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Neuroimaging findings in infantile GM1 gangliosidosis  

Microsoft Academic Search

GM1 gangliosidosis is an autosomal recessive glycosphingolipid storage disease caused by defects in the enzyme ?-galactosidase. Three clinical forms (infantile-, juvenile-, and adult-onset) of the disease are recognized. Patients with infantile GM1 gangliosidosis present at birth or shortly thereafter with somatic and bony changes, followed by severe neurological deterioration ultimately leading to death within the first 2 years of life.

Ilknur Erol; Füsun Alehan; M. Ali Pourbagher; Oguz Canan; S. Vefa Yildirim



962. Treatment of Feline GM1 Gangliosidosis with Mesenchymal Stem Cells and Lentiviral Gene Therapy  

Microsoft Academic Search

Deficiency of lysosomal ?-galactosidase causes GM1 gangliosidosis, an inherited, progressive neurological disorder in which GM1 ganglioside accumulates in all tissues, including thymus, liver and brain. In addition to abnormal neuronal histology and function, gangliosidosis pathology involves a significant inflammatory component and therefore is similar to other neurodegenerative disorders such as Alzheimer and Parkinson disease. GM1 gangliosidosis occurs in humans, mice

Douglas R. Martin; Karin Haack; Glenn P. Niemeyer; Nancy R. Cox; Tal Kafri; Henry J. Baker



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-Colon, 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



[Three siblings with type 3 GM1-gangliosidosis--pathophysiology of dystonia and MRI findings].  


GM1-gangliosidosis is a rare neurovisceral storage disease caused by an inherited deficiency of acid beta-galactosidase. The characteristic neurological feature of type 3 (adult or chronic) GM1-gangliosidosis is usually a slowly progressive dystonia with dysarthria due to predominant involvement of basal ganglia. About 20 adult patients with this disorder have been reported in the literature. However, there are no reports of 3 brothers with type 3 GM1-gangliosidosis, and MRI findings. Case 1 (proband): A 28-year-old man was hospitalized because of facial grimace, dysarthria, and generalized dystonia. He was born after normal pregnancy and delivery. His development was normal until 3 years of age when the difficulties of speaking and walking were noticed by his parents. These neurological abnormalities progressed slowly and facial grimace and dystonic movements occurred 7 years later. He could not walk at 22 years of age. On admission, he was bedridden with marked scoliosis and subluxation of the mandibule. The communication was possible only by pointing the words written on the board. Case 2: A 33-year-old man, elder brother of case 1, showed the similar neurological features and clinical course. Slit-lamp examination revealed corneal opacities which were located in the deep stroma. Case 3: A 33-year-old man, elder brother of case 1 or case 2. At age 10-11, he noted similar symptoms as case 1 or case 2. The severity of dystonia was milder than his brothers. A diagnosis of GM1-gangliosidosis in three patients was made on the basis of the following data.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2123760

Uyama, E; Terasaki, T; Owada, M; Naito, M; Araki, S



Molecular consequences of the pathogenic mutation in feline GM1 gangliosidosis  

PubMed Central

GM1 gangliosidosis is an inherited, fatal neurodegenerative disease caused by deficiency of lysosomal ?-D-galactosidase (EC and consequent storage of undegraded GM1 ganglioside. To characterize the genetic mutation responsible for feline GM1 gangliosidosis, the normal sequence of feline ?-galactosidase cDNA first was defined. The feline ?-galactosidase open reading frame is 2010 base pairs, producing a protein of 669 amino acids. The putative signal sequence consists of amino acids 1–24 of the ?-galactosidase precursor protein, which contains seven potential N-linked glycosylation sites, as in the human protein. Overall sequence homology between feline and human ?-galactosidase is 74% for the open reading frame and 82% for the amino acid sequence. After normal ?-galactosidase was sequenced, the mutation responsible for feline GM1 gangliosidosis was defined as a G to C substitution at position 1448 of the open reading frame, resulting in an amino acid substitution at arginine 483, known to cause GM1 gangliosidosis in humans. Feline ?-galactosidase messenger RNA levels were normal in cerebral cortex, as determined by quantitative RT-PCR assays. Although enzymatic activity is severely reduced by the mutation, a full-length feline ?-galactosidase cDNA restored activity in transfected GM1 fibroblasts to 18-times normal. ?-Galactosidase protein levels in GM1 tissues were normal on Western blots, but immunofluorescence analysis demonstrated that the majority of mutant ?-galactosidase protein did not reach the lysosome. Additionally, GM1 cat fibroblasts demonstrated increased expression of glucose-related protein 78/BiP and protein disulfide isomerase, suggesting that the unfolded protein response plays a role in pathogenesis of feline GM1 gangliosidosis. PMID:18353697

Martin, Douglas R.; Rigat, Brigitte A.; Foureman, Polly; Varadarajan, G.S.; Hwang, Misako; Krum, Barbara K.; Smith, Bruce F.; Callahan, John W.; Mahuran, Don J.; Baker, Henry J.



Chemical chaperone therapy: clinical effect in murine G(M1)-gangliosidosis.  


Certain low-molecular-weight substrate analogs act both as in vitro competitive inhibitors of lysosomal hydrolases and as intracellular enhancers (chemical chaperones) by stabilization of mutant proteins. In this study, we performed oral administration of a chaperone compound N-octyl-4-epi-beta-valienamine to G(M1)-gangliosidosis model mice expressing R201C mutant human beta-galactosidase. A newly developed neurological scoring system was used for clinical assessment. N-Octyl-4-epi-beta-valienamine was delivered rapidly to the brain, increased beta-galactosidase activity, decreased ganglioside G(M1), and prevented neurological deterioration within a few months. No adverse effect was observed during this experiment. N-Octyl-4-epi-beta-valienamine will be useful for chemical chaperone therapy of human G(M1)-gangliosidosis. PMID:17994547

Suzuki, Yoshiyuki; Ichinomiya, Satoshi; Kurosawa, Mieko; Ohkubo, Masato; Watanabe, Hiroshi; Iwasaki, Hiroyuki; Matsuda, Junichiro; Noguchi, Yoko; Takimoto, Kazuhiro; Itoh, Masayuki; Tabe, Miho; Iida, Masami; Kubo, Takatoshi; Ogawa, Seiichiro; Nanba, Eiji; Higaki, Katsumi; Ohno, Kousaku; Brady, Roscoe O



A Bicyclic 1-Deoxygalactonojirimycin Derivative as a Novel Pharmacological Chaperone for GM1 Gangliosidosis  

PubMed Central

Lysosomal ?-galactosidase (?-Gal) deficiency causes a group of disorders that include neuronopathic GM1 gangliosidosis and non-neuronopathic Morquio B disease. We have previously proposed the use of small molecule ligands of ?-Gal as pharmacological chaperones (PCs) for the treatment of GM1 gangliosidosis brain pathology. Although it is still under development, PC therapy has yielded promising preclinical results in several lysosomal diseases. In this study, we evaluated the effect of bicyclic 1-deoxygalactonojirimycin (DGJ) derivative of the sp2-iminosugar type, namely 5N,6S-(N?-butyliminomethylidene)-6-thio-1- deoxygalactonojirimycin (6S-NBI-DGJ), as a novel PC for human mutant ?-Gal. In vitro, 6S-NBI-DGJ had the ability to inhibit the activity of human ?-Gal in a competitive manner and was able to protect this enzyme from heat-induced degradation. Computational analysis supported that the rigid glycone bicyclic core of 6S-NBI-DGJ binds to the active site of the enzyme, with the aglycone N?-butyl substituent, in a precise E-orientation, located at a hydrophobic region nearby. Chaperone potential profiling indicated significant increases of enzyme activity in 24 of 88 ?-Gal mutants, including four common mutations. Finally, oral administration of 6S-NBI-DGJ ameliorated the brain pathology of GM1 gangliosidosis model mice. These results suggest that 6S-NBI-DGJ is a novel PC that may be effective on a broad range of ?-Gal mutants. PMID:23337983

Takai, Tomoko; Higaki, Katsumi; Aguilar-Moncayo, Matilde; Mena-Barragan, Teresa; Hirano, Yuki; Yura, Kei; Yu, Liang; Ninomiya, Haruaki; Garcia-Moreno, M. Isabel; Sakakibara, Yasubumi; Ohno, Kousaku; Nanba, Eiji; Ortiz Mellet, Carmen; Garcia Fernandez, Jose M.; Suzuki, Yoshiyuki



Exome sequencing as a diagnostic tool in a case of undiagnosed juvenile-onset GM1-gangliosidosis  

PubMed Central

Objective: To utilize high-throughput sequencing to determine the etiology of juvenile-onset neurodegeneration in a 19-year-old woman with progressive motor and cognitive decline. Methods: Exome sequencing identified an initial list of 133,555 variants in the proband's family, which were filtered using segregation analysis, presence in dbSNP, and an empirically derived gene exclusion list. The filtered list comprised 52 genes: 21 homozygous variants and 31 compound heterozygous variants. These variants were subsequently scrutinized with predicted pathogenicity programs and for association with appropriate clinical syndromes. Results: Exome sequencing data identified 2 GLB1 variants (c.602G>A, p.R201H; c.785G>T, p.G262V). ?-Galactosidase enzyme analysis prior to our evaluation was reported as normal; however, subsequent testing was consistent with juvenile-onset GM1-gangliosidosis. Urine oligosaccharide analysis was positive for multiple oligosaccharides with terminal galactose residues. Conclusions: We describe a patient with juvenile-onset neurodegeneration that had eluded diagnosis for over a decade. GM1-gangliosidosis had previously been excluded from consideration, but was subsequently identified as the correct diagnosis using exome sequencing. Exome sequencing can evaluate genes not previously associated with neurodegeneration, as well as most known neurodegeneration-associated genes. Our results demonstrate the utility of “agnostic” exome sequencing to evaluate patients with undiagnosed disorders, without prejudice from prior testing results. PMID:22675082

Adams, David A.; Markello, Thomas; Golas, Gretchen; Yang, Sandra; Sincan, Murat; Simeonov, Dimitre R.; Fuentes Fajardo, Karin; Hansen, Nancy F.; Cherukuri, Praveen F.; Cruz, Pedro; Teer, Jamie K.; Mullikin, James C.; Boerkoel, Cornelius F.; Gahl, William A.; Tifft, Cynthia J.



AAV-Mediated Gene Delivery in Adult GM1Gangliosidosis Mice Corrects Lysosomal Storage in CNS and Improves Survival  

Microsoft Academic Search

BackgroundGM1-gangliosidosis is a glycosphingolipid (GSL) lysosomal storage disease caused by a genetic deficiency of acid ?-galactosidase (?gal), which results in the accumulation of GM1-ganglioside and its asialo-form (GA1) primarily in the CNS. Age of onset ranges from infancy to adulthood, and excessive ganglioside accumulation produces progressive neurodegeneration and psychomotor retardation in humans. Currently, there are no effective therapies for the

Rena C. Baek; Marike L. D. Broekman; Stanley G. Leroy; Laryssa A. Tierney; Michael A. Sandberg; Alessandra D'Azzo; Thomas N. Seyfried; Miguel Sena-Esteves; Alfred Lewin



Serial MRI Features of Canine GM1 Gangliosidosis: A Possible Imaging Biomarker for Diagnosis and Progression of the Disease  

PubMed Central

GM1 gangliosidosis is a fatal neurodegenerative lysosomal storage disease caused by an autosomal recessively inherited deficiency of ?-galactosidase activity. Effective therapies need to be developed to treat the disease. In Shiba Inu dogs, one of the canine GM1 gangliosidosis models, neurological signs of the disease, including ataxia, start at approximately 5 months of age and progress until the terminal stage at 12 to 15 months of age. In the present study, serial MR images were taken of an affected dog from a model colony of GM1 gangliosidosis and 4 sporadic clinical cases demonstrating the same mutation in order to characterize the MRI features of this canine GM1 gangliosidosis. By 2 months of age at the latest and persisting until the terminal stage of the disease, the MR findings consistently displayed diffuse hyperintensity in the white matter of the entire cerebrum on T2-weighted images. In addition, brain atrophy manifested at 9 months of age and progressed thereafter. Although a definitive diagnosis depends on biochemical and genetic analyses, these MR characteristics could serve as a diagnostic marker in suspect animals with or without neurological signs. Furthermore, serial changes in MR images could be used as a biomarker to noninvasively monitor the efficacy of newly developed therapeutic strategies. PMID:22536126

Hasegawa, Daisuke; Yamato, Osamu; Nakamoto, Yuya; Ozawa, Tsuyoshi; Yabuki, Akira; Itamoto, Kazuhito; Kuwabara, Takayuki; Fujita, Michio; Takahashi, Kimimasa; Mizoguchi, Shunta; Orima, Hiromitsu



AAV-Mediated Gene Delivery in Adult GM1-Gangliosidosis Mice Corrects Lysosomal Storage in CNS and Improves Survival  

PubMed Central

Background GM1-gangliosidosis is a glycosphingolipid (GSL) lysosomal storage disease caused by a genetic deficiency of acid ?-galactosidase (?gal), which results in the accumulation of GM1-ganglioside and its asialo-form (GA1) primarily in the CNS. Age of onset ranges from infancy to adulthood, and excessive ganglioside accumulation produces progressive neurodegeneration and psychomotor retardation in humans. Currently, there are no effective therapies for the treatment of GM1-gangliosidosis. Methodology/Principal Findings In this study we examined the effect of thalamic infusion of AAV2/1-?gal vector in adult GM1 mice on enzyme distribution, activity, and GSL content in the CNS, motor behavior, and survival. Six to eight week-old GM1 mice received bilateral injections of AAV vector in the thalamus, or thalamus and deep cerebellar nuclei (DCN) with pre-determined endpoints at 1 and 4 months post-injection, and the humane endpoint, or 52 weeks of age. Enzyme activity was elevated throughout the CNS of AAV-treated GM1 mice and GSL storage nearly normalized in most structures analyzed, except in the spinal cord which showed ?50% reduction compared to age-matched untreated GM1 mice spinal cord. Survival was significantly longer in AAV-treated GM1 mice (52 wks) than in untreated mice. However the motor performance of AAV-treated GM1 mice declined over time at a rate similar to that observed in untreated GM1 mice. Conclusions/Significance Our studies show that the AAV-modified thalamus can be used as a ‘built-in’ central node network for widespread distribution of lysosomal enzymes in the mouse cerebrum. In addition, this study indicates that thalamic delivery of AAV vectors should be combined with additional targets to supply the cerebellum and spinal cord with therapeutic levels of enzyme necessary to achieve complete correction of the neurological phenotype in GM1 mice. PMID:20976108

Baek, Rena C.; Broekman, Marike L. D.; Leroy, Stanley G.; Tierney, Laryssa A.; Sandberg, Michael A.; d'Azzo, Alessandra; Seyfried, Thomas N.; Sena-Esteves, Miguel



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.



Characterization of beta-galactosidase mutations Asp332-->Asn and Arg148-->Ser, and a polymorphism, Ser532-->Gly, in a case of GM1 gangliosidosis.  

PubMed Central

We have identified and characterized three missense mutations in a patient with type 1 G(M1) gangliosidosis, namely a substitution of G for A at nucleotide position 1044 (G1044-->A; in exon 10) on one allele, which converts Asp(332) into asparagine, and both a mutation (C492-->A in exon 4, leading to the amino acid change of Arg(148)-->Ser) and a polymorphism (A1644-->G in exon 15, leading to a change of Ser(532)-->Gly) on the other allele. This patient had less than 1% residual beta-galactosidase activity and minimally detectable levels of immunoreactive beta-galactosidase protein in fibroblasts. To account for the above findings, a series of expression and immunolocalization studies were undertaken to assess the impact of each mutation. Transient overexpression in COS-1 cells of cDNAs encoding Asp(332)Asn, Arg(148)Ser and Ser(532)Gly mutant beta-galactosidases produced abundant amounts of precursor beta-galactosidase, with activities of 0, 84 and 81% compared with the cDNA clone for wild-type beta-galactosidase (GP8). Since the level of vector-driven expression is much less in Chinese hamster ovary (CHO) cells than in COS-1 cells, and we knew that exogenous beta-galactosidase undergoes lysosomal processing when expressed in these cells, transient expression studies were performed of Arg(148)Ser and Ser(532)Gly, which yielded active forms of the enzyme. In this case, the Arg(148)Ser and Ser(532)Gly products gave rise to 11% and 86% of the control activity respectively. These results were not unexpected, since the Arg(148)Ser mutation introduced a major conformational change into the protein, and we anticipated that it would be degraded in the endoplasmic reticulum (ER), whereas the polymorphism was expected to produce near-normal activity. To examine the effect of the Asp(332)Asn mutation on the catalytic activity, we isolated CHO clones permanently transfected with the Asp(332)Asn and Asp(332)Glu constructs, purified the enzymes by substrate-analogue-affinity chromatography, and determined their kinetic parameters. The V(max) values of both mutant recombinant enzymes were markedly reduced (less than 0.9% of the control), and the K(m) values were unchanged compared with the corresponding wild-type enzyme isolated at the same time. Both the Arg(148)Ser beta-galactosidase in CHO cells and Asp(332)Asn beta-galactosidases (in COS-1 and CHO cells) produced abundant immunoreaction in the perinuclear area, consistent with localization in the ER. A low amount was detected in lysosomes. Incubation of patient fibroblasts in the presence of leupeptin, which reduces the rate of degradation of lysosomal beta-galactosidase by thiol proteases, had no effect on residual enzyme activity, and immunostaining was again detected largely in the perinuclear area (localized to the ER) with much lower amounts in the lysosomes. In summary, the Arg(148)Ser mutation has no effect on catalytic activity, whereas the Asp(332)Asn mutation seriously reduces catalytic activity, suggesting that Asp(332) might play a role in the active site. Immunofluorescence studies indicate the expressed mutant proteins with Arg(148)Ser and Asp(332)Asn mutations are held up in the ER, where they are probably degraded, resulting in only minimum amounts of the enzyme becoming localized in the lysosomes. These results are completely consistent with findings in the cultured fibroblasts. Our results imply that most of the missense mutations described in G(M1) gangliosidosis to date have little effect on catalytic activity, but do affect protein conformation such that the resulting protein cannot be transported out of the ER and fails to arrive in the lysosome. This accounts for the minimal amounts of enzyme protein and activity seen in most G(M1) gangliosidosis patient fibroblasts. PMID:10839995

Zhang, S; Bagshaw, R; Hilson, W; Oho, Y; Hinek, A; Clarke, J T; Callahan, J W



Detection of antibodies in neuropathy patients by synthetic GM1 mimics.  


Antibodies to the ganglioside GM1 are associated with various forms of acute and chronic immune-mediated neuropathy, including Guillain-Barré syndrome (GBS) and multifocal motor neuropathy. In diagnostics and research, these antibodies are usually detected by GM1 preparations derived from bovine brain tissue, which are non-covalently attached to solid carriers such as enzyme-linked immunosorbent assay (ELISA) plates. Such brain-derived GM1 preparations are potentially contaminated with other glycolipids. In the current study, uncontaminated mono- and divalent synthetic analogs of the ganglioside GM1 were successfully attached via covalent bonds onto the surface of ELISA plates. The resulting modified diagnostic tool showed strong affinities and good specificities for binding of monoclonal mouse and human anti-GM1 antibodies and cholera toxin, as well as for the anti-GM1 antibodies in serum samples from neuropathy patients. While these proof-of-principle experiments reveal the potential of synthetic ganglioside mimics in diagnostics, they show the necessity of further studies to overcome certain limitations, specifically the non-specific interactions in the negative control assays with synthetic GM1. PMID:21798866

Pukin, Aliaksei V; Jacobs, Bart C; Tio-Gillen, Anne P; Gilbert, Michel; Endtz, Hubert P; van Belkum, Alex; Visser, Gerben M; Zuilhof, Han



Ganglioside-monosialic acid (GM1) prevents oxaliplatin-induced peripheral neurotoxicity in patients with gastrointestinal tumors  

PubMed Central

Background Oxaliplatin, an effective antineoplastic agent againstgastrointestinal tumors, can cause severe peripheral neurotoxicity, which seriously limits its clinical application. To date, there are no effective treatments for this complication. Ganglioside-monosialic acid (GM1) has been shown to protect neurons against injuries and degeneration. The aim of this study was to evaluate the effects of GM1 on preventing oxaliplatin-induced neurotoxicity in patients with gastrointestinal tumors. Methods In this study, 120 patients with gastrointestinal tumors were enrolled, andthey received the treatment of XELOX (oxaliplatin and capecitabine) and FOLFOX4 (oxaliplatin, leukovolin and 5-fluorouracil). The patients were randomly divided into two groups, the experimental group and control group, with60 patients ineach. On the day chemotherapy was initiated, the experimental group received GM1 intravenously (100 mg once daily) for 3 days, while no neuroprotective agents were applied in the control group. The incidence rates and classification of neurotoxicity in the two groups were evaluated and the differences between the two groups were examined. Furthermore, whether GM1 affected the therapeutic effects of chemotherapy was also examined. Results The grade of neurotoxicity in the experimental group was significantly lower than in the control group (P<0.05, Mann–Whitney U test). The probability of occurrence of low-grade neurotoxicity (grade 0 and 1) in the experimental group was higher than that in the control group (logistic ordinal regression); whereas the probability of occurrence of high-grade neurotoxicity (grade 2 and 3) in the experimental group was lower than in the control group (logistic ordinal regression). Conclusion The data suggested that GM1 could reduce the grade of oxaliplatin-induced neurotoxicity and was an effective neuroprotective agent against oxaliplatin-induced high-grade neurotoxicity in patients with gastrointestinal tumors. PMID:23351188



Infantile G M1 Gangliosidosis: Complete Morphology and Histochemistry of Two Autopsy Cases, with Particular Reference to Delayed Central Nervous System Myelination  

Microsoft Academic Search

Inborn metabolic errors causing lysosomal storage, such as ?-galactosidase deficiency (GM1 gangliosidosis [GM1]), have well-recognized effects on cellular function and morphology. In some classically “neuronal” storage diseases, including\\u000a GM1, neuroradiologic observations of infants have suggested a delay in myelination on the basis of persistently “immature” signal\\u000a intensities monitored over time. We sought to evaluate in a semiquantitative fashion the pattern

Rebecca D. Folkerth; Joseph Alroy; Ina Bhan; Edward M. Kaye



Lower motor neuron syndrome associated with IgG anti-GM1 antibodies revisited.  


A patient, who developed an amyotrophic lateral sclerosis-like disorder subsequent to ganglioside treatment, had IgM antibodies to GM2 as well as to minor gangliosides X1 and X2 containing GM2 epitope. These gangliosides as well as GM1 were tested in 655 sera obtained from patients who were suspected of having amyotrophic lateral sclerosis or motor neuron disease to find a treatable condition. Three patients had high titers of IgG anti-GM1 antibodies, but no IgM anti-GM1 antibodies. One of the patients also had IgG anti-X2 antibodies. The patients, being diagnosed with having lower motor neuron syndrome, had neither upper motor neuron signs nor multifocal conduction block. Both IgM and IgG anti-GM1 antibodies should be tested in patients who have lower motor neuron syndrome. PMID:24841627

Yuki, Nobuhiro; Yanaka, Chiaki; Sudo, Makoto; Funakoshi, Miyuki; Ishida, Hideharu; Mori, Masahiro; Kanda, Fumio; Hirata, Koichi



Application of delayed extraction matrix-assisted laser desorption ionization time-of-flight mass spectrometry for analysis of sphingolipids in tissues from sphingolipidosis patients.  


Sphingolipidosis is due to defects in enzymes involved in hydrolysis of sphingolipids. We analyzed sphingolipids in tissues from patients with sphingolipidosis, including Farber disease (FD, acid ceramidase deficiency), Gaucher disease (GD), Niemann-Pick disease type C (NPDC), and GM1-gangliosidosis (GM1G), using delayed extraction matrix-assisted laser desorption ionization time-of-flight mass spectrometry (DE MALDI-TOF-MS). Crude lipids were extracted from about 100 mg wet weight of autopsied tissues, including liver, spleen, cerebrum or cerebellum. After mild alkaline treatment, a sphingolipid fraction was prepared from the crude lipids and analyzed by DE MALDI-TOF-MS. The results were as follows: (a) In FD liver both the ceramide/sphingomyelin and ceramide/monohexosylceramide ratios were significantly high; (b) in both liver and spleen from a GD patient, the glucosylceramide/sphingomyelin ratio was raised; (c) in liver from a NPDC patient, the monohexosylceramide/sphingomyelin ratio was markedly low, suggesting an increase of sphingomyelin; and (d) in all tissues examined in the GM1G patient, GM1-gangliosides or asialo-GM1-gangliosides, that are undetectable in a normal control, were increased. In conclusion, sphingolipids in human tissues could be directly determined by DE MALDI-TOF-MS, with only a small amount of specimens. This method will be useful for the diagnosis and biochemical evaluation of sphingolipidosis patients. PMID:10491988

Fujiwaki, T; Yamaguchi, S; Sukegawa, K; Taketomi, T



GD1b-specific antibodies may bind to complex of GQ1b and GM1, causing ataxia.  


Monospecific IgG antibodies to GD1b ganglioside (GD1b-specific antibodies) have been found in patients with acute ataxic neuropathy and Guillain-Barré syndrome, but the association of the GD1b-specific antibodies with specific neurological conditions has yet to be established. We tested sera from more than 10,000 patients with various neurological disorders, and found six sera, which contained IgG antibodies to GD1b, but not to LM1, GM1, GM1b, GD1a, GalNAc-GD1a, GT1a, GT1b and GQ1b. All six patients who carried GD1b-specific antibodies presented with acute onset of ataxia and monophasic course of the illness, of whom five demonstrated cerebellar-like ataxia. Four patients had antecedent symptoms of upper respiratory tract infection. The six patients demonstrated areflexia, and four complained of distal numbness. All the six patients who had the GD1b-specific antibodies carried IgG antibodies to complex of GQ1b/GM1 and GT1a/GM1. GD1b-specific antibodies were significantly absorbed by GQ1b/GM1 and GT1a/GM1 and anti-GQ1b/GM1 and -GT1a/GM1 antibodies were absorbed by GD1b. In conclusion, the GD1b-specific antibodies, which recognizes GQ1b/GM1 or GT1a/GM1 complex, are associated with acute ataxia. PMID:24859332

Yuki, Nobuhiro; Fukami, Yuki; Yanaka, Chiaki; Koike, Saiko; Hirata, Koichi



Application of delayed extraction matrix-assisted laser desorption ionization time-of-flight mass spectrometry for analysis of sphingolipids in cultured skin fibroblasts from sphingolipidosis patients.  


Sphingolipidoses are caused by defects of enzymes involved in the hydrolysis of sphingolipids. Using delayed extraction matrix-assisted laser desorption ionization time-of-flight mass spectrometry (DE MALDI-TOF-MS), we analyzed sphingolipids in cultured skin fibroblasts from patients with sphingolipidoses, including: (a) Farber disease (FD, acid ceramidase deficiency); (b) Gaucher disease (GD); (c) Niemann-Pick disease type C (NPDC); and (d) GM1-gangliosidosis (GM1G). Crude lipids were extracted from about 50 mg wet weight of cultured skin fibroblasts. After mild alkaline treatment, a sphingolipid fraction was prepared from the crude lipids and analyzed by DE MALDI-TOF-MS. The results were as follows: (a) in fibroblasts from the FD patient, the ceramide/sphingomyelin and ceramide/monohexosylceramide ratios were both significantly high; (b) in the GD patient, the glucosylceramide/sphingomyelin ratio was increased; on the other hand; (c) in the NPDC patient, the monohexosylceramide/sphingomyelin ratio was within normal range; and (d) in the GM1G patient, no specific data were obtained. Sphingolipids in cultured fibroblasts can be evaluated by DE MALDI-TOF-MS, whereas GM1-ganglioside or its asialo derivatives are not detectable. With this DE MALDI-TOF-MS method, ceramide or monohexosylceramide accumulating in cultured fibroblasts from cases of sphingolipidoses, such as FD and GD, respectively, can be easily detected. PMID:11934514

Fujiwaki, Takehisa; Yamaguchi, Seiji; Sukegawa, Kazuko; Taketomi, Tamotsu



Motor neuron diseases and amyotrophic lateral sclerosis: GM1 antibodies and paraproteinemia.  


Six of 110 patients (5.5%) with forms of motor neuron disease had abnormal titers of GM1 antibodies of 1:1,600 or higher. Four others came with previously known high titers. Three patients with upper motor neuron (UMN) signs had titers of 1,600; those with probable or no UMN signs had higher titers. Nine patients had conduction block; six of them had abnormal antibody titers, four with 6,400 or higher. Therefore, patients with motor neuron disease and abnormal anti-GM1 titers may have UMN signs or conduction block. PMID:8437712

Sanders, K A; Rowland, L P; Murphy, P L; Younger, D S; Latov, N; Sherman, W H; Pesce, M; Lange, D J



GM1 reduces infarct volume after focal cerebral ischemia.  


The efficacy of monosialoganglioside GM1 treatment was evaluated in a model of experimental stroke. Cerebral ischemia was induced by permanent occlusion of left middle cerebral artery. GM1 was administered intravenously soon after the occlusion of the artery and then intramuscularly daily for 7 days. Results indicate that GM1 can reduce the extent of infarct volume and neurochemical deficits associated with the ischemic event. The protection was more evident in the cortex than in the caudate-putamen. These observations confirm and extend the evidence of the GM1 efficacy in experimental models of stroke and further support the usefulness of gangliosides in the treatment of these pathologies. PMID:8313942

Lazzaro, A; Seren, M S; Koga, T; Zanoni, R; Schiavo, N; Manev, H



Total Synthesis of the Aminopropyl Functionalized Ganglioside GM1  

PubMed Central

GM1 is a common ganglioside pentasaccharide present on mammalian cell surface. It has been shown to play important roles in cellular communications and initiation of ?-amyloid aggregation. In order to synthesize GM1, an efficient synthetic route was developed via a [3+2] strategy. The GM3 trisaccharide acceptor bearing an azido propyl group at the reducing end was prepared using the traditional acetamide protected sialyl thioglycosyl donor, which gave better stereoselectivity than sialyl donors protected with trichloroacetamide or oxazolidinone. The glycosylation of the axial 4-hydroxyl group of GM3 by the disaccharide donor was found to be highly dependent on donor protective groups. Donor bearing the more rigid benzylidene group gave low glycosylation yield. Replacing the benzylidene with acetates led to productive coupling and formation of the fully protected GM1 pentasaccharide. Deprotection of the pentasaccharide produced GM1 functionalized with the amino propyl side chain, which will be a valuable probe for biological studies. PMID:22389646

Sun, Bin; Yang, Bo; Huang, Xuefei



Marked increase of methylumbelliferyl-tetra-N-acetylchitotetraoside hydrolase activity in plasma from Gaucher disease patients.  


Methylumbelliferyl-tetra-N-acetylchitotetraoside hydrolase activity was increased 53- to 484-fold in plasma from Gaucher disease patients and no activator could be found. High activity was also measured in other lysosomal storage diseases including Krabbe disease, Wolman disease, GM1-gangliosidosis and to a lesser extent Niemann-Pick disease type B, but the activities were lower than the lowest values in Gaucher patients. Kinetic properties of the high activity in Gaucher plasma were similar to those of controls. It is not known whether the increased activity represents intrinsic enzyme activity or increased enzyme concentration. It is possible that this enzyme may help in the detection of Gaucher disease or in the assessment of enzyme therapy with beta-D-glucosidase (Ceredase). PMID:8803778

den Tandt, W R; van Hoof, F



?-Cyclodextrin decreases cholera toxin binding to GM1-gangliosides  

PubMed Central

Cholera toxin (CT), the principal virulence factor secreted by Vibrio cholerae, is an A-B5 type exotoxin that binds to host cell GM1-gangliosides and is responsible for cholera diarrhoea. We tested the hypothesis that the cyclic hexasaccharide ?-cyclodextrin (?-CD), but not the cyclic heptasaccharides methyl-?-cyclodextrin (MD-?-CD) and hydroxypropyl-?-cyclodextrin (HP-?-CD) inhibit binding of CT to GM1-gangliosides. We report that ?-CD decreases CT binding to GM1-ganglioside-coated microtitre plate wells and on the surface of fixed HeLa cells in a concentration-dependent manner, suggesting that this may be a promising lead for the development of compounds with therapeutic properties. PMID:23538564

Ermolinsky, Boris; Peredelchuk, Michael



T cell adhesion regulation from clustering GM1 lipid rafts  

Microsoft Academic Search

Lipid rafts are small laterally mobile cell membrane structures that are highly enriched in lymphocyte signaling molecules. Lipid rafts can form from the assembly of specialized lipids and proteins through hydrophobic associations from saturated acyl chains. GM1 gangliosides are a common lipid raft component and have been shown to be essential in many T cell functions. Current lipid raft theory

Jason Sterling Mitchell



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; Patiño, Edwin; Marella, Chakravarthy; Peláez-Jaramillo, Carlos; Garidel, Patrick; Gutsmann, Thomas; Brandenburg, Klaus; Heinbockel, Lena



Efeito do gangliosídeo GM1 sobre a atividade da catalase em estriado, hipocampo e córtex cerebral de ratos.  

E-print Network

??O monossialogangliosídeo (GM1) é um glicoesfingolipídio presente na maioria das membranas celulares que possui propriedades antioxidantes e neuroprotetoras. O GM1 protege o sistema nervoso central… (more)

Ana Flávia Furian



A photoreactive derivative of radiolabeled GM1 ganglioside: Preparation and use to establish the involvement of specific proteins in GM1 uptake by human fibroblasts in culture  

SciTech Connect

A new procedure was used to synthesize a derivative of ganglioside GM1 containing a photoreactive nitrophenyl azide group at the end of the fatty acyl moiety, using deAc-deAcyl-GM1 obtained by deacetylation of the sialic acid and deacylation of the ceramide portion of GM1. This deAc-deAcyl-GM1 was first acylated at the long chain base amino group with 12-aminododecanoic acid, which has the amino group protected by a fluorenyl residue, and tritium labeled at the sialic acid amino group with ({sup 3}H)acetic anhydride of very high specific radioactivity. Cultured human fibroblasts were exposed to mixtures of radioactive photolabeled GM1 for different times and then illuminated and the radioactive protein patterns studied by SDS-PAGE. After 2 h of exposure, the photolabeled GM1 was stably associated to the cells and underwent almost no metabolic processing, behaving exactly as the underivatized natural GM1. Under these conditions very few proteins became radioactive. Thus, it is evident that the ganglioside binding to fibroblasts and insertion into the outer layer of the plasma membrane involve few individual proteins. When the incubation was prolonged to 24 h, photolabeled GM1 underwent extensive metabolic processing and gave origins to the corresponding ganglioside derivatives of GM2, GM3, and GD1a. Under these conditions many proteins became radioactive, a consequence of GM1 transfer from the surface to the interior or the cell and of the ready availability of interaction of GM1 and its metabolites.

Sonnino, S.; Chigorno, V.; Acquotti, D.; Pitto, M.; Kirschner, G.; Tettamanti, G. (Univ. of Milan (Italy))



IVIg inhibits classical pathway activity and anti-GM1 IgM-mediated complement deposition in MMN.  


The effects of intravenous immunoglobulins (IVIg) on anti-GM1 IgM titer and function, classical complement pathway activity, and antibody-complement interaction were investigated in 62 patients with multifocal motor neuropathy (MMN). In vitro, IVIg decreased complement deposition by anti-GM1 IgM antibodies. First IVIg treatment (2 g/kg) decreased C1q and C4 concentrations and classical pathway activity in serum. In sera from patients receiving IVIg maintenance therapy (0.4 g/kg) C4 concentrations and classical pathway activity were generally lower at higher IgG concentrations. The beneficial effects of IVIg in MMN may be explained by reduced antibody-mediated complement deposition in nerves amplified by a systemically attenuated classical pathway. PMID:20920831

Piepers, Sanne; Jansen, Marc D; Cats, Elisabeth A; van Sorge, Nina M; van den Berg, Leonard H; van der Pol, W-Ludo



Ganglioside GM1 and GM3 in early human brain development: An immunocytochemical study  

Microsoft Academic Search

The distribution of GM1 and GM3 gangliosides in human brain development between gestational week (g.w.) 6 and 15 was demonstrated by an immunocytochemical approach using polyclonal anti-GM1 and anti-GM3 antibodies. The first appearance of GM1- and GM3-positive cells was recorded as early as in g.w. 6. Both antibodies labeled the cells in the ventricular zone of the telencephalic wall, with

M. Stojiljkovic´; T. Blagojevic´; S. Vukosavic´; N. D. Zvezdina; S. Pekovic´; G. Nikezic´; L. Rakic´



GM 1 monosialoganglioside pretreatment protects against soman-induced seizure-related brain damage  

Microsoft Academic Search

The effects of GM1 monosialoganglioside pretreatment on brain damage resulting from soman-induced seizure activity were examined in this study.\\u000a Male Sprague-Dawley rats were infused with GM1 via an osmotic minipump connected through a permanent cannula implanted intracerebroventricularly and challenged with soman\\u000a (83 ?g\\/kg, i.e., 1.25 × LD50) 4 d after initiation of GM1 infusion. Electrocorticographic recordings were monitored via indwelling

Gerald P. H. Ballough; Frank J. Cann; Catherine D. Smith; Jeffry S. Forster; Cathleen E. Kling; Margaret G. Filbert



GM3, GM2 and GM1 mimics designed for biosensing: chemoenzymatic synthesis, target affinities and 900 MHz NMR analysis.  


Undec-10-enyl, undec-10-ynyl and 11-azidoundecyl glycoside analogues corresponding to the oligosaccharides of human gangliosides GM3, GM2 and GM1 were synthesized in high yields using glycosyltransferases from Campylobacter jejuni. Due to poor water solubility of the substrates, the reactions were carried out in methanol-water media, which for the first time were shown to be compatible with the C. jejuni alpha-(2-->3)-sialyltransferase (CST-06) and beta-(1-->4)-N-acetylgalactosaminyltransferase (CJL-30). Bioequivalence of our synthetic analogues and natural gangliosides was examined by binding to Vibrio cholerae toxin and to the B subunit of Escherichia coli heat-labile enterotoxin. This bioequivalence was confirmed by binding mouse and human monoclonal antibodies to GM1 and acute phase sera containing IgM and IgG antibodies to GM1 from patients with the immune-mediated polyneuropathy Guillain-Barré syndrome. The synthesized compounds were analyzed by 1D and 2D 900 MHz NMR spectroscopy. TOCSY and DQF-COSY experiments in combination with 13C-1H correlation measurements (HSQC, HMBC) were carried out for primary structural characterization, and a complete assignment of all 1H and 13C chemical shifts is presented. PMID:18255051

Pukin, Aliaksei V; Weijers, Carel A G M; van Lagen, Barend; Wechselberger, Rainer; Sun, Bin; Gilbert, Michel; Karwaski, Marie-France; Florack, Dion E A; Jacobs, Bart C; Tio-Gillen, Anne P; van Belkum, Alex; Endtz, Hubert P; Visser, Gerben M; Zuilhof, Han



Effects of Methylprednisolone And Ganglioside GM-1 on a Spinal Lesion: A Functional Analysis  

PubMed Central

OBJECTIVES The pharmacological effects of methylprednisolone (MP) and ganglioside GM-1 on spinal injuries have been thoroughly investigated, but only a few studies have evaluated the interaction between these two drugs. METHODS Twenty-four Wistar rats were subjected to contusive injury of the spinal cord produced by the NYU system. These animals were divided into four groups: group I was injected with MP; group II was injected with GM-1; group III was injected with MP together with GM-1; and group control received physiological serum. The animals were evaluated with regard to their recovery of locomotive function by means of the BBB test on the second, seventh and fourteenth days after receiving the contusive injury to the spinal cord. They were sacrificed on the fourteenth day. RESULTS This study demonstrated that the MP and GM-1 groups presented functional results that were better than those of the control group, although the enhanced recovery of group II (GM-1) relative to the control group was not statistically significant (p>0.05). The most notable recovery of locomotive function was observed in the group that received MP alone (p<0.05). The group that received MP together with GM-1 presented results that were better than those of the control group (p<0.05). CONCLUSION Administration of methylprednisolone alone or with GM-1 was shown to be effective for recovery of locomotive function. Combined administration of these drugs resulted in better outcomes than administration of methylprednisolone alone. PMID:18568249

Carvalho, Marcio Oliveira Penna; de Barros Filho, Tarcisio Eloy Pessoa; Tebet, Marcos Antonio



Decoupling polarization of the Golgi apparatus and GM1 in the plasma membrane.  


Cell polarization is a process of coordinated cellular rearrangements that prepare the cell for migration. GM1 is synthesized in the Golgi apparatus and localized in membrane microdomains that appear at the leading edge of polarized cells, but the mechanism by which GM1 accumulates asymmetrically is unknown. The Golgi apparatus itself becomes oriented toward the leading edge during cell polarization, which is thought to contribute to plasma membrane asymmetry. Using quantitative image analysis techniques, we measure the extent of polarization of the Golgi apparatus and GM1 in the plasma membrane simultaneously in individual cells subject to a wound assay. We find that GM1 polarization starts just 10 min after stimulation with growth factors, while Golgi apparatus polarization takes 30 min. Drugs that block Golgi polarization or function have no effect on GM1 polarization, and, conversely, inhibiting GM1 polarization does not affect Golgi apparatus polarization. Evaluation of Golgi apparatus and GM1 polarization in single cells reveals no correlation between the two events. Our results indicate that Golgi apparatus and GM1 polarization are controlled by distinct intracellular cascades involving the Ras/Raf/MEK/ERK and the PI3K/Akt/mTOR pathways, respectively. Analysis of cell migration and invasion suggest that MEK/ERK activation is crucial for two dimensional migration, while PI3K activation drives three dimensional invasion, and no cumulative effect is observed from blocking both simultaneously. The independent biochemical control of GM1 polarity by PI3K and Golgi apparatus polarity by MEK/ERK may act synergistically to regulate and reinforce directional selection in cell migration. PMID:24312472

Bisel, Blaine; Calamai, Martino; Vanzi, Francesco; Pavone, Francesco Saverio



Partitioning and confinement of GM1 ganglioside induced by amyloid aggregates.  


Growing evidence shows that GM1 ganglioside is involved in amyloid deposition and toxicity. By means of real-time single particle tracking, we show that amyloid oligomers and aggregates formed by A?1-42 and amylin, two peptides associated, respectively, with the development of Alzheimer's disease and type II diabetes, interact with GM1 and decrease dramatically its lateral diffusion on the plasma membrane of living neuroblastoma cells. The confinement of GM1, a constituent of membrane rafts involved in neuroprotection, at the level of both types of amyloid aggregates can interfere with cell signaling pathways and contribute to the loss of neuroprotection. PMID:23523632

Calamai, Martino; Pavone, Francesco S



GM1 ganglioside improves spatial learning and memory of aged rats  

Microsoft Academic Search

GM1 ganglioside, 30 mg\\/kg, i.p., was administered to cognitively impaired aged rats for 30 days, and spatial learning and memory evaluated in a Morris water maze paradigm. During treatment with GM1, aged animals improved both the acquisition and retention of place navigation, as reflected by reduced escape latencies and swim distances to a hidden platform, and persistently performed better than

Tamara G. Fong; Norton H. Neff; Maria Hadjiconstantinou



In search of a solution to the sphinx-like riddle of GM1.  


Among the many glycoconjugates contributing to the sugar code, gangliosides have drawn special attention owing to their predominance as the major sialoglycoconjugate category within the nervous system. However, their occurrence, albeit at lower levels, appears ubiquitous in vertebrate cells and even some invertebrate tissues. Now that over 100 gangliosides have been structurally characterized, their diverse physiological functions constitute a remaining enigma. This has been especially true of GM1, for which a surprising array of functions has already been revealed. Our current research has focused on two areas of GM1 function: (a) signaling induced in neural and immune cells by cross-linking of GM1 in the plasma membrane that leads to activation of TRPC5 (transient receptor potiential, canonical form 5) channels, a process important in neuritogenesis and autoimmune suppression; (b) activation by GM1 of a sodium-calcium exchanger (NCX) in the inner membrane of the nuclear envelope (NE) with resulting modulation of nuclear and cellular calcium. The latter has a role in maintaining neuronal viability, loss of which renders neurons vulnerable to Ca(2+) overload. Pathological manifestations in mutant mice and their cultured neurons lacking GM1 have shown dramatic rescue with a membrane permeable derivative of GM1 that enters the nucleus and restores NCX activity. Nuclear function of GM1 is related to the presence of neuraminidase in the NE, an enzyme that generates GM1 through hydrolysis of GD1a. A different isoform of this enzyme was found in each of the two membranes of the NE. PMID:21076871

Ledeen, Robert W; Wu, Gusheng



Coexpression of Ganglioside Antigen Fuc-GM1, Neural-Cell Adhesion Molecule, Carcinoembryonic Antigen, and Carbohydrate Tumor-Associated Antigen CA 50 in Lung Cancer  

Microsoft Academic Search

With the aid of specific monoclonal antibodies, tumor tissues from 68 patients with lung cancer were examined for their expression of two small cell lung carcinoma (SCLC) antigens, Fuc-GMl (fucosyl GM1; IV2FucII3NeuAc GgOse4) and neural-cell adhesion molecule (NCAM), and two broader tumor antigens, carcinoembryonic antigen (CEA) and carbohydrate cancer-associated antigen CA 50. Expression of Fuc-GMl was seen in 75% and

Fred-Thomas Brezicka; Sante Olling; Bengt Bergman; Håkan Berggren; Carl-Peter Engström; Sten Hammarström; Jan Holmgren; Sture Larsson; Leif Lindholm



A Trp474Cys mutation in the alpha-subunit of beta-hexosaminidase causes a subacute encephalopathic form of G{sub M2} gangliosidosis, type 1  

SciTech Connect

Mutations in the HEXA gene that encodes the {alpha}-subunit of the heterodimeric lysosomal enzyme {beta}-hexosaminidase A, or Hex A ({alpha}{beta}), cause G{sub M2} gangliosidosis, type 1. The infantile form (Tay-Sachs disease) results when there is no residual Hex A activity, while less severe and more variable clinical phenotypes result when residual Hex A activity is present. A non-Jewish male who presented with an acute psychotic episode at age 16 was diagnosed with a subacute encephalopathic form of G{sub M2} gangliosidosis. At age 19, chronic psychosis with intermittent acute exacerbations remains the most disabling symptom in this patient and his affected brother although both exhibit some ataxia and moderately severe dysarthria. We have found a 4 bp insertion (+TATC 1278) associated with infantile Tay-Sachs disease on one allele; no previously identified mutation was found on the second allele. SSCP analysis detected a shift in exon 13 and sequencing revealed a G1422C mutation in the second allele that results in a Trp474Cys substitution. The presence of the mutation was confirmed by the loss of HaeIII and ScrFI sites in exon 13 PCR products from the subjects and their father. The mutation was introduced into the {alpha}-subunit cDNA and Hex S ({alpha}{alpha}) and Hex A ({alpha}{beta}) were transiently expressed in monkey COS-7 cells. The Trp474Cys mutant protein had approximately 5% and 12% of wild-type Hex S and Hex A activity, respectively. Western blot analysis revealed a small amount of residual mature {alpha}-subunit and a normal level of precursor protein. We conclude that the Trp474Cys mutation is the cause of the Hex A deficiency associated with a subacute (juvenile-onset) phenotype in this patient. Like other mutations in exon 13 of HEXA, it appears to affect intracellular processing. Studies of the defect in intracellular processing are in progress.

Petroulakis, E.; Cao, Z.; Salo, T. [Univ. of Manitoba, Winnipeg (Canada)] [and others



Using GM(1,1) method to forecast the development of cell phone market in Taiwan  

Microsoft Academic Search

This research aims to predict the sale amount of 3G mobile phone market of Chunghwa Telecom by GM (1,1) 4 terms prediction model and regression of 3G developing trend and attempts to formulate the suitable countermeasures for 3G development. The result of this research is that the grey prediction theory can fit the four-term development precisely in the 3G market.

Chaang-Yung Kung; Huei-Shr Chen; Chih-Cheng Huang; Kun-Li Wen



Normally Occurring Human Anti-GM1 Immunoglobulin M Antibodies and the Immune Response to Bacteria  

Microsoft Academic Search

Anti-GM1 antibodies of the immunoglobulin M (IgM) isotype are normal components of the antibody repertoire of adult human serum. Using a sensitive high-performance thin-layer chromatography (HPTLC) immunostaining assay, we found that these antibodies were absent in the umbilical vein and children <1 month of age but could be detected after 1 month of age. Although most of the children older

María E. Alaniz; Ricardo D. Lardone; Silvia L. Yudowski; María I. Farace; Gustavo A. Nores



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



Synthesis of reference standards to enable single cell metabolomic studies of tetramethylrhodamine-labeled ganglioside GM1  

Microsoft Academic Search

Ganglioside GM1 and its seven potential catabolic products: asialo-GM1, GM2, asialo-GM2, GM3, Lac-Cer, Glc-Cer and Cer, were labeled with tetramethylrhodamine (TMR) to permit ultra-sensitive analysis using laser-induced fluorescence (LIF) detection. The preparation involved acylation of the homogenous C18lyso-forms of GM1, Lac-Cer, Glc-Cer and Cer with the N-hydroxysuccinimide ester of a ?-alanine-tethered 6-TMR derivative, followed by conversion of these labeled products

E. Andreas Larsson; Ulf Olsson; Colin D. Whitmore; Rita Martins; Guido Tettamanti; Ronald L. Schnaar; Norman J. Dovichi; Monica M. Palcic; Ole Hindsgaul



Neurophysiological and immunohistochemical studies of IgG anti-GM1 monoclonal antibody on neuromuscular transmission: effects in rat neuromuscular junctions.  


Guillain-Barré syndrome, which is a variant of acute inflammatory neuropathy, is associated with anti-GM1 antibodies and causes ataxia. We investigated the effects of IgG anti-GM1 monoclonal antibody (IgG anti-GM1 mAb) on spontaneous muscle action potentials in a rat spinal cord-muscle co-culture system and the localization of IgG anti-GM1 mAb binding in the rat hemi-diaphragm. The frequency of spontaneous muscle action potentials in innervated muscle cells was acutely inhibited by IgG anti-GM1 mAb. When cultures were pretreated with GM2 synthase antisense oligodeoxynucleotide, IgG anti-GM1 mAb failed to inhibit spontaneous muscle action potentials, demonstrating the importance of the GM1 epitope in the action of IgG anti-GM1 mAb. Immunohistochemistry of rat hemi-diaphragm showed that IgG anti-GM1 mAb binding overlapped with neurofilament 200 (NF200) antibodies staining, but not ?-bungarotoxin (?-BuTx) staining, demonstrating that IgG anti-GM1 mAb was localized at the presynaptic nerve terminal. IgG anti-GM1 mAb binding overlapped with syntaxin antibody and S-100 antibody in the nerve terminal. After collagenase treatment, IgG anti-GM1 mAb and NF200 antibodies did not show staining, but ?-BuTx selectively stained the hemi-diaphragm. IgG anti-GM1 mAb binds to the presynaptic nerve terminal of neuromuscular junctions. Therefore, we suggest that the inhibitory effect of IgG anti-GM1 mAb on spontaneous muscle action potentials is related to the GM1 epitope in presynaptic motor nerve terminals at the NMJs. PMID:23820959

Hotta, Sayako; Nagaoka, Takumi; Taguchi, Kyoji; Nakatani, Yoshihiko; Utsnomiya, Iku; Masuda, Yutaka; Abe, Kenji; Yuki, Nobuhiro



Binding, Conformational Transition and Dimerization of Amyloid-? Peptide on GM1-Containing Ternary Membrane: Insights from Molecular Dynamics Simulation  

PubMed Central

Interactions of amyloid-? (A?) with neuronal membrane are associated with the progression of Alzheimer’s disease (AD). Ganglioside GM1 has been shown to promote the structural conversion of A? and increase the rate of peptide aggregation; but the exact nature of interaction driving theses processes remains to be explored. In this work, we have carried out atomistic-scale computer simulations (totaling 2.65 µs) to investigate the behavior of A? monomer and dimers in GM1-containing raft-like membrane. The oligosaccharide head-group of GM1 was observed to act as scaffold for A?-binding through sugar-specific interactions. Starting from the initial helical peptide conformation, a ?-hairpin motif was formed at the C-terminus of the GM1-bound A?-monomer; that didn’t appear in absence of GM1 (both in fluid POPC and liquid-ordered cholesterol/POPC bilayers and also in aqueous medium) within the simulation time span. For A?-dimers, the ?-structure was further enhanced by peptide-peptide interactions, which might influence the propensity of A? to aggregate into higher-ordered structures. The salt-bridges and inter-peptide hydrogen bonds were found to account for dimer stability. We observed spontaneous formation of intra-peptide D23-K28 salt-bridge and a turn at V24GSN27 region - long been accepted as characteristic structural-motifs for amyloid self-assembly. Altogether, our results provide atomistic details of A?-GM1 and A?-A? interactions and demonstrate their importance in the early-stages of GM1-mediated A?-oligomerisation on membrane surface. PMID:23951128

Manna, Moutusi; Mukhopadhyay, Chaitali



Beyond glycoproteins as galectin counterreceptors: tumor-effector T cell growth control via ganglioside GM1 [corrected].  


Glycoprotein glycan chains, by virtue of structure, topology of presentation and connection to signal-inducing units, are functional galectin counterreceptors. As example, cross-linking of the ?(5)?(1) integrin by galectin-1 on carcinoma cells leads to G(1) arrest or anoikis. Contact-dependent switching from proliferation to differentiation in cultured neuroblastoma cells (SK-N-MC) also utilizes galectin-1. Activity enhancement of a cell surface sialidase underlies the shift in glycan display to ganglioside GM1. Its pentasaccharide within microdomains becomes the target. Similarly, this recognition pair is upregulated upon T cell activation. Cross-linking of GM1 along with associated ?(4)/?(5)?(1) integrins elicits Ca(2+)-influx via TRPC5 channels as the relevant response for T effector cell (T(eff)) suppression. Unlike T(eff) cells from wild-type mice, those from genetically altered mice lacking GM1 are not suppressed by galectin-1 or regulatory T cells. Similarly, in the context of GM1 deficiency in NOD mice, T(eff) cells are associated with resistance to regulatory T cell suppression, which is reversed by applied GM1. The broad array of glycosphingolipid structures suggests the possible existence of several novel counterreceptors targeted to endogenous lectins, with sulfatide-galectin-4 interplay within apical delivery serving as recent example. PMID:22524425

Ledeen, Robert W; Wu, Gusheng; André, Sabine; Bleich, David; Huet, Guillemette; Kaltner, Herbert; Kopitz, Jürgen; Gabius, Hans-Joachim



Synthesis of reference standards to enable single cell metabolomic studies of tetramethylrhodamine-labeled ganglioside GM1.  


Ganglioside GM1 and its seven potential catabolic products: asialo-GM1, GM2, asialo-GM2, GM3, Lac-Cer, Glc-Cer and Cer, were labeled with tetramethylrhodamine (TMR) to permit ultra-sensitive analysis using laser-induced fluorescence (LIF) detection. The preparation involved acylation of the homogenous C(18)lyso-forms of GM1, Lac-Cer, Glc-Cer and Cer with the N-hydroxysuccinimide ester of a beta-alanine-tethered 6-TMR derivative, followed by conversion of these labeled products using galactosidase, sialidase, and sialyltransferase enzymes. The TMR-glycolipid analogs produced are detectable on TLC down to the 1 ng level by the naked eye. All eight compounds could be separated within 4 min in capillary electrophoresis where they could be detected at the zeptomole (ca. 1000 molecule) level using LIF. PMID:17069778

Larsson, E Andreas; Olsson, Ulf; Whitmore, Colin D; Martins, Rita; Tettamanti, Guido; Schnaar, Ronald L; Dovichi, Norman J; Palcic, Monica M; Hindsgaul, Ole



Clustering T-cell GM1 lipid rafts increases cellular resistance to shear on fibronectin through changes in integrin affinity and cytoskeletal dynamics  

Microsoft Academic Search

Lipid rafts are small laterally mobile microdomains that are highly enriched in lymphocyte signaling molecules. GM1 gangliosides are a common lipid raft component and have been shown to be important in many T-cell functions. The aggregation of specific GM1 lipid rafts can control many T-cell activation events, including their novel association with T-cell integrins. We found that clustering GM1 lipid

Jason S Mitchell; Wells S Brown; Darren G Woodside; Peter Vanderslice; Bradley W McIntyre



GM1 Ganglioside Activates ERK1/2 and Akt Downstream of Trk Tyrosine Kinase and Protects PC12 Cells Against Hydrogen Peroxide Toxicity.  


Ganglioside GM1 at micro- and nanomolar concentrations was shown to increase the viability of pheochromocytoma PC12 cells exposed to hydrogen peroxide and diminish the accumulation of reactive oxygen species and oxidative inactivation of Na(+),K(+)-ATPase, the effects of micromolar GM1 being more pronounced than those of nanomolar GM1. These effects of GM1 were abolished by Trk receptor tyrosine kinase inhibitor and diminished by MEK1/2, phosphoinositide 3-kinase and protein kinase C inhibitors. Hydrogen peroxide activates Trk tyrosine kinase; Akt and ERK1/2 are activated downstream of this protein kinase. GM1 was found to activate Trk receptor tyrosine kinase in PC12 cells. GM1 (100 nM and 10 µM) increased the basal activity of Akt, but did not change Akt activity in cells exposed to hydrogen peroxide. Basal ERK1/2 activity in PC12 cells was increased by GM1 at a concentration of 10 µM, but not at nanomolar concentrations. Activation of ERK1/2 by hydrogen peroxide was enhanced by GM1 at a concentration of 10 µM and to a lesser extent at a concentration of 100 nM. Thus, the protective and metabolic effects of GM1 ganglioside on PC12 cells exposed to hydrogen peroxide appear to depend on the activation of Trk receptor tyrosine kinase and downstream activation of Akt and ERK1/2. PMID:25216715

Zakharova, Irina O; Sokolova, Tatyana V; Vlasova, Yulia A; Furaev, Victor V; Rychkova, Maria P; Avrova, Natalia F



Fusion procedure for Coxeter groups of type B and complex reflection groups G(m,1,n)  

E-print Network

A complete system of primitive pairwise orthogonal idempotents for the Coxeter groups of type $B$ and, more generally, for the complex reflection groups $G(m,1,n)$ is constructed by a sequence of evaluations of a rational function in several variables with values in the group ring. The evaluations correspond to the eigenvalues of the two arrays of Jucys--Murphy elements.

O. V. Ogievetsky; L. Poulain d'Andecy



Role of Lipid Rafts and GM1 in the Segregation and Processing of Prion Protein  

PubMed Central

The prion protein (PrPC) is highly expressed within the nervous system. Similar to other GPI-anchored proteins, PrPC is found in lipid rafts, membrane domains enriched in cholesterol and sphingolipids. PrPC raft association, together with raft lipid composition, appears essential for the conversion of PrPC into the scrapie isoform PrPSc, and the development of prion disease. Controversial findings were reported on the nature of PrPC-containing rafts, as well as on the distribution of PrPC between rafts and non-raft membranes. We investigated PrPC/ganglioside relationships and their influence on PrPC localization in a neuronal cellular model, cerebellar granule cells. Our findings argue that in these cells at least two PrPC conformations coexist: in lipid rafts PrPC is present in the native folding (?-helical), stabilized by chemico-physical condition, while it is mainly present in other membrane compartments in a PrPSc-like conformation. We verified, by means of antibody reactivity and circular dichroism spectroscopy, that changes in lipid raft-ganglioside content alters PrPC conformation and interaction with lipid bilayers, without modifying PrPC distribution or cleavage. Our data provide new insights into the cellular mechanism of prion conversion and suggest that GM1-prion protein interaction at the cell surface could play a significant role in the mechanism predisposing to pathology. PMID:24859148

Botto, Laura; Cunati, Diana; Coco, Silvia; Sesana, Silvia; Bulbarelli, Alessandra; Biasini, Emiliano; Colombo, Laura; Negro, Alessandro; Chiesa, Roberto; Masserini, Massimo; Palestini, Paola



The sialic acid residue of exogenous GM1 ganglioside is recycled for biosynthesis of sialoglycoconjugates in rat liver.  

PubMed Central

In order to assess metabolic recycling of sialic acid, GM1 ganglioside [nomenclature of Svennerholm (1964) J. Lipid. Res. 5, 145-155; IUPAC-IUB Recommendations (1977) Lipids 12, 455-468], 14C-radiolabelled at the acetyl group of sialic acid, was intravenously injected into Wistar rats, and the presence of radioactive sialic acid in liver sialoglycolipids (gangliosides) and sialoglycoproteins was ascertained. A time-course study (20 min-72 h) showed that the radioactivity present in the liver distributed in the following fractions, with reciprocal proportion varying with time: the protein (glycoprotein) fraction, the ganglioside fraction and the diffusible fraction, which contained low-Mr compounds, including sialic acid. Ganglioside-linked radioactivity gradually decreased with time; protein-linked radioactivity appeared soon after injection (20 min), reached a maximum around 20 h, then slowly diminished; diffusible radioactivity provided a sharp peak at 4 h, then rapidly decreased till disappearing after 40 h. The behaviour of bound radioactivity in the individual liver gangliosides was as follows: (a) rapid diminution with time in GM1, although with a lower rate at the longer times after injection; (b) early appearance (20 min) with a peak at 1 h, followed by continuous diminution, in GM2; (c) early appearance (20 min), peak at 1 h, diminution till 4 h, followed by a plateau, in GM3; (d) appearance at 60 min, maximum around 40 h and slow diminution thereafter, in GD1a, GD1b and GT1b. A detailed study, accomplished at 40 h after injection, demonstrated that almost all radioactivity present in the protein fraction was released by mild acid treatment and recovered in purified sialic acid; most of radioactive glycoprotein-bound sialic acid was releasable by sialidase action. In addition, the radioactivity present in the different gangliosides was exclusively carried by sialic acid and present in both sialidase-resistant and sialidase-labile residues. Only in the case of GD1a was the specific radioactivity of sialidase-resistant sialic acid superior to that of sialidase-releasable sialic acid. The results obtained lead to the following conclusions: (a) radioactive GM3 and GM2 were produced by degradation of GM1 taken up; GM3 originated partly by a process of neosynthesis; (b) radioactive GM1 consisted in part of residual exogenous GM1 and in part of a neosynthetized product; (c) radioactive GD1a originated in part by direct sialylation of GM1 taken up and in part by a neosynthetic process; (d) radioactive GD1b and GT1b resulted only from neosynthesis.(ABSTRACT TRUNCATED AT 400 WORDS) Images Fig. 3. Fig. 5. PMID:3689344

Ghidoni, R; Trinchera, M; Sonnino, S; Chigorno, V; Tettamanti, G



The ?-subunit of cholera toxin has a high affinity for ganglioside GM1 embedded into solid supported lipid membranes with a lipid raft-like composition.  


In this communication, we report on the fabrication of GM1-rich solid-supported bilayer lipid membranes (ssBLM) made of sphingomyelin and cholesterol, the main components of lipid rafts,which are the physiological hosting microenvironment of GM1 on the cell membrane. The functionality of the ganglioside has been checked by measuring the apparent dissociation constant K(D) of the complex formed by the ?-subunit of the cholera toxin and GM1. The value found deviates less than one order of magnitude from that measured for in vivo cells, indicating the potential of these ssBLM as optimized in vitro biomimetic platforms. PMID:24122042

Margheri, G; D'Agostino, R; Trigari, S; Sottini, S; Del Rosso, M



A Single Native Ganglioside GM1-Binding Site Is Sufficient for Cholera Toxin To Bind to Cells and Complete the Intoxication Pathway  

PubMed Central

ABSTRACT Cholera toxin (CT) from Vibrio cholerae is responsible for the majority of the symptoms of the diarrheal disease cholera. CT is a heterohexameric protein complex with a 240-residue A subunit and a pentameric B subunit of identical 103-residue B polypeptides. The A subunit is proteolytically cleaved within a disulfide-linked loop to generate the A1 and A2 fragments. The B subunit of wild-type (wt) CT binds 5 cell surface ganglioside GM1 (GM1) molecules, and the toxin-GM1 complex traffics from the plasma membrane (PM) retrograde through endosomes and the Golgi apparatus to the endoplasmic reticulum (ER). From the ER, the enzymatic A1 fragment retrotranslocates to the cytosol to cause disease. Clustering of GM1 by multivalent toxin binding can structurally remodel cell membranes in ways that may assist toxin uptake and retrograde trafficking. We have recently found, however, that CT may traffic from the PM to the ER by exploiting an endogenous glycosphingolipid pathway (A. A. Wolf et al., Infect. Immun. 76:1476–1484, 2008, and D. J. F. Chinnapen et al., Dev. Cell 23:573–586, 2012), suggesting that multivalent binding to GM1 is dispensable. Here we formally tested this idea by creating homogenous chimeric holotoxins with defined numbers of native GM1 binding sites from zero (nonbinding) to five (wild type). We found that a single GM1 binding site is sufficient for activity of the holotoxin. Therefore, remodeling of cell membranes by mechanisms that involve multivalent binding of toxin to GM1 receptors is not essential for toxicity of CT. PMID:23111873

Jobling, Michael G.; Yang, ZhiJie; Kam, Wendy R.; Lencer, Wayne I.; Holmes, Randall K.



Leptin inhibits amyloid ?-protein fibrillogenesis by decreasing GM1 gangliosides on the neuronal cell surface through PI3K/Akt/mTOR pathway.  


Leptin is a centrally acting hormone that controls metabolic pathways. Recent epidemiological studies suggest that plasma leptin is protective against Alzheimer's disease. However, the mechanism that underlies this effect remains uncertain. To investigate whether leptin inhibits the assembly of amyloid ?-protein (A?) on the cell surface of neurons, we treated primary neurons with leptin. Leptin treatment decreased the GM1 ganglioside (GM1) levels in the detergent-resistant membrane microdomains (DRMs) of neurons. The increase in GM1 expression induced by leptin was inhibited after pre-treatment with inhibitors of phosphatidylinositol 3-kinase (LY294002), Akt (triciribine) and the mammalian target of rapamycin (i.e. rapamycin), but not by an inhibitor of extracellular signal-regulated kinase (PD98059). In addition, pre-treatment with these reagents blocked the induction of GM1 in DRMs by leptin. Furthermore, A? assembly on the cell surface of neurons was inhibited greatly after treatment with leptin. This reduction was markedly inhibited after pre-treatment with LY294002, triciribine, and rapamycin. These results suggest that leptin significantly inhibits A? assembly by decreasing GM1 expression in DRMs of the neuronal surface through the phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin pathway. These findings highlight the importance of understanding the function of leptin in AD brains. In this study, our aim was to determine whether leptin regulates the expression and localization of GM1 on the neuronal membrane and if it induces the formation of A? assembly on the cell surface of neurons. Our results suggest that leptin regulates the expression of GM1 in DRMs of the neuronal membranes. Moreover, leptin does not seem to facilitate fibrillogenesis of exogenously added soluble A? from the cell surface of neurons. PMID:25039425

Yamamoto, Naoki; Tanida, Mamoru; Kasahara, Rika; Sobue, Kazuya; Suzuki, Kenji



Naloxone rapidly evokes endogenous kappa opioid receptor-mediated hyperalgesia in naïve mice pretreated briefly with GM1 ganglioside or in chronic morphine-dependent mice.  


Low-dose naloxone-precipitated withdrawal hyperalgesia is a reliable indicator of physical dependence after chronic morphine treatment. A remarkably similar long-lasting (>3-4 h) hyperalgesia is evoked by injection of a low dose of naloxone (10 microg/kg, s.c.) in naïve mice after acute pretreatment with the glycolipid, GM1 ganglioside (1 mg/kg) (measured by warm-water-immersion tail-flick assays). GM1 treatment markedly increases the efficacy of excitatory Gs-coupled opioid receptor signaling in nociceptive neurons. Co-treatment with an ultra-low-dose (0.1 ng/kg, s.c.) of the broad-spectrum opioid receptor antagonist, naltrexone or the selective kappa opioid receptor antagonist, nor-binaltorphimine, blocks naloxone-evoked hyperalgesia in GM1-pretreated naïve mice and unmasks prominent, long-lasting (>4 h) inhibitory opioid receptor-mediated analgesia. This unmasked analgesia can be rapidly blocked by injection after 1-2 h of a high dose of naltrexone (10 mg/kg) or nor-binaltorphimine (0.1 mg/kg). Because no exogenous opioid is administered to GM1-treated mice, we suggest that naloxone may evoke hyperalgesia by inducing release of endogenous bimodally acting opioid agonists from neurons in nociceptive networks by antagonizing putative presynaptic inhibitory opioid autoreceptors that "gate" the release of endogenous opioids. In the absence of exogenous opioids, the specific pharmacological manipulations utilized in our tail-flick assays on GM1-treated mice provide a novel bioassay to detect the release of endogenous bimodally acting (excitatory/inhibitory) opioid agonists. Because mu excitatory opioid receptor signaling is blocked by ultra-low doses of naloxone, the higher doses of naloxone that evoke hyperalgesia in GM1-treated mice cannot be mediated by activation of mu opioid receptors. Co-treatment with ultra-low-dose naltrexone or nor-binaltorphimine may selectively block signaling by endogenous GM1-sensitized excitatory kappa opioid receptors, unmasking inhibitory kappa opioid receptor signaling, and converting endogenous opioid receptor-mediated hyperalgesia to analgesia. Co-treatment with kelatorphan stabilizes putative endogenous opioid peptide agonists released by naloxone in GM1-treated mice, so that analgesia is evoked rather than hyperalgesia. Acute treatment of chronic morphine-dependent mice with ultra-low-dose naltrexone (0.1 ng/kg) results in remarkably similar rapid blocking of naloxone (10 microg/kg)-precipitated withdrawal hyperalgesia and unmasking of prominent opioid analgesia. These studies may clarify complex mechanisms underlying opioid physical dependence and opioid addiction. PMID:17692296

Crain, Stanley M; Shen, Ke-Fei



Naloxone rapidly evokes endogenous kappa opioid receptor-mediated hyperalgesia in naïve mice pretreated briefly with GM1 ganglioside or in chronic morphine-dependent mice  

Microsoft Academic Search

Low-dose naloxone-precipitated withdrawal hyperalgesia is a reliable indicator of physical dependence after chronic morphine treatment. A remarkably similar long-lasting (>3–4 h) hyperalgesia is evoked by injection of a low dose of naloxone (10 ?g\\/kg, s.c.) in naïve mice after acute pretreatment with the glycolipid, GM1 ganglioside (1 mg\\/kg) (measured by warm-water-immersion tail-flick assays). GM1 treatment markedly increases the efficacy of excitatory Gs-coupled opioid

Stanley M. Crain; Ke-Fei Shen



Differential recovery of sensorimotor function in GM1 ganglioside-treated vs. spontaneously recovered MPTP-treated cats: partial striatal dopaminergic reinnervation vs. neurochemical compensation  

Microsoft Academic Search

Administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to cats results in a parkinsonian syndrome characterized by rigidity, akinesia, bradykinesia, decreased response to external sensory stimuli and depletion of nigrostriatal dopamine. Cats spontaneously recover gross sensorimotor functions despite little recovery of the dopaminergic innervation of the striatum. In contrast, GM1 ganglioside administration accelerates gross behavioral recovery and causes an increased dopaminergic innervation of the

J. S. Schneider; J. A. Schroeder; David S. Rothblat



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



Reduction in the adherence of Pseudomonas aeruginosa to native cystic fibrosis epithelium with anti-asialoGM1 antibody and neuraminidase inhibition  

Microsoft Academic Search

Reduction in the adherence of Pseudomonas aeruginosa to native cystic fibrosis epithelium with anti-asialoGM1 antibody and neuraminidase inhibition. J. Davies, A. Dewar, A. Bush, T. Pitt, D. Gruenert, D.M. Geddes, E.W.F.W. Alton. #ERS Journals Ltd 1999. ABSTRACT: The high incidence of colonization of the cystic fibrosis (CF) airway with Pseudomonas aeruginosa has been attributed to several mechanisms including increased numbers

J. Davies; A. dewar; A. Bush; T. Pitt; D. Gruenert; D. M. Geddes; E. W. F. W. Alton



Ganglioside GM1 protects cAMP 3? 5?: Phosphodiesterase from inactivation caused by lipid peroxidation in brain synaptosomes of rats  

Microsoft Academic Search

The preincubation of synaptosomes with nanomolar concentrations of ganglioside GM1 was shown to protect Ca2+-dependent and Ca2+-independent cyclic nucleotide phosphodiesterase from inactivation caused by lipid peroxidation (LPO) induction. Thus, Ca2+-dependent phosphodiesterase activity decreased to approximately 34% of the initial value following 30 min of LPO induction,\\u000a but it constituted more than 60% of the control activity if synaptosomes were preincubated

Yulia Y. Tyurina; Vladimir A. Tyurin; Natalia F. Avrova



Induction of GM1a/GD1b synthase triggers complex ganglioside expression and alters neuroblastoma cell behavior; a new tumor cell model of ganglioside function  

PubMed Central

Neuroblastoma is the most common extracranial solid tumor in children and tumor ganglioside composition has been linked to its biological and clinical behavior. We recently found that high expression of complex gangliosides that are products of the enzyme GM1a/GD1b synthase predicts a more favorable outcome in human neuroblastoma, and others have shown that complex gangliosides such as GD1a inhibit metastasis of murine tumors. To determine how a switch from structurally simple to structurally complex ganglioside expression affects neuroblastoma cell behavior, we engineered IMR32 human neuroblastoma cells, which contain almost exclusively (89%) the simple gangliosides (SG) GM2, GD2, GM3, and GD3, to overexpress the complex gangliosides (CG) GM1, GD1a, GD1b and GT1b, by stable retroviral-mediated transduction of the cDNA encoding GM1a/GD1b synthase. This strikingly altered cellular ganglioside composition without affecting total ganglioside content: There was a 23-fold increase in the ratio of complex to simple gangliosides in GM1a/GD1b synthase-transduced cells (IMR32-CG) vs. wild type (IMR32) or vector-transfected (IMR32-V) cells with essentially no expression of the clinical neuroblastoma marker, GD2, confirming effectiveness of this molecular switch from simple to complex ganglioside synthesis. Probing for consequences of the switch, we found that among functional properties of IMR32-CG cells, cell migration was inhibited and Rho/Rac1 activities were altered, while proliferation kinetics and cell differentiation were unaffected. These findings further implicate cellular ganglioside composition in determining cell migration characteristics of tumor cells. This IMR32 model system should be useful in delineating the impact of ganglioside composition on tumor cell function. PMID:21519903

Dong, Lixian; Liu, Yihui; Colberg-Poley, Anamaris M.; Kaucic, Karen; Ladisch, Stephan



Fibroblast screening for chaperone therapy in ?-galactosidosis  

Microsoft Academic Search

We performed screening of ?-galactosidase-deficient fibroblasts for possible chemical chaperone therapy using N-octyl-4-epi-?-valienamine (NOEV) in patients with GM1-gangliosidosis and Morquio B disease (?-galactosidosis). Fibroblasts were cultured with NOEV for 4 days and ?-galactosidase activity was measured. Mutation analysis was performed simultaneously. Two separate criteria were set for evaluation of the chaperone effect: a relative increase of enzyme activity (more than

Hiroyuki Iwasaki; Hiroshi Watanabe; Masami Iida; Seiichiro Ogawa; Miho Tabe; Katsumi Higaki; Eiji Nanba; Yoshiyuki Suzuki



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



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



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.  


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



Anti-glycoprotein D monoclonal antibody protects against herpes simplex virus type 1-induced diseases in mice functionally depleted of selected T-cell subsets or asialo GM1+ cells.  

PubMed Central

Passive transfer of a monoclonal antibody (MAb) specific for glycoprotein D (gD) is highly effective in preventing the development of herpes simplex virus type 1-induced stromal keratitis. In the present study, we investigated whether animals which had been functionally depleted of T-cell subsets or asialo GM1+ cells would continue to be responsive to MAb therapy. BALB/c mice were depleted of CD4+, CD8+, or asialo GM1+ cells by treatment with anti-L3T4, anti-Lyt 2.2, or anti-asialo GM1 antibodies, respectively. Functional depletion of CD4+ cells was documented by the loss of delayed-type hypersensitivity responsiveness, while CD8+ cell depletion was accompanied by abrogation of cytotoxic lymphocyte activity. Anti-asialo GM1 treatment led to the loss of natural killer cell lytic activity. Mice depleted of the desired cell population and infected on the scarified cornea with herpes simplex virus type 1 uniformly developed necrotizing stromal keratitis by 3 weeks postinfection. A single inoculation of anti-gD MAb (55 micrograms) given intraperitoneally 24 h postinfection strongly protected hosts depleted of CD4+ cells against stromal keratitis. Likewise, antibody treatment in CD8+ or asialo GM1+ cell-depleted hosts was as therapeutically effective as that seen in non-cell-depleted mice. We also observed that in cell-depleted mice, the virus spread into the central nervous system and caused encephalitis. The CD4+ cell-depleted mice were the most severely affected, as 100% developed fatal disease. Anti-gD MAb treatment successfully protected all (32 of 32) CD4+-, CD8+-, or asialo GM1(+)-depleted hosts against encephalitis. We therefore conclude that antibody-mediated prevention of stromal keratitis and encephalitis does not require the obligatory participation of CD4+, CD8+, or asialo GM1+ cells. However, when mice were simultaneously depleted of both CD4+ and CD8+ T-cell subsets, antibody treatment could not prevent fatal encephalitis. Thus, antibody can compensate for the functional loss of one but not two T-lymphocyte subpopulations. PMID:1920624

Staats, H F; Oakes, J E; Lausch, R N



Ganglioside GM1/galectin-dependent growth regulation in human neuroblastoma cells: special properties of bivalent galectin-4 and significance of linker length for ligand selection.  


Orchestrated upregulation of cell surface presentation of ganglioside GM1 and homodimeric galectin-1 is the molecular basis for growth regulation of human neuroblastoma (SK-N-MC) cells. Further study led to the discovery of competitive inhibition by galectin-3, prompting us to test tandem-repeat-type galectin-4 (two different lectin domains connected by a 42-amino-acid linker). This lectin bound to cells at comparably high affinity without involvement of the ganglioside, as disclosed by assays in the presence of cholera toxin B-subunit or galectin-1 and blocking glucosylceramide synthesis. Notably, when tested separately, binding of both lectin domains showed partial sensitivity to the bacterial agglutinin. Despite its ability for cross-linking surface association of galectin-4 did not affect proliferation, in contrast to homodimeric galectins. The truncation of linker length from 42 to 16 amino acids altered binding properties to let partial sensitivity to the bacterial lectin emerge. Cross-competition between parental and engineered proteins did not exceed 40%. No effect on cell growth was detected. This study reveals complete functional divergence between galectins differing in the spatial mode of lectin-site presentation and dependence of reactivity to distinct counter-receptor(s) on linker length. Due to the documented presence of galectin-4 in the nervous system and its affinity for sulfatide these in vitro results indicate the potential for a distinct functionality profile of this lectin in vivo, giving further research direction. PMID:22234579

Kopitz, Jürgen; Ballikaya, Seda; André, Sabine; Gabius, Hans-Joachim



Aggregation of liposomes induced by the toxic peptides Alzheimer's Abetas, human amylin and prion (106-126): facilitation by membrane-bound GM1 ganglioside.  


To compare both the peptide molecular self-aggregation and the interaction with membrane lipids of the Alzheimer's amyloid beta (Abeta)40, Abeta42 peptides, and the cytotoxic peptides human amylin and prion (106-126) peptides, we applied a liposome aggregation technology. The kinetics of the changes in the optical density (DeltaOD) of liposome suspensions generated by the aggregation of liposomes induced by these peptides, allowed us to comparatively analyze their phospholipid affinity and self-aggregation. The kinetic curves showed an initial nonlinear region where d(DeltaOD)/dt followed first order kinetics corresponding to the binding of the peptides to the membrane of the liposome, a linear region where d(DeltaOD)/dt was constant, corresponding to the interaction between two membrane-bound peptide molecules, and a final slower increasing nonlinear region that corresponds to nucleation or seeding of aggregation. The analysis of the aggregation curves demonstrated that amylin and prion peptides also showed affinity for the acidic phospholipid phosphatidylserine (PS), as it has previously been shown for the Alzheimer's Abeta40, Abeta42 peptides. Abeta42 showed the highest, and amylin the lowest, affinity for the liposome membrane. When bound to the membrane of the liposomes, all the peptides preserved the self-aggregation characteristics observed in solution. Aging the Abeta40 and Abeta42 peptide solutions that permit molecular self-aggregation reduced their capacity to induce liposome aggregation. The self-aggregation of membrane-bound prion molecules was several orders of magnitude higher than that observed for the other toxic peptides. Incorporation of the ganglioside GM1 into the membrane of liposomes enhanced the peptide-induced liposome aggregation. Kinetic analysis revealed that this enhancement was due to facilitation of the formation of bridges between membrane-bound peptide molecules, demonstrating that the peptide-membrane interaction and the peptide amyloidogenesis are independent functions performed at separate molecular regions. PMID:15063003

Kurganov, Boris; Doh, Michael; Arispe, Nelson



Genetics Home Reference: Dystonia  


... U.S. National Library of Medicine® Home Conditions Genes Chromosomes Handbook Glossary Resources Conditions > Dystonia Related topics on Genetics Home Reference: dopa-responsive dystonia dystonia 6 early-onset primary dystonia GM1 gangliosidosis hypermanganesemia with ...


Airway Epithelium, Inflammation, and Mechanisms of Disease: A Tribute to Carol B. Basbaum AsialoGM1 and TLR5 Cooperate in Flagellin-Induced Nucleotide Signaling to Activate Erk1\\/2  

Microsoft Academic Search

2 mobilization, and Erk1\\/2 activation. Conversely, the activation of NF-B by flagellin is dependent on signaling through TLR5. These results prompted us to ask whether the flagellin-induced TLR5 signaling pathway was intersecting with or mutually independent of the nucleotide receptor pathway acti- vated downstream of asialoGM1. Herein, we demonstrate that the release of ATP induced by flagellin is dependent on

Nancy McNamara; Marianne Gallup; Anatol Sucher; Inna Maltseva; David McKemy; Carol Basbaum


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



Vacuolating megalencephalic leukoencephalopathy in 12 Israeli patients.  


Leukodystrophy with macrocephaly as the main features of infantile neurodegenerative disease are characteristics of Canavan's disease, L-2-hydroxyglutaric aciduria, type I glutaric aciduria, and Alexander's disease. Also occasionally described are occidental congenital muscular dystrophy, G(M)2-gangliosidosis, metachromatic leukodystrophy, Krabbe's disease, and mucopolysaccharidosis. Since 1995, over 60 patients with a new syndrome, vacuolating megalencephalic leukoencephalopathy, have been described. The syndrome is characterized by macrocephaly, a slowly progressive clinical course of ataxia, spastic paraparesis, and seizure disorder with relatively spared cognition. Unlike other leukodystrophies with macrocephaly (except Alexander's disease), no metabolic marker has been found. We describe a similar group of 12 patients from two different Jewish ethnic origins in whom consanguinity is prominent. These patients have neuroimaging features and magnetic resonance spectroscopy findings indicating that there is an initial increase in white-matter edema with subsequent cystic formation. Consistent with loss of tissue in these areas, brain metabolites are reduced. The familial incidence in this group of patients is suggestive of autosomal-recessive inheritance. PMID:11292232

Ben-Zeev, B; Gross, V; Kushnir, T; Shalev, R; Hoffman, C; Shinar, Y; Pras, E; Brand, N



Patient \\  

Microsoft Academic Search

Contemporary medical decision making has been characterized as a struggle be- tween patients who are reportedly making more demands for medical interventions such as diagnostic tests and prescription drugs and physicians who are encouraged to partner with patients and satisfy them while simultaneously keeping medical costs down. Understanding this dynamic requires attention to the interactional strategies whereby patients indicate what

Virginia Teas Gill



STD-NMR used to elucidate the fine binding specificity of pathogenic anti-ganglioside antibodies directly in patient serum.  


High-resolution binding profiles were elucidated for anti-GM1 IgM autoantibodies from two patients with a progressive form of paraproteinemic polyneuropathy. Antibody-ligand interaction was characterized by generating STD-NMR signals in target ganglio-oligosaccharides added directly to patient sera, without the requirement of antibody fractionation. Both immunoglobulins were found to have similar binding modalities, with interaction confined to two distinct spatially separated regions of GM1: the terminal betaGal(1-3)betaGalNAc disaccharide unit and the sialic acid residue. We describe a unique and powerful biophysical technique applied to define the molecular interaction between autoimmune disease-causing antibodies and their ganglioside targets. PMID:19105626

Houliston, R Scott; Jacobs, Bart C; Tio-Gillen, Anne P; Verschuuren, Jan J; Khieu, Nam H; Gilbert, Michel; Jarrell, Harold C



Biochemistry and genetics of gangliosidoses.  


The gangliosidoses comprise an-ever increasing number of biochemically and phenotypically variant diseases. In most of them an autosomal recessive inherited deficiency of a lysosomal hydrolase results in the fatal accumulation of glucolipids (predominantly in the nervous tissue) and of oligosaccharides. The structure, substrate specificity, immunological properties of and genetic studies on the relevant glycosidases, ganglioside GM1 beta-galactosidase and beta-hexosaminidase isoenzymes, are reviewed in this paper. Contrary to general expectation, only a poor correlation is observed between the severity of the disease and residual activity of the defective enzyme when measured with synthetic or natural substrates in the presence of detergents. For the understanding of variant diseases and for their pre- and postnatal diagnosis, the necessity of studying the substrate specificity of normal and mutated enzymes under conditions similar to the in vivo situation, e.g., with natural substrates in the presence of appropriate activator proteins, is stressed. The possibility that detergents may have adverse affects on the substrate specificity of the enzymes is discussed for the beta-hexosaminidases. The significance of activator proteins for the proper interaction of lipid substrates and water-soluble hydrolases is illustrated by the fatal glycolipid storage resulting from an activator protein deficiency in the AB variant of GM2-gangliosidosis. Recent somatic complementation studies have revealed the existence of a presumably post-translational modification factor necessary for the expression of ganglioside GM1 beta-galactosidase activity. This factor is deficient in a group of variants of GM1-glangliosidosis. Among the possible reasons for the variability of enzyme activity levels in heterozygotes and patients, allelic mutations, formation of hybrid enzymes, and the existence of patients as compound heterozygotes are discussed. All these may result in the production of mutant enzymes with an altered specificity for a variety of natural substrates. PMID:116955

Sandhoff, K; Christomanou, H



Antibodies to Glycoproteins Shared by Human Peripheral Nerve and Campylobacter jejuni in Patients with Multifocal Motor Neuropathy  

PubMed Central

We have tested serum samples from 24 patients with multifocal motor neuropathy (MMN) for reactivity to ganglioside GM1 and to Gal(?1–3)GalNAc-bearing glycoproteins isolated from human peripheral nerve and from Campylobacter jejuni (Cj) serotype O:19. IgM anti-GM1 antibodies were detected by ELISA in 11 patients (45.8%) with MMN and in only one subject (4%) from the control group. Western blots showed positive reactivity of sera from 6 patients (25%) with MMN to several Gal(?1–3)GalNAc-bearing glycoproteins from human peripheral nerve and from Cj O:19 isolates. Sera from three patients (12.5%) with MMN showed positively reactive bands with similar electrophoretic mobility in all isolates (60–62?kDa, 48–51?kDa, 42?kDa, and 38?kDa). All six patients showed positive reactivity to 48–52 kDa protein isolated from human peripheral nerve. Increased titer of IgG antibodies to 60–62?kDa protein isolated from Cj O:19 associated with Guillain-Barré syndrome was detected in three patients, and their serum showed also IgG positive reactivity to peripheral nerve antigen with the same electrophoretic mobility. One of these patients had a previous history of Cj infection which suggests the possibility that Cj may be also involved in the pathogenesis of MMN. PMID:23762534

Poceva-Panovska, Ana; Knezevic Apostolski, Sladjana



[Ultrastructural study of conjunctival biopsies in metabolic diseases of the nervous system].  


Forty conjunctival biopsies from children suffering from metabolic diseases of the CNS were studied ultrastructurally. In 20 cases they were abnormal (8 mucopolysaccharidosis, 6 GM1 gangliosidosis, 4 infantile neuroaxonal dystrophy, 1 GM2 gangliosidosis, 1 late infantile ceroid lipofuscinosis). In the 20 remaining cases the biopsies did not show abnormalities. From these, 2 were proven as Leigh disease and Hallervorden-Spatz disease in which there is no conjunctival ultrastructural alterations; in 2 cases (one metachromatic leukodystrophy and one adrenoleukodystrophy) the results were false negative); in 4 clinically suspected cases of late infantile ceroid lipofuscinosis no alterations were observed and the results were not conclusive. In the remaining 12 cases the negatives allowed to rule out lysosomal disorders. The ultrastructural study of the conjunctival biopsy is an important tool for the diagnosis of neurological metabolic diseases of children mainly when sophisticated biochemical procedures are not available. PMID:3111452

Rosemberg, S; Campos, C



Bickerstaff's brainstem encephalitis, Miller Fisher syndrome and Guillain-Barr? syndrome overlap in an asthma patient with negative anti-ganglioside antibodies  

PubMed Central

Background Bickerstaff’s brainstem encephalitis (BBE), together with Miller Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS) were considered to form a continuous clinical spectrum. An anti-GQ1b antibody syndrome has been proposed to underlie the common pathophysiology for the three disorders; however, other studies have found a positive anti-GM1 instead of anti-GQ1b antibody. Case presentation Here we report a 20-year-old male patient with overlapping BBE, MFS and GBS. The patient had a positive family history of bronchial asthma and had suffered from the condition for over 15?years. He developed BBE symptoms nine days after an asthma exacerbation. During the course of illness, he had significantly elevated IgE levels in both serum and cerebrospinal fluid. Serologic analysis of antibodies against ganglioside complexes (anti-GDIa, anti-GDIb, anti-GM1, anti-GM2, anti-GM3, anti-GQIb and anti-GTIb antibodies) showed negative results. Conclusions Since asthma has recently been related to autoimmune disease, our case supports an autoimmune mechanism underlying the clinical spectrum composed of BBE, MFS and GBS. However, contrary to a proposed anti-GQ1b antibody syndrome, we would suggest that pathogenesis of this clinical spectrum is not limited to anti-ganglioside antibodies. PMID:22698187



Macroautophagy is not directly involved in the metabolism of amyloid precursor protein.  


Alterations in the metabolism of amyloid precursor protein (APP) are believed to play a central role in Alzheimer disease pathogenesis. Burgeoning data indicate that APP is proteolytically processed in endosomal-autophagic-lysosomal compartments. In this study, we used both in vivo and in vitro paradigms to determine whether alterations in macroautophagy affect APP metabolism. Three mouse models of glycosphingolipid storage diseases, namely Niemann-Pick type C1, GM1 gangliosidosis, and Sandhoff disease, had mTOR-independent increases in the autophagic vacuole (AV)-associated protein, LC3-II, indicative of impaired lysosomal flux. APP C-terminal fragments (APP-CTFs) were also increased in brains of the three mouse models; however, discrepancies between LC3-II and APP-CTFs were seen between primary (GM1 gangliosidosis and Sandhoff disease) and secondary (Niemann-Pick type C1) lysosomal storage models. APP-CTFs were proportionately higher than LC3-II in cerebellar regions of GM1 gangliosidosis and Sandhoff disease, although LC3-II increased before APP-CTFs in brains of NPC1 mice. Endogenous murine A?40 from RIPA-soluble extracts was increased in brains of all three mice. The in vivo relationship between AV and APP-CTF accumulation was also seen in cultured neurons treated with agents that impair primary (chloroquine and leupeptin + pepstatin) and secondary (U18666A and vinblastine) lysosomal flux. However, A? secretion was unaffected by agents that induced autophagy (rapamycin) or impaired AV clearance, and LC3-II-positive AVs predominantly co-localized with degradative LAMP-1-positive lysosomes. These data suggest that neuronal macroautophagy does not directly regulate APP metabolism but highlights the important anti-amyloidogenic role of lysosomal proteolysis in post-secretase APP-CTF catabolism. PMID:20864542

Boland, Barry; Smith, David A; Mooney, Declan; Jung, Sonia S; Walsh, Dominic M; Platt, Frances M



GM1-Containing Lipid Rafts Are Depleted within Clathrin-Coated Pits  

Microsoft Academic Search

Recent studies show that markers for lipid rafts are among the plasma membrane components most likely to be internalized independently of clathrin-coated pits, and there is evidence to suggest that lipid rafts may play a functional role in endocytic trafficking [1–5]. However, lipid rafts themselves are commonly defined purely in biochemical terms, by resistance to detergent extraction. The existence of

B. J. Nichols



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



GM1 structure determines SV40-induced membrane invagination and infection  

E-print Network

other multivalent glycolipid ligands are also internalized by clathrin-independent endo- cytosis14 domains in vitro22 , and multivalent binding is required for efficient endocytosis23 . By binding to up . Whether multivalent binding and glycolipid structure mediate the proc- ess of cell infection by colloidal

Sens, Pierre


GM1 and NGF synergism on choline acetyltransferase and choline uptake in aged brain  

Microsoft Academic Search

In the brain of aged rats high affinity choline uptake (HAChU) of the striatum, hippocampus, and frontal cortex is lower than in young rats, while choline acetyltransferase (ChAT) activity is lower in striatum and frontal cortex. Infusion into the lateral cerebral ventricle with nerve growth factor (NGF) enhances the low values of these cholinergic markers in a dose- and region-dependent

T. G. Fong; V. Vogelsberg; N. H. Neff; M. Hadjiconstantinou



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

PubMed Central

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.



Do patients having a decrease in SNAP amplitude during the course of MMN present with a different condition?  


A decrease in sensory nerve action potentials (SNAP) amplitude has been recently reported in some patients during the course of multifocal motor neuropathy with conduction blocks (MMNCB). It is not known if those patients have different clinical expression and disability when compared with typical MMNCB. Clinical, biological and electrophysiological assessments were performed in 15 patients fitting the diagnosis criteria of MMNCB, including normal SNAP amplitude at initial examination. Patients presenting with nerve entrapment or associated disease causative of sensory neuropathy were excluded. Median time of follow-up was 3 years (1-17 years). At the last examination, four patients had at least one SNAP amplitude below 50% of normal value. None had clinically objective sensory loss. Clinical and electrophysiological data obtained at the last examination were compared between patients with normal SNAP amplitude and patients with decreased SNAP amplitude. No difference between both population in term of age, sex, disease duration, anti-GM1 antibody titers, CSF data and number of conduction blocks was noted. In contrast, patients with decreased SNAP amplitude had worse overall neuropathy limitation scale (ONLS) scores (7 vs. 2; p = 0.02), a higher number of affected nerves (12.5 vs. 4; p = 0.018), a higher number of affected limb regions (6 vs. 2; p = 0.019) and lower median CMAP amplitude (2 mV vs. 6.5 mV; p = 0.04). They were all dependent on higher doses of IVIg (1.4 g/(kg 4 weeks vs. 0.6; p = 0.018). A reduction in SNAP amplitude during the course of MMNCB is associated with a more severe disease and a more prominent axonal loss. This result needs to be confirmed in a larger cohort. PMID:19641982

Delmont, Emilien; Benaïm, Charles; Launay, Mael; Sacconi, Sabrina; Soriani, Marie-Hélène; Desnuelle, Claude



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


Association of antibodies to ganglioside complexes and conduction blocks in axonal Guillain-Barré syndrome presenting as acute motor conduction block neuropathy.  


A close relationship between acute motor conduction block neuropathy and antibodies against the complex of GM1 and GalNAc-GD1a has been reported. This study investigates the hypothesis that conduction block at the early phase of axonal Guillain-Barré syndrome (GBS) is also associated with such ganglioside complexes. Sera were obtained from seven French patients with initial evidence of isolated conduction blocks that resolved or progressed to acute motor axonal neuropathy. Serum IgG to asialo-GM1 and gangliosides of LM1, GM1, GM1b, GD1a, GalNAc-GD1a, GD1b, GT1a, GT1b, and GQ1b as well as their complexes were measured. Five of seven patients progressed within the first month of disease to AMAN. One patient had IgG antibodies against the complex of asialo-GM1 and each of the other ganglioside antigens. Another patient carried IgG antibodies against GM1 complex with GM1b, GD1a, and GT1a as well as asialo-GM1 complex with GD1a and GT1a. None had IgG antibodies against GM1/GalNAc-GD1a complex. Six patients had IgG against single antigens GM1, GD1a, GalNAc-GD1a, GD1b, and asialo-GM1. In three patients, a reduced reaction against GM1/GalNAc-GD1a complex was observed. The presence of conduction block in axonal GBS is not always associated with anti-GM1/GalNAc-GD1a complex antibodies. PMID:24750296

Créange, Alain; Shahrizaila, Nortina; Salhi, Hayet; Lefaucheur, Jean-Pascal; Yuki, Nobuhiro



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.


To forecast the investment in the treatment of the environmental pollution of China by Gm (1,1)  

Microsoft Academic Search

The environmental problem is one of the focus problems in the process of the development of society and economy in our country. The treatment of environmental pollution is an effectual way to solve the current environmental pollution in our country. However, the lack of the investment in the treatment of environment pollution becomes the \\

Hongwei Li; Dequn Zhou; Yunlong Sun



Patients' narratives.  


Patients who suffer from inflammatory skin disease are at risk of stigmatisation and physical and psychological co-morbidities. To an extent these issues can be offset by effective coping strategies. The cumulative balance of these interactions will often lead to impairment, especially in those whose coping mechanisms are maladaptive or do not exist. When this situation arises, the detrimental effect of these various morbidities is termed 'cumulative life course impairment' (CLCI). We present 2 typical cases, one of a patient suffering from severe psoriasis and another of a patient suffering severe atopic eczema, as examples of how patients with inflammatory skin disease may be affected by CLCI. Their experiences demonstrate that the presence of inflammatory skin disease changes key life choices with resultant effect on career and relationships, amongst others. Although longitudinal evidence to support this CLCI is lacking, these patient narratives add support to the concept of CLCI. PMID:23796819

Foulkes, Amy C; Warren, Richard B




PubMed Central

Background First implemented in 1990, patient navigation interventions are emerging as an approach to reduce cancer disparities. However, there is lack of consensus about how patient navigation is defined, what patient navigators do, and what their qualifications should be. Little is known about the efficacy and cost effectiveness of patient navigation. Methods We conducted a qualitative synthesis of published literature on cancer patient navigation. Using the keywords “navigator” or “navigation” and “cancer,” we identified 45 articles from Pubmed and reference searches that were published or in press through October 2007. 16 provided data on efficacy of navigation in improving timeliness and receipt of cancer screening, diagnostic follow-up care, and treatment. Patient navigation services are defined and differentiated from other outreach services. Results Overall there is evidence for some degree of efficacy for patient navigation in increasing participation in cancer screening and adherence to diagnostic follow-up care following an abnormality, with increases in screening ranging from 10.8% to 17.1% and increases in adherence to diagnostic follow-up care ranging from 21% to 29.2%, when compared to control patients. There is less evidence regarding efficacy of patient navigation in reducing either late stage cancer diagnosis or delays in initiation of cancer treatment or improving outcomes during cancer survivorship. There were methodological limitations in most studies, such as lack of control groups, small sample sizes, and contamination with other interventions. Conclusions Although cancer-related patient navigation interventions are being increasingly adopted across the U.S. and Canada, further research is necessary to evaluate their efficacy and cost-effectiveness in improving cancer care. PMID:18780320

Wells, Kristen J.; Battaglia, Tracy A.; Dudley, Donald J.; Garcia, Roland; Greene, Amanda; Calhoun, Elizabeth; Mandelblatt, Jeanne S.; Paskett, Electra D.; Raich, Peter C.



Patient passport.  


This article outlines the development, testing and evaluation of a patient passport designed specifically for people with severe asthma, who often prefer to self-manage rather than attend emergency services, and thereby put their lives at risk. PMID:25369963



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 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.


"Patient Zero":  

PubMed Central

Summary This article contextualizes the production and reception of And the Band Played On, Randy Shilts’s popular history of the initial recognition of the American AIDS epidemic. Published over twenty-five years ago, the book and its most notorious character, “Patient Zero,” are in particular need of a critical historical treatment. The article presents a more balanced consideration—a “patient’s view”—of Gaétan Dugas’s experience of the early years of AIDS. I oppose the assertion that Dugas, the so-called Patient Zero, ignored incontrovertible information about the condition and was intent on spreading his infection. Instead I argue that scientific ideas in 1982 and 1983 about AIDS and the transmissibility of a causative agent were later portrayed to be more self-evident than they were at the time. The article also traces how Shilts’s highly selective—and highly readable—characterization of Dugas rapidly became embedded in discussions about the need to criminalize the reckless transmission of HIV. PMID:24769806

McKay, Richard A.



Patient's perspective.  


An unknown, but significant subgroup (perhaps the majority), of patients who have undergone chemotherapy treatment for their cancer report a subsequent decline in cognitive performance (e.g., difficulty in balancing a checkbook; forgetting or mixing up names of friends or relatives, etc.). The condition has been termed chemo fog, chemo brain, or some similar term to reflect the fact that the symptoms are usually difficult to describe and involve domains of cognition such as attention, concentration, memory, speed of information processing, multitasking, or ability to organize information. The deficits are reported to persist. The magnitude of the negative impact on quality of life depends, as does the condition itself, on multiple and varied factors. This chapter relates the experience of one patient. PMID:20738000

Raffa, Robert B; Martin, Kathleen J



Patient Corner

Biospecimens are biological materials from people (such as tissue, blood, plasma, and urine) that can be used for diagnosis and basic research. When cancer patients undergo procedures such as a blood draw, biopsy or surgery in which a specimen is removed for diagnostic or therapeutic purposes, it is often possible for a small amount of residual specimen to be stored and later used for research.


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 ...


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



Patient Education Patient and Family Education  

E-print Network

Patient Education Patient and Family Education Resources to Quit Smoking or Using Tobacco Washington Tobacco Quit Line 877-270-STOP (877-270-7867) Spanish: 877-2NOFUME (877-266-3863) TTY: 877 for good. #12;Page 2 Patient and Family Education Resources to Quit Smoking or Using Tobacco Each person

Hochberg, Michael


Counseling the Coronary Patient  

ERIC Educational Resources Information Center

The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

Semmler, Caryl; Semmler, Maynard



Physician accountability, patient safety and patient compensation.  


In Canada, the response to adverse medical events follows one or more of three main paths: patient safety, physician accountability and patient compensation. While their goals differ, each of these responses serves a valuable function. There are however competing imperatives inherent in each response, particularly in terms of information disclosure: Effective patient safety depends on the full and protected disclosure of all information relevant to an adverse event and requires a "no blame" environment. While natural justice demands that a physician be held accountable for his actions, the doctor should be accorded the right of due process and be judged against an established standard of care. This is necessarily a fault-finding activity. Patient compensation meets both accountability demands and the social justice imperatives of supporting a patient injured through physician negligence. The most effective approach is one that achieves balance between competing imperatives. With clear information disclosure rules, patient safety, physician accountability and patient compensation can operate synergistically. PMID:16900793

Gray, John E



Improving patient safety culture  

Microsoft Academic Search

Purpose – Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. Design\\/methodology\\/approach – Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the

Johan Hellings; Ward Schrooten; Niek S. Klazinga; Arthur Vleugels



The Angry Dying Patient  

PubMed Central

Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way. PMID:15014699

Houston, Robert E.



CD4 ligation excludes the Carma1-Bcl10-MALT1 complex from GM1-positive membrane rafts in CD3/CD28 activated T cells  

E-print Network

10-MALT1 complex in membrane rafts. We report that treatment of CD3/CD28-activated Jurkat T cells and exclusion of ZAP-70, SLP-76, PLC1 and Vav-1 from membrane rafts of Jurkat T cells [4]. Moreover, 13B8 not identify the link between the proximal modulation of the lipid-protein rheostat in membrane rafts

Boyer, Edmond


Dose and time-dependent hippocampal cholinergic lesions induced by ethylcholine mustard aziridinium ion: Effects of nerve growth factor, GM 1 ganglioside, and vitamin E  

Microsoft Academic Search

Ethylcholine mustard aziridinium ion (ECMA) was infused intracerebroventricularly (icv) to rats followed by measurement of two markers of presynaptic cholinergic neurons, choline acetyltransferase (ChAT) activity and high affinity choline transport (HAChT), in the hippocampus and cortex. Bilateral icv administration of 1, 2, or 3 nmol of ECMA per side produced dose-dependent reductions in each marker in the hippocampus, but not

Gail V. W. Johnson; Michele Simonato; Richard S. Jope



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


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

E-print Network

assembly is a nucleation-dependent polymerization process characterized by an initial lag phase (5, 6). It has been proposed that during nucleation, A monomers first reversibly assemble into micelles at concentrations above a critical micelle concentration (CMC), after which fibrils nucleate within these micelles

Lee, Ka Yee C.


Feasibility of Establishing an Industrial Investment Fund in Jiangsu Coastal Area - Based on Cobb -- Douglas Production Function and GM (1, 1) Prediction Model  

Microsoft Academic Search

The development strategy of Jiangsu coastal area is not only a province-level planning, it has become one of our national strategies. However, capital protection is the challenge facing economic development in Jiangsu coastal district. First, this paper transformed the established Cobb-Douglas Production Function to an expression of investment level in order to calculate respectively the investment level parameters for recent

Wei Dai; Xiaojun Zhou



NCCCP: Patient Survey

The overall purpose of the patient experience survey is to gain an understanding of patients' perspectives on the NCCCP pilot study and to assess how well patients' health care and informational needs are being met. Through the survey, RTI assessed patients' overall satisfaction with care, their view of multidisciplinary care team coordination, knowledge of NCCCP services, emotional and financial support received from the program, and experiences with access to appointments and waiting time.


[Patient blood management--The preoperative patient].  


Preoperative anaemia is an independent risk factor for an increase in perioperative morbidity and mortality. Patient Blood Management (PBM) aims for an early detection of anaemia in elective surgery patients. Reasons for anaemia should be detected and causally treated if possible. A multidisciplinary team of specialists aims for diagnosis and causative treatment of easily treatable and frequent causes of anaemia like iron deficiency, bleeding or (autoimmune) haemolysis using patients' specific history, examination, laboratory and technical methods. Such an outpatient PBM programme is only feasible, if anaesthesiologists, surgeons, haematologists, gastroenterologists, gynecologists, laboratory and transfusion medicine specialists work together in a PBM team using a common PBM plan. Communication within this team as well as with the patients' physicians in their private offices is key for a long lasting success of such a PBM programme. PMID:24792598

Müller, Markus M; Fischer, Dania; Stock, Ulrich; Geisen, Christof; Steffen, Björn; Nussbaumer, Judith; Meybohm, Patrick



Modelling patient states in intensive care patients  

E-print Network

Extensive bedside monitoring in hospital Intensive Care Units (ICU) has resulted in a deluge of information on patient physiology. Consequently, clinical decision makers have to reason with data that is simultaneously large ...

Kshetri, Kanak Bikram



Patient-centered Care.  


Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351

Reynolds, April



RESEARCH Open Access Patient-reported outcomes among patients using  

E-print Network

RESEARCH Open Access Patient-reported outcomes among patients using exenatide twice daily, prospective observational study conducted in six European countries. Patients initiated exenatide twice daily between main cohorts were conducted. Results: There were 2388 patients eligible for analysis (exenatide

Paris-Sud XI, Université de


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.



How do patients define \\  

Microsoft Academic Search

Results: The patients' mean age was 72.7 (± 15) years; 61% were female. Content analysis pro- duced 9 categories connoted positively\\/negatively; the mean number of categories\\/patient response was 2.4 (± 1.3), ranging from 1-6. Sensitivity\\/ insensitivity to feelings were in the forefront, together with the importance of the relational dimension and the need to provide treatment tailored to the patient's

Christophe Luthya; Christine Cedraschi; Eliane Perrin; Anne-Françoise Allaz


Helping Patients Manage Stress  

PubMed Central

Stress and worry are always a part of our patients' problems and frequently the sole cause of their symptoms. Ways of relieving anxiety in different types of patients are described, according to complexity and time required. The main principles are: adequate diagnosis; explanation of the stress symptom cycle; supportive reassurance; identification and reduction of stressors where possible, and varying degrees of personal development to bring patients' level of functioning and adjustment up to match his stresses. Objections and difficulties are discussed, together with benefits such as diminised use of anxiolytics; a healthier adjustment for the patient, and greater job satisfaction for the physician. PMID:21283346

Rainham, David C.



Thermoplastic Patient Fixation  

Microsoft Academic Search

\\u000a Background and Purpose:  Several methods have been developed to reduce tumor motions and patient movements during radiotherapy of lung cancer. In this\\u000a study, a multislice CT-based analysis was performed to examine the effect of a thermoplastic patient immobilization system\\u000a on the chest wall and tumor motions.\\u000a \\u000a \\u000a \\u000a Patients and Methods:  Ten patients with stage II–IV lung cancer were enrolled into the study. According

Arpad Kovacs; Janaki Hadjiev; Ferenc Lakosi; Marta Vallyon; Zsolt Cselik; Peter Bogner; Akos Horvath; Imre Repa



Patient Education Thesaurus.  

ERIC Educational Resources Information Center

This thesaurus was compiled to make the materials in the Patient Education Room of the Donald J. Vincent Medical Library at Riverside Methodist Hospital, Columbus, Ohio, more accessible to patients. Subjects are grouped in fairly broad categories (e.g., Aging & Problems of Aging; Alcohol & Alcohol Abuse; Careers in the Medical Field; Childhood and…

Cooper, Lynn


Pruritus in hemodialysis patients  

Microsoft Academic Search

BACKGROUND: Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD), however little progress is seen in our understanding of its pathogenesis. The aim of this study was to evaluate the frequency of pruritus in HD patients in Tehran, Iran, and to correlate its presence and intensity with relevant clinical and laboratory parameters. METHODS: One hundred

Maryam Akhyani; Mohammad-Reza Ganji; Nasrin Samadi; Behnaz Khamesan; Maryam Daneshpazhooh



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.


Gestational A PATIENT'S  

E-print Network

diabetes, its causes, and its features and includes a general treatment plan to help control the conditionManaging Gestational Diabetes A PATIENT'S GUIDE TO A HEALTHY PREGNANCY U.S. Department of Health to improve the health of mothers, children, and families. Managing Gestational Diabetes: A Patient's Guide

Rau, Don C.


The right patient.  


This article offers professional opinions and advice on how physicians should prepare in order to protect themselves and their practices during this turbulent time in healthcare reform. This article presents real-life scenarios to help physicians understand what they may face and what actions they should take in anticipation of the future in healthcare. The article focuses on the concept of "the right patient," defining the characteristics of patients that benefit the financial aspect of a practice and those who do not. Its purpose is not to encourage physicians to deny care to patients who are poorly insured or uninsured, but to guide in the establishment of a smart and safe balance between the two. Strategies are discussed on how to attract the right patient and what these patients mean to the practice. The importance of practice marketing is also highlighted, along with an emphasis on the necessity of change in order to survive in the future healthcare environment. PMID:22413597

Howrigon, Ron



Patient-focused care.  


The trend away from a departmental focus and toward "patient-focused" care in hospitals is described; advantages of and barriers to such a change and its effects on pharmacy are discussed. Patient-focused care is characterized by decentralization of services, cross-training of personnel from different departments to provide basic care, interdisciplinary collaboration, various degrees of organizational restructuring, use of "clinical pathways"--recommended components of care for patients with a particular diagnosis, simplification and redesign of work to eliminate steps and save time (e.g., providing care according to predetermined protocols and charting only exceptions to the protocol), and increased involvement of patients in their own care. Its objectives are to use nonclinical and clinical staff more effectively and to improve patients' perceptions of the quality of care and staff members' job satisfaction. It is unrealistic to expect quick reductions in hospital costs through patient-focused care, and workers will worry about job security if an institution overemphasizes this aspect. A 1993 survey of 311 hospitals found that almost half had or planned to have patient-focused care projects. Adoption of patient-focused care projects may be slowed by workers' fear of new responsibilities and new reporting relationships. However, not all patient-focused care models involve radical organizational changes, and reorganizations can be such that pharmacy staff members are still connected to the pharmacy department even if they are supervised by a nonpharmacist. In some institutions patient-focused care projects have given pharmacy its first opportunity for decentralization.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8266955

Vogel, D P



Sepsis in burned patients.  


A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4%) developed clinically and microbiologically proven sepsis. Twenty-six (53.1%) were males and 23 (46.9%) females with a mean age of 22 years (range one to 89 years) and mean burned body surface area of 37.7 +/- 18.4% (range 7 to 84%). Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6%) patients had only one and nine (18.4%) had up to three episodes of sepsis. Thirty (61.2%) patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococccus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9%) episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 (24.2%) episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5%) patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication. PMID:15049101

de Macedo, Jefferson Lessa; Rosa, Simone C; Castro, Cleudson



Gambling among methadone patients.  


In this paper we assess participation in various forms of gambling activities and establish the prevalence of pathological gambling in a sample of patients (N = 117) enrolled in a large methadone maintenance treatment program in New York City. Respondents were interviewed with a protocol that incorporates the South Oaks Gambling Screen. We found that gambling was a common part of the regular activities of many patients, that 15% of the patients had some problem with gambling, and that an additional 16% were probable pathological gamblers. The implications of our findings are discussed. PMID:7558485

Spunt, B; Lesieur, H; Hunt, D; Cahill, L



Psychiatric patient and anaesthesia  

PubMed Central

Many patients with psychiatric illnesses are prescribed long-term drug treatment, and the anaesthesiologist must be aware of potential interactions with anaesthetic agents. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the patient about to undergo anaesthesia and surgery. This article highlights the effects of anaesthetics on patients taking antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors and lithium carbonate. The risk that should be considered in the perioperative period are the extent of surgery, the patient's physical state, anaesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms and risk of psychiatric recurrence and relapse. PMID:22529413

Attri, Joginder Pal; Bala, Neeru; Chatrath, Veena



JAMA Patient Page: Shingles  


... of the American Medical Association JAMA PATIENT PAGE Shingles S hingles is a painful condition caused by the ... the United States alone. Shingles, also known as herpes zoster , occurs in persons who have already had chickenpox. ...


Insurance Resources for Patients  


... the health and safety of their employees. The ACA has developed resources to assist patients in advocating ... employee benefits. Resources to Educate Others about Chiropractic ACA has a number of resources available to educate ...


JAMA Patient Page: Concussion  


JAMA PATIENT PAGE Concussion C oncussion (or mild traumatic brain injury) is a brain injury caused by blunt head trauma. In the United States, concussion affects more than 1 million individuals each year. ...


Patient & Family Support Programs  

E-print Network

Patients and supporters welcome. Support Services Room, Level 3, NCCC Pancreatic Cancer Support Group May with Pancreatic Cancer Action Network Support Services Room, Level 3, NCCC PSA at NCCC: Prostate Support Alliance

Myers, Lawrence C.


Why make people patients?  

PubMed Central

People confront their doctors with three modes of unhealth - disease, illness and sickness. Each is discussed, and the question is asked and answered as to why in this situation people wish to become patients. PMID:1177270

Marinker, Marshall



JAMA Patient Page: Gout  


... DrPH/ Boston University School of Medicine Uric acid crystals The JAMA Patient Page is a public service ... is confirmed by the presence of uric acid crystals in the joint fluid. Steps for prevention of ...


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. ...


Mycobacteremia in AIDS patients  

Microsoft Academic Search

Summary The importance of blood cultures in diagnosing disseminated mycobacteriosis in AIDS patients was evaluated. Blood samples were screened for mycobacteria by culture and microscopic techniques. Mycobacteremia was proven in 20\\/136 (14.7%) AIDS patients, the agent being M. avium-M. intracellulare (MAI) in 16 cases and M. tuberculosis in four cases. The rate of cases with positive blood samples in disseminated

B. Ruf; D. Schürmann; W. Brehmer; H. Mauch; H. D. Pohle



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.



Sex Education for Patients  

PubMed Central

Sex education evokes a wide variety of responses in the community and from teachers. Consequently, physicians have a responsibility to present sex education material in a factual, objective way. Many people are misinformed about sexual behavior. Physicians can help patients and the community by being aware of appropriate sex education for each age group. A curriculum for sex education, and opportunities to provide sex information for patients of different ages and stages in the lifecycle, are described. PMID:21274069

Zitner, David



Patient Considerations and Preparation  

Microsoft Academic Search

\\u000a The key to delivering good care to any patient remains a proper ­history and physical examination. This is no different for\\u000a dialysis patients despite the short nature of interventions and relative low-risk of complications. A proper history and physical\\u000a helps guide short- and long-term therapy. Below is an outline of major points to be considered.

Dheeraj K. Rajan



PubMed Central

There are at present two opposing points of view on problems of dealing with the intersexed patient (not the typical homosexual or transvestite) who has clearcut anatomical or biochemical qualities of the opposite sex. The first is that in the growing child or adult coming for treatment, the sex the patient should adopt is the summation of somatic sex. The other is that the sex role should be assigned according to the predominant psychological identification already present. A case history of a middle-aged pseudohermaphrodite, castrated in youth but raised from birth as a female and living thus in “homosexual” relations with women until examined and interviewed at UCLA Medical Center is presented to illustrate the psychological problems in sexual identity with which the patient had to cope. Psychiatric investigation revealed how confused the patient's sex identity was until treatment by a team consisting of psychiatrist, psychologist and endocrinologist permitted the patient, even at so late a date, finally to establish what his gender is. The patient was able, despite early rearing as a female and a castrating operation, to swing to a more masculine identification. This was possible because of some uncertainty of sexual role from an early age. PMID:13834894

Stoller, Robert J.; Rosen, Alexander C.



Patient Attitudes to Tonsillectomy  

PubMed Central

Introduction. Recent changes to primary care trusts' Procedures of Limited Clinical Value (PLCV) policy mean that otolaryngologists must now follow policy rather than exercising clinical judgment when listing patients for tonsillectomy. Objectives. To gauge perception within the general public of when tonsillectomy is acceptable and to compare this to the current policy. Method. All patients or their parents attending the adult and paediatric outpatient ENT departments were asked to anonymously complete questionnaires. Results. One hundred and twenty-five completed questionnaires were collected. Thirty-one percent of respondents thought tonsillectomy should be offered solely on patient request, 19% after one to three bouts, and 35% after four to six bouts of tonsillitis. Only 9% thought the current guidelines were reasonable. Patients who had suffered recurrent tonsillitis or had undergone previous tonsillectomy generally thought tonsillectomy advisable after more bouts of tonsillitis than those who had not. Fourteen patients fulfilled the SIGN guidelines for tonsillectomy for recurrent tonsillitis. Of these, 13 (93%) felt that suffering 4–6 bouts of tonsillitis was reasonable before tonsillectomy. Conclusion. All patients we surveyed who meet the current PLCV and SIGN guidelines regarding the appropriateness of tonsillectomy for recurrent tonsillitis perceive that they are excessive, believing that 4–6 bouts of recurrent tonsillitis are adequate to justify tonsillectomy. PMID:23320167

Ubayasiri, Kishan; Kothari, Ravi; McClelland, Lisha; De, Mriganka



Patient involvement in patient safety: Protocol for developing an intervention using patient reports of organisational safety and patient incident reporting  

Microsoft Academic Search

Background  Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety\\u000a incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety -\\u000a a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent\\u000a patient safety incidents

Jane K Ward; Rosemary RC McEachan; Rebecca Lawton; Gerry Armitage; Ian Watt; John Wright



Fatigue in cancer patients.  

PubMed Central

In this paper an overview is presented on what is currently known of fatigue in cancer. Fatigue is considered to be a multi-dimensional concept, that should be measured as such. However, fatigue has been assessed mostly by single items in general symptom checklists. The few specific instruments that have been used in cancer patient populations are discussed. The majority of cancer patients, about 70%, report feelings of fatigue during radio- or chemotherapy. Follow-up results show that, at least for some diagnoses, patients remain fatigued long after treatment has ended. Somatic and psychological mechanisms that have been proposed to explain fatigue are discussed. It is argued that the significance of the results obtained on fatigue as a symptom in cancer depends on comparison with other patient and non-patient populations. Also the occurrence of a response-shift has to be considered, leading to under reporting of fatigue. Finally, possible interventions to decrease feelings of fatigue are presented. PMID:8347475

Smets, E. M.; Garssen, B.; Schuster-Uitterhoeve, A. L.; de Haes, J. C.



Emotional support for cancer patients: what do patients really want?  

Microsoft Academic Search

For many cancer patients and their families the experience of cancer is an intensely stressful one. Emotional support is important for most cancer patients during their illness and can be gained from different people and services. This study evaluates patients' attitudes to different sources of support and rates their satisfaction with sources already used. A total of 431 patients completed

ML Slevin; SE Nichols; SM Downer; P Wilson; TA Lister; S Arnott; J Maher; RL Souhami; JS Tobias; AH Goldstone; M Cody



[Respecting patient intimacy].  


Transparency as a general rule for all our professional acts casts doubts about the statement of the Hippocratic Oath that says "Whatever I see or hear in the lives of my patients, I will keep secret, as considering all such things to be private". Medical secrecy protects the intimacy of patients, who reveal to their physicians their most hidden secrets aiming to recover their health. Therefore, physicians should receive those secrets with reverence and care, as servers and not as their owners. The values associated with the respect for personal intimacy are the anthropological basis of medical confidentiality. A medical act is performed by definition between two equally honorable individuals. Therefore, the professional honors the trust of his patient, maintaining strict confidence of what is revealed. Therefore, medical secrecy must be strengthened rather than weakened, pursuing common wealth and dignity. PMID:25117042



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.



Characterizing "nonresponsive" methadone patients.  


A review of records at a large urban methadone clinic revealed a substantial group of patients with treatment tenures of at least 6 months whose urinalysis results indicated continued regular use of opiates. In an attempt to characterize these "nonresponsive" patients and to identify their specific treatment needs, we compared them to a group of patients with comparable treatment tenures but whose urinalysis results indicated little or no recent illicit opiate use. Contrary to expectations, opiate use itself was virtually the only feature that clearly distinguished the two groups. "Responders" and "nonresponders" did not differ significantly on measures of psychosocial problem severity in any other area, nor did they differ in their treatment service utilization. Moreover, examination of admission data indicated that the two groups showed similar rates of improvement in the severity of their psychosocial problems in all seven measured areas. The implications of these results for treatment and clinic administration are discussed. PMID:9845861

Belding, M A; McLellan, A T; Zanis, D A; Incmikoski, R



Mental patients in prisons  

PubMed Central

Mental conditions usually affect cognitive, emotional and volitional aspects and functions of the personality, which are also functions of interest in law, as they are essential at the time of adjudicating guilt, labeling the accused a criminal, and proffering a sentence. A relationship between mental illness and criminality has, thus, been described and given as one of the reasons for the large number of mental patients in prisons. Whether this relationship is one of causality or one that flows through many other variables is a matter of debate, but there is no debating that prisons have become a de facto part, and an important one, of mental health systems in many countries. This paper deals with the issue of the relationship and provides estimates of prevalence of mental patients in prisons culled from many studies in different countries. It also provides some direction for the management of mental patients as they crowd correctional systems. PMID:19812758




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.


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.


Hospital Patients Are Adult Learners.  

ERIC Educational Resources Information Center

Patient education is recognized by health care providers and patients themselves as an important component of adequate health care for hospital patients. Through this informational process, patients receive information about specific health problems, learn the necessary competencies to deal with them, and develop accepting attitudes toward the…

Caffarella, Rosemary S.


Patient Satisfaction: Improving HCAHPS scores  

E-print Network

Patient Satisfaction: Improving HCAHPS scores in the Johns Hopkins Hospital Department of Medicine Leadership Program for the Advancement of Patient Care Quality and Safety ·Regardless of location. Patient satisfaction is an important aspect of patient care and is progressively being utilized

von der Heydt, Rüdiger


Patient Education Strategies in Dermatology  

PubMed Central

Patient education is an important aspect of patient care in dermatology. Successful education increases patient satisfaction and results in improved outcomes and adherence. This article discusses the role of patient education in dermatology. Specifically, Part I of the review examines evidence demonstrating the benefits of patient education and recognizes the challenges that limit effective patient education. These challenges can be summarized as barriers to understanding, poor patient recall, conflicting information, and barriers to physician delivery. Further descriptions and an assessment of these limitations along with methods to combat them are included in the review. PMID:20725581

Holder, Jessica L.



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.


Introduction to Interviewing Patients.  

ERIC Educational Resources Information Center

Over a period of two semesters, each of the students in the family medicine course at the SUNY Buffalo School of Medicine was asked to come to the Family Medicine Center to be videotaped while interviewing a simulated patient. This pilot project is discussed. (Author/MLW)

Lenkei, Elaine; Bissonette, Raymond



JAMA Patient Page: Glaucoma  


... are 2 main types of glaucoma: open-angle glaucoma and angle-closure glaucoma . These are descriptions of 2 different problems with ... the optic nerve. Some patients with open-angle glaucoma do not have high pressure in the eye. ...


Thromboprophylaxis for trauma patients  

PubMed Central

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of DVT and PE. To compare the effects of different thromboprophylaxis interventions and their relative effects according to the type of trauma.

Lozano, Luis Manuel Barrera; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales, Carlos Hernando



Patient Safety Executive Walkarounds  

Microsoft Academic Search

Since the release of the IOM report To Err Is Human in 1999, significant progress has been made in patient safety. One of the remaining challenges is the need to continually improve the culture of safety. This is a long-term proposition, and one that must be driven foremost by our leaders. In a consensus statement from the National Quality Forum,

Suzanne Graham; John Brookey; Catherine Steadman


Improving MS patient care  

Microsoft Academic Search

Multiple sclerosis (MS) is a multidimensional, chronic, neurological disease affecting young people that often interferes with their life and career plans. Patient care begins at the time of diagnosis, and particular emphasis should be placed on proper education about the variable disease course and treatment options. Clinical assessment at regular intervals using quantitative measures is recommended in order to obtain

Peter Rieckmann



A Patient's Best Friend.  

ERIC Educational Resources Information Center

The author describes the development of a pet therapy program at a rehabilitation unit of a hospital. She discusses documentation of the success of pet therapy programs, picking out the right pets, responsibilities of caring for the pet, training the pet, patient response, and program policies. (CT)

Haggard, Ann



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.


Patients' Bill of Rights  

NSDL National Science Digital Library

The Senate debate on what has come to be known as the "Patients' Bill of Rights" is the focus of this weekùs In the News. The call for legislation of this type has garnered increased attention and support over the past two years as complaints have mounted over the often unappealable decisions of HMOs to deny coverage or restrict access. While both Democrats and Republicans favor such legislation, there are key differences between the two parties' approaches. Republicans have offered a bill that establishes an independent medical reviewer for insured patients denied coverage, while Democrats favor giving patients expanded litigation options as a way to discipline HMOs. Democrats also want to see legislation that returns the ultimate decision on medical treatment to the patient's physician. Republicans disagree with this approach, seeing it as a return to the cost problems that generated the widespread need for HMOs originally. Finally, the Republican version of this legislation promises full protection only to Federal employees as GOP legislators argue the states already protect private employees.

Charbonneau, David D.


Patient educational needs of patients undergoing surgery for lung cancer.  


There often exists a discrepancy between the information health care professionals (HCPs) provide to patients in preoperative teaching sessions and the information patients perceive as important. This study's purpose was to determine what information patients undergoing a lung cancer surgical resection wanted to learn before and after their surgery and also to uncover the information HCPs currently provide to these patients. Ten patients were interviewed preoperatively and postoperatively, and eleven HCPs involved in both their preoperative and postoperative care were interviewed. Emerging themes were noted. Patients reported that the most helpful aspects of the preoperative education included surgical details and the importance of physiotherapy, including exercises. Postoperatively, patients wished they had known more about postoperative pain. HCPs provided information that they felt prepared, informed and empowered their patients. Overall, patients expressed satisfaction with the information they received; they felt prepared for their surgery but not for postoperative pain control. PMID:24756546

King, Judy; Chamberland, Paul; Rawji, Anissa; Ager, Amanda; Léger, Renée; Michaels, Robin; Poitras, Renée; Skelton, Deborah; Warren, Michelle



Chronic Illness and Patient Satisfaction  

PubMed Central

Objective To examine how the relationship between patient characteristics, patient experience with the health care system, and overall satisfaction with care varies with illness complexity. Data Sources/Study Setting Telephone survey in 14 U.S. geographical areas. Study Design Structural equation modeling was used to examine how relationships among patient characteristics, three constructs representing patient experience with the health care system, and overall satisfaction with care vary across patients by number of chronic illnesses. Data Collection/Extraction Methods Random digital dial telephone survey of adults with one or more chronic illnesses. Principal Findings Patients with more chronic illnesses report higher overall satisfaction. The total effects of better patient–provider interaction and support for patient self-management are associated with higher satisfaction for all levels of chronic illness. The latter effect increases with illness burden. Older, female, or insured patients are more satisfied; highly educated patients are less satisfied. Conclusions Providers seeking to improve their patient satisfaction scores could do so by considering patient characteristics when accepting new patients or deciding who to refer to other providers for treatment. However, our findings suggest constructive actions that providers can take to improve their patient satisfaction scores without selection on patient characteristics. PMID:22515159

Carlin, Caroline S; Christianson, Jon B; Keenan, Patricia; Finch, Michael



Building an effective doctor-patient relationship: From patient satisfaction to patient participation  

Microsoft Academic Search

In this paper, the authors argue that patient satisfaction is an insufficient measure of the quality of the doctor-patient relationship. While shown to have a salutary effect on patient anxiety concerning illness and treatment, the only other significant outcome associated with levels of satisfaction is utilization behavior. This is not surprising, the authors argue, since prevailing conceptualizations of patient satisfaction

Edward J. Speedling; David N. Rose



Patient satisfaction with healthcare in asthmatics and patients with COPD before and after patient education  

Microsoft Academic Search

Patient satisfaction with general practitioners (GP) and pulmonary outpatient clinics has not been previously compared in patients with asthma and chronic obstructive pulmonary disease (COPD) in addition to the effect of patient education on this satisfaction.We randomly allocated 78 asthmatics and 62 patients with COPD after ordinary outpatient management to a control or an intervention group. Intervention consisted of educational




Metabolic cardiomyopathies  

PubMed Central

The energy needed by cardiac muscle to maintain proper function is supplied by adenosine Ariphosphate primarily (ATP) production through breakdown of fatty acids. Metabolic cardiomyopathies can be caused by disturbances in metabolism, for example diabetes mellitus, hypertrophy and heart failure or alcoholic cardiomyopathy. Deficiency in enzymes of the mitochondrial ?-oxidation show a varying degree of cardiac manifestation. Aberrations of mitochondrial DNA lead to a wide variety of cardiac disorders, without any obvious correlation between genotype and phenotype. A completely different pathogenetic model comprises cardiac manifestation of systemic metabolic diseases caused by deficiencies of various enzymes in a variety of metabolic pathways. Examples of these disorders are glycogen storage diseases (e.g. glycogenosis type II and III), lysosomal storage diseases (e.g. Niemann-Pick disease, Gaucher disease, I-cell disease, various types of mucopolysaccharidoses, GM1 gangliosidosis, galactosialidosis, carbohydrate–deficient glycoprotein syndromes and Sandhoff's disease). There are some systemic diseases which can also affect the heart, for example triosephosphate isomerase deficiency, hereditary haemochromatosis, CD 36 defect or propionic acidaemia. PMID:11298185

Guertl, Barbara; Noehammer, Christa; Hoefler, Gerald



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



[Pylephlebitis in pediatric patients].  


Pylephlebitis is defined as thrombophlebitis of the portal vein or its tributaries. It is a rare disease commonly associated with acute appendicitis and it has a high rate of morbidity and mortality. Doppler ultrasound and computed tomography scan are the methods of choice to confirm diagnosis. The most frequent long-term complication in these patients is portal vein cavernoma, with subsequent portal hypertension. An early diagnosis, timely antibiotic therapy and removal of infection are essential therapeutic measures to diminish mortality. The need for anticoagulation therapy in children remains controversial. We report on a child with acute abdomen and sepsis with a diagnosis of pylephlebitis secondary to appendiceal inflammation. The patient received long-term antibiotic therapy and subcutaneous anticoagulation. Deferred appendectomy was performed with favorably outcome. PMID:24955918

Degano, Lucas Alberto; El Kik, Soraya Anis; Rizzi, Ana



Patient health questionnaire. Using a patient-focused assessment tool.  

PubMed Central

A patient health questionnaire was developed for use in family practice to help identify lifestyle risk factors, assess health care needs, and better understand patients. This article discusses the questionnaire's development and practical application. Images Figure 3 PMID:8616290

Mitchell, J. D.



Der Alkoholkranke als Patient  

Microsoft Academic Search

\\u000a Summary  Chronic alcohol abuse is of significant clinical and economic relevance. A major part of internal medical pathology is associated\\u000a with chronic alcoholism. 50% of all accidents with subsequent traumatic injuries are related to alcohol intake. Patients who\\u000a are chronic alcohol abusers have prolonged hospital stays and substantial increases in postoperative morbidity.\\u000a \\u000a A sophisticated diagnosis of alcoholism within standard clinical routine

Jan-Philipp Breuer; Tim Neumann; Andreas Heinz; Wolfgang J. Kox; Claudia Spies



Medicating Your Patients  

Microsoft Academic Search

\\u000a Years ago patients would see the doctor and would be closely followed for one or two prescribed medications. Adverse interactions\\u000a were rare. Today many people over the age of 50 are taking at least four or five medications and many could be taking up to\\u000a 15 different drugs daily. Over 3.5 billion prescriptions are filled annually in the United States,

William F. Bria; Nancy B. Finn


Communication and Patient Safety  

Microsoft Academic Search

Faulty communication is among the most common underlying causes of medical error and frequently erodes the doctor-patient\\u000a relationship. Communication should be understood in the broadest sense, including nonverbal, oral, and written. This chapter\\u000a reviews the most common mechanisms responsible for communication failures and recommends specific routines to minimize or\\u000a avoid them altogether.

Mark Gorney


[When patients become models].  


In order to boost the self-esteem of patients suffering from cancer and to present the public with a different image of the disease, the Ouest oncology institute of Angers organized a fashion show. Lengthy preparations enabled these models-for-a-day to feel at ease on the catwalk and draw a real benefit from the whole experience. Amid the success and emotion, they were able to forget, for a moment, their disease. PMID:24624723

Lecomte, Cyriaque



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 safety in hospitals  

Microsoft Academic Search

In various studies outside the Netherlands, it has been shown that a substantial number of patients suffer some kind of injury during their treatment in a hospital. The incidence of these so-called adverse events varies between 2.9% and 16.6%; of these, estimates between more than a quarter and up to half are considered to have been avoidable. Preventable adverse events

J. M. Cuperus-Bosma; C. Wagner; G. van der Wal



Malnutrition in hemodialysis patients.  


Increasing attention has been paid recently to the problem of protein and energy malnutrition and its effects on mortality and morbidity in hemodialysis (HD) patients. Protein deficiency has received more attention than other nutritional problems, largely because its consequences are more easily measured and large population studies have demonstrated the adverse effects of even small decreases in serum albumin on patient's survival. This review discusses these findings and presents other indicators of early malnutrition, which range from static measurements of plasma constituents such as transferrin and insulin-like growth factor 1 (IGF-1), kinetic measurements of protein catabolic rate (PCR) derived from urea kinetic modeling, and noninvasive measurements of body composition. In addition, the predialytic and dialytic factors that influence nutritional status, including the adverse effects of uremia, inadequate dialysis, membrane bioincompatibility, and intercurrent illness requiring hospitalization, as well as socioeconomic factors, are discussed. While some of these are difficult to deal with, the review emphasizes simple interventions that are likely to benefit the patient, including the delivery of optimal dialysis, appropriate choice of medications, and dietary interventions. Once malnutrition is established, parenteral nutrition may reverse the objective evidence of malnutrition, but its effects on survival have not yet been documented. Finally, the review addresses the effects of therapeutic substances such as growth hormone (GH) and erythropoietin (EPO) in combination with nutrients that at present appear to be favorable but are still being evaluated. PMID:8430672

Hakim, R M; Levin, N



The visually impaired patient.  


Blindness or low vision affects more than 3 million Americans 40 years and older, and this number is projected to reach 5.5 million by 2020. In addition to treating a patient's vision loss and comorbid medical issues, physicians must be aware of the physical limitations and social issues associated with vision loss to optimize health and independent living for the visually impaired patient. In the United States, the four most prevalent etiologies of vision loss in persons 40 years and older are age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Exudative macular degeneration is treated with laser therapy, and progression of nonexudative macular degeneration in its advanced stages may be slowed with high-dose antioxidant and zinc regimens. The value of screening for glaucoma is uncertain; management of this condition relies on topical ocular medications. Cataract symptoms include decreased visual acuity, decreased color perception, decreased contrast sensitivity, and glare disability. Lifestyle and environmental interventions can improve function in patients with cataracts, but surgery is commonly performed if the condition worsens. Diabetic retinopathy responds to tight glucose control, and severe cases marked by macular edema are treated with laser photocoagulation. Vision-enhancing devices can help magnify objects, and nonoptical interventions include special filters and enhanced lighting. PMID:18533377

Rosenberg, Eric A; Sperazza, Laura C



Patient perspectives of patient-provider communication after adverse events  

Microsoft Academic Search

Objective. To explore patient perceptions of patient-provider communication after an actual adverse medical event because prior patient error studies are rarely based on real situations. Design. We conducted four patient focus groups using a semi-structured guide. We analyzed transcripts using an editing approach to identify themes. Setting. Three sites in Colorado. Study participants. Participants were recruited from statewide post-injury program.




Discharge advice in cancer patients: posttreatment patients' report  

Microsoft Academic Search

BACKGROUND: Cancer patients are presented with advice and instructions during treatment and at discharge. Most recommendations aim at relief of physical problems, psychosocial well-being, and patients' health care behaviors. Patients often struggle to incorporate advice into daily life, and this influences symptom relief, quality of life, and even longevity. OBJECTIVE: The aim of this study was to gain insight into

J. De Leeuw; J. B. Prins; M. A. W. Merkx; H. A. M. Marres; T. van Achterberg



JAMA Patient Page: Palliative Sedation  


... not intended to cause death or shorten life. ADVANCE DIRECTIVES Decisions regarding the end of life are difficult. ... his or her own decisions and has no advance directive (documents that state in advance a patient’s end- ...


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


The physician-patient relationship revisited: the patient's view.  


The importance of the physician-patient relationship for the health care market is beyond controversy. Recent work emphasizes a two-sided asymmetric information relationship between physician and patient. In contrast to most work looking only at the physician's perspective, our paper concentrates on the patient's view. Estimation results support the hypotheses that physician consultation and health relevant behavior are not stochastically independent. In the recursive bivariate probit model, patient's health relevant behavior has a significant influence on the probability of a physician visit. This means that health care demand and not only the contact decision is determined by both, patient and physician. PMID:18597172

Schneider, Udo; Ulrich, Volker



Trauma in the Elderly Patient  

Microsoft Academic Search

dvanced age is a well-known risk factor for poor outcomes in trauma patients. Older patients can benefit from the intensive monitoring and aggressive management asso- ciated with trauma team involvement. Several common topics were chosen for dis- cussion in which the treatment options may differ slightly because of the advanced age of the patient. We discuss the following selected topics:

Gregory P. Victorino; Terry J. Chong; Jay D. Pal



Counseling Patients With Genital Warts  

Microsoft Academic Search

Counseling patients about any sexually transmitted disease (STD) is difficult, for both the physician and the patient, but a diagnosis of genital warts presents particular challenges. For many patients, being told that they have any STD comes as a shock. Although fear is a common reaction, the relationship between human papillomavirus (HPV) and cancer has made the presence of genital



Patient satisfaction in New Zealand  

Microsoft Academic Search

Aims To determine whether the Patient Survey Guidelines developed for district health board (DHBs) in 2000 are being adhered to and what the results of the survey can tell us about patient satisfaction in New Zealand. Method Nationwide patient survey data obtained from the Ministry of Health under the Official Information Act was examined to determine the validity and reliability

Gerard Zwier



Malpractice risks with suicidal patients  

Microsoft Academic Search

Discusses the suicide of a patient as one of the most difficult events that a psychotherapist will ever experience. In addition to the emotional turmoil, a psychotherapist may encounter legal complications because patient suicides are potentially the basis of a malpractice suit. The malpractice risks when treating suicidal patients in inpatient and outpatient settings are explored. The legal principles of

Samuel Knapp; Leon VandeCreek



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



What Exactly Is Patient Safety?  

Microsoft Academic Search

We articulate an intellectual history and a definition, description, and model of patient safety. We define patient safety as a discipline in the health care professions that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. We also define patient safety as an attribute of health care systems that minimizes the incidence and

Linda Emanuel; Don Berwick; James Conway; John Combes; Martin Hatlie; Lucian Leape; James Reason; Paul Schyve; Charles Vincent; Merrilyn Walton


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



Automation of Patient Dependency Systems  

Microsoft Academic Search

One of the most challenging decisions in resource allocations in hospitals is: how to allocate nursing duties on the basis of patients' needs? Patient Dependency Systems, in different forms, can be used to provide information for staffing decisions and budgetary developments. That is why Patient Dependency Systems are emerging as powerful tools in hospital management. It is anticipated that their

F. Soliman



Microcomputer as patient educator.  


A computer-assisted lesson on general drug knowledge as a patient education tool is described. A drug I.Q. quiz is one of seven microcomputer lessons available to patients in the waiting room of an ambulatory-care clinic. The drug quiz consists of 19 multiple-choice and six true or false questions. After each question, the computer responds with a brief paragraph keyed to the answer selected by the user. If the answer for a multiple-choice question is incorrect, the user can reanswer the question before proceeding. At the end of the lesson, a score is graphically displayed and the user is asked to evaluate the lesson. The computer stores the total number of lessons completed, total scores, number of times each question was answered incorrectly on first and second attempts, number of times each question was answered a second time, and each user's responses to the quiz and evaluation questions. Based on 313 completions of the drug quiz from September 1981 through May 1982, 86% of the users stated that they learned at least something useful, and 72% liked the quiz. The mean (+/- S.D.) number of correct answers on the first attempt was 16 +/- 5; scores improved by an average of 2.5 +/- 2 by reanswering questions. Of 2421 multiple-choice questions answered incorrectly, 62% were reanswered. Of these second attempts, 52% were correct. Item validity scores indicated that the drug quiz serves as a realistic appraisal of drug knowledge. The microcomputer can be an effective medium for patient education. PMID:7180860

Beck, R J; Ellis, L B; Scott, D M; Raines, J R; Hakanson, N



Carctol: Profit before Patients?  

PubMed Central

Summary Background Carctol is a herbal remedy that recently was widely reported to offer a cure for a range of cancers. This article is aimed at evaluating the evidence that supports this claim. Methods In addition to numerous websites, we conducted systematic searches in six electronic databases. Any factual information relating to Carctol was considered. Results The websites provided the composition of the herbal mixture and numerous claims as to its effectiveness. However, not a single scientific study of any style was found. Conclusions The claim that Carctol is of any benefit to cancer patients is not supported by scientific evidence. PMID:20877681

Ernst, Edzard



Patient involvement in patient safety: How willing are patients to participate?  

Microsoft Academic Search

BackgroundDespite growing recognition internationally that patients can help to promote their own safety, little evidence exists on how willing patients are to take on an active role.ObjectivesTo investigate medical and surgical patients' perceived willingness to participate in different safety-related behaviours and the potential impact of doctors'\\/nurses' encouragement on patients' willingness levels.DesignCross-sectional exploratory study using a survey that addressed willingness to

R E Davis; N Sevdalis; C A Vincent



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



[Neurological complications in cancer patients].  


Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care. PMID:25146945

Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich



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.



The patient-doctor relationship.  


In this essay I speak about the need to put the patient first when discussing the relationship between the patient and the doctor. From my own experience of having been a cancer patient, I argue that most patients appreciate and feel empowered by knowledge about their illness if this knowledge is given sensitively. I also try to explain why doctors need to recognise and respond sensitively to the patient's need to be healed, psychologically, as well, especially in cases of serious or chronic illnesses. PMID:22864068

Rajaram, Usha



Outpatient Surgery and Patient Safety— The Patient's Voice  

Microsoft Academic Search

Four outpatient surgery centers from a large Midwestern community participated in this study assessing the impact of an intervention—aimed at improving the collection of patients' pre-operative clinical information—on both the patients' clinical outcomes and staffs' quality of working life. As part of this study the investigators developed a patient telephone survey to assess the incidence of common or undesirable postoperative

Ann Schoofs Hundt; Pascale Carayon; Scott Springman; Maureen Smith; Kelly Florek; Rupa Sheth; Margaret Dorshorst


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



Der Patient als Experte.  


Patients as Experts: Determining Benefit by Using Assessments of Ability (ICIDH)When health economy and quality mangement are dealing with the cost-benefit relationship, to this day description, calculation, and assessment of the benefit are missing to a great extent. Deliberations in terms of cause and effect do not go beyond the model of pathogenesis (etiology - pathology - manifestation) and descriptions on the organ level (ICD). Only the international classification of impairments, disabilities, and handicaps (ICIDH) as a separate estimation of the resulting manifestations of illness on the levels of organ, individual, and society is capable to elucidate this benefit. It is the patient who is the expert to decide what he needs, what he wants, and what he can do, thus, evaluating on an individual level his loss of capability. The ICIDH is regarded as the key for the management of chronic diseases. The characteristics of being chronically ill require the integration of salutogenesis and the consideration of the hierarchy of needs. The specially developed MARA model serves as pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve (mean age-related ability) as ethical guideline. In quality circles the MARA model, which is based on ICIDH, hierarchy of needs and salutogenesis, can offer apatient-oriented basis of discussion for benefit assessments, and, in a pragmatical way, it can facilitate the introduction of evidence-based medicine. By the change of view from the organ level with multifactorial aspects to the individual level, in which the abilities can be understood as a monofactor, a high consensus potential between several participants of discussion in health service is possible. PMID:9892837




Bedside nursing handover: Patients' opinions.  


Within the context of contemporary nursing practice, bedside handover has been advocated as a potentially more suitable mode for achieving patient-centred care. Given that patients can play an important role in the process, better understanding of patients' perspectives of bedside handover could be a critical determinate for successful implementation of the practice. Using a phenomenological approach, this study attempted to explore patients' perceptions of bedside nursing handover. Four key themes emerged from the patient interviews: 'a more effective and personalised approach', 'being empowered and contributing to error minimization', 'privacy, confidentiality and sensitive topics', and 'training need and avoidance of using technical jargon'. Patients welcome bedside handover as they can be empowered through participation in the process. Nevertheless, attention is needed to ensure that adequate training is provided to nurses and to minimize the use of technical jargon so that handover is delivered with a professional and consistent approach. PMID:25289733

Lu, Sai; Kerr, Debra; McKinlay, Louise



Risk management with suicidal patients.  


The patient who is at-risk for suicide is complex and is difficult to evaluate and treat effectively. Should suicidal behavior occur, the clinician faces the potential wrath of bereaved survivors and their externalized blame exercised through a malpractice suit. The clinician's duty of care to a patient is to act affirmatively to protect a patient from violent acts against self. A finding of malpractice is established if the court finds that this duty was breached, through an act of omission or commission relative to the standard of care, and that this breach was proximately related to the patient's suicidal behavior. This article discusses the standard of care and factors that determine liability in a suicide death of a patient. An extensive list of recommendations for competent caregiving for the at-risk patient and risk management guidelines are then presented. PMID:16342285

Berman, Alan L



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



A Porsche for patient accrual.  


A $1,000 lottery ticket for a Porsche Boxster automobile was offered to the investigator who accrued the most patients to a Southwest Oncology Group prostate cancer protocol. This was done with the admirable intention of increasing patient accrual and improving the outlook for men with high risk prostate cancer. However, the offer of this prize also makes the statement that it is permissible to reward a doctor with an expensive automobile for putting patients on an oncology research protocol. Awarding an expensive prize for patient accrual risks eroding public confidence by creating the perception that clinical investigators, swayed by the allure of an expensive automobile, were motivated by material self-interest rather than the welfare of their patients and the advancement of medical science. I suspect that if the practice of expensive rewards for patient accrual became widespread the cumulative damage would ultimately outweigh the benefits. PMID:16377593

Steinberg, David



[Interpersonal patterns in obese patients].  


In the last decades the number of obese and pre-obese patients in Western industrial nations increased. Obese patients have been largely unsuccessful in losing weight over time, but the causes of their difficulties and the causes of their obesity have remained unclear. We examined whether the attachment style and its interaction with interpersonal processes would shed light on this question. We analyzed 107 obese or pre-obese patients before the start of a weight loss intervention program. We used the Adult Attachement Prototype Rating (AAPR)-interview and related questionnaires (Helping Alliance Questionnaire (HAQ), Inventory of Interpersonal Problems (IIP-D), Brief Symptom Inventory (BSI)). According to the AAPR-rating 54% of the patients were secure and 46% insecure attached. The results suggest that insecure attachment style has an impact on psychic strain in obese patients unrelated to weight, gender and age. Additionally the insecure attachment style influences the therapeutic alliance experienced by patients and the therapist. PMID:24446185

Kiesewetter, Sybille; Köpsel, Andrea; Pfeiffer, Andreas F; Köpp, Werner; Kastner, Sabrina; Orth-Gomér, Kristina; Deter, Hans-Christian



Ischemic stroke in prediabetic patients.  


To describe the clinical characteristics of first-ever ischemic stroke (IS) patients with prediabetes, and to compare them with diabetes mellitus (DM) and non-DM patient characteristics. Retrospective analysis of a prospective series of first-ever acute IS patients. Patients were classified as non-DM (HbA1c during admission <5.7 % and no previous evidence of 2 or more fasting glucose >126 mg/dL), prediabetes (HbA1c from 5.7 to 6.4 %), and DM (previous DM diagnosis or HbA1c ?6.5 % independently of current blood glucose). Demographic and clinical characteristics were compared between the three groups, along with outcome data [early neurological deterioration (END), 3-month poor outcome, 3-month mortality, outcome after rtPA treatment]. No demographic differences were observed. Prediabetic patients had more arterial hypertension (p = 0.006) and higher waist circumference (p < 0.0001) than non-DM patients, and DM patients had more hypercholesterolemia (p < 0.0001), body mass index (p = 0.017), and coronary artery disease (p = 0.005) than prediabetics. There were differences in TOAST subtype distribution (p < 0.0001). There were no differences in rtPA treatment success rate between groups. Multivariate analysis adjusted by age and stroke severity showed that DM but not prediabetes is an independent factor associated with END and 3-month poor outcome. Prediabetic patients with IS exhibit an "intermediate" vascular risk factor profile between that of non-DM and DM patients. In contrast to DM patients, IS prognosis in patients with prediabetes is similar to non-DM patients. PMID:25022941

Roquer, Jaume; Rodríguez-Campello, Ana; Cuadrado-Godia, Elisa; Giralt-Steinhauer, Eva; Jiménez-Conde, Jordi; Dégano, Irene R; Ois, Angel



Patient Understanding of Food Labels  

Microsoft Academic Search

Results: Most patients (89%) reported using food labels. While 75% of patients reported at least a high school education and 77% had 9th-grade literacy skills, only 37% had 9th-grade math skills. On average, patients answered 69% (standard deviation, 21%) of the food-label questions correctly. Common reasons for incorrect responses included misapplication of the serving size, confusion due to extraneous material

Russell L. Rothman; Ryan Housam; Hilary Weiss; Dianne Davis; Rebecca Gregory; Tebeb Gebretsadik; Ayumi Shintani; Tom A. Elasy



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



Oesophagogastrectomy in patients over 70.  

PubMed Central

Although the results of oesophageal resection for benign and malignant disease are well documented, the risk of operative death and long term survival in patients over the age of 70 is not well defined. The outcome has been reviewed for 46 patients (23 male, 23 female) aged 70 years or more (mean 74 years) undergoing oesophageal resection during a period of seven years; 16 patients were 75 years or over. All resections were performed with the EEA stapler, except for one cervical anastomosis that was stitched by hand. In 42 patients resection was for malignancy. Six patients died within 30 days of operation or during the initial hospital stay, giving an operative mortality of 13%. Only one of the 16 patients aged 75 years or more died. Cardiopulmonary complications accounted for most of the operative deaths. Patients were scored retrospectively by a multifactual risk factor. Patients who left hospital had a mean preoperative score of 3.66, compared with 15.2 for those who died. Use of such a score may help to improve selection for surgery in this age group. It is concluded that oesophagogastrectomy may be performed in selected patients over the age of 70 years with acceptable mortality, morbidity, and length of hospital stay. PMID:2928999

Muehrcke, D D; Kaplan, D K; Donnelly, R J



Hepatitis C in haematological patients.  


There is no consensus guideline concerning the management of chronic hepatitis C patients during chemotherapy, and immunosuppression. However, there are some suggestions in literature that hepatitis C viral load increases during chemotherapy and there is a risk of rebound immunity against hepatitis C after discontinuation of immunosuppression with a consequent liver injury. A close monitoring of liver function of these patients is prudent during treatment of haematological malignancy. Antiviral treatment is deferred after the completion of chemotherapy and recovery of patients' immunity to minimize the toxicity of treatment. A combination of pegylated interferon and ribavirin is the standard therapy in hepatitis C infected haematological patients. PMID:21188204

Hwang, Y Y; Liang, R H S



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



Malnutrition among gynaecological cancer patients  

Microsoft Academic Search

Objective:To assess the nutritional status of patients with gynaecological cancer.Design:A prospective study assessing the nutritional status of gynaecological patients with suspected or proven gynaecological cancer.Setting:Queensland Centre for Gynaecological Cancer, Brisbane, Australia; a tertiary referral centre for gynaecological cancer.Subjects:One hundred forty-five patients with suspected or proven gynaecological cancer aged 20–91 years.Intervention:Scored patient-generated subjective global assessment (PG-SGA) and serum albumin before treatment.Results:One

B Laky; M Janda; J Bauer; C Vavra; G Cleghorn; A Obermair



JAMA Patient Page: Acute Sinusitis  


... of the American Medical Association JAMA PATIENT PAGE Acute Sinusitis R espiratory tract infections, including the common cold and acute sinusitis, affect millions of individuals every year. Colds ...


JAMA Patient Page: Hypertrophic Cardiomyopathy  


... the American Medical Association JAMA PATIENT PAGE Hypertrophic Cardiomyopathy C ardiomyopathies are diseases affecting heart muscle. In hypertrophic cardiomyopathy (HCM, aka idiopathic hypertrophic subaortic stenosis, asymmetric septal ...


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



Medical Cannabis Patients: Patient Profiles and Health Care Utilization Patterns  

Microsoft Academic Search

The possible medicinal uses of cannabis are growing, yet research on how patients use medical cannabis facility services remains scarce. This article reports on the Cannabis Care Study, in which 130 medical cannabis patients at seven facilities in the San Francisco Bay Area were surveyed to gather information about demographics, personal health practices, health outcomes, service use, and satisfaction with

Amanda Reiman



Expanding patient involvement in care. Effects on patient outcomes  

Microsoft Academic Search

An intervention was developed to increase patient involvement in care. Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask questions and negotiate medical decisions with their physicians during a 20-minute session before their regularly scheduled visit. In a randomized controlled trial we compared this intervention with a standard educational session

Sheldon Greenfield; Sherrie H. Kaplan; Ware John E. Jr



[Patient transfer between 2 hospital services: informing patients].  


In order to determine what inpatients transferred to another inpatient care facility know about their health problems, the motives for their transfer, and the level of agreement between patients and physicians on these issues, we conducted a semi-structured interview and a content analysis of the transfer letter of 64 consecutive patients transferred from an academic internal medicine unit to a related intermediate care internal medicine unit with a vocation of rehabilitation and psychosocial care. After a mean length of stay of 18.5 +/- 11 days, 31% of patients did not know their medical diagnosis and only 54% knew at least one motive of transfer they agreed with. Only 48.5% of patients described a motive of transfer which was also found in their transfer letter. Doctors and patients disagreed on a psychosocial motive for transfer for 15.5% of patients. 14% of patients were opposed to their transfer and 7% did not know why they were transfered. Finally 22% of transfer letters were not informative enough to allow comparison. We conclude that at the time of their transfer a large number of patients lack adequate information on their diagnosis and on the reasons for their transfer. PMID:8763083

Huber, P; Allaz, A F



Fostering patient safety competencies using multiple-patient simulation experiences.  


This multisite study examined the impact of multiple-patient simulation experiences on the development of nursing students' patient safety competencies in the final semester of their baccalaureate or associate degree nursing program. It extends the Jeffries Simulation Model by investigating how the student factors of tolerance for ambiguity and self-reported grade point average (GPA), in addition to age, relate to the outcomes of simulation. The study showed that students' safety competencies improved significantly from the first to the second simulation. Student age, GPA, and tolerance of ambiguity were not significantly correlated to the students' demonstration of patient safety competencies. The findings of this study contribute to the science of nursing education by providing evidence for nursing educators related to the impact of multiple-patient simulations on improving and documenting students' patient safety competencies before their entry into the workforce. PMID:19942034

Ironside, Pamela M; Jeffries, Pamela R; Martin, Anne



Vancomycin Dosing in Neutropenic Patients  

PubMed Central

Background To compare vancomycin pharmacokinetic parameters in patients with and without neutropenia. Methods Patients ?18 years admitted on general wards were included. Routinely vancomycin trough and peak plasma concentrations were measured with a fluorescence polarization immunoassay. Pharmacokinetic parameters of individual patients were determined with maximum a posterior Bayesian estimation (MW Pharm 3.60). Neutropenia was defined as neutrophils <0.5×109 cells/L. Principal Findings A total of 171 patients were included. Patients with neutropenia (n?=?56) had higher clearance of vancomycin (CLva), 67 (±26) mL/min, compared to patients without neutropenia (n?=?115), CLva 50 (±22) mL/min (p<0.001). No significant difference was found in serum creatinine and vancomycin volume of distribution. Neutropenia was positively associated with CLva, independently of relevant co-variables (B: 12.122, 95%CI: 1.095 to 23.149, p?=?0.031). On average patients with neutropenia needed 33% higher doses of vancomycin to attain adequate exposure, i.e. AUC24?400 mg×h/L. Furthermore, 15 initially neutropenic patients in our study group received vancomycin for a second administration period. Ten patients received the second administration period during another neutropenic period and 5 patients during a non-neutropenic phase. All 5 patients with vancomycin during both neutropenic and non-neutropenic phase had higher CLva (91 (±26) mL/min) during the neutropenic period and lower CLva (45 (±10) mL/min) during the non-neutropenic phase (p?=?0.009). Conclusion This study shows that most patients with neutropenia have augmented CLva. In a small group of patients that received vancomycin during two episodes, the augmented CLva seems to be reversible in the non-neutropenic period. Our data indicate that it is important to increase the daily dose with one third in patients with neutropenia (from 15 mg/kg twice daily to 13 mg/kg three times daily). Frequent performance of therapeutic drug monitoring in patients with neutropenia may prevent both therapy failure due to low AUCs and overcomes toxicity due to high vancomycin trough concentrations during recovery from neutropenia. PMID:25390637

Haeseker, Michiel B.; Croes, Sander; Neef, Cees; Bruggeman, Cathrien A.; Stolk, Leo M. L.; Verbon, Annelies



Patient Protection and Risk Selection  

PubMed Central

BACKGROUND Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician-level risk selection has not been studied. OBJECTIVE To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS National mailed survey of primary care physicians in 1997–1998, oversampling physicians in areas with more capitated health plans. RESULTS The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients. PMID:11903774

Wynia, Matthew K; Zucker, Deborah; Supran, Stacey; Selker, Harry P



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


Patient-controlled propofol sedation for elderly patients: safety and patient attitude toward control  

Microsoft Academic Search

Purpose  Little information is available regarding the use of patient-controlled sedation (PCS) among elderly patients undergoing operative\\u000a procedures under local or regional anaesthesia. This prospective, randomized study evaluated the safety of propofol PCS, and\\u000a the attitude among elderly patients toward self-administration of sedation during cataract surgery.\\u000a \\u000a \\u000a \\u000a Methods  Prospective, randomized study conducted in a University affiliated, tertiary-care hospital. Fifty-five elderly patients (aged\\u000a 65–79

Ian A. Herrick; Adrian W. Gelb; Bruce Nichols; Joyce Kirkby



Critically Ill Cancer Patients: Indications  

E-print Network

Critically Ill Cancer Patients: Indications for Concurrent Palliative Care Although significant in the need for supportive services such as palliative care concomitantly with life-prolonging treatments), the approach of palliative care is to promote quality of life for patients and their families during life

von der Heydt, Rüdiger


Cardiac Arrhythmias in Hemodialysis Patients  

Microsoft Academic Search

Cardiac arrhythmias were evaluated in 100 patients undergoing regular maintenance hemodialysis for chronic renal failure by Holier ECG monitoring a 72-hour period beginning on the day of hemodialysis. Clinically significant ventricular arrhythmias (more than 700 beats\\/24 h) were found in 18 patients (the frequent group) in whom premature ventricular contractions (PVCs) were recorded frequently during and for 4 h after

Ken-ichi Kimura; Kaoru Tabei; Yasushi Asano; Saichi Hosoda



Consensual norms regarding patient involvement  

Microsoft Academic Search

A stratified sample of 72 nurses, physicians and members of the general public met together in small tripartite dialogue groups each month for 20 months, in order to mutually identify health care behaviors that effectively involve patients in their own health care. Content analysis of 200 hours of verbatim transcripts from the dialogue sessions yielded 1245 patient involvement behaviors. These

Sandra J. Weiss



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.



Art Therapy with Laryngectomy Patients.  

ERIC Educational Resources Information Center

Reports on the experiences of patients with laryngeal cancer who used art therapy. Drawing on 14 years of experience and 109 laryngeal cancer patients, describes treatment results and the case material substantiating the distinct role of art therapy. Provides an overview of the special medical and therapeutic needs of this group. (RJM)

Anand, Susan Ainlay; Anand, Vinod K.



Patient's breath controls comfort devices  

NASA Technical Reports Server (NTRS)

Patient assist system for totally disabled persons was developed which permits a person, so paralyzed as to be unable to move, to activate by breathing, a call system to summon assistance, turn the page of a book, ajust his bed, or do any one of a number of other things. System consists of patient assist control and breath actuated switch.

Schrader, M.; Carpenter, B.; Nichols, C. D.



Virtual Patients in Pharmacy Education  

PubMed Central

A review of the literature relating to the use of virtual patients in teaching pharmaceutical care to pharmacy students was conducted. Only 7 articles met the inclusion criteria for the review and 4 of the studies were conducted in North America. Few articles identified by the review used virtual patient technology that was true-to-life and/or validated. PMID:22761533

Jabbur-Lopes, Monique O.; Mesquita, Alessandra R.; Silva, Leila M. A.; De Almeida Neto, Abilio



Patients' beliefs about cancer management  

Microsoft Academic Search

The results of a questionnaire answered by 205 medical patients are reported (100 patients with cancer and 105 with other medical conditions). The questionnaire examined beliefs and preferences regarding various aspects of cancer, including expectations of medical management and treatment. The issues examined relate to beliefs and preferences about information giving, trust of doctors' control of decision making, expectations of

John Buchanan; Walter Cosolo; Robyn Millership; Allan Zimet; John Zalcberg; Ron Borland; Ian Haines



Patient education in The Netherlands.  


This article presents the development of patient education (PE) in The Netherlands from a historical perspective. A description is given of the first pioneering years from the 70s till the late 80s, in which early topics like the organization of PE, the orchestration of PE between different disciplines, the role of the social environment, the provision of PE in difficult patient groups and--most of all--the technical development of educational materials took the time and attention of the growing group of professionals that were engaged in patient education. Recent developments concern the legal aspects of PE, national policy, the role of health insurance, the position of patient organizations and the development of patient education in specific professional groups, e.g. general practitioners, nurses, physiotherapists, pharmacists, and dentists. There is no doubt that patient education has been professionalized considerably during the last decades. Nevertheless, new issues emerge and some old issues still need to be solved. The effective use of information material, the need for counseling as part of PE, and the relevance of coordination of care are longtime, but still actual problems in PE. More recent issues are the pressures on PE because of capacity restraints, the influence of the media and perhaps most of all: the apparent need for a patient-centered attitude and a more two-sided way of communication. Finally, the future policy topics in the Dutch patient education are discussed. PMID:11390152

Bensing, J M; Visser, A; Saan, H



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.



JAMA Patient Page: Organ Donation  


... and Human Services • Transplant Recipients International Organization Inc INFORM YOURSELF To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA ’s Web site at ...


Cryptococcosis in apparently immunocompetent patients  

Microsoft Academic Search

Summary Background: Few reports have described the clinical and microbiological features of cryptococcosis in immunocompetent patients. Aim: To compare clinical presentations and out- comes of cryptococcosis in immunocompetent vs. immunocompromised patients. Design: Retrospective case series. Methods: All culture- or histology-confirmed cases (n ¼ 46) of cryptococcosis in two acute hospitals in Hong Kong (1995-2005) were included. Clinical presentations, rates of

G. Lui; N. LEE; M. IP; K. W. CHOI; Y. K. TSO; E. LAM; S. CHAU; R. LAI; C. S. COCKRAM



Patient Disclosure of Medical Misdeeds  

ERIC Educational Resources Information Center

Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical…

Bergen, Clara; Stivers, Tanya



Patient Grissil and Jonsonian Satire  

Microsoft Academic Search

It has generally been assumed that the relationship between Thomas Dekker, Henry Chettle, and William Haughton’s Patient Grissil and Ben Jonson’s Every Man Out of His Humour is limited to the similarity between episodes where the characters Emulo and Brisk recount duels in which they have participated. In fact, in another of its subplots Patient Grissil responds to the satirical

Tom Rutter



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.


Viscoelastic cushion for patient support  

NASA Technical Reports Server (NTRS)

Flexible container, filled with liquid, provides supportive device which conforms to patient's anatomy. Uniform cushion pressure prevents formation of decubitus ulcers, while the porous sponge substructure damps fluid movement through cushion response so that patient is not dumped when his weight shifts.

Sauers, D. G.



Prednisone: Drug Information for Patients  

E-print Network

Prednisone: Drug Information for Patients Approved by the UHS Patient Education Committee Revised 6 Arthritis Asthma Inflammatory Bowel Disease Leukemia & Lymphoma Skin rashes Tonsillitis Prednisone with a healthcare provider before receiving any vaccines, as current or recent use of Prednisone may either increase

Yener, Aylin


Autoantibody Signature Differentiates Wilms Tumor Patients from Neuroblastoma Patients  

PubMed Central

Several studies report autoantibody signatures in cancer. The majority of these studies analyzed adult tumors and compared the seroreactivity pattern of tumor patients with the pattern in healthy controls. Here, we compared the autoimmune response in patients with neuroblastoma and patients with Wilms tumor representing two different childhood tumors. We were able to differentiate untreated neuroblastoma patients from untreated Wilms tumor patients with an accuracy of 86.8%, a sensitivity of 87.0% and a specificity of 86.7%. The separation of treated neuroblastoma patients from treated Wilms tumor patients' yielded comparable results with an accuracy of 83.8%. We furthermore identified the antigens that contribute most to the differentiation between both tumor types. The analysis of these antigens revealed that neuroblastoma was considerably more immunogenic than Wilms tumor. The reported antigens have not been found to be relevant for comparative analyses between other tumors and controls. In summary, neuroblastoma appears as a highly immunogenic tumor as demonstrated by the extended number of antigens that separate this tumor from Wilms tumor. PMID:22194956

Schmitt, Jana; Keller, Andreas; Nourkami-Tutdibi, Nasenien; Heisel, Sabrina; Habel, Nunja; Leidinger, Petra; Ludwig, Nicole; Gessler, Manfred; Graf, Norbert; Berthold, Frank; Lenhof, Hans-Peter; Meese, Eckart



The transition from 'informed patient' care to 'patient informed' care.  


We are in the midst of a real change in the application of information technology to support the delivery of healthcare. We are seeing a shift from the 'informed patient' which has resulted from improved access to healthcare information, primarily from the Web, to the 'participative patient' as we move into Web 2.0 territory. The last decade has seen significant strides in the application of healthcare information to support patient care including: Increased access to healthcare related information by the patient through access to healthcare information on the Web (1.0). The development of electronic patient/health records. Improved access to knowledge for care professionals has enabled the dissipation of professional clinical skills with the introduction of nurse practitioners and increased use of therapies. Improved access to patient related information across disciplines is beginning to enable the shift from acute based to community based care. The introduction of home care technologies has enabled self monitoring in supporting self care. There are also developments in the way care is provided with an increasing diversity of healthcare providers with the challenges this has presented in exchanging patient related information to support continuity of care. We are now at another major turning point that could present greater challenges for healthcare professionals, organisations and the patient or client. These developments include: The application of information sharing services commonly referred to as Web 2.0. As a result we are seeing a transition from the 'informed patient' to the 'participative patient' that will present increasing challenges for healthcare professionals and healthcare organisations in adapting care to embrace this evolution. New entrants to the ehealth market are now emerging such as Google and Microsoft who are competing to 'own' the 'healthcare consumer'. Open source solutions for EPR/EHRs are now emerging that will challenge the traditional mechanisms for delivery of organisational healthcare solutions. Technologies that have been growing in use and demand over the past decade are now being applied to healthcare including digital TV and mobile computing. What then are the challenges for patients, healthcare organisations and information service providers as we move from the passive role of the patient in the provision of their care to a more participative role? PMID:18560085

Gardiner, Ruth



Helping patients discuss CINV management: development of a Patient Charter.  


In April 2012, an Expert Group of specialist cancer nurses working in a variety of settings (e.g. chemotherapy delivery, chemotherapy service design, research, nurse leadership and patient information/advocacy) participated in telephone/web-based meetings, with the aim of sharing current experience of chemotherapy-induced nausea and vomiting (CINV) management, and reaching a consensus on the development of a Patient Charter, designed to help patients understand CINV management, and setting out key questions they may wish to ask their healthcare professionals. PMID:23593098

Young, Annie; Dielenseger, Pascale; Fernandez Ortega, Paz; Fernandez Perez, Dolores; Jones, Philippa; Lennan, Elaine; O'Donovan, Eileen; Sharp, Sue; Whiteford, Alison; Wiles, Lilian



Not Your "Typical Patient": Cryptococcal Meningitis in an Immunocompetent Patient  

PubMed Central

Meningitis, when caused by the fungal mycoses Cryptococcus neoformans, is normally seen in immunocompromised hosts. However, immunocompetent patients are also susceptible to cryptococcal meningitis (CM). In patients with an intact immune system, CM usually presents with the typical signs and symptoms of meningitis: fever, stiff neck, and headache. Major implications for the primary and advanced practice nursing plans of carefor CM patients include a thorough history and physical exam, early diagnosis and treatment, and an individualized plan of care focused on minimizing sequelae and side effects of treatment and maximizing functional recovery. PMID:16001819

Thompson, Hilaire I.



Preferences of patients for patient centred approach to consultation in primary care: observational study  

Microsoft Academic Search

Objective To identify patient's preferences for patient centred consultation in general practice. Design Questionnaire study. Setting Consecutive patients in the waiting room of three doctors' surgeries. Main outcome measures Key domains of patient centredness from the patient perspective. Predictors of preferences for patient centredness, a prescription, and examination. Results 865 patients participated: 824 (95%) returned the pre›consultation questionnaire and were

Paul Little; Hazel Everitt; Ian Williamson; Greg Warner; Michael Moore; Clare Gould; Kate Ferrier; Sheila Payne




PubMed Central

Patient-centered outcomes research (PCOR) aims to improve care quality and patient outcomes by providing information that patients, clinicians, and family members need regarding treatment alternatives, and emphasizing patient input to inform the research process. PCOR capitalizes on available data sources and generates new evidence to provide timely and relevant information and can be conducted using prospective data collection, disease registries, electronic medical records, aggregated results from prior research, and administrative claims. Given PCOR’s emphasis on the patient perspective, methods to incorporate patient-reported outcomes (PROs) are critical. PROs are defined by the U.S. Food & Drug Administration as “Any report coming directly from patients… about a health condition and its treatment.” However, PROs have not routinely been collected in a way that facilitates their use in PCOR. Electronic medical records, disease registries, and administrative data have only rarely collected, or been linked to, PROs. Recent technological developments facilitate the electronic collection of PROs and linkage of PRO data, offering new opportunities for putting the patient perspective in PCOR. This paper describes the importance of and methods for using PROs for PCOR. We (1) define PROs; (2) identify how PROs can be used in PCOR, and the critical role of electronic data methods for facilitating the use of PRO data in PCOR; (3) outline the challenges and key unanswered questions that need to be addressed for the routine use of PROs in PCOR; and (4) discuss policy and research interventions to accelerate the integration of PROs with clinical data. PMID:23774513

Snyder, Claire F.; Jensen, Roxanne E.; Segal, Jodi B.; Wu, Albert W.



Identity disturbance in distant patients.  


Chronically distant, emotionally isolated patients often present with identity disturbance. Identity, it is argued, develops as a thematic pattern of narcissism, shaped by the nature of the mother's early libidinal influences on the child's sense of self. Identity provides a form of self-definition that addresses the question, Who am I? In the treatment of these patients, resistances to narcissistic vulnerabilities (narcissistic resistances) provide an illusory sense of security and induce the analyst to avoid attention to a central pathological problem: primitive and frightening needs for, and unconscious fantasies of, dependence on, and functionality for, another. Patients' avoidance of material and therapeutic interactions that deal with their dependencies are aspects of a tacit contract with the analyst to foreclose examination of their considerable problems with inner stability. Among these problems are anxieties regarding intrusion and loss of separateness. As analysis proceeds, elements of such a patient's identity become clarified and are used to understand and organize the material for both analyst and patient. This can allow the patient to articulate a more embodied and vital experience of individuality. A case is presented to illustrate the analysis of a patient using this approach. PMID:23526544

Hoffman, Irwin



Enhancing patient self-management  

PubMed Central

In the context of HIV as a chronic disease, care being delivered with more constrained budgets and being more complex as many patients are ageing, the need for disease self-management is increasingly recognized. Like in other chronic diseases, HIV care and treatment guidelines increasingly promote the enhancement of health management by patients, within a framework of closer collaboration with their healthcare providers. Therefore, patients progressively become key resources on which health systems should count for efficiency and improvement. Is this a principle or is this reality? We are aware that to count in healthcare, resources must be allocated the necessary support. How does the required support translate into patients’ real lives? Do patient education programmes respond adequately to these needs? Are chronic care models really applicable in contexts where care is not yet sufficiently coordinated, especially with regards to people who are ageing with HIV and the multiple types of care they need? How far should a patient take responsibility for making best of healthcare resources? From the perspective of a person living and ageing with HIV, the role of patients in the management of their own health will be discussed. PMID:25394005

Volny-Anne, Alain



Celebrity Patients, VIPs, and Potentates  

PubMed Central

Background: During the second half of the 20th century, the literature on the doctor-patient relationship mainly dealt with the management of “difficult” (personality-disordered) patients. Similar problems, however, surround other types of “special” patients. Method: An overview and analysis of the literature were conducted. As a result, such patients can be subcategorized by their main presentations; each requires a specific management strategy. Results: Three types of “special” patients stir up irrational feelings in their caregivers. Sick celebrities threaten to focus public scrutiny on the private world of medical caregivers. VIPs generate awe in caregivers, with loss of the objectivity essential to the practice of scientific medicine. Potentates unearth narcissism in the caregiver-patient relationship, which triggers a struggle between power and shame. Pride, privacy, and the staff's need to be in control are all threatened by introduction of the special patient into medicine's closed culture. Conclusion: The privacy that is owed to sick celebrities should be extended to protect overexposed staff. The awe and loss of medical objectivity that VIPs generate are counteracted by team leadership dedicated to avoiding any deviation from standard clinical procedure. Moreover, the collective ill will surrounding potentates can be neutralized by reassuring them that they are “special”—and by caregivers mending their own vulnerable self-esteem. PMID:15014712

Groves, James E.; Dunderdale, Barbara A.; Stern, Theodore A.



Contribution of patient and hospital characteristics to adverse patient incidents.  

PubMed Central

The 1974 medical malpractice "crisis" brought about extensive legislation and insurance regulation in the United States. Hospitals in many states are now required to support risk management programs that include investigation and systematic analyses of adverse patient incidents. However, no research supports the hypothesis that systematic analysis of adverse patient incidents can identify contributory factors. In this study, a simple prediction model was used to estimate relationships between adverse incidents and selected patient and environmental characteristics in a large hospital. While some of the incident-characteristic relationships were significant, none of the estimated equations yielded results that could be logically translated into policy recommendations for the hospital. These results point to the need for further research. The benefits that positive research results would have for patients, hospitals, an the bill-paying public are obvious. Additional negative results would suggest that many legislative bodies and regulatory agencies were presumptions in requiring hospitals to conduct analyses of incidents. PMID:7461973

Elnicki, R A; Schmitt, J P



Thrombotic risk in thalassemic patients.  


Hemostatic parameters of 495 beta-thalassemic patients (421 with thalassemia major and 74 with thalassemia intermedia) were analyzed, to assess their association with the described thrombophilic condition and to verify the role of additional risk factors (e.g. persistent postsplenectomy thrombocytosis, insulin dependent diabetes mellitus, estrogen-progestin treatment and atrial fibrillation). The prevalence of thromboembolic accidents was 5.2% and in four patients (15.3%) inherited or acquired predisposing defects were recognized. The incidence of thromboembolic events and the associated relative risk due to hemocoagulative abnormalities in these patients are discussed. PMID:10091165

Moratelli, S; De Sanctis, V; Gemmati, D; Serino, M L; Mari, R; Gamberini, M R; Scapoli, G L



[Current practise in splenectomised patients].  


Asplenia is found in a very heterogeneous group of patients with a wide range of age and comorbidities. These patients have an increased risk of overwhelming post-splenectomy infections (OPSI) even several decades after splenectomy. The mortality rate associated with OPSI is 30 - 60 %, which is why the immunisation against encapsulated bacteria is mandatory. In addition these patients show an increased risk of thrombosis of the portal venous system. In the present article all the necessary, during daily practice often neglected preventive measures and behavioural rules are discussed. PMID:23454566

Goede, Jeroen S; Siciliano, Daniele R



With patient satisfaction under increasing scrutiny, consider patient callbacks.  


Under the final rules for Medicare's value-based purchasing program, one-third of the funding that is set aside to reward quality will be based on how patients rate their hospital experience. However, some EDs are already working to maximize patient satisfaction by implementing programs or policies whereby patients who have been discharged are routinely called to make sure their recovery is going well, as well as to intervene if there is an opportunity for service recovery. There are benefits to having ED clinicians make the follow-up calls themselves, but some health care organizations are also reaping benefits by having non-clinicians collect feedback on individual clinicians as well as specific facilities. In addition to potentially boosting quality and customer service, experts say callbacks are useful in curbing malpractice litigation. To avoid pushback among staff, consider beginning a program of patient callbacks by asking clinicians to call back just two patients per shift worked, and to share their experiences with colleagues. For maximum value, experts recommend that patient callbacks be made within one to four days of discharge. PMID:21749006



Patient education in Europe: united differences  

Microsoft Academic Search

This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education



Patient education in Europe: united differences  

Microsoft Academic Search

This issue of Patient Education and Counseling presents the state of the art of patient education in several European countries. It is based on papers presented at a meeting in Paris on the evolution and development of patient education in western, central and eastern Europe (May 1999). Also patient education in the US is presented in this issue. Patient education

Adriaan Visser; Alain Deccache; Jozien Bensing



[Neurological presentations of lysosomal diseases in adult patients].  


Lysosomal diseases represent a large group of genetic storage disorders characterized by a defect in the catabolism of complex molecules within the lysosome. Effective treatments are now possible for some of them given progresses in bone-marrow transplantation, enzyme replacement therapy and substrate reduction therapy. Neurologists and psychiatrists are concerned by these diseases because they can present in adolescence or adulthood with progressive neuropsychiatric signs. Here we focus on late-onset clinical forms which can be met in an adult neurology or psychiatric department. Lysosomal diseases were classified into 3 groups: (1) leukodystrophies (metachromatic leukodystrophy, Krabbe's disease and Salla's disease); (2) Neurodegenerative or psychiatric-like diseases (GM1 and GM2 gangliosidoses, Niemann Pick type C disease, sialidosis type I, ceroid-lipofuscinosis, mucopolysaccharidosis type III); (3) multisystemic diseases (Gaucher's disease, Fabry's disease, alpha and B mannosidosis, Niemann Pick disease type B, fucosidosis, Schindler/Kanzaki disease, and mucopolysaccharidosis type I and II. We propose a diagnostic approach guided by clinical examination, brain MRI, electrodiagnostic studies and abdominal echography. PMID:18033028

Sedel, F; Turpin, J-C; Baumann, N



JAMA Patient Page: Myocardial Infarction  


... of the American Medical Association JAMA PATIENT PAGE Myocardial Infarction M yocardial infarction , also known as a heart attack, can strike without warning. A myocardial infarction occurs when blood supply to a part of ...


JAMA Patient Page: Testicular Cancer  


... of the American Medical Association JAMA PATIENT PAGE Testicular Cancer C ancer of the testicle, the male reproductive ... developed nations, the chance of a man developing testicular cancer during his life is 1 in 300. The ...


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 ...


Hypercalcitoninaemia in patients with pheochromocytoma.  


As pheochromocytoma sometimes is accompanied by medullary thyroid carcinoma (in the sense of multiple endocrine adonomatosis type II = Sipple-Syndrome), serum calcitonin (CT) was measured by radioimmunoassay in 4 patients with pheochromocytoma. Before extirpation of the adreno-medullary tumor, serum CT was distinctly increased to 3 and 30 ng/ml in 2 of 4 patients, respectively. After removal of the tumor, serum CT was normal in the patients and pentagastrin stimulation produced no exaggerated CT response. In hydrochloric acid extracts from the two corresponding pheochromocytoma tissues, immunoreactive-Calcitonin (IR-CT) was detected, the concentrations amounting 1 and 4 ng/mg wet tissue. These findings suggest that hypercalcitonism in patients with pheochromocytoma cannot always be ascribed to the thyroid, i.e. increased calcitonin levels do not necessarily indicate a medullary carcinoma of this organ. PMID:672141

Raue, F; Bayer, J M; Rahn, K H; Herfarth, C; Minne, H; Ziegler, R



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: Mechanical Ventilation  


... of the American Medical Association JAMA PATIENT PAGE Mechanical Ventilation T he support of respiration (breathing) with devices is known as mechanical ventilation . Mechanical ventilation, provided by ventilators , is used ...


JAMA Patient Page: Periodontal Disease  


... loss Receding gum line Plaque or tartar on teeth Healthy Gums Periodontal Disease Gums adherent to tooth Healthy bone O R A L H E A L T H The Journal of the American Medical Association JAMA PATIENT PAGE ...


Medical Technology for Superior Patient  

E-print Network

Trusted Medical Technology for Superior Patient Care Technical Services Partnership � Comprehensive healthcare technology management and services Technical Services Partnership (TSP) helps healthcare throughout the life cycle Keeping up with the rapid advances in health care technology is a complex

Hayden, Nancy J.



Microsoft Academic Search

PurposeAn increasing number of operative procedures in pediatric urology can be performed by laparoscopy. We report our experience with laparoscopic heminephroureterectomy, which is a typical operation in pediatric patients.

Gunter Janetschek; Jorg Seibold; Christian Radmayr; Georg Bartsch



Acalculous Cholecystitis in Burned Patients.  

National Technical Information Service (NTIS)

Ten cases of acalculous cholecystitis in burned patients are reviewed. The disorder appears to be associated with overwhelming bacterial invasion or other postburn complications leading to dehydration or necessitating surgery. Recommendations regarding pr...

A. M. Munster, B. A. Pruitt, M. N. Goodwin



The almost untreatable narcissistic patient.  


Clinical experience in the Personality Disorders Institute at Weill Cornell Medical College suggests that patients with borderline personality organization and a narcissistic personality disorder have a more serious prognosis than all other personality disorders functioning at the borderline level, and that those who in addition present significant antisocial behavior have an even worse prognosis (Clarkin, Yeomans, and Kernberg 1999; Stone 1990). This negative trend culminates in a group of practically untreatable patients with antisocial personality disorder, who represent the most severe cases of pathological narcissism. There are also patients with severe narcissistic personality disorder, functioning at an overt borderline level with significant antisocial features, but not presenting an antisocial personality disorder proper, who at times respond to treatment, while others do not. These patients are explored here, with a focus on particular psychotherapeutic techniques that have proven helpful, as well as on the limits of these technical approaches. PMID:17601104

Kernberg, Otto F



Processing Requests for Patient Data

This document describes general policies of the NCI funded cancer Cooperative Groups on providing individual patient data to investigators for use in research projects. Each group will have a more detailed set of procedures implementing the general policy.


Representing the patient in data  

NASA Astrophysics Data System (ADS)

In today's world, medical information on patients is usually recorded by a variety of health care providers who write their thoughts either on paper or in a word processing program. Telemedicine and other high technology initiatives add to the existing information database. However, most stored data are not easily linked. This makes it difficult to do process evaluations and nearly impossible to determine treatment effectiveness. Any aggregate data analysis must rely on the very few standardized patient data points that may include some demographic information, diagnosis and codable procedures. This paper demonstrates the utility of business process reengineering techniques using Integrated Computer Assisted Manufacturing Definition modeling to create a data model in which patient information is used to build an analyzable database. This provides the infrastructure in which to store all patient data.

Hoffman, Kenneth J.



JAMA Patient Page: Helicobacter pylori  


... for H pylori . SYMPTOMS AND SIGNS OF A PEPTIC ULCER FOR MORE INFORMATION Centers for Disease Control and ... English, Spanish, and French. A Patient Page on peptic ulcers was published in the October 24/31, 2001, ...


JAMA Patient Page: The Spleen  


... the American Medical Association JAMA PATIENT PAGE The Spleen T he spleen is an organ that lies behind the stomach ... an injury to the spleen. REMOVAL OF THE SPLEEN FOR MORE INFORMATION • Centers for Disease Control and ...


JAMA Patient Page: Pressure Ulcers  


... the American Medical Association JAMA PATIENT PAGE Pressure Ulcers A pressure ulcer is an injury to the skin as a ... 203/259-8724. PREVENTION AND TREATMENT OF PRESSURE ULCERS Prevention of pressure ulcers is key because treatment ...


JAMA Patient Page: Vaginal Symptoms  


... of such symptoms are not due to a sexually transmitted disease. The March 17, 2004, issue of JAMA includes ... A Patient Page on screening and prevention of sexually transmitted diseases was published in the January 3, 2001, issue. ...


JAMA Patient Page: Aortic Aneurysms  


... of the American Medical Association JAMA PATIENT PAGE Aortic Aneurysms T he aorta is the body’s largest artery ... wall that may stretch and bulge outwards. An aortic aneurysm is a stretched and bulging section in the ...


Colorectal Surgery in Cirrhotic Patients  

PubMed Central

Patients with cirrhosis have a greater risk of morbidity and mortality following colorectal surgery. Therefore, preoperative medical optimization and risk assessment using criteria such as the MELD score are vital in preventing complications. Some risk factors include age, urgency of surgery, and ASA score. Postoperative morbidity and mortality are related to portal hypertension, ascites, infection, and anastomotic and stomal complications. This review highlights the assessment of risk and perioperative management of cirrhotic patients undergoing colorectal surgery. PMID:24550693

Steinhagen, Randolph M.



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



Seeing Patients Through Genetic Lenses  

PubMed Central

Biotechnology is changing how doctors ‘see’ patients and disease processes. Optical probes and computer-assisted genetic screening tools let researchers peer into the structure and functions of cellular proteins on a molecular level. Soon, this clearer vision of individual patients will be available in the clinic, making drug and biologic treatments safer. These new lenses will push medicine toward risk prediction and away from acute intervention. PMID:23393472




Information technologies and patient safety.  


Advances in health information technology provide significant opportunities for improvements in surgical patient safety. The adoption and use of electronic health records can enhance communication along the surgical spectrum of care. Bar coding and radiofrequency identification technology are strategies to prevent retained surgical sponges and for tracking the operating room supply chain. Computerized intraoperative monitoring systems can improve the performance of the operating room team. Automated data registries collect patient information to be analyzed and used for surgical quality improvement. PMID:22269262

Ellner, Scott J; Joyner, Paul W



NOTES. Study on patients' perspective  

PubMed Central

Introduction Rapid development of minimally invasive surgery has led to escalation of the demands placed on health care professionals. Nowadays the patient is the one to choose where and how she/he wants to be operated on. Perioperative and postoperative quality of life is the most common item impacting the patients’ choice. Laparoscopic surgery is undoubtedly advantageous in several applications; however a further improvement of medical services has been introduced: the NOTES technique. This novel surgical approach definitively eliminates the problem of having scars. Though NOTES is still in the clinical trial stage, it might become an alternative for selected procedures soon. At this point it is necessary to define the patients’ expectations and preferences. Aim To evaluate patients’ opinions on the four surgical approaches: open, laparoscopic, transvaginal and transgastric. Material and methods For this purpose a special questionnaire was designed and one hundred randomly selected women were asked to complete it. Results The laparoscopic access was preferable in most aspects, closely followed by the transvaginal access. Open and transgastric approaches were considered as dangerous and disadvantageous. Conclusions Currently NOTES is a possible reality of tomorrow for some procedures. The transvaginal access was scored as “attractive”, “cosmetically attractive” and “technologically advanced”, as opposed to the transgastric access. The fact of manipulation in the intimate region requires thorough attention in future NOTES studies. Though the patients currently prefer the laparoscopic approach, this study proves that further development of transvaginal NOTES technology is acceptable and to some extent desired by the patients. PMID:24130638

Stefaniak, Tomasz; Laski, Dariusz; Mackowiak, Malgorzata; Czurylo, Alicja; Hac, Stanislaw; Lachinski, Andrzej J.; Sledzinski, Zbigniew



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



Informed consent in Indian patients.  

PubMed Central

It is commonly believed that patients in India do not need to be told about their operations as they are unable to understand the complexities and forget the salient facts soon afterwards. Obtaining informed consent is therefore considered to be an unnecessary ritual. We studied 100 consecutive patients undergoing elective major abdominal operations and asked them 5 days after their operations to recall certain details about the procedure which had been explained to them preoperatively. Seventy per cent of the patients recalled the relevant data. The ability was the same in males and females (67% and 69%) but the older, less educated and poorer patients performed worse than the others. Ninety-eight per cent of the patients appreciated being given the information as it reduced their anxiety about the operation. Indian patients are able to comprehend and should be informed about the details of their operation. Particular care should be taken during explanation to the old, poor and illiterate. In these informed consent should be a continuous process rather than a single event and the information should also be given to a younger and more educated relative. PMID:8676316

Sanwal, A K; Kumar, S; Sahni, P; Nundy, S



Informed consent in Indian patients.  


It is commonly believed that patients in India do not need to be told about their operations as they are unable to understand the complexities and forget the salient facts soon afterwards. Obtaining informed consent is therefore considered to be an unnecessary ritual. We studied 100 consecutive patients undergoing elective major abdominal operations and asked them 5 days after their operations to recall certain details about the procedure which had been explained to them preoperatively. Seventy per cent of the patients recalled the relevant data. The ability was the same in males and females (67% and 69%) but the older, less educated and poorer patients performed worse than the others. Ninety-eight per cent of the patients appreciated being given the information as it reduced their anxiety about the operation. Indian patients are able to comprehend and should be informed about the details of their operation. Particular care should be taken during explanation to the old, poor and illiterate. In these informed consent should be a continuous process rather than a single event and the information should also be given to a younger and more educated relative. PMID:8676316

Sanwal, A K; Kumar, S; Sahni, P; Nundy, S



Balance billing: the patients' perspective  

PubMed Central

We study the effects of 'balance billing', i.e., allowing physicians to charge a fee from patients in addition to the fee paid by Medicare. First, we show that on pure efficiency grounds the optimal Medicare fee under balance billing is zero. An active Medicare policy thus can only be justified when distributional concerns are accounted for. Extending the analysis by Glazer and McGuire, we therefore analyze the optimal policy from the patients' point of view. We demonstrate that, from the patients' perspective, a positive fee can be superior under balance billing. Furthermore, patient welfare can be lower if balance billing is prohibited. In particular, this is the case if the administrative costs of Medicare are large. However, we cannot rule out that prohibiting balance billing may be superior. Finally, we show that payer fee discrimination increases patient welfare if Medicare's administrative costs are high or if Medicare's optimal fee under balance billing implies lower quality for fee-only patients. JEL-classification: I11, I18, H51 PMID:22827899



42 CFR 412.608 - Patients' rights regarding the collection of patient assessment data.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Patients' rights regarding the collection of...Rehabilitation Units § 412.608 Patients' rights regarding the collection of...patient assessment. (d) The patient rights specified in this section...



Depression and Anxiety in Migraine Patients  


... Depression and Anxiety in Migraine Patients Print Email Depression and Anxiety in Migraine Patients ACHE Newsletter Sign ... newsletter by entering your e-mail address below. Depression and Anxiety in Migraine Patients Todd A. Smitherman, ...


Patients assessing students' assignments; making the patient experience real.  


The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work. PMID:22153055

Munro, Jane; Whyte, Fiona; Stewart, Jim; Letters, Andrew



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



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



Rhabdomyolysis in obese trauma patients.  


Patients sustaining traumatic injuries are at risk for development of rhabdomyolysis. The effect of obesity on this risk is unknown. This study attempted to characterize the role of obesity in the development of rhabdomyolysis after trauma. This was a retrospective review of all trauma patients with creatine kinase (CK) levels admitted to the surgical intensive care unit (SICU) at a Level I trauma center from February 2011 until July 2013. Patients were divided based on their body mass index (BMI): overweight/obese group with BMI 25 kg/m(2) or greater and nonoverweight/obese group with BMI less than 25 kg/m(2). Primary outcome was CK greater than 10,000 U/L. During the 30-month study period, 198 trauma patients with available CK levels were admitted to the SICU. The majority (27.8%) of patients were involved in a motor vehicle collision. There were 96 patients (48.4%) with BMI 25 kg/m(2) or greater and 102 (51.5%) with BMI less than 25 kg/m(2). There was no difference in creatinine levels between the two groups (1.5 ± 1.2 mg/dL vs 1.5 ± 1.4 mg/dL, P = 0.83). BMI 25 kg/m(2) or greater was independently associated with the development of CK greater than 10,000 U/L (14.6 vs 4.9%; adjusted odds ratio, 3.03; P = 0.04). Patients with BMI 25 kg/m(2) or greater are at a significantly higher risk for rhabdomyolysis after trauma. Aggressive CK level monitoring to prevent rhabdomyolysis in this population is strongly encouraged. PMID:25264650

Chan, Joshua L; Imai, Taryne; Barmparas, Galinos; Lee, Jonathan B; Lamb, Alex W; Melo, Nicolas; Margulies, Daniel; Ley, Eric J



Dry eye in LASIK patients  

PubMed Central

Background Increasing age is a known risk factor for developing dry eye. The specific aims of the present study were to determine the prevalence of dry eye syndrome (DES) and use of post-operative dry eye medications in a relatively young population presenting for LASIK surgery at an academic ophthalmology clinic. Findings A retrospective, analysis of 948 de-identified patient charts (median age 39 years, not age stratified) was performed to extract pre-LASIK diagnoses and post-LASIK medication lists. Clinical evaluation for DES and the results of Schirmer’s reflex tear flow test were used to assign LASIK patients into Normal, Pre-dry eye (Pre-DES), and Dry Eye Syndrome (DES) groups; which were then compared for use of dry eye medications. Based on pre-operative diagnoses, only 2% (CI: 1.3 – 3.1) of LASIK patients presented with overt DES. Unexpectantly, 25% (CI: 22.2 – 27.6) of LASIK patients labeled Pre-DES were not classified by the clinician as having overt DES, yet they showed poor reflex tear flow rates ? 5 mm before surgery, and frequently used post-operative lubricant dry eye medications. Conclusions Although the number of patients with pre-existing eye conditions was unknown, a sizable portion of relatively young LASIK patients displays poor reflex tear flow without overt DES. Such patients could go on to develop more serious consequences of poor tear flow, such as corneal abrasion and erosion. More specific, dry eye medications may be needed for ideal treatment. PMID:24994125



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



Mushroom keratoplasty in pediatric patients?  

PubMed Central

Objective To report the outcome of mushroom keratoplasty for the treatment of full thickness corneal disease in pediatric patients with healthy endothelium. Methods A retrospective analysis of pediatric patients who underwent mushroom keratoplasty. The medical records of pediatric patients suffering from full thickness corneal stromal disease with normal endothelium who underwent mushroom keratoplasty at our Institution were included. A two-piece donor graft consisting of a large anterior stromal lamella (9.0 mm in diameter and ±250 ?m in thickness) and a small posterior lamella (5–6.5 mm in diameter) including deep stroma and endothelium, prepared with the aid of a microkeratome had been transplanted in all cases. Ophthalmic examination including slit lamp examination, best corrected visual acuity, and corneal topography was performed preoperatively and at each postoperative visit on all patients. The endothelial cells were assessed by specular microscopy in these patients. Results Six eyes of six patients (five males and one female) were included. The mean age was 9.3 years (range 5–15 years). Average follow-up was 17.8 months (range 9–48 months). There were no early or late complications recorded. All corneas were clear at the last follow up visit. Preoperative best corrected visual acuity (BCVA) was worse than 20/70 in all six eyes. Postoperatively, four eyes achieved BCVA of 20/40 or better. Endothelial cell loss (n eyes = 3 averaged 24% (range 19–31%). The mean endothelial cell loss was 24% (range 19–31%) among these patients. Conclusions Microkeratome assisted mushroom keratoplasty is a viable surgical option for pediatric eyes with full thickness corneal stromal disease and healthy endothelium. Mushroom keratoplasty combines the refractive advantage of a large penetrating keratoplasty with the survival advantage of a small penetrating keratoplasty. Furthermore, mushroom keratoplasty exhibits the mechanical advantage of a shaped keratoplasty. PMID:23960935

Busin, Massimo; Beltz, Jacqueline; Scorcia, Vincenzo



Patient blood management in Europe  

PubMed Central

Summary Preoperative anaemia is common in patients undergoing orthopaedic and other major surgery. Anaemia is associated with increased risks of postoperative mortality and morbidity, infectious complications, prolonged hospitalization, and a greater likelihood of allogeneic red blood cell (RBC) transfusion. Evidence of the clinical and economic disadvantages of RBC transfusion in treating perioperative anaemia has prompted recommendations for its restriction and a growing interest in approaches that rely on patients' own (rather than donor) blood. These approaches are collectively termed ‘patient blood management’ (PBM). PBM involves the use of multidisciplinary, multimodal, individualized strategies to minimize RBC transfusion with the ultimate goal of improving patient outcomes. PBM relies on approaches (pillars) that detect and treat perioperative anaemia and reduce surgical blood loss and perioperative coagulopathy to harness and optimize physiological tolerance of anaemia. After the recent resolution 63.12 of the World Health Assembly, the implementation of PBM is encouraged in all WHO member states. This new standard of care is now established in some centres in the USA and Austria, in Western Australia, and nationally in the Netherlands. However, there is a pressing need for European healthcare providers to integrate PBM strategies into routine care for patients undergoing orthopaedic and other types of surgery in order to reduce the use of unnecessary transfusions and improve the quality of care. After reviewing current PBM practices in Europe, this article offers recommendations supporting its wider implementation, focusing on anaemia management, the first of the three pillars of PBM. PMID:22628393

Shander, A.; Van Aken, H.; Colomina, M. J.; Gombotz, H.; Hofmann, A.; Krauspe, R.; Lasocki, S.; Richards, T.; Slappendel, R.; Spahn, D. R.



Transforming healthcare through patient empowerment.  


The United States faces tremendous challenges with its healthcare system. By any standard, it is expensive and performs poorly in most measures of health and thus, is in great need of reform. But how do we reform things without making the situation worse? Some of the more fundamental problems arise from the combination of a fee-for-service payment system for physicians with insurance-based financing care. This combination results in conflicts among the interests of patients, physicians and payers. This paper examines this issue from a decision analytic perspective, starting with a definition of the patient-centered view, and an assessment of the practicality of controlling costs by making healthcare more patient-centric. It then illustrates how fee-for-service models corrupt decision-making and other solutions designed to reign in the abuses of the fee-for-service model and also negatively impacts the quality of decision making for individual patients. Whatever the strategies for health reform, the degree of patient-centeredness of care is a benchmark that allows policy makers to understand how far they have had to deviate from optimal to achieve the desired ends of cost control. PMID:20543244

Lenert, Leslie



Medication reconciliation in hemodialysis patients.  


Medication reconciliation is an effective process to reduce adverse drug events (ADEs) and harm associated with the loss of medication information as patients transfer between health care settings. Patients with end stage renal disease (ESRD) are at a high risk of experiencing drug-related problems (DRPs) because they take many medications, have multiple comorbidities, and require frequent medication changes. We evaluated the potential impact of medication reconciliation and optimization in the ambulatory care setting at the time of patient transfer from an in-centre dialysis unit to a satellite dialysis unit. Overall, 15 patients (78.8%) had at least one unintended medication variance. The majority of unintended variances (56%) were caused by the physician/nurse practitioner (NP) omitting an order for medication that the patient was taking. In this small study, medication reconciliation was effective at identifying and rectifying medication errors and optimizing pharmacotherapy at the time of transfer from an in-centre hemodialysis to a satellite dialysis unit. PMID:19175192

Ledger, Séadna; Choma, Gail



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



Bedside evaluation of dizzy patients.  


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; Kim, Ji-Soo



Falls in elderly hemodialysis patients.  


The elderly, (age ? 65 years) hemodialysis (HD) patient population is growing rapidly across the world. The risk of accidental falls is very high in this patient population due to multiple factors which include aging, underlying renal disease and adverse events associated with HD treatments. Falls, the most common cause of fatal injury among elderly, not only increase morbidity and mortality, but also increase costs to the health system. Prediction of falls and interventions to prevent or minimize fall risk and associated complications will be a major step in helping these patients as well as decreasing financial and social burdens. Thus, it is vital to learn how to approach this important problem. In this review, we will summarize the epidemiology, risk factors, pathophysiology and complications of falls in elderly HD patients. We will also focus on available methods to assess and predict the patients at higher risk of falling and will provide recommendations for interventions to reduce the occurrence of falls in this population. PMID:21750022

Abdel-Rahman, E M; Turgut, F; Turkmen, K; Balogun, R A



Prescribing and partnership with patients.  


There have been widespread changes in society and the roles of professionals. This change is also reflected in health care, where there is now acceptance of the need to involve patients in decision making. In prescribing specifically, the concordance agenda was developed alongside these initiatives to encourage improved medication taking and reduce wastage. However the extent to which these partnerships are delivered in practice remains unclear. This paper explores some of the issues to be considered when preparing patients and professionals for partnership and summarizes the limited evidence of barriers to, and benefits of, this approach. Firstly patients must be given the confidence, skills and knowledge to be partners. They need information about medicines, provided in ways known to be acceptable to them. Likewise professionals may need new skills to be partners. They need to understand the patient agenda and may need training and support to change the ways in which they consult with patients. There are also practical issues such as the perceived increase in time taken when consulting in partnership mode, room layout, computer interfaces and record keeping. Health care professionals other than doctors are also expected to behave in partnership mode, whether this is as prescribers in their own right or in supporting the prescribing of others. Whilst much has been claimed for the benefit of partnership approaches, hard evidence is limited. However whilst there is still much more to understand there will be no going back to the paternalistic model of the mid 20th century. PMID:22621201

Bond, Christine; Blenkinsopp, Alison; Raynor, David K



[Patient-physician electronic communication].  


There is a patient demand for online services provided by their doctor, but at the present, in Belgium, there are very few physicians offering such services. This article examines the different types of services and the practical, technical, legal and economic aspects of an interface for electronic doctor-patient communication in the ambulatory sector in the Belgian context. The inventory of pilot projects carried out in other countries shows high patient satisfaction rates and a low impact on doctors' workload. However, the lack of funding hinders the implementation. Given the confidential nature of data exchanged, both high level of security and development of guidelines adapted to the local Belgian context are required. Electronic communication should remain one of the modalities in a therapeutic relationship. At a technical level, using the Belgian electronic identity card and the opportunity to create a digital signature with legal value would provide a solution to most of the security requirements. PMID:21942075

Davidsen, C; André, J-F; Giet, D; Vanmeerbeek, M



[Kawasaki disease in adult patients].  


Kawasaki disease (KD) is a multisystemic vasculitis affecting mainly the skin, mucosa, and lymph nodes. Coronary artery aneurysms occur in 25% of patients but their prevalence is reduced to 4% in those patients treated with intravenous immunoglobulin (IVIg) within 10 days of illness onset. Interesting data recently published relate to physiopathology and diagnosis of the disease. Investigations identified an antigen-driven IgA oligoclonal response directed against cytoplasmic inclusions in KD tissues. An algorithm using laboratory tests and echocardiography has been recently proposed to improve early detection of incomplete KD. Although KD predominantly affects children, it may be also of interest for adult physicians. First, patients may develop long-term cardiovascular event. Coronary artery aneurysms may lead to the development of coronary stenosis or thrombosis. Despite the absence of coronary lesions during the acute phase of the disease, patients may present morphological and functional sequelae of coronary and peripheral arteries at convalescent phase. These potential arterial sequelae require long-term follow-up and treatment of associated cardiovascular risk factors. Although the level of injury seems to be correlated with the severity of initial coronary lesions, long-term course of vascular injuries is poorly known. Second, KD may occur in adults with 91 cases reported in the literature. Twenty-one cases have been reported in HIV infected patients. Intravenous immunoglobulins appear to shorten the disease course. Recent studies highlight the existence of incomplete KD and symptomatic coronary aneurysms in adults. Overall, these data suggest that adult patients with biological or echocardiographic features suggestive of incomplete KD should receive prompt IVIg to prevent coronary artery sequelae. PMID:20537446

Sève, P; Lega, J-C



Airway management in obese patient.  


Oxygenation maintenance is the cornerstone of airway management in the obese patient related to anatomic and pathophysiologic issues. Difficult mask ventilation (DMV) risk is increased in obese patients according recognized predictors (Body Mass Index [BMI]>26 kg/m2, age >55 years, jaw protrusion severely limited, lack of teeth, snoring, beard, Mallampati class III or IV) and should systematically search. Difficult tracheal intubation (DTI) risk may be increased and risk should be assessed in a careful manner. Increased neck circumference and high BMI (>35 kg/m2) should be added to "standard" preoperative airway assessment including:Mallampati class, mouth opening and thyromental distance. In obese patients, preoxygenation is mandatory by 25° head-up position achieving better gas exchange than in supine position. In addition, to prevent early arterial oxygen desaturation related to a reduced functional residual capacity (FRC), atelectasis formation during anesthetic induction and after tracheal intubation, non invasive positive pressure ventilation and application of PEEP throughout this period are recommended. Airway management in obese patients has to consider: the anesthesia technique with maintenance or not of spontaneous ventilation, the available oxygenation technique in case of anticipated DMV, and the appropriate tracheal intubation technique (fiberoptic intubation technique or videolaryngoscope) according to the patient status and will. In unexpected difficult airway, the very first priority is oxygenation and a predefined strategy has to be implemented with oxygenation devices first (supraglottic devices or ILMA). Lastly, the final step of the obese airway management is tracheal extubation and recovery. A strategy with a fully awake patient, without residual paralysis, and a 25° head-up position is mandatory. PMID:24122033

Langeron, O; Birenbaum, A; Le Saché, F; Raux, M



Chronic constipation in hemiplegic patients  

PubMed Central

AIM: To assess the prevalence of bowel dysfunction in hemiplegic patients, and its relationship with the site of neurological lesion, physical immobilization and pharmacotherapy. METHODS: Ninety consecutive hemiplegic patients and 81 consecutive orthopedic patients were investigated during physical motor rehabilitation in the same period, in the same center and on the same diet. All subjects were interviewed ? 3 mo after injury using a questionnaire inquiring about bowel habits before injury and at the time of the interview. Patients’ mobility was evaluated by the Adapted Patient Evaluation Conference System. Drugs considered for the analysis were nitrates, angiogenic converting enzyme (ACE) inhibitors, calcium antagonists, anticoagulants, antithrombotics, antidepressants, anti-epileptics. RESULTS: Mobility scores were similar in the two groups. De novo constipation (OR = 5.36) was a frequent outcome of the neurological accident. Hemiplegics showed an increased risk of straining at stool (OR: 4.33), reduced call to evacuate (OR: 4.13), sensation of incomplete evacuation (OR: 3.69), use of laxatives (OR: 3.75). Logistic regression model showed that constipation was significantly and independently associated with hemiplegia. A positive association was found between constipation and use of nitrates and antithrombotics in both groups. Constipation was not related to the site of brain injury. CONCLUSION: Chronic constipation is a possible outcome of cerebrovascular accidents occurring in 30% of neurologically stabilized hemiplegic patients. Its onset after a cerebrovascular accident appears to be independent from the injured brain hemisphere, and unrelated to physical inactivity. Pharmacological treatment with nitrates and antithrombotics may represent an independent risk factor for developing chronic constipation. PMID:17663511

Bracci, F; Badiali, D; Pezzotti, P; Scivoletto, G; Fuoco, U; Lucente, L Di; Petrelli, A; Corazziari, E



Patient Dose in Diagnostic Radiology  

NASA Astrophysics Data System (ADS)

One of the basic principles, stated explicitly in Article 4 of the EC Council Directive 97/43 Euratom, is optimization. This means that all radiological examinations should be performed with a dose that is As Low As Reasonably Achievable (ALARA principle applied to the protection of the patient) in order to obtain the required diagnostic information. Therefore, dose needs to be determined with the relationship between image quality and dose always kept in mind. In this paper, radiation quantities and units to report patient doses in diagnostic radiology will be identified.

Noel, Alain


Infrared-Guided Patient Setup for Lung Cancer Patients  

SciTech Connect

Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts were compared with the daily electronic portal device image shifts using both the central axis iGPS marker and all five iGPS markers. For shift calculation using the five markers, rotational misalignment was included. The level of agreement between the iGPS and portal imaging to evaluate the setup was evaluated as the frequency of the shift difference in the range of 0-5 mm, 5-10 mm, and >10 mm. Results: Data were obtained for 450 treatment sessions for 15 patients. The difference in the isocenter shifts between the weekly vs. daily images was 0-5 mm in 42%, 5-10 mm in 30%, and >10 mm in 10% of the images. The shifts seen using the iGPS data were 0-5 mm in 81%, 5-10 mm in 14%, and >10 mm in 5%. Using only the central axis iGPS marker, the difference between the iGPS and portal images was <5 mm in 77%, 5-10 mm in 16%, and >10 mm in 7% in the left-right direction and 73%, 18%, and 9% in the superoinferior direction, respectively. When all five iGPS markers were used, the disagreements between the iGPS and portal image shifts >10 mm were reduced from 7% to 2% in the left-right direction and 9% to 3% in the superoinferior direction. Larger reductions were also seen (e.g., a reduction from 50% to 0% in 1 patient). Conclusion: The daily iGPS-based shifts correlated well with the daily electronic portal device-based shifts. When patient movement has nonlinear rotational components, a combination of surface markers and portal images might be particularly beneficial to improve the setup for lung cancer patients.

Lyatskaya, Yulia; James, Steven; Killoran, Joseph H.; Soto, Ricardo; Mamon, Harvey J.; Chin, Lee [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States); Allen, Aaron M. [Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA (United States)], E-mail:



Occupational therapy for stroke patients at home  

Microsoft Academic Search

The provision of occupational therapy for stroke patients by the social services was examined in 327 patients who had been discharged from hospital. Two- thirds (64%) of the patients were referred to the social service occupational therapist (SSOT). The occupational therapist visited a median of seven days from referral, treated the patient twice and then closed the case.The SSOT provided

PA Clarke; H. Collins; Jrf Gladman



The UKPDS: implications for the dyslipidaemic patient  

Microsoft Academic Search

The UK Prospective Diabetes Study (UKPDS) is the largest intervention trial to date of patients with type 2 diabetes, involving 5102 newly diagnosed diabetic patients. Results showed that 59% of patient deaths were from cardiovascular disease. While intensive treatment of glucose produced a significant 25% reduction in microvascular endpoints compared with diet only (p=0.0099), patients with type 2 diabetes usually

R. Holman



Patient Satisfaction with Transgender Health Services  

Microsoft Academic Search

Measuring patient satisfaction (i.e., patients' subjective evaluation of health care services received) is increasingly important in assessing health care outcomes because of the current emphasis on greater partnership between providers (therapist, doctor, staff) and consumers (patients) in health care. In care of transgender persons, achieving good patient satisfaction is particularly challenging given the primary role mental health professionals play as




X linked ocular albinism in Japanese patients  

Microsoft Academic Search

Thirteen affected Japanese male patients and 13 female carriers with X linked ocular albinism from seven families were examined to assess their clinical findings and to compare them with those of white and black patients. Affected Japanese patients had poor visual acuity, horizontal nystagmus, macular hypoplasia, and loss of stereopsis. Some affected patients had non-albinotic fundus with moderate pigmentation. The

T Shiono; M Tsunoda; Y Chida; M Nakazawa; M Tamai



Truth-telling and patient diagnoses  

Microsoft Academic Search

How do physicians handle informing patients of their diagnoses and how much information do patients really want? How do registered nurses view both sides of this question?Three questionnaires were constructed and administered in a mid-size hospital in New York state. Physicians and nurses underestimate the number of patients who want detailed information. Patients who earn more than average, have a

Robert J Sullivan; Lawrence W Menapace; Royce M White



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.



Q fever nieningoencephalitis in five patients  

Microsoft Academic Search

Within the last four years, we have observed five patients with epidemiological, clinical, and serological features that were consistent with Q fever meningoencephalitis. Attempts to isolate Coxiella burnetii from the cerebrospinal fluid of two patients were unsuccessful. Neurological features ranged from coma, general seizures, confusion, to palsy and meningitis. All patients were febrile. These patients were neuroradiologicaly investigated. Since 1984,

M. Drancourt; D. Raoult; B. Xeridat; L. Milandre; M. Nesri; P. Dano



Challenging patient safety culture: survey results  

Microsoft Academic Search

Purpose – The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. Design\\/methodology\\/approach – The Patient Safety Culture Hospital questionnaire was distributed hospital-wide in five general hospitals. It evaluates ten patient safety culture dimensions and two outcomes. The scores

Johan Hellings; Ward Schrooten; Niek Klazinga; Arthur Vleugels



Improved Survival of Patients with Cystic Fibrosis  


... survival of patients with CF has improved. Overall, male patients have better survival than females, as do patients with no symptoms at diagnosis. Patients with certain gene abnormalities seem to have worse survival than others. ... in survival occur, males born and diagnosed with CF in 2010 would ...


Colonic subepithelial collagenous thickening in diabetic patients  

Microsoft Academic Search

PURPOSE: This study was designed to investigate the effect of intestinal subepithelial collagenous thickening on diabetic diarrhea because one of the seven patients diagnosed with collagenous colitis was diabetic. METHODS: Rectosigmoidoscopic rectal biopsies were taken from 50 diabetic patients (8 with and 42 without diarrhea), 20 nondiabetic patients with diarrhea, and 10 healthy patients. Histopathologic examinations and measurements of subepithelial

Olcay Kandemir; Cengiz Utas; ömür Gönen; Tahir E. Patiroglu; ömer özbakir; Fahrettin Kelestimur; Mehmet Yücesoy



Nursing care of patients with Parkinson's disease.  


Nursing interventions for each of the symptoms of Parkinson's disease, muscle rigidity, bradykinesia, tremors at rest and postural reflex abnormalities, are designed to increase the patient's quality of life by minimizing symptoms. Nurses are responsible for planning patient medication schedules to maximize drug effectiveness. Dietary implications include a low-protein regimen for the patient during the day, eliminating foods high in Vitamin B6, high caloric foods, and soft-solid foods offered at frequent feedings. Constipation is addressed by increasing the patient's fiber and fluid intake and by increasing the patient's mobility. Patient mobility is increased when the patient is taught purposeful activities and to concentrate on the way he walks. Communication is facilitated if the patient takes deep breaths before speaking and uses diaphragmatic speech. A telephone receiver which amplifies the patient's voice is also available. Interventions are good only if the patient chooses to implement them; he is the head of the health team planning his care. PMID:3226657

Szigeti, E



Nurse overestimation of patients' health literacy.  


Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates. PMID:24093346

Dickens, Carolyn; Lambert, Bruce L; Cromwell, Terese; Piano, Mariann R



Nurse Overestimation of Patients' Health Literacy  

PubMed Central

Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates. PMID:24093346

Dickens, Carolyn; Lambert, Bruce L.; Cromwell, Terese; Piano, Mariann R.



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.



Tetrahydrobiopterin responsiveness in patients with phenylketonuria  

Microsoft Academic Search

Abstract Objectives: To investigate the BH4 response in a group of patients with phenylketonuria (PKU) in order to offer this alternative treatment to the responsive patients. Design and,methods: The 24-h-long Phe\\/BH4 loading test was performed on 64 PKU patients requiring dietary treatment. Results: All patients with mild-PKU and 75% of patients with moderate-PKU were BH4 responsive, while only 11% of

Belen Perez-duenas; Maria Antonia Vilaseca; Anna Mas; Nilo Lambruschini; Rafael Artuch; Lilian Gomez; Julia Pineda; Alejandra Gutierrez; Montse Mila; Jaume Campistol


Treatment utilization by patients with personality disorders  

Microsoft Academic Search

Objective: Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder.\\u000aMethod: Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups—schizotypal, borderline, avoidant, and obsessive-compulsive—and in a comparison group of patients with major depressive disorder.\\u000aResults: Patients with personality

Donna S. Bender; Regina T. Dolan; Andrew E. Skodol; Charles A. Sanislow; Ingrid R. Dyck; Thomas H. McGlashan; M. Tracie Shea; Mary C. Zanarini; John M. Oldham; John G. Gunderson



Type 2 Diabetic Patient-Centered Care  

Microsoft Academic Search

Background : The prevalence of diabetes mellitus has increased worldwide including Thailand. Management of diabetes should be considered biological and psychosocial. Patient-centered care was applied in the present study. Patient-centered care is a process interaction between the clinician and the patient. It refers to the clinician's behavioral skill in the consultation. Patient-centered care customizes seeking and accepting the patient's ideas,

Somjit Prueksaritanond; Saisunee Tubtimtes; Kornthong Asavanich; Vasunee Tiewtranon


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

Tahepold, Heli; van den Brink-Muinen, Atie; Maaroos, Heidi-Ingrid



Dehydration and the dying patient  

Microsoft Academic Search

This study investigated the relationship between symptoms and dehydration in 82 subjects with malignant disease. Assessment of respiratory tract secretions, thirst, and dry mouth were made during the dying phase, and serum biochemistry was analyzed. Follow-up data were also collected when the patient died. The median time from entry into the study until death was 2 days. All subjects died

John E. Ellershaw; Jane M. Sutcliffe; Cicely M. Saunders



Dialysis Patient Characteristics and Outcomes  

Microsoft Academic Search

This article describes a demonstration project designed to explore psychosocial risk and resiliency factors, social work interventions and health-related outcomes with dialysis patients. The study is unique in including an interdisciplinary research team to guide the process, using available data contained within the medical record and focusing on interventions and outcomes over time rather than at one or two points

Judith Dobrof; Arlene Dolinko; Elena Lichtiger; Jaime Uribarri; Irwin Epstein



Sleep disturbances in dialysis patients  

Microsoft Academic Search

Sleep disturbances are extremely common in dialysis patients. Subjective sleep complaints are reported in up to 80% of those surveyed and sleep apnoea syndrome, restless legs syndrome, and periodic limb movement disorder are much more prevalent than in the general population. Excessive daytime sleepiness is also an important problem. These sleep abnormalities appear to have significant negative effects on quality

Kathy P. Parker



[Psychological support to burn patients].  


Severe burns and their treatment are among the most painful experiences a person can have. Emotional needs of burn patients have long been overshadowed by the focus on survival. Today, when the survival rate is much higher than in the past, the need of psychological and psychosocial engagement in working with victims of severe burns has emerged. A patient undergoing various stages of adjustment is faced with emotional challenges that accompany physical recovery. Adapting to burn injury involves a complex interplay between patient characteristics before the occurrence of burn, environmental factors, and the nature of the burns and medical care required. Adaptation implies adoption of new ideas about themselves and their body, new body image and new self image. Psychiatric and psychological treatment must be incorporated in burn treatment centers within a multidisciplinary treatment team. Psychology and psychotherapy should address the problem of loss, grief, acceptance of body image and self image, in terms of psychiatric conditions of delirium, acute stress disorder, posttraumatic stress disorder, anxiety, depression and other psychiatric disorders. Technical assistance and support should be provided to the patient family members. In some cases, psychosocial treatment never ends; it takes years, later related to rehabilitated burns. PMID:25326989

Vlastelica, Mirela



Syringomyelia in an older patient.  


We describe the case of an 80-year-old man who presented with lower limb upper motor neurone weakness and spinothalamic tract sensory deficit secondary to previously undiagnosed syringomyelia. The case highlights the need for methodical history, examination and investigation in elderly patients to achieve diagnostic accuracy. PMID:25034378

Gill, Rupinder; Birns, Jonathan



Support groups for cancer patients  

Microsoft Academic Search

Within the last two decades psychosocial group interventions have been developed to help cancer patients cope better with the psychosocial sequelae of cancer diagnosis and treatment. Support groups include a variety of different approaches some of which focus on behavioral aspects and symptoms (e.g. pain, fatigue) and some on the expression of emotions. Most of these support programs are structured

Joachim Weis



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.


Ethical issues in patient restraint.  


This article examines the ethical issues that arise in relation to restraint in mental health, dementia care and stroke care. The themes can, however, be applied to all areas of healthcare. The article also discusses how "four quadrants" of practice situations--medical indications, patient preferences, quality of life and contextual features--can be used to analyse three different restraint situations. PMID:21667649

Gallagher, Ann


Clinical Course in 9 Patients  

Microsoft Academic Search

Results: The illness began in these patients after the age of 40 years, with prominent burning or tingling limb pain, occasionally with radicular features or with less well- defined back, neck, or abdominal pain. Leg or infre- quently arm weakness appeared concurrently or soon af- ter the onset of pain. The most distinctive feature was a saltatory progression of symptoms,

Joshua D. Katz; Allan H. Ropper



Evaluation of Online Patient Safety  

E-print Network

hospital-based medical errors and improving health care in the U.S. (IOM, 2001) Distance learning, from effective was the technology platform used). (1) Ambient Institute (2009). The U.S. market for self:// ments/Ambient-Insight-2009-US-Academic- eLearning-Market.pdf . (2) Armstrong institute online patient

Connor, Ed


Fusarium Infections in Immunocompromised Patients  

PubMed Central

Fusarium species cause a broad spectrum of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical form of fusariosis depends largely on the immune status of the host and the portal of entry, with superficial and localized disease occurring mostly in immunocompetent patients and invasive and disseminated disease affecting immunocompromised patients. Risk factors for severe fusariosis include prolonged neutropenia and T-cell immunodeficiency, especially in hematopoietic stem cell transplant recipients with severe graft-versus-host disease. The most frequent presentation of disseminated fusariosis is a combination of characteristic cutaneous lesions and positive blood cultures, with or without lung or sinus involvement. The prognosis is poor and is determined largely by degree of immunosuppression and extent of infection, with virtually a 100% death rate among persistently neutropenic patients with disseminated disease. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy. Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered. PMID:17934079

Nucci, Marcio; Anaissie, Elias



[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



Medication Lists for Elderly Patients  

PubMed Central

OBJECTIVE To determine how often the lists of regular medications derived in geriatric clinics by examination of “medication bags” and interview matched those found during in-home inspections and interviews. DESIGN Prospective cross-sectional study. SETTING Geriatric clinics at three university-affiliated hospitals. PARTICIPANTS Consecutive community-dwelling outpatients 65 years or older who were newly referred. METHODS The in-home medication inspection used a semistructured interview followed by a room-to-room search. The medications identified in the home were compared with the medication list derived in clinic by examination of the “medication bag” and interview. MAIN RESULTS Fifty patients with a mean age of 78.9 years participated. The mean number of regular medications (prescription and nonprescription) was 6.3, and the mean number of regular prescription medications was 3.6. A comparison of clinic versus in-home medication lists revealed that 48% (95% confidence interval [95% CI], 34% to 62%) of patients had at least 1 omission of any regular medication and 19% (95%, CI 10% to 32%) of patients had at least 1 omission of a regular prescription medication. CONCLUSION The clinic-derived medication list resulted in a complete listing of all regular medications in only 52% taking regular medications. More specific instructions to patients to bring all prescription and nonprescription medications and all vitamins, herbal, and natural remedies, and more directed questions by physicians may result in more complete clinic medication lists. PMID:11251762

Yang, John C; Tomlinson, George; Naglie, Gary



[Enriching patient care with aromatherapy].  


There are increasing numbers of initiatives in healthcare institutions focusing on the benefits of essential oils. Received positively by patients who appreciate the resulting wellbeing, these innovative approaches around aromatherapy are based on the initiative of pioneering caregivers. Following on from an international congress held each year in Grasse, this article presents some example schemes. PMID:25065196

Sogno-Lalloz, Isabelle



Consultation and the Suicidal Patient.  

ERIC Educational Resources Information Center

Argues for paradigm shift in how mental health professionals approach their work with psychiatric patients in midst of suicidal crisis and suggests that time has come to discuss standard of care based on integration of detected risk factors, effective education and training in suicidology, and routine use of consultation and teamwork. (Author/NB)

Bongar, Bruce



Lifestyle Questionnaire Patient Name:______________________________________ Date:_________________  

E-print Network

for your visual needs. It is important that you understand that many patients still need to wear glasses in seeing well without glasses in the following situations? Distance vision: (driving, golf, tennis, other sports, watching television) ___ Prefer no Distance glasses. ___ I wouldn't mind wearing Distance glasses


Physicians' attitudes toward female patients.  


The relative impact of a patient's sex and expressivity (expression of a personal problem) on attitudes of physicians toward patients was assessed using case simulations and questionnaires. Eight simulated cases were used that varied by presenting complaint, patient sex, and inclusion or exclusion of a personal problem. Two non-identical cases were read by each of 253 primary-care physicians, yielding 506 questionnaires for analysis. Of the physicians, 25 per cent believed women were likely to make excessive demands on physician time, although only 14 per cent believed this likely of men (p less than 0.01); women's complaints were judged more likely to be influenced by emotional factors (65 per cent versus 51 per cent in men, p less than 0.01), and were identified as psychosomatic more frequently than were men's (21 per cent versus 9 per cent, p less than 0.01). No sex differences were observed for tranquilizer prescriptions. Sex differences persisted when complaint and expressiveness were controlled; however, physicians' reactions to expressivity were strong enough to equalize male-female differences in some items. Although non-expressive women were more likely to receive a psychosomatic diagnosis than non-expressive men (14 per cent versus 2 per cent, p less than 0.01), expressive men and women were almost equally likely to receive psychosomatic diagnoses. Thus, differences in labeling occurred as a function of the patient's sex and expressivity. The effects of these differences on quality of care remain to be determined. PMID:7266111

Bernstein, B; Kane, R



Hyponatraemia in the elderly patient  

Microsoft Academic Search

The elderly are at risk of developing hyponatraemia because of age related changes in renal function and body composition. Factors regulating sodium and water balance in the elderly are reviewed with emphasis on iatrogenic factors. Since rapid reversal of hyponatraemia may cause neurological damage in some patients, the optimum rate of correction is discussed.

L. R. Solomon; G. Sangster; Michael Lye



Physicians' Reactions to Overweight Patients  

NSDL National Science Digital Library

This case study, by David M. Lane of Rice University, assesses the question, "Do physicians discriminate against overweight patients?" This study indicates that, at least in one respect, they do. Basic concepts are t-test, means, and boxplots. The experimental design, materials, descriptive statistics, inferential statistics, and raw data are given.

Lane, David M.



Depressive symptoms in schizophrenic patients  

PubMed Central

Distinction between true negative and depressive symptoms in schizophrenia is difficult. In the present study we seek to establish the psychological profile of depression-prone schizophrenic patients. We addressed the issue by comparing the expression of psychological indices, such as the feelings of being in control of events, anxiety, mood, and the style of coping with stress in depressive and non-depressive schizophrenics. We also analyzed the strength of the association of these indices with the presence of depressive symptoms. A total of 49 patients (18 women and 31 men, aged 23-59) were enrolled into the study, consisting of a self-reported psychometric survey. We found that the prevalence of clinically significant depression in schizophrenic patients was 61%. The factors which contributed to the intensification of depressive symptoms were the external locus of control, anxiety, gloomy mood, and the emotion-oriented coping with stress. We conclude that psychological testing may discern those schizophrenic patients who would be at risk of depression development and may help separate the blurred boundaries between depressive and negative symptoms of schizophrenia. PMID:22112362



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,



Microsoft Academic Search

A b s t r a c t: Renal osteodystrophy, vascular disease and mortality are believed to be linked in patients with chronic kidney disease (CKD), although to date most of the evidence is based only on statistical associations. The precise pathophysiology of vascu- lar calcification in end stagerenal disease (ESRD) is unknown, but risk factors include age, hypertension, time


[Rehabilitation of patients with stroke].  


Stroke is one of the most frequent causes of death and disability. 14,000 to 15,000 individuals are hit by stroke in Norway annually, and the incidence is expected to rise. Optimal organization of rehabilitation for stroke patients has been extensively documented during the last 10 years. It is established that a larger reduction of disability and mortality for stroke patients is obtained by treatment and rehabilitation in stroke units than in general medical wards. WHO Region Europe recommends that all stroke patients are treated in stroke units in the acute phase. Additional reduction in mortality and disability is achieved through home-based rehabilitation, coordination by a multidisciplinary ambulatory team and by emphasizing cooperation between different levels of healthcare. Strategies for organising rehabilitation for different stroke patients must be based on scientific evidence; more knowledge is needed and much research is currently ongoing. The field of neuroscience has developed quickly during the last years, and evidence of brain plasticity gives reason to believe that an increase in the amount and intensity of training is important for an optimal effect. There is a need for more systematized knowledge, and further research will hopefully define a more specific and optimal strategy for stroke rehabilitation within a few years. PMID:17304272

Fjaertoft, Hild; Indredavik, Bent



Patient Safety in Nursing Homes  

Microsoft Academic Search

Safety of residents has gained increased popularity in recent years following a report from the Institute of Medicine attributing 98,000 hospital deaths each year to errors by staff. As a result, regulatory agencies, advocates, and health care providers have shifted their focus to understanding patient safety and developing a culture that promotes safety. However, nursing homes lag behind other health

Kali Thomas



OUTPATIENT TREATMENT REPORT PATIENT Name: ____________________________________________________  

E-print Network

Address: FUNCTIONAL IMPAIRMENT City: State: Zip: ADLs Physical Health Phone: Fax: Family observable outcomes #1. I have communicated with patient's psychiatrist or therapist: Yes No N/A ICD-9 If affective or psychotic disorder is present and no medications are prescribed, please explain: Family

Walker, Matthew P.


Patients, friends, and relationship boundaries.  

PubMed Central

When patient and physician are close friends, both professional and personal relationships can suffer. Jointly exploring and setting explicit boundaries can help avoid conflict and maintain these valuable relationships. This is particularly important when the physician practises in a small community where such concurrent relationships are unavoidable. PMID:8292931

Rourke, J. T.; Smith, L. F.; Brown, J. B.



Exercise for the Overweight Patient.  

ERIC Educational Resources Information Center

Exercise can help patients maintain lean body mass during weight loss. Although exercise is not extremely useful in shedding excess pounds, it helps keep off weight lost through calorie restriction. This article discusses the specifics of exercise prescription, types of exercise, motivation to exercise, and special problems such as diabetes. (SM)

Work, Janis A.



Bone lead in dialysis patients  

Microsoft Academic Search

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

Frank L Van de Vyver; Patrick C D'Haese; Walter J Visser; Monique M Elseviers; Lutgarde J Knippenberg; Ludwig V Lamberts; Richard P Wedeen; Marc E De Broe



[DGRW-update: patient education].  


Patient education programmes, i.?e. standardized, manualized, interactive group programmes aiming to increase self-management and empowerment, are a core element of medical rehabilitation for chronic conditions. In an update of the evidence of the effectiveness of patient education, its effectiveness was proven for a broad spectrum of chronic disorders, such as diabetes mellitus, chronic low back pain, rheumatoid arthritis, coronary heart disease, chronic heart failure, bronchial asthma, COPD, and cancer, as well as for the modification of health behaviours, such as diet and exercise. To sustain effects, aftercare interventions, such as support provided by phone, were found to be successful. Interventions targeted to particular patient groups according to gender, age, or migration background are also being developed more frequently. When evaluating educational interventions not only distal outcomes, such as quality of life and participation, should be used but also proximal outcomes such as self-management skills. A recent survey of patient education practice in medical rehabilitation revealed a continuing potential for optimization relative to manualization, evaluation and didactics. However, the dissemination of innovative programmes into rehabilitation routine presents a major challenge. PMID:21976261

Faller, H; Reusch, A; Meng, K



Natural cytotoxicity in patients undergoing radiation therapy  

SciTech Connect

Natural cytotoxicity against K562 target cells was measured in 51 adults with solid epithelial malignant tumors who were untreated, in 42 patients who were studied within 6 weeks following completion of radiotherapy (4,000-7,000 rads), and in 27 normal subjects. In both the radiated and the nonirradiated groups, mean cytotoxicity for patients with localized cancers was not significantly different from that of the normal controls, whereas mean cytotoxicity for patients with advanced cancers was significantly lower than that for normal controls and patients with localized disease. Twelve percent of nonirradiated patients and 13% of radiated patients with localized tumors, but 46% of nonirradiated patients and 44% of irradiated patients with advanced cancers, failed to exhibit normal NK activity. Mean cytotoxicity for irradiated patients was not significantly different from that of untreated patients. PBL from most patients showed enhanced cytotoxicity after preincubation of PBL with interferon (IFN alpha). Mean cytotoxicities for nonirradiated and irradiated patients after IFN alpha pretreatment of PBL were not significantly different. In both patient groups, IFN alpha-boosted killing was significantly less in patients with advanced disease than in patients with local tumors or normals. These results indicated that radiotherapy has no significant effect on spontaneous or IFN alpha-boosted natural cytotoxicity.

Kadish, A.S.; Ghossein, N.A.



The practice orientations of physicians and patients: the effect of doctor–patient congruence on satisfaction  

Microsoft Academic Search

This study investigated the extent to which the individual orientations of physicians and patients and the congruence between them are associated with patient satisfaction. A survey was mailed to 400 physicians and 1020 of their patients. All respondents filled out the Patient–Practitioner Orientation Scale, which measures the roles that doctors and patients believe each should play in the course of

Edward Krupat; Susan L. Rosenkranz; Carter M. Yeager; Karen Barnard; Samuel M. Putnam; Thomas S. Inui



Poor Antipsychotic Adherence Among Patients With Schizophrenia: Medication and Patient Factors  

Microsoft Academic Search

Many patients with schizophrenia are poorly adherent with antipsychotic medications. The newer, atypical antipsychotics may be more acceptable to patients and result in increased adherence. We used national Department of Veterans Affairs (VA) pharmacy data to examine whether patients receiving atypical agents are more adherent with their medication and explored patient factors associated with adherence. Patients who received a diagnosis

Marcia Valenstein; Frederic C. Blow; Laurel A. Copeland; John F. McCarthy; John E. Zeber; Leah Gillon; C. Raymond Bingham; Thomas Stavenger



Quick Guide for Staff Caring for Patients on Suicide Precautions 1. Before patient arrives to unit  

E-print Network

Quick Guide for Staff Caring for Patients on Suicide Precautions 1. Before patient arrives to unit trust. Educate patient and family. Inspect room each shift. Communicate appropriately with staff. Evaluate patient including suicide risk, at least every 24 hours. Monitor Visitors. Document patient

Oliver, Douglas L.


Patient Versus Therapist Alliance: Whose Perception Matters?  

PubMed Central

Development of working alliance was examined for 25 opioid-abusing pain patients and their therapists. Patients participated in an 8-session intervention based on adherence strategies and employing a supportive, psychoeducational approach; methadone was prescribed for pain. Treatment goals included opioid analgesic adherence and decreasing pain, functional interference, and substance abuse. Patients and therapists completed the Helping Alliance Questionnaire-II following each treatment session. At baseline, patients’ and therapists’ scores indicated good alliance. Patient alliance grew significantly over time, regardless of addiction severity and independent of treatment outcomes. In contrast, therapist alliance grew only for patients without substance abuse co-morbidity and/or who had good outcomes. Patients’ and therapists’ alliance scores were consistent during sessions focused on emotional bonds but diverged during sessions that demanded behavior change, suggesting therapists may have reacted negatively to patients’ lack of progress. Whether therapists’ reactions to poor performers impacted subsequent patient outcomes is unknown, but should be investigated. PMID:18082997

Bethea, Angela R.; Acosta, Michelle C.; Haller, Deborah L.



Ethically optimal interventions with impaired patients.  


It may be difficult to imagine having a severe impairment such as quadriplegia or being dependent on a respirator. There is evidence that when careproviders make treatment decisions for patients who are in these situations, we imagine the patients are worse-off than they report they are -- most patients with even very severe impairments report that they greatly value being alive. This misperception may cause us to make treatment decisions for patients with impairments that we might not make for other patients. In this article I describe how to provide better care for patients who have impairments. This includes not presupposing that the patients' quality of life is decreased, considering with patients how outside factors may be limiting their functioning, and seeking to help offset these factors, if we can, when they exist, to avoid allowing patients' impairments to result in their being truly "disabled". PMID:24779312

Howe, Edmund G



[Virtual operations on real patients].  


The tremendous amount of available medical digital data requires media for intuitive information perception. Virtual reality (VR) presents a technique for processing the visual data from various diagnostic modalities. From a synthetic patient model, the required compact information can be generated. The patient model is the basis for planning and processing of surgical procedures. Stereoscopically visualized 3-D reconstructions of, for example, tomographic scans are used for virtual operations. Today, prototypical tools for the virtual training of certain surgical procedures are known. Possible VR applications in surgery range from the combination of virtual and real data (augmented reality) and intraoperative computer assistance (navigation) to remotely performed operations (telerobotics). In particular, the optimization of the man-machine interface to integrate VR applications in operating theaters is required. PMID:9931590

Schlag, P M; Graschew, G; Bellaire, G; Engel-Murke, F



Severity assessment in trauma patient.  


Severity assessment in trauma patients is mandatory. It started during initial phone call that alerts emergency services when a trauma occurred. On-call physician assesses severity based on witness-provided information, to adapt emergency response (paramedics, emergency physicians). Initial severity assessment is subsequently improved based on first-responder provided informations. Whenever information comes, it helps providing adequate therapeutics and orientating the patient to the appropriate hospital. Severity assessment is based upon pre-trauma medical conditions, mechanism of injury, anatomical lesions and their consequences on physiology. Severity information can be summarized using scores, yet those are not used in France, except for post-hoc scientific purposes. Triage is usually performed using algorithms. Whatever the way triage is performed, triage tools are based on mortality as main judgement criterion. Other criteria should be considered, such as therapeutics requirements. The benefit of biomarkers of ultrasonography at prehospital setting remains to be assessed. PMID:23906735

Raux, M; Vivien, B; Tourtier, J-P; Langeron, O



Semantic remote patient monitoring system.  


We propose an automated and personalized remote patient monitoring (RPM) system, which is applied to care homes and is dependent on the manipulation of semantics describing situations during patient monitoring in ontological models. Decision making in RPM is based on reasoning performed upon ontologies, which secures the delivery of appropriate e-health services in care homes. Our working experiment shows an example of preventive e-healthcare, but it can be extended to any situation that requires either urgent action from healthcare professionals or a simple recommendation during RPM. We use Semantic Web technology and OWL/SWRL-enabled ontologies to illustrate the proposal and feasibility of implementing this RPM system as a software solution in pervasive healthcare. It will be of interest to healthcare professionals, who can directly shape and populate the proposed ontological model, and software engineers, who would consider using OWL/SWRL when creating e-health services in general. PMID:23363406

Shojanoori, Reza; Juric, Radmila



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



Informal Caregiving for Cancer Patients  

PubMed Central

According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long-term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided. PMID:23695928

Romito, Francesca; Goldzweig, Gil; Cormio, Claudia; Hagedoorn, Mariet; Andersen, Barbara L.



Total Body Irradiation (TBI) in Pediatric Patients  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Purpose:\\u000a   To retrospectively analyze patient characteristics, treatment, and treatment outcome of pediatric patients with hematologic\\u000a diseases treated with total body irradiation (TBI) between 1978 and 2006.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a   32 pediatric patients were referred to the Department of Radiation-Oncology at the University of Zurich\\u000a for TBI. Records of regular follow-up of 28 patients were available for review. Patient characteristics

Claudia Linsenmeier; Daniel Thoennessen; Laura Negretti; Jean-Pierre Bourquin; Tino Streller; Urs Martin Lütolf; Susanne Oertel



Curbing Inflammation in Burn Patients  

PubMed Central

Patients who suffer from severe burns develop metabolic imbalances and systemic inflammatory response syndrome (SIRS) which can result in multiple organ failure and death. Research aimed at reducing the inflammatory process has yielded new insight into burn injury therapies. In this review, we discuss strategies used to curb inflammation in burn injuries and note that further studies with high quality evidence are necessary. PMID:23762773

Farina, Jayme A.; Rosique, Marina Junqueira; Rosique, Rodrigo G.



Pneumonia in the Pregnant Patient  

Microsoft Academic Search

Community acquired pneumonia is a common illness, and pneumonia and influenza serve as the seventh leading cause of death\\u000a in the United States. In the pregnant patient, pneumonia is the most common cause of fatal non-obstetric infection (1–3).\\u000a Pneumonia can have adverse consequences for both the mother and her fetus, with certain infections (particularly viral and\\u000a fungal) assuming greater virulence

Samar Khan; Michael S. Niederman


Incisional Hernia in Obese Patients  

Microsoft Academic Search

Incisional hernia is one of the most frequent complications of abdominal surgery [1,2]. Different aetiologies have been hypothesized, including patient factors such as older age, cancer, diabetes, malnutrition,\\u000a chronic steroid therapy, and wound factors such as lower midline incision, re-incision and wound infections [3,4]. In abdominal surgery, by far, obesity has long been recognised as one of the most relevant

Luigi Angrisani; Michele Lorenzo; Pier Paolo Cutolo


Reviews: Provider?patient interaction  

Microsoft Academic Search

Health Communication: Theory And Practice. By Gary L. Kreps and Barbara C. Thornton. New York: Longman, 1984, pp. xi & 287. $15.95.Routine Complications: Troubles with Talk Between Doctors and Patients. By Candace West. Bloomington, IN: Indiana University Press, 1984, pp. 175. $27.50 (cloth).Communication and counseling in health care. By Vincent M. Riccardi and Suzanne M. Kurtz. Springfield, IL: Charles C.

Vicki S. Freimuth; Elaine M. Litton; Ian MacPhail M. D; Scott Conard; Barbara Ogur M. D; Roberta Ann Smith; Imogene King; Dan OHair; Debra Roter; Alice R. Redland



Patient safety in Dutch hospitals  

Microsoft Academic Search

In various studies outside the Netherlands, it has been shown that a substantial number of patients suffer from some kind of harm during their treatment in hospital. The incidence of these so-called adverse events varies between 2.9% and 16.6%; it is estimated that between over a quarter and a half of these are considered to be avoidable. Preventable adverse events

C. Wagner; J. Cuperus-Bosma; G. van der Wal



Imaging the back pain patient.  


Imaging is an integral part of the clinical examination of the patient with back pain; it is, however, often used excessively and without consideration of the underlying literature. The primary role of imaging is the identification of systemic disease as a cause of the back or limb pain; magnetic resonance imaging (MRI) excels at this. Systemic disease as a cause of back or limb pain is, however, rare. Most back and radiating limb pain is of benign nature, owing to degenerative phenomena. There is no role for imaging in the initial evaluation of the patient with back pain in the absence of signs or symptoms of systemic disease. When conservative care fails, imaging may be undertaken with due consideration of its risks: labeling the patient as suffering from a degenerative disease, cost, radiation exposure, and provoking unwarranted minimally invasive or surgical intervention. Imaging can well depict disc degeneration and disc herniation. Imaging can suggest the presence of discogenic pain, but the lack of a pathoanatomic gold standard obviates any definitive conclusions. The imaging natural history of disc herniation is resolution. There is very poor correlation between imaging findings of disc herniation and the clinical presentation or course. Psychosocial factors predict functional disability due to disc herniation better than imaging. Imaging with MRI, computed tomography (CT), or CT myelography can readily identify central canal, lateral recess, or foraminal compromise. Only when an imaging finding is concordant with the patient's pain pattern or neurologic deficit can causation be considered. The zygapophysial (facet) and sacroiliac joint are thought to be responsible for axial back pain, although with less frequency than the disc. Imaging findings of the structural changes of osteoarthritis do not correlate with pain production. Physiologic imaging, either with single-photon emission CT bone scan, heavily T2-weighted MRI sequences (short-tau inversion recovery), or gadolinium enhancement, can detect inflammation and are more predictive of an axial pain generator. PMID:20977958

Maus, Timothy



Rebuilding immunity in cancer patients  

PubMed Central

Rebuilding and maintaining immunity is paramount to the success of cancer immunotherapy and hematopoietic stem cell transplantation. If immune surveillance indeed can protect from cancer, the very manifestation of malignancy means that the disease has prevailed over immunity. Yet, often, tumor–specific T cells can be found in cancer patients irrespective of vaccination. Interestingly, patients suffering from malignancy often harbor unexpectedly high levels of immature CD14+HLA-DR? monocytes, although the abundance of CD4+ cells, CD8+ cells and CD4+CD25high cells may be normal. It is plausible that in cancer such cells suppress T cell function, analogous to CD14+HLA-DR? cells in sepsis and major trauma, in addition to their likely failure to re–present tumor-associated antigens once dendritic cells have initiated the T cell response. Recent evidence indicates that tumor–borne adenosine, lactate and hypoxia in the tumor environment may modulate tumor–specific immunity to a significant extent, but their effects on myeloid cell function is unclear. Thus, understanding and controlling these factors may appreciably impact the success of rebuilding and maintaining immunity in cancer patients. PMID:17827037

Vuk-Pavlovic, Stanimir



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)



Quality Assurance: Patient Chart Reviews  

NASA Astrophysics Data System (ADS)

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.; Odero, D. O.



[Bladder tumors in young patients].  


Bladder tumours classically affect the elderly, but can also occur in young adults. The authors studied the prognosis of these tumours in patients under the age of 40. In their experience, these tumours represent 3.27% of all bladder tumours. 26 patients with a mean age of 34 years (20-40 years), 8 under the age of 30, were studied. There was a marked male predominance (23 males, 3 females). The tumour was a transitional cell carcinoma in 25 cases and a squamous cell carcinoma in 1 case. It was superficial in 11 cases and invasive in 15 cases. Transurethral resection and cystectomy were performed in 9 cases of superficial tumours and 11 cases of invasive tumours, respectively. In the group of superficial tumours, a favourable course was observed in 7 cases, with 3 cases of recurrence and 1 case of progression. In the group of invasive tumours, a favourable course was observed in 6 cases, recurrence was observed in 2 cases and 5 patients died. Superficial tumours therefore have a better prognosis in subjects under the age of 30. Invasive tumours are more frequent and often advanced, suggesting a marked potential for progression. Their prognosis depends on tumour stage, and is not correlated with age. PMID:9533150

Aboutaieb, R; Dakir, M; Sarrf, I; el Moussaoui, A; Bennani, S; el Mrini, M; Meziane, F; Benjelloun, S



Bronchopulmonary Kaposi's sarcoma in patients with AIDS.  

PubMed Central

BACKGROUND: Kaposi's sarcoma in HIV antibody positive patients may affect the lungs. This study describes the presentation, chest radiographic appearances, and pulmonary function test abnormalities in patients with AIDS who had tracheobronchial Kaposi's sarcoma. METHODS AND RESULTS: Twenty nine (8%) of 361 consecutive HIV antibody positive patients undergoing bronchoscopy for respiratory symptoms had tracheobronchial Kaposi's sarcoma. Eight patients had intercurrent infections and one had previously received chemotherapy for cutaneous Kaposi's sarcoma; these patients were excluded. Seven of the remaining 20 patients had localised Kaposi's sarcoma (lesions confined to the trachea or the subsegments of one lobe) and 13 had widespread Kaposi's sarcoma (affecting the trachea and one lobe or the subsegments of more than one lobe); 19 patients also had cutaneous and palatal Kaposi's sarcoma. Seven patients, four with widespread disease, had a normal radiograph. All patients had reduced transfer factor (TLCO) and transfer coefficient (KCO) but only those with widespread disease had reductions in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). Follow up pulmonary function testing in seven patients (median three months later) showed further reductions in TLCO. All four patients who received no treatment had progressive radiographic abnormalities; bronchoscopy in two patients showed progressive tracheobronchial disease, and two patients had further reductions in FEV1 and FVC. In three patients treated with chemotherapy palliation of symptoms was achieved but two had further reductions in FEV1 and FVC and the radiograph deteriorated. Bronchoscopy showed regression of disease in only one patient. CONCLUSION: Pulmonary Kaposi's sarcoma produces abnormalities of TLCO even in patients with localised disease; airflow obstruction may occur in patients with widespread disease. Bronchoscopic reassessment of the extent of disease may not accurately reflect response to chemotherapy. PMID:1440467

Miller, R F; Tomlinson, M C; Cottrill, C P; Donald, J J; Spittle, M F; Semple, S J



Epidemiological features of Turkish patients with sarcoidosis.  


Epidemiological characteristics of sarcoidosis differ according to geographical distribution. The aim of our study was to disclose epidemiological characteristics in our country. The data was collected from investigators, who sent information on newly-diagnosed patients via internet. In 2 years 198 female and 95 male patients were enrolled to the study (f/m:2.08). Mean age of patients was 44+/-13 years (17-90). Mean age of male patients was 38+/-12 while mean age of female patients was 48+/-13 (p<0.001). 73.4% of patients were nonsmokers (85.4% of females; 48.4% of males; (p<0.001)). About 50% of our 293 patients were housewives. Familial sarcoidosis was found in 3 patients' first degree relatives. Estimated annual incidence of sarcoidosis for Turkey was calculated as 4 per 100,000 person. According to our study, 2/3 of sarcoidosis patients were women; mean age of patients was 45 and the disease began 10 years later in female patients. 80% of patients were nonsmokers; negative relation between sarcoidosis and smoking was evident especially in women. Familial sarcoidosis frequency was lower compared to other studies in the literature. There was no occupational exposure history in our patients. Our incidence rate, is similar with the results of other European studies. PMID:19181507

Musellim, B; Kumbasar, O O; Ongen, G; Cetinkaya, E; Turker, H; Uzaslan, E; Yenturk, E; Uzun, O; Saglam, L; Celik, G; Okumus, G; Annakkaya, A N; Altiay, G; Tabak, L; Sakar, A; Kiter, G; Erturan, S; Turktas, H; Yalniz, E; Akkoclu, A; Ogus, C; Dogan, O T; Ozkan, M; Aktogu, S; Uzel, I



Patients' Experiences with Navigation for Cancer Care  

PubMed Central

Objective We examined how navigation, defined as the assessment and alleviation of barriers to adequate health care, influences patients' perspectives on the quality of their cancer care. Methods We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in New York. We interviewed patients about their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results Thirty-five patients newly diagnosed with breast or colorectal cancer. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving, and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusion Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. Navigated patients received emotional support and assistance with information needs, problem-solving, and logistical aspects of cancer care coordination. Practice Implications Navigation services may help improve cancer care outcomes important to patients by addressing fragmented, confusing, uncoordinated, or inefficient care. PMID:20006459

Carroll, Jennifer K.; Humiston, Sharon G.; Meldrum, Sean C.; Salamone, Charcy M.; Jean-Pierre, Pascal; Epstein, Ronald M.; Fiscella, Kevin



Stem Cell Transplant Patients and Fungal Infections  


... About . Fungal Diseases Share Compartir Stem Cell Transplant Patients and Fungal Infections As a stem ... Top of Page Preventing fungal infections in stem cell transplant patients Fungi are difficult to avoid because ...


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.



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2012 CFR

...concerning patients' mail published by the Veterans Health Administration, Department of Veterans Affairs, and/or the local health care...personal funds of patients published by the Veterans Health Administration. (5) Social...



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2013 CFR

...concerning patients' mail published by the Veterans Health Administration, Department of Veterans Affairs, and/or the local health care...personal funds of patients published by the Veterans Health Administration. (5) Social...



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2010 CFR

...concerning patients' mail published by the Veterans Health Administration, Department of Veterans Affairs, and/or the local health care...personal funds of patients published by the Veterans Health Administration. (5) Social...



38 CFR 17.33 - Patients' rights.  

Code of Federal Regulations, 2011 CFR

...concerning patients' mail published by the Veterans Health Administration, Department of Veterans Affairs, and/or the local health care...personal funds of patients published by the Veterans Health Administration. (5) Social...



Preventing Venous Thromboembolism in Hospitalized Patients  


... Another way to prevent VTE is to put mechanical devices that squeeze the lower part of patients’ ... the bene?ts and harms of blood thinners and mechanical devices for preventing VTE in patients hospitalized for ...


Doctors Often Unaware Their Patients Have Catheters  


... Related MedlinePlus Pages Health Facilities Health Occupations Patient Safety THURSDAY, Oct. 23, 2014 (HealthDay News) -- Hospital patients often have tubes placed in their veins to deliver medication or take blood ...


JAMA Patient Page: Basic Science Research  


... of Health and Human Services VALUE OF BASIC SCIENCE RESEARCH Basic science research can help in a ... dedicated to basic science and translational research. Basic Science Research JAMA PATIENT PAGE The JAMA Patient Page ...


Wood's light in Microsporum canis positive patients.  


In 64 patients with culturally proven Microsporum canis infections, Wood's light examination was performed. In 30 patients (47%) the characteristic fluorescence correlated with the cultural findings, whereas in the remaining 34 patients (53%), Microsporum canis was isolated, although Wood's light examination was negative. Of the 30 positive and 34 negative cases eight patients of each group had been pre-treated. From the results presented, Wood's light examination has a poor sensitivity in cases of Microsporum canis-infections. PMID:9470413

Kefalidou, S; Odia, S; Gruseck, E; Schmidt, T; Ring, J; Abeck, D



[Coronary artery disease in diabetic patients].  


It is possible to decrease the rate of progression of coronary artery disease in diabetic patients by controlling all risk factors including hyperglycemia and by the prescription of statin and aspirin in high risk patients. After a coronary event, the management of the patient must be as optimal as possible in terms of pharmacological treatment and revascularization. "Ever more" is the key line in these patients. PMID:18839684

Henry, Patrick



Supporting Patients’ Participation in Decision Making  

Microsoft Academic Search

Evidence-based medicine integrates clinical experience with patient’s values using the best available evidence (1). In the past, physicians acted as agents in the best interest of their patients (2). These roles are now changing. Although physicians are still considered experts in diagnosing and identifying treatment\\u000a options, patients are increasingly recognized as the best experts for judging values associated with options

Annette M. O’Connor; Dawn Stacey


Toe amputation in the diabetic patient  

Microsoft Academic Search

Background. We considered whether it is more practical to amputate the toe of a diabetic patient with osteomyelitis and good circulation or to treat the patient with antibiotics for a prolonged period.Methods. We undertook a retrospective study of 141 diabetic patients who had undergone a toe-ray amputation for proven or documented osteomyelitis.Results. The mean ankle\\/brachial index of all patients was

Morris D Kerstein; Vincent Welter; Vivian Gahtan; Andrew B Roberts



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



Incisional Hernia Repair in Renal Transplantation Patients  

Microsoft Academic Search

Introduction: Abdominal wall dehiscence in renal transplantation patients risks the survival of the transplanted organ. No\\u000a clear treatment algorithm exists in the literature for this group of patients. Methods: Between 1992 and 2001, the Division\\u000a of Plastic Surgery at the University of Maryland treated 41 of 2499 renal transplant patients. Based on a retrospective review\\u000a of these patients, an algorithm

Edward N. Li; Ronald P. Silverman; Nelson H. Goldberg



Developing patient education in community pharmacy  

Microsoft Academic Search

This thesis deals with the development of patient education in the community pharmacy. The research questions concentrate on the determinants of technicians? patient education behavior\\u000aand the effects of a one-year lasting intervention program on the patient education activities\\u000ain the pharmacy. This summary reports about the research methodology and the results.\\u000aResearch methodology\\u000aThe studied patient education behavior concerned

A. T. G. Blom



International telepsychiatry: a study of patient acceptability  

Microsoft Academic Search

Summary An international telepsychiatry service was established between Denmark and Sweden for cross-cultural patient groups, such as asylum seekers, refugees and migrants. Over an 18-month period starting in mid 2006, 30 patients were treated by telepsychiatry (21 men and 9 women). The patients received mental health care by videoconferencing from providers who spoke the patients' own language, i.e. without the

Davor Mucic



Hierachy of Needs of Geriatric Patients  

Microsoft Academic Search

Background: The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. Objective: The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique

E. Majercsik



[Treatments for otorhinolaryngological patients with psychiatric disorders].  


There are few systems in place for patients with psychiatric disorders who need treatments for physical complications. In Tokyo, "The Tokyo metropolitan psychiatric emergency system" was established in 1981, and Ome Municipal General Hospital participated in it. Under this system, fifteen patients with psychiatric disorders were treated for otorhinolaryngological diseases in our department from April 2005 to March 2011. We reviewed the fifteen patients. The coexisting psychiatric disorders were schizophrenia in twelve patients, and mental retardation, Korsakoff's syndrome, and Alzheimer's dementia in one patient each, respectively. All the patients had been receiving psychiatric treatment. The otorhinolaryngological diseases were head and neck cancer in nine patients, chronic sinusitis in three patients, and benign salivary gland tumor, cholesteatoma, and epistaxis in one patient each, respectively. Among the fifteen patients, thirteen could complete their treatment, but two dropped out due to exacerbation of their psychiatric symptoms. The therapeutic course is uncertain in otorhinolaryngological diseases occurring concomitantly with psychiatric disorders, especially in head and neck cancer, because it may be difficult to prioritize the problem when determining the treatment options and delivering the treatment. Thus, we should treat patients with psychiatric disorders carefully on a case-by-case basis depending on their psychiatric symptoms. It is also important to cooperate with psychiatrists and patients' families. PMID:23539958

Nishio, Ayako; Sumi, Takuro; Yamada, Masato; Kuwahata, Yuko



The patient chose to die: why?  


The elderly patient's choice to die may only appear to be independent of the family's choices. Behind the patient's choice often lie implicit interpersonal as well as overt personal reasons. These must be understood in order to provide optimal care for the patient and family. Case examples of undeliberate and deliberate clarification are offered. PMID:1778499

Montalvo, B




E-print Network

Health Sciences (Treadwell) Library 29 Warren Library 29 Patient Education Television Channel 29 GLOSSARY AND REFERENCES 28 EDUCATION RESOURCES AND LIBRARIES 29 The Blum Patient and Family Learning Center 29 The MGH hours 37 Television 37 Waiting rooms for families 37 MGH OFFICES 38-39 Chaplain 38 International Patient

Mootha, Vamsi K.


Helping cancer patients disclose their concerns  

Microsoft Academic Search

Health professionals are reluctant to enquire actively about cancer patients' concerns and feelings. They fear that probing will damage patients psychologically and believe they have had insufficient training in the relevant interviewing skills. In considering how their interviewing skills might be improved, the key question is which interviewing behaviours promote patient disclosure and which inhibit it. To test our predictions

P. Maguire; A. Faulkner; K. Booth; C. Elliott; V. Hillier



Love between therapist and patient: a review.  


To avoid the passions of love and hate between them, therapists and patients construct and preserve negative barriers of angry criticism, dissatisfaction, and sadomasochism. This review aims to help therapists tolerate and work with loving feelings between patient and therapist for the benefit of the patient. PMID:8867571

Coen, S J



Hepatopulmonary Syndrome in Noncirrhotic Portal Hypertensive Patients  

Microsoft Academic Search

Hepatopulmonary syndrome has yet not been sufficiently assessed in noncirrhotic portal hypertension. The prevalence of hepatopulmonary syndrome was determined in 31 consecutive patients with noncirrhotic portal hypertension (19 idiopathic portal hypertension, 7 portal vein thrombosis, 5 congenital hepatic fibrosis) and 46 patients with liver cirrhosis. Contrast echocardiography was carried out in all patients. Macroaggregated albumin lung perfusion scans were performed

Sabahattin Kaymakoglu; Tevfik Kahraman; Hasan Kudat; Kadir Demir; Yilmaz Cakaloglu; Isik Adalet; Dinc Dincer; Fatih Besisik; Güngör Boztas; Ahmet Bilge Sözen; Zeynel Mungan; Atilla Okten



Patient adherence to antihypertensive medical regimens  

Microsoft Academic Search

The initial findings from a long-term study of patient adherence to antihypertensive medical regimens are reported; the research was designed to identify factors related to adherence. Data were collected by means of personal interviews and from medication records for a sample of 132 hypertensive patients of private physicians. Patient beliefs about their susceptibility to the effects of hypertension, about the

J. P. Kirscht; I. M. Rosenstock



Precise positioning of patients for radiation therapy  

Microsoft Academic Search

A number of immobilization schemes which permit precise daily positioning of patients for radiation therapy are discussed. Pretreatment and post-treatment radiographs have been taken with the patient in the treatment position and analyzed to determine the amount of intratreatment movement. Studies of patients in the supine, seated and decubitus positions indicate mean movements of less than 1 mm with a

Lynn J. Verhey; Michael Goitein; Patricia McNulty; John E. Munzenrider; Herman D. Suit



Aberrant Hepatic Artery in Patients Undergoing Pancreaticoduodenectomy  

Microsoft Academic Search

Background: It is very important to keep the integrity of the hepatic artery blood supply in patients treated by pancreaticoduodenectomy. Knowing and identifying hepatic artery anomalies is helpful to avoid injuring them during the procedure of pancreaticoduodenectomy in patients with ampullary tumors (including cancer in the pancreatic head). Methods: Aberrant hepatic artery in patients with ampullary tumors was identified by

Feng Yang; Jiang Long; De-Liang Fu; Chen Jin; Xian-Jun Yu; Jin Xu; Quan-Xing Ni



Physician's Death Anxiety and Patient Outcomes.  

ERIC Educational Resources Information Center

It was shown that terminal patients of physicians with high death anxiety survive longer during their final hospital stay than terminal patients of physicians with low death anxiety. Physicians high in death anxiety seem to be less willing to accept patients' terminality and use heroic measures to keep them alive. (Author)

Schulz, Richard; Aderman, David



Thoracic BB injuries in pediatric patients.  


Penetrating thoracic injury from BB shot remains an innocuous event in most patients, but factors including location, proximity, gun type, and patient weight may identify groups at risk. The following cases demonstrate morbidity and mortality in two patients, and this experience may suggest the need for reassessment of this injury. PMID:7897723

Fernandez, L G; Radhakrishnan, J; Gordon, R T; Shah, M R; Lain, K Y; Messersmith, R N; Roettger, R H; Norwood, S H



Dementia Patient Suffering and Caregiver Depression  

Microsoft Academic Search

Cross-sectional and longitudinal analyses were carried out to assess the relationship between dementia patient suffering, caregiver depression, and antidepressant medication use in 1222 dementia patients and their caregivers. We assessed the prevalence of 2 types of patient suffering, emotional and existential distress, and examined their independent associations with caregiver depression and antidepressant medication use when controlling for sociodemographic characteristics of

Richard Schulz; Kathleen A. McGinnis; Song Zhang; Lynn M. Martire; Randy S. Hebert; Scott R. Beach; Bozena Zdaniuk; Sara J. Czaja; Steven H. Belle



Survival analysis and prognosis for dementia patients  

Microsoft Academic Search

How long a dementia patient is cared for in the home before admission to a nursing home depends on the state of the patient and the state of the caregiver. Using 5-year follow-up data, the times until entry to nursing home and until death are modeled using a Cox survival model in which patient and caregiver variables at entry to

C. A. McGilchrist; H. Brodaty; K. E. Peters; L. Harris



Patient and Staff Safety: Voluntary Reporting  

Microsoft Academic Search

Central to efforts to assure the quality of patient care in hospitals is having accurate data about quality and patient problems. The purpose was to describe the reporting rates of medication administration errors (MAE), patient falls, and occupational injuries. A questionnaire was distributed to staff nurses (N = 1105 respondents) in a national sample of 25 hospitals. This addressed voluntary

Mary A. Blegen; Thomas Vaughn; Ginette Pepper; Carol Vojir; Karen Stratton; Michal Boyd; Gail Armstrong



Falls Amongst Institutionalised PsychoGeriatric Patients  

Microsoft Academic Search

Falls are common among the elderly patients in the psycho-geriatric wards and yet they have been understudied. A fall is a multi-factorial syndrome involving the patient and the environment. Psycho- geriatric patients who fall may suffer serious physical injuries that result in morbidity, further institu- tionalisation or even mortality. This study aims to examine the contributing factors to, and morbidity

K D Lim; K C Ng; S K Ng; L L Ng


Does breast cancer change patients’ dietary habits?  

Microsoft Academic Search

Purpose: The results of epidemiological studies on diet and cancer are often difficult to interpret on an individual level and may influence patients’ beliefs, attitudes and behaviour. This study investigated the behaviour of breast cancer patients and their attitudes to dietary changes and the need of dietary advice during their disease.Patients and methods: The study population consisted of breast cancer

EK Salminen; HK Lagström; SP Heikkilä; SJ Salminen



Osteoporosis in adult patients with celiac disease  

Microsoft Academic Search

We investigated the bone mineral density (BMD) and prevalence of osteopenia and osteoporosis in adult celiac patients with varying disease states. In this cross-sectional study the data on the severity of celiac disease and BMD were collected from 77 celiac patients (28 newly diagnosed and 49 previously diagnosed celiac patients), and BMD results were compared with those of 157 control

T Kemppainen; H Kröger; E Janatuinen; I Arnala; V.-M Kosma; P Pikkarainen; R Julkunen; J Jurvelin; E Alhava; M Uusitupa



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



Radiation doses to patients during ERCP  

Microsoft Academic Search

Background: There is a scarcity of data regarding the radiation dose and associated risks to patients during ERCP. Dose area product (DAP) measurements can be used to estimate an effective dose (ED) to patients undergoing ERCP. This measure allows radiation risk associated with such procedures to be quantified. The aim of this study was to evaluate the ED to patients

Catherine J. Larkin; Adam Workman; Richard E. R. Wright; Tony C. K. Tham



Patient autonomy, paternalism, and the conscientious physician  

Microsoft Academic Search

This paper concerns itself with the concept of diminished competence with particular regard to the problems and options that mentally compromised patients raise for medical management. It proceeds through three general stages: (1) a restatement of the sense and grounds of the new patients' rights ethos which the existence of such patients calls into question; (2) a consideration of what

Stephen Wear



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



A Research Agenda for Advancing Patient,  

E-print Network

The Business Case for Sustainability and Improved Patient/Worker Safety and Health in Hospitals and Health CareA 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

Illinois at Chicago, University of


Transitional Cell Carcinoma in Dialysis Patients  

Microsoft Academic Search

Objective: The aim of our study was to determine whether there is an increased incidence of urothelial cancer, especially transitional cell carcinoma (TCC), in uremic patients on dialysis.Methods: Retrospective chart analyses were completed for 1,910 uremic patients undergoing maintenance dialysis between January 1987 and December 1997. The incidence of urinary tract cancer was assessed. Only the patients with cancers diagnosed



The Dental Health Status of Dialysis Patients  

Microsoft Academic Search

Background: The number of patients with kidney failure who require dialysis is growing by 10% to 15% annually, and the likelihood that dentists will treat such patients is also increasing. The dental care of patients undergoing dialysis can be complex, given the prevalence of comorbid conditions such as diabetes, hypertension, renal osteodystrophy and immunosuppression, the presence of nondental prosthetic devices,

Brenda M. Krasko


Peritoneal Sclerosis in Peritoneal Dialysis Patients  

Microsoft Academic Search

Peritoneal sclerosis, a disorder similar to that previously identified in nonuremic patients, is being noted in peritoneal dialysis patients with increasing frequency. The etiology in dialysis patients remains unknown. An association with previous or ongoing peritoneal inflammation or irritation suggests that the incidence of peritoneal sclerosis could be reduced by rapidly controlling peritonitis and by eliminating the irritant properties of

Todd S. Ing; John T. Daugirdas; Vasant C. Gandhi



A Practical Approach to Patient Teaching.  

ERIC Educational Resources Information Center

The authors have developed a step-by-step plan designed to assist nurses to successfully integrate patient teaching into their practice. This plan includes an overview of patient teaching, identifies barriers to patient teaching, and presents a specific framework for establishing an effective program to minimize these barriers. (SSH)

Corkadel, Linda; McGlashan, ReNel



Implementing Patient Safety Initiatives in Rural Hospitals  

ERIC Educational Resources Information Center

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary



Arrhythmias in Patients with Congenital Heart Disease  

Microsoft Academic Search

Writing an “update” on the management of arrhythmias in patients with congenital heart disease is sobering. In the past four years, there is too little new, prospectively acquired information to direct treatment. There is new data about treatment of arrhythmias in patients with other forms of heart disease, which can be applied to patients with congenital heart disease. This “update”

Seshadri Balaji; Michael J. Silka; John H. McAnulty



Understanding Cancer Series: Patient's Genetic Background

While attention must be paid to the changes discovered within the genomic profile of a cancerous growth, equal attention must be paid to the intrinsic genetic background of each patient. Cancer does not develop in a vacuum, but within a patient, and each patient's distinctive genetic background results from both intrinsic and extrinsic factors.


Vaccination recommendations for patients with neuromuscular disease.  


Neuromuscular diseases (NMDs) encompass a broad spectrum of conditions. Because infections may be relevant to the final prognosis of most NMDs, vaccination appears to be the simplest and most effective solution for protecting NMD patients from vaccine-preventable infections. However, very few studies have evaluated the immunogenicity, safety, tolerability, and efficacy of different vaccines in NMD patients; therefore, detailed vaccination recommendations for NMD patients are not available. Here, we present vaccination recommendations from a group of Italian Scientific Societies for optimal disease prevention in NMD patients that maintain high safety levels. We found that NMD patients can be classified into two groups according to immune function: patients with normal immunity and patients who are immunocompromised, including those who intermittently or continuously take immunosuppressive therapy. Patients with normal immunity and do not take immunosuppressive therapy can be vaccinated as healthy subjects. In contrast, immunocompromised patients, including those who take immunosuppressive therapy, should receive all inactivated vaccines as well as influenza and pneumococcal vaccines; these patients should not be administered live attenuated vaccines. In all cases, the efficacy and long-term persistence of immunity from vaccination in NMD patients can be lower than in normal subjects. Household contacts of immunocompromised NMD patients should also be vaccinated appropriately. PMID:25223270

Esposito, Susanna; Bruno, Claudio; Berardinelli, Angela; Filosto, Massimiliano; Mongini, Tiziana; Morandi, Lucia; Musumeci, Olimpia; Pegoraro, Elena; Siciliano, Gabriele; Tonin, Paola; Marrosu, Gianni; Minetti, Carlo; Servida, Maura; Fiorillo, Chiara; Conforti, Giorgio; Scapolan, Silvia; Ansaldi, Filippo; Vianello, Andrea; Castaldi, Silvana; Principi, Nicola; Toscano, Antonio; Moggio, Maurizio



Effects of Bariatric Surgery in Older Patients  

Microsoft Academic Search

Objective: Evaluate the safety and efficacy of bariatric surgery in older patients. Background: Because of an increased morbidity in older patients who may not be as active as younger individuals, there remain concerns that they may not tolerate the operation well or lose adequate amounts of weight. Methods: The database of patients who had undergone bariatric surgery since 1980 and

Harvey J. Sugerman; Eric J. DeMaria; John M. Kellum; Elizabeth L. Sugerman; Jill G. Meador; Luke G. Wolfe



Can We Improve Patient Safety?  

PubMed Central

Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child’s condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of “plan–continue–fail” with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this “step back” should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential. PMID:25279366

Corbally, Martin Thomas



Emotional function in dementia patients.  


Behavioural and psychological symptoms of dementia, which can be considered as hyperreactivity of the emotional functioning of dementia, can be alleviated or aggravated by the behavioural and psychological symptoms of the caregiver. Comfortable stimulations of emotional function through sensory stimulations are effective methods for alleviating behavioural and psychological symptoms of dementia. Although cognitive function deteriorates with age, emotional function is often retained even in advanced years. Thus, it is recommended that care in patients with dementia be focused mainly on the stimulation of emotional function (e.g. sympathy and empathy, which are human traits), rather than relying solely on the stimulation of cognitive function. PMID:25250479

Fujii, Masahiko; Butler, James P; Sasaki, Hidetada



Rheumatic manifestations in diabetic patients.  


Diabetes mellitus (DM), a worldwide high prevalence disease, is associated with a large variety of rheumatic manifestations. For most of these affections, pathophysiologic correlations are not well established. Some of them, such as diabetic cheiroarthropathy, neuropathic arthritis, diabetic amyotrophy, diabetic muscle infraction, are considered intrinsic complications of DM. For others, like diffuse idiopathic skeletal hyperostosis or reflex sympathetic dystrophy, DM is considered a predisposing condition. In most cases, these affections cause pain and disability, affecting the quality of life of diabetic patients, but once correctly diagnosed, they often respond to the treatment, that generally requires a multidisciplinary team. This article reviews some epidemiological, clinical, diagnostic and therapeutic aspects of these conditions. PMID:23049626

Serban, A L; Udrea, G F



Must doctors save their patients?  

PubMed Central

Do doctors and other medical staff have an obligation to treat those who need their help? This paper assumes no legal or contractual obligations but attempts to discover whether there is any general moral obligation to treat those in need. In particular the questions of whether or not the obligation that falls on medical staff is different from that of others and of whether doctors are more blameworthy than others if they fail to treat patients are examined. Finally we look at the question of the burden of this obligation and at the responsibility of society to mitigate its hardships. PMID:6668586

Harris, J



Cochlear implantation in psoriasis patients.  


Cochlear implantation has become a safe and effective method for the auditory rehabilitation of severe to profound sensorineural hearing loss. Flap problems are the commonest of the surgical complications [Axon PR, Mawman DJ, Upile T, Ramsden RT. Cochlear implantation in the presence of chronic suppurative otitis media. J Laryngol Otology 1997;111:228-32] and the risk increases further when associated with medical conditions predisposing to infection. We present two patients with psoriasis who underwent cochlear implant surgery, discussing the risk of surgical site infection and treatment options to minimise infection. PMID:17055206

Basavaraj, Sreeshyla; Wardrop, Peter; Sivaji, Nagaraj; Shanks, Mary; Allen, Agnes A



New Help for MS Patients  

NASA Technical Reports Server (NTRS)

The Mark VII MicroClimate Medical Personal Cooling system enables multiple sclerosis' victims, as well as cerebral palsy, spinabifida patients and others to lower their body temperatures. Although this is not a cure, cooling can produce a dramatic improvement in symptoms. The Multiple Sclerosis Association of America has placed cool suits in MS research care centers. This technology originated in the need for cooling systems in spa@esuits. "Cool Suits" are now used by hazardous materials workers, armored vehicle crews, firefighters and crop dusters. A surgical personal cooling system has also been developed for medical personnel working in hot operating room environments.



Management of patients with empyema.  


Empyema is the term used to describe an accumulation of pus in a body cavity such as the pleural space as a result of bacterial infection. The condition is serious because it is difficult for the immune system to resolve infection in this area. Empyema can be avoided by the use of appropriate antibiotic therapy and good aseptic technique when dealing with any situation that breaches the chest wall. Treatment of this condition may be medical but if the condition does not resolve, surgical intervention is required. The nursing role involves providing support, education and long-term management for patients with empyema. PMID:24666086

Myatt, Rebecca


Protecting patients, staff, and property.  


With the safety and security of all hospital users paramount, the need to safeguard valuable equipment against theft, and NHS security breaches on the rise, can estates and facilities managers afford to compromise when it comes to security in healthcare facilities? Tina Hughan, marketing director at one of the world's leading door opening, locking, security, and access control product specialists, Assa Abloy, discusses how both accessibility and whole-life costing must be taken into consideration when implementing security measures to ensure the highest level of patient safety and quality of care. PMID:25004557

Hughan, Tina



Patients' Perceptions Of Generic Medications  

PubMed Central

Insurers and policymakers encourage the use of generic drugs to reduce costs, but generics remain underused. We conducted a national survey of commercially insured adults to evaluate their perceptions about generic drugs. Patients agreed that generics are less expensive and a better value than brand-name drugs, and are just as safe. However, although 56 percent reported that Americans should use more generics, only 37.6 percent prefer to take generics. We discuss perceptions about communicating with practitioners about generics, generic substitution, and policymakers’ role in influencing generic use. These findings underscore the challenge that providers, insurers, and policymakers face in stimulating the cost-effective use of medications. PMID:19276015

Shrank, William H.; Cox, Emily R.; Fischer, Michael A.; Mehta, Jyotsna; Choudhry, Niteesh K.



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



Promoting patient partnership in wound care.  


Involving patients in their care is a key component of the NHS plan and clinical governance (Department of Health, 1999a). Involvement is enhanced through nurse-patient relationships which are based on partnership in which the patient's viewpoint is given equal weight to that of the practitioner. In the management of wounds, this may be complex due to conflict between clinically effective treatment and a patient's wish. High quality care relies on a holistic assessment of the patient and a negotiated care plan which is implemented and evaluated in order to judge the effectiveness of care. PMID:11832807

Bentley, J



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



Free tissue transfer in pediatric patients.  


The majority of reports on free tissue transfer involve adults; few have specifically addressed children. During the past 5 years, 20 free tissue transfers were performed in 19 pediatric patients. Patients ranged in age from 3 to 17 years, with a mean age of 10 years. Eight patients were 6 years and younger; 11 patients were 13 to 17 years old. Soft-tissue defects requiring reconstruction resulted from acute trauma in 12 patients, tumor ablation in 5 patients, infection in 1 patient, and hemifacial atrophy in 1 patient. Soft-tissue defects occurred in the lower extremity in 16 patients, the head and neck in 2 patients, and the upper extremity in 1 patient. The donor tissues included the latissimus dorsi muscle in 7 patients, the radial forearm flap in 7 patients, the rectus abdominis muscle in 4 patients, and the scapular fasciocutaneous flap in 2 patients. All patients received aspirin preoperatively. Mean operative time was 6.5 hours, with a range of 4 to 8 hours. Postoperative heparin infusion was used for 5 days in 7 of the 8 patients age 6 years and younger. All free tissue transfers were successful. One flap to a traumatic foot wound (patient age, 4 years) had a venous thrombosis on the second postoperative day, and was successfully treated with urokinase and heparin infusions and repeat venous anastomosis. There were no other significant morbidities and no mortalities. Hospitalization following free tissue transfer averaged 13 days, with a range of 6 to 37 days. Follow-up has averaged 31 months, with a range of 8 to 59 months. Late complications included a progressive equinus deformity 3 years after a heel reconstruction following a lawn mower injury and a contour deformity following a scapula flap to a gunshot wound of the foot. Sixteen of the 17 lower extremity reconstructions have shown normal growth. No growth disturbances or significant functional losses have occurred at the donor sites. Most patients have maintained normal extremity function including participation in athletics. Special considerations in this group of patients have included subtherapeutic heparin infusion during the postoperative period in young children, minimizing the aesthetic defect at the donor site and providing composite reconstructions whenever possible. PMID:8792963

Serletti, J M; Schingo, V A; Deuber, M A; Carras, A J; Herrera, H R; Reale, V F



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?


A new imperative for patient relationship management.  


Managing relationships with patients and their families before, during, and after treatment is central to the success of health systems of the future. Revenue cycle staff are critical to an organization's efforts to build patient loyalty, because revenue cycle operations involve one of the few standardized processes in health care to engage with patients on and off campus. A patient engagement initiative implemented by Gwinnett Medical Center in Atlanta delivered a better billing experience for 86 percent of patients surveyed--either with Gwinnett or with another hospital. PMID:24511775

Dougherty, Cathy; Levin, Steve



Is exercise ignored in palliative cancer patients?  


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



Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC)  

Microsoft Academic Search

BACKGROUND: Patient safety is a critical component to the quality of health care. As health care organizations endeavour to improve their quality of care, there is a growing recognition of the importance of establishing a culture of patient safety. In this research, the authors use the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to assess the culture of patient

I-Chi Chen; Hung-Hui Li



A comparison of metacognitions in patients with hallucinations, delusions, panic disorder, and non-patient controls  

Microsoft Academic Search

This study tested the hypothesis that metacognitions are a general vulnerability factor for psychological disorder. It was predicted that patients with psychosis (hallucinations or delusions), and patients with panic disorder would score higher than non-patients on measures of metacognition. Moreover, it was hypothesised that patients showing most dysregulation of thinking (voice-hearers) would endorse significantly higher metacognition scores than individuals in

Anthony P Morrison; Adrian Wells



Does tumor status influence cancer patients’ satisfaction with the doctor-patient interaction?  

Microsoft Academic Search

The interaction of patients with their doctors impacts the experience of disease at many levels. It is thus important to measure patient satisfaction with such interaction as an outcome of care. Our goal was to investigate whether tumor status influences patient satisfaction with interaction with their doctors. Specifically, we investigated whether patients with no evidence of disease (NED), localized, or

Richard Bitar; Andrea Bezjak; Kenneth Mah; D. Andrew Loblaw; Andrew P. Gotowiec; Gerald M. Devins



Medical Specialists??? Patient-Centered Communication and Patient-Reported Outcomes  

Microsoft Academic Search

Background: Physicians' patient-centered communication in the medical consultation is generally expected to improve patient out- comes. However, empirical evidence is contradictory so far, and most studies were done in primary care. Objective: We sought to determine the association of specialists' patient-centered communication with patient satisfaction, adher- ence, and health status. Methods: Residents and specialists in internal medicine (n 30) and

Linda C. Zandbelt; Ellen M. A. Smets; Frans J. Oort; Mieke H. Godfried



Decision Support for Patient Preference-based Care Planning : Effects on Nursing Care and Patient Outcomes  

Microsoft Academic Search

ObjectiveWhile preference elicitation techniques have been effective in helping patients make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. The purpose of this study was to evaluate a decision support system for eliciting elderly patients' preferences for self-care capability and providing this information to

Cornelia M Ruland



Nutritional concerns in cancer patients.  


One of the prime nutritional concerns in cancer patients is cachexia and deteriorating nutritional status. Cachexia can occur as a result of either treatment or the tumor itself. The progressive malnutrition ultimately affects performance status and organ function. Tolerance to treatment may thus be decreased, which, in turn, may adversely affect toxicity and response. In addition, the deleterious effects of malnutrition on the immune system can increase susceptibility to infection. The weakness and fatigue related to muscle wasting and changes in metabolism affect physical appearance, leading to a loss of self-esteem. Thus, the vicious cycle of cachexia severely impacts on every aspect of daily life. Providing nutritional support and effective treatment may reverse the cachexia. Studies involving caloric supplements alone have not been encouraging. Conversely, studies using megestrol acetate have shown that cancer patients gain weight and that their sense of well-being improves. However, the mechanisms of weight gain remain unknown, and further studies are needed to determine the mechanisms by which appetite is stimulated or catabolism is inhibited or both. Nursing interventions to stimulate appetite and promote greater food intake, coupled with the use of agents that alter metabolism, such as megestrol acetate, may reverse the trend of cachexia and thus provide an increased sense of well-being and improved quality of life. PMID:2727453

Tait, N; Aisner, J



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.



Mechanical ventilation in cancer patients.  


Acute respiratory failure (ARF) in cancer patients remains a frequent and severe complication, despite the general improved outcome over the last decade. The survival of cancer patients requiring ventilatory support in Intensive Care Unit (ICU) has dramatically improved over the last years. The diagnostic approach, including an invasive strategy using fiber optic bronchoscopy or a non-invasive strategy, must be effective to identify a diagnostic, as it is a crucial prognostic factor. The use of non-invasive ventilation (NIV) instead of invasive mechanical ventilation (IMV), has contributed to decrease mortality, but NIV has to be used in appropriate situations. Indeed, NIV failure (i.e., need for IMV) is deleterious. Classical prognostic factors are not relevant anymore. The number of organ failure at admission and over the first 7 ICU days governs outcomes. Ventilatory support can thus be included in different management contexts: full code management with unlimited use of life sustaining therapies, full code management for a limited period, no-intubation decision, or the use of palliative NIV. The objectives of this review article are to summarize the modified ARF diagnostic and therapeutic management, induced by improvements in both intensive care and onco-hematologic management and recent literature data. PMID:24280820

Saillard, C; Mokart, D; Lemiale, V; Azoulay, E



Laparoscopic cholecystectomy. Experience with 375 consecutive patients.  

PubMed Central

Three hundred seventy-five consecutive patients underwent laparoscopic cholecystectomy from September 1989 to January 1991. Three hundred forty-one (91%) presented on an elective basis, and the remaining 34 patients (9%) were admitted for acute cholecystitis (24), gallstone pancreatitis (9), and cholangitis (1). Of the 375 patients, 20 were converted to laparotomy and cholecystectomy, for an overall success rate of 95% for patients undergoing laparoscopic cholecystectomy. Three hundred nineteen patients (90%) were discharged within 24 hours of surgery. Operative cholangiography was completed in 141 patients, showing choledocholithiasis in five (managed by postoperative endoscopic retrograde cholangiopancreatography [ERCP] in 4, common bile duct exploration [CBDE] in 1). Two retained stones (0.9%) were detected in 214 patients not undergoing cholangiography. Three patients (0.8%) were reoperated on because of perioperative complications. Overall morbidity for patients undergoing laparoscopic cholecystectomy was 3.5%. Major complications (0.6%) included a single common hepatic duct injury and a delayed cystic duct leak at 10 days. Minor complications occurred in 11 patients (2.9%). The single perioperative death (0.3%) was due to a myocardial infarction on postoperative day 3, after an otherwise uncomplicated laparoscopic procedure. Laparoscopic cholecystectomy appears to offer significant advantages to patient recovery, and these data suggest that it can be performed with an efficacy, morbidity rate, and mortality rate similar to those of open cholecystectomy. Images Fig. 4. Fig. 5. Fig. 2. Fig. 3. Fig. 6. PMID:1835346

Bailey, R W; Zucker, K A; Flowers, J L; Scovill, W A; Graham, S M; Imbembo, A L



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



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



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



Transurethral microwave therapy: patient selection and outcome.  


Forty-one patients with benign prostatic disease awaiting transurethral resection of the prostate were offered transurethral microwave therapy as an alternative. Pre-operative assessment consisted of symptom scores, prostate-specific antigen levels, flow rates and urinary tract ultrasound with residual urine estimation. Patients were reassessed 6 weeks, 3 months and 6 months after microwave treatment. Twenty-three patients had a successful outcome and 18 an unsuccessful outcome to treatment. Fifteen of the 18 with an unsuccessful outcome could have been predicted by the presence of one or more of the following pretreatment features: glands over 50 g (10 patients), the presence of a median lobe (5 patients), high residual urine (6 patients), a history of recurrent urinary infection (2 patients) and coexisting neurological disorders such as parkinsonism (1 patient) and CVA (1 patient). Three failures had none of these criteria present and could not have been predicted from their pretreatment assessment. Transurethral microwave therapy produces subjective and objective improvements in appropriately selected patients. Patients with large glands or decompensated bladders fail to benefit and should continue to be treated by conventional surgery. PMID:7536157

Bunce, C J; Bdesha, A S; Dinneen, M; Vukusic, J; Snell, M E; Witherow, R O



Patient Groups and the Construction of the Patient-Consumer in Britain: An Historical Overview.  


This article presents an historical overview of the changing meaning of the patient-consumer, and specifically the role played by patient groups in constructing the patient as consumer. It is argued that patient groups were central to the formation of the patient-consumer, but as health consumerism was taken on by the state, they lost control of this figure. Competing understandings of what it meant to be a patient-consumer developed, a shift that raises further questions about the unity of claims made in the name of the patient-consumer. PMID:20798768

Mold, Alex



Proteinuria in patients with sickle cell disease.  


Proteinuria is a complication of sickle cell nephropathy that can progress to renal insufficiency and end-stage renal disease. The magnitude of proteinuria among patients with sickle cell disease (SCD) has been reported with variable prevalence. The aim of this study was to determine the prevalence of proteinuria in a large number of patients with SCD in Eastern Saudi Arabia. The urinalyses of 940 non-diabetic patients with SCD were tested for the presence of proteinuria. The glomerular filtration rate (e-GFR) of all patients was estimated using the Cockcroft- Gault equation. Proteinuria was found in 79 of 940 patients with SCD (prevalence 8.4%). The mean age of the affected patients with proteinuria was 33 ± 15.4 years (10-76). The mean GFR was 118 mL/min/1.73 m 2 . This study indicates that patients with SCD in Eastern Saudi Arabia have a low prevalence of proteinuria and preserved GFR. PMID:25193903

Alkhunaizi, Ahmed M; Al-Khatti, Adil A



Patients' perspectives on electroconvulsive therapy: systematic review  

PubMed Central

Objective To ascertain patients' views on the benefits of and possible memory loss from electroconvulsive therapy. Design Descriptive systematic review. Data sources Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. Study selection Articles with patients' views after treatment with electroconvulsive therapy. Data extraction 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. Data synthesis The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. Conclusions The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded. PMID:12816822

Rose, Diana; Fleischmann, Pete; Wykes, Til; Leese, Morven; Bindman, Jonathan



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



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



Patient registries for substance use disorders.  


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



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



Compassionate care: enhancing physician-patient communication and education in dermatology: Part II: Patient education.  


Patient education is a fundamental part of caring for patients. A practice gap exists, where patients want more information, while health care providers are limited by time constraints or difficulty helping patients understand or remember. To provide patient-centered care, it is important to assess the needs and goals, health beliefs, and health literacy of each patient. This allows health care providers to individualize education for patients. The use of techniques, such as gaining attention, providing clear and memorable explanations, and assessing understanding through "teach-back," can improve patient education. Verbal education during the office visit is considered the criterion standard. However, handouts, visual aids, audiovisual media, and Internet websites are examples of teaching aids that can be used as an adjunct to verbal instruction. Part II of this 2-part series on patient-physician interaction reviews the importance and need for patient education along with specific guidelines and techniques that can be used. PMID:23394924

Hong, Judith; Nguyen, Tien V; Prose, Neil S



Immunobiological relationships between Vibrio fluvialis and Vibrio cholerae enterotoxins  

Microsoft Academic Search

A total of 26 strains of Vibrio fluvialis was included in this study, which were isolated from patients with diarrhoea and other sources. The GM1 enzyme linked immunosorbent assays performed with the culture filtrates of V. fluvialis yielded negative results, indicating that their receptor site is different from that of the known labile toxin. The cholera antitoxin failed to neutralize

CR Ahsan; SC Sanyal; A Zaman; PKB Neogy; MI Huq



Bronchopulmonary Kaposi's sarcoma in patients with AIDS.  

PubMed Central

BACKGROUND: Kaposi's sarcoma is the most common secondary neoplasm to complicate HIV infection and may cause pulmonary disease. METHODS: A prospective study was carried out in 140 consecutive patients who were HIV seropositive and required bronchoscopy for new respiratory symptoms of at least two weeks' duration, with either a chest radiographic abnormality or abnormality of pulmonary function. The patients were classified into those with single local endobronchial lesions of Kaposi's sarcoma or generalised widespread lesions. Before bronchoscopy all patients had routine simple pulmonary function tests and chest radiography. RESULTS: Thirty nine (21%) patients had evidence of cutaneous Kaposi's sarcoma. Nineteen of the 39 were found to have endobronchial Kaposi's sarcoma lesions at bronchoscopy, but none of those who did not have cutaneous Kaposi's sarcoma. Respiratory symptoms of cough and breathlessness and radiographic abnormalities were attributed to Kaposi's sarcoma in this group, except in four patients who had concomitant pneumocystis pneumonia. Eight patients had local endobronchial Kaposi's sarcoma lesions and 11 had extensive lesions. Patients with extensive lesions had more widespread radiographic abnormalities; four of the patients with local endobronchial lesions had normal chest radiographs. All patients had reduced tr