosis of AOG is often delayed because patients present with psychotic symptoms that mimic dementia, schizophrenia, mania, and depression. Because AOG patients typically respond poorly to psychiatric drug therapy and the symptomatology is so diverse, nurses must design and implement nursing care that ensures safety, structure, and comfort. PMID:1759864

Hamilton, D



Understanding Patient Safety Confidentiality  


... care quality issues. To encourage the reporting and analysis of medical errors, PSQIA provides Federal privilege and ... information collected and created during the reporting and analysis of patient safety events. The confidentiality provisions will ...


Strongyloidiasis in Transplant Patients  

PubMed Central

Strongyloides stercoralis is an intestinal nematode that can persist in the human host for decades after the initial infection and can progress to fulminant hyperinfection syndrome in immunocompromised hosts. We describe a patient who died of Strongyloides hyperinfection syndrome 2 months after orthotopic heart transplantation and discuss approaches to prevention, diagnosis, and treatment. Current practice guidelines recommend screening for and treatment of Strongyloides infection before transplantation, but physicians in the United States often miss opportunities to identify patients with chronic strongyloidiasis. Screening tests have limitations, and clinical suspicion remains an important component of the evaluation before transplantation. After immunocompromised patients develop hyperinfection syndrome, diagnosis is often delayed and mortality is high, so emphasis must be placed on screening and treatment before transplantation. We review current strategies for prevention, diagnosis, and treatment of chronic intestinal strongyloidiasis in patients who will undergo transplantation and discuss the clinical features and management of Strongyloides hyperinfection syndrome in transplant recipients. PMID:19807271

Roxby, Alison C.; Gottlieb, Geoffrey S.; Limaye1, Ajit P.



JAMA Patient Page: Retinopathy  


... A Patient Page on causes of visual impairment was published in the October 15, 2003, issue. ... health problems that put them at risk for visual impairment should see an ophthalmologist (a doctor with specialized ...


JAMA Patient Page: Syphilis  


... of the American Medical Association JAMA PATIENT PAGE Syphilis S yphilis , a disease caused by the Treponema pallidum ... painless sore or ulcer that occurs in primary syphilis , the first stage of syphilis. It can appear ...


JAMA Patient Page: Insomnia  


... of the American Medical Association JAMA PATIENT PAGE Insomnia I nsomnia (trouble falling asleep or staying asleep) ... 21, 2003, issue of JAMA. POSSIBLE CAUSES OF INSOMNIA FOR MORE INFORMATION • National Sleep Foundation www.sleepfoundation. ...


Patient Emergency Grants  


... its seventh decade, is a national not-for-profit organization that fosters programs and research that improve ... is a national, 501 c(3) not-for-profit organization. © About Us | Patient Resources | Professional Resources | Support ...


The Immunocompromised Patient  

PubMed Central

The number of immunocompromised persons—as well as the importance of family physicians understanding their state—is increasing. In many instances the family physician will first identify or provide day-to-day care for such patients while they live in the community. This article gives an overview of certain aspects of normal host immunity, etiology and mechanisms in immunocompromisation, and outlines techniques for recognition and management of this special group of patients. PMID:21263824

Mahon, J.L.; Stiller, C.R.



The somatizing patient  

Microsoft Academic Search

The authors discuss the significance of identifying primary care patients with dramatic and persistent unexplained physical\\u000a (medical) symptoms, especially given the concerns about containing health care costs. Such patients are a cause of frustration\\u000a to the clinician, because the clinician may experience a sense of failure after using the state of the art and still being\\u000a eluded by a diagnosis.

Vicenzio Holder-Perkins; Thomas Wise; Darvin E. Williams



Leadership for patient care.  


In an era of change in health-care delivery and, particularly, change in patient care, leadership is the cornerstone of change management. The environment of the 1990s will challenge even the most sophisticated and capable health-care executives. This paper discusses key aspects of leadership and models them to the patient-care setting. Leadership will be the differentiating factor as organizations seek competitive advantage. PMID:1958816

Nackel, J G; Shelley, S R



Federally Listed Patient Safety Organizations  


... Us Espańol FAQ Email Updates Search Patient Safety Organization (PSO) Program Main menu Home Listed PSOs ... Continued Listing Certification Change of Listing Information Resources Patient Safety Act Patient Safety Rule Notice of 2008 Proposed ...


The patient's view.  


The medical practitioner has always had to juggle several roles. First and foremost, the doctor is a healer, a provider of curative services. Second, he is an examiner, an assessor of the patient's health status. Third, he is a researcher, always trying to push the boundaries of medical knowledge. Fourth, he is a rationer of services, he decides how best to apportion the limited resources at his disposal. Traditionally, the patient-doctor relationship has been largely exclusive in nature and the doctor would quite comfortably slip in and out of these roles, his focus centred on his patient's interests. In this era of large corporate health care providers, multi-billion-biotechnology industry, mammoth pharmaceutical companies, medical insurance schemes and international trade instruments, it has become increasingly difficult for the doctor to juggle these four roles. He is constantly subjected to conflicting demands. Patients' interests do not always come first anymore and patients are beginning to realise this. They no longer trust the medical profession unreservedly. There has been steady erosion of the patient-doctor relationship most clearly evidenced by the rising tide of litigation against doctors. There needs to be a reappraisal of these roles that the doctor plays. The conflicts must be recognised and addressed. Patients need to be informed and their interests must be protected if the doctor-patient relationship is to be restored. Medical malpractice suits are on the increase. The tort system as it exists is failing both doctors and patients. The question we must ask is what are patients looking for when they sue doctors? Most of the time they need compensation for the injuries suffered. Sometimes they are looking for accountability, they want the doctor to be punished in some way. Sometimes they merely want to air their grievances and know that they are heard. The current system more often than not takes too long to compensate, the process is a gamble and doctors who are clearly negligent quietly settle and are rarely censured. We need to revamp the existing system to allow for speedy and equitable compensation; true accountability; and articulation and auditing of standards of practice. PMID:14556356

Rachagan, S S; Sharon, K



Canadian patient safety champions: collaborating on improving patient safety.  


Patients for Patient Safety Canada champions have grown in numbers and purpose since their initiation into the World Health and Pan-American Health Organizations' Patients for Patient Safety initiative in May 2006. The 25 Canadian patients and family members not only share their adverse event experiences but are actively engaged in collaboration with health professionals, administrators and decision-makers to initiate proactive patient safety strategies. Their intention is to have their stories heard as tools for learning. They also wish to raise local, regional and national awareness of patient safety problems. The different patient and family stories and experiences share some common issues and suggested solutions that might make a difference in patient safety. One key solution is involving patients and families not only in discussions of treatment and follow-up when adverse events occur but also proactively on patient safety advisory committees. These actions would acknowledge a common interest in seeing that the right things are done. Patients and families share the common interest of all those advocating for patient safety, namely, First do no harm (attributed to Hippocrates, circa 470-360 B.C.). The patients and families of Patients for Patient Safety Canada are a group of committed, dedicated individuals who should be acknowledged for sharing their experiences and trying to make a difference in patient safety. PMID:18382169

Kovacs Burns, Katharina



[Multimedia preoperative patient information].  


Due to heavy workloads and shortage of staff, doctors often find it difficult to explain operations to their patients with the legally required detail and timing (in Germany, 24 h preop). This is however mandatory for obtaining informed consent. We developed a computer program that generates films explaining 24 common orthopedic operations and blood transfusion. They explain the operation, early postoperative phase, and benefits and risks to the patient. At our clinic, this program is used in daily routine and precedes the actual doctor-patient conversation for informed consent. We asked 300 patients about their satisfaction with the newly developed program. The multimedia presentation gives the patient more time, enough detail and clarity, and the chance to repeat parts of the film. For the doctor, it saves time. The time gap required in Germany between explanation and operation is thus easily adhered to. In case of legal problems, the film can be used for evidence. The use of this multimedia presentation to help in getting informed consent is improving workflow considerably. PMID:15249968

Klima, S; Hein, W; Hube, A; Hube, R



JAMA Patient Page  

NSDL National Science Digital Library

The Journal of the American Medical Association (JAMA) has been committed to providing the general public with a number of high-quality print and online resources in recent years, and their collection of Patient Pages is quite thorough and most welcome. With over 390 entries, each Patient Page contains a basic overview of such topics as Lyme disease, dementia, lymphoma, and dozens of other conditions, medical procedures, and practices. Along with succinct and accessible summaries for each entry, visitors will also find illustrations, graphs, and diagrams that help explain each topic. All in all, this site is a tremendous resource, and it is worth noting that many of these Patient Pages are also available in Spanish.


Patient Safety Network  

NSDL National Science Digital Library

The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network (PSNet) website contains recent news and resources to provide those studying to be in the medical profession and for those currently in the medical field. Resources include an extensive glossary as well as a vast supply of articles from various periodicals. The site also contains numerous �Did You Know?� articles that include visual aids and citations. Articles can be sorted or browsed by target audience, resource type, clinical area, error type, safety target, approach to improving safety, and setting of care. Users have the ability to sign up for the weekly AHRQ Patient Safety Network and monthly AHRQ Web Morbidity and Mortality (WEBM&M) newsletters. Users may also sign up for a free account on the AHRQ Patient Safety Network website to receive e-mail alerts that match the users' interests.


Black patients receive less clinical trial information than white patients

A study from the Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute comparing how physicians discuss clinical trials during clinical interactions with black patients versus white patients further confirms racial disparities in the quality of communication between physicians and patients. Oncologists provided black patients with less information overall about cancer clinical trials compared with white patients, according to data presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, Oct. 27-30, 2012.


Alcoholism in Tuberculous Patients  

PubMed Central

The incidence of alcoholism among patients suffering from tuberculosis in the Tuberculosis Hospital in Winnipeg was determined, and attention is drawn to the need to treat tuberculosis and alcoholism concurrently. In all, 306 patients with tuberculosis were studied and 32 alcoholics were discovered among them. This frequency is five times that estimated in the adult population of Canada. Ninety-two per cent of these alcoholics were addicted before the tuberculous disease was discovered. No direct causative factor was discovered linking alcoholism and tuberculosis. Poor socioeconomic status appears to be a common etiological factor. PMID:14217248

Pincock, T. A.



Glaucoma in patients with uveitis  

Microsoft Academic Search

The records of 100 patients (161 eyes) with uveitis were reviewed retrospectively to determine the prevalence of increased intraocular pressure, the forms of uveitis most commonly associated with glaucoma, and the forms that require specific glaucoma therapy. Secondary glaucoma was present in 23 patients (31 eyes): three of 24 patients with acute uveitis (three eyes, 12% of acute uveitis patients)

W C Panek; G N Holland; D A Lee; R E Christensen



Babesiosis in Immunocompetent Patients, Europe  

PubMed Central

We report 2 cases of babesiosis in immunocompetent patients in France. A severe influenza-like disease developed in both patients 2 weeks after they had been bitten by ticks. Diagnosis was obtained from blood smears, and Babesia divergens was identified by PCR in 1 case. Babesiosis in Europe occurs in healthy patients, not only in splenectomized patients. PMID:21192869

Zadeh, Mahsa Mohseni; Hansmann, Yves; Grawey, Isabelle; Christmann, Daniel; Aguillon, Sarah; Jouglin, Maggy; Chauvin, Alain; De Briel, Dominique



Medical Technology for Superior Patient  

E-print Network

-ending drive to: · Assure patient and staff safety · Increase patient satisfaction · Attain superior clinical Protection Partnership for items normally under service contract · Patient safety and risk management on contemporary issues in healthcare technology, new clinical technology, compliance training, patient safety

Hayden, Nancy J.


Patient-centered Care & Communication

Patient-centeredness is increasingly being recognized as a critical indicator of high-quality health care delivery. Although several definitions of patient-centeredness have been proposed in the literature, two attributes are considered central to the delivery of patient-centered care. These attributes are being responsive to patient needs and incorporating the patient's perspective and experiences in care planning and decision-making.


Patient informed choice for altruism.  


Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient's altruistic treatment refusal should be respected. PMID:25033333

Doukas, David J; Hardwig, John



The Adolescent Patient.  

ERIC Educational Resources Information Center

Written to orient the physician and paramedical personnel to the adolescent patient, the book provides information concerning the changes of adolescence, and age-related problems and illnesses. Part 1 discusses the essence of adolescence by describing physical, mental, and emotional growth and development. Part 2, the major section, consists of 21…

Daniel, William A., Jr.


Patient Education on Pain  

MedlinePLUS Videos and Cool Tools

... Health 06. Safe Use of Over-the-Counter Medicine 07. What Does "Safe and Effective" Mean? 08. Medications - Aspirin 09. Medications - Acetaminophen 10. Medications - NSAIDS 11. Medications - Opioids 12. Side Effects of Opioids 13. Topical Anesthetics 14. Physician-Patient ...


The patient champion.  


I have been seconded to NHS England as professional lead for experience of care. Blackpool Teaching Hospitals NHS Trust, where I work as assistant director of nursing with responsibility for patient experience, has been supportive of me undertaking the secondment, which was advertised on NHS Jobs. PMID:25563130

Jebb, Paul



Authorization Patient Information  

E-print Network

Authorization Patient Information Student Health Center 501 Student Health Irvine, CA 92697-5200 949-824-5302 Fax 949-824-3033 Authorization for Release of Health Information Student ID No.: Date of Birth: (select authorization) Last Name First Name Initial Address City State Zip Phone ALL MEDICAL

Rose, Michael R.


Training Patient and Family Storytellers and Patient and Family Faculty  

PubMed Central

Narrative medicine has become a prominent method of developing more empathetic relationships between medical clinicians and patients, on the basis of a deeper understanding of the patient experience. Beyond its usefulness during clinical encounters, patient storytelling can inform processes and procedures in Advisory Councils, Committee Meetings, and Family as Faculty settings, leading to improved quality and safety in health care. Armed with a better understanding of the patient experience, clinicians and administrators can make decisions, hopefully in collaboration with patients, that will enrich the patient experience and increase satisfaction among patients, families, and staff. Patient and family storytelling is a key component of the collaboration that is ideal when an organization seeks to deliver patient- and family-centered care. Providing patients and families with training will make the narratives they share more powerful. Health care organizations will find that purposeful storytelling can be an invaluable aspect of a patient- and family-centered culture. Well-delivered storytelling will support quality- and safety-improvement efforts and contribute to improved patient satisfaction. This article provides instruction for teaching patients and families how to tell stories with purpose and offers advice about how to support patients, families, and clinicians participating in this effort. PMID:24355906

Morrise, Lisa; Stevens, Katy Jo



Association of patient-reported care coordination with patient satisfaction.  


Little is known about the relationship between care coordination directly assessed from the patient's perspective and patient satisfaction. This study applied multiple logistic regression models to examine associations between patient-reported care coordination and patient satisfaction among 1367 patients with diabetes. We found robust positive relationship between care coordination and patient satisfaction with overall chronic care (odds ratio [OR] = 1.78), one's regular doctor (OR = 1.85), and the way care was organized (OR = 1.98). Implications for health plans, providers, and future research are discussed. PMID:25469580

Wang, Margaret C; Mosen, David; Shuster, Elizabeth; Bellows, Jim



Gastric Cancer in Young Patients  

PubMed Central

Aim. The aim of this study was to see the clinical, pathological, and demographic profile of young patients with stomach carcinoma besides association with p53. Patients and Methods. Prospective study of young patients with stomach carcinoma from January 2005 to December 2009. A total of 50 patients with age less than 40 years were studied. Results. Male female ratio was 1?:?1.08 in young patients and 2.5?:?1 in older patients. A positive family history of stomach cancer in the first degree relatives was present in 10% of young patients. Resection was possible only in 50% young patients. 26% young patients underwent only palliative gastrojejunostomy. The most common operation was lower partial gastrectomy in 68%. Amongst the intraoperative findings peritoneal metastasis was seen in 17.4% in young patients. 50% young patients presented in stage IV as per AJCC classification (P value .004; sig.). None of the patients presented as stage 1 disease in young group. Conclusion. Early detection of stomach carcinoma is very important in all patients but in young patients it is of paramount importance. PMID:24381753

Dhobi, Manzoor A.; Wani, Khursheed Alam; Parray, Fazl Qadir; Wani, Rouf A.; Peer, G. Q.; Abdullah, Safiya; Wani, Imtiyaz A.; Wani, Muneer A.; Shah, Mubashir A.; Thakur, Natasha



Patient assault: a comparison of patient and staff perceptions.  


The purpose of this study was to compare the perceptions of assaultive patients and staff victims regarding assault incidents. The hypotheses were as follows: (1) There will be congruence between patients' and victims' reports of objective or factual information regarding the assaults and (2) there will not be congruence between patients' and victims' reports of subjective information about the assaults. Monahan's (1981) framework was used for assessing violence on the assaultive patient and the assaulted staff member. Patients who assaulted a nursing staff member and nursing staff members who were assaulted were interviewed, and the congruence of responses between each pair (patient and staff member) on each question was assessed. For 10 items designated as objective, there was agreement between patients and victims in 6 cases and disagreement in 4 cases. For 8 subjective items, in all cases patients and victims gave different perceptions. PMID:7706063

Lanza, M L; Kayne, H L



Power to the patient.  


Getting and giving advice are two different things, especially when it comes to health care. Just ask Hamilton Jordan, former adviser to Jimmy Carter. When he was diagnosed with cancer, he didn't rely on anyone else's advice. What sets him apart from the average patient? The answer, increasingly, is not much. In fact Jordan personifies a new health care consumer: educated, interested, aware, and active in charting the course of his or her own health care. PMID:8897793

Hagland, M



Patient Safety in Surgery  

PubMed Central

Background: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. Methods: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. Results: The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (? = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. Conclusions: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety. PMID:16632997

Makary, Martin A.; Sexton, J Bryan; Freischlag, Julie A.; Millman, E Anne; Pryor, David; Holzmueller, Christine; Pronovost, Peter J.



Asthma Patient Education  

Microsoft Academic Search

Patient education is an integral component of effective asthma management that is necessary for all age groups. It can be\\u000a viewed as a two-staged process, which involves not only the acquisition of knowledge, but also the integration of skills and\\u000a attitudes that leads to a change in behaviour. Effectively this is asthma self management education (SME). People with asthma\\u000a often

Vanessa M. McDonald; Peter G. Gibson


Patient perceptions of MRSA.  


Drug-resistant nosocomial infections are an increasing problem. This issue has received considerable media coverage. To our knowledge there have been no studies investigating patient awareness and perceptions of nosocomial infections. A total of 113 surgical out-patients completed a questionnaire stating whether they had heard of either superbugs or MRSA. A series of questions were asked about the source of any information; methods of transmission and prevention; the consequences of infection and their emotional response if they were to acquire MRSA. Fifty patients (44%) had heard of superbugs or MRSA mainly via the media (58%) or from hospital staff (44%). The majority would feel either angry or afraid if they acquired MRSA in hospital, but there was good awareness of both methods of infection control and the consequences of infection. From our study, we conclude that the media is at least as important as health professionals in providing information. Concerns regarding nosocomial infection may need to be addressed prior to admission. PMID:12648346

Hamour, Sally M A; O'Bichere, Austin; Peters, John L; McDonald, Peter J



Structured preoperative patient education for patient-controlled analgesia  

Microsoft Academic Search

Study Objective: To investigate the effectiveness of a structured preoperative education program in patients receiving patient-controlled analgesia (PCA).Design: Randomized controlled trial.Setting: University-affiliated hospital.Patients: 60 ASA physical status I and II women undergoing major gynecologic surgery.Interventions: Patients were randomly allocated to receive either standard information given during routine preanesthetic assessment (n = 30) or additional structured preoperative education on the use

Kwok Key Lam; Matthew T. V Chan; Phoon Ping Chen; Warwick D. Ngan Kee



Angle closure in younger patients.  

PubMed Central

PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention. PMID:12545694

Chang, Brian M; Liebmann, Jeffrey M; Ritch, Robert



[Tracheostomy in pediatrics patients].  


This is a case study of 79 children who under-went a tracheostomy with three different techniques, used in succession on three different groups of patients: surgical, percutaneous with progressive probes and translaryngeal technique. The pediatric patient, only under the age of 10, starts showing clear-cut anatomical differences compared to an adult, which gradually become more marked the younger the patient is. The causes of increased difficulties that can normally be found in these patients are obviously due to the reduced diameter of the airway and, above all, the high degree of pliability of the cartilaginous frame. After the discovery that even minimal external pressure can cause the collapse of the tracheal walls, it was decided to adopt the systematic use of a rigid bronchoscope, in order to be able to offer internal support to the anterior wall. The following advantages were obtained in the various techniques: In surgery it permitted the reduction, through the protrusion of the trachea, of the size of the operatory field, of the tracheal opening and consequently of the local trauma. It also caused less bleeding and reduced the risk of lesion to the pleural dome which are very frequent when a bronchoscope is not used. In the percutaneous method the bronchoscope allowed the application of the technique without complications, even in infants of only a few months' old, because it eliminated tracheal squashing, caused by the introduction of the needle, dilators and especially cannula, and the relative danger of lesion to the posterior wall of the trachea. This complication which was always impending in the original technique, which does not involve the use of a rigid bronchoscope, is the main reason which lead to the ban on PDT for patients younger than 16-18. In the translaryngeal method the advantages are of minor importance because they are limited to the initial stage of the procedure, the introduction of the needle and guide wire which are quicker and more precise. As regard the dilation, the TLT mode has a high level of intrinsic safety and is perfectly suitable to the anatomy of the child. In fact it is carried out from the inside towards the outside, causing a tendency to evertion of the tracheal wall which the physician must even limit with external pressure. It is remarkable that this contrast in pressure and the resulting compression of the peristomal tissues creates advantages, which are essential in younger children, that cannot be found in other tracheal techniques. These advantages are the complete absence of loss of blood, minimal local trauma and a perfect adherence of the stoma to the cannula, particularly effective at level of the tracheal wall. PMID:12029259

Fantoni, A; Ripamonti, D



Patient Initals University of Washington  

E-print Network

_________ Patient Initals University of Washington Patient Acknowledgement for Kidney Transplantation in Donor Exchange KIDNEY RECIPIENT You have been given the opportunity to participate in the Paired Kidney Donation Exchange program because you and your prospective kidney donor

Borenstein, Elhanan


Shoulder instability in older patients.  


Glenohumeral instability has a bimodal age distribution, with most affected patients younger than 40 years, but with a second peak in older patients. Glenohumeral dislocations in older patients often present with complex injury patterns, including rotator cuff tears, fractures, and neurovascular injuries. Glenohumeral instability in patients older than 40 years requires a different approach to treatment. An algorithmic approach aids the surgeon in the stepwise decision-making process necessary to treat this injury pattern. PMID:24975764

Paxton, E Scott; Dodson, Christopher C; Lazarus, Mark D



Skin lesions in diabetic patients  

Microsoft Academic Search

Objective It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. Methods A total of 403 diabetic patients, 31% type 1 and 69% type 2,

N T Foss; D P Polon; M H Takada; M C Foss-Freitas; M C Foss


Insomnia in maintenance haemodialysis patients  

Microsoft Academic Search

Background. Studies in the last 15 years have shown a high prevalence of sleep disorders in maintenance haemodialysis (HD) patients. Methods. To investigate whether the new technical and therapeutic advances of the last decade have had a positive impact on sleep disturbances in HD patients: 694 patients (384 males, 310 females) were surveyed using a specific questionnaire; their clinical, lifestyle

Massimo Sabbatini; Bruno Minale; Anna Crispo; Antonio Pisani; Annalisa Ragosta; Raffaela Esposito; Antonio Cesaro; Bruno Cianciaruso; Vittorio E. Andreucci



Strategies for enhancing patient compliance  

Microsoft Academic Search

Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically

Marshall H. Becker; Lois A. Maiman



Involving patients in clinical education.  


The interdependent relationship between the clinical teacher, the learner and the patient is a vital part of clinical education. Changing health services and patient expectations have stimulated the need for teachers to consider patients' rights and needs as active participants and partners in clinical teaching. PMID:20852549

McKimm, Judy



Methadone Patients and Alcohol Abuse  

Microsoft Academic Search

A literature review was conducted on the excess use of alcohol by methadone patients. Although the rate of alcohol abuse among methadone patients was found to be high (compared to general population estimates), the rate was comparable to individuals who engaged in risk-taking behaviors and individuals under stress, such as college students and emergency room patients. Comparisons of rates for

Gennaro Ottomanelli



Evaluation of Online Patient Safety  

E-print Network

Evaluation of Online Patient Safety Certification Program The seminal 2001 IOM Report, "Crossing-testing, the effectiveness of AI's program in imparting key concepts on the science of patient safety to practicing-phased evaluation methodology requiring me to: beta-test AI's online patient safety certification program

Connor, Ed


Epstein-Barr virus-induced transformation of B cells for the diagnosis of genetic metabolic disorders--enumerative conditions for cryopreservation.  


Epstein-Barr virus (EBV) infection in vitro causes transformation of B cells and generates B lymphoblastoid cell lines (LCLs). These LCLs have been widely used for the diagnostic of several genetic metabolic disorders. However, up to now, efficiency of LCL generation has been based on misleading subjective analysis. In this study, quantitative analyses have been performed to indicate efficiency of B-cell transformation to measuring human lysosomal acid hydrolases associated with: GM1-gangliosidosis type I, Gaucher disease and mucopolysaccharidosis type I. Peripheral blood mononuclear cells were isolated from 13 subjects, and LCLs were produced by culturing them with EBV for 12 days. Activities of the enzymes beta-galactosidase, beta-glucosidase and alpha-iduronidase were measured before and after cryopreservation in liquid nitrogen for 30 days. Efficiency of the B-cell transformation was screened every 4 days by the enumeration of cell proliferation, cell counts and changes in granularity estimated by flow cytometry. We observed the generation of 13 LCLs. Cell transformation was confirmed by the gradual increase of cellular clusters, cell size and granularity. In addition, we determined that the activity of the enzymes mentioned above did not change following cryopreservation. These data suggest that our enumerative approach for screening of EBV-LCLs is efficient for the enzymatic determination of human lysosomal acid hydrolases and may thus replace misleading subjective analyses. PMID:16426420

Mello, A S; Burin, M G; Michellin, K; Viapiana, M; Giugliani, R; Coelho, J C; Bauer, M E



Lysosomal multienzyme complex: pros and cons of working together.  


The ubiquitous distribution of lysosomes and their heterogeneous protein composition reflects the versatility of these organelles in maintaining cell homeostasis and their importance in tissue differentiation and remodeling. In lysosomes, the degradation of complex, macromolecular substrates requires the synergistic action of multiple hydrolases that usually work in a stepwise fashion. This catalytic machinery explains the existence of lysosomal enzyme complexes that can be dynamically assembled and disassembled to efficiently and quickly adapt to the pool of substrates to be processed or degraded, adding extra tiers to the regulation of the individual protein components. An example of such a complex is the one composed of three hydrolases that are ubiquitously but differentially expressed: the serine carboxypeptidase, protective protein/cathepsin A (PPCA), the sialidase, neuraminidase-1 (NEU1), and the glycosidase ?-galactosidase (?-GAL). Next to this 'core' complex, the existence of sub-complexes, which may contain additional components, and function at the cell surface or extracellularly, suggests as yet unexplored functions of these enzymes. Here we review how studies of basic biological processes in the mouse models of three lysosomal storage disorders, galactosialidosis, sialidosis, and GM1-gangliosidosis, revealed new and unexpected roles for the three respective affected enzymes, Ppca, Neu1, and ?-Gal, that go beyond their canonical degradative activities. These findings have broadened our perspective on their functions and may pave the way for the development of new therapies for these lysosomal storage disorders. PMID:24337808

Bonten, Erik J; Annunziata, Ida; d'Azzo, Alessandra



Reassessment of rectal approach to neuropathology in childhood  

PubMed Central

A series of 93 rectal biopsies performed for diagnosis of suspected progressive neurometabolic disease between 1967 and 1973 is reviewed, and the results of this and of two previously published series totalling 307 biopsies are analysed. In GM1 and GM2 gangliosidosis, Batten's disease, and certain other neuronal storage diseases rectal biopsy is a reliable diagnostic alternative to brain biopsy. However, the need for biopsy has diminished with improvement in other diagnostic methods, particularly enzyme assay, the availability of which should determine the extent to which biopsy is used. It is suggested that rectal biopsy is necessary in the various forms of Batten's disease and in the neurovisceral storage disease with supranuclear ophthalmoplegia described by Neville et al. (1973). In certain diseases its use is unjustified, either because the result would be negative or because other less traumatic, reliable investigations are available. On rare occasions it is justifiable to use rectal biopsy either as an `excluding investigation' to exclude Batten's disease for certain in a healthy sib of a known case with this disorder or to detect the disease before onset of clinical symptoms. The need for a full thickness biopsy and for a full range of staining methods is emphasized. Without these the investigation cannot be expected to give diagnostic information and may be misleading, giving `false negative' results. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6 PMID:829767

Brett, E. M.; Lake, B. D.



Bibliotherapy in a Patients' Library *  

PubMed Central

This paper describes the involvement of patients in the Patients' Library at McLean Hospital, and the relationship between them and the librarian in library activities. The publication of a patients' magazine is discussed, with case histories of persons who had taken part in its production. The Patients' Librarian has a personal role in patient therapy, and accounts are given of various activities such as play-reading, poetry-reading, and the discussion of poems by established writers, with therapeutic aims in view. Actual clinical experiences are given. PMID:5146769

McDowell, David J.



Financial Distress in Cancer Patients  

PubMed Central

Novel diagnostic and therapeutic options offer hope to cancer patients with both localized and advanced disease. However, many of these treatments are often costly and even well-insured patients can face high out-of-pocket costs. Families may also be at risk of financial distress due to lost wages and other treatment-related expenses. Research is needed to measure and characterize financial distress in cancer patients and understand how it affects their quality of life. In addition, health care providers need to be trained to counsel patients and their families so they can make patient-centered treatment decisions that reflect their preferences and values. PMID:24349677

de Souza, Jonas A.; Wong, Yu-Ning



The 'Patient experience' revolution.  


We're arguably at the most pivotal time in our young profession. The ACA has provided EMS an unprecedented opportunity to become a part of the healthcare system, a move that many of us have dreamed about for decades. We need to pay attention to the changing dynamics of the environment in which we operate. The factors that currently impact hospitals, doctors and other healthcare providers will also impact us sooner than we think. Take the time to help shape our future and how we participate in this new healthcare system. It's time to focus on the patient and the patient's experience with our service. Wayne Gretzky said two important things during an interview when he was asked what makes him such a great hockey player. One was, "You miss 100% of the shots you don't take." The other was, "A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be. I skate to where the puck is going to be, not where it has been." Our advice to you is to go ahead, take the shot, get ahead of the other team and focus on improved customer satisfaction sooner rather than later. PMID:24660359

Hooten, Doug; Zavadsky, Matt



Albuminuria of hypertensive patients.  


Renal dysfunction as a consequence of malignant hypertension has been recognized for decades in patients with essential hypertension. It has been shown only recently, however, that albuminuria (including underlying albuminuria not detectable by conventional tests, i.e. microalbuminuria) has emerged as a frequent sequela of essential hypertension. Furthermore, renal dysfunction of the elderly as a result of ischemic nephropathy, in the absence of malignant hypertension, has turned out to be an important long-term outcome in the patient with essential hypertension. The presence of albuminuria is a strong predictor of cardiovascular events. Albuminuria is associated with more severe hypertension and with evidence of more advanced target organ damage (e.g. LVH). It is more prevalent in the elderly. It is unknown whether the predictive value of albuminuria reflects its association with more severe hypertension and end-organ damage, or whether albuminuria serves as an indicator of capillary leakiness which causes detectable abnormalities in the renal microcirculation but reflects more generalized endothelial barrier dysfunction predisposing to accelerated atherogenesis. PMID:1295707

Rambausek, M; Fliser, D; Ritz, E



Stealing in eating disordered patients.  


Previous studies have noted high rates of stealing behavior in patients with eating disorders. To assess the significance of stealing in eating disordered patients, the authors compared the eating and purging behavior, levels of psychologic symptomatology, and alcohol use of 181 eating disordered patients with and without a history of stealing. Overall, the patients with a history of stealing had significantly more dysfunctional eating and purging behavior. Those patients with a history of stealing reported significantly more psychological distress including more depression, interpersonal sensitivity, obsessive compulsive behavior, and hostility. The authors conclude that stealing behavior should be assessed in patients with eating disorders as a history of stealing may define a subgroup of more severely impaired patients. PMID:2005074

Krahn, D D; Nairn, K; Gosnell, B A; Drewnowski, A



[Treatment of patients with osteoarthritis].  


The therapeutic management of patients with osteoarthritis aims to decrease pain and inflammation, improve physical function, and to apply safe and effective treatments. A patient-centered approach implies the active participation of the patient in the design of the treatment plan and in timely and informed decision-making at all stages of the disease. The nucleus of treatment is patient education, physical activity and therapeutic exercise, together with weight control in overweight or obese patients. Self-care by the individual and by the family is fundamental in day-to-day patient management. The use of physical therapies, technical aids (walking sticks, etc.) and simple analgesics, opium alkaloids, and antiinflammatory drugs have demonstrated effectiveness in controlling pain, improving physical function and quality of life and their use is clearly indicated in the treatment of osteoarthritis. Conservative surgery and joint replacement is indicated when treatment goals are not achieved in specific patients. PMID:24467960

Vargas Negrín, Francisco; Medina Abellán, María D; Hermosa Hernán, Juan Carlos; de Felipe Medina, Ricardo



Patients' views of nurses' competence.  


This study examines, from the patients' perspective, what is meant by competent nursing and how, with this perspective in mind, patients would view the prospect of assessing the competence of nurses. There is a little empirical research that clarifies professional competence from the patient's perspective. Nursing curricula in the UK have shifted attention to 'competencies' as the outcome of nurse education and, in an era of patient involvement, their views are important to investigate. The study utilises a grounded theory approach. Data were collected in Central Scotland between 2001 and 2003. Twenty-seven patients participated. Data were analysed, in keeping with the grounded theory tradition, utilising the constant comparative method. Patients described the foundation of competent nursing practice as technical care and nursing knowledge. Patients assume that technical care is competent as safe guards are considered to be in place to protect patients. When technical competence is assumed, interpersonal attributes become the most important indicator of the quality of nursing care. The results of this study highlight uncertainty about whether patients feel able to assess the competence of nurses. The results of this study may have implications for nurses internationally when trying to involve patients in the assessment of nurses. PMID:17014931

Calman, Lynn



Simulation: improving patient outcomes.  


Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim



Perceptions of Patient Safety: What Influences Patient and Provider Involvement?.  

E-print Network

??Patient safety strategies have traditionally involved the promotion of provider-oriented practices aimed at reducing known risks associated with surgery, infection, and continuity of care. With… (more)

Bishop, Andrea C.



H:\\AAAHC\\P&P\\Administration\\PP Patient Rights and Responsibilities.docx Patient Rights Patient Responsibilities  

E-print Network

privacy, safety and security within the health center. 4. Patient disclosures and records are treatedH:\\AAAHC\\P&P\\Administration\\PP Patient Rights and Responsibilities.docx Patient Rights Patient Responsibilities 1. Patients are treated with respect, consideration and dignity. 2. Patients are provided

Sura, Philip


Prioritization strategies for patient evacuations.  


Evacuation from a health care facility is considered last resort, and in the event of a complete evacuation, a standard planning assumption is that all patients will be evacuated. A literature review of the suggested prioritization strategies for evacuation planning-as well as the transportation priorities used in actual facility evacuations-shows a lack of consensus about whether critical or non-critical care patients should be transferred first. In addition, it is implied that these policies are "greedy" in that one patient group is given priority, and patients from that group are chosen to be completely evacuated before any patients are evacuated from the other group. The purpose of this paper is to present a dynamic programming model for emergency patient evacuations and show that a greedy, "all-or-nothing" policy is not always optimal as well as discuss insights of the resulting optimal prioritization strategies for unit- or floor-level evacuations. PMID:23666434

Childers, Ashley Kay; Mayorga, Maria E; Taaffe, Kevin M



Immune imbalance in cancer patients.  


The immune status of the tumor-bearing patient remains poorly defined. In various solid-tumor-bearing patients, we demonstrated the absence of ADCC modifications in the patient in relapse or in evolution. These same patients presented a significant increase in immune complexes when compared with patients in remission. Furthermore, we noted a decreased NK activity, a decreased number of ARFC, corresponding to a helper T cell subpopulation, and a corollary increase in T-dependent suppressor activity. These results, on the whole, suggest an immune imbalance and that the helper cell-suppressor cell ratio should be investigated in greater depth within the context of the immune response in the cancer patient. PMID:6453412

Serrou, B; Gauci, L; Caraux, J; Cupissol, D; Thierry, C; Esteve, C



Patient safety: a shared responsibility.  


Patient safety is an essential and vital component of quality nursing care. However, the nation's health care system is prone to errors, and can be detrimental to safe patient care, as a result of basic systems flaws. A variety of stakeholders (society in general; patients; individual nurses; nursing educators, administrators, and researchers; physicians; governments and legislative bodies; professional associations; and accrediting agencies) are responsible for ensuring that patient care is safely delivered and that no harm occurs to patients. The responsibility of these stakeholders in addressing patient safety in the context of a nursing shortage is discussed, along with specific actions they have taken, and can continue to take, to promote safe care. PMID:14656198

Ballard, Karen A



Patient Care in Stereotactic Radiosurgery  

Microsoft Academic Search

\\u000a The intention of this chapter is to provide basic guidelines surrounding the patient process in relation to stereotactic radiosurgery,\\u000a with the goal of providing a seamless and pleasant experience for the patient and staff. Although the role of the registered\\u000a nurse (RN) is highlighted, additional disciplines may gain insight into the patient perspective. Expectantly, valuable information\\u000a will be gained not

Terri F. Biggins


Patient discharge referral: interdisciplinary collaboration.  

PubMed Central

The INFORMM (Information Network For Online Retrieval & Medical Management) patient discharge referral form is interdisciplinary in scope. The initial automated form, implemented on 41 general inpatient care units as of December, 1991, involved the collaboration of the departments of Nursing, Social Services, Medical Records, and Patient Registration. As development proceeds, it is expected that other clinical disciplines will contribute additional data and information to augment and complement the content of the patient discharge referral form. PMID:1482892

Prophet, C. M.



Patient centric identification and association.  


Increased technological complexity of medical devices and systems coupled with increased workloads and reduced staffing, have created difficulties and discontinuities in the management of patient information. These issues have directly impacted and contributed to a rise in equipment-related errors, patient dissatisfaction, a potential for patient injury and resulting overall increased concern for patient safety. In response these concerns a variety of new devices, systems and applications have been developed to share information, provide cross checks along with verified delivery of critical information to the point of care. These applications include biomedical information systems, medication administration, sample collection, and electronic medical records. The deployment of these new integrated and networked devices, systems and applications are dependent on an accurate and consistent patient identification and association methodology which dynamically manages the relationship between patients, staff and equipment. Since the association information is common to many applications and utilizes a variety of technologies, (i.e. active and passive radio frequency identification (RFID), barcodes, etc.) an institutional approach is necessary to mange these processes in a consistent manor utilizing a common set of identification hardware. Implementation of a "Patient Centric Identification and Association Platform" represents a significant advance in the management of clinical patient information. The implementation of a Biomedical Device Information Network at Memorial Sloan-Kettering Cancer Center (MSKCC) integrates the identification and association of patients with devices and care providers and provides the methodologies to manage alarms, providing the ability to filter low priority or nuisance alarms. This implementation enables critical information to be distributed directly to care providers utilizing dedicated communications devices. Patient Centric Identification and Association is the enabling technology providing precise identification and association establishing an enhanced environment of care, increased patient safety, and a clear proactive response to the regulatory requirements of the Joint Commission (JCAHO) national patient safety initiatives. PMID:19964258

Frisch, P; Miodownik, S; Booth, P; Carragee, P; Dowling, M



Experiment in progressive patient care.  


A successful experiment is described in providing total progressive patient care in a small hospital. This was based on dividing ward services into nursing and "hotel" services, the latter being provided by a housekeeping team. Patients were divided into three categories according to the amount of nursing care needed, and two wards were converted, one into an intensive care unit, the other into a homeward bound unit, with high and low nurse/patient ratios respectively. PMID:5676716

Hartley, R; O'Flynn, W R; Rake, M; Wooster, M



Elderly patients with pancreatic cancer.  


Pancreatic cancer marked significant increase of incidence during the last decades in the elderly population. Despite the certain increase of incidence there are no international guidelines for elderly patients who are suffering from pancreatic cancer. During the ASCO Annual Meeting 2014, two abstracts focusing on elderly patients suffering from different histological types of pancreatic cancer were presented. The first retrospective study (Abstract #4119) showed the benefit of the systemic treatment on overall survival for elderly patients with stage IV pancreatic adenocarcinoma. The second retrospective study (Abstract #4112) demonstrates the positive effect of somatostatin analogue (octreotide-LAR) treatment on overall survival for elderly patients with neuroendocrine pancreatic carcinoma. PMID:25076333

Kougioumtzopoulou, Andromachi S; Syrigos, Kostas N; Saif, Muhammad Wasif



Childhood cancer patients at school.  


The aim of this study was to assess the school-related problems of childhood cancer patients. A cross-sectional questionnaire study for school-aged children with extracranial malignancies, in the area of Turku University Hospital serving around 1000000 people. Siblings, healthy pupils and teachers were studied as controls. 43 patients responded. None of the patients or controls was placed in special educational programmes. However, 30.8% of the patients, 15.7% of the controls and 3.7% of the siblings had required extra tutoring. The patients' results differed statistically from both the siblings' (P=0.022) and the controls' (P=0.041) results. The school marks in mathematics (P=0.05) and in foreign languages (P=0.06) tended to be worse for the patients than for the healthy controls. Bullying was reported by 31.7% of the patients, 10.9% of controls (P=0.0012) and 8.3% of the siblings (P=0.056). The biggest problem faced by the cancer patients was bullying-the patients reported approximately 3 times as much bullying as the healthy children did. It seems that there are still several aspects which need to be reconsidered when these children return to school or start their school-life as survivors of childhood cancer. Some proposals are presented. PMID:12044510

Lähteenmäki, P M; Huostila, J; Hinkka, S; Salmi, T T



AKI in an HIV Patient  

PubMed Central

The renal manifestations of patients infected with HIV are diverse. Patients may have podocytopathies ranging from a minimal-change–type lesions to FSGS or collapsing glomerulopathy. Furthermore, such patients produce a variety of autoantibodies without clinical signs of the disease. Antiretroviral drugs also cause renal injury, including crystals and tubular injury, acute interstitial nephritis, or mitochondrial toxicity. In these circumstances, it is essential to perform a renal biopsy for diagnosis and to guide treatment. Here we describe a patient with HIV who presented with AKI and hematuria without concomitant systemic manifestations. Renal biopsy elucidated the cause of acute deterioration of kidney function. PMID:23559580

Hartle, P. Matthew; Carlo, Mariu E.; Dwyer, Jamie P.



Patient Education Leads to Better Care for Heart Patients.  

ERIC Educational Resources Information Center

The staff of a heart and circulatory disease program of a State department of health conducted a special project at a city hospital which showed that a well-organized treatment and education program for patients with congestive heart failure increased the patient's knowledge of his disease, medication, and diet as well as his adherence to a…

Rosenberg, Stanley G.


The Patient-Centered Medical Home and Patient Experience  

PubMed Central

Objective To examine the relationship between practices' reported use of patient-centered medical home (PCMH) processes and patients' perceptions of their care experience. Data Source Primary survey data from 393 physician practices and 1,304 patients receiving care in those practices. Study Design This is an observational, cross-sectional study. Using standard ordinary least-squares and a sample selection model, we estimated the association between patients' care experience and the use of PCMH processes in the practices where they receive care. Data Collection We linked data from a nationally representative survey of individuals with chronic disease and two nationally representative surveys of physician practices. Principal Findings We found that practices' use of PCMH processes was not associated with patient experience after controlling for sample selection as well as practice and patient characteristics. Conclusions In our study, which was large, but somewhat limited in its measures of the PCMH and of patient experience, we found no association between PCMH processes and patient experience. The continued accumulation of evidence related to the possibilities of the PCMH, how PCMH is measured, and how the impact of PCMH is gauged provides important information for health care decision makers. PMID:22670806

Martsolf, Grant R; Alexander, Jeffrey A; Shi, Yunfeng; Casalino, Lawrence P; Rittenhouse, Diane R; Scanlon, Dennis P; Shortell, Stephen M



Avoiding Patient Distortions in Psychotherapy with Borderline Personality Disorder Patients  

Microsoft Academic Search

Patients with borderline personality disorder (BPD) have a reputation among psychotherapists for distorted thinking and misleading reports about their interpersonal relationships. This article discusses the difficulty in ascertaining whether seeming distortions are caused by true cognitive deficiencies or are instead caused by purposeful or subconscious manipulation of relationships. The tendency of BPD patients to use an impressionistic cognitive style that

David M. Allen; Stephanie Whitson



What Do Patients Want? Patient Preference in Wound Care  

PubMed Central

Patient preferences are statements made or actions taken by consumers that reflect their desirability of a range of health options. The concept occupies an increasingly prominent place at the center of healthcare reform, and is connected to all aspects of healthcare, including discovery, research, delivery, outcome, and payment. Patient preference research has focused on shared decisions, decisional aids, and clinical practice guideline development, with limited study in acute and chronic wound care populations. The wound care community has focused primarily on patient focused symptoms and quality of life measurement. With increasing recognition of wound care as a medical specialty and as a public health concern that consumes extensive resources, attention to the preferences of end-users with wounds is necessary. This article will provide an overview of related patient-centered concepts and begin to establish a framework for consideration of patient preference in wound care. PMID:25126474

Corbett, Lisa Q.; Ennis, William J.



Candidemia in pediatric surgery patients.  


Candida spp. are the fourth leading cause of bloodstream infection. While the literature on neonatal candidemia is abundant, its prevalence in pediatric surgery cases is hardly mentioned. This study was carried out over a 5-year period to evaluate the prevalence of candidemia in pediatric surgery intensive care unit patients (ICU), and to examine both the neonatal and hospital risk factors for developing candidemia in comparison to control groups of patients with either no infection or with bacteremia, type and outcome of therapy. A total of 1,359 pediatric surgery patients admitted to the ICU and high dependency unit (HDU) were included in the study. Using relevant specimens from them, a microbiological survey was carried out on admission and weekly thereafter. Twenty-five patients developed candidemia during the study period. Twenty-one of them were admitted to ICU. Nine were low birth weight and immature neonates. All 25 patients had underlying disease, most involving the gastroentestinal tract and requiring surgical intervention. All patients had been given broad-spectrum beta-lactam antibiotics with or without aminoglycosides and an anti-anaerobic drug prior to candidemia. The data show that patients who were not infected had very few risk factors that could predispose to candidemia. The bacteremic group of patients had more risk factors: mainly ICU stay, prior antibiotic therapy or GI surgery. The candidemia patients outnumbered these two groups in both neonatal and hospital risk factors. Twenty-three candidemia patients had received amphotericin B and 2 had fluconazole. Seventeen of them improved and the rest expired during therapy. Fourteen of the Candida isolated were C. albicans while the rest belonged to other Candida spp. dominated by C. parapsilosis. In conclusion, candidemia was infrequent in pediatric surgery patients. ICU stay, GI surgery and prior broad-spectrum antibiotic therapy were important risk factors. PMID:10949983

Mokaddas, E M; Ramadan, S A; Abo el Maaty, S H; Sanyal, S C



CRCHD - Patient Navigation Information: Publications, Web Sites, and Applications

CRCHD - Patient Navigation Information: Publications, Web Sites, and Applications  Back to CRCHD Ongoing Research PNP Background Patient Navigation Information Patient Navigation Concept What Are Patient Navigators? Patient Navigation


Care of the terminal patient  

Microsoft Academic Search

In the work of health professions there have always been those who believed that the important thing was to treat all the patients until the final consequences, but there are also those who have considered that the important thing was to treat the patient and when this was not possible, to care for him until the end. Amongst the latter

R. Buisán; J. C. Delgado


Patient-centered Communication Research

Several recent reports, including NCI's Strategic Plan for Leading the Nation and the NCI-designated cancer center directors' report Accelerating Successes Against Cancer, have recognized the salience of patient-clinician communication in optimizing cancer patients' and survivors' health outcomes.


Nurse Burnout and Patient Satisfaction  

Microsoft Academic Search

Background: Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. Objectives: This study examines the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care. Research Design\\/Subjects: We conducted cross-sectional surveys of

Doris C. Vahey; Linda H. Aiken; Douglas M. Sloane; Sean P. Clarke; Delfino Vargas



Patient education in pain control  

Microsoft Academic Search

Patients' concerns about reporting pain and using analgesics have been cited as major contributors to the problem of inadequate pain management. The purpose of this paper is to describe a program of research in which we have focused on these patient concerns, or as we refer to them, \\

S. Ward; S. Hughes; H. Donovan; R. Serlin



Selecting automated patient care systems.  


Although the nursing department may contribute to the selection process for other automated hospital systems, the nursing administrator's most critical and complex project will be selecting the patient care system. This article provides an overview of the key issues that must be examined in the selection process for a patient care system. PMID:3935759

Ginsburg, D A; Browning, S J



Pharmacotherapeutics for the AIDS Patient.  

ERIC Educational Resources Information Center

Anticipated shifts in the demographics of the Acquired Immune Deficiency Syndrome (AIDS) epidemic are examined, current state-of-the-art AIDS patient management is summarized, and some unique facets of drug therapy in the AIDS patient are discussed, including adverse reactions, complex drug interactions, use of investigational drugs, and…

Fife, Kenneth H.



Liver Biopsy in Cirrhotic Patients  

Microsoft Academic Search

Liver biopsy remains an important tool for the evaluation of patients with hepatic disease. However, clinicians utilize a variety of biopsy techniques including automated cutting needle devices, manual cutting needles, and aspiration needles. Using a large study cohort of patients with advanced fibrosis\\/cirrhosis we sought to evaluate practices and outcomes of the biopsy technique used by study investigators across the

Kenneth E. Sherman; Zachary D. Goodman; Sara T. Sullivan; Sima Faris-Young



Bone disease in burn patients.  


Burn patients are at risk for bone disease due to aluminum (Al) exposure from use of antacids and albumin, partial immobilization, and increased production of endogenous glucocorticoids. Moreover, severely burned children are growth impaired up to 3 years after the burn. To determine the extent of bone disease, we studied nine men and three women, ages 18-41 years, with greater than 50% body surface area burn. Seven patients underwent iliac crest bone biopsy following double tetracycline labeling, one additional patient expired after a single label, and three others had postmortem specimens obtained for quantitative Al only. Serial serum and urine samples were obtained weekly until biopsy or death. All biopsied patients had reduced bone formation and osteoid area, surface, and width, with mineral apposition rate, osteoblast surface, and osteoclast number with normal eroded surfaces compared to age- and sex-matched normal ambulatory volunteers. Burn patients also had reduced bone formation, mineral apposition rate, osteoid area, and surface compared to age-matched volunteers at short-term bed rest. Serum levels of osteocalcin were low. Most patients had mild hypercalcemia but only a third had hypercalciuria. All patients had elevated Al in blood or urine; urine Al correlated inversely with serum osteocalcin. In 60% significant bone Al was detectable by stain or quantitation. Our data are compatible with burn patients having markedly reduced bone turnover. Al loading, partial immobilization, endogenous corticosteroids, and cytokine production may be among the etiologic factors. PMID:8456588

Klein, G L; Herndon, D N; Rutan, T C; Sherrard, D J; Coburn, J W; Langman, C B; Thomas, M L; Haddad, J G; Cooper, C W; Miller, N L



Patient Perspectives of Medical Confidentiality  

PubMed Central

OBJECTIVE To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients. PMID:12911650

Sankar, Pamela; Mora, Susan; Merz, Jon F; Jones, Nora L



The Coronary Patient in Industry  

NASA Technical Reports Server (NTRS)

The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.

Schuster, B.



Liver fibrosis in overweight patients  

Microsoft Academic Search

Background & Aims: A common clinical issue is whether overweight patients with abnormal liver function test results should undergo liver biopsy. Although serious liver injury can occur, its prevalence and risk factors are not well known. Methods: Ninety-three consecutive patients with abnormal liver function tests (but without overt liver disease), body mass index (BMI) > 25 kg\\/m2, and no alcoholic,

Vlad Ratziu; Philippe Giral; Frederic Charlotte; Eric Bruckert; Vincent Thibault; Ioannis Theodorou; Lina Khalil; Gérard Turpin; Pierre Opolon; Thierry Poynard



Virtual Patients in Geriatric Education  

ERIC Educational Resources Information Center

The virtual patient is a case-based computer program that combines textual information with multimedia elements such as audio, graphics, and animation. It is increasingly being utilized as a teaching modality by medical educators in various fields of instruction. The inherent complexity of older patients and the shortage of geriatrics educators…

Tan, Zaldy S.; Mulhausen, Paul L.; Smith, Stephen R.; Ruiz, Jorge G.



Therapist-patient relationship in treatment of chronic schizophrenic patients.  


Long-term hospitalized schizophrenic patients of a whole chronic unit of a psychiatric hospital were exposed during a six-months period to a psycho-therapeutically approach of active engagement of the therapist that best can be described as "good enough mother" (Winnicot) approach or a creation of primary identification (Freeman). The effect of the treatment with special attention to the therapist-patient relationship was measured by specially designed bi-polar scale. Statistically significant differences were found on every measured quality. The research suggests that the relationship therapist-patient based on the basic trust influences the outcome of the illness. PMID:11795193

Ivezi?, S; Ljubimir, V; Urli?, I



Patients' perspectives on actinic keratosis.  


Many factors influence patients' perspectives on actinic keratosis (AK). The wish to keep a sense of control prompts many to seek information, which they then interpret according to their personal perspective. Speculations regarding the risk of getting skin cancer and emotional reactions may be expected due to worries about the worsening of the condition, losing control, and participating in UV-related activities. In their contact with physicians, treatment can be an additional issue. Treatment of AK may cause pain and may in itself result in a perceived diminished quality of life. The Actinic Keratosis Quality of Life questionnaire can be used as a valuable tool to represent the effects of treatment on quality of life and to classify patient subpopulations. Studies have suggested that AK patients are more compliant compared to those with other skin diseases. Still fear of stigmatisation may be present during treatment, which may disturb social life. Social and personal factors are crucial to patients' coping strategies, and financial aspects may have an impact on advisable UV-related behaviours. Some AK patients may benefit from interventions to improve their stress response capacity. The clear causality of AK requires a change in behaviour, which is met by multi-conditioned resistance. The physician should be aware that patients might feign acceptance but justify continued UV exposure to themselves with a variety of arguments. Tanning is of great importance for the self-esteem of many AK patients, and tanning addiction should be considered. © 2015 S. Karger AG, Basel. PMID:25561200

Esmann, Solveig



Spiritual care in hospitalized patients  

PubMed Central

BACKGROUND: Spiritual needs are among an individual's essential needs in all places and times. With his physical and spiritual dimensions and the mutual effect of these two dimensions, human has spiritual needs as well. These needs are an intrinsic need throughout the life; therefore, they will remain as a major element of holistic nursing care. One of the greatest challenges for nurses is to satisfy the patients’ spiritual needs. METHODS: This is a qualitative study with hermeneutic phenomenological approach. Data were collected from 16 patients hospitalized in internal medicine-surgery wards and 6 nurses in the respective wards. Data were generated by open-ended interview and analyzed using Diekelmann's seven-stage method. Rigorousness of findings was confirmed by use of this method as well as team interpretation, and referring to the text and participants. RESULTS: In final interpretation of the findings, totally 10 sub-themes, three themes including formation of mutual relation with patient, encouraging the patient, and providing the necessary conditions for patient's connection with God, and one constitutive pattern, namely spiritual need of hospitalized patients. CONCLUSIONS: Spiritual needs are those needs whose satisfaction causes the person's spiritual growth and make the person a social, hopeful individual who always thanks God. They include the need for communication with others, communication with God, and being hopeful. In this study, the three obtained themes are the spiritual needs whose satisfaction is possible in nursing system. Considering these spiritual aspects accelerates patient's treatment. PMID:22039390

Yousefi, Hojjatollah; Abedi, Heidar Ali



76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Child Health Patient Safety...  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Child Health Patient Safety Organization, Inc. AGENCY...relinquishment from Child Health Patient Safety Organization, Inc. of its...



76 FR 9350 - Patient Safety Organizations: Voluntary Delisting From Rocky Mountain Patient Safety Organization  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Delisting From Rocky Mountain Patient Safety Organization AGENCY: Agency for...SUMMARY: Rocky Mountain Patient Safety Organization: AHRQ has...



78 FR 40146 - Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety...  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety Institute AGENCY: Agency for...SUMMARY: The Patient Safety and Quality Improvement Act...



78 FR 59036 - Patient Safety Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc.  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc. AGENCY...SUMMARY: The Patient Safety and Quality Improvement Act...



Improving oral hygiene for patients.  


Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care. PMID:25563127

Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda



Patient participation in pressure injury prevention: giving patient's a voice.  


Pressure injuries burden patients and healthcare organisations, with some preventative practices having little impact on prevalence reduction. Patient participation in care may be an effective pressure injury prevention strategy, yet patient preferences are unknown. The aim of this interpretive study was to describe patients' perceptions of their current and future role in pressure injury prevention. Semi-structured interviews were conducted with 20 adult inpatients recruited from four medical units, at two Australian metropolitan hospitals. Interview data were analysed using content analysis, with three categories emerging: 'experiencing pressure injuries'; 'participating in pressure injury prevention'; and 'resourcing pressure injury prevention and treatment'. These categories reflect the complex nature of participants' pressure injury experience. The findings suggest participants gather pressure injury knowledge from first-hand and vicarious experience; knowledge they bring to hospital. Most participants preferred a proactive pressure injury prevention role. Many identified barriers in the healthcare environment that impeded their participation and affected their experience of pressure injuries and pressure injury prevention. If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners. PMID:24117711

Latimer, Sharon; Chaboyer, Wendy; Gillespie, Brigid



Patient blood management to reduce transfusion need.  


Patient blood management is a multidisciplinary, patient-centered approach aimed at improving patient outcomes, preserving the blood supply, and reducing costs. By identifying patients at risk for transfusion and taking steps to maintain hemoglobin concentration, manage anemia, optimize hemostasis, and minimize blood loss, clinicians can improve patient outcomes. PMID:25621967

Lynn, Shannon



Support for Patients and Families  


... organizations helping people with rare diseases; includes a database of patient support and health-related organizations. Genetic ... Online) is the National Library of Medicine's online database containing more than 8,000 records, including location ...


Managing immunosuppression in medical patients.  


Immunosuppressive drugs are increasingly widely used. Safe use requires knowledge of the side-effect profile, contraindications and precautions before starting, and the monitoring regimen, and patients should be fully informed of the risks and benefits before starting. PMID:19584781

Pritchard, C W; Hawthorne, A B



JAMA Patient Page: Subclinical Hypothyroidism  


... the American Medical Association JAMA PATIENT PAGE Subclinical Hypothyroidism T he thyroid gland , a 2-inch-long, ... thyroid to work harder. Subclinical (without obvious symptoms) hypothyroidism (low thyroid function) describes a situation in which ...


JAMA Patient Page: Cystic Fibrosis  


... of the American Medical Association JAMA PATIENT PAGE Cystic Fibrosis C ystic fibrosis (CF) is a genetic (inherited) ... of the CF gene, that child will develop cystic fibrosis and can also pass the CF gene on ...


JAMA Patient Page: Pressure Ulcers  


... • Association for the Advancement of Wound Care .shtml INFORM YOURSELF To ... Ulcer Advisory Board, Association for the Advancement of Wound Care, American Academy of Family Physicians The JAMA Patient ...


Learning problems in neurofibromatosis patients.  


Learning problems in patients with neurofibromatosis (NF) are probably the most frequent characteristics after those that define the disorder. They are not secondary to the physical problems. A recent survey that compared children who have NF with their siblings revealed a 37% greater incidence of learning disabilities in the children with NF. Intelligence quotient (IQ) data from several studies indicate that almost all patients with NF have a normal IQ, but there is a progression from low normal to normal as these patients reach adulthood. The most common psychoeducational problems include visual-perceptual-motor delay, spelling and arithmetic disabilities, and a cluster of weaknesses related to cortical organization, similar to those seen in children with attention-deficit disorders. A type of learning disability unique to patients with NF has not been identified, and the diagnosis and treatment of the learning problems are generally the same as for children without NF. PMID:2502350

Stine, S B; Adams, W V



Patience and Patients: Understanding the  

E-print Network

Patience and Patients: Understanding the spectrum of Alzheimer's disease of Alzheimer's disease Moderator Adrian Ivinson, PhD Director, Harvard Neuro Professor of Neurology, Harvard Medical School Director, Center for Alzheimer

Chou, James


JAMA Patient Page: Helicobacter pylori  


... the American Medical Association JAMA PATIENT PAGE Helicobacter pylori H elicobacter pylori ( H pylori ) is a common bacterium that is present in ... people older than 60 years are affected. Helicobacter pylori is found in the mucous lining of the ...


CDRP - Patient Navigator Program - Funding

As part of the "Cooperative Planning Grant for Cancer Disparities Research Partnership Program," (CDRP) the National Cancer Institute's Center to Reduce Cancer Health Disparities provided funding for a Patient Navigator Program to be implemented at the funded sites.


JAMA Patient Page: Bed Bugs  


... of the American Medical Association JAMA PATIENT PAGE Bed Bugs B ed bugs, Cimex lectularius , have been ... which thrives in temperate and tropical regions worldwide. Bed bugs are exclusively hematophagous (they feed only on ...


Bathing a patient in bed  


Bed bath; Sponge bath ... Some patients cannot safely leave their beds to bathe. For these people, daily bed baths can help keep their skin healthy, control odor, and increase comfort. If moving the ...


JAMA Patient Page: Atopic Eczema  


... All rights reserved. JAMA PATIENT PAGE| Dermatology Atopic Eczema Eczemais a chronic skin condition and is also called common type is atopic eczema, in which a dry, itchy rash develops. Atopic ...


JAMA Patient Page: Short Stature  


... Association. All rights reserved. JAMA PATIENT PAGE| Pediatrics Short Stature Short stature means that a person is significantly shorter than ... 3% of people in the United States have short stature. What Causes Short Stature? Short stature can have ...


JAMA Patient Page: Anal Fissure  


... All rights reserved. JAMA PATIENT PAGE| Digestive System Anal Fissure An anal fissure is a tear in the opening of ... anus that can cause pain, itching, and bleeding. Anal fissures are common in infants but less so ...


Patient safety: the ethical imperative.  


Nurses have the ethical obligation to prevent and manage medical errors. Ethical theories for justification of stance are provided along with suggestions for disclosing errors to patients. PMID:18549129

Lachman, Vicki D



How patients make treatment choices.  


The medical field has undergone a quiet revolution during the past three decades. Patients have been brought into the treatment decision process as never before. Gone are the days when the patient was delivered the diagnosis and simply told how their disorder was to be treated. Rather, widespread use of shared decision making has changed the way that patients and their physicians interact. The development of best clinical practices from concepts of evidence-based medicine has shown that, for many disorders, the various treatment options result in near-equivalent outcomes. More recently, the democratization of medical information by the internet has made the patient a much better informed consumer, and thus a more active participant in his or her own care. PMID:18682718

Hellenthal, Nicholas; Ellison, Lars



Noma in an immunocompromised patient.  


Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery. PMID:24192747

Silva, Igor Henrique Morais; Faria, Andreza Barkokebas S de; Fonseca, Deborah Daniela Diniz; Aguiar, Carlos Menezes; Carvalho, Alessandra Tavares; Gueiros, Luiz Alcino; Leao, Jair Carneiro



Pericardial disease in renal patients.  


Pericardial disease is common in patients with renal disease. Approximately 20% of uremic patients requiring chronic dialysis develop uremic pericarditis or dialysis pericarditis. In all forms of uremic pericarditis, cardiac tamponade is the main danger. Pericardial contents are sterile unless secondarily infected. Differential diagnosis may be difficult, especially in mentally confused patients and because nonuremic intercurrent pericarditis of any cause is always possible. In uremic patients, frequent autonomic impairment and decreased cardiac adenylate cyclase limit heart rate increases during pericarditis, even during tamponade, so that the heart rate may be deceptively slow even with fever and hypotension. Adequate renal dialysis effectively ends uremic pericarditis. Several factors are associated with precipitating dialysis pericarditis and effusion, above all inadequate dialysis. Pericarditis in hepatorenal failure occurs at relatively low blood urea nitrogen levels and does not respond to dialysis. PMID:11172559

Gunukula, S R; Spodick, D H



Corneal temperature in schizophrenia patients.  


Most data imply that dopaminergic transmission is essential for proper hypothalamic-mediated core temperature regulation. Altered central dopaminergic transmission is suggested to be involved in the pathophysiology of schizophrenia. Thus, hypothetically, schizophrenia patients might be at increased risk of developing thermoregulatory dysregulation manifested by alterations in core temperature, as well as in peripheral tissue, the temperature of which has been shown to correlate with core temperature (e.g. cornea). Previous small pilot studies of ours showed that schizophrenia patients may exhibit corneal temperature abnormalities. Hence, we assessed corneal temperature in a controlled sample of drug-free ( n =11) and medicated ( n =28) schizophrenia patients compared to healthy comparison subjects ( n =9), using a FLIR thermal imaging camera. Drug-free schizophrenia patients exhibited significantly higher corneal temperature compared to healthy subjects, typical antipsychotic drug (APD)-treated patients ( n =16) and atypical APD-treated patients ( n =12) (37.08+/-1.46 degrees C vs. 33.37+/-2.51 degrees C, 31.08+/-1.43 degrees C and 31.67+/-0.44 degrees C respectively, p <0.0001; p <0.001 vs. each group separately). The healthy comparison subjects and the atypical APD-treated patients exhibited comparable corneal temperatures and these two groups exhibited higher corneal temperatures compared to the typical APD-treated patients ( p <0.01 and p =0.051 respectively). In conclusion, this study indicates that drug-free schizophrenia patients exhibit substantially higher corneal temperature compared to healthy comparison subjects or medicated patients, and that APDs may decrease corneal temperature either to normal (atypical APD) or to subnormal (typical APD) values. The relevance of these phenomena to the pathophysiology of schizophrenia, the biological mechanism underlying drug-induced corneal temperature alterations, the possible role of temperature-lowering drugs (neuroleptics or non-neuroleptics) on schizophrenic psychosis as well as the role of corneal temperature as a tool to evaluate adherence to APD treatment merit further investigation via larger samples of both medicated and drug-free schizophrenia patients compared to matched controlled subjects. PMID:15927092

Shiloh, Roni; Munitz, Hanan; Portuguese, Shirley; Gross-Isseroff, Ruth; Sigler, Mayanit; Bodinger, Liron; Katz, Nachum; Stryjer, Rafael; Hermesh, Haggai; Weizman, Abraham



Patient-centred tobacco management.  


Patient-centred tobacco management approaches tobacco smoking as a chronic disease and can be offered to all smokers irrespective of their attitude to quitting. Maintaining a long-term relationship with smokers enables the adoption of flexible solutions and shared goals. It is argued that patient-centred tobacco management potentially heightens the chances of eventual abstinence for smokers who are unable, or not yet ready to quit. PMID:24256210

Gould, Gillian S



Foldable Denture: For Microstomia Patient  

PubMed Central

Microstomia may result from surgical treatment of orofacial neoplasms, cleft lips, maxillofacial trauma, burns, radiotherapy, or scleroderma. A maximal oral opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. This clinical paper presents the prosthodontic management of a total edentulous patient with microstomia. Sectional mandibular and maxillary trays and foldable mandibular and maxillary denture were fabricated for the total edentulous patient. PMID:22957279

Kumar, Sandeep; Arora, Aman; Yadav, Reena



Patient Simulators Train Emergency Caregivers  

NASA Technical Reports Server (NTRS)

Johnson Space Center teamed up with Sarasota, Florida-based METI (now CAE Healthcare) through the STTR program to ruggedize the company’s patient simulators for training astronauts in microgravity environments. The design modifications were implemented in future patient simulators that are now used to train first responders in the US military as well as fire departments and other agencies that work in disaster zones.



Nutritional Considerations for Cancer Patients  

PubMed Central

Although weight loss is a frequent, though not invariable, component of the cancer syndrome, the associated malnutrition is a poor prognostic sign among both children and adults. This article describes the possible mechanisms of cancer cachexia; reviews the present state of nutritional support in cancer patients; identifies nutritional problems and workable approaches during the pre- and post-treatment periods; discusses the unconventional nutritional practices commonly encountered and lists resource materials for patients and families. PMID:21274086

Chen, Angela



[Oral management for cancer patients].  


Chemotherapy and radiotherapy administered to cancer patients can be harmful because of their effect on normal cells as well as cancer cells, and cause many adverse events. The oral cavity is one of the sites most vulnerable to the direct and indirect effects of cancer therapy. Severe adverse events of the oral cavity can not only reduce a patient's QOL, but also disrupt cancer treatment. We discuss the concept of oral management by maintenance of the oral environment. PMID:24335358

Kishimoto, Hiromitsu; Shudo, Atsushi



Psychiatric symptoms in vertiginous patients.  


Backgrounds: Psychiatric comorbidity is common in vertiginous patients. The risk of psychiatric disorder is increased in patients with previous mental problems, but earlier mentally healthy may develop symptoms as well. Especially in chronic phase of vertigo, psychological factors have a significant role in the morbidity. Aims: The aim of this study was to evaluate the prevalence of psychiatric problems in vertiginous patients in a community sample. Methods: A prospective evaluation of psychiatric symptoms based on self-rating scales [Beck Depression Inventory (BDI), Zung Anxiety Scale (SAS), DSM-IV and ICD-10 Personality Questionnaire (DIP-Q)] in a community sample of 100 vertiginous subjects in the Academic Tertiary Otolaryngology Department at the Helsinki University Hospital, Finland. Results: The prevalence of any psychiatric problem was 68% (68 patients); 19% had depressiveness and 12% symptoms of anxiety. Altogether 63 (63%) patients met the criteria of personality disorder. The most prevalent personality disorder was obsessive-compulsive (46 patients). Personality disorder alone seems not to affect functional capacity and is of importance only when comorbid with symptoms of anxiety and depression. The prevalence of psychiatric symptoms did not correlate with severity of vertigo symptoms or other co-occurring diseases. Conclusions: The prevalence of any psychiatric symptoms was high among vertiginous patients. In the chronic phase of vertigo, it seems that vertigo symptoms themselves do not influence on subjective feelings of debilitation. Psychiatric disorders worsen the clinical picture of vertigo along a more debilitating and disabling course. Psychiatric differential diagnoses should accompany the neuro-otology diagnostic procedure in patients with a chronic state of vertigo and greater disability. PMID:25394373

Ketola, Sirpa; Havia, Mari; Appelberg, Björn; Kentala, Erna



"My patients are the sickest".  


People with symptoms of the irritable bowel syndrome represent a broad spectrum with respect to severity of symptoms. Only a minority of them seek medical help and thereby become patients. The more severe are the symptoms that are experienced, the lower are the quality of life ratings, but patients will be more prone to participate in enquiries. This makes it very difficult to gain a representative picture of quality of life in irritable bowel syndrome. PMID:16607139

Müller-Lissner, Stefan



Laparoscopic Cholecystectomy in Cirrhotic Patients  

PubMed Central

Background and Objectives: Gallstones are twice as common in cirrhotic patients as in the general population. Although laparoscopic cholecystectomy (LC) has become the gold standard for symptomatic gallstones, cirrhosis has been considered an absolute or relative contraindication. Many authors have reported on the safety of LC in cirrhotic patients. We reviewed our patients retrospectively and assessed the safety of LC in cirrhotic patients at a tertiary care hospital in Pakistan. Methods: From January 2003 to December 2005, a retrospective study was conducted at SU IV, Liaquat University of Medical & Health Sciences Jamshoro. All the cirrhotic patients with Child-Pugh class A and B cirrhosis undergoing LC were included in the study. Cirrhosis was diagnosed based on clinical, biochemical, ultrasonography, and intraoperative findings of the nodular liver and histopathological study. Results: Of 250 patients undergoing laparoscopic cholecystectomy, 20 (12.5%) were cirrhotic. Of these 20, 12 (60%) were Childs group A and 8 (40%) were group B. Thirty percent were hepatitis B positive, and 70% were hepatitis C positive. Preoperative diagnosis of cirrhosis was possible in 80% of cases, and 20% were diagnosed during surgery. Morbidity rate was 15% and mortality rate was 0%. Two patients developed postoperative ascites, and mean hospital stay was 2.8±0.1 days. Of the 20 cases, 2 (10%) were converted to open cholecystectomy. The mean operation time was 70.2±32.54 minutes. Conclusion: Laparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in select patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the lower morbidity rate and reduced hospital stay. PMID:20202403

Muneer, Ambreen



OPSI threat in hematological patients.  


Overwhelming post-splenectomy infection (OPSI) is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flu-like syndrome to a fulminant, potentially fatal, sepsis. The risk of OPSI is higher in children and in patients with underlying benign or malignant hematological disorders. We retrospectively assessed OPSI magnitude in a high risk cohort of 162 adult splenectomized patients with malignant (19%) and non malignant (81%) hematological diseases, over a 25-year period: 59 of them splenectomized after immunization against encapsulated bacteria, and 103, splenectomized in the previous 12-year study, receiving only life-long oral penicillin prophylaxis. The influence of splenectomy on the immune system, as well as the incidence, diagnosis, risk factors, preventive measures and management of OPSI are also outlined. OPSI occurred in 7 patients (4%) with a median age of 37 years at time interval from splenectomy ranging from 10 days to 12 years. All OPSIs occurred in non immunized patients, except one fatal Staphylococcus aureus -mediated OPSI in a patient adequately immunized before splenectomy. Our analysis further provides evidence that OPSI is a lifelong risk and that current immune prophylaxis significantly decreases OPSI development. Improvement in patients' education about long-term risk of OPSI and increased physician awareness to face a potentially lethal medical emergency, according to the current surviving sepsis guidelines, represent mandatory strategies for preventing and managing OPSI appropriately. PMID:24251241

Serio, B; Pezzullo, L; Giudice, V; Fontana, R; Annunziata, S; Ferrara, I; Rosamilio, R; De Luca, C; Rocco, M; Montuori, N; Selleri, C



Difficult physician-patient relationships.  


Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system. PMID:10186308

Reifsteck, S W



[Addiction patients in emergency departments].  


Addiction patients in emergency departments are common assignments from the rescue services. Often there are recurring images of the same patient. Patients with acute intoxications are passed from the emergency services in different constitution to the emergency department. The challenge to the treating emergency team and the infrastructure is correspondingly high. Nevertheless, the emergency treatment should include a comprehensive initial somatic and later psychosomatic treatment regim in these patients, this treatment option should always be offered and discussed again and again. Furthermore patients who are admitted to the hospital on emergency wards because of general medical or surgical problems, have in up to 10 % of cases a problematic behaviour with respect to their alcohol consumption, but are "compensated" at the time of entry. It is thus appropriate for all emergency patients who need to be hospitalized to perform a screening for a problematic alcohol consumption. there are appropriate questionnaires that take little time and can also be performed on emergency rooms, but you have to remember! PMID:25257116

Nohl, Felix; Kohler, Hans-Peter



OPSI threat in hematological patients  

PubMed Central

Overwhelming post-splenectomy infection (OPSI) is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flu-like syndrome to a fulminant, potentially fatal, sepsis. The risk of OPSI is higher in children and in patients with underlying benign or malignant hematological disorders. We retrospectively assessed OPSI magnitude in a high risk cohort of 162 adult splenectomized patients with malignant (19%) and non malignant (81%) hematological diseases, over a 25-year period: 59 of them splenectomized after immunization against encapsulated bacteria, and 103, splenectomized in the previous 12-year study, receiving only life-long oral penicillin prophylaxis. The influence of splenectomy on the immune system, as well as the incidence, diagnosis, risk factors, preventive measures and management of OPSI are also outlined. OPSI occurred in 7 patients (4%) with a median age of 37 years at time interval from splenectomy ranging from 10 days to 12 years. All OPSIs occurred in non immunized patients, except one fatal Staphylococcus aureus -mediated OPSI in a patient adequately immunized before splenectomy. Our analysis further provides evidence that OPSI is a lifelong risk and that current immune prophylaxis significantly decreases OPSI development. Improvement in patients’ education about long-term risk of OPSI and increased physician awareness to face a potentially lethal medical emergency, according to the current surviving sepsis guidelines, represent mandatory strategies for preventing and managing OPSI appropriately. PMID:24251241

Serio, B; Pezzullo, L; Giudice, V; Fontana, R; Annunziata, S; Ferrara, I; Rosamilio, R; De Luca, C; Rocco, M; Montuori, N; Selleri, C


Organ Transplant Patients: Pet Safety Tips  


... Patients Infants and Young Children Publications & Materials Organ Transplant Patients Share Compartir Pet Safety Tips Patients who have received organ transplants are more likely than most people to get ...


42 CFR 412.606 - Patient assessments.  

Code of Federal Regulations, 2010 CFR

...inpatient rehabilitation facility patient assessment instrument specified...section as part of his or her patient assessment in accordance with the schedule described in § 412.610. IRFs must also complete a patient assessment instrument in...



42 CFR 412.606 - Patient assessments.  

Code of Federal Regulations, 2011 CFR

...inpatient rehabilitation facility patient assessment instrument specified...section as part of his or her patient assessment in accordance with the schedule described in § 412.610. IRFs must also complete a patient assessment instrument in...



Patient Safety: Guide to Safe Plastic Surgery  


... Information > Patient Safety Guide to Safe Plastic Surgery Patient Safety More Resources... Choose a surgeon you can trust ... can trust Find Your Surgeon Find Your Surgeon Patient Safety Radio Message Plastic surgery involves many choices. The ...


75 FR 30306 - Responding To Disruptive Patients  

Federal Register 2010, 2011, 2012, 2013

...jeopardize the health or safety of other patients, VA staff, or guests at...jeopardize the health or safety of patients or other individuals who...jeopardize the health or safety of other patients, VA staff, or guests...



75 FR 69881 - Responding to Disruptive Patients  

Federal Register 2010, 2011, 2012, 2013

...indicate[s] a total care for other patients [sic] safety, as well as the disruptive patient's safety.'' The commenter agreed that the...or could jeopardize the health or safety of other patients, VA staff, or guests at the...



Antimicrobial Dose in Obese Patient  

PubMed Central

Introduction Obesity is a chronic disease that has become one of major public health issue in Malaysia because of its association with other disease states including cardiovascular disease and diabetes. Despite continuous efforts to educate the public about the health risks associated with obesity, prevalence of the disease continues to increase. Dosing of many medications are based on weight, limited data are available on how antimicrobial agents should be dosed in obesity. The aim of this case presentation is to discuss dose of antibiotic in obese patient. Case report: Patient: GMN, Malay, Female, 45 year old, 150kg, transferred from medical ward to ICU with problems of fever, orthopnea, sepsis secondary to nosocomial pneumonia. She was admitted to hospital a week ago for SOB on exertion, cyanosis, mildly dyspneic, somasthenia, bilateral ankle swelling. There was no fever, cough, chest pain, clubbing, flapping tremor. Her grand father has pre-morbid history of obesity, HPT, DM and asthma. She was non alcoholic, smoker, and not on diet control. The diagnosis Pickwickian syndrome was made. Patient was treated with IV Dopamine 11mcg/kg/min, IV Morphine 4mg/h. IV GTN 15mcg/min, IV Ca gluconate 10g/24h for 3/7, IV Zantac 50mg tds, IV Augmentin 1.2g tds, IV Lasix 40mg od, IV Plasil 10mg tds, S.c heparin 5000IU bd. patient become stable and moved to medical ward to continue her treatment. Discussion: The altered physiologic function seen in obese patients is a concern in patients receiving antimicrobial agents because therapeutic outcomes depend on achieving a minimum inhibitory concentration (MIC). The therapeutic effect of any drug can be altered when any of the 4 pharmacokinetic processes (absorption, distribution, metabolism, or elimination) are altered. Decreased blood flow rates and increased renal clearance in obese patients can affect drug distribution and elimination. Changes in serum protein levels can change the metabolism and distribution of drugs that are highly protein bound; the effects of these physiologic differences should be considered when administrating antimicrobial agents in obese patients. Conclusion: Generally this patient was moderately well managed in view of inappropriate combination of antibiotic, duplication or unnecessary use of antibiotic for treatment of sepsis, more clinical studies are needed to determine antibiotic dose in obese patient.

Kassab, Sawsan; Syed Sulaiman, Syed Azhar; Abdul Aziz, Noorizan




E-print Network

TITLE: AUTHORIZATION TO DISCLOSE PATIENT INFORMATION PATIENT ACCESS ­ USE AND DISCLOSURE OF MEDICAL, an insurance company, to the patient or any other party as authorized by the patient. Protected Health to a patient; to researchers as authorized by the patient or an IRB approval; as required by law

Columbia University


Reducing patient suffering through compassionate connected care.  


Patient experience continues to play an increasingly critical role in quality outcomes and reimbursement. Nurse executives are tasked with helping direct-care nurses connect with patients to improve care experiences. Connecting with patients in compassionate ways to alleviate inherent patient suffering and prevent avoidable suffering is key to improving the patient experience. The Compassionate Connected Care framework identifies strategies for meeting the challenges of connecting with patients and reducing suffering. Methods integrate clinical, operational, cultural, and behavioral aspects of care to target patient needs based on condition. Caregivers learn to better express empathy and compassion to patients, and nurse leaders are better equipped to engage nurses at the bedside. PMID:25208270

Dempsey, Christina; Wojciechowski, Sharyl; McConville, Elizabeth; Drain, Maxwell



Immunoregulation in pancreatic cancer patients.  


Metastatic pancreatic cancer is one of the most aggressive cancer known in man yet specific antitumor immunity has been demonstrated in lymph nodes draining the sites of pancreatic tumors. Despite this immunity, pancreatic cancer patients suffer a quick demise. To further define tumor immunity in patients with metastatic pancreatic cancer, we sought to characterize helper T cell subsets, serum cytokines, cellular cytotoxicity that is both T-cell and non-T cell mediated, as well as known tumor-derived immunosuppressive products that may be present in their peripheral blood. Significantly heightened levels of interleukin 2 (IL-2), a Th1 cytokine, were found in patients before treatment with chemotherapy while serum IL-10, a Th2 cytokine, were at significantly lower levels than observed in normal donors tested between their fifth and seventh decades of life. IL-10 levels increased progressively with age as a serum-bound protein in normal, healthy donors tested between the ages of 24 through 61. An age associated progression of increased IL-10 levels was not observed in pancreatic cancer patients. Few patients had detectable serum levels of soluble fas ligand but approximately half had elevated levels of a tumor marker, detected with the CA-15.3 assay, known as soluble MUCIN 1 (MUC1). Cell mediated cytotoxicity including T-cell mediated killing of pancreatic tumor cell lines was detected in many patients. These data suggest that pancreatic cancer patients have activated type 1 helper T cells that can support development of cell-mediated immunity, and that their sera contain lowered levels of the "anti-inflammatory" type 2 cytokine, IL-10. PMID:10478644

Plate, J M; Shott, S; Harris, J E



Managing diabetes in dialysis patients.  


Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with dietitians and podiatrists. PMID:22282737

O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A



The Patient Health Questionnaire-9: Validation among Patients with Glaucoma  

PubMed Central

Background Depression and anxiety are two common normal responses to a chronic disease such as glaucoma. This study analysed the measurement properties of the depression screening instrument - Patient Health Questionnaire-9 (PHQ-9) using Rasch analysis to determine if it can be used as a measure. Methods In this hospital-based cross-sectional study, the PHQ-9 was administered to primary glaucoma adults attending a glaucoma clinic of a tertiary eye care centre, South India. All patients underwent a comprehensive clinical evaluation. Patient demographics and sub-type of glaucoma were abstracted from the medical record. Rasch analysis was used to investigate the following properties of the PHQ-9: behaviour of the response categories, measurement precision (assessed using person separation reliability, PSR; minimum recommended value 0.80), unidimensionality (assessed using item fit [0.7–1.3] and principal components analysis of residuals), and targeting. Results 198 patients (mean age ± standard deviation ?=?59.83±12.34 years; 67% male) were included. The native PHQ-9 did not fit the Rasch model. The response categories showed disordered thresholds which became ordered after category reorganization. Measurement precision was below acceptable limits (0.62) and targeting was sub-optimal (?1.27 logits). Four items misfit that were deleted iteratively following which a set of five items fit the Rasch model. However measurement precision failed to improve and targeting worsened further (?1.62 logits). Conclusions The PHQ-9, in its present form, provides suboptimal assessment of depression in patients with glaucoma in India. Therefore, there is a need to develop a new depression instrument for our glaucoma population. A superior strategy would be to use the item bank for depression but this will also need to be validated in glaucoma patients before deciding its utility. PMID:24999659

Gothwal, Vijaya K.; Bagga, Deepak K.; Bharani, Seelam; Sumalini, Rebecca; Reddy, Shailaja P.



Probiotics in critically ill patients.  


Severe sepsis with associated multisystem organ dysfunction is a leading cause of death in patients hospitalized in intensive care units. The gastrointestinal system plays a key role in the pathogenesis of multisystem organ dysfunction owing to a breakdown of intestinal barrier function and increased translocation of bacteria and bacterial components into the systemic circulation. During critical illness, alterations occur in gut microflora owing to several factors, including changes in circulating stress hormones, gut ischemia, immunosuppression, the use of antibiotics, and lack of nutrients. The importance of endogenous strains of probiotic bacteria such as Bifidobacterium and Lactobacillus in maintaining intestinal barrier function and also in modulating mucosal and systemic immune responses is becoming evident from numerous studies. Bacteria in synbiotic (prebiotic and probiotic combinations) and probiotic (mutistrain combinations) preparations are being used experimentally in the treatment of acute pancreatitis, liver transplantation, and in trauma patients. Recent studies have shown treatment of patients with multiple trauma or acute pancreatitis with synbiotic preparations resulted in reduced rates of infection, sepsis, and mortality in patients. Enterally fed patients in the intensive care unit treated with a probiotic compound demonstrated enhanced immune function and decreased incidence of diarrhea. Results from these clinical trials are encouraging, and warrant further investigation to clarify which probiotic bacterial strains are of most benefit to this population. PMID:18806700

Madsen, Karen



Bedside Evaluation of Dizzy Patients  

PubMed Central

In recent decades there has been marked progress in the imaging and laboratory evaluation of dizzy patients. However, detailed history taking and comprehensive bedside neurotological evaluation remain crucial for a diagnosis of dizziness. Bedside neurotological evaluation should include examinations for ocular alignment, spontaneous and gaze-evoked nystagmus, the vestibulo-ocular reflex, saccades, smooth pursuit, and balance. In patients with acute spontaneous vertigo, negative head impulse test, direction-changing nystagmus, and skew deviation mostly indicate central vestibular disorders. In contrast, patients with unilateral peripheral deafferentation invariably have a positive head impulse test and mixed horizontal-torsional nystagmus beating away from the lesion side. Since suppression by visual fixation is the rule in peripheral nystagmus and is frequent even in central nystagmus, removal of visual fixation using Frenzel glasses is required for the proper evaluation of central as well as peripheral nystagmus. Head-shaking, cranial vibration, hyperventilation, pressure to the external auditory canal, and loud sounds may disclose underlying vestibular dysfunction by inducing nystagmus or modulating the spontaneous nystagmus. In patients with positional vertigo, the diagnosis can be made by determining patterns of the nystagmus induced during various positional maneuvers that include straight head hanging, the Dix-Hallpike maneuver, supine head roll, and head turning and bending while sitting. Abnormal smooth pursuit and saccades, and severe imbalance also indicate central pathologies. Physicians should be familiar with bedside neurotological examinations and be aware of the clinical implications of the findings when evaluating dizzy patients. PMID:24285961

Huh, Young-Eun



Patient perspectives on radiation dose.  


People with genetic cancer syndromes have a special interest in imaging. They also have special risk factors with respect to radiation. They need to utilize the potential of imaging while keeping in mind concerns about cumulative radiation exposure. Before imaging, early detection of problems was limited. With imaging, issues can be identified when they are small and a good plan of action can be developed early. Operations can be planned and metastatic cancer avoided. The positive contribution of imaging to the care of these patients can be profound. However, this additional surveillance is not without cost. An average patient with 1 of these syndromes will undergo 100 or more scans in their lifetime. Imaging professionals should be able to describe the risks and benefits of each scan in terms that the patient and the ordering physician can understand to make smart decisions about the ordering of scans. Why CT versus MRI? When are x-ray or ultrasound appropriate, and when are they not? What are the costs and the medical risks for the patient? What value does this picture add for the physician? Is there a way to answer the medical question with a test other than a scan? Medicine is a team sport, and the patient is an integral member of the team. PMID:24589397

Graff, Joyce



Chromosome analysis of 894 patients.  


Metaphase chromosome analysis from cultured blood lymphocytes was performed in 894 consecutive patients from the year 1981 to early 1989. G-bands by trypsin using Giemsa (GTG) was routinely employed during the last five years supplemented with other banding techniques if required. High resolution chromosome banding was performed in cases suspected of structural chromosome abnormality. Successful studies were obtained in 862 (96.4%). Out of the successful cases, 232 (26.9%) had informative results, and 193 (22.4%) had chromosome abnormalities. Down's syndrome was found in 110 cases. Edwards' and Patau's syndromes were found in 4 and 7 cases respectively. A case of trisomy 14 mosaic was found. There were 2 cases of trisomy 22 syndrome, one case with 46,XX/47,XX,+mar(22) and another case with 46,XX/47,XX,+r(22) karyotype. There were 39 cases of sex chromosome abnormalities, 27 of which had Turner's syndrome. Kline-felter syndrome was found in 8 patients. Triple X syndrome and true hermaphrodite (46,XX/46,XY) was each found in one case. Autosomal deletions were found in 19 patients. Autosomal duplications were found in 4 patients, and autosomal translocations were found in 10 patients. Some of these autosomal structural abnormal cases have been included in the chromosomal syndromes mentioned above. PMID:1861129

Panich, V; Jinorose, U



PATIENT RIGHTS AND RESPONSIBILITIES As a patient you have the right to: As a patient you have the responsibility to  

E-print Network

PATIENT RIGHTS AND RESPONSIBILITIES As a patient you have the right to: As a patient you have appointment time. Give at least 24 hours notice to cancel an appointment. Treat the staff and other patients with respect, consideration and dignity. Follow all Texas State rules and regulations pertaining to safety

Long, Nicholas


[Pulmonary toxoplasmosis in immunosuppressed patient].  


Pulmonary toxoplasmosis occurs mainly in immunosuppressed patients and its diagnosis mainly relies upon biological confirmation of the parasite. We present the case of a 47 years patient in medullar aplasia after induction chemotherapy for acute lymphoblastic leukemia that developed pulmonary infiltrates of parasitic origin. The diagnosis of pulmonary toxoplasmosis was established after identification of the parasite in brochioloalveolar lavage fluid (BAL) and peripheral blood. Serological tests are of limited utility in immunosuppressed patients. We used classical methods for the diagnosis of parasitosis but they are being replaced by molecular methods. Polymerase Chain Reaction (PCR) allows a highly specific and sensitive diagnosis on any sample but it cannot be performed in any center. PMID:23077869

Rîp?, Carmen; Cojocaru, Ingrid; Luca, Mariana; Luca, C?t?lina Mihaela; Leon, Maria; Bahnea, Roxana-Gabriela



Cancer Patients Versus Cancer Survivors  

PubMed Central

Two studies examined the social and emotional implications of different linguistic classifications of individuals with cancer. Undergraduates were randomly assigned to rate their reactions to either cancer patients or cancer survivors. Across studies, participants held more favorable perceptions of the character of cancer survivors relative to cancer patients and displayed more positive attitudes toward the former group. In addition, participants in Study 1 reported greater willingness to interact with cancer survivors compared with cancer patients. Positive perceptions of prognosis did not appear to account for favorable attitudes toward cancer survivors; most participants in Study 2 did not assume that cancer survivors were beyond the treatment phase of their illness or cured of their disease. Findings point to a potentially powerful effect of word choice on reactions to individuals with cancer. PMID:24371366

Mosher, Catherine E.; Danoff-Burg, Sharon



Investigating patient-centered care.  


This issue provides many articles reporting on research pertinent to patient-centered care, with great richness in the variety of methods and settings. Topics include disparities in the availability of care and the type of care provided (including a randomized trial), effecting elective hospitalizations on future patient satisfaction, the effect of the specific content of the after visit summary, 2 articles related to aspects of shared decision making, 2 articles considering the effects of practice culture, plus a report on divergent views on how to integrate behavioral and primary health care. Differences between academic and nonacademic family medicine practice are finally documented, with important dissimilarities in patient-centered care. Family physicians are highly involved with dementia care. An exciting report documents a high negative predictive value for a new genomic expression test for coronary artery disease in family medicine that uses combinations of gene expression instead of individual gene testing. PMID:24610178

Bowman, Marjorie A; Neale, Anne Victoria



The diabetic patient in Ramadan.  


During the month of Ramadan, all healthy, adult Muslims are required to fast from dawn to sunset. Fasting during Ramadan involves abstaining from food, water, beverages, smoking, oral drugs, and sexual intercourse. Although the Quran exempts chronically ill from fasting, many Muslims with diabetes still fast during Ramadan. Patients with diabetes who fast during the month of Ramadan can have acute complications. The risk of complications in fasting individuals with diabetes increases with longer periods of fasting. All patients with diabetes who wish to fast during Ramadan should be prepared by undergoing a medical assessment and engaging in a structured education program to undertake the fast as safely as possible. Although some guidelines do exist, there is an overwhelming need for better designed clinical trials which could provide us with evidence-based information and guidance in the management of patients with diabetes fasting Ramadan. PMID:24761380

Chamsi-Pasha, Hassan; Aljabri, Khalid S



Seizure Treatment in Transplant Patients  

PubMed Central

Opinion statement Solid organ transplantation is frequently complicated by a spectrum of seizure types, including single partial-onset or generalized tonic-clonic seizures, acute repetitive seizures or status epilepticus, and sometimes the evolution of symptomatic epilepsy. There is currently no specific evidence involving the transplant patient population to guide the selection, administration, or duration of antiepileptic drug (AED) therapy, so familiarity with clinical AED pharmacology and application of sound judgment are necessary for successful patient outcomes. An initial detailed search for symptomatic seizure etiologies, including metabolic, infectious, cerebrovascular, and calcineurin inhibitor treatment-related neuro-toxic complications such as posterior reversible encephalopathy syndrome (PRES), is imperative, as underlying central nervous system disorders may impose additional serious risks to cerebral or general health if not promptly detected and appropriately treated. The mainstay for post-transplant seizure management is AED therapy directed toward the suspected seizure type. Unfavorable drug interactions could place the transplanted organ at risk, so choosing an AED with limited interaction potential is also crucial. When the transplanted organ is dysfunctional or vulnerable to rejection, AEDs without substantial hepatic metabolism are favored in post-liver transplant patients, whereas after renal transplantation, AEDs with predominantly renal elimination may require dosage adjustment to prevent adverse effects. Levetiracetam, gabapentin, pregabalin, and lacosamide are drugs of choice for treatment of partial-onset seizures in post-transplant patients given their efficacy spectrum, generally excellent tolerability, and lack of drug interaction potential. Levetiracetam is the drug of choice for primary generalized seizures in post-transplant patients. When intravenous drugs are necessary for acute seizure management, benzodiazepines and fosphenytoin are the traditional and best evidence-based options, although intravenous levetiracetam, valproate, and lacosamide are emerging options. Availability of several newer AEDs has greatly expanded the therapeutic armamentarium for safe and efficacious treatment of post-transplant seizures, but future prospective clinical trials and pharmacokinetic studies within this specific patient population are needed. PMID:22660960

Shepard, Paul W.



[Hilarein, a patient education game for kidney transplant patients].  


At Nice university hospital, an educational board game has been designed by the kidney transplant team for patients suffering from kidney failure. Hilarein is a tool to support therapeutic education which demonstrates that it is possible to learn while having fun. PMID:23593797

Césarini, Carole; Callens, Cécile



Managing complications in cirrhotic patients  

PubMed Central

Liver cirrhosis is a serious and potentially life-threatening condition. This life-threatening condition usually arises from complications of cirrhosis. While variceal bleeding is the most acute and probably best studied, several other complications of liver cirrhosis are more insidious in their onset but nevertheless more important for the long-term management and outcome of these patients. This review summarizes the topics discussed during the UEG-EASL Hepatology postgraduate course of the United European Gastroenterology Week 2013 and discusses emergency surgical conditions in cirrhotic patients, the management of hepatic encephalopathy, ascites and hepatorenal syndrome, coagulation disorders, and liver cancer. PMID:25653862

Angeli, Paolo; Cordoba, Juan; Farges, Oliver; Valla, Dominique



Space Technology for Patient Monitoring  

NASA Technical Reports Server (NTRS)

A contract for the development of an astronaut monitoring system in the early days of the space program provided Mennen Medical, Inc. with a foundation in telemetry that led to the development of a computerized medical electronic system used by hospitals. Mennen was the first company to adopt solid state design in patient monitoring and to offer multipatient telemetry monitoring. Telemetry converts instrument data to electrical signals and relays them to a remote receiver where they are displayed. From a central station, a nurse can monitor several patients. Company products include VISTA systems and Horizon 2000 Monitor.



Nonfearful Panic Disorder in Chest Pain Patients  

Microsoft Academic Search

The prevalence of nonfearful panic disorder (panic attacks without the experience of fear) was estimated in 199 patients consecutively referred to outpatient cardiac investigation for chest pain. Fifty-nine patients met the criteria for panic disorder, and 17 patients fulfilled the criteria for nonfearful panic disorder. The patients with nonfearful panic disorder had lower scores on self- reported panic symptoms and




Breaking bad news to patients with cancer.  


For the patient with cancer, bad news can occur several times between diagnosis and death. Patients expect honesty from professionals. Patients may choose to face up to bad news or actively deny what is happening. Nurses need to be able to deal with the patient's emotional response to bad news. PMID:8718375

Morton, R



Family Support and the Cancer Patient.  

ERIC Educational Resources Information Center

Research has shown that social support is psychologically beneficial to cancer patients, with support from families being especially important. A survey of the social support needs of 407 cancer patients and an in-depth interview study of 55 of those patients were conducted to examine issues concerning family support and cancer patients. Results…

Dakof, Gayle A.; And Others


Hypnotherapy in radiotherapy patients: A randomized trial  

Microsoft Academic Search

Purpose: To determine whether hypnotherapy reduces anxiety and improves the quality of life in cancer patients undergoing curative radiotherapy (RT). Methods and materials: After providing written informed consent, 69 patients were randomized between standard curative RT alone (36 controls) and RT plus hypnotherapy (33 patients). Patients in the hypnotherapy group received hypnotherapy at the intake, before RT simulation, before the

Lukas J. A.. Stalpers; Hanna C. da Costa; Merijn A. E. Merbis; Andries A. Fortuin; Martin J. Muller



Ozone Therapy in Patients with Retinitis Pigmentosa  

Microsoft Academic Search

The aim of this study is to determine the efficacy of ozone therapy in patients with Retinitis Pigmentosa (RP). A controlled, randomized, double blind clinical trial involving 68 patients was performed. Patients were divided into 2 groups: ozone, patients treated with ozone by rectal administration (dose=10?mg), during 15 sessions; control, as ozone group, but using oxygen. The main outcome variable

Mirtha Copello; Frank Eguía; Silvia Menéndez; Niusdalys Menéndez



Thallium-201 stress imaging in hypertensive patients  

SciTech Connect

To assess the potential effect of hypertension on the results of thallium-201 stress imaging in patients with chest pain, 272 thallium-201 stress tests performed in 133 hypertensive patients and 139 normotensive patients over a 1-year period were reviewed. Normotensive and hypertensive patients were similar in age, gender distribution, prevalence of cardiac risk factors (tobacco smoking, hyperlipidemia, and diabetes mellitus), medications, and clinical symptoms of coronary disease. Electrocardiographic criteria for left ventricular hypertrophy were present in 16 hypertensive patients. Stepwise probability analysis was used to determine the likelihood of coronary artery disease for each patient. In patients with mid to high likelihood of coronary disease (greater than 25% probability), abnormal thallium-201 stress images were present in 54 of 60 (90%) hypertensive patients compared with 51 of 64 (80%) normotensive patients. However, in 73 patients with a low likelihood of coronary disease (less than or equal to 25% probability), abnormal thallium-201 stress images were present in 21 patients (29%) of the hypertensive group compared with only 5 of 75 (7%) of the normotensive patients (p less than 0.001). These findings suggest that in patients with a mid to high likelihood of coronary artery disease, coexistent hypertension does not affect the results of thallium-201 exercise stress testing. However, in patients with a low likelihood of coronary artery disease, abnormal thallium-201 stress images are obtained more frequently in hypertensive patients than in normotensive patients.

Schulman, D.S.; Francis, C.K.; Black, H.R.; Wackers, F.J.



2014 Hospital National Patient Safety Goals  

E-print Network

2014 Hospital National Patient Safety Goals The purpose of the National Patient Safety Goals is to improve patient safety. The goals focus on problems in health care safety and how to solve them communication NPSG.02.03.01 Identify patient safety risks NPSG.15.01.01 Prevent mistakes in surgery UP.01

Finley Jr., Russell L.


Do Goals Set on Rounds Match Patient  

E-print Network

and patient safety (Pronovost et al., 2003). Patient care goals (PCG) are determined on rounds then executed Program for the Advancement of Patient Care Quality and Safety · DGS continue to serve as an effectiveDo Goals Set on Rounds Match Patient Care Interventions in a Surgical ICU? For the last 14 years

Connor, Ed


Patient Care Planning: An Interdisciplinary Approach  

PubMed Central

The INFORMM Patient Care Planning System provides interdepartmental communication and individualized patient care plans based upon current standards of care. This interdisciplinary system facilitates the identification of patient problems and nursing diagnoses as well as patient care orders. The selected nurses' and physicians' orders are integrated and organized by care plan categories in printouts. As a system by-product, Patient Care Planning automatically generates and calculates patient acuity which can be reviewed immediately online. After the patient's discharge, nursing critical data are retained online to permit an update at the time of a subsequent patient admission. Both key entry and light pen selection options are available to the users. User personnel maintain the system database and tailor screen content to suit the needs of each patient care unit or patient population.

Prophet, Colleen M.



Prediction on Cold Chain Logistics Demand of Urban Residents in Jiangsu Province during the Twelfth Five-Year Plan Period: Based on Estimates of GM (1,1) Model  

Microsoft Academic Search

This paper takes the total yield of products that need refrigerated transport as the impact factors of transport aggregate of cold chain logistics, such as meat, aquatic products, quick-frozen noodle, fruits, vegetables, dairy, and medicine. Through selecting the consumption data of urban residents on transported products via cold chain in Jiangsu Province from 2005 to 2000 as sample, this paper

Yan-min Zheng; Yan-cai Zhang; Hong-feng Xu



Countering the stereotype of the unpopular patient.  


Labelling theory and Stockwell's seminal work on the unpopular patient can help inform nurses' interactions with patients in the modern healthcare system. Today, older patients might be deemed unpopular because of their perceived personality, attitudes or communication, and because their needs fit poorly with the service available to them. These, and other factors, such as staffing levels, length of hospital stays, and patients' expectations as consumers, help to influence what defines an unpopular patient. PMID:23901458

Price, Bob



Improving patient flow in the emergency department.  


To improve patient flow in the ED, hospitals should: Establish a measure of patient demand by hour, and design a system to handle it. Appropriately capacitate triage processes and systems. Use a system for patient segmentation and establish distinct processes for different patient segments. Consider using team triage, and examine current triage protocols. Devise a method of tracking patients and results. Field a willing staff with a burning platform. PMID:18990843

Jensen, Kirk; Crane, Jody



Patient Expectations from Consultation with Family Physician  

PubMed Central

Aim To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. Method We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped patients completed a questionnaire about their expectations before and after the consultation. Patient assessment of expected and obtained psychosocial support and biomedical information during the consultation with physician were compared. Two investigators independently assessed patient involvement in the consultation process on the basis of videotaped consultations, using a 5-point scale. Results Receiving an explanation of biomedical information and discussing psychosocial aspects was assessed as important by 57.4-66.8% and 17.8-36.1% patients, respectively. The physicians did not meet patient expectations in the case of three biomedical aspects of consultation: cause of symptoms, severity of symptoms, and test results. Younger patients evaluated the importance of discussing psychological problems higher than older patients. The involvement of the patients was high in the problem defining process, in the physicians' overall responsiveness to the patients, and in their picking up of the patient's cues. The patients were involved less in the decision making process. Conclusion Discussing biomedical issues was more important for the patients than discussing psychological issues. The patients wanted to hear more about the cause and seriousness of their symptoms and about test results. The family physicians provided more psychosocial care than the patients had expected. Considering high patient involvement in the consultation process and the overall responsiveness of the family physicians to the patients during the consultation, Estonian physicians provide patient-centered consultations. PMID:16489708

Tähep?ld, Heli; van den Brink-Muinen, Atie; Maaroos, Heidi-Ingrid



Wounds in patients with HIV.  


Highly active antiretroviral therapy has dramatically reduced morbidity and mortality among patients who are HIV-positive. A retrospective review of the authors' data separated subjects into cohorts based on HIV status and matched them for age and gender. The authors' data reveal a higher fraction of venous ulcers compared with a lower fraction of pressure ulcers in the seropositive population. PMID:25133341

McMeeking, Alexander; Kim, In; Ross, Frank; Ayello, Elizabeth A; Brem, Harold; Linton, Patrick; O'Neill, Daniel K



Social Work Patient & Family Services  

E-print Network

Social Work and Patient & Family Services 601 Elmwood Avenue RM. 1-1450 P. O. Box 650 Rochester, NY Social Work office lo- cated? The Social Work office is located on the first floor of Strong Memorial Hospital, Rm. 1-1450 How do I get in touch with a social worker? The social work department is open Monday

Goldman, Steven A.


JAMA Patient Page: Premature Infants  


... Kennedy Shriver National Institute of Child Health and Human Development • Nemours Foundation’s Center for ... Kennedy Shriver National Institute of Child Health and Human Development, Nemours Foundation (KidsHealth) The JAMA Patient Page is ...


Patient perspectives of telemedicine quality  

PubMed Central

Background The purpose of this study was to explore the quality attributes required for effective telemedicine encounters from the perspective of the patient. Methods We used a multi-method (direct observation, focus groups, survey) field study to collect data from patients who had experienced telemedicine encounters. Multi-perspectives (researcher and provider) were used to interpret a rich set of data from both a research and practice perspective. Results The result of this field study is a taxonomy of quality attributes for telemedicine service encounters that prioritizes the attributes from the patient perspective. We identify opportunities to control the level of quality for each attribute (ie, who is responsible for control of each attribute and when control can be exerted in relation to the encounter process). This analysis reveals that many quality attributes are in the hands of various stakeholders, and all attributes can be addressed proactively to some degree before the encounter begins. Conclusion Identification of the quality attributes important to a telemedicine encounter from a patient perspective enables one to better design telemedicine encounters. This preliminary work not only identifies such attributes, but also ascertains who is best able to address quality issues prior to an encounter. For practitioners, explicit representation of the quality attributes of technology-based systems and processes and insight on controlling key attributes are essential to implementation, utilization, management, and common understanding. PMID:25565781

LeRouge, Cynthia M; Garfield, Monica J; Hevner, Alan R



Spouses of Patients with Dementia  

Microsoft Academic Search

Caregiver spouses struggle to cope with the multiple demands of caregiving and complexities of medical care. In this article, the emotional, marital, attachment, and spiritual aspects of spousal caregiving for patients with dementia are addressed. This paper explores what keeps spouses together during this devastating illness. The literature has been reviewed to identify value systems that enable spouses to continue

Sheila Loboprabhu; Victor Molinari; Kimberly Arlinghaus; Ellen Barr; James Lomax



Home Care for Cancer Patients  


... be given by authorized agencies. Contact the insurance company to see which services are covered. Many national organizations, such as the American Cancer Society (ACS), offer services to cancer patients and their families. Services vary among ACS chapters; however, many of ...


Hypocitraturia in patients with urolithiasis.  

PubMed Central

The urinary citrate/creatinine ratio was evaluated in 25 children with idiopathic calcium urolithiasis and 24 controls. The mean (SD) urinary citrate/creatinine ratio in controls and patients was 0.510 (0.205) and 0.181 (0.076), respectively, a statistically significant difference. In neither group was there a relation between age and urinary citrate excretion. PMID:8669940

Akçay, T; Konuko?lu, D; Celik, C



JAMA Patient Page: Retinal Detachment  


JAMA PATIENT PAGE Retinal Detachment CROSS SECTION V I T R E O U S Optic nerve Retinal vessel Pupil Iris Lens Cornea Retina (detached) ... the nerve connecting the eye to the brain). Retinal detachment is the separation of the retina from the ...


Smoking among morbidly obese patients  

Microsoft Academic Search

BACKGROUND: Smokers usually have a lower Body Mass Index (BMI) when compared to non-smokers. Such a relationship, however, has not been fully studied in obese and morbidly obese patients. The objective of this study was to evaluate the relationship between smoking and BMI among obese and morbidly obese subjects. METHODS: In a case-control study design, 1022 individuals of both genders,

Raquel Chatkin; Claudio C Mottin; José M Chatkin



IU Health Physicians Patient Education  

E-print Network

educational materials EXCLUSION--No exclusion Informed Consent: Study shows better informed consent following recall of complications, risks and other components of informed consent. Greater recall was equated to a more "informed' informed consent. Improved Outcomes: Informed patients are more likely to be compliant

Zhou, Yaoqi


Patient Advocate Steering Committee Roster

Patient Advocate Steering Committee Roster Co-chairs Elizabeth FrankBreast Cancer Steering CommitteeDana Farber Cancer InstituteBoston, MA Karl SchwartzLymphoma Steering CommitteeRiegelsville, PA Members Jack AielloMyeloma Steering CommitteeSan Jose,


Capsule endoscopy in pediatric patients  

PubMed Central

Wireless capsule endoscope (WCE) for the investigation of the small bowel is an approved technique both in adults and children (more than 10 years old). The present review provides data on the indications, diagnostic yield, adverse events and limitations of the WCE technique in children and tries to predict the future of WCE usage in this population of patients. PMID:18636660

Shamir, Raanan; Eliakim, Rami



Setting priorities for patient safety  

Microsoft Academic Search

Background: Current “flags” for adverse events (AEs) are biased towards those with serious outcomes, potentially leading to failure to address mundane common problems.Aim: To provide a basis for setting priorities to improve patient safety by ranking adverse events by resource consumption as well as by outcome. This was done by classifying a set of AEs, according to how they may

W B Runciman; M J Edmonds; M Pradhan



Information technology for patient safety  

Microsoft Academic Search

BackgroundResearch on patient care has identified substantial variations in the quality and safety of healthcare and the considerable risks of iatrogenic harm as significant issues. These failings contribute to the high rates of potentially avoidable morbidity and mortality and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in

Christopher Huckvale; Josip Car; Masanori Akiyama; Safurah Jaafar; Tawfik Khoja; Ammar Bin Khalid; Aziz Sheikh; Azeem Majeed



JAMA Patient Page: Caregiver Support  


Copyright 2014 American Medical Association. All rights reserved. JAMA PATIENT PAGE| Geriatrics/Aging Caregiver Support As the number of elderly people in the United States continues to grow, more and more individuals will need full-time caregivers at home. The Problem of Caregiver Burden Being a primary ...


[Enteral nutrition in cancer patients].  


The significance of nutritional management in patients with malignant tumors is under-recognized due to the lack of clear evidence of a direct link with survival rate. However, for cancer patients, with markedly reduced food intake continuing for?7 days or intake of under 60% of estimated energy expenditure for?10 days, as referred to in the European Society for Clinical Nutrition and Metabolism, rapid implementation of nutritional support constitutes a clinically appropriate intervention. With regard to route of administration, as with other conditions, enteral nutritional management is recommended if the gastrointestinal tract is available. The utility of enteral immunonutrition formulae containing eicosapentaenoic acid and other forms of nutritional management has also recently been reported and further studies are anticipated. However, the principles of nutritional management for cancer patients comprise not simply weight increase or improvement in nutritional markers but the maintenance of patient QOL in ways that include alleviation of symptoms and antitumor therapy side-effects, and decreased risk of infection. Administration routes such as percutaneous endoscopic gastrostomy should therefore also be discussed from this perspective. PMID:25335700

Suzuki, Yutaka



Outcomes, preferences for resuscitation, and physician-patient communication among patients with metastatic colorectal cancer  

Microsoft Academic Search

Purpose: To describe characteristics, outcomes, and decision making in patients with colorectal cancer metastatic to the liver, and to examine the relationship of doctor-patient communication with patient understanding of prognosis and physician understanding of patients’ treatment preferences.Patients and Methods: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was a prospective cohort study conducted at

Paul Haidet; Mary Beth Hamel; Roger B Davis; Neil Wenger; Douglas Reding; Peter S Kussin; Alfred F Connors; Joanne Lynn; Russell S Phillips



Patient and GP characteristics associated with antidepressant treatment in depressed patients: a multilevel analysis  

Microsoft Academic Search

Background: Antidepressants are frequently prescribed drugs in Dutch general practice, but patients differ in the treatment they receive. Both patient and GP characteristics may explain this difference. Objectives: To identify patient and GP characteristics associated with antidepressant treatment in depressed patients. Methods: Routinely collected general practice registration data (including a morbidity registration ) and a patient census both derived from

L. van Dijk; A. Volkers; D. de Bakker



Peutz-Jeghers syndrome: a patient’s view  

Microsoft Academic Search

Life with Peutz-Jeghers syndrome (PJS) is complex and demanding, affecting not only the patients, but also their family members,\\u000a loved ones, and clinicians. In general, clinicians and researchers have defined the syndrome. Now, in addition, people with\\u000a PJS and their caregivers use the Internet for medical research and to find others with whom to share information and support.\\u000a An online

Stephanie Sugars


Creating an anticoagulant patient education class.  


A patient education workgroup was developed on a progressive care medical/vascular surgical unit. The workgroup identified patient education needs regarding discharge education for postsurgical patients and those discharging with oral anticoagulants (OAC). Staff surveys aided the workgroup in identifying a need for additional discharge education for patients and families. After various methods of patient education were explored, it was determined the workgroup could best meet the needs of the patient population through a class format providing group discussion and interaction. Logistical details and class formatting were configured to meet both the needs of the patients and the nursing staff. Current institutional patient education pamphlets were used to develop the content for the class. Physician review and input were obtained during the development of the content. A patient education specialist was also consulted to ensure proper literacy levels were used. To meet the Joint Commission National Patient Safety Goal regarding anticoagulant safety, the content focused on home management, which included the following: knowledge of INR goal range, dietary factors, when to call the provider and safety precautions. Other topics to promote self-efficacy in anticoagulation therapy were also included in the content. Postclass evaluations completed by patients and families provided useful feedback for continuous improvement and patient satisfaction. Preliminary survey results indicate high patient satisfaction with the class. Plans include a quality improvement project to evaluate the effectiveness of the patient education class on OAC. PMID:21074115

Eickhoff, Jennifer S; Wangen, Tina M; Notch, Katie B; Ferguson, Tanya J; Nickel, Travis W; Schafer, Amy R; Bush, Diana L



Vigabatrin in pediatric patients with refractory epilepsy.  


New generation antiepileptic medications have improved seizure outcome in patients with intractable epilepsy. We studied the efficacy and side effect profile of vigabatrin (VGB) in pediatric patients with intractable seizure disorder. We reviewed the database of our short-term video-EEG monitoring laboratory to screen patients with intractable epilepsy who were on VGB either alone or in combination for three months or more. We subsequently reviewed the medical records of these patients to abstract clinical information regarding age, sex, seizure type, epilepsy syndrome, efficacy and side effects of VGB. Of 111 patients, 75 (68%) were male and 36 (32%) female. Seizure onset was during the newborn period in 12 patients (11%), during the first year of life beyond the newborn period in 47 patients (42%), between 1-5 years in 23 patients (21%), and above five years in the remaining 29 patients (26%). Fifty-four patients (48.6%) had partial onset seizures with or without secondary generalization; 49 patients (44.1%) had primary generalized seizures; 8 patients (7.2%) had two or more types of seizure. Fifty-three percent of patients had mental retardation, and 35% had abnormal findings on physical/ neurological examination. Of 98 patients, 70 (71.4%) had abnormal magnetic resonance imaging (MRI) findings. Ninety-seven percent of patients had been on polytherapy before VGB was added to treatment. VGB reduced seizure frequency by at least 50% in 33.3% of patients with partial seizures, and in 30.6% of patients with primary generalized seizures. Six of the responders with partial seizures had complete resolution of their seizures. Most common side effects included visual field defects, increased appetite and obesity. Vigabatrin seems to be more effective in partial seizures in childhood intractable epilepsy. Patients should be closely monitored regarding side effects of VGB. PMID:16562782

Turanli, Güzide; Celebi, Asli; Yalnizo?lu, Dilek; Topçu, Meral; Topalo?lu, Haluk; Banu, Anlar; Aysun, Sabiha



42 CFR 495.306 - Establishing patient volume.  

Code of Federal Regulations, 2011 CFR

...Methodology, patient encounter —(1) EPs. To calculate Medicaid patient volume...Methodology, patient panel —(1) EPs. To calculate Medicaid patient volume...patient volume determination. (3) All EPs in the group practice or clinic must...



42 CFR 495.306 - Establishing patient volume.  

Code of Federal Regulations, 2013 CFR

...Methodology, patient encounter —(1) EPs. To calculate Medicaid patient volume...Methodology, patient panel —(1) EPs. To calculate Medicaid patient volume...patient volume determination. (3) All EPs in the group practice or clinic must...



42 CFR 495.306 - Establishing patient volume.  

Code of Federal Regulations, 2012 CFR

...Methodology, patient encounter —(1) EPs. To calculate Medicaid patient volume...Methodology, patient panel —(1) EPs. To calculate Medicaid patient volume...patient volume determination. (3) All EPs in the group practice or clinic must...



76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for...relinquishment from Emergency Medicine Patient Safety Foundation of its status as...



76 FR 9351 - Patient Safety Organizations: Voluntary Delisting From West Virginia Center for Patient Safety  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Delisting From West Virginia Center for Patient Safety AGENCY: Agency for Healthcare...SUMMARY West Virginia Center for Patient Safety: AHRQ has accepted a...



76 FR 79192 - Patient Safety Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization AGENCY: Agency for...voluntary relinquishment from the HSMS Patient Safety Organization of its status...



76 FR 60495 - Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group AGENCY: Agency for Healthcare...voluntary relinquishment from The Patient Safety Group of its status as a...



76 FR 7855 - Patient Safety Organizations: Voluntary Delisting From Community Medical Foundation for Patient...  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Delisting...Community Medical Foundation for Patient Safety AGENCY: Agency for Healthcare...Community Medical Foundation for Patient Safety: AHRQ has accepted a...



77 FR 42738 - Patient Safety Organizations: Voluntary Relinquishment From the Coalition for Quality and Patient...  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment...the Coalition for Quality and Patient Safety of Chicagoland (CQPS PSO) AGENCY...SUMMARY: The Patient Safety and Quality Improvement Act...



77 FR 11120 - Patient Safety Organizations: Voluntary Relinquishment From UAB Health System Patient Safety...  

Federal Register 2010, 2011, 2012, 2013

...Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From UAB Health System Patient Safety Organization AGENCY: Agency for...relinquishment from the UAB Health System Patient Safety Organization of its status...





We studied 30 patients with diagnosis of liver cirrhosis (clinical, biochemical, pathologyc and images diagnosis); each patients was evaluated for hepatitis C antbodies (Elisa 2rd/3rd generation) and 27 patients were evaluated for hepatitis B surface antigen. The most characteristic symptoms and signs were ascitis (60%), anorexia (63.65%) and asthenia (66.65%). Hypo albuminemia in 82% of cases; 65.5% with serum aminotransferasas high level; 84% with trombocytopenia. Two patients were positive of hepatitis C antiboides (6.65%) and two patients olso were hepatitis B surface antigen positive. One patients was positive for anti-HVC and HBsAg. PMID:12138384

Balbin, Graciela; Cueva, Ariela; Vildosóla, Hermán



Patents with an "I" = patients.  


The authors address how patent protection in the United States is often quite narrow in scope, difficult to obtain, and insufficient in duration, thus stifling research and development of potential breakthrough pharmaceuticals. The authors further posit that countries that have enacted stronger intellectual property rights and research incentives have seen tremendous increases in foreign direct investment. In addressing critics of the current patent system, the authors show that alternatives to biotechnology patents would not demonstrably improve innovation and development of beneficial medicines. The authors conclude that given the substantial evidence of the patent system's benefits, and the mere speculation that patents have a deleterious effect on patients, no suggestions currently proposed to replace or improve the patent system will have the same beneficial effects for patients. PMID:21950241

Martin, Alice O; Devadas, Sendil K



Thromboembolic disease in cancer patients.  


Thromboembolic events are common among patients with cancer as a consequence of cancer- and treatment-related factors. As these events are the second most frequent cause of death in this population, their prevention and treatment are important. Venous ultrasonography is the technique of choice for diagnosis, with sensitivity and specificity above 95 % in symptomatic thrombosis. Routine prophylaxis is not recommended for ambulatory patients, although it could be useful in selected cases. On the other hand, all inpatients should receive prophylactic therapy unless contraindicated. Therapy of thromboembolic disease is based on anticoagulants. Clinical trials demonstrate that the use of low-weight heparins is associated with a lower incidence of bleeding and recurrent thrombosis as compared with non-fractionated heparin or warfarin. Options for recurrent thrombosis include change to another anticoagulant agent, increasing doses of the same agent and cava filters. PMID:23430009

Hindi, Nadia; Cordero, Nazaret; Espinosa, Enrique



Cardiac Emergencies in Neurosurgical Patients  

PubMed Central

Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events.

Petropolis, Andrea; Cappellani, Ronald B.



Ventilatory strategies in trauma patients  

PubMed Central

Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented. PMID:24550626

Arora, Shubhangi; Singh, Preet Mohinder; Trikha, Anjan



Stressors in ICU: patients’ evaluation  

Microsoft Academic Search

Objective: To study the physical and psychological stressors in the intensive care unit (ICU) and to correlate stressors with different\\u000a demographic variables.\\u000a \\u000a \\u000a Design: Cross-sectional analytical survey.\\u000a \\u000a \\u000a \\u000a \\u000a Setting: Intensive care unit of a private hospital.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and participants: 50 randomly selected ICU patients during the first week of their ICU stay.\\u000a \\u000a \\u000a \\u000a \\u000a Measurements and results: The Intensive Care Unit Environmental Stressor Scale

M. A. F. P. Novaes; A. Aronovich; M. B. Ferraz; E. Knobel



Gay patients. Context for care.  

PubMed Central

Gays and lesbians are a part of our society and our practices: real people with real lives, not stereotypes. Understanding their inner world and their social milieu is the first step to providing care that is holistic and appropriate. The "coming out" process and other unique health issues are described. Guidance is provided on how to identify and relate to gay and lesbian patients. PMID:8199524

Gibson, G.; Saunders, D. E.



Antibiotic Therapy in Neutropenic Patients  

Microsoft Academic Search

\\u000a In neutropenic patients, a fever and\\/or suspected infection requires immediate antimicrobial treatment. The choice of the\\u000a first-line empirical drugs should take into account the risk of complications of the underlying malignancy; type of treatment;\\u000a degree, duration, and type of immunosuppression; clinical presentation; and local bacterial ecology. The initial treatment\\u000a should cover a broad range of organisms, including Pseudomonas aeruginosa. However,

Matthieu Legrand; Adeline Max; Bertrand Gachot


Integrity of Electronic Patient Records  

Microsoft Academic Search

\\u000a We discuss a reference model for security measures to preserve integrity of information. Unlike traditional approaches which\\u000a focus on an defensive approach to preserving integrity, we also present offensive measures to stimulate integrity of information,\\u000a by providing feedback from usage. The reference model is used to analyze the security measures proposed in the design of the\\u000a Dutch national Electronic Patient

Joris Hulstijn; Jan van der Jagt; Pieter Heijboer


Oral complications in cancer patients  

SciTech Connect

Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.

Carl, W.



Support for patients loosing sight.  


This overview on support of patients loosing sight is based on a literature survey regarding reading disabilities and orientation and on results of experience trials performed at the University Eye Clinic Tübingen. In reading disorders, the main goal of rehabilitation is to regain or maintain the ability to read newspaper print. The fundament of rehabilitation is the use of optical and electronical devices and the application of specially designed training programs. The ability of a person with low vision to achieve successful orientation and mobility rehabilitation depends on residual vision, posture and balance, body image, auditory and tactile abilities, intelligence and personality. Rehabilitation efforts focus on the enhancement of residual vision applying magnifying contrast-enhancing and photomultiplying devices. The main pillar of orientation and mobility rehabilitation is a training especially designed for the patient's needs. Rehabilitation efforts must be tailored to the type of vision loss and to specific functional implications--the success rate is high. An optimal fitting of the required spectrum of low vision aids should be provided to the patient and importantly, professional teaching and training is recommended. Activities of daily living, orientation and mobility, and psychological concerns must be addressed. Close cooperation with other branches of rehabilitation is essential. PMID:12876839

Trauzettel-Klosinski, Susanne; Hahn, Gesa-Astrid



Bone lead in dialysis patients.  


We measured lead and calcium in multiple bone biopsies from 11 cadavers without known excessive past exposure to lead. Paired iliac crest, transiliac and tibial bone biopsies from these cadavers indicated that in bone biopsy specimens the lead/calcium ratio is more reproducible than the absolute lead concentration. There were no significant differences between the lead/calcium ratios from the iliac crest, transiliac, or tibial specimens. Transiliac bone biopsies from 35 patients (13 patients showing symptoms of slight or moderate degree of renal failure, medical history of gout and/or arterial hypertension and 22 lead workers with chelatable lead in excess of 1000 micrograms) indicated that the lead and the lead/calcium ratio in bone biopsies reflect body lead stores as estimated by the EDT A test (r = 0.87 and 0.83, respectively). Chemical and histological studies of transiliac biopsies previously obtained from 153 dialysis patients (from 8 dialysis centers from Belgium, France and Germany) for studies of aluminum-induced bone disease showed that chronic renal failure and dialysis do not cause accumulation of lead in bone and elevated bone lead does not appear to alter trabecular bone histomorphometry. We found that in 5% of the hemodialysis population studied, bone lead concentrations approximated levels found in active lead workers. PMID:3129611

Van de Vyver, F L; D'Haese, P C; Visser, W J; Elseviers, M M; Knippenberg, L J; Lamberts, L V; Wedeen, R P; De Broe, M E



Postural control in hemodialysis patients.  


The current investigation examined whether patients undergoing hemodialysis (HD) have reduced standing postural control performance during simultaneous cognitive task performance (i.e. dual task cost (DTC)) compared to age-gender matched controls. 19 persons undergoing HD and 19 age, gender, and body mass index (BMI) matched controls participated in the investigation. All participants performed 2 trials of quiet standing balance and 2 postural trials in which they performed a cognitive task. Postural control was indexed with various measures of the center of pressure (COP) trajectory. The change in postural control with a cognitive task (e.g. dual task cost DTC) was quantified as a change in the center of COP parameters of postural control from quiet standing to the cognitive condition. The primary observations were that (1) HD patients had significantly greater postural sway than age, gender, BMI matched controls (p's < 0.05); (2) HD patients had a greater DTC than the controls during quiet standing (p's < 0.05). The observations highlight that HD participants have poor postural control that is further exacerbated by a simultaneous performance of a cognitive task. It is possible that this impaired postural control places HD participants at elevated fall risk. Further study is necessary to determine contributing factors to an increased DTC in this population and whether targeted interventions such as exercise can reduce DTC. PMID:24189110

Shin, Sunghoon; Chung, Hae Ryong; Fitschen, Peter J; Kistler, Brandon M; Park, Hyun Woo; Wilund, Kenneth R; Sosnoff, Jacob J



Rehabilitation of the burn patient  

PubMed Central

Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration PMID:21321643

Procter, Fiona



Quality Assurance: Patient Chart Reviews  

SciTech Connect

Recent developments in radiation therapy have immensely impacted the way the radiation dose is delivered to patients undergoing radiation treatments. However, the fundamental quality assurance (QA) issues underlying the radiation therapy still remain the accuracy of the radiation dose and the radiation safety. One of the major duties of clinical medical physicists in the radiation therapy departments still revolves around ensuring the accuracy of dose delivery to the planning target volume (PTV), the reduction of unintended radiation to normal organs and minimization of the radiation exposure to the medical personnel based on ALARA (as low as reasonably achievable) principle. Many of the errors in radiation therapy can be minimized through a comprehensive program of periodic checks. One of the QA procedures on the patient comes in the form of chart reviews which could be in either electronic or paper-based format. We present the quality assurance procedures that have to be performed on the patient records from the beginning and periodically to the end of the treatment, based on the guidelines from the American Association of Physicists in Medicine (AAPM) and American College of Physicians (ACP)

Oginni, B. M. [Department of Physics and Astronomy, Ohio University, Athens, OH 45701 (United States); Odero, D. O. [Raleigh Regional Cancer Center, Beckley, West Virginia 25801 (United States)



Patient advocacy and DSM-5  

PubMed Central

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback. PMID:23683696



Relationship Between Nursing Documentation and Patients’ Mortality  

PubMed Central

Background Nurses alter their monitoring behavior as a patient’s clinical condition deteriorates, often detecting and documenting subtle changes before physiological trends are apparent. It was hypothesized that a nurse’s behavior of recording optional documentation (beyond what is required) reflects concern about a patient’s status and that mining data from patients’ electronic health records for the presence of these features could help predict patients’ mortality. Methods Data-mining methods were used to analyze electronic nursing documentation from a 15-month period at a large, urban academic medical center. Mortality rates and the frequency of vital sign measurements (beyond required) and optional nursing comment documentation were analyzed for a random set of patients and patients who experienced a cardiac arrest during their hospitalization. Patients were stratified by age-adjusted Charlson comorbidity index. Results A total of 15 000 acute care patients and 145 cardiac arrest patients were studied. Patients who died had a mean of 0.9 to 1.5 more optional comments and 6.1 to 10 more vital signs documented within 48 hours than did patients who survived. A higher frequency of comment and vital sign documentation was also associated with a higher likelihood of cardiac arrest. Of patients who had a cardiac arrest, those with more documented comments were more likely to die. Conclusions For the first time, nursing documentation patterns have been linked to patients’ mortality. Findings were consistent with the hypothesis that some features of nursing documentation within electronic health records can be used to predict mortality. With future work, these associations could be used in real time to establish a threshold of concern indicating a risk for deterioration in a patient’s condition. PMID:23817819

Collins, Sarah A.; Cato, Kenrick; Albers, David; Scott, Karen; Stetson, Peter D.; Bakken, Suzanne; Vawdrey, David K.



Introducing Pharmacy Students to Patient Pathographies.  

ERIC Educational Resources Information Center

Pathography is defined as a personal account of illness written by the patient, a friend or relative. The authors advocate the use of patient pathography as an additional or alternative teaching tool for the medical history record. (Author/JM)

Diggs, Amanda M.; Anderson-Harper, Heidi M.; Janer, Ann L.



Thymectomy: Common Questions Patients Ask about Thymectomies  


... operative need for prolonged respiratory support with a ventilator (breathing machine), many patients require pre-operative plasma ... awakening, the tube will be attached to a ventilator. Ordinarily after the surgery, the patient will go ...


Pulling a patient up in bed  


... may slowly slide when the person is in bed for a long time. The person may ask ... Moving a patient in bed ... You must move or pull someone up in bed the right way to avoid injuring the patient's ...


Body dysmorphic disorder in Iranian orthodontic patients.  


Patient's preoccupations with perceived defect in appearance or excessive concern about minimal flaws are among diagnostic criteria of body dysmorphic disorder (BDD). Sufferers usually seek cosmetic procedures such as orthodontic treatment. This study was conducted to estimate the prevalence of BDD among a sample of Iranian orthodontic patients. A total of 270 orthodontic patients were evaluated with BDD-YBOCS questionnaire for the diagnosis of BDD. Fifteen patients (5.5%) were screened positive for BDD. BDD was more frequent among females, singles and in younger patients. Most of the BDD patients experienced multiple previous orthodontic evaluations. The relative high prevalence of BDD among orthodontic patients in Iran offers that orthodontists should take psychologically based problems such as BDD into account while evaluating patient's orthodontic problems. PMID:25130153

Yassaei, Soghra; Goldani Moghadam, Mahdjoube; Aghili, Hossein; Tabatabaei, Seyed Mahmoud



Hypercoagulable State in Five Thalassemia Intermedia Patients  

Microsoft Academic Search

Fifty-three patients of thalassemia intermedia and 40 controls were studied for clinical evidence of thrombosis and laboratory evidence of hypercoagulable state. Thrombotic episodes were detected in 5 (9.4%) patients. Two of these 5 patients with thrombosis were splenectomized. Laboratory evaluation showed presence of thrombocytosis in 8 (15%), 5 of these were splenectomized. Platelet hyperaggregation was detected in 12 (22.2%) patients.

Maitreyee Bhattacharyya; Meganathan Kannan; Ved P. Chaudhry; M. Mahapatra; H. Pati; Renu Saxena



Perfectionism in Obsessive-Compulsive Disorder patients  

Microsoft Academic Search

Considerable theory and anecdotal evidence has suggested that patients with Obsessive-Compulsive Disorder (OCD) are more perfectionistic. Evidence with non-clinical populations supports this hypothesis. However, no data are available on levels of perfectionism among patients diagnosed with OCD. The present study extends findings on perfectionism and OCD by comparing perfectionism levels of OCD-diagnosed patients with those of non-patients and a group

Randy O. Frost; Gail Steketee



Oculomotor dysfunction in patients with syphilis.  

PubMed Central

Four patients with syphilis or, in two instances, possibly some other treponematosis, underwent oculomotor and audiological tests. The oculomotor test result was abnormal in all four patients. Three had abnormal smooth pursuit eye movements and two of them had hypometric voluntary horizontal saccades, which indicate that the central nervous system (CNS) was affected. Moreover, one of the patients had pathological auditory brain stem responses, which indicate brain stem dysfunction. Another patient had signs of Meničre's syndrome in one ear. PMID:3583275

Rosenhall, U; Löwhagen, G B; Roupe, G



Oculomotor dysfunction in patients with syphilis.  


Four patients with syphilis or, in two instances, possibly some other treponematosis, underwent oculomotor and audiological tests. The oculomotor test result was abnormal in all four patients. Three had abnormal smooth pursuit eye movements and two of them had hypometric voluntary horizontal saccades, which indicate that the central nervous system (CNS) was affected. Moreover, one of the patients had pathological auditory brain stem responses, which indicate brain stem dysfunction. Another patient had signs of Meničre's syndrome in one ear. PMID:3583275

Rosenhall, U; Löwhagen, G B; Roupe, G



Sexuality and the patient with dementia  

Microsoft Academic Search

Caretakers in a geropsychiatric medical unit offering care to patients with dementia diagnoses were surveyed regarding their\\u000a views of the sexual conduct of their patients. The majority of them described difficulties in managing patients who displayed\\u000a sexual behaviors. Sexually active and interested patients were both male and female. The majority of the sexual encounters\\u000a observed by caretakers was not considered

Kathleen S. Mayers



Patient Appreciation Day in radiation oncology.  


Patients undergoing radiation therapy struggle with many physical and emotional stressors. Many ways to help patients cope with stressors and improve the treatment experience are found in the literature, including humor, art, entertainment, and hospitality. At H. Lee Moffitt Cancer Center, the radiation therapy nurses and staff members use entertainment in an annual patient appreciation day event as one way to give back to the patients. PMID:25095305

Cirillo, Dianne



Community outcome in cognitively normal schizophrenia patients.  


Recent reports suggest that cognition is relatively preserved in some schizophrenia patients. However, little is known about the functional advantage these patients may demonstrate. The purpose of this study was to identify cognitively normal patients with a recently developed test battery and to determine the functional benefit of this normality relative to cognitively impaired patients. Average-range cognitive ability was defined by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) composite score (T?40) and applied to 100 patients with schizophrenia or schizoaffective disorder and to 81 non-psychiatric research participants. With group assignment adjusted for demographic variables, this procedure yielded 14 cognitively normal patients, 21 cognitively impaired patients, and 21 healthy adults with normal-range MCCB scores. Cognitively normal patients were indistinguishable from controls across all MCCB scales. Furthermore, their performance was superior to impaired patients on all scales except Social Cognition. Cognitively normal patients were also superior to impaired patients on a summary index of simulated life skills and functional competence. Nevertheless, both patient groups were equally disadvantaged relative to controls in independent community living. These findings suggest that normal-range cognition exists in schizophrenia, but fails to translate into enhanced community outcome. PMID:25083826

Muharib, Eva; Heinrichs, R Walter; Miles, Ashley; Pinnock, Farena; McDermid Vaz, Stephanie; Ammari, Narmeen



Counseling cancer patients about herbal medicine  

Microsoft Academic Search

More than half of all cancer patients now use some form of complementary\\/alternative medicine, yet the majority of these patients do not disclose this use to their physicians. Health care practitioners need to educate themselves about the complementary\\/alternative medicine products their patients are using. Eight herbal products (astragalus, essiac, Asian ginseng, Siberian ginseng, green tea, garlic, Hoxsey formula and iscador)

Michael Smith; Heather S. Boon



Pericarditis in a patient with Legionnaires' disease  

SciTech Connect

Pericardial involvement with legionnaires' disease is rare. Pericarditis with legionnaires' pneumonia developed in a patient with previous mediastinal irradiation for Hodgkin's disease. Subsequently, the patient had progressive symptoms of pericardial constriction that required pericardiectomy. Acute infection with agents such as legionnaires' bacillus may precipitate the late appearance of pericardial disease in patients with previous mediastinal irradiation.

Landes, B.W.; Pogson, G.W.; Beauchamp, G.D.; Skillman, R.K.; Brewer, J.H.



Patients' Appraisal of Psychiatric Trainee Interview Skills  

ERIC Educational Resources Information Center

Objective: The aim of this pilot project was to explore the extent to which judgments made by psychiatrist examiners accord with those of patients in postgraduate clinical examinations, so as to inform further consideration of the role of patients in such assessments. Method: Senior psychiatrist examiners (N=8) and patients (N=30) rated 16 aspects…

Mellsop, Graham W.; MacDonald, Joanna; El Badri, Selim; Menkes, David



Hypercoagulable State in Five Thalassemia Intermedia Patients  

Microsoft Academic Search

Summary: Fifty-three patients of thalassemia intermedia and 40 controls were studied for clinical evidence of throm- bosis and laboratory evidence of hypercoagulable state. Thrombotic episodes were detected in 5 (9.4%) patients. Two of these 5 patients with thrombosis were splenec- tomized. Laboratory evaluation showed presence of throm- bocytosis in 8 (15%), 5 of these were splenectomized. Platelet hyperaggregation was detected

Maitreyee Bhattacharyya; Meganathan Kannan; Ved P. Chaudhry; M. Mahapatra; H. Pati; Renu Saxena


Behcet's syndrome in 32 patients in Yorkshire  

Microsoft Academic Search

Thirty-two patients with Behcet's syndrome were surveyed clinically, radiologically, and immunologically. HLA antigens were determined in a proportion. The patients were culled from a defined geographical area (Yorkshire) with a population of 5 million. 21 patients satisfied Mason and Barnes's (1969) criteria for major disease. 100% had mouth ulceration, 91% genital ulceration, 66% skin complaints, and 63% arthritis (of the

M A Chamberlain



Memory impairment in patients with cirrhosis.  

PubMed Central

BACKGROUND AND AIM: Subclinical hepatic encephalopathy (HE) in cirrhotic patients is usually characterized by memory impairment and psychomotor slowing. Our aim was to investigate memory status in cirrhotic patients with and without clinically overt HE. MATERIAL AND METHODS: Thirty-two cirrhotic patients (10 female and 22 male) aged 49 +/- 17 years and 20 healthy subjects (six female and 14 male) aged 46 +/- 12 years were included in the study. Memory status was defined by Wechsler Memory Scale, verbal memory process and complex memory process tests. RESULTS: Grade-1 HE was detected in 7 (22%) patients with cirrhosis. We detected 36 to 92% decrement in various memory tests in cirrhotic patients without HE as compared to healthy subjects. The scores for all psychometric testing results were significantly lower in cirrhotic patients without HE as compared to healthy subjects. We detected 42.9 to 100% decrement in various memory tests in cirrhotic patients with HE than cirrhotic patients without HE. However, there was no statistical significant difference between cirrhotic patients with and without HE. There was no statistical significant difference in cirrhotic patients with Child-Pugh A, B, and C. CONCLUSION: In conclusion, memory status was influenced in which patients with cirrhosis yet has a normal mental and neurological status to routine clinical examination (subclinical HE). Occasionally, decreased memory performance may adversely affect the satisfaction and lifestyle of these patients. Therefore, subclinical HE is an important social problem. PMID:15712784

Bahceci, Funda; Yildirim, Bulent; Karincaoglu, Melih; Dogan, Ibrahim; Sipahi, Birsen



Blink vergence in an antimetropic patient.  


A patient with uncorrected antimetropia was found to attain motor fusion through blinking. Although this patient was also able to attain motor fusion through saccadic vergence and slow fusional vergence, he usually relied on blink vergence. In this patient, blink vergence was an efficient alternative to slow fusional vergence. PMID:3799812

Peli, E; McCormack, G



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2010 CFR

...Possessions. Each patient has the right to, governing fire safety regulations, restrictions... (4) Money. Each patient has the right to keep...adversely affect the patient's return to independent...jeopardize the health or safety of others, or...



NASA's contributions to patient monitoring, appendix  

NASA Technical Reports Server (NTRS)

Health care problems, and markets for patient monitoring equipment are discussed along with contributions to all phases of patient monitoring, and technology transfer to nonaerospace problems. Health care medical requirements, and NASA achievements in patient monitoring are described, and a summary of the technology transfer is included.

Murray, D. M.; Siemens, W. D.



Coma Patient Monitoring System Using Image Processing  

NASA Astrophysics Data System (ADS)

COMA PATIENT MONITORING SYSTEM provides high quality healthcare services in the near future. To provide more convenient and comprehensive medical monitoring in big hospitals since it is tough job for medical personnel to monitor each patient for 24 hours.. The latest development in patient monitoring system can be used in Intensive Care Unit (ICU), Critical Care Unit (CCU), and Emergency Rooms of hospital. During treatment, the patient monitor is continuously monitoring the coma patient to transmit the important information. Also in the emergency cases, doctor are able to monitor patient condition efficiently to reduce time consumption, thus it provides more effective healthcare system. So due to importance of patient monitoring system, the continuous monitoring of the coma patient can be simplified. This paper investigates about the effects seen in the patient using "Coma Patient Monitoring System" which is a very advanced product related to physical changes in body movement of the patient and gives Warning in form of alarm and display on the LCD in less than one second time. It also passes a sms to a person sitting at the distant place if there exists any movement in any body part of the patient. The model for the system uses Keil software for the software implementation of the developed system.

Sankalp, Meenu



Focal glomerulosclerosis in patients with unilateral nephrectomy  

Microsoft Academic Search

Focal glomerulosclerosis in patients with unilateral nephrectomy. To investigate whether proteinuria and focal glomerulosclerosis (FSG) might develop in humans as well as in experimental models following a reduction in renal mass, we performed a retrospective study of 24 patients previously nephrectomized for unilateral renal disease. None of the patients presented signs of systemic diseases, Alport syndrome, essential hypertension, reflux nephropathy,

Pietro Zucchelli; Leonardo Cagnoli; Silvia Casanova; Ugo Donini; Sonia Pasquali



Surgical indications for patients with hyperammonemia  

Microsoft Academic Search

Background\\/Purpose: The authors surgically treated seven of eight patients with congenital portosystemic shunt and hyperammonemia. This entity is uncommon in children.Methods: The patients included five boys and three girls with a mean age of 8 years (range, 7 months to 24 years). Preoperative symptoms included hyperammonemia. Hepatic encephalopathy was evident in five patients. Diagnosis and assessment were made by ultrasound

Shinji Ikeda; Yoshihisa Sera; Hajime Ohshiro; Shinichiro Uchino; Takako Uchino; Fumio Endo



Removable partial overdentures for the irradiated patient  

SciTech Connect

Patients who have received radiotherapy to the head and neck area must avoid dental extractions and seek simplicity in treatment and home care follow-up. For partially edentulous patients, removable partial overdenture therapy can fulfill these goals while maintaining the high level of function and aesthetics desired by patients.11 references.

Rosenberg, S.W. (New York Univ. School of Dentistry, NY (USA))



Mechanism of stroke in patients taking aspirin.  


During a 1-year period, we prospectively studied the mechanism and severity of stroke in 47 patients sustaining a cerebral infarction while taking aspirin. The mechanism of stroke was undetermined in 12 patients (26%). In the remaining 35 patients, we identified 39 potential mechanisms: large-artery atherosclerosis (19 patients, 40%), cardioembolism (15 patients, 32%), and small-vessel occlusive disease (5 patients, 11%). Of 11 patients with carotid atherosclerosis and stroke, 9 (82%) had greater than 90% carotid stenosis or occlusion; of 12 patients with stroke of undetermined mechanism, 10 (83%) had previous stroke, of which 8 were also of undetermined mechanisms. Disability after stroke was moderate or severe in 27 patients (57%). These data suggest that (1) stroke in patients taking aspirin has a variety of etiologies and frequently causes moderate or severe disability; (2) patients with carotid disease failing aspirin often have high-grade carotid stenosis or occlusion; (3) stroke of undetermined mechanism may recur more frequently than other stroke subtypes in patients taking aspirin. PMID:2146524

Chimowitz, M I; Furlan, A J; Nayak, S; Sila, C A



Group education for patients with rheumatoid arthritis  

Microsoft Academic Search

Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining żself-managementż behaviors. We developed a group education program based on social learning theory and the `Arthritis Self Management Courseż developed in

Erik Taal; Rob P. Riemsma; Herman L. M. Brus; Erwin R. Seydel; Johannes J. Rasker; Oene Wiegman



Health Insurance & Patient-Centered Medical Homes  

E-print Network

Health Insurance & Patient- Centered Medical Homes Office of Rural Health Area Health Education the groundwork for a patient-centered medical home program in Montana. · Cancer Clinical Trials- clarifying Initiatives The CSI is studying the following state-based reforms: · Patient-Centered Medical Homes- laying

Maxwell, Bruce D.


Patient information that promotes healt literacy.  


Health literacy is the ability to make informed health decisions in everyday life. For many patients and carers, decision-making is made more difficult by the fact that high-quality information is unavailable to them. The Pulmonary Hypertension Association has created patient materials that promote health literacy to help patients and their families make decisions that are well informed. PMID:23631098

Armstrong, Iain; Harries, Carl


Patient compliance with CHAMPUS mental health referrals  

Microsoft Academic Search

Studied patients' willingness to use the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) for psychotherapy by conducting phone interviews with 96 patients referred to psychotherapists by clinicians through CHAMPUS. Therapist and clinician ratings were compared to patient ratings. Low socioeconomic Ss were as likely to comply with the referral as were higher socioeconomic Ss. Therapists underestimated the

Ronald M. Jennings; J. D. Ball



Mitral valve repair in patients over  

Microsoft Academic Search

The question of whether to repair or replace the mitral valve in the elderly remains unanswered. The purpose of our study is to describe our experience with mitral valve repair (MVR) using Carpentier's technique in patients 70 years and older. Fifty consecutive patients underwent MVR between 1984-1992. There were 30 female patients. All had 2 + or more mitral regurgitation

H. Azar; S. Szentpetery



Hydrocortisone Therapy for Patients with Septic Shock  

Microsoft Academic Search

Background Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appro- priately after the administration of corticotropin. Methods In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg

Charles L. Sprung; Djillali Annane; Didier Keh; Rui Moreno; Mervyn Singer; Klaus Freivogel; Yoram G. Weiss; Julie Benbenishty; Armin Kalenka; Helmuth Forst; Pierre-Francois Laterre; Konrad Reinhart; Brian H. Cuthbertson; Didier Payen; Josef Briegel



Patient Safety Events During Pediatric Hospitalizations  

Microsoft Academic Search

Objective. Our objective was to describe potential patient safety events for hospitalized children, using the patient safety indicators (PSIs), and examine associations with these events. Methods. PSI algorithms, developed by researchers at the Agency for Healthcare Research and Quality to iden- tify potential in-hospital patient safety problems using administrative data, were applied to 3.8 million dis- charge records for children

Marlene R. Miller; Anne Elixhauser; Chunliu Zhan



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2012 CFR

...Possessions. Each patient has the right to, governing fire safety regulations, restrictions... (4) Money. Each patient has the right to keep...adversely affect the patient's return to independent...jeopardize the health or safety of others, or...



A Research Agenda for Advancing Patient,  

E-print Network

A Research Agenda for Advancing Patient, Worker and Environmental Health and Safety in the Health, patient, and worker safety issues related to building and operating health care institutions. This paper influencing patient, worker and environmental safety and sustainability in the healthcare sector. The editors

Illinois at Chicago, University of


38 CFR 17.33 - Patients' rights.  

...Possessions. Each patient has the right to, governing fire safety regulations, restrictions... (4) Money. Each patient has the right to keep...adversely affect the patient's return to independent...jeopardize the health or safety of others, or...



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2011 CFR

...Possessions. Each patient has the right to, governing fire safety regulations, restrictions... (4) Money. Each patient has the right to keep...adversely affect the patient's return to independent...jeopardize the health or safety of others, or...



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2013 CFR

...Possessions. Each patient has the right to, governing fire safety regulations, restrictions... (4) Money. Each patient has the right to keep...adversely affect the patient's return to independent...jeopardize the health or safety of others, or...



Unrecognized delirium in ED geriatric patients  

Microsoft Academic Search

To determine the sensitivity of an emergency physician's conventional evaluation compared with the validated Confusion Assessment Method (CAM) regarding the recognition of acute confusional states (delirium) in elderly Emergency Department (ED) patients, a cohort of 385 patients presenting to an urban teaching hospital ED was systematically assembled. Patients had to be conscious, able to speak and older than 64 years

Lawrence M Lewis; Douglas K Miller; John E Morley; Mary Jo Nork; Laura C Lasater



The elderly patients on hemodialysis  

PubMed Central

Nephrologists care for an increasing number of elderly patients on hemodialysis. As such, an understanding of the overlap among complications of hemodialysis and geriatric syndromes is crucial. This article reviews hemodialysis management issues including vascular access, hypertension, anemia and bone and mineral disorders with an attention towards the distinct medical needs of the elderly. Key concepts of geriatrics — frailty, dementia and palliative care — are also discussed, as nephrologists frequently participate in decision-making directed toward balancing longevity, functional status and the burden of therapy. PMID:20424572




Physician Grief with Patient Death  

PubMed Central

The genuine prevalence and intensity of grief reactions among physicians in response to patient death is unknown. However, a number of authorities and studies indicate that such experiences are fairly commonplace among physicians practicing in the clinical arena. In addition, it appears that the grief response of physicians may be tempered by a number of personal and environmental/contextual factors. A number of authors have proffered various approaches to resolving grief responses in these unique circumstances and many emphasize the importance of doing so in an effort to stave off burnout. PMID:22666638

Sansone, Lori A.



Hereditary hemorrhagic telangiectasia in Japanese patients.  


To describe clinical presentations of hereditary hemorrhagic telangiectasia (HHT) patients in Japan. There were 80 patients (40 men and 40 women, age 2-78, mean 39.4 years old), who were either genetically verified or genetically not identifiable but clinically definite HHT patients. Clinical presentations of these HHT patients were analyzed retrospectively. Radiological examinations, which included at least brain magnetic resonance imaging and lung computed tomography, were performed when indicated. Seventy-eight patients had either endoglin (ENG) or activin A receptor type II-like 1 (ACVRL1) mutation. They were 53 HHT1 patients with ENG mutation in 27 families and 25 HHT2 patients with ACVRL1 mutation in 17 families. Two other female patients were clinically definite HHT, but genetic mutation could not be identified. Nosebleeds were noted in 53/53 (100%) HHT1 and 24/25 (96%) HHT2 patients. Telangiectases were observed in 34/53 (64%) HHT1 and 18/25 (72%) HHT2 patients. Pulmonary arteriovenous malformations (AVMs) were noted in 33/52 HHT1 (63%) and 5/25 HHT2 patients (20%). Brain AVMs were detected in 12/51 HHT1 (24%) and 1/25 HHT2 (4%) patients. Hepatic AVMs were noted in 7/29 (24%) HHT1 and 16/20 (80%) HHT2 patients. The number of HHT1 patients was roughly twice as many as that of HHT2 patients in Japan. Pulmonary and brain AVMs were predominantly observed in HHT1 while hepatic AVMs were detected in HHT2. It seemed that ethnicity and regionality had minimal roles in the clinical presentation of HHT. PMID:24196379

Komiyama, Masaki; Ishiguro, Tomoya; Yamada, Osamu; Morisaki, Hiroko; Morisaki, Takayuki



Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction  

PubMed Central

Background The cost to the NHS of missed or inappropriate hospital appointments is considerable. Alternative methods of appointment scheduling might be more flexible to patients’ needs without jeopardising health and service quality. The objective was to systematically review evidence of patient initiated clinics in secondary care on patient reported outcomes among patients with chronic/recurrent conditions. Methods Seven databases were searched from inception to June 2013. Hand searching of included studies references was also conducted. Studies comparing the effects of patient initiated clinics with traditional consultant led clinics in secondary care for patients with long term chronic or recurrent diseases on health related quality of life and/or patient satisfaction were included. Data was extracted by one reviewer and checked by a second. Results were synthesised narratively. Results Seven studies were included in the review, these covered a total of 1,655 participants across three conditions: breast cancer, inflammatory bowel disease and rheumatoid arthritis. Quality of reporting was variable. Results showed no significant differences between the intervention and control groups for psychological and health related quality of life outcomes indicating no evidence of harm. Some patients reported significantly more satisfaction using patient-initiated clinics than usual care (p patient initiated clinics to result in greater patient and clinician satisfaction. The patient-consultant relationship appeared to play an important part in patient satisfaction and should be considered an important area of future research as should the presence or absence of a guidebook to aid self-management. Patient initiated clinics fit the models of care suggested by policy makers and so further research into long term outcomes for patients and service use in this area of practice is both relevant and timely. PMID:24289832



Physician-patient communication in managed care.  

PubMed Central

The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent literature on physician-patient communication. We also describe ways that managed care plans can promote more effective communication between physicians and patients. PMID:8553634

Gordon, G H; Baker, L; Levinson, W



Listening to the voice of the patient.  


Comments on the article by T. J. Waltz et al. (see record 2014-31795-001). The article used population based screening to identify patients with depressive illness. An important feature of this article is that it addresses the needs of the patient, not the organization of the care system. It points us to patient perspectives and choices more than practice or system level offerings. This article should remind us that patient satisfaction and patient preferences are every bit as important, if not more so, to achieving good clinical outcomes as selection of the proper treatment (Swift, Callahan, & Vollmer, 2011). (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:25485825

Pomerantz, Andrew S



Physician-patient communication in managed care.  


The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent literature on physician-patient communication. We also describe ways that managed care plans can promote more effective communication between physicians and patients. PMID:8553634

Gordon, G H; Baker, L; Levinson, W



Factors Affecting Patients' Compliance With Doctors' Advice  

PubMed Central

To what extent, and with what success, are family physicians advising patients to diet, exercise and reduce smoking? A study of 24 family physicians in Nova Scotia and New Brunswick and 66 patients with cardiovascular problems showed that two-thirds of the patients received some such advice during the audiotaped visit. Of those who did receive such advice, 29% reported at a home interview ten days later that they remembered the advice. The doctor's behavior in the interaction was found to influence the patient's memory of the advice. However, the patient's attitudes and problems were the only variables shown to affect whether or not he followed the advice. PMID:21286512

Stewart, Moira



Quality of sleep in patients undergoing hemodialysis  

Microsoft Academic Search

Background  Sleeping problems are common in hemodialysis (HD) patients. The aim of this study was to determine sleep quality (SQ) in HD\\u000a patients and to evaluate its relationship with patient’s quality of life (QoL), sociodemographic and laboratory data.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Two hundred HD patients from the Hemodialysis Clinic, Bosnia and Herzegovina, were enrolled in the study. There were 122 men\\u000a and 78 women

Badema ?engi?; Halima Resi?; Goce Spasovski; Emir Avdi?; Azra Alajbegovi?


Is exercise ignored in palliative cancer patients?  

PubMed Central

Exercise and rehabilitation approaches in palliative care programs for cancer patients affect patients’ symptoms, physical functioning, muscle strength, emotional wellbeing, psychological symptoms, functional capacities, quality of life, mortality and morbidity positively. Based on scientific data, palliative cancer patients should be recommended to participate in exercise programs. There is no standard approach to recipe an exercise regimen for a palliative cancer survivor. Studies for demonstrating the positive effects of exercising in palliative care patients are increasing in number day by day. At this point, increasing awareness about exercising in the entire team monitoring the patient and our efforts in this matter seems to be very important. PMID:25114869

Eyigor, Sibel; Akdeniz, Sedef



Radiographic techniques for the pediatric patient.  


Obtaining quality radiographs on pediatric patients can be a challenge. Suggestions for communicating with patients about radiation safety and the need for radiographs can facilitate the process. Guidelines for radiographic exposure intervals for young patients are key elements in the reduction of exposure to ionizing radiation and are presented in this paper. The child patient presents unique challenges for the dental professional and special techniques are presented in this article that may be helpful in the conducting radiographic examinations for this patient population. PMID:12167951

Schwartz, S



Cytogenetic analysis in patients with myelodysplastic syndrome.  


Forty-six patients with myelodysplastic syndrome (MDS) were studied. Chromosomal abnormalities were observed in 20 of the 46 patients (43%). Abnormalities of chromosome No. 5 occurred in 6 patients (13%); four of them had a deletion of the long arm of this chromosome [del (5q)]. Four patients had monosomy 7 (8.6%), and six patients had trisomy 8 (13%). Our results suggest that chromosomal abnormalities, deletion (5q), monosomy 7 and trisomy 8, might play important roles in the pathogenesis of MDS. PMID:2098765

Hu, N; Bian, M



Effects of Program and Patient Characteristics on Retention of Drug Treatment Patients.  

ERIC Educational Resources Information Center

Studied the effects of program and patient characteristics on patient retention in residential, out-patient, and methadone maintenance drug treatment programs. Data for 26,047 patients in 87 programs show that threshold retention rates were generally low for all 3 program types, although program practice and service provision played important…

Hser, Yih-Ing; Joshi, Vandana; Maglione, Margaret; Chou, Chih Ping; Anglin, M. Douglas



Acute Effects of Drug Abuse in Schizophrenic Patients: Clinical Observations and Patients’ Self-Reports  

Microsoft Academic Search

Substance abuse among schizophrenic patients is an increasingly recognized clinical phenomenon. The authors review experimental and observed clinical effects of drug abuse and patients’ subjective experiences of acute intoxication. Though drug abuse may exacerbate psychotic symptoms, abused drugs may also lead to transient symptom reduction in subgroups of schizophrenic patients. Some patients report feeling less dysphoric, less anxious, and more

Lisa Dixon; Gretchen Haas; Peter Weiden; John Sweeney; Allen Frances



Albumin synthesis in surgical patients.  


Albumin plasma concentrations are being used as indicators of nutritional status and hepatic function based on the assumption that plasma levels reflect the rate of albumin synthesis. However, it has been shown that albumin levels are not reliable markers of albumin synthesis under a variety of clinical conditions including inflammation, malnutrition, diabetes mellitus, liver disease, and surgical tissue trauma. To date, only a few studies have measured albumin synthesis in surgical and critically ill patients. This review summarizes the findings from these studies, which used different tracer methodology in various surgical or critically ill patient populations. The results indicate that the fractional synthesis rate of albumin appears to decrease during surgery, followed by an increase during the postoperative phase. In the early postoperative phase, albumin fractional synthesis rate can be stimulated by perioperative nutrition, if enough amino acids are being provided and if nutrition is being initiated before the operation. The physiologic meaning of albumin synthesis after surgery, however, still needs to be further clarified. PMID:23333435

Hülshoff, Ansgar; Schricker, Thomas; Elgendy, Hamed; Hatzakorzian, Roupen; Lattermann, Ralph



[Psychosocial background in sterility patients].  


150 childless couples from the infertility clinic of the department of gynecology and obstetrics, University of Graz, received a questionnaire. Psychosocial factors and special problems of childless marriage represented the background at which the investigation was aimed. Of special interest were the reactions of the male partner regarding the andrological investigation within the gynecological department. The patients were confronted by a total of 41 questions. 15 of them were equal for both partners, whereas the male partner had to answer 11 additional questions. The questionnaire concerned problems such as interactions of the couple, motivations for the desire of children, psychosomatics, andrological investigation within the gynecological department and the organization of the andrological outpatient section. 72% of the questionnaires were returned. More than 50% of the sterile couples preferred to attend the infertility clinic together. 26% felt restrictions in their sexual behaviour due to the unrealized desire of children, 48% expected an improvement in their partnership if they could have children. 98% considered their childless marriage as a problem of both partners. The desire to set up a family ranks first on the list of motivations. The evaluation of the questionnaire yielded valuable results for the infertility clinic and especially for the andrological department. 72% of the andrological patients did not feel embarrassed by being evaluated and treated in a women's department. 63% preferred to attend the andrological department jointly with their wife. PMID:6557979

Pusch, H



Gallbladder function in diabetic patients  

SciTech Connect

Gallbladder emptying and filling was studied in eight diabetic and six normal control patients. None of the patients had gallstones. Cholescintigraphy was performed using (/sup 99m/Tc)disofenin, and gallbladder emptying was studied using a 45-min i.v. infusion of the octapeptide of cholecystokinin (OP-CCK) 20 ng/kg X hr. The peak filling rate was greater in diabetic than in normal subjects; however, emptying of the gallbladder in response to OP-CCK was significantly less in the diabetic subjects (51.6 +/- 10.4% compared with 77.2 +/- 4.9%). When the diabetic group was subdivided into obese and nonobese diabetics, the obese diabetics had a much lower percentage of emptying than the nonobese diabetics (30.0 +/- 10.4% compared with 73.1 +/- 9.3%). These findings suggest that obese diabetics may have impaired emptying of the gallbladder even in the absence of gallstones. The more rapid rate of gallbladder filling in obesity may indicate hypotonicity of the gallbladder. The combination of these abnormalities may predispose the obese diabetic to the development of gallstones.

Shreiner, D.P.; Sarva, R.P.; Van Thiel, D.; Yingvorapant, N.



Patient skin preparation for surgery.  


Skin preparation of the patient begins before arriving to the operating room; its purpose is to reduce the risk of post operative wound infection. The objective of this study was to assess the skin preparation for surgical procedures in 3 different hospitals of the General Organization for Teaching Hospitals & Institutes (GOTHI) and to determine their conformity to the existing protocol and make comparisons between them in their performance. A prospective study using the audit was done for 1 month, nearly for the same period in each of the 3 hospitals (A,B,C) to observe the skin preparation practices considering showering, hair removal and the 5 steps of patient skin preparation on table in the operating room. The global results revealed that the compliance rate in the three hospitals together as regards performing the 5 steps of skin preparation in the operating room was 36.2%. It was 50.6% in hospital A, 43.3% in hospital B and 18.7% in hospital C. As regards showering before surgery, it was 55%, removing hair appropriately (clipping) was 23.7% and removing hair by means was 44.6%. PMID:19302781

El Sayed, Iman A; Hashem, Samar A; El Sayed, Abdallah S; Gadoua, Iman M; Kamel, Ahlam E; Perse, Olivia K; Baghagho, Ehssan A; Terzaki, Soraya R



Thrombelastography in the surgical patient.  


Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. However, these tests have considerable limitations. Information regarding the kinetics of clot formation, clot strength, interaction of the coagulation components, platelet function and fibrinolysis is not available. Moreover, there is an important delay in obtaining test results. In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data. PMID:20150854

Bischof, D; Dalbert, S; Zollinger, A; Ganter, M T; Gantner, M T; Hofer, C K



The ageing patient with haemophilia.  


Older patients with haemophilia (PWH) face many challenges related not only to haemophilia but also to general comorbidities associated with ageing. This article discusses the clinical experience published about the high prevalence of diseases in older PWH. These conditions are managed in the general population by healthcare workers with little training in haemophilia. Haemophilic arthropathy is common in elderly PWH. Prophylaxis starting at an early age in sufficient dose regimens to prevent arthropathy did not occur in patients who are now older than around 40 yr. Many PWH above this age thus have limitations in their activities of daily life. Cardiovascular diseases have become increasingly common in the growing, ageing cohort of PWH. Lifestyle issues such as sexual dysfunction may be exacerbated by the medical issues and psychological problems associated with haemophilia. Hepatitis C virus is a leading problem in PWH. Coinfection with HIV accelerates the progression to end-stage liver disease. Acute and chronic renal failure is more common in adult PWH than in general population. Other comorbidities are reviewed. The evidence is scarce, so it is imperative to report any experience regarding the diagnosis and treatment of these entities, to improve the quality of life of older PWH. PMID:25560790

Canaro, Mariana; Goranova-Marinova, Veselina; Berntorp, Erik



Intracerebral temperature in neurosurgical patients.  


Recent laboratory results have indicated that the ischemic brain is very sensitive to minor variations in temperature. This has created new interest in hypothermia and brain temperature. There is, however, very little information available regarding human intracerebral temperature and its relation to body core temperature during normal and pathological circumstances. We therefore made continuous measurements of the temperature of the lateral ventricle in 15 neurosurgical patients utilizing a newly developed technique with copper-constantan thermocouples introduced through a plastic catheter also used for monitoring intracranial pressure. The intraventricular temperature was higher than the rectal temperature during approximately 90% of all measurements. The largest temperature gradient measured was 2.3 degrees C. Usually the difference between the temperature of the rectum and the brain was much smaller, the mean value being 0.33 degrees C. For the patients in the most severe condition, the rectal temperature was sufficiently close to the brain temperature to afford a reliable basis for adequate clinical judgment. PMID:1876249

Mellergĺrd, P; Nordström, C H



Pharmacogenetic information for patients on drug labels  

PubMed Central

Advances in pharmacogenetic research have improved our understanding of adverse drug responses and have led to the development of pharmacogenetic tests and targeted drugs. However, the extent of the communication process and provision of information to patients about pharmacogenetics is unclear. Pharmacogenetic information may be included in sections of a drug’s package insert intended for patients, which is provided directly to patients or communicated via the health provider. To determine what pharmacogenetic information, if any, is included in patient-targeted sections of the drug label, we reviewed the labels listed in the US Food and Drug Administration’s Table of Pharmacogenomic Biomarkers in Drug Labels. To date, 140 drugs include pharmacogenetic-related information in the approved label. Our analysis revealed that pharmacogenetic information is included in patient-targeted sections for a minority (n=29; 21%) of drug labels, with no obvious pattern associated with the inclusion of pharmacogenetic information. Therefore, patients are unlikely to learn about pharmacogenetics through written materials dispensed with the drug. Given that there are also inconsistencies with regard to inclusion of pharmacogenetic information in the patient counseling information section, it is also unlikely that patients are receiving adequate pharmacogenetic information from their provider. The inconsistent presence of pharmacogenetic information in patient-targeted sections of drug labels suggests a need to review the criteria for inclusion of information in patient-targeted sections in order to increase consistency and patient knowledge of pharmacogenetic information. PMID:25342916

Haga, Susanne B; Mills, Rachel; Moaddeb, Jivan



Cytogenetic studies in patients with mastocytosis.  


Chromosomal aberrations in hematopoietic cells are common in malignant hematological disorders and have also been reported in some patients with mastocytosis. In this study, 34 patients with either urticaria pigmentosa or systemic mastocytosis were investigated by cytogenetic analysis of bone marrow cells. A follow-up investigation was performed in 22 patients. Clones with chromosome abnormalities were found in 32% of the patients at the first examination and in 27% at the second examination; in total, 41% of the patients had an abnormal clone in at least one examination. No clinical correlation was found with regard to cytogenetic results, with the exception of four patients who had an associated hematological disease and poor prognosis. In the second examination, only 6 patients had an unchanged chromosome pattern, and 4 of the patients with an initial normal pattern had appearance of abnormal clones; however, in 7 patients, the initial abnormal cells disappeared. The abnormalities were, among others, deletions of chromosomes 5, 7, 11, and 20. The proportion of cells with structural or numerical chromosome changes was higher in comparison with reported control groups. The frequency and type of chromosome abnormalities in bone marrow cells from patients with mastocytosis was about the same as observed in other chronic myeloproliferative disorders and myelodysplastic syndromes, diseases which also developed in 4 of our patients. An association between malignant hematological disorders and mastocytosis have been suggested by us and others. The chromosome abnormalities maybe reflect a genetic instability of the hematopoietic cells in mastocytosis. PMID:10942803

Swolin, B; Rödjer, S; Roupe, G



Experience with sorafenib and the elderly patient.  


Renal cell carcinoma primarily affects older individuals. Approximately half of all new renal cell carcinoma diagnoses are made in persons 65 years of age or older. Devising a treatment plan for the elderly patient population requires special consideration. Age-related physiological, cognitive, and social characteristics of elderly patients may influence each stage of patient care. Until recently, treatment options were limited for elderly patients with renal cell carcinoma. Sorafenib is the first multikinase inhibitor approved for use in renal cell carcinoma in the United States and Europe. In the phase III Treatment Approaches in Renal Cell Cancer Global Evaluation Trial, sorafenib significantly extended progression-free survival in patients with advanced renal cell carcinoma, regardless of age. Incidence rates of adverse events were not significantly higher in elderly patients receiving sorafenib than in younger patients. Thus, sorafenib represents an important treatment option for elderly patients with renal cell carcinoma. This report describes particular considerations for physicians to be aware of when choosing a treatment regimen for their elderly patients with renal cell carcinoma and offers recommendations on how to integrate specific management strategies into clinical practice that will optimize the use of sorafenib in the elderly. The strategies focus on patient selection, assessment of quality of life, management of adverse events, and appropriate dose modifications. The goal of these recommendations is to maximize the clinical benefit of sorafenib in the elderly patient population through appropriate use. PMID:20043216

Dutcher, Janice P; Tannir, Nizar; Bellmunt, Joaquim; Escudier, Bernard



Optimizing patient involvement in quality improvement  

PubMed Central

IntroductionPatient and public involvement in healthcare planning, service development and health-related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches. MethodsThree case study quality improvement projects were purposively sampled from a broader programme. We used an ethnographic approach involving 126 in-depth interviews, 12?weeks of non-participant observations and documentary analysis. Data analysis was based on the constant comparative method. ResultsThe three projects differed in the ways they involved patients in their quality improvement work, including their rationales for including patients. We characterized three very different models of patient involvement, which were each influenced by project context. Patients played distinctive roles across the three projects, acting in some cases as intermediaries between the wider patient community and clinicians, and sometimes undertaking persuasive work to convince clinicians of the need for change. We identified specific strategies that can be used to help ensure that patient involvement works most effectively and that the enthusiasm of patients to make a difference is not dissipated. ConclusionPatient involvement in quality improvement work needs careful management to realize its full potential. PMID:23374430

Armstrong, Natalie; Herbert, Georgia; Aveling, Emma-Louise; Dixon-Woods, Mary; Martin, Graham



Patient education preferences in ophthalmic care  

PubMed Central

Background The learning preferences of ophthalmology patients were examined. Methods Results from a voluntary survey of ophthalmology patients were analyzed for education preferences and for correlation with race, age, and ophthalmic topic. Results To learn about eye disease, patients preferred one-on-one sessions with providers as well as printed materials and websites recommended by providers. Patients currently learning from the provider were older (average age 59 years), and patients learning from the Internet (average age 49 years) and family and friends (average age 51 years) were younger. Patients interested in cataracts, glaucoma, macular degeneration, and dry eye were older; patients interested in double vision and glasses were younger. There were racial differences regarding topic preferences, with Black patients most interested in glaucoma (46%), diabetic retinopathy (31%), and cataracts (28%) and White patients most interested in cataracts (22%), glaucoma (22%), and macular degeneration (19%). Conclusion Most ophthalmology patients preferred personalized education: one-on-one with their provider or a health educator and materials (printed and electronic) recommended by their provider. Age-related topics were more popular with older patients, and diseases with racial risk factors were more popular with high risk racial groups. PMID:24812493

Rosdahl, Jullia A; Swamy, Lakshmi; Stinnett, Sandra; Muir, Kelly W



Lister's relationship with patients: ‘A successful case’  

PubMed Central

An important aspect of Joseph Lister's work that has received relatively little attention is his relationship with patients. However, a manuscript written by one of his patients, Margaret Mathewson's ‘A Sketch of Eight Months a patient, in the Royal Infirmary of Edinburgh, A.D. 1877’, provides detail about the surgeon as seen ‘from below’—that is, by a charity patient. Although excerpts from Mathewson's ‘Sketch’ have previously been published, an earlier version of the ‘Sketch’ has only recently been identified as such. That earlier version represents Lister not only as actively concerned with patient education, but also as strongly supportive of patients' rights, encouraging ward patients to report maltreatment at the hands of the staff. PMID:24686396

Carpenter, Mary Wilson



Hyperamylasemia in patients with eating disorders.  


Hyperamylasemia, which has been reported in patients with the eating disorders anorexia nervosa and bulimia, generally has been thought to result from pancreatitis. To evaluate the mechanisms of hyperamylasemia, we measured amylase, lipase, and isoamylase activity in 17 consecutive patients admitted to the eating disorder unit. Six patients had elevated amylase activity, and 5 of these 6 had isolated increases in salivary isoamylase activity. Six other patients had normal serum total amylase activity but modest elevations in the salivary isoamylase fraction. No patient developed clinical evidence of pancreatitis during hospitalization. Thus, the hyperamylasemia in patients with anorexia and bulimia often is caused by increased salivary-type amylase activity. The appropriate diagnostic test for hyperamylasemia in patients with anorexia or bulimia is the simple measurement of serum lipase or pancreatic isoamylase activity. If these levels are found to be normal, further tests to exclude pancreatitis are unnecessary. PMID:2431640

Humphries, L L; Adams, L J; Eckfeldt, J H; Levitt, M D; McClain, C J



Anaerobic bacteremia in patients with acute leukemia.  


We reviewed 402 hospital admissions of patients with acute leukemia to define the frequency and characteristics of anaerobic bacteremia in this patient population. Six (5.2%) of the 116 septicemia episodes documented in these patients were caused by anaerobes (Bacteroides species, 3; Fusobacterium species, 2; and Clostridium tertium, 1); two of these episodes were polymicrobial. Five patients had had prior bacteremia. All six patients were receiving broad-spectrum antibiotics, including an anti-pseudomonal penicillin, at the time of the episode. In each instance, the absolute granulocyte count was 0/mm3. Five patients had clinically apparent sources of infection, including perirectal abscess, gastrointestinal bleeding, or Clostridium difficile-associated diarrhea. Anaerobic bacteremia is an infrequent occurrence in granulocytopenic patients with acute leukemia, but may occur when there is obvious disruption of normal gastrointestinal anatomic barriers. PMID:2647821

Brown, E A; Talbot, G H; Provencher, M; Cassileth, P



Nonmedical Treatment of Patients with Dementia  

PubMed Central

This article reviews some nonmedical interventions that psychiatrists and other clinicians in the field of neuroscience can provide to their patients with dementia. The author discusses how clinicians can help patients and their caregivers understand the diagnosis causing the dementia (whether it be Alzheimer's, traumatic brain injury, Parkinson's disease, or vascular dementia) and help them to set realistic expectations of the treatment process for the patient and his or her loved ones. The author also reviews how clinicians can help caregivers modify their interactions with the patients when required to enhance not only the quality of life for the patient but the quality of life for the caregiver as well. Finally, the author reviews how clinicians can take on new initiatives that may help both the patients with dementia and their loved ones/caregivers when the patients are at the end stages of their disease. PMID:21860842



Genetics patients' perspectives on clinical genomic testing  

PubMed Central

Aims Advances in next-generation sequencing technologies make it possible to envisage multiple contexts in which genomic tools might be used to enhance patient care. We describe how genetics patients and their caregivers view the promises and perils of clinical genomic testing. Patients & methods Fifty-one interviews with patients and parents of pediatric patients seeking genetic evaluation at an academic medical center. Results Themes from interviews include participants' enthusiasm for clinical genomic testing for diagnostic purposes, medical benefits and concerns about emotional and psychosocial burdens resulting from clinical genomic testing. Conclusion By clarifying these patients' and caregivers' views of clinical genomic testing, the findings we report can help to anticipate other patients' reactions to new forms of personalized medicine enabled by genomic technologies. PMID:24955098

McGowan, Michelle L; Glinka, Allison; Highland, Janelle; Asaad, George; Sharp, Richard R



Patient registries for substance use disorders  

PubMed Central

This commentary discusses the need for developing patient registries of substance use disorders (SUD) in general medical settings. A patient registry is a tool that documents the natural history of target diseases. Clinicians and researchers use registries to monitor patient comorbidities, care procedures and processes, and treatment effectiveness for the purpose of improving care quality. Enactments of the Affordable Care Act 2010 and the Mental Health Parity and Addiction Equity Act 2008 open opportunities for many substance users to receive treatment services in general medical settings. An increased number of patients with a wide spectrum of SUD will initially receive services with a chronic disease management approach in primary care. The establishment of computer-based SUD patient registries can be assisted by wide adoption of electronic health record systems. The linkage of SUD patient registries with electronic health record systems can facilitate the advancement of SUD treatment research efforts and improve patient care. PMID:25114612

Tai, Betty; Hu, Lian; Ghitza, Udi E; Sparenborg, Steven; VanVeldhuisen, Paul; Lindblad, Robert



Evidence-Based Cardiology in Hemodialysis Patients  

PubMed Central

Cardiac events are the major cause of death in hemodialysis patients. Because of the paucity of randomized clinical trials (RCTs) in hemodialysis patients, most cardiovascular therapies in this population are based on observational studies or results extrapolated from studies that excluded hemodialysis patients. However, associations discovered in observational studies do not prove causality, and these studies often report surrogate outcomes rather than clinical end points. Furthermore, interventions that show effectiveness in the general population may have drastically different outcomes and side effect profiles in hemodialysis patients. This review discusses the results of RCTs undertaken recently to evaluate cardiovascular therapies in hemodialysis patients and emphasizes clinically relevant outcomes. Although some interventions have produced similar outcomes in hemodialysis patients and the general population, others have not, suggesting that the management of cardiovascular disease in hemodialysis patients may require strategies that differ from the best practice guidelines applied to general population. PMID:24136920



Functional health literacy and the quality of physician-patient communication among diabetes patients  

Microsoft Academic Search

While patients with poor functional health literacy (FHL) have difficulties reading and comprehending written medical instructions, it is not known whether these patients also experience problems with other modes of communication, such as face-to-face encounters with primary care physicians. We enrolled 408 English- and Spanish-speaking diabetes patients to examine whether patients with inadequate FHL report worse communication than patients with

Dean Schillinger; Andrew Bindmana; Frances Wang; Anita Stewart; John Piette



Patient empowerment and motivational interviewing: engaging patients to self-manage their own care.  


Patient empowerment is centered on the belief that patients should be in control of their own care and that behavioral changes and adherence to therapies cannot be achieved unless patients internalize the need for self-change. Data have consistently shown improved outcomes among patients on dialysis who are engaged, empowered and self-managing. Motivational interviewing provides a technique that can be applied by nephrology nurses to partner with patients and engage them in the management of their own care. PMID:19715108

McCarley, Patricia



Patient’s perception of a nurse-led Trastuzumab pathway  

PubMed Central

This paper presents the development of a pathway at a cancer unit in Northern England. The pathway aimed to ensure that patients with early breast cancer who were receiving Trastuzumab did so in a safe manner. This was achieved by developing a multiprofessional pathway, which crossed traditional boundaries to ensure the patient received the best care available. This paper describes the patient’s perception of the pathway obtained through a patient satisfaction survey and suggestions for its future direction. PMID:24761160

Roe, Helen



Patient-centering approaches for the surgical oncologist: palliative care, patient navigation, and distress screening.  


Surgeons can more effectively meet the public's increased expectation of patient-centered care by directing attention to pain, non-pain symptoms, including depression and anxiety, in addition to the patient's personal preferences, resources, and support needs. Patient navigation and palliative care, both pioneered by surgeons, provide complementary frameworks for the screening, assessment and intervention needed to achieve enhanced patient outcomes including adherence to care, improved quality of life and patient satisfaction. PMID:24995436

Dunn, Geoffrey P; Miller, Nina



[Work capacity in patients on hemodialysis].  


The quality of life is considerably impaired in patients on regular hemodialysis has been changed. It is difficult to determine it because there are no general definitions or measuring instruments. There are objective and subjective components of the quality of life, one among them being occupational ability. During the progression of chronic renal disease (CRD) to terminal renal failure (TRF) physical activity of the patients becomes poorer. In this stage, their physical activity is by 40-60% below the value expected for the same healthy age cohort. The intention of this analysis was to determine occupational ability in patients on regular hemodialysis. The analysis included 161 patients on hemodialysis, 78 (48.5%) female and 83 (51.5%) male, mean age 61.2 +/- 13.1 years, and mean time on hemodialysis was 54 +/- 71.9 months. All patients filled-out a self-administered questionnaire on schooling and occupational ability. The cause of TRF was glomerulonephritis in 45 (26.8%), diabetes mellitus in 42 (26.3%), nephrosclerosis in 26 (16.1%), and pyelonephritis in 12 (7.4%) patients. Age distribution was as follows: 0-19 years 1 patient, 20-44 years 14 (8.7%); 45-64 years 64 (39.8%) and 65 years 82 (50.9%) patients. Educational structure: elementary school 65 (40.4%), secondary school 79 (49.1%), college 10 (6.2%), and university 6 (3.7%) patients. Occupational structure: retired 123 (76.4%), housekeeper 20 (12.4%), never employed 4 (2.5%), employed 10 (6.2%), unemployed 2 (1.2%), 1 child and 1 student. Among employed patients there were 7 men and 3 women. Their educational level was as follow: elementary school 1 patient, secondary school 8 patients, college 1 patient. At the beginning of hemodialysis their occupational status was: full-time employment 30 (18.6%) patients, part-time employment 1 patient, longer time on sick-leave payment (3.1%), retired 95 (59%), pupils and students 3, unemployed 2, and 1 child did not attended school. Time interval between the beginning of hemodialysis and retirement was: less than 1 year work 13 (36.1%) patients, 1-2 year work 6 (16.7%), three year work 2 patients, more than 8 year work 2 patients, and 10 year work only 3 patients, for 14, 18 and 26 years each. Two patients lost their job for employer bankruptcy. The judgment of patients regarding their occupational ability was as follows: out of 161 patients, 23 (14.3%) felt fit for work, 12 on full-time and 11 on part-time basis. Occupationally incapable were 46.6% of patients, and 63 felt unable to take care of another person. Some kind of additional activity, like working in garden or taking care of children was reported by 26 patients. The aforementioned results showed that 22.4% of the patients were occupationally active at the time of starting hemodialysis. Many patients were retired after hemodialysis had started. Only 6.2% of hemodialysis patients were occupationally active although 14.3% felt occupationally capable. The main reasons for such a low level of employment were advanced age, diminished physical activity due to the disease, and difficulties associated with the socioeconomic situation in the country. PMID:15125397

Orli?, Lidija; Mati?-Glazar, Durdica; Sladoje Martinovi?, Branka; Vlahovi?, Ana



Lysosomal storage diseases as an etiology of nonimmune hydrops: a systematic review.  


We performed a systematic review of the literature to evaluate the incidence and types of lysosomal storage disorders (LSDs) in case series of nonimmune hydrops (NIH). PubMed and Ovid were reviewed for case series evaluating the workup of NIH diagnosed in utero or in the neonatal period in human subjects. Search terms were as follows: nonimmune hydrops, non immune hydrops, metabolic genetic disorders, and lysosomal storage disorders. The time period searched was 1979 through January 2014. Retrospective case series with at least 5 cases of fetal and/or neonatal NIH with its workup mentioned were identified. Idiopathic NIH was defined as NIH without an apparent cause after an initial workup. Exclusion criteria included studies published in languages other than English and review articles. The 3 authors screened all abstracts and manuscripts independently. Metaanalysis of Observational Studies in Epidemiology guidelines were followed. Fifty-four case series with 678 total cases of NIH were identified. The overall incidence of LSD was 5.2% (35 of 678) in all NIH cases that tested for any LSD and 17.4% (35 of 201) in idiopathic NIH cases. The 3 most common LSDs identified in cases of NIH, in order of decreasing incidence, were Mucopolysaccharidosis type VII, Gaucher's disease, and GM1-gangliosidosis. LSDs occur in 5.2% of all NIH cases and in 17.4% of idiopathic NIH cases and so should be screened for in this clinical scenario. Additionally, if a comprehensive LSD workup is completed on idiopathic cases, 29.6% of those would be reclassified as LSD. LSD testing does not only allow diagnosis but also ensures better counseling, appropriate management, and planning for possible early intervention. Moreover, their detection may aid in a prenatal diagnosis in subsequent pregnancies. PMID:25305402

Gimovsky, Alexis C; Luzi, Paola; Berghella, Vincenzo



Serum Protein Profile Alterations in Hemodialysis Patients  

SciTech Connect

Background: Serum protein profiling patterns can reflect the pathological state of a patient and therefore may be useful for clinical diagnostics. Here, we present results from a pilot study of proteomic expression patterns in hemodialysis patients designed to evaluate the range of serum proteomic alterations in this population. Methods: Surface-Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOFMS) was used to analyze serum obtained from patients on periodic hemodialysis treatment and healthy controls. Serum samples from patients and controls were first fractionated into six eluants on a strong anion exchange column, followed by application to four array chemistries representing cation exchange, anion exchange, metal affinity and hydrophobic surfaces. A total of 144 SELDI-TOF-MS spectra were obtained from each serum sample. Results: The overall profiles of the patient and control samples were consistent and reproducible. However, 30 well-defined protein differences were observed; 15 proteins were elevated and 15 were decreased in patients compared to controls. Serum from one patient exhibited novel protein peaks suggesting possible additional changes due to a secondary disease process. Conclusion: SELDI-TOF-MS demonstrated dramatic serum protein profile differences between patients and controls. Similarity in protein profiles among dialysis patients suggests that patient physiological responses to end-stage renal disease and/or dialysis therapy have a major effect on serum protein profiles.

Murphy, G A; Davies, R W; Choi, M W; Perkins, J; Turteltaub, K W; McCutchen-Maloney, S L; Langlois, R G; Curzi, M P; Trebes, J E; Fitch, J P; Dalmasso, E A; Colston, B W; Ying, Y; Chromy, B A



[Diagnostic and treatment goals in elderly patients].  


Improved quality of life and greater independence are becoming increasingly important as treatment goals in elderly patients, while merely extending life expectancy is only rarely the primary treatment goal. In elderly patients in particular, the patient's wishes are extremely important when deciding on the treatment goals. If patients are no longer able to express their wishes, the treating physician must establish what their presumed wishes are. Relatives and carers are particularly important in determining a patient's presumed wishes. A standardized geriatric assessment and interventions conducted on the basis of this assessment can give patients greater independence in everyday activities (e.g., walking, personal hygiene, eating) and can avoid them having to go into a nursing home or at least delay this move. In addition, the patient's prognosis is improved, which is manifested inter alia in a longer life-span. A basic geriatric assessment should therefore be conducted in all elderly patients. Standardized testing methods are used to examine the following areas: everyday activities, mobility/risk of falling, and cognition. Patients with the relevant risk combinations should also be screened for malnutrition. Comorbidities are a decisive factor influencing the prognosis in tumor patients. The comorbidities should be recorded using a structured method, e.g., the Charlson Comorbidity Index, and taken into account when deciding on treatment. PMID:17932635

Leischker, A H; Kolb, G F



Patient satisfaction and normative decision theory.  

PubMed Central

This article explores the application of normative decision theory (NDT) to the challenge of facilitating and measuring patient satisfaction. Patient satisfaction is the appraisal, by an individual, of the extent to which the care provided has met that individual's expectations and preferences. Classic decision analysis provides a graphic and computational strategy to link patient preferences for outcomes to the treatment choices likely to produce the outcomes. Multiple criteria models enable the complex judgment task of measuring patient satisfaction to be decomposed into elemental factors that reflect patient preferences, thus facilitating evaluation of care in terms of factors relevant to the individual patient. Through the application of NDT models, it is possible to use patient preferences as a guide to the treatment planning and care monitoring process and to construct measures of patient satisfaction that are meaningful to the individual. Nursing informatics, with its foundations in both information management and decision sciences, provides the tools and data necessary to promote care provided in accord with patient preferences and to ensure appraisal of satisfaction that aptly captures the complex, multidimensional nature of patient preferences. PMID:7583649

Brennan, P F



Disability in Indian patients with haemophilia.  


Chronic shortage of clotting factor concentrates, exorbitant treatment costs and the poor economic status of patients makes disability an inevitable consequence of haemophilia in India. The prevalence and risk factors for disability were studied in 148 patients with severe haemophilia A registered at five haemophilia clinics in the country. Disability was measured using a scoring method that used a compilation of functional ability, mobility and range-of-motion scores for each patient. Patients ranged in age from 5 to 55 years. Only nine of 148 patients were free of disability. The proportion of disability free patients in the 5-12, 13-24 and 25+ age groups were 14.3%, 4.4% and 0% respectively. The risk factors significantly associated with disability were patients age, socio-economic status, number of persons in the family, family history of haemophilia, frequency of physiotherapy exercises, home use of coagulation factor concentrate and type of blood product(s) used, that is clotting factor concentrate or cryoprecipitate. The study highlights the need to provide coagulation factor concentrates in sufficient amounts to prevent disability, the beneficial role of physiotherapy exercises and the advantage of older patients as peer educators for younger patients. The most important utility of the data is to demonstrate the widespread prevalence of disability amongst patients, its social costs in terms of incomplete education and unemployment, which justifies the need to include haemophilia as one of the conditions under the Disability Act of India. PMID:17610556

Kar, A; Mirkazemi, R; Singh, P; Potnis-Lele, M; Lohade, S; Lalwani, A; Saha, A S



Risk factors for thrombosis in lupus patients.  

PubMed Central

Lupus anticoagulant, concentrations of anticardiolipin antibodies, antithrombin III, plasminogen, (free) protein S, protein C, prothrombin, platelet counts, and bleeding times were determined in 74 lupus patients (58 with systemic lupus erythematosus; 16 with lupus-like disease) to establish the presence of risk factors for thrombosis in these patients. Of the variables evaluated, lupus anticoagulant had the strongest association with a history of thrombosis. Both positive anticardiolipin antibody concentrations and the presence of (mild) thrombocytopenia were significantly associated with a history of thrombosis and the presence of lupus anticoagulant. Reduced concentrations of antithrombin III, plasminogen, (free) protein S, and protein C were found in some patients but were not associated with either thrombosis or lupus anticoagulant. Mean concentrations of total protein S were significantly lower in patients with thrombosis than in those without and in patients with lupus anticoagulant than in those without. The antigenic concentration of prothrombin was reduced in 3/74 (4%) lupus patients. These three patients had lupus anticoagulant but no history of thrombosis, which suggests that a low prothrombin concentration protects patients with lupus anticoagulant from the development of thrombosis. A prolonged bleeding time was associated with the presence of lupus anticoagulant but not with a history of thrombosis. Analysis by stepwise logistic regression did not disclose additional risk factors for thrombosis in lupus patients with lupus anticoagulant. Increased antithrombin III concentrations and decreased free protein S concentrations are often found in lupus patients, unrelated to lupus anticoagulant or thrombosis. PMID:2512863

Hasselaar, P; Derksen, R H; Blokzijl, L; Hessing, M; Nieuwenhuis, H K; Bouma, B N; De Groot, P G



Lorcainide in patients with refractory ventricular tachyarrhythmia.  


Lorcainide, a new antiarrhythmic agent with local anesthetic or membrane-stabilizing properties similar to those of quinidine, was tested in 76 patients with diverse types of heart disease and recurrent ventricular tachycardia or ventricular fibrillation. Lorcainide was administered for 72 to 96 hours in a dose ranging from 200 to 400 mg daily. Evaluation of drug efficacy involved ambulatory monitoring and exercise stress testing in 60 patients who had high grade ventricular arrhythmia. Invasive electrophysiologic testing was carried out in the remaining 16 patients who exhibited infrequent ventricular ectopic activity during control studies. Lorcainide was effective in 21 (38%) of 56 patients evaluated for suppression of ventricular ectopic activity and in 6 (40%) of 15 who had invasive testing. In five patients, the drug was discontinued because of toxic reactions. Thus, 27 (38%) of the 71 patients who completed the drug study responded to lorcainide. Side effects, reported by 42 patients (55.3%), consisted primarily of insomnia and gastrointestinal symptoms; 7 experienced aggravation of arrhythmia. Fifteen patients were discharged while receiving lorcainide therapy, but in four the treatment was discontinued after 2 months because of side effects. Three patients died, one suddenly. It is concluded that lorcainide is of value in a small subset of patients with life-threatening ventricular arrhythmias who have proven refractory to conventional drugs. Its usefulness is limited by the high frequency of insomnia. PMID:6715710

Chesnie, B; Lampert, S; Podrid, P; Lown, B



Factors associated with hopelessness in epileptic patients  

PubMed Central

AIM: To investigate factors related to hopelessness in a sample of epileptic patients, including measures of depression and quality of life (QOL). METHODS: Sixty-nine participants were administered the following psychometric instruments: Beck Depression Inventory-II, Beck Hopelessness Scale (BHS), and QOL in Epilepsy (QOLIE)-89. Patients were dichotomized into two categories: those affected by epilepsy with generalized tonic-clonic seizures vs those having epilepsy with partial seizures. RESULTS: The groups differed on the QOLIE Role Limitation/Emotional dimension. Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems than patients with other types of epilepsy (89.57 ± 25.49 vs 72.86 ± 36.38; t63 = -2.16; P < 0.05). All of the respondents reported moderate to severe depression, and 21.7% of patients with generalized seizures and 28.6% of patients with other diagnoses had BHS total scores ? 9 indicating a higher suicidal risk. The study did not control for years of the illness. CONCLUSION: Patients with generalized seizures reported more limitations in common social/role activities related to emotional problems compared to patients with other types of seizures. Patients at increased suicide risk as evaluated by the BHS were older than those who had a lower suicidal risk. Future studies are required to further investigate the impact of hopelessness on the outcome of epileptic patients. PMID:25540729

Pompili, Maurizio; Serafini, Gianluca; Innamorati, Marco; Montebovi, Franco; Lamis, Dorian A; Milelli, Mariantonietta; Giuliani, Manuela; Caporro, Matteo; Tisei, Paolo; Lester, David; Amore, Mario; Girardi, Paolo; Buttinelli, Carla



Smoking behaviour of patients undergoing cardiac surgery  

PubMed Central

Objectives Investigate smoking behaviour and opinions on tobacco use in patients undergoing cardiac surgery. Methods In this descriptive study, 200 patients were preoperatively asked to complete a questionnaire on their 'smoking habits'. Smoking behaviour, smoking cessation, tobacco and health, smoking in hospital and smoking after the operation were the main subjects. Eighty percent of the questionnaires (161 patients) could be used in the study. The total group was divided into three groups: group A: patients smoking at the moment of hospitalisation, group B: patients who had stopped smoking and group C: patients who had never smoked. Results There is a difference in the answers between the three groups. For most patients the relation between tobacco use and cardiovascular disease is not clear; there is obviously an information gap. More than 50% of the patients do not agree with smoking in hospital, not even in 'smokers rooms'. Most patients have the intention of stopping smoking after their heart operation. This is an individual decision and support seems minimal. Conclusion This study confirms that the relation between smoking and cardiovascular diseases is not clear for many cardiac patients. Hospitalisation can be a good moment for smoking cessation, but support is necessary. ImagesFigure 1

Gabriel, M.; Noyez, L.; Verheugt, F.W.A.; Brouwer, R.M.H.J.



Cerebrovascular Profile Assessment in Parkinson's Disease Patients.  


Introduction: Parkinson's disease (PD) is one of the most common neurodegenerative diseases, and PD patients can present a variety of comorbidities that increase with age. Among them, cardiovascular and cerebrovascular diseases are the most prominent. Aim: To assess the cardiovascular and cerebrovascular profiles of PD patients. Patients and Methods: The cardiovascular risk factors of 126 PD patients were assessed according to laboratory tests (fasting blood sugar, serum cholesterol, triglycerides, and total lipids), Doppler ultrasound examinations and personal histories of cerebrovascular disease (ischemic/hemorrhagic), cardiovascular disease (myocardial infarct or angina confirmed by electrocardiogram), hypertension and diabetes. All patients underwent cerebral structural imaging procedures: computed tomography or magnetic resonance imaging. Results: 58.73% of the patients presented with hypertension, with a slight predominance of female patients (65.38% vs. 47.92%, P = 0.05). Carotid or vertebral atheromatosis was present in 39 (30.95%) and 28 (22.22%) of patients, respectively, and was statistically correlated with the presence of ischemic lesions on cerebral imaging. Regarding the computed tomography findings, 33 patients (28.21%) presented with cortical atrophy that was not correlated with any of the investigated cardiovascular factors. Conclusion: Our findings indicate that risk factors for cardiovascular and cerebrovascular diseases are common in PD patients, possibly due to their older age. The presence of atherosclerosis and its complications can be detected in cerebral imaging studies. PMID:24938774

Perju-Dumbrava, L; Muntean, M L; Mure?anu, D F



Best practice for atrial fibrillation patient education.  


Patients' beliefs about their health (and illness), medications and healthcare they receive are important determinants of whether or not they accept recommended treatments; influence their coping responses in relation to their illness; make them adhere to recommended therapy and ultimately affect health outcomes. Incorporation of patients' preferences for therapy should now be considered an integral part of the decision-making process. This gradual shift in health-care practice from paternalistic to shared-decision making, whereby there is a two-way exchange of information between the patient and healthcare provider and both are involved in the treatment decision, requires a reasonable level of understanding and knowledge of the condition and its treatment by the patient. However, patients with atrial fibrillation (AF) often have poor knowledge about their condition and the benefits and risks of AF and AF treatments. Physicians and other healthcare providers may have doubts over a patient's ability to adhere to certain treatment regimens, particularly oral anticoagulation, due in part to the lack of patient knowledge, and this may be an important determinant of whether such treatments are even considered as therapeutic options. Further, patients often hold misconceptions about AF and treatment options, which may act as barriers to their acceptance of the condition and adherence to therapy. This review will summarise the literature on the knowledge of patients about AF and its management, how patients' values and preferences can impact on their treatment choices, the ideal components of patient education, the impact of educational interventions on patients' knowledge and perceptions of AF, and where appropriate highlight specific issues facing lone AF patients. PMID:25175094

Lane, Deirdre A; Barker, Rachel V; Lip, Gregory Y H



Transforming the patient experience in radiation therapy.  


Healthcare providers are paying more attention to behavioral neuroscience research that confirms what patients intuitively know: physical environments deeply influence one's sense of well being. Recognizing the importance of comforting environments, healthcare providers have been working with architects to design new facilities around the patient's experience. This doesn't mean that functional and technical considerations are unimportant; it's just that the patient's experience comes first. The patient is the most important user of a healthcare facility, and yet is the only user not sitting at the table during design meetings. For this reason, some healthcare providers work with their architects to develop the conceptual design from the patient's standpoint before seeking detailed staff input. Many indignities experienced by patients may be unwittingly imposed by caring and dedicated professional staff. Medical clutter, waste containers, water coolers, coffee makers, personal displays and decorations add up to create a distressing level of visual chaos. Departments are required to eliminate clutter and maintain a calm, pleasing environment. Employees appreciate a well-designed physical environment, too. Facilities that reduce stress for patients have the same impact on staff, alleviating tension as they care for patients. Putting the patient's experience first need not add capital construction cost to a project. Rearranging spaces for the sake of the patient adds no more to floor area. Added windows, skylights and interior finishes can add cost, but the incremental cost of these amenities is small in proportion to the total project cost. Facilities project powerful visual dues about an institution's values. Providers who carefully plan for a positive patient experience traditionally enjoy strong reputations and exceptional customer loyalty. These providers know that good design is not simply wrapping a pretty facade around a building or decorating the lobby. Good design is the careful orchestration of uplifting and encouraging experiences for patients throughout their entire visit. For providers who achieve this, architecture becomes evidence that they put their patients first. PMID:14699925

Jarvis, J Andrew



Weight of epilepsy in brain tumor patients.  


About 20-40% of patients with brain tumor have seizures; all of whom must be treated with antiepileptic drugs (AEDs) that can cause side effects which may influence quality of life (QoL). However, little data are available regarding the weight of epilepsy on QoL in brain tumor (BT) patients, despite the fact that epilepsy is considered the most important risk factor for long-term disability in this patient population. Aim of this study is to explore the weight of epilepsy in BT patients, and to identify which factors might contribute to their epilepsy burden, as expressed by them only at their first visit in a specialized epilepsy center, in order to have a snapshot for that moment in their care cycle. We reviewed medical charts and results from a battery of tests (routinely given at our outpatient center), administered to 100 consecutive BTRE patients at their first visit, followed from 2007 to 2010. Our results reveal: (1) neurological performances and global neurocognitive status were not influenced by factors related to neoplastic disease or to epilepsy (2) side effects, cognitive deficits, and QoL concerns, as well as patients' perception of these, were significantly related to polytherapy, especially in patients who had been taking AEDs for a period longer that 6 months (3) the seizure number did not influence patients' QoL. We found that the weight of epilepsy in BTRE patients was related to AED therapy. Our study highlights the fact that epilepsy in our patients adds a significant burden, and suggests the need to give the proper attention to patients' concerns regarding the challenges that this pathology might present. Nevertheless, future studies could be designed with a follow-up period and with a patient stratification in order to better understand the weight of epilepsy for these patients. PMID:24789254

Maschio, Marta; Sperati, Francesca; Dinapoli, Loredana; Vidiri, Antonello; Fabi, Alessandra; Pace, Andrea; Pompili, Alfredo; Carapella, Carmine Maria; Cantelmi, Tonino



Clinical management of dying patients.  

PubMed Central

Dying is universal, and death should be a peaceful time. Myriad comfort measures are available in the last weeks before life ends. Discussions about end-of-life issues often suffer from lack of informed opinion. Palliative care experts have identified specific somatic and psychological sources of distress for dying patients and their loved ones. Pain, shortness of breath, nausea and vomiting, and fear of abandonment contribute substantially to both physical and psychological discomfort toward the end of life. Simple, effective methods exist for relieving those symptoms. Knowledge about the natural events associated with dying and an informed approach to medical and psychological interventions contribute to systematic and successful comfort care. We describe the origin of physical and psychological distress at the end of life and provide strategies for alleviating many of the discomforts. PMID:7571591

Gavrin, J; Chapman, C R



OR resuscitation for trauma patients.  


1. The results of multiple studies have shown evidence that immediate access to the operating room has significantly contributed to improved outcome in several categories of trauma patients. 2. "Walk through" table top exercises were held in the OR suite to identify problems. These mock resuscitations were particularly helpful in solving logistical and equipment problems. 3. Prehospital care providers were given classes regarding triage criteria and operating room logistics. 4. Continuing education for OR and trauma nurses included videotape review and critique of ORR, trauma-specific inservice programs presented by the trauma coordinators and physicians, and attendance at weekly videotape review and trauma conference presented by the Division of Trauma. Easy recognition of individual team members, an important issue, required the use of name badges. PMID:8342227

Hollingsworth-Fridlund, P; Bernal Hall, J; Dias, J B



Patient referral differences among specialties.  

PubMed Central

Data from the Seventh Periodic Survey of Physicians are examined for differences in referral rates among five major medical specialties. Referral rates for each specialty are regressed against physician-related and patient-related predictor variables. On the basis of Freidson's distinction between "colleague-dependent" and "client-dependent" specialties, the hypothesis tested is that physician-related variables explain more of the variance in referral rates of colleague-dependent than of client-dependent specialists. Although this use of Freidson's classification is not strongly supported by the results, the variables found to correlate with referral differences suggest that public policies aimed to increase access to care may produce a reduction in continuity of care as an unintended second-order effect. PMID:1219003

Shortell, S M; Vahovich, S G



Representing Patient Assessments in LOINC®  

PubMed Central

Without being included in accepted vocabulary standards, the results of completed patient assessment instruments cannot be easily shared in health information exchanges. To address this important barrier, we have developed a robust model to represent assessments in LOINC through iterative refinement and collaborative development. To capture the essential aspects of the assessment, the LOINC model represents the hierarchical panel structure, global item attributes, panel-specific item attributes, and structured answer lists. All assessments are available in a uniform format within the freely available LOINC distribution. We have successfully added many assessments to LOINC in this model, including several federally required assessments that contain functioning and disability content. We continue adding to this “master question file” to further enable interoperable exchange, storage, and processing of assessment data. PMID:21347095

Vreeman, Daniel J.; McDonald, Clement J.; Huff, Stanley M.



Cholangiography in the jaundiced patient.  

PubMed Central

Though local practice will reflect the previously acquired expertise of the operators, it seems reasonable to employ a minimum of percutaneous transhepatic cholangiography, and, ideally, this in combination with ERCP for preoperative cholangiography in patients with cholestatic jaundice. Few cases will defy both techniques. The morbidity is well known and if properly anticipated can be reduced to a minimum by judicious use of antibacterial agents and early surgical intervention when appropriate. Grey-scale ultrasonography by indicating the diameter of the bile ducts enables one to select percutaneous transhepatic cholangiography for dilated ducts and ERCP for non-dilated ducts with an almost 100% success rate for the former and only slightly less for the latter in experienced hands. PMID:137181

Elias, E



Approach to the Hypophosphatemic Patient  

PubMed Central

Hypophosphatemia is commonly missed due to nonspecific signs and symptoms, but it causes considerable morbidity and in some cases contributes to mortality. Three primary mechanisms of hypophosphatemia exist: increased renal excretion, decreased intestinal absorption, and shifts from the extracellular to intracellular compartments. Renal hypophosphatemia can be further divided into fibroblast growth factor 23-mediated or non-fibroblast growth factor 23-mediated causes. Proper diagnosis requires a thorough medication history, family history, physical examination, and assessment of renal tubular phosphate handling to identify the cause. During the past decade, our understanding of phosphate metabolism has grown greatly through the study of rare disorders of phosphate homeostasis. Treatment of hypophosphatemia depends on the underlying disorder and requires close biochemical monitoring. This article illustrates an approach to the hypophosphatemic patient and discusses normal phosphate metabolism. PMID:22392950

Imel, Erik A.



Automated Illustration of Patients Instructions  

PubMed Central

A picture can be a powerful communication tool. However, creating pictures to illustrate patient instructions can be a costly and time-consuming task. Building on our prior research in this area, we developed a computer application that automatically converts text to pictures using natural language processing and computer graphics techniques. After iterative testing, the automated illustration system was evaluated using 49 previously unseen cardiology discharge instructions. The completeness of the system-generated illustrations was assessed by three raters using a three-level scale. The average inter-rater agreement for text correctly represented in the pictograph was about 66 percent. Since illustration in this context is intended to enhance rather than replace text, these results support the feasibility of conducting automated illustration. PMID:23304392

Bui, Duy; Nakamura, Carlos; Bray, Bruce E.; Zeng-Treitler, Qing



The physician-patient relationship: the impact of patient-obtained medical information.  


We investigate the impact of patient-obtained medical information (POMI) on the physician-patient relationship when patients, as a group, are heterogeneously informed and a physician's interests do not coincide with those of her patients. Introducing additional well-informed patients to the population discontinuously affects the physician's strategy, having no effect unless a sufficient quantity is added. When few patients are well informed, increasing the precision of their information level has no effect on the physician's strategy. Alternately, when a sufficient number of well-informed patients exists, increasing the precision of their information allows all patients to free-ride by receiving more appropriate treatment recommendations.Counterintuitively, we also identify circumstances under which increasing the general level of information may potentially harm patients. PMID:16550612

Xie, Bin; Dilts, David M; Shor, Mikhael



Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction  

PubMed Central

The goal of postmastectomy breast reconstruction is to restore a woman’s body image and to satisfy her personal expectations regarding the results of surgery. Studies in other surgical areas have shown that unrecognized or unfulfilled expectations may predict dissatisfaction more strongly than even the technical success of the surgery. Patient expectations play an especially critical role in elective procedures, such as cancer reconstruction, where the patient’s primary motivation is improved health-related quality of life. In breast reconstruction, assessment of patient expectations is therefore vital to optimal patient care. This report summarizes the existing literature on patient expectations regarding breast reconstruction, and provides a viewpoint on how this field can evolve. Specifically, we consider how systematic measurement and management of patient expectations may improve patient education, shared medical decision-making and patient perception of outcomes. PMID:22458616

Pusic, Andrea L; Klassen, Anne F; Snell, Laura; Cano, Stefan J; McCarthy, Colleen; Scott, Amie; Cemal, Yeliz; Rubin, Lisa R; Cordeiro, Peter G



75 FR 57477 - Patient Safety Organizations: Voluntary Delisting  

Federal Register 2010, 2011, 2012, 2013

...SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Delisting AGENCY...Creighton Center for Health Services Research and Patient Safety (CHRP) Patient Safety Organization (PSO). The Patient Safety...



75 FR 57281 - Patient Safety Organizations: Voluntary delisting  

Federal Register 2010, 2011, 2012, 2013

...Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary delisting AGENCY...voluntary relinquishment from the Florida Patient Safety Corporation of its status as a Patient Safety Organization (PSO). The Patient...



42 CFR 413.184 - Payment exception: Pediatric patient mix.  

...diagnosis; (iii) Home patients and ages; (iv) In-facility patients, staff-assisted, or self-dialysis; (v) Diabetic patients; and (vi) Patients isolated because of contagious disease. (2) The facility also must— (i)...



Patient–Physician Role Relationships and Patient Activation among Individuals with Chronic Illness  

PubMed Central

Objective To examine whether chronically ill patients’ perceptions of their role relationships with their physicians are associated with levels of patient activation. Data Sources Random digit dial survey of 8,140 chronically ill patients and the Area Resource File. Study Design Cross-sectional, multivariate analysis of the relationship between dimensions of patient–physician role relationships and level of patient activation. The study controlled for variables related to patient demographics, socioeconomic status, health status, and market and family context. Principal Findings Higher perceived quality of interpersonal exchange with physicians, greater fairness in the treatment process, and more out-of-office contact with physicians were associated with higher levels of patient activation. Treatment goal setting was not significantly associated with patient activation. Conclusion Patient–physician relationships are an important factor in patients taking a more active role in their health and health care. Efforts to increase activation that focus only on individual patients ignore the important fact that the nature of roles and relationships between provider and patient can shape the behaviors and attitudes of patients in ways that support or discourage patient activation. PMID:22098418

Alexander, Jeffrey A; Hearld, Larry R; Mittler, Jessica N; Harvey, Jillian



Prevalence of fibromyalgia in hemodialysis patients.  


This study sought to determine the prevalence of fibromyalgia syndrome and to identify whether fibromyalgia was associated with various clinical symptoms and laboratory parameters in hemodialysis patients. One hundred and forty-eight hemodialysis patients were examined for fibromyalgia symptoms according to the American College of Rheumatology criteria. Demographic characteristics, as well as causes of kidney failure, dialysis duration, and symptoms related to fibromyalgia were investigated. Of 148 patients, 18 (12.2%) were diagnosed with fibromyalgia. Patients with fibromyalgia had significantly poorer sleeping satisfaction than the control group (P = .02).The Beck Depression Inventory score was higher in 77.8% of the fibromyalgia patients than that in the control group (P = .006), but there was no significant difference in the anxiety score between the two groups (P = .86).In conclusion, there was a higher prevalence of fibromyalgia in hemodialysis patients than previously reported. Sleep disturbances and depression levels correlated with fibromyalgia. PMID:24878948

Samimagham, Hamidreza; Haghighi, Anousheh; Tayebi, Mehdi; Jenabi, Arya; Arabi, Mohsen; Kianmehr, Nahid



Disruptive medical patients. Forensically informed decision making.  

PubMed Central

Patients who disrupt medical care create problems for physicians. The risks are not entirely clinical. Although these patients may compromise sound clinical judgment, some are also litigious and express their dissatisfaction in legal or other forums. It then becomes necessary for treating physicians to be aware of the legal and ethical boundaries of their patient care responsibilities. Some disruptive patients are treated by setting limits, which is usually affirmed by health care agreements. A hospital review board may advise clinicians on these agreements and on the management of disruptive patients. If termination of the physician-patient relationship is considered, physicians must follow proper protocol. We examine these forensic considerations and place them in the context of malpractice. Communication, consultation, and documentation are the key elements in reducing liability. PMID:1595274

Sparr, L. F.; Rogers, J. L.; Beahrs, J. O.; Mazur, D. J.



Management of the critically poisoned patient  

PubMed Central

Background Clinicians are often challenged to manage critically ill poison patients. The clinical effects encountered in poisoned patients are dependent on numerous variables, such as the dose, the length of exposure time, and the pre-existing health of the patient. The goal of this article is to introduce the basic concepts for evaluation of poisoned patients and review the appropriate management of such patients based on the currently available literature. Methods An unsystematic review of the medical literature was performed and articles pertaining to human poisoning were obtained. The literature selected was based on the preference and clinical expertise of authors. Discussion If a poisoning is recognized early and appropriate testing and supportive care is initiated rapidly, the majority of patient outcomes will be good. Judicious use of antidotes should be practiced and clinicians should clearly understand the indications and contraindications of antidotes prior to administration. PMID:19563673

Boyle, Jennifer S; Bechtel, Laura K; Holstege, Christopher P



Challenges in Interventional Radiology: The Pregnant Patient  

PubMed Central

A pregnant patient presenting to interventional radiology (IR) has a different set of needs from any other patient requiring a procedure. Often, the patient's care can be in direct conflict with the growth and development of the fetus, whether it be optimal fluoroscopic imaging, adequate sedation of the mother, or the timing of the needed procedure. Despite the additional risks and complexities associated with pregnancy, IR procedures can be performed safely for the pregnant patient with knowledge of the special and general needs of the pregnant patient, use of acceptable medications and procedures likely to be encountered during pregnancy, in addition to strategies to protect the patient and her fetus from the hazards of radiation. PMID:24436567

Moon, Eunice K.; Wang, Weiping; Newman, James S.; Bayona-Molano, Maria Del Pilar



Patient access to rheumatoid arthritis treatments  

Microsoft Academic Search

This paper is an introduction to the study “The Burden of Rheumatoid Arthritis and Patient Access to Treatment”. The objective\\u000a of the study is to compare patient access to new drugs in Europe, North America and a selection of other countrie